NINNESCAH VALLEY HEALTH SYSTEMS INC: Form 990, tax year 2021
View the entire original 990 at ProPublica ↗
- Organization
- NINNESCAH VALLEY HEALTH SYSTEMS INC (EIN 48-0761700)
- Tax period
- 2021-05-01 to 2022-04-30
- Filed
- 2023-02-07
- IRS object ID
- 202300389349301105
- Schema version
- 2021v4.2
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule H
- Schedule J
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2023-02-07T09:12:44-06:00 | ReturnTs |
| Tax Period End | 2022-04-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | FORVIS LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1551 N WATERFRONT PKWY STE 300 | AddressLine1Txt |
| City | WICHITA | CityNm |
| State Abbreviation | KS | StateAbbreviationCd |
| ZIP | 672066601 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2021-05-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 480761700 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | NINNESCAH VALLEY HEALTH SYSTEMS INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| In Care Of | % THAD TURNER | InCareOfNm |
| Business Name Control | NINN | BusinessNameControlTxt |
| Phone | 6205323147 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 376 | AddressLine1Txt |
| City | KINGMAN | CityNm |
| State Abbreviation | KS | StateAbbreviationCd |
| ZIP | 67068 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | PRESTON SAUERS | PersonNm |
| Person Title | CEO | PersonTitleTxt |
| Phone | 6205323147 | PhoneNum |
| Signature | 2022-11-15 | SignatureDt |
| Discuss With Paid Preparer | Yes (true) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | SHANNAN | PersonFirstNm |
| Person Last | FLACH | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | SHAWNELL LINOT | PreparerPersonNm |
| PTIN | P01663908 | PTIN |
| Phone | 3162652811 | PhoneNum |
Additional Filer Information AdditionalFilerInformation
Trusted Customer TrustedCustomerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | 3 | TrustedCustomerCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2021 | TaxYr |
| Build TS | 2023-03-07 01:45:13Z | BuildTS |
Form 990 IRS990
Doing Business As Name DoingBusinessAsName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | KINGMAN HEALTHCARE CENTER | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | PRESTON SAUERS | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 376 | AddressLine1Txt |
| City | KINGMAN | CityNm |
| State Abbreviation | KS | StateAbbreviationCd |
| ZIP | 67068 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $17,554,141 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.KINGMANHC.COM | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1996 | FormationYr |
| Legal Domicile State | KS | LegalDomicileStateCd |
| Activity Or Mission | EXCEPTIONAL CARE. EVERY TIME. ACUTE CARE HOSPITAL MEETING THE PRIMARY HEALTHCARE NEEDS OF KINGMAN COUNTY AND THE SURROUNDING COMMUNITIES. | ActivityOrMissionDesc |
| Voting Members Governing Body | 7 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 7 | VotingMembersIndependentCnt |
| Total Employee | 180 | TotalEmployeeCnt |
| Total Volunteers | 30 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $5,248,060 | PYContributionsGrantsAmt |
| CY Contributions Grants | $2,530,407 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $13,070,083 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $14,597,421 | CYProgramServiceRevenueAmt |
| PY Investment Income | $43,675 | PYInvestmentIncomeAmt |
| CY Investment Income | $10,430 | CYInvestmentIncomeAmt |
| PY Other Revenue | $181,225 | PYOtherRevenueAmt |
| CY Other Revenue | $350,914 | CYOtherRevenueAmt |
| PY Total Revenue | $18,543,043 | PYTotalRevenueAmt |
| CY Total Revenue | $17,489,172 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $400 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $300 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $8,143,906 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $8,948,327 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $6,280,377 | PYOtherExpensesAmt |
| CY Other Expenses | $6,936,073 | CYOtherExpensesAmt |
| PY Total Expenses | $14,424,683 | PYTotalExpensesAmt |
| CY Total Expenses | $15,884,700 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $4,118,360 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $1,604,472 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $13,137,854 | TotalAssetsBOYAmt |
| Total Assets EOY | $15,148,315 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $6,609,122 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $6,988,915 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $6,528,732 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $8,159,400 | NetAssetsOrFundBalancesEOYAmt |
| Mission | EXCEPTIONAL CARE. EVERY TIME. BE THE FACILITY OF CHOICE BY LEADING WELLNESS THROUGH INNOVATION, PARTNERSHIPS, COMPASSION, AND QUALITY. | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $13,158,358 | ExpenseAmt |
| Grant | $300 | GrantAmt |
| Revenue | $14,629,146 | RevenueAmt |
| Desc | HEALTH CARE SERVICES PROVIDED TO THE PEOPLE OF KINGMAN COUNTY AND THE SURROUNDING COMMUNITIES. DURING THE FISCAL YEAR 2022, THE HOSPITAL HAD 1,652 INPATIENT DAYS, 2,123 EMERGENCY ROOM VISITS, AND 271 SURGERIES. TOTAL OUTPATIENT VISITS TOTALED 23,172. IN ADDITION, THE HOSPITAL PROVIDES TWO RURAL HEALTH CLINICS. ONE CLINIC IS WITHIN THE CITY OF KINGMAN AND ONE IS IN THE NEIGHBORING COMMUNITY OF CUNNINGHAM. TOTAL CLINIC VISITS TOTALED 9,077 FOR FISCAL YEAR 2022. | Desc |
| Total Program Service Expenses | $13,158,358 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (true) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (true) | ScheduleBRequiredInd |
| Political Campaign Acty | false | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (true) | LobbyingActivitiesInd |
