KEOKUK AREA HOSPITAL: Form 990, tax year 2011

View the entire original 990 at ProPublica ↗

Organization: KEOKUK AREA HOSPITAL (EIN 42-0710268)
Tax period: 2011-10-01 to 2012-09-30
Filed: 2013-02-12
IRS object ID: 201310439349300006
Schema version: 2011v1.2
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

Return header ReturnHeader

Field	Value	IRS element (for citing)
Timestamp	2013-02-12T07:44:48-07:00	Timestamp
Tax Period End Date	2012-09-30	TaxPeriodEndDate
Return Type	990	ReturnType
Tax Period Begin Date	2011-10-01	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	walter winkler	Name
Title	CFO	Title
Phone	3195268661	Phone
Date Signed	2013-02-08	DateSigned

Field	Value	IRS element (for citing)
Tax Year	2011	TaxYear
Build TS	2016-02-25 16:41:14Z	BuildTS

Form 990 IRS990

Field	Value	IRS element (for citing)
Name Of Principal Officer Person	walter winkler	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	24850748	GrossReceipts
Group Return For Affiliates	0	GroupReturnForAffiliates
Organization501c3	X	Organization501c3
Web Site	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/assuring access to quality healthcare services regardless of ability to pay.	ActivityOrMissionDescription
Nbr Voting Members Governing Body	11	NbrVotingMembersGoverningBody
Nbr Independent Voting Members	11	NbrIndependentVotingMembers
Total Nbr Employees	430	TotalNbrEmployees
Total Nbr Volunteers	200	TotalNbrVolunteers
Total Gross UBI	0	TotalGrossUBI
Net Unrelated Business Txbl Income	0	NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year	55870	ContributionsGrantsPriorYear
Contributions Grants Current Year	40056	ContributionsGrantsCurrentYear
Program Service Revenue Prior Year	28422996	ProgramServiceRevenuePriorYear
Program Service Revenue CY	23853868	ProgramServiceRevenueCY
Investment Income Prior Year	204709	InvestmentIncomePriorYear
Investment Income Current Year	-43500	InvestmentIncomeCurrentYear
Other Revenue Prior Year	699437	OtherRevenuePriorYear
Other Revenue Current Year	1000324	OtherRevenueCurrentYear
Total Revenue Prior Year	29383012	TotalRevenuePriorYear
Total Revenue Current Year	24850748	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	17040400	SalariesEtcPriorYear
Salaries Etc Current Year	14783615	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	13994352	OtherExpensePriorYear
Other Expenses Current Year	10961151	OtherExpensesCurrentYear
Total Expenses Prior Year	31034752	TotalExpensesPriorYear
Total Expenses Current Year	25744766	TotalExpensesCurrentYear
Revenues Less Expenses Prior Year	-1651740	RevenuesLessExpensesPriorYear
Revenues Less Expenses CY	-894018	RevenuesLessExpensesCY
Total Assets BOY	16487269	TotalAssetsBOY
Total Assets EOY	15808372	TotalAssetsEOY
Total Liabilities BOY	11751250	TotalLiabilitiesBOY
Total Liabilities EOY	12373410	TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY	4736019	NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY	3434962	NetAssetsOrFundBalancesEOY
Mission Description	Improving Community Health assuring access to quality healthcare services regardless of ability to pay.	MissionDescription
Significant New Program Services	0	SignificantNewProgramServices
Significant Change	0	SignificantChange
Expense	25258028	Expense
Revenue	55768664	Revenue
Description	Keokuk Area Hospital is a private 501 c 3 tax exempt charitable community primary care acute hospital with a mission of ensuring quality healthcare services are available to all residents of our community regardless of their ability to pay. The hospital provides emergency are, outpatient, and inpatient services to about 45,000 patients each year. About 75% of these patients are either Medicare, Medicaid, or indigent, and result in more than $6,000,000 of uncompensated cost of care each year. KAH struggles to continue providing this uncompensated care due to growing Medicare and Medicaid cost shortfalls as the hospital receives only about 75% of the cost of caring for these patients. To date, efforts by KAH have been highly successful as demonstrated by the wide scope of services available for a community hospital and the relatively low cost when compared with other facilities of KAH's size locally, regionally, or nationally (as evidenced by the Iowa Hospital Association Databank and other benchmarking entities). However, continued payment below cost has resulted in KAH closing our psychiatric unit, inpatient rehab unit, and skilled nursing facility, and is impacting the ability of the hospital to continue delivering services and recruiting physicians to the area. The Governing Board is made up of local concerned residents from various business and professional backgrounds who serve without compensation. In addition to a total of over $6,000,000 of uncompensated cost, which includes subsidies for mental health services, obstetrics, swing bed services, emergency room services, and many other hospital services and several hundred thousand dollars of subsidies to the local Community Health Center of Southeast Iowa, KAH services and community benefit include: 1. Recruitment and retention of physicians to the hospital community 2. Stop smoking clinics, radon clinics, advanced directive clinics and I can Cope programs 3. Community Health Education of mny types 4. Support groups for many chronic and acute illnesses 5. Self Help programs 6. Health Screening services 7. Immunization clinics and support 8. Counseling for a variety of topics 9. In home services 10. Transportation services 11. Physician referral service - The hospital aids any patients presenting themselves for medical treatment in finding a physician if they do not have one 12. Baby Hot Line 0 A 24 hour hotline is available to the hospital OB department for expectant mothers to call with concerns of questions about their pregnancies or care of infants. 