GREELEY COUNTY HEALTH SERVICES INC: Form 990, tax year 2017
View the entire original 990 at ProPublica ↗
- Organization
- GREELEY COUNTY HEALTH SERVICES INC (EIN 30-0078435)
- Tax period
- 2017-01-01 to 2017-12-31
- Filed
- 2018-11-15
- IRS object ID
- 201823199349304117
- 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
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule H
- Schedule J
- Schedule L
- Schedule O
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2018-11-15T09:33:55-06:00 | ReturnTs |
| Tax Period End | 2017-12-31 | 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 | 1551 N WATERFRONT PKWY STE 300 | AddressLine1Txt |
| City | WICHITA | CityNm |
| State Abbreviation | KS | StateAbbreviationCd |
| ZIP | 672066601 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2017-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 300078435 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | GREELEY COUNTY HEALTH SERVICES INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| In Care Of | % TRICE WATTS | InCareOfNm |
| Business Name Control | GREE | BusinessNameControlTxt |
| Phone | 6203764221 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 506 THIRD STREET | AddressLine1Txt |
| City | TRIBUNE | CityNm |
| State Abbreviation | KS | StateAbbreviationCd |
| ZIP | 67879 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | BURKE KLINE | PersonNm |
| Person Title | CEO | PersonTitleTxt |
| Phone | 8162216300 | PhoneNum |
| Signature | 2018-11-15 | SignatureDt |
| Discuss With Paid Preparer | Yes (true) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | STEVEN L WEBB | PreparerPersonNm |
| PTIN | P00235405 | PTIN |
| Phone | 3162652811 | PhoneNum |
| Preparation | 2018-11-15 | 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 | 48010220183195000007 | FederalOriginalSubmissionId |
| Federal Original Submission Id | 2018-11-15 | FederalOriginalSubmissionIdDt |
| Filing License Type | P | FilingLicenseTypeCd |
| At Submission Creation Device Id | 305047111E71B1EF7CF07F45C8273AFE2A22C5B3 | AtSubmissionCreationDeviceId |
| At Submission Filing Device Id | 91DD30FEEB741F1A7672B92B7EACB194C0F2AFCF | 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 | STEVEN MANGAN | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 506 THIRD STREET | AddressLine1Txt |
| City | TRIBUNE | CityNm |
| State Abbreviation | KS | StateAbbreviationCd |
| ZIP | 67879 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $11,662,888 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.MYGCHS.COM | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 2006 | FormationYr |
| Legal Domicile State | KS | LegalDomicileStateCd |
| Activity Or Mission | THE MISSION OF GREELEY COUNTY HEALTH SERVICES IS TO BE A COMPASSIONATE, INNOVATIVE AND CARING FAMILY WITH YOUR HEALTH AND WELL-BEING IN MIND. | ActivityOrMissionDesc |
| Voting Members Governing Body | 5 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 4 | VotingMembersIndependentCnt |
| Total Employee | 171 | TotalEmployeeCnt |
| Total Volunteers | 17 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| PY Contributions Grants | $1,052,631 | PYContributionsGrantsAmt |
| CY Contributions Grants | $1,464,507 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $9,479,376 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $9,758,459 | CYProgramServiceRevenueAmt |
| PY Investment Income | $9,706 | PYInvestmentIncomeAmt |
| CY Investment Income | $11,526 | CYInvestmentIncomeAmt |
| PY Other Revenue | $378,507 | PYOtherRevenueAmt |
| CY Other Revenue | $428,396 | CYOtherRevenueAmt |
| PY Total Revenue | $10,920,220 | PYTotalRevenueAmt |
| CY Total Revenue | $11,662,888 | 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 | $6,394,055 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $6,631,572 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $4,431,678 | PYOtherExpensesAmt |
| CY Other Expenses | $4,540,499 | CYOtherExpensesAmt |
| PY Total Expenses | $10,825,733 | PYTotalExpensesAmt |
| CY Total Expenses | $11,172,071 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $94,487 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $490,817 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $5,408,183 | TotalAssetsBOYAmt |
