CLARA BARTON HOSPITAL ASSOCIATION INC HOISINGTON KANSAS: Form 990, tax year 2021
View the entire original 990 at ProPublica ↗
- Organization
- CLARA BARTON HOSPITAL ASSOCIATION INC HOISINGTON KANSAS (EIN 48-0576039)
- Tax period
- 2021-01-01 to 2021-12-31
- Filed
- 2022-10-17
- IRS object ID
- 202202909349300610
- 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 I
- Schedule J
- Schedule K
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2022-10-17T07:39:07-05:00 | ReturnTs |
| Tax Period End | 2021-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 481026809 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Wendling Noe Nelson & Johnson LLC | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 623 SW 10th Ave Suite 300 | AddressLine1Txt |
| City | Topeka | CityNm |
| State Abbreviation | KS | StateAbbreviationCd |
| ZIP | 66612 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2021-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 480576039 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Clara Barton Hospital Association Inc | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | CLAR | BusinessNameControlTxt |
| Phone | 6206532114 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 250 West 9th Street | AddressLine1Txt |
| City | Hoisington | CityNm |
| State Abbreviation | KS | StateAbbreviationCd |
| ZIP | 675441799 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | James G Blackwell | PersonNm |
| Person Title | CEO | PersonTitleTxt |
| Phone | 6206532114 | PhoneNum |
| Signature | 2022-10-05 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | James | PersonFirstNm |
| Person Last | Blackwell | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Cameron L Werth | PreparerPersonNm |
| PTIN | P01797399 | PTIN |
| Phone | 7852334226 | PhoneNum |
| Preparation | 2022-10-05 | PreparationDt |
Additional Filer Information AdditionalFilerInformation
Trusted Customer TrustedCustomerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | 3 | TrustedCustomerCd |
| Authentication Assurance Level | AAL1 | AuthenticationAssuranceLevelCd |
| Identity Assurance Level | IAL1 | IdentityAssuranceLevelCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2021 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | James G Blackwell | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 250 West 9th Street | AddressLine1Txt |
| City | Hoisington | CityNm |
| State Abbreviation | KS | StateAbbreviationCd |
| ZIP | 675441799 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $38,789,770 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | www.clarabartonhospital.com | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1946 | FormationYr |
| Legal Domicile State | KS | LegalDomicileStateCd |
| Activity Or Mission | Provision of inpatient and outpatient hospital services, primary care services, and surgical services to residents of our service area. | ActivityOrMissionDesc |
| Voting Members Governing Body | 10 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 8 | VotingMembersIndependentCnt |
| Total Employee | 338 | TotalEmployeeCnt |
| Total Volunteers | 22 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $317,334 | PYContributionsGrantsAmt |
| CY Contributions Grants | $5,576,596 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $25,567,343 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $31,889,931 | CYProgramServiceRevenueAmt |
| PY Investment Income | $317,046 | PYInvestmentIncomeAmt |
| CY Investment Income | $416,414 | CYInvestmentIncomeAmt |
| PY Other Revenue | $537,180 | PYOtherRevenueAmt |
| CY Other Revenue | $773,038 | CYOtherRevenueAmt |
| PY Total Revenue | $26,738,903 | PYTotalRevenueAmt |
| CY Total Revenue | $38,655,979 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $1,633 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $6,446 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $16,487,738 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $19,683,452 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $91,283 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $10,431,472 | PYOtherExpensesAmt |
| CY Other Expenses | $12,791,276 | CYOtherExpensesAmt |
| PY Total Expenses | $26,920,843 | PYTotalExpensesAmt |
| CY Total Expenses | $32,481,174 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$181,940 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $6,174,805 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $38,717,618 | TotalAssetsBOYAmt |
| Total Assets EOY | $42,373,084 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $27,755,193 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $24,424,017 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $10,962,425 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $17,949,067 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | Clara Barton Hospital Association is dedicated to meeting the health care needs and improving the quality of life for the community we serve. We continually pursue clinical excellence in an atmosphere of caring and compassion. We are deeply committed to serving all in need within our resources. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $28,471,059 | ExpenseAmt |
| Grant | $6,446 | GrantAmt |
| Revenue | $32,136,307 | RevenueAmt |
| Desc | Clara Barton Hospital Association provided a wide range of health care services to residents of its service area including 3,303 patient days of inpatient care, 24,535 outpatient hospital visits and 35,995 visits to our primary care and surgical clinics. | Desc |
| Total Program Service Expenses | $28,471,059 | 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 | 0 | 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 | Yes (1) | 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 | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 55 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 338 | 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 | 10 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 8 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | 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 | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | James G Blackwell | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 6206532114 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 250 West 9th Street | AddressLine1Txt |
| City | Hoisington | CityNm |
| State Abbreviation | KS | StateAbbreviationCd |
