AMBERWELL ATCHISON ASSOCIATION: Form 990, tax year 2019

View the entire original 990 at ProPublica ↗

Organization
AMBERWELL ATCHISON ASSOCIATION (EIN 48-0561974)
Tax period
2019-10-01 to 2020-09-30
Filed
2021-08-13
IRS object ID
202122259349301607
Schema version
2019v5.2
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 ReturnHeader

FieldValueIRS element (for citing)
Return2021-08-13T09:04:18-05:00ReturnTs
Tax Period End2020-09-30TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN476097913PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1SEIM JOHNSON LLPBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line118081 BURT STREET SUITE 200AddressLine1Txt
CityOMAHACityNm
State AbbreviationNEStateAbbreviationCd
ZIP680224722ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2019-10-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN480561974EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1ATCHISON HOSPITAL ASSOCIATIONBusinessNameLine1Txt
FieldValueIRS element (for citing)
Business Name ControlATCHBusinessNameControlTxt
Phone9133605584PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1800 RAVEN HILL DRIVEAddressLine1Txt
CityATCHISONCityNm
State AbbreviationKSStateAbbreviationCd
ZIP66002ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonJIM FRASERPersonNm
Person TitleCHIEF FINANCIAL OFFICERPersonTitleTxt
Phone9133605584PhoneNum
Signature2021-08-12SignatureDt
Discuss With Paid PreparerYes (1)DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonWENDY R COOLEYPreparerPersonNm
PTINP01523804PTIN
Phone4023302660PhoneNum
FieldValueIRS element (for citing)
Tax2019TaxYr
Build TS2022-09-23 18:48:47ZBuildTS

Form 990 IRS990

Doing Business As Name DoingBusinessAsName

FieldValueIRS element (for citing)
Business Name Line1AMBERWELL HEALTHBusinessNameLine1Txt
FieldValueIRS element (for citing)
Principal OfficerJEFF PERRYPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line1800 RAVEN HILL DRIVEAddressLine1Txt
CityATCHISONCityNm
State AbbreviationKSStateAbbreviationCd
ZIP66002ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$58,716,113GrossReceiptsAmt
Group Return For Affiliates0GroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website AddressWWW.AMBERWELLHEALTH.ORGWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation1912FormationYr
Legal Domicile StateKSLegalDomicileStateCd
Activity Or MissionTO PROVIDE EXCELLENT HEALTH CARE AND IMPROVE THE QUALITY OF LIFE IN OUR COMMUNITY.ActivityOrMissionDesc
Voting Members Governing Body9VotingMembersGoverningBodyCnt
Voting Members Independent8VotingMembersIndependentCnt
Total Employee379TotalEmployeeCnt
Total Volunteers75TotalVolunteersCnt
Total Gross UBI$13,500TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$8,772NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$586,132PYContributionsGrantsAmt
CY Contributions Grants$2,094,787CYContributionsGrantsAmt
PY Program Service Revenue$45,738,581PYProgramServiceRevenueAmt
CY Program Service Revenue$46,844,396CYProgramServiceRevenueAmt
PY Investment Income$282,061PYInvestmentIncomeAmt
CY Investment Income$539,006CYInvestmentIncomeAmt
PY Other Revenue$75,715PYOtherRevenueAmt
CY Other Revenue$92,289CYOtherRevenueAmt
PY Total Revenue$46,682,489PYTotalRevenueAmt
CY Total Revenue$49,570,478CYTotalRevenueAmt
PY Grants And Similar Paid$0PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$0CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$23,813,638PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$26,163,634CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$20,988,102PYOtherExpensesAmt
CY Other Expenses$23,355,055CYOtherExpensesAmt
PY Total Expenses$44,801,740PYTotalExpensesAmt
CY Total Expenses$49,518,689CYTotalExpensesAmt
PY Revenues Less Expenses$1,880,749PYRevenuesLessExpensesAmt
CY Revenues Less Expenses$51,789CYRevenuesLessExpensesAmt
Total Assets BOY$49,795,262TotalAssetsBOYAmt
Total Assets EOY$57,818,379TotalAssetsEOYAmt
Total Liabilities BOY$30,205,505TotalLiabilitiesBOYAmt
Total Liabilities EOY$38,182,371TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$19,589,757NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$19,636,008NetAssetsOrFundBalancesEOYAmt
MissionTO PROVIDE EXCELLENT HEALTH CARE AND IMPROVE THE QUALITY OF LIFE IN OUR COMMUNITY.MissionDesc
Significant New Program Srvc0SignificantNewProgramSrvcInd
Significant Change0SignificantChangeInd
Expense$43,490,177ExpenseAmt
Revenue$46,829,892RevenueAmt
DescATCHISON HOSPITAL PROVIDED ACUTE INPATIENT AND OUTPATIENT HEALTH SERVICES TO THE GENERAL PUBLIC. SERVICES INCLUDE BUT ARE NOT LIMITED TO: EMERGENCY SERVICES, HOME HEALTH AND HOSPICE, GENERAL INPATIENT ACUTE SERVICES, RADIOLOGY, & OBSTETRICS. THE NUMBER OF PEOPLE SERVED DURING THE FISCAL YEAR ENDING 09/30/20 WAS 168,545.Desc
Total Program Service Expenses$43,490,177TotalProgramServiceExpensesAmt
Described In Section501c3Yes (1)DescribedInSection501c3Ind
Schedule B RequiredYes (1)ScheduleBRequiredInd
Political Campaign Acty0PoliticalCampaignActyInd
Lobbying ActivitiesYes (1)LobbyingActivitiesInd
Subject To Proxy Tax0SubjectToProxyTaxInd
Donor Advised Fund0DonorAdvisedFundInd
Conservation EasementsYes (1)ConservationEasementsInd
Collections Of Art0CollectionsOfArtInd
Credit Counseling0CreditCounselingInd
Donor Rstr Or Quasi Endowments0DonorRstrOrQuasiEndowmentsInd
Report Land Building EquipmentYes (1)ReportLandBuildingEquipmentInd
Report Investments Other Sec0ReportInvestmentsOtherSecInd
Report Program Related Invst0ReportProgramRelatedInvstInd
Report Other Assets0ReportOtherAssetsInd
Report Other LiabilitiesYes (1)ReportOtherLiabilitiesInd
Include FIN48 FootnoteYes (1)IncludeFIN48FootnoteInd
Independent Audit Fincl Stmt0IndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtYes (1)ConsolidatedAuditFinclStmtInd
School Operating0SchoolOperatingInd
Foreign Office0ForeignOfficeInd
Foreign Activities0ForeignActivitiesInd
More Than5000 K To Org0MoreThan5000KToOrgInd
More Than5000 K To Individuals0MoreThan5000KToIndividualsInd
Professional Fundraising0ProfessionalFundraisingInd
Fundraising Activities0FundraisingActivitiesInd
Gaming Activities0GamingActivitiesInd
Operate HospitalYes (1)OperateHospitalInd
Audited Financial Stmt AttYes (1)AuditedFinancialStmtAttInd
Grants To Organizations0GrantsToOrganizationsInd
Grants To Individuals0GrantsToIndividualsInd
Schedule J RequiredYes (1)ScheduleJRequiredInd
Tax Exempt BondsYes (1)TaxExemptBondsInd
Invest Tax Exempt Bonds0InvestTaxExemptBondsInd
Escrow Account0EscrowAccountInd
On Behalf Of Issuer0OnBehalfOfIssuerInd
Engaged In Excess Benefit Trans0EngagedInExcessBenefitTransInd
PY Excess Benefit Trans0PYExcessBenefitTransInd
Loan Outstanding0LoanOutstandingInd
Grant To Related Person0GrantToRelatedPersonInd
Business Rln With Org Mem0BusinessRlnWithOrgMemInd
Business Rln With Fam Mem0BusinessRlnWithFamMemInd
Business Rln With35 Ctrl Ent0BusinessRlnWith35CtrlEntInd
Deductible Non Cash Contri0DeductibleNonCashContriInd
Deductible Art Contribution0DeductibleArtContributionInd
Terminate Operations0TerminateOperationsInd
Partial Liquidation0PartialLiquidationInd
Disregarded Entity0DisregardedEntityInd
Related EntityYes (1)RelatedEntityInd
Related Organization Ctrl EntYes (1)RelatedOrganizationCtrlEntInd
Transaction With Control Ent0TransactionWithControlEntInd
Trnsfr Exmpt Non Chrtbl Rltd Org0TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted Prtshp0ActivitiesConductedPrtshpInd
Schedule O RequiredYes (1)ScheduleORequiredInd
IRP Document36IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Backup Wthld ComplianceYes (1)BackupWthldComplianceInd
Employee379EmployeeCnt
Employment Tax Returns FiledYes (1)EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over LimitYes (1)UnrelatedBusIncmOverLimitInd
Form990 T FiledYes (1)Form990TFiledInd
Foreign Financial Account0ForeignFinancialAccountInd
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTransInd
Taxable Party Notification0TaxablePartyNotificationInd
Nondeductible Contributions0NondeductibleContributionsInd
Quid Pro Quo Contributions0QuidProQuoContributionsInd
Form8282 Property Disposed Of0Form8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft Cntrct0RcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft Cntrct0PayPremiumsPrsnlBnftCntrctInd
Indoor Tanning Services0IndoorTanningServicesInd
Subj To Tax Rmnrtn Ex Prcht Pymt0SubjToTaxRmnrtnExPrchtPymtInd
Subject To Excs Tax Net Invst Inc0SubjectToExcsTaxNetInvstIncInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members9GoverningBodyVotingMembersCnt
Independent Voting Member8IndependentVotingMemberCnt
Family Or Business Rln0FamilyOrBusinessRlnInd
Delegation Of Mgmt Duties0DelegationOfMgmtDutiesInd
Change To Org Documents0ChangeToOrgDocumentsInd
Material Diversion Or Misuse0MaterialDiversionOrMisuseInd
Members Or Stockholders0MembersOrStockholdersInd
Election Of Board Members0ElectionOfBoardMembersInd
Decisions Subject To Approva0DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (1)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (1)MinutesOfCommitteesInd
Officer Mailing Address0OfficerMailingAddressInd
Local Chapters0LocalChaptersInd
Form990 Provided To Gvrn BodyYes (1)Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (1)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (1)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (1)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (1)WhistleblowerPolicyInd
Document Retention PolicyYes (1)DocumentRetentionPolicyInd
Compensation Process CEOYes (1)CompensationProcessCEOInd
Compensation Process OtherYes (1)CompensationProcessOtherInd
Investment In Joint Venture0InvestmentInJointVentureInd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

