GREELEY COUNTY HEALTH SERVICES INC: Form 990, tax year 2011
View the entire original 990 at ProPublica ↗
- Organization
- GREELEY COUNTY HEALTH SERVICES INC (EIN 30-0078435)
- Tax period
- 2011-01-01 to 2011-12-31
- Filed
- 2012-11-14
- IRS object ID
- 201203199349303155
- Schema version
- 2011v1.3
- 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 O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2012-11-14T11:30:30-06:00 | Timestamp |
| Tax Period End Date | 2011-12-31 | 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 | 1551 N WATERFRONT PKWY STE 300 | AddressLine1 |
| City | WICHITA | City |
| State | KS | State |
| ZIP Code | 672066601 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2011-01-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 300078435 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | GREELEY COUNTY HEALTH SERVICES | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| In Care Of Name | % JAMES L SMITH CFO | InCareOfName |
| Name Control | GREE | NameControl |
| Phone | 6203764221 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 506 THIRD STREET | AddressLine1 |
| City | TRIBUNE | City |
| State | KS | State |
| ZIP Code | 67879 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | JAMES L SMITH | Name |
| Title | CFO | Title |
| Date Signed | 2012-11-15 | DateSigned |
| Authorize Third Party | true | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | ELIZABETH S HOGAN | Name |
| Phone | 3162652811 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2011 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | JAMES L SMITH | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 506 THIRD STREET | AddressLine1 |
| City | TRIBUNE | City |
| State | KS | State |
| ZIP Code | 67879 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 8840008 | GrossReceipts |
| Group Return For Affiliates | false | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.MYGCHS.COM | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 2006 | YearFormation |
| State Legal Domicile | KS | StateLegalDomicile |
| Activity Or Mission Description | ADDRESS HEALTHCARE NEEDS THROUGH THE EFFECTIVE PARTNERING OF A COMPASSIONATE STAFF WITH QUALITY CARE. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 5 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 5 | NbrIndependentVotingMembers |
| Total Nbr Employees | 162 | TotalNbrEmployees |
| Total Nbr Volunteers | 5 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 638973 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 555449 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 8204297 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 7750388 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 2523 | InvestmentIncomePriorYear |
| Investment Income Current Year | 3732 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 648880 | OtherRevenuePriorYear |
| Other Revenue Current Year | 530439 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 9494673 | TotalRevenuePriorYear |
| Total Revenue Current Year | 8840008 | 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 | 6493409 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 5648123 | 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 | 3598419 | OtherExpensePriorYear |
| Other Expenses Current Year | 3688794 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 10091828 | TotalExpensesPriorYear |
| Total Expenses Current Year | 9336917 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | -597155 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | -496909 | RevenuesLessExpensesCY |
| Total Assets BOY | 5072991 | TotalAssetsBOY |
| Total Assets EOY | 4804022 | TotalAssetsEOY |
| Total Liabilities BOY | 1907894 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 2135834 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 3165097 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 2668188 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | SEE SCHEDULE O | MissionDescription |
| Significant New Program Services | false | SignificantNewProgramServices |
| Significant Change | false | SignificantChange |
| Expense | 1501379 | Expense |
