GREAT PLAINS OF SABETHA INC: Form 990, tax year 2014
View the entire original 990 at ProPublica ↗
- Organization
- GREAT PLAINS OF SABETHA INC (EIN 48-1236156)
- Tax period
- 2014-01-01 to 2014-12-31
- Filed
- 2015-11-11
- IRS object ID
- 201513159349302781
- Schema version
- 2014v5.0
- 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
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule H
- Schedule J
- Schedule M
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2015-11-11T13:33:39-06:00 | ReturnTs |
| Tax Period End | 2014-12-31 | 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 | 2014-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 481236156 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | GREAT PLAINS OF SABETHA INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| In Care Of | % MIKE HAND | InCareOfNm |
| Business Name Control | GREA | BusinessNameControlTxt |
| Phone | 3166851523 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 250 NORTH ROCK ROAD STE 160 | AddressLine1Txt |
| City | WICHITA | CityNm |
| State Abbreviation | KS | StateAbbreviationCd |
| ZIP | 67206 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | MIKE HAND | PersonNm |
| Person Title | CFO AND SENIOR VICE PRESIDENT | PersonTitleTxt |
| Phone | 7855432111 | PhoneNum |
| Signature | 2015-11-15 | SignatureDt |
| Discuss With Paid Preparer | Yes (true) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | ELIZABETH S HOGAN | PreparerPersonNm |
| PTIN | P00273248 | PTIN |
| Phone | 3162652811 | PhoneNum |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2014 | TaxYr |
| Build TS | 2016-03-07 17:11:31Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | MIKE HAND | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 250 NORTH ROCK ROAD STE 160 | AddressLine1Txt |
| City | WICHITA | CityNm |
| State Abbreviation | KS | StateAbbreviationCd |
| ZIP | 67206 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $11,540,412 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.SABETHAHOSPITAL.COM | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 2000 | FormationYr |
| Legal Domicile State | KS | LegalDomicileStateCd |
| Activity Or Mission | ACUTE CARE HOSPITAL THAT PROVIDES MEDICAL CARE TO THE GENERAL PUBLIC IN SABETHA, KANSAS AND SURROUNDING RURAL COMMUNITIES. | ActivityOrMissionDesc |
| Voting Members Governing Body | 10 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 9 | VotingMembersIndependentCnt |
| Total Employee | 167 | TotalEmployeeCnt |
| Total Volunteers | 69 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| PY Contributions Grants | $466,057 | PYContributionsGrantsAmt |
| CY Contributions Grants | $212,800 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $10,308,408 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $10,889,871 | CYProgramServiceRevenueAmt |
| PY Investment Income | $16,736 | PYInvestmentIncomeAmt |
| CY Investment Income | -$53 | CYInvestmentIncomeAmt |
| PY Other Revenue | $206,954 | PYOtherRevenueAmt |
| CY Other Revenue | $388,423 | CYOtherRevenueAmt |
| PY Total Revenue | $10,998,155 | PYTotalRevenueAmt |
| CY Total Revenue | $11,491,041 | 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 | $6,485,258 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $6,705,988 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $4,547,291 | PYOtherExpensesAmt |
| CY Other Expenses | $4,593,740 | CYOtherExpensesAmt |
| PY Total Expenses | $11,032,549 | PYTotalExpensesAmt |
| CY Total Expenses | $11,299,728 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$34,394 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $191,313 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $7,533,531 | TotalAssetsBOYAmt |
| Total Assets EOY | $7,892,337 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $1,607,258 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $1,897,732 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $5,926,273 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $5,994,605 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | TO OPERATE HOSPITAL FACILITIES FOR THE DELIVERY OF HOSPITAL AND RELATED HEALTH CARE SERVICES, HEALTH RELATED EDUCATION, AS WELL AS THE PROMOTION OF HEALTH AND WELLNESS, WITHOUT REGARD TO RACE, CREED, COLOR, SEX, OR FINANCIAL CIRCUMSTANCES. | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $9,599,651 | ExpenseAmt |
| Grant | $0 | GrantAmt |
| Revenue | $11,160,547 | RevenueAmt |
| Desc | SEE SCHEDULE O. | Desc |
| Total Program Service Expenses | $9,599,651 | 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 | Yes (true) | ConsolidatedAuditFinclStmtInd |
| School Operating | false | SchoolOperatingInd |
| Foreign Office | false | ForeignOfficeInd |
| Foreign Activities | false | ForeignActivitiesInd |
| More Than5000 K To Org | false | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividualsInd |
| Professional Fundraising | false | ProfessionalFundraisingInd |
| Fundraising Activities | false | FundraisingActivitiesInd |
| Gaming Activities | false | GamingActivitiesInd |