| Total Assets EOY | $5,828,980 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $1,293,141 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $1,223,121 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $4,115,042 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $4,605,859 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | THE MISSION OF GREELEY COUNTY HEALTH SERVICES IS TO BE A COMPASSIONATE, INNOVATIVE AND CARING FAMILY WITH YOUR HEALTH AND WELL-BEING IN MIND. | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $9,771,860 | ExpenseAmt |
| Grant | $0 | GrantAmt |
| Revenue | $10,061,396 | RevenueAmt |
| Desc | A CRITICAL ACCESS HOSPITAL WITH 288 TOTAL ADMISSIONS IN 2017, ALSO PROVIDED RURAL HEALTH CLINIC/OUTPATIENT SERVICES WITH 9,793 CLINIC VISITS, AS WELL AS PROVIDED LONG TERM CARE SERVICES FOR 11,285 RESIDENT PATIENT DAYS IN 2017. | Desc |
| Total Program Service Expenses | $9,771,860 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (true) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (true) | ScheduleBRequiredInd |
| Political Campaign Acty | false | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (true) | 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 | false | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | false | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (true) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | false | 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 | Yes (true) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (true) | AuditedFinancialStmtAttInd |
| 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 | Yes (true) | 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 | false | RelatedEntityInd |
| Related Organization Ctrl Ent | false | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | false | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | false | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (true) | ScheduleORequiredInd |
| IRP Document | 11 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (true) | BackupWthldComplianceInd |
| Employee | 171 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (true) | EmploymentTaxReturnsFiledInd |
| 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 | 5 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 4 | IndependentVotingMemberCnt |
| Family Or Business Rln | false | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | Yes (true) | DelegationOfMgmtDutiesInd |
| Change To Org Documents | false | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | false | MembersOrStockholdersInd |
| Election Of Board Members | false | 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 | TRICE WATTS | PersonNm |
| Phone | 6203764221 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 506 THIRD STREET | AddressLine1Txt |
| City | TRIBUNE | CityNm |
| State Abbreviation | KS | StateAbbreviationCd |
| ZIP | 67879 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | Yes (X) | InfoInScheduleOPartVIIInd |
Form990 Part VII Section A Form990PartVIISectionAGrp (11 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 |
|---|---|---|---|---|---|---|---|---|
| STEVE MANGAN | ||||||||
| DIRECTOR/CHAIR | 1.0 | 0.0 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| KENNETH ZERR | ||||||||
| DIRECTOR/SECRETARY/TREASURER | 1.0 | 0.0 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| LINDA PETERSON | ||||||||
| DIRECTOR | 1.0 | 0.0 | Yes (X) | $0 | $0 | $0 | ||
| CHRIS DIXON | ||||||||
| DIRECTOR | 1.0 | 0.0 | Yes (X) | $0 | $0 | $0 | ||
| BROCK SLOAN | ||||||||
| DIRECTOR | 1.0 | 0.0 | Yes (X) | $0 | $0 | $0 | ||
| LUKE SENDEN | ||||||||
| CFO | 40.0 | 0.0 | Yes (X) | $0 | $0 | $0 | ||
| BURKE KLINE | ||||||||
| CEO | 40.0 | 0.0 | Yes (X) | $0 | $0 | $0 | ||
| WENDEL ELLIS | ||||||||
| MD | 32.0 | 0.0 | $332,446 | $0 | $34,586 | Yes (X) | ||
| SHEILA M SCHEFFE | ||||||||
| MD | 24.0 | 0.0 | $164,944 | $0 | $13,392 | Yes (X) | ||
| MELISSA BORTHWICK | ||||||||
| PHYSICIANS ASSISTANT | 32.0 | 0.0 | $137,139 | $0 | $4,559 | Yes (X) | ||
| BRIAN MILLAR | ||||||||
| PHYSICAL THERAPY MANAGER | 40.0 | 0.0 | $117,538 | $0 | $22,852 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $752,067 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $75,389 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 4 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | false | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (true) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | false | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (4 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| QUOROM HEALTH RESOURCES | |||||
| 1573 MALLORY LANE STE 200 | BRENTWOOD | TN | 37027 | MANAGEMENT SERVICES | $523,138 |
| HI PLAINS ULTRASOUND | |||||
