CLARA BARTON HOSPITAL ASSOCIATION INC HOISINGTON KANSAS: Form 990, tax year 2012
View the entire original 990 at ProPublica ↗
- Organization
- CLARA BARTON HOSPITAL ASSOCIATION INC HOISINGTON KANSAS (EIN 48-0576039)
- Tax period
- 2012-01-01 to 2012-12-31
- Filed
- 2013-11-13
- IRS object ID
- 201313179349304101
- Schema version
- 2012v2.1
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule D
- Schedule H
- Schedule J
- Schedule K
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2013-11-13T14:40:15-06:00 | Timestamp |
| Tax Period End Date | 2012-12-31 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 481026809 | EIN |
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Wendling Noe Nelson & Johnson LLC | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 534 S Kansas Ave Suite 1500 | AddressLine1 |
| City | Topeka | City |
| State | KS | State |
| ZIP Code | 666033491 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2012-01-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 480576039 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Clara Barton Hospital Association Inc | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | CLAR | NameControl |
| Phone | 6206532114 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 250 West 9th Street | AddressLine1 |
| City | Hoisington | City |
| State | KS | State |
| ZIP Code | 675441799 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Jim Blackwell | Name |
| Title | Chief Financial Officer | Title |
| Phone | 6206532114 | Phone |
| Date Signed | 2013-11-12 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Derek H Hart | Name |
| PTIN | P01054116 | PTIN |
| Phone | 7852334226 | Phone |
| Date Prepared | 2013-11-12 | DatePrepared |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2012 | TaxYear |
| Build TS | 2016-02-25 16:41:14Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | Jim Blackwell | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 250 West 9th Street | AddressLine1 |
| City | Hoisington | City |
| State | KS | State |
| ZIP Code | 675441799 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 17071164 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | www.clarabartonhospital.org | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1946 | YearFormation |
| State Legal Domicile | KS | StateLegalDomicile |
| Activity Or Mission Description | Provision of inaptient and outpatient hospital services, primary care services, and surgical services to residents of our service area. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 10 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 8 | NbrIndependentVotingMembers |
| Total Nbr Employees | 197 | TotalNbrEmployees |
| Total Nbr Volunteers | 13 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 61849 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 63906 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 16004838 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 16490844 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 81422 | InvestmentIncomePriorYear |
| Investment Income Current Year | 121773 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 304962 | OtherRevenuePriorYear |
| Other Revenue Current Year | 337734 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 16453071 | TotalRevenuePriorYear |
| Total Revenue Current Year | 17014257 | 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 | 8587140 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 9414491 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 63581 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 7622684 | OtherExpensePriorYear |
| Other Expenses Current Year | 7198005 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 16209824 | TotalExpensesPriorYear |
| Total Expenses Current Year | 16612496 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 243247 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 401761 | RevenuesLessExpensesCY |
| Total Assets BOY | 12123861 | TotalAssetsBOY |
| Total Assets EOY | 12384240 | TotalAssetsEOY |
| Total Liabilities BOY | 5893850 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 5391017 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 6230011 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 6993223 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | Clara Barton Hospital Association is dedicated to meeting the health care needs and improving the quality of life for the community we serve. We continually pursue clinical excellence in an atmosphere of caring and compassion. We are deeply committed to serving all in need within our resources. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 13997740 | Expense |
| Revenue | 16490844 | Revenue |
