HIAWATHA HOSPITAL ASSOCIATION INC: Form 990, tax year 2013
View the entire original 990 at ProPublica ↗
- Organization
- HIAWATHA HOSPITAL ASSOCIATION INC (EIN 48-0577658)
- Tax period
- 2013-01-01 to 2013-12-31
- Filed
- 2014-11-14
- IRS object ID
- 201403189349300320
- Schema version
- 2013v3.1
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule H
- Schedule I
- Schedule J
- Schedule K
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2014-11-14T07:12:36-06:00 | ReturnTs |
| Tax Period End | 2013-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BKD LLP | BusinessNameLine1 |
Preparer US Address PreparerUSAddress
| 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 | ReturnTypeCd |
| Tax Period Begin | 2013-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 480577658 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Hiawatha Hospital Association Inc | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| In Care Of | % JENNY KNUDSON | InCareOfNm |
| Business Name Control | HIAW | BusinessNameControlTxt |
| Phone | 7857422131 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 300 UTAH STREET | AddressLine1 |
| Address Line2 | Suite | AddressLine2 |
| City | HIAWATHA | City |
| State | KS | State |
| ZIP Code | 66434 | ZIPCode |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | JOHN MOORE | PersonNm |
| Person Title | CEO | PersonTitleTxt |
| Phone | 7857422131 | PhoneNum |
| Signature | 2014-11-17 | SignatureDt |
| Discuss With Paid Preparer | Yes (true) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Michael J Engle | PreparerPersonNm |
| PTIN | P00482834 | PTIN |
| Phone | 7857422131 | PhoneNum |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2013 | TaxYr |
| Build TS | 2015-11-30 17:44:51Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | JOHN MOORE | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 300 UTAH STREET | AddressLine1 |
| City | HIAWATHA | City |
| State | KS | State |
| ZIP Code | 66434 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $26,382,392 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | www.hch-ks.org | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1945 | FormationYr |
| Legal Domicile State | KS | LegalDomicileStateCd |
| Activity Or Mission | AS A RURAL COMMUNITY HOSPITAL, HIAWATHA HOSPITAL'S PRIMARY GOAL IS TO PROVIDE MODERN, RELIABLE, AND AFFORDABLE HEALTH SERVICES THAT BEST MEET THE NEEDS OF OUR COMMUNITY RESIDENTS. | ActivityOrMissionDesc |
| Voting Members Governing Body | 10 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 8 | VotingMembersIndependentCnt |
| Total Employee | 293 | TotalEmployeeCnt |
| Total Volunteers | 8 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $58,393 | PYContributionsGrantsAmt |
| CY Contributions Grants | $105,241 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $22,690,658 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $26,132,212 | CYProgramServiceRevenueAmt |
| PY Investment Income | $31,804 | PYInvestmentIncomeAmt |
| CY Investment Income | $16,735 | CYInvestmentIncomeAmt |
| PY Other Revenue | $113,873 | PYOtherRevenueAmt |
| CY Other Revenue | $111,655 | CYOtherRevenueAmt |
| PY Total Revenue | $22,894,728 | PYTotalRevenueAmt |
| CY Total Revenue | $26,365,843 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $21,726 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $17,861 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $13,103,213 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $13,907,775 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $2,101 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $10,343,832 | PYOtherExpensesAmt |
| CY Other Expenses | $11,607,099 | CYOtherExpensesAmt |
| PY Total Expenses | $23,468,771 | PYTotalExpensesAmt |
| CY Total Expenses | $25,532,735 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$574,043 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $833,108 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $25,398,373 | TotalAssetsBOYAmt |
| Total Assets EOY | $26,745,965 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $11,230,380 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $11,791,941 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $14,167,993 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $14,954,024 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | SEE SCHEDULE O | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $21,475,182 | ExpenseAmt |
| Grant | $17,861 | GrantAmt |
| Revenue | $26,132,212 | RevenueAmt |
| Desc | SEE SCHEDULE O | Desc |
| Total Program Service Expenses | $21,475,182 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (true) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (true) | ScheduleBRequiredInd |
| Political Campaign Acty | false | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (true) | LobbyingActivitiesInd |
| Subject To Proxy Tax | false | SubjectToProxyTaxInd |
| Donor Advised Fund | false | DonorAdvisedFundInd |
| Conservation Easements | false | ConservationEasementsInd |
| Collections Of Art | false | CollectionsOfArtInd |
| Credit Counseling | false | CreditCounselingInd |
| Temp Or Permanent Endowments | false | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (true) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | false | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | false | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (true) | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (true) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | false | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | false | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (true) | ConsolidatedAuditFinclStmtInd |
| School Operating | false | SchoolOperatingInd |
| Foreign Office | false | ForeignOfficeInd |
| Foreign Activities | false | ForeignActivitiesInd |
| More Than5000 K To Org | false | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividualsInd |
| Professional Fundraising | false | ProfessionalFundraisingInd |
| Fundraising Activities | false | FundraisingActivitiesInd |
| Gaming Activities | false | GamingActivitiesInd |
| Operate Hospital | Yes (true) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (true) | AuditedFinancialStmtAttInd |
| Grants To Organizations | false | GrantsToOrganizationsInd |
| Grants To Individuals | Yes (true) | GrantsToIndividualsInd |
| Schedule J Required | Yes (true) | ScheduleJRequiredInd |
| Tax Exempt Bonds | Yes (true) | TaxExemptBondsInd |
| Invest Tax Exempt Bonds | false | InvestTaxExemptBondsInd |
| Escrow Account | false | EscrowAccountInd |
| On Behalf Of Issuer | false | OnBehalfOfIssuerInd |
| Engaged In Excess Benefit Trans | false | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | false | PYExcessBenefitTransInd |
| Loan Outstanding | false | LoanOutstandingInd |
| Grant To Related Person | false | GrantToRelatedPersonInd |
| Business Rln With Org Mem | false | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | false | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | false | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | false | DeductibleNonCashContriInd |
