2025-11-12T14:16:25-06:00 2024-12-31 450250958 EIDE BAILLY LLP 18081 BURT ST STE 200 OMAHA NE 680224722 990 2024-01-01 480561974 AMBERWELL ATCHISON ASSOCIATION AMBE 9133605584 800 RAVEN HILL DRIVE ATCHISON KS 66002 CHASE DUDZINSKI CHIEF FINANCIAL OFFICER 9133605584 2025-11-12 1 1 WENDY R COOLEY CPA P01523804 4023302660 2025-11-12 2024 2025-03-06 01:10:19Z AMBERWELL ATCHISON JARED ABEL 800 RAVEN HILL DRIVE ATCHISON KS 66002 62365308 0 X WWW.AMBERWELLHEALTH.ORG X 1912 KS TO PROVIDE EXCELLENT HEALTH CARE AND IMPROVE THE QUALITY OF LIFE IN OUR COMMUNITY. 6 6 597 54 0 0 903221 3177211 52989078 58675786 518912 443543 69550 68768 54480761 62365308 0 0 0 0 36464212 37913327 0 0 0 25570015 24525068 62034227 62438395 -7553466 -73087 47789695 45265684 37302760 34559437 10486935 10706247 X AMBERWELL HEALTH PROVIDES COMPASSIONATE CARE WITH CLINICAL EXCELLENCE. 0 0 52536972 58675786 AMBERWELL ATCHISON ASSOCIATION D/B/A AMBERWELL ATCHISON (HOSPITAL) IS A CRITICAL ACCESS HOSPITAL (CAH) THAT PROVIDES RELATED INPATIENT, OUTPATIENT, EMERGENCY CARE, AND PHYSICIAN SERVICES TO PATIENTS IN AND AROUND ATCHISON, KANSAS.AMBERWELL ATCHISON PROVIDED ACUTE INPATIENT AND OUTPATIENT HEALTH SERVICES TO THE GENERAL PUBLIC. SERVICES INCLUDE BUT ARE NOT LIMITED TO: EMERGENCY SERVICES, HOME HEALTH AND HOSPICE, GENERAL INPATIENT ACUTE SERVICES, RADIOLOGY, & OBSTETRICS. THE NUMBER OF PATIENTS SERVED DURING THE YEAR ENDING 12/31/24 WAS 41,447.STATEMENT CONTINUED ON SCHEDULE O.THE HOSPITAL MAINTAINS A FINANCIAL ASSISTANCE POLICY FOR PATIENTS WHO ARE FINANCIALLY UNABLE TO PAY FOR THE HEALTHCARE SERVICES THEY RECEIVE. IT IS THE POLICY OF THE HOSPITAL NOT TO PURSUE COLLECTION OF AMOUNTS DETERMINED TO QUALIFY AS PATIENT FINANCIAL ASSISTANCE UNDER THE POLICY. ACCORDINGLY, THE HOSPITAL DOES NOT REPORT THESE AMOUNTS IN PATIENT SERVICE REVENUE. THE HOSPITAL DETERMINES THE COSTS ASSOCIATED WITH PROVIDING CHARITY CARE BY AGGREGATING THE DIRECT AND IN DIRECT COSTS, INCLUDING SALARIES, BENEFITS, SUPPLIES, AND OTHER OPERATING EXPENSES, BASED ON AN OVERALL COST TO CHARGE RATIO. THE COSTS OF CARING FOR THESE PATIENTS FOR THE YEAR ENDED DECEMBER 31, 2024 WERE APPROXIMATELY $624,000. 52536972 1 1 0 1 0 0 1 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 37 0 1 597 1 0 0 0 0 0 0 0 0 0 0 0 0 X 6 6 0 0 0 0 0 0 0 1 0 0 0 1 1 1 1 1 1 1 0 0 X CHASE DUDZINSKI 9133605584 800 RAVEN HILL DRIVE ATCHISON KS 66002 LARRY MEARS CHAIRPERSON 1.00 1.00 X X 0 0 0 JERRY HENRY VICE CHAIRPERSON 1.00 1.00 X X 0 0 0 LORIN AFFIELD SECRETARY 1.00 1.00 X X 0 0 0 JORDAN HAWK TREASURER 1.00 0.00 X X 0 0 0 CHARO KELLEY DIRECTOR 1.00 0.00 X 0 0 0 RENEE NUGENT DIRECTOR AS OF 7/24 1.00 0.00 X 0 0 0 CHASE DUDZINSKI CFO 40.00 2.00 X 279958 0 45536 JEFFREY PERRY PRESIDENT & CEO THRU 5/24 40.00 2.00 X 293661 0 14253 JARED ABEL PRESIDENT & CEO FROM 6/24 40.00 2.00 X 176131 0 11993 MCGARRETT GROTH DO CHIEF OF MEDICAL STAFF 40.00 0.00 X 511737 0 39804 NORMA GREEN MD CHIEF MEDICAL OFFICER 40.00 0.00 X 284167 0 37241 ALICIA SORENSEN COO/CHIEF NURSING OFFICER 40.00 0.00 X 198817 0 35995 RODERICK WARREN MD FACS PHYSICIAN 40.00 0.00 X 715819 0 35772 JOHNATHAN LECK MD PHYSICIAN 40.00 0.00 X 721537 0 27085 BRIAN DUNCAN MD PHYSICIAN 40.00 0.00 X 699087 0 38973 JUSTIN THELEMAN MD PHYSICIAN 40.00 0.00 X 509181 0 45441 LANE YOUNG CRNA 40.00 0.00 X 326258 0 30112 4716353 0 362205 64 0 1 0 ADVOCATE HEALTH SERVICES 800 RAVEN HILL DRIVE ATCHISON KS 66002 CONTRACT LABOR 1030869 CPSI PO BOX 11407 BIRMINGHAM AL 352466448 AR MANAGEMENT SERVICES 831837 KEARNEY CONSTRUCTION 6199 OSAGE ROAD ATCHISON KS 66002 CONSTRUCTION COSTS 816514 SPENCER FANE LLP PO BOX 872037 KANSAS CITY MO 641872037 LEGAL SERVICES 488269 MEDICAL INFORMATION TECH PO BOX 74569 CHICAGO IL 60696 SERVICE FEES FOR SOFTWARE 354259 20 500000 2171588 505623 3177211 PROGRAM SERVICE REVENUE 621110 52967822 52967822 PHARMACY REVENUE 621110 2994761 2994761 AFFILIATE REVENUE 621110 2198258 2198258 514945 514945 58675786 352334 352334 91209 91209 68768 0 68768 68768 68768 62365308 58675786 0 512311 1932994 1110013 822981 29510562 25581831 3928731 520908 412905 108003 3809139 2996518 812621 2139724 1794554 345170 463484 463484 161258 88870 72388 8214 8214 4021006 2779598 1241408 134657 1974 132683 3565057 2565948 999109 707004 668819 38185 1055566 1016227 39339 285273 251636 33637 913983 891972 22011 3787523 3696338 91185 656842 230399 426443 MEDICAL SUPPLIES 5749502 5749502 REPAIRS AND MAINTENANCE 2548688 2284392 264296 FOOD 223421 223421 DUES & SUBSCRIPTIONS 183958 183958 59632 8097 51535 62438395 52536972 9901423 0 2993 2993 6226435 7694308 8367896 10017416 1631824 1148246 784733 911671 63649557 50316515 15169100 13333042 11229670 9285900 508045 291512 291712 282168 3577287 2298428 47789695 45265684 5542137 4890442 17867738 15428854 10780000 10780000 3112885 3460141 37302760 34559437 X 10486935 10706247 10486935 10706247 47789695 45265684 X -73087 189376 103023 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 8214 8214 0 PART II-B, LINE 1: A PERCENTAGE OF THE ANNUAL DUES PAID TO THE KANSAS HOSPITAL ASSOCIATION AND THE AMERICAN HOSPITAL ASSOCIATION ARE ATTRIBUTABLE TO LOBBYING. X 1 3.00 1 0 964642 964642 43349779 33223116 10126663 16653597 14629670 2023927 2681539 2463729 217810 13333042 THIRD-PARTY PAYOR SETTLEMENTS 303689 RIGHT OF USE ASSET 1994739 2298428 DEFERRED COMPENSATION 258276 LEASE LIABILITY 2086685 THIRD PARTY PAYOR SETTLEMENTS 1115180 3460141 X 62554684 189376 189376 62365308 0 62365308 62438395 0 62438395 0 62438395 PART II, LINE 9: CONSERVATION EASEMENTS ARE REPORTED AT HISTORICAL COSTS AS LAND. PART X, LINE 2: THE HOSPITAL ACCOUNTS FOR UNCERTAINTIES IN ACCOUNTING FOR INCOME TAX ASSETS AND LIABILITIES USING GUIDANCE INCLUDED IN FASB ASC 740, INCOME TAXES. THE HOSPITAL RECOGNIZES THE EFFECT OF INCOME TAX POSITIONS ONLY IF THOSE POSITIONS ARE MORE LIKELY THAN NOT OF BEING SUSTAINED. AT DECEMBER 31, 2024 AND 2023, THE HOSPITAL HAD NO UNCERTAIN TAX POSITIONS ACCRUED. 1 1 X 1 X 1 X 1 1 1 0 1 1 624000 624000 0.01000 7275208 5198214 2076994 0.03330 7899208 5198214 2700994 0.04330 10902585 7365325 3537260 0.05670 10902585 7365325 3537260 0.05670 18801793 12563539 6238254 0.10000 1 2065798 349120 12237886 12120368 117518 X 1 1 1 1 AMBERWELL ATCHISON ASSOCIATION 800 RAVEN HILL DRIVE ATCHISON KS 66002 WWW.AMBERWELLHEALTH.ORG H-003-001 X X X X 5 PROVIDER BASED RURAL HEALTH CLINICS AMBERWELL ATCHISON ASSOCIATION 1 0 0 1 X X X X X X X X X 22 1 0 1 1 X PART V, PAGE 8 X 1 22 1 PART V, PAGE 8 0 1 X 200.000000000000 200.000000000000 X X X X X X 1 1 X X X 1 X HTTPS://AMBERWELLHEALTH.ORG/PATIENT-RESOURCES/ X HTTPS://AMBERWELLHEALTH.ORG/PATIENT-RESOURCES/ X HTTPS://AMBERWELLHEALTH.ORG/PATIENT-RESOURCES/ X X X X X 1 X 0 X X X X 1 X 0 0 AMBERWELL ATCHISON ASSOCIATION PART V, SECTION B, LINE 5: THE HOSPITAL CONDUCTED A TOWN HALL MEETING WITH KEY STAKE HOLDERS INVOLVED AND CONDUCTED ONLINE SURVEYS. THESE STAKE HOLDERS INCLUDED AMBERWELL ATCHISON, CITY OF ATCHISON, ATCHISON CHAMBER OF COMMERCE, MINNISTERIAL ALLIANCE, ATCHISON COMMUNITY HEALTH CLINIC, ATCHISON COUNTY HEALTH DEPARTMENT, HOPE FAMILY THERAPY, ATCHISON CHILD CARE ASSOCIATION, LOCAL AND COUNTY SCHOOL DISTRICTS, GUIDANCE CENTER, AND ATCHISON YMCA. THE ABOVE STAKE HOLDERS REPRESENT THE NEEDS OF THE BROADER COMMUNITY AND ITS SURROUNDING COUNTY'S. ALL DEMOGRAPHICS WOULD BE REPRESENTED BY THESE STAKE HOLDERS. THE CHNA PROCESS STARTED IN DECEMBER 2021 WITH VARIOUS MEETINGS HELD THROUGHOUT 2022. AMBERWELL ATCHISON ASSOCIATION PART V, SECTION B, LINE 6B: CITY OF ATCHISON, ATCHISON CHAMBER OF COMMERCE, MINNISTERIAL ALLIANCE, ATCHISON COMMUNITY HEALTH CLINIC, ATCHISON COUNTY HEALTH DEPARTMENT, HOPE FAMILY THERAPY, ATCHISON CHILD CARE ASSOCIATION, LOCAL AND COUNTY SCHOOL DISTRICTS, GUIDANCE CENTER, AND ATCHISON YMCA. AMBERWELL ATCHISON ASSOCIATION PART V, SECTION B, LINE 11: THE COMMUNITY HEALTH NEEDS ASSESSMENT WAS COMPLETED IN 2022. THE FOLLOWING NEEDS WERE IDENTIFIED: MENTAL HEALTH, SUICIDE PREVENTION, SUBSTANCE ABUSE, AND UNINSURED/UNDERINSURED. THE FOLLOWING NEEDS WILL BE ADDRESSED BY AMBERWELL ATCHISON ASSOCIATION AND OTHER LOCAL PARTNERS:MENTAL HEALTH:1. MAINTAIN A COMMUNITY INVENTORY OF SERVICES TO DOCUMENT THE AVAILABILITY OF MENTAL HEALTH RESOURCES, INCLUDING HOURS OF SERVICE. MAKE THE INVENTORY AVAILABLE TO THE PUBLIC AS NEEDED. DOCUMENT MENTAL HEALTH SERVICES BY AGE CATEGORIES.2. INCREASE DEPRESSION SCREENINGS BY PRIMARY CARE PROVIDERS.3. EXPLORE DEVELOPING A TASK FORCE AMONG CARE COORDINATORS OF AGENCIES TO WORK TOGETHER TO ENSURE THAT PATIENTS ARE GETTING CARE THAT THEY NEED AND TO IDENTIFY WHAT BARRIERS EXIST. INCREASED COLLABORATION BETWEEN AGENCIES TO BENEFIT THE PATIENTS WE SERVE.4. EXPAND MENTAL HEALTH TRAINING AND CREATE EDUCATION (MATERIALS / PRESENTATIONS) IN SCHOOLS AND COMMUNITY PROGRAMS TO DESTIGMATIZE MENTAL HEALTH ISSUES.5. CONTINUE TO REFER MENTAL HEALTH PATIENTS TO THE GUIDANCE CENTER, ACHC, AMBERWELL, HEALTH DEPT, AND OTHERS.6. INVESTIGATE GRANT WRITING TO FUND MENTAL HEALTH EDUCATION AND SERVICES. IF AVAILABLE, DESIGNATE A COMMUNITY LEAD TO ATTAIN THE NECESSARY GRANT.7. PROMOTE EXISTING MENTAL HEALTH SERVICES, FACILITIES, AND PROVIDERS. EDUCATE COMMUNITY ON PLACEMENT PROCESS AND OPTIONS THROUGH HOSPITAL PHYSICIANS, CLINICS, AND E.R.8. EXPAND ACCESS TO MENTAL HEALTH THROUGH ADDING ADDITIONAL MENTAL HEALTH PROFESSIONALS TO SERVE THE COMMUNITY.9. CONTINUE TO CONTRACT WITH THE GUIDANCE CENTER TO SEND A MENTAL HEALTH SCREENER TO THE EMERGENCY DEPARTMENT TO ASSESS PATIENT-NEEDS AND TREATMENT OPTIONS AVAILABLE.10. CONTINUED PARTNERSHIPS WITH AREA SCHOOLS AROUND MENTAL HEALTH EDUCATION AND SERVICES FOR BOTH STAFF AND STUDENTS.IN 2024, BOARD APPROVAL WAS SECURED FOR THE DEVELOPMENT OF SENIOR LIFE SOLUTIONS, AN OUTPATIENT GERIATRIC PSYCHIATRY PROGRAM. GROUNDBREAKING FOR THE FACILITY TOOK PLACE IN 2025, MARKING A SIGNIFICANT STEP FORWARD IN EXPANDING MENTAL HEALTH SERVICES FOR OLDER ADULTS.UNINSURED/UNDERINSURED:1. PROVIDE A SLIDING SCALE FOR COST OF CARE TO UNINSURED, UNDERINSURED, AND VULNERABLE PATIENTS IN THE COMMUNITY.2. SUPPORT THE IMPLEMENTATION OF AN INSURANCE PROGRAM THROUGH THE CHAMBER TO HELP SMALL BUSINESSES PROVIDE INSURANCE.3. SUPPORT COMMUNITY AWARENESS OF MEDICAID EXPANSION.4. UTILIZE COMMUNITY HEALTH WORKERS TO PROVIDE EDUCATION, REFERRAL AND FOLLOW-UP, CASE MANAGEMENT, HOME VISITING, ETC. FOR THOSE AT HIGH RISK FOR POOR HEALTH OUTCOMES REGARDLESS OF THE ABILITY TO PAY.5. MAKE PRICING FOR HOSPITAL PROCEDURES AND OTHER HEALTH CARE SERVICES PUBLICLY AVAILABLE.6. PROVIDE HEALTH CARE SERVICES ON SCHOOL PREMISES TO STUDENTS.7. PROVIDE HEALTHCARE BENEFITS NAVIGATOR TO AID COMMUNITY MEMBERS IN UNDERSTANDING INSURANCE OPTIONS AND TO GET THE BEST BENEFITS FOR THEIR PERSONAL SITUATION.8. SEEK LEGISLATION TO INCLUDE MENTAL HEALTH IN COVERED SERVICES UNDER HSAS, ETC.9. EXPLORE PATIENT ASSISTANCE PROGRAM TO HELP DELIVER NEEDED MEDICATIONS TO THE UNINSURED/UNDERINSURED AND LOW INCOME.IN 2024, WE LAUNCHED A PHARMACY DELIVERY SERVICE TO ENHANCE MEDICATION ACCESS AND CONVENIENCE FOR OUR PATIENTS. ADDITIONALLY, WE EXPANDED OUR CHARITY CARE PROGRAM TO INCLUDE PHARMACEUTICAL PRESCRIPTIONS, ENSURING BROADER SUPPORT FOR INDIVIDUALS FACING FINANCIAL BARRIERS TO TREATMENT.THE ORGANIZATION WILL NOT DIRECTLY BE ADDRESSING THE FOLLOWING NEEDS THAT WERE IDENTIFIED IN THE CHNA SINCE THEY ARE NOT PART OF THE HOSPITAL'S MISSION OF CRITICAL OPERATIONS: SUICIDE PREVENTION, SUBSTANCE ABUSE, POVERTY, AND CHILDCARE SERVICES. INSTEAD, THE HOSPITAL WILL PARTNER WITH OTHER COMMUNITY AGENCIES AS APPROPRIATE. AMBERWELL ATCHISON ASSOCIATION PART V, SECTION B, LINE 13H: A DISCOUNT IN 10% INCREMENTS (RANGING FROM 10% TO 100%) IS GIVEN ON INCOME UP TO 200% OF FEDERAL POVERTY GUIDELINES. THERE ARE INSTANCES WHEN A PATIENT MAY APPEAR ELIGIBLE FOR FINANCIAL DISCOUNTS, BUT THERE IS NO FINANCIAL ASSISTANCE FORM ON FILE OR LACK OF SUPPORTING DOCUMENTATION. IN THE EVENT THERE IS NO EVIDENCE TO SUPPORT A PATIENT'S ELIGIBILITY FOR FINANCIAL ASSISTANCE, AMBERWELL ATCHISON MAY USE OUTSIDE AGENCIES OR VENDORS IN DETERMINING ELIGIBILITY AND POTENTIAL DISCOUNT AMOUNTS. THESE RESOURCES MAY USE DEMOGRAPHIC AND HOUSEHOLD INFORMATION AND/OR CREDIT SCORING TECHNOLOGY TO DETERMINE THE PERCENT OF ASSISTANCE TO APPLY TO THE PATIENT'S ACCOUNT. SCHEDULE H, PART V, SECTION B, LINE 7A AND 10A: COMMUNITY HEALTH NEEDS ASSESSMENT AND IMPLEMENTATIONSTRATEGY WEBSITE:HTTPS://AMBERWELLHEALTH.ORG/COMMUNITY-HEALTH-NEEDS-ASSESSMENT/ 1 1 - AMBERWELL LANSING CLINIC 1004 PROGRESS DRIVE SUITE 180 LANSING KS 66043 PHYSICIAN CLINIC PART I, LINE 3C: A DISCOUNT IN 10% INCREMENTS (RANGING FROM 10% TO 100%) IS GIVEN ON INCOME UP TO 200% OF FEDERAL POVERTY GUIDELINES. THERE ARE INSTANCES WHEN A PATIENT MAY APPEAR ELIGIBLE FOR FINANCIAL DISCOUNTS, BUT THERE IS NO FINANCIAL ASSISTANCE FORM ON FILE OR LACK OF SUPPORTING DOCUMENTATION. IN THE EVENT THERE IS NO EVIDENCE TO SUPPORT A PATIENT'S ELIGIBILITY FOR FINANCIAL ASSISTANCE, AMBERWELL ATCHISON MAY USE OUTSIDE AGENCIES OR VENDORS IN DETERMINING ELIGIBILITY AND POTENTIAL DISCOUNT AMOUNTS. THESE RESOURCES MAY USE DEMOGRAPHIC AND HOUSEHOLD INFORMATION AND/OR CREDIT SCORING TECHNOLOGY TO DETERMINE THE PERCENT OF ASSISTANCE TO APPLY TO THE PATIENT'S ACCOUNT. PART I, LINE 7: CHARITY CARE EXPENSE WAS CONVERTED TO COST ON LINE 7A BASED ON AN OVERALL COST TO CHARGE RATIO ADDRESSING ALL PATIENT SEGMENTS. UNREIMBURSED MEDICAID ON LINE 7B WAS CALCULATED USING THE COST-TO-CHARGE RATIO DERIVED FROM WORKSHEET 2. THE COST FOR SUBSIDIZED HEALTH SERVICES REPORTED ON LINE 7G WAS DETERMINED USING THE MEDICARE COST REPORT. PART III, LINE 2: THE AMOUNT ON LINE 2 REPRESENTS IMPLICIT PRICE CONCESSIONS. THE HOSPITAL DETERMINES ITS ESTIMATE OF IMPLICIT PRICE CONCESSIONS BASED ON ITS HISTORICAL COLLECTION EXPERIENCE WITH THIS CLASS OF PATIENTS. PART III, LINE 3: THE ESTIMATED AMOUNT OF THE ORGANIZATION'S IMPLICIT PRICE CONCESSIONS ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S CHARITY CARE POLICY IS CALCULATED BASED ON AN APPROXIMATE 16.9% OF INDIVIDUALS LIVING BELOW THE POVERTY LEVEL IN THE SERVICE AREA. PART III, LINE 4: THE FOOTNOTE TO THE ORGANIZATION'S FINANCIAL STATEMENTS CAN BE FOUND ON PAGES 13 AND 14 OF THE ATTACHED AUDITED FINANCIAL STATEMENTS. PART III, LINE 8: AMBERWELL ATCHISON PROVIDES SERVICES TO PATIENTS UNDER THE MEDICARE PROGRAM KNOWING THEY WILL NOT RECOVER ALL THE COSTS ASSOCIATED WITH PROVIDING THESE SERVICES. PROVIDING THESE SERVICES IS ESSENTIAL TO THESE PATIENTS AND THE COMMUNITY AND INCREASES THEIR ACCESS TO HEALTHCARE SERVICES. TOTAL REVENUE RECEIVED FROM MEDICARE IS THE GROSS REIMBURSEMENT PLUS SETTLEMENT. BOTH TOTAL REVENUE RECEIVED FROM MEDICARE AND THE MEDICARE ALLOWABLE COSTS ARE REPORTED FROM THE MEDICARE COST REPORT. THE MEDICARE COST REPORT IS COMPLETED BASED ON THE RULES AND REGULATIONS SET FORTH BY THE CENTERS FOR MEDICARE AND MEDICAID SERVICES.HOSPITAL SERVICES REIMBURSED ON A FEE SCHEDULE ARE NOT INCLUDED IN THE MEDICARE CALCULATION PER THE 990 INSTRUCTIONS. HAD THIS BEEN REPORTED THERE WOULD HAVE BEEN A LOSS FROM MEDICARE SERVICES.MEDICARE FEE SCHEDULE REVENUE $ 491,537MEDICARE ESTIMATED COSTS OF CARE RELATING TO PAYMENTS (771,791)NET (SHORTAGE) $ (280,254) PART III, LINE 9B: THE HOSPITAL WILL NOT PURSUE EXTRAORDINARY COLLECTION ACTIVITIES ON PATIENTS FOR AT LEAST 120 DAYS FROM THE DATE OF THE FIRST STATEMENT AND PROVIDES PATIENTS 240 DAYS TO APPLY FOR ASSISTANCE. AFTER FINANCIAL ASSISTANCE DISCOUNTS HAVE BEEN APPLIED, ANY REMAINING SELF-PAY BALANCES WILL BE THE RESPONSIBILITY OF THE PATIENT/GUARANTOR, AND SUBJECT TO THE NORMAL STATEMENT PROCESS. THE PATIENT/GUARANTOR WILL RECEIVE A STATEMENT FROM OUR BILLING COMPANY. THEY WILL CONTINUE TO RECEIVE MONTHLY STATEMENTS FROM OUR BILLING COMPANY, AS WELL AS INTERMITTENT PHONE CALLS FOR APPROXIMATELY 120 DAYS UNTIL THE BALANCE IS PAID IN FULL OR A PAYMENT PLAN HAS BEEN SET UP. IF PAYMENT PLAN ARRANGEMENTS OR PAYMENT IN FULL HAVE NOT BEEN RECEIVED, THEY WILL RECEIVE A FINAL NOTICE, AND BE SUBJECT TO FURTHER COLLECTION PROCESSES. WE ENCOURAGE PAYMENT IN FULL BUT UNDERSTAND THAT IS NOT ALWAYS POSSIBLE AND OFFER PAYMENT PLANS.FINANCIAL ASSISTANCE MAY BE APPLIED ON ANY ACCOUNT(S) THAT HAS BEEN ASSIGNED TO AN OUTSIDE COLLECTION AGENCY. THE HOSPITAL CAN PLACE ACCOUNTS WITH A COLLECTION AGENCY WITHIN 120 DAYS, HOWEVER, THE COLLECTION AGENCY CANNOT BEGIN ANY EXTRAORDINARY COLLECTION ACTIONS AS DEFINED BY THE PATIENT PROTECTION AND AFFORDABLE CARE ACT SUBSECTION 501(R) SUCH AS LEGAL PROCESS, SELLING DEBT, REPORTING ADVERSE INFORMATION ON CREDIT BUREAUS, COMMENCE CIVIL ACTION, GARNISH WAGES, COMPLETE A LIEN OR CAUSE AN ARREST BEFORE THE FIRST 240 DAYS FROM THE DATE OF THE FIRST STATEMENT. ACCOUNTS ASSIGNED TO AN OUTSIDE AGENCY WILL BE REVIEWED ON A CASE-BY-CASE BASIS. PART VI, LINE 2: AMBERWELL ATCHISON ASSOCIATION HAS ACCESS TO THE KANSAS HEALTH INITIATIVE SURVEY ON HEALTH INDICATORS. BASED ON THESE INDICATORS, THE HOSPITAL DETERMINES THE NEEDS OF THE COMMUNITY AND WHAT PROGRAMS TO IMPLEMENT. PART VI, LINE 3: PATIENTS ARE GIVEN A PAMPHLET DESCRIBING THE POLICY FOR FINANCIAL ASSISTANCE WHEN THEY ARE ADMITTED. THE ADMITTING OFFICE ASKS THEM TO SPEAK WITH THE HOSPITAL FINANCIAL COUNSELOR IF THEY DO NOT HAVE INSURANCE. AFTER THE PATIENT RECEIVES THEIR STATEMENT IN THE MAIL, THEY CAN CALL IN AND TALK WITH THE FINANCIAL COUNSELOR. IF THE ACCOUNT GOES TO A COLLECTION COMPANY BECAUSE THE PATIENT DID NOT PAY OR TALK WITH THE FINANCIAL COUNSELOR, THE COLLECTION COMPANY WILL GIVE THEM THE PROPER APPLICATION TO FILL OUT TO SEE IF THEY ARE ELIGIBLE FOR FINANCIAL ASSISTANCE. PART VI, LINE 4: AMBERWELL HEALTH SERVES THE COMMUNITY OF ATCHISON, KANSAS AND THE SURROUNDING ATCHISON COUNTY. THERE ARE OVER 650 EMPLOYEES SERVING ACROSS 7 AMBERWELL LOCATIONS IN 6 COMMUNITIES IN THE NORTHEAST KANSAS AREA. AMBERWELL HEALTH IS COMMITTED TO INNOVATING RURAL HEALTH SOLUTIONS AND INVESTING IN PEOPLE, FACILITIES, AND EQUIPMENT TO ENSURE THAT ACCESS TO QUALITY, LOCAL HEALTHCARE CONTINUES IN OUR COMMUNITIES.THE HOSPITAL SERVES A COMMUNITY OF APPROXIMATELY 10,600 PEOPLE WITH A MEDIAN HOUSEHOLD INCOME OF $54,695. THE SURROUNDING COUNTY HAS A POPULATION OF AN ADDITIONAL 6,300 PEOPLE. 16.9% OF THE POPULATION LIVE BELOW THE FEDERAL POVERTY LEVEL (1.57K OUT OF 9.25K PEOPLE), A NUMBER THAT IS HIGHER THAN THE NATIONAL AVERAGE OF 10.6%.PRIMARY CARE PHYSICIANS IN ATCHISON COUNTY, KS SEE AN AVERAGE OF 2,730 PATIENTS PER YEAR. THIS REPRESENTS A 1.52% INCREASE FROM THE PREVIOUS YEAR (2,689 PATIENTS). THE PERCENTAGE OF UNINSURED INDIVIDUALS DECLINED TO 3.29%. 96.71% OF THE POPULATION OF ATCHISON, KS HAS HEALTH COVERAGE, WITH 29.38% ON EMPLOYEE PLANS, 12.54% ON MEDICAID, 43.01% ON MEDICARE, 8.85% ON NON-GROUP PLANS, AND 2.93% ON MILITARY OR VA PLANS.THE MOST COMMON EMPLOYMENT SECTORS ARE EDUCATIONAL SERVICES, MANUFACTURING, AND RETAIL TRADE. PART VI, LINE 5: AMBERWELL ATCHISON IS GOVERNED BY A 6-MEMBER, VOLUNTEER BOARD OF DIRECTORS THAT REPRESENT KEY AREAS WITHIN ATCHISON COUNTY AS WELL AS THE MEDICAL STAFF. THE HOSPITAL APPLIES SURPLUS FUNDS TO EQUIPMENT AND BUILDING UPGRADES TO ENSURE THE HEALTH CARE NEEDS OF THE COMMUNITY IS SERVED. AMBERWELL HEALTH OPERATES AN EMERGENCY ROOM AVAILABLE TO ALL REGARDLESS OF ABILITY TO PAY.AMBERWELL ATCHISON BELIEVES COMMUNITY BENEFIT GOES BEYOND HOSPITAL VISITS AND EMERGENCY CARE. IT MEANS GETTING INVOLVED AND WORKING TO IMPROVE THE HEALTH OF OUR COMMUNITY; IT MEANS HELPING OTHERS PURSUE GOOD HEALTH THROUGH DONATIONS, EDUCATION AND VOLUNTEERISM. THE FOLLOWING IS A SUMMARY OF THE NUMEROUS ACTIVITIES, INITIATIVES AND EVENTS THAT HAVE BEEN IMPLEMENTED IN SUPPORT OF PROVIDING COMMUNITY BENEFITS TO THE RESIDENTS IN THE ATCHISON COMMUNITY AND REGION. LIVE WELL LIVE ATCHISON, IS A HOSPITAL INITIATIVE THAT INVOLVES PARTNERSHIPS WITH THE KANSAS HEALTH INITIATIVE, ATCHISON COUNTY SCHOOLS, BENEDICTINE COLLEGE, CITY AND COUNTY GOVERNMENTS, STATE REPRESENTATIVES, FAITH-BASED CHURCHES, THE HEALTH DEPARTMENT, COUNTY EXTENSION OFFICE AND AREA BUSINESSES, HEALTH AND SERVICE AGENCIES, AS WELL AS COMMUNITY AND CIVIC ORGANIZATIONS. THE GROUP IS WORKING TOWARD IMPROVING THE HEALTH BEHAVIORS AND LIFESTYLE OF ATCHISON COUNTY. AMBERWELL ATCHISON'S "BEST CARE COMMUNITY HEALTH FAIR," IS AN ANNUAL EVENT BY THE HOSPITAL AND HELD AT THE ATCHISON ELEMENTARY SCHOOL. HOSPITAL EMPLOYEES AS WELL AS COMMUNITY HEALTH AGENCIES, ORGANIZATIONS, LOCAL AND REGIONAL AREA RESPONDERS AND PHYSICIAN PRACTICES, PROVIDE HEALTH SCREENINGS, INTERACTIVE EDUCATIONAL, SAFETY AND FITNESS ACTIVITIES. AMBERWELL ATCHISON SUPPORTS THE ATCHISON COMMUNITY HEALTH CLINIC, A FEDERAL QUALIFIED HEALTH CLINIC, BY SUBSIDIZING THE CLINIC'S FACILITIES RENT FREE, GENERAL MAINTENANCE AND SNOW REMOVAL. THE HOSPITAL CONDUCTS AND SPONSORS SUPPORT GROUPS AND CLASSES THAT PROVIDE ONGOING EDUCATION AND COUNSELING SUCH AS GRIEF SUPPORT, BIRTHING AND CHILDCARE CLASSES. ADDITIONALLY, THE HOSPITAL OFFERS A HOSPICE VOLUNTEER PROGRAM. THE HOSPITAL ALSO PROVIDES SPONSORSHIP AND DONATIONS TO VARIOUS ORGANIZATIONS, LOCAL SCHOOLS AND NURSING HOMES, AS WELL AS COMMUNITY INITIATIVES SUCH AS: RELAY FOR LIFE, AMELIA EARHART FESTIVAL, BEAUTIFICATION OF OUR CITY, FARM SAFETY DAYS, JOGGIN' FOR THE NOGGIN', PARTICIPATION IN LOCAL AND REGIONAL HEALTH FAIRS AND PHYSICIAN SUPPORT AT LOCAL HIGH SCHOOL AND COLLEGE ATHLETIC EVENTS. AMBERWELL ATCHISON'S CARE TEAM, AN EMPLOYEE GROUP THAT GENERATES AND 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. X 1 1 X X X 0 0 0 0 0 0 0 0 0 RODERICK WARREN MD FACS PHYSICIAN 712010 0 3809 0 0 0 6981 0 29175 0 751975 0 0 0 JOHNATHAN LECK MD PHYSICIAN 452464 0 269073 0 0 0 8580 0 19261 0 749378 0 0 0 BRIAN DUNCAN MD PHYSICIAN 623315 0 75772 0 0 0 10182 0 29547 0 738816 0 0 0 JUSTIN THELEMAN MD PHYSICIAN 509181 0 0 0 0 0 10350 0 35847 0 555378 0 0 0 MCGARRETT GROTH DO CHIEF OF MEDICAL STAFF 497073 0 14664 0 0 0 5853 0 34708 0 552298 0 0 0 LANE YOUNG CRNA 326258 0 0 0 0 0 5638 0 25230 0 357126 0 0 0 CHASE DUDZINSKI CFO 270858 0 9100 0 0 0 8545 0 37747 0 326250 0 0 0 NORMA GREEN MD CHIEF MEDICAL OFFICER 254915 0 29252 0 0 0 7839 0 30159 0 322165 0 0 0 JEFFREY PERRY PRESIDENT & CEO THRU 5/24 224046 0 69615 0 0 0 5001 0 9631 0 308293 0 0 0 ALICIA SORENSEN COO/CHIEF NURSING OFFICER 189717 0 9100 0 0 0 5904 0 30829 0 235550 0 0 0 JARED ABEL PRESIDENT & CEO FROM 6/24 172305 0 3826 0 0 0 0 0 12309 0 188440 0 0 0 PART I, LINE 1A SOCIAL CLUB DUES WERE PAID BY THE HOSPITAL FOR JEFFREY PERRY AND WERE NOT INCLUDED IN HIS W-2 AS TAXABLE COMPENSATION BECAUSE THEY WERE USED 100% FOR BUSINESS. A CITY OF ATCHISON KANSAS 486025033 046687CM9 2017-06-06 8835000 SEE PART VI. 0 0 0 B CITY OF ATCHISON KANSAS 486025033 046687CV9 2017-10-19 5910000 SEE PART VI. 0 0 0 C CITY OF ATCHISON KANSAS 486025033 046687DG1 2019-10-30 4255000 SEE PART VI. 0 0 0 A 1205000 8835000 79515 8755485 1 0 1 1 B 245000 5910000 117700 5792300 0 1 1 1 C 1460000 4295481 80961 1844906 2329133 2023 0 1 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 B 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 C 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 A 0 0 0 1 0 0 0 0 1 B 0 0 0 1 0 0 0 1 1 C 0 0 0 1 0 0 0 0 1 A 1 B 1 C 1 DATE REBATE COMPUTATION PERFORMED ISSUER NAME: CITY OF ATCHISON, KANSAS DATE THE REBATE COMPUTATION WAS PERFORMED: 06/01/2022 ISSUER NAME: CITY OF ATCHISON, KANSAS DATE THE REBATE COMPUTATION WAS PERFORMED: 10/01/2022 ISSUER NAME: CITY OF ATCHISON, KANSAS DATE THE REBATE COMPUTATION WAS PERFORMED: 02/07/2025 PART I, LINE A, COLUMN (F): CURRENT REFUND A PORTION OF THE 2008A BONDS. THE 2008A BONDS WERE ORIGINALLY ISSUED ON 9/23/2008. PART I, LINE B, COLUMN (F): CURRENT REFUND A PORTION OF THE 2009 BONDS. THE 2009 BONDS WERE ORIGINALLY ISSUED ON 6/30/2009. PART I, LINE C, COLUMN (F): ADVANCE REFUND REMAINING PORTION OF THE 2009 BONDS. THE 2009 BONDS WERE ORIGINALLY ISSUED ON 6/30/2009. PART I, LINE D, COLUMN (F): CURRENT REFUND TAXABLE BANK LOAN. THE TAXABLE BANK LOAN WAS ORIGINALLY ISSUED ON 7/21/2015. RENOVATIONS AND EQUIPMENT FOR HOSPITAL FACILITIES. PART II, COLUMN C, LINE 11: THIS AMOUNT REPRESENTS $5,786,846 OF BOND PROCEEDS USED TO ADVANCE REFUND A PORTION OF THE 2009 BONDS AND $4,954 ALLOCATED TO PAY INTEREST ON THE BONDS. PART II, COLUMN D, LINE 3: AMOUNT DOES NOT EQUAL THE ISSUE PRICE AS A RESULT OF INTEREST EARNED ON THE BOND PROCEEDS DURING THE PROJECT PERIOD. PART II, COLUMN D, LINE 11: THIS AMOUNT IS COMPRISED OF $1,709,258 OF BOND PROCEEDS THAT WERE USED TO CURRENT REFUND THE TAXABLE BANK LOAN WITH EXCHANGE BANK & TRUST ON 10/30/2019 AND $1,510 OF UNSPENT PROCEEDS ON DEPOSIT IN THE COST OF ISSUANCE FUND THAT WAS ALLOCATED TO PAY INTEREST ON THE BONDS. PART IV, COLUMN C, LINE 6: PROCEEDS WERE DEPOSITED AND HELD IN A YIELD RESTRICTED ESCROW FOR THE REFUNDED BOND BEYOND THE AVAILABLE TEMPORARY PERIOD. ALL SUCH PROCEEDS HAVE BEEN SPENT. FORM 990, PART VI, SECTION A, LINE 8B THE ORGANIZATION DOES NOT HAVE COMMITTEES WITH AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY. FORM 990, PART VI, SECTION B, LINE 11B AN INDEPENDENT ACCOUNTING FIRM PREPARES AND REVIEWS THE FORM 990. THE FORM 990 IS THEN REVIEWED BY THE ORGANIZATION'S MANAGEMENT. ANY QUESTIONS OR CONCERNS THE ORGANIZATION'S MANAGEMENT HAS ARE ADDRESSED AND ANY CORRECTIONS OR CLARIFICATIONS ARE MADE. THE FORM 990 IS THEN PROVIDED TO THE BOARD PRIOR TO FILING WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C AT THE TIME OF THE ELECTION OR HIRE AND ANNUALLY THEREAFTER, THE GOVERNING BOARD MEMBERS, OFFICERS, AND KEY EMPLOYEES SHALL PROVIDE THE APPLICABLE CONFLICT OF INTEREST DISCLOSURES WHICH SHALL BE COMPLETED TO IDENTIFY ANY RELATIONSHIPS, POSITIONS, OR CIRCUMSTANCES IN WHICH IT IS BELIEVED A CONFLICT MAY ARISE. IF A CONFLICT ARISES, THE BOARD MEMBER ABSTAINS FROM THE VOTE OF THE CONFLICTED POSITION. FORM 990, PART VI, SECTION B, LINE 15A THE ORGANIZATION ENGAGES ITS LEGAL COUNSEL TO PREPARE COMPENSATION DATA STUDIES. IN ADDITION TO VARIOUS DATA COLLECTED, OTHER HOSPITALS' 990'S ARE REVIEWED AND COMBINED IN THE COMPENSATION STUDY. THE HOSPITAL'S LEGAL COUNSEL REVIEWS THE STUDY WITH THE BOARD OF DIRECTORS TO ADJUST THE PRESIDENT & CEO'S COMPENSATION. ANY DECISION THAT IS MADE IN REGARDS TO THE PRESIDENT & CEO'S COMPENSATION IS DOCUMENTED BY THE BOARD OF DIRECTORS. THE PROCESS WAS LAST COMPLETED IN 2024. THE CEO AND HUMAN RESOURCE DIRECTOR CONDUCT AN ANNUAL REVIEW OF OTHER OFFICERS AND KEY EMPLOYEES' COMPENSATION BASED ON COMPARABLE DATA OF OTHER ORGANIZATIONS OF SIMILAR SIZE AND INDUSTRY. THIS IS DONE ON AN ANNUAL BASIS AND DOCUMENTED IN THE PERSONNEL FILES. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE NOT MADE AVAILABLE TO THE PUBLIC. FORM 990, PART XI, LINE 9: NMTC EQUITY TRANSFER 103,023. 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. AMBERWELL HEALTH LLC 800 RAVEN HILL DRIVE ATCHISON KS 66002 873578396 CENTRALIZED OFFICE FOR AFFILIATES KS 0 0 AMBERWELL ATCHISON ASSOCIATION AMBERWELL HEALTH FOUNDATION 800 RAVEN HILL DRIVE ATCHISON KS 66002 480955489 SUPPORT AMBERWELL ATCHISON ASSOCIATION KS 501(C)(3) LINE 12B, II AMBERWELL ATCHISON ASSOCIATION 1 AMBERWELL ATCHISON SUPPORT ORGANIZATION 800 RAVEN HILL DRIVE ATCHISON KS 66002 932800795 SUPPORT AMBERWELL ATCHISON ASSOCIATION KS 501(C)(3) LINE 12A, I AMBERWELL ATCHISON ASSOCIATION 1 0 0 1 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 0 AMBERWELL HEALTH FOUNDATION C 500000 CASH TRANSFERRED AMBERWELL ATCHISON SUPPORT ORGANIZATION R 103023 EQUITY TRANSFERRED