13. The hospital provides appropriate telecommunication devices for the hearing impaired, as well as policies that ensure that persons handicapped in any manner can be cared for. 14. Hospital Social Services assist patients in applying for Medicare and Medicaid benefits, finding long term care services for those who need them, and supporting both the patient and families during their hospital stay and any time after 15. The hospital's business office provides hundreds of hours of insurance counseling and assistance to patients in getting properly reimbursed through their insuring agent 16. The hospital provides various other telephone information programs through the hospital Psychiatric Department, as well as the Emergency Department 17. The hospital also provides a variety of assistance to local organizations and people seeking health care services and/or information, and participates with all local health care related organizations in coordinating services and referrals 18. The hospital has a formal improvement program with participation by all levels of employees. The PI efforts are aimed at continually improving care and increasing productivity and cost effectiveness 19. As a demonstration of the ongoing support of the community, more than 200 volunteers continue to provide thousands of hours of time and service to patients and visitors at the hospital, and also raise significant funds towards the purchase of needed hospital equipment. The Board is committed to providing services in our community only if they can be provided in a quality manner and at a cost that is no greater than can be provided elsewhere. The hospital has also been operated without any tax support from the community and the hospital board is committed to operating the facility in such a manner that it does not become a burden to the community. The Board is also committed to charging for services in an equitable manner, and distributing costs of providing services across the broadest segment of payers possible The greater Keokuk area includes Lee County Iowa, Hancock County Illinois, and Clark County Missouri. Each of these areas are rural and this entire market area continues to experience some of the highest unemployment rates in their respective states, caused by plant closings and cutbacks. As a result of the demographics of our area and reimbursement characteristics of Medicare and Medicaid programs (which do not pay the cost of care in rural Iowa) less than 25% of patients' third party payers must bear the burden of government shortfalls and indigent care. These third party payers do not always make up the deficit created by government and indigent patients which has resulted in losses for Keokuk Area Hospital in six of the past ten years despite KAH being a low cost hospital by any benchmarking information available. 2012 resulted in a large loss of $890k despite a reduction of expenses of over $3 Million. Keokuk Area hospital cost shortfalls from Medicare alone have exceeded $27,5,000,000 over the past 14 years, making it difficult to purchase needed technology, new facilities, and equipment as well as impacting Keokuk Area Hospital's ability to provide competitive wages and benefits in our labor market. Keokuk Area Hospital employees have not had a wage increase for 3 years and contributions to the employee's 401k pension plan have been suspended to help over come government reimbursement shortfalls. Many rural Iowa hospitals have the same issues, however, most have been able to take advantage of the federal government's Critical Access Hospital program which increases Medicare payment to 101% of costs, and which once achieved brings higher payment from both Medicaid and some commercial payers such as Wellmark. Keokuk Area Hospital's census has diminished to the point where it is now operating as a Critical Access Hospital and meets all of the requirements of being a Critical Access Hospital, however, it cannot be designated as such because it is less than 35 miles from the nearest hospital, despite the fact that there is a critical access hospital within 17 miles of Keokuk, and despite the fact that Keokuk Area Hospital has been designated as a "necessary hospital" by the State of Iowa. As was the case with other hospitals prior to the Critical Access Hospital legislation being enacted, Keokuk Area Hospital is struggling to survive financially due to the failure of Medicare and Medicaid to pay the cost of caring for their enrollees. The Keokuk Community is being discriminated against simply because our Hospital was not smaller at an earlier date. The mission of caring for all Keokuk Area Residents regardless of their ability to pay creates a huge Community Benefit, however, this benefit is in jeopardy due to CMS policy of paying other hospitals in similar Communities higher rates while denying the Keokuk Community the same reimbursement.	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	25258028	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	1	ReportOtherAssets
Report Other Liabilities	1	ReportOtherLiabilities
Report Fin48 Footnote	0	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
Transaction Related Entity	0	TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org	0	TransfersToExemptNonChrtblOrg
Activities Conducted Partnership	0	ActivitiesConductedPartnership
Schedule O Required	1	ScheduleORequired
Number Forms Transmitted With1096	34	NumberFormsTransmittedWith1096
Number W2 G Included	0	NumberW2GIncluded
Compliance With Backup Witholding	1	ComplianceWithBackupWitholding
Number Of Employees	430	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	11	NumberIndependentVotingMembers
Family Or Business Relationship	0	FamilyOrBusinessRelationship
Delegation Of Management Duties	0	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
Upon Request	X	UponRequest

