AMBERWELL ATCHISON ASSOCIATION: Form 990, tax year 2009
View the entire original 990 at ProPublica ↗
- Organization
- AMBERWELL ATCHISON ASSOCIATION (EIN 48-0561974)
- Tax period
- 2009-10-01 to 2010-09-30
- Filed
- 2011-08-15
- IRS object ID
- 201122279349304092
- Schema version
- 2009v1.7
- 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 K
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2011-08-15T16:28:10-04:00 | Timestamp |
| Tax Period End Date | 2010-09-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BKD LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1201 Walnut Suite 1700 | AddressLine1 |
| City | Kansas City | City |
| State | MO | State |
| ZIP Code | 641062246 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2009-10-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 480561974 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Atchison Hospital Association | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | ATCH | NameControl |
| Phone | 9133605584 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 800 Raven Hill Drive | AddressLine1 |
| City | Atchison | City |
| State | KS | State |
| ZIP Code | 66002 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | JOHN L JACOBSON | Name |
| Title | CEO | Title |
| Phone | 9133605584 | Phone |
| Date Signed | 2011-08-15 | DateSigned |
| Authorize Third Party | true | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Michael J Engle | Name |
| Phone | 8162216300 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2009 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | JOHN L JACOBSON | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 800 RAVEN HILL DRIVE | AddressLine1 |
| City | ATCHISON | City |
| State | KS | State |
| ZIP Code | 66002 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 31937103 | GrossReceipts |
| Group Return For Affiliates | false | GroupReturnForAffiliates |
| Organization501c | X | Organization501c |
| Web Site | WWW.ATCHISONHOSPITAL.ORG | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1912 | YearFormation |
| State Legal Domicile | KS | StateLegalDomicile |
| Activity Or Mission Description | TO PROVIDE EXCELLENT HEALTH CARE AND IMPROVE THE QUALITY OF LIFE IN OUR COMMUNITY | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 7 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 7 | NbrIndependentVotingMembers |
| Total Nbr Employees | 356 | TotalNbrEmployees |
| Total Nbr Volunteers | 6 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 1660877 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 122678 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 28307878 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 31165822 | ProgramServiceRevenueCY |
| Investment Income Prior Year | -32648 | InvestmentIncomePriorYear |
| Investment Income Current Year | 27408 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 656770 | OtherRevenuePriorYear |
| Other Revenue Current Year | 480725 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 30592877 | TotalRevenuePriorYear |
| Total Revenue Current Year | 31796633 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 3217000 | 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 | 15970492 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 17904607 | 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 | 19524289 | OtherExpensePriorYear |
| Other Expenses Current Year | 18184122 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 38711781 | TotalExpensesPriorYear |
| Total Expenses Current Year | 36088729 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | -8118904 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | -4292096 | RevenuesLessExpensesCY |
| Total Assets BOY | 62470726 | TotalAssetsBOY |
| Total Assets EOY | 50938335 | TotalAssetsEOY |
| Total Liabilities BOY | 49780337 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 41974964 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 12690389 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 8963371 | NetAssetsOrFundBalancesEOY |
| Mission Description | TO PROVIDE EXCELLENT HEALTH CARE AND IMPROVE THE QUALITY OF LIFE IN OUR COMMUNITY | MissionDescription |
| Significant New Program Services | false | SignificantNewProgramServices |
| Significant Change | false | SignificantChange |
| Expense | 29380816 | Expense |
| Grants | 0 | Grants |
| Revenue | 31165822 | Revenue |
