HIAWATHA HOSPITAL ASSOCIATION INC: Form 990, tax year 2010
View the entire original 990 at ProPublica ↗
- Organization
- HIAWATHA HOSPITAL ASSOCIATION INC (EIN 48-0577658)
- Tax period
- 2010-01-01 to 2010-12-31
- Filed
- 2011-11-15
- IRS object ID
- 201123199349305602
- Schema version
- 2010v3.4
- 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 I
- Schedule J
- Schedule K
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2011-11-15T12:49:43-05:00 | Timestamp |
| Tax Period End Date | 2010-12-31 | 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 | 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 | 2010-01-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 480577658 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Hiawatha Hospital Association Inc | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | HIAW | NameControl |
| Phone | 7857422131 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 300 UTAH STREET | AddressLine1 |
| City | HIAWATHA | City |
| State | KS | State |
| ZIP Code | 66434 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | JOHN MOORE | Name |
| Title | CEO | Title |
| Phone | 7857422131 | Phone |
| Date Signed | 2011-11-15 | 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 | 2010 | TaxYear |
| Build TS | 2016-03-07 17:11:31Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | JOHN MOORE | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 300 UTAH STREET | AddressLine1 |
| City | HIAWATHA | City |
| State | KS | State |
| ZIP Code | 66434 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 22411385 | GrossReceipts |
| Group Return For Affiliates | false | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | www.hch-ks.org | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1945 | YearFormation |
| State Legal Domicile | KS | StateLegalDomicile |
| Activity Or Mission Description | AS A RURAL COMMUNITY HOSPITAL, HIAWATHA HOSPITAL ASSOCIATION'S PRIMARY GOAL IS TO PROVIDE MODERN, RELIABLE, AND AFFORDABLE HEALTH SERVICES THAT BEST MEET THE NEEDS OF OUR COMMUNITY RESIDENTS. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 10 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 8 | NbrIndependentVotingMembers |
| Total Nbr Employees | 262 | TotalNbrEmployees |
| Total Nbr Volunteers | 8 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 88926 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 2584049 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 19505695 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 19598909 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 15811 | InvestmentIncomePriorYear |
| Investment Income Current Year | 25444 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 212564 | OtherRevenuePriorYear |
| Other Revenue Current Year | 148427 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 19822996 | TotalRevenuePriorYear |
| Total Revenue Current Year | 22356829 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 53821 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 21067 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 10850742 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 11245373 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 5739 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 8594686 | OtherExpensePriorYear |
| Other Expenses Current Year | 8339219 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 19499249 | TotalExpensesPriorYear |
| Total Expenses Current Year | 19605659 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 323747 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 2751170 | RevenuesLessExpensesCY |
| Total Assets BOY | 20529456 | TotalAssetsBOY |
| Total Assets EOY | 24177300 | TotalAssetsEOY |
| Total Liabilities BOY | 6847860 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 9059678 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 13681596 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 15117622 | 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 | 16356058 | Expense |
| Grants | 21067 | Grants |
| Revenue | 19598909 | Revenue |
| Description | SEE SCHEDULE O | Description |
| Total Program Service Expense | 16356058 | 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 |
| 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 | 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 |
| Financial Stmt Attached | false | FinancialStmtAttached |
| Grants To Organizations | true | GrantsToOrganizations |
| Grants To Individuals | true | 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 |
| Transaction Related Entity | true | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | false | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | false | ActivitiesConductedPartnership |
| Schedule O Required | true | ScheduleORequired |
| Number Forms Transmitted With1096 | 33 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | true | ComplianceWithBackupWitholding |
| Number Of Employees | 262 | 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 | 10 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 8 | NumberIndependentVotingMembers |
| Family Or Business Relationship | true | 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 | false | DocumentRetentionPolicy |
| Compensation Process CEO | true | CompensationProcessCEO |
| Compensation Process Other | false | CompensationProcessOther |
| Investment In Joint Venture | false | InvestmentInJointVenture |