| Operate Hospital | 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 | false | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | Yes (true) | DeductibleNonCashContriInd |
| Deductible Art Contribution | false | DeductibleArtContributionInd |
| Terminate Operations | false | TerminateOperationsInd |
| Partial Liquidation | false | PartialLiquidationInd |
| Disregarded Entity | false | DisregardedEntityInd |
| Related Entity | Yes (true) | RelatedEntityInd |
| Related Organization Ctrl Ent | Yes (true) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | false | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | false | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | false | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (true) | ScheduleORequiredInd |
| IRP Document | 25 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (true) | BackupWthldComplianceInd |
| Employee | 167 | 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 | Yes (true) | QuidProQuoContributionsInd |
| Quid Pro Quo Contri Discl | Yes (true) | QuidProQuoContriDisclInd |
| 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 | 10 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 9 | IndependentVotingMemberCnt |
| Family Or Business Rln | Yes (true) | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | false | DelegationOfMgmtDutiesInd |
| Change To Org Documents | false | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (true) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (true) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (true) | 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 | false | CompensationProcessCEOInd |
| Compensation Process Other | false | 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 | MIKE HAND | PersonNm |
| Phone | 3166851523 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 250 NORTH ROCK ROAD STE 160 | AddressLine1Txt |
| City | WICHITA | CityNm |
| State Abbreviation | KS | StateAbbreviationCd |
| ZIP | 67206 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (18 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 |
|---|---|---|---|---|---|---|---|---|
| THOMAS E KELLER DVM | ||||||||
| CHAIRMAN/DIRECTOR | 0.25 | 2.25 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| DAVE DELLASEGA | ||||||||
| PRESIDENT/CEO/DIRECTOR | 2.0 | 40.0 | Yes (X) | Yes (X) | $0 | $184,141 | $29,272 | |
| BILL NAVIS | ||||||||
| VICE PRESIDENT/DIRECTOR | 0.25 | 2.25 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| JOHN TERRILL | ||||||||
| VICE PRESIDENT/DIRECTOR | 0.25 | 2.25 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| ROBERT HAMILTON | ||||||||
| SECRETARY/DIRECTOR | 0.25 | 2.25 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| STEVE CARLSON | ||||||||
| TREASURER/DIRECTOR | 0.25 | 2.25 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| DAVE RANKIN | ||||||||
| DIRECTOR | 0.25 | 2.25 | Yes (X) | $0 | $0 | $0 | ||
| DR BARBARA BROWN APPLEGATE | ||||||||
| DIRECTOR | 0.25 | 2.25 | Yes (X) | $0 | $0 | $0 | ||
| TERRY DESCHAINE | ||||||||
| DIRECTOR | 0.25 | 2.25 | Yes (X) | $0 | $0 | $0 | ||
| LOGAN SPRUNGER | ||||||||
| VICE PRESIDENT/DIRECTOR | 0.25 | 2.25 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| BETH MEYERES | ||||||||
| VICE PRESIDENT/DIRECTOR | 0.25 | 2.25 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| MIKE HAND | ||||||||
| CFO | 2.0 | 40.0 | Yes (X) | $0 | $136,809 | $33,148 | ||
| LORA KEY | ||||||||
| ADMINISTRATOR | 40.0 | 0.0 | Yes (X) | $92,940 | $0 | $27,973 | ||
| KEVIN KENNALLY | ||||||||
| PHYSICIAN | 40.0 | 0.0 | $276,982 | $0 | $45,032 | Yes (X) | ||
| GREGG WENGER | ||||||||
| PHYSICIAN | 40.0 | 0.0 | $187,822 | $0 | $29,108 | Yes (X) | ||
| JAMES LONGABAUGH | ||||||||
| PHYSICIAN | 40.0 | 0.0 | $225,714 | $0 | $34,225 | Yes (X) | ||
| CHRISTIAN TRAMP | ||||||||
| PHYSICIAN | 40.0 | 0.0 | $217,340 | $0 | $40,880 | Yes (X) | ||
| KERSTIN GLYNN | ||||||||
| PHYSICIAN | 40.0 | 0.0 | $250,627 | $0 | $41,954 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,251,425 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $320,950 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $281,592 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 5 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | false | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (true) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | false | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| ServicesServicesDesc | CompensationCompensationAmt |
|---|---|
| EXEC PARTNERS IN ANESTHESIA | |
| ANESTHESIA SERVICES | $350,000 |
| MHS DATA CENTER | |
| COMPUTER SUPPORT | $239,965 |
| STORMONT VAIL HEALTHCARE | |
| LAB SERVICES | $124,106 |
| GPHA | |
| MANAGEMENT | $123,303 |
| SHARED MEDICAL SERVICES INC | |
| MRI SERVICES | $107,100 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 5 | CntrctRcvdGreaterThan100KCnt |
| Fundraising | $14,394 | FundraisingAmt |
| Government Grants | $8,790 | GovernmentGrantsAmt |
| All Other Contributions | $189,616 | AllOtherContributionsAmt |
| Noncash Contributions | $72,778 | NoncashContributionsAmt |