| Description | ATCHISON HOSPITAL PROVIDED ACUTE INPATIENT AND OUTPATIENT HEALTH SERVICES TO THE GENERAL PUBLIC. SERVICES INCLUDE BUT ARE NOT LIMITED TO: EMERGENCY SERVICES, HOME HEALTH & HOSPICE, GENERAL INPATIENT ACUTE SERVICES, RADIOLOGY & OBSTETRICS. NUMBER OF PEOPLE SERVED DURING FISCAL YEAR ENDING 09/30/2010 WERE 77,797. | Description |
| Total Program Service Expense | 29380816 | TotalProgramServiceExpense |
| Described In501 C3 | true | DescribedIn501C3 |
| Schedule B Required | true | ScheduleBRequired |
| Political Activities | false | PoliticalActivities |
| Lobbying Activities | true | LobbyingActivities |
| Donor Advised Funds | false | DonorAdvisedFunds |
| Conservation Easements | false | ConservationEasements |
| Collections Of Art | false | CollectionsOfArt |
| Credit Counseling | false | CreditCounseling |
| Term Or Permanent Endowments | false | TermOrPermanentEndowments |
| Balance Sheet Amounts Reported | true | BalanceSheetAmountsReported |
| Independent Audit Financial Stmt | false | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | true | 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 |
| Grants To Organizations | false | GrantsToOrganizations |
| Grants To Individuals | false | GrantsToIndividuals |
| Schedule J Required | true | ScheduleJRequired |
| Tax Exempt Bonds | true | TaxExemptBonds |
| Invest Tax Exempt Bonds | false | InvestTaxExemptBonds |
| Escrow Account | false | EscrowAccount |
| On Behalf Of Issuer | false | OnBehalfOfIssuer |
| 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 | false | DisregardedEntity |
| Related Entity | true | RelatedEntity |
| Related Org Controlled Entity | true | RelatedOrgControlledEntity |
| Transfers To Exempt Non Chrtbl Org | false | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | false | ActivitiesConductedPartnership |
| Schedule O Required | true | ScheduleORequired |
| Number Forms Transmitted With1096 | 19 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | true | ComplianceWithBackupWitholding |
| Number Of Employees | 356 | 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 |
| Nbr Voting Governing Body Members | 7 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 7 | NumberIndependentVotingMembers |
| Family Or Business Relationship | false | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | false | DelegationOfManagementDuties |
| Changes To Organizing Docs | false | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuse |
| Members Or Stockholders | false | MembersOrStockholders |
| Election Of Board Members | false | ElectionOfBoardMembers |
| Decisions Subject To Approval | false | DecisionsSubjectToApproval |
| Minutes Of Governing Body | true | MinutesOfGoverningBody |
| Minutes Of Committees | true | MinutesOfCommittees |
| Officer Mailing Address | false | OfficerMailingAddress |
| Local Chapters | false | LocalChapters |
| Form990 Provided To Governing Body | true | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | true | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | true | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | true | RegularMonitoringEnforcement |
| Whistleblower Policy | true | WhistleblowerPolicy |
| Document Retention Policy | true | DocumentRetentionPolicy |
| Compensation Process CEO | true | CompensationProcessCEO |
| Compensation Process Other | false | CompensationProcessOther |
| Investment In Joint Venture | false | InvestmentInJointVenture |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | JOHN L JACOBSON | NamePerson |
| Telephone Number | 9133605584 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 800 RAVEN HILL DRIVE | AddressLine1 |
| City | ATCHISON | City |
| State | KS | State |
| ZIP Code | 66002 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (14 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 |
|---|---|---|---|---|---|---|---|
| JOHN L JACOBSON | |||||||
| DIRECTOR/CEO | 40.0 | X | X | 185225 | 0 | 38116 | |
| JOHN SETTICH | |||||||
| DIRECTOR/CHAIRPERSON | 1.0 | X | X | 0 | 0 | 0 | |
| BOB ADRIAN | |||||||
| DIRECTOR | 1.0 | X | 0 | 0 | 0 | ||
| MARK WINDSOR | |||||||
| DIRECTOR/TREASURER | 1.0 | X | X | 0 | 0 | 0 | |
| LOUISE REGENSTIEN | |||||||
| DIRECTOR | 1.0 | X | 0 | 0 | 0 | ||
| WILLIAM THORNTON | |||||||
| DIRECTOR | 1.0 | X | 0 | 0 | 0 | ||
| DENNIS GARRETT | |||||||
| DIRECTOR/SECRETARY | 1.0 | X | X | 0 | 0 | 0 | |
| LORNE ARCHER | |||||||
| CFO | 40.0 | X | 101561 | 0 | 9981 | ||
| CHARLENE CLAUSE | |||||||
| CNO | 40.0 | X | 112288 | 0 | 12869 | ||
| CHAD JOHANNING MD | |||||||