| ZIP | 675441799 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (20 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Key EmployeeKeyEmployeeInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| Marla Mooney | ||||||||
| Vice-Chairperson thru Jan 2021 | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| Kathy Kaiser | ||||||||
| Secretary/Vice-Chairperson beg. Feb 2021 | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| Jim Carney | ||||||||
| Treasurer | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| Lisa Beran | ||||||||
| Chairperson | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| Doug Hubbard | ||||||||
| Director/Secretary beg, Feb 2021 | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| Jim Blackwell | ||||||||
| President/CEO/CFO | 40.00 | Yes (X) | Yes (X) | $196,546 | $0 | $38,899 | ||
| Nathaniel Knackstedt | ||||||||
| Director/Chief of Staff | 40.00 | Yes (X) | $340,013 | $0 | $38,785 | |||
| Tona King | ||||||||
| Director thru Feb 2021 | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| Jonathan Kelly | ||||||||
| Director thru Aug 2021 | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| Gary Shook | ||||||||
| Director | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| Karisa Cowan | ||||||||
| Director beg. Sept 2021 | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| Kathy Burt | ||||||||
| Director beg. March 2021 | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| Lois McLelland | ||||||||
| Director beg. Sept 2021 | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| Kim Kindscher | ||||||||
| Director Feb 2021 - Aug 2021 | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| Amanda Hoffman | ||||||||
| Pharmacist/COO | 40.00 | $246,476 | $0 | $42,230 | Yes (X) | |||
| Taylor Bieberle | ||||||||
| Physician Assistant | 40.00 | $176,193 | $0 | $37,790 | Yes (X) | |||
| Timothy Webb | ||||||||
| Physician | 40.00 | $406,204 | $0 | $32,436 | Yes (X) | |||
| Patrick Stiles | ||||||||
| General Surgeon | 40.00 | $947,385 | $0 | $38,864 | Yes (X) | |||
| Phillip Barnes | ||||||||
| Physician Assistant | 40.00 | $168,367 | $0 | $34,468 | Yes (X) | |||
| Kyle Renner | ||||||||
| Physician | 40.00 | $295,744 | $0 | $45,142 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $2,776,928 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $308,614 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 16 | 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 |
|---|---|---|---|---|---|
| Cerner Coporation | |||||
| PO Box 959156 | St Louis | MO | 631959156 | Computer support services | $537,627 |
| Wichita Surgical Specialists | |||||
| 818 N Emporia Suite 200 | Wichita | KS | 67214 | Surgical services | $497,798 |
| Affiliated Medical Services | |||||
| PO Box 12127 | Wichita | KS | 672772127 | Lab Services | $287,822 |
| Shared Medical Services Inc | |||||
| 209 Limestone Pass | Great Bend | KS | 67530 | MRI and PET Services | $282,135 |
| Daniel Brendan Rice | |||||
| 13710 E Ayesbury St | Wichita | KS | 67228 | ER Physician coverage | $273,627 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 12 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $28,435 | RelatedOrganizationsAmt |
| Government Grants | $5,420,212 | GovernmentGrantsAmt |
| All Other Contributions | $127,949 | AllOtherContributionsAmt |
| Total Contributions | $5,576,596 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| Patient service revenue | 622110 | $30,221,662 | $30,221,662 |
| 340b drug program revenue | 622110 | $1,668,269 | $1,668,269 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $31,889,931 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $405,086 | TotalRevenueColumnAmt |
| Exclusion | $405,086 | ExclusionAmt |
Royalties Revenue RoyaltiesRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $455,963 | TotalRevenueColumnAmt |
| Exclusion | $455,963 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $19,570 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $0 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $19,570 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $19,570 | TotalRevenueColumnAmt |
| Exclusion | $19,570 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $145,119 | SecuritiesAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $133,791 | SecuritiesAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $11,328 | SecuritiesAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $11,328 | TotalRevenueColumnAmt |
| Exclusion | $11,328 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt | ExclusionExclusionAmt |
|---|---|---|---|---|
| All other | 621990 | $189,564 | $189,564 | |
| Purchase discounts and rebates | 621990 | $56,812 | $56,812 | |
| Cafeteria | 722210 | $51,129 | $51,129 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $297,505 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $38,655,979 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $32,136,307 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $943,076 | ExclusionAmt |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,446 | TotalAmt |
| Program Services | $6,446 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $614,815 | TotalAmt |
| Program Services | $379,027 | ProgramServicesAmt |
| Management And General | $235,788 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $15,624,299 | TotalAmt |
| Program Services | $14,124,958 | ProgramServicesAmt |
| Management And General | $1,430,208 | ManagementAndGeneralAmt |
| Fundraising | $69,133 | FundraisingAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $314,590 | TotalAmt |
| Program Services | $287,019 | ProgramServicesAmt |
| Management And General | $26,150 | ManagementAndGeneralAmt |
| Fundraising | $1,421 | FundraisingAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,146,583 | TotalAmt |
| Program Services | $1,946,474 | ProgramServicesAmt |
| Management And General | $190,613 | ManagementAndGeneralAmt |
| Fundraising | $9,496 | FundraisingAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $983,165 | TotalAmt |
| Program Services | $879,932 | ProgramServicesAmt |
| Management And General | $99,005 | ManagementAndGeneralAmt |
| Fundraising | $4,228 | FundraisingAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $17,533 | TotalAmt |
| Management And General | $17,533 | ManagementAndGeneralAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $7,840 | TotalAmt |
| Management And General | $7,840 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,550,048 | TotalAmt |
