HIAWATHA HOSPITAL ASSOCIATION INC: Form 990, tax year 2022
View the entire original 990 at ProPublica ↗
- Organization
- HIAWATHA HOSPITAL ASSOCIATION INC (EIN 48-0577658)
- Tax period
- 2022-01-01 to 2022-12-31
- Filed
- 2023-11-15
- IRS object ID
- 202313199349322736
- Schema version
- 2022v5.0
- 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 L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2023-11-15T16:04:21-06:00 | ReturnTs |
| Tax Period End | 2022-12-31 | 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 | 2022-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 480577658 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | HIAWATHA HOSPITAL ASSOCIATION INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | HIAW | BusinessNameControlTxt |
| Phone | 9133605584 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 300 UTAH STREET | AddressLine1Txt |
| City | HIAWATHA | CityNm |
| State Abbreviation | KS | StateAbbreviationCd |
| ZIP | 66434 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | JEFFERY PERRY | PersonNm |
| Person Title | CEO | PersonTitleTxt |
| Phone | 9133605584 | PhoneNum |
| Signature | 2023-11-15 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | JEFFERY | PersonFirstNm |
| Person Last | PERRY | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
| 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 | 2023-11-15 | PreparationDt |
Additional Filer Information AdditionalFilerInformation
Trusted Customer TrustedCustomerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | 2 | TrustedCustomerCd |
| Authentication Assurance Level | AAL1 | AuthenticationAssuranceLevelCd |
| Identity Assurance Level | IAL1 | IdentityAssuranceLevelCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2022 | TaxYr |
| Build TS | 2023-04-26 12:10:37Z | BuildTS |
Form 990 IRS990
Doing Business As Name DoingBusinessAsName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | AMBERWELL HIAWATHA | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | JEFFERY PERRY | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 300 UTAH STREET | AddressLine1Txt |
| City | HIAWATHA | CityNm |
| State Abbreviation | KS | StateAbbreviationCd |
| ZIP | 66434 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $30,810,836 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | HTTPS://WWW.HCH-KS.ORG/ | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1945 | FormationYr |
| Legal Domicile State | KS | LegalDomicileStateCd |
| Activity Or Mission | PROVIDE MODERN, RELIABLE, AFFORDABLE HEALTH CARE THAT BEST MEETS THE NEEDS OF OUR COMMUNITY. | ActivityOrMissionDesc |
| Voting Members Governing Body | 7 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 6 | VotingMembersIndependentCnt |
| Total Employee | 321 | TotalEmployeeCnt |
| Total Volunteers | 6 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $6,575,295 | PYContributionsGrantsAmt |
| CY Contributions Grants | $2,788,081 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $29,968,646 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $27,953,607 | CYProgramServiceRevenueAmt |
| PY Investment Income | $12,695 | PYInvestmentIncomeAmt |
| CY Investment Income | $16,004 | CYInvestmentIncomeAmt |
| PY Other Revenue | $77,893 | PYOtherRevenueAmt |
| CY Other Revenue | $52,644 | CYOtherRevenueAmt |
| PY Total Revenue | $36,634,529 | PYTotalRevenueAmt |
| CY Total Revenue | $30,810,336 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $10,102 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $10,834 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $15,845,235 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $15,804,890 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $15,264,673 | PYOtherExpensesAmt |
| CY Other Expenses | $15,504,050 | CYOtherExpensesAmt |
| PY Total Expenses | $31,120,010 | PYTotalExpensesAmt |
| CY Total Expenses | $31,319,774 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $5,514,519 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$509,438 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $31,506,410 | TotalAssetsBOYAmt |
| Total Assets EOY | $24,339,775 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $15,126,815 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $8,616,967 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $16,379,595 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $15,722,808 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | AMBERWELL HIAWATHA PROVIDES COMPASSIONATE CARE WITH CLINICAL EXCELLENCE. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $27,080,293 | ExpenseAmt |
| Grant | $10,834 | GrantAmt |
| Revenue | $28,004,919 | RevenueAmt |
| Desc | HIAWATHA HOSPITAL ASSOCIATION, INC. DBA AMBERWELL HEALTH HIAWATHA IS A CRITICAL ACCESS HOSPITAL (CAH) THAT PROVIDES RELATED INPATIENT, OUTPATIENT, EMERGENCY CARE, AND PHYSICIAN SERVICES TO PATIENTS IN HIAWATHA, KANSAS AND SURROUNDING AREAS. HIAWATHA COMMUNITY HOSPITAL'S PRIMARY GOAL IS TO PROVIDE QUALITY, MODERN, AFFORDABLE HEALTHCARE TO OUR COMMUNITY. IN 2022, WE PROVIDED SERVICE FOR 2,864 INPATIENT DAYS, 66 INPATIENT SURGERIES AND 741 OUTPATIENT SURGERIES. WE DELIVERED 52 BABIES AND PROVIDED OUTPATIENT SERVICES TO 50,829 PATIENTS. (STATEMENT CONTINUED ON SCHEDULE O)BY PROVIDING SERVICES LIKE OBSTETRICS AND 24 HOUR EMERGENCY SERVICES THAT NOT ALL SMALL RURAL HOSPITALS PROVIDE, EVEN THOUGH THE PROGRAMS ARE NOT ALWAYS PROFITABLE FOR THE HOSPITAL, WE STRONGLY FEEL THAT THESE SERVICES PROVIDE NECESSARY CARE TO ADDRESS OUR COMMUNITY'S OVERALL HEALTH WHILE PROMOTING OUR MISSION AS A CHARITABLE ORGANIZATION.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, 2022 WAS APPROXIMATELY $275,000. | Desc |