| PHYSICIAN | 40.0 | 165184 | 0 | 5311 | X | ||
| MICHAEL JONES MD | |||||||
| PHYSICIAN | 40.0 | 236284 | 0 | 16419 | X | ||
| JON SIEBERT MD | |||||||
| PHYSICIAN | 40.0 | 214469 | 0 | 28495 | X | ||
| AARON SINCLAIR MD | |||||||
| PHYSICIAN | 40.0 | 289497 | 0 | 16477 | X | ||
| DINA SEIBERT MD | |||||||
| PHYSICIAN | 32.0 | 131121 | 0 | 16163 | X | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 1435629 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 143831 | TotalOtherCompensation |
| Number Individuals GT100 K | 14 | NumberIndividualsGT100K |
| Formers Listed | false | FormersListed |
| Total Comp GT150 K | true | TotalCompGT150K |
| Compensation From Other Sources | false | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|
| JE DUNN | |
| CONSTRUCTION | 849446 |
| MSI SYSTEMS | |
| CONSTRUCTION | 491201 |
| MARLATT CONSTRUCTION INC | |
| CONSTRUCTION | 413285 |
| WATERSTONE BENEFIT ADMIN | |
| TPA | 339660 |
| LABCORP | |
| REFERENCE LAB | 249864 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 13 | NumberOfContractorsGT100K |
| Related Organizations | 23200 | RelatedOrganizations |
| Government Grants | 12454 | GovernmentGrants |
| All Other Contributions | 87024 | AllOtherContributions |
| Total Contributions | 122678 | TotalContributions |
Program Service Revenue ProgramServiceRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | NET PATIENT SERVICE REVENUE | Description |
| Business Code | 621400 | BusinessCode |
| Total Revenue Column | 31165822 | TotalRevenueColumn |
| Related Or Exempt Function Income | 31165822 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 31165822 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 911 | TotalRevenueColumn |
| Exclusion | $911 | ExclusionAmount |
Income From Invest Bond Proceeds IncomeFromInvestBondProceeds
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 26497 | TotalRevenueColumn |
| Exclusion | $26,497 | ExclusionAmount |
Royalties Revenue RoyaltiesRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 90160 | Real |
Less Rental Expenses LessRentalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 140470 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | -50310 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -50310 | TotalRevenueColumn |
| Exclusion | -$50,310 | 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 | ExclusionExclusionAmount |
|---|---|---|---|
| DIETARY SERVICES | 722210 | 102963 | $102,963 |
| AMBULANCE TAX APPORTIONMENT | 621910 | 322000 | $322,000 |
| MEDIMATE REVENUE | 621400 | 79706 | $79,706 |
Miscellaneous Revenue MiscellaneousRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 26366 | TotalRevenueColumn |
| Exclusion | $26,366 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 531035 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 31796633 | TotalRevenueColumn |
| Related Or Exempt Function Income | 31165822 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $508,133 | 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 | 449028 | Total |
| Management And General | 449028 | 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 | 13580938 | Total |
| Program Services | 12178020 | ProgramServices |
| Management And General | 1402918 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 176045 | Total |
| Program Services | 150494 | ProgramServices |
| Management And General | 25551 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2720309 | Total |
| Program Services | 2325479 | ProgramServices |
| Management And General | 394830 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 978287 | Total |
| Program Services | 836297 | ProgramServices |
| Management And General | 141990 | ManagementAndGeneral |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 125464 | Total |
| Management And General | 125464 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 99000 | Total |
| Management And General | 99000 | 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 | 1858880 | Total |
| Program Services | 1395565 | ProgramServices |
| Management And General | 463315 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 91810 | Total |
| Program Services | 68927 | ProgramServices |
| Management And General | 22883 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3074275 | Total |
| Program Services | 3074275 | ProgramServices |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 280846 | Total |
| Program Services | 210847 | ProgramServices |
| Management And General | 69999 | ManagementAndGeneral |
