AMBERWELL ATCHISON ASSOCIATION: Form 990, tax year 2023
View the entire original 990 at ProPublica ↗
- Organization
- AMBERWELL ATCHISON ASSOCIATION (EIN 48-0561974)
- Tax period
- 2023-01-01 to 2023-12-31
- Filed
- 2024-11-14
- IRS object ID
- 202403199349312460
- Schema version
- 2023v5.1
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule H
- Schedule J
- Schedule K
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2024-11-14T14:44:59-06:00 | ReturnTs |
| Tax Period End | 2023-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 450250958 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | EIDE BAILLY LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 18081 BURT ST STE 200 | AddressLine1Txt |
| City | OMAHA | CityNm |
| State Abbreviation | NE | StateAbbreviationCd |
| ZIP | 680224722 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2023-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 480561974 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | AMBERWELL ATCHISON ASSOCIATION | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | AMBE | BusinessNameControlTxt |
| Phone | 9133605584 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 800 RAVEN HILL DRIVE | AddressLine1Txt |
| City | ATCHISON | CityNm |
| State Abbreviation | KS | StateAbbreviationCd |
| ZIP | 66002 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | CHASE DUDZINSKI | PersonNm |
| Person Title | CHIEF FINANCIAL OFFICER | PersonTitleTxt |
| Phone | 9133605584 | PhoneNum |
| Signature | 2024-11-14 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IRS Responsible Prty Info Curr | Yes (1) | IRSResponsiblePrtyInfoCurrInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | WENDY R COOLEY CPA | PreparerPersonNm |
| PTIN | P01523804 | PTIN |
| Phone | 4023302660 | PhoneNum |
| Preparation | 2024-11-13 | PreparationDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2023 | TaxYr |
| Build TS | 2024-10-15 13:58:12Z | BuildTS |
Form 990 IRS990
Doing Business As Name DoingBusinessAsName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | AMBERWELL ATCHISON | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | JEFFREY PERRY | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 800 RAVEN HILL DRIVE | AddressLine1Txt |
| City | ATCHISON | CityNm |
| State Abbreviation | KS | StateAbbreviationCd |
| ZIP | 66002 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $54,480,761 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.AMBERWELLHEALTH.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1912 | FormationYr |
| Legal Domicile State | KS | LegalDomicileStateCd |
| Activity Or Mission | TO PROVIDE EXCELLENT HEALTH CARE AND IMPROVE THE QUALITY OF LIFE IN OUR COMMUNITY. | ActivityOrMissionDesc |
| Voting Members Governing Body | 5 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 5 | VotingMembersIndependentCnt |
| Total Employee | 605 | TotalEmployeeCnt |
| Total Volunteers | 53 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $3,206,022 | PYContributionsGrantsAmt |
| CY Contributions Grants | $903,221 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $51,964,954 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $52,989,078 | CYProgramServiceRevenueAmt |
| PY Investment Income | $260,882 | PYInvestmentIncomeAmt |
| CY Investment Income | $518,912 | CYInvestmentIncomeAmt |
| PY Other Revenue | $18,738 | PYOtherRevenueAmt |
| CY Other Revenue | $69,550 | CYOtherRevenueAmt |
| PY Total Revenue | $55,450,596 | PYTotalRevenueAmt |
| CY Total Revenue | $54,480,761 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $31,738,983 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $36,464,212 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $24,438,379 | PYOtherExpensesAmt |
| CY Other Expenses | $25,570,015 | CYOtherExpensesAmt |
| PY Total Expenses | $56,177,362 | PYTotalExpensesAmt |
| CY Total Expenses | $62,034,227 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$726,766 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$7,553,466 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $52,494,414 | TotalAssetsBOYAmt |
| Total Assets EOY | $47,789,695 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $26,333,019 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $37,302,760 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $26,161,395 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $10,486,935 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | AMBERWELL HEALTH PROVIDES COMPASSIONATE CARE WITH CLINICAL EXCELLENCE. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | Yes (1) | SignificantChangeInd |
| Expense | $52,555,495 | ExpenseAmt |
| Revenue | $52,989,078 | RevenueAmt |
| Desc | AMBERWELL ATCHISON ASSOCIATION D/B/A AMBERWELL ATCHISON (HOSPITAL) IS A CRITICAL ACCESS HOSPITAL (CAH) THAT PROVIDES RELATED INPATIENT, OUTPATIENT, EMERGENCY CARE, AND PHYSICIAN SERVICES TO PATIENTS IN AND AROUND ATCHISON, KANSAS.AMBERWELL ATCHISON PROVIDED ACUTE INPATIENT AND OUTPATIENT HEALTH SERVICES TO THE GENERAL PUBLIC. SERVICES INCLUDE BUT ARE NOT LIMITED TO: EMERGENCY SERVICES, HOME HEALTH AND HOSPICE, GENERAL INPATIENT ACUTE SERVICES, RADIOLOGY, & OBSTETRICS. THE NUMBER OF PATIENTS SERVED DURING THE YEAR ENDING 12/31/23 WAS 117,343.STATEMENT CONTINUED ON SCHEDULE O.THE HOSPITAL MAINTAINS A FINANCIAL ASSISTANCE POLICY FOR PATIENTS WHO ARE FINANCIALLY UNABLE TO PAY FOR THE HEALTHCARE SERVICES THEY RECEIVE. IT IS THE POLICY OF THE HOSPITAL NOT TO PURSUE COLLECTION OF AMOUNTS DETERMINED TO QUALIFY AS PATIENT FINANCIAL ASSISTANCE UNDER THE POLICY. ACCORDINGLY, THE HOSPITAL DOES NOT REPORT THESE AMOUNTS IN PATIENT SERVICE REVENUE. THE HOSPITAL DETERMINES THE COSTS ASSOCIATED WITH PROVIDING CHARITY CARE BY AGGREGATING THE DIRECT AND IN DIRECT COSTS, INCLUDING SALARIES, BENEFITS, SUPPLIES, AND OTHER OPERATING EXPENSES, BASED ON AN OVERALL COST TO CHARGE RATIO. THE COSTS OF CARING FOR THESE PATIENTS FOR THE YEAR ENDED DECEMBER 31, 2023 WERE APPROXIMATELY $691,000. | Desc |
| Total Program Service Expenses | $52,555,495 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (1) | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | Yes (1) | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | 0 | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (1) | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | Yes (1) | TaxExemptBondsInd |
| Invest Tax Exempt Bonds | 0 | InvestTaxExemptBondsInd |
