RURAL HEALTH RESOURCES OF JACKSON CO INC: Form 990, tax year 2011
View the entire original 990 at ProPublica ↗
- Organization
- RURAL HEALTH RESOURCES OF JACKSON CO INC (EIN 74-2826278)
- Tax period
- 2011-04-01 to 2012-03-31
- Filed
- 2013-02-15
- IRS object ID
- 201310469349301711
- Schema version
- 2011v1.5
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule H
- Schedule J
- Schedule L
- Schedule O
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2013-02-15T11:54:55-06:00 | Timestamp |
| Tax Period End Date | 2012-03-31 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BKD LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1201 Walnut Suite 1700 | AddressLine1 |
| City | Kansas City | City |
| State | MO | State |
| ZIP Code | 641062246 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2011-04-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 742826278 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Rural Health Resources of Jackson County Inc | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| In Care Of Name | % MARLENE KRANZ | InCareOfName |
| Name Control | RURA | NameControl |
| Phone | 7853642116 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1110 Columbine Drive | AddressLine1 |
| City | Holton | City |
| State | KS | State |
| ZIP Code | 66436 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | CARRIE SAIA | Name |
| Title | INTERIM CEO | Title |
| Date Signed | 2013-02-15 | DateSigned |
| Authorize Third Party | true | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Michael J Engle | Name |
| Phone | 8162216300 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2011 | TaxYear |
| Build TS | 2016-02-25 16:41:14Z | BuildTS |
Form 990 IRS990
Doing Business As DoingBusinessAs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | HOLTON COMMUNITY HOSPITAL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | CARRIE SAIA | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1110 COLUMBINE DRIVE | AddressLine1 |
| City | HOLTON | City |
| State | KS | State |
| ZIP Code | 66436 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 11703379 | GrossReceipts |
| Group Return For Affiliates | false | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | HTTP://WWW.HOLTONHOSPITAL.COM | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1997 | YearFormation |
| State Legal Domicile | KS | StateLegalDomicile |
| Activity Or Mission Description | TO PROVIDE HIGH QUALITY HEALTHCARE SERVICES TO ALL OF JACKSON COUNTY AND SURROUNDING COMMUNITIES WHILE CONSISTENTLY DEMONSTRATING PROFESSIONALISM WITH THE HOMETOWN TOUCH. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 7 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 5 | NbrIndependentVotingMembers |
| Total Nbr Employees | 167 | TotalNbrEmployees |
| Total Nbr Volunteers | 14 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 106348 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 95320 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 10602407 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 11238479 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 20226 | InvestmentIncomePriorYear |
| Investment Income Current Year | 43577 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 369003 | OtherRevenuePriorYear |
| Other Revenue Current Year | 325666 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 11097984 | TotalRevenuePriorYear |
| Total Revenue Current Year | 11703042 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 0 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 100 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 5817246 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 5908159 | 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 | 4855912 | OtherExpensePriorYear |
| Other Expenses Current Year | 5094514 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 10673158 | TotalExpensesPriorYear |
| Total Expenses Current Year | 11002773 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 424826 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 700269 | RevenuesLessExpensesCY |
| Total Assets BOY | 7311715 | TotalAssetsBOY |
| Total Assets EOY | 7888598 | TotalAssetsEOY |
| Total Liabilities BOY | 4660539 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 4537153 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 2651176 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 3351445 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | TO PROVIDE PROFESSIONALISM, COMPASSION AND EXCELLANCE IN HEALTHCARE FOR A HEALTHIER COMMUNITY. | MissionDescription |
| Significant New Program Services | false | SignificantNewProgramServices |
| Significant Change | false | SignificantChange |
| Expense | 7033241 | Expense |
| Grants | 0 | Grants |
| Revenue | 8846416 | Revenue |
| Description | SEE SCHEDULE O | Description |
Activity2 Activity2
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 2201650 | Expense |
| Grants | 0 | Grants |
| Revenue | 2392063 | Revenue |
| Description | THERE ARE 2 RURAL HEALTH CLINICS: 1 RURAL HEALTH CLINIC WITHIN THE SAME COMMUNITY WHERE THE HOSPITAL RESIDES, AND 1 RURAL HEALTH CLINIC IN A SMALLER NEARBY COMMUNITY. THE RURAL HEALTH CLINICS REPORTED 15,799 VISITS FROM 4/1/11 THROUGH 3/31/12. PROVIDERS FOR THE RURAL HEALTH CLINICS LIVE AND WORK IN THE SAME COMMUNITY AND ARE ACTIVELY INVOLVED IN COMMUNITY ACTIVITIES OFFERING A LARGE VARIETY OF EDUCATIONAL SERVICES AS WELL AS CLINICAL SERVICES SUCH AS PROVIDING THE LOCAL HIGH SCHOOL A SPORTS MEDICINE CLINIC AND COVERAGE BY PROVIDERS AT HOME SPORTING EVENTS. | Description |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expense | 9234891 | TotalProgramServiceExpense |
| Described In501 C3 | true | DescribedIn501C3 |
| Schedule B Required | true | ScheduleBRequired |
| Political Activities | false | PoliticalActivities |
| Lobbying Activities | true | LobbyingActivities |
| Donor Advised Funds | false | DonorAdvisedFunds |
| Conservation Easements | false | ConservationEasements |
| Collections Of Art | false | CollectionsOfArt |
| Credit Counseling | false | CreditCounseling |
| Term Or Permanent Endowments | true | TermOrPermanentEndowments |
| Report Land Bldg Equip | true | ReportLandBldgEquip |
| Report Invest Oth Securities | false | ReportInvestOthSecurities |
| Report Prog Rel Invest | false | ReportProgRelInvest |
| Report Other Assets | false | ReportOtherAssets |
| Report Other Liabilities | true | ReportOtherLiabilities |
| Report Fin48 Footnote | true | ReportFin48Footnote |