| 1618 CONARD AVENUE | GARDEN CITY | KS | 67846 | MEDICAL SERVICES | $115,560 |
| SYSCO | |||||
| 5000 BEELER ST | DENVER | CO | 80238 | FOOD SERVICES | $122,852 |
| MEDLINE INDUSTRIES | |||||
| 2015 16TH ST | DALLAS | TX | 753121080 | MEDICAL SERVICES | $106,426 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 4 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $1,066,756 | GovernmentGrantsAmt |
| All Other Contributions | $397,751 | AllOtherContributionsAmt |
| Total Contributions | $1,464,507 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | NET PATIENT SERVICE REVENUE | Desc |
| Business | 621110 | BusinessCd |
| Total Revenue Column | $9,758,459 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $9,758,459 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $9,758,459 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $11,526 | TotalRevenueColumnAmt |
| Exclusion | $11,526 | 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 | $12,266 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $12,266 | RealAmt |
| Personal | $0 | PersonalAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $12,266 | TotalRevenueColumnAmt |
| Exclusion | $12,266 | ExclusionAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
| 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 (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt | ExclusionExclusionAmt |
|---|---|---|---|---|
| OUTSIDE SERVICES | 621110 | $302,937 | $302,937 | |
| EMPLOYEE/GUEST MEALS | 722513 | $92,659 | $92,659 | |
| All Other Misc Revenue | 900099 | $20,534 | $20,534 |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $20,534 | TotalRevenueColumnAmt |
| Exclusion | $20,534 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $416,130 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $11,662,888 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $10,061,396 | RelatedOrExemptFuncIncomeAmt |
| Exclusion | $136,985 | ExclusionAmt |
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 | $5,448,964 | TotalAmt |
| Program Services | $5,010,447 | ProgramServicesAmt |
| Management And General | $438,517 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $141,256 | TotalAmt |
| Program Services | $130,120 | ProgramServicesAmt |
| Management And General | $11,136 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $664,644 | TotalAmt |
| Program Services | $616,562 | ProgramServicesAmt |
| Management And General | $48,082 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $376,708 | TotalAmt |
| Program Services | $346,392 | ProgramServicesAmt |
| Management And General | $30,316 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $522,999 | TotalAmt |
| Management And General | $522,999 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $46,765 | TotalAmt |
| Management And General | $46,765 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $108,730 | TotalAmt |
| Management And General | $108,730 | 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 | $1,078,555 | TotalAmt |
| Program Services | $1,044,315 | ProgramServicesAmt |
| Management And General | $34,240 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $18,772 | TotalAmt |
| Management And General | $18,772 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $261,653 | TotalAmt |
| Program Services | $222,878 | ProgramServicesAmt |
| Management And General | $38,775 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Royalties RoyaltiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $243,523 | TotalAmt |
| Program Services | $216,172 | ProgramServicesAmt |
| Management And General | $27,351 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $71,300 | TotalAmt |
| Program Services | $62,048 | ProgramServicesAmt |
| Management And General | $9,252 | 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 | $21,954 | TotalAmt |
| Program Services | $20,673 | ProgramServicesAmt |
| Management And General | $1,281 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,845 | TotalAmt |
| Program Services | $3,845 | ProgramServicesAmt |
Payments To Affiliates PaymentsToAffiliatesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $370,615 | TotalAmt |
| Program Services | $353,718 | ProgramServicesAmt |
| Management And General | $16,897 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $78,687 | TotalAmt |
| Program Services | $76,254 | ProgramServicesAmt |
| Management And General | $2,433 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| MEDICAL SUPPLIES | $953,561 | $953,561 | |
| BAD DEBT EXPENSE | $357,751 | $357,751 | |