| Revenue | 2487856 | Revenue |
| Description | A CRITICAL ACCESS HOSPITAL WITH 342 TOTAL ADMISSIONS IN 2011 | Description |
Activity2 Activity2
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 4504136 | Expense |
| Revenue | 4492911 | Revenue |
| Description | PROVIDING RURAL HEALTH CLINIC/OUTPATIENT SERVICES | Description |
Activity3 Activity3
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 1896478 | Expense |
| Revenue | 1283407 | Revenue |
| Description | PROVIDING LONG TERM CARE SERVICES FOR 9,380 RESIDENT PATIENT DAYS IN 2011 | Description |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expense | 7901993 | TotalProgramServiceExpense |
| Described In501 C3 | true | DescribedIn501C3 |
| Schedule B Required | true | ScheduleBRequired |
| Political Activities | false | PoliticalActivities |
| Lobbying Activities | true | LobbyingActivities |
| Subject To Proxy Tax | false | SubjectToProxyTax |
| Donor Advised Funds | false | DonorAdvisedFunds |
| Conservation Easements | false | ConservationEasements |
| Collections Of Art | false | CollectionsOfArt |
| Credit Counseling | false | CreditCounseling |
| Term Or Permanent Endowments | false | 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 | false | 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 | false | 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 | true | 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 | 20 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | true | ComplianceWithBackupWitholding |
| Number Of Employees | 162 | 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 | 5 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 5 | NumberIndependentVotingMembers |
| Family Or Business Relationship | true | 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 | false | RegularMonitoringEnforcement |
| Whistleblower Policy | true | WhistleblowerPolicy |
| Document Retention Policy | true | DocumentRetentionPolicy |
| Compensation Process CEO | true | CompensationProcessCEO |
| Compensation Process Other | true | CompensationProcessOther |
| Investment In Joint Venture | false | InvestmentInJointVenture |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | JAMES L SMITH CFO | NamePerson |
| Telephone Number | 6203764221 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 506 THIRD STREET | AddressLine1 |
| City | TRIBUNE | City |
| State | KS | State |
| ZIP Code | 67879 | 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 |
|---|---|---|---|---|---|---|---|
| STEVE MANGAN | |||||||
| DIRECTOR/CHAIR | 1.0 | X | X | 0 | 0 | 0 | |
| KENNETH ZERR | |||||||
| DIRECTOR/TREASURER | 1.0 | X | X | 0 | 0 | 0 | |
| SUSAN SCHNEIDER | |||||||
| DIRECTOR | 1.0 | X | 0 | 0 | 0 | ||
| DON SMITH | |||||||
| DIRECTOR | 1.0 | X | 0 | 0 | 0 | ||
| CINDY SCHNEIDER | |||||||
| DIRECTOR | 1.0 | X | 0 | 0 | 0 | ||
| DEBORAH LEHNER | |||||||
| CHIEF EXECUTIVE OFFICER | 40.0 | X | 104500 | 0 | 33994 | ||
| JAMES L SMITH | |||||||
| CHIEF FINANCIAL OFFICER | 40.0 | X | 105557 | 0 | 26996 | ||
| WILLIAM HARTLEY | |||||||
| INTERIM CHIEF EXEC. OFFICER | 40.0 | X | 16917 | 0 | 4364 | ||
| SHEILA SCHEFFE MD | |||||||
| PHYSICIAN | 40.0 | 170675 | 0 | 14993 | X | ||
| WENDEL ELLIS DO | |||||||
| PHYSICIAN | 40.0 | 331706 | 0 | 34668 | X | ||
| RANDALL FAHRENHOLTZ MD | |||||||
| PHYSICIAN | 40.0 | 240691 | 0 | 46792 | X | ||
| BRIAN MILLER | |||||||
| PHYSICAL THERAPY MGR | 40.0 | 104383 | 0 | 13830 | X | ||
| ROBIN LIU MD | |||||||
| PHYSICIAN | 40.0 | 147761 | 0 | 14533 | X | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 1222190 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 190170 | TotalOtherCompensation |
| Number Individuals GT100 K | 7 | NumberIndividualsGT100K |
| Formers Listed | false | FormersListed |
| Total Comp GT150 K | true | TotalCompGT150K |
| Compensation From Other Sources | false | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (2 entries)
| Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|
| QUORUM HEALTH RESOURCES | |
| MANAGEMENT SERVICES | 342228 |
| ANESTHESIA ASSOCIATES | |
| ANESTHESIA SERVICES | 187760 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 2 | NumberOfContractorsGT100K |