| Deductible Art Contribution | false | DeductibleArtContributionInd |
| Terminate Operations | false | TerminateOperationsInd |
| Partial Liquidation | false | PartialLiquidationInd |
| Disregarded Entity | false | DisregardedEntityInd |
| Related Entity | Yes (true) | RelatedEntityInd |
| Related Organization Ctrl Ent | Yes (true) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | Yes (true) | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | false | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | false | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (true) | ScheduleORequiredInd |
| IRP Document | 21 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (true) | BackupWthldComplianceInd |
| Employee | 293 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (true) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | false | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | false | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | false | TaxablePartyNotificationInd |
| Nondeductible Contributions | false | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | false | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | false | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | false | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | false | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 10 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 8 | IndependentVotingMemberCnt |
| Family Or Business Rln | Yes (true) | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | false | DelegationOfMgmtDutiesInd |
| Change To Org Documents | false | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | false | MembersOrStockholdersInd |
| Election Of Board Members | false | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | false | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (true) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (true) | MinutesOfCommitteesInd |
| Officer Mailing Address | false | OfficerMailingAddressInd |
| Local Chapters | false | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (true) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (true) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (true) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (true) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (true) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (true) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (true) | CompensationProcessCEOInd |
| Compensation Process Other | false | CompensationProcessOtherInd |
| Investment In Joint Venture | false | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | KS | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | JENNY KNUDSON | PersonNm |
| Phone | 7857426210 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 300 UTAH STREET | AddressLine1 |
| City | HIAWATHA | City |
| State | KS | State |
| ZIP Code | 66434 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionAGrp (16 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|
| ANDY PETERSON | |||||||
| TRUSTEE | 1.0 | Yes (X) | $0 | $0 | $0 | ||
| LORI ELLIOT | |||||||
| TRUSTEE | 1.0 | Yes (X) | $0 | $0 | $0 | ||
| FONDA LAFRENZ | |||||||
| TRUSTEE/SECRETARY/TREASURER | 1.0 | Yes (X) | $4,830 | $0 | $16 | Yes (X) | |
| ERIC MCPEAK | |||||||
| TRUSTEE/PRESIDENT | 1.0 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| HILLARY BOYE | |||||||
| TRUSTEE | 1.0 | Yes (X) | $0 | $0 | $0 | ||
| CHERYL RASMUSSEN | |||||||
| TRUSTEE | 1.0 | Yes (X) | $0 | $0 | $0 | ||
| GALEN MEYER | |||||||
| TRUSTEE | 1.0 | Yes (X) | $0 | $0 | $0 | ||
| NICK HRENCHER | |||||||
| TRUSTEE/VICE PRESIDENT | 1.0 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| ERIK MADSEN | |||||||
| TRUSTEE | 1.0 | Yes (X) | $0 | $0 | $0 | ||
| DR PETE ROSA | |||||||
| TRUSTEE/MD | 40.0 | Yes (X) | $291,387 | $0 | $33,224 | ||
| JOHN MOORE | |||||||
| ADMINISTRATOR/CEO | 40.0 | $144,164 | $0 | $24,540 | Yes (X) | ||
| DR BYRON BIGHAM | |||||||
| MD | 40.0 | $259,217 | $0 | $28,793 | Yes (X) | ||
| DR STEFFEN SHAMBURG | |||||||
| MD | 40.0 | $407,778 | $0 | $60,040 | Yes (X) | ||
| DR JULIE ROSA | |||||||
| MD | 20.0 | $134,359 | $0 | $17,574 | Yes (X) | ||
| DR CROSBY GERNON | |||||||
| MD | 40.0 | $449,226 | $0 | $44,858 | Yes (X) | ||
| JEAN ABEITA | |||||||
| PHARMACIST | 40.0 | $117,262 | $0 | $21,938 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,808,223 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $230,983 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 9 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | false | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (true) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | false | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| ServicesServicesDesc | CompensationCompensationAmt |
|---|---|
| STEVEN GUNNELS | |
| crna | $459,920 |
| STARS INC | |
| THERAPY | $423,797 |
| ORANGE COMMERCIAL credit | |
| CONTRACT NURSING | $176,625 |
| ROCK PORT TELEPHONE | |
| IT CONTRACTING | $313,136 |
| ICE TECHNOLOGIES | |
| EMR CONSULTING | $167,685 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 11 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $63,898 | RelatedOrganizationsAmt |
| Government Grants | $24,365 | GovernmentGrantsAmt |
| All Other Contributions | $16,978 | AllOtherContributionsAmt |
| Total Contributions | $105,241 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (4 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| PATIENT SERVICE REVENUE | 621110 | $22,491,475 | $22,491,475 |
| OTHER PATIENT REVENUE | 621110 | $30,020 | $30,020 |
| 340B PHARMACY | 446110 | $1,715,854 | $1,715,854 |
| EMR INCENTIVE REVENUE | 621110 | $1,894,863 | $1,894,863 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $26,132,212 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $14,735 | TotalRevenueColumnAmt |
| Exclusion | $14,735 | ExclusionAmt |
Incm From Invest Bond Proceeds IncmFromInvestBondProceedsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Royalties Revenue RoyaltiesRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $45,835 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $16,549 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $29,286 | RealAmt |
| Personal | $0 | PersonalAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $29,286 | TotalRevenueColumnAmt |
| Exclusion | $29,286 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $2,000 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $2,000 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $2,000 | TotalRevenueColumnAmt |
| Exclusion | $2,000 | ExclusionAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Net Income From Gaming NetIncomeFromGamingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Net Income Or Loss NetIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Other Revenue Misc OtherRevenueMiscGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | CAFETERIA INCOME | Desc |
| Business | 722210 | BusinessCd |
| Total Revenue Column | $82,369 | TotalRevenueColumnAmt |