| Independent Audit Financial Stmt | true | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | false | ConsolidatedAuditFinancialStmt |
| School | false | School |
| Foreign Office | false | ForeignOffice |
| Foreign Activities | false | ForeignActivities |
| More Than5000 K To Organizations | false | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividuals |
| Professional Fundraising | false | ProfessionalFundraising |
| Fundraising Activities | false | FundraisingActivities |
| Gaming | false | Gaming |
| Hospital | true | Hospital |
| Financial Stmt Attached | true | FinancialStmtAttached |
| Grants To Organizations | false | GrantsToOrganizations |
| Grants To Individuals | false | GrantsToIndividuals |
| Schedule J Required | true | ScheduleJRequired |
| Tax Exempt Bonds | false | TaxExemptBonds |
| Excess Benefit Transaction | false | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | false | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | false | LoanToOfficerOrDQP |
| Grant To Related Person | false | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | false | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | true | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | false | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | false | DeductibleNonCashContributions |
| Deductible Contributions Of Art | false | DeductibleContributionsOfArt |
| Terminated | false | Terminated |
| Partial Liquidation | false | PartialLiquidation |
| Disregarded Entity | false | DisregardedEntity |
| Related Entity | false | RelatedEntity |
| Related Org Controlled Entity | false | RelatedOrgControlledEntity |
| Transaction Related Entity | false | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | false | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | false | ActivitiesConductedPartnership |
| Schedule O Required | true | ScheduleORequired |
| Number Forms Transmitted With1096 | 10 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | true | ComplianceWithBackupWitholding |
| Number Of Employees | 167 | NumberOfEmployees |
| Employment Tax Returns Filed | true | EmploymentTaxReturnsFiled |
| Unrelated Business Income | false | UnrelatedBusinessIncome |
| Foreign Financial Account | false | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTrans |
| Taxable Party Notification | false | TaxablePartyNotification |
| Non Deductible Contributions | false | NonDeductibleContributions |
| Quid Pro Quo Contributions | false | QuidProQuoContributions |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | false | FundsToPayPremiums |
| Premiums Paid | false | PremiumsPaid |
| Indoor Tanning Services | false | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 7 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 5 | NumberIndependentVotingMembers |
| Family Or Business Relationship | false | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | true | DelegationOfManagementDuties |
| Changes To Organizing Docs | false | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuse |
| Members Or Stockholders | false | MembersOrStockholders |
| Election Of Board Members | false | ElectionOfBoardMembers |
| Decisions Subject To Approval | false | DecisionsSubjectToApproval |
| Minutes Of Governing Body | true | MinutesOfGoverningBody |
| Minutes Of Committees | true | MinutesOfCommittees |
| Officer Mailing Address | false | OfficerMailingAddress |
| Local Chapters | false | LocalChapters |
| Form990 Provided To Governing Body | true | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | true | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | true | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | true | RegularMonitoringEnforcement |
| Whistleblower Policy | true | WhistleblowerPolicy |
| Document Retention Policy | true | DocumentRetentionPolicy |
| Compensation Process CEO | true | CompensationProcessCEO |
| Compensation Process Other | false | CompensationProcessOther |
| Investment In Joint Venture | false | InvestmentInJointVenture |
| States Where Copy Of Return Is Filed | KS | StatesWhereCopyOfReturnIsFiled |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | MARLENE KRANZ | NamePerson |
| Telephone Number | 7853649636 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1110 COLUMBINE DRIVE | AddressLine1 |
| City | HOLTON | City |
| State | KS | State |
| ZIP Code | 66436 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (13 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|
| CATHERINE E REED | |||||||
| BOARD CHAIR | 1.0 | X | X | ||||
| RICHARD LAKE | |||||||
| BOARD VICE CHAIR | 1.0 | X | X | ||||
| MARGARET PAGEL | |||||||
| BOARD SECRETARY | 1.0 | X | X | ||||
| ALEX GILLILAND | |||||||
| BOARD TREASURER | 1.0 | X | X | ||||
| BOBBI MCGRATH | |||||||
| BOARD MEMBER | 1.0 | X | |||||
| IRVIN SANDERSON | |||||||
| BOARD MEMBER | 1.0 | X | |||||
| JANET ZWONITZER | |||||||
| BOARD MEMBER | 1.0 | X | |||||
| RONALD MARSHALL | |||||||
| CHIEF EXECUTIVE OFFICER | 40.0 | X | 141978 | 0 | 21639 | ||
| CLINT M COLBERG | |||||||
| MEDICAL PROVIER | 40.0 | 179235 | 0 | 22695 | X | ||
| LEE R SCHNEE | |||||||
| MEDICAL PROVIER | 40.0 | 188863 | 0 | 17793 | X | ||
| MALIA S WARNER | |||||||
| MEDICAL PROVIER | 40.0 | 197512 | 0 | 23409 | X | ||
| VANCE R LASSEY | |||||||
| MEDICAL PROVIER | 40.0 | 189845 | 0 | 17808 | X | ||
| JOEL R HUTCHINS | |||||||
| MEDICAL PROVIER | 40.0 | 176227 | 0 | 7739 | X | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 1073660 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 111083 | TotalOtherCompensation |
| Number Individuals GT100 K | 6 | NumberIndividualsGT100K |
| Formers Listed | false | FormersListed |
| Total Comp GT150 K | true | TotalCompGT150K |
| Compensation From Other Sources | false | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (4 entries)
| Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|
| ST FRANCIS HEALTH CENTER | |
| MANAGEMENT SERVICES | 824533 |
| GLENDAVNIC ANESTHESIA PLLC | |
| ANESTHESIA SERVICES | 300000 |
| SHARED MEDICAL SERVICES | |
| MRI SERVICES | 149900 |
| HEALTHCARE MANAGEMENT SERVICES | |
| SOFTWARE SUPPORT | 134010 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 4 | NumberOfContractorsGT100K |
| Government Grants | 29525 | GovernmentGrants |
| All Other Contributions | 65795 | AllOtherContributions |
| Total Contributions | 95320 | TotalContributions |
Program Service Revenue ProgramServiceRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | NET PATIENT SERVICE REVENUE | Description |