| Subject To Proxy Tax | false | SubjectToProxyTaxInd |
| Donor Advised Fund | false | DonorAdvisedFundInd |
| Conservation Easements | false | ConservationEasementsInd |
| Collections Of Art | false | CollectionsOfArtInd |
| Credit Counseling | false | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | false | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (true) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | false | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | false | ReportProgramRelatedInvstInd |
| Report Other Assets | false | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (true) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | false | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (true) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | false | ConsolidatedAuditFinclStmtInd |
| School Operating | false | SchoolOperatingInd |
| Foreign Office | false | ForeignOfficeInd |
| Foreign Activities | false | ForeignActivitiesInd |
| More Than5000 K To Org | false | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividualsInd |
| Professional Fundraising | false | ProfessionalFundraisingInd |
| Fundraising Activities | false | FundraisingActivitiesInd |
| Gaming Activities | false | GamingActivitiesInd |
| Operate Hospital | Yes (true) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (true) | AuditedFinancialStmtAttInd |
| Grants To Organizations | false | GrantsToOrganizationsInd |
| Grants To Individuals | false | GrantsToIndividualsInd |
| Schedule J Required | Yes (true) | ScheduleJRequiredInd |
| Tax Exempt Bonds | false | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | false | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | false | PYExcessBenefitTransInd |
| Loan Outstanding | false | LoanOutstandingInd |
| Grant To Related Person | false | GrantToRelatedPersonInd |
| Business Rln With Org Mem | false | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | false | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | false | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | false | DeductibleNonCashContriInd |
| Deductible Art Contribution | false | DeductibleArtContributionInd |
| Terminate Operations | false | TerminateOperationsInd |
| Partial Liquidation | false | PartialLiquidationInd |
| Disregarded Entity | false | DisregardedEntityInd |
| Related Entity | Yes (true) | RelatedEntityInd |
| Related Organization Ctrl Ent | false | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | false | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | false | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (true) | ScheduleORequiredInd |
| IRP Document | 25 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (true) | BackupWthldComplianceInd |
| Employee | 180 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (true) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | Yes (true) | UnrelatedBusIncmOverLimitInd |
| Form990 T Filed | Yes (true) | Form990TFiledInd |
| Foreign Financial Account | false | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | false | TaxablePartyNotificationInd |
| Nondeductible Contributions | false | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | false | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | false | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | false | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | false | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | false | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | false | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 7 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 7 | IndependentVotingMemberCnt |
| Family Or Business Rln | false | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | false | DelegationOfMgmtDutiesInd |
| Change To Org Documents | false | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | false | MembersOrStockholdersInd |
| Election Of Board Members | false | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | false | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (true) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (true) | MinutesOfCommitteesInd |
| Officer Mailing Address | false | OfficerMailingAddressInd |
| Local Chapters | false | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (true) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (true) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (true) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (true) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (true) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (true) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (true) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (true) | CompensationProcessOtherInd |
| Investment In Joint Venture | false | InvestmentInJointVentureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | THAD TURNER | PersonNm |
| Phone | 6205323147 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 750 WEST D AVENUE | AddressLine1Txt |
| City | KINGMAN | CityNm |
| State Abbreviation | KS | StateAbbreviationCd |
| ZIP | 67068 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | Yes (X) | InfoInScheduleOPartVIIInd |
Form990 Part VII Section A Form990PartVIISectionAGrp (15 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Highest Compensated EmployeeHighestCompensatedEmployeeInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd |
|---|---|---|---|---|---|---|---|---|
| ERIN BAXA | ||||||||
| PHYSICIAN | 40.0 | 0.0 | Yes (X) | $381,052 | $0 | $3,802 | ||
| CHERIE MORRIS | ||||||||
| PHYSICIAN | 40.0 | 0.0 | Yes (X) | $233,927 | $0 | $2,523 | ||
| PAUL HALDERSON | ||||||||