| Exclusion | $82,369 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $82,369 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $26,365,843 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $26,132,212 | RelatedOrExemptFuncIncomeAmt |
| Exclusion | $128,390 | ExclusionAmt |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,667 | TotalAmt |
| Program Services | $2,667 | ProgramServicesAmt |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $15,194 | TotalAmt |
| Program Services | $15,194 | ProgramServicesAmt |
Foreign Grants ForeignGrantsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Benefits To Members BenefitsToMembersGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $476,071 | TotalAmt |
| Program Services | $417,574 | ProgramServicesAmt |
| Management And General | $58,497 | ManagementAndGeneralAmt |
Comp Disqual Persons CompDisqualPersonsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $10,049,041 | TotalAmt |
| Program Services | $8,668,887 | ProgramServicesAmt |
| Management And General | $1,380,154 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $370,354 | TotalAmt |
| Program Services | $319,554 | ProgramServicesAmt |
| Management And General | $50,800 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,299,387 | TotalAmt |
| Program Services | $1,755,720 | ProgramServicesAmt |
| Management And General | $543,667 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $712,922 | TotalAmt |
| Program Services | $622,741 | ProgramServicesAmt |
| Management And General | $90,181 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $7,781 | TotalAmt |
| Management And General | $7,781 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $117,265 | TotalAmt |
| Management And General | $117,265 | ManagementAndGeneralAmt |
Fees For Services Lobbying FeesForServicesLobbyingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Prof Fundraising FeesForServicesProfFundraising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,372,937 | TotalAmt |
| Program Services | $2,874,653 | ProgramServicesAmt |
| Management And General | $496,183 | ManagementAndGeneralAmt |
| Fundraising | $2,101 | FundraisingAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $58,183 | TotalAmt |
| Program Services | $31,873 | ProgramServicesAmt |
| Management And General | $26,310 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $446,525 | TotalAmt |
| Program Services | $294,123 | ProgramServicesAmt |
| Management And General | $152,402 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $91,529 | TotalAmt |
| Program Services | $44,161 | ProgramServicesAmt |
| Management And General | $47,368 | ManagementAndGeneralAmt |
Royalties RoyaltiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $470,256 | TotalAmt |
| Program Services | $345,194 | ProgramServicesAmt |
| Management And General | $125,062 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $64,376 | TotalAmt |
| Program Services | $56,709 | ProgramServicesAmt |
| Management And General | $7,667 | ManagementAndGeneralAmt |
Pymt Travel Entrtnmnt Pub Ofcl PymtTravelEntrtnmntPubOfclGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $456,105 | TotalAmt |
| Program Services | $381,741 | ProgramServicesAmt |
| Management And General | $74,364 | ManagementAndGeneralAmt |
Payments To Affiliates PaymentsToAffiliatesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,777,717 | TotalAmt |
| Program Services | $1,178,431 | ProgramServicesAmt |
| Management And General | $599,286 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $158,412 | TotalAmt |
| Program Services | $87,581 | ProgramServicesAmt |
| Management And General | $70,831 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| BAD DEBT EXPENSE | $518,568 | $518,568 | |
| REPAIRS & MAINTENANCE | $633,076 | $540,791 | $92,285 |
| DUES & SUBSCRIPTIONS | $171,801 | $120,436 | $51,365 |
| MEDICAL SUPPLIES | $2,864,010 | $2,864,010 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $398,558 | TotalAmt |
| Program Services | $334,574 | ProgramServicesAmt |
| Management And General | $63,984 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $25,532,735 | TotalAmt |
| Program Services | $21,475,182 | ProgramServicesAmt |
| Management And General | $4,055,452 | ManagementAndGeneralAmt |
| Fundraising | $2,101 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $286 | BOYAmt |
| EOY | $286 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,154,075 | BOYAmt |
| EOY | $3,992,590 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $50,121 | BOYAmt |
| EOY | $49,607 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,924,348 | BOYAmt |
| EOY | $4,083,209 | EOYAmt |
Receivables From Officers Etc ReceivablesFromOfficersEtcGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $506,334 | BOYAmt |
| EOY | $486,471 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $196,833 | BOYAmt |
| EOY | $215,682 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $30,055,663 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $15,437,792 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $15,545,204 | BOYAmt |
| EOY | $14,617,871 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,021,172 | BOYAmt |
| EOY | $3,300,249 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $25,398,373 | BOYAmt |
| EOY | $26,745,965 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,232,855 | BOYAmt |
| EOY | $2,558,255 | EOYAmt |
Grants Payable GrantsPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,335,000 | BOYAmt |
| EOY | $4,145,000 | EOYAmt |
Escrow Account Liability EscrowAccountLiabilityGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Loans From Officers Directors LoansFromOfficersDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,662,525 | BOYAmt |
| EOY | $4,588,686 | EOYAmt |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $500,000 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,230,380 | BOYAmt |
| EOY | $11,791,941 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $14,102,888 | BOYAmt |
| EOY | $14,889,433 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $65,105 | BOYAmt |
| EOY | $64,591 | EOYAmt |
Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $14,167,993 | BOYAmt |
| EOY | $14,954,024 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $25,398,373 | BOYAmt |
| EOY | $26,745,965 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $833,108 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | -$47,077 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | false | AccountantCompileOrReviewInd |
| FS Audited | Yes (true) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (true) | AuditCommitteeInd |
| Federal Grant Audit Required | false | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule C IRS990ScheduleC
Total Grassroots Lobbying TotalGrassrootsLobbyingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Filing Organizations Total | $5,509 | FilingOrganizationsTotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Direct Lobbying | TotalDirectLobbyingGrp |
Total Lobbying Expend TotalLobbyingExpendGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Filing Organizations Total | $5,509 | FilingOrganizationsTotalAmt |