| FOOD | $192,125 | $192,125 | |
| REPAIRS & MAINTENANCE | $116,018 | $109,658 | $6,360 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $93,646 | TotalAmt |
| Program Services | $55,341 | ProgramServicesAmt |
| Management And General | $38,305 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $11,172,071 | TotalAmt |
| Program Services | $9,771,860 | ProgramServicesAmt |
| Management And General | $1,400,211 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $75,420 | BOYAmt |
| EOY | $11,765 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,256,096 | BOYAmt |
| EOY | $1,747,483 | 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 | $1,079,083 | BOYAmt |
| EOY | $1,359,097 | 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 | $145,595 | BOYAmt |
| EOY | $82,031 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $133,182 | BOYAmt |
| EOY | $181,869 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $6,800,049 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $4,398,314 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,497,616 | BOYAmt |
| EOY | $2,401,735 | 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 | $221,191 | BOYAmt |
| EOY | $45,000 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,408,183 | BOYAmt |
| EOY | $5,828,980 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,252,332 | BOYAmt |
| EOY | $1,208,723 | 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 | $0 | 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 | $40,809 | BOYAmt |
| EOY | $14,398 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,293,141 | BOYAmt |
| EOY | $1,223,121 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,656,163 | BOYAmt |
| EOY | $2,216,450 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,458,879 | BOYAmt |
| EOY | $2,389,409 | 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 | $4,115,042 | BOYAmt |
| EOY | $4,605,859 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,408,183 | BOYAmt |
| EOY | $5,828,980 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $490,817 | 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) |
|---|---|---|
| Separate Basis Fincl Stmt | Yes (X) | SeparateBasisFinclStmtInd |
| 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 C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Grassroots Lobbying | TotalGrassrootsLobbyingGrp | |
| Total Direct Lobbying | TotalDirectLobbyingGrp | |
| Total Lobbying Expend | TotalLobbyingExpendGrp | |
| Other Exempt Purpose Expend | OtherExemptPurposeExpendGrp | |
| Total Exempt Purpose Expend | TotalExemptPurposeExpendGrp | |
| Lobbying Nontaxable Amount | LobbyingNontaxableAmountGrp | |
| Grassroots Nontaxable | GrassrootsNontaxableGrp | |
| Tot Lbbyng Grassroot Mns Non Tx | TotLbbyngGrassrootMnsNonTxGrp | |
| Tot Lbby Expend Mns Lbbyng Non Tx | TotLbbyExpendMnsLbbyngNonTxGrp | |
| Form4720 Filed | false | Form4720FiledInd |
| Volunteers | false | VolunteersInd |
| Paid Staff Or Management | false | PaidStaffOrManagementInd |
| Media Advertisements | false | MediaAdvertisementsInd |
| Mailings Members | false | MailingsMembersInd |
| Publications Or Broadcast | false | PublicationsOrBroadcastInd |
| Grants Other Organizations | Yes (true) | GrantsOtherOrganizationsInd |
| Grants Other Organizations | $3,067 | GrantsOtherOrganizationsAmt |
| Direct Contact Legislators | false | DirectContactLegislatorsInd |
| Rallies Demonstrations | false | RalliesDemonstrationsInd |
| Other Activities | false | OtherActivitiesInd |
| Total Lobbying Expenditures | $3,067 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | false | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE C, PART II-B, LINE 1F | FormAndLineReferenceDesc |
| Explanation | A PORTION OF THE DUES PAID TO THE KHA AND LEADINGAGE WERE FOR LOBBYING AND ADVOCACY. | ExplanationTxt |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Art Public Exhibition Amounts | ArtPublicExhibitionAmountsGrp | |
| Held Works Art | HeldWorksArtGrp | |
| Agent Trustee Etc | false | AgentTrusteeEtcInd |
| Incl Escrow Custodial Acct Liab | false | InclEscrowCustodialAcctLiabInd |
| 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 | $301,707 | OtherCostOrOtherBasisAmt |
| Book Value | $301,707 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $3,747,367 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,937,870 | DepreciationAmt |
| Book Value | $1,809,497 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Leasehold Improvements | LeaseholdImprovementsGrp |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $2,689,263 | OtherCostOrOtherBasisAmt |