| Program Services | $1,994,890 | ProgramServicesAmt |
| Management And General | $555,023 | ManagementAndGeneralAmt |
| Fundraising | $135 | FundraisingAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $103,438 | TotalAmt |
| Program Services | $50,993 | ProgramServicesAmt |
| Management And General | $52,445 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,398,966 | TotalAmt |
| Program Services | $1,171,407 | ProgramServicesAmt |
| Management And General | $226,849 | ManagementAndGeneralAmt |
| Fundraising | $710 | FundraisingAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $552,427 | TotalAmt |
| Program Services | $414,320 | ProgramServicesAmt |
| Management And General | $138,107 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $311,626 | TotalAmt |
| Program Services | $258,533 | ProgramServicesAmt |
| Management And General | $51,977 | ManagementAndGeneralAmt |
| Fundraising | $1,116 | FundraisingAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $46,963 | TotalAmt |
| Program Services | $44,114 | ProgramServicesAmt |
| Management And General | $2,846 | ManagementAndGeneralAmt |
| Fundraising | $3 | FundraisingAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $131,440 | TotalAmt |
| Management And General | $131,440 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,499,754 | TotalAmt |
| Program Services | $1,294,060 | ProgramServicesAmt |
| Management And General | $201,259 | ManagementAndGeneralAmt |
| Fundraising | $4,435 | FundraisingAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $187,807 | TotalAmt |
| Program Services | $46,911 | ProgramServicesAmt |
| Management And General | $140,751 | ManagementAndGeneralAmt |
| Fundraising | $145 | FundraisingAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt | FundraisingFundraisingAmt |
|---|---|---|---|---|
| Pharmacy supplies | $2,341,908 | $2,341,908 | ||
| Medical supplies | $1,383,815 | $1,383,815 | ||
| 340B program | $852,120 | $852,120 | ||
| Repairs and maintenance | $503,126 | $477,820 | $24,888 | $418 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $902,465 | TotalAmt |
| Program Services | $516,312 | ProgramServicesAmt |
| Management And General | $386,110 | ManagementAndGeneralAmt |
| Fundraising | $43 | FundraisingAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $32,481,174 | TotalAmt |
| Program Services | $28,471,059 | ProgramServicesAmt |
| Management And General | $3,918,832 | ManagementAndGeneralAmt |
| Fundraising | $91,283 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $389,199 | BOYAmt |
| EOY | $446,916 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $20,872,403 | BOYAmt |
| EOY | $13,987,474 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,605,222 | BOYAmt |
| EOY | $3,728,263 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $969,364 | BOYAmt |
| EOY | $990,973 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $569,286 | BOYAmt |
| EOY | $596,821 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $29,547,661 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $13,745,306 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,257,575 | BOYAmt |
| EOY | $15,802,355 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,779,913 | BOYAmt |
| EOY | $5,452,566 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,274,656 | BOYAmt |
| EOY | $1,367,716 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $38,717,618 | BOYAmt |
| EOY | $42,373,084 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,839,478 | BOYAmt |
| EOY | $6,691,547 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,629,411 | BOYAmt |
| EOY | $1,112,404 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $12,751,852 | BOYAmt |
| EOY | $12,520,952 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,392,052 | BOYAmt |
| EOY | $1,099,114 | EOYAmt |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,142,400 | BOYAmt |
| EOY | $3,000,000 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $27,755,193 | BOYAmt |
| EOY | $24,424,017 | 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 | $10,397,450 | BOYAmt |
| EOY | $16,715,099 | EOYAmt |
Donor Restriction Net Assets DonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $564,975 | BOYAmt |
| EOY | $1,233,968 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,962,425 | BOYAmt |
| EOY | $17,949,067 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $38,717,618 | BOYAmt |
| EOY | $42,373,084 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $6,174,805 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $242,844 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | $568,993 | OtherChangesInNetAssetsAmt |
| 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 | Yes (1) | GrantsOtherOrganizationsInd |
| Grants Other Organizations | $5,464 | GrantsOtherOrganizationsAmt |
| Direct Contact Legislators | 0 | DirectContactLegislatorsInd |
| Rallies Demonstrations | 0 | RalliesDemonstrationsInd |
| Other Activities | 0 | OtherActivitiesInd |
| Total Lobbying Expenditures | $5,464 | 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 | Clara Barton Hospital Association, Inc., is a member of the Kansas Hospital Association and the American Hospital Association. Both of these organizations engage in lobbying activities for hospital and general health care interests as part of the services provided to members. | ExplanationTxt |
Schedule D IRS990ScheduleD
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,854,765 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,478,486 | DepreciationAmt |
| Book Value | $376,279 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $8,672,734 | OtherCostOrOtherBasisAmt |
| Depreciation | $6,717,263 | DepreciationAmt |
| Book Value | $1,955,471 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $8,866,459 | OtherCostOrOtherBasisAmt |
| Depreciation | $5,549,557 | DepreciationAmt |
| Book Value | $3,316,902 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $10,153,703 | OtherCostOrOtherBasisAmt |
| Book Value | $10,153,703 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $15,802,355 | TotalBookValueLandBuildingsAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $39,461,367 | TotalRevEtcAuditedFinclStmtAmt |
| Net Unrealized Gains Invst | $242,844 | NetUnrealizedGainsInvstAmt |
| Other Revenue | -$6,449 | OtherRevenueAmt |
| Revenue Not Reported | $236,395 | RevenueNotReportedAmt |