| Government Grants | 467451 | GovernmentGrants |
| All Other Contributions | 87998 | AllOtherContributions |
| Total Contributions | 555449 | TotalContributions |
Program Service Revenue ProgramServiceRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | NET PATIENT SERVICE REVENUE | Description |
| Business Code | 621110 | BusinessCode |
| Total Revenue Column | 7750388 | TotalRevenueColumn |
| Related Or Exempt Function Income | 7750388 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 7750388 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 3732 | TotalRevenueColumn |
| Exclusion | $3,732 | 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 | 1862 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 1862 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 1862 | TotalRevenueColumn |
| Exclusion | $1,862 | ExclusionAmount |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
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 | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome | ExclusionExclusionAmount |
|---|---|---|---|---|
| OUTSIDE SERVICES | 621110 | 450908 | 450908 | |
| EMPLOYEE/GUEST MEALS | 900099 | 62878 | 62878 | |
| MISCELLANEOUS INCOME | 900099 | 14791 | $14,791 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 528577 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 8840008 | TotalRevenueColumn |
| Related Or Exempt Function Income | 8264174 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $20,385 | ExclusionAmount |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
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 | 292328 | Total |
| Management And General | 292328 | ManagementAndGeneral |
Comp Disqual Persons CompDisqualPersons
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 4274043 | Total |
| Program Services | 3965864 | ProgramServices |
| Management And General | 308179 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 305283 | Total |
| Program Services | 283271 | ProgramServices |
| Management And General | 22012 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 471192 | Total |
| Program Services | 437217 | ProgramServices |
| Management And General | 33975 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 305277 | Total |
| Program Services | 283265 | ProgramServices |
| Management And General | 22012 | ManagementAndGeneral |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 342228 | Total |
| Management And General | 342228 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 16781 | Total |
| Management And General | 16781 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 113482 | Total |
| Management And General | 113482 | 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 | 929093 | Total |
| Program Services | 862101 | ProgramServices |
| Management And General | 66992 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 66733 | Total |
| Program Services | 7325 | ProgramServices |
| Management And General | 59408 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 963207 | Total |
| Program Services | 893755 | ProgramServices |
| Management And General | 69452 | ManagementAndGeneral |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Royalties Royalties
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 255320 | Total |
| Program Services | 236910 | ProgramServices |
| Management And General | 18410 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 35457 | Total |
| Program Services | 32900 | ProgramServices |
| Management And General | 2557 | 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 | 25715 | Total |
| Program Services | 23861 | ProgramServices |
| Management And General | 1854 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 52627 | Total |
| Program Services | 48832 | ProgramServices |
| Management And General | 3795 | ManagementAndGeneral |
Payments To Affiliates PaymentsToAffiliates
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 335062 | Total |
| Program Services | 310902 | ProgramServices |
| Management And General | 24160 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 87872 | Total |