| Depreciation | $2,451,538 | DepreciationAmt |
| Book Value | $237,725 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $61,712 | OtherCostOrOtherBasisAmt |
| Depreciation | $8,906 | DepreciationAmt |
| Book Value | $52,806 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $2,401,735 | TotalBookValueLandBuildingsAmt |
| Total Rev Etc Audited Fincl Stmt | $11,305,137 | TotalRevEtcAuditedFinclStmtAmt |
| Other Revenue | -$357,751 | OtherRevenueAmt |
| Revenue Not Reported | -$357,751 | RevenueNotReportedAmt |
| Revenue Subtotal | $11,662,888 | RevenueSubtotalAmt |
| Total Revenue Per Form990 | $11,662,888 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $10,814,320 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Subtotal | $10,814,320 | ExpensesSubtotalAmt |
| Other Expenses Not Included | $357,751 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $357,751 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $11,172,071 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| SCHEDULE D, PART X, LINE 2 | MANAGEMENT HAS EVALUATED THEIR INCOME TAX POSITIONS UNDER THE GUIDANCE INCLUDED IN ASC 740. BASED ON THEIR REVIEW, MANAGEMENT HAS NOT IDENTIFIED ANY MATERIAL UNCERTAIN TAX POSITIONS TO BE RECORDED OR DISCLOSED IN THE FINANCIAL STATEMENTS. |
| SCHEDULE D, PART XI, LINE 2D | BAD DEBT EXPENSE (357,751) |
| SCHEDULE D, PART XII, LINE 4B | BAD DEBT EXPENSE 357,751 |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (true) | FinancialAssistancePolicyInd |
| Written Policy | Yes (true) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (true) | FPGReferenceFreeCareInd |
| Percent200 | Yes (X) | Percent200Ind |
| FPG Reference Discounted Care | Yes (true) | FPGReferenceDiscountedCareInd |
| Percent300 | Yes (X) | Percent300Ind |
| Free Care Medically Indigent | Yes (true) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (true) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | false | ExpensesExceedBudgetInd |
| Annual Community Bnft Report | Yes (true) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (true) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $67,205 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $67,205 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00620 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,072,128 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $973,193 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $98,935 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00910 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,139,333 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $973,193 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $166,140 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01530 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,030 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $2,030 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00020 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,030 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $2,030 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00020 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,141,363 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $973,193 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $168,170 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01550 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | false | BadDebtExpenseReportedInd |
| Bad Debt Expense | $357,751 | BadDebtExpenseAmt |
| Reimbursed By Medicare | $2,834,882 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $1,862,507 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | $972,375 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | Yes (X) | CostToChargeRatioInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (true) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (true) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | GREELEY COUNTY HEALTH SERVICES | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 506 3RD ST | AddressLine1Txt |
| City | TRIBUNE | CityNm |
| State Abbreviation | KS | StateAbbreviationCd |
| ZIP | 67879 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | WWW.MYGCHS.COM | WebsiteAddressTxt |