| States Where Copy Of Return Is Filed | KS | StatesWhereCopyOfReturnIsFiled |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | JENNY KNUDSON | NamePerson |
| Telephone Number | 7857426210 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 300 UTAH STREET | AddressLine1 |
| City | HIAWATHA | City |
| State | KS | State |
| ZIP Code | 66434 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | X | InfoInScheduleOPartVII |
Form990 Part VII Section A Form990PartVIISectionA (16 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | OfficerOfficer | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|
| ANDY PETERSON | |||||||
| TRUSTEE | 1.0 | X | 0 | 0 | 0 | ||
| LORI ELLIOT | |||||||
| TRUSTEE | 1.0 | X | 0 | 0 | 0 | ||
| FONDA LAFRENZ | |||||||
| TRUSTEE | 3.25 | X | 8640 | 0 | 0 | ||
| ERIC MCPEAK | |||||||
| TRUSTEE | 1.0 | X | 0 | 0 | 0 | ||
| TERRY RESCHKE | |||||||
| TRUSTEE | 1.0 | X | 0 | 0 | 0 | ||
| DON NYE | |||||||
| TRUSTEE | 1.0 | X | 0 | 0 | 0 | ||
| DAVE REIST | |||||||
| TRUSTEE/PRESIDENT | 1.0 | X | 0 | 0 | 0 | X | |
| DEL ELFFNER | |||||||
| TRUSTEE/VICE PRESIDENT | 1.0 | X | 0 | 0 | 0 | X | |
| RANDY FEE | |||||||
| TRUSTEE/SECRETARY/TREASURER | 1.0 | X | 0 | 0 | 0 | X | |
| DR BRYON BIGHAM | |||||||
| TRUSTEE/MD | 40.0 | X | 233278 | 0 | 23414 | ||
| JOHN MOORE | |||||||
| ADMINISTRATOR/CEO | 40.0 | 149808 | 0 | 22048 | X | ||
| DR STEFFEN SHAMBURG | |||||||
| MD | 40.0 | 309389 | 0 | 23393 | X | ||
| DR JULIE ROSA | |||||||
| MD | 40.0 | 121040 | 0 | 3435 | X | ||
| DR PETE ROSA | |||||||
| MD | 40.0 | 234382 | 0 | 23708 | X | ||
| DR CROSBY GERNON | |||||||
| MD | 40.0 | 457898 | 0 | 31695 | X | ||
| JEAN ABEITA | |||||||
| PHARMACIST | 40.0 | 109163 | 0 | 18212 | X | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 1623598 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 145905 | 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 (5 entries)
| Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|
| STEVEN H GUNNELS ANESTHESIA | |
| ANESTHESIA | 608800 |
| STARS INC | |
| THERAPY | 541053 |
| ST FRANCIS HOSPITAL AND MEDICAL | |
| MEDICAL TESTING | 228821 |
| SHARED MEDICAL SERVICES | |
| MRI | 187525 |
| AHRS CONSTRUCTION | |
| CONSTRUCTION | 4770400 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 9 | NumberOfContractorsGT100K |
| Government Grants | 36808 | GovernmentGrants |
| All Other Contributions | 2547241 | AllOtherContributions |
| Total Contributions | 2584049 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (2 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|
| PATIENT SERVICE REVENUE | 621110 | 19586684 | 19586684 |
| OTHER PATIENT REVENUE | 621110 | 12225 | 12225 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 19598909 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 26248 | TotalRevenueColumn |
| Exclusion | $26,248 | 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 | 51497 | Real |
Less Rental Expenses LessRentalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 46252 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 5245 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 5245 | TotalRevenueColumn |
| Exclusion | $5,245 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 7500 | Other |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 8304 | Other |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | -804 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -804 | TotalRevenueColumn |
| Exclusion | -$804 | ExclusionAmount |
Net Income From Fundraising Events NetIncomeFromFundraisingEvents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Net Income From Gaming NetIncomeFromGaming
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Net Income Or Loss NetIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Other Revenue Misc OtherRevenueMisc
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | CAFETERIA INCOME | Description |
| Business Code | 722210 | BusinessCode |
| Total Revenue Column | 143182 | TotalRevenueColumn |
| Exclusion | $143,182 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 143182 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 22356829 | TotalRevenueColumn |
| Related Or Exempt Function Income | 19598909 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $173,871 | ExclusionAmount |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 7867 | Total |
| Program Services | 7867 | ProgramServices |
Grants To Domestic Individuals GrantsToDomesticIndividuals
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 13200 | Total |
| Program Services | 13200 | ProgramServices |
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 | 437188 | Total |
| Program Services | 380183 | ProgramServices |
| Management And General | 57005 | 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 | 8576822 | Total |
| Program Services | 7458485 | ProgramServices |
| Management And General | 1118337 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 298201 | Total |
| Program Services | 253662 | ProgramServices |
| Management And General | 44539 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1324074 | Total |
| Program Services | 1055930 | ProgramServices |
| Management And General | 268144 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 609088 | Total |
| Program Services | 539230 | ProgramServices |
| Management And General | 69858 | 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 | 6782 | Total |
| Management And General | 6782 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 79124 | Total |