| Total Program Service Expenses | $27,080,293 | 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 | 0 | 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 | 0 | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (1) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | 0 | 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 | Yes (1) | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | Yes (1) | 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 | 0 | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 50 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 321 | 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 | 7 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 6 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | Yes (1) | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | 0 | MembersOrStockholdersInd |
| Election Of Board Members | 0 | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (1) | 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 | SHARESE MOSER | PersonNm |
| Phone | 7857426431 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 300 UTAH STREET | AddressLine1Txt |
| City | HIAWATHA | CityNm |
| State Abbreviation | KS | StateAbbreviationCd |
| ZIP | 66434 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (16 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 |
|---|---|---|---|---|---|---|---|---|---|
| GREG RODVELT | |||||||||
| PRESIDENT | 0.50 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| DEL ELFFNER | |||||||||
| VICE PRESIDENT | 0.30 | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| JOHN MOORE | |||||||||
| SECRETARY/TREASURER | 0.30 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| ERIC INGMIRE | |||||||||
| DIRECTOR | 0.30 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| MANDY GRAHAM | |||||||||
| DIRECTOR | 0.30 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| WILLIE GEISENDORF | |||||||||
| DIRECTOR | 0.30 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| HOWARD ELLIOTT | |||||||||
| DIRECTOR | 0.30 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| ANDREA COLLINS-KELLER | |||||||||
| DIRECTOR THRU 06/22 | 0.30 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| SHARESE MOSER | |||||||||
| DIRECTOR OF FINANCE | 40.00 | 0.00 | Yes (X) | $80,092 | $0 | $23,739 | |||
| JEFFERY PERRY | |||||||||
| CEO | 20.00 | 0.00 | Yes (X) | $169,189 | $0 | $1,415 | |||
| DR JESSICA JARVIS | |||||||||
| PHYSICIAN | 40.00 | 0.00 | $393,063 | $0 | $52,732 | Yes (X) | |||
| DR CROSBY GERNON | |||||||||
| RADIOLOGIST | 40.00 | 0.00 | $398,484 | $0 | $48,551 | Yes (X) | |||
| DR BRYON BIGHAM | |||||||||
| PHYSICIAN | 40.00 | 0.00 | $216,502 | $0 | $32,356 | Yes (X) | |||
| DUSTIN WILLIAMS | |||||||||
| APRN | 40.00 | 0.00 | $286,373 | $0 | $46,960 | Yes (X) | |||
| DR LOWELL SEARIGHT | |||||||||
| PHYSICIAN | 40.00 | 0.00 | $184,743 | $0 | $19,523 | Yes (X) | |||
| DR ANNA CLELAND-LEIGHTON | |||||||||
| PHYSICIAN | 40.00 | 0.00 | $275,282 | $0 | $43,197 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $2,003,728 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $268,473 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 14 | 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 |
|---|---|---|---|---|---|
| MIDWEST DATA CENTER | |||||
| PO BOX 39 | ROCK PORT | MO | 64482 | IT SERVICES | $374,935 |
| NORTHEASTERN ANESTHESIA SERVICES PA | |||||
| 1706 GRACELAND DR | SABETHA | KS | 66534 | ANESTHESIOLOGY SERVICES | $307,292 |
| GRACE ANESTHESIA SERVICES LLC | |||||
| PO BOX 535 | CARROLL | IA | 51401 | ANESTHESIOLOGY SERVICES | $217,615 |
| ASHLEY HOUSTON | |||||
| 1712 SW AMHURST RD | TOPEKA | KS | 66604 | LEASED EMPLOYEE - OB | $197,200 |
| STEVEN H GUNNELLS ANESTHESIA | |||||
| 2561 LINDEN AVE | HIAWATHA | KS | 66434 | ANESTHESIOLOGY SERVICES | $196,650 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 9 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $224,747 | RelatedOrganizationsAmt |
| Government Grants | $2,043,720 | GovernmentGrantsAmt |
| All Other Contributions | $519,614 | AllOtherContributionsAmt |
| Total Contributions | $2,788,081 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| PATIENT SERVICE REVENUE | 621110 | $27,323,818 | $27,323,818 |
| PHARMACY REVENUE | 456110 | $443,640 | $443,640 |
Total Oth Program Service Rev TotalOthProgramServiceRevGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $186,149 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $186,149 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $27,953,607 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $16,004 | TotalRevenueColumnAmt |
| Exclusion | $16,004 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $1,832 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $500 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $1,332 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,332 | TotalRevenueColumnAmt |
| Exclusion | $1,332 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | CAFETERIA | Desc |
| Business | 900099 | BusinessCd |
| Total Revenue Column | $51,312 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $51,312 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $51,312 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $30,810,336 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $28,004,919 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $17,336 | 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 | $10,834 | TotalAmt |
| Program Services | $10,834 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $720,230 | TotalAmt |
| Program Services | $445,795 | ProgramServicesAmt |
| Management And General | $274,435 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $12,279,629 | TotalAmt |
| Program Services | $11,705,175 | ProgramServicesAmt |
| Management And General | $574,454 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $349,546 | TotalAmt |
| Program Services | $339,295 | ProgramServicesAmt |