| State License | H036001 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Critical Access Hospital | Yes (X) | CriticalAccessHospitalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | GREELEY COUNTY HEALTH SERVICES | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | Yes (true) | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | false | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (true) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Prior CHNA Impact | Yes (X) | PriorCHNAImpactInd |
| CHNA Conducted | 16 | CHNAConductedYr |
| Take Into Account Others Input | Yes (true) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | false | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | Yes (true) | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (true) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | SEE PART V, SECTION C | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (true) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 16 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (true) | StrategyPostedWebsiteInd |
| Strategy Website URL | SEE PART V, SECTION C | StrategyWebsiteURLTxt |
| Organization Incur Excise Tax | false | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (true) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 200. | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 300. | FPGFamilyIncmLmtDscntCarePct |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| Explained Basis | Yes (true) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (true) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Includes Publicity Measures | Yes (true) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | SEE PART V, SECTION C | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | SEE PART V, SECTION C | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | SEE PART V, SECTION C | FAPSummaryOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| Notified FAP Copy Bill Display | Yes (X) | NotifiedFAPCopyBillDisplayInd |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| FAP Translated | Yes (X) | FAPTranslatedInd |
| FAP Actions On Nonpayment | Yes (true) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | false | CollectionActivitiesInd |
| Provided Written Notice | Yes (X) | ProvidedWrittenNoticeInd |
| Made Effort Orally Notify | Yes (X) | MadeEffortOrallyNotifyInd |
| Processed FAP Application | Yes (X) | ProcessedFAPApplicationInd |
| Nondis Emergency Care Policy | Yes (true) | NondisEmergencyCarePolicyInd |
| Look Back Medicare Private | Yes (X) | LookBackMedicarePrivateInd |
| Amounts Generally Billed | false | AmountsGenerallyBilledInd |
| Gross Charges | false | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (6 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| SCHEDULE H, PART V, SECTION B, LINE 5 | MEMBERS OF THE GREELEY COUNTY DEVELOPMENT BOARD AND STAFF INTERVIEWED 15 COMMUNITY MEMBERS. WHEN SELECTING INDIVIDUALS FOR THE INTERVIEWS, THE BOARD DELIBERATELY SELECTED A DIVERSE GROUP OF PEOPLE FROM BUSINESS, EDUCATION, HEALTH AND HUMAN SERVICES AND GOVERNMENT. |
| SCHEDULE H, PART V, SECTION B, LINE 6B | GREELEY COUNTY HEALTH DEPARTMENT WALLACE COUNTY HEALTH DEPARTMENT GREELEY COUNTY COMMUNITY DEVELOPMENT |
| SCHEDULE H, PART V, SECTION B, LINE 7A | http://mygchs.com/wp-content/uploads/CHNA-2016-Executive-Summary-Recommend ation-and-Resolution-Rev-Nov-2016-signed.pdf |
| SCHEDULE H, PART V, SECTION B, LINE 10A | HTTP://MYGCHS.COM/WP-CONTENT/UPLOADS/2016-GCHS-CHNA-EXECUTIVE-SUMMARY-FINA L-NOV.PDF |
| SCHEDULE H, PART V, SECTION B, LINE 11 | TO ADDRESS QUALITY CHILDCARE AVAILABILITY AND AFFORDABILITY, COMING UP FOR THE NEXT YEAR, GCHS HAS ENGAGED WITH THE KU MBA PROGRAM TO CONDUCT AN EXTENSIVE STUDY ON THE CURRENT OPPORTUNITIES AND REMAINING NEED FOR CHILDCARE IN BOTH GREELEY AND WALLACE COUNTIES. TO ADDRESS DENTAL CARE AND PREVENTIVE SCREENINGS AVAILABILITY, GCHS CONDUCTED A SITE VISIT FOR KU MBA STUDENTS IN GREELEY AND WALLACE COUNTIES - THEY MET WITH MORE THAN 30 INDIVIDUALS DURING THE DAY. GCHS PROPOSED A SURVEY TO POPULATION IN BOTH COUNTIES. IN ADDITION, EACH SCHOOL SYSTEM HAS A FREE PREVENTIVE DENTAL VISIT AVAILABLE FOR EACH CHILD AT LEAST ONCE ANNUALLY. TO ADDRESS ALCOHOLISM AND DRUG DEPENDENCE AS WELL AS TREATMENT, GCHS HAS BEEN INVOLVED WITH A PARTNERSHIP WITH COMPASS BEHAVIORAL HEALTH. THEIR IN-HOUSE COUNSELOR VICK NORTON IS NOW A LICENSED SUBSTANCE ABUSE COUNSELOR AND IS AVAILABLE FOR TREATMENT. A CELEBRATE RECOVERY PROGRAM IS AVAILABLE IN WALLACE COUNTY. ADDITIONALLY, EACH COUNTY HOSTS A COMMUNITY HEALTH FAIR WITH EDUCATIONAL TOPICS AVAILABLE. TO ADDRESS EDUCATING ADULTS AND YOUTH ON HOW TO AVOID UNSAFE SEX AND GET ACCESS TO CONTRACEPTIVES, GCHS CLINICIANS PROVIDE AN ANNUAL EDUCATIONAL OPPORTUNITY IN COORDINATION