| Management And General | 79124 | 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 | 2562410 | Total |
| Program Services | 2195657 | ProgramServices |
| Management And General | 361014 | ManagementAndGeneral |
| Fundraising | 5739 | Fundraising |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 61984 | Total |
| Program Services | 32276 | ProgramServices |
| Management And General | 29708 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2436339 | Total |
| Program Services | 2319186 | ProgramServices |
| Management And General | 117153 | ManagementAndGeneral |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 85878 | Total |
| Program Services | 39487 | ProgramServices |
| Management And General | 46391 | ManagementAndGeneral |
Royalties Royalties
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 275067 | Total |
| Program Services | 186182 | ProgramServices |
| Management And General | 88885 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 44339 | Total |
| Program Services | 34123 | ProgramServices |
| Management And General | 10216 | 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 | 203166 | Total |
| Program Services | 134062 | ProgramServices |
| Management And General | 69104 | ManagementAndGeneral |
Payments To Affiliates PaymentsToAffiliates
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1052104 | Total |
| Program Services | 702521 | ProgramServices |
| Management And General | 349583 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 406479 | Total |
| Program Services | 89995 | ProgramServices |
| Management And General | 316484 | ManagementAndGeneral |
Other Expenses OtherExpenses (5 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| BAD DEBT EXPENSE | 353477 | 353477 | |
| REPAIRS & MAINTENANCE | 343541 | 245959 | 97582 |
| DUES & SUBSCRIPTIONS | 80353 | 43408 | 36945 |
| EDUCATION EXPENSES | 32176 | 12263 | 19913 |
| _ |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 316000 | Total |
| Program Services | 258905 | ProgramServices |
| Management And General | 57095 | ManagementAndGeneral |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 19605659 | Total |
| Program Services | 16356058 | ProgramServices |
| Management And General | 3243862 | ManagementAndGeneral |
| Fundraising | 5739 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 265 | BOY |
| EOY | 265 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4373376 | BOY |
| EOY | 5434449 | EOY |
Pledges And Grants Receivable PledgesAndGrantsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2442789 | BOY |
| EOY | 66388 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2271523 | BOY |
| EOY | 2820405 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 681598 | BOY |
| EOY | 675088 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 165287 | BOY |
| EOY | 263854 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 25221020 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 11146098 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 9542568 | BOY |
| EOY | 14074922 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 426797 | BOY |
| EOY | 0 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 625253 | BOY |
| EOY | 841929 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 20529456 | BOY |
| EOY | 24177300 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1655855 | BOY |
| EOY | 1718373 | EOY |
Tax Exempt Bond Liabilities TaxExemptBondLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4855000 | BOY |
| EOY | 4690000 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 337005 | BOY |
| EOY | 2651305 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6847860 | BOY |
| EOY | 9059678 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 11217031 | BOY |
| EOY | 15035043 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2464565 | BOY |
| EOY | 82579 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 13681596 | BOY |
| EOY | 15117622 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 20529456 | BOY |
| EOY | 24177300 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | 2751170 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | -1315144 | ReconcilationOtherChanges |
| 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
Total Grassroots Lobbying TotalGrassrootsLobbying
| Field | Value | IRS element (for citing) |
|---|---|---|
| Filing Organizations Totals | 4082 | FilingOrganizationsTotals |
Total Direct Lobbying TotalDirectLobbying
| Field | Value | IRS element (for citing) |
|---|---|---|
| Filing Organizations Totals | 0 | FilingOrganizationsTotals |
Total Lobbying Expenditures TotalLobbyingExpenditures
| Field | Value | IRS element (for citing) |
|---|---|---|
| Filing Organizations Totals | 4082 | FilingOrganizationsTotals |
Other Exempt Purpose Expenditures OtherExemptPurposeExpenditures
| Field | Value | IRS element (for citing) |
|---|---|---|
| Filing Organizations Totals | 16351976 | FilingOrganizationsTotals |
Total Exempt Purpose Expenditures TotalExemptPurposeExpenditures
| Field | Value | IRS element (for citing) |
|---|---|---|
| Filing Organizations Totals | 16356058 | FilingOrganizationsTotals |
Lobbying Nontaxable LobbyingNontaxableAmount
| Field | Value | IRS element (for citing) |
|---|---|---|
| Filing Organizations Totals | 967803 | FilingOrganizationsTotals |
Grassroots Nontaxable GrassrootsNontaxableAmount
| Field | Value | IRS element (for citing) |
|---|---|---|