| Business Code | 621110 | BusinessCode |
| Total Revenue Column | 11238479 | TotalRevenueColumn |
| Related Or Exempt Function Income | 11238479 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 11238479 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 43914 | TotalRevenueColumn |
| Exclusion | $43,914 | ExclusionAmount |
Income From Invest Bond Proceeds IncomeFromInvestBondProceeds
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Royalties Revenue RoyaltiesRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 60 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 60 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 60 | TotalRevenueColumn |
| Exclusion | $60 | ExclusionAmount |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 337 | Other |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | -337 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -337 | TotalRevenueColumn |
| Exclusion | -$337 | ExclusionAmount |
Net Income From Fundraising Events NetIncomeFromFundraisingEvents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Net Income From Gaming NetIncomeFromGaming
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Net Income Or Loss NetIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Other Revenue Misc OtherRevenueMisc (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | ExclusionExclusionAmount |
|---|---|---|---|
| CAFETERIA | 623000 | 22639 | $22,639 |
| MEDICAL RECORDS | 623000 | 8325 | $8,325 |
| ALL OTHER MISC REVENUE | 623000 | 294642 | $294,642 |
Miscellaneous Revenue MiscellaneousRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 294642 | TotalRevenueColumn |
| Exclusion | $294,642 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 325606 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 11703042 | TotalRevenueColumn |
| Related Or Exempt Function Income | 11238479 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $369,243 | ExclusionAmount |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 100 | Total |
| Program Services | 100 | ProgramServices |
Grants To Domestic Individuals GrantsToDomesticIndividuals
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Foreign Grants ForeignGrants
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Benefits To Members BenefitsToMembers
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 152004 | Total |
| Program Services | 110030 | ProgramServices |
| Management And General | 41974 | ManagementAndGeneral |
Comp Disqual Persons CompDisqualPersons
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 104628 | Total |
| Program Services | 104628 | ProgramServices |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 4967899 | Total |
| Program Services | 4459322 | ProgramServices |
| Management And General | 508577 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 58825 | Total |
| Program Services | 51330 | ProgramServices |
| Management And General | 7495 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 238303 | Total |
| Program Services | 182776 | ProgramServices |
| Management And General | 55527 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 386500 | Total |
| Program Services | 347922 | ProgramServices |
| Management And General | 38578 | ManagementAndGeneral |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1865 | Total |
| Management And General | 1865 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 82579 | Total |
| Management And General | 82579 | ManagementAndGeneral |
Fees For Services Lobbying FeesForServicesLobbying
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Prof Fundraising FeesForServicesProfFundraising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1716417 | Total |
| Program Services | 1269429 | ProgramServices |
| Management And General | 446988 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 36026 | Total |
| Program Services | 105 | ProgramServices |
| Management And General | 35921 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 533474 | Total |
| Program Services | 477460 | ProgramServices |
| Management And General | 56014 | ManagementAndGeneral |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 110557 | Total |
| Program Services | 1190 | ProgramServices |
| Management And General | 109367 | ManagementAndGeneral |
Royalties Royalties
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 343053 | Total |
| Program Services | 248323 | ProgramServices |
| Management And General | 94730 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 53882 | Total |
| Program Services | 38473 | ProgramServices |
| Management And General | 15409 | ManagementAndGeneral |
Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 193411 | Total |
| Program Services | 140003 | ProgramServices |
| Management And General | 53408 | ManagementAndGeneral |
Payments To Affiliates PaymentsToAffiliates
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 422193 | Total |
| Program Services | 305609 | ProgramServices |
| Management And General | 116584 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 226279 | Total |
| Program Services | 205408 | ProgramServices |
| Management And General | 20871 | ManagementAndGeneral |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| BAD DEBT EXPENSE | 500301 | 500301 | |
| REPAIRS & MAINTENANCE | 206470 | 176314 | 30156 |
| DUES & SUBSCRIPTIONS | 38276 | 21310 | 16966 |
| MEDICAL SUPPLIES | 542441 | 542441 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 87290 | Total |
| Program Services | 52417 | ProgramServices |
| Management And General | 34873 | ManagementAndGeneral |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 11002773 | Total |
| Program Services | 9234891 | ProgramServices |
| Management And General | 1767882 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 455 | BOY |
| EOY | 460 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1736580 | BOY |
| EOY | 2629092 | EOY |
Pledges And Grants Receivable PledgesAndGrantsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1228903 | BOY |
| EOY | 1345611 | EOY |
Receivables From Officers Etc ReceivablesFromOfficersEtc
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Receivables From Disqual Persons ReceivablesFromDisqualPersons
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Other Notes Loans Receivable Net OtherNotesLoansReceivableNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 99681 | BOY |
| EOY | 114910 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 111046 | BOY |