WITH GREELEY COUNTY HIGH SCHOOL TO CONDUCT A SERIES OF PROGRAMS CALLED HEALTHY MOMENTS WHICH ARE TO HELP PROVIDE INFORMATION ON SAFE SEX, REPRODUCTION, SAFE RELATIONSHIPS AND OTHER POTENTIAL TEEN BEHAVIORS. TO ADDRESS HOUSING AS A LIMITING FACTOR IN ATTRACTING NEW RESIDENTS, GREELEY COUNTY ECONOMIC DEVELOPMENT HAS AN AGGRESSIVE COMMUNITY HOUSING ENDEAVOR UNDERWAY TO PROVIDE ADDITIONAL, LOWER COST HOUSING ALTERNATIVES IN THE COMMUNITY. TO DATE, FOUR DUPLEXES HAVE BEEN BUILT. TO ADDRESS EARLY CHILDHOOD EDUCATION NEEDS, WALLACE COUNTY HAS AN EXCELLENT HEAD START PROGRAM IN PLACE. GCHS CLINICIANS ASSIST BY GIVING CLINIC TOURS, TEDDY BEAR CLINICS AND ANNUAL PHYSICALS. ADDITIONALLY, GREELEY COUNTY HAS GROWN THE LEARNING PROGRAMS ASSOCIATED WITH THE LIBRARY. THERE ARE NOW MULTIPLE PROGRAMS EACH WEEK. TO ADDRESS CHRONIC PHYSICAL AND MENTAL ILLNESS CONCERNS, GCHS HAS IMPLEMENTED A PATIENT CARE COORDINATOR TO ASSIST THE MOST CHRONICALLY AND SERIOUSLY ILL PATIENTS IN MANAGING THEIR CARE. GCHS PARTICIPATED IN AN INTEGRATED BEHAVIORAL HEALTH GRANT IN SOUTHWEST KANSAS WHICH PLACED A SOCIAL WORKER IN CLINIC. ADDITIONALLY, EACH COUNTY HOSTS A COMMUNITY HEALTH FAIR WITH RELEVANT TOPICS ASSOCIATED WITH CHRONIC DISEASES ANNUALLY. TO ADDRESS CONCERNS OF ACCESS T0 HEALTHCARE FOR THE UNINSURED, A PATIENT FINANCIAL ASSISTANCE COUNSELOR IS AVAILABLE TO DIRECTLY ASSIST PATIENTS WITH THEIR FINANCIAL NEEDS. SHE ASSISTS THEM WITH PHARMACEUTICAL RESOURCES, DISABILITY AND MEDICAID APPLICATIONS, ACA INSURANCE SIGNUP AND ACCESSING MYRIAD OTHER SOCIAL RESOURCES. SHE ALSO ASSISTS PATIENTS IN SEEKING CHARITY CARE WITH OUTSIDE FACILITIES THEY MAY HAVE BEEN REFERRED TO FROM OUR FACILITY. ADDITIONALLY, GCHS PARTICIPATES WITH THE NATIONAL HEALTH SERVICE CORPS AND IS HOME TO PRIMARY CARE CLINICS IN SHARON SPRINGS AND TRIBUNE WHICH IS COMMITTED TO CARING FOR PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. |
| SCHEDULE H, PART V, LINE 16A, 16B, & 16C | HTTP://MYGCHS.COM/FINANCIAL-ASSISTANCE/ |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 3 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (3 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| GREELEY COUNTY FAMILY PRACTICE | ||||
| 321 E HARPER | TRIBUNE | KS | 67879 | RURAL HEALTH CLINIC |
| WALLACE COUNTY FAMILY PRACTICE | ||||
| 504 E 6TH ST | SHARON SPRINGS | KS | 67758 | RURAL HEALTH CLINIC |
| GREELEY COUNTY LONG-TERM CARE | ||||
| 320 E GREELEY | TRIBUNE | KS | 67879 | LONG-TERM CARE |
Supplemental Information Detail SupplementalInformationDetail (11 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| SCHEDULE H, PART I, LINE 7 | THE COSTING METHODOLOGY USED TO CALCULATE THE AMOUNTS CONTAINED IN THE TABLE OF PART I, LINE 7, OF SCHEDULE H, IS A COST TO CHARGE RATIO. SCHEDULE H, PART I, LINE 7 COLUMN F THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $357,751. |
| SCHEDULE H, PART III, SECTION A, LINE 2 | THE HOSPITAL REPORTS PATIENT ACCOUNTS RECEIVABLE FOR SERVICES RENDERED AT NET REALIZABLE AMOUNTS FROM THIRD-PARTY PAYERS, PATIENTS AND OTHERS. THE HOSPITAL PROVIDES AN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS BASED UPON A REVIEW OF OUTSTANDING RECEIVABLES, HISTORICAL COLLECTION INFORMATION AND EXISTING ECONOMIC CONDITIONS. |
| SCHEDULE H, PART III, SECTION A, LINE 4 | PAGE 9 OF THE AUDITED FINANCIALS UNDER NOTE 1. |
| SCHEDULE H, PART III, SECTION B, LINE 8 | THE ANNUAL MEDICARE COST REPORT IS THE SOURCE FOR THE COSTING METHODOLOGY FOR SCHEDULE H, PART III, SECTION B, LINE 6. |
| SCHEDULE H, PART III, SECTION C, LINE 9B | THE ACCOUNTS OF UNINSURED OR UNDER-INSURED PATIENTS WHO HAVE APPLIED FOR MEDICAL ASSISTANCE OR FINANCIAL ASSISTANCE ARE HELD WITHOUT FURTHER COLLECTION ACTION, UNTIL THE APPLICATION PROCESS HAS BEEN COMPLETE. |
| SCHEDULE H, PART VI, LINE 2 | GREELEY COUNTY HEALTH SERVICES USES LOCAL AND STATE BASED DATA TO ASSIST ITS MEDICAL STAFF IN ASSESSING THE HEALTH CARE NEEDS OF THE COMMUNITIES IT SERVES AND PROVIDES BASIC FAMILY BASED PRIMARY CARE. |
| SCHEDULE H, PART VI, LINE 3 | ALL PATIENTS PRESENTING TO OUR FACILITY WHO ARE UNINSURED/UNDER-INSURED ARE PRESENTED WITH THE OPPORTUNITY FOR FINANCIAL ASSISTANCE APPLICATION. A PATIENT FINANCIAL ASSISTANCE COUNSELOR IS AVAILABLE FULL TIME FOR INQUIRIES AND CONSULTING REGARDING ALL AVAILABLE FINANCIAL AID PROGRAMS. |
| SCHEDULE H, PART VI, LINE 4 | THE COMMUNITY IS A FRONTIER, RURAL COMMUNITY IN WESTERN KANSAS. THE RURAL POPULATION AMONG THE THREE COUNTIES SERVED BY THE FACILITY IS APPROXIMATELY 3,000 PEOPLE. THE SERVICE AREA COVERS 8,000 SQUARE MILES. THE AREA IS PREDOMINANTLY AGRICULTURAL BASED. |