| Revenue Subtotal | $39,224,972 | RevenueSubtotalAmt |
| Other Revenues Not Included | -$568,993 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | -$568,993 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $38,655,979 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $32,474,725 | TotExpnsEtcAuditedFinclStmtAmt |
| Other Expenses Included | -$6,449 | OtherExpensesIncludedAmt |
| Expenses Not Reported | -$6,449 | ExpensesNotReportedAmt |
| Expenses Subtotal | $32,481,174 | ExpensesSubtotalAmt |
| Expenses Not Rpt Fincl Stmt | $0 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $32,481,174 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part X, Line 2: | Management is not aware of any uncertainties in income tax positions. |
| Part XI, Line 2d - Other Adjustments: | Contribution expense included in revenues on financial statements -6,449. |
| Part XI, Line 4b - Other Adjustments: | Change in beneficial interest in net assets of Foundation, net of transfers -568,993. |
| Part XII, Line 2d - Other Adjustments: | Contribution expense included in revenues on financial statements -6,449. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
| Percent150 | Yes (X) | Percent150Ind |
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
| Percent300 | Yes (X) | Percent300Ind |
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | 0 | ExpensesExceedBudgetInd |
| 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 | $594,992 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $594,992 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01830 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,648,544 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,487,281 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,161,263 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.03580 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $3,243,536 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,487,281 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,756,255 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.05410 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $85,985 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $85,985 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00260 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $179,710 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $179,710 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00550 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $8,347,600 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $6,772,912 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,574,688 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.04850 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $8,613,295 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $6,772,912 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,840,383 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.05660 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $11,856,831 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $8,260,193 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $3,596,638 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.11070 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $1,338,344 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $26,767 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $9,701,917 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $9,605,858 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | $96,059 | 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 (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 | Clara Barton Hospital | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 250 West 9th Street | AddressLine1Txt |
| City | Hoisington | CityNm |
| State Abbreviation | KS | StateAbbreviationCd |
| ZIP | 675441799 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| State License | H005003 | 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 | Physician clinics & rural health clinics | OtherDesc |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Clara Barton 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 | 21 | 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 | https://clarabartonhospital.com/ | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 21 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | https://clarabartonhospital.com/ | 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 | 150.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 300.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Income Level Criteria | Yes (X) | IncomeLevelCriteriaInd |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | https://clarabartonhospital.com/ | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | https://clarabartonhospital.com/ | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | https://clarabartonhospital.com/ | 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 |
| Made Effort Orally Notify | Yes (X) | MadeEffortOrallyNotifyInd |
| Processed FAP Application | Yes (X) | ProcessedFAPApplicationInd |
| Made Presumptive Elig Determ | Yes (X) | MadePresumptiveEligDetermInd |
| Other Actions Taken | Yes (X) | OtherActionsTakenInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Look Back Medicare Private | Yes (X) | LookBackMedicarePrivateInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Clara Barton Hospital Association, Inc. | Part V, Section B, Line 5: The CHNA was conducted in collaboration with the Barton County Health Department. The Hospital reached out to members of the community with broad interests in the community served and special knowledge of or expertise in public health from groups such as local hospitals, public health community, free clinics, community based clinics, service providers, school leaders, and local government. A Town Hall meeting of 39 attendees was conducted. The Town Hall meeting reflected on the size and seriousness of any health concerns cited and discussed current community health strengths, as well as identifying and ranking top community health concerns. In addition to the Town Hall meeting, CHNA surveys were completed by Barton County residents. The survey was created to measure Barton County residents' views regarding health care perceptions of delivery, access, and health practices. |
| Clara Barton Hospital Association, Inc. | Part V, Section B, Line 6b: Barton County Health Department (located in Great Bend, KS - Barton County) |
