KEOKUK AREA HOSPITAL: Form 990, tax year 2012
View the entire original 990 at ProPublica ↗
- Organization
- KEOKUK AREA HOSPITAL (EIN 42-0710268)
- Tax period
- 2012-10-01 to 2013-09-30
- Filed
- 2014-05-12
- IRS object ID
- 201411339349300311
- Schema version
- 2012v2.0
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule D
- Schedule H
- Schedule J
- Schedule O
- Schedule R
- Reasonable Cause Explanation
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2014-05-12T22:48:59-07:00 | Timestamp |
| Tax Period End Date | 2013-09-30 | TaxPeriodEndDate |
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2012-10-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 420710268 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | KEOKUK AREA HOSPITAL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | KEOK | NameControl |
| Phone | 3195247150 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1600 Morgan Street | AddressLine1 |
| City | Keokuk | City |
| State | IA | State |
| ZIP Code | 52632 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Joseph Whiting | Name |
| Title | Interim Chief Executive Officer | Title |
| Phone | 3195247150 | Phone |
| Date Signed | 2014-05-12 | DateSigned |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2012 | TaxYear |
| Build TS | 2015-11-30 17:44:51Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | Joseph Whiting | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1600 Morgan Street | AddressLine1 |
| City | Keokuk | City |
| State | IA | State |
| ZIP Code | 52632 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 22219243 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | www.keokukhealthsystems.org | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1975 | YearFormation |
| State Legal Domicile | IA | StateLegalDomicile |
| Activity Or Mission Description | Improving Community Health and ensuring access to quality healthcare services regardless of ability to pay. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 11 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 10 | NbrIndependentVotingMembers |
| Total Nbr Employees | 391 | TotalNbrEmployees |
| Total Nbr Volunteers | 200 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 40056 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 64071 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 23853868 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 19759572 | ProgramServiceRevenueCY |
| Investment Income Prior Year | -43500 | InvestmentIncomePriorYear |
| Investment Income Current Year | 110599 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 1000324 | OtherRevenuePriorYear |
| Other Revenue Current Year | 2285001 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 24850748 | TotalRevenuePriorYear |
| Total Revenue Current Year | 22219243 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 0 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 0 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 14783615 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 12374704 | 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 | 10961151 | OtherExpensePriorYear |
| Other Expenses Current Year | 10672584 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 25744766 | TotalExpensesPriorYear |
| Total Expenses Current Year | 23047288 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | -894018 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | -828045 | RevenuesLessExpensesCY |
| Total Assets BOY | 15808372 | TotalAssetsBOY |
| Total Assets EOY | 14267387 | TotalAssetsEOY |
| Total Liabilities BOY | 12373410 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 12432783 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 3434962 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 1834604 | NetAssetsOrFundBalancesEOY |
| Mission Description | Improving Community Health and ensuring access to quality healthcare services regardless of ability to pay. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 22293086 | Expense |
| Grants | 0 | Grants |
| Revenue | 22219243 | Revenue |
| Description | Keokuk Area Hospital is a private 501 c 3 tax exempt acute care hospital with a mission of ensuring quality healthcare services are available to all residents of the community regardless of ability to pay. The hospital provides emergency care, inpatient and outpatient services to the Tri-State region. Approximately 65% of gross patient service revenue is derived under federal and state third-party reimbursement programs and another 7% is private pay. According to the FY 2013 Cost Report prepared by the hospital's external auditors, KAH is underfunded by Medicare and Medicaid by approximately $3,000,000. In order to close that deficit, the hospital is undergoing a turnaround journey to create a financially stable organization that meets the needs of the community. This journey includes expense reduction initiatives as well as revenue growth opportunities. Surgery has been identified as a center of excellence evident by the recruitment of a fulltime general surgeon and fulltime orthopedic surgeon. Primary care is also a main focus evident by the recruitment of three new mid-level providers who joined the hospital's primary care physician group, TSMG. | Description |
| Total Of Other Program Service Exp | 0 | TotalOfOtherProgramServiceExp |
| Total Of Other Program Service Grnt | 0 | TotalOfOtherProgramServiceGrnt |
| Total Of Other Program Service Rev | 0 | TotalOfOtherProgramServiceRev |