| Management And General | $10,251 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,584,674 | TotalAmt |
| Program Services | $1,470,783 | ProgramServicesAmt |
| Management And General | $113,891 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $870,811 | TotalAmt |
| Program Services | $829,856 | ProgramServicesAmt |
| Management And General | $40,955 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $128,137 | TotalAmt |
| Program Services | $25,685 | ProgramServicesAmt |
| Management And General | $102,452 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $135,712 | TotalAmt |
| Management And General | $135,712 | ManagementAndGeneralAmt |
Fees For Services Lobbying FeesForServicesLobbyingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,017 | TotalAmt |
| Management And General | $4,017 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,664,389 | TotalAmt |
| Program Services | $5,460,752 | ProgramServicesAmt |
| Management And General | $203,637 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $105,550 | TotalAmt |
| Program Services | $60,717 | ProgramServicesAmt |
| Management And General | $44,833 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $896,505 | TotalAmt |
| Program Services | $855,452 | ProgramServicesAmt |
| Management And General | $41,053 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $393,300 | TotalAmt |
| Program Services | $104,684 | ProgramServicesAmt |
| Management And General | $288,616 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $484,792 | TotalAmt |
| Program Services | $153,761 | ProgramServicesAmt |
| Management And General | $331,031 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $127,004 | TotalAmt |
| Program Services | $123,874 | ProgramServicesAmt |
| Management And General | $3,130 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $236,611 | TotalAmt |
| Program Services | $53,364 | ProgramServicesAmt |
| Management And General | $183,247 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,402,068 | TotalAmt |
| Program Services | $219,690 | ProgramServicesAmt |
| Management And General | $1,182,378 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $553,133 | TotalAmt |
| Program Services | $195,869 | ProgramServicesAmt |
| Management And General | $357,264 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (3 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| MEDICAL SUPPLIES | $3,972,630 | $3,737,375 | $235,255 |
| REPAIRS AND MAINTENANCE | $404,509 | $404,509 | |
| DUES & SUBSCRIPTIONS | $313,310 | $278,115 | $35,195 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $682,383 | TotalAmt |
| Program Services | $604,708 | ProgramServicesAmt |
| Management And General | $77,675 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $31,319,774 | TotalAmt |
| Program Services | $27,080,293 | ProgramServicesAmt |
| Management And General | $4,239,481 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $366 | BOYAmt |
| EOY | $565 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $13,540,608 | BOYAmt |
| EOY | $2,992,962 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,737,443 | BOYAmt |
| EOY | $5,995,741 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $813,797 | BOYAmt |
| EOY | $528,780 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $182,630 | BOYAmt |
| EOY | $233,271 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $36,413,177 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $24,157,314 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,489,649 | BOYAmt |
| EOY | $12,255,863 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $679,120 | EOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $261,000 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,741,917 | BOYAmt |
| EOY | $1,392,473 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $31,506,410 | BOYAmt |
| EOY | $24,339,775 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,611,680 | BOYAmt |
| EOY | $2,857,358 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,428,615 | BOYAmt |
| EOY | $0 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,955,000 | BOYAmt |
| EOY | $5,447,525 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $124,709 | BOYAmt |
| EOY | $312,084 | EOYAmt |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,850,582 | BOYAmt |
| EOY | $0 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $156,229 | BOYAmt |
| EOY | $0 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $15,126,815 | BOYAmt |
| EOY | $8,616,967 | 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 | $15,735,573 | BOYAmt |
| EOY | $15,226,135 | EOYAmt |
Donor Restriction Net Assets DonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $644,022 | BOYAmt |
| EOY | $496,673 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $16,379,595 | BOYAmt |
| EOY | $15,722,808 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $31,506,410 | BOYAmt |
| EOY | $24,339,775 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | -$509,438 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | -$147,349 | 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) |
|---|---|---|
| Separate Basis Fincl Stmt | Yes (X) | SeparateBasisFinclStmtInd |
| 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 | $4,017 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $4,017 | 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 | A PORTION OF THE DUES PAID TO KANSAS HOSPITAL ASSOCIATION AND AMERICAN HOSPITAL ASSOCIATION ARE ATTRIBUTABLE TO LOBBYING. | ExplanationTxt |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $784,309 | OtherCostOrOtherBasisAmt |
| Book Value | $784,309 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $20,078,012 | OtherCostOrOtherBasisAmt |
| Depreciation | $12,142,951 | DepreciationAmt |
| Book Value | $7,935,061 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $13,939,887 | OtherCostOrOtherBasisAmt |