| Filing Organizations Totals | 241951 | FilingOrganizationsTotals |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tot Lobbying Grassroot Minus Non Tx | TotLobbyingGrassrootMinusNonTx | |
| Tot Lobby Expend Mns Lobbying Nontx | TotLobbyExpendMnsLobbyingNontx | |
| Form4720 Filed | false | Form4720Filed |
Lobbying Nontaxable Amount2 LobbyingNontaxableAmount2
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Year Minus3 | 1000000 | CurrentYearMinus3 |
| Current Year Minus2 | 1000000 | CurrentYearMinus2 |
| Current Year Minus1 | 971194 | CurrentYearMinus1 |
| Current Year | 967803 | CurrentYear |
| Total | 3938997 | Total |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Lobbying Ceiling | $5,908,496 | LobbyingCeilingAmount |
Total Lobbying Expenditures2 TotalLobbyingExpenditures2
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Year Minus3 | 2551 | CurrentYearMinus3 |
| Current Year Minus2 | 3660 | CurrentYearMinus2 |
| Current Year Minus1 | 3916 | CurrentYearMinus1 |
| Current Year | 4082 | CurrentYear |
| Total | 14209 | Total |
Grassroots Nontaxable Amount2 GrassrootsNontaxableAmount2
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Year Minus3 | 250000 | CurrentYearMinus3 |
| Current Year Minus2 | 250000 | CurrentYearMinus2 |
| Current Year Minus1 | 242799 | CurrentYearMinus1 |
| Current Year | 241951 | CurrentYear |
| Total | 984750 | Total |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grassroots Ceiling | $1,477,125 | GrassrootsCeilingAmount |
Grassroots Lobbying Expenditures GrassrootsLobbyingExpenditures
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Year Minus3 | 2551 | CurrentYearMinus3 |
| Current Year Minus2 | 3660 | CurrentYearMinus2 |
| Current Year Minus1 | 3916 | CurrentYearMinus1 |
| Current Year | 4082 | CurrentYear |
| Total | 14209 | Total |
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 | 371808 | OtherCostOrOtherBasis |
| Book Value | 371808 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 10722860 | OtherCostOrOtherBasis |
| Depreciation | 5294235 | Depreciation |
| Book Value | 5428625 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Leasehold Improvements | LeaseholdImprovements |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 7150662 | OtherCostOrOtherBasis |
| Depreciation | 5605403 | Depreciation |
| Book Value | 1545259 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 6975690 | OtherCostOrOtherBasis |
| Depreciation | 246460 | Depreciation |
| Book Value | 6729230 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 14074922 | TotalOfBookValueLandBuildings |
| Federal Income Tax Liability | 0 | FederalIncomeTaxLiability |
| Total Of Amounts | 0 | TotalOfAmounts |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | UNCERTAIN TAX POSITIONS DISCLOSURE | Identifier |
| Return Reference | SCHEDULE D, PART X, LINE 2 | ReturnReference |
| Explanation | 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. | Explanation |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | true | CharityCarePolicy |
| Written Policy | true | WrittenPolicy |
| FPG Reference Free Care | true | FPGReferenceFreeCare |
| Pcent150 | X | Pcent150 |
| FPG Reference Discounted Care | true | FPGReferenceDiscountedCare |
| Pcent400 | X | Pcent400 |
| Free Disc Care Medically Indigent | true | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | false | AmountsBudgetedForCharityCare |
| Annual Community Benefit Report | false | AnnualCommunityBenefitReport |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 422188 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 12000 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 410188 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.02090 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 1799629 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 1138941 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 660688 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.03370 | PercentOfTotalExpense |
Unreimbursed Costs UnreimbursedCosts
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 7325 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 11953 | DirectOffsettingRevenue |
| Net Community Benefit Expense | -4628 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00020 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 2229142 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 1162894 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1066248 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.05440 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 433583 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 33443 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 400140 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.02040 | PercentOfTotalExpense |
Health Professions Education HealthProfessionsEducation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 1080 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 1080 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00010 | PercentOfTotalExpense |
Cash And In Kind Contributions CashAndInKindContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 7587 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 7587 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00040 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 442250 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 33443 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 408807 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.02090 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 2671392 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 1196337 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1475055 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.07530 | PercentOfTotalExpense |