Other Exempt Purpose Expend OtherExemptPurposeExpendGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Filing Organizations Total | $25,527,226 | FilingOrganizationsTotalAmt |
Total Exempt Purpose Expend TotalExemptPurposeExpendGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Filing Organizations Total | $25,532,735 | FilingOrganizationsTotalAmt |
Lobbying Nontaxable Amount LobbyingNontaxableAmountGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Filing Organizations Total | $1,000,000 | FilingOrganizationsTotalAmt |
Grassroots Nontaxable GrassrootsNontaxableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Filing Organizations Total | $250,000 | FilingOrganizationsTotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tot Lbbyng Grassroot Mns Non Tx | TotLbbyngGrassrootMnsNonTxGrp | |
| Tot Lbby Expend Mns Lbbyng Non Tx | TotLbbyExpendMnsLbbyngNonTxGrp | |
| Form4720 Filed | false | Form4720FiledInd |
Avg Lobbying Nontaxable Amount AvgLobbyingNontaxableAmountGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Year Minus3 | $967,803 | CurrentYearMinus3Amt |
| Current Year Minus2 | $1,000,000 | CurrentYearMinus2Amt |
| Current Year Minus1 | $1,000,000 | CurrentYearMinus1Amt |
| Current Year | $1,000,000 | CurrentYearAmt |
| Total | $3,967,803 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Lobbying Ceiling | $5,951,705 | LobbyingCeilingAmt |
Avg Total Lobbying Expend AvgTotalLobbyingExpendGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Year Minus3 | $4,082 | CurrentYearMinus3Amt |
| Current Year Minus2 | $4,401 | CurrentYearMinus2Amt |
| Current Year Minus1 | $4,425 | CurrentYearMinus1Amt |
| Current Year | $5,509 | CurrentYearAmt |
| Total | $18,417 | TotalAmt |
Avg Grassroots Nontaxable AvgGrassrootsNontaxableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Year Minus3 | $241,951 | CurrentYearMinus3Amt |
| Current Year Minus2 | $250,000 | CurrentYearMinus2Amt |
| Current Year Minus1 | $250,000 | CurrentYearMinus1Amt |
| Current Year | $250,000 | CurrentYearAmt |
| Total | $991,951 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grassroots Ceiling | $1,487,927 | GrassrootsCeilingAmt |
Avg Grassroots Lobbying Expend AvgGrassrootsLobbyingExpendGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Year Minus3 | $4,082 | CurrentYearMinus3Amt |
| Current Year Minus2 | $4,401 | CurrentYearMinus2Amt |
| Current Year Minus1 | $4,425 | CurrentYearMinus1Amt |
| Current Year | $5,509 | CurrentYearAmt |
| Total | $18,417 | TotalAmt |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Art Public Exhibition Amounts | ArtPublicExhibitionAmountsGrp | |
| Held Works Art | HeldWorksArtGrp | |
| CY Minus3 Yr Endwmt Fund | CYMinus3YrEndwmtFundGrp | |
| CY Minus4 Yr Endwmt Fund | CYMinus4YrEndwmtFundGrp |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $769,309 | OtherCostOrOtherBasisAmt |
| Book Value | $769,309 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $17,196,663 | OtherCostOrOtherBasisAmt |
| Depreciation | $7,426,352 | DepreciationAmt |
| Book Value | $9,770,311 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Leasehold Improvements | LeaseholdImprovementsGrp |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $10,826,055 | OtherCostOrOtherBasisAmt |
| Depreciation | $7,447,140 | DepreciationAmt |
| Book Value | $3,378,915 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,263,636 | OtherCostOrOtherBasisAmt |
| Depreciation | $564,300 | DepreciationAmt |
| Book Value | $699,336 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $14,617,871 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp (3 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| DUE FROM THIRD-PARTY PAYERS | $3,218,726 |
| BOND ISSUANCE COSTS | $80,523 |
| DEPOSITS | $1,000 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $3,300,249 | TotalBookValueOtherAssetsAmt |
| Federal Income Tax Liability | $0 | FederalIncomeTaxLiabilityAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | LINE OF CREDIT | Desc |
| Amt | $500,000 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $500,000 | TotalLiabilityAmt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE D, PART X, LINE 2 | FormAndLineReferenceDesc |
| 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. | ExplanationTxt |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (true) | FinancialAssistancePolicyInd |
| Written Policy | Yes (true) | WrittenPolicyInd |
| FPG Reference Free Care | Yes (true) | FPGReferenceFreeCareInd |
| Percent150 | Yes (X) | Percent150Ind |
| FPG Reference Discounted Care | Yes (true) | FPGReferenceDiscountedCareInd |
| Percent200 D | Yes (X) | Percent200DInd |
| Free Care Medically Indigent | Yes (true) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | false | FinancialAssistanceBudgetInd |
| Annual Community Bnft Report | false | AnnualCommunityBnftReportInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $366,520 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $366,520 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01470 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,974,331 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,504,499 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,469,832 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.05880 | TotalExpensePct |
Unreimbursed Costs UnreimbursedCostsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $160,289 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $73,821 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $86,468 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00350 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $3,501,140 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,578,320 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,922,820 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.07700 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $60,928 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $16,630 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $44,298 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00180 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,120 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $1,120 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00010 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $13,030 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $4,523 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $8,506 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00030 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $5,000 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $5,000 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00020 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $80,078 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $21,153 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $58,924 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00240 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $3,581,218 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,599,473 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,981,744 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.07940 | TotalExpensePct |