Royalties Royalties
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 716438 | Total |
| Program Services | 537870 | ProgramServices |
| Management And General | 178568 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 117629 | Total |
| Management And General | 117629 | ManagementAndGeneral |
Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1713907 | Total |
| Management And General | 1713907 | ManagementAndGeneral |
Payments To Affiliates PaymentsToAffiliates
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3251046 | Total |
| Program Services | 2440742 | ProgramServices |
| Management And General | 810304 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 571365 | Total |
| Program Services | 428956 | ProgramServices |
| Management And General | 142409 | ManagementAndGeneral |
Other Expenses OtherExpenses (5 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| BAD DEBT | 5252061 | 5252061 | |
| IMPAIRMENT OF BUILDING | 355148 | 355148 | |
| REPAIRS & MAINTENANCE | 595808 | 447306 | 148502 |
| DUES AND SUBSCRIPTIONS | 46067 | 46067 | |
| MISCELLANEOUSE EXPENSE | 34378 | 33977 | 401 |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 36088729 | Total |
| Program Services | 29380816 | ProgramServices |
| Management And General | 6707913 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 390769 | BOY |
| EOY | 402074 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2925199 | BOY |
| EOY | 381603 | EOY |
Pledges And Grants Receivable PledgesAndGrantsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 108507 | BOY |
| EOY | 52467 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4957087 | BOY |
| EOY | 5256222 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 569426 | BOY |
| EOY | 586780 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 460879 | BOY |
| EOY | 344513 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 50307486 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 11279276 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 39385219 | BOY |
| EOY | 39028210 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 12491950 | BOY |
| EOY | 3383091 | EOY |
Investments Program Related InvestmentsProgramRelated
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 41986 | BOY |
| EOY | 35462 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1139704 | BOY |
| EOY | 1467913 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 62470726 | BOY |
| EOY | 50938335 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 7135985 | BOY |
| EOY | 3089679 | EOY |
Grants Payable GrantsPayable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3217000 | BOY |
| EOY | 0 | EOY |
Tax Exempt Bond Liabilities TaxExemptBondLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 37135000 | BOY |
| EOY | 36030132 | EOY |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 923644 | BOY |
| EOY | 1545440 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1368708 | BOY |
| EOY | 1309713 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 49780337 | BOY |
| EOY | 41974964 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 12438668 | BOY |
| EOY | 8767689 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 251721 | BOY |
| EOY | 195682 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 12690389 | BOY |
| EOY | 8963371 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 62470726 | BOY |
| EOY | 50938335 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | false | AccountantCompileOrReview |
| FS Audited | true | FSAudited |
| Audit Committee | true | AuditCommittee |
| Financial Statement Consolidated | X | FinancialStatementConsolidated |
| Federal Grant Audit Required | false | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Grassroots Lobbying | TotalGrassrootsLobbying | |
| Total Direct Lobbying | TotalDirectLobbying | |
| Total Lobbying Expenditures | TotalLobbyingExpenditures | |
| Other Exempt Purpose Expenditures | OtherExemptPurposeExpenditures | |
| Total Exempt Purpose Expenditures | TotalExemptPurposeExpenditures | |
| Lobbying Nontaxable | LobbyingNontaxableAmount | |
| Grassroots Nontaxable | GrassrootsNontaxableAmount | |
| Tot Lobbying Grassroot Minus Non Tx | TotLobbyingGrassrootMinusNonTx | |
| Tot Lobby Expend Mns Lobbying Nontx | TotLobbyExpendMnsLobbyingNontx | |
| Volunteers | false | Volunteers |
| Paid Staff Or Management | false | PaidStaffOrManagement |
| Media Advertisements | false | MediaAdvertisements |
| Mailings Members | false | MailingsMembers |
| Publications Or Broadcast | false | PublicationsOrBroadcast |
| Grants Other Organizations | true | GrantsOtherOrganizations |
| Grants Other Organizations | $6,871 | GrantsOtherOrganizationsAmount |
| Direct Contact Legislators | false | DirectContactLegislators |
| Rallies Demonstrations | false | RalliesDemonstrations |
| Other Activities | false | OtherActivities |
| Total Lobbying Expenditures IIB | 6871 | TotalLobbyingExpendituresIIB |
| Not Described In501c3 | false | NotDescribedIn501c3 |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Art Public Exhibition Amts | ArtPublicExhibitionAmts | |
| Held Works Of Art Amts | HeldWorksOfArtAmts |
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 1069320 | OtherCostOrOtherBasis |
| Book Value | 1069320 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 15341417 | OtherCostOrOtherBasis |
| Depreciation | 10144689 | Depreciation |
| Book Value | 5196728 | BookValue |
Leasehold Improvements LeaseholdImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 123901 | OtherCostOrOtherBasis |
| Depreciation | 0 | Depreciation |
| Book Value | 123901 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 30832021 | OtherCostOrOtherBasis |
| Depreciation | 1019885 | Depreciation |
| Book Value | 29812136 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 2940827 | OtherCostOrOtherBasis |
| Depreciation | 114702 | Depreciation |
| Book Value | 2826125 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 39028210 | TotalOfBookValueLandBuildings |
| Federal Income Tax Liability | 0 | FederalIncomeTaxLiability |
Other Liabilities OtherLiabilities (3 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| DUE TO AFFILIATE | $1,082,106 |
| ASSET RETIREMENT OBLIGATION | $0 |
| Deferred Compensation | $227,607 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 1309713 | TotalOfAmounts |
| Total Revenue | 31796633 | TotalRevenue |
| Total Expenses | 36088729 | TotalExpenses |
| Excess Or Deficit For Year | -4292096 | ExcessOrDeficitForYear |
| Other | $621,117 | OtherAmount |
| Total Adjustments | 621117 | TotalAdjustments |
| Excess Or Deficit Per FS | -3670979 | ExcessOrDeficitPerFS |
| Tot Revenue Etc Audited Fincl Stmt | 31931786 | TotRevenueEtcAuditedFinclStmt |
| Other Revenues | 178253 | OtherRevenues |
| Revenue Not Rptd F990 | 178253 | RevenueNotRptdF990 |
| Revenue Subtotal | 31753533 | RevenueSubtotal |
| Other Revenues Not Included | 43100 | OtherRevenuesNotIncluded |
| Revenue Not Rptd On Fin Stmt | 43100 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 31796633 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 36232986 | TotExpensesEtcAuditedFinclStmt |
| Other Expenses Included | 187357 | OtherExpensesIncluded |
| Expenses Not Rptd F990 | 187357 | ExpensesNotRptdF990 |
| Expenses Subtotal | 36045629 | ExpensesSubtotal |
| Other Expenses Not Included | 43100 | OtherExpensesNotIncluded |
| Expenses Not Rptd On Fin Stmt | 43100 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 36088729 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV (4 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| UNCERTAIN TAX POSITIONS DISCLOSURE | SCHEDULE D, PART X, LINE 2 | MANAGEMENT HAS EVALUATED THEIR INCOME TAX POSITIONS UNDER THE GUIDANCE INCLUDED IN ASC 740. BASED ON THEIR REVIEW, MANAGEMENT HAS NOT IDENTIFIED ANY MATERIAL UNCERTAIN TAX POSITIONS TO BE RECORDED OR DISCLOSED IN THE FINANCIAL STATEMENTS |
| RECONCILIATION OF CHANGE IN NET ASSETS | SCHEDULE D, PART XI, LINE 8 | CONTRIBUTIONS FOR PROPERTY ACQUISITIONS $ 565,078 ASSETS RELEASED FROM RESTRICTION $ 56,039 --------- $ 621,117 |
| RECONCILIATION OF REVENUE PER AUDITED FINANCIAL STATEMENTS | SCHEDULE D, PART XII, LINES 2D & 4B | LINE 2D: RENTAL PROPERTY EXPENSES $ 140,470 RELATED ORGANIZATION'S REVENUE $ 37,783 --------- $ 178,253 LINE 4B: ELIMINATIONS $ 43,100 |
| RECONCILIATION OF EXPENSES PER AUDITED FINANCIAL STATEMENTS | SCHEDULE D, PART XII, LINES 2D & 4B | LINE 2D: RENTAL PROPERTY EXPENSES $ 140,470 RELATED ORGANIZATION'S EXPENSES $ 46,887 --------- $ 187,357 LINE 4B: ELIMINATIONS $ 43,100 |
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 |
| Pcent300 | X | Pcent300 |
| 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 | 549584 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 0 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 549584 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01520 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 4342179 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 2486708 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1855471 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.05140 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 4891763 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 2486708 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 2405055 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.06660 | PercentOfTotalExpense |
Subsidized Health Services SubsidizedHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 2636357 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 0 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 0 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.07310 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 2636357 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 0 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 0 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.07310 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 7528120 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 2486708 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 2405055 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.13970 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | false | BadDebtExpenseReported |
| Bad Debt Expense | $2,636,357 | BadDebtExpenseAmount |
| Amount Attributable To | 0 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 13413364 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 14043137 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | -629773 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | X | CostToChargeRatio |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | true | WrittenDebtCollectionPolicy |
| Provision For Charity Care | true | ProvisionForCharityCare |
Form990 Schedule H Part V Form990ScheduleHPartV (3 entries)
| Address Line1Address/AddressLine1 | CityAddress/City | StateAddress/State | ZIP CodeAddress/ZIPCode | Licensed HospitalLicensedHospital | General Medical And SurgicalGeneralMedicalAndSurgical | Critical Access HospitalCriticalAccessHospital | Er24 HoursEr24Hours | OtherOther |
|---|---|---|---|---|---|---|---|---|
| ATCHISON HOSPITAL | ||||||||
| 800 RAVEN HILL DRIVE | ATCHISON | KS | 66002 | X | X | X | X | |
| FAMILY MEDICAL CENTER OF TROY | ||||||||
| 311 W LOCUST | TROY | KS | 66087 | RURAL HEALTH CLINIC | ||||
| FAMILY MEDICAL CENTER OF EFFINGHAM | ||||||||
| 5120 MAIN ST | EFFINGHAM | KS | 66023 | RURAL HEALTH CLINIC | ||||
Form990 Schedule H Part VI Form990ScheduleHPartVI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Costing Method Used | 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 CALCULATED USING WORKSHEET 2. | CostingMethodUsed |
| Percent Of Total Expense Expln | 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 $5,252,061. | PercentOfTotalExpenseExpln |
| Bad Debt Footnote | RCC. THE MAJORITY OF THESE ARE FROM PATIENTS THAT ENTER THE FACILITY SERVICE STREAM THROUGH THE EMERGENCY DEPARTMENT. AS A COMMUNITY HOSPITAL, WE TREAT ALL PATIENTS PRESENTING AT THE ED WITHOUT REGARD TO ABILITY TO PAY. | BadDebtFootnote |
| Shortfall As Community Benefit | THE MEDICARE SHORTFALL SHOULD NOT BE TREATED AS A COMMUNITY BENEFIT COST. THE COSTING METHODOLOGY CONSISTED OF INFORMATION FROM THE HOSPITAL'S ACCOUNTING SYSTEM AS WELL AS COSTS FROM THE MEDICARE COST REPORT. | ShortfallAsCommunityBenefit |
| Debt Collection Policy | THE HOSPITAL DOES NOT PURSUE COLLECTION OF AMOUNTS DETERMINED TO BE CHARITY CARE. | DebtCollectionPolicy |
| Needs Assessment | ACCESS TO KANSAS HEALTH INITIATIVE SURVEY ON HEALTH INDICATORS | NeedsAssessment |
| Patient Education Assistance | PAMPHLET AT ADMISSION, CONTACT WITH SELF-PAY COLLECTION AND COLLECTION AGENCY SERVICES | PatientEducationAssistance |
| Community Information | NORTHEAST KANSAS AND SOUTHERN BUCHANAN COUNTY, MISSOURI | CommunityInformation |
| Community Building Activities | HEALTH FAIR WITH EDUCATIONAL, COMMUNITY HEALTH/WELLNESS/SUPPORT ORGANIZATION INFORMATION, AND HEALTH SCREENINGS. | CommunityBuildingActivities |
| Other Information | OPEN MEDICAL STAFF, VOLUNTEER COMMUNITY BOARD, SURPLUS FUNDS ARE RE-INVESTED IN EQUIPMENT AND/OR NEW/EXPANSION OF HEALTH-RELATED PROGRAMS | OtherInformation |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Club Dues Or Fees | X | ClubDuesOrFees |
| Written Policy Re T And E Expenses | true | WrittenPolicyReTAndEExpenses |
| Substantiation Required | true | SubstantiationRequired |
| Independent Consultant | X | IndependentConsultant |
| Written Employment Contract | X | WrittenEmploymentContract |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | false | SeverancePayment |
| Supplemental Nonqual Retire Plan | true | 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 | true | AnyNonFixedPayments |
| Initial Contract Exception | false | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (5 entries)
| Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| JOHN L JACOBSON | |||||||||||||
| 170125 | 0 | 15100 | 0 | 0 | 0 | 28552 | 0 | 9564 | 0 | 223341 | 0 | 0 | 0 |
| CHAD JOHANNING MD | |||||||||||||
| 162299 | 0 | 0 | 0 | 2885 | 0 | 0 | 0 | 5311 | 0 | 170495 | 0 | 0 | 0 |
| MICHAEL JONES MD | |||||||||||||
| 236284 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 16419 | 0 | 252703 | 0 | 0 | 0 |
| JON SIEBERT MD | |||||||||||||
| 214469 | 0 | 0 | 0 | 0 | 0 | 12100 | 0 | 16395 | 0 | 242964 | 0 | 0 | 0 |
| AARON SINCLAIR MD | |||||||||||||
| 286292 | 0 | 0 | 0 | 3205 | 0 | 0 | 0 | 16477 | 0 | 305974 | 0 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII (3 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| HEALTH OR SOCIAL CLUB DUES OR INITIATION FEES | SCHEDULE J, PART I, LINE 1A | SOCIAL CLUB DUES WERE PAID BY THE HOSPITAL FOR JOHN L. JACOBSON, LORNE ARCHER, AND CHARLENE CLAUSE AND WERE NOT INCLUDED IN THEIR W-2'S AS TAXABLE COMPENSATION BECAUSE THEY WERE USED 100% FOR BUSINESS. |
| SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN | SCHEDULE J, PART I, LINE 4B | JOHN L. JACOBSON $ 23,052 |
| Non-Fixed Payments for Officers or Directors | SCHEDULE J, PART I, LINE 7 | Officers are eligible for Bonus payments annually based on pre-determined goal attainment AND ACTUAL/BUDGET COMPARISON OF THE HOSPITAL. |
Schedule K IRS990ScheduleK
Form990 Schedule K Part I Form990ScheduleKPartI (3 entries)
| Issuer EINIssuerEIN | CUSIP NumberCUSIPNumber | Date IssuedDateIssued | Issue PriceIssuePrice | Description Of PurposeDescriptionOfPurpose | DefeasedDefeased | On Behalf Of IssuerOnBehalfOfIssuer |
|---|---|---|---|---|---|---|
| CITY OF ATCHISON | ||||||
| 486025033 | 046687AW9 | 2008-09-23 | 10000000 | REPLACEMENT OF FACILITIES | false | false |
| CITY OF ATCHISON | ||||||
| 486025033 | 046687AW9 | 2008-09-23 | 7500000 | REDEMPTION OF SERIES 2007 BOND | false | false |
| CITY OF ATCHISON | ||||||
| 486025033 | 046687CA5 | 2009-06-30 | 17620000 | REPLACEMENT OF FACILITIES | false | false |
Form990 Schedule K Part II Form990ScheduleKPartII (3 entries)
| Total ProceedsTotalProceeds | Amount In Reserve FundAmountInReserveFund | Amount DefeasedAmountDefeased | Amount UnspentAmountUnspent | Issuance Costs From ProceedsIssuanceCostsFromProceeds | Working Capital ExpendituresWorkingCapitalExpenditures | Capital ExpendituresCapitalExpenditures | Year Of Subst CompletionYearOfSubstCompletion | Current RefundingCurrentRefunding | Advance RefundingAdvanceRefunding | Final Allocation MadeFinalAllocationMade | Adequate Books And Recds MaintaindAdequateBooksAndRecdsMaintaind |
|---|---|---|---|---|---|---|---|---|---|---|---|
| 10000000 | 0 | 0 | 0 | 206983 | 0 | 0 | 2008 | false | false | true | true |
| 7500000 | 0 | 0 | 0 | 156373 | 0 | 0 | 2008 | true | false | true | true |
| 17620000 | 0 | 0 | 0 | 396323 | 0 | 0 | 2009 | false | false | true | true |
Form990 Schedule K Part III Form990ScheduleKPartIII (3 entries)
| Owning Bond Financed PropertyOwningBondFinancedProperty | Any Lease ArrangementsAnyLeaseArrangements | Mngment Cntrct Bond Financd PrprtyMngmentCntrctBondFinancdPrprty | Any Research AgreementsAnyResearchAgreements | Bond Counsel Routinely EngagedBondCounselRoutinelyEngaged | Prcntge Prvt Business Use By OthersPrcntgePrvtBusinessUseByOthers | Percentage Of Prvt Business Re UBIPercentageOfPrvtBusinessReUBI | Total Private Business UseTotalPrivateBusinessUse | Post Issuance Compliance ProcdrsPostIssuanceComplianceProcdrs |
|---|---|---|---|---|---|---|---|---|
| false | false | false | false | true | 0.00000 | 0.00000 | 0.00000 | true |
| false | false | false | false | true | 0.00000 | 0.00000 | 0.00000 | true |
| false | false | false | false | true | 0.00000 | 0.00000 | 0.00000 | true |
Form990 Schedule K Part IV Form990ScheduleKPartIV (3 entries)
| Form8038 T FiledForm8038TFiled | Variable Rate IssueVariableRateIssue | Hedge Identified In Books And RecdsHedgeIdentifiedInBooksAndRecds | Gross Proceeds Invested In GICGrossProceedsInvestedInGIC | Gross Proceeds InvestedGrossProceedsInvested | Exception To RebateExceptionToRebate |
|---|---|---|---|---|---|
| false | false | false | false | false | false |
| false | false | false | false | false | false |
| false | false | false | false | false | false |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (5 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| FORM 990 REVIEW PROCESS | FORM 990, PART VI, SECTION B, LINE 11A | AN INDEPENDENT ACCOUNTING FIRM PREPARES AND REVIEWS THE 990. THE 990 IS THEN REVIEWED BY THE ORGANIZATION'S MANAGEMENT. ANY QUESTIONS AND CONCERNS THE ORGANIZATION'S MANAGEMENT HAVE ARE ADDRESSED AND ANY CORRECTIONS OR CLARIFICATIONS ARE MADE. THE 990 IS THEN REVIEWED BY THE HOSPITAL FINANCE COMMITTEE. ANY QUESTIONS AND CONCERNS THE FINANCE COMMITTEE HAVE ARE ADDRESSED AND ANY CORRECTIONS OR CLARIFICATIONS ARE MADE. THE 990 IS THEN REVIEWED BY THE BOARD OF DIRECTORS, ANY CORRECTIONS OR CONCERNS THE BOARD HAVE ARE ADDRESSED PRIOR TO FILING. |
| CONFLICT OF INTEREST POLICY | FORM 990, PART VI, SECTION B, LINE 12C | AT THE TIME OF ELECTION OR HIRE AND ANNUALLY THEREAFTER, THE GOVERNING BOARD MEMBERS, OFFICERS, AND KEY EMPLOYEES SHALL PROVIDE THE APPLICABLE CONFLICT OF INTEREST DISCLOSURES WHICH SHALL BE COMPLETED TO IDENTIFY ANY RELATIONSHIPS, POSITIONS, OR CIRCUMSTANCES IN WHICH IT IS BELIEVED A CONFLICT MAY ARISE. IF A CONFLICT ARISES, THE BOARD MEMBER ABSTAINS FROM THE VOTE OF THE CONFLICTED POSITION. |
| COMPENSATION REVIEW | FORM 990, PART VI, SECTION B, LINES 15A & B | LINE 15A: IN 2010, THE ORGANIZATION CONSULTED AN INDEPENDENT FIRM TO PREPARE A COMPENSATION DATA STUDY. THE INDEPENDENT BOARD OF DIRECTORS TOOK THE INFORMATION FROM THE COMPENSATION STUDY AND USED IT TO REVIEW AND ADJUST THE CEO'S COMPENSATION. ANY DECISION THAT IS MADE IN REGARDS TO THE CEO'S COMPENSATION IS DOCUMENTED BY THE BOARD OF DIRECTORS. LINE 15B: THE CEO AND HUMAN RESOURCE DIRECTOR CONDUCTS AN ANNUAL REVIEW OF OTHER OFFICERS AND KEY EMPLOYEES' COMPENSATION BASED ON COMPARABLE DATA OF OTHER ORGANIZATION OF A SIMILAR SIZE AND INDUSTRY. |
| AVAILABILITY OF DOCUMENTS | FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE NOT MADE AVAILABLE TO THE PUBLIC. |
| AVERAGE HOURS WORKED PER WEEK AT RELATED ORGANIZATION | FORM 990, PART VII | HOURS WORKED FOR RELATED ORGANIZATIONS -------------------------------------- JOHN L. JACOBSON 1 LORNE ARCHER 2 |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII
Name Of Disregarded Entity NameOfDisregardedEntity
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RIVERBEND REGIONAL HEALTHCARE FOUNDATION | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 800 RAVEN HILL DRIVE | AddressLine1 |
| City | ATCHISON | City |
| State | KS | State |
| ZIP Code | 66002 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 480955489 | EIN |
| Primary Activities | SUPPORT | PrimaryActivities |
| Legal Domicile State | KS | LegalDomicileState |
| Exempt Code Section | 501(C)(3) | ExemptCodeSection |
| Public Charity Status | 11B | PublicCharityStatus |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | NA | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | false | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | false | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | false | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | false | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | true | LoansOrGuaranteesFromOtherOrg |
| Sale Of Assets To Other Org | false | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | false | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | false | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | false | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | false | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | false | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | false | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | true | SharingOfFacilities |
| Sharing Of Paid Employees | true | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | false | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | false | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | false | OtherTransferToOtherOrg |
| Other Transfer From Other Org | true | OtherTransferFromOtherOrg |
Transactions Related Orgs Table TransactionsRelatedOrgsTable (2 entries)
| Transaction TypeTransactionType | Amount InvolvedAmountInvolved |
|---|---|
| RIVERBEND REGIONAL HEALTHCARE FOUNDATION | |
| R | 475000 |
| RIVERBEND REGIONAL HEALTHCARE FOUNDATION | |
| E | 9500000 |