| Clara Barton Hospital Association, Inc. | Part V, Section B, Line 11: The annual update below pertains to the CHNA and implementation strategy completed for the 2018 tax year, which is the third-annual update for the three-year cycle. Next year's annual update will pertain to the CHNA and implementation strategy completed for the 2021 tax year.1.Diabetic Education (Diet/Exercise) and Decreasing ObesityCBH continues to offer a full range of inpatient and outpatient nutrition services designed to help our patients achieve optimal health and feel their best. Our goal is to provide evidence-based nutrition care for treatment of acute and chronic illnesses and to promote nutritional health for adults and children who are either referred by their physician or taking steps on their own to improve their health. Whether someone simply wants to learn to eat healthier, or if they have special dietary needs, our registered dietitian will conduct an individualized nutrition assessment and create an individualized plan just for that person. Reasons why individuals may seek the assistance of a Registered Dietitian: Chronic Disease, Gut Health, Disordered Eating, Women's Health, Athletes, Patients interested in Bariatric Surgery, Practical Lifestyle Advice.CBH has representation on several boards that focus on diet and exercise such as the Health for Life Coalitions, Be Well Barton County and Kansas Healthy Hospitals.CBH remains dedicated to providing our community nutrition expertise. During 2021 we very actively looked to hire an additional Registered Dietitian. One was found and is slated to start in January 2022.Through out the year CBH posts healthy recipes on our Facebook to share with the community.Quarterly Lab fairs are offered to the public at a discounted rate.Clara Barton offers a full range of both inpatient and outpatient nutrition services designed to help patients achieve optimal health.April 28, 2021, CBH hosted a community wide event for National Walk at Lunch Day.May 2021, bike sharrows were painted on streets in Great Bend to encourage biking and to make it safer for the community. May 2021 the Cottonwood Extension office share information on "Kids and Vegetables". Topics included how to keep snacks healthy. How to follow the MyPlate food guide system for healthy eating. How to involve kids in selecting and preparing their healthy snacks. June 2021 the Cottonwood Extension office shared information on "Fluids important to manage heat, humidity safely". Topics included staying hydrated as the temperature climbs. Why water is important and how much you should drink. The effects of excessive water loss or dehydration as well as the signs of heat exhaustion.During the Barton County Fair, July 2021, nutritious smoothie recipes were shared with attendees. A blender bike was brought in. A bike with an apparatus above the wheel holding the blender. Participants could hop on the bike and blend up a smoothie. The blender bike was brought in to support and encourage children and families to eat well and be active.Tuesday October 5, 2021, the Hoisington Library hosted an educational program about fermenting vegetables. The program shared the different methods of fermenting vegetables and the health benefits of including a small amount of fermented food in a healthy daily meal plan. 2. Provide SpecialistsCBH continues to partner with Wichita Urology to bring Dr. Andrew Jensen twice a month. With Salina Regional Neurosurgery to bring Dr. Scott Boswell once a month and Rheumatologist Dr. Kenneth Baxa six times a month. Central Kansas Orthopedic Group to bring the orthopedic services of Dr. Randall Hildebrand to the community twice a month, once for clinic and once for surgical procedures. With the Hutchinson Clinic to bring Dr. Costy Mattar a cardiology specialist twice a month, OB/GYN services of Dr. Christine Sanders monthly, Pulmonologist Dr. Humayun Ashraf once a month, Podiatrist Andrea Drieling monthly and Dr. Curt Thompson a diagnostic radiology specialist weekly. With the Wichita Surgical Specialists to bring Dr. Brett Grizzell specializing in cardiothoracic surgery monthly. With Abay Neuroscience of Wichita to bring Dr. Matthew Henry monthly. With Maternal - Fetal Associates of Kansas to bring Dr. Evans, MD - Perinatology monthly. With Cardiovascular Consultants of Wichita to bring Cardiologist Dr. Bassem Chehab, MD twice a month.June of 2021 CBH expanded its pediatric care services with the addition of Pediatrician Dr. Kayla Johnson.Dr. Roxanne Stiles joined our surgical practice August 2021. 3. Improve Assessment/Placement for Mental HealthFebruary 2021 CBH received their annual recertification as a Patient-Centered Medical Home by the national Committee for Quality Assurance (NCQA). This certification establishes a model of care that is patient-focused, improving the quality of care, enhancing patient experience, building relationships between patients and providers, and providing additional clinic services to better serve patient needs. This includes a quality measure tracking the number of PHQ-9 assessments that are completed.CBH continued our partnership with the KU Alzheimer's Disease Center to improve assessment of Alzheimer patients and to provide care giver counceling once a month. CBH offers Behavioral & Mental Health Therapy for children and adults. July 2021 The Golden Belt Community Foundation awarded a $25,000 grant to the Zero Reasons Why project in our community. The goal is to reduce youth suicide rates. Superintendents from all Golden Belt schools meet to get a better understanding of the program and how they might incorporate it in their schools. Joining as partners in this program are the Behavioral Health Advisory Committee; Juvenile Justice Authority; and Suicide Prevention Task Force of the Central Kansas Partnership.Fall of 2021 Hoisington High School Students started the Zero Reasons Why Program. This is a teen-led campaign to reduce teen suicide and emphasize that mental health is as important as physical health. Other schools getting involved include: Central Plains, Stafford, St John-Hudson, Ellinwood, Sterling, Chase-Raymond, Lyons, Great Bend, Fort Larned and Pawnee Heights.Luna, a Bernese Mountain Therapy Dog and her handler Glen stops by CBH on a weekly basis to visit patients providing love and comfort.Saturday, September 18, 2021 the community held the Golden Belt Glow Run for Life 5k/1 mile run at Veterans memorial Park in