FieldValueIRS element (for citing)
PersonJIM FRASERPersonNm
Phone9133672131PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1800 RAVEN HILL DRIVEAddressLine1Txt
CityATCHISONCityNm
State AbbreviationKSStateAbbreviationCd
ZIP66002ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (19 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtHighest Compensated EmployeeHighestCompensatedEmployeeIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndFormer Ofcr Director TrusteeFormerOfcrDirectorTrusteeIndOfficerOfficerInd
EJ WILKINSON
PHYSICIAN40.000.00Yes (X)$612,491$0$34,988
DARIN ALLEN
MEDICAL DIRECTOR OF ANESTHESIA40.000.00Yes (X)$451,235$0$39,364
JONATHAN LECK
CHIEF OF MEDICAL STAFF40.000.00$466,892$0$18,197Yes (X)
JOHN L JACOBSON
FORMER CEO40.000.00$399,400$0$8,727Yes (X)
STEVEN ROVENSTINE
PHYSICIAN40.000.00Yes (X)$345,587$0$35,423
DONALD ABLES
PHYSICIAN40.000.00Yes (X)$317,547$0$35,931
PAM RIZZA
PHYSICIAN40.000.00Yes (X)$289,620$0$38,286
GARY R FOLL
CFO40.002.00$165,614$0$23,827Yes (X)
JEFF PERRY
CEO40.001.00$152,940$0$3,516Yes (X)
SUSAN MYERS
CHAIRPERSON1.000.00$0$0$0Yes (X)Yes (X)
GUS GRIFFIN
VICE CHAIRPERSON THRU 05/201.000.00$0$0$0Yes (X)Yes (X)
LYDIA FUNK
VICE CHAIRPERSON1.000.00$0$0$0Yes (X)Yes (X)
LARRY MEARS
SECRETARY1.000.00$0$0$0Yes (X)Yes (X)
STEVE MINNIS
SECRETARY THRU 12/191.000.00$0$0$0Yes (X)Yes (X)
TODD GIGSTAD
TREASURER1.000.00$0$0$0Yes (X)Yes (X)
MELINDA PREGONT
DIRECTOR1.000.00$0$0$0Yes (X)
JIM ROWLAND
DIRECTOR1.000.00$0$0$0Yes (X)
LORIN AFFIELD
DIRECTOR1.000.00$0$0$0Yes (X)
JERRY HERNY
DIRECTOR1.000.00$0$0$0Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$3,201,326TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$0TotReportableCompRltdOrgAmt
Total Other Compensation$238,259TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K39IndivRcvdGreaterThan100KCnt
Former Ofcr Employees ListedYes (1)FormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (1)TotalCompGreaterThan150KInd
Compensation From Other Srcs0CompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (4 entries)

Address Line1ContractorAddress/USAddress/AddressLine1TxtCityContractorAddress/USAddress/CityNmState AbbreviationContractorAddress/USAddress/StateAbbreviationCdZIPContractorAddress/USAddress/ZIPCdServicesServicesDescCompensationCompensationAmt
SPENCER FANE
1000 WALNUT ST STE 1400KANSAS CITYMO64106LEGAL SERVICES$268,469
CASCADE HEALTH SERVICES
1045 SWIFT AVENUEKANSAS CITYMO64116STAFFING SERVICES$167,336
THOMAS FAMILY PRACTICE
174 DEER RUNATCHISONKS66002MEDICAL SERVICES$111,902
SEIM JOHNSON LLP
18081 BURT STREET STE 200OMAHANE68022ACCOUNTING SERVICES$106,689
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K4CntrctRcvdGreaterThan100KCnt
Government Grants$1,774,662GovernmentGrantsAmt
All Other Contributions$320,125AllOtherContributionsAmt
Total Contributions$2,094,787TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (3 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
NET PATIENT SERVICE REVENUE624100$24,128,143$24,128,143
MEDICARE/MEDICAID624100$19,396,786$19,396,786
340B DRUG PRICING PROGRAM624100$2,992,945$2,992,945

Total Oth Program Service Rev TotalOthProgramServiceRevGrp

FieldValueIRS element (for citing)
Total Revenue Column$326,522TotalRevenueColumnAmt
Related Or Exempt Func Income$326,522RelatedOrExemptFuncIncomeAmt
FieldValueIRS element (for citing)
Total Program Service Revenue$46,844,396TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$264,110TotalRevenueColumnAmt
Exclusion$264,110ExclusionAmt

Incm From Invest Bond Proceeds IncmFromInvestBondProceedsGrp

FieldValueIRS element (for citing)
Total Revenue Column$48,479TotalRevenueColumnAmt
Exclusion$48,479ExclusionAmt

Gross Rents GrossRentsGrp

FieldValueIRS element (for citing)
Real$57,749RealAmt

Less Rental Expenses LessRentalExpensesGrp

FieldValueIRS element (for citing)
Real$58,753RealAmt

Rental Income Or Loss RentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Real-$1,004RealAmt

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column-$1,004TotalRevenueColumnAmt
Related Or Exempt Func Income-$14,504RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$13,500UnrelatedBusinessRevenueAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

FieldValueIRS element (for citing)
Securities$9,095,403SecuritiesAmt
Other$217,896OtherAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

FieldValueIRS element (for citing)
Securities$9,015,603SecuritiesAmt
Other$71,279OtherAmt

Gain Or Loss GainOrLossGrp

FieldValueIRS element (for citing)
Securities$79,800SecuritiesAmt
Other$146,617OtherAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

FieldValueIRS element (for citing)
Total Revenue Column$226,417TotalRevenueColumnAmt
Exclusion$226,417ExclusionAmt

Other Revenue Misc OtherRevenueMiscGrp

FieldValueIRS element (for citing)
DescCAFETERIADesc
Business722210BusinessCd
Total Revenue Column$93,293TotalRevenueColumnAmt
Exclusion$93,293ExclusionAmt
FieldValueIRS element (for citing)
Other Revenue Total$93,293OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$49,570,478TotalRevenueColumnAmt
Related Or Exempt Func Income$46,829,892RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$13,500UnrelatedBusinessRevenueAmt
Exclusion$632,299ExclusionAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$345,897TotalAmt
Management And General$345,897ManagementAndGeneralAmt