| Escrow Account | 0 | EscrowAccountInd |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuerInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | 0 | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | Yes (1) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | Yes (1) | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 35 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 605 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | 0 | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | 0 | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 5 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 5 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | 0 | MembersOrStockholdersInd |
| Election Of Board Members | 0 | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | 0 | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | 0 | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | CHASE DUDZINSKI | PersonNm |
| Phone | 9133605584 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 800 RAVEN HILL DRIVE | AddressLine1Txt |
| City | ATCHISON | CityNm |
| State Abbreviation | KS | StateAbbreviationCd |
| ZIP | 66002 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (15 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Key EmployeeKeyEmployeeInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|---|
| LARRY MEARS | |||||||||
| CHAIRPERSON | 1.00 | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| JERRY HENRY | |||||||||
| VICE CHAIRPERSON | 1.00 | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| LORIN AFFIELD | |||||||||
| SECRETARY | 1.00 | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| JORDAN HAWK | |||||||||
| TREASURER | 1.00 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| LYDIA FUNK | |||||||||
| DIRECTOR THRU 2/2023 | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| CHARO KELLEY | |||||||||
| DIRECTOR | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| JEFFREY PERRY | |||||||||
| PRESIDENT & CEO | 40.00 | 2.00 | Yes (X) | $434,522 | $0 | $16,004 | |||
| CHASE DUDZINSKI | |||||||||
| CFO | 40.00 | 2.00 | Yes (X) | $250,652 | $0 | $29,813 | |||
| NORMA GREEN MD | |||||||||
| CHIEF MEDICAL OFFICER | 40.00 | 0.00 | $256,266 | $0 | $29,113 | Yes (X) | |||
| ALICIA SORENSEN | |||||||||
| COO/CHIEF NURSING OFFICER | 40.00 | 0.00 | $196,527 | $0 | $26,551 | Yes (X) | |||
| JONATHAN LECK MD | |||||||||
| PHYSICIAN | 40.00 | 0.00 | $764,014 | $0 | $21,815 | Yes (X) | |||
| BRIAN DUNCAN MD | |||||||||
| PHYSICIAN | 40.00 | 0.00 | $738,909 | $0 | $28,256 | Yes (X) | |||
| RODERICK WARREN MD FACS | |||||||||
| PHYSICIAN | 40.00 | 0.00 | $658,346 | $0 | $17,030 | Yes (X) | |||
| MCGARRETT GROTH DO | |||||||||
| PHYSICIAN | 40.00 | 0.00 | $476,843 | $0 | $30,601 | Yes (X) | |||
| JUSTIN THELEMAN MD | |||||||||
| PHYSICIAN | 40.00 | 0.00 | $449,090 | $0 | $23,764 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $4,225,169 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $222,947 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 68 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| STRAUB CONSTRUCTION CO INC | |||||
| 7775 MEADOW VIEW DRIVE | SHAWNEE | KS | 66227 | CONSTRUCTION SERVICES | $1,796,068 |
| ADVOCATE HEALTH SERVICES | |||||
| 800 RAVEN HILL DRIVE | ATCHISON | KS | 66002 | CONTRACT LABOR | $1,380,837 |
| QUALIVIS | |||||
| PO BOX 123847 | DALLAS | TX | 753123847 | CONTRACT LABOR | $937,727 |
| CPSI | |||||
| PO BOX 11407 | BIRMINGHAM | AL | 352466448 | AR MANAGEMENT SERVICES | $823,708 |
| SPENCER FANE LLP | |||||
| PO BOX 872037 | KANSAS CITY | MO | 641872037 | LEGAL SERVICES | $447,727 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 26 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $250,000 | RelatedOrganizationsAmt |
| Government Grants | $260,214 | GovernmentGrantsAmt |
| All Other Contributions | $393,007 | AllOtherContributionsAmt |
| Noncash Contributions | $8,400 | NoncashContributionsAmt |
| Total Contributions | $903,221 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| PATIENT SERVICE REVENUE | 621110 | $49,191,189 | $49,191,189 |
| AFFILIATE REVENUE | 621110 | $1,954,019 | $1,954,019 |
| PHARMACY REVENUE | 621110 | $1,086,931 | $1,086,931 |
Total Oth Program Service Rev TotalOthProgramServiceRevGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $756,939 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $756,939 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $52,989,078 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $434,495 | TotalRevenueColumnAmt |
| Exclusion | $434,495 | ExclusionAmt |
Incm From Invest Bond Proceeds IncmFromInvestBondProceedsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $84,417 | TotalRevenueColumnAmt |
| Exclusion | $84,417 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $69,550 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $0 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $69,550 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $69,550 | TotalRevenueColumnAmt |
| Exclusion | $69,550 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $54,480,761 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $52,989,078 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $588,462 | ExclusionAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,240,863 | TotalAmt |
| Program Services | $509,172 | ProgramServicesAmt |
| Management And General | $731,691 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $28,783,541 | TotalAmt |
| Program Services | $25,105,712 | ProgramServicesAmt |
| Management And General | $3,677,829 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $486,201 | TotalAmt |
| Program Services | $384,337 | ProgramServicesAmt |
| Management And General | $101,864 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,877,342 | TotalAmt |
| Program Services | $3,138,729 | ProgramServicesAmt |
| Management And General | $738,613 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,076,265 | TotalAmt |
| Program Services | $1,758,637 | ProgramServicesAmt |
| Management And General | $317,628 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $475,245 | TotalAmt |
| Management And General | $475,245 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $251,219 | TotalAmt |
| Program Services | $9,560 | ProgramServicesAmt |
| Management And General | $241,659 | ManagementAndGeneralAmt |
Fees For Services Lobbying FeesForServicesLobbyingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $7,808 | TotalAmt |
| Management And General | $7,808 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,934,973 | TotalAmt |
| Program Services | $3,719,526 | ProgramServicesAmt |
| Management And General | $1,215,447 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $194,248 | TotalAmt |
| Program Services | $13,437 | ProgramServicesAmt |
| Management And General | $180,811 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,983,219 | TotalAmt |