Economic Development EconomicDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $7,152 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $7,152 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00030 | TotalExpensePct |
Health Improvement Advocacy HealthImprovementAdvocacyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,266 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $1,266 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00010 | TotalExpensePct |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $8,418 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $8,418 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00040 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | false | BadDebtExpenseReportedInd |
| Bad Debt Expense | $518,568 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $10,371 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $12,099,443 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $12,489,030 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$389,587 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | Yes (X) | CostToChargeRatioInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (true) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (true) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | HIAWATHA HOSPITAL ASSOCIATION | BusinessNameLine1 |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 300 UTAH STREET | AddressLine1 |
| City | HIAWATHA | City |
| State | KS | State |
| ZIP Code | 66434 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | hch-ks.org | WebsiteAddressTxt |
| State License | H-007-001 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Critical Access Hospital | Yes (X) | CriticalAccessHospitalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | HIAWATHA HOSPITAL ASSOCIATION | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| CHNA Conducted | Yes (true) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Information Gaps | Yes (X) | InformationGapsInd |
| CHNA Conducted | 13 | CHNAConductedYr |
| Take Into Account Others Input | Yes (true) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | false | CHNAConductedWithOtherFcltsInd |
| CHNA Report Widely Available | Yes (true) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | HCH-KS.ORG | OwnWebsiteURLTxt |
| Rpt Available Upon Request | Yes (X) | RptAvailableUponRequestInd |
| Rpt Available Thru Other Method | Yes (X) | RptAvailableThruOtherMethodInd |
| Adopt Implementation Strategy | Yes (X) | AdoptImplementationStrategyInd |
| Exec Implementation Strategy | Yes (X) | ExecImplementationStrategyInd |
| Prioritize Health Needs | Yes (X) | PrioritizeHealthNeedsInd |
| Prioritize Services | Yes (X) | PrioritizeServicesInd |
| All Needs Addressed | Yes (true) | AllNeedsAddressedInd |
| Organization Incur Excise Tax | false | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (true) | EligCriteriaExplainedInd |
| FPG Used Deter Elig Free Care | Yes (true) | FPGUsedDeterEligFreeCareInd |
| FPG Family Incm Lmt Free Care | 150. | FPGFamilyIncmLmtFreeCarePct |
| FPG Used Determ Elig Dscnt Care | Yes (true) | FPGUsedDetermEligDscntCareInd |
| FPG Family Incm Lmt Dscnt Care | 250. | FPGFamilyIncmLmtDscntCarePct |
| Explained Basis | Yes (true) | ExplainedBasisInd |
| Income Level | Yes (X) | IncomeLevelInd |
| Asset Level | Yes (X) | AssetLevelInd |
| Medical Indigency | Yes (X) | MedicalIndigencyInd |
| Uninsured Discount | Yes (X) | UninsuredDiscountInd |
| Medicaid Medicare | Yes (X) | MedicaidMedicareInd |
| Other Factors | Yes (X) | OtherFactorsInd |
| App Financial Asst Expln | Yes (true) | AppFinancialAsstExplnInd |
| Includes Publicity Measures | Yes (true) | IncludesPublicityMeasuresInd |
| Posted On Website | Yes (X) | PostedOnWebsiteInd |
| Attached To Invoice | Yes (X) | AttachedToInvoiceInd |
| Provided On Admission | Yes (X) | ProvidedOnAdmissionInd |
| Available On Request | Yes (X) | AvailableOnRequestInd |
| FAP Actions On Nonpayment | Yes (true) | FAPActionsOnNonpaymentInd |
| Collection Activities | false | CollectionActivitiesInd |
| FAP Notified Upon Admission | Yes (X) | FAPNotifiedUponAdmissionInd |
| FAP Notified Before Discharge | Yes (X) | FAPNotifiedBeforeDischargeInd |
| FAP Notified All Patients | Yes (X) | FAPNotifiedAllPatientsInd |
| Nondis Emergency Care Policy | Yes (true) | NondisEmergencyCarePolicyInd |
| Medicare Rates | Yes (X) | MedicareRatesInd |
| Amounts Generally Billed | false | AmountsGenerallyBilledInd |
| Gross Charges | false | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| SCHEDULE H, PART V, LINE 3 | A committee was formed to provide guidance on creating the survey and feedback on prioritizing the survey results. The members were chosen carefully in hopes of getting a wide cross section of individuals with community and health knowledge. The following are the individuals serving on that committee: John Moore CEO/Administrator Hiawatha Community Hospital; Jenny Knudson Controller HCH, Hiawatha Foundation Economic Development Board Member; Karla Harter Nursing Director Brown County Health Department; Dr Pete Rosa Director of Medical Staff HCH, Primary Care Physician at Highland Family Practice, School board member; Sheri Wessel, PA Director of New You weight loss clinic HCHFP, Resident Nemaha County; Dr Crosby Gernon Hiawatha City Mayor, Radiologist HCH; Lynn Dierking, RN Director HCH Home Health Agency; Karen Wilson Executive Director Northeast Kansas Area Agency on Aging which also administrates KanCare enrollment, and Resident of Doniphan County; Lynne Ladner Hiawatha City Administrator, Hiawatha Foundation for Economic Development board member; Kristin Boltz Nurse Practioner at White Cloud Health Station that serves Iowa Sac & Fox Tribal Nation in Northern Brown County; Michelle Shamburg, PA Health Care Provider Kickapoo Tribal Nation in southern Brown County; Wendy Shoemaker, EMT New You weight loss clinic. The committee helped formulate questions for the survey. Once the survey was complete, the group met to review the findings, add their own input, prioritize projects and give input on devising an implementation strategy. |
| SCHEDULE H, PART V, LINE 5D | THE CHNA WAS DISTRIBUTED TO THE INDIVIDUALS INVOLVED IN ITS CREATION FOR DISPLAY AND DISSEMINATION HOWEVER THEY PLEASED. |
| SCHEDULE H, PART V, LINE 12I | SPECIAL CONSIDERATIONS MAY BE MADE FOR COLLEGE STUDENTS. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 3 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (3 entries)
| Address Line1USAddress/AddressLine1 | CityUSAddress/City | StateUSAddress/State | ZIP CodeUSAddress/ZIPCode | FacilityFacilityTxt |
|---|---|---|---|---|
| HIAWATHA COMMUNITY HOSPITAL HOME HEALTH | ||||
| 300 UTAH STREET | HIAWATHA | KS | 66434 | HOME HEALTH AGENCY |
| HIAWATHA COMM HOSP FAM PRACTICE CLINIC | ||||
| 300 OREGON STREET 2ND FLOOR | HIAWATHA | KS | 66434 | RURAL HEALTH CLINIC |
| HIAWATHA COMM HOSPITAL HIGHLAND CLINIC | ||||