| Total Program Service Expense | 22293086 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 0 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 0 | LobbyingActivities |
| Subject To Proxy Tax | 0 | SubjectToProxyTax |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 0 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 1 | ReportLandBldgEquip |
| Report Invest Oth Securities | 0 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 0 | ReportOtherAssets |
| Report Other Liabilities | 1 | ReportOtherLiabilities |
| Report Fin48 Footnote | 1 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 1 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 0 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 0 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 1 | Hospital |
| Financial Stmt Attached | 1 | FinancialStmtAttached |
| Grants To Organizations | 0 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 0 | TaxExemptBonds |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 0 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 0 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 1 | RelatedEntity |
| Related Org Controlled Entity | 0 | RelatedOrgControlledEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 37 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 391 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 0 | UnrelatedBusinessIncome |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 11 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 10 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 1 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 1 | MembersOrStockholders |
| Election Of Board Members | 1 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 1 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 1 | CompensationProcessCEO |
| Compensation Process Other | 1 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| Other Website | X | OtherWebsite |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Keokuk Area Hospital | BusinessNameLine1 |
| Business Name Line2 | ATTN Accounting | BusinessNameLine2 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 3195247150 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1600 Morgan Street | AddressLine1 |
| City | Keokuk | City |
| State | IA | State |
| ZIP Code | 52632 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (15 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Average Hours Per Week RelatedAverageHoursPerWeekRelated | Individual Trustee Or DirectorIndividualTrusteeOrDirector | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | OfficerOfficer | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|---|
| Greg Miller | ||||||||
| Member, Board of Directors | 0 | 1 | X | 0 | 0 | 0 | ||
| Walt Stephens | ||||||||
| Chairman, Board of Directors | 0 | 1 | X | 0 | 0 | 0 | X | |
| Mike Klauser | ||||||||
| Member, Board of Directors | 0 | 1 | X | 0 | 0 | 0 | ||
| Kiran Khanolkar MD | ||||||||
| Member, Board of Directors | 0 | 40 | X | 0 | 226062 | 15046 | ||
| Kent Nixon | ||||||||
| Vice Chair, Board of Directors & Corporate Treasurer | 0 | 1 | X | 0 | 0 | 0 | X | |
| Mike Maher | ||||||||
| Member, Board of Directors | 0 | 1 | X | 0 | 0 | 0 | ||
| Wendy Swank | ||||||||
| Member, Board of Directors & Corporate Secretary | 0 | 1 | X | 0 | 0 | 0 | X | |
| Tom Marion | ||||||||
| Member, Board of Directors | 0 | 1 | X | 0 | 0 | 0 | ||
| Ron Scott | ||||||||
| Member, Board of Directors | 0 | 1 | X | 0 | 0 | 0 | ||
| David Waddell MD | ||||||||
| Member, Board of Directors | 0 | 1 | X | 0 | 0 | 0 | ||
| Dick Logsdon | ||||||||
| Member, Board of Directors | 0 | 1 | X | 0 | 0 | 0 | ||
| Wally Winkler | ||||||||
| CEO/CFO | 40 | 0 | 38250 | 0 | 2292 | X | ||
| Susan Pankey | ||||||||
| CNO | 40 | 0 | 20940 | 0 | 1975 | X | ||
| Elizabeth Gregory | ||||||||
| Pharmacy Director | 40 | 0 | 122839 | 0 | 14727 | X | ||
| Jagadamba Kantanmeni | ||||||||
| Anesthesiologist | 40 | 0 | 300692 | 0 | 9452 | X | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 482721 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 226062 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 43492 | TotalOtherCompensation |
| Number Individuals GT100 K | 2 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation | Address Line2AddressOfContractor/AddressUS/AddressLine2 |
|---|---|---|---|---|---|---|
| PT Services Rehabilitation Inc | ||||||
| Box 833 | Tiffin | OH | 44883 | Physical Therapy | 144265 | |
| Blessing Physician Services | ||||||
| Box 5007 | Quincy | IL | 61232 | Emergency Room Physician Group | 1634922 | |
| Fitch Healthcare | ||||||
| 903 Commerce Drive | Oak Brook | IL | 60523 | Management Services | 437634 | Suite 160 |
| Shared Medical Services | ||||||
| 209 Limestone | Cottage Grove | WI | 53527 | MRI Services | 303015 | |
| RPH On The Go | ||||||
| PO Box 1024640 | Atlanta | GA | 30368 | Pharmacy Services | 108508 | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 5 | NumberOfContractorsGT100K |
| Federated Campaigns | 0 | FederatedCampaigns |
| Membership Dues | 0 | MembershipDues |
| Fundraising Events | 0 | FundraisingEvents |
| Related Organizations | 0 | RelatedOrganizations |
| Government Grants | 40928 | GovernmentGrants |
| All Other Contributions | 23143 | AllOtherContributions |
| Noncash Contributions | 0 | NoncashContributions |
| Total Contributions | 64071 | TotalContributions |
Program Service Revenue ProgramServiceRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | Hospital Services | Description |
| Business Code | 622000 | BusinessCode |