| Total Contributions | $212,800 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | NET PATIENT SERVICE REVENUE | Desc |
| Business | 621300 | BusinessCd |
| Total Revenue Column | $10,889,871 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $10,889,871 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $10,889,871 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $17,708 | TotalRevenueColumnAmt |
| Exclusion | $17,708 | 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 | $16,500 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $16,500 | RealAmt |
| Personal | $0 | PersonalAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $16,500 | TotalRevenueColumnAmt |
| Exclusion | $16,500 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $28,386 | OtherAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $46,147 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | -$17,761 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$17,761 | TotalRevenueColumnAmt |
| Exclusion | -$17,761 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contri Rpt Fundraising Event | $14,394 | ContriRptFundraisingEventAmt |
| Fundraising Direct Expenses | $3,224 | FundraisingDirectExpensesAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$3,224 | TotalRevenueColumnAmt |
| Exclusion | -$3,224 | ExclusionAmt |
Net Income From Gaming NetIncomeFromGamingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
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 |
|---|---|---|---|---|
| EHR INCENTIVE REVENUE | 900099 | $218,208 | $218,208 | |
| OUTSIDE SERVICES | 621300 | $47,468 | $47,468 | |
| EMPLOYEE/GUEST MEALS | 722513 | $15,648 | $15,648 |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $93,823 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $5,000 | RelatedOrExemptFuncIncomeAmt |
| Exclusion | $88,823 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $375,147 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $11,491,041 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $11,160,547 | RelatedOrExemptFuncIncomeAmt |
| Exclusion | $117,694 | 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 | $120,913 | TotalAmt |
| Management And General | $120,913 | ManagementAndGeneralAmt |
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 | $5,289,522 | TotalAmt |
| Program Services | $4,607,763 | ProgramServicesAmt |
| Management And General | $681,759 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $418,798 | TotalAmt |
| Program Services | $358,139 | ProgramServicesAmt |
| Management And General | $60,659 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $516,864 | TotalAmt |
| Program Services | $398,386 | ProgramServicesAmt |
| Management And General | $118,478 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $359,891 | TotalAmt |
| Program Services | $307,700 | ProgramServicesAmt |
| Management And General | $52,191 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $105,327 | TotalAmt |
| Management And General | $105,327 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,357 | TotalAmt |
| Management And General | $6,357 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $37,940 | TotalAmt |
| Management And General | $37,940 | 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 | $1,298,140 | TotalAmt |
| Program Services | $1,093,867 | ProgramServicesAmt |
| Management And General | $204,273 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $26,223 | TotalAmt |
| Program Services | $12,943 | ProgramServicesAmt |
| Management And General | $13,280 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $221,924 | TotalAmt |
| Program Services | $152,243 | ProgramServicesAmt |
| Management And General | $69,681 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $12,634 | TotalAmt |
| Program Services | $5,882 | ProgramServicesAmt |
| Management And General | $6,752 | ManagementAndGeneralAmt |
Royalties RoyaltiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $232,492 | TotalAmt |
| Program Services | $221,233 | ProgramServicesAmt |
| Management And General | $11,259 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $16,315 | TotalAmt |
| Program Services | $5,226 | ProgramServicesAmt |
| Management And General | $11,089 | 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 | $48,138 | TotalAmt |
| Program Services | $36,868 | ProgramServicesAmt |
| Management And General | $11,270 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $17,284 | TotalAmt |
| Program Services | $15,953 | ProgramServicesAmt |
| Management And General | $1,331 | ManagementAndGeneralAmt |
Payments To Affiliates PaymentsToAffiliatesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $650,254 | TotalAmt |
| Program Services | $604,502 | ProgramServicesAmt |
| Management And General | $45,752 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $120,802 | TotalAmt |
| Program Services | $37,839 | ProgramServicesAmt |
| Management And General | $82,963 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| MEDICAL SUPPLIES & DRUGS | $1,261,976 | $1,261,960 | $16 |
| RENTAL EQUIPMENT & REPAIRS | $335,376 | $320,070 | $15,306 |
| BAD DEBT EXPENSE | $101,590 | $101,