| EOY | 103053 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 8167285 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 4567653 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3873833 | BOY |
| EOY | 3599632 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Investments Program Related InvestmentsProgramRelated
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Intangible Assets IntangibleAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 261217 | BOY |
| EOY | 95840 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 7311715 | BOY |
| EOY | 7888598 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 567383 | BOY |
| EOY | 811728 | EOY |
Grants Payable GrantsPayable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Deferred Revenue DeferredRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Tax Exempt Bond Liabilities TaxExemptBondLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3375000 | BOY |
| EOY | 3245000 | EOY |
Escrow Account Liability EscrowAccountLiability
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Loans From Officers Directors LoansFromOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 718156 | BOY |
| EOY | 343425 | EOY |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 137000 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4660539 | BOY |
| EOY | 4537153 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2593330 | BOY |
| EOY | 3293599 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Permanently Restricted Net Assets PermanentlyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 57846 | BOY |
| EOY | 57846 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2651176 | BOY |
| EOY | 3351445 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 7311715 | BOY |
| EOY | 7888598 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expenses | 700269 | ReconcilationRevenueExpenses |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | false | AccountantCompileOrReview |
| FS Audited | true | FSAudited |
| Audit Committee | false | AuditCommittee |
| Financial Statement Separate | X | FinancialStatementSeparate |
| Federal Grant Audit Required | false | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Grassroots Lobbying | TotalGrassrootsLobbying | |
| Total Direct Lobbying | TotalDirectLobbying | |
| Total Lobbying Expenditures | TotalLobbyingExpenditures | |
| Other Exempt Purpose Expenditures | OtherExemptPurposeExpenditures | |
| Total Exempt Purpose Expenditures | TotalExemptPurposeExpenditures | |
| Lobbying Nontaxable | LobbyingNontaxableAmount | |
| Grassroots Nontaxable | GrassrootsNontaxableAmount | |
| Tot Lobbying Grassroot Minus Non Tx | TotLobbyingGrassrootMinusNonTx | |
| Tot Lobby Expend Mns Lobbying Nontx | TotLobbyExpendMnsLobbyingNontx | |
| Volunteers | false | Volunteers |
| Paid Staff Or Management | false | PaidStaffOrManagement |
| Media Advertisements | false | MediaAdvertisements |
| Mailings Members | false | MailingsMembers |
| Publications Or Broadcast | false | PublicationsOrBroadcast |
| Grants Other Organizations | true | GrantsOtherOrganizations |
| Grants Other Organizations | $1,954 | GrantsOtherOrganizationsAmount |
| Direct Contact Legislators | false | DirectContactLegislators |
| Rallies Demonstrations | false | RalliesDemonstrations |
| Other Activities | false | OtherActivities |
| Total Lobbying Expenditures IIB | 1954 | TotalLobbyingExpendituresIIB |
| Not Described In501c3 | false | NotDescribedIn501c3 |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Art Public Exhibition Amts | ArtPublicExhibitionAmts | |
| Held Works Of Art Amts | HeldWorksOfArtAmts |
Current Year CurrentYear
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 57846 | BeginningOfYearBalance |
| Investment Earnings Or Losses | 1180 | InvestmentEarningsOrLosses |
| Other Expenditures | 1180 | OtherExpenditures |
| End Of Year Balance | 57846 | EndOfYearBalance |
Current Year Minus1 Year CurrentYearMinus1Year
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 58600 | BeginningOfYearBalance |
| Investment Earnings Or Losses | 1391 | InvestmentEarningsOrLosses |
| Other Expenditures | 2145 | OtherExpenditures |
| End Of Year Balance | 57846 | EndOfYearBalance |
Current Year Minus2 Years CurrentYearMinus2Years
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 58600 | BeginningOfYearBalance |
| Investment Earnings Or Losses | 2277 | InvestmentEarningsOrLosses |
| Other Expenditures | 2277 | OtherExpenditures |
| End Of Year Balance | 58600 | EndOfYearBalance |
Current Year Minus3 Years CurrentYearMinus3Years
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 58600 | BeginningOfYearBalance |
| Investment Earnings Or Losses | 1747 | InvestmentEarningsOrLosses |
| Other Expenditures | 1747 | OtherExpenditures |
| End Of Year Balance | 58600 | EndOfYearBalance |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Designated EOY Balance | 0.00000 | BoardDesignatedEOYBalance |
| Permanent Endowment EOY Balance | 1.00000 | PermanentEndowmentEOYBalance |
| Term Endowment EOY Balance | 0.00000 | TermEndowmentEOYBalance |
| Endowments Held By Unrelated Orgs | false | EndowmentsHeldByUnrelatedOrgs |
| Endowments Held By Related Orgs | false | EndowmentsHeldByRelatedOrgs |
| Land | Land |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 4210875 | OtherCostOrOtherBasis |
| Depreciation | 1472402 | Depreciation |
| Book Value | 2738473 | BookValue |
Leasehold Improvements LeaseholdImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 194216 | OtherCostOrOtherBasis |
| Depreciation | 37934 | Depreciation |
| Book Value | 156282 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 3481722 | OtherCostOrOtherBasis |
| Depreciation | 2814996 | Depreciation |
| Book Value | 666726 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 280472 | OtherCostOrOtherBasis |
| Depreciation | 242321 | Depreciation |
| Book Value | 38151 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 3599632 | TotalOfBookValueLandBuildings |
| Federal Income Tax Liability | 0 | FederalIncomeTaxLiability |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | DUE TO THIRD PARTY | Description |
| Amount | $137,000 | Amount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 137000 | TotalOfAmounts |
| Total Revenue | 11703042 | TotalRevenue |
| Total Expenses | 11002773 | TotalExpenses |
| Excess Or Deficit For Year | 700269 | ExcessOrDeficitForYear |
| Excess Or Deficit Per FS | 700269 | ExcessOrDeficitPerFS |
| Tot Revenue Etc Audited Fincl Stmt | 11703042 | TotRevenueEtcAuditedFinclStmt |
| Revenue Subtotal | 11703042 | RevenueSubtotal |