Economic Development EconomicDevelopment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 1 | NumberOfActivitiesOrPrograms |
| Persons Served | 10700 | PersonsServed |
| Total Community Building Expense | 3999 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 3999 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00020 | PercentOfTotalExpense |
Community Support CommunitySupport
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 1 | NumberOfActivitiesOrPrograms |
| Persons Served | 3000 | PersonsServed |
| Total Community Building Expense | 21930 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 21930 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00110 | PercentOfTotalExpense |
Total Total
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 2 | NumberOfActivitiesOrPrograms |
| Persons Served | 13700 | PersonsServed |
| Total Community Building Expense | 25929 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 25929 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00130 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | false | BadDebtExpenseReported |
| Bad Debt Expense | $216,646 | BadDebtExpenseAmount |
| Amount Attributable To | 43000 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 9018124 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 8979807 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | 38317 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | X | CostToChargeRatio |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | true | WrittenDebtCollectionPolicy |
| Provision For Charity Care | true | ProvisionForCharityCare |
| Number Of Hospital Facilities | 1 | NumberOfHospitalFacilities |
Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility Number | 1 | FacilityNumber |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | HIAWATHA HOSPITAL ASSOCIATION | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 300 UTAH STREET | AddressLine1 |
| City | HIAWATHA | City |
| State | KS | State |
| ZIP Code | 66434 | 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 | HIAWATHA HOSPITAL ASSOCIATION | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Other Facilities | 3 | NumberOfOtherFacilities |
Other Facilities OtherFacilities (3 entries)
| Address Line1Address/AddressLine1 | CityAddress/City | StateAddress/State | ZIP CodeAddress/ZIPCode | Facility TypeFacilityType |
|---|---|---|---|---|
| HIAWATHA COMMUNITY HOSPITAL HOME HEALTH | ||||
| 300 UTAH STREET | HIAWATHA | KS | 66434 | HOME HEALTH AGENCY |
| HIAWATHA COMM HOSP FAM PRACTICE CLINIC | ||||
| 314 OREGON STREET | HIAWATHA | KS | 66434 | RURAL HEALTH CLINIC |
| HIAWATHA COMM HOSPITAL HIGHLAND CLINIC | ||||
| 415 S MAIN STREET | HIAWATHA | KS | 66434 | RURAL HEALTH CLINIC |
Form990 Schedule H Part VI Form990ScheduleHPartVI (9 entries)
| IdentifierIdentifier | ExplanationExplanation | Return ReferenceReturnReference |
|---|---|---|
| SCHEDULE H, PART I, LINE 7, COLUMN F | THE AMOUNT OF BAD DEBT EXPENSE REMOVED FROM TOTAL EXPENSES FOR CALCULATING THE NET COMMUNITY BENEFIT EXPENSE PERCENTAGE WAS $353,477. | |
| SCHEDULE H, PART I, LINE 7 | THE HOSPITAL USES THE COST-TO-CHARGE RATIO. THIS METHOD WAS USED TO CALCULATE THE FIGURES IN THE TABLE AND WAS DETERMINED BY COMPARING PATIENT CARE COST TO PATIENT CARE CHARGES. | |
| COMMUNITY BUILDING ACTIVITIES | ONE OF OUR BIGGEST PROJECTS IN 2010 WAS WORK ON THE START UP OF A COMMUNITY DAY CARE CENTER. THE HOSPITAL WAS INSTRUMENTAL IN GETTING INTERESTED PARTIES TOGETHER, DOING COMMUNITY SURVEYS FOR NEED, APPROACHING VARIOUS ENTITIES FOR FUNDING, AND FORMING THE LEGAL ENTITY. THE HOSPITAL ALSO PROVIDED MAN HOURS TO ACHEIVE THIS AS WELL AS A MEETING LOCATION AND MEALS FOR MEETINGS. WHILE THE COMMUNITY HAS SEVERAL INDIVIDUALS WHO DO DAYCARE, THERE IS ADDITIONAL NEED FOR THE SERVICES AS MOST SITTERS HAVE A LENGTHY WAIT LIST. ALSO IMPACTING THE NEED IS THE FACT THAT IF AN INDIVIDUAL SITTER IS ILL OR TAKES TIME OFF, IT OFTEN RESULTS IN PARENTS HAVING TO TAKE TIME OFF FROM WORK TO BE WITH THEIR CHILDREN WHICH CAN BE STRESSFUL FOR PARENTS. THE COMMUNITY CENTER WILL NOT ONLY PROVIDE QUALITY DAYCARE FOR ADDITIONAL CHILDREN, BUT WILL ALSO PROVIDE A BETTER WORK ENVIRONMENT WITH SOME BENEFITS FOR SOME OF THE SITTERS THAT ARE CURRENTLY SELF EMPLOYED. | SCHEDULE H, PART II |
| BAD DEBT EXPENSE | The Hospital reports patient accounts receivable for services rendered at net realizable amounts from third-party payers, patients and others. The Hospital provides an allowance for doubtful accounts based upon a review of outstanding receivables, historical collection information and existing economic conditions. As a service to the patient, the Hospital bills third-party payers directly and bills the patient when the patient's liability is determined. Patient accounts receivable are due in full when billed. Accounts are considered delinquent and subsequently written off as bad debts based on individual credit evaluation and specific circumstances of the account. Line 2 is the organization's bad debt figure net of collections and then multiplied by the organization's cost to charge ratio. The organization figured 20% of those belong in charity care but were ineligible because they wouldn't complete paperwork. However, beginning in October of 2010, Hiawatha Hospital Association (HHA) started doing presumptive charity care. HHA sends accounts who the organization feels would qualify but don't have evidence due to lack of paperwork from patients to an agency that can verify their financial situation. If based on that evaluation, they qualify, HHA rolls them to charity care. Because HHA started this program so late in 2010, there is still about 20% of the bad debt total that would have qualified but were processed before HHA began the program. | SCHEDULE H, PART III, LINE 4 |
