ST ROSE HEALTH CENTER INC: Form 990, tax year 2016
View the entire original 990 at ProPublica ↗
- Organization
- ST ROSE HEALTH CENTER INC (EIN 47-2117443)
- Tax period
- 2016-07-01 to 2017-06-30
- Filed
- 2018-05-04
- IRS object ID
- 201821249349301357
- Schema version
- 2016v3.0
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2018-05-04T13:58:39-05:00 | ReturnTs |
| Tax Period End | 2017-06-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 481026809 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Wendling Noe Nelson & Johnson LLC | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 534 S Kansas Ave Suite 1500 | AddressLine1Txt |
| City | Topeka | CityNm |
| State Abbreviation | KS | StateAbbreviationCd |
| ZIP | 666033491 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2016-07-01 | 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) |
|---|---|---|
| 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 | 2018-04-25 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Heather R Eichem | PreparerPersonNm |
| PTIN | P01515553 | PTIN |
| Phone | 7852334226 | PhoneNum |
| Preparation | 2018-04-25 | PreparationDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2016 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | 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 | $6,269,210 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | 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. St. Rose Health Center'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 | 17 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $4,951,800 | PYContributionsGrantsAmt |
| CY Contributions Grants | $2,363,112 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $4,619,039 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $3,836,632 | CYProgramServiceRevenueAmt |
| PY Investment Income | $5,283 | PYInvestmentIncomeAmt |
| CY Investment Income | -$29,851 | CYInvestmentIncomeAmt |
| PY Other Revenue | $152,587 | PYOtherRevenueAmt |
| CY Other Revenue | $55,284 | CYOtherRevenueAmt |
| PY Total Revenue | $9,728,709 | PYTotalRevenueAmt |
| CY Total Revenue | $6,225,177 | 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 | $4,270,916 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $3,629,058 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $4,582,374 | PYOtherExpensesAmt |
| CY Other Expenses | $3,699,368 | CYOtherExpensesAmt |
| PY Total Expenses | $8,853,290 | PYTotalExpensesAmt |
| CY Total Expenses | $7,328,426 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $875,419 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$1,103,249 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $15,085,080 | TotalAssetsBOYAmt |
| Total Assets EOY | $12,739,599 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $2,285,627 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $1,043,395 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $12,799,453 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $11,696,204 | NetAssetsOrFundBalancesEOYAmt |
| Mission | St. Rose Health Center is committed to serving the health care needs of our communities. St. Rose Health Center's goal is to help people stay healthy and manage chronic illnesses. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $6,040,291 | ExpenseAmt |
| Revenue | $3,813,873 | 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 | $6,040,291 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Temp Or Permanent Endowments | 0 | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | 0 | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (1) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | 0 | OperateHospitalInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 21 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 0 | EmployeeCnt |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 6 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 0 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | George Harms CFO of Hays Medical C | 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 | ||||||||
| Chairperson | 0.50 | 40.00 | Yes (X) | Yes (X) | $0 | $94,513 | $7,301 | |
| George Harms | ||||||||
| Vice-Chairperson | 0.50 | 40.00 | Yes (X) | Yes (X) | $0 | $311,382 | $78,461 | |
| Terry Siek | ||||||||
| Secretary | 0.50 | 40.00 | Yes (X) | Yes (X) | $0 | $230,404 | $58,013 | |
| Shae Veach | ||||||||
| Treasurer/CEO | 0.50 | 40.00 | Yes (X) | Yes (X) | $0 | $240,646 | $73,640 | |
| Bryce Young | ||||||||
| Board Member | 0.50 | 40.00 | Yes (X) | $0 | $332,241 | $95,883 | ||
| John Jeter MD | ||||||||
| Board Member | 0.50 | 40.00 | Yes (X) | $0 | $750,080 | $148,373 | ||
| Scott Taylor | ||||||||
| Board Member through June 2017 | 0.50 | Yes (X) | $0 | $0 | $0 | |||
| Dan Enderson | ||||||||
| Board Member through June 2017 | 0.50 | Yes (X) | $0 | $0 | $0 | |||
| Tom Gessell | ||||||||
| Board Member through June 2017 | 0.50 | Yes (X) | $0 | $0 | $0 | |||
| James McReynolds | ||||||||
| Physician | 40.00 | $0 | $220,747 | $37,919 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $0 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $2,180,013 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $499,590 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 0 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (3 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| Hays Medical Center | |||||
| 2220 Canterbury | Hays | KS | 67601 | Misc Services | $1,036,290 |
| Radiology Associates of Hays | |||||
| 2501 E 13th Street | Hays | KS | 67601 | Radiology Services | $256,802 |
| Anesthesiologist Associates of Hays | |||||
| PO Box 821 | Hays | KS | 67601 | Anesthesiology Services | $125,000 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 3 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $1,143,430 | RelatedOrganizationsAmt |
| Government Grants | $36,936 | GovernmentGrantsAmt |
| All Other Contributions | $1,182,746 | AllOtherContributionsAmt |
| Total Contributions | $2,363,112 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | Net patient service re | Desc |
| Business | 621990 | BusinessCd |
| Total Revenue Column | $3,833,779 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $3,833,779 | RelatedOrExemptFuncIncomeAmt |
Total Oth Program Service Rev TotalOthProgramServiceRevGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $2,853 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $2,853 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $3,836,632 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $463 | TotalRevenueColumnAmt |
| Exclusion | $463 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $47,729 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $0 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $47,729 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $47,729 | TotalRevenueColumnAmt |
| Exclusion | $47,729 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $13,719 | OtherAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $44,033 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | -$30,314 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$30,314 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | -$30,314 | RelatedOrExemptFuncIncomeAmt |
Other Revenue Misc OtherRevenueMiscGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | Gift shop | Desc |
| Business | 453220 | BusinessCd |
| Total Revenue Column | $7,555 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $7,555 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $7,555 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $6,225,177 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $3,813,873 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $48,192 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,850,419 | TotalAmt |
| Program Services | $2,497,507 | ProgramServicesAmt |
| Management And General | $352,912 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $132,860 | TotalAmt |
| Program Services | $116,411 | ProgramServicesAmt |
| Management And General | $16,449 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $443,384 | TotalAmt |
| Program Services | $388,488 | ProgramServicesAmt |
| Management And General | $54,896 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $202,395 | TotalAmt |
| Program Services | $177,336 | ProgramServicesAmt |
| Management And General | $25,059 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $266,844 | TotalAmt |
| Management And General | $266,844 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $31,109 | TotalAmt |
| Management And General | $31,109 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,026,851 | TotalAmt |
| Program Services | $924,286 | ProgramServicesAmt |
| Management And General | $102,565 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $24,659 | TotalAmt |
| Program Services | $216 | ProgramServicesAmt |
| Management And General | $24,443 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $17,017 | TotalAmt |
| Program Services | $11,027 | ProgramServicesAmt |
| Management And General | $5,990 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $55,077 | TotalAmt |
| Program Services | $48,545 | ProgramServicesAmt |
| Management And General | $6,532 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $130,497 | TotalAmt |
| Program Services | $127,117 | ProgramServicesAmt |
| Management And General | $3,380 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $38,946 | TotalAmt |
| Program Services | $37,461 | ProgramServicesAmt |
| Management And General | $1,485 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $22,470 | TotalAmt |
| Program Services | $22,123 | ProgramServicesAmt |
| Management And General | $347 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $985,438 | TotalAmt |
| Program Services | $959,915 | ProgramServicesAmt |
| Management And General | $25,523 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $32,347 | TotalAmt |
| Program Services | $30,257 | ProgramServicesAmt |
| Management And General | $2,090 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Management And GeneralManagementAndGeneralAmt | Program ServicesProgramServicesAmt |
|---|---|---|---|
| Taxes and assessments | $307,619 | $307,619 | |
| Repairs and maintenance | $291,599 | $170 | $291,429 |
| Pharmaceuticals | $201,223 | $201,223 | |
| Medical supplies | $121,736 | $121,736 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $145,936 | TotalAmt |
| Program Services | $85,214 | ProgramServicesAmt |
| Management And General | $60,722 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $7,328,426 | TotalAmt |
| Program Services | $6,040,291 | ProgramServicesAmt |
| Management And General | $1,288,135 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,597,631 | BOYAmt |
| EOY | $1,066,899 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $73,056 | BOYAmt |
| EOY | $89,717 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $435,791 | BOYAmt |
| EOY | $597,507 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $85,555 | BOYAmt |
| EOY | $34,342 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $81,001 | BOYAmt |
| EOY | $56,221 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $12,765,884 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $1,953,538 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,787,728 | BOYAmt |
| EOY | $10,812,346 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,024,318 | BOYAmt |
| EOY | $82,567 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $15,085,080 | BOYAmt |
| EOY | $12,739,599 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,285,627 | BOYAmt |
| EOY | $707,157 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $336,238 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,285,627 | BOYAmt |
| EOY | $1,043,395 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $12,799,453 | BOYAmt |
| EOY | $11,696,204 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $12,799,453 | BOYAmt |
| EOY | $11,696,204 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $15,085,080 | BOYAmt |
| EOY | $12,739,599 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | -$1,103,249 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consol And Sep Basis Fincl Stmt | Yes (X) | ConsolAndSepBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule D IRS990ScheduleD
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 | $5,611,254 | OtherCostOrOtherBasisAmt |
| Depreciation | $494,576 | DepreciationAmt |
| Book Value | $5,116,678 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $5,528,310 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,256,340 | DepreciationAmt |
| Book Value | $4,271,970 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,366,320 | OtherCostOrOtherBasisAmt |
| Depreciation | $202,622 | DepreciationAmt |
| Book Value | $1,163,698 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $10,812,346 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)
| DescDesc | AmtAmt |
|---|---|
| Due to Pawnee Valley Community Hospital | $800 |
| Due to Hays Medical Center | $335,438 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $336,238 | TotalLiabilityAmt |
| Total Rev Etc Audited Fincl Stmt | $6,255,491 | TotalRevEtcAuditedFinclStmtAmt |
| Revenue Not Reported | $0 | RevenueNotReportedAmt |
| Revenue Subtotal | $6,255,491 | RevenueSubtotalAmt |
| Other Revenues Not Included | -$30,314 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | -$30,314 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $6,225,177 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $7,358,740 | TotExpnsEtcAuditedFinclStmtAmt |
| Other Expenses Included | $30,314 | OtherExpensesIncludedAmt |
| Expenses Not Reported | $30,314 | ExpensesNotReportedAmt |
| Expenses Subtotal | $7,328,426 | ExpensesSubtotalAmt |
| Expenses Not Rpt Fincl Stmt | $0 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $7,328,426 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part XI, Line 4b - Other Adjustments: | Loss on sale of equipment -30,314. |
| Part XII, Line 2d - Other Adjustments: | Loss on sale of equipment 30,314. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (1) | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (6 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| George Harms | ||||||||||||||
| Vice-Chairperson | $0 | $251,161 | $0 | $60,221 | $0 | $0 | $0 | $62,901 | $0 | $15,560 | $0 | $389,843 | $0 | $0 |
| Terry Siek | ||||||||||||||
| Secretary | $0 | $194,074 | $0 | $36,330 | $0 | $0 | $0 | $48,548 | $0 | $9,465 | $0 | $288,417 | $0 | $0 |
| Shae Veach | ||||||||||||||
| Treasurer/CEO | $0 | $186,000 | $0 | $33,877 | $0 | $20,769 | $0 | $47,575 | $0 | $26,065 | $0 | $314,286 | $0 | $0 |
| Bryce Young | ||||||||||||||
| Board Member | $0 | $265,759 | $0 | $66,482 | $0 | $0 | $0 | $67,126 | $0 | $28,757 | $0 | $428,124 | $0 | $0 |
| John Jeter MD | ||||||||||||||
| Board Member | $0 | $542,748 | $0 | $185,472 | $0 | $21,860 | $0 | $125,434 | $0 | $22,939 | $0 | $898,453 | $0 | $0 |
| James McReynolds | ||||||||||||||
| Physician | $0 | $211,747 | $0 | $0 | $0 | $9,000 | $0 | $13,440 | $0 | $24,479 | $0 | $258,666 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part I, Line 3 | A related organization uses a compensation committee, independent compensation consultant, written employment contract, and approval 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. - $109,534 Bryce Young - $51,226 George Harms - $47,001 Shae Veach - $34,067 Terry Siek - $34,677 |
| Part I, Line 6 | A portion of incentive compensation for officers and key employees of Hays Medical Center, Inc., a related organization, is determined by net earnings exceeding budget for the fiscal year. |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (7 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 | Medical professional fees: Program service expenses 168,578. Management and general expenses 0. Fundraising expenses 0. Total expenses 168,578. Laboratory services: Program service expenses 33,536. Management and general expenses 0. Fundraising expenses 0. Total expenses 33,536. Nonmedical professional fees: Program service expenses 437,530. Management and general expenses 21,019. Fundraising expenses 0. Total expenses 458,549. Collection and billing fees: Program service expenses 140,586. Management and general expenses 15,516. Fundraising expenses 0. Total expenses 156,102. Other purchased services: Program service expenses 144,056. Management and general expenses 66,030. Fundraising expenses 0. Total expenses 210,086. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (4 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|
| Hays Medical Center Inc | |||||||||
| 2220 Canterbury Dr | Hays | KS | 67601 | 480559088 | Hospital | KS | 501(c)(3) | Line 3 | 0 |
| HaysMed Partners Inc | |||||||||
| 2220 Canterbury Dr | Hays | KS | 67601 | 270877152 | Owns management contract for Pawnee Valley Community Hospital | KS | 501(c)(3) | Line 3 | 0 |
| University of Kansas Hospital Authority | |||||||||
| 3901 Rainbow Blvd | Kansas City | KS | 66160 | 481202402 | Sole voting member of Hays Medical Center | KS | 0 | ||
| Pawnee Valley Community Hospital | |||||||||
| 923 Carroll Ave | Larned | KS | 67550 | 481253246 | Hospital operated by Hays Medical Center | KS | 501(c)(3) | Line 3 | 0 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (1) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | Yes (1) | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | Yes (1) | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | Yes (1) | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (1) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | 0 | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp (5 entries)
| Transaction TypeTransactionTypeTxt | InvolvedInvolvedAmt | Method Of Amount DeterminationMethodOfAmountDeterminationTxt |
|---|---|---|
| Hays Medical Center Inc | ||
| C | $1,143,430 | Cash paid |
| Hays Medical Center Inc | ||
| D | $80,430 | Amount due |
| Hays Medical Center Inc | ||
| E | $335,438 | Amount receivable |
| Hays Medical Center Inc | ||
| M | $968,471 | Cash paid |
| Hays Medical Center Inc | ||
| O | $3,621,559 | Cash paid |