| Description | Clara Barton Hospital Association provided a wide range of health care services to residents of its service area including 3,031 patient days of inpatient care, 21,452 outpatient hospital visits and 25,842 visits to our primary care and surgical clinics. | Description |
| Total Program Service Expense | 13997740 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | 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 | 0 | ReportOtherLiabilities |
| Report Fin48 Footnote | 1 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 1 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 0 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 0 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 1 | Hospital |
| Financial Stmt Attached | 1 | FinancialStmtAttached |
| Grants To Organizations | 0 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 1 | TaxExemptBonds |
| Invest Tax Exempt Bonds | 0 | InvestTaxExemptBonds |
| Escrow Account | 0 | EscrowAccount |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuer |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 1 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 0 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 0 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 1 | RelatedEntity |
| Related Org Controlled Entity | 0 | RelatedOrgControlledEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 45 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 197 | 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 |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributions |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 10 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 8 | 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 | 0 | 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 | 0 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Jim Blackwell | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 6206532114 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 250 West 9th Street | AddressLine1 |
| City | Hoisington | City |
| State | KS | State |
| ZIP Code | 675441799 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (16 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 |
|---|---|---|---|---|---|---|---|
| Curt J Colson | |||||||
| President/CEO | 40.00 | X | X | 123099 | 0 | 32795 | |
| Jon Radke | |||||||
| Secretary | 1.00 | X | X | 0 | 0 | 0 | |
| Kathy Kaiser | |||||||
| Director | 1.00 | X | 0 | 0 | 0 | ||
| Troy Bailey | |||||||
| Chairman | 1.00 | X | X | 0 | 0 | 0 | |
| Paul Woydziak | |||||||
| Vice-Chariman | 1.00 | X | X | 0 | 0 | 0 | |
| Jean Cavanaugh | |||||||
| Director | 1.00 | X | 0 | 0 | 0 | ||
| Mike Aylward | |||||||
| Director | 1.00 | X | 0 | 0 | 0 | ||
| Joshua Durham | |||||||
| Director/Chief of Staff | 40.00 | X | 259710 | 0 | 33831 | ||
| Marla Mooney | |||||||
| Treasurer | 1.00 | X | X | 0 | 0 | 0 | |
| Taylor Klug | |||||||
| Director | 1.00 | X | 0 | 0 | 0 | ||
| James G Blackwell | |||||||
| Vice President/CFO | 40.00 | X | 103578 | 0 | 32205 | ||
| Ann R Taylor | |||||||
| Physician | 40.00 | 182661 | 0 | 16965 | X | ||
| Nathaniel Knackstedt | |||||||
| Physician | 40.00 | 221850 | 0 | 35689 | X | ||
| Robin Durrett | |||||||
| Surgeon | 40.00 | 349766 | 0 | 8154 | X | ||
| Timothy Webb | |||||||
| Physician | 40.00 | 199672 | 0 | 15432 | X | ||
| Phillip Barnes | |||||||
| Physician Assistant | 40.00 | 122136 | 0 | 29000 | X | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 1562472 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 204071 | TotalOtherCompensation |
| Number Individuals GT100 K | 13 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| Docs Who Care PA | |||||
| 1337 South Fountain Drive | Olathe | KS | 66061 | ER Physician Coverage | 358133 |
| Leslie M Landau DO PA | |||||
| PO Box 470 | Kirksville | MO | 63501 | Surgery | 313200 |
| Aramark Uniform Services | |||||
| 2275 Cassens Drive | Fenton | MO | 63026 | Laundry | 258290 |
| Allstaff Chtd | |||||
| 2000 Washington Street | Great Bend | KS | 67530 | Nursing | 160791 |
| Mobile Imaging Inc | |||||
| 3520 Lakin Ave | Great Bend | KS | 67530 | Sonography | 156304 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 10 | NumberOfContractorsGT100K |
| Related Organizations | 49060 | RelatedOrganizations |
| Government Grants | 11250 | GovernmentGrants |
| All Other Contributions | 3596 | AllOtherContributions |
| Total Contributions | 63906 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (5 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|
| Patient service revenue | 621990 | 16363291 | 16363291 |
| Purchase discounts and rebates | 621990 | 64877 | 64877 |
| Patient account interest | 621990 | 24141 | 24141 |
| Lab fair | 621990 | 21449 | 21449 |
| Miscellaneous | 621990 | 17086 | 17086 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 16490844 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 135850 | TotalRevenueColumn |