| 415 S MAIN STREET | HIAWATHA | KS | 66434 | RURAL HEALTH CLINIC |
Supplemental Information Detail SupplementalInformationDetail (11 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| SCHEDULE H, PART I, LINE 7, COLUMN F | THE AMOUNT OF BAD DEBT EXPENSE REMOVED FROM TOTAL EXPENSES FOR CALCULATING THE NET COMMUNITY BENEFIT EXPENSE PERCENTAGE WAS $518,568. |
| SCHEDULE H, PART I, LINE 7 | THE HOSPITAL USES THE COST-TO-CHARGE RATIO. THIS METHOD WAS USED TO CALCULATE THE FIGURES IN THE TABLE AND WAS DETERMINED BY COMPARING PATIENT CARE COST TO PATIENT CARE CHARGES. |
| SCHEDULE H, PART I, LINE 7G | The weight loss clinic is our subsidized service. We do receive minimal payment from insurance and patients on the services, but the cost is far geater than our income. The clinic takes a balanced approach to solving patient weight issues. The clinic evaluates reasons that make it difficult to lose weight, or keep it off, including metabolism, environment and motivation. A participant will spend time with a physician, dietitican, personal trainer, therapist, and a pharmacist if needed. The physician helps the patient set a realistic healthy weight goal, and evaluates any potential underlying medical reasons for the extra weight. The registered dietician helps the patient set up a healthy balanced meal and snack plan. The personal trainer devises an exercise plan that will help meet the weight goal while addressing any areas of physical limitation. The therapist will help the patient evaluate any underlying behaviors that may be contributing to the extra weight. The pharmacist can review the patient's medication list for possible medications that may impede progress, and also is available for any patient that is a good candidate for weight loss medication therapy. The individuals are provided a group of peers going through the program for support. Once the patient has started on their regimen, there are follow up visits to monitor progress and refine personal program to help the individual meet their goal. This project is important to us as many of the health related issues that face our community and were identified in the community benefit survey were issues that would improve with weight loss. |
| SCHEDULE H, PART II, LINES 2 & 7 | ECONOMIC DEVELOPMENT - HHA EMPLOYEE REPRESENTS THE HOSPITAL ON THE HIAWATHA ECONOMIC DEVELOPMENT COUNCIL TO DISCUSS THE HOSPITAL'S INVOLVEMENT IN IMPROVING THE COMMUNITY'S ECONOMIC HEALTH AND DEVELOPMENT. COMMUNITY HEALTH IMPROVEMENT ADVOCACY - HHA EMPLOYEE SERVES ON THE BOARD OF A LOCAL COMMUNITY DAY CARE FACILITY, HHA EMPLOYEE SERVES AS SCHOOL BOARD MEMBER, AND THE HOSPITAL OPERATED A WEIGHT LOSS CLINIC TO BETTER SUPPORT THE HOSPITAL'S COMMUNITY AND HEALTHY LIVING. |
| SCHEDULE H, PART III, LINE 4 | The Hospital reports patient accounts receivable for services rendered at net realizable amounts from third-party payers, patients and others. The Hospital provides an allowance for doubtful accounts based upon a review of outstanding receivables, historical collection information, and existing economic conditions. As a service to the patient, the Hospital bills third-party payers directly and bills the patient when the patient's liability is determined. Patient accounts receivable are due in full when billed. Accounts are considered delinquent and subsequently written off as bad debts based on individual credit evaluation and specific circumstances of the account. Line 2 is THE ORGANIZATION'S BAD DEBT FIGURE NET OF COLLECTIONS AND THEN MULTIPLIED BY THE ORGANIZATION'S COST TO CHARGE RATIO. THE ORGANIZATION FIGURED 2% OF THOSE BELONG IN CHARITY CARE BUT WERE INELIGIBLE BECAUSE THEY WOULDN'T COMPLETE PAPERWORK OR THE BUSINESS OFFICE DIDN'T HAVE ENOUGH INFORMATION TO BE ABLE TO SEND THEM TO PRESUMPTIVE CHARITY CARE. |
| SCHEDULE H, PART III, LINE 8 | Lines 5 & 6 came from the cost report. The shortfall comes from cuts to the Medicare program. Due to budget constraints, Medicare pays less for services, but we continue to provide the same level of care. |
| SCHEDULE H, PART III, LINE 9B | ON EACH STATEMENT WE STATE THAT WE HAVE A CHARITY CARE POLICY. FOR 3 MONTHS A STATEMENT IS SENT. AFTER 3RD STATEMENT, A COLLECTION LETTER GOES OUT WITH A CHARITY CARE APPLICATION. THE FOLLOWING MONTH IT IS LISTED ON THE BAD DEBT LIST. AT THE END OF THE FOLLOWING MONTH THE ACCOUNT IS WRITTEN OFF TO BAD DEBT AND SENT TO COLLECTIONS, OR LITIGATION. IF IT GOES TO LITIGATION, NOTIFICATION IS MADE THROUGH CERTIFIED MAIL. ANOTHER CHARITY CARE APPLICATION IS SENT ALONG WITH THE NOTIFICATION LETTER. |
| SCHEDULE H, PART VI, LINE 2 | EVERY THREE YEARS, USING STATISTICAL DATA FROM THE US CENSUS AND RELIABLE HEALTH STATS FOR THE AREA, A COMMUNITY SURVEY IS CREATED THAT ENCOURAGES FREE TEXT RESPONSES. BASED ON THE RESPONSES OF THE COMMUNITY, A PLAN IS DEVELOPED THAT PRIORITIZES THE AREAS THAT THE HOSPITAL CAN MOST ASSIST IN MEETING THE COMMUNITY IDENTIFIED NEEDS. |
| SCHEDULE H, PART VI, LINE 3 | THE HOSPITAL'S SOCIAL SERVICES DEPARTMENT SPEAKS WITH PATIENTS REGARDING ELIGIBILITY FOR CHARITY CARE, MEDICAID, AND VARIOUS OTHER ASSISTANCE PROGRAMS THAT ARE AVAILABLE. OUR BUSINESS OFFICE MANAGER ALSO SPEAKS WITH PATIENTS REGARDING THE AVAILABILITY FOR DISABILITY DETERMINATION. PROVIDERS OFTEN BRING UP OUR CHARITY CARE PROGRAM WITH PATIENTS AT TIME OF TREATMENT. A CHARITY CARE PAMPHLET IS AVAILABLE AT ADMISSIONS AND APPLICATIONS ARE OFTEN HANDED OUT AT TIME OF ADMISSION FOR OUTPATIENT SERVICES. THE CHARITY CARE POLICY IS ALSO PUBLISHED ON OUR WEBSITE. THE FACT THAT WE HAVE A CHARITY CARE PROGRAM IS PRINTED ON THE BOTTOM OF EVERY STATEMENT THAT GOES OUT. THE CHARITY CARE APPLICATION IS PRINTED ON THE BACK OF ALL COLLECTION LETTERS AND PRE-LITIGATION CERTIFIED LETTERS. |
| SCHEDULE H, PART VI, LINE 4 | OUR GEOGRAPHIC AREA INCLUDES ALL OF BROWN COUNTY AND PARTS OF DONIPHAN, ATCHISON, AND NEMAHA COUNTIES IN KANSAS AND PARTS OF RICHARDSON COUNTY NEBRASKA. 55% OF OUR COMMUNITY IS 45 YEARS OLD AND UNDER. 26% IS AGE 45 TO 64. 19% OF THE POPULATION IS OVER 65 YEARS OF AGE. 26% OF THE COMMUNITY HOUSEHOLDS ARE BELOW THE POVERTY LEVEL FOR A FAMILY OF FOUR. |
| SCHEDULE H, PART VI, LINE 5 | AS A TAX EXEMPT, NOT FOR PROFIT ENTITY, HIAWATHA COMMUNITY HOSPITAL'S PURPOSE IS TO PROVIDE THE BEST SERVICES POSSIBLE IN A MANNER THAT IS ACCESSIBLE TO ALL INDIVIDUALS. OFFERING OUR SERVICES AT NO, OR REDUCED COST TO THOSE WHO MEET OUR CHARITY REQUIREMENTS IS A CORNERSTONE OF OUR MISSION. AS THE ECONOMIC CLIMATE IN THE COMMUNITY CHANGED, SO DID OUR CHARITY CARE SERVICES. IN 2010 WE BEGAN A PRESUMPTIVE CHARITY CARE PROGRAM THAT ALLOWS US TO GRANT CHARITY CARE TO THOSE INDIVIDUALS WHO QUALIFY BUT WON'T COMPLETE THE REQUIRED PAPERWORK WE NEED TO SUBSTANTIATE THE NEED FOR ASSISTANCE. ALSO SUPPPORTING OUR STATUS IS OUR COMMITMENT TO PROVIDE QUALITY SERVICE AND STAFF. TO THAT END, THE HIAWATHA COMMUNITY HOSPITAL PROVIDES SCHOLARSHIPS FOR EDUCATION IN HEALTH RELATED FIELDS. ANOTHER MANNER IN WHICH WE SUPPORT OUR NOT FOR PROFIT STATUS IS THROUGH PUBLIC HEALTH EDUCATIONAL PROGRAMS FOR THE COMMUNITY. WE PROVIDE DIABETES, HYPERTENSION AND SMOKING CESSATION EDUCATION. WE ALSO RUN A WEIGHT LOSS CLINIC. |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (true) | GrantRecordsMaintainedInd |