| Depreciation | $10,837,384 | DepreciationAmt |
| Book Value | $3,102,503 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,610,969 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,176,979 | DepreciationAmt |
| Book Value | $433,990 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $12,255,863 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp (3 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| ESTIMATED THIRD-PARTY PAYOR SETTLEMENT | $797,807 |
| RIGHT-OF-USE ASSETS OPERATING LEASE | $97,993 |
| INTEREST IN NET ASSETS OF HIAWATHA COMMUNITY HOSPITAL FOUNDATION | $496,673 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $1,392,473 | TotalBookValueOtherAssetsAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $30,810,836 | TotalRevEtcAuditedFinclStmtAmt |
| Other Revenue | $500 | OtherRevenueAmt |
| Revenue Not Reported | $500 | RevenueNotReportedAmt |
| Revenue Subtotal | $30,810,336 | RevenueSubtotalAmt |
| Revenue Not Reported Fincl Stmt | $0 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $30,810,336 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $31,320,274 | TotExpnsEtcAuditedFinclStmtAmt |
| Other Expenses Included | $500 | OtherExpensesIncludedAmt |
| Expenses Not Reported | $500 | ExpensesNotReportedAmt |
| Expenses Subtotal | $31,319,774 | ExpensesSubtotalAmt |
| Expenses Not Rpt Fincl Stmt | $0 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $31,319,774 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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, 2022 AND 2021, THE HOSPITAL HAD NO UNCERTAIN TAX POSITIONS ACCRUED. |
| PART XI, LINE 2D - OTHER ADJUSTMENTS: | RENTAL EXPENSE 500. |
| PART XII, LINE 2D - OTHER ADJUSTMENTS: | RENTAL EXPENSE 500. |
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 |
| Percent300 | Yes (X) | Percent300Ind |
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | 0 | FinancialAssistanceBudgetInd |
| 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 | $275,000 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $275,000 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00880 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $4,220,503 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $3,791,997 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $428,506 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01370 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $4,495,503 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $3,791,997 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $703,506 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02250 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $4,989 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $4,989 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00020 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $218,421 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $218,421 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00700 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $223,410 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $223,410 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00720 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $4,718,913 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $3,791,997 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $926,916 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02970 | TotalExpensePct |
Community Support CommunitySupportGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,182 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $2,182 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00010 | TotalExpensePct |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,182 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $2,182 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00010 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $1,059,949 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $190,791 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $11,828,059 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $11,922,397 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$94,338 | 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 | HIAWATHA HOSPITAL ASSOCIATION INC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 300 UTAH STREET | AddressLine1Txt |
| City | HIAWATHA | CityNm |
| State Abbreviation | KS | StateAbbreviationCd |
| ZIP | 66434 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | WWW.HCH-KS.ORG | WebsiteAddressTxt |
| State License | H007001 | 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 | 2 PROVIDER BASED RURAL HEALTH CLINICS | OtherDesc |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | HIAWATHA HOSPITAL ASSOCIATION INC | 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 | 300.000000000000 | 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 |
| 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 |
| Provided Nonprofit Contact | Yes (X) | ProvidedNonprofitContactInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | HTTPS://AMBERWELLHEALTH.ORG/PATIENT-RESOURCES/FINANCIAL-ASSISTANCE-HIAWATHA | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | HTTPS://AMBERWELLHEALTH.ORG/PATIENT-RESOURCES/FINANCIAL-ASSISTANCE-HIAWATHA | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | HTTPS://AMBERWELLHEALTH.ORG/PATIENT-RESOURCES/FINANCIAL-ASSISTANCE-HIAWATHA | 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 (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 | Yes (X) | LookBackMedicareInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| HIAWATHA HOSPITAL ASSOCIATION, INC. | PART V, SECTION B, LINE 5: WE CHOSE INDIVIDUALS WHO WOULD HAVE UNIQUE UNDERSTANDING OF THE DIFFERENT POPULATIONS IN OUR COMMUNITY TO BE ON THE COMMITTEE. THE COMMITTEE HELPED FORMULATE THE SURVEY TO TAKE TO OUR COMMUNITY AND GAVE SIGNIFICANT FEEDBACK AND DIRECTION ABOUT WHAT SPECIFIC POPULATION NEEDS WERE.INCLUDED ON THE COMMITTEE:AMBERWELL HIAWATHAKANZA MENTAL HEALTHHORIZON THERAPYNEK AREA AGENCY ON AGINGAMBERWELL HEALTHGN BANKNEK MULTICOUNTY HEALTH DEPARTMENTSCITY OF HIAWATHAHIAWATHA FUMC |