The Books Are In Care Of TheBooksAreInCareOf

Field	Value	IRS element (for citing)
Name Person	Walter H Winkler	NamePerson
Telephone Number	3195268661	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 (16 entries)

TitleTitle	Average Hours Per WeekAverageHoursPerWeek	Individual Trustee Or DirectorIndividualTrusteeOrDirector	Reportable Comp From OrganizationReportableCompFromOrganization	Reportable Comp From Related OrgsReportableCompFromRelatedOrgs	Other CompensationOtherCompensation	OfficerOfficer	Highest Compensated EmployeeHighestCompensatedEmployee	Key EmployeeKeyEmployee
Jim Bowles
Board Member	1	X	0	0	0
Walt Stephens
Board Member (President)	1	X	0	0	0	X
Jeff Allerman
Board Member	1	X	0	0	0
Anne Schock
Board Member	1	X	0	0	0
Kiran Khanolkar MD
Board Member	1	X	0	263430	0
Neville Crenshaw DO
Family Practitioner	1	X	0	0	0
Kent Nixon
Board Member (Vice President)	1	X	0	0	0	X
Allan Zastrow
Exec Director/CEO	1	X	168256	0	13750		X
Mike Maher
Board Member	1	X	0	0	0
Wendy Swank
Board Member	1	X	0	0	0
Tom Marion
Board Member	1	X	0	0	0
Walter H Winkler
CEO/CFO	40		116515	0	13750	X	X	X
Susan Pankey
Chief Nursing Executive	40		108286	0	11853	X	X	X
Elizabeth Allen
Staff PHarmacist	40		121782	0	11853		X
Jagadamba Kantanmeni
Anesthesiologist	40		323771	0	8202		X
John J Miller
Certified Nurse Anesthetist	40		111733	0	5926		X

Field	Value	IRS element (for citing)
Total Reportable Comp From Org	950343	TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs	263430	TotalReportableCompFrmRltdOrgs
Total Other Compensation	65334	TotalOtherCompensation
Number Individuals GT100 K	6	NumberIndividualsGT100K
Formers Listed	0	FormersListed
Total Comp GT150 K	1	TotalCompGT150K
Compensation From Other Sources	1	CompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1	CityAddressOfContractor/AddressUS/City	StateAddressOfContractor/AddressUS/State	ZIP CodeAddressOfContractor/AddressUS/ZIPCode	Description Of ServicesDescriptionOfServices	CompensationCompensation
PT Services Rehabilitation Inc
Box 833	Tiffin	OH	44883	Physical Therapy	327940
Kirk Green
2020 Meadow Lane	Keokuk	IA	52632	Orthopedic Surgeon	400000
Blessing Physician Services
Box 5007	Quincy	IL	61232	Emergency Room Physician Coverage	1684682
Pathology Services
2916 S Brentwood Blvd	St Louis	MO	63144	Pathologist Services	140000
Shared Medical Services
Box 330	Cottage Grove	WI	53527	MRI	292500