Grants Other Asst To Indiv In US GrantsOtherAsstToIndivInUSGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Type | SCHOLARSHIPS | GrantTypeTxt |
| Recipient | 5 | RecipientCnt |
| Cash Grant | $15,194 | CashGrantAmt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE I, PART III | FormAndLineReferenceDesc |
| Explanation | 1) COMMUNITY SCHOLARSHIP - HCH HAS GIVEN SCHOLARSHIPS TO COMMUNITY MEMBERS PURSUING A DEGREE IN THE MEDICAL FIELD. AFTER THE SCHOLARSHIP IS APPROVED BY HOSPITAL CEO, THE TUITION IS PAID TO THE SCHOOL, THE STUDENT OR THE STUDENT LOAN HOLDER. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | false | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | false | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | false | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | false | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | false | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | Yes (true) | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | false | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | false | AnyNonFixedPaymentsInd |
| Initial Contract Exception | false | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (6 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| DR PETE ROSA | ||||||||||||||
| TRUSTEE/MD | $224,392 | $0 | $66,995 | $0 | $0 | $0 | $13,802 | $0 | $19,421 | $0 | $324,610 | $0 | $0 | $0 |
| JOHN MOORE | ||||||||||||||
| ADMINISTRATOR/CEO | $144,164 | $0 | $0 | $0 | $0 | $0 | $6,220 | $0 | $18,320 | $0 | $168,704 | $0 | $0 | $0 |
| DR BYRON BIGHAM | ||||||||||||||
| MD | $229,492 | $0 | $29,725 | $0 | $0 | $0 | $9,872 | $0 | $18,921 | $0 | $288,010 | $0 | $0 | $0 |
| DR STEFFEN SHAMBURG | ||||||||||||||
| MD | $352,778 | $0 | $55,000 | $0 | $0 | $0 | $43,118 | $0 | $16,921 | $0 | $467,817 | $0 | $0 | $0 |
| DR JULIE ROSA | ||||||||||||||
| MD | $104,417 | $0 | $29,941 | $0 | $0 | $0 | $17,574 | $0 | $0 | $0 | $151,933 | $0 | $0 | $0 |
| DR CROSBY GERNON | ||||||||||||||
| MD | $434,226 | $0 | $15,000 | $0 | $0 | $0 | $27,919 | $0 | $16,939 | $0 | $494,084 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE J, PART I, LINE 6A | FormAndLineReferenceDesc |
| Explanation | The family physicians that are contracted with the hospital to provide services in our rural health care clinic and our radiologist are all eligible for additional compensation beyond their base pay rate. Each physician's expenses and revenues are tracked through their own department. Periodically throughout the year, if their respective departments are showing a positive net income, then they are eligible to receive additional compensation. The amount of net revenue to be distributed mid year is decided between the physicians and the Administrator. By the year end, 100% of the net revenue will be distributed as long as it doesn't exceed the annual maximum compensation amounts in the physician's respective contracts. To determine what each physician's portion of the distribution will be, income statements are run by physician that include allocations for building expenses and expenses and revenues from mid-levels. | ExplanationTxt |
Schedule K IRS990ScheduleK
Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
Issuer Name IssuerName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CITY OF HIAWATHA | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Issuer EIN | 483025665 | BondIssuerEIN |
| CUSIP | 428545BD8 | CUSIPNum |
| Bond Issued | 2007-03-29 | BondIssuedDt |
| Issue Price | $5,175,000 | IssuePriceAmt |
| Purpose | SEE SCHEDULE K, PART V | PurposeDesc |
| Defeased | false | DefeasedInd |
| On Behalf Of Issuer | false | OnBehalfOfIssuerInd |
| Pool Financing | false | PoolFinancingInd |
Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Retired | $1,030,000 | RetiredAmt |
| Bond Defeased | $0 | BondDefeasedAmt |
| Total Proceeds | $5,175,000 | TotalProceedsAmt |
| In Reserve Fund | $0 | InReserveFundAmt |
| Capitalized Interest | $0 | CapitalizedInterestAmt |
| Refunding Escrow | $0 | RefundingEscrowAmt |
| Issuance Costs From Proceeds | $105,804 | IssuanceCostsFromProceedsAmt |
| Credit Enhancement | $0 | CreditEnhancementAmt |
| Working Capital Expenditures | $0 | WorkingCapitalExpendituresAmt |
| Capital Expenditures | $5,069,196 | CapitalExpendituresAmt |
| Other Spent Proceeds | $0 | OtherSpentProceedsAmt |
| Unspent | $0 | UnspentAmt |
| Substantial Completion | 2007 | SubstantialCompletionYr |
| Current Refunding | Yes (true) | CurrentRefundingInd |
| Advance Refunding | false | AdvanceRefundingInd |
| Final Allocation Made | Yes (true) | FinalAllocationMadeInd |
| Adequate Books And Rec Maint | Yes (true) | AdequateBooksAndRecMaintInd |
Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Owning Bond Financed Property | false | OwningBondFinancedPropertyInd |
| Any Lease Arrangements | false | AnyLeaseArrangementsInd |
| Mgmt Contract Bond Fincd Prop | false | MgmtContractBondFincdPropInd |
| Any Research Agreements | Yes (true) | AnyResearchAgreementsInd |
| Engage Bond Counsel Research | Yes (true) | EngageBondCounselResearchInd |
| Private Bus Use By Others | 0 | PrivateBusUseByOthersPct |
| Bond Iss Meet Prvt Sec Pymt Test | false | BondIssMeetPrvtSecPymtTestInd |
| Change In Use Bond Financed Prop | false | ChangeInUseBondFinancedPropInd |
| Remedial Action Taken | false | RemedialActionTakenInd |
| Procs Nonqualified Bond Remdtd | Yes (true) | ProcsNonqualifiedBondRemdtdInd |
Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Form8038 T Filed | false | Form8038TFiledInd |
| Rebate Not Due Yet | false | RebateNotDueYetInd |
| Exception To Rebate | false | ExceptionToRebateInd |
| No Rebate Due | false | NoRebateDueInd |
| Variable Rate Issue | false | VariableRateIssueInd |
| Hedge Identified In Bks And Rec | false | HedgeIdentifiedInBksAndRecInd |
Hedge Provider Name HedgeProviderName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | 0 | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Proceeds Invested In GIC | false | GrossProceedsInvestedInGICInd |
GIC Provider Name GICProviderName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | 0 | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Proceeds Invested | false | GrossProceedsInvestedInd |
| Written Proc To Monitor Reqs | false | WrittenProcToMonitorReqsInd |
Procedures Corrective Action ProceduresCorrectiveActionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Procedures Corrective Action | false | ProceduresCorrectiveActionInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | DESCRIPTION OF PURPOSE | FormAndLineReferenceDesc |