| PHYSICIAN ASSISTANT | 40.0 | 0.0 | Yes (X) | $152,967 | $0 | $11,632 | ||
| KIMBERLY WIDLER | ||||||||
| APRN | 40.0 | 0.0 | Yes (X) | $135,848 | $0 | $3,423 | ||
| BRENDA CHAVEZ | ||||||||
| APRN | 40.0 | 0.0 | Yes (X) | $127,288 | $0 | $6,492 | ||
| SHANNAN FLACH | ||||||||
| CEO 6/16/2017-5/8/2021 | 40.0 | 0.0 | $97,513 | $0 | $4,128 | Yes (X) | ||
| THAD TURNER | ||||||||
| CFO | 40.0 | 0.0 | $90,237 | $0 | $11,013 | Yes (X) | ||
| PRESTON SAUERS | ||||||||
| CEO 4/21/2021-CURRENT | 40.0 | 0.0 | $96,845 | $0 | $1,732 | Yes (X) | ||
| ANDREW PIESTER | ||||||||
| DIRECTOR | 1.0 | 0.0 | $0 | $0 | $0 | Yes (X) | ||
| ANGIE MALONEY | ||||||||
| SECRETARY/DIRECTOR | 1.0 | 0.0 | $0 | $0 | $0 | Yes (X) | Yes (X) | |
| GREG SCHREINER | ||||||||
| VICE CHAIRMAN/DIRECTOR | 1.0 | 0.0 | $0 | $0 | $0 | Yes (X) | Yes (X) | |
| MICHELE KYLE | ||||||||
| DIRECTOR | 1.0 | 0.0 | $0 | $0 | $0 | Yes (X) | ||
| NEIL FREUND | ||||||||
| CHAIRMAN/DIRECTOR | 1.0 | 0.0 | $0 | $0 | $0 | Yes (X) | Yes (X) | |
| ROGER VANLANDINGHAM | ||||||||
| TREASURER/DIRECTOR | 1.0 | 0.0 | $0 | $0 | $0 | Yes (X) | Yes (X) | |
| STEVE WITTY | ||||||||
| DIRECTOR | 1.0 | 0.0 | $0 | $0 | $0 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,315,677 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $44,745 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 6 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | false | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (true) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | false | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| NABHOLZ CONSTRUCTION | |||||
| 17300 W 116TH STREET | LENEXA | KS | 66219 | CONSTRUCTION MANAGER | $894,175 |
| CPSI | |||||
| PO BOX 850309 | MOBILE | AL | 36685 | EHR SERVICES | $252,112 |
| WICHITA SURGICAL SPECIALISTS | |||||
| 818 N EMPORIA AVE | WICHITA | KS | 67214 | CONTRACTED SURGEON | $163,494 |
| CMW INC | |||||
| 806 E SKINNER | WICHITA | KS | 67211 | CONSTRUCTION SERVICE | $389,800 |
| BUCHANAN TECHNOLOGIES | |||||
| 3450 N ROCK ROAD | WICHITA | KS | 67226 | MANAGED IT SERVICES | $113,500 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 8 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $2,517,536 | GovernmentGrantsAmt |
| All Other Contributions | $12,871 | AllOtherContributionsAmt |
| Total Contributions | $2,530,407 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| NET PATIENT SERVICE REVENUE | 621300 | $12,905,884 | $12,905,884 |
| 340B PHARMACY REVENUE | 446110 | $1,691,537 | $1,691,537 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $14,597,421 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $10,430 | TotalRevenueColumnAmt |
| Exclusion | $10,430 | ExclusionAmt |
Incm From Invest Bond Proceeds IncmFromInvestBondProceedsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Royalties Revenue RoyaltiesRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $50,767 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $50,767 | RealAmt |
| Personal | $0 | PersonalAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $50,767 | TotalRevenueColumnAmt |
| Exclusion | $50,767 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $64,969 | OtherAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $64,969 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Fundraising Gross Income | $0 | FundraisingGrossIncomeAmt |
| Fundraising Direct Expenses | $0 | FundraisingDirectExpensesAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gaming Gross Income | $0 | GamingGrossIncomeAmt |
| Gaming Direct Expenses | $0 | GamingDirectExpensesAmt |
Net Income From Gaming NetIncomeFromGamingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Sales Of Inventory | $0 | GrossSalesOfInventoryAmt |
| Cost Of Goods Sold | $0 | CostOfGoodsSoldAmt |
Net Income Or Loss NetIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Other Revenue Misc OtherRevenueMiscGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt | ExclusionExclusionAmt |
|---|---|---|---|---|
| INTEREST ON PATIENT ACCOUNTS | 900099 | $16,791 | $16,791 | |
| EMPLOYEE/GUEST MEALS | 900099 | $18,427 | $18,427 | |
| All Other Misc Revenue | 900099 | $264,929 | $14,934 | $249,995 |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $264,929 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $14,934 | RelatedOrExemptFuncIncomeAmt |
| Exclusion | $249,995 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $300,147 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $17,489,172 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $14,629,146 | RelatedOrExemptFuncIncomeAmt |
| Exclusion | $329,619 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $300 | TotalAmt |
| Program Services | $300 | ProgramServicesAmt |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Foreign Grants ForeignGrantsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Benefits To Members BenefitsToMembersGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $304,595 | TotalAmt |
| Management And General | $304,595 | ManagementAndGeneralAmt |
Comp Disqual Persons CompDisqualPersonsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $7,207,152 | TotalAmt |
| Program Services | $6,370,079 | ProgramServicesAmt |
| Management And General | $837,073 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $103,230 | TotalAmt |
| Program Services | $81,938 | ProgramServicesAmt |
| Management And General | $21,292 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $802,450 | TotalAmt |
| Program Services | $647,772 | ProgramServicesAmt |
| Management And General | $154,678 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $530,900 | TotalAmt |
| Program Services | $421,400 | ProgramServicesAmt |
| Management And General | $109,500 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $9,525 | TotalAmt |