| HIAWATHA HOSPITAL ASSOCIATION, INC. | PART V, SECTION B, LINE 6B: BROWN COUNTY HEALTH DEPARTMENT |
| HIAWATHA HOSPITAL ASSOCIATION, INC. | PART V, SECTION B, LINE 11: THE HOSPITAL COMPLETED ITS COMMUNITY HEALTH NEEDS ASSESSMENT IN 2022. THE FOLLOWING NEEDS WERE IDENTIFIED AND WILL BE ADDRESSED OVER THE NEXT 3 YEARS.PRIMARY CARE / MENTAL HEALTH CARE INTEGRATED DELIVERY1. ASSESS PCP COMFORT AND INVOLVEMENT IN DIAGNOSING AND TREATING COMMON MENTAL HEALTH CONDITIONS.2. EXPLORE INTEGRATED BEHAVIORAL CARE MODELS AND EVALUATE COMMUNITY RESOURCES REQUIRED TO IMPLEMENT.3. RESEARCH GRANTS FOR PRIMARY CARE PRACTICES TO HIRE BEHAVIORAL HEALTH PROVIDERS OR OTHERWISE FACILITATE THE ADOPTION OF MODELS TO INTEGRATE BEHAVIORAL HEALTH AND PRIMARY CARE.MENTAL HEALTH (DIAGNOSIS, PLACEMENT, AFTERCARE, AWARENESS, AND PROVIDERS)1. MAINTAIN A COMMUNITY INVENTORY OF SERVICES TO DOCUMENT THE AVAILABILITY OF MENTAL HEALTH RESOURCES, INCLUDING HOURS OF SERVICE. 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. EXPAND MENTAL HEALTH TRAINING AND CREATE EDUCATION (MATERIALS / PRESENTATIONS) IN SCHOOLS AND COMMUNITY PROGRAMS TO DESTIGMATIZE MENTAL HEALTH ISSUES. EXPAND ACCESS TO MENTAL HEALTH THROUGH ADDING ADDITIONAL MENTAL HEALTH PROFESSIONALS TO SERVE THE COMMUNITY. 4. INVESTIGATE GRANT WRITING TO FUND MENTAL HEALTH EDUCATION AND SERVICES. IF AVAILABLE, DESIGNATE COMMUNITY LEAD TO ATTAIN THE NECESSARY GRANT. 5. PROMOTE EXISTING MENTAL HEALTH SERVICES, FACILITIES, AND PROVIDERS. EDUCATE COMMUNITY ON PLACEMENT PROCESS AND OPTIONS THROUGH HOSPITAL PHYSICIANS, CLINICS, AND E.R. 6. ESTABLISH SUPPORT GROUPS (SUCH AS FAMILIES WITH MENTAL HEALTH CRISES, GRIEF GROUP) LED BY A SOCIAL WORKER.HOUSING1. RESEARCH ZONING MODELS IN OTHER RURAL COMMUNITIES FOR AFFORDABLE HOUSING POLICIES AND SOLUTIONS.2. CONTINUE WITH GRANT WRITING TO FUND PUBLIC / SAFE HOUSING. IF AVAILABLE, DESIGNATE COMMUNITY LEAD TO WORK TO ATTAIN THE NECESSARY GRANTS FOR AFFORDABLE HOUSING. 3. PROVIDE MEDIATION SERVICES BETWEEN TENANTS AND LANDLORDS TO RESOLVE CONFLICT AND PREVENT EVICTION 4. CONTINUE TO OFFER FREE LOTS FOR HOUSING / BUILDING A HOME WITH SPECIFICATIONS. 5. OFFER DEBT ADVICE FROM TRAINED PROVIDERS TO TENANTS WITH UNPAID, OVERDUE RENT TO HELP REPAY DEBT AND INCREASE FINANCIAL LITERACY.6. SUPPORT A COMBINATION OF LAND USES (E.G., RESIDENTIAL, COMMERCIAL, RECREATIONAL) IN DEVELOPMENT INITIATIVES, THROUGH ZONING REGULATIONS OR SMART GROWTH INITIATIVES.7. CONTINUE TO UTILIZE NEK-CAP HOME REPAIR / RENTAL ASSISTANCE PROGRAMS.HEALTHCARE TRANSPORTATION ARE NEEDS IDENTIFIED THAT THE HOSPITAL IS NOT ABLE TO ADDRESS EITHER BECAUSE IT IS OUT OF THEIR JURISDICTION OR DUE TO LACK OF FUNDING.FOOD INSECURITY1. PURSUE GRANTS TO FUND LOCAL FOOD PANTRIES AND FOOD DISTRIBUTION FOR LOW-INCOME RESIDENTS. 2. ATTRACT NEW GROCERY STORES VIA FINANCING INITIATIVES, TAX INCENTIVES, OR ZONING REGULATION.3. EXPLORE OPPORTUNITIES FOR GROUP PURCHASE AND DISTRIBUTION OF GROCERY ITEMS AT A REDUCED PRICE. 4. EXPLORE BACKPACK FOOD PROGRAMS TO CLOSE THE GAP IN MEALS FOR CHILDREN BETWEEN FRIDAY LUNCH AND MONDAY BREAKFAST BY PROVIDING FOOD FOR CHILDREN OVER WEEKENDS AS WELL AS FOR LONGER BREAKS DURING THE SCHOOL YEAR. 5. EDUCATE COMMUNITY ON SNAP BENEFITS FOR SENIORS TO ENSURE ALL WHO ARE ELIGIBLE ARE REGISTERED.POVERTY1. CREATE AN INVENTORY OF ALL AGENCIES SERVING BROWN COUNTY. DISCOVER THE CAUSES OF ALL AGENCIES AND PROVIDE RESOURCE GUIDE TO COMMUNITY.2. RESEARCH AND SUPPORT EVIDENCED-BASED INTERGENERATIONAL POVERTY PROGRAMS OF PROVIDING POSITIVE SCHOOL ENVIRONMENT.3. PROVIDE EDUCATION TO FAMILIES, IMPROVE QUALITY OF FAMILY RELATIONSHIPS, TEACH KEY FAMILY MANAGEMENT SKILLS.CHRONIC DISEASE MANAGEMENT (DIABETIC)1. CONTINUE DIABETES PREVENTION LIFESTYLE CHANGE PROGRAM WITH SELF-MANAGEMENT EDUCATION AND MEDICAL NUTRITION THERAPY FOR THOSE WITH DIABETES OR PRE-DIABETES.2. EXPLORE OFFERING MOBILE OR OFFSITE DIABETIC SCREENINGS IN COMMUNITY.3. OFFER EXERCISE CLASSES AND FITNESS PROGRAM SUPPORT IN COMMUNITY.4. SUPPORT TEMPORARY PROGRAMS THAT WORK TO ENERGIZE PARTICIPANTS TO LOSE WEIGHT VIA PRIZES, OFTEN COMBINED WITH EDUCATION, WEIGHT STATUS AND FOOD INTAKE TRACKING, REGULAR CHECK-INS, AND GROUP SUPPORT.5. BUILD, STRENGTHEN, AND MAINTAIN SOCIAL NETWORKS THAT PROVIDE SUPPORTIVE RELATIONSHIPS FOR BEHAVIOR CHANGE THROUGH WALKING GROUPS OR OTHER COMMUNITY-BASED INTERVENTIONS. |
| 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 (15 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 3C: | IN ADDITION TO FPG, THE ORGANIZATION USES ASSET LEVEL, INSURANCE STATUS, RESIDENCY, MEDICAL INDIGENCY, AND UNDERINSURANCE STATUS AS FACTORS IN DETERMINING ELIGIBILITY FOR FREE OR DISCOUNTED CARE. |
| PART I, LINE 6A: | THE COMMUNITY BENEFIT REPORT IS PREPARED BY VVV CONSULTING AND IS POSTED ON THE HOSPITAL'S WEBSITE. |
| 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. COMMUNITY HEALTH IMPROVEMENT SERVICES, LINE 7E, ARE REPORTED BASED ON ACTUAL EXPENSES RECORDED FROM THE EVENTS IN THE GENERAL LEDGER. |
| PART II, COMMUNITY BUILDING ACTIVITIES: | LITTLE HANDS DAYCARE IS A NOT FOR PROFIT DAYCARE THAT PROVIDES LICENSED, RELIABLE, QUALITY DAYCARE AND EDUCATION TO CHILDREN IN THE COMMUNITY. ONE OF THE ISSUES CITED BY LOCAL EMPLOYERS WHEN RECRUITING WORK WAS A LACK OF OPENINGS WITH LOCAL DAYCARE PROVIDERS. LITTLE HANDS WAS STARTED TO ADDRESS THAT NEED. HIAWATHA HOSPITAL'S CONTRIBUTIONS IN TIME AND SUPPLIES HAS HELPED THEM TO BE ABLE TO PROVIDE QUALITY SERVICES WHILE OPERATING ON MINIMAL MARGINS. |