| Explanation | REFINANCE EXISTING BOND TO BUILD | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (12 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART III, LINE 1 | HIAWATHA COMMUNITY HOSPITAL'S HIGHEST PRIORITY IS THE PROVISION OF QUALITY HEALTH CARE TO OUR PATIENTS THROUGHOUT NORTHEAST KANSAS. COMPREHENSIVE SERVICES INCLUDE PRIMARY, SECONDARY, AND LONG-TERM CARE. TO CARRY OUT THIS MISSION, HEALTH PROFESSIONALS WITHIN THE HOSPITAL CONTINUALLY WORK TOGETHER TO IMPROVE PATIENT CARE AND EDUCATION. THIS TEAM APPROACH ASSURES THAT OUR PATIENTS WILL BENEFIT FROM THE MOST UP-TO-DATE MEDICAL PRACTICES AVAILABLE. THE HOSPITAL CAN ONLY CONTINUE TO EXIST TO SERVE ITS MISSION THROUGH SOUND FINANCIAL MANAGEMENT AND STRATEGIC PLANNING. THEREFORE, THE PRINCIPLES OF COST EFFECTIVENESS AND EFFICIENCY GOVERN THE DEVELOPMENT OF HEALTH CARE POLICY FOR THE HOSPITAL. EXTERNAL AND INTERNAL ASSESSMENTS ARE DONE TO DETERMINE EVOLUTIONARY NEEDS AND TO RESPOND TO THE DEMANDS OF EVER-CHANGING TECHNOLOGY. HIAWATHA COMMUNITY HOSPITAL FEELS A STRONG COMMITMENT TO ITS EMPLOYEES AND STRIVES ALWAYS TO TREAT THEM FAIRLY, RESPONSIBLY, AND WITH A SENSE OF CONCERN FOR THEIR WELL-BEING. THE PROVISION OF COMPREHENSIVE CONTINUING EDUCATION IS ESSENTIAL TO MAINTAIN ADEQUATE SKILL LEVELS AND FOSTER A SENSE OF PRIDE AND PROFESSIONALISM. AS A COMMUNITY HOSPITAL, HIAWATHA COMMUNITY HOSPITAL RECOGNIZES ITS RESPONSIBILITY TO PROVIDE PUBLIC HEALTH EDUCATION AND, AS SUCH, STRIVES TO SERVE AS A REGIONAL HEALTH RESOURCE CENTER. MEDICAL AND PROFESSIONAL STAFF ARE ENCOURAGED TO PARTICIPATE IN COMMUNITY ACTIVITIES AND EDUCATION. |
| FORM 990, PART III, LINE 4A | AS A TAX-EXEMPT, NOT-FOR-PROFIT ENTITY, HIAWATHA COMMUNITY HOSPITAL'S PURPOSE IS TO PROVIDE THE BEST SERVICES POSSIBLE IN A MANNER THAT IS ACCESSIBLE TO ALL INDIVIDUALS. OFFERING OUR SERVICES AT NO OR REDUCED COST TO THOSE WHO MEET OUR CHARITY REQUIREMENTS IS A CORNERSTONE OF OUR MISSION. TO ENSURE THAT AS MANY INDIVIDUALS AS POSSIBLE ARE DEEMED ELIGIBLE FOR CHARITY CARE, WE IMPLEMENTED A PRESUMPTIVE CHARITY CARE PROGRAM. THIS PROGRAM WILL VERIFY PATIENT FINANCIAL SITUATIONS ALLOWING US TO INCLUDE THEM IN THE CHARITY CARE PROGRAM EVEN IF THEY DON'T WANT TO COMPLETE THE PAPERWORK THEMSELVES. WE FEEL THAT THIS PROGRAM IS A GREAT WAY TO GET INDIVIUALS IN NEED THE CARE THEY DESERVE WITHOUT ADDED FINANCIAL STRESS. ALSO SUPPORTING OUR TAX-EXEMPT STATUS IS OUR COMMITMENT TO PROVIDE QUALITY SERVICE AND STAFF. TO THAT END, THE HIAWATHA COMMUNITY HOSPITAL DISTRIBUTED OVER $15,000 IN SCHOLARSHIPS IN 2013. ANOTHER MANNER IN WHICH WE SUPPORT OUR NOT-FOR-PROFIT STATUS IS THROUGH PUBLIC HEALTH EDUCATIONAL PROGRAMS FOR THE COMMUNITY. WE PROVIDE DIABETES, HYPERTENSION, AND SMOKING CESSATION EDUCATION. FINALLY, IN ADDRESSING COMMUNITY CONCERN FOR SAFE PLACES FOR CHILDREN, WE DONATED $5,000 TO THE NOT-FOR-PROFIT COMMUNITY DAY CARE FACILITY IN TOWN. |
| FORM 990, PART VI, SECTION A, LINE 2 | DR. PETE ROSA AND DR. JULIE ROSA HAVE A FAMILY RELATIONSHIP. |
| FORM 990, PART VI, SECTION B, LINE 11B | AN INDEPENDENT ACCOUNTING FIRM PREPARES AND REVIEWS THE 990. THE 990 IS THEN REVIEWED BY THE ORGANIZATION'S OFFICERS AND ACCOUNTING PERSONNEL. ANY QUESTIONS OR CONCERNS THE ORGANIZATION'S OFFICERS AND ACCOUNTING PERSONNEL HAVE ARE ADDRESSED AND ANY CORRECTIONS OR CLARIFICATIONS THAT NEED TO BE MADE ARE MADE. THE FINAL FORM 990 WITH ALL REQUIRED SCHEDULES IS THEN PROVIDED TO ALL VOTING MEMBERS OF THE BOARD PRIOR TO FILING THE 990. |
| FORM 990, PART VI, SECTION B, LINE 12C | All employees and decision makers for the Hospital are covered under this policy. Conflicts are either reviewed by the Corporate Compliance Officer or the Board President. At Board meetings, the Board Chair is appraised of all conflicts of interest and then asks the member to abstain from discussing and voting on topics of conflict. |
| FORM 990, PART VI, SECTION B, LINE 15A | THE DIRECTOR OF HUMAN RESOURCES PERIODICALLY PROVIDES THE PRESIDENT OF THE BOARD OF DIRECTORS WITH A COMPENSATION SURVEY COMPILED BY THE KANSAS HOSPITAL ASSOCIATION. THE SURVEY DELINEATES COMPENSATION PACKAGES FOR ADMINISTRATORS AT HOSPITALS THAT ARE SIMILAR TO HIAWATHA. BASED ON THAT SURVEY, THE ADMINISTRATOR'S PERFORMANCE, AND THE PERFORMANCE OF THE HOSPITAL, THE BOARD SETS THE ADMINISTRATOR'S SALARY. FOR 2013, NO RAISES WERE GIVEN, SO THERE WAS NO ANNUAL OFFICIAL REVIEW. |
| FORM 990, PART VI, LINE 19 | THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. |
| FORM 990, PART XI, LINE 9 | CHANGE IN FOUNDATION ASSETS $ (46,563) CHANGE IN ESTATE RECEIVABLE $ ( 514) ---------- TOTAL $ (47,077) |
| FORM 990 PART IX LINE 11G | DESCRIPTION:CONTRACT SERVICES TOTAL FEES:3269615 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:CONSULTING FEES TOTAL FEES:7590 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:COLLECTION EXPENSE TOTAL FEES:83122 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:MISCELLANEOUS FEES TOTAL FEES:12610 |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp
Disregarded Entity Name DisregardedEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | HIAWATHA HOSPITAL ASSOCIATION FOUNDATION | BusinessNameLine1 |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 300 UTAH STREET | AddressLine1 |
| City | HIAWATHA | City |
| State | KS | State |
| ZIP Code | 66434 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 481223766 | EIN |
| Primary Activities | FUNDRAISING | PrimaryActivitiesTxt |
| Legal Domicile State | KS | LegalDomicileStateCd |
| Exempt Code Section | 501(C)(3) | ExemptCodeSectionTxt |
| Public Charity Status | 11D | PublicCharityStatusTxt |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | HHA | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Controlled Organization | false | ControlledOrganizationInd |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp
Related Organization Name RelatedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CHARITABLE REMAINDER TRUST (1) | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Primary Activities | TRUST | PrimaryActivitiesTxt |
| Legal Domicile State | KS | LegalDomicileStateCd |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | NA | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Controlled Organization | false | ControlledOrganizationInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | false | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | false | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (true) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | false | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | false | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | false | DivRelatedOrganizationInd |
| Asset Sale To Other Org | false | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | false | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | false | AssetExchangeInd |
| Rental Of Facilities To Oth Org | false | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | false | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | false | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | false | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (true) | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (true) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | false | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | false | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | false | TransferToOtherOrgInd |
| Transfer From Other Org | Yes (true) | TransferFromOtherOrgInd |