| Exclusion | $135,850 | ExclusionAmount |
Royalties Revenue RoyaltiesRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 268150 | TotalRevenueColumn |
| Exclusion | $268,150 | ExclusionAmount |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 22398 | Real |
Less Rental Expenses LessRentalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 3188 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 19210 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 19210 | TotalRevenueColumn |
| Exclusion | $19,210 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 3266 | Securities |
| Other | 36376 | Other |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 0 | Securities |
| Other | 53719 | Other |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 3266 | Securities |
| Other | -17343 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -14077 | TotalRevenueColumn |
| Exclusion | -$14,077 | ExclusionAmount |
Other Revenue Misc OtherRevenueMisc (2 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | ExclusionExclusionAmount |
|---|---|---|---|
| Cafeteria | 722210 | 47363 | $47,363 |
| Meals on wheels | 624210 | 3011 | $3,011 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 50374 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 17014257 | TotalRevenueColumn |
| Related Or Exempt Function Income | 16490844 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $459,507 | ExclusionAmount |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 585218 | Total |
| Program Services | 293541 | ProgramServices |
| Management And General | 291677 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 7511784 | Total |
| Program Services | 6449067 | ProgramServices |
| Management And General | 1013646 | ManagementAndGeneral |
| Fundraising | 49071 | Fundraising |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 112957 | Total |
| Program Services | 99413 | ProgramServices |
| Management And General | 12766 | ManagementAndGeneral |
| Fundraising | 778 | Fundraising |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 664659 | Total |
| Program Services | 601910 | ProgramServices |
| Management And General | 58149 | ManagementAndGeneral |
| Fundraising | 4600 | Fundraising |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 539873 | Total |
| Program Services | 452840 | ProgramServices |
| Management And General | 83721 | ManagementAndGeneral |
| Fundraising | 3312 | Fundraising |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 32108 | Total |
| Management And General | 32108 | ManagementAndGeneral |
Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1250 | Total |
| Management And General | 1250 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2444099 | Total |
| Program Services | 2223275 | ProgramServices |
| Management And General | 220759 | ManagementAndGeneral |
| Fundraising | 65 | Fundraising |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 70125 | Total |
| Program Services | 39130 | ProgramServices |
| Management And General | 30995 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 709754 | Total |
| Program Services | 604729 | ProgramServices |
| Management And General | 103084 | ManagementAndGeneral |
| Fundraising | 1941 | Fundraising |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 155246 | Total |
| Management And General | 155246 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 338000 | Total |
| Program Services | 282910 | ProgramServices |
| Management And General | 54161 | ManagementAndGeneral |
| Fundraising | 929 | Fundraising |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 35860 | Total |
| Program Services | 30628 | ProgramServices |
| Management And General | 5231 | ManagementAndGeneral |
| Fundraising | 1 | Fundraising |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 199374 | Total |
| Program Services | 199374 | ProgramServices |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 835507 | Total |
| Program Services | 676927 | ProgramServices |
| Management And General | 155906 | ManagementAndGeneral |
| Fundraising | 2674 | Fundraising |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 136112 | Total |
| Management And General | 136112 | ManagementAndGeneral |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral | FundraisingFundraising |
|---|---|---|---|---|
| Pharmacy supplies | 871270 | 871270 | ||
| Medical supplies | 619164 | 619164 | 0 | |
| Repairs and maintenance | 253387 | 240878 | 12304 | 205 |
| Minor equipment | 206725 | 130506 | 76216 | 3 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 290024 | Total |
| Program Services | 182178 | ProgramServices |
| Management And General | 107844 | ManagementAndGeneral |
| Fundraising | 2 | Fundraising |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 16612496 | Total |