| Program Services | $3,989,265 | ProgramServicesAmt |
| Management And General | $993,954 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $503,188 | TotalAmt |
| Program Services | $458,031 | ProgramServicesAmt |
| Management And General | $45,157 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,426,367 | TotalAmt |
| Program Services | $1,364,730 | ProgramServicesAmt |
| Management And General | $61,637 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $299,724 | TotalAmt |
| Program Services | $261,449 | ProgramServicesAmt |
| Management And General | $38,275 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $845,477 | TotalAmt |
| Program Services | $822,836 | ProgramServicesAmt |
| Management And General | $22,641 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,060,902 | TotalAmt |
| Program Services | $3,952,031 | ProgramServicesAmt |
| Management And General | $108,871 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $615,471 | TotalAmt |
| Program Services | $218,859 | ProgramServicesAmt |
| Management And General | $396,612 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| MEDICAL SUPPLIES | $5,277,984 | $5,277,984 | |
| REPAIRS AND MAINTENANCE | $1,161,276 | $1,078,451 | $82,825 |
| DUES & SUBSCRIPTIONS | $263,656 | $263,656 | |
| FOOD | $229,093 | $229,093 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $40,165 | TotalAmt |
| Management And General | $40,165 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $62,034,227 | TotalAmt |
| Program Services | $52,555,495 | ProgramServicesAmt |
| Management And General | $9,478,732 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,706,798 | BOYAmt |
| EOY | $2,993 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,732,949 | BOYAmt |
| EOY | $6,226,435 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,710,055 | BOYAmt |
| EOY | $8,367,896 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,023,900 | BOYAmt |
| EOY | $1,631,824 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $841,042 | BOYAmt |
| EOY | $784,733 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $62,304,666 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $47,135,566 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $15,661,087 | BOYAmt |
| EOY | $15,169,100 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,013,556 | BOYAmt |
| EOY | $11,229,670 | EOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $245,853 | BOYAmt |
| EOY | $508,045 | EOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $514,468 | BOYAmt |
| EOY | $291,712 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,044,706 | BOYAmt |
| EOY | $3,577,287 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $52,494,414 | BOYAmt |
| EOY | $47,789,695 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,882,337 | BOYAmt |
| EOY | $5,542,137 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $20,871,975 | BOYAmt |
| EOY | $17,867,738 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $25,718 | BOYAmt |
| EOY | $10,780,000 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $552,989 | BOYAmt |
| EOY | $3,112,885 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $26,333,019 | BOYAmt |
| EOY | $37,302,760 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows FASB117 | Yes (X) | OrganizationFollowsFASB117Ind |
No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $25,661,395 | BOYAmt |
| EOY | $10,486,935 | EOYAmt |
Donor Restriction Net Assets DonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $500,000 | BOYAmt |
| EOY | $0 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $26,161,395 | BOYAmt |
| EOY | $10,486,935 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $52,494,414 | BOYAmt |
| EOY | $47,789,695 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | -$7,553,466 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $267,462 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | -$8,388,456 | OtherChangesInNetAssetsAmt |
| Info In Schedule O Part XII | Yes (X) | InfoInScheduleOPartXIIInd |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | Yes (1) | FederalGrantAuditRequiredInd |
| Federal Grant Audit Performed | Yes (1) | FederalGrantAuditPerformedInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| 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) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | VolunteersInd |
| Paid Staff Or Management | 0 | PaidStaffOrManagementInd |
| Media Advertisements | 0 | MediaAdvertisementsInd |
| Mailings Members | 0 | MailingsMembersInd |
| Publications Or Broadcast | 0 | PublicationsOrBroadcastInd |
| Grants Other Organizations | 0 | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | 0 | DirectContactLegislatorsInd |
| Rallies Demonstrations | 0 | RalliesDemonstrationsInd |
| Other Activities | Yes (1) | OtherActivitiesInd |
| Other Activities | $7,808 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $7,808 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | 0 | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART II-B, LINE 1: | FormAndLineReferenceDesc |
| Explanation | THE AMOUNT INCLUDES A PERCENTAGE OF THE ANNUAL DUES PAID TO THE KANSAS HOSPITAL ASSOCIATION AND THE AMERICAN HOSPITAL ASSOCIATION THAT ARE ATTRIBUTABLE TO LOBBYING. | ExplanationTxt |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Protection Natural Habitat | Yes (X) | ProtectionNaturalHabitatInd |
| Total Easements | 1 | TotalEasementsCnt |
| Total Acreage | 3.00 | TotalAcreageCnt |
| States Easements Held | 1 | StatesEasementsHeldCnt |
| Written Policy Monitoring | 0 | WrittenPolicyMonitoringInd |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $964,642 | OtherCostOrOtherBasisAmt |
| Book Value | $964,642 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $41,475,476 | OtherCostOrOtherBasisAmt |
| Depreciation | $30,779,950 | DepreciationAmt |
| Book Value | $10,695,526 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $16,265,023 | OtherCostOrOtherBasisAmt |
| Depreciation | $14,041,900 | DepreciationAmt |
| Book Value | $2,223,123 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $3,599,525 | OtherCostOrOtherBasisAmt |
| Depreciation | $2,313,716 | DepreciationAmt |
| Book Value | $1,285,809 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $15,169,100 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp (2 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| THIRD-PARTY PAYOR SETTLEMENTS | $1,012,628 |
| RIGHT OF USE ASSET | $2,564,659 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $3,577,287 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)
| DescDesc | AmtAmt |
|---|---|
| DEFERRED COMPENSATION | $514,739 |