| COLLECTION PRACTICES | ON EACH STATEMENT HHA STATES THAT THE ORGANIZATION HAS A CHARITY CARE POLICY. FOR 3 MONTHS A STATEMENT IS SENT. AFTER THE 3RD STATEMENT, A COLLECTION LETTER GOES OUT WITH A CHARITY CARE APPLICATION. THE FOLLOWING MONTH IT IS LISTED ON THE BAD DEBT LIST. AT THE END OF THE FOLLOWING MONTH THE ACCOUNT IS WRITTEN OFF TO BAD DEBT AND SENT TO COLLLECTIONS OR LITIGATION. IF IT GOES TO LITIGATION, NOTIFICATION IS MADE THROUGH CERTIFIED MAIL, IN WHICH ANOTHER CHARITY CARE APPLICATION IS SENT ALONG WITH THE LETTER. | SCHEDULE H, PART III, LINE 9B |
| NEEDS ASSESSMENT | THE ASSESSMENT OF COMMUNITY NEEDS IS A COMPILATION OF ISSUES IDENTIFIED BY THE ADMINISTRATOR, PHYSICIANS, NURSING STAFF, AND INFORMAL COMMUNITY INPUT. THESE ISSUES ARE VALIDATED AND SUPPLEMENTED BY CONTRACTOR STUDIES AND GOVERNMENTAL AGENCY FEEDBACK. | SCHEDULE H, PART VI, LINE 2 |
| PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE | THE HOSPITAL'S SOCIAL SERVICES DEPARTMENT SPEAKS WITH PATIENTS REGARDING ELIGIBILITY FOR CHARITY CARE, MEDICAID, AND VARIOUS OTHER ASSITANCE PROGRAMS THAT ARE AVAILABLE. OUR BUSINESS OFFICE MANAGER ALSO SPEAKS WITH PATIENTS REGARDING THE AVAILABILITY FOR DISABILITY DETERMINATION. PROVIDERS OFTEN BRING UP OUR CHARITY CARE PROGRAM WITH PATIENTS AT THE TIME OF TREATMENT. A CHARITY CARE PAMPHLET IS AVAILABLE AT ADMISSIONS AND APPLICATIONS ARE OFTEN HANDED OUT AT THE TIME OF ADMISSION FOR OUTPATIENT SERVICES. THE CHARITY CARE POLICY IS ALSO PUBLISHED ON OUR WEBSITE. THE FACT THAT WE HAVE A CHARITY CARE PROGRAM IS PRINTED ON THE BOTTOM OF EVERY STATEMENT THAT GOES OUT. THE CHARITY CARE APPLICATION IS PRINTED ON THE BACK OF ALL COLLECTION LETTERS AND PRE-LITIGATION CERTIFIED LETTERS. | SCHEDULE H, PART VI, LINE 3 |
| COMMUNITY INFORMATION | OUR GEOGRAPHIC AREA INCLUDES ALL OF BROWN COUNTY AND PARTS OF DONIPHAN, ATCHISON, AND NEMAHA COUNTIES IN KANSAS AND PARTS OF RICHARDSON COUNTY NEBRASKA. 55% OF OUR COMMUNITY IS 45 YEARS OLD AND UNDER. 26% IS AGE 45 TO 64. 19% OF THE POPULATION IS OVER 65 YEARS OF AGE. 26% OF THE COMMUNITY HOUSEHOLDS ARE BELOW THE POVERTY LEVEL FOR A FAMILY OF FOUR. | SCHEDULE H, PART VI, LINE 4 |
| PROMOTION OF COMMUNITY HEALTH | AS A TAX EXEMPT, NOT FOR PROFIT ENTITY, HIAWATHA COMMUNITY HOSPITAL'S PURPOSE IS TO PROVIDE THE BEST SERVICES POSSIBLE IN A MANNER THAT IS ACCESSIBLE TO ALL INDIVIDUALS. OFFERING OUR SERVICES AT NO, OR REDUCED COST TO THOSE WHO MEET OUR CHARITY REQUIREMENTS IS A CONERSTONE OF OUR MISSION. AS THE ECONOMIC CLIMATE IN THE COMMUNITY CHANGED, SO DID OUR CHARITY CARE SERVICES. IN 2010 WE BEGAN A PRESUMPTIVE CHARITY CARE PROGRAM THAT ALLOWS US TO GRANT CHARITY CARE TO THOSE INDIVIDUALS WHO QUALIFY BUT WON'T COMPLETE THE REQUIRED PAPERWORK WE NEED TO SUBSTANTIATE THE NEED FOR ASSISTANCE. ALSO SUPPPORTING OUR STATUS IS OUR COMMITMENT TO PROVIDE QUALITY SERVICE AND STAFF. TO THAT END, THE HIAWATHA COMMUNITY HOSPITAL PROVIDES SCHOLARSHIPS FOR EDUCATION IN HEALTH RELATED FIELDS. ANOTHER MANNER IN WHICH WE SUPPORT OUR NOT FOR PROFIT STATUS IS THROUGH PUBLIC HEALTH EDUCATIONAL PROGRAMS FOR THE COMMUNITY. WE PROVIDE DIABETES, HYPERTENSION AND SMOKING CESSATION EDUCATION. | SCHEDULE H, PART VI, LINE 5 |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Records Maintained | true | RecordsMaintained |
| No Grant More Than5000 | X | NoGrantMoreThan5000 |
Form990 Schedule I Part III Form990ScheduleIPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Type Of Grant | SCHOLARSHIPS | TypeOfGrant |
| Number Of Recipients | 13 | NumberOfRecipients |
| Amount Of Cash Grant | 13200 | AmountOfCashGrant |
Form990 Schedule I Part IV Form990ScheduleIPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | PROCESS FOR MONITORING SCHOLARSHIPS | Identifier |
| Return Reference | SCHEDULE I, PART III | ReturnReference |
| Explanation | 1) COMMUNITY SCHOLARSHIP - HCH HAS GIVEN SCHOLARSHIPS TO COMMUNITY MEMBERS PURSUING A DEGREE IN THE MEDICAL FIELD. AFTER THE SCHOLARSHIP IS APPROVED BY JOHN, THE TUITION IS PAID TO THE SCHOOL, THE STUDENT OR THE STUDENT LOAN HOLDER. | Explanation |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Survey | X | CompensationSurvey |
| 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 | true | 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 (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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| DR BRYON BIGHAM | |||||||||||||
| 182545 | 0 | 50733 | 0 | 0 | 0 | 7917 | 0 | 15497 | 0 | 256692 | 0 | 0 | 0 |
| JOHN MOORE | |||||||||||||
| 149808 | 0 | 0 | 0 | 0 | 0 | 6515 | 0 | 15533 | 0 | 171856 | 0 | 0 | 0 |
| DR STEFFEN SHAMBURG | |||||||||||||
| 230141 | 0 | 79248 | 0 | 0 | 0 | 9860 | 0 | 13533 | 0 | 332782 | 0 | 0 | 0 |
| DR PETE ROSA | |||||||||||||
| 186443 | 0 | 47939 | 0 | 0 | 0 | 8095 | 0 | 15613 | 0 | 258090 | 0 | 0 | 0 |