Field	Value	IRS element (for citing)
Number Of Contractors GT100 K	6	NumberOfContractorsGT100K
Federated Campaigns	0	FederatedCampaigns
Membership Dues	0	MembershipDues
Fundraising Events	0	FundraisingEvents
Related Organizations	0	RelatedOrganizations
Government Grants	14241	GovernmentGrants
All Other Contributions	25815	AllOtherContributions
Noncash Contributions	0	NoncashContributions
Total Contributions	40056	TotalContributions

Program Service Revenue ProgramServiceRevenue

Field	Value	IRS element (for citing)
Description	Hospital Services	Description
Business Code	622000	BusinessCode
Total Revenue Column	23853868	TotalRevenueColumn
Related Or Exempt Function Income	23853868	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	23853868	TotalProgramServiceRevenue

Investment Income InvestmentIncome

Field	Value	IRS element (for citing)
Total Revenue Column	-43500	TotalRevenueColumn
Related Or Exempt Function Income	-43500	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	ExclusionExclusionAmount
Cafeteria/laundry/rent/etc.	622000	358811	358811	$0
Weight Loss Program	622000	230280	230280	$0
Miscellaneous	622000	411233	411233	$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	1000324	TotalOtherRevenue

Total Revenue TotalRevenue

Field	Value	IRS element (for citing)
Total Revenue Column	24850748	TotalRevenueColumn
Related Or Exempt Function Income	24810692	RelatedOrExemptFunctionIncome
Unrelated Business Revenue	0	UnrelatedBusinessRevenue
Exclusion	$0	ExclusionAmount

Comp Current Officers Directors CompCurrentOfficersDirectors

Field	Value	IRS element (for citing)
Total	393057	Total
Management And General	393057	ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

Field	Value	IRS element (for citing)
Total	11545209	Total
Program Services	11545209	ProgramServices
Management And General	0	ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

Field	Value	IRS element (for citing)
Total	130915	Total
Program Services	126605	ProgramServices
Management And General	4310	ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

Field	Value	IRS element (for citing)
Total	1880694	Total
Program Services	1818773	ProgramServices
Management And General	61921	ManagementAndGeneral

Payroll Taxes PayrollTaxes

Field	Value	IRS element (for citing)
Total	833740	Total
Program Services	806290	ProgramServices
Management And General	27450	ManagementAndGeneral

Fees For Services Other FeesForServicesOther

Field	Value	IRS element (for citing)
Total	2913433	Total
Program Services	2913433	ProgramServices

Information Technology InformationTechnology

Field	Value	IRS element (for citing)
Total	115817	Total
Program Services	115817	ProgramServices

Occupancy Occupancy

Field	Value	IRS element (for citing)
Total	487925	Total
Program Services	487925	ProgramServices

Travel Travel

Field	Value	IRS element (for citing)
Total	86511	Total
Program Services	86511	ProgramServices

Interest Interest

Field	Value	IRS element (for citing)
Total	399091	Total
Program Services	399091	ProgramServices

Depreciation Depletion DepreciationDepletion

Field	Value	IRS element (for citing)
Total	1255771	Total
Program Services	1255771	ProgramServices

Insurance Insurance

Field	Value	IRS element (for citing)
Total	114514	Total
Program Services	114514	ProgramServices

Other Expenses OtherExpenses (4 entries)

DescriptionDescription	TotalTotal	Program ServicesProgramServices
Supplies	3751401	3751401
Repairs and Minor Equip	715953	715953
Recruitment and Physician Support	590441	590441
Miscellaneous	530294	530294

Total Functional Expenses TotalFunctionalExpenses

Field	Value	IRS element (for citing)
Total	25744766	Total
Program Services	25258028	ProgramServices
Management And General	486738	ManagementAndGeneral
Fundraising	0	Fundraising

Cash Non Interest Bearing CashNonInterestBearing

Field	Value	IRS element (for citing)
BOY	579662	BOY
EOY	553965	EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

Field	Value	IRS element (for citing)
BOY	1400818	BOY
EOY	1468715	EOY

Accounts Receivable AccountsReceivable

Field	Value	IRS element (for citing)
BOY	4375104	BOY
EOY	4957833	EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