| Total Revenue Column | 19759572 | TotalRevenueColumn |
| Related Or Exempt Function Income | 19759572 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $0 | ExclusionAmount |
Total Oth Program Service Revenue TotalOthProgramServiceRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
| Related Or Exempt Function Income | 0 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $0 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 19759572 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 110599 | TotalRevenueColumn |
| Related Or Exempt Function Income | 110599 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $0 | ExclusionAmount |
Income From Invest Bond Proceeds IncomeFromInvestBondProceeds
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
| Related Or Exempt Function Income | 0 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $0 | ExclusionAmount |
Royalties Revenue RoyaltiesRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
| Related Or Exempt Function Income | 0 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $0 | ExclusionAmount |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 0 | Real |
| Personal | 0 | Personal |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 0 | Securities |
| Other | 0 | Other |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrbtns Rprtd Fundraising Events | 0 | CntrbtnsRprtdFundraisingEvents |
Other Revenue Misc OtherRevenueMisc (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome | Unrelated Business RevenueUnrelatedBusinessRevenue | ExclusionExclusionAmount |
|---|---|---|---|---|---|
| Cafeteria/laundry/rent/misc | 622000 | 473191 | 473191 | 0 | $0 |
| Weight Loss Program | 622000 | 99474 | 99474 | 0 | $0 |
| EHR Incentive Program | 622000 | 1712336 | 1712336 | 0 | $0 |
Miscellaneous Revenue MiscellaneousRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
| Related Or Exempt Function Income | 0 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $0 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 2285001 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 22219243 | TotalRevenueColumn |
| Related Or Exempt Function Income | 22155172 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $0 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | X | InfoInScheduleOPartIX |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 59190 | Total |
| Program Services | 0 | ProgramServices |
| Management And General | 59190 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 9817148 | Total |
| Program Services | 9817148 | ProgramServices |
| Management And General | 0 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 8144 | Total |
| Program Services | 8095 | ProgramServices |
| Management And General | 49 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1785539 | Total |
| Program Services | 1774838 | ProgramServices |
| Management And General | 10701 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 704683 | Total |
| Program Services | 700460 | ProgramServices |
| Management And General | 4223 | ManagementAndGeneral |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 568798 | Total |
| Program Services | 0 | ProgramServices |
| Management And General | 568798 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 24003 | Total |
| Program Services | 0 | ProgramServices |
| Management And General | 24003 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 55212 | Total |
| Program Services | 0 | ProgramServices |
| Management And General | 55212 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2922206 | Total |
| Program Services | 2890180 | ProgramServices |
| Management And General | 32026 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 17951 | Total |
| Program Services | 17951 | ProgramServices |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 114941 | Total |
| Program Services | 114941 | ProgramServices |
| Management And General | 0 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 480270 | Total |
| Program Services | 480270 | ProgramServices |
| Management And General | 0 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 49207 | Total |
| Program Services | 49207 | ProgramServices |
| Management And General | 0 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 393422 | Total |
| Program Services | 393422 | ProgramServices |
| Management And General | 0 | ManagementAndGeneral |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1265340 | Total |
| Program Services | 1265340 | ProgramServices |
| Management And General | 0 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 116208 | Total |
| Program Services | 116208 | ProgramServices |
| Management And General | 0 | ManagementAndGeneral |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral | FundraisingFundraising |
|---|---|---|---|---|
| Supplies (Medical & Office) | 3173506 | 3173506 | 0 | 0 |
| Repairs and Minor Equipment | 646679 | 646679 | 0 | 0 |
| Recruitment & Physician Support | 322540 | 322540 | 0 | 0 |
| Miscellaneous | 522301 | 522301 | 0 | 0 |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 23047288 | Total |
| Program Services | 22293086 | ProgramServices |
| Management And General | 754202 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 553965 | BOY |
| EOY | 1115769 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1468715 | BOY |
| EOY | 1512593 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4957833 | BOY |
| EOY | 3878350 | EOY |
Other Notes Loans Receivable Net OtherNotesLoansReceivableNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 307973 | BOY |