| Program Services | 13997740 | ProgramServices |
| Management And General | 2551175 | ManagementAndGeneral |
| Fundraising | 63581 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 167448 | BOY |
| EOY | 987 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1608969 | BOY |
| EOY | 1227760 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1765385 | BOY |
| EOY | 1503193 | EOY |
Receivables From Officers Etc ReceivablesFromOfficersEtc
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 123111 | EOY |
Other Notes Loans Receivable Net OtherNotesLoansReceivableNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 1500 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 523689 | BOY |
| EOY | 511806 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 208392 | BOY |
| EOY | 210142 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 12575585 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 8566220 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4511879 | BOY |
| EOY | 4009365 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2173542 | BOY |
| EOY | 2947819 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5002 | BOY |
| EOY | 5547 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1159555 | BOY |
| EOY | 1843010 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 12123861 | BOY |
| EOY | 12384240 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1647331 | BOY |
| EOY | 1636884 | EOY |
Tax Exempt Bond Liabilities TaxExemptBondLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3740784 | BOY |
| EOY | 3480697 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 505735 | BOY |
| EOY | 273436 | EOY |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5893850 | BOY |
| EOY | 5391017 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5668498 | BOY |
| EOY | 6187195 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 299038 | BOY |
| EOY | 536138 | EOY |
Permanently Restricted Net Assets PermanentlyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 262475 | BOY |
| EOY | 269890 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6230011 | BOY |
| EOY | 6993223 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 12123861 | BOY |
| EOY | 12384240 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | 401761 | ReconcilationRevenueExpenses |
| Reconciliation Unrealized Invest | 80704 | ReconciliationUnrealizedInvest |
| Reconcilation Other Changes | 280747 | ReconcilationOtherChanges |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
FS Audited Basis FSAuditedBasis
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Statement Separate | X | FinancialStatementSeparate |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | 1 | AuditCommittee |
| Federal Grant Audit Required | 0 | 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 D IRS990ScheduleD
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 557102 | OtherCostOrOtherBasis |
| Depreciation | 377746 | Depreciation |
| Book Value | 179356 | BookValue |
Leasehold Improvements LeaseholdImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 6526626 | OtherCostOrOtherBasis |
| Depreciation | 4180046 | Depreciation |
| Book Value | 2346580 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 4455567 | OtherCostOrOtherBasis |
| Depreciation | 3515374 | Depreciation |
| Book Value | 940193 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 1036290 | OtherCostOrOtherBasis |
| Depreciation | 493054 | Depreciation |
| Book Value | 543236 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 4009365 | TotalOfBookValueLandBuildings |
Other Assets OtherAssets (4 entries)
| DescriptionDescription | Book ValueBookValue |
|---|---|
| Beneficial interest in net assets of CBH Foundation | 777098 |
| Deferred financing costs | 114769 |
| Accrued Interest receivable | 4101 |
| Estimated third-party payor settlements | 947042 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | 1843010 | TotalBookValueOtherAssets |
| Footnote In Part XIII | X | FootnoteInPartXIII |
| Tot Revenue Etc Audited Fincl Stmt | 17094961 | TotRevenueEtcAuditedFinclStmt |
| Net Unrealized Gains Investments | 80704 | NetUnrealizedGainsInvestments |
| Revenue Not Rptd F990 | 80704 | RevenueNotRptdF990 |
| Revenue Subtotal | 17014257 | RevenueSubtotal |
| Revenue Not Rptd On Fin Stmt | 0 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 17014257 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 16612496 | TotExpensesEtcAuditedFinclStmt |
| Expenses Not Rptd F990 | 0 | ExpensesNotRptdF990 |
| Expenses Subtotal | 16612496 | ExpensesSubtotal |
| Expenses Not Rptd On Fin Stmt | 0 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 16612496 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIII Form990ScheduleDPartXIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | Description of Uncertain Tax Positions Under FIN 48: | Identifier |