| LEASE LIABILITY | $2,598,146 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $3,112,885 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $54,748,223 | TotalRevEtcAuditedFinclStmtAmt |
| Net Unrealized Gains Invst | $267,462 | NetUnrealizedGainsInvstAmt |
| Revenue Not Reported | $267,462 | RevenueNotReportedAmt |
| Revenue Subtotal | $54,480,761 | RevenueSubtotalAmt |
| Revenue Not Reported Fincl Stmt | $0 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $54,480,761 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $62,034,227 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Not Reported | $0 | ExpensesNotReportedAmt |
| Expenses Subtotal | $62,034,227 | ExpensesSubtotalAmt |
| Expenses Not Rpt Fincl Stmt | $0 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $62,034,227 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART II, LINE 9: | CONSERVATION EASEMENTS ARE REPORTED AT HISTORICAL COSTS AS LAND. |
| PART X, LINE 2: | THE HOSPITAL ACCOUNTS FOR UNCERTAINTIES IN ACCOUNTING FOR INCOME TAX ASSETS AND LIABILITIES USING GUIDANCE INCLUDED IN FASB ASC 740, INCOME TAXES. THE HOSPITAL RECOGNIZES THE EFFECT OF INCOME TAX POSITIONS ONLY IF THOSE POSITIONS ARE MORE LIKELY THAN NOT OF BEING SUSTAINED. AT DECEMBER 31, 2023 AND 2022, THE HOSPITAL HAD NO UNCERTAIN TAX POSITIONS ACCRUED. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
| Percent200 | Yes (X) | Percent200Ind |
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
| Percent200 D | Yes (X) | Percent200DInd |
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | Yes (1) | ExpensesExceedBudgetInd |
| Unable To Provide Care | 0 | UnableToProvideCareInd |
| Annual Community Bnft Report | Yes (1) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (1) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $691,000 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $691,000 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01110 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $7,971,074 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $5,486,202 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,484,872 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.04010 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $8,662,074 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $5,486,202 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $3,175,872 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.05120 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $8,662,074 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $5,486,202 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $3,175,872 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.05120 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $2,103,171 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $340,714 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $14,540,221 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $15,405,527 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$865,306 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (1) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | AMBERWELL ATCHISON ASSOCIATION | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 800 RAVEN HILL DRIVE | AddressLine1Txt |
| City | ATCHISON | CityNm |
| State Abbreviation | KS | StateAbbreviationCd |
| ZIP | 66002 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | WWW.AMBERWELLHEALTH.ORG | WebsiteAddressTxt |
| State License | H-003-001 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Critical Access Hospital | Yes (X) | CriticalAccessHospitalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
| Other | 3 PROVIDER BASED RURAL HEALTH CLINICS | OtherDesc |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | AMBERWELL ATCHISON ASSOCIATION | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | 0 | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | 0 | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (1) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Prior CHNA Impact | Yes (X) | PriorCHNAImpactInd |
| CHNA Conducted | 22 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | 0 | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | Yes (1) | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | PART V, PAGE 8 | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 22 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | PART V, PAGE 8 | StrategyWebsiteURLTxt |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 200.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 200.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| Residency Criteria | Yes (X) | ResidencyCriteriaInd |
| Other Criteria | Yes (X) | OtherCriteriaInd |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | HTTPS://AMBERWELLHEALTH.ORG/PATIENT-RESOURCES/ | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | HTTPS://AMBERWELLHEALTH.ORG/PATIENT-RESOURCES/ | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | HTTPS://AMBERWELLHEALTH.ORG/PATIENT-RESOURCES/ | FAPSummaryOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| Notified FAP Copy Bill Display | Yes (X) | NotifiedFAPCopyBillDisplayInd |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| Provided Written Notice | Yes (X) | ProvidedWrittenNoticeInd |
| Made Effort Orally Notify | Yes (X) | MadeEffortOrallyNotifyInd |
| Processed FAP Application | Yes (X) | ProcessedFAPApplicationInd |
| Made Presumptive Elig Determ | Yes (X) | MadePresumptiveEligDetermInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Look Back Medicare Private | Yes (X) | LookBackMedicarePrivateInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| AMBERWELL ATCHISON ASSOCIATION | PART V, SECTION B, LINE 5: THE HOSPITAL CONDUCTED A TOWN HALL MEETING WITH KEY STAKE HOLDERS INVOLVED AND CONDUCTED ONLINE SURVEYS. THESE STAKE HOLDERS INCLUDED AMBERWELL ATCHISON, CITY OF ATCHISON, ATCHISON CHAMBER OF COMMERCE, MINNISTERIAL ALLIANCE, ATCHISON COMMUNITY HEALTH CLINIC, ATCHISON COUNTY HEALTH DEPARTMENT, HOPE FAMILY THERAPY, ATCHISON CHILD CARE ASSOCIATION, LOCAL AND COUNTY SCHOOL DISTRICTS, GUIDANCE CENTER, AND ATCHISON YMCA. THE ABOVE STAKE HOLDERS REPRESENT THE NEEDS OF THE BROADER COMMUNITY AND ITS SURROUNDING COUNTY'S. ALL DEMOGRAPHICS WOULD BE REPRESENTED BY THESE STAKE HOLDERS. THE CHNA PROCESS STARTED IN DECEMBER 2021 WITH VARIOUS MEETINGS HELD THROUGHOUT 2022. |
| AMBERWELL ATCHISON ASSOCIATION | PART V, SECTION B, LINE 6B: CITY OF ATCHISON, ATCHISON CHAMBER OF COMMERCE, MINNISTERIAL ALLIANCE, ATCHISON COMMUNITY HEALTH CLINIC, ATCHISON COUNTY HEALTH DEPARTMENT, HOPE FAMILY THERAPY, ATCHISON CHILD CARE ASSOCIATION, LOCAL AND COUNTY SCHOOL DISTRICTS, GUIDANCE CENTER, AND ATCHISON YMCA. |