Great Bend. This event is an awareness and remembrance event that raises awareness for suicide prevention. The Cottonwood extension District Facebook page has started including segments for "Wellness Wednesday" These posts are short videos created by the staff at High Plains mental Health, that address mental health topics.4. Develop Substance Abuse Education (Alcohol & Tobacco)A Tobacco Free City Park ordinance was passed in the City of Hoisington February 2021. This includes all forms of tobacco as well as e-cigarettes. April 2021 New Tobacco Free Park Signage was placed in both Great Bend and Hoisington Parks.Rise Up Central Ks has been very active in the community providing resources to prevent, overcome, and abstain from substance misuse. September 2021 Barton County Commission approved a Recovery Proclamation. September 2021 held a Narcan March at Jack Kilby Bandshell. The event included recovery out loud, speakers and luminaries.Antibiotic Stewardship is a coordinated program designed to promote the appropriate use of antimicrobials. Goals of this program include improving patient outcomes, decreasing the spread of infection, and reducing bacterial resistance. Drug resistant bacteria develop from the misuse of antibiotics and can result in life-threatening infections. Taking steps to encourage proper antibiotic use helps to slow bacterial resistance, decrease adverse health effects, and ensure that life-saving medications remain available. At CBH our focus on antibiotic stewardship directly correlates with the principals of community health and wellness. CBH continue efforts in developing complete antibiotic stewardship program that promote the proper use of antibiotic medications. Our stewardship efforts demonstrate a commitment to our patients by improving safety, outcomes, and a dedication to quality of care.During 2021 the All-Stars program continued in our local school systems. The programs are designed to help students talk about the benefits of avoiding drugs and alcohol. One of its goals is to reduce use and abuse, especially of gateway drugs: alcohol, cigarettes, marijuana and inhalants. Free Naloxone Training offered February 2021 - Participants learned how to recognize and respond to signs of an overdose and how to administer Naloxone. |
| Clara Barton Hospital Association, Inc. | Part V, Section B, Line 11: CBH again partnered with the Great Bend Health department to host a community baby shower for pregnant mothers in need. Education was provided on Smoking Cessation, Safe Sleep and Breast Feeding.CBH continues to participate in the Kan-Quit cessation program. 5. Provide Sex Education in Schools (Decrease Teenage Pregnancy, Decrease Unmarried Mothers)During 2021 the All-Stars program continued in our local school systems. The programs are designed to help students talk about the benefits of avoiding drugs and alcohol, but it also seeks to help students avoid other risky behaviors, such as early sexual experience, fighting and bulling.Prevention education and services are provided by the Barton County Health Department. They include services such as sex education, birth control counseling, physical exams, pap tests, disease screening, sexual and reproductive health, family planning etc.6. Improve Immunization RatesFebruary 2021 CBH received their annual recertification as a Patient-Centered Medical Home by the national Committee for Quality Assurance (NCQA). This certification establishes a model of care that is patient-focused, improving the quality of care, enhancing patient experience, building relationships between patients and providers, and providing additional clinic services to better serve patient needs. This includes a quality measure for Immunizations.Flu vaccines and covid vaccines are offered anytime in all of CBH clinics. In addition the following opportunities were made available to the community:CBH hosted a Drive-Thru for Covid Vaccines from 8:00 - 10:00 3/10/2021.CBH hosted a Walk-in COVID Vaccine Clinic during our Lab Fair from 7:00 - 9:00 4/17/2021.CBH hosted a Drive-Thru for Covid Vaccines from 8:00 - 10:00 4/21/2021.CBH hosted a Drive-Thru for Flu Vaccines from 8:00 - 10:00 10/9/2021.CBH hosted a Vaccine Clinic 11/3/2021 from 7:00 - 11:00. Vaccines available included: Flu, Covid and Covid booster. Free breakfast was given to everyone attending this event.CBH Staff went directly to the schools in Hoisington to give faculty and students vaccinations as well as several community worksites.7. Provide Senior Physical Activity at a Reasonable PriceThe Hoisington activity center charges a small one-time life-time fee of $20 for anyone who lives in the Hoisington school district USD 431. The City of Hoisington offers several free parks where residents can walk, run, and play. Bicentennial Park offers a 1-mile outdoor walking trail along with tennis courts, horseshoe pits, pickleball courts and a dog park.CBH offers a walking loop around the hospital campus. 2.5 laps is a mile. The loop also offers 5 pieces of exercise equipment geared towards Physical Therapy rehab and the Seniors.Great Bend Recreation Center offers reduced (daily, monthly, six month and yearly) rates for seniors. Walking is free to the public. Senior Activities are available most of the time for free. Veterans' Memorial Park in Great Bend offers a 1-mile fitness trail, tennis courts, a fitness station with workout equipment, a dog park and fishing. Club 1 Fitness is the largest health club in Great Bend. It offers a comprehensive weight room, cardio equipment, an Olympic size swimming pool and offers over 40 group fitness classes, including many for the Senior age group. Memberships are discounted for Seniors. Hoisington is in the process of establishing a bike share program. During 2021 bikes were purchased, bike station sites were selected and erected. Public access will be given in 2022. Bikes will be stationed near the city office, Rodeway Inn & Suites Hotel and the Hoisington Activity Center. Free to the public. |
| Clara Barton Hospital Association, Inc. | Part V, Section B, Line 20e: CBH notified all uninsured patients about the Hospital's FAP by letter, orally, and on patient statements. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 4 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (4 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| 1 - Clara Barton Medical Clinic | ||||
| 252 W 9th Street | Hoisington | KS | 67544 | Rural health clinic |
| 2 - Clara Barton Surgical & Specialty Clinic | ||||
| 351 W 10th Street | Hoisington | KS | 67544 | Physician clinic |
| 3 - Russell Family Medical Care | ||||
| 410 N Main Street Suite C | Russell | KS | 67665 | Rural health clinic |
| 4 - Clara Barton Medical Clinic | ||||
| 1301 Jackson Street | Great Bend | KS | 67530 | Rural health clinic |
Supplemental Information Detail SupplementalInformationDetail (9 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part I, Line 7: | Financial assistance at cost was determined by utilizing departmental cost-to-charge ratios for financial assistance provided in areas that are reported as subsidized health services. An overall cost-to-charge ratio derived from Worksheet 2 was used to determine the cost of financial assistance provided for services not reported as subsidized health services.Unreimbursed Medicaid costs were also determined using a blend of cost-to-charge ratios for certain services and an overall cost-to-charge ratio derived from Worksheet 2 for all other services.The cost of providing subsidized health services was determined using a cost-to-charge ratio for each service.Actual costs and revenues were utilized for all other items reported on line 7. |
| Part I, Line 7g: | Subsidized health services are comprised of services that the Hospital provides despite a financial loss to the organization. These services include the operation of a 24-hour emergency room, physician clinics, diabetic and dietician services, and various therapy services. The amount of costs attributed to physician clinics amount to $4,627,050. |
| Part III, Line 4: | The Hospital recognizes patient service revenue associated with services provided to patients who have third-party payor coverage on the basis of contractual rates for the services rendered. For uninsured patients that do not qualify for charity care, the Hospital recognizes revenue on the basis of its standard rates for services provided. On the basis of historical experience, a significant portion of the Hospital's uninsured patients will be unable or unwilling to pay for the services provided. Thus, the Hospital records a significant provision for bad debts related to uninsured patients in the period the services are provided.Part III, Line 2:Bad debt expense at cost was determined by utilizing departmental cost-to-charge ratios for financial assistance provided in areas that are reported as subsidized health services. An overall cost-to-charge ratio derived from Worksheet 2 was applied to the charges deemed uncollectible during the year for all other services.Part III, Line 3:Bad debt expense attributable to patients eligible under the organization's financial assistance policy was determined using an estimated 2% of total bad debts. The Hospital takes steps to assist individuals who are believed to qualify for financial assistance prior to writing accounts off as uncollectible.All non-reimbursed costs for treatment of patients in our community provides a community benefit since patients unwilling or unable to pay have received a valuable service at no cost or at a reduced cost to them. This improves the health of our community as a whole. |
| Part III, Line 8: | Medicare allowable costs were determined by using amounts from the Hospital's Medicare cost report as filed with the Medicare Administrative Contractor. The Medicare cost report apportions actual costs to the Medicare program using charges for ancillary services and patient days for nursing services. Caring for Medicare patients fulfills a community need and relieves a government burden as these patients typically have low or fixed income. Therefore, any shortfall should be included as a community benefit. |
| Part III, Line 9b: | The collection policy states that the patient must cooperate with the Hospital to provide the information and documentation necessary to apply for other existing financial resources that may be available to pay for health care services, such as Medicaid. Then the information is gathered and assessed in order to determine eligibility for charity care. Whenever possible, prior to admission, the Hospital will conduct a pre-admission interview with the patient, the guarantor, and/or the patient's legal representative. Those patients who may qualify for financial assistance from a governmental program will be referred to the appropriate program, prior to the consideration for charity care. |
| Part VI, Line 2: | The Hospital works closely with the Barton County Health Department and Kansas Department of Health and Environment to identify trends in the community. Education and information is provided to the public, including information on West Nile, chicken pox, and whooping cough, for example. The Hospital also trends data in the hospital and clinics to identify emerging issues. The Hospital has provided, a fall prevention program, "Stepping On", for interested elderly members of Hoisington and surrounding areas. The Hospital also trends trauma data in the emergency room and as a result provided literature to the public on fall prevention. |
| Part VI, Line 3: | There is signage posted at admissions desk. Patients are referred to a financial counselor at admission if they do not have insurance. The financial counselor also works with a Medicaid helper to try and get qualified patients registered for the Medicaid program. Effort is made during billing of deductible and co-payment to see if patient can qualify for charity care. |
| Part VI, Line 4: | The community being served is located in central Kansas and consists of approximately 2,700 residents. The average household income is $47,566. 12.6% of the community residents live below federal poverty level. Neighboring hospitals include facilities in Ellinwood and Great Bend. They are approximately 18 and 11 miles away respectively. |
| Part VI, Line 5: | The Hospital's Board of Directors is elected from the community at large. This allows independent individuals who reside in the primary service area to serve as a director. The Hospital also extends medical staff privileges to all qualified physicians in the community. Any surplus in funds is retained by the Hospital and aids in improving overall patient care and facility maintenance. |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (1) | GrantRecordsMaintainedInd |
Recipient Table RecipientTable
Recipient Business Name RecipientBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Clara Barton Hospital Foundation | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 250 W Ninth Street | AddressLine1Txt |
| City | Hoisington | CityNm |
| State Abbreviation | KS | StateAbbreviationCd |
| ZIP | 67544 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Recipient EIN | 481077460 | RecipientEIN |
| Cash Grant | $6,446 | CashGrantAmt |
| Non Cash Assistance | $0 | NonCashAssistanceAmt |
| Valuation Method Used | Cash paid | ValuationMethodUsedDesc |
| Purpose Of Grant | General purpose funds from memorials and lab/book fair proceeds. | PurposeOfGrantTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 1 | Total501c3OrgCnt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part I, Line 2: | FormAndLineReferenceDesc |
| Explanation | The Hospital monitors grants by remitting only management approved amounts directly to the organizations supported. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Employment Contract | Yes (X) | WrittenEmploymentContractInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (8 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Patrick Stiles | ||||||||||||||
| General Surgeon | $445,283 | $0 | $502,102 | $0 | $0 | $0 | $8,700 | $0 | $30,164 | $0 | $986,249 | $0 | $0 | $0 |
| Timothy Webb | ||||||||||||||
| Physician | $343,844 | $0 | $62,360 | $0 | $0 | $0 | $8,700 | $0 | $23,736 | $0 | $438,640 | $0 | $0 | $0 |
| Nathaniel Knackstedt | ||||||||||||||
| Director/Chief of Staff | $293,158 | $0 | $46,855 | $0 | $0 | $0 | $8,700 | $0 | $30,085 | $0 | $378,798 | $0 | $0 | $0 |
| Kyle Renner | ||||||||||||||
| Physician | $282,989 | $0 | $12,755 | $0 | $0 | $0 | $14,994 | $0 | $30,148 | $0 | $340,886 | $0 | $0 | $0 |
| Amanda Hoffman | ||||||||||||||
| Pharmacist/COO | $245,946 | $0 | $530 | $0 | $0 | $0 | $7,518 | $0 | $34,712 | $0 | $288,706 | $0 | $0 | $0 |
| Jim Blackwell | ||||||||||||||
| President/CEO/CFO | $196,092 | $0 | $454 | $0 | $0 | $0 | $7,122 | $0 | $31,777 | $0 | $235,445 | $0 | $0 | $0 |
| Taylor Bieberle | ||||||||||||||
| Physician Assistant | $158,927 | $0 | $17,266 | $0 | $0 | $0 | $3,876 | $0 | $33,914 | $0 | $213,983 | $0 | $0 | $0 |
| Phillip Barnes | ||||||||||||||
| Physician Assistant | $144,102 | $0 | $24,265 | $0 | $0 | $0 | $4,717 | $0 | $29,751 | $0 | $202,835 | $0 | $0 | $0 |
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 | Hoisington Public Building Commission | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Issuer EIN | 471454939 | BondIssuerEIN |
| CUSIP | 43466QBA6 | CUSIPNum |
| Bond Issued | 2020-10-15 | BondIssuedDt |
| Issue Price | $12,569,466 | IssuePriceAmt |
| Purpose | Renovate and expand the Hospital | 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 |
| Total Proceeds | $12,572,534 | TotalProceedsAmt |
| Capitalized Interest | $361,822 | CapitalizedInterestAmt |
| Issuance Costs From Proceeds | $216,638 | IssuanceCostsFromProceedsAmt |
| Capital Expenditures | $4,921,489 | CapitalExpendituresAmt |
| Unspent | $7,072,585 | UnspentAmt |
| Refunding Tax Exempt Bonds | 0 | RefundingTaxExemptBondsInd |
| Refunding Taxable Bonds | 0 | RefundingTaxableBondsInd |
| Final Allocation Made | 0 | 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 |
| Bond Iss Meet Prvt Sec Pymt Test | 0 | BondIssMeetPrvtSecPymtTestInd |
| Change In Use Bond Financed Prop | 0 | ChangeInUseBondFinancedPropInd |
| Procs Nonqualified Bond Remdtd | 0 | 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 | Yes (1) | 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 | Schedule K, Part II, Line 3, Total proceeds of issue | FormAndLineReferenceDesc |
| Explanation | The difference between Part II, Line 3 and Part I, Column (e) represent year-to-date investment earnings on bond proceeds. | ExplanationTxt |
Schedule L IRS990ScheduleL
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp (2 entries)
| Relationship DescriptionRelationshipDescriptionTxt | TransactionTransactionAmt | TransactionTransactionDesc | Sharing Of RevenuesSharingOfRevenuesInd |
|---|---|---|---|
| Anita Blackwell | |||
| Spouse of James G. Blackwell, current officer | $74,259 | Employment arrangement | 0 |
| Cardinal Pharmacy | |||
| Partially owned by Marla Mooney, officer through Jan. 2021 | $496,234 | Dispensing fees remitted in accordance with 340B drug program agreement | 0 |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (7 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part VI, Section A, line 6 | Members of Clara Barton Hospital Foundation, Inc. are automatically members of Clara Barton Hospital Association, Inc. |
| Form 990, Part VI, Section A, line 7a | Members of Clara Barton Hospital Association, Inc. elect members of the governing body. |
| Form 990, Part VI, Section B, line 11b | Form 990 provided to governing body and reviewed prior to filing. |
| Form 990, Part VI, Section B, line 12c | A conflict of interest disclosure form is provided to each Board Member and is reviewed annually. |
| Form 990, Part VI, Section B, line 15 | The organization uses the KHA Salary Survey as a guide for determining CEO compensation with Board of Directors approval. The KHA Salary Survey is used by the CEO when determining compensation for other officers and key employees. |
| 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 written request. |
| Form 990, Part XI, line 9: | Change in beneficial interest in Foundation net of transfers 568,993. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp
Disregarded Entity Name DisregardedEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Clara Barton Hospital Foundation Inc | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO Box 25 | AddressLine1Txt |
| City | Hoisington | CityNm |
| State Abbreviation | KS | StateAbbreviationCd |
| ZIP | 67544 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 481077460 | EIN |
| Primary Activities | Provide support to Clara Barton Hospital | PrimaryActivitiesTxt |
| Legal Domicile State | KS | LegalDomicileStateCd |
| Exempt Code Section | 501(c)(3) | ExemptCodeSectionTxt |
| Public Charity Status | Line 7 | PublicCharityStatusTxt |
| Direct Controlling NA | N/A | DirectControllingNACd |
| Controlled Organization | 0 | ControlledOrganizationInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | Yes (1) | 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 | Yes (1) | 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 |
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