| PART III, LINE 2: | THE HOSPITAL DETERMINES ITS ESTIMATE OF IMPLICIT PRICE CONCESSIONS BASED ON ITS HISTORICAL COLLECTION EXPERIENCE WITH THIS CLASS OF PATIENTS. |
| PART III, LINE 3: | APPROXIMATELY 18% OF THE HOSPITAL'S IMPLICIT PRICE CONCESSIONS IS ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY. THIS IS THE APPROXIMATE PERCENTAGE OF APPLICATIONS DENIED OR NOT RETURNED DUE TO INSUFFICIENT INFORMATION.ACCOUNTS ARE REVIEWED FOR FINANCIAL ASSISTANCE. INDIVIDUALS ARE CONTACTED AND ASKED TO COMPLETE A FINANCIAL ASSISTANCE APPLICATION. MANY INDIVIDUALS ARE NOT WILLING TO COMPLETE THE APPLICATION. AT THAT POINT THEY ARE GRANTED PRESUMPTIVE FINANCIAL ASSISTANCE STATUS AND THEIR BALANCES ARE WRITTEN OFF TO CHARITY CARE. WHILE WE FEEL THAT WE WORK VERY DILIGENTLY TO PROVIDE FINANCIAL ASSISTANCE TO THOSE WHO QUALIFY, WE CANNOT GUARANTEE A PERFECT SYSTEM. |
| PART III, LINE 4: | THE FOOTNOTE TO THE ORGANIZATION'S FINANCIAL STATEMENTS CAN BE FOUND ON PAGES 10-11 OF THE ATTACHED AUDITED FINANCIAL STATEMENTS. |
| PART III, LINE 8: | HIAWATHA HOSPITAL ASSOCIATION, INC. 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: | CHARITY CARE APPLICATIONS ARE MADE AVAILABLE TO ALL PATIENTS AT THE TIME OF REGISTRATION, ON STATEMENTS, AND ON THE WEBSITE. 120 DAYS AFTER THE FIRST POST DISCHARGE STATEMENT IS MADE ON AN ACCOUNT, IF PAYMENT ISN'T MADE AND A CHARITY CARE APPLICATION ISN'T COMPLETED THE PATIENT'S NAME IS RUN THROUGH A COMPANY TO CHECK FOR PRESUMPTIVE CHARITY CARE. IF THEY QUALIFY, THEY ARE OFFERED AN APPLICATION AGAIN. IF THEY FAIL TO COMPLETE THE APPLICATION, THEY ARE WRITTEN OFF TO CHARITY CARE UNDER OUR PRESUMPTIVE CHARITY CARE PROGRAM. IF THEY DO NOT QUALIFY FOR CHARITY CARE, AND HAVE NOT RESPONDED TO OUR REQUESTS FOR PAYMENTS FOR 120 DAYS, THEN THE ACCOUNT IS GRANTED APPROVAL BY THE BOARD OF TRUSTEES. ONCE AN ACCOUNT IS GRANTED APPROVAL BY THE BOARD, IT IS SENT TO THE COLLECTION AGENCY. WE GIVE THE COLLECTION AGENCY SEVERAL MONTHS TO COLLECT THE DEBT. IF THEY ARE UNSUCCESSFUL, THE ACCOUNT IS RETURNED TO THE HOSPITAL AND WRITTEN OFF. |
| PART VI, LINE 2: | NOT ONLY DID WE SEEK FEEDBACK FROM COMMITTEE MEMBERS REPRESENTING LESSER-HEARD VOICES FROM OUR COMMUNITY, BUT WE MADE AN ONLINE SURVEY AVAILABLE, WE PUT HARD COPIES OF THE SURVEY IN MULTIPLE PLACES INCLUDING ALL OF THE TOWNS IN OUR SERVICE AREA. WE COMBINED THAT FEEDBACK WITH STATISTICAL INFORMATION FROM RELIABLE SOURCES TO IDENTIFY PRIORITIES. |
| PART VI, LINE 3: | WE POST INFORMATION ABOUT OUR FAPS EXISTENCE IN PROMINENT LOCATIONS. WE MAKE COPIES OF THE FAP AVAILABLE DURING REGISTRATION, IN INPATIENT ROOMS, ONLINE, AND ON OUR BILLING CORRESPONDENCE. |
| PART VI, LINE 4: | THE HOSPITAL SERVES A GEOGRAPHIC AREA THAT ENCOMPASSES ATCHISON, BROWN, DONIPHAN, JACKSON AND NEMAHA COUNTIES IN KANSAS, AND RICHARDSON COUNTY IN NEBRASKA. OF THOSE PATIENTS, 85% ARE FROM BROWN AND DONIPHAN COUNTIES. THESE ARE MOSTLY RURAL COMMUNITIES. 88% OF THE POPULATION OF THE BROWN AND DONIPHAN COUNTIES THAT IS 25 YEARS OR OLDER HAS A MINIMUM OF A HIGH SCHOOL DIPLOMA, 16% HAS A BACHELORS DEGREE OR HIGHER. THE AVERAGE MEDIAN HOUSEHOLD INCOME IS $41,300 COMPARED TO THE STATE WIDE MEDIAN HOUSEHOLD INCOME OF $50,594. 16% OF THE POPULATION LIVES IN POVERTY; 19% FOR BROWN COUNTY ALONE. 16% OF THE POPULATION IN BROWN AND DONIPHAN COUNTIES DOES NOT HAVE HEALTH INSURANCE. |
| PART VI, LINE 5: | WE SUPPORT A WIDE ARRAY OF PROGRAMS AND PROJECTS IN OUR COMMUNITY. MANY OF OUR KEY EMPLOYEES SERVE ON MULTIPLE BOARDS THAT HAVE A POSITIVE IMPACT ON VARIOUS ASPECTS OF THE COMMUNITY. WE PROVIDE DONATIONS OF BOTH TIME AND MONEY TO VARIOUS SERVICE ORGANIZATIONS. |
| PART VI, LINE 6: | THE HOSPITAL IS PART OF AN AFFILIATED HEALTH CARE SYSTEM WITH AMBERWELL ATCHISON ASSOCIATION. |
| PART VI, LINE 7, REPORTS FILED WITH STATES | KS |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| 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 | Yes (1) | 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 (7 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| DR CROSBY GERNON | ||||||||||||||
| RADIOLOGIST | $398,484 | $0 | $0 | $0 | $0 | $0 | $14,525 | $0 | $34,026 | $0 | $447,035 | $0 | $0 | $0 |
| DR JESSICA JARVIS | ||||||||||||||
| PHYSICIAN | $352,732 | $0 | $40,331 | $0 | $0 | $0 | $13,494 | $0 | $39,238 | $0 | $445,795 | $0 | $0 | $0 |
| DUSTIN WILLIAMS | ||||||||||||||
| APRN | $235,356 | $0 | $51,017 | $0 | $0 | $0 | $10,184 | $0 | $36,776 | $0 | $333,333 | $0 | $0 | $0 |
| DR ANNA CLELAND-LEIGHTON | ||||||||||||||
| PHYSICIAN | $275,282 | $0 | $0 | $0 | $0 | $0 | $3,293 | $0 | $39,904 | $0 | $318,479 | $0 | $0 | $0 |
| DR BRYON BIGHAM | ||||||||||||||
| PHYSICIAN | $207,502 | $0 | $9,000 | $0 | $0 | $0 | $8,895 | $0 | $23,461 | $0 | $248,858 | $0 | $0 | $0 |
| DR LOWELL SEARIGHT | ||||||||||||||
| PHYSICIAN | $168,296 | $0 | $16,447 | $0 | $0 | $0 | $7,188 | $0 | $12,335 | $0 | $204,266 | $0 | $0 | $0 |
| JEFFERY PERRY | ||||||||||||||
| CEO | $169,189 | $0 | $0 | $0 | $0 | $0 | $1,415 | $0 | $0 | $0 | $170,604 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 5 | FormAndLineReferenceDesc |
| Explanation | THE PROVIDERS ARE PAID A PERFORMANCE BONUS BASED ON PRODUCTIVITY AND CONSIDERATION OF REVENUES. | ExplanationTxt |
Schedule K IRS990ScheduleK
Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
Issuer Name IssuerName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CITY OF HIAWATHA KANSAS | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Issuer EIN | 486025665 | BondIssuerEIN |
| CUSIP | 428545CY1 | CUSIPNum |
| Bond Issued | 2020-03-31 | BondIssuedDt |
| Issue Price | $6,295,000 | IssuePriceAmt |
| Purpose | SEE PART VI | PurposeDesc |
| Defeased | 0 | DefeasedInd |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuerInd |
| Pool Financing | 0 | PoolFinancingInd |
Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Retired | $685,000 | RetiredAmt |