| AMBERWELL ATCHISON ASSOCIATION | PART V, SECTION B, LINE 11: THE COMMUNITY HEALTH NEEDS ASSESSMENT WAS COMPLETED IN 2022. THE FOLLOWING NEEDS WERE IDENTIFIED: MENTAL HEALTH, SUICIDE PREVENTION, SUBSTANCE ABUSE, AND UNINSURED/UNDERINSURED. THE FOLLOWING NEEDS WILL BE ADDRESSED BY AMBERWELL ATCHISON ASSOCIATION AND OTHER LOCAL PARTNERS:MENTAL HEALTH (DIAGNOSIS / TREATMENT / AFTERCARE) WITH A SPECIAL FOCUS ON AWARENESS AND ACCESS TO PROVIDERS:1. MAINTAIN A COMMUNITY INVENTORY OF SERVICES TO DOCUMENT THE AVAILABILITY OF MENTAL HEALTH RESOURCES, INCLUDING HOURS OF SERVICE AND MAKE THE INVENTORY AVAILABLE TO THE PUBLIC, AS NEEDED. DOCUMENT MENTAL HEALTH SERVICES BY AGE CATEGORIES.2. INCREASE DEPRESSION SCREENINGS BY PRIMARY CARE PROVIDERS.3. EXPLORE DEVELOPING A TASK FORCE AMONG CARE COORDINATORS OF AGENCIES TO WORK TOGETHER TO ENSURE THAT PATIENTS ARE GETTING CARE THAT THEY NEED AND TO IDENTIFY WHAT BARRIERS EXIST. INCREASED COLLABORATION BETWEEN AGENCIES TO BENEFIT THE PATIENTS WE SERVE.4. EXPAND MENTAL HEALTH TRAINING AND CREATE EDUCATION (MATERIALS / PRESENTATIONS) IN SCHOOLS AND COMMUNITY PROGRAMS TO DESTIGMATIZE MENTAL HEALTH ISSUES.5. CONTINUE TO REFER MENTAL HEALTH PATIENTS TO THE GUIDANCE CENTER, ACHC, AMBERWELL, HEALTH DEPT, AND OTHERS.6. INVESTIGATE GRANT WRITING TO FUND MENTAL HEALTH EDUCATION AND SERVICES. IF AVAILABLE, DESIGNATE A COMMUNITY LEAD TO ATTAIN THE NECESSARY GRANT.7. PROMOTE EXISTING MENTAL HEALTH SERVICES, FACILITIES, AND PROVIDERS. EDUCATE COMMUNITY ON PLACEMENT PROCESS AND OPTIONS THROUGH HOSPITAL PHYSICIANS, CLINICS, AND E.R.8. EXPAND ACCESS TO MENTAL HEALTH THROUGH ADDING ADDITIONAL MENTAL HEALTH PROFESSIONALS TO SERVE THE COMMUNITY.9. CONTINUE TO CONTRACT WITH THE GUIDANCE CENTER TO SEND A MENTAL HEALTH SCREENER TO THE EMERGENCY DEPARTMENT TO ASSESS PATIENT-NEEDS AND TREATMENT OPTIONS AVAILABLE.10. CONTINUE PARTNERSHIPS WITH AREA SCHOOLS AROUND MENTAL HEALTH EDUCATION AND SERVICES FOR BOTH STAFF AND STUDENTS.DURING 2023 A COMMUNITY HEALTH WORKS PROGRAM WAS IMPLEMENTED TO HELP WITH MENTAL HEALTH ISSUES WITHIN THE COMMUNITY. UNINSURED/UNDERINSURED:1. PROVIDE A SLIDING SCALE FOR COST OF CARE TO UNINSURED, UNDERINSURED, AND VULNERABLE PATIENTS IN THE COMMUNITY.2. SUPPORT THE IMPLEMENTATION OF AN INSURANCE PROGRAM THROUGH THE CHAMBER TO HELP SMALL BUSINESSES PROVIDE INSURANCE.3. SUPPORT COMMUNITY AWARENESS OF MEDICAID EXPANSION.4. UTILIZE COMMUNITY HEALTH WORKERS TO PROVIDE EDUCATION, REFERRAL AND FOLLOW-UP, CASE MANAGEMENT, HOME VISITING, ETC. FOR THOSE AT HIGH RISK FOR POOR HEALTH OUTCOMES REGARDLESS OF THE ABILITY TO PAY.5. MAKE PRICING FOR HOSPITAL PROCEDURES AND OTHER HEALTH CARE SERVICES PUBLICLY AVAILABLE.6. PROVIDE HEALTH CARE SERVICES ON SCHOOL PREMISES TO STUDENTS.7. PROVIDE HEALTHCARE BENEFITS NAVIGATOR TO AID COMMUNITY MEMBERS IN UNDERSTANDING INSURANCE OPTIONS AND TO GET THE BEST BENEFITS FOR THEIR PERSONAL SITUATION.8. SEEK LEGISLATION TO INCLUDE MENTAL HEALTH IN COVERED SERVICES UNDER HSAS, ETC.9. EXPLORE PATIENT ASSISTANCE PROGRAM TO HELP DELIVER NEEDED MEDICATIONS TO THE UNINSURED/UNDERINSURED AND LOW INCOME.DURING 2023 AMBERWELL ATCHISON PROVIDED ADDITIONAL ASSISTANCE TO THE UNINSURED AND UNDERINSURED PATIENTS. THE HOSPITAL CREATED AN ONLINE FINANCIAL ASSISTANCE PORTAL TO ALLOW EASY ACCESS TO FINANCIAL ASSISTANCE. THE HOSPITAL ALSO COLLABORATED WITH BENEDICTINE COLLEGE, THE LOCAL COLLEGE, TO PROVIDE ONSITE PROVIDERS WHEN NEEDED. AND LASTLY, THE HOSPITAL PARTNERED WITH ADVOCATE HEALTH TO PROVIDE A MEDICARE ASSISTANCE PROGRAM FOR THOSE IN NEED.THE ORGANIZATION WILL NOT DIRECTLY BE ADDRESSING THE FOLLOWING NEEDS THAT WERE IDENTIFIED IN THE CHNA SINCE THEY ARE NOT PART OF THE HOSPITAL'S MISSION OF CRITICAL OPERATIONS - SUICIDE PREVENTION, SUBSTANCE ABUSE, POVERTY, AND CHILDCARE SERVICES. INSTEAD, THE HOSPITAL WILL PARTNER WITH OTHER COMMUNITY AGENCIES AS APPROPRIATE. |
| AMBERWELL ATCHISON ASSOCIATION | PART V, SECTION B, LINE 13H: A DISCOUNT IN 10% INCREMENTS (RANGING FROM 10% TO 100%) IS GIVEN ON INCOME UP TO 200% OF FEDERAL POVERTY GUIDELINES. THERE ARE INSTANCES WHEN A PATIENT MAY APPEAR ELIGIBLE FOR FINANCIAL DISCOUNTS, BUT THERE IS NO FINANCIAL ASSISTANCE FORM ON FILE OR LACK OF SUPPORTING DOCUMENTATION. IN THE EVENT THERE IS NO EVIDENCE TO SUPPORT A PATIENT'S ELIGIBILITY FOR FINANCIAL ASSISTANCE, AMBERWELL ATCHISON MAY USE OUTSIDE AGENCIES OR VENDORS IN DETERMINING ELIGIBILITY AND POTENTIAL DISCOUNT AMOUNTS. THESE RESOURCES MAY USE DEMOGRAPHIC AND HOUSEHOLD INFORMATION AND/OR CREDIT SCORING TECHNOLOGY TO DETERMINE THE PERCENT OF ASSISTANCE TO APPLY TO THE PATIENT'S ACCOUNT. |
| SCHEDULE H, PART V, SECTION B, LINE 7A AND 10A: | COMMUNITY HEALTH NEEDS ASSESSMENT AND IMPLEMENTATIONSTRATEGY WEBSITE:HTTPS://AMBERWELLHEALTH.ORG/COMMUNITY-HEALTH-NEEDS-ASSESSMENT/ |
Supplemental Information Detail SupplementalInformationDetail (11 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 3C: | A DISCOUNT IN 10% INCREMENTS (RANGING FROM 10% TO 100%) IS GIVEN ON INCOME UP TO 200% OF FEDERAL POVERTY GUIDELINES. THERE ARE INSTANCES WHEN A PATIENT MAY APPEAR ELIGIBLE FOR FINANCIAL DISCOUNTS, BUT THERE IS NO FINANCIAL ASSISTANCE FORM ON FILE OR LACK OF SUPPORTING DOCUMENTATION. IN THE EVENT THERE IS NO EVIDENCE TO SUPPORT A PATIENT'S ELIGIBILITY FOR FINANCIAL ASSISTANCE, AMBERWELL ATCHISON MAY USE OUTSIDE AGENCIES OR VENDORS IN DETERMINING ELIGIBILITY AND POTENTIAL DISCOUNT AMOUNTS. THESE RESOURCES MAY USE DEMOGRAPHIC AND HOUSEHOLD INFORMATION AND/OR CREDIT SCORING TECHNOLOGY TO DETERMINE THE PERCENT OF ASSISTANCE TO APPLY TO THE PATIENT'S ACCOUNT. |
| PART I, LINE 7: | CHARITY CARE EXPENSE WAS CONVERTED TO COST ON LINE 7A BASED ON AN OVERALL COST TO CHARGE RATIO ADDRESSING ALL PATIENT SEGMENTS. UNREIMBURSED MEDICAID ON LINE 7B WAS CALCULATED USING THE COST-TO-CHARGE RATIO DERIVED FROM WORKSHEET 2. |
| PART III, LINE 2: | THE AMOUNT ON LINE 2 REPRESENTS IMPLICIT PRICE CONCESSIONS. THE HOSPITAL DETERMINES ITS ESTIMATE OF IMPLICIT PRICE CONCESSIONS BASED ON ITS HISTORICAL COLLECTION EXPERIENCE WITH THIS CLASS OF PATIENTS. |
| PART III, LINE 3: | THE ESTIMATED AMOUNT OF THE ORGANIZATION'S IMPLICIT PRICE CONCESSIONS ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S CHARITY CARE POLICY IS CALCULATED BASED ON AN APPROXIMATE 16.2% OF INDIVIDUALS LIVING BELOW THE POVERTY LEVEL IN THE SERVICE AREA. |
| PART III, LINE 4: | THE FOOTNOTE TO THE ORGANIZATION'S FINANCIAL STATEMENTS CAN BE FOUND ON PAGES 13 AND 14 OF THE ATTACHED AUDITED FINANCIAL STATEMENTS. |