| EOY | 173368 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 991376 | BOY |
| EOY | 990032 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 152478 | BOY |
| EOY | 92057 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 29363449 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 23280595 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6499605 | BOY |
| EOY | 6082854 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 876427 | BOY |
| EOY | 422364 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 15808372 | BOY |
| EOY | 14267387 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6517545 | BOY |
| EOY | 7735484 | EOY |
Tax Exempt Bond Liabilities TaxExemptBondLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3305608 | BOY |
| EOY | 2910968 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2550257 | BOY |
| EOY | 1786331 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 12373410 | BOY |
| EOY | 12432783 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3409735 | BOY |
| EOY | 1801321 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 25227 | BOY |
| EOY | 33283 | 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 | 3434962 | BOY |
| EOY | 1834604 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 15808372 | BOY |
| EOY | 14267387 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | -828045 | ReconcilationRevenueExpenses |
| Reconciliation Unrealized Invest | 0 | ReconciliationUnrealizedInvest |
| Reconcilation Donated Services | 0 | ReconcilationDonatedServices |
| Reconcilation Invest Expenses | 0 | ReconcilationInvestExpenses |
| Reconcilation Prior Adjustment | 0 | ReconcilationPriorAdjustment |
| Reconcilation Other Changes | -772313 | ReconcilationOtherChanges |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
| Audit Committee | 1 | AuditCommittee |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
Schedule D IRS990ScheduleD
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | 0 | InvestmentCostOrOtherBasis |
| Other Cost Or Other Basis | 438675 | OtherCostOrOtherBasis |
| Book Value | 438675 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | 0 | InvestmentCostOrOtherBasis |
| Other Cost Or Other Basis | 505333 | OtherCostOrOtherBasis |
| Depreciation | 457268 | Depreciation |
| Book Value | 48065 | BookValue |
Leasehold Improvements LeaseholdImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | 0 | InvestmentCostOrOtherBasis |
| Other Cost Or Other Basis | 17041957 | OtherCostOrOtherBasis |
| Depreciation | 13537069 | Depreciation |
| Book Value | 3504888 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | 0 | InvestmentCostOrOtherBasis |
| Other Cost Or Other Basis | 7239570 | OtherCostOrOtherBasis |
| Depreciation | 6358337 | Depreciation |
| Book Value | 881233 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | 0 | InvestmentCostOrOtherBasis |
| Other Cost Or Other Basis | 4137914 | OtherCostOrOtherBasis |
| Depreciation | 2927921 | Depreciation |
| Book Value | 1209993 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 6082854 | TotalOfBookValueLandBuildings |
| Federal Income Tax Liability | 0 | FederalIncomeTaxLiability |
Other Liabilities OtherLiabilities (3 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| Capital Lease Obligations | $1,155,628 |
| Notes Payable | $608,510 |
| Line of Credit | $22,193 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 1786331 | TotalOfAmounts |
| Footnote In Part XIII | X | FootnoteInPartXIII |
| Tot Revenue Etc Audited Fincl Stmt | 22044573 | TotRevenueEtcAuditedFinclStmt |
| Net Unrealized Gains Investments | 0 | NetUnrealizedGainsInvestments |
| Donated Srvc And Use Of Facilities | 0 | DonatedSrvcAndUseOfFacilities |
| Recoveries Of Prior Year Grants | 0 | RecoveriesOfPriorYearGrants |
| Other Revenues | 0 | OtherRevenues |
| Revenue Not Rptd F990 | 0 | RevenueNotRptdF990 |
| Revenue Subtotal | 22044573 | RevenueSubtotal |
| Investment Expenses Not Included | 0 | InvestmentExpensesNotIncluded |
| Other Revenues Not Included | 174670 | OtherRevenuesNotIncluded |
| Revenue Not Rptd On Fin Stmt | 174670 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 22219243 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 23047288 | TotExpensesEtcAuditedFinclStmt |
| Donated Services Use Of Facilities | 0 | DonatedServicesUseOfFacilities |
| Prior Year Adjustments | 0 | PriorYearAdjustments |
| Losses Reported | 0 | LossesReported |
| Other Expenses Included | 0 | OtherExpensesIncluded |
| Expenses Not Rptd F990 | 0 | ExpensesNotRptdF990 |
| Expenses Subtotal | 23047288 | ExpensesSubtotal |
| Investment Expenses Not Included2 | 0 | InvestmentExpensesNotIncluded2 |
| Other Expenses Not Included | 0 | OtherExpensesNotIncluded |
| Expenses Not Rptd On Fin Stmt | 0 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 23047288 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIII Form990ScheduleDPartXIII (2 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| SchD_P10_S00_L02 | Schedule D, Part X, Line 2 | Footnote for uncertain tax positions under fin 48: Tax positions are not offset or aggregated with other positions. Tax positions that meet the "more likely than not" recognition threshold are measured as the largest amount of tax benefit that is more than 50% likely to be realized on settlement with the applicable taxing authority. The portion of the benefits associated with tax positions taken that exceeds the amount measured as described above is reflected as a liability for uncertain tax benefits in the accompanying balance sheets along with any associated interest and penalties that would be payable to the taxing authorities upon examination. As of September 30, 2013 and 2012, there were no uncertain tax benefits related to uncertain tax positions identified and recorded as a liability. |
| SchD_P11_S00_L04b | Schedule D, Part XI, Line 4b | Total contains $64,071 of unrestricted donations and grant income and $110,599 of a gain in sale of investments, change in unrealized gains on trading investments and income on investments limited as to use. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | 1 | CharityCarePolicy |
| Written Policy | 1 | WrittenPolicy |
| FPG Reference Free Care | 1 | FPGReferenceFreeCare |
| Pcent100 | X | Pcent100 |
| FPG Reference Discounted Care | 1 | FPGReferenceDiscountedCare |
| Pcent400 | X | Pcent400 |
| Free Disc Care Medically Indigent | 1 | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | 1 | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | 1 | ExpensesExceededBudget |
| Unable To Provide Care | 0 | UnableToProvideCare |
| Annual Community Benefit Report | 1 | AnnualCommunityBenefitReport |
| Report Publically Available | 0 | ReportPublicallyAvailable |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 411505 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 411505 | NetCommunityBenefitExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 770250 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 770250 | NetCommunityBenefitExpense |
Unreimbursed Costs UnreimbursedCosts
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 87946 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 87946 | NetCommunityBenefitExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 0 | NumberOfActivitiesOrPrograms |
| Persons Served | 0 | PersonsServed |
| Total Community Benefit Expense | 1269701 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 0 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1269701 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 43455 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 43455 | NetCommunityBenefitExpense |
Health Professions Education HealthProfessionsEducation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 382954 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 382954 | NetCommunityBenefitExpense |
Subsidized Health Services SubsidizedHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 755964 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 755964 | NetCommunityBenefitExpense |
Research Research
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 0 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 0 | NetCommunityBenefitExpense |
Cash And In Kind Contributions CashAndInKindContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 0 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 0 | NetCommunityBenefitExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 0 | NumberOfActivitiesOrPrograms |
| Persons Served | 0 | PersonsServed |
| Total Community Benefit Expense | 1182373 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 0 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1182373 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 0 | NumberOfActivitiesOrPrograms |
| Persons Served | 0 | PersonsServed |
| Total Community Benefit Expense | 2452074 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 0 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 2452074 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0 | PercentOfTotalExpense |
Physical Improvements And Housing PhysicalImprovementsAndHousing
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 600 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 600 | NetCommunityBuildingExpense |
Economic Development EconomicDevelopment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 2620 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 2620 | NetCommunityBuildingExpense |
Community Support CommunitySupport
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 3410 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 3410 | NetCommunityBuildingExpense |
Environmental Improvements EnvironmentalImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 0 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 0 | NetCommunityBuildingExpense |
Leadership Development LeadershipDevelopment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 2761 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 2761 | NetCommunityBuildingExpense |
Coalition Building CoalitionBuilding
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 13693 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 13693 | NetCommunityBuildingExpense |
Health Improvement Advocacy HealthImprovementAdvocacy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 800 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 800 | NetCommunityBuildingExpense |
Workforce Development WorkforceDevelopment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 8509 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 8509 | NetCommunityBuildingExpense |
Other Other
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 0 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 0 | NetCommunityBuildingExpense |
Total Total
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 0 | NumberOfActivitiesOrPrograms |
| Persons Served | 0 | PersonsServed |
| Total Community Building Expense | 32393 | TotalCommunityBuildingExpense |
| Direct Offsetting Revenue | 0 | DirectOffsettingRevenue |
| Net Community Building Expense | 32393 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 1 | BadDebtExpenseReported |
| Bad Debt Expense | $2,369,233 | BadDebtExpenseAmount |
| Amount Attributable To | 1097757 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 9245585 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 11478880 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | -2233295 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | X | CostToChargeRatio |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | 1 | WrittenDebtCollectionPolicy |
| Provision For Charity Care | 1 | ProvisionForCharityCare |
| Number Of Hospital Facilities | 1 | NumberOfHospitalFacilities |
Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility Number | 1 | FacilityNumber |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Keokuk Area Hospital | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1600 Morgan Street | AddressLine1 |
| City | Keokuk | City |
| State | IA | State |
| ZIP Code | 52632 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | www.keokukhealthsystems.org | WebsiteAddress |
| Licensed Hospital | X | LicensedHospital |
| General Medical And Surgical | X | GeneralMedicalAndSurgical |
| Er24 Hours | X | Er24Hours |
Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Keokuk Area Hospital | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
| CHNA Conducted | 1 | CHNAConducted |
| Community Definition | X | CommunityDefinition |
| Community Demographics | X | CommunityDemographics |
| Existing Resources | X | ExistingResources |
| How Data Obtained | X | HowDataObtained |
| Community Health Needs | X | CommunityHealthNeeds |
| Other Health Issues | X | OtherHealthIssues |
| Identifying Process | X | IdentifyingProcess |
| Consulting Process | X | ConsultingProcess |
| Needs Assessment Conducted | 13 | NeedsAssessmentConducted |
| Take Into Account | 1 | TakeIntoAccount |
| Other Facilities | 1 | OtherFacilities |
| CHNA Widely Available | 1 | CHNAWidelyAvailable |
| Own Website | X | OwnWebsite |
| On Request | X | OnRequest |
| Adopt Implement Strategy | X | AdoptImplementStrategy |
| Execute Implement Strategy | X | ExecuteImplementStrategy |
| Adopt Budget | X | AdoptBudget |
| Prioritize Health Needs | X | PrioritizeHealthNeeds |
| Prioritize Services | X | PrioritizeServices |
| All Needs Addressed | 0 | AllNeedsAddressed |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTax |
| Eligibility Criteria Explained | 1 | EligibilityCriteriaExplained |
| Uses FPG Free | 1 | UsesFPGFree |
| FPG Free Percent | 100 | FPGFreePercent |
| Uses FPG Discounted | 1 | UsesFPGDiscounted |
| FPG Discount Percent | 400 | FPGDiscountPercent |
| Explains Basis | 1 | ExplainsBasis |
| Income Level | X | IncomeLevel |
| Asset Level | X | AssetLevel |
| Insurance Status | X | InsuranceStatus |
| Uninsured Discount | X | UninsuredDiscount |
| Explains Application Method | 1 | ExplainsApplicationMethod |
| Includes Publicity Measures | 1 | IncludesPublicityMeasures |
| Available On Request | X | AvailableOnRequest |
| Actions On Nonpayment | 1 | ActionsOnNonpayment |
| Permit Other Actions | X | PermitOtherActions |
| Collection Activities | 0 | CollectionActivities |
| Notify Upon Admission | X | NotifyUponAdmission |
| Notified All Patients | X | NotifiedAllPatients |
| Documented Determination | X | DocumentedDetermination |
| Nondiscrim Emergency Care Policy | 1 | NondiscrimEmergencyCarePolicy |
| Used Other Method | X | UsedOtherMethod |
| Amounts Generally Billed | 0 | AmountsGenerallyBilled |
| Gross Charges | 0 | GrossCharges |
Form990 Schedule H Part VI Form990ScheduleHPartVI (17 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| SchH_P01_S00_L07 | Schedule H, Part I, Line 7 | Ratio of cost to charges is applied to gross charges. |
| SchH_P01_S00_L072f | Schedule H, Part I, Line 7, Column f | 0 (zero) |
| SchH_P01_S00_L07g | Schedule H, Part I, Line 7g | All of the $755,964 is attributable to the hospital providing subsidized services to patients of Tri-State Medical Group, a related organization which is affiliated with the Community Health Centers of Southeastern Iowa (CHC), and Keokuk Area Hospital provides the subsidy to ensure CHC patients have access to primary care services. |
| SchH_P02_S00_L00 | Schedule H, Part II | Involving hospital staff in outside organizations and working with them to provide health education and assessment provides a forum to keep the hospital aware of the community needs while building coalitions to address those needs. |
| SchH_P03_S0A_L04 | Schedule H, Part III, Section A, Line 4 | Patient receivables are written off as bad debt when deemed uncollectable. Recoveries of receivables previously written off are recorded as a reduction of bad debt expense when received (page 10). |
| SchH_P03_S0B_L08 | Schedule H, Part III, Section B, Line 8 | Medicare pays Keokuk Area Hospital substantially less than reasonable cost which represents uncompensated care just like provided to the indigent patients who cannot pay for their services. The cost of this care is calculated per the Medicare Cost Report methodology. |
| SchH_P03_S0C_L09b | Schedule H, Part III, Section C, Line 9b | If information is available to confirm eligibility for charity care, collection activity is not pursued. |
| SchH_P05_S0B_L04 | Schedule H, Part V, Section B, Line 4 | Keokuk Area Hospital participated in the Community Wide Needs Assessment with Fort Madison Community Hospital. |
| SchH_P05_S0B_L07 | Schedule H, Part V, Section B, Line 7 | SOME OF THE HEALTH ISSUES IDENTIFIED THROUGH THE ASSESSMENT WERE ALREADY BEING ADDRESSED IN THE SERVICE AREA BY THE LEE COUNTY HEALTH DEPARTMENT AND FORT MADISON COMMUNITY HOSPITAL. ADDITIONALLY, SOME COMMUNITY NEEDS SUCH AS INCREASED NUTRITION & FITNESS, IMPROVED BICYCLE/WALKING TRAILS AND IMPROVED HEALTH DEPARTMENT FACILITIES WERE BEYOND THE SCOPE, EXPERTISE AND RESOURCES AVAILABE AT KEOKUK AREA HOSPTIAL. |
| SchH_P05_S0B_L16 | Schedule H, Part V, Section B, Line 16 | PATIENTS FOLLOW THE HOSPTIAL BILLING AND COLLECTIONS POLICY UNLESS THEY APPLY AND QUALIFY FOR FINANCIAL ASSISTANCE. THE FINANCIAL ASSISTANCE POLICY REQUIRES PATIENTS TO AGREE AND ADHERE TO A PAYMENT SCHEUDULE TO OBTAIN THE COMPLETE DISCOUNT THEY QUALIFY FOR. |
| SchH_P05_S0B_L20 | Schedule H, Part V, Section B, Line 20 | THE HOSPTIAL USES ITS CHARGE MASTER RATES LESS A 40% DISCOUNT. |
| SchH_P06_S00_L02 | Schedule H, Part VI, Line 2 | KEOKUK AREA HOSPTIAL PARTICIPATES WITH MANY HEALTH RELATED ORGANZIATIONS TO ASSESS HEALTHCARE NEEDS IN LEE COUNTY, IOWA AND SHARES THE RESULTS IN A WRITTEN COMMUNITY ASSESSMENT REPORT. |
| SchH_P06_S00_L03 | Schedule H, Part VI, Line 3 | Bills and statements include a written notice to patients that financial assistance is available and encourages patients to either call or visit the Business Office is they are interested. |
| SchH_P06_S00_L04 | Schedule H, Part VI, Line 4 | KEOKUK AREA HOSPITAL SERVES THE POPULATIONS OF SOUTHERN LEE COUNTY IN IOWA, WESTERN HANCOCK COUNTY IN ILLINOIS, AND NORTHERN CLARK COUNTY IN MISSOURI. MORE THAN 23% OF THE KEOKUK POPULATION IS BELOW THE FEDERAL POVERTY LEVEL. 75% OF ALL PATIENTS ARE MEDICARE, MEDICAID OR INDIGENT ALL OF WHICH REIMBURSE THE HOSPITAL LESS THAN COST AND 25% OF THE REMAINING INSURED POPULATION DOES NOT MAKE UP FO THESE COST SHORTFALLS. |
| SchH_P06_S00_L05 | Schedule H, Part VI, Line 5 | KEOKUK AREA HOSPITAL HAS AN ALL VOLUNTEER BOARD OF DIRECTORS MADE UP OF LOCAL COMMUNITY MEMBERS WHO SERVE WITHOUT COMPENSATION. THE MEDCIAL STAFF IS OPEN TO ALL INTERESTED MEDICAL PRACTITIONERS WHO ARE APPROPRAITELY CREDENTIALED. ALL FUNDS GENERATED BY THE HOSPTIAL ARE UTILIZED FOR PATIENT RELATED SERVICES AND TO ENSURE THAT ALL PATIENTS IN OUR MARKET HAVE ACCESS TO QUALITY HEALTHCARE SERVICES REGARDLESS OF THEIR ABILITY TO PAY. |
| SchH_P06_S00_L06 | Schedule H, Part VI, Line 6 | KEOKUK AREA HOSPITAL PROVIDES INPATIENT AND OUTPATIENT HEALTHCARE SERVICES. TRI-STATE MEDICAL GROUP PROVIDES MEDICAL OFFICES AND ACCESS TO PRIMARY CARE FOR COMMUNITY HEALTH CENTER PATIENTS. KEOKUK AREA MEDICAL EQUIPMENT AND SUPPLY PROVIDES DME AND PHARMACY SERVICES IN CLOSE PROXIMITY TO BOTH KAH AND TSMG. ALL SERVICES ARE COORDINATED TO HELP REDUCE LENGTH OF STAY IN THE HOSPTIAL AND ENSURE CONTINUITY OF CARE FROM ONE LEVEL TO ANOTHER. |
| SchH_P06_S00_L07 | Schedule H, Part VI, Line 7 | IOWA |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | X | CompensationCommittee |
| Form990 Of Other Organizations | X | Form990OfOtherOrganizations |
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | 0 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 0 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 0 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 0 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 0 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 0 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | Kiran Khanolkar MD | NamePerson |
| Title | Member, Board of Directors | Title |
| Base Compensation Filing Org | 0 | BaseCompensationFilingOrg |
| Comp Based On Related Orgs | 140256 | CompBasedOnRelatedOrgs |
| Bonus Filing Org | 0 | BonusFilingOrg |
| Bonus Related Orgs | 85806 | BonusRelatedOrgs |
| Other Compensation Filing Org | 0 | OtherCompensationFilingOrg |
| Other Compensation Related Orgs | 0 | OtherCompensationRelatedOrgs |
| Deferred Comp Filing Org | 0 | DeferredCompFilingOrg |
| Deferred Comp Related Orgs | 0 | DeferredCompRelatedOrgs |
| Nontaxable Benefits Filing Org | 0 | NontaxableBenefitsFilingOrg |
| Nontaxable Benefits Related Orgs | 24452 | NontaxableBenefitsRelatedOrgs |
| Total Compensation Filing Org | 0 | TotalCompensationFilingOrg |
| Total Compensation Related Orgs | 250514 | TotalCompensationRelatedOrgs |
| Comp Report Prior990 Filing Org | 0 | CompReportPrior990FilingOrg |
| Comp Report Prior990 Related Orgs | 0 | CompReportPrior990RelatedOrgs |
Form990 Schedule J Part III Form990ScheduleJPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | SchJ_P01_S00_L03 | Identifier |
| Return Reference | Schedule J, Part I, Line 3 | ReturnReference |
| Explanation | All highly compensated employees are reviewed with the Board of Directors using benchmark data from numerous sources including the Iowa Hospital Association salary surveys, MGMA physician compensation and similar hospital 990s. | Explanation |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (10 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| F990_P06_S0A_L03 | Form 990, Part VI, Section A, Line 3 | The organization delegated control over management duties to Fitch Healthcare. |
| F990_P06_S0A_L06 | Form 990, Part VI, Section A, Line 6 | The Chief of Staff and KAH Foundation President are automatically on the Board based on their elected positions. |
| F990_P06_S0A_L07a | Form 990, Part VI, Section A, Line 7a | Keokuk Health Systems Inc 42-1237361 |
| F990_P06_S0A_L07b | Form 990, Part VI, Section A, Line 7b | Keokuk Health Systems Inc 42-1237361 is the parent company of Keokuk Area Hospital and sole member. |
| F990_P06_S0B_L11b | Form 990, Part VI, Section B, Line 11b | A draft of the 990 is distributed to the Board of Directors prior to filing. |
| F990_P06_S0B_L12c | Form 990, Part VI, Section B, Line 12c | All employees, officers, and directors are required to disclose any conflicts of interest at the point they arise and sign a conflict of interest statement annually attesting that they have disclosed any conflicts of interest. |
| F990_P06_S0B_L15 | Form 990, Part VI, Section B, Line 15 | The Board of Directors Executive Committee review and establishes all compensation arrangements with highly paid employees utilizing benchmark data from various sources including the Iowa Hospital Association wage and salary surveys and physician compensation surveys. |
| F990_P06_S0C_L19 | Form 990, Part VI, Section C, Line 19 | Organizational documents are available upon request and the 990 is published on www.guidestar.com. |
| F990_P09_S00_L11g | Form 990, Part IX, Line 11g | Amount represents contracted services in the ancillary departments as well as the emergency room. |
| F990_P11_S00_L09 | Form 990, Part XI, Line 9 | Transfer of equity to TSMG to subsidize medical care (-$410,000); allowance recorded against affiliate advances (-$1,025,000); net asset transfer from Keokuk Health Systems for dissolution of ODS ($554,597); contributions for property and equipment and minor equipment ($108,090). |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII (3 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Public Charity StatusPublicCharityStatus | Direct Controlling Entity NADirectControllingEntityNA | Business Name Line1DirectControllingEntityName/BusinessNameLine1 |
|---|---|---|---|---|---|---|---|---|---|---|
| Keokuk Health Systems Inc | ||||||||||
| 1600 Morgan Street | Keokuk | IA | 52632 | 421237361 | Parent Company of Keokuk Area Hospital | IA | 501 c 3 | exempt non profit | N/A | |
| Tri State Medical Group | ||||||||||
| 1600 Morgan Street | Keokuk | IA | 52632 | 421435525 | Medical Offices | IA | 501 c 3 | exempt non profit | Keokuk Health Systems Inc | |
| Keokuk Area Hospital Foundation | ||||||||||
| 1600 Morgan Street | Keokuk | IA | 52632 | 411202608 | Fundraising | IA | 501 c 3 | exempt non profit | Keokuk Health Systems Inc | |
Form990 Schedule R Part IV Form990ScheduleRPartIV (2 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivityPrimaryActivity | Legal Domicile StateLegalDomicileState | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Type Of EntityTypeOfEntity | Percentage OwnershipPercentageOwnership |
|---|---|---|---|---|---|---|---|---|---|
| Keokuk Area Hospital Organized Delivery System | |||||||||
| 1600 Morgan Street | Keokuk | IA | 52632 | 421474799 | Non Profit Indemnity Health Insurance | IA | Keokuk Health Systems Inc | C | 1 |
| Keokuk Area Medical Equipment Inc | |||||||||
| 1600 Morgan Street | Keokuk | IA | 52632 | 421237312 | Durable Medical Equipment and Pharmacy Sales | IA | Keokuk Health Systems Inc | C | 1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 0 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 1 | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | 1 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 0 | LoansOrGuaranteesFromOtherOrg |
| Dividends Related Organization | 0 | DividendsRelatedOrganization |
| Sale Of Assets To Other Org | 0 | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | 0 | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | 0 | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | 0 | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | 0 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 0 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 0 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 0 | SharingOfFacilities |
| Sharing Of Paid Employees | 0 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 0 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 0 | OtherTransferFromOtherOrg |
Transactions Related Orgs Table TransactionsRelatedOrgsTable (2 entries)
| Transaction TypeTransactionType | Amount InvolvedAmountInvolved | Method Of Amt DeterminationMethodOfAmtDetermination |
|---|---|---|
| Tri State Medical Group | ||
| b | 755964 | Keokuk Area Hospital subsidizes care of patients seen at TSMG through an affiliation agreement with the Community Health Centers of Southeastern Iowa. This subsidy basically represents the cost of expenditures utilized by TSMG to care for these patients that were not reimbursed by third party programs or individuals. |
| Keokuk Health Systems Inc | ||
| c | 554597 | Keokuk Area Hospital provided equity to the Keokuk Area Hospital Organized Delivery System through Keokuk Health Systems. The KAH ODS has been non operational for the past three years and this amount involved is a return of equity to KAH through KHS. |
Reasonable Cause Explanation ReasonableCauseExplanation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Explanation | The longtime CFO and Controller left in 2013 and no one remaining in the organization had participated in the completion of the 990s in prior years. An extension was filed for Keokuk Health Systems by February 15, 2014 under the assumption that the Health Systems return would cover all entities. However, in April of 2014 it was discovered that each entity files a separate 990 and therefore an extension until May 15, 2014 was immediately filed. Please allow the three month extension without a fine as the organization does not have the financial resources available to pay the penalties. | Explanation |