| Total Proceeds | $6,295,000 | TotalProceedsAmt |
| Issuance Costs From Proceeds | $125,900 | IssuanceCostsFromProceedsAmt |
| Capital Expenditures | $2,000,000 | CapitalExpendituresAmt |
| Other Spent Proceeds | $4,169,100 | OtherSpentProceedsAmt |
| Substantial Completion | 2022 | SubstantialCompletionYr |
| Refunding Tax Exempt Bonds | Yes (1) | RefundingTaxExemptBondsInd |
| Refunding Taxable Bonds | 0 | RefundingTaxableBondsInd |
| Final Allocation Made | Yes (1) | FinalAllocationMadeInd |
| Adequate Books And Rec Maint | Yes (1) | AdequateBooksAndRecMaintInd |
Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Owning Bond Financed Property | 0 | OwningBondFinancedPropertyInd |
| Any Lease Arrangements | 0 | AnyLeaseArrangementsInd |
| Mgmt Contract Bond Fincd Prop | 0 | MgmtContractBondFincdPropInd |
| Any Research Agreements | 0 | AnyResearchAgreementsInd |
| Private Bus Use By Others | 0.00000 | PrivateBusUseByOthersPct |
| Private Bus Concerning UBI | 0.00000 | PrivateBusConcerningUBIPct |
| Total Private Business Use | 0.00000 | TotalPrivateBusinessUsePct |
| Bond Iss Meet Prvt Sec Pymt Test | 0 | BondIssMeetPrvtSecPymtTestInd |
| Change In Use Bond Financed Prop | 0 | ChangeInUseBondFinancedPropInd |
| Procs Nonqualified Bond Remdtd | Yes (1) | ProcsNonqualifiedBondRemdtdInd |
Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Form8038 T Filed | 0 | Form8038TFiledInd |
| Rebate Not Due Yet | 0 | RebateNotDueYetInd |
| Exception To Rebate | 0 | ExceptionToRebateInd |
| No Rebate Due | 0 | NoRebateDueInd |
| Variable Rate Issue | 0 | VariableRateIssueInd |
| Hedge Identified In Bks And Rec | 0 | HedgeIdentifiedInBksAndRecInd |
| Gross Proceeds Invested In GIC | 0 | GrossProceedsInvestedInGICInd |
| Gross Proceeds Invested | 0 | GrossProceedsInvestedInd |
| Written Proc To Monitor Reqs | Yes (1) | WrittenProcToMonitorReqsInd |
Procedures Corrective Action ProceduresCorrectiveActionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Procedures Corrective Action | Yes (1) | ProceduresCorrectiveActionInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE A, COLUMN F | FormAndLineReferenceDesc |
| Explanation | THE BONDS WERE ISSUED TO (1) REFUND THE SERIES 2014 BONDS (ISSUED 9/29/2014) AND (2) MAKE CAPITAL IMPROVEMENTS INCLUDING STRUCTURAL IMPROVEMENTS AND THE ACQUISITION OF CAPITAL ASSETS TO IMPROVE HOSPITAL SERVICES. | ExplanationTxt |
Schedule L IRS990ScheduleL
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp
Name Of Interested NameOfInterested
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | MANDY GRAHAM | PersonNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Relationship Description | MANDY GRAHAM, TRUSTEE, AND A GREATER THAN 35% OWNER OF RESTORE | RelationshipDescriptionTxt |
| Transaction | $148,095 | TransactionAmt |
| Transaction | PAYMENT FOR SPEECH THERAPY SERVICES | TransactionDesc |
| Sharing Of Revenues | 0 | SharingOfRevenuesInd |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (10 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 4 | THE BYLAWS WERE REVISED TO CHANGE THE TERM OF THE BOARD MEMBERS FROM THREE TO FOUR YEARS. |
| FORM 990, PART VI, SECTION A, LINE 7B | THE GOVERNING BOARD SHALL HAVE RESPONSIBILITY FOR THE MANAGEMENT AND OPERATION OF THE HOSPITAL ACTIVITIES SUBJECT TO THE RATIFICATION RIGHTS OF THE HEALTH SYSTEM SET FORTH IN THE AFFILIATION AGREEMENT, WHICH INCLUDES: A. THE HEALTH SYSTEM'S RIGHT TO RATIFY THE APPOINTMENT AND RETENTION OF DIRECTORS OF THE GOVERNING BOARD, WHICH, APPROVAL MAY ONLY BE WITHHELD BY THE HEALTH SYSTEM DUE TO A CANDIDATE'S CONFLICT OF INTEREST OR FAILURE TO MEET BEST PRACTICES FOR HOSPITAL GOVERNANCE; B. THE HEALTH SYSTEM'S RIGHT TO EXERCISE REASONABLY NECESSARY MANAGEMENT AUTHORITY IN ORDER FOR THE HEALTH SYSTEM TO PROVIDE SERVICES AS A "HOME OFFICE" ON BEHALF OF THE HOSPITAL WHICH, PURSUANT TO 42 CFR PART 485 AND THE REGULATIONS PROMULGATED BY THE LICENSING AUTHORITY OF THE STATE OF KANSAS, MAY BE DELEGATED TO A MANAGEMENT COMPANY BY A STATE LICENSED CRITICAL ACCESS HOSPITAL, EXCLUDING THOSE AUTHORITIES WHICH, PURSUANT TO THE FOREGOING REGULATIONS OR THE EXPRESS TERMS OF THE AFFILIATION AGREEMENT ARE RETAINED BY THE HOSPITAL'S GOVERNING BOARD; C. THE HEALTH SYSTEM'S RIGHT TO FACILITATE THE ADOPTION OF THE ANNUAL CAPITAL AND OPERATING BUDGETS AS FOLLOWS. THE HEALTH SYSTEM SHALL HAVE AUTHORITY AND RESPONSIBILITY FOR CREATING A HOSPITAL BUDGET PROCESS WHICH WILL HAVE THE FOLLOWING CONDITIONS: I. THE HEALTH SYSTEM WILL ANNUALLY PROVIDE THE PROTOCOLS FOR THE HOSPITAL BUDGET PROCESS WHICH THE HOSPITAL MUST FOLLOW IN CREATING THE HOSPITAL BUDGET; II. THE HOSPITAL'S CHIEF EXECUTIVE OFFICER AND CHIEF FINANCIAL OFFICER WILL ANNUALLY IMPLEMENT THE HOSPITAL BUDGET PROCESS WITH THE ASSISTANCE OF THE HEALTH SYSTEM, TO INCLUDE HOSPITALS' DEPARTMENT MANAGERS; III. ANNUALLY, THE HOSPITAL'S GOVERNING BOARD WILL SUBMIT A HOSPITAL BUDGET TO THE HEALTH SYSTEM DIRECTORS WHO MAY EITHER A) APPROVE; OR, B) REJECT AND SEND BACK TO THE HOSPITAL'S GOVERNING BOARD WITH RECOMMENDED CHANGES. THE HOSPITAL'S GOVERNING BOARD WILL BE REQUIRED TO SEND A REVISED HOSPITAL BUDGET TO THE HEALTH SYSTEM DIRECTORS WHO MAY THEREAFTER EITHER APPROVE OR MODIFY THE HOSPITAL BUDGET, WHICH THE HOSPITAL'S GOVERNING BOARD SHALL ADOPT; AND IV. THE ANNUAL HOSPITAL BUDGET WILL INCLUDE PROVISIONS THAT AUTHORIZE DISCRETIONARY SPENDING BY THE HOSPITAL'S GOVERNING BOARD WITHIN THE HOSPITAL'S BUDGET AND STRATEGIC PLAN DURING THE HOSPITAL'S FISCAL YEAR. D. THE HEALTH SYSTEM'S RIGHT TO APPROVE OF ANY STRATEGIC PLANS OR MATERIAL NONCLINICAL PROGRAMING AND MARKETING PLANS, INCLUDING MATERIAL MODIFICATIONS THEREOF; E. THE HEALTH SYSTEM'S PRE-AUTHORIZATION OF DEBT INCURRED, ASSUMED, OR GUARANTEED BY THE HOSPITAL OTHER THAN AS PROVIDED FOR IN ANY APPROVED ANNUAL CAPITAL