| Total Revenue Per Form990 | 11703042 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 11002773 | TotExpensesEtcAuditedFinclStmt |
| Expenses Subtotal | 11002773 | ExpensesSubtotal |
| Total Expenses Per Form990 | 11002773 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV (2 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| INTENDED USES OF THE ORGANIZATION'S ENDOWMENT FUNDS | SCHEDULE D, PART V, LINE 4 | THE PERMANENTLY DONOR RESTRICTED ENDOWMENT ONLY ALLOWS THE ORGANIZATION TO USE INTEREST INCOME FOR OPERATIONS. |
| UNCERTAIN TAX POSITIONS DISCLOSURE | SCHEDULE D, PART X, LINE 2 | MANAGEMENT HAS EVALUATED THEIR INCOME TAX POSITIONS UNDER THE GUIDANCE INCLUDED IN ASC 740. BASED ON THEIR REVIEW, MANAGEMENT HAS NOT IDENTIFIED ANY MATERIAL UNCERTAIN TAX POSITIONS TO BE RECORDED OR DISCLOSED IN THE FINANCIAL STATEMENTS. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | true | CharityCarePolicy |
| Written Policy | true | WrittenPolicy |
| FPG Reference Free Care | true | FPGReferenceFreeCare |
| Pcent200 | X | Pcent200 |
| FPG Reference Discounted Care | true | FPGReferenceDiscountedCare |
| Pcent200 D | X | Pcent200D |
| Free Disc Care Medically Indigent | true | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | false | AmountsBudgetedForCharityCare |
| Annual Community Benefit Report | true | AnnualCommunityBenefitReport |
| Report Publically Available | true | ReportPublicallyAvailable |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 29049 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 29049 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00260 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 942852 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 597563 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 345289 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.03140 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 971901 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 597563 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 374338 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.03400 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 54230 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 25170 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 29060 | NetCommunityBenefitExpense |
Health Professions Education HealthProfessionsEducation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 49276 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 49276 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00450 | PercentOfTotalExpense |
Cash And In Kind Contributions CashAndInKindContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 2310 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 2310 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00020 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 105816 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 25170 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 80646 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00470 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 1077717 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 622733 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 454984 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.03870 | PercentOfTotalExpense |
Economic Development EconomicDevelopment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 3 | NumberOfActivitiesOrPrograms |
| Total Community Building Expense | 4108 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 4108 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00040 | PercentOfTotalExpense |
Environmental Improvements EnvironmentalImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 1 | NumberOfActivitiesOrPrograms |
| Total Community Building Expense | 312 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 312 | NetCommunityBuildingExpense |
Coalition Building CoalitionBuilding
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 1 | NumberOfActivitiesOrPrograms |
| Total Community Building Expense | 1116 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 1116 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00010 | PercentOfTotalExpense |
Total Total
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 5 | NumberOfActivitiesOrPrograms |
| Total Community Building Expense | 5536 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 5536 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00050 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | false | BadDebtExpenseReported |
| Bad Debt Expense | $285,872 | BadDebtExpenseAmount |
| Amount Attributable To | 14081 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 5005319 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 4803045 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | 202274 | 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 | true | WrittenDebtCollectionPolicy |
| Provision For Charity Care | true | 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 | HOLTON COMMUNITY HOSPITAL | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1110 COLUMBINE DRIVE | AddressLine1 |
| City | HOLTON | City |
| State | KS | State |
| ZIP Code | 66436 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | X | LicensedHospital |
| Critical Access Hospital | X | CriticalAccessHospital |
| 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 | HOLTON COMMUNITY HOSPITAL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
| Eligibility Criteria Explained | true | EligibilityCriteriaExplained |
| Uses FPG Free | true | UsesFPGFree |
| FPG Free Percent | 200. | FPGFreePercent |
| Uses FPG Discounted | true | UsesFPGDiscounted |
| FPG Discount Percent | 200. | FPGDiscountPercent |
| Explains Basis | true | ExplainsBasis |
| Income Level | X | IncomeLevel |
| Explains Application Method | true | ExplainsApplicationMethod |
| Includes Publicity Measures | true | IncludesPublicityMeasures |
| Posted On Website | X | PostedOnWebsite |
| Attached To Invoices | X | AttachedToInvoices |
| Posted In Emergency Room | X | PostedInEmergencyRoom |
| Posted In Admission Office | X | PostedInAdmissionOffice |
| Available On Request | X | AvailableOnRequest |
| Actions On Nonpayment | true | ActionsOnNonpayment |
| Collection Activities | false | CollectionActivities |
| Nondiscrim Emergency Care Policy | true | NondiscrimEmergencyCarePolicy |
| Used Other Method | X | UsedOtherMethod |
| Amounts Generally Billed | false | AmountsGenerallyBilled |
| Gross Charges | false | GrossCharges |
Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Other Facilities | 2 | NumberOfOtherFacilities |
Other Facilities OtherFacilities (2 entries)
| Address Line1Address/AddressLine1 | CityAddress/City | StateAddress/State | ZIP CodeAddress/ZIPCode | Facility TypeFacilityType |
|---|---|---|---|---|
| FAMILY PRACTICE ASSOCIATES - HOLTON | ||||
| 1100 COLUMBINE DRIVE | HOLTON | KS | 66436 | RURAL HEALTH CLINIC |
| FAMILY PRACTICE ASSOCIATES - HOYT | ||||
| 207 HIGHLAND AVENUE | HOYT | KS | 66440 | RURAL HEALTH CLINIC |
Form990 Schedule H Part VI Form990ScheduleHPartVI (10 entries)
| IdentifierIdentifier | ExplanationExplanation | Return ReferenceReturnReference |
|---|---|---|
| SCHEDULE H, PART I, LINE 7, COLUMN F | THE AMOUNT OF BAD DEBT EXPENSE REMOVED FROM TOTAL EXPENSES FOR CALCULATING THE NET COMMUNITY BENEFIT EXPENSE PERCENTAGE WAS $500,301. | |
| SCHEDULE H, PART I, LINE 7 | THE COSTING METHODOLOGY USED TO CALCULATE THE AMOUNTS CONTAINED IN THE TABLE OF PART I, LINE 7, OF SCHEDULE H, IS A COST TO CHARGE RATIO. | |
| COMMUNITY BUILDING ACTIVITIES | THE HOSPITAL IS A COMMITTED PARTNER IN PROMOTING COMMUNITY HEALTH EDUCATION. THE REHABILITATION DEPT HAS 7 - CERTIFIED ARTHRITIS FOUNDATION EXERCISE INSTRUCTORS OFFERING WEEKLY CLASSES AT SEVERAL COMMUNITY LOCATIONS. SOCIAL SERVICES DIRECTOR SPONSORS MONTHLY GRIEF SUPPORT GROUP FOR THOSE SADDENED BY A LOSS OF A LOVED ONE OR FRIEND AS WELL AS A MONTHLY ALZHEIMER'S SUPPORT GROUP. SPORTS PHYSICALS ARE OFFERED AT LOCAL SCHOOLS TO MAKE SURE THE SPORTS ORIENTATED YOUNG PEOPLE ARE HEALTHY. THE HOSPITAL OFFERS HEALTH SERVICES EDUCATION IN WEEKLY LOCAL NEWSPAPERS. PROVIDERS AND OTHER ALLIED HEALTH PROFESSIONALS ARE ACTIVE IN SPONSORING INTERNS AND STUDENT JOB SHADOWS TO ENCOURAGE AND EMPHASIZE HEALTH CARE PROVIDERS IN SMALL RURAL COMMUNITIES. | SCHEDULE H, PART II |
| BAD DEBT EXPENSE | The Hospital reports patient accounts receivable for services rendered at net realizable amounts from third-party payers, patients and others. The Hospital provides an allowance for doubtful accounts based upon a review of outstanding receivables, historical collection information and existing economic conditions. As a service to the patient, the Hospital bills third-party payers directly and bills the patient when the patient's liability is determined. Patient accounts receivable are due in accordance with a predetermined payment plan based on the value of the patient's balance. Accounts are considered delinquent and subsequently written off as bad debts based on individual credit evaluation and specific circumstances of the account. Patients are also given the option to finance the self-pay balance due with a local financial institution, in which the Hospital guarantees 100% of the debt. BAD DEBT EXPENSE (AT COST) IDENTIFIED THE PROVISION FOR UNCOLLECTIBLES FROM 3/31/12 AUDITED 'STATEMENT OF OPERATIONS. MULTIPLIED THAT AMOUNT BY THE COST-TO-CHARGE RATIO. CHARITY CARE (AT COST): LOGS MAINTAINED BY CASH COLLECTOR. LOG CONTAINS DATA OF THE DOLLAR AMOUNT TURNED TO BAD DEBT WHERE A CHARITY CARE APPLICATION WAS SENT BUT NOT RETURNED AND WHEN CHARITY CARE APPLICATION WAS RETURNED BUT PATIENT DID NOT FULFILL FINANCIAL OBLIGATION. SUBSEQUENTLY, MULTIPLIED THAT AMOUNT BY THE COST-TO-CHARGE RATIO IDENTIFIED IN SCHEDULE H, PART I. | SCHEDULE H, PART III, LINE 4 |
| COLLECTION PRACTICES | WHEN A RESPONSIBLE PARTY IS UNABLE TO MEET THE FINANCIAL OBLIGATION GUIDELINES AS DESCRIBED IN THE HOSPITAL'S FINANCIAL POLICY, THE PARTY IS ADVISED OF THE AVAILABILITY OF CHARITY CARE OR FINANCIAL ASSISTANCE. CLARIFICATION IS MADE AS TO WHETHER THE PATIENT HAS PRIMARY INSURANCE. IF NO PRIMARY INSURANCE IS AVAILABLE IT IS EXPLAINED THAT PER THE POLICY AN APPLICATION TO MEDICAID IS REQUIRED BEFORE CHARITY CARE CAN BE CONSIDERED. IF MEDICAID DENIES ELIGIBILITY, A WRITTEN STATEMENT FROM MEDICAID IS REQUIRED. ONCE A MEDICAID ELIGIBILITY DENIAL IS RECEIVED A CHARITY CARE APPLICATION IS OFFERED. THE RESPONSIBLE PARTY IS REQUIRED TO COMPLETE A CHARITY CARE APPLICATION AND SUBMIT ALL DOCUMENTATION INDICATED (AS OUTLINED ON APPLICATION) IN ORDER FOR THE HOSPITAL TO DETERMINE CHARITY CARE ELIGIBILITY. IF AN APPLICATION IS NOT RETURNED AFTER 15-DAYS, A COURTESY EXTENSION OF 5 ADDITIONAL DAYS IS AUTHORIZED. AFTER THE 5-DAY EXTENSION AND CHARITY CARE APPLICATION ALONG WITH REQUIRED DOCUMENTATION IS NOT RECEIVED, FURTHER COLLECTION ACTION IS TAKEN. THE COLLECTION PROCESS CONTINUES UNTIL THE RESPONSIBLE PARTY CONTACTS A PATIENT FINANCIAL COUNSELOR OR RETURNS THE APPLICATION WITH REQUIRED DOCUMENTATION. ONCE A CHARITY CARE APPLICATION IS RECEIVED, IF NOT ALL THE REQUIRED FINANCIAL DOCUMENTATION (AS OUTLINED ON THE APPLICATION) ARE SUBMITTED, A COURTESY LETTER IS SENT TO THE RESPONSIBLE PARTY REQUESTING THE INFORMATION BE RETURNED WITHIN 15-DAYS IN ORDER TO BE CONSIDERED. IF THE REQUIRED DOCUMENTATION IS THEN SUBSEQUENTLY NOT RECEIVED WITHIN THOSE 15-DAYS AND NO CONTACT WITH THE PATIENT FINANCIAL COUNSELOR IS MADE, THE CHARITY CARE APPLICATION IS DENIED AND FURTHER COLLECTION ACTION IS TAKEN. | SCHEDULE H, PART III, LINE 9B |
| MAXIMUM AMOUNTS CHARGED TO FAP-ELIGIBLE INDIVIDUALS | No distinction made in charges between those individuals who do not have insurance covering an emergent situation or other medically necessary care. Subsequently, individual has right to apply for Financial Assistance. | SCHEDULE H, PART V, SECTION B, LINE 19D |
| NEEDS ASSESSMENT | Our current 12-bed hospital is located within the outer region of the Holton city limits. Our expanded facilities allow us to provide a broad range of healthcare services to all members of our community without regard to age, race, sex or financial constraints. Our Rehabilitation Services department provides a full-compliment of occupational and physical therapies, including a lymphedema management program and speech therapy. Our Cardiovascular Services department provides cardiac rehab, as well as performs pulmonary function procedures and stress tests, and provides one-on-one diabetes education and tobacco cessation counseling. Our Surgery department provides 24/7 surgical services. We have a large variety of specialty physicians who treat patients in the facility as well as perform many surgical procedures. Our Radiology department, in collaboration with St. Francis Hospital, provides mobile Nuclear Medicine testing on site. The facility also contracts with Shared Medical Services, Inc. to provide on-site mobile MRI testing. The Radiology department is also very proud to have a 32-slice