| DR CROSBY GERNON | |||||||||||||
| 311273 | 0 | 130125 | 0 | 16500 | 0 | 17690 | 0 | 14005 | 0 | 489593 | 0 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | COMPENSATION CONTIGENT ON NET EARNINGS | Identifier |
| Return Reference | SCHEDULE J, PART I, LINE 6A | ReturnReference |
| Explanation | The family physicians that are contracted with the hospital to provide services in our rural health care clinic and our radiologist are all eligible for additional compensation beyond their base pay rate. Each physician's expenses and revenues are tracked through their own department. Periodically throughout the year, if their respective departments are showing a positive net income, then they are eligible to receive additional compensation. The amount of net revenue to be distributed mid year is decided between the physicians and the Administrator. By the year end, 100% of the net revenue will be distributed as long as it doesn't exceed the annual maximum compensation amounts in the physician's respective contracts. To determine what each physician's portion of the distribution will be, income statements are run by physician that include allocations for building expenses and expenses and revenues from mid-levels. | Explanation |
Schedule K IRS990ScheduleK
Form990 Schedule K Part I Form990ScheduleKPartI
Issuer Name IssuerName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CITY OF HIAWATHA | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Issuer EIN | 486025665 | IssuerEIN |
| CUSIP Number | 428545BD8 | CUSIPNumber |
| Date Issued | 2007-03-29 | DateIssued |
| Issue Price | 5175000 | IssuePrice |
| Description Of Purpose | SEE SCHEDULE K, PART V | DescriptionOfPurpose |
| Defeased | false | Defeased |
| On Behalf Of Issuer | false | OnBehalfOfIssuer |
| Pool Financing | false | PoolFinancing |
Form990 Schedule K Part II Form990ScheduleKPartII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Amount Retired | 0 | AmountRetired |
| Amount Bond Defeased | 0 | AmountBondDefeased |
| Total Proceeds | 5175000 | TotalProceeds |
| Amount In Reserve Fund | 0 | AmountInReserveFund |
| Capitalized Interest | 0 | CapitalizedInterest |
| Refunding Escrow | 0 | RefundingEscrow |
| Issuance Costs From Proceeds | 105804 | IssuanceCostsFromProceeds |
| Credit Enhancement | 0 | CreditEnhancement |
| Working Capital Expenditures | 0 | WorkingCapitalExpenditures |
| Capital Expenditures | 5069196 | CapitalExpenditures |
| Other Spent Proceeds | 0 | OtherSpentProceeds |
| Amount Unspent | 0 | AmountUnspent |
| Year Of Subst Completion | 2007 | YearOfSubstCompletion |
| Current Refunding | true | CurrentRefunding |
| Advance Refunding | false | AdvanceRefunding |
| Final Allocation Made | true | FinalAllocationMade |
| Adequate Books And Recds Maintaind | true | AdequateBooksAndRecdsMaintaind |
Form990 Schedule K Part III Form990ScheduleKPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Owning Bond Financed Property | false | OwningBondFinancedProperty |
| Any Lease Arrangements | false | AnyLeaseArrangements |
| Mngment Cntrct Bond Financd Prprty | false | MngmentCntrctBondFinancdPrprty |
| Any Research Agreements | false | AnyResearchAgreements |
| Bond Counsel Routinely Engaged | true | BondCounselRoutinelyEngaged |
| Prcntge Prvt Business Use By Others | 0.00000 | PrcntgePrvtBusinessUseByOthers |
| Percentage Of Prvt Business Re UBI | 0.00000 | PercentageOfPrvtBusinessReUBI |
| Total Private Business Use | 0.00000 | TotalPrivateBusinessUse |
| Post Issuance Compliance Procdrs | true | PostIssuanceComplianceProcdrs |
Form990 Schedule K Part IV Form990ScheduleKPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form8038 T Filed | false | Form8038TFiled |
| Variable Rate Issue | false | VariableRateIssue |
| Hedge Identified In Books And Recds | false | HedgeIdentifiedInBooksAndRecds |
| Gross Proceeds Invested In GIC | false | GrossProceedsInvestedInGIC |
| Gross Proceeds Invested | false | GrossProceedsInvested |
| Exception To Rebate | false | ExceptionToRebate |
Form990 Schedule K Part V Form990ScheduleKPartV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | DESCRIPTION OF PURPOSE | Identifier |
| Return Reference | SCHEDULE K, PART I, LINE A, COLUMN F | ReturnReference |
| Explanation | REFINANCE EXISTING BOND TO BUILD | Explanation |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (11 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| ORGANIZATION'S MISSION | FORM 990, PART III, LINE 1 | HIAWATHA COMMUNITY HOSPITAL'S HIGHEST PRIORITY IS THE PROVISION OF QUALITY HEALTH CARE TO OUR PATIENTS THROUGHOUT NORTHEAST KANSAS. COMPREHENSIVE SERVICES INCLUDE PRIMARY, SECONDARY, AND LONG-TERM CARE. TO CARRY OUT THIS MISSION, HEALTH PROFESSIONALS WITHIN THE HOSPITAL CONTINUALLY WORK TOGETHER TO IMPROVE PATIENT CARE AND EDUCATION. THIS TEAM APPROACH ASSURES THAT OUR PATIENTS WILL BENEFIT FROM THE MOST UP-TO-DATE MEDICAL PRACTICES AVAILABLE. THE HOSPITAL CAN ONLY CONTINUE TO EXIST TO SERVE ITS MISSION THROUGH SOUND FINANCIAL MANAGEMENT AND STRATEGIC PLANNING. THEREFORE, THE PRINCIPLES OF COST EFFECTIVENESS AND EFFICIENCY GOVERN THE DEVELOPMENT OF HEALTH CARE POLICY FOR THE HOSPITAL. EXTERNAL AND INTERNAL ASSESSMENTS ARE DONE TO DETERMINE EVOLUTIONARY NEEDS AND TO RESPOND TO THE DEMANDS OF EVER CHANGING TECHNOLOGY. HIAWATHA COMMUNITY HOSPITAL FEELS A STRONG COMMITMENT TO ITS EMPLOYEES AND STRIVES ALWAYS TO TREAT THEM FAIRLY, RESPONSIBLY, AND WITH A SENSE OF CONCERN FOR THEIR WELL-BEING. THE PROVISION OF COMPREHENSIVE CONTINUING EDUCATION IS ESSENTIAL TO MAINTAIN ADEQUATE SKILL LEVELS AND FOSTER A SENSE OF PRIDE AND PROFESSIONALISM. AS A COMMUNITY HOSPITAL, HIAWATHA COMMUNITY HOSPITAL RECOGNIZES ITS RESPONSIBILITY TO PROVIDE PUBLIC HEALTH EDUCATION AND AS SUCH, STRIVES TO SERVE AS A REGIONAL HEALTH RESOURCE CENTER. MEDICAL AND PROFESSIONAL STAFF ARE ENCOURAGED TO PARTICIPATE IN COMMUNITY ACTIVITIES AND EDUCATION. |