| Return Reference | Part X, Line 2: | ReturnReference |
| Explanation | The Hospital is a not-for-porfit corporation as described in Section 501(c)(3) of the Internal Revenue Code and is exempt from federal income taxes on related income pursuant to Sectin 501(a) of the code. Management is not aware of any uncertainties in income tax positions. Tax years ending on and before December 31, 2009, are not subject to examination by taxing authorities. | Explanation |
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 |
| Pcent300 | X | Pcent300 |
| Free Disc Care Medically Indigent | 1 | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | 1 | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | 0 | ExpensesExceededBudget |
| Annual Community Benefit Report | 0 | AnnualCommunityBenefitReport |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 282484 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 282484 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01700 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 857473 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 784571 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 72902 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00440 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 1139957 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 784571 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 355386 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.02140 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 1490 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 1490 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00010 | PercentOfTotalExpense |
Health Professions Education HealthProfessionsEducation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 7646 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 7646 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00050 | PercentOfTotalExpense |
Subsidized Health Services SubsidizedHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 3971974 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 3061998 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 909976 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.05480 | PercentOfTotalExpense |
Cash And In Kind Contributions CashAndInKindContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 3703 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 3703 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00020 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 3984813 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 3061998 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 922815 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.05560 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 5124770 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 3846569 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1278201 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.07700 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 1 | BadDebtExpenseReported |
| Bad Debt Expense | $508,718 | BadDebtExpenseAmount |
| Amount Attributable To | 50872 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 6173374 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 6112251 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | 61123 | 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 | Clara Barton Hospital | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 250 West 9th Street | AddressLine1 |
| City | Hoisington | City |
| State | KS | State |
| ZIP Code | 675441799 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | X | LicensedHospital |
| General Medical And Surgical | X | GeneralMedicalAndSurgical |
| Critical Access Hospital | X | CriticalAccessHospital |
| Er24 Hours | X | Er24Hours |
| Other | Physician clinics & rural health clinics | Other |
Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Clara Barton Hospital Association Inc | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
| Eligibility Criteria Explained | 1 | EligibilityCriteriaExplained |
| Uses FPG Free | 1 | UsesFPGFree |
| FPG Free Percent | 100.000000000000 | FPGFreePercent |
| Uses FPG Discounted | 1 | UsesFPGDiscounted |
| FPG Discount Percent | 300.000000000000 | FPGDiscountPercent |
| Explains Basis | 1 | ExplainsBasis |
| Income Level | X | IncomeLevel |
| Asset Level | X | AssetLevel |
| Medical Indigency | X | MedicalIndigency |
| Insurance Status | X | InsuranceStatus |
| Medicaid Medicare | X | MedicaidMedicare |
| Explains Application Method | 1 | ExplainsApplicationMethod |
| Includes Publicity Measures | 1 | IncludesPublicityMeasures |
| Posted On Website | X | PostedOnWebsite |
| Attached To Invoices | X | AttachedToInvoices |