| PART III, LINE 8: | AMBERWELL ATCHISON PROVIDES SERVICES TO PATIENTS UNDER THE MEDICARE PROGRAM KNOWING THEY WILL NOT RECOVER ALL THE COSTS ASSOCIATED WITH PROVIDING THESE SERVICES. PROVIDING THESE SERVICES IS ESSENTIAL TO THESE PATIENTS AND THE COMMUNITY AND INCREASES THEIR ACCESS TO HEALTHCARE SERVICES. THEREFORE, THE MEDICARE SHORTFALL IS CONSIDERED A COMMUNITY BENEFIT.TOTAL REVENUE RECEIVED FROM MEDICARE IS THE GROSS REIMBURSEMENT PLUS SETTLEMENT. BOTH TOTAL REVENUE RECEIVED FROM MEDICARE AND THE MEDICARE ALLOWABLE COSTS ARE REPORTED FROM THE MEDICARE COST REPORT. THE MEDICARE COST REPORT IS COMPLETED BASED ON THE RULES AND REGULATIONS SET FORTH BY THE CENTERS FOR MEDICARE AND MEDICAID SERVICES. |
| PART III, LINE 9B: | THE HOSPITAL WILL NOT PURSUE EXTRAORDINARY COLLECTION ACTIVITIES ON PATIENTS FOR AT LEAST 120 DAYS FROM THE DATE OF THE FIRST STATEMENT AND PROVIDES PATIENTS 240 DAYS TO APPLY FOR ASSISTANCE. AFTER FINANCIAL ASSISTANCE DISCOUNTS HAVE BEEN APPLIED, ANY REMAINING SELF-PAY BALANCES WILL BE THE RESPONSIBILITY OF THE PATIENT/GUARANTOR, AND SUBJECT TO THE NORMAL STATEMENT PROCESS. THE PATIENT/GUARANTOR WILL RECEIVE A STATEMENT FROM OUR BILLING COMPANY. THEY WILL CONTINUE TO RECEIVE MONTHLY STATEMENTS FROM OUR BILLING COMPANY, AS WELL AS INTERMITTENT PHONE CALLS FOR APPROXIMATELY 120 DAYS UNTIL THE BALANCE IS PAID IN FULL OR A PAYMENT PLAN HAS BEEN SET UP. IF PAYMENT PLAN ARRANGEMENTS OR PAYMENT IN FULL HAVE NOT BEEN RECEIVED, THEY WILL RECEIVE A FINAL NOTICE, AND BE SUBJECT TO FURTHER COLLECTION PROCESSES. WE ENCOURAGE PAYMENT IN FULL BUT UNDERSTAND THAT IS NOT ALWAYS POSSIBLE AND OFFER PAYMENT PLANS.FINANCIAL ASSISTANCE MAY BE APPLIED ON ANY ACCOUNT(S) THAT HAS BEEN ASSIGNED TO AN OUTSIDE COLLECTION AGENCY. THE HOSPITAL CAN PLACE ACCOUNTS WITH A COLLECTION AGENCY WITHIN 120 DAYS, HOWEVER, THE COLLECTION AGENCY CANNOT BEGIN ANY EXTRAORDINARY COLLECTION ACTIONS AS DEFINED BY THE PATIENT PROTECTION AND AFFORDABLE CARE ACT SUBSECTION 501(R) SUCH AS LEGAL PROCESS, SELLING DEBT, REPORTING ADVERSE INFORMATION ON CREDIT BUREAUS, COMMENCE CIVIL ACTION, GARNISH WAGES, COMPLETE A LIEN OR CAUSE AN ARREST BEFORE THE FIRST 240 DAYS FROM THE DATE OF THE FIRST STATEMENT. ACCOUNTS ASSIGNED TO AN OUTSIDE AGENCY WILL BE REVIEWED ON A CASE-BY-CASE BASIS. |
| PART VI, LINE 2: | AMBERWELL ATCHISON ASSOCIATION HAS ACCESS TO THE KANSAS HEALTH INITIATIVE SURVEY ON HEALTH INDICATORS. BASED ON THESE INDICATORS, THE HOSPITAL DETERMINES THE NEEDS OF THE COMMUNITY AND WHAT PROGRAMS TO IMPLEMENT. |
| PART VI, LINE 3: | PATIENTS ARE GIVEN A PAMPHLET DESCRIBING THE POLICY FOR FINANCIAL ASSISTANCE WHEN THEY ARE ADMITTED. THE ADMITTING OFFICE ASKS THEM TO SPEAK WITH THE HOSPITAL FINANCIAL COUNSELOR IF THEY DO NOT HAVE INSURANCE. AFTER THE PATIENT RECEIVES THEIR STATEMENT IN THE MAIL, THEY CAN CALL IN AND TALK WITH THE FINANCIAL COUNSELOR. IF THE ACCOUNT GOES TO A COLLECTION COMPANY BECAUSE THE PATIENT DID NOT PAY OR TALK WITH THE FINANCIAL COUNSELOR, THE COLLECTION COMPANY WILL GIVE THEM THE PROPER APPLICATION TO FILL OUT TO SEE IF THEY ARE ELIGIBLE FOR FINANCIAL ASSISTANCE. |
| PART VI, LINE 4: | AMBERWELL ATCHISON SERVES THE COMMUNITY OF ATCHISON, KANSAS AND THE SURROUNDING ATCHISON COUNTY. AS OF JANUARY 2022, THERE ARE OVER 650 EMPLOYEES SERVING ACROSS 7 AMBERWELL LOCATIONS IN 6 COMMUNITIES IN THE NORTHEAST KANSAS AREA. AMBERWELL HEALTH IS COMMITTED TO INNOVATING RURAL HEALTH SOLUTIONS AND INVESTING IN PEOPLE, FACILITIES, AND EQUIPMENT TO ENSURE THAT ACCESS TO QUALITY, LOCAL HEALTHCARE CONTINUES IN OUR COMMUNITIES.THE HOSPITAL SERVES A COMMUNITY OF APPROXIMATELY 10,600 PEOPLE WITH A MEDIAN HOUSEHOLD INCOME OF $47,742. THE SURROUNDING COUNTY HAS A POPULATION OF AN ADDITIONAL 6,300 PEOPLE. 16.2% OF THE POPULATION LIVE BELOW THE FEDERAL POVERTY LEVEL (1.57K OUT OF 9.25K PEOPLE), A NUMBER THAT IS HIGHER THAN THE NATIONAL AVERAGE OF 12.8%.PRIMARY CARE PHYSICIANS IN ATCHISON COUNTY, KS SEE AN AVERAGE OF 2,296 PATIENTS PER YEAR. THIS REPRESENTS A 13.4% INCREASE FROM THE PREVIOUS YEAR (2,024 PATIENTS). THE PERCENTAGE OF UNINSURED INDIVIDUALS DECLINED TO 7.64%. 92.4% OF THE POPULATION OF ATCHISON, KS HAS HEALTH COVERAGE, WITH 52.3% ON EMPLOYEE PLANS, 12.9% ON MEDICAID, 12% ON MEDICARE, 12.3% ON NON-GROUP PLANS, AND 2.8% ON MILITARY OR VA PLANS.THE MOST COMMON EMPLOYMENT SECTORS ARE EDUCATIONAL SERVICES, MANUFACTURING, AND RETAIL TRADE. |
| PART VI, LINE 5: | AMBERWELL ATCHISON IS GOVERNED BY A 5-MEMBER, VOLUNTEER BOARD OF DIRECTORS THAT REPRESENT KEY AREAS WITHIN ATCHISON COUNTY AS WELL AS THE MEDICAL STAFF. THE HOSPITAL APPLIES SURPLUS FUNDS TO EQUIPMENT AND BUILDING UPGRADES TO ENSURE THE HEALTH CARE NEEDS OF THE COMMUNITY IS SERVED. AMBERWELL HEALTH OPERATES AN EMERGENCY ROOM AVAILABLE TO ALL REGARDLESS OF ABILITY TO PAY.AMBERWELL ATCHISON BELIEVES COMMUNITY BENEFIT GOES BEYOND HOSPITAL VISITS AND EMERGENCY CARE. IT MEANS GETTING INVOLVED AND WORKING TO IMPROVE THE HEALTH OF OUR COMMUNITY; IT MEANS HELPING OTHERS PURSUE GOOD HEALTH THROUGH DONATIONS, EDUCATION AND VOLUNTEERISM. THE FOLLOWING IS A SUMMARY OF THE NUMEROUS ACTIVITIES, INITIATIVES AND EVENTS THAT HAVE BEEN IMPLEMENTED IN SUPPORT OF PROVIDING COMMUNITY BENEFITS TO THE RESIDENTS IN THE ATCHISON COMMUNITY AND REGION. LIVE WELL LIVE ATCHISON, IS A HOSPITAL INITIATIVE THAT INVOLVES PARTNERSHIPS WITH THE KANSAS HEALTH INITIATIVE, ATCHISON COUNTY SCHOOLS, BENEDICTINE COLLEGE, CITY AND COUNTY GOVERNMENTS, STATE REPRESENTATIVES, FAITH-BASED CHURCHES, THE HEALTH DEPARTMENT, COUNTY EXTENSION OFFICE AND AREA BUSINESSES, HEALTH AND SERVICE AGENCIES, AS WELL AS COMMUNITY AND CIVIC ORGANIZATIONS. THE GROUP IS WORKING TOWARD IMPROVING THE HEALTH BEHAVIORS AND LIFESTYLE OF ATCHISON COUNTY. AMBERWELL ATCHISON'S "BEST CARE COMMUNITY HEALTH FAIR," IS AN ANNUAL EVENT BY THE HOSPITAL AND HELD AT THE ATCHISON ELEMENTARY SCHOOL. HOSPITAL EMPLOYEES AS WELL AS COMMUNITY HEALTH AGENCIES, ORGANIZATIONS, LOCAL AND REGIONAL AREA RESPONDERS AND PHYSICIAN PRACTICES, PROVIDE HEALTH SCREENINGS, INTERACTIVE EDUCATIONAL, SAFETY AND FITNESS ACTIVITIES. AMBERWELL ATCHISON SUPPORTS THE ATCHISON COMMUNITY HEALTH CLINIC, A FEDERAL QUALIFIED HEALTH CLINIC, BY SUBSIDIZING THE CLINIC'S FACILITIES RENT FREE, GENERAL MAINTENANCE AND SNOW REMOVAL. THE HOSPITAL CONDUCTS AND SPONSORS SUPPORT GROUPS AND CLASSES THAT PROVIDE ONGOING EDUCATION AND COUNSELING SUCH AS GRIEF SUPPORT, BIRTHING AND CHILDCARE CLASSES. ADDITIONALLY, THE HOSPITAL OFFERS A HOSPICE VOLUNTEER PROGRAM. THE HOSPITAL ALSO PROVIDES SPONSORSHIP AND DONATIONS TO VARIOUS ORGANIZATIONS, LOCAL SCHOOLS AND NURSING HOMES, AS WELL AS COMMUNITY INITIATIVES SUCH AS: RELAY FOR LIFE, AMELIA EARHART FESTIVAL, BEAUTIFICATION OF OUR CITY, FARM SAFETY DAYS, JOGGIN' FOR THE NOGGIN', PARTICIPATION IN LOCAL AND REGIONAL HEALTH FAIRS AND PHYSICIAN SUPPORT AT LOCAL HIGH SCHOOL AND COLLEGE ATHLETIC EVENTS. AMBERWELL ATCHISON'S CARE TEAM, AN EMPLOYEE GROUP THAT GENERATES INITIATES FUNDRAISERS AND DONATES EARNED PROCEEDS TO VARIOUS LOCAL CHARITIES. THE HOSPITAL AS WELL AS THE ATCHISON HOSPITAL AUXILIARY, EACH HOSTS COMMUNITY BLOOD DRIVES THROUGHOUT THE YEAR. THE HOSPITAL PROVIDES COMMUNITY EDUCATION AND CAREER DEVELOPMENT TO ORGANIZATIONS, SCHOOLS AND COLLEGES THROUGHOUT THE AREA THROUGH SPEAKING ENGAGEMENTS, CAREER FAIRS, CLASS IN-SERVICES AND HOSPITAL TOURS. IN ADDITION, HOSPITAL EMPLOYEES VOLUNTEER THEIR SERVICE WITH COMMUNITY NOT-FOR-PROFIT AND CIVIC ORGANIZATIONS AND COMMITTEES, INCLUDING THE CHAMBER OF COMMERCE, WORKFORCE DEVELOPMENT, ROTARY, LIONS CLUB, YMCA, GUIDANCE CENTER MENTAL HEALTH CENTER AND THE MULTIDISCIPLINARY CHILD TEAM AND THE BOY SCOUTS. THE HOSPITAL OFFERS A JOB SHADOWING PROGRAM WHICH OFFERS TEENS EXPOSURE TO A VARIETY OF CAREERS WITHIN THE MEDICAL PROFESSION. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Club Dues Or Fees | Yes (X) | ClubDuesOrFeesInd |
| Written Policy Ref T And E Expnss | Yes (1) | WrittenPolicyRefTAndEExpnssInd |
| Substantiation Required | Yes (1) | SubstantiationRequiredInd |
| Independent Consultant | Yes (X) | IndependentConsultantInd |
| Form990 Of Other Organizations | Yes (X) | Form990OfOtherOrganizationsInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (9 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| JONATHAN LECK MD | ||||||||||||||
| PHYSICIAN | $465,628 | $0 | $298,386 | $0 | $0 | $0 | $8,580 | $0 | $13,585 | $0 | $786,179 | $0 | $0 | $0 |
| BRIAN DUNCAN MD | ||||||||||||||
| PHYSICIAN | $618,133 | $0 | $120,776 | $0 | $0 | $0 | $7,556 | $0 | $21,051 | $0 | $767,516 | $0 | $0 | $0 |
| RODERICK WARREN MD FACS | ||||||||||||||
| PHYSICIAN | $658,346 | $0 | $0 | $0 | $0 | $0 | $6,652 | $0 | $10,729 | $0 | $675,727 | $0 | $0 | $0 |
| MCGARRETT GROTH DO | ||||||||||||||
| PHYSICIAN | $447,735 | $0 | $29,108 | $0 | $0 | $0 | $9,900 | $0 | $21,095 | $0 | $507,838 | $0 | $0 | $0 |
| JUSTIN THELEMAN MD | ||||||||||||||
| PHYSICIAN | $449,090 | $0 | $0 | $0 | $0 | $0 | $2,103 | $0 | $22,057 | $0 | $473,250 | $0 | $0 | $0 |
| JEFFREY PERRY | ||||||||||||||
| PRESIDENT & CEO | $361,022 | $0 | $73,500 | $0 | $0 | $0 | $9,900 | $0 | $6,454 | $0 | $450,876 | $0 | $0 | $0 |
| NORMA GREEN MD | ||||||||||||||
| CHIEF MEDICAL OFFICER | $242,091 | $0 | $14,175 | $0 | $0 | $0 | $7,453 | $0 | $22,026 | $0 | $285,745 | $0 | $0 | $0 |
| CHASE DUDZINSKI | ||||||||||||||
| CFO | $244,568 | $0 | $6,084 | $0 | $0 | $0 | $7,672 | $0 | $22,491 | $0 | $280,815 | $0 | $0 | $0 |
| ALICIA SORENSEN | ||||||||||||||
| COO/CHIEF NURSING OFFICER | $186,727 | $0 | $9,800 | $0 | $0 | $0 | $4,410 | $0 | $22,491 | $0 | $223,428 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 1A | FormAndLineReferenceDesc |
| Explanation | SOCIAL CLUB DUES WERE PAID BY THE HOSPITAL FOR JEFFREY PERRY AND WERE NOT INCLUDED IN HIS W-2 AS TAXABLE COMPENSATION BECAUSE THEY WERE USED 100% FOR BUSINESS. | ExplanationTxt |
Schedule K IRS990ScheduleK
Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp (4 entries)
| Bond ReferenceBondReferenceCd | Bond Issuer EINBondIssuerEIN | CUSIPCUSIPNum | Bond IssuedBondIssuedDt | Issue PriceIssuePriceAmt | PurposePurposeDesc | DefeasedDefeasedInd | On Behalf Of IssuerOnBehalfOfIssuerInd | Pool FinancingPoolFinancingInd |
|---|---|---|---|---|---|---|---|---|
| CITY OF ATCHISON KANSAS | ||||||||
| A | 486025033 | 046687CM9 | 2017-06-06 | $8,835,000 | SEE PART VI. | 0 | 0 | 0 |
| CITY OF ATCHISON KANSAS | ||||||||
| B | 486025033 | 046687CR8 | 2017-06-06 | $3,400,000 | SEE PART VI. | 0 | 0 | 0 |
| CITY OF ATCHISON KANSAS | ||||||||
| C | 486025033 | 046687CV9 | 2017-10-19 | $5,910,000 | SEE PART VI. | 0 | 0 | 0 |
| CITY OF ATCHISON KANSAS | ||||||||
| D | 486025033 | 046687DG1 | 2019-10-30 | $4,255,000 | SEE PART VI. | 0 | 0 | 0 |
Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp (4 entries)
| Bond ReferenceBondReferenceCd | Total ProceedsTotalProceedsAmt | Issuance Costs From ProceedsIssuanceCostsFromProceedsAmt | Other Spent ProceedsOtherSpentProceedsAmt | Refunding Tax Exempt BondsRefundingTaxExemptBondsInd | Refunding Taxable BondsRefundingTaxableBondsInd | Final Allocation MadeFinalAllocationMadeInd | Adequate Books And Rec MaintAdequateBooksAndRecMaintInd | RetiredRetiredAmt | Capital ExpendituresCapitalExpendituresAmt | Substantial CompletionSubstantialCompletionYr |
|---|---|---|---|---|---|---|---|---|---|---|
| A | $8,835,000 | $79,515 | $8,755,485 | Yes (1) | 0 | Yes (1) | Yes (1) | |||
| B | $3,400,000 | $30,600 | $3,369,400 | Yes (1) | 0 | Yes (1) | Yes (1) | $2,475,000 | ||
| C | $5,910,000 | $117,700 | $5,792,300 | 0 | Yes (1) | Yes (1) | Yes (1) | $195,000 | ||
| D | $4,295,481 | $80,961 | $2,329,133 | 0 | Yes (1) | Yes (1) | Yes (1) | $1,140,000 | $1,844,906 | 2023 |
Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp (4 entries)
| Bond ReferenceBondReferenceCd | Owning Bond Financed PropertyOwningBondFinancedPropertyInd | Any Lease ArrangementsAnyLeaseArrangementsInd | Mgmt Contract Bond Fincd PropMgmtContractBondFincdPropInd | Any Research AgreementsAnyResearchAgreementsInd | Private Bus Use By OthersPrivateBusUseByOthersPct | Private Bus Concerning UBIPrivateBusConcerningUBIPct | Total Private Business UseTotalPrivateBusinessUsePct | Bond Iss Meet Prvt Sec Pymt TestBondIssMeetPrvtSecPymtTestInd | Change In Use Bond Financed PropChangeInUseBondFinancedPropInd | Procs Nonqualified Bond RemdtdProcsNonqualifiedBondRemdtdInd |
|---|---|---|---|---|---|---|---|---|---|---|
| A | 0 | 0 | 0 | 0 | 0.00000 | 0.00000 | 0.00000 | 0 | 0 | Yes (1) |
| B | 0 | 0 | 0 | 0 | 0.00000 | 0.00000 | 0.00000 | 0 | 0 | Yes (1) |
| C | 0 | 0 | 0 | 0 | 0.00000 | 0.00000 | 0.00000 | 0 | 0 | Yes (1) |
| D | 0 | 0 | 0 | 0 | 0.00000 | 0.00000 | 0.00000 | 0 | 0 | Yes (1) |
Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp (4 entries)
| Bond ReferenceBondReferenceCd | Form8038 T FiledForm8038TFiledInd | Rebate Not Due YetRebateNotDueYetInd | Exception To RebateExceptionToRebateInd | No Rebate DueNoRebateDueInd | Variable Rate IssueVariableRateIssueInd | Hedge Identified In Bks And RecHedgeIdentifiedInBksAndRecInd | Gross Proceeds Invested In GICGrossProceedsInvestedInGICInd | Gross Proceeds InvestedGrossProceedsInvestedInd | Written Proc To Monitor ReqsWrittenProcToMonitorReqsInd |
|---|---|---|---|---|---|---|---|---|---|
| A | 0 | 0 | 0 | Yes (1) | 0 | 0 | 0 | 0 | Yes (1) |
| B | 0 | 0 | 0 | Yes (1) | 0 | 0 | 0 | 0 | Yes (1) |
| C | 0 | 0 | 0 | Yes (1) | 0 | 0 | 0 | Yes (1) | Yes (1) |
| D | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | Yes (1) |
Procedures Corrective Action ProceduresCorrectiveActionGrp (4 entries)