| Management And General | $9,525 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $102,088 | TotalAmt |
| Management And General | $102,088 | ManagementAndGeneralAmt |
Fees For Services Lobbying FeesForServicesLobbyingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,455 | TotalAmt |
| Management And General | $1,455 | ManagementAndGeneralAmt |
Fees For Services Prof Fundraising FeesForServicesProfFundraising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,699,003 | TotalAmt |
| Program Services | $1,311,325 | ProgramServicesAmt |
| Management And General | $387,678 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $39,681 | TotalAmt |
| Management And General | $39,681 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,205,889 | TotalAmt |
| Program Services | $980,233 | ProgramServicesAmt |
| Management And General | $225,656 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Royalties RoyaltiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $220,356 | TotalAmt |
| Program Services | $181,421 | ProgramServicesAmt |
| Management And General | $38,935 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $89,758 | TotalAmt |
| Program Services | $28,573 | ProgramServicesAmt |
| Management And General | $61,185 | ManagementAndGeneralAmt |
Pymt Travel Entrtnmnt Pub Ofcl PymtTravelEntrtnmntPubOfclGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $137,191 | TotalAmt |
| Program Services | $108,895 | ProgramServicesAmt |
| Management And General | $28,296 | ManagementAndGeneralAmt |
Payments To Affiliates PaymentsToAffiliatesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $799,225 | TotalAmt |
| Program Services | $634,382 | ProgramServicesAmt |
| Management And General | $164,843 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $109,087 | TotalAmt |
| Program Services | $21,605 | ProgramServicesAmt |
| Management And General | $87,482 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| MEDICAL SUPPLIES | $1,854,990 | $1,854,990 | |
| DUES & SUBSCRIPTIONS | $110,622 | $67,213 | $43,409 |
| EQUIPMENT RENTAL & MAINT. | $412,944 | $383,302 | $29,642 |
| FOOD | $57,545 | $57,545 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $86,714 | TotalAmt |
| Program Services | $7,385 | ProgramServicesAmt |
| Management And General | $79,329 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $15,884,700 | TotalAmt |
| Program Services | $13,158,358 | ProgramServicesAmt |
| Management And General | $2,726,342 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $988,154 | BOYAmt |
| EOY | -$7,280 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,048,586 | BOYAmt |
| EOY | $5,650,279 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,344,751 | BOYAmt |
| EOY | $2,071,781 | EOYAmt |
Receivables From Officers Etc ReceivablesFromOfficersEtcGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $295,927 | BOYAmt |
| EOY | $366,216 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $47,535 | BOYAmt |
| EOY | $69,270 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $17,321,048 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $10,826,150 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,454,653 | BOYAmt |
| EOY | $6,494,898 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $157,822 | BOYAmt |
| EOY | $267,821 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $28,159 | BOYAmt |
| EOY | $53,760 | EOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $772,267 | BOYAmt |
| EOY | $181,570 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $13,137,854 | BOYAmt |
| EOY | $15,148,315 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,088,518 | BOYAmt |
| EOY | $1,577,440 | EOYAmt |
Grants Payable GrantsPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $607,614 | BOYAmt |
| EOY | $0 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,859,462 | BOYAmt |
| EOY | $0 | EOYAmt |
Escrow Account Liability EscrowAccountLiabilityGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Loans From Officers Directors LoansFromOfficersDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $53,528 | BOYAmt |
| EOY | $5,251,475 | EOYAmt |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $160,000 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,609,122 | BOYAmt |
| EOY | $6,988,915 | 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 | $6,408,240 | BOYAmt |
| EOY | $7,837,819 | EOYAmt |
Donor Restriction Net Assets DonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $120,492 | BOYAmt |
| EOY | $321,581 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,528,732 | BOYAmt |
| EOY | $8,159,400 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $13,137,854 | BOYAmt |
| EOY | $15,148,315 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $1,604,472 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $26,196 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | false | AccountantCompileOrReviewInd |
| FS Audited | Yes (true) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Separate Basis Fincl Stmt | Yes (X) | SeparateBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (true) | AuditCommitteeInd |
| Federal Grant Audit Required | Yes (true) | FederalGrantAuditRequiredInd |
| Federal Grant Audit Performed | Yes (true) | 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) |
|---|---|---|
| Total Grassroots Lobbying | TotalGrassrootsLobbyingGrp | |
| Total Direct Lobbying | TotalDirectLobbyingGrp | |
| Total Lobbying Expend | TotalLobbyingExpendGrp | |
| Other Exempt Purpose Expend | OtherExemptPurposeExpendGrp | |
| Total Exempt Purpose Expend | TotalExemptPurposeExpendGrp | |
| Lobbying Nontaxable Amount | LobbyingNontaxableAmountGrp | |
| Grassroots Nontaxable | GrassrootsNontaxableGrp | |
| Tot Lbbyng Grassroot Mns Non Tx | TotLbbyngGrassrootMnsNonTxGrp | |
| Tot Lbby Expend Mns Lbbyng Non Tx | TotLbbyExpendMnsLbbyngNonTxGrp | |
| Volunteers | false | VolunteersInd |
| Paid Staff Or Management | false | PaidStaffOrManagementInd |
| Media Advertisements | false | MediaAdvertisementsInd |
| Mailings Members | false | MailingsMembersInd |
| Publications Or Broadcast | false | PublicationsOrBroadcastInd |
| Grants Other Organizations | Yes (true) | GrantsOtherOrganizationsInd |
| Grants Other Organizations | $1,455 | GrantsOtherOrganizationsAmt |
| Direct Contact Legislators | false | DirectContactLegislatorsInd |
| Rallies Demonstrations | false | RalliesDemonstrationsInd |
| Other Activities | false | OtherActivitiesInd |
| Total Lobbying Expenditures | $1,455 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | false | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE C, PART II-B, LINE 1F | FormAndLineReferenceDesc |
| Explanation | A PORTION OF THE ANNUAL DUES PAID TO KHA AND AHA ARE USED FOR LOBBYING. | ExplanationTxt |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Art Public Exhibition Amounts | ArtPublicExhibitionAmountsGrp | |
| Held Works Art | HeldWorksArtGrp | |
| CY Minus3 Yr Endwmt Fund | CYMinus3YrEndwmtFundGrp | |
| CY Minus4 Yr Endwmt Fund | CYMinus4YrEndwmtFundGrp |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $74,923 | OtherCostOrOtherBasisAmt |
| Book Value | $74,923 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $8,900,560 | OtherCostOrOtherBasisAmt |
| Depreciation | $4,147,412 | DepreciationAmt |
| Book Value | $4,753,148 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Leasehold Improvements | LeaseholdImprovementsGrp |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $8,071,824 | OtherCostOrOtherBasisAmt |
| Depreciation | $6,484,601 | DepreciationAmt |
| Book Value | $1,587,223 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $273,741 | OtherCostOrOtherBasisAmt |
| Depreciation | $194,137 | DepreciationAmt |
| Book Value | $79,604 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $6,494,898 | TotalBookValueLandBuildingsAmt |
| Federal Income Tax Liability | $0 | FederalIncomeTaxLiabilityAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | DUE TO THIRD PARTY PAYERS | Desc |
| Amt | $160,000 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $160,000 | TotalLiabilityAmt |
| Total Rev Etc Audited Fincl Stmt | $17,489,172 | TotalRevEtcAuditedFinclStmtAmt |
| Revenue Subtotal | $17,489,172 | RevenueSubtotalAmt |
| Total Revenue Per Form990 | $17,489,172 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $15,884,700 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Subtotal | $15,884,700 | ExpensesSubtotalAmt |
| Total Expenses Per Form990 | $15,884,700 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE D, PART X, LINE 2 | FormAndLineReferenceDesc |
| Explanation | THE SYSTEM HAS BEEN RECOGNIZED AS EXEMPT FROM INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND A SIMILAR PROVISION OF STATE LAW. HOWEVER, THE SYSTEM IS SUBJECT TO FEDERAL INCOME TAX ON ANY UNRELATED BUSINESS TAXABLE INCOME. THE SYSTEM RECOGNIZES THE FINANCIAL STATEMENT BENEFIT OF A TAX POSITION ONLY AFTER DETERMINING THAT THE RELEVANT TAX AUTHORITY WOULD MORE LIKELY THAN NOT SUSTAIN THE POSITION FOLLOWING AN AUDIT. | ExplanationTxt |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (true) | FinancialAssistancePolicyInd |
| Written Policy | Yes (true) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (true) | FPGReferenceFreeCareInd |
| Percent100 | Yes (X) | Percent100Ind |
| FPG Reference Discounted Care | Yes (true) | FPGReferenceDiscountedCareInd |
| Percent200 D | Yes (X) | Percent200DInd |
| Free Care Medically Indigent | Yes (true) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (true) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | Yes (true) | ExpensesExceedBudgetInd |
| Unable To Provide Care | false | UnableToProvideCareInd |
| Annual Community Bnft Report | Yes (true) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (true) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $82,376 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $82,376 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00520 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $769,740 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $434,716 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $335,024 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02110 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $852,116 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $434,716 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $417,400 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02630 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $40,581 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $40,581 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00260 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $40,581 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $40,581 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00260 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $892,697 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $434,716 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $457,981 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02890 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (true) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $881,849 | BadDebtExpenseAmt |
| Reimbursed By Medicare | $5,375,801 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $6,869,796 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$1,493,995 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | Yes (X) | CostToChargeRatioInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (true) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (true) | 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 | KINGMAN HEALTHCARE CENTER | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 750 W D AVENUE | AddressLine1Txt |
| City | KINGMAN | CityNm |
| State Abbreviation | KS | StateAbbreviationCd |
| ZIP | 67068 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | WWW.KINGMANHC.COM | WebsiteAddressTxt |
| State License | H048001 | 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 |
| Facility Reporting Group | 1 | FacilityReportingGroupCd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | KINGMAN HEALTHCARE CENTER | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | false | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | false | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (true) | 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 | 21 | CHNAConductedYr |
| Take Into Account Others Input | Yes (true) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | false | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | false | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (true) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | SEE PART V, SECTION C | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (true) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 21 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (true) | StrategyPostedWebsiteInd |
| Strategy Website URL | SEE PART V, SECTION C | StrategyWebsiteURLTxt |
| Organization Incur Excise Tax | false | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (true) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 100 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 200. | FPGFamilyIncmLmtDscntCarePct |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| Explained Basis | Yes (true) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (true) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Provided Nonprofit Contact | Yes (X) | ProvidedNonprofitContactInd |
| Includes Publicity Measures | Yes (true) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | SEE PART V, SECTION C | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | SEE PART V, SECTION C | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | SEE PART V, SECTION C | 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 Translated | Yes (X) | FAPTranslatedInd |
| FAP Actions On Nonpayment | Yes (true) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | false | 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 (true) | NondisEmergencyCarePolicyInd |
| Look Back Medicaid Medcr Prvt | Yes (X) | LookBackMedicaidMedcrPrvtInd |
| Amounts Generally Billed | false | AmountsGenerallyBilledInd |
| Gross Charges | false | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (7 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| SCHEDULE H, PART V, SECTION B, LINE 5 | THE HOSPITAL, LOCAL HEALTH DEPARTMENT AND COMMUNITY PROVIDERS, ALONG WITH VARIOUS COMMUNITY LEADERS, PARTICIPATED IN COMMITTEE MEETINGS TO DETERMINE RELEVANT ISSUES AND PROPOSE AN ACTION PLAN TO IMPROVE LOCAL CIRCUMSTANCES. THE COMMITTEE THEN PRESENTED THEIR ACTION PLAN TO THE COMMUNITY FOR REVIEW AND IMPLEMENTATION. |
| SCHEDULE H, PART V, SECTION B, LINE 7A | https://www.kingmanhc.com/docs/Kingman_CHNA.pdf?sub=About%20Us |
| SCHEDULE H, PART V, SECTION B, LINE 10A | https://www.kingmanhc.com/docs/2022_CHNA_Implementation_Strategy.pdf?sub=A bout%20Us |
| SCHEDULE H, PART V, SECTION B, LINE 11 | FOR MENTAL HEALTH ISSUES, KHC IS IMPLEMENTING SENIOR LIFE SOLUTIONS, WHICH PROVIDES GERIATRIC PSYCHIATRIC OUTPATIENT SERVICES. KHC ALSO EMPLOYS A LICENSED SOCIAL WORKER WHO LEADS A CAREGIVER SUPPORT GROUP. SPORTS PHYSICALS FOR SCHOOL-AGED CHILDREN HAVE BEEN EXPANDED INTO COMPREHENSIVE ANNUAL WELLNESS VISITS. FOR PRIMARY CARE PHYSICIANS, KHC HAS RECRUITED TWO PHYSICIANS - ONE WILL JOIN IN 2023 AND ONE WILL JOIN IN 2024. FOR DISEASE PREVENTION & MANAGEMENT, KHC WILL WORK TO DEVELOP A CHRONIC CARE MANAGEMENT PROGRAM AND WORK WITH PATIENTS TO DEVELOP A COMPREHENSIVE CARE PLAN. FOR CHRONIC DISEASE PREVENTION, THE HOSPITAL PROVIDES LAB AND RADIOLOGY SERVICES FOR THE CARE NET CLINIC (REDUCED COST OR FREE SERVICES) TO SERVE THE INDIGENT AND UNINSURED RESIDENTS OF KINGMAN COUNTY. THE HOSPITAL HAS HIRED A DIETICIAN TO EDUCATE AND PROVIDE CONSULTATION SERVICES FOR CARDIAC, WEIGHT LOSS, AND DIABETIC PATIENTS. FOR SERVICES NEEDED RELATED TO MENTAL ILLNESS AND MENTAL HEALTH, THE HOSPITAL ER TREATS THOSE WITH MENTAL ILLNESS SYMPTOMS AND REFERS/TRANSFERS THEM TO THEIR NEXT LINE OF CARE. FOR LACK OF HEALTH KNOWLEDGE AND AWARENESS OF SERVICES, THE HOSPITAL REGULARLY USES SOCIAL MEDIA TO REACH AS MANY RESIDENTS OF THE COUNTY AS POSSIBLE. THE HOSPITAL ALSO REGULARLY USES THE LOCAL NEWSPAPER TO INFORM THE COMMUNITY OF SERVICES AVAILABLE. |
| SCHEDULE H, PART V, SECTION B, LINE 16A | https://www.kingmanhc.com/docs/FAP_New.pdf |
| SCHEDULE H, PART V, SECTION B, LINE 16B | https://www.kingmanhc.com/docs/Financial_Assistance_Application_2021.pdf |
| SCHEDULE H, PART V, SECTION B, LINE 16C | https://www.kingmanhc.com/docs/Plain_Language_Summary_2021.pdf |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 3 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (3 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| KINGMAN HEALTHCARE CENTER FAMILY CLINIC | ||||
| 750 WEST D AVENUE | KINGMAN | KS | 67068 | RURAL HEALTH CLINIC |
| CUNNINGHAM CLINIC | ||||
| 112 N MAIN | CUNNINGHAM | KS | 67035 | RURAL HEALTH CLINIC |
| DONLEY MEMORIAL CLINIC | ||||
| 437 CEDAR STREET | KINGMAN | KS | 67068 | RURAL HEALTH CLINIC |
Supplemental Information Detail SupplementalInformationDetail (12 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| SCHEDULE H, PART I, LINE 3C | THE HOSPITAL USED FACTORS OTHER THAN FPG IN DETERMINING ELIGIBILITY FOR PROVIDING FREE OR DISCOUNTED CARE. THESE FACTORS INCLUDED: MEDICAL INDIGENCY, INSURANCE STATUS, AND UNDERINSURANCE STATUS. |
| SCHEDULE H, PART I, LINE 7, COLUMN F | NOT APPLICABLE DUE TO ADOPTION OF ASC 606 REVENUE CONTRACTIONS WITH CUSTOMERS. |
| SCHEDULE H, PART I, LINE 7 | THE COSTING METHODOLOGY USED TO CALCULATE THE AMOUNTS CONTAINED IN THE TABLE OF PART I, LINE 7, OF SCHEDULE H, IS A COST TO CHARGE RATIO. |
| SCHEDULE H, PART III, SECTION A, LINE 2 | ONCE REASONABLE EFFORTS HAVE BEEN EXHAUSTED (AS REQUIRED BY IRS 501(R)) THE CHARGES ARE TURNED OVER TO A COLLECTION AGENCY. THESE CHARGES ARE EXPENSED TO BAD DEBT EXPENSE. DURING THE COURSE OF THE YEAR, ANY BAD DEBT RECOVERIES ARE NETTED AGAINST BAD DEBT EXPENSE. SHOULD THE HOSPITAL BE NOTIFIED OF A BANKRUPTCY, THE ASSOCIATED CHARGES ARE EXPENSED TO BAD DEBT EXPENSE. FURTHERMORE, PROVISIONS ARE MADE FOR SELF-PAY CHARGES TO ALLOW FOR THE EXPECTED UNCOLLECTABLE CHARGES. THE METHOD USED FOR THE ALLOWANCE IS A 6-MONTH LOOK BACK TO DETERMINE THE COLLECTABILITY OF SELF-PAY ACCOUNTS. |
| SCHEDULE H, PART III, SECTION A, LINE 3 | A COST TO CHARGE RATIO IS USED TO DETERMINE AMOUNTS OF BAD DEBT AT COST AND BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS UNDER THE CHARITY CARE POLICY. THE COST TO CHARGE RATIO IS MULTIPLIED BY THE CHANGES IN BAD DEBT. |
| SCHEDULE H, PART III, SECTION A, LINE 4 | NOT APPLICABLE DUE TO ADOPTION OF ASC 606 REVENUE FROM CONTRACTS WITH CUSTOMERS. |
| SCHEDULE H, PART III, SECTION B, LINE 8 | SERVING PATIENTS WITH GOVERNMENT HEALTH BENEFITS, SUCH AS MEDICARE, IS A COMPONENT OF THE COMMUNITY BENEFIT STANDARD THAT TAX-EXEMPT HOSPITALS ARE HELD TO. THIS IMPLIES THAT SERVING MEDICARE PATIENTS IS A COMMUNITY BENEFIT AND THAT THE HOSPITAL OPERATES TO PROMOTE THE HEALTH OF THE COMMUNITY. THE SYSTEM USES MEDICARE COST REPORT METHODOLOGY, WHICH APPORTIONS ROUTINE COSTS (ROOM AND BOARD) BASED ON MEDICARE OR MEDICAID DAYS TO TOTAL DAYS AND APPORTIONS ANCILLARY COSTS BASED ON PROGRAM CHARGES TO TOTAL CHARGES. |
| SCHEDULE H, PART III, SECTION C, LINE 9B | AFTER FOLLOWING BILLING PROCEDURES AND DETERMINING NO INSURANCE COVERAGE APPLIES TO OUTSTANDING AMOUNTS DUE, THE FOLLOWING PROCEDURES ARE IN PLACE: THE FIRST STATEMENT IS SENT TO THE PATIENT AFTER 30 DAYS; THE SECOND STATEMENT IS SENT AFTER 60 DAYS; THE THIRD STATEMENT IS SENT AFTER 90 DAYS; THE FINAL STATEMENT IS SENT AFTER 120 DAYS; THE ACCOUNT IS SENT TO A THIRD-PARTY COLLECTION AGENCY IF NO PROGRESS ON THE ACCOUNT IS MADE |
| SCHEDULE H, PART VI, LINE 2 | ONE SIGNIFICANT WAY IS THE COMMUNITY HEALTH NEEDS ASSESSMENT. IN ORDER TO COMPLETE THE CHNA, AS REQUIRED BY IRC SECTION 501(R), POPULATION DEMOGRAPHICS AND SOCIOECONOMIC CHARACTERISTICS OF THE COMMUNITY WERE GATHERED AND REPORTED UTILIZING VARIOUS THIRD PARTIES. THE HEALTH STATUS OF THE COMMUNITY WAS THEN REVIEWED. INFORMATION ON THE LEADING CAUSES OF DEATH AND MORBIDITY INFORMATION WAS ANALYZED IN CONJUNCTION WITH HEALTH OUTCOMES AND FACTORS REPORTED FOR THE COMMUNITY BY WWW.COUNTYHEALTHRANKINGS.ORG. HEALTH FACTORS WITH SIGNIFICANT OPPORTUNITY FOR IMPROVEMENT WERE NOTED. COMMUNITY INPUT WAS PROVIDED THROUGH KEY INFORMANT INTERVIEWS OF SEVEN STAKEHOLDERS. INFORMATION GATHERED WAS ANALYZED AND REVIEWED TO IDENTIFY HEALTH ISSUES OF UNINSURED PERSONS, LOW-INCOME PERSONS, AND MINORITY GROUPS AND THE COMMUNITY AS A WHOLE. HEALTH NEEDS WERE RANKED UTILIZING A WEIGHTING METHOD THAT WEIGHS: 1. THE SIZE OF THE PROBLEM, 2. THE SERIOUSNESS OF THE PROBLEM, 3. THE PREVALENCE OF COMMON THEMES, AND 4. THE ALIGNMENT WITH HOSPITAL'S RESOURCES. AN INVENTORY OF HEALTH CARE FACILITIES AND OTHER COMMUNITY RESOURCES POTENTIALLY AVAILABLE TO ADDRESS THE SIGNIFICANT HEALTH NEEDS IDENTIFIED THROUGH THE CHNA WAS PREPARED AND COLLABORATIVE EFFORTS WERE IDENTIFIED. OTHER THAN THE CHNA, HOSPITAL STAFF REVIEWS STATISTICAL DATA PROVIDED BY THE KANSAS HOSPITAL ASSOCIATION, KDHE, AND OTHERS. THE HOSPITAL ALSO IS INVOLVED IN THE COMMUNITY WITH LOCAL ORGANIZATIONS LIKE THE ROTARY CLUB, LIONS CLUB, LOCAL CHURCHES, AND OTHERS. |
| SCHEDULE H, PART VI, LINE 3 | THE HOSPITAL POSTS SIGNS ABOUT THE AVAILABILITY OF THE CHARITY CARE PROGRAM IN THE HOSPITAL AND AT THE KINGMAN HEALTH DEPARTMENT. ALL THE LOCAL PHYSICIANS KNOW ABOUT THE HOSPITAL'S CHARITY CARE PROGRAM SO THAT IF A PATIENT NEEDS SERVICES THEY CAN INFORM THE PATIENT ABOUT IT. THE HOSPITAL HAS A STAND WITH BROCHURES ON THE CHARITY CARE PROGRAM AS WELL AS BROCHURES ON OTHER PROGRAMS SUCH AS MEDICAID, CHILDREN'S MERCY, AND UNICARE. THE HOSPITAL EMPLOYS A PATIENT ADVOCATE WHO WILL HELP PATIENTS COMPLETE THE CHARITY CARE PROCESS AND ANSWER ANY QUESTIONS ABOUT THE PROGRAM. THIS EMPLOYEE WILL ALSO HELP PATIENTS WITH MEDICAID APPLICATIONS IF IT IS DETERMINED THAT THE PATIENT MIGHT QUALIFY FOR THIS PROGRAM. |
| SCHEDULE H, PART VI, LINE 4 | THE HOSPITAL IS LOCATED IN A RURAL COMMUNITY IN KINGMAN COUNTY KANSAS. THIS COUNTY IS IN SOUTH CENTRAL KANSAS. KINGMAN COUNTY HAS APPROXIMATELY 7,600 RESIDENTS WITH APPROXIMATELY 8% OF THE POPULATION FALLING UNDER THE POVERTY GUIDELINES, AND 21% BEING OVER THE AGE OF 65. THE HOSPITAL IS THE ONLY HOSPITAL LOCATED IN THE COUNTY AND THE NEXT CLOSEST HOSPITAL IS OVER 20 MILES AWAY. |
| SCHEDULE H, PART VI, LINE 5 | THE HOSPITAL FURTHERS ITS EXEMPT PURPOSE BY PROMOTING THE HEALTH OF THE COMMUNITY IN SEVERAL WAYS. THE HOSPITAL EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN THE COMMUNITY. THE HOSPITAL ALSO RECRUITS AND PROVIDES SPACE TO SPECIALISTS SO THEY CAN CONDUCT CLINICS AND PROVIDE SERVICES FOR PATIENTS IN THE COMMUNITY. THE HOSPITAL ALSO PROVIDES FREE CLINICS AND SCREENINGS THROUGHOUT THE YEAR. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | false | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | false | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | false | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | false | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | false | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | false | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | false | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | false | AnyNonFixedPaymentsInd |
| Initial Contract Exception | false | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (3 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| ERIN BAXA | ||||||||||||||
| PHYSICIAN | $380,896 | $0 | $0 | $0 | $156 | $0 | $0 | $0 | $3,802 | $0 | $384,854 | $0 | $0 | $0 |
| CHERIE MORRIS | ||||||||||||||
| PHYSICIAN | $233,776 | $0 | $0 | $0 | $151 | $0 | $0 | $0 | $2,523 | $0 | $236,450 | $0 | $0 | $0 |
| PAUL HALDERSON | ||||||||||||||
| PHYSICIAN ASSISTANT | $152,321 | $0 | $0 | $0 | $646 | $0 | $0 | $0 | $11,632 | $0 | $164,599 | $0 | $0 | $0 |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (17 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION B, LINE 11B | THE FORM 990 IS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM. THE CFO REVIEWS A DRAFT OF THE 990 AND ALL REQUIRED SCHEDULES. THE ENTIRE BOARD IS THEN PROVIDED WITH AN ELECTRONIC COPY OF THE FORM 990 AND ALL REQUIRED SCHEDULES PRIOR TO FILING WITH THE IRS. |
| FORM 990, PART VI, SECTION B, LINE 12C | BOARD MEMBERS AND OFFICERS AT THE TIME OF HIRE AND ANNUALLY THEREAFTER ARE REMINDED OF THE CONFLICT OF INTEREST GUIDELINES COVERED IN THE CORPORATION'S GOVERNING BODY BYLAWS AND ARE ASKED TO SIGN A CONFLICT OF INTEREST STATEMENT. ANY CONFLICT OF INTEREST MUST BE DISCLOSED TO THE BOARD AND/OR CEO. ANY MEMBER WITH A CONFLICT OF INTEREST SHALL ABSENT THEMSELVES FROM THE DISCUSSION OF THE ISSUE BEFORE THE BOARD AND MUST ABSTAIN FROM VOTING ON ANY ISSUE IN WHICH A CONFLICT IS PRESENT. |
| FORM 990, PART VI, SECTION B, LINE 15A | ALL RAISES ARE APPROVED BY THE BOARD OF DIRECTORS. SALARIES AND WAGES ARE COMPARED ANNUALLY TO THE KANSAS HOSPITAL ASSOCIATION'S SALARY AND WAGE SURVEY FOR REASONABLENESS. THE BOARD DESIGNATES THE HUMAN RESOURCE DIRECTOR TO REVIEW THE SURVEY AND MAKE ANY ADJUSTMENTS NECESSARY. |
| FORM 990, PART VI, SECTION B, LINE 15B | THE HUMAN RESOURCES OFFICER AND THE CEO CONDUCTED THE REVIEW. THE REVIEW IS CONDUCTED YEARLY AND WAS LAST COMPLETED IN 2021. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION DOES NOT MAKE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY OR FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC. |
| FORM 990, PART XI, LINE 9 | CHANGE IN INTEREST IN NET ASSETS OF KCHF 26,196 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:PURCHASED SERVICES TOTAL FEES:1130002 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:PHYSICIAN FEES TOTAL FEES:7532 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:DATA PROCESSING FEE TOTAL FEES:144082 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:PHYISICAN RECRUITMENT TOTAL FEES:1500 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:ANESTHESIOLOGY FEES TOTAL FEES:62655 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:LAB FEES TOTAL FEES:130924 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:RADIOLOGY FEES TOTAL FEES:111419 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:PHARAMCY FEES TOTAL FEES:79995 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:PHYSICAL THERAPY FEES TOTAL FEES:4869 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:SPEECH THERAPY FEES TOTAL FEES:22988 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:COLLECTION FEES TOTAL FEES:3037 |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp
Disregarded Entity Name DisregardedEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | KINGMAN HEALTHCARE CENTER FOUNDATION | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 750 W D AVENUE | AddressLine1Txt |
| City | KINGMAN | CityNm |
| State Abbreviation | KS | StateAbbreviationCd |
| ZIP | 67068 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 481095031 | EIN |
| Primary Activities | SUPPORT NVHS | PrimaryActivitiesTxt |
| Legal Domicile State | KS | LegalDomicileStateCd |
| Exempt Code Section | 501(C)(3) | ExemptCodeSectionTxt |
| Public Charity Status | 12D | PublicCharityStatusTxt |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | NA | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Controlled Organization | false | ControlledOrganizationInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | false | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | false | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | false | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | false | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | false | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | false | DivRelatedOrganizationInd |
| Asset Sale To Other Org | false | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | false | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | false | AssetExchangeInd |
| Rental Of Facilities To Oth Org | false | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | false | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | false | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | false | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | false | SharingOfFacilitiesInd |
| Paid Employees Sharing | false | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | false | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | false | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | false | TransferToOtherOrgInd |
| Transfer From Other Org | false | TransferFromOtherOrgInd |