| Posted In Admission Office | X | PostedInAdmissionOffice |
| Available On Request | X | AvailableOnRequest |
| Actions On Nonpayment | 1 | ActionsOnNonpayment |
| Collection Activities | 0 | CollectionActivities |
| Notify Upon Admission | X | NotifyUponAdmission |
| Notify Before Discharge | X | NotifyBeforeDischarge |
| Notified All Patients | X | NotifiedAllPatients |
| Documented Determination | X | DocumentedDetermination |
| Other Actions Taken | X | OtherActionsTaken |
| Nondiscrim Emergency Care Policy | 1 | NondiscrimEmergencyCarePolicy |
| Used Other Method | X | UsedOtherMethod |
| Amounts Generally Billed | 1 | AmountsGenerallyBilled |
| Gross Charges | 0 | 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 |
|---|---|---|---|---|
| Russell Family Medical Care | ||||
| 410 N Main Street Suite C | Russell | KS | 67665 | Rural health clinic |
| Clara Barton Hospital Surgical Clinic | ||||
| 1301 Jackson Street | Great Bend | KS | 67530 | Physician clinic |
Form990 Schedule H Part VI Form990ScheduleHPartVI (11 entries)
| ExplanationExplanation | IdentifierIdentifier |
|---|---|
| Part I, Line 7: Financial assistance at cost was determined by utilizing departmental cost-to-charge ratios for financial assistance provided in areas that are reported as subsidized health services. An overall cost-to-charge ratio derived from Worksheet 2 was used to determine the cost of financial assistance provided for services not reported as subsidized health services.Unreimbursed Medicaid costs were also determined using a blend of cost-to-charge ratios for certain services and an overall cost-to-charge ratio derived from Worksheet 2 for all other services.The cost of providing subsidized health services was determined using a cost-to-charge ratio for each service.Actual costs and revenues were utilized for all other items reported on line 7. | |
| Part I, Line 7g: Subsidized health services are comprised of services that the Hospital provides despite a financial loss to the organization. These services include the operation of a 24-hour emergency room and the operation of two rural health clinics. Costs attributable to physician clinics included on line 7(g), column (c) were $2,352,318 and unreimbursed costs attributable to physician clinics included on line 7(g), column (e) were $346,512. | |
| Part III, Line 4: The Hospital recognizes patient service revenue associated with services provided to patients who have third-party payor coverage on the basis of contractual rates for the services rendered. For uninsured patients that do not qualify for charity care, the Hospital recognizes revenue on the basis of its standard rates for services provided. On the basis of historical experience, a significant portion of the Hospital's uninsured patients will be unable or unwilling to pay for the services provided. Thus, the Hospital records a significant provision for bad debts related to uninsured patients in the period the services are provided.Bad debt expense at cost was determined by utilizing departmental cost-to-charge ratios for financial assistance provided in areas that are reported as subsidized health services. An overall cost-to-charge ratio derived from Worksheet 2 was applied to the charges deemed uncollectible during the year for all other services.Bad debt expense attributable to patients eligible under the organization's financial assistance policy was determined using an estimated 10% of total bad debts. The Hospital takes steps to assist individuals who are believed to qualify for financial assistance prior to writing accounts off as uncollectible.All non-reimbursed costs for treatment of patients in our community provides a community benefit since patients unwilling or unable to pay have received a valuable service at no cost or at a reduced cost to them. This improves the health of our community as a whole. | |
| Part III, Line 8: Medicare allowable costs were determined by using amounts from the Hospital's Medicare cost report as filed with the Medicare Administrative Contractor. The Medicare cost report apportions actual costs to the Medicare program using charges for ancillary services and patient days for nursing services. | |
| Part III, Line 9b: The collection policy states that the patient must cooperate with the Hospital to provide the information and documentation necessary to apply for other existing financial resources that may be available to pay for health care services, such as Medicaid. Then the information is gathered and assessed in order to determine eligibility for charity care. Whenever possible, prior to admission, the Hospital will conduct a pre-admission interview with the patient, the guarantor, and/or the patient's legal representative. Those patients who may qualify for financial assistance from a governmental program will be referred to the appropriate program, prior to the consideration for charity care. | |
| Part V, Section B, Line 18e: Clara Barton Hospital Association, Inc., notified all uninsured patients about the Hospital's charity care program by letter. | Clara Barton Hospital Association, Inc. |
| Part V, Section B, Line 20d: Discounts to billed charges were applied based on the income of FAP-eligible patients or guarantors. | Clara Barton Hospital Association, Inc. |
| Part V, Section B, Line 21: Discounts to billed charges were applied based on the income of FAP-eligible patients or guarantors. | Clara Barton Hospital Association, Inc. |
| Part VI, Line 3: There is signage posted at admissions desk. Patients are referred to a financial counselor at admission if they do not have insurance. The financial counselor also works with a Medicaid helper to try and get qualified patients register for the Medicaid program. Effort is made during billing of deductible and co-payment to see if patient can qualify for charity care. | |
| Part VI, Line 4: The community being served is located in central Kansas and consists of approximately 2,800 residents. The average household income is $32,993. 15.4% of the community residents live below federal poverty level, and 4.7% of the community residents live below 50% of the federal poverty level. Neighboring hospitals include one facilities in Ellinwood and Great Bend. They are approximately 18 and 11 miles away respectively. | |
| Part VI, Line 5: The Hospital's Board of Directors is elected from the community at large. This allows independent individuals who reside in the primary service area to serve as a director. The Hospital also extends medical staff privileges to all qualified physicians in the community. Any surplus in funds is retained by the Hospital and aids in improving overall patient care and facility maintenance. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Employment Contract | X | WrittenEmploymentContract |
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | 0 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 0 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 0 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 0 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 0 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 0 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (7 entries)
| TitleTitle | 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Curt J Colson | ||||||||||||||
| President/CEO | 120017 | 0 | 0 | 0 | 3082 | 0 | 3704 | 0 | 29091 | 0 | 155894 | 0 | 0 | 0 |
| Joshua Durham | ||||||||||||||
| Director/Chief of Staff | 259710 | 0 | 0 | 0 | 0 | 0 | 6914 | 0 | 26917 | 0 | 293541 | 0 | 0 | 0 |
| Ann R Taylor | ||||||||||||||
| Physician | 182661 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 16965 | 0 | 199626 | 0 | 0 | 0 |
| Nathaniel Knackstedt | ||||||||||||||
| Physician | 221850 | 0 | 0 | 0 | 0 | 0 | 6292 | 0 | 29397 | 0 | 257539 | 0 | 0 | 0 |
| Robin Durrett | ||||||||||||||
| Surgeon | 349766 | 0 | 0 | 0 | 0 | 0 | 7500 | 0 | 654 | 0 | 357920 | 0 | 0 | 0 |
| Timothy Webb | ||||||||||||||
| Physician | 199672 | 0 | 0 | 0 | 0 | 0 | 1887 | 0 | 13545 | 0 | 215104 | 0 | 0 | 0 |
| Phillip Barnes | ||||||||||||||
| Physician Assistant | 122136 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 29000 | 0 | 151136 | 0 | 0 | 0 |
Schedule K IRS990ScheduleK
Form990 Schedule K Part I Form990ScheduleKPartI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
Issuer Name IssuerName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Hoisington Public Building Commission Hoisington Kansas | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Issuer EIN | 486012386 | IssuerEIN |
| CUSIP Number | 000434661 | CUSIPNumber |
| Date Issued | 2006-03-23 | DateIssued |
| Issue Price | 5019230 | IssuePrice |
| Description Of Purpose | Refund outstanding bonds issued on 12/19/2000 and 2/27/2003 | DescriptionOfPurpose |
| Defeased | 0 | Defeased |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuer |
| Pool Financing | 0 | PoolFinancing |
Form990 Schedule K Part II Form990ScheduleKPartII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Amount Retired | 1470000 | AmountRetired |
| Total Proceeds | 5019230 | TotalProceeds |
| Issuance Costs From Proceeds | 97212 | IssuanceCostsFromProceeds |
| Credit Enhancement | 79389 | CreditEnhancement |
| Other Spent Proceeds | 4842629 | OtherSpentProceeds |
| Year Of Subst Completion | 2006 | YearOfSubstCompletion |
| Current Refunding | 1 | CurrentRefunding |
| Advance Refunding | 1 | AdvanceRefunding |
| Final Allocation Made | 1 | FinalAllocationMade |
| Adequate Books And Recds Maintaind | 1 | AdequateBooksAndRecdsMaintaind |
Form990 Schedule K Part III Form990ScheduleKPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Owning Bond Financed Property | 0 | OwningBondFinancedProperty |
| Any Lease Arrangements | 0 | AnyLeaseArrangements |
| Mngment Cntrct Bond Financd Prprty | 0 | MngmentCntrctBondFinancdPrprty |
| Any Research Agreements | 0 | AnyResearchAgreements |
| Bond Iss Meet Prvt Security Pay Test | 0 | BondIssMeetPrvtSecurityPayTest |
| Change In Use Bond Financed Prop | 0 | ChangeInUseBondFinancedProp |
| Non Qualified Bond Remed Procdrs | 0 | NonQualifiedBondRemedProcdrs |
Form990 Schedule K Part IV Form990ScheduleKPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Form8038 T Filed | 0 | Form8038TFiled |
| Rebate Not Due Yet | 0 | RebateNotDueYet |
| Exception To Rebate | 0 | ExceptionToRebate |
| No Rebate Due | 0 | NoRebateDue |
| Variable Rate Issue | 0 | VariableRateIssue |
| Hedge Identified In Books And Recds | 0 | HedgeIdentifiedInBooksAndRecds |
| Gross Proceeds Invested In GIC | 0 | GrossProceedsInvestedInGIC |
| Gross Proceeds Invested | 0 | GrossProceedsInvested |
| Written Proc To Monitor Reqs | 0 | WrittenProcToMonitorReqs |
Form990 Schedule K Part V Form990ScheduleKPartV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Proc To Undertk Corrective Action | 1 | ProcToUndertkCorrectiveAction |
Schedule L IRS990ScheduleL
Loan Table LoanTable
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | Timothy Webb | NamePerson |
| Relationship With Organization | Highly compensated employee | RelationshipWithOrganization |
| Purpose Of Loan | Recruitment | PurposeOfLoan |
| Loan From Organization | X | LoanFromOrganization |
| Original Principal | $138,500 | OriginalPrincipalAmount |
| Balance Due | 123111 | BalanceDue |
| Default | 0 | Default |
| Approved By Board | 1 | ApprovedByBoard |
| Written Agreement | 1 | WrittenAgreement |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Balance Due | 123111 | TotalBalanceDue |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (7 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| Form 990, Part VI, Section A, line 6 | Members of Clara Barton Hospital Foundation, Inc., are automatically members of Clara Barton Hospital Association, Inc. | |
| Form 990, Part VI, Section A, line 7a | Members of Clara Barton Hospital Association, Inc., elect members of the governing body. | |
| Form 990, Part VI, Section B, line 11 | Form 990 provided to governing body and reviewed prior to filing. | |
| Form 990, Part VI, Section B, line 12c | A conflict of interest disclosure form is provided to each Board Member and is reviewed annually. | |
| Form 990, Part VI, Section B, line 15a | The organization uses the KHA Salary Survey as a guide for determining CEO compensation with Board of Directors approval. The KHA Salary Survey is used by the CEO when determining compensation for other officers and key employees. | |
| Form 990, Part VI, Section C, line 19 | The organization makes its governing documents, conflict of interest policy, and financial statements available to the public upon written request. | |
| Form 990, Part XI, line 9: | Change in permanently restricted beneficial interest in Foundation 7,415. Change in temporarily restricted beneficial interest in Foundation 273,332. | Changes in Net Assets or Fund Balances: |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII
Name Of Disregarded Entity NameOfDisregardedEntity
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Clara Barton Hospital Foundation Inc | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO Box 25 | AddressLine1 |
| City | Hoisington | City |
| State | KS | State |
| ZIP Code | 67544 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 481077460 | EIN |
| Primary Activities | Provide support to the hospital. | PrimaryActivities |
| Legal Domicile State | KS | LegalDomicileState |
| Exempt Code Section | 501(c)(3) | ExemptCodeSection |
| Public Charity Status | 170(b)(1) | PublicCharityStatus |
| Controlled Org | 0 | ControlledOrg |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 0 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 1 | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | 1 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 0 | LoansOrGuaranteesFromOtherOrg |
| Dividends Related Organization | 0 | DividendsRelatedOrganization |
| Sale Of Assets To Other Org | 0 | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | 0 | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | 0 | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | 0 | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | 0 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 1 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 0 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 1 | SharingOfFacilities |
| Sharing Of Paid Employees | 1 | 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 |