| Program Services | 71412 | ProgramServices |
| Management And General | 16460 | ManagementAndGeneral |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| BAD DEBT EXPENSE | 176212 | 176212 | |
| REPAIRS & MAINTENANCE | 132295 | 122756 | 9539 |
| EQUIPMENT RENTAL | 52703 | 48903 | 3800 |
| MINOR EQUIPMENT | 47869 | 44417 | 3452 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 56138 | Total |
| Program Services | 52090 | ProgramServices |
| Management And General | 4048 | ManagementAndGeneral |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 9336917 | Total |
| Program Services | 7901993 | ProgramServices |
| Management And General | 1434924 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 243213 | BOY |
| EOY | 32023 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 73858 | BOY |
| EOY | 40131 | 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 | 1223799 | BOY |
| EOY | 1363937 | 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 | 106133 | BOY |
| EOY | 89202 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 153907 | BOY |
| EOY | 118709 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 4681684 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 1710664 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3262081 | BOY |
| EOY | 2971020 | 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 | 10000 | BOY |
| EOY | 189000 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5072991 | BOY |
| EOY | 4804022 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1410558 | BOY |
| EOY | 1316921 | 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 | 15000 | BOY |
| EOY | 235958 | EOY |
Tax Exempt Bond Liabilities TaxExemptBondLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | 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 | 0 | BOY |
| EOY | 0 | EOY |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 482336 | BOY |
| EOY | 582955 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1907894 | BOY |
| EOY | 2135834 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 235352 | BOY |
| EOY | -69877 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2929745 | BOY |
| EOY | 2738065 | EOY |
Permanently Restricted Net Assets PermanentlyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3165097 | BOY |
| EOY | 2668188 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5072991 | BOY |
| EOY | 4804022 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expenses | -496909 | ReconcilationRevenueExpenses |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | false | AccountantCompileOrReview |
| FS Audited | true | FSAudited |
| Audit Committee | true | 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 | |
| Form4720 Filed | false | Form4720Filed |
| 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 | false | GrantsOtherOrganizations |
| Direct Contact Legislators | false | DirectContactLegislators |
| Rallies Demonstrations | false | RalliesDemonstrations |
| Other Activities | true | OtherActivities |
| Other Activities | $472 | OtherActivitiesAmount |
| Total Lobbying Expenditures IIB | 472 | TotalLobbyingExpendituresIIB |
| Not Described In501c3 | false | NotDescribedIn501c3 |
| Form4720 Filed4912 Tax | false | Form4720Filed4912Tax |
Form990 Schedule C Part IV Form990ScheduleCPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | LOBBYING EXPENSES | Identifier |
| Return Reference | SCHEDULE C, PART II-B, LINE 1i | ReturnReference |
| Explanation | A PORTION OF DUES PAID TO THE KHA AND AHA WAS FOR LOBBYING AND ADVOCACY. | Explanation |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Art Public Exhibition Amts | ArtPublicExhibitionAmts | |
| Held Works Of Art Amts | HeldWorksOfArtAmts | |
| Agent Trustee Etc | false | AgentTrusteeEtc |
| Included On FS | false | IncludedOnFS |
| Current Year Minus3 Years | CurrentYearMinus3Years |
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 49851 | OtherCostOrOtherBasis |
| Book Value | 49851 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 3600737 | OtherCostOrOtherBasis |
| Depreciation | 1004320 | Depreciation |
| Book Value | 2596417 | BookValue |