Comp Disqual Persons CompDisqualPersonsGrp

FieldValueIRS element (for citing)
Total$485,089TotalAmt
Program Services$485,089ProgramServicesAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$21,373,339TotalAmt
Program Services$19,148,448ProgramServicesAmt
Management And General$2,224,891ManagementAndGeneralAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$349,460TotalAmt
Program Services$313,718ProgramServicesAmt
Management And General$35,742ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$2,177,570TotalAmt
Program Services$1,954,324ProgramServicesAmt
Management And General$223,246ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$1,432,279TotalAmt
Program Services$1,272,864ProgramServicesAmt
Management And General$159,415ManagementAndGeneralAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$357,013TotalAmt
Management And General$357,013ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$172,828TotalAmt
Management And General$172,828ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$3,305,235TotalAmt
Program Services$2,537,102ProgramServicesAmt
Management And General$768,133ManagementAndGeneralAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$177,735TotalAmt
Management And General$177,735ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$2,012,137TotalAmt
Program Services$1,884,563ProgramServicesAmt
Management And General$127,574ManagementAndGeneralAmt

Information Technology InformationTechnologyGrp

FieldValueIRS element (for citing)
Total$636,931TotalAmt
Program Services$570,851ProgramServicesAmt
Management And General$66,080ManagementAndGeneralAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$641,493TotalAmt
Program Services$604,810ProgramServicesAmt
Management And General$36,683ManagementAndGeneralAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$126,049TotalAmt
Program Services$112,172ProgramServicesAmt
Management And General$13,877ManagementAndGeneralAmt

Conferences Meetings ConferencesMeetingsGrp

FieldValueIRS element (for citing)
Total$118,060TotalAmt
Program Services$113,627ProgramServicesAmt
Management And General$4,433ManagementAndGeneralAmt

Interest InterestGrp

FieldValueIRS element (for citing)
Total$967,648TotalAmt
Program Services$927,567ProgramServicesAmt
Management And General$40,081ManagementAndGeneralAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$3,950,631TotalAmt
Program Services$3,786,992ProgramServicesAmt
Management And General$163,639ManagementAndGeneralAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$352,164TotalAmt
Program Services$343,665ProgramServicesAmt
Management And General$8,499ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmt
MEDICAL SUPPLIES$6,077,853$6,077,853
BAD DEBT$2,667,442$2,667,442
COLLECTION FEES$1,477,880$467,887$1,009,993
FOOD$168,396$168,396

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$145,560TotalAmt
Program Services$52,807ProgramServicesAmt
Management And General$92,753ManagementAndGeneralAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$49,518,689TotalAmt
Program Services$43,490,177ProgramServicesAmt
Management And General$6,028,512ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$8,099,411BOYAmt
EOY$12,635,216EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$893,926BOYAmt
EOY$5,291,779EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$5,765,434BOYAmt
EOY$5,190,757EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

FieldValueIRS element (for citing)
BOY$1,251,351BOYAmt
EOY$1,431,846EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$745,440BOYAmt
EOY$703,536EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$56,087,644LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$37,652,432LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$20,833,458BOYAmt
EOY$18,435,212EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

FieldValueIRS element (for citing)
BOY$12,090,798BOYAmt
EOY$13,392,517EOYAmt

Investments Program Related InvestmentsProgramRelatedGrp

FieldValueIRS element (for citing)
BOY$115,444BOYAmt
EOY$86,851EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$650,665EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$49,795,262BOYAmt
EOY$57,818,379EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$3,623,666BOYAmt
EOY$3,927,758EOYAmt

Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$23,508,258BOYAmt
EOY$25,371,742EOYAmt

Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp

FieldValueIRS element (for citing)
BOY$2,087,064BOYAmt
EOY$356,889EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$986,517BOYAmt
EOY$8,525,982EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$30,205,505BOYAmt
EOY$38,182,371EOYAmt
FieldValueIRS element (for citing)
Organization Follows FASB117Yes (X)OrganizationFollowsFASB117Ind

No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp

FieldValueIRS element (for citing)
BOY$19,396,541BOYAmt
EOY$19,636,008EOYAmt

Donor Restriction Net Assets DonorRestrictionNetAssetsGrp

FieldValueIRS element (for citing)
BOY$193,216BOYAmt
EOY$0EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$19,589,757BOYAmt
EOY$19,636,008EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$49,795,262BOYAmt
EOY$57,818,379EOYAmt
FieldValueIRS element (for citing)
Reconcilation Revenue Expnss$51,789ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst-$5,538NetUnrlzdGainsLossesInvstAmt
Other Changes In Net Assets$0OtherChangesInNetAssetsAmt
Info In Schedule O Part XIIYes (X)InfoInScheduleOPartXIIInd
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or Review0AccountantCompileOrReviewInd
FS AuditedYes (1)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Consolidated Basis Fincl StmtYes (X)ConsolidatedBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit CommitteeYes (1)AuditCommitteeInd
Federal Grant Audit Required0FederalGrantAuditRequiredInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
HospitalYes (X)HospitalInd

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

FieldValueIRS element (for citing)
ContributorRESTRICTEDContributorNum

Contributor Business Name ContributorBusinessName

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor US Address ContributorUSAddress

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Total ContributionsRESTRICTEDTotalContributionsAmt

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
Volunteers0VolunteersInd
Paid Staff Or Management0PaidStaffOrManagementInd
Media Advertisements0MediaAdvertisementsInd
Mailings Members0MailingsMembersInd
Publications Or Broadcast0PublicationsOrBroadcastInd
Grants Other Organizations0GrantsOtherOrganizationsInd
Direct Contact Legislators0DirectContactLegislatorsInd
Rallies Demonstrations0RalliesDemonstrationsInd
Other ActivitiesYes (1)OtherActivitiesInd
Other Activities$9,073OtherActivitiesAmt
Total Lobbying Expenditures$9,073TotalLobbyingExpendituresAmt
Not Described Section501c30NotDescribedSection501c3Ind

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferencePART II-B, LINE 1:FormAndLineReferenceDesc
ExplanationLOBBYING EXPENSES THROUGH DUES PAID TO THE KANSAS HOSPITAL ASSOCIATION AND THE AMERICAN HOSPITAL ASSOCIATION.ExplanationTxt

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Protection Natural HabitatYes (X)ProtectionNaturalHabitatInd
Total Easements1TotalEasementsCnt
Total Acreage3.00TotalAcreageCnt
States Easements Held1StatesEasementsHeldCnt
Written Policy Monitoring0WrittenPolicyMonitoringInd

Land LandGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$964,642OtherCostOrOtherBasisAmt
Book Value$964,642BookValueAmt

Buildings BuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$35,204,236OtherCostOrOtherBasisAmt
Depreciation$23,117,129DepreciationAmt
Book Value$12,087,107BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$14,753,686OtherCostOrOtherBasisAmt
Depreciation$11,789,164DepreciationAmt
Book Value$2,964,522BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$5,165,080OtherCostOrOtherBasisAmt
Depreciation$2,746,139DepreciationAmt
Book Value$2,418,941BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$18,435,212TotalBookValueLandBuildingsAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)

DescDescAmtAmt
DEFERRED COMPENSATION$758,995
REFUNDABLE ADVANCES - CARES ACT FUNDS$7,766,987
FieldValueIRS element (for citing)
Total Liability$8,525,982TotalLiabilityAmt
Footnote TextYes (X)FootnoteTextInd

Supplemental Information Detail SupplementalInformationDetail (2 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
PART II, LINE 9:CONSERVATION EASEMENTS ARE REPORTED AT HISTORICAL COSTS AS LAND.
PART X, LINE 2:THE HOSPITAL AND FOUNDATION ARE NOT-FOR-PROFIT CORPORATIONS AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. THE HOSPITAL AND FOUNDATION HAVE RECEIVED DETERMINATION LETTERS INDICATING THAT THEY ARE EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE INTERNAL REVENUE CODE. THE INTERNAL REVENUE SERVICE HAS ESTABLISHED STANDARDS TO BE MET TO MAINTAIN TAX EXEMPT STATUS. THE HOSPITAL AND FOUNDATION ACCOUNT FOR UNCERTAINTIES IN ACCOUNTING FOR INCOME TAX ASSETS AND LIABILITIES USING GUIDANCE INCLUDED IN FASB ASC 740, INCOME TAXES. THE HOSPITAL AND FOUNDATION RECOGNIZE THE EFFECT OF INCOME TAX POSITIONS ONLY IF THOSE POSITIONS ARE MORE LIKELY THAN NOT OF BEING SUSTAINED. AT SEPTEMBER 30, 2020 AND 2019, THE HOSPITAL AND FOUNDATION HAD NO UNCERTAIN TAX POSITIONS ACCRUED.

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Financial Assistance PolicyYes (1)FinancialAssistancePolicyInd
Written PolicyYes (1)WrittenPolicyInd
All Hospitals PolicyYes (X)AllHospitalsPolicyInd
FPG Reference Free CareYes (1)FPGReferenceFreeCareInd
Percent200Yes (X)Percent200Ind
FPG Reference Discounted CareYes (1)FPGReferenceDiscountedCareInd
Percent200 DYes (X)Percent200DInd
Free Care Medically IndigentYes (1)FreeCareMedicallyIndigentInd
Financial Assistance BudgetYes (1)FinancialAssistanceBudgetInd
Expenses Exceed BudgetYes (1)ExpensesExceedBudgetInd
Unable To Provide Care0UnableToProvideCareInd
Annual Community Bnft ReportYes (1)AnnualCommunityBnftReportInd
Report Publically AvailableYes (1)ReportPublicallyAvailableInd

Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp

FieldValueIRS element (for citing)
Total Community Benefit Expns$49,655TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$49,655NetCommunityBenefitExpnsAmt
Total Expense0.00110TotalExpensePct

Unreimbursed Medicaid UnreimbursedMedicaidGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$4,704,524TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$2,576,430DirectOffsettingRevenueAmt
Net Community Benefit Expns$2,128,094NetCommunityBenefitExpnsAmt
Total Expense0.04540TotalExpensePct

Total Financial Assistance Typ TotalFinancialAssistanceTyp

FieldValueIRS element (for citing)
Total Community Benefit Expns$4,754,179TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$2,576,430DirectOffsettingRevenueAmt
Net Community Benefit Expns$2,177,749NetCommunityBenefitExpnsAmt
Total Expense0.04650TotalExpensePct

Community Health Services CommunityHealthServicesGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$5,818TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$5,818NetCommunityBenefitExpnsAmt
Total Expense0.00010TotalExpensePct

Subsidized Health Services SubsidizedHealthServicesGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$1,047,313TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$1,047,313NetCommunityBenefitExpnsAmt
Total Expense0.02240TotalExpensePct

Total Other Benefits TotalOtherBenefitsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$1,053,131TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$1,053,131NetCommunityBenefitExpnsAmt
Total Expense0.02250TotalExpensePct

Total Community Benefits TotalCommunityBenefitsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$5,807,310TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$2,576,430DirectOffsettingRevenueAmt
Net Community Benefit Expns$3,230,880NetCommunityBenefitExpnsAmt
Total Expense0.06900TotalExpensePct
FieldValueIRS element (for citing)
Bad Debt Expense ReportedYes (1)BadDebtExpenseReportedInd
Bad Debt Expense$2,667,442BadDebtExpenseAmt
Bad Debt Expense Attributable$0BadDebtExpenseAttributableAmt
Reimbursed By Medicare$14,854,995ReimbursedByMedicareAmt
Cost Of Care Reimbursed By Medcr$14,792,288CostOfCareReimbursedByMedcrAmt
Medicare Surplus Or Shortfall$62,707MedicareSurplusOrShortfallAmt

Costing Methodology Used CostingMethodologyUsedGrp

FieldValueIRS element (for citing)
Cost To Charge RatioYes (X)CostToChargeRatioInd
FieldValueIRS element (for citing)
Written Debt Collection PolicyYes (1)WrittenDebtCollectionPolicyInd
Financial Assistance PrvsnYes (1)FinancialAssistancePrvsnInd
Hospital Facilities1HospitalFacilitiesCnt

Hospital Facilities HospitalFacilitiesGrp

FieldValueIRS element (for citing)
Facility1FacilityNum

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1ATCHISON HOSPITAL ASSOCIATIONBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line1800 RAVEN HILL DRIVEAddressLine1Txt
CityATCHISONCityNm
State AbbreviationKSStateAbbreviationCd
ZIP66002ZIPCd
FieldValueIRS element (for citing)
Website AddressWWW.AMBERWELLHEALTH.ORGWebsiteAddressTxt
State LicenseH-003-001StateLicenseNum
Licensed HospitalYes (X)LicensedHospitalInd
General Medical And SurgicalYes (X)GeneralMedicalAndSurgicalInd
Critical Access HospitalYes (X)CriticalAccessHospitalInd
Emergency Room24 HrsYes (X)EmergencyRoom24HrsInd

Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1ATCHISON HOSPITAL ASSOCIATIONBusinessNameLine1Txt
FieldValueIRS element (for citing)
Facility1FacilityNum
First Licensed CY Or PY0FirstLicensedCYOrPYInd
Tax Exempt Hospital CY Or PY0TaxExemptHospitalCYOrPYInd
CHNA ConductedYes (1)CHNAConductedInd
Community DefinitionYes (X)CommunityDefinitionInd
Community DemographicsYes (X)CommunityDemographicsInd
Existing ResourcesYes (X)ExistingResourcesInd
How Data ObtainedYes (X)HowDataObtainedInd
Community Health NeedsYes (X)CommunityHealthNeedsInd
Other Health IssuesYes (X)OtherHealthIssuesInd
Community Hlth Needs Id ProcessYes (X)CommunityHlthNeedsIdProcessInd
Consulting ProcessYes (X)ConsultingProcessInd
Prior CHNA ImpactYes (X)PriorCHNAImpactInd
CHNA Conducted18CHNAConductedYr
Take Into Account Others InputYes (1)TakeIntoAccountOthersInputInd
CHNA Conducted With Other Fclts0CHNAConductedWithOtherFcltsInd
CHNA Conducted With Non FcltsYes (1)CHNAConductedWithNonFcltsInd
CHNA Report Widely AvailableYes (1)CHNAReportWidelyAvailableInd
Rpt Available On Own WebsiteYes (X)RptAvailableOnOwnWebsiteInd
Own Website URLWWW.AMBERWELLHEALTH.ORGOwnWebsiteURLTxt
Paper Copy Public InspectionYes (X)PaperCopyPublicInspectionInd
Implementation Strategy AdoptYes (1)ImplementationStrategyAdoptInd
Implementation Strategy Adpt18ImplementationStrategyAdptYr
Strategy Posted WebsiteYes (1)StrategyPostedWebsiteInd
Strategy Website URLWWW.AMBERWELLHEALTH.ORGStrategyWebsiteURLTxt
Organization Incur Excise Tax0OrganizationIncurExciseTaxInd
Elig Criteria ExplainedYes (1)EligCriteriaExplainedInd
FPG Family Incm Lmt Free DscntYes (X)FPGFamilyIncmLmtFreeDscntInd
FPG Family Incm Lmt Free Care200.000000000000FPGFamilyIncmLmtFreeCarePct
FPG Family Incm Lmt Dscnt Care200.000000000000FPGFamilyIncmLmtDscntCarePct
Medical Indigency CriteriaYes (X)MedicalIndigencyCriteriaInd
Insurance Status CriteriaYes (X)InsuranceStatusCriteriaInd
Underinsurance Stat CriteriaYes (X)UnderinsuranceStatCriteriaInd
Residency CriteriaYes (X)ResidencyCriteriaInd
Other CriteriaYes (X)OtherCriteriaInd
Explained BasisYes (1)ExplainedBasisInd
App Financial Asst ExplnYes (1)AppFinancialAsstExplnInd
Described InfoYes (X)DescribedInfoInd
Described Suprt DocYes (X)DescribedSuprtDocInd
Provided Hospital ContactYes (X)ProvidedHospitalContactInd
Includes Publicity MeasuresYes (1)IncludesPublicityMeasuresInd
FAP Available On WebsiteYes (X)FAPAvailableOnWebsiteInd
FAP Available On Website URLWWW.AMBERWELLHEALTH.ORGFAPAvailableOnWebsiteURLTxt
FAP App Available On WebsiteYes (X)FAPAppAvailableOnWebsiteInd
FAP App Available On Website URLWWW.AMBERWELLHEALTH.ORGFAPAppAvailableOnWebsiteURLTxt
FAP Summary On WebsiteYes (X)FAPSummaryOnWebsiteInd
FAP Summary On Website URLWWW.AMBERWELLHEALTH.ORGFAPSummaryOnWebsiteURLTxt
FAP Avlbl On Request No ChargeYes (X)FAPAvlblOnRequestNoChargeInd
FAP App Avlbl On Request No ChrgYes (X)FAPAppAvlblOnRequestNoChrgInd
FAP Sum Avlbl On Request No ChrgYes (X)FAPSumAvlblOnRequestNoChrgInd
Notified FAP Copy Bill DisplayYes (X)NotifiedFAPCopyBillDisplayInd
Communtity Notified FAPYes (X)CommuntityNotifiedFAPInd
FAP Actions On NonpaymentYes (1)FAPActionsOnNonpaymentInd
Permit No ActionsYes (X)PermitNoActionsInd
Collection Activities0CollectionActivitiesInd
Provided Written NoticeYes (X)ProvidedWrittenNoticeInd
Made Effort Orally NotifyYes (X)MadeEffortOrallyNotifyInd
Processed FAP ApplicationYes (X)ProcessedFAPApplicationInd
Made Presumptive Elig DetermYes (X)MadePresumptiveEligDetermInd
Nondis Emergency Care PolicyYes (1)NondisEmergencyCarePolicyInd
Look Back Medicare PrivateYes (X)LookBackMedicarePrivateInd
Amounts Generally Billed0AmountsGenerallyBilledInd
Gross Charges0GrossChargesInd

Supplemental Information SupplementalInformationGrp (4 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
ATCHISON HOSPITAL ASSOCIATIONPART V, SECTION B, LINE 5: COMMUNITY BENEFIT NEEDS WERE OBTAINED BY A WRITTEN SURVEY MAILED TO THE COMMUNITY AND BY A TOWN HALL WHERE INTERESTED PARTIES COULD COME TOGETHER IN PERSON AND DESCRIBE THEIR NEEDS.
ATCHISON HOSPITAL ASSOCIATIONPART V, SECTION B, LINE 6B: NEK MULTI-COUNTY HEALTH DEPARTMENTATCHISON COUNTY HEALTH DEPARTMENT
ATCHISON HOSPITAL ASSOCIATIONPART V, SECTION B, LINE 11: THE HOSPITAL IS AFFILIATED WITH AN ORGANIZATION NAMED LIVE WELL LIVE ATCHISON. THEIR SOLE PURPOSE IS TO ADDRESS THE HEALTHCARE NEEDS OF THE COMMUNITY. THE ORGANIZATION IS MADE UP OF CITY AND COUNTY OFFICIALS, HEALTH DEPARTMENT, THE HOSPITAL, MAJOR EMPLOYERS, THE SCHOOL DISTRICTS, BENEDICTINE COLLEGE, FAITH BASED CHURCHES, AREA BUSINESSES, HEALTH AND SERVICE AGENCIES AS WELL AS COMMUNITY AND CIVIC ORGANIZATIONS. ANY NEEDS THAT CAN BE ADDRESSED ARE ADDRESSED BY EITHER LIVE WELL LIVE ATCHISON, THE GUIDANCE CENTER ( MENTAL HEALTH PROVIDER ) OR THE ATCHISON HOSPITAL.ECONOMIC DEVELOPMENT AND HEALTHCARE TRANSPORTATION ARE THE TWO THINGS THAT THE HOSPITAL IS NOT ABLE TO ADDRESS EITHER BECAUSE IT IS OUT OF THEIR JURISDICTION OR FROM LACK OF FUNDING.
ATCHISON HOSPITAL ASSOCIATIONPART V, SECTION B, LINE 13H: THERE ARE INSTANCES WHEN A PATIENT MAY APPEAR ELIGIBLE FOR FINANCIAL DISCOUNTS, BUT THERE IS NO FINANCIAL ASSISTANCE FORM ON FILE OR LACK OF SUPPORTING DOCUMENTATION. IN THE EVENT THERE IS NO EVIDENCE TO SUPPORT A PATIENT'S ELIGIBILITY FOR FINANCIAL ASSISTANCE, ATCHISON HOSPITAL MAY USE OUTSIDE AGENCIES OR VENDORS IN DETERMINING ELIGIBILITY AND POTENTIAL DISCOUNT AMOUNTS. THESE RESOURCES MAY USE DEMOGRAPHIC AND HOUSEHOLD INFORMATION AND/OR CREDIT SCORING TECHNOLOGY TO DETERMINE THE PERCENT OF ASSISTANCE TO APPLY TO THE PATIENT'S ACCOUNT.
FieldValueIRS element (for citing)
Facility2FacilityNum

Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp

Oth Hlth Care Fclts OthHlthCareFcltsGrp (2 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdFacilityFacilityTxt
1 - ATCHISON INTERNAL MEDICINE & FAMILY PRA
800 RAVEN HILL DRIVEATCHISONKS66002RURAL HEALTH CLINIC
2 - FAMILY MEDICAL CENTER OF TROY
311 W LOCUSTTROYKS66087RURAL HEALTH CLINIC

Supplemental Information Detail SupplementalInformationDetail (13 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
PART I, LINE 3C:NOT APPLICABLE: FEDERAL POVERTY GUIDELINES ARE USED TO DETERMINE ELIGIBILITY FOR PROVIDING FREE AND DISCOUNTED CARE TO LOW INCOME INDIVIDUALS.
PART I, LINE 6A:ATCHISON HOSPITAL'S COMMUNITY BENEFIT REPORT IS NOT PREPARED BY A RELATED ORGANIZATION.
PART I, LINE 7:THE COSTING METHODOLOGY USED TO CALCULATE THE AMOUNTS CONTAINED IN THE TABLE OF PART I, LINE 7, OR SCHEDULE H, IS A COST TO CHARGE RATIO CALCULATED USING WORKSHEET 2.
PART I, LINE 7G:THERE ARE NO COSTS ATTRIBUTABLE TO A PHYSICIAN CLINIC INCLUDED ON LINE 7G.
PART I, LN 7 COL(F):THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25(A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $2,667,442.
PART III, LINE 2:IN EVALUATING THE COLLECTIBILITY OF ACCOUNTS RECEIVABLE, THE HOSPITAL ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS AND PROVISION FOR BAD DEBTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYOR SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS. FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE HOSPITAL ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS AND A PROVISION FOR BAD DEBTS FOR THOSE ACCOUNTS OVER A CERTAIN AGE BASED ON DISCHARGE THAT MAKE THE REALIZATION OF AMOUNTS DUE UNLIKELY. FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), THE HOSPITAL RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES IF NEGOTIATED) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS.
PART III, LINE 4:THE HOSPITAL'S FINANCIAL STATMENTS DO NOT CONTAIN A SPECIFIC FOOTNOTE DESCRIBING BAD DEBT. HOWEVER, PAGES 8, 10 AND 11 OF THE ATTACHED FINANCIAL STATEMENTS INCLUDE FOOTNOTES TITLED "PATIENT RECEIVABLES" "PATIENT SERVICE REVENUE AND "PATIENT FINANCIAL ASSISTANCE".
PART III, LINE 9B:THE HOSPITAL DOES NOT PURSUE COLLECTION ON ACCOUNTS THAT HAVE BEEN DETERMINED TO BE ELIGIBLE FOR CHARITY CARE.
PART VI, LINE 2:ATCHISON HOSPITAL ASSOCIATION HAS ACCESS TO THE KANSAS HEALTH INITIATIVE SURVEY ON HEALTH INDICATORS. BASED ON THESE INDICATORS, ATCHISON HOSPITAL DETERMINES THE NEEDS OF THE COMMUNITY AND WHAT PROGRAMS TO IMPLEMENT.
PART VI, LINE 3:PATIENTS ARE GIVEN A PAMPHLET DESCRIBING THE POLICY FOR FINANCIAL ASSISTANCE WHEN THEY ARE ADMITTED. THE ADMITTING OFFICE ASKS THEM TO SPEAK WITH THE HOSPITAL FINANCIAL COUNSELOR IF THEY DO NOT HAVE INSURANCE. AFTER THE PATIENT RECEIVES THEIR STATEMENT IN THE MAIL, THEY CAN CALL IN AND TALK WITH THE FINANCIAL COUNSELOR. IF THE ACCOUNT GOES TO A COLLECTION COMPANY BECAUSE THE PATIENT DID NOT PAY OR TALK WITH THE FINANCIAL COUNSELOR, THE COLLECTION COMPANY WILL GIVE THEM THE PROPER APPLICATION TO FILL OUT TO SEE IF THEY ARE ELIGIBLE FOR FINANCIAL ASSISTANCE.
PART VI, LINE 4:THE HOSPITAL SERVES THE COMMUNITY OF ATCHISON, KANSAS AND THE SURROUNDING COUNTY OF ATCHISON, KANSAS. ATCHISON IS A COMMUNITY OF APPROXIMATELY 10,500 PEOPLE WHO WOULD BE DESCRIBED AS MOSTLY COMPRISED OF BLUE-COLLAR AND LOW-INCOME INDIVIDUALS. THE SURROUNDING COUNTY HAS A POPULATION OF AN ADDITIONAL 6,300 PEOPLE. THERE ARE SEVERAL LARGE FARMS WHICH PLANT ROW CROPS OF CORN AND BEANS.
PART VI, LINE 5:ATCHISON HOSPITAL BELIEVES COMMUNITY BENEFIT GOES BEYOND HOSPITAL VISITS AND EMERGENCY CARE. IT MEANS GETTING INVOLVED AND WORKING TO IMPROVE THE HEALTH OF OUR COMMUNITY; IT MEANS HELPING OTHERS PURSUE GOOD HEALTH THROUGH DONATIONS, EDUCATION AND VOLUNTEERISM. THE FOLLOWING IS A SUMMARY OF THE NUMEROUS ACTIVITIES, INITIATIVES AND EVENTS THAT HAVE BEEN IMPLEMENTED IN SUPPORT OF PROVIDING COMMUNITY BENEFITS TO THE RESIDENTS IN THE ATCHISON COMMUNITY AND REGION. LIVE WELL LIVE ATCHISON, IS A HOSPITAL INITIATIVE THAT INVOLVES PARTNERSHIPS WITH THE KANSAS HEALTH INITIATIVE, ATCHISON COUNTY SCHOOLS, BENEDICTINE COLLEGE, CITY AND COUNTY GOVERNMENTS, STATE REPRESENTATIVES, FAITH-BASED CHURCHES, THE HEALTH DEPARTMENT, COUNTY EXTENSION OFFICE AND AREA BUSINESSES, HEALTH AND SERVICE AGENCIES, AS WELL AS COMMUNITY AND CIVIC ORGANIZATIONS. THE GROUP IS WORKING TOWARD IMPROVING THE HEALTH BEHAVIORS AND LIFESTYLE OF ATCHISON COUNTY. ATCHISON HOSPITAL'S "BEST CARE COMMUNITY HEALTH FAIR," IS AN ANNUAL EVENT BY THE HOSPITAL AND HELD AT THE ATCHISON ELEMENTARY SCHOOL. HOSPITAL EMPLOYEES AS WELL AS COMMUNITY HEALTH AGENCIES, ORGANIZATIONS, LOCAL AND REGIONAL AREA RESPONDERS AND PHYSICIAN PRACTICES, PROVIDE HEALTH SCREENINGS, INTERACTIVE EDUCATIONAL, SAFETY AND FITNESS ACTIVITIES. ATCHISON HOSPITAL SUPPORTS THE ATCHISON COMMUNITY HEALTH CLINIC, A FEDERAL QUALIFIED HEALTH CLINIC, BY SUBSIDIZING THE CLINIC'S FACILITIES RENT FREE, GENERAL MAINTENANCE AND SNOW REMOVAL. THE HOSPITAL CONDUCTS AND SPONSORS SUPPORT GROUPS AND CLASSES THAT PROVIDE ONGOING EDUCATION AND COUNSELING SUCH AS GRIEF SUPPORT, BIRTHING AND CHILDCARE CLASSES. ADDITIONALLY, THE HOSPITAL OFFERS A HOSPICE VOLUNTEER PROGRAM. THE HOSPITAL ALSO PROVIDES SPONSORSHIP AND DONATIONS TO VARIOUS ORGANIZATIONS, LOCAL SCHOOLS AND NURSING HOMES, AS WELL AS COMMUNITY INITIATIVES. THEY INCLUDE: RELAY FOR LIFE, AMELIA EARHART FESTIVAL, BEAUTIFICATION OF OUR CITY, FARM SAFETY DAYS, JOGGIN' FOR THE NOGGIN', PARTICIPATION IN LOCAL AND REGIONAL HEALTH FAIRS AND PHYSICIAN SUPPORT AT LOCAL HIGH SCHOOL AND COLLEGE ATHLETIC EVENTS. ATCHISON HOSPITAL'S CARE TEAM, AN EMPLOYEE GROUP THAT GENERATES INITIATES FUNDRAISERS AND DONATES EARNED PROCEEDS TO VARIOUS LOCAL CHARITIES. THE HOSPITAL AS WELL AS THE ATCHISON HOSPITAL AUXILIARY, EACH HOSTS COMMUNITY BLOOD DRIVES THROUGHOUT THE YEAR. THE HOSPITAL PROVIDES COMMUNITY EDUCATION AND CAREER DEVELOPMENT TO ORGANIZATIONS, SCHOOLS AND COLLEGES THROUGHOUT THE AREA THROUGH SPEAKING ENGAGEMENTS, CAREER FAIRS, CLASS IN-SERVICES AND HOSPITAL TOURS. IN ADDITION, HOSPITAL EMPLOYEES VOLUNTEER THEIR SERVICE WITH COMMUNITY NOT-FOR-PROFIT AND CIVIC ORGANIZATIONS AND COMMITTEES, INCLUDING THE CHAMBER OF COMMERCE, WORKFORCE DEVELOPMENT, ROTARY, LIONS CLUB, YMCA, GUIDANCE CENTER MENTAL HEALTH CENTER AND THE MULTIDISCIPLINARY CHILD TEAM AND THE BOY SCOUTS. THE HOSPITAL OFFERS A JOB SHADOWING PROGRAM WHICH OFFERS TEENS EXPOSURE TO A VARIETY OF CAREERS WITHIN THE MEDICAL PROFESSION.
PART VI, LINE 6:ATCHISON HOSPITAL ASSOCIATION IS NOT PART OF AN AFFILIATED HEALTH CARE SYSTEM.

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Club Dues Or FeesYes (X)ClubDuesOrFeesInd
Written Policy Ref T And E ExpnssYes (1)WrittenPolicyRefTAndEExpnssInd
Substantiation RequiredYes (1)SubstantiationRequiredInd
Independent ConsultantYes (X)IndependentConsultantInd
Form990 Of Other OrganizationsYes (X)Form990OfOtherOrganizationsInd
Compensation SurveyYes (X)CompensationSurveyInd
Board Or Committee ApprovalYes (X)BoardOrCommitteeApprovalInd
Severance Payment0SeverancePaymentInd
Supplemental Nonqual Rtr Plan0SupplementalNonqualRtrPlanInd
Equity Based Comp Arrngm0EquityBasedCompArrngmInd
Comp Based On Revenue Of Flng Org0CompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related Orgs0CompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng Org0CompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd Orgs0CompBsdNetEarnsRltdOrgsInd
Any Non Fixed PaymentsYes (1)AnyNonFixedPaymentsInd
Initial Contract Exception0InitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (9 entries)

TitleTitleTxtBase Compensation Filing OrgBaseCompensationFilingOrgAmtCompensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmtBonus Filing OrganizationBonusFilingOrganizationAmountBonus Related OrganizationsBonusRelatedOrganizationsAmtOther Compensation Filing OrgOtherCompensationFilingOrgAmtOther Compensation Rltd OrgsOtherCompensationRltdOrgsAmtDeferred Compensation Flng OrgDeferredCompensationFlngOrgAmtDeferred Comp Rltd OrgsDeferredCompRltdOrgsAmtNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmtNontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmtTotal Compensation Filing OrgTotalCompensationFilingOrgAmtTotal Compensation Rltd OrgsTotalCompensationRltdOrgsAmtComp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmtComp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt
EJ WILKINSON
PHYSICIAN$608,541$0$3,950$0$0$0$5,781$0$29,207$0$647,479$0$0$0
DARIN ALLEN
MEDICAL DIRECTOR OF ANESTHESIA$451,127$0$0$0$108$0$13,072$0$26,292$0$490,599$0$0$0
JONATHAN LECK
CHIEF OF MEDICAL STAFF$385,044$0$81,752$0$96$0$9,659$0$8,538$0$485,089$0$0$0
JOHN L JACOBSON
FORMER CEO$398,532$0$0$0$868$0$2,885$0$5,842$0$408,127$0$0$0
STEVEN ROVENSTINE
PHYSICIAN$325,311$0$20,000$0$276$0$7,131$0$28,292$0$381,010$0$0$0
DONALD ABLES
PHYSICIAN$316,755$0$0$0$792$0$9,929$0$26,002$0$353,478$0$0$0
PAM RIZZA
PHYSICIAN$289,512$0$0$0$108$0$9,500$0$28,786$0$327,906$0$0$0
GARY R FOLL
CFO$164,822$0$0$0$792$0$4,758$0$19,069$0$189,441$0$0$0
JEFF PERRY
CEO$145,350$0$7,515$0$75$0$0$0$3,516$0$156,456$0$0$0

Supplemental Information Detail SupplementalInformationDetail (2 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
PART 1, LINE 1A:SOCIAL CLUB DUES WERE PAID BY THE HOSPITAL FOR JOHN L. JACOBSON AND JEFF PERRY AND WERE NOT INCLUDED IN EITHER W-2 AS TAXABLE COMPENSATION BECAUSE THEY WERE USED 100% FOR BUSINESS.
PART 1, LINE 7:VARIOUS EMPLOYED PHYSICIANS ARE PROVIDED THE OPPORTUNITY FOR BONUS POTENTIAL. IN THEIR CONTRACT WITH THE HOSPITAL ARE TIERS BASED ON CURRENT MEDICAL GROUP MANAGEMENT ASSOCIATION REGIONAL DATA. IF THE PHYSICIANS ANNUALIZED NET QUALIFIED PATIENT CHARGES EXCEEDS THE TIER, A PERCENTAGE OF THEIR NET QUALIFIED PATIENT CHARGES ARE ELIGIBLE FOR BONUS SUBJECT TO THEIR ANNUAL BASE COMPENSATION.

Schedule K IRS990ScheduleK

Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp (4 entries)

Bond ReferenceBondReferenceCdBond Issuer EINBondIssuerEINCUSIPCUSIPNumBond IssuedBondIssuedDtIssue PriceIssuePriceAmtPurposePurposeDescDefeasedDefeasedIndOn Behalf Of IssuerOnBehalfOfIssuerIndPool FinancingPoolFinancingInd
CITY OF ATCHISON KS
A486025033046687CV92017-10-19$5,910,000SEE PART VI.000
CITY OF ATCHISON KS
B486025033046687CF42016-07-27$9,450,000SEE PART VI.000
CITY OF ATCHISON KS
C486025033046687CM92017-06-06$8,835,000SEE PART VI.000
CITY OF ATCHISON KS
D486025033046687CR82017-06-06$3,400,000SEE PART VI.000

Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp (4 entries)

Bond ReferenceBondReferenceCdRetiredRetiredAmtTotal ProceedsTotalProceedsAmtIn Reserve FundInReserveFundAmtIssuance Costs From ProceedsIssuanceCostsFromProceedsAmtOther Spent ProceedsOtherSpentProceedsAmtSubstantial CompletionSubstantialCompletionYrRefunding Tax Exempt BondsRefundingTaxExemptBondsIndRefunding Taxable BondsRefundingTaxableBondsIndFinal Allocation MadeFinalAllocationMadeIndAdequate Books And Rec MaintAdequateBooksAndRecMaintInd
A$45,000$5,910,000$626,218$117,700$5,792,30020100Yes (1)Yes (1)Yes (1)
B$5,760,000$9,450,000$715,707$185,895$9,264,10520100Yes (1)Yes (1)Yes (1)
C$8,835,000$932,724$79,515$8,755,4852010Yes (1)0Yes (1)Yes (1)
D$75,000$3,400,000$360,613$30,600$3,369,4002010Yes (1)0Yes (1)Yes (1)

Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp (4 entries)

Bond ReferenceBondReferenceCdOwning Bond Financed PropertyOwningBondFinancedPropertyIndAny Lease ArrangementsAnyLeaseArrangementsIndMgmt Contract Bond Fincd PropMgmtContractBondFincdPropIndEngage Bond Counsel ContractsEngageBondCounselContractsIndAny Research AgreementsAnyResearchAgreementsIndPrivate Bus Use By OthersPrivateBusUseByOthersPctPrivate Bus Concerning UBIPrivateBusConcerningUBIPctTotal Private Business UseTotalPrivateBusinessUsePctBond Iss Meet Prvt Sec Pymt TestBondIssMeetPrvtSecPymtTestIndChange In Use Bond Financed PropChangeInUseBondFinancedPropIndProcs Nonqualified Bond RemdtdProcsNonqualifiedBondRemdtdInd
A00Yes (1)Yes (1)00.000000.000000.0000000Yes (1)
B00Yes (1)Yes (1)00.000000.000000.0000000Yes (1)
C00Yes (1)Yes (1)00.000000.000000.0000000Yes (1)
D00Yes (1)Yes (1)00.000000.000000.0000000Yes (1)

Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp (4 entries)

Bond ReferenceBondReferenceCdForm8038 T FiledForm8038TFiledIndRebate Not Due YetRebateNotDueYetIndException To RebateExceptionToRebateIndNo Rebate DueNoRebateDueIndVariable Rate IssueVariableRateIssueIndHedge Identified In Bks And RecHedgeIdentifiedInBksAndRecIndGross Proceeds Invested In GICGrossProceedsInvestedInGICIndGross Proceeds InvestedGrossProceedsInvestedIndWritten Proc To Monitor ReqsWrittenProcToMonitorReqsInd
A0Yes (1)00000Yes (1)Yes (1)
B0Yes (1)00000Yes (1)Yes (1)
C0Yes (1)000000Yes (1)
D0Yes (1)000000Yes (1)

Procedures Corrective Action ProceduresCorrectiveActionGrp (4 entries)

Bond ReferenceBondReferenceCdProcedures Corrective ActionProceduresCorrectiveActionInd
AYes (1)
BYes (1)
CYes (1)
DYes (1)

Supplemental Information Detail SupplementalInformationDetail (14 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
PART I, LINE B, COLUMN (F):ADVANCE REFUND A PORTION OF THE 2008A, 2008B, AND 2009 BONDS. THE 2008A BONDS WERE ORIGINALLY ISSUED ON 9/23/2008; THE 2008B BONDS WERE ORIGINALLY ISSUED ON 9/23/2008; THE 2009 BONDS WERE ORIGINALLY ISSUED ON 6/30/2009.
PART I, LINE C, COLUMN (F):CURRENT REFUND A PORTION OF THE 2008A BONDS. THE 2008A BONDS WERE ORIGINALLY ISSUED ON 9/23/2008.
PART I, LINE D, COLUMN (F):CURRENT REFUND A PORTION OF THE 2009 BONDS. THE 2009 BONDS WERE ORIGINALLY ISSUED ON 6/30/2009.
PART I, LINE A, COLUMN (F):ADVANCE REFUND REMAINING PORTION OF THE 2009 BONDS. THE 2009 BONDS WERE ORIGINALLY ISSUED ON 6/30/2009.
PART II, COLUMN B, LINE 11:THIS AMOUNT WAS USED TO ADVANCE REFUND A PORTION OF THE 2008A BONDS, 2008B BONDS AND 2009 BONDS.
PART II, COLUMN C, LINE 11:THIS AMOUNT WAS USED TO CURRENT REFUND A PORTION OF THE 2008A BONDS.
PART II, COLUMN D, LINE 11:THIS AMOUNTS WAS USED TO CURRENT REFUND A PORTION OF THE 2009 BONDS.
PART II, COLUMN A, LINE 11:THIS AMOUNT REPRESENTS $5,786,846.35 OF BOND PROCEEDS USED TO ADVANCE REFUND A PORTION OF THE 2009 BONDS AND $5,453.65 ALLOCATED TO PAY INTEREST ON THE BONDS.
PART IV, COLUMN B, LINE 6:PROCEEDS WERE DEPOSITED AND HELD IN A YIELD RESTRICTED ESCROW FOR THE REFUNDED BONDS BEYOND THE AVAILABLE TEMPORARY PERIOD. ALL SUCH PROCEEDS HAVE BEEN SPENT.
PART IV, COLUMN A, LINE 6:PROCEEDS WERE DEPOSITED AND HELD IN A YIELD RESTRICTED ESCROW FOR THE REFUNDED BONDS BEYOND THE AVAILABLE TEMPORARY PERIOD. ALL SUCH PROCEEDS HAVE BEEN SPENT.
PART I, LINE A2, COLUMN (F):CURRENT REFUND TAXABLE BANK LOAN. THE TAXABLE BANK LOAN WAS ORIGINALLY ISSUED ON 7/21/2015. RENOVATIONS TO AND EQUIPMENT FOR HOSPITAL FACILITIES.
PART II, LINE 3, COLUMN A2:AMOUNT DOES NOT EQUAL ISSUE PRICE AS A RESULT OF INVESTMENT EARNINGS EARNED DURING THE PROJECT PERIOD.
PART II, COLUMN A2, LINE 11:THIS AMOUNT WAS USED TO CURRENT REFUND THE TAXABLE BANK LOAN ON 10/30/2019.
PART II, COLUMN A2, LINE 13:THE NEW MONEY PORTION OF THE PROJECT HAS NOT BEEN COMPLETED.

Schedule K IRS990ScheduleK

Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd

Issuer Name IssuerName

FieldValueIRS element (for citing)
Business Name Line1CITY OF ATCHISON KSBusinessNameLine1Txt
FieldValueIRS element (for citing)
Bond Issuer EIN486025033BondIssuerEIN
CUSIP046687DG1CUSIPNum
Bond Issued2019-10-30BondIssuedDt
Issue Price$4,255,000IssuePriceAmt
PurposeSEE PART VI.PurposeDesc
Defeased0DefeasedInd
On Behalf Of Issuer0OnBehalfOfIssuerInd
Pool Financing0PoolFinancingInd

Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Retired$235,000RetiredAmt
Total Proceeds$4,267,064TotalProceedsAmt
Issuance Costs From Proceeds$82,475IssuanceCostsFromProceedsAmt
Capital Expenditures$11,696CapitalExpendituresAmt
Other Spent Proceeds$1,709,258OtherSpentProceedsAmt
Unspent$2,463,636UnspentAmt
Refunding Tax Exempt Bonds0RefundingTaxExemptBondsInd
Refunding Taxable BondsYes (1)RefundingTaxableBondsInd
Final Allocation Made0FinalAllocationMadeInd
Adequate Books And Rec MaintYes (1)AdequateBooksAndRecMaintInd

Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Owning Bond Financed Property0OwningBondFinancedPropertyInd
Any Lease Arrangements0AnyLeaseArrangementsInd
Mgmt Contract Bond Fincd Prop0MgmtContractBondFincdPropInd
Any Research Agreements0AnyResearchAgreementsInd
Private Bus Use By Others0.00000PrivateBusUseByOthersPct
Private Bus Concerning UBI0.00000PrivateBusConcerningUBIPct
Total Private Business Use0.00000TotalPrivateBusinessUsePct
Bond Iss Meet Prvt Sec Pymt Test0BondIssMeetPrvtSecPymtTestInd
Change In Use Bond Financed Prop0ChangeInUseBondFinancedPropInd
Procs Nonqualified Bond RemdtdYes (1)ProcsNonqualifiedBondRemdtdInd

Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Form8038 T Filed0Form8038TFiledInd
Rebate Not Due YetYes (1)RebateNotDueYetInd
Exception To Rebate0ExceptionToRebateInd
No Rebate Due0NoRebateDueInd
Variable Rate Issue0VariableRateIssueInd
Hedge Identified In Bks And Rec0HedgeIdentifiedInBksAndRecInd
Gross Proceeds Invested In GIC0GrossProceedsInvestedInGICInd
Gross Proceeds Invested0GrossProceedsInvestedInd
Written Proc To Monitor ReqsYes (1)WrittenProcToMonitorReqsInd

Procedures Corrective Action ProceduresCorrectiveActionGrp

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Procedures Corrective ActionYes (1)ProceduresCorrectiveActionInd

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (5 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990, PART VI, SECTION B, LINE 11BAN INDEPENDENT ACCOUNTING FIRM PREPARES AND REVIEWS THE 990. THE 990 IS THEN REVIEWED BY THE ORGANIZATION'S MANAGEMENT. ANY QUESTIONS OR CONCERNS THE ORGANIZATION'S MANAGEMENT HAVE ARE ADDRESSED AND ANY CORRECTIONS OR CLARIFICATIONS ARE MADE. THE 990 IS THEN REVIEWED BY THE HOSPITAL FINANCE COMMITTEE. ANY QUESTIONS OR CONCERNS THE FINANCE COMMITTEE HAVE ARE ADDRESSED AND ANY CORRECTIONS OR CLARIFICATIONS ARE MADE. THE 990 IS THEN REVIEWED BY THE BOARD OF DIRECTORS, ANY CORRECTIONS OR CONCERNS THE BOARD HAVE ARE ADDRESSED PRIOR TO FILING.
FORM 990, PART VI, SECTION B, LINE 12CAT THE TIME OF THE ELECTION OR HIRE AND ANNUALLY THEREAFTER, THE GOVERNING BOARD MEMBERS, OFFICERS, AND KEY EMPLOYEES SHALL PROVIDE THE APPLICABLE CONFLICT OF INTEREST DISCLOSURES WHICH SHALL BE COMPLETED TO IDENTIFY ANY RELATIONSHIPS, POSITIONS, OR CIRCUMSTANCES IN WHICH IT IS BELIEVED A CONFLICT MAY ARISE. IF A CONFLICT ARISES, THE BOARD MEMBER ABSTAINS FROM THE VOTE OF THE CONFLICTED POSITION.
FORM 990, PART VI, SECTION B, LINE 15IN 2019, THE ORGANIZATION ENGAGED ITS LEGAL COUNSEL TO PREPARE A COMPENSATION DATA STUDY. IN ADDITION TO VARIOUS DATA COLLECTED, OTHER HOSPITALS' 990'S WERE REVIEWED AND COMBINED IN THE COMPENSATION STUDY. THE HOSPITAL'S LEGAL COUNSEL REVIEWED THE STUDY WITH THE BOARD OF DIRECTORS TO ADJUST THE CEO'S COMPENSATION. ANY DECISION THAT IS MADE IN REGARDS TO THE CEO'S COMPENSATION IS DOCUMENTED BY THE BOARD OF DIRECTORS. THE CEO AND HUMAN RESOURCE DIRECTOR CONDUCT AN ANNUAL REVIEW OF OTHER OFFICERS AND KEY EMPLOYEES' COMPENSATION BASED ON COMPARABLE DATA OF OTHER ORGANIZATIONS OF SIMILAR SIZE AND INDUSTRY. PHYSICIAN COMPENSATION IS DETERMINED BASED ON CONTRACT AND IS COMPARED TO RECENT MEDICAL GROUP MANAGEMENT ASSOCIATION INFORMATION BY REGION TO DETERMINE FAIR MARKET COMPENSATION.
FORM 990, PART VI, SECTION C, LINE 19THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE NOT MADE AVAILABLE TO THE PUBLIC.
FORM 990, PART XI, LINE 2C:AN INDEPENDENT ACCOUNTING FIRM AUDITS THE ORGANIZATION'S FINANCIAL STATEMENTS. THE ORGANIZATION HAS A COMMITTEE THAT ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF ITS FINANCIAL STATEMENTS AND SELECTION OF AN INDEPENDENT ACCOUNTANT. THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR.

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp

Disregarded Entity Name DisregardedEntityName

FieldValueIRS element (for citing)
Business Name Line1RIVERBEND REGIONAL HEALTHCARE FOUNDATIONBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line1800 RAVEN HILL DRIVEAddressLine1Txt
CityATCHISONCityNm
State AbbreviationKSStateAbbreviationCd
ZIP66002ZIPCd
FieldValueIRS element (for citing)
EIN480955489EIN
Primary ActivitiesSUPPORT ATCHISON HOSPITAL ASSOCIATIONPrimaryActivitiesTxt
Legal Domicile StateKSLegalDomicileStateCd
Exempt Code Section501(C)(3)ExemptCodeSectionTxt
Public Charity StatusLINE 12B, IIPublicCharityStatusTxt

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1ATCHISON HOSPITAL ASSOCIATIONBusinessNameLine1Txt
FieldValueIRS element (for citing)
Controlled OrganizationYes (1)ControlledOrganizationInd
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts Rylts0ReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth Org0GiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth Org0GiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth Org0LoansOrGuaranteesFromOthOrgInd
Div Related Organization0DivRelatedOrganizationInd
Asset Sale To Other Org0AssetSaleToOtherOrgInd
Asset Purchase From Other Org0AssetPurchaseFromOtherOrgInd
Asset Exchange0AssetExchangeInd
Rental Of Facilities To Oth Org0RentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth Org0RentalOfFcltsFromOthOrgInd
Perform Of Services For Oth Org0PerformOfServicesForOthOrgInd
Perform Of Services By Other Org0PerformOfServicesByOtherOrgInd
Sharing Of FacilitiesYes (1)SharingOfFacilitiesInd
Paid Employees SharingYes (1)PaidEmployeesSharingInd
Reimbursement Paid To Other Org0ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrgInd
Transfer To Other Org0TransferToOtherOrgInd
Transfer From Other Org0TransferFromOtherOrgInd

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