ST ROSE HEALTH CENTER INC: Form 990, tax year 2017
View the entire original 990 at ProPublica ↗
- Organization
- ST ROSE HEALTH CENTER INC (EIN 47-2117443)
- Tax period
- 2017-07-01 to 2018-06-30
- Filed
- 2019-05-15
- IRS object ID
- 201931359349310513
- Schema version
- 2017v2.3
- 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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2019-05-15T15:10:59-05:00 | ReturnTs |
| Tax Period End | 2018-06-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BKD LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1201 Walnut Suite 1700 | AddressLine1Txt |
| City | Kansas City | CityNm |
| State Abbreviation | MO | StateAbbreviationCd |
| ZIP | 641062246 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2017-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 472117443 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | St Rose Health Center | BusinessNameLine1Txt |
| Business Name Line2 | c/o Hays Medical Center | BusinessNameLine2Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| In Care Of | % GEORGE HARMS CFO OF HMC | InCareOfNm |
| Business Name Control | STRO | BusinessNameControlTxt |
| Phone | 7856235000 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2220 Canterbury Drive | AddressLine1Txt |
| City | Hays | CityNm |
| State Abbreviation | KS | StateAbbreviationCd |
| ZIP | 67601 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | SHAE VEACH | PersonNm |
| Person Title | CEO | PersonTitleTxt |
| Phone | 7856235000 | PhoneNum |
| Signature | 2019-05-15 | SignatureDt |
| Discuss With Paid Preparer | Yes (true) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Michael J Engle | PreparerPersonNm |
| PTIN | P00482834 | PTIN |
| Phone | 8162216300 | PhoneNum |
| Preparation | 2019-05-15 | PreparationDt |
Filing Security Information FilingSecurityInformation
IP Address IPAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| I Pv4 Address | 167.68.126.162 | IPv4AddressTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Federal Original Submission Id | 43372220191355000034 | FederalOriginalSubmissionId |
| Federal Original Submission Id | 2019-05-15 | FederalOriginalSubmissionIdDt |
| Filing License Type | P | FilingLicenseTypeCd |
| At Submission Creation Device Id | 05BF3D2C04DC7F26D6541C8D2E1E912A8523520D | AtSubmissionCreationDeviceId |
| At Submission Filing Device Id | B63AEF58A3948584CFC9994E7E12F4E53EEB27F2 | AtSubmissionFilingDeviceId |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2017 | TaxYr |
| Build TS | 2019-02-21 02:37:17Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | SHAE VEACH | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2220 Canterbury Drive | AddressLine1Txt |
| City | Hays | CityNm |
| State Abbreviation | KS | StateAbbreviationCd |
| ZIP | 67601 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $3,838,261 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | www.strosehc.com | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 2014 | FormationYr |
| Legal Domicile State | KS | LegalDomicileStateCd |
| Activity Or Mission | ST. ROSE HEALTH CENTER IS COMMITTED TO SERVING THE HEALTH CARE NEEDS OF OUR COMMUNITIES. SRHC'S GOAL IS TO HELP PEOPLE STAY HEALTHY AND MANAGE CHRONIC ILLNESSES. | ActivityOrMissionDesc |
| Voting Members Governing Body | 6 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 0 | VotingMembersIndependentCnt |
| Total Employee | 0 | TotalEmployeeCnt |
| Total Volunteers | 16 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $2,363,112 | PYContributionsGrantsAmt |
| CY Contributions Grants | $52,784 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $3,836,632 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $3,494,594 | CYProgramServiceRevenueAmt |
| PY Investment Income | -$29,851 | PYInvestmentIncomeAmt |
| CY Investment Income | -$116,941 | CYInvestmentIncomeAmt |
| PY Other Revenue | $55,284 | PYOtherRevenueAmt |
| CY Other Revenue | $290,447 | CYOtherRevenueAmt |
| PY Total Revenue | $6,225,177 | PYTotalRevenueAmt |
| CY Total Revenue | $3,720,884 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $3,629,058 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $3,564,277 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $3,699,368 | PYOtherExpensesAmt |
| CY Other Expenses | $3,107,613 | CYOtherExpensesAmt |
| PY Total Expenses | $7,328,426 | PYTotalExpensesAmt |
| CY Total Expenses | $6,671,890 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$1,103,249 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$2,951,006 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $12,739,599 | TotalAssetsBOYAmt |
| Total Assets EOY | $10,909,250 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $1,043,395 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $2,164,052 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $11,696,204 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $8,745,198 | NetAssetsOrFundBalancesEOYAmt |
| Mission | ST. ROSE HEALTH CENTER IS COMMITTED TO SERVING THE HEALTH CARE NEEDS OF OUR COMMUNITIES. SRHC'S GOAL IS TO HELP PEOPLE STAY HEALTHY AND MANAGE CHRONIC ILLNESSES. | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $5,832,632 | ExpenseAmt |
| Grant | $0 | GrantAmt |
| Revenue | $3,586,107 | RevenueAmt |
| Desc | PATIENT CARE - PROGRAM SERVICES CONSIST OF ROUTINE HEALTHCARE SERVICES PROVIDED BY A HEALTHCARE ORGANIZATION AS DESCRIBED IN 501(C)(3) OF THE IRC. | Desc |
| Total Program Service Expenses | $5,832,632 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (true) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (true) | ScheduleBRequiredInd |
| Political Campaign Acty | false | PoliticalCampaignActyInd |
| Lobbying Activities | false | LobbyingActivitiesInd |
| Subject To Proxy Tax | false | SubjectToProxyTaxInd |
| Donor Advised Fund | false | DonorAdvisedFundInd |
| Conservation Easements | false | ConservationEasementsInd |
| Collections Of Art | false | CollectionsOfArtInd |
| Credit Counseling | false | CreditCounselingInd |
| Temp Or Permanent Endowments | false | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (true) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | false | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | false | ReportProgramRelatedInvstInd |
| Report Other Assets | false | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (true) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | false | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | false | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (true) | ConsolidatedAuditFinclStmtInd |
| School Operating | false | SchoolOperatingInd |
| Foreign Office | false | ForeignOfficeInd |
| Foreign Activities | false | ForeignActivitiesInd |
| More Than5000 K To Org | false | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividualsInd |
| Professional Fundraising | false | ProfessionalFundraisingInd |
| Fundraising Activities | false | FundraisingActivitiesInd |
| Gaming Activities | false | GamingActivitiesInd |
| Operate Hospital | false | OperateHospitalInd |
| Grants To Organizations | false | GrantsToOrganizationsInd |
| Grants To Individuals | false | GrantsToIndividualsInd |
| Schedule J Required | Yes (true) | ScheduleJRequiredInd |
| Tax Exempt Bonds | false | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | false | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | false | PYExcessBenefitTransInd |
| Loan Outstanding | false | LoanOutstandingInd |
| Grant To Related Person | false | GrantToRelatedPersonInd |
| Business Rln With Org Mem | false | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | false | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | false | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | false | DeductibleNonCashContriInd |
| Deductible Art Contribution | false | DeductibleArtContributionInd |
| Terminate Operations | false | TerminateOperationsInd |
| Partial Liquidation | false | PartialLiquidationInd |
| Disregarded Entity | false | DisregardedEntityInd |
| Related Entity | Yes (true) | RelatedEntityInd |
| Related Organization Ctrl Ent | Yes (true) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | Yes (true) | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | false | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | false | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (true) | ScheduleORequiredInd |
| IRP Document | 15 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (true) | BackupWthldComplianceInd |
| Employee | 0 | EmployeeCnt |
| Unrelated Bus Incm Over Limit | false | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | false | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | false | TaxablePartyNotificationInd |
| Nondeductible Contributions | false | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | false | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | false | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | false | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | false | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 6 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 0 | IndependentVotingMemberCnt |
| Family Or Business Rln | false | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | false | DelegationOfMgmtDutiesInd |
| Change To Org Documents | false | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (true) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (true) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | false | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (true) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (true) | MinutesOfCommitteesInd |
| Officer Mailing Address | false | OfficerMailingAddressInd |
| Local Chapters | false | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (true) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (true) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (true) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (true) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (true) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (true) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (true) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (true) | CompensationProcessOtherInd |
| Investment In Joint Venture | false | InvestmentInJointVentureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | GEORGE HARMS CFO OF HMC | PersonNm |
| Phone | 7856235000 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2220 CANTERBURY DRIVE | AddressLine1Txt |
| City | HAYS | CityNm |
| State Abbreviation | KS | StateAbbreviationCd |
| ZIP | 67601 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (10 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| Joannah Applequist | ||||||||
| President | 0.5 | 40.0 | Yes (X) | Yes (X) | $0 | $160,373 | $33,907 | |
| George Harms | ||||||||
| Vice-President | 0.5 | 40.0 | Yes (X) | Yes (X) | $0 | $279,856 | $71,874 | |
| Terry Siek | ||||||||
| Secretary | 0.5 | 40.0 | Yes (X) | Yes (X) | $0 | $197,553 | $51,184 | |
| Shae Veach | ||||||||
| Treasurer/CEO | 0.5 | 40.0 | Yes (X) | Yes (X) | $0 | $211,544 | $69,083 | |
| Bryce Young | ||||||||
| Board Member | 0.5 | 40.0 | Yes (X) | $0 | $273,220 | $85,038 | ||
| Edward Herrman | ||||||||
| Board Member | 0.5 | 40.0 | Yes (X) | $0 | $68,143 | $12,388 | ||
| John Jeter MD | ||||||||
| Board Member | 0.5 | 40.0 | Yes (X) | $0 | $573,058 | $120,521 | ||
| James McReynolds | ||||||||
| Physician | 40.0 | 0.0 | $253,637 | $0 | $40,072 | Yes (X) | ||
| Edmond Habash | ||||||||
| Physician Assistant | 0.0 | 40.0 | $127,787 | $0 | $17,460 | Yes (X) | ||
| Jeanne Habash | ||||||||
| Physician Assistant | 0.0 | 40.0 | $102,791 | $0 | $24,139 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $484,215 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $1,763,747 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $525,666 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 3 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | false | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (true) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | false | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (3 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| High Plains Roofing | |||||
| PO Box 1347 | HAYS | KS | 67601 | Labor & Materials | $114,940 |
| G E Healthcare | |||||
| PO Box 843553 | DALLAS | TX | 75284 | Service Contract | $101,205 |
| Hays Medical Center | |||||
| 2220 Canterbury Dr | HAYS | KS | 67601 | SUPPORT SERVICES | $1,021,559 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 3 | CntrctRcvdGreaterThan100KCnt |
| Federated Campaigns | $6,000 | FederatedCampaignsAmt |
| Related Organizations | $1,100 | RelatedOrganizationsAmt |
| All Other Contributions | $45,684 | AllOtherContributionsAmt |
| Total Contributions | $52,784 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | Net Patient Service Revenue | Desc |
| Business | 621990 | BusinessCd |
| Total Revenue Column | $3,494,594 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $3,494,594 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $3,494,594 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $436 | TotalRevenueColumnAmt |
| Exclusion | $436 | ExclusionAmt |
Incm From Invest Bond Proceeds IncmFromInvestBondProceedsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Royalties Revenue RoyaltiesRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $46,049 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $46,049 | RealAmt |
| Personal | $0 | PersonalAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $46,049 | TotalRevenueColumnAmt |
| Exclusion | $46,049 | ExclusionAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $117,377 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | -$117,377 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$117,377 | TotalRevenueColumnAmt |
| Exclusion | -$117,377 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Fundraising Gross Income | $0 | FundraisingGrossIncomeAmt |
| Fundraising Direct Expenses | $0 | FundraisingDirectExpensesAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gaming Gross Income | $0 | GamingGrossIncomeAmt |
| Gaming Direct Expenses | $0 | GamingDirectExpensesAmt |
Net Income From Gaming NetIncomeFromGamingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Sales Of Inventory | $0 | GrossSalesOfInventoryAmt |
| Cost Of Goods Sold | $0 | CostOfGoodsSoldAmt |
Net Income Or Loss NetIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Other Revenue Misc OtherRevenueMiscGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | MISCELLANEOUS | Desc |
| Business | 900099 | BusinessCd |
| Total Revenue Column | $244,398 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $91,513 | RelatedOrExemptFuncIncomeAmt |
| Exclusion | $152,885 | ExclusionAmt |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $244,398 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $91,513 | RelatedOrExemptFuncIncomeAmt |
| Exclusion | $152,885 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $244,398 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $3,720,884 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $3,586,107 | RelatedOrExemptFuncIncomeAmt |
| Exclusion | $81,993 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Foreign Grants ForeignGrantsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Benefits To Members BenefitsToMembersGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Comp Disqual Persons CompDisqualPersonsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,723,851 | TotalAmt |
| Program Services | $2,512,032 | ProgramServicesAmt |
| Management And General | $211,819 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $138,160 | TotalAmt |
| Program Services | $127,416 | ProgramServicesAmt |
| Management And General | $10,744 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $508,459 | TotalAmt |
| Program Services | $468,919 | ProgramServicesAmt |
| Management And General | $39,540 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $193,807 | TotalAmt |
| Program Services | $178,736 | ProgramServicesAmt |
| Management And General | $15,071 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $255,993 | TotalAmt |
| Management And General | $255,993 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $12,860 | TotalAmt |
| Management And General | $12,860 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $59,324 | TotalAmt |
| Management And General | $59,324 | ManagementAndGeneralAmt |
Fees For Services Lobbying FeesForServicesLobbyingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Prof Fundraising FeesForServicesProfFundraising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,098,267 | TotalAmt |
| Program Services | $1,055,937 | ProgramServicesAmt |
| Management And General | $42,330 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $25,156 | TotalAmt |
| Program Services | $42 | ProgramServicesAmt |
| Management And General | $25,114 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $55,857 | TotalAmt |
| Program Services | $21,845 | ProgramServicesAmt |
| Management And General | $34,012 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $72,620 | TotalAmt |
| Program Services | $43,572 | ProgramServicesAmt |
| Management And General | $29,048 | ManagementAndGeneralAmt |
Royalties RoyaltiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $240,305 | TotalAmt |
| Program Services | $179,804 | ProgramServicesAmt |
| Management And General | $60,501 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $40,365 | TotalAmt |
| Program Services | $38,707 | ProgramServicesAmt |
| Management And General | $1,658 | ManagementAndGeneralAmt |
Pymt Travel Entrtnmnt Pub Ofcl PymtTravelEntrtnmntPubOfclGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Payments To Affiliates PaymentsToAffiliatesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $929,868 | TotalAmt |
| Program Services | $905,784 | ProgramServicesAmt |
| Management And General | $24,084 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $26,921 | TotalAmt |
| Program Services | $16,153 | ProgramServicesAmt |
| Management And General | $10,768 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| Repairs & Maintence | $45,101 | $45,101 | |
| Medical Supplies | $115,040 | $115,040 | |
| PHARMACEUTICALS | $99,543 | $99,543 | |
| DUES & SUBSCRIPTIONS | $12,411 | $7,613 | $4,798 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $17,982 | TotalAmt |
| Program Services | $16,388 | ProgramServicesAmt |
| Management And General | $1,594 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,671,890 | TotalAmt |
| Program Services | $5,832,632 | ProgramServicesAmt |
| Management And General | $839,258 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,066,899 | BOYAmt |
| EOY | $376,236 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $89,717 | BOYAmt |
| EOY | $0 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $597,507 | BOYAmt |
| EOY | $656,152 | EOYAmt |
Receivables From Officers Etc ReceivablesFromOfficersEtcGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $34,342 | BOYAmt |
| EOY | $34,705 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $56,221 | BOYAmt |
| EOY | $41,117 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $12,569,303 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $2,768,263 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,812,346 | BOYAmt |
| EOY | $9,801,040 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $82,567 | BOYAmt |
| EOY | $0 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $12,739,599 | BOYAmt |
| EOY | $10,909,250 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $707,157 | BOYAmt |
| EOY | $378,923 | EOYAmt |
Grants Payable GrantsPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $1,306 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Escrow Account Liability EscrowAccountLiabilityGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Loans From Officers Directors LoansFromOfficersDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $336,238 | BOYAmt |
| EOY | $1,783,823 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,043,395 | BOYAmt |
| EOY | $2,164,052 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,696,204 | BOYAmt |
| EOY | $8,745,198 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,696,204 | BOYAmt |
| EOY | $8,745,198 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $12,739,599 | BOYAmt |
| EOY | $10,909,250 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | -$2,951,006 | ReconcilationRevenueExpnssAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | false | AccountantCompileOrReviewInd |
| FS Audited | Yes (true) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (true) | AuditCommitteeInd |
| Federal Grant Audit Required | false | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Art Public Exhibition Amounts | ArtPublicExhibitionAmountsGrp | |
| Held Works Art | HeldWorksArtGrp | |
| CY Minus3 Yr Endwmt Fund | CYMinus3YrEndwmtFundGrp | |
| CY Minus4 Yr Endwmt Fund | CYMinus4YrEndwmtFundGrp |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $260,000 | OtherCostOrOtherBasisAmt |
| Book Value | $260,000 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $5,611,253 | OtherCostOrOtherBasisAmt |
| Depreciation | $745,653 | DepreciationAmt |
| Book Value | $4,865,600 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Leasehold Improvements | LeaseholdImprovementsGrp |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $5,331,730 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,704,205 | DepreciationAmt |
| Book Value | $3,627,525 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,366,320 | OtherCostOrOtherBasisAmt |
| Depreciation | $318,405 | DepreciationAmt |
| Book Value | $1,047,915 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $9,801,040 | TotalBookValueLandBuildingsAmt |
| Federal Income Tax Liability | $0 | FederalIncomeTaxLiabilityAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | DUE TO RELATED PARTIES | Desc |
| Amt | $1,783,823 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $1,783,823 | TotalLiabilityAmt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | false | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (true) | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | false | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | false | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | false | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | false | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | false | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | false | AnyNonFixedPaymentsInd |
| Initial Contract Exception | false | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (7 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Joannah Applequist | ||||||||||||||
| President | $0 | $157,294 | $0 | $3,079 | $0 | $0 | $0 | $22,110 | $0 | $11,797 | $0 | $194,280 | $0 | $0 |
| George Harms | ||||||||||||||
| Vice-President | $0 | $279,856 | $0 | $0 | $0 | $0 | $0 | $56,552 | $0 | $15,322 | $0 | $351,730 | $0 | $0 |
| Terry Siek | ||||||||||||||
| Secretary | $0 | $197,553 | $0 | $0 | $0 | $0 | $0 | $41,654 | $0 | $9,530 | $0 | $248,737 | $0 | $0 |
| Shae Veach | ||||||||||||||
| Treasurer/CEO | $0 | $195,390 | $0 | $0 | $0 | $16,154 | $0 | $43,242 | $0 | $25,841 | $0 | $280,627 | $0 | $0 |
| Bryce Young | ||||||||||||||
| Board Member | $0 | $273,220 | $0 | $0 | $0 | $0 | $0 | $57,845 | $0 | $27,193 | $0 | $358,258 | $0 | $0 |
| James McReynolds | ||||||||||||||
| Physician | $211,663 | $0 | $28,974 | $0 | $13,000 | $0 | $15,418 | $0 | $24,654 | $0 | $293,709 | $0 | $0 | $0 |
| John Jeter MD | ||||||||||||||
| Board Member | $0 | $570,992 | $0 | $569 | $0 | $1,497 | $0 | $102,168 | $0 | $18,353 | $0 | $693,579 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 3 | A RELATED ORGANIZATION USES A COMPENSATION COMMITTEE, INDEPENDENT COMPENSATION CONSULTANT, WRITTEN EMPLOYMENT CONTRACT, AND APROVAL BY THE BOARD OR COMPENSATION COMMITTEE TO ESTABLISH THE COMPENSATION OF THE HOSPITAL'S ADMINISTRATOR. |
| PART I, LINE 4B | CONTRIBUTIONS TO THE PLAN: JOHN JETER, M.D. $ 85,968 BRYCE YOUNG $ 41,991 GEORGE HARMS $ 42,148 SHAE VEACH $ 30,195 TERRY SIEK $ 29,753 |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (10 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 6 | THE ONLY MEMBER OF THE ORGANIZATION IS HAYS MEDICAL CENTER, INC., A NOT-FOR-PROFIT CORPORATION. |
| FORM 990, PART VI, SECTION A, LINE 7A | THE HEALTH CENTER IS GOVERNED BY A SIX PERSON BOARD OF DIRECTORS WITH ALL SIX MEMBERS BEING NOMINATED BY HAYS MEDICAL CENTER, INC. |
| FORM 990, PART VI, SECTION B, LINE 11B | FORM 990 WAS REVIEWED WITH THE BOARD MEMBERS PRIOR TO FILING. |
| FORM 990, PART VI, SECTION B, LINE 12C | OFFICERS, DIRECTORS, KEY EMPLOYEES, ALONG WITH ALL ASSOCIATES, ARE REQUIRED TO COMPLETE A CONFLICT OF INTEREST STATEMENT ANNUALLY. THE STATEMENTS ARE USED TO MONITOR AND ENFORCE COMPLIANCE WITH THE POLICY. |
| FORM 990, PART VI, SECTION B, LINE 15 | THE ADMINISTRATOR AND OFFICERS' SALARIES ARE REVIEWED ANNUALLY BY AN INDEPENDENT CONSULTING GROUP AND THE BOARD MEMBERS. |
| FORM 990, PART VI, SECTION C, LINE 19 | THESE DOCUMENTS ARE NOT MADE AVAILABLE TO THE PUBLIC. |
| FORM 990 PART IX LINE 11G | DESCRIPTION:COLLECTION & BILLING FEES TOTAL FEES:122189 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:LABORATORY FEES TOTAL FEES:45369 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:PURCHASED SERVICES TOTAL FEES:456140 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:PROFESSIONAL FEES TOTAL FEES:474569 |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (8 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|---|
| HAYS MEDICAL CENTER INC | ||||||||||
| 2220 CANTERBURY DRI | HAYS | KS | 67601 | 480559088 | HOSPITAL | KS | 501(C)(3) | LINE 3 | UKHA | Yes (true) |
| HAYSMED PARTNERS INC | ||||||||||
| 2220 CANTERBURY DR | HAYS | KS | 67601 | 270877152 | MANAGEMENT | KS | 501(C)(3) | LINE 3 | HMC | Yes (true) |
| UNIVERSITY OF KANSAS HOSPITAL AUTHORITY | ||||||||||
| 3901 RAINBOW BLVD | KANSAS CITY | KS | 66160 | 481202402 | HOSPITAL | KS | NA | false | ||
| PAYNEE VALLEY COMMUNITY HOSPITAL | ||||||||||
| 923 CARROLL AVE | LARNED | KS | 67550 | 481253246 | HOSPITAL | KS | 501(C)(3) | LINE 3 | HMP INC | Yes (true) |
| PAWNEE VALLEY COMMUNITY HOSPITAL FDN | ||||||||||
| 923 CARROLL AVE | LARNED | KS | 67550 | 455333776 | SUPPORT | KS | 501(C)(3) | LINE 12A | PVCH | Yes (true) |
| Hadley Foundation Inc | ||||||||||
| 1200 Main | Hays | KS | 67601 | 481107034 | GRANTS | KS | 501(C)(3) | 12C | NA | false |
| TURNING POINT THE CENTER FOR HOPE | ||||||||||
| 8900 STATE LINE ROAD STE 240 | LEAWOOD | KS | 66206 | 431900039 | HEALTHCARE | KS | 501(C)(3) | 7 | UKHA | Yes (true) |
| KANSAS UNIVERSITY PHYSICIANS INC | ||||||||||
| 3901 RAINBOW BLVD 4070 DELP | KANSAS CITY | MO | 66160 | 481163756 | HEALTHCARE | KS | 501(C)(3) | 10 | UKP | Yes (true) |
Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (5 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | General Or Managing PartnerGeneralOrManagingPartnerInd |
|---|---|---|---|---|---|---|---|---|
| KU MEDWEST AMBULATORY SURGERY | ||||||||
| 7405 RENNER ROAD | SHAWNEE | KS | 66217 | 020664568 | HEALTHCARE | KS | UKHA | false |
| UKH SPORTS MED LLC | ||||||||
| 2330 SHAWNEE MISSION PKWY STE 200 | WESTWOOD | KS | 66205 | 463123647 | HEALTHCARE | KS | UKHA | false |
| KH ALLIANCE LLC | ||||||||
| 4000 CAMBRIDGE STREET | KANSAS CITY | KS | 66160 | 472838147 | HEALTHCARE | KS | UKHA | false |
| KANSAS CLINICAL IMPROVEMENT COLLABORATIV | ||||||||
| 112 SW 7TH STREET SUITE 3C | TOPEKA | KS | 66603 | 812776361 | HEALTHCARE | KS | UKHA | false |
| KANSAS PRIMARY CARE ALLIANCE LLC | ||||||||
| 2330 SHAWNEE MISSION PKWY SUITE 200 | WESTWOODK | KS | 66205 | 463164140 | HEALTHCARE | KS | UKHA | false |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (4 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Entity TypeEntityTypeTxt | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|
| JAYHAWK PRIMARY CARE INC | |||||||||
| 2300 SHAWNEE MISSION PARKWAY STE 3 | WESTWOOD | KS | 66205 | 481159444 | HEALTHCARE | KS | UKHA | C-CORP | Yes (true) |
| MID-AMERICA CARDIOLOGY ASSOCIATES INC | |||||||||
| 4000 CAMBRIDGE STREET STE G600 | KANSAS CITY | KS | 66160 | 480980010 | HEALTHCARE | MO | UKHA | C-CORP | Yes (true) |
| UNIVERSITY OF KANSAS PHYSICIANS INC | |||||||||
| 2330 SHAWNEE MISSION PKWY STE 200 | WESTWOOD | KS | 66205 | 471214865 | HEALTHCARE | KS | UKHA | C-CORP | Yes (true) |
| UKHA PROGRAM SUPPORT INC | |||||||||
| 2330 SHAWNEE MISSION PKWY STE 200 | WESTWOOD | KS | 66205 | 455571151 | REAL ESTATE | KS | UKHA | C-CORP | Yes (true) |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | false | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | false | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (true) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | Yes (true) | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | Yes (true) | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | false | DivRelatedOrganizationInd |
| Asset Sale To Other Org | false | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | false | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | false | AssetExchangeInd |
| Rental Of Facilities To Oth Org | Yes (true) | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | false | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | false | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (true) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | false | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (true) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (true) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | false | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | false | TransferToOtherOrgInd |
| Transfer From Other Org | false | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp (2 entries)
| Transaction TypeTransactionTypeTxt | InvolvedInvolvedAmt | Method Of Amount DeterminationMethodOfAmountDeterminationTxt |
|---|---|---|
| HAYS MEDICAL CENTER INC | ||
| M | $1,021,559 | FMV |
| HAYS MEDICAL CENTER INC | ||
| P | $75,409 | FMV |