Leasehold Improvements LeaseholdImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 11585 | OtherCostOrOtherBasis |
| Depreciation | 5514 | Depreciation |
| Book Value | 6071 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 1019511 | OtherCostOrOtherBasis |
| Depreciation | 700830 | Depreciation |
| Book Value | 318681 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 0 | OtherCostOrOtherBasis |
| Depreciation | 0 | Depreciation |
| Book Value | 0 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 2971020 | TotalOfBookValueLandBuildings |
| Federal Income Tax Liability | 0 | FederalIncomeTaxLiability |
| Total Of Amounts | 0 | TotalOfAmounts |
| Total Revenue | 8840008 | TotalRevenue |
| Total Expenses | 9336917 | TotalExpenses |
| Excess Or Deficit For Year | -496909 | ExcessOrDeficitForYear |
| Excess Or Deficit Per FS | -496909 | ExcessOrDeficitPerFS |
| Tot Revenue Etc Audited Fincl Stmt | 8611169 | TotRevenueEtcAuditedFinclStmt |
| Revenue Subtotal | 8611169 | RevenueSubtotal |
| Other Revenues Not Included | 228839 | OtherRevenuesNotIncluded |
| Revenue Not Rptd On Fin Stmt | 228839 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 8840008 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 9108078 | TotExpensesEtcAuditedFinclStmt |
| Expenses Subtotal | 9108078 | ExpensesSubtotal |
| Other Expenses Not Included | 228839 | OtherExpensesNotIncluded |
| Expenses Not Rptd On Fin Stmt | 228839 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 9336917 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV (3 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| UNCERTAIN TAX POSITIONS | 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. |
| RECONCILIATION OF REVENUE | SCHEDULE D, PART XII, LINE 4B | BAD DEBT EXPENSE $176,212 RECLASSED TO EXPENSE 52,627 ------- $228,839 |
| RECONCILIATION OF EXPENSES | SCHEDULE D, PART XIII, LINE 4B | BAD DEBT EXPENSE $176,212 RECLASSED FROM REVENUE 52,627 ------- $228,839 |
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 | true | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | true | ExpensesExceededBudget |
| Unable To Provide Care | false | UnableToProvideCare |
| Annual Community Benefit Report | false | AnnualCommunityBenefitReport |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 182773 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 182773 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01960 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 910251 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 960998 | DirectOffsettingRevenue |
| Net Community Benefit Expense | -50747 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00000 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 1093024 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 960998 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 132026 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01960 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 1500 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 1500 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00020 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 1500 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 1500 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00020 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 1094524 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 960998 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 133526 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01980 | PercentOfTotalExpense |
Health Improvement Advocacy HealthImprovementAdvocacy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 4 | NumberOfActivitiesOrPrograms |
| Persons Served | 250 | PersonsServed |
| Total Community Building Expense | 1500 | TotalCommunityBuildingExpense |
Total Total
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 4 | NumberOfActivitiesOrPrograms |
| Persons Served | 250 | PersonsServed |
| Total Community Building Expense | 1500 | TotalCommunityBuildingExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | false | BadDebtExpenseReported |
| Bad Debt Expense | $176,212 | BadDebtExpenseAmount |
| Amount Reimbursed By Medicare | 3152059 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 3120538 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | 31521 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost Accounting System | X | CostAccountingSystem |
| 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 | GREELEY COUNTY HEALTH SERVICES | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 506 THIRD STREET | AddressLine1 |
| City | TRIBUNE | City |
| State | KS | State |
| ZIP Code | 67879 | 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 |
Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | GREELEY COUNTY HEALTH SERVICES | 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 |
| Insurance Status | X | InsuranceStatus |
| Uninsured Discount | X | UninsuredDiscount |
| Medicaid Medicare | X | MedicaidMedicare |
| State Regulation | X | StateRegulation |
| Explains Application Method | true | ExplainsApplicationMethod |
| Includes Publicity Measures | true | IncludesPublicityMeasures |
| Posted In Emergency Room | X | PostedInEmergencyRoom |
| Posted In Admission Office | X | PostedInAdmissionOffice |
| Provided On Admission | X | ProvidedOnAdmission |
| Available On Request | X | AvailableOnRequest |
| Actions On Nonpayment | true | ActionsOnNonpayment |
| Collection Activities | false | CollectionActivities |
| Notify Upon Admission | X | NotifyUponAdmission |
| Notify Before Discharge | X | NotifyBeforeDischarge |
| Notified All Patients | X | NotifiedAllPatients |
| Documented Determination | X | DocumentedDetermination |
| Nondiscrim Emergency Care Policy | true | NondiscrimEmergencyCarePolicy |
| Used Other Method | X | UsedOtherMethod |
| Amounts Generally Billed | false | AmountsGenerallyBilled |
| Gross Charges | false | GrossCharges |
Form990 Schedule H Part VI Form990ScheduleHPartVI (10 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| PERCENTAGE CALCULATION | SCHEDULE H, PART I, LINE 7, COLUMN F | THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $176,212. |
| COSTING METHODOLOGY | 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. |
| BAD DEBT EXPENSE | SCHEDULE H, PART III, SECTION A, LINE 4 | 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 UNCOLLECTIBLE ACCOUNTS BASED UPON A REVIEW OF OUTSTANDING RECEIVABLES, HISTORICAL COLLECTION INFORMATION AND EXISTING ECONOMIC CONDITIONS. THE HOSPITAL HAS AGREEMENTS WITH THIRD-PARTY PAYERS THAT PROVIDE FOR PAYMENTS TO THE HOSPITAL AT AMOUNTS DIFFERENT FROM ITS ESTABLISHED RATES. NET PATIENT SERVICE REVENUE IS REPORTED AT THE ESTIMATED NET REALIZABLE AMOUNTS FROM PATIENTS, THIRD-PARTY PAYERS AND OTHERS FOR SERVICES RENDERED AND INCLUDES ESTIMATED RETROACTIVE REVENUE ADJUSTMENTS AND A PROVISION FOR UNCOLLECTIBLE ACCOUNTS. RETROACTIVE ADJUSTMENTS ARE CONSIDERED IN THE RECOGNITION OF REVENUE ON AN ESTIMATED BASIS IN THE PERIOD THE RELATED SERVICES ARE RENDERED AND SUCH ESTIMATED AMOUNTS ARE REVISED IN FUTURE PERIODS AS ADJUSTMENTS BECOME KNOWN. |
| MEDICARE | SCHEDULE H, PART III, SECTION B, LINE 8 | THE ANNUAL MEDICARE COST REPORT IS THE SOURCE FOR THE COSTING METHODOLOGY FOR SCHEDULE H, PART III, SECTION B, LINE 6. |
| COLLECTION PRACTICES | SCHEDULE H, PART III, SECTION C, LINE 9B | THE ACCOUNTS OF UNINSURED OR UNDERINSURED PATIENTS WHO HAVE APPLIED FOR MEDICAL ASSISTANCE OR FINANCIAL ASSISTANCE ARE HELD WITHOUT FURTHER COLLECTION ACTION, UNTIL THE APPLICATION PROCESS HAS BEEN COMPLETED. |
| CHARGES FOR MEDICAL CARE | SCHEDULE H, PART V, LINE 19 | GREELEY COUNTY HEALTH SERVICES USES THE SAME GROSS CHARGE FOR ALL PATIENTS SEEKING EMERGENCY OR OTHER MEDICALLY NECESSARY CARE REGARDLESS OF THE PRIMARY PAYOR AND/OR FAP ELIGIBILITY. ALL FAP-ELIGIBLE PATIENTS RECEIVE A SLIDING FEE SCHEDULE DISCOUNT BETWEEN 20% AND 100% BASED ON INCOME GUIDELINES. |
| NEEDS ASSESSMENT | SCHEDULE H, PART VI, LINE 2 | GREELEY COUNTY HEALTH SERVICES USES LOCAL AND STATE BASED DATA TO ASSIST ITS MEDICAL STAFF IN ASSESSING THE HEALTH CARE NEEDS OF THE COMMUNITIES IT SERVES AND PROVIDES BASIC FAMILY BASED PRIMARY CARE. |
| PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE | SCHEDULE H, PART VI, LINE 3 | ALL PATIENTS PRESENTING TO OUR FACILITY WHO ARE UNINSURED/UNDERINSURED ARE PRESENTED WITH THE OPPORTUNITY FOR FINANCIAL ASSISTANCE. A PATIENT FINANCIAL ASSISTANCE COUNSELOR IS AVAILABLE FULL TIME FOR INQUIRIES & CONSULTING REGARDING ALL AVAILABLE FINANCIAL AID PROGRAMS. |
| COMMUNITY INFORMATION | SCHEDULE H, PART VI, LINE 4 | THE COMMUNITY IS A FRONTIER, RURAL COMMUNITY IN WESTERN KANSAS. THE RURAL POPULATION AMONG THE THREE COUNTIES SERVED BY THE FACILITY IS APPROXIMATELY 3,000 PEOPLE. THE SERVICE AREA COVERS 8,000 SQUARE MILES. THE AREA IS PREDOMINANTLY AGRICULTURAL BASED. |
| PROMOTION OF COMMUNITY HEALTH | SCHEDULE H, PART VI, LINE 5 | THE FACILITY DOES HAVE AN OPEN MEDICAL STAFF WITH SUPPORTING MID-LEVEL PRACTITIONERS, A COUNTY GOVERNMENT APPOINTED COMMUNITY BOARD THAT RECEIVES APPROXIMATELY 3% SUPPORT FROM LOCAL TAX APPROPRIATIONS, AND HOLDS NUMEROUS COMMUNITY ACTIVITIES SUCH AS HEALTH FAIRS, FREE FLU SHOT CLINICS, AND NUMEROUS HEALTH AND WELLNESS ACTIVITIES TO PROMOTE COMMUNITY HEALTH. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Employment Contract | X | WrittenEmploymentContract |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| 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 (4 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|
| SHEILA SCHEFFE MD | |||||||||||
| 170675 | 0 | 0 | 0 | 0 | 0 | 8134 | 0 | 6859 | 0 | 185668 | 0 |
| WENDEL ELLIS DO | |||||||||||
| 331706 | 0 | 0 | 0 | 0 | 0 | 11850 | 0 | 22818 | 0 | 366374 | 0 |
| RANDALL FAHRENHOLTZ MD | |||||||||||
| 240691 | 0 | 0 | 0 | 0 | 0 | 28134 | 0 | 18658 | 0 | 287483 | 0 |
| ROBIN LIU MD | |||||||||||
| 147761 | 0 | 0 | 0 | 0 | 0 | 6988 | 0 | 7545 | 0 | 162294 | 0 |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (6 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| ORGANIZATION'S MISSION | FORM 990, PART III, LINE 1 | GREELEY COUNTY HEALTH SERVICES STRIVES TO ADDRESS THE HEALTHCARE NEEDS OF THE REGION THROUGH THE EFFECTIVE PARTNERING OF A COMPASSIONATE STAFF WITH QUALITY CARE ROOTED IN THE CONTINUOUS PURSUIT OF BEST PRACTICES. WE UTILIZE APPROPRIATE TECHNOLOGY TO MINIMIZE THE EFFECTS OF CHRONIC DISEASE, FOCUS ON PROVIDING PREVENTIVE MEDICINE AND TREAT EACH PATIENT'S MIND, BODY AND SOUL WITHIN THE FAMILY MEDICINE SPECTRUM OF CARE. |
| FAMILY RELATIONSHIP | FORM 990, PART VI, SECTION A, LINE 2 | SUSAN SCHNEIDER AND CINDY SCHNEIDER HAVE A FAMILY RELATIONSHIP. |
| MANAGEMENT DUTIES | FORM 990, PART VI, SECTION A, LINE 13 | GREELEY COUNTY HEALTH SERVICES HOLDS A MANAGEMENT CONTRACT WITH QUORUM HEALTH RESOURCES OF BRENTWOOD, TENNESSEE. QUORUM HEALTH RESOURCES APPOINTS A CHIEF EXECUTIVE OFFICER AND A CHIEF FINANCIAL OFFICER TO MANAGE DAY-TO-DAY OPERATIONS AND FINANCIAL RESPONSIBILITIES. |
| FORM 990 REVIEW PROCESS | FORM 990, PART VI, SECTION B, LINE 11B | AN INDEPENDENT ACCOUNTING FIRM PREPARES THE FORM 990. THE CFO THEN REVIEWS THE COMPLETE FORM 990 AND ALL REQUIRED SCHEDULES. ANY QUESTIONS OR CONCERNS ARE ADDRESSED AND ANY NECESSARY CHANGES ARE MADE PRIOR TO FILING. THE FORM 990 WITH ALL REQUIRED SCHEDULES IS THEN PROVIDED TO THE ENTIRE BOARD BEFORE FILING WITH THE IRS. |
| COMPENSATION REVIEW | FORM 990, PART VI, SECTION B, LINES 15A & 15B | THE BOARD OF DIRECTORS AND QUORUM HEALTH RESOURCES REVIEW BOTH THE CEO'S AND CFO'S COMPENSATION ANNUALLY. COMPARISON DATA FROM SIMILAR ORGANIZATIONS IS USED TO DETERMINE ANY PAY INCREASES. ALL DELIBERATIONS AND DECISIONS ARE DOCUMENTED. |
| AVAILABILITY OF DOCUMENTS | FORM 990, PART VI, SECTION C, LINE 19 | THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND AUDITED FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. |
Schedule R IRS990ScheduleR
Form990 Schedule R Part I Form990ScheduleRPartI
Name Of Disregarded Entity NameOfDisregardedEntity
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SOUTHWIND HEALTH RESOURCES | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 514 BROADWAY | AddressLine1 |
| City | TRIBUNE | City |
| State | KS | State |
| ZIP Code | 67879 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 262767444 | EIN |
| Primary Activities | HEALTHCARE | PrimaryActivities |
| Legal Domicile State | KS | LegalDomicileState |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | NA | BusinessNameLine1 |