CT scanner which provides high resolution images. A CT scanner with this capability is a rarity in a hospital of our size. Our hospital offers a full-service, 24-7 emergency department with a physician available at all times. We have transfer agreements with surrounding hospitals for those patients who present to the hospital Emergency Department and require care beyond our capabilities. Our 12-bed in-patient unit provides care to medical-surgical patients, sub-acute patients, pediatrics and geriatrics. We provide obstetrical and newborn care patient services which is becoming increasingly rare among rural hospitals. We are also licensed to provide Swingbed services, allowing patients to return to their home community to receive in-patient rehabilitation and recovery services. Holton Community Hospital has a full-service home health and hospice program. Our award-winning hospice delivers end of life care to patients of providers throughout northeast Kansas. Our Rural Health Clinic (Family Practice Associates) has two locations in Holton and Hoyt, Kansas. Our mix of five physicians, one Physician Assistant and two Advanced Registered Nurse Practitioners allows our community members to find a provider that best serves their health care needs. Seeing a need for sports medicine services within our local community, a contractual agreement was reached with the local school system, USD 336. Our Physician's Assistant, also a registered physical therapist, offers sports medicine services 2 afternoons per week at Holton High School. He also attends all home games, and away games as needed, to assist with possible injuries that might occur. In 2009, a Women's Health Task Force was formed to investigate possible new women's services at our facility. Through the Task Force's findings we have increased our available gynecological services to include an OB/GYN in our outpatient facility. We have also increased our OB services offered. We have been distributing Patient Satisfaction Surveys throughout our surgical, inpatient, outpatient, rural health clinic, emergency room and rehabilitation services for approximately 3 years. The results of these surveys are compiled monthly and are used to better our patient services. We have also established a surgical oversight committee that meets monthly on how to improve services and processes in the surgery department. This committee has recently held a dinner at which invited community members, some users of our services, and others, were given the opportunity to discuss their experience(s) at Holton Community Hospital, or their chosen facility. Holton Community Hospital staff has used the information gathered to better our surgical department. We are committed to providing quality healthcare to all members of our community. Because we are a small town hospital, a majority of our patients have a strong bond with our staff. This allows us to provide care that extends beyond just medical needs. The cost and difficulty in seeking care in other areas for our elderly and poor population reinforces the need for a strong community hospital. We strive to meet this need by providing all services possible. | SCHEDULE H, PART VI, LINE 2 |
| PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE | HOLTON COMMUNITY HOSPITAL POSTS SIGNS AT ITS REGISTRATION LOCATIONS REGARDING THE AVAILABILITY OF OUR FINANCIAL ASSISTANCE PROGRAM. THE AVAILABILITY OF A FINANCIAL ASSISTANCE PROGRAM IS ALSO IDENTIFIED ON ALL HOSPITAL PATIENT SERVICE RELATED LETTERS AND GUARANTOR STATEMENTS. ONCE A PATIENT CALLS TO INQUIRE ABOUT THE FINANCIAL ASSISTANCE PROGRAM THE PATIENT FINANCIAL COUNSELOR WORKS ONE-ON-ONE WITH THE PATIENTS OUTLINING THE REQUIREMENTS, DOCUMENTS NEEDED AND EXPLAINS OUR FINANCIAL ASSISTANCE PROGRAM IN DETAIL. | SCHEDULE H, PART VI, LINE 3 |
| COMMUNITY INFORMATION | HOLTON COMMUNITY HOSPITAL AND FAMILY PRACTICE ASSOCIATES PHYSICIAN'S CLINIC ARE THE PREMIERE HEALTHCARE PROVIDERS IN OUR COUNTY. LIKE OTHER RURAL HOSPITALS, HCH SERVES A HIGHER PERCENTAGE OF ELDERLY AND CHILDREN LIVING IN POVERTY WHILE THE COUNTY EXPERIENCES HIGHER LEVELS OF UNEMPLOYMENT AND LOWER INCOMES. ACCORDING TO A REPORT GENERATED BY THE KANSAS RURAL HEALTH OPTIONS PROJECT, RURAL INDIVIDUALS REPORT POORER OVERALL HEALTH AND MORE CHRONIC HEALTH CONDITIONS. ADDITIONALLY, RURAL COUNTIES SEE A HIGHER RATE OF UNINSURED INDIVIDUALS AND HAVE FEWER HEALTH CARE SERVICES AVAILABLE TO THEM. FINALLY, PEOPLE IN RURAL COMMUNITIES ARE MORE LIKELY TO DERIVE PART OF THEIR INCOME FROM THE HEALTHCARE INDUSTRY (EITHER DIRECTLY OR INDIRECTLY). JACKSON COUNTY HOLDS THE DESIGNATION OF BEING A HEALTH PROFESSIONAL SHORTAGE AREA (HPSA). THIS DESIGNATION COMES FROM THE KANSAS DEPARTMENT OF HEALTH AND ENVIRONMENT (KDHE) AND IDENTIFIES AREAS OF THE STATE THAT ARE MEDICALLY UNDERSERVED. ACCORDING TO THE WEBSITE, KANSASHEALTHMATTERS.ORG, EACH PHYSICIAN IN JACKSON COUNTY HAS A POTENTIAL 1,745 INDIVIDUALS TO PROVIDE CARE TO. ADDITIONALLY, THIS SAME WEBSITE NOTED THAT IN 2009 MORE THAN 15.9% OF OUR COUNTY HAS NO HEALTH INSURANCE. KANSASHEALTHMATTERS.ORG ALSO REPORTS THAT 12.5% OF JACKSON COUNTY, KANSAS CHILDREN UNDER THE AGE OF 18 WERE LIVING AT OR BELOW THE POVERTY LINE. (REPORTING PERIOD: 2006-2010) IN COMPARISON, ACCORDING TO THE US CENSUS BUREAU, AMERICAN COMMUNITY SURVEY REPORT FOR THE PERIOD 2007-2011, 9.5% OF JACKSON COUNTY RESIDENTS LIVED BELOW THE POVERTY LEVEL. THE SAME REPORT NOTED THE PER CAPITA PERSONAL INCOME OF JACKSON COUNTY RESIDENTS FROM 2006-2011 WAS APPROXIMATELY $24,200.00, COMPARED TO THE STATE'S PER CAPITA PERSONAL INCOME OF $26,425.00. ADDITIONALLY, IN A RECENT SURVEY COMPLETED BY THE UNIVERSITY OF WISCONSIN POPULATION HEALTH INSTITUTE AND THE ROBERT WOOD JOHNSON FOUNDATION, JACKSON COUNTY RANKED 44TH IN THE STATE ON THE HEALTH OF OUR COUNTY. JACKSON COUNTY SCORES BELOW STATE BENCHMARKS IN HEALTH CARE, HEALTHY BEHAVIORS AND SOCIAL AND ECONOMIC FACTORS. THERE IS NO CONTRADICTORY INFORMATION TO CHALLENGE THAT THERE ARE STILL 81 PRIMARY CARE PROVIDERS PER 100,000 RESIDENTS IN THE COUNTY (ACTUAL NUMBER: 11 PROVIDERS), BELOW THE STATE'S AVERAGES OF 115 AND THE TARGET RATE OF 151. | SCHEDULE H, PART VI, LINE 4 |
| PROMOTION OF COMMUNITY HEALTH | HOSPITAL EMPLOYEES ARE ENCOURAGED TO PARTICIPATE IN LOCAL COMMUNITY ACTIVITIES. EMPLOYEES ARE MEMBERS OF THE LOCAL CHAMBER OF COMMERCE; SERVE AS BOARD MEMBERS WITH SEVERAL LOCAL ORGANIZATIONS; BOARD MEMBERS OF A STATE ORGANIZATION PROMOTING THE PATIENT FINANCIAL SERVICES SEGMENT OF HEALTHCARE. EMPLOYEES ARE INVOLVED ON SEVERAL LEVELS WITH YOUTH PROGRAMS. EMPLOYEES PROVIDE INSERVICE TRAINING TO VARIOUS LOCAL AGENCIES ON HEALTH ORIENTED SUBJECTS SUCH AS MEDICAL ADMINISTRATION. | SCHEDULE H, PART VI, LINE 5 |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | false | SeverancePayment |