OR OPERATING BUDGET; F. THE HEALTH SYSTEM'S PRE-AUTHORIZATION OF ANY MATERIAL ACQUISITION, DISPOSITION, FORMATION, ORGANIZATION OR INVESTMENT BY THE HOSPITAL OF OR IN ANY OTHER CORPORATION, PARTNERSHIP, LIMITED LIABILITY COMPANY, OTHER ENTITY OR JOINT VENTURE; G. THE HEALTH SYSTEM'S PRE-AUTHORIZATION OF THE SALE, DISPOSITION, MORTGAGE, OR ENCUMBRANCE OF ANY ASSETS DEDICATED TO THE OPERATIONS OF THE HOSPITAL; H. THE HEALTH SYSTEM'S PRE-AUTHORIZATION OF THE HOSPITAL TO ENTER INTO ANY MERGER, CONSOLIDATION OR JOINT VENTURE; OR TO SELL OR DISPOSE OF SUBSTANTIALLY ALL OF THE ASSETS OF THE HOSPITAL OR ANY OF ITS RESPECTIVE SUBSIDIARIES; OR TO CREATE OR ACQUIRE ANY SUBSIDIARY ORGANIZATION; I. THE HEALTH SYSTEM'S PRE-AUTHORIZATION OF THE HOSPITAL TO INSTITUTE ANY BANKRUPTCY, INSOLVENCY OR REORGANIZATION PROCEEDINGS FOR ITSELF OR ANY SUBSIDIARY; J. THE HEALTH SYSTEM'S PRE-AUTHORIZATION OF A CAPITAL INVESTMENT BY THE HOSPITAL OR ANY OF ITS SUBSIDIARIES IN ANY INDIVIDUAL ENTITY OR PROJECT IN THE FORM OF CASH OR EITHER TANGIBLE OR INTANGIBLE PROPERTY, EXCEPT AS PROVIDED IN ANY APPROVED ANNUAL CAPITAL OR OPERATING BUDGET; K. THE HEALTH SYSTEM'S PRE-AUTHORIZATION TO DEVELOP, IMPLEMENT OR APPROVE THE TERMINATION OF A SERVICE LINE BY THE HOSPITAL OR ITS SUBSIDIARIES; L. THE HEALTH SYSTEM'S PRE-AUTHORIZATION OF ANY AMENDMENT OF THE ARTICLES OF INCORPORATION OR BYLAWS OF THE HOSPITAL OR ITS SUBSIDIARIES TO THE EXTENT THAT IT WOULD A) IMPACT THE RESERVED POWERS SET FORTH IN THE AFFILIATION AGREEMENT; OR B) REASONABLY BE EXPECTED TO HAVE A MATERIAL STRATEGIC, COMPETITIVE OR FINANCIAL IMPACT ON THE HEALTH SYSTEM OR ANY OF ITS AFFILIATES; AND M. THE HEALTH SYSTEM'S COLLABORATION WITH THE HOSPITAL'S GOVERNING BOARD'S APPOINTMENT OR REAPPOINTMENT OF A CHIEF EXECUTIVE OFFICER IN A PROCESS DESCRIBED IN THE AFFILIATION AGREEMENT. |
| FORM 990, PART VI, SECTION A, LINE 8B | THE HEALTH SYSTEM DOES NOT HAVE A COMMITTEE THAT ACTS ON BEHALF OF THE GOVERNING BOARD. |
| FORM 990, PART VI, SECTION B, LINE 11B | AN INDEPENDENT ACCOUNTING FIRM PREPARES AND REVIEWS THE 990. THE 990 IS THEN REVIEWED BY THE ORGANIZATION'S OFFICERS AND ACCOUNTING PERSONNEL. ANY QUESTIONS OR CONCERNS THE ORGANIZATION'S OFFICERS AND ACCOUNTING PERSONNEL HAVE ARE ADDRESSED AND ANY CORRECTIONS OR CLARIFICATIONS THAT NEED TO BE MADE ARE MADE. THE FINAL FORM 990 WITH ALL REQUIRED SCHEDULES IS THEN PROVIDED TO ALL VOTING MEMBERS OF THE BOARD PRIOR TO FILING. |
| FORM 990, PART VI, SECTION B, LINE 12C | ALL EMPLOYEES AND DECISION MAKERS FOR THE HOSPITAL ARE COVERED UNDER THIS POLICY. CONFLICTS ARE EITHER REVIEWED BY THE CORPORATE COMPLIANCE OFFICER OR THE BOARD PRESIDENT. AT BOARD MEETINGS, THE BOARD CHAIR IS APPRAISED OF ALL CONFLICTS OF INTEREST AND THEN ASKS THE MEMBER TO ABSTAIN FROM DISCUSSING AND VOTING ON TOPICS OF CONFLICT. |
| FORM 990, PART VI, SECTION B, LINE 15A | HUMAN RESOURCES PERIODICALLY PROVIDES THE PRESIDENT OF THE BOARD OF DIRECTORS WITH A COMPENSATION SURVEY COMPILED BY THE KANSAS HOSPITAL ASSOCIATION. THE SURVEY DELINEATES COMPENSATION PACKAGES FOR ADMINISTRATORS AT HOSPITALS THAT ARE SIMILAR TO HIAWATHA. BASED ON THAT SURVEY, THE CEO'S PERFORMANCE, AND THE PERFORMANCE OF THE HOSPITAL, THE BOARD SETS THE CEO'S SALARY. THE LAST EVALUATION WAS GIVEN IN 2021 WHILE HIRING OUR CURRENT CEO. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. |
| FORM 990, PART IX, LINE 11G | OTHER SERVICE FEES: PROGRAM SERVICE EXPENSES 18,140. MANAGEMENT AND GENERAL EXPENSES 79,018. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 97,158. PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 714,856. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 714,856. CONTRACT SERVICES: PROGRAM SERVICE EXPENSES 3,911,788. MANAGEMENT AND GENERAL EXPENSES 124,619. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,036,407. LEASED EMPLOYEES: PROGRAM SERVICE EXPENSES 815,968. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 815,968. |
| FORM 990, PART XI, LINE 9: | CHANGE IN INTEREST IN FOUNDATION -147,349. |
| FORM 990, PAGE 12, PART XII, LINE 2C: | THE BOARD OF DIRECTORS HAS THE RESPONSIBILITY OF SELECTING THE INDEPENDENT ACCOUNTANT TO COMPLETE THE AUDIT WORK. THE FINANCE COMMITTEE OF THE BOARD OF DIRECTORS HAS THE RESPONSIBILITY FOR THE OVERSIGHT OF THE AUDIT. UPON CONCLUSION OF THE AUDIT, THE AUDITING FIRM PRESENTS THE RESULTS AND FINDINGS TO THE BOARD OF DIRECTORS. THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp
Disregarded Entity Name DisregardedEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | HIAWATHA COMMUNITY HOSPITAL FOUNDATION | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 300 UTAH STREET | AddressLine1Txt |
| City | HIAWATHA | CityNm |
| State Abbreviation | KS | StateAbbreviationCd |
| ZIP | 66434 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 481223766 | EIN |
| Primary Activities | FUNDRAISING | PrimaryActivitiesTxt |
| Legal Domicile State | KS | LegalDomicileStateCd |
| Exempt Code Section | 501(C)(3) | ExemptCodeSectionTxt |
| Public Charity Status | LINE 12D, III-O | PublicCharityStatusTxt |
| Controlled Organization | 0 | ControlledOrganizationInd |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp
Related Organization Name RelatedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CHARITABLE REMAINDER TRUST (1) | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Primary Activities | TRUST | PrimaryActivitiesTxt |
| Legal Domicile State | KS | LegalDomicileStateCd |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | HHA | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Entity Type | T | EntityTypeTxt |
| Controlled Organization | Yes (1) | ControlledOrganizationInd |
| 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 | 0 | 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 | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |