STRATEGY STUDIO / PUBLIC DATA EXPLORER

CLARA BARTON HOSPITAL ASSOCIATION INC HOISINGTON KANSAS: Form 990, tax year 2013

View the entire original 990 at ProPublica ↗

Organization
CLARA BARTON HOSPITAL ASSOCIATION INC HOISINGTON KANSAS (EIN 48-0576039)
Tax period
2013-01-01 to 2013-12-31
Filed
2014-08-13
IRS object ID
201412259349301561
Schema version
2013v3.0
Source
Download XML · Original 990 at ProPublica

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

Return header ReturnHeader

FieldValueIRS element (for citing)
Return2014-08-13T10:47:14-05:00ReturnTs
Tax Period End2013-12-31TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN481026809PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1Wendling Noe Nelson & Johnson LLCBusinessNameLine1

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line1534 S Kansas Ave Suite 1500AddressLine1
CityTopekaCity
StateKSState
ZIP Code666033491ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2013-01-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN480576039EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1Clara Barton Hospital Association IncBusinessNameLine1
FieldValueIRS element (for citing)
Business Name ControlCLARBusinessNameControlTxt
Phone6206532114PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1250 West 9th StreetAddressLine1
CityHoisingtonCity
StateKSState
ZIP Code675441799ZIPCode

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonJim BlackwellPersonNm
Person TitleChief Financial OfficerPersonTitleTxt
Phone6206532114PhoneNum
Signature2014-08-13SignatureDt
Discuss With Paid PreparerYes (1)DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonDerek H HartPreparerPersonNm
PTINP01054116PTIN
Phone7852334226PhoneNum
Preparation2014-08-13PreparationDt
FieldValueIRS element (for citing)
Tax2013TaxYr
Build TS2015-11-30 17:44:51ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Principal OfficerJim BlackwellPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line1250 West 9th StreetAddressLine1
CityHoisingtonCity
StateKSState
ZIP Code675441799ZIPCode
FieldValueIRS element (for citing)
Gross Receipts$20,708,963GrossReceiptsAmt
Group Return For Affiliates0GroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website Addresswww.clarabartonhospital.orgWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation1946FormationYr
Legal Domicile StateKSLegalDomicileStateCd
Activity Or MissionProvision of inaptient and outpatient hospital services, primary care services, and surgical services to residents of our service area.ActivityOrMissionDesc
Voting Members Governing Body10VotingMembersGoverningBodyCnt
Voting Members Independent8VotingMembersIndependentCnt
Total Employee223TotalEmployeeCnt
Total Volunteers11TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$63,906PYContributionsGrantsAmt
CY Contributions Grants$140,112CYContributionsGrantsAmt
PY Program Service Revenue$16,490,844PYProgramServiceRevenueAmt
CY Program Service Revenue$16,864,249CYProgramServiceRevenueAmt
PY Investment Income$121,773PYInvestmentIncomeAmt
CY Investment Income$136,642CYInvestmentIncomeAmt
PY Other Revenue$337,734PYOtherRevenueAmt
CY Other Revenue$347,188CYOtherRevenueAmt
PY Total Revenue$17,014,257PYTotalRevenueAmt
CY Total Revenue$17,488,191CYTotalRevenueAmt
PY Grants And Similar Paid$0PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$0CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$9,414,491PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$9,750,596CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$75,564CYTotalFundraisingExpenseAmt
PY Other Expenses$7,198,005PYOtherExpensesAmt
CY Other Expenses$7,639,474CYOtherExpensesAmt
PY Total Expenses$16,612,496PYTotalExpensesAmt
CY Total Expenses$17,390,070CYTotalExpensesAmt
PY Revenues Less Expenses$401,761PYRevenuesLessExpensesAmt
CY Revenues Less Expenses$98,121CYRevenuesLessExpensesAmt
Total Assets BOY$12,384,240TotalAssetsBOYAmt
Total Assets EOY$12,690,483TotalAssetsEOYAmt
Total Liabilities BOY$5,391,017TotalLiabilitiesBOYAmt
Total Liabilities EOY$5,339,164TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$6,993,223NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$7,351,319NetAssetsOrFundBalancesEOYAmt
Info In Schedule O Part IIIYes (X)InfoInScheduleOPartIIIInd
MissionClara Barton Hospital Association is dedicated to meeting the health care needs and improving the quality of life for the community we serve. We continually pursue clinical excellence in an atmosphere of caring and compassion. We are deeply committed to serving all in need within our resources.MissionDesc
Significant New Program Srvc0SignificantNewProgramSrvcInd
Significant Change0SignificantChangeInd
Expense$14,769,903ExpenseAmt
Revenue$16,864,249RevenueAmt
DescClara Barton Hospital Association provided a wide range of health care services to residents of its service area including 3,280 patient days of inpatient care, 20,588 outpatient hospital visits and 25,950 visits to our primary care and surgical clinics.Desc
Total Program Service Expenses$14,769,903TotalProgramServiceExpensesAmt
Described In Section501c3Yes (1)DescribedInSection501c3Ind
Schedule B RequiredYes (1)ScheduleBRequiredInd
Political Campaign Acty0PoliticalCampaignActyInd
Lobbying ActivitiesYes (1)LobbyingActivitiesInd
Subject To Proxy Tax0SubjectToProxyTaxInd
Donor Advised Fund0DonorAdvisedFundInd
Conservation Easements0ConservationEasementsInd
Collections Of Art0CollectionsOfArtInd
Credit Counseling0CreditCounselingInd
Temp Or Permanent Endowments0TempOrPermanentEndowmentsInd
Report Land Building EquipmentYes (1)ReportLandBuildingEquipmentInd
Report Investments Other Sec0ReportInvestmentsOtherSecInd
Report Program Related Invst0ReportProgramRelatedInvstInd
Report Other AssetsYes (1)ReportOtherAssetsInd
Report Other Liabilities0ReportOtherLiabilitiesInd
Include FIN48 FootnoteYes (1)IncludeFIN48FootnoteInd
Independent Audit Fincl StmtYes (1)IndependentAuditFinclStmtInd
Consolidated Audit Fincl Stmt0ConsolidatedAuditFinclStmtInd
School Operating0SchoolOperatingInd
Foreign Office0ForeignOfficeInd
Foreign Activities0ForeignActivitiesInd
More Than5000 K To Org0MoreThan5000KToOrgInd
More Than5000 K To Individuals0MoreThan5000KToIndividualsInd
Professional Fundraising0ProfessionalFundraisingInd
Fundraising Activities0FundraisingActivitiesInd
Gaming Activities0GamingActivitiesInd
Operate HospitalYes (1)OperateHospitalInd
Audited Financial Stmt AttYes (1)AuditedFinancialStmtAttInd
Grants To Organizations0GrantsToOrganizationsInd
Grants To Individuals0GrantsToIndividualsInd
Schedule J RequiredYes (1)ScheduleJRequiredInd
Tax Exempt BondsYes (1)TaxExemptBondsInd
Invest Tax Exempt Bonds0InvestTaxExemptBondsInd
Escrow Account0EscrowAccountInd
On Behalf Of Issuer0OnBehalfOfIssuerInd
Engaged In Excess Benefit Trans0EngagedInExcessBenefitTransInd
PY Excess Benefit Trans0PYExcessBenefitTransInd
Loan OutstandingYes (1)LoanOutstandingInd
Grant To Related Person0GrantToRelatedPersonInd
Business Rln With Org Mem0BusinessRlnWithOrgMemInd
Business Rln With Fam MemYes (1)BusinessRlnWithFamMemInd
Business Rln With Officer Ent0BusinessRlnWithOfficerEntInd
Deductible Non Cash Contri0DeductibleNonCashContriInd
Deductible Art Contribution0DeductibleArtContributionInd
Terminate Operations0TerminateOperationsInd
Partial Liquidation0PartialLiquidationInd
Disregarded Entity0DisregardedEntityInd
Related EntityYes (1)RelatedEntityInd
Related Organization Ctrl Ent0RelatedOrganizationCtrlEntInd
Trnsfr Exmpt Non Chrtbl Rltd Org0TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted Prtshp0ActivitiesConductedPrtshpInd
Schedule O RequiredYes (1)ScheduleORequiredInd
IRP Document49IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Backup Wthld ComplianceYes (1)BackupWthldComplianceInd
Employee223EmployeeCnt
Employment Tax Returns FiledYes (1)EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over Limit0UnrelatedBusIncmOverLimitInd
Foreign Financial Account0ForeignFinancialAccountInd
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTransInd
Taxable Party Notification0TaxablePartyNotificationInd
Nondeductible Contributions0NondeductibleContributionsInd
Quid Pro Quo Contributions0QuidProQuoContributionsInd
Form8282 Property Disposed Of0Form8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft Cntrct0RcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft Cntrct0PayPremiumsPrsnlBnftCntrctInd
Indoor Tanning Services0IndoorTanningServicesInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members10GoverningBodyVotingMembersCnt
Independent Voting Member8IndependentVotingMemberCnt
Family Or Business Rln0FamilyOrBusinessRlnInd
Delegation Of Mgmt Duties0DelegationOfMgmtDutiesInd
Change To Org Documents0ChangeToOrgDocumentsInd
Material Diversion Or Misuse0MaterialDiversionOrMisuseInd
Members Or StockholdersYes (1)MembersOrStockholdersInd
Election Of Board MembersYes (1)ElectionOfBoardMembersInd
Decisions Subject To Approva0DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (1)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (1)MinutesOfCommitteesInd
Officer Mailing Address0OfficerMailingAddressInd
Local Chapters0LocalChaptersInd
Form990 Provided To Gvrn BodyYes (1)Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (1)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (1)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (1)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (1)WhistleblowerPolicyInd
Document Retention PolicyYes (1)DocumentRetentionPolicyInd
Compensation Process CEOYes (1)CompensationProcessCEOInd
Compensation Process Other0CompensationProcessOtherInd
Investment In Joint Venture0InvestmentInJointVentureInd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1Jim BlackwellBusinessNameLine1
FieldValueIRS element (for citing)
Phone6206532114PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1250 West 9th StreetAddressLine1
CityHoisingtonCity
StateKSState
ZIP Code675441799ZIPCode

Form990 Part VII Section A Form990PartVIISectionAGrp (16 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndOfficerOfficerIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtHighest Compensated EmployeeHighestCompensatedEmployeeInd
Curt J Colson
President/CEO40.00Yes (X)Yes (X)$130,127$0$33,707
Jon Radke
Secretary1.00Yes (X)Yes (X)$0$0$0
Troy Bailey
Chairman1.00Yes (X)Yes (X)$0$0$0
Paul Woydziak
Vice-Chariman1.00Yes (X)Yes (X)$0$0$0
Mike Aylward
Director1.00Yes (X)$0$0$0
Nathaniel Knackstedt
Director/Chief of Staff40.00Yes (X)$233,387$0$36,177
Marla Mooney
Treasurer1.00Yes (X)Yes (X)$0$0$0
Taylor Smith
Director1.00Yes (X)$0$0$0
Karla Crissman
Director1.00Yes (X)$0$0$0
Jim Carney
Director1.00Yes (X)$0$0$0
James G Blackwell
Vice President/CFO40.00Yes (X)$107,896$0$33,243
Robin Durrett
Surgeon40.00$544,137$0$22,565Yes (X)
Timothy Webb
Physician40.00$352,204$0$27,697Yes (X)
Phillip Barnes
Physician Assistant40.00$127,113$0$29,942Yes (X)
Linda Krug
Physician Assistant40.00$121,036$0$21,573Yes (X)
Celeste M Meitner
Pharmacist40.00$108,205$0$17,021Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$1,724,105TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$0TotReportableCompRltdOrgAmt
Total Other Compensation$221,925TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K9IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed0FormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (1)TotalCompGreaterThan150KInd
Compensation From Other Srcs0CompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (5 entries)

Address Line1ContractorAddress/USAddress/AddressLine1CityContractorAddress/USAddress/CityStateContractorAddress/USAddress/StateZIP CodeContractorAddress/USAddress/ZIPCodeServicesServicesDescCompensationCompensationAmt
Docs Who Care PA
1337 South Fountain DriveOlatheKS66061ER Physician Coverage$486,366
Aramark Uniform Services
115 N First StBurbankCA91502Laundry services$302,467
Leslie M Landau DO PA
PO Box 470KirksvilleMO63501Surgeon$253,170
MModal Services LTD
9009 Carothers Parkway Suite C-2FranklinTN37067Transcription$191,212
Mobile Imaging Inc
3520 Lakin AveGreat BendKS67530Sonography$179,934
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K11CntrctRcvdGreaterThan100KCnt
Related Organizations$111,792RelatedOrganizationsAmt
Government Grants$23,385GovernmentGrantsAmt
All Other Contributions$4,935AllOtherContributionsAmt
Total Contributions$140,112TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (5 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
Patient service revenue621990$16,738,594$16,738,594
Purchase discounts and rebates621990$54,182$54,182
Lab fairs621990$24,837$24,837
Miscellaneous621990$24,373$24,373
Patient account interest621990$22,263$22,263
FieldValueIRS element (for citing)
Total Program Service Revenue$16,864,249TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$163,118TotalRevenueColumnAmt
Exclusion$163,118ExclusionAmt

Royalties Revenue RoyaltiesRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$275,864TotalRevenueColumnAmt
Exclusion$275,864ExclusionAmt

Gross Rents GrossRentsGrp

FieldValueIRS element (for citing)
Real$14,709RealAmt

Less Rental Expenses LessRentalExpensesGrp

FieldValueIRS element (for citing)
Real$0RealAmt

Rental Income Or Loss RentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Real$14,709RealAmt

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column$14,709TotalRevenueColumnAmt
Exclusion$14,709ExclusionAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

FieldValueIRS element (for citing)
Securities$3,194,296SecuritiesAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

FieldValueIRS element (for citing)
Securities$3,220,772SecuritiesAmt

Gain Or Loss GainOrLossGrp

FieldValueIRS element (for citing)
Securities-$26,476SecuritiesAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

FieldValueIRS element (for citing)
Total Revenue Column-$26,476TotalRevenueColumnAmt
Exclusion-$26,476ExclusionAmt

Other Revenue Misc OtherRevenueMiscGrp

FieldValueIRS element (for citing)
DescCafeteriaDesc
Business722210BusinessCd
Total Revenue Column$56,615TotalRevenueColumnAmt
Exclusion$56,615ExclusionAmt
FieldValueIRS element (for citing)
Other Revenue Total$56,615OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$17,488,191TotalRevenueColumnAmt
Related Or Exempt Func Income$16,864,249RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$483,830ExclusionAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$576,765TotalAmt
Program Services$270,606ProgramServicesAmt
Management And General$306,159ManagementAndGeneralAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$7,722,691TotalAmt
Program Services$6,632,937ProgramServicesAmt
Management And General$1,037,078ManagementAndGeneralAmt
Fundraising$52,676FundraisingAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$135,273TotalAmt
Program Services$118,300ProgramServicesAmt
Management And General$16,019ManagementAndGeneralAmt
Fundraising$954FundraisingAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$756,625TotalAmt
Program Services$680,139ProgramServicesAmt
Management And General$71,029ManagementAndGeneralAmt
Fundraising$5,457FundraisingAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$559,242TotalAmt
Program Services$468,622ProgramServicesAmt
Management And General$87,025ManagementAndGeneralAmt
Fundraising$3,595FundraisingAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$15,903TotalAmt
Management And General$15,903ManagementAndGeneralAmt

Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp

FieldValueIRS element (for citing)
Total$1,325TotalAmt
Management And General$1,325ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$2,736,532TotalAmt
Program Services$2,537,502ProgramServicesAmt
Management And General$198,953ManagementAndGeneralAmt
Fundraising$77FundraisingAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$49,609TotalAmt
Program Services$27,179ProgramServicesAmt
Management And General$22,430ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$713,732TotalAmt
Program Services$611,560ProgramServicesAmt
Management And General$93,156ManagementAndGeneralAmt
Fundraising$9,016FundraisingAmt

Information Technology InformationTechnologyGrp

FieldValueIRS element (for citing)
Total$162,390TotalAmt
Management And General$162,390ManagementAndGeneralAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$308,570TotalAmt
Program Services$263,477ProgramServicesAmt
Management And General$44,180ManagementAndGeneralAmt
Fundraising$913FundraisingAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$40,753TotalAmt
Program Services$36,564ProgramServicesAmt
Management And General$4,188ManagementAndGeneralAmt
Fundraising$1FundraisingAmt

Interest InterestGrp

FieldValueIRS element (for citing)
Total$180,356TotalAmt
Program Services$180,356ProgramServicesAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$769,279TotalAmt
Program Services$640,040ProgramServicesAmt
Management And General$126,623ManagementAndGeneralAmt
Fundraising$2,616FundraisingAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$114,878TotalAmt
Management And General$114,878ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmtFundraisingFundraisingAmt
Medical supplies$998,151$998,151
Pharmacy supplies$763,308$763,308
Repairs and maintenance$259,738$246,738$12,762$238
Minor equipment$233,423$116,476$116,928$19

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$291,527TotalAmt
Program Services$177,948ProgramServicesAmt
Management And General$113,577ManagementAndGeneralAmt
Fundraising$2FundraisingAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$17,390,070TotalAmt
Program Services$14,769,903ProgramServicesAmt
Management And General$2,544,603ManagementAndGeneralAmt
Fundraising$75,564FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$987BOYAmt
EOY$987EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$1,227,760BOYAmt
EOY$1,796,417EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$1,503,193BOYAmt
EOY$1,723,828EOYAmt

Receivables From Officers Etc ReceivablesFromOfficersEtcGrp

FieldValueIRS element (for citing)
BOY$123,111BOYAmt
EOY$100,028EOYAmt

Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp

FieldValueIRS element (for citing)
BOY$1,500BOYAmt
EOY$4,500EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

FieldValueIRS element (for citing)
BOY$511,806BOYAmt
EOY$487,893EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$210,142BOYAmt
EOY$220,392EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$12,546,110LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$8,819,146LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$4,009,365BOYAmt
EOY$3,726,964EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

FieldValueIRS element (for citing)
BOY$2,947,819BOYAmt
EOY$3,111,883EOYAmt

Investments Other Securities InvestmentsOtherSecuritiesGrp

FieldValueIRS element (for citing)
BOY$5,547BOYAmt
EOY$5,547EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$1,843,010BOYAmt
EOY$1,512,044EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$12,384,240BOYAmt
EOY$12,690,483EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$1,636,884BOYAmt
EOY$1,963,536EOYAmt

Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$3,480,697BOYAmt
EOY$3,210,611EOYAmt

Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp

FieldValueIRS element (for citing)
BOY$273,436BOYAmt
EOY$165,017EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$5,391,017BOYAmt
EOY$5,339,164EOYAmt
FieldValueIRS element (for citing)
Organization Follows SFAS117Yes (X)OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

FieldValueIRS element (for citing)
BOY$6,187,195BOYAmt
EOY$6,473,147EOYAmt

Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp

FieldValueIRS element (for citing)
BOY$536,138BOYAmt
EOY$603,839EOYAmt

Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp

FieldValueIRS element (for citing)
BOY$269,890BOYAmt
EOY$274,333EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$6,993,223BOYAmt
EOY$7,351,319EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$12,384,240BOYAmt
EOY$12,690,483EOYAmt
FieldValueIRS element (for citing)
Info In Schedule O Part XIYes (X)InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss$98,121ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst$187,831NetUnrlzdGainsLossesInvstAmt
Other Changes In Net Assets$72,144OtherChangesInNetAssetsAmt
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or Review0AccountantCompileOrReviewInd
FS AuditedYes (1)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Separate Basis Fincl StmtYes (X)SeparateBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit CommitteeYes (1)AuditCommitteeInd
Federal Grant Audit Required0FederalGrantAuditRequiredInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
HospitalYes (X)HospitalInd

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

FieldValueIRS element (for citing)
ContributorRESTRICTEDContributorNum

Contributor Business Name ContributorBusinessName

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor US Address ContributorUSAddress

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

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
Volunteers0VolunteersInd
Paid Staff Or Management0PaidStaffOrManagementInd
Media Advertisements0MediaAdvertisementsInd
Mailings Members0MailingsMembersInd
Publications Or Broadcast0PublicationsOrBroadcastInd
Grants Other OrganizationsYes (1)GrantsOtherOrganizationsInd
Grants Other Organizations$4,725GrantsOtherOrganizationsAmt
Direct Contact Legislators0DirectContactLegislatorsInd
Rallies Demonstrations0RalliesDemonstrationsInd
Other Activities0OtherActivitiesInd
Total Lobbying Expenditures$4,725TotalLobbyingExpendituresAmt
Not Described Section501c30NotDescribedSection501c3Ind

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferencePart II-B, Line 1:FormAndLineReferenceDesc
ExplanationThe portion of annual dues paid to hospital and medical associations attributed to lobbying activities by the associations.ExplanationTxt

Schedule D IRS990ScheduleD

Buildings BuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$554,300OtherCostOrOtherBasisAmt
Depreciation$388,441DepreciationAmt
Book Value$165,859BookValueAmt

Leasehold Improvements LeaseholdImprovementsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$6,404,736OtherCostOrOtherBasisAmt
Depreciation$4,367,906DepreciationAmt
Book Value$2,036,830BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$4,550,784OtherCostOrOtherBasisAmt
Depreciation$3,507,903DepreciationAmt
Book Value$1,042,881BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$1,036,290OtherCostOrOtherBasisAmt
Depreciation$554,896DepreciationAmt
Book Value$481,394BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$3,726,964TotalBookValueLandBuildingsAmt

Other Assets Org OtherAssetsOrgGrp (4 entries)

DescDescBook ValueBookValueAmt
Beneficial interest in net assets of CBH Foundation$849,242
Deferred financing costs$96,050
Accrued interest receivable$3,318
Estimated third-party payor settlements$563,434
FieldValueIRS element (for citing)
Total Book Value Other Assets$1,512,044TotalBookValueOtherAssetsAmt
Footnote TextYes (X)FootnoteTextInd
Total Rev Etc Audited Fincl Stmt$17,488,191TotalRevEtcAuditedFinclStmtAmt
Revenue Not Reported$0RevenueNotReportedAmt
Revenue Subtotal$17,488,191RevenueSubtotalAmt
Revenue Not Reported Fincl Stmt$0RevenueNotReportedFinclStmtAmt
Total Revenue Per Form990$17,488,191TotalRevenuePerForm990Amt
Tot Expns Etc Audited Fincl Stmt$17,390,070TotExpnsEtcAuditedFinclStmtAmt
Expenses Not Reported$0ExpensesNotReportedAmt
Expenses Subtotal$17,390,070ExpensesSubtotalAmt
Expenses Not Rpt Fincl Stmt$0ExpensesNotRptFinclStmtAmt
Total Expenses Per Form990$17,390,070TotalExpensesPerForm990Amt

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferencePart X, Line 2:FormAndLineReferenceDesc
ExplanationThe Hospital is a not-for-porfit corporation as described in Section 501(c)(3) of the Internal Revenue Code and is exempt from federal income taxes on related income pursuant to Sectin 501(a) of the code. Management is not aware of any uncertainties in income tax positions. Tax years ending on and before December 31, 2010, are not subject to examination by taxing authorities.ExplanationTxt

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Financial Assistance PolicyYes (1)FinancialAssistancePolicyInd
Written PolicyYes (1)WrittenPolicyInd
FPG Reference Free CareYes (1)FPGReferenceFreeCareInd
Percent100Yes (X)Percent100Ind
FPG Reference Discounted CareYes (1)FPGReferenceDiscountedCareInd
Percent300Yes (X)Percent300Ind
Free Care Medically IndigentYes (1)FreeCareMedicallyIndigentInd
Financial Assistance BudgetYes (1)FinancialAssistanceBudgetInd
Expenses Exceed Budget0ExpensesExceedBudgetInd
Annual Community Bnft Report0AnnualCommunityBnftReportInd

Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp

FieldValueIRS element (for citing)
Total Community Benefit Expns$259,072TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$259,072NetCommunityBenefitExpnsAmt
Total Expense0.01490TotalExpensePct

Unreimbursed Medicaid UnreimbursedMedicaidGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$1,119,667TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$530,309DirectOffsettingRevenueAmt
Net Community Benefit Expns$589,358NetCommunityBenefitExpnsAmt
Total Expense0.03390TotalExpensePct

Total Financial Assistance Typ TotalFinancialAssistanceTyp

FieldValueIRS element (for citing)
Total Community Benefit Expns$1,378,739TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$530,309DirectOffsettingRevenueAmt
Net Community Benefit Expns$848,430NetCommunityBenefitExpnsAmt
Total Expense0.04880TotalExpensePct

Community Health Services CommunityHealthServicesGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$2,533TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$2,533NetCommunityBenefitExpnsAmt
Total Expense0.00010TotalExpensePct

Health Professions Education HealthProfessionsEducationGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$5,973TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$5,973NetCommunityBenefitExpnsAmt
Total Expense0.00030TotalExpensePct

Subsidized Health Services SubsidizedHealthServicesGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$1,485,945TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$961,787DirectOffsettingRevenueAmt
Net Community Benefit Expns$524,158NetCommunityBenefitExpnsAmt
Total Expense0.03010TotalExpensePct

Cash And In Kind Contributions CashAndInKindContributionsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$2,100TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$2,100NetCommunityBenefitExpnsAmt
Total Expense0.00010TotalExpensePct

Total Other Benefits TotalOtherBenefitsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$1,496,551TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$961,787DirectOffsettingRevenueAmt
Net Community Benefit Expns$534,764NetCommunityBenefitExpnsAmt
Total Expense0.03060TotalExpensePct

Total Community Benefits TotalCommunityBenefitsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$2,875,290TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$1,492,096DirectOffsettingRevenueAmt
Net Community Benefit Expns$1,383,194NetCommunityBenefitExpnsAmt
Total Expense0.07940TotalExpensePct
FieldValueIRS element (for citing)
Bad Debt Expense ReportedYes (1)BadDebtExpenseReportedInd
Bad Debt Expense$427,176BadDebtExpenseAmt
Bad Debt Expense Attributable$42,718BadDebtExpenseAttributableAmt
Reimbursed By Medicare$6,359,106ReimbursedByMedicareAmt
Cost Of Care Reimbursed By Medcr$6,389,339CostOfCareReimbursedByMedcrAmt
Medicare Surplus Or Shortfall-$30,233MedicareSurplusOrShortfallAmt

Costing Methodology Used CostingMethodologyUsedGrp

FieldValueIRS element (for citing)
Cost To Charge RatioYes (X)CostToChargeRatioInd
FieldValueIRS element (for citing)
Written Debt Collection PolicyYes (1)WrittenDebtCollectionPolicyInd
Financial Assistance PrvsnYes (1)FinancialAssistancePrvsnInd
Hospital Facilities1HospitalFacilitiesCnt

Hospital Facilities HospitalFacilitiesGrp

FieldValueIRS element (for citing)
Facility1FacilityNum

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1Clara Barton HospitalBusinessNameLine1

US Address USAddress

FieldValueIRS element (for citing)
Address Line1250 West 9th StreetAddressLine1
CityHoisingtonCity
StateKSState
ZIP Code675441799ZIPCode
FieldValueIRS element (for citing)
State LicenseH005003StateLicenseNum
Licensed HospitalYes (X)LicensedHospitalInd
General Medical And SurgicalYes (X)GeneralMedicalAndSurgicalInd
Critical Access HospitalYes (X)CriticalAccessHospitalInd
Emergency Room24 HrsYes (X)EmergencyRoom24HrsInd
OtherPhysician clinics & rural health clinicsOtherDesc

Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1Clara Barton Hospital Association IncBusinessNameLine1
FieldValueIRS element (for citing)
Facility1FacilityNum
CHNA ConductedYes (1)CHNAConductedInd
Community DefinitionYes (X)CommunityDefinitionInd
Community DemographicsYes (X)CommunityDemographicsInd
Existing ResourcesYes (X)ExistingResourcesInd
How Data ObtainedYes (X)HowDataObtainedInd
Community Health NeedsYes (X)CommunityHealthNeedsInd
Other Health IssuesYes (X)OtherHealthIssuesInd
Community Hlth Needs Id ProcessYes (X)CommunityHlthNeedsIdProcessInd
Consulting ProcessYes (X)ConsultingProcessInd
Information GapsYes (X)InformationGapsInd
CHNA Conducted12CHNAConductedYr
Take Into Account Others InputYes (1)TakeIntoAccountOthersInputInd
CHNA Conducted With Other FcltsYes (1)CHNAConductedWithOtherFcltsInd
CHNA Report Widely AvailableYes (1)CHNAReportWidelyAvailableInd
Rpt Available On Own WebsiteYes (X)RptAvailableOnOwnWebsiteInd
Own Website URLwww.clarabartonhospital.orgOwnWebsiteURLTxt
Adopt Implementation StrategyYes (X)AdoptImplementationStrategyInd
Exec Implementation StrategyYes (X)ExecImplementationStrategyInd
Develop Community Wide PlanYes (X)DevelopCommunityWidePlanInd
Exec Community Wide PlanYes (X)ExecCommunityWidePlanInd
Include Operational PlanYes (X)IncludeOperationalPlanInd
Adopt BudgetYes (X)AdoptBudgetInd
Prioritize Health NeedsYes (X)PrioritizeHealthNeedsInd
Prioritize ServicesYes (X)PrioritizeServicesInd
All Needs Addressed0AllNeedsAddressedInd
Organization Incur Excise Tax0OrganizationIncurExciseTaxInd
Elig Criteria ExplainedYes (1)EligCriteriaExplainedInd
FPG Used Deter Elig Free CareYes (1)FPGUsedDeterEligFreeCareInd
FPG Family Incm Lmt Free Care100.000000000000FPGFamilyIncmLmtFreeCarePct
FPG Used Determ Elig Dscnt CareYes (1)FPGUsedDetermEligDscntCareInd
FPG Family Incm Lmt Dscnt Care300.000000000000FPGFamilyIncmLmtDscntCarePct
Explained BasisYes (1)ExplainedBasisInd
Income LevelYes (X)IncomeLevelInd
Asset LevelYes (X)AssetLevelInd
Medical IndigencyYes (X)MedicalIndigencyInd
Insurance StatusYes (X)InsuranceStatusInd
Uninsured DiscountYes (X)UninsuredDiscountInd
Medicaid MedicareYes (X)MedicaidMedicareInd
App Financial Asst ExplnYes (1)AppFinancialAsstExplnInd
Includes Publicity MeasuresYes (1)IncludesPublicityMeasuresInd
Posted On WebsiteYes (X)PostedOnWebsiteInd
Attached To InvoiceYes (X)AttachedToInvoiceInd
Posted In Emergency RoomYes (X)PostedInEmergencyRoomInd
Posted In Admission OfficeYes (X)PostedInAdmissionOfficeInd
Provided On AdmissionYes (X)ProvidedOnAdmissionInd
Available On RequestYes (X)AvailableOnRequestInd
FAP Actions On NonpaymentYes (1)FAPActionsOnNonpaymentInd
Collection Activities0CollectionActivitiesInd
FAP Notified Upon AdmissionYes (X)FAPNotifiedUponAdmissionInd
FAP Notified Before DischargeYes (X)FAPNotifiedBeforeDischargeInd
FAP Notified All PatientsYes (X)FAPNotifiedAllPatientsInd
Documented Elig DeterminationYes (X)DocumentedEligDeterminationInd
Other Actions TakenYes (X)OtherActionsTakenInd
Nondis Emergency Care PolicyYes (1)NondisEmergencyCarePolicyInd
Other Method UsedYes (X)OtherMethodUsedInd
Amounts Generally Billed0AmountsGenerallyBilledInd
Gross Charges0GrossChargesInd

Supplemental Information SupplementalInformationGrp (5 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Clara Barton Hospital Association, Inc.Part V, Section B, Line 3: The CHNA was conducted in collaboration with Great Bend Regional, Ellinwood District Hospital, St. Rose's ASC, and the Barton County Health Department. The Hospital reached out to members of the community with broad interests in the community served and special knowledge of or expertise in public health from groups such as local hospitals, public health community, mental health community, free clinics, community based clinics, service providers, local residents, community leaders, opinion leaders, school leaders, business leaders, local government, faith-based organizations and persons (or organizations serving them), people with chronic conditions, uninsured community members, low income residents, and minority groups. A Town Hall meeting of 37 attendees was conducted. The Town Hall meeting reflected on the size and seriousness of any health concerns cited and discussed current community health strengths, as well as identifying and ranking top community health concerns. In addition to the Town Hall meeting, CHNA surveys were mailed to 2,000 randomly selected Barton County residents. 230 area households in the community completed the CHNA survey. The survey was created to measure Barton County residents' views regarding health care perceptions of delivery, access, and health practices.
Clara Barton Hospital Association, Inc.Part V, Section B, Line 4: Great Bend Regional (located in Great Bend, KS - Barton County), Ellinwood District Hospital (located in Ellinwood, KS - Barton County), and St. Rose's ASC (located in Great Bend, KS - Barton County)
Clara Barton Hospital Association, Inc.Part V, Section B, Line 7: The teen pregnancy rate and health care transportation out of the county were not addressed due to limited resources.
Clara Barton Hospital Association, Inc.Part V, Section B, Line 18e: Clara Barton Hospital Association, Inc., notified all uninsured patients about the Hospital's charity care program by letter.
Clara Barton Hospital Association, Inc.Part V, Section B, Line 20d: Maximum amounts that can be charged were determined by calculating the amounts generally billed (AGB). AGB is calculated based on the look back method.
FieldValueIRS element (for citing)
Facility2FacilityNum

Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp

Oth Hlth Care Fclts OthHlthCareFcltsGrp (2 entries)

Address Line1USAddress/AddressLine1CityUSAddress/CityStateUSAddress/StateZIP CodeUSAddress/ZIPCodeFacilityFacilityTxt
Russell Family Medical Care
410 N Main Street Suite CRussellKS67665Rural health clinic
Clara Barton Hospital Surgical Clinic
1301 Jackson StreetGreat BendKS67530Physician clinic

Supplemental Information Detail SupplementalInformationDetail (8 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Part I, Line 7:Financial assistance at cost was determined by utilizing departmental cost-to-charge ratios for financial assistance provided in areas that are reported as subsidized health services. An overall cost-to-charge ratio derived from Worksheet 2 was used to determine the cost of financial assistance provided for services not reported as subsidized health services.Unreimbursed Medicaid costs were also determined using a blend of cost-to-charge ratios for certain services and an overall cost-to-charge ratio derived from Worksheet 2 for all other services.The cost of providing subsidized health services was determined using a cost-to-charge ratio for each service.Actual costs and revenues were utilized for all other items reported on line 7.
Part I, Line 7g:Subsidized health services are comprised of services that the Hospital provides despite a financial loss to the organization. These services include the operation of a 24-hour emergency room.
Part III, Line 4:The Hospital recognizes patient service revenue associated with services provided to patients who have third-party payor coverage on the basis of contractual rates for the services rendered. For uninsured patients that do not qualify for charity care, the Hospital recognizes revenue on the basis of its standard rates for services provided. On the basis of historical experience, a significant portion of the Hospital's uninsured patients will be unable or unwilling to pay for the services provided. Thus, the Hospital records a significant provision for bad debts related to uninsured patients in the period the services are provided.Bad debt expense at cost was determined by utilizing departmental cost-to-charge ratios for financial assistance provided in areas that are reported as subsidized health services. An overall cost-to-charge ratio derived from Worksheet 2 was applied to the charges deemed uncollectible during the year for all other services.Bad debt expense attributable to patients eligible under the organization's financial assistance policy was determined using an estimated 10% of total bad debts. The Hospital takes steps to assist individuals who are believed to qualify for financial assistance prior to writing accounts off as uncollectible.All non-reimbursed costs for treatment of patients in our community provides a community benefit since patients unwilling or unable to pay have received a valuable service at no cost or at a reduced cost to them. This improves the health of our community as a whole.
Part III, Line 8:Medicare allowable costs were determined by using amounts from the Hospital's Medicare cost report as filed with the Medicare Administrative Contractor. The Medicare cost report apportions actual costs to the Medicare program using charges for ancillary services and patient days for nursing services.
Part III, Line 9b:The collection policy states that the patient must cooperate with the Hospital to provide the information and documentation necessary to apply for other existing financial resources that may be available to pay for health care services, such as Medicaid. Then the information is gathered and assessed in order to determine eligibility for charity care. Whenever possible, prior to admission, the Hospital will conduct a pre-admission interview with the patient, the guarantor, and/or the patient's legal representative. Those patients who may qualify for financial assistance from a governmental program will be referred to the appropriate program, prior to the consideration for charity care.
Part VI, Line 3:There is signage posted at admissions desk. Patients are referred to a financial counselor at admission if they do not have insurance. The financial counselor also works with a Medicaid helper to try and get qualified patients register for the Medicaid program. Effort is made during billing of deductible and co-payment to see if patient can qualify for charity care.
Part VI, Line 4:The community being served is located in central Kansas and consists of approximately 2,800 residents. The average household income is $32,993. 15.4% of the community residents live below federal poverty level, and 4.7% of the community residents live below 50% of the federal poverty level. Neighboring hospitals include facilities in Ellinwood and Great Bend. They are approximately 18 and 11 miles away respectively.
Part VI, Line 5:The Hospital's Board of Directors is elected from the community at large. This allows independent individuals who reside in the primary service area to serve as a director. The Hospital also extends medical staff privileges to all qualified physicians in the community. Any surplus in funds is retained by the Hospital and aids in improving overall patient care and facility maintenance.

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Written Employment ContractYes (X)WrittenEmploymentContractInd
Compensation SurveyYes (X)CompensationSurveyInd
Board Or Committee ApprovalYes (X)BoardOrCommitteeApprovalInd
Severance Payment0SeverancePaymentInd
Supplemental Nonqual Rtr Plan0SupplementalNonqualRtrPlanInd
Equity Based Comp Arrngm0EquityBasedCompArrngmInd
Comp Based On Revenue Of Flng Org0CompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related Orgs0CompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng Org0CompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd Orgs0CompBsdNetEarnsRltdOrgsInd
Any Non Fixed Payments0AnyNonFixedPaymentsInd
Initial Contract Exception0InitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (5 entries)

TitleTitleTxtBase Compensation Filing OrgBaseCompensationFilingOrgAmtCompensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmtBonus Filing OrganizationBonusFilingOrganizationAmountBonus Related OrganizationsBonusRelatedOrganizationsAmtOther Compensation Filing OrgOtherCompensationFilingOrgAmtOther Compensation Rltd OrgsOtherCompensationRltdOrgsAmtDeferred Compensation Flng OrgDeferredCompensationFlngOrgAmtDeferred Comp Rltd OrgsDeferredCompRltdOrgsAmtNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmtNontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmtTotal Compensation Filing OrgTotalCompensationFilingOrgAmtTotal Compensation Rltd OrgsTotalCompensationRltdOrgsAmtComp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmtComp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt
Curt J Colson
President/CEO$125,127$0$5,000$0$0$0$3,765$0$29,942$0$163,834$0$0$0
Nathaniel Knackstedt
Director/Chief of Staff$233,387$0$0$0$0$0$6,010$0$30,167$0$269,564$0$0$0
Robin Durrett
Surgeon$482,557$0$61,580$0$0$0$7,500$0$15,065$0$566,702$0$0$0
Timothy Webb
Physician$352,204$0$0$0$0$0$7,650$0$20,047$0$379,901$0$0$0
Phillip Barnes
Physician Assistant$112,735$0$14,378$0$0$0$0$0$29,942$0$157,055$0$0$0

Schedule K IRS990ScheduleK

Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd

Issuer Name IssuerName

FieldValueIRS element (for citing)
Business Name Line1Hoisington Public Building Commission Hoisington KansasBusinessNameLine1
FieldValueIRS element (for citing)
Bond Issuer EIN486012386BondIssuerEIN
CUSIP000434661CUSIPNum
Bond Issued2006-03-23BondIssuedDt
Issue Price$5,019,230IssuePriceAmt
PurposeRefund outstanding bonds issued on 12/19/2000 and 2/27/2003PurposeDesc
Defeased0DefeasedInd
On Behalf Of Issuer0OnBehalfOfIssuerInd
Pool Financing0PoolFinancingInd

Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Retired$1,730,000RetiredAmt
Total Proceeds$5,165,979TotalProceedsAmt
In Reserve Fund$459,077InReserveFundAmt
Issuance Costs From Proceeds$97,212IssuanceCostsFromProceedsAmt
Credit Enhancement$79,389CreditEnhancementAmt
Other Spent Proceeds$4,842,628OtherSpentProceedsAmt
Substantial Completion2006SubstantialCompletionYr
Current RefundingYes (1)CurrentRefundingInd
Advance RefundingYes (1)AdvanceRefundingInd
Final Allocation MadeYes (1)FinalAllocationMadeInd
Adequate Books And Rec MaintYes (1)AdequateBooksAndRecMaintInd

Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Owning Bond Financed Property0OwningBondFinancedPropertyInd
Any Lease Arrangements0AnyLeaseArrangementsInd
Mgmt Contract Bond Fincd Prop0MgmtContractBondFincdPropInd
Any Research Agreements0AnyResearchAgreementsInd
Bond Iss Meet Prvt Sec Pymt Test0BondIssMeetPrvtSecPymtTestInd
Change In Use Bond Financed Prop0ChangeInUseBondFinancedPropInd
Procs Nonqualified Bond Remdtd0ProcsNonqualifiedBondRemdtdInd

Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Form8038 T Filed0Form8038TFiledInd
Rebate Not Due Yet0RebateNotDueYetInd
Exception To Rebate0ExceptionToRebateInd
No Rebate DueYes (1)NoRebateDueInd
Variable Rate Issue0VariableRateIssueInd
Hedge Identified In Bks And Rec0HedgeIdentifiedInBksAndRecInd
Gross Proceeds Invested In GIC0GrossProceedsInvestedInGICInd
Gross Proceeds Invested0GrossProceedsInvestedInd
Written Proc To Monitor Reqs0WrittenProcToMonitorReqsInd

Procedures Corrective Action ProceduresCorrectiveActionGrp

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Procedures Corrective Action0ProceduresCorrectiveActionInd

Supplemental Information Detail SupplementalInformationDetail (2 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Date Rebate Computation PerformedIssuer Name: Hoisington Public Building Commission, Hoisington, Kansas Date the Rebate Computation was Performed: 03/23/2011
Schedule K, Part II, Line 3, Total proceeds of issueThe difference between Part II, Line 3 and Part I, Column (e) is investment earnings.

Schedule L IRS990ScheduleL

Loans Btwn Org Interested Prsn LoansBtwnOrgInterestedPrsnGrp

FieldValueIRS element (for citing)
PersonTimothy WebbPersonNm
Relationship With OrgHighly compensated employeeRelationshipWithOrgTxt
Loan PurposeRecruitmentLoanPurposeTxt
Loan From OrganizationYes (X)LoanFromOrganizationInd
Original Principal$138,500OriginalPrincipalAmt
Balance Due$100,028BalanceDueAmt
Default0DefaultInd
Board Or Committee ApprovalYes (1)BoardOrCommitteeApprovalInd
Written AgreementYes (1)WrittenAgreementInd
FieldValueIRS element (for citing)
Total Balance Due$100,028TotalBalanceDueAmt

Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp

Name Of Interested NameOfInterested

FieldValueIRS element (for citing)
PersonAnita BlackwellPersonNm
FieldValueIRS element (for citing)
Relationship DescriptionSpouse of Jim Blackwell, current officerRelationshipDescriptionTxt
Transaction$41,686TransactionAmt
TransactionEmployment arrangementTransactionDesc
Sharing Of Revenues0SharingOfRevenuesInd

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (7 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Form 990, Part VI, Section A, line 6Members of Clara Barton Hospital Foundation, Inc., are automatically members of Clara Barton Hospital Association, Inc.
Form 990, Part VI, Section A, line 7aMembers of Clara Barton Hospital Association, Inc., elect members of the governing body.
Form 990, Part VI, Section B, line 11Form 990 provided to governing body and reviewed prior to filing.
Form 990, Part VI, Section B, line 12cA conflict of interest disclosure form is provided to each Board Member and is reviewed annually.
Form 990, Part VI, Section B, line 15aThe organization uses the KHA Salary Survey as a guide for determining CEO compensation with Board of Directors approval. The KHA Salary Survey is used by the CEO when determining compensation for other officers and key employees.
Form 990, Part VI, Section C, line 19The organization makes its governing documents, conflict of interest policy, and financial statements available to the public upon written request.
Form 990, Part XI, line 9:Change in permanently restricted beneficial interest in Foundation 4,443. Change in temporarily restricted beneficial interest in Foundation 67,701.

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp

Disregarded Entity Name DisregardedEntityName

FieldValueIRS element (for citing)
Business Name Line1Clara Barton Hospital Foundation IncBusinessNameLine1

US Address USAddress

FieldValueIRS element (for citing)
Address Line1PO Box 25AddressLine1
CityHoisingtonCity
StateKSState
ZIP Code67544ZIPCode
FieldValueIRS element (for citing)
EIN481077460EIN
Primary ActivitiesProvide support to Clara Barton HospitalPrimaryActivitiesTxt
Legal Domicile StateKSLegalDomicileStateCd
Exempt Code Section501(c)(3)ExemptCodeSectionTxt
Public Charity StatusLine 7PublicCharityStatusTxt
Direct Controlling NAN/ADirectControllingNACd
Controlled Organization0ControlledOrganizationInd
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts Rylts0ReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth OrgYes (1)GiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth OrgYes (1)GiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth Org0LoansOrGuaranteesFromOthOrgInd
Div Related Organization0DivRelatedOrganizationInd
Asset Sale To Other Org0AssetSaleToOtherOrgInd
Asset Purchase From Other Org0AssetPurchaseFromOtherOrgInd
Asset Exchange0AssetExchangeInd
Rental Of Facilities To Oth Org0RentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth Org0RentalOfFcltsFromOthOrgInd
Perform Of Services For Oth OrgYes (1)PerformOfServicesForOthOrgInd
Perform Of Services By Other Org0PerformOfServicesByOtherOrgInd
Sharing Of FacilitiesYes (1)SharingOfFacilitiesInd
Paid Employees SharingYes (1)PaidEmployeesSharingInd
Reimbursement Paid To Other Org0ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrgInd
Transfer To Other Org0TransferToOtherOrgInd
Transfer From Other Org0TransferFromOtherOrgInd