| PROGRAM SERVICE ACCOMPLISHMENT | FORM 990, PART III, LINE 4A | AS A TAX EXEMPT, NOT FOR PROFIT ENTITY HIAWATHA COMMUNITY HOSPITAL'S PURPOSE IS TO PROVIDE THE BEST SERVICES POSSIBLE IN A MANNER THAT IS ACCESSIBLE TO ALL INDIVIDUALS. OFFERING OUR SERVICES AT NO, OR REDUCED COST TO THOSE WHO MEET OUR CHARITY REQUIREMENTS IS A CORNERSTONE OF OUR MISSION. WE OFTEN TIMES HAVE DIFFICULUTY GETTING PATIENTS WHOM WE SUSPECT WILL QUALIFY FOR CHARITY CARE TO COMPLETE NECESSARY PAPERWORK TO QUALIFY. IN 2010, WE BEGAN A PRESUMPTIVE CHARITY CARE PROGRAM. WE SEND PATIENTS WHOM WE SUSPECT WILL QUALIFY BUT HAVEN'T COMPLETED PAPERWORK TO A COMPANY THAT CAN VERIFY THEIR FINANCIAL SITUATION. IF THEY QUALIFY, CHARITY CARE IS GRANTED. WE FEEL THAT THIS PROGRAM IS A GREAT WAY TO GET INDIVIUALS IN NEED THE CARE THEY DESERVE WITHOUT ADDED FINANCIAL STRESS. ALSO SUPPORTING OUR TAX EXEMPT STATUS IS OUR COMMITMENT TO PROVIDE QUALITY SERVICE AND STAFF. TO THAT END, THE HIAWATHA COMMUNITY HOSPITAL DISTRIBUTED OVER $13,000 IN SCHOLARSHIPS IN 2010. ANOTHER MANNER IN WHICH WE SUPPORT OUR NOT FOR PROFIT STATUS IS THROUGH PUBLIC HEALTH EDUCATIONAL PROGRAMS FOR THE COMMUNITY. WE PROVIDE DIABETES, HYPERTENSION, AND SMOKING CESSATION EDUCATION. |
| ATTACHMENT OF AUDITED FINANCIAL STATEMENTS | FORM 990, PART IV, LINE 20B | PER THE IRS' FORM 990 INSTRUCTIONS, AN ORGANIZATION OEPRATING ONE OR MORE HOSPITALS AT ANY TIME DURING THE YEAR MUST ATTACH A COPY OF ITS AUDITED FINANICAL STATEMENTS TO THE TAX RETURN IF ITS TAX YEAR BEGAN AFTER MARCH 23, 2010. HIAWATHA HOSPITAL ASSOCIATION, INC.'S AUDITED FINANCIAL STATEMENTS ARE NOT ATTACHED BECAUSE ITS TAX YEAR BEGAN ON JANUARY 1, 2010. |
| FAMILY RELATIONSHIP | FORM 990, PART VI, SECTION A, LINE 2 | DR. PETE ROSA AND DR. JULIE ROSA HAVE A FAMILY RELATIONSHIP. |
| FORM 990 REVIEW PROCESS | FORM 990, PART VI, SECTION B, LINE 11B | AN INDEPENDENT ACCOUNTING FIRM PREPARES AND REVIEWS THE 990. THE 990 IS THEN REVIEWED BY THE ORGANIZATION'S OFFICERS AND ACCOUNTING PERSONNEL. ANY QUESTIONS AND CONCERNS THE ORGANIZATION'S OFFICERS AND ACCOUNTING PERSONNEL HAVE ARE ADDRESSED AND ANY CORRECTIONS OR CLARIFICATIONS THAT NEED TO BE MADE ARE MADE. THE FINAL FORM 990 WITH ALL REQUIRED SCHEDULES IS THEN PROVIDED TO ALL VOTING MEMBERS OF THE BOARD PRIOR TO FILING THE 990. |
| CONFLICT OF INTEREST POLICY | FORM 990, PART VI, SECTION B, LINE 12C | All employees and decision makers for the Hospital are covered under this policy. Conflicts are either reviewed by the Corporate Compliance Officer, or the Board President. At Board meetings, the Board Chair is appraised of all conflicts of interest and then asks the member to abstain from discussing and voting on topics of conflict. |
| WRITTEN DOCUMENT RETENTION & DESTRUCTION POLICY | FORM 990, PART VI, SECTION B, LINE 14 | THE ORGANIZATION IS IN THE PROCESS OF IMPLEMENTING A DOCUMENT RETENTION AND DESTRUCTION POLICY, IT IS EXPECTED THE POLICY WILL BE IN PLACE BY DECEMBER 31, 2011. |
| COMPENSATION REVIEW | FORM 990, PART VI, SECTION B, LINE 15A | The Director of Human Resources provides the President of the Board of Directors with a compensation survey compiled by the Kansas Hospital Association. The survey delineates compensation packages for Administrators at hospitals that are similar to Hiawatha. Based on that survey, the Administrator's performance, and the performance of the hospital, the Board sets the administrator's salary. |
| AVAILABILITY OF DOCUMENTS | FORM 990, PART VI, LINE 19 | THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. |
| RECONCILIATION OF NET ASSETS | FORM 990, PART XI, LINE 5 | UNREALIZED GAIN ON INVESTMENTS $ 12,826 CHANGE IN FOUNDATION ASSETS $ 1,054,016 CHANGE IN ESTATE RECEIVABLE $ (160,535) NET ASSETS RELEASED FROM RESTRICTION $ (2,221,451) ------------- $ (1,315,144) |
| HOURS DEVOTED FOR RELATED ORGANIZATION | FORM 990 PART VII | NAME:DEL ELFFNER TITLE:TRUSTEE/VICE PRESIDENT HOURS:2 |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII
Name Of Disregarded Entity NameOfDisregardedEntity
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | HIAWATHA HOSPITAL ASSOCIATION FOUNDATION | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 300 UTAH STREET | AddressLine1 |
| City | HIAWATHA | City |
| State | KS | State |
| ZIP Code | 66434 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 481223766 | EIN |
| Primary Activities | FUNDRAISING | PrimaryActivities |
| Legal Domicile State | KS | LegalDomicileState |
| Exempt Code Section | 501(C)(3) | ExemptCodeSection |
| Public Charity Status | 11A | PublicCharityStatus |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | HHA | 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 | false | 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
Name Of Other Organization NameOfOtherOrganization
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | HIAWATHA HOSPITAL ASSOCIATION FOUNDATION | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Transaction Type | R | TransactionType |
| Amount Involved | 1045172 | AmountInvolved |