| Supplemental Nonqual Retire Plan | false | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | false | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | false | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | false | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | false | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | false | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | false | AnyNonFixedPayments |
| Initial Contract Exception | false | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (6 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| RONALD MARSHALL | |||||||||||||
| 136177 | 0 | 0 | 0 | 5801 | 0 | 7353 | 0 | 14286 | 0 | 163617 | 0 | 0 | 0 |
| CLINT M COLBERG | |||||||||||||
| 177507 | 0 | 0 | 0 | 1728 | 0 | 3683 | 0 | 19012 | 0 | 201930 | 0 | 0 | 0 |
| LEE R SCHNEE | |||||||||||||
| 187229 | 0 | 0 | 0 | 1634 | 0 | 3781 | 0 | 14012 | 0 | 206656 | 0 | 0 | 0 |
| MALIA S WARNER | |||||||||||||
| 197416 | 0 | 0 | 0 | 96 | 0 | 3397 | 0 | 20012 | 0 | 220921 | 0 | 0 | 0 |
| VANCE R LASSEY | |||||||||||||
| 189737 | 0 | 0 | 0 | 108 | 0 | 3796 | 0 | 14012 | 0 | 207653 | 0 | 0 | 0 |
| JOEL R HUTCHINS | |||||||||||||
| 175435 | 0 | 0 | 0 | 792 | 0 | 3281 | 0 | 4458 | 0 | 183966 | 0 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | RON MARSHALL COMPENSATION | Identifier |
| Return Reference | FORM 990, PART VII, SECTION A, LINE 1A AND SCHEDULE J, PART II | ReturnReference |
| Explanation | THE COMPENSATION BEING REPORTED FOR RON MARSHALL IS PAID BY ST. FRANCIS HEALTH CENTER WHICH IS PART OF THE MANAGEMENT CONTRACT. | Explanation |
Schedule L IRS990ScheduleL
Form990 Schedule L Part IV Form990ScheduleLPartIV
Name Of Interested Person NameOfInterestedPerson
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | SEE SCHEDULE L PART V | NamePerson |
Form990 Schedule L Part V Form990ScheduleLPartV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | BUSINESS TRANSACTIONS INVOLVING INTERESTED PERSONS | Identifier |
| Return Reference | SCHEDULE L, PART IV | ReturnReference |
| Explanation | (A) CODY UTZ (B) CODY UTZ IS THE DAUGHTER OF CATHLEEN REED WHO IS A BOARD MEMBER. (C) $ 74,186 (D) CODY UTZ IS AN EMPLOYEE OF RURAL HEALTH RESOURCES OF JACKSON COUNTY. (E) NO (A) KAY RASH (B) KAY RASH IS THE SISTER OF MARGARET PAGEL WHO IS A BOARD MEMBER. (C) $ 30,442 (D) KAY RASH IS AN EMPLOYEE OF RURAL HEALTH RESOURCES OF JACKSON COUNTY. (E) NO | Explanation |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (6 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| PROGRAM SERVICE ACCOMPLISHMENT | FORM 990, PART III, LINE 4A | HOLTON COMMUNITY HOSPITAL (HCH) IS A 12-BED CRITICAL ACCESS HOSPITAL IN A SMALL RURAL COMMUNITY. HCH OFFERS A WIDE RANGE OF SERVICES INCLUDING PHYSICAL THERAPY, OCCUPATIONAL THERAPY, SPEECH THERAPY, REGISTERED DIETICIAN SERVICES, MRI, MRA, NUCLEAR MEDICINE, CT SCAN ALONG WITH OTHER RADIOLOGY SERVICES, SURGERY, LABORATORY, A CERTIFIED DIABETIC EDUCATION PROGRAM, CARDIOVASCULAR SERVICES, CERTIFIED LYMPHEDEMA PROGRAM, AND WOUND CARE SERVICES AS WELL AS A VARIETY OF SPECIALTY PROVIDER SERVICES. THE HOSPITAL STAFF IS CERTIFIED TO TEACH OUTREACH SERVICES UNDER THE NATIONAL ARTHRITIS FOUNDATION EXERCISE PROGRAM. THE HOSPITAL ALSO OFFERS HOME HEALTH AND HOSPICE SERVICES. THE HOSPITAL PROVIDED 24/7 EMERGENCY ROOM SERVICES WITH 2,269 EMERGENCY ROOM VISITS RECORDED FROM 4/1/11 THROUGH 3/31/12. EMERGENCY ROOM SERVICES ARE SUPPORTED BY STAFF TRAINED IN ADVANCED CARDIAC LIFE SUPPORT, CPR, EMERGENCY NURSING PEDIATRICS, TRAUMA NURSING CORE CURRICULUM, AND PEDIATRIC ADVANCED LIFE SUPPORT. HOSPITAL IDENTIFIED 16,765 INPATIENT HOURS AND 1,797 OBSERVATION HOURS AND 229 EXTENDED RECOVERY HOURS OF CARE FROM 4/1/11 THROUGH 3/31/12. |
| MANAGEMENT DUTIES | FORM 990, PART VI, SECTION A, LINE 3 | RURAL HEALTH RESOURCES OF JACKSON COUNTY HOLDS A MANAGEMENT CONTRACT WITH SISTERS OF CHARITY OF LEAVENWORTH/ST. FRANCIS HEALTH CENTER, TOPEKA, KS. SISTERS OF CHARITY OF LEAVENWORTH APPOINTS A CHIEF EXECUTIVE OFFICER TO MANAGE DAY-TO-DAY OPERATIONS. |
| FORM 990 REVIEW PROCESS | FORM 990, PART VI, SECTION B, LINE 11B | AN INDEPENDENT ACCOUNTING FIRM PREPARES AND REVIEWS THE FORM 990. THE 990 IS THEN REVIEWED BY THE CEO AND CONTROLLER OF RURAL HEALTH RESOURCES OF JACKSON COUNTY (RHRJC). ANY QUESTIONS OR CONCERNS THAT ARISE ARE ADDRESSED WITH THE ACCOUNTING FIRM AND CORRECTIONS, CLARIFICATIONS OR REVISIONS ARE MADE AS NECESSARY. THE FINAL 990 WITH ALL REQUIRED SCHEDULES IS THEN PROVIDED TO ALL VOTING MEMBERS OF THE BOARD OF RHRJC PRIOR TO THE FILING OF THE 990. |
| CONFLICT OF INTEREST POLICY | FORM 990, PART VI, SECTION B, LINE 12C | UPON HIRE (OR IN THE CASE OF ELECTION OF BOARD MEMBERS) AND ANNUALLY THEREAFTER, THE CEO OR DESIGNEE(S) SHALL PROVIDE TO THE BOARD, STAFF AND EMPLOYED PROVIDERS OF RURAL HEALTH RESOURCES OF JACKSON COUNTY (RHRJC) A COPY OF THE CONFLICT OF INTEREST POLICY AND THE APPLICABLE CONFLICT OF INTEREST DISCLOSURE FORM. THESE DOCUMENTS WILL BE COMPLETED TO IDENTIFY ANY RELATIONSHIPS, POSITIONS, OR CIRCUMSTANCES IN WHICH IT IS BELIEVED A CONFLICT MAY ARISE. THE ANNUAL MONITORING AND REVIEW PROCESS WILL BE PART OF RHRJC'S CORPORATE COMPLIANCE PLAN. ANY POTENTIAL CONFLICT OF INTEREST CONCERNS THAT ARISE SHALL BE REPORTED BY THE CEO TO THE BOARD CHAIR. SHOULD THE CONCERN INVOLVE THE BOARD CHAIR, THE BOARD VICE-CHAIR WILL BE INFORMED INSTEAD. EACH BOARD MEMBER, STAFF MEMBER OR EMPLOYED PROVIDER SHALL FULLY DISCLOSE ANY AND ALL ACTUAL OR POTENTIAL CONFLICTS, DUALITY OF INTEREST OR RESPONSIBILITY INVOLVING INDIVIDUAL, PERSONAL, OR BUSINESS ISSUES WHICH MAY EXIST. IF THERE IS A CONFLICT, THE CONFLICTED INDIVIDUALS ABSTAIN FROM VOTING. |
| COMPENSATION REVIEW | FORM 990, PART VI, SECTION B, LINE 15A | THE BOARD OF DIRECTORS OF RURAL HEALTH RESOURCES OF JACKSON COUNTY, D.B.A. HOLTON COMMUNITY HOSPITAL, APPROVED IN MAY 2008 A MANAGEMENT CONTRACT WITH ST. FRANCIS HEALTH CENTER IN TOPEKA, KANSAS. AS PART OF THIS MANAGEMENT CONTRACT, THE CHIEF EXECUTIVE OFFICER OF HOLTON COMMUNITY HOSPITAL IS PROVIDED BY ST. FRANCIS. AS PART OF THE APPROVAL PROCESS THE BOARD DETERMINED THE CONTRACT PROVIDED SERVICES AND MANAGEMENT AT THE EQUIVALENT OF FAIR MARKET VALUE. |
| AVAILABILITY OF DOCUMENTS | FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. |