| SCHEDULE H, PART VI, LINE 5 | THE FACILITY DOES HAVE AN OPEN MEDICAL STAFF WITH SUPPORTING MID-LEVEL PRACTITIONERS, A COUNTY GOVERNMENT APPOINTED COMMUNITY BOARD THAT RECEIVES APPROXIMATELY 3% SUPPORT FROM LOCAL TAX APPROPRIATIONS, AND HOLDS NUMEROUS COMMUNITY ACTIVITIES SUCH AS HEALTH FAIRS, FREE FLU SHOT CLINICS, AND NUMEROUS HEALTH AND WELLNESS ACTIVITIES TO PROMOTE COMMUNITY HEALTH. |
| SCHEDULE H, PART VI, LINE 6 | N/A |
| SCHEDULE H, PART VI, LINE 7 | N/A |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | false | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | false | 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 (2 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| WENDEL ELLIS | ||||||||||||||
| MD | $331,631 | $0 | $0 | $0 | $815 | $0 | $10,039 | $0 | $24,547 | $0 | $367,032 | $0 | $0 | $0 |
| SHEILA M SCHEFFE | ||||||||||||||
| MD | $164,233 | $0 | $0 | $0 | $711 | $0 | $4,954 | $0 | $8,438 | $0 | $178,336 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE J, PART I, LINE 3 | FormAndLineReferenceDesc |
| Explanation | COMPENSATION FOR BURKE KLINE, CEO, IS SET BY QUOROM HEALTH RESOURCES, AN INDPENDENT ORGANIZATION THAT WAS CONTRACTED TO PERFORM THE MANAGEMENT SERVICES FOR GREELEY COUNTY HEALTH SERVICES, INC. QUOROM HEALTH RESOURCES USED A WRITTEN EMPLOYMENT CONTRACT AND APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE IN DETERMING COMPENSATION. | ExplanationTxt |
Schedule L IRS990ScheduleL
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp
Name Of Interested NameOfInterested
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | GREAT PLAINS PHARMACY - CHRIS DIXON | PersonNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Relationship Description | TRUSTEE | RelationshipDescriptionTxt |
| Transaction | $416,161 | TransactionAmt |
| Transaction | DRUG STORE PURCHASES | TransactionDesc |
| Sharing Of Revenues | false | SharingOfRevenuesInd |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (6 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART III, LINE 1 | GREELEY COUNTY HEALTH SERVICES STRIVES TO ADDRESS THE HEALTHCARE NEEDS OF THE REGION THROUGH THE EFFECTIVE PARTNERING OF A COMPASSIONATE STAFF WITH QUALITY CARE ROOTED IN THE CONTINUOUS PURSUIT OF BEST PRACTICES. WE UTILIZE APPROPRIATE TECHNOLOGY TO MINIMIZE THE EFFECTS OF CHRONIC DISEASE, FOCUS ON PROVIDING PREVENTIVE MEDICINE AND TREAT EACH PATIENT'S MIND, BODY AND SOUL WITHIN THE FAMILY MEDICINE SPECTRUM OF CARE. FORM 990, PART VI, SECTION A, LINE 3 GREELEY COUNTY HEALTH SERVICES HOLDS A MANAGEMENT CONTRACT WITH QUORUM HEALTH RESOURCES OF BRENTWOOD, TENNESSEE. QUORUM HEALTH RESOURCES APPOINTS A CHIEF EXECUTIVE OFFICER TO MANAGE DAY-TO-DAY OPERATIONS. DURING 2017. BURKE KLINE SERVED AS THE TOP MANAGEMENT OFFICIAL FOR GREELEY COUNTY HEALTH SERVICES. HIS COMPENSATION IS INCLUDED IN THE MANAGEMENT FEE PAID TO QUORUM HEALTH RESOURCES AND REPORTED ON PART VII, SECTION B, OF THE 990. |
| FORM 990, PART VI, SECTION B, LINE 11B | AN INDEPENDENT ACCOUNTING FIRM PREPARES THE FORM 990. THE CFO THEN REVIEWS THE COMPLETE FORM 990 AND ALL REQUIRED SCHEDULES. ANY QUESTIONS OR CONCERNS ARE ADDRESSED AND ANY NECESSARY CHANGES ARE MADE PRIOR TO FILING. THE FORM 990 WITH ALL REQUIRED SCHEDULES WILL BE PROVIDED TO THE ENTIRE BOARD SUBSEQUENT TO FILING WITH THE IRS. |
| FORM 990, PART VI, SECTION B, LINE 12C | THE CONFLICT OF INTEREST POLICY APPLIES TO ALL BOARD MEMBERS AND OFFICERS. IT IS REVIEWED ANNUALLY BY THE BOARD MEMBERS AND OFFICERS. ANY POTENTIAL CONFLICTS OF INTEREST THAT ARE DISCLOSED ARE REVIEWED BY THE BOARD CHAIRMAN TO DETERMINE IF AN ACTUAL CONFLICT OF INTEREST EXISTS. INDIVIDUALS WITH A POTENTIAL CONFLICT OF INTEREST ARE PROHIBITED FROM VOTING OR PARTICIPATING IN DISCUSSIONS REGARDING THE POTENTIAL CONFLICT. |
| FORM 990, PART VI, SECTION B, LINE 15A | THE BOARD OF DIRECTORS AND QUORUM HEALTH RESOURCES REVIEW BOTH THE CEO'S AND CFO'S COMPENSATION ANNUALLY. COMPARISON DATA FROM SIMILAR ORGANIZATIONS IS USED TO DETERMINE ANY PAY INCREASES. ALL DELIBERATIONS AND DECISIONS ARE DOCUMENTED. |
| FORM 990, PART VI, SECTION B, LINE 15B | THE BOARD OF DIRECTORS AND QUORUM HEALTH RESOURCES REVIEW KEY EMPLOYEE COMPENSATION AT CONTRACT RENEWALS. COMPARISON DATA FROM SIMILAR ORGANIZATIONS IS USED TO DETERMINE ANY PAY INCREASES. ALL DELIBERATIONS AND DECISIONS ARE DOCUMENTED. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND AUDITED FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. |