| Bond ReferenceBondReferenceCd | Procedures Corrective ActionProceduresCorrectiveActionInd |
|---|---|
| A | Yes (1) |
| B | Yes (1) |
| C | Yes (1) |
| D | Yes (1) |
Supplemental Information Detail SupplementalInformationDetail (9 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| DATE REBATE COMPUTATION PERFORMED | ISSUER NAME: CITY OF ATCHISON, KANSAS DATE THE REBATE COMPUTATION WAS PERFORMED: 06/01/2022 ISSUER NAME: CITY OF ATCHISON, KANSAS DATE THE REBATE COMPUTATION WAS PERFORMED: 06/01/2022 ISSUER NAME: CITY OF ATCHISON, KANSAS DATE THE REBATE COMPUTATION WAS PERFORMED: 10/01/2022 |
| PART I, LINE A, COLUMN (F): | CURRENT REFUND A PORTION OF THE 2008A BONDS. THE 2008A BONDS WERE ORIGINALLY ISSUED ON 9/23/2008. |
| PART I, LINE B, COLUMN (F): | CURRENT REFUND A PORTION OF THE 2009 BONDS. THE 2009 BONDS WERE ORIGINALLY ISSUED ON 6/30/2009. |
| PART I, LINE C, COLUMN (F): | ADVANCE REFUND REMAINING PORTION OF THE 2009 BONDS. THE 2009 BONDS WERE ORIGINALLY ISSUED ON 6/30/2009. |
| PART I, LINE D, COLUMN (F): | CURRENT REFUND TAXABLE BANK LOAN. THE TAXABLE BANK LOAN WAS ORIGINALLY ISSUED ON 7/21/2015. RENOVATIONS AND EQUIPMENT FOR HOSPITAL FACILITIES. |
| PART II, COLUMN C, LINE 11: | THIS AMOUNT REPRESENTS $5,786,846 OF BOND PROCEEDS USED TO ADVANCE REFUND A PORTION OF THE 2009 BONDS AND $4,954 ALLOCATED TO PAY INTEREST ON THE BONDS. |
| PART II, COLUMN D, LINE 3: | AMOUNT DOES NOT EQUAL THE ISSUE PRICE AS A RESULT OF INTEREST EARNED ON THE BOND PROCEEDS DURING THE PROJECT PERIOD. |
| PART II, COLUMN D, LINE 11: | THIS AMOUNT IS COMPRISED OF $1,709,258 OF BOND PROCEEDS THAT WERE USED TO CURRENT REFUND THE TAXABLE BANK LOAN WITH EXCHANGE BANK & TRUST ON 10/30/2019 AND $1,510 OF UNSPENT PROCEEDS ON DEPOSIT IN THE COST OF ISSUANCE FUND THAT WAS ALLOCATED TO PAY INTEREST ON THE BONDS. |
| PART IV, COLUMN C, LINE 6: | PROCEEDS WERE DEPOSITED AND HELD IN A YIELD RESTRICTED ESCROW FOR THE REFUNDED BOND BEYOND THE AVAILABLE TEMPORARY PERIOD. ALL SUCH PROCEEDS HAVE BEEN SPENT. |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (8 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART III, LINE 3 | EFFECTIVE MARCH 1, 2020, THE ORGANIZATION AND HIAWATHA HOSPITAL ASSOCIATION (HIAWATHA) ENTERED INTO AN AFFILIATION AGREEMENT (THE AGREEMENT) WITH AMBERWELL HEALTH, LLC. DURING 2022, HERINGTON HOSPITAL, INC. (HERINGTON) JOINED THE AGREEMENT. UNDER THE TERMS OF THE AGREEMENT, EACH HOSPITAL WILL BE AN AFFILIATE OF AMBERWELL HEALTH, LLC. THE AFFILIATION WAS ESTABLISHED FOR THE PURPOSES OF SUPPORTING HEALTH AND WELFARE OF THE RESIDENTS IN THE RURAL COMMUNITY, TO COORDINATE THE ACTIVITIES AND ACHIEVE OPERATIONAL EFFICIENCIES AMONG THE ORGANIZATIONS AND TO ENSURE THE DELIVERY OF CARE THROUGH RURAL HOSPITALS. THE HOSPITALS WILL CONTINUE TO MAINTAIN THEIR OWN GOVERNING BOARDS AND HAVE SEPARATE DECISION-MAKING AUTHORITY. DURING 2023, HERINGTON DISCONTINUED OPERATIONS, CLOSED THE FACILITY, AND IS NO LONGER A MEMBER OF THE AGREEMENT. |
| FORM 990, PART VI, SECTION A, LINE 8B | THE ORGANIZATION DOES NOT HAVE COMMITTEES WITH AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY. |
| FORM 990, PART VI, SECTION B, LINE 11B | AN INDEPENDENT ACCOUNTING FIRM PREPARES AND REVIEWS THE FORM 990. THE FORM 990 IS THEN REVIEWED BY THE ORGANIZATION'S MANAGEMENT. ANY QUESTIONS OR CONCERNS THE ORGANIZATION'S MANAGEMENT HAS ARE ADDRESSED AND ANY CORRECTIONS OR CLARIFICATIONS ARE MADE. THE FORM 990 IS THEN PROVIDED TO THE BOARD PRIOR TO FILING WITH THE IRS. |
| FORM 990, PART VI, SECTION B, LINE 12C | AT THE TIME OF THE 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. |
| FORM 990, PART VI, SECTION B, LINE 15A | THE ORGANIZATION ENGAGES ITS LEGAL COUNSEL TO PREPARE COMPENSATION DATA STUDIES. IN ADDITION TO VARIOUS DATA COLLECTED, OTHER HOSPITALS' 990'S ARE REVIEWED AND COMBINED IN THE COMPENSATION STUDY. THE HOSPITAL'S LEGAL COUNSEL REVIEWS THE STUDY WITH THE BOARD OF DIRECTORS TO ADJUST THE PRESIDENT & CEO'S COMPENSATION. ANY DECISION THAT IS MADE IN REGARDS TO THE PRESIDENT & CEO'S COMPENSATION IS DOCUMENTED BY THE BOARD OF DIRECTORS. THE PROCESS WAS LAST COMPLETED IN FEBRUARY 2023. THE CEO AND HUMAN RESOURCE DIRECTOR CONDUCT AN ANNUAL REVIEW OF OTHER OFFICERS AND KEY EMPLOYEES' COMPENSATION BASED ON COMPARABLE DATA OF OTHER ORGANIZATIONS OF SIMILAR SIZE AND INDUSTRY. THIS IS DONE ON AN ANNUAL BASIS AND DOCUMENTED IN THE PERSONNEL FILES. |
| 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. |
| FORM 990, PART XI, LINE 9: | NMTC EQUITY TRANSFER -8,388,456. |
| FORM 990, PART XI, LINE 2C: | AN INDEPENDENT ACCOUNTING FIRM AUDITS THE ORGANIZATION'S FINANCIAL STATEMENTS. THE ORGANIZATION HAS A COMMITTEE THAT ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF ITS FINANCIAL STATEMENTS AND SELECTION OF AN INDEPENDENT ACCOUNTANT. THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. |
Schedule R IRS990ScheduleR
Id Disregarded Entities IdDisregardedEntitiesGrp
Disregarded Entity Name DisregardedEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | AMBERWELL HEALTH LLC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 800 RAVEN HILL DRIVE | AddressLine1Txt |
| City | ATCHISON | CityNm |
| State Abbreviation | KS | StateAbbreviationCd |
| ZIP | 66002 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 873578396 | EIN |
| Primary Activities | CENTRALIZED OFFICE FOR AFFILIATES | PrimaryActivitiesTxt |
| Legal Domicile State | KS | LegalDomicileStateCd |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | AMBERWELL ATCHISON ASSOCIATION | BusinessNameLine1Txt |
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|---|
| AMBERWELL HEALTH FOUNDATION | ||||||||||
| 800 RAVEN HILL DRIVE | ATCHISON | KS | 66002 | 480955489 | SUPPORT AMBERWELL ATCHISON ASSOCIATION | KS | 501(C)(3) | LINE 12B, II | AMBERWELL ATCHISON ASSOCIATION | Yes (1) |
| AMBERWELL ATCHISON SUPPORT ORGANIZATION | ||||||||||
| 800 RAVEN HILL DRIVE | ATCHISON | KS | 66002 | 932800795 | SUPPORT AMBERWELL ATCHISON ASSOCIATION | KS | 501(C)(3) | LINE 12A, I | AMBERWELL ATCHISON ASSOCIATION | Yes (1) |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (1) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (1) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (1) | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | Yes (1) | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp (2 entries)
| Transaction TypeTransactionTypeTxt | InvolvedInvolvedAmt | Method Of Amount DeterminationMethodOfAmountDeterminationTxt |
|---|---|---|
| AMBERWELL HEALTH FOUNDATION | ||
| C | $250,000 | CASH TRANSFERRED |
| AMBERWELL ATCHISON SUPPORT ORGANIZATION | ||
| R | $8,388,456 | EQUITY TRANSFERRED |