Field	Value	IRS element (for citing)
BOY	886697	BOY
EOY	307973	EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

Field	Value	IRS element (for citing)
BOY	1015249	BOY
EOY	991376	EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

Field	Value	IRS element (for citing)
BOY	79273	BOY
EOY	152478	EOY

Field	Value	IRS element (for citing)
Land Buildings Equipment Basis	28623565	LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec	22123960	LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

Field	Value	IRS element (for citing)
BOY	6785676	BOY
EOY	6499605	EOY

Other Assets Total OtherAssetsTotal

Field	Value	IRS element (for citing)
BOY	1364790	BOY
EOY	876427	EOY

Total Assets TotalAssets

Field	Value	IRS element (for citing)
BOY	16487269	BOY
EOY	15808372	EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

Field	Value	IRS element (for citing)
BOY	5546519	BOY
EOY	6517545	EOY

Grants Payable GrantsPayable

Field	Value	IRS element (for citing)
BOY	0	BOY

Deferred Revenue DeferredRevenue

Field	Value	IRS element (for citing)
BOY	0	BOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

Field	Value	IRS element (for citing)
BOY	3889446	BOY
EOY	3305608	EOY

Escrow Account Liability EscrowAccountLiability

Field	Value	IRS element (for citing)
BOY	0	BOY

Loans From Officers Directors LoansFromOfficersDirectors

Field	Value	IRS element (for citing)
BOY	0	BOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

Field	Value	IRS element (for citing)
BOY	0	BOY

Unsecured Notes Loans Payable UnsecuredNotesLoansPayable

Field	Value	IRS element (for citing)
BOY	0	BOY

Other Liabilities OtherLiabilities

Field	Value	IRS element (for citing)
BOY	2315285	BOY
EOY	2550257	EOY

Total Liabilities TotalLiabilities

Field	Value	IRS element (for citing)
BOY	11751250	BOY
EOY	12373410	EOY

Field	Value	IRS element (for citing)
Follow SFAS117	X	FollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

Field	Value	IRS element (for citing)
BOY	4690725	BOY
EOY	3409735	EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

Field	Value	IRS element (for citing)
BOY	45294	BOY
EOY	25227	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	4736019	BOY
EOY	3434962	EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

Field	Value	IRS element (for citing)
BOY	16487269	BOY
EOY	15808372	EOY

Field	Value	IRS element (for citing)
Info In Schedule O Part XI	X	InfoInScheduleOPartXI
Reconcilation Revenue Expenses	-894018	ReconcilationRevenueExpenses
Reconcilation Other Changes	-407039	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	0	Depreciation
Book Value	505333	BookValue

Leasehold Improvements LeaseholdImprovements

Field	Value	IRS element (for citing)
Investment Cost Or Other Basis	0	InvestmentCostOrOtherBasis
Other Cost Or Other Basis	17069484	OtherCostOrOtherBasis
Depreciation	13653640	Depreciation
Book Value	3415844	BookValue

Equipment Equipment

Field	Value	IRS element (for citing)
Investment Cost Or Other Basis	0	InvestmentCostOrOtherBasis
Other Cost Or Other Basis	6654755	OtherCostOrOtherBasis
Depreciation	5323045	Depreciation
Book Value	1331710	BookValue

Other Land Buildings OtherLandBuildings

Field	Value	IRS element (for citing)
Investment Cost Or Other Basis	0	InvestmentCostOrOtherBasis
Other Cost Or Other Basis	3955318	OtherCostOrOtherBasis
Depreciation	3147275	Depreciation
Book Value	808043	BookValue

Field	Value	IRS element (for citing)
Total Of Book Value Land Buildings	6499605	TotalOfBookValueLandBuildings

Other Assets OtherAssets (2 entries)

DescriptionDescription	Book ValueBookValue
Advance to affiliates	839005
Deferred Financing Costs	37422

Field	Value	IRS element (for citing)
Total Book Value Other Assets	876427	TotalBookValueOtherAssets
Federal Income Tax Liability	0	FederalIncomeTaxLiability

Other Liabilities OtherLiabilities (3 entries)

DescriptionDescription	AmountAmount
Capital lease obligations	$1,749,400
Notes	$613,481
Line of Credit	$187,376

Field	Value	IRS element (for citing)
Total Of Amounts	2550257	TotalOfAmounts
Total Revenue	24850748	TotalRevenue
Total Expenses	25744766	TotalExpenses
Excess Or Deficit For Year	-894018	ExcessOrDeficitForYear
Net Unrealized GL On Investments	0	NetUnrealizedGLOnInvestments
Donated Services And Facilities	0	DonatedServicesAndFacilities
Investment Expenses	0	InvestmentExpenses
Prior Period Adjustments	0	PriorPeriodAdjustments
Other	$0	OtherAmount
Total Adjustments	0	TotalAdjustments
Excess Or Deficit Per FS	-894018	ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt	24850748	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	24850748	RevenueSubtotal
Investment Expenses Not Included	0	InvestmentExpensesNotIncluded
Other Revenues Not Included	0	OtherRevenuesNotIncluded
Revenue Not Rptd On Fin Stmt	0	RevenueNotRptdOnFinStmt
Total Revenue Per Form990	24850748	TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt	25744766	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	25744766	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	25744766	TotalExpensesPerForm990

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	1	ReportPublicallyAvailable

Charity Care At Cost CharityCareAtCost

Field	Value	IRS element (for citing)
Total Community Benefit Expense	430320	TotalCommunityBenefitExpense
Net Community Benefit Expense	430320	NetCommunityBenefitExpense

Unreimbursed Medicaid UnreimbursedMedicaid

Field	Value	IRS element (for citing)
Total Community Benefit Expense	1195534	TotalCommunityBenefitExpense
Net Community Benefit Expense	1195534	NetCommunityBenefitExpense

Unreimbursed Costs UnreimbursedCosts

Field	Value	IRS element (for citing)
Total Community Benefit Expense	68322	TotalCommunityBenefitExpense
Net Community Benefit Expense	68322	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	1694176	TotalCommunityBenefitExpense
Direct Offsetting Revenue	0	DirectOffsettingRevenue
Net Community Benefit Expense	1694176	NetCommunityBenefitExpense
Percent Of Total Expense	0	PercentOfTotalExpense

Community Health Services CommunityHealthServices

Field	Value	IRS element (for citing)
Persons Served	3240	PersonsServed
Total Community Benefit Expense	58827	TotalCommunityBenefitExpense
Net Community Benefit Expense	58827	NetCommunityBenefitExpense

Health Professions Education HealthProfessionsEducation

Field	Value	IRS element (for citing)
Persons Served	52	PersonsServed
Total Community Benefit Expense	460061	TotalCommunityBenefitExpense
Net Community Benefit Expense	460061	NetCommunityBenefitExpense

Subsidized Health Services SubsidizedHealthServices

Field	Value	IRS element (for citing)
Total Community Benefit Expense	839604	TotalCommunityBenefitExpense
Net Community Benefit Expense	839604	NetCommunityBenefitExpense

Total Other Benefits TotalOtherBenefits

Field	Value	IRS element (for citing)
Number Of Activities Or Programs	0	NumberOfActivitiesOrPrograms
Persons Served	3292	PersonsServed
Total Community Benefit Expense	1358492	TotalCommunityBenefitExpense
Direct Offsetting Revenue	0	DirectOffsettingRevenue
Net Community Benefit Expense	1358492	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	3292	PersonsServed
Total Community Benefit Expense	3052668	TotalCommunityBenefitExpense
Direct Offsetting Revenue	0	DirectOffsettingRevenue
Net Community Benefit Expense	3052668	NetCommunityBenefitExpense
Percent Of Total Expense	0	PercentOfTotalExpense

Physical Improvements And Housing PhysicalImprovementsAndHousing

Field	Value	IRS element (for citing)
Total Community Building Expense	1080	TotalCommunityBuildingExpense
Net Community Building Expense	1080	NetCommunityBuildingExpense

Economic Development EconomicDevelopment

Field	Value	IRS element (for citing)
Total Community Building Expense	3000	TotalCommunityBuildingExpense
Net Community Building Expense	3000	NetCommunityBuildingExpense

Community Support CommunitySupport

Field	Value	IRS element (for citing)
Total Community Building Expense	4970	TotalCommunityBuildingExpense
Net Community Building Expense	4970	NetCommunityBuildingExpense

Environmental Improvements EnvironmentalImprovements

Field	Value	IRS element (for citing)
Total Community Building Expense	3128	TotalCommunityBuildingExpense
Net Community Building Expense	3128	NetCommunityBuildingExpense

Leadership Development LeadershipDevelopment

Field	Value	IRS element (for citing)
Total Community Building Expense	13652	TotalCommunityBuildingExpense
Net Community Building Expense	13652	NetCommunityBuildingExpense

Coalition Building CoalitionBuilding

Field	Value	IRS element (for citing)
Total Community Building Expense	5200	TotalCommunityBuildingExpense
Net Community Building Expense	5200	NetCommunityBuildingExpense

Health Improvement Advocacy HealthImprovementAdvocacy

Field	Value	IRS element (for citing)
Total Community Building Expense	86886	TotalCommunityBuildingExpense
Net Community Building Expense	86886	NetCommunityBuildingExpense

Workforce Development WorkforceDevelopment

Field	Value	IRS element (for citing)
Total Community Building Expense	117916	TotalCommunityBuildingExpense
Net Community Building Expense	117916	NetCommunityBuildingExpense

Total Total

Field	Value	IRS element (for citing)
Number Of Activities Or Programs	0	NumberOfActivitiesOrPrograms
Persons Served	0	PersonsServed
Total Community Building Expense	235832	TotalCommunityBuildingExpense
Direct Offsetting Revenue	0	DirectOffsettingRevenue
Net Community Building Expense	235832	NetCommunityBuildingExpense
Percent Of Total Expense	0	PercentOfTotalExpense

Field	Value	IRS element (for citing)
Bad Debt Expense Reported	1	BadDebtExpenseReported
Bad Debt Expense	$2,750,322	BadDebtExpenseAmount
Amount Attributable To	1269645	AmountAttributableTo
Amount Reimbursed By Medicare	9829251	AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare	12083280	CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall	-2254029	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)
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
Information Gaps	X	InformationGaps
Needs Assessment Conducted	12	NeedsAssessmentConducted
Take Into Account	1	TakeIntoAccount
Other Facilities	1	OtherFacilities
CHNA Widely Available	1	CHNAWidelyAvailable
Own Website	X	OwnWebsite
On Request	X	OnRequest
Develop Community Plan	X	DevelopCommunityPlan
Participate Community Plan	X	ParticipateCommunityPlan
Prioritize Health Needs	X	PrioritizeHealthNeeds
All Needs Addressed	1	AllNeedsAddressed

Form990 Schedule H Part VI Form990ScheduleHPartVI (15 entries)

IdentifierIdentifier	Return ReferenceReturnReference	ExplanationExplanation
SchH_P01_S00_L06a	Schedule H, Part I, Line 6a	Keokuk Area Hospital submitted data to the Iowa Hospital Association which prepares Community Benefit Reports for Iowa Hospitals IHA is not a related organization
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 $839604 is attributable to the hospital providing subsidized services to patients of Tri State Medical Group a related organization TSMG is affiliated with the Community Health Centers of Southeast Iowa and Keokuk Area Hospital provides this subsidy to ensure CHC patients have access to primary medical care
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 Community needs, while building coalitions to address these needs.
SchH_P03_S0A_L04	Schedule H, Part III, Section A, Line 4	Patient receivables due directly from the patients are carried at the original charge for the service provided less amounts covered by third-party payors and less an estimated allowance for doubtful receivables based on a review of all outstanding amounts on a monthly basis. Management determines the allowance for doubtful accounts by identifying troubled accounts by historical experience applied to an aging of accounts and by considering the patients' financial history, credit history and current economic conditions. The Hospital does not charge interest on patient receivables. Patient receivables are written off as bad debt when deemed uncollectible. Recoveries of receivables previously written off are recorded as a reduction of bad debt expense when received....For uninsured patients that do not qualify for charity care the Hospital recognizes revenue on the basis of its standard rates for services provided (or on the basis of discounted rates if negotiated or provided by policy) 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.
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 care provided to 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 a patient is eligible for charity care collection services are not pursued.
SchH_P05_S0B_L04	Schedule H, Part V, Section B, Line 4	Keokuk Area Hospital participated in the Community Wide Needs Assessment along with many other healthcare and civic organizations in Lee County Iowa
SchH_P06_S00_L02	Schedule H, Part VI, Line 2	KAH participates with as many health related organizations as possible to assess healthcare needs in Lee County Iowa and shares the results in a written Community Assessment
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 if 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 all of which are economically depressed. More than 23% of the Keokuk population is below the federal poverty level. 75% of all patients are either Medicaid, Medicare, or Indigent, all of which reimburse Keokuk Area Hospital less than cost and the 25% remaining insured population does not make up for 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 Medical Staff is open to all interested medical practitioners who are appropriately credentialled. All funds generated by the Hospital are utilized for patient related services and ensuring that all patients of our market have access to quality medical services regardless of their ability to pay.
SchH_P06_S00_L06	Schedule H, Part VI, Line 6	Keokuk Area Hospital provides inpatient and outpatient health care services Tri State Medical Group provides medical offices and access to medical care for Community Health Center patients, and Keokuk Area Medical Equipment provides DME and pharmacy services including MAP services which help indigent patient obtain drugs at no cost from the manufacturer All services are coordinated to help reduce lengths of stay in the hospital and ensure that care is provided in the appropriate setting and that there is 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	1	AnyNonFixedPayments
Initial Contract Exception	0	InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (2 entries)

Base Compensation Filing OrgBaseCompensationFilingOrg	Comp Based On Related OrgsCompBasedOnRelatedOrgs	Bonus Filing OrgBonusFilingOrg	Bonus Related OrgsBonusRelatedOrgs	Other Compensation Filing OrgOtherCompensationFilingOrg	Other Compensation Related OrgsOtherCompensationRelatedOrgs	Deferred Comp Filing OrgDeferredCompFilingOrg	Deferred Comp Related OrgsDeferredCompRelatedOrgs	Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg	Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs	Total Compensation Filing OrgTotalCompensationFilingOrg	Total Compensation Related OrgsTotalCompensationRelatedOrgs	Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg	Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
Kiran Khanolkar MD
0	140233	0	113768	0	0	0	0	0	21281	0	275282	0	0
Allan Zastrow
154949	0	0	0	5200	0	0	0	21857	0	182006	0	0	0

Form990 Schedule J Part III Form990ScheduleJPartIII (2 entries)

IdentifierIdentifier	Return ReferenceReturnReference	ExplanationExplanation
SchJ_P01_S00_L03	Schedule J, Part I, Line 3	All highly paid individuals' wages are reviewed and established by the Board of Directors using benchmark data from numerous sources including the Iowa Hospital Association salary surveys, physician compensation surveys, etc.
SchJ_P01_S00_L07	Schedule J, Part I, Line 7	Part of the physician Board Member's compensation from a related organization is subject to RVU production. (Relative Value Units)

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (8 entries)

IdentifierIdentifier	Return ReferenceReturnReference	ExplanationExplanation
F990_P06_S0A_L06	Form 990, Part VI, Section A, Line 6	Keokuk Health Systems, Inc XXX-XX-XXXX
F990_P06_S0A_L07a	Form 990, Part VI, Section A, Line 7a	Keokuk Health Systems, Inc XXX-XX-XXXX
F990_P06_S0A_L07b	Form 990, Part VI, Section A, Line 7b	Keokuk Health Systems, Inc XXX-XX-XXXX is the parent company of Keokuk Area Hospital and sole member
F990_P06_S0B_L11b	Form 990, Part VI, Section B, Line 11b	Distributed to Board Executive Committee prior to filing and to all Board Members after filing
F990_P06_S0B_L12c	Form 990, Part VI, Section B, Line 12c	All employees, officers, and directors are required to disclose any conflict of interests at the point they arise and to 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 reviews and establishes all compensation arrangements with highly paid employs 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	Yes documents are available upon request and the 990 is published at guidestar.com
F990_P11_S00_L05	Form 990, Part XI, Line 5	Transfer of equity to TSMG to subsidize medical care at Community Health Center -$840000 Return of equity from KAH ODS dissolved insurance plan $357816 Contributions of equipment $75145

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
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	840000	Keokuk Area Hospital subsidized care of patients seen at TSMG through an affiliation with the Community Health Centers of Southeast 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	357816	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 two years and this $356816 is a return of equity to Keokuk Area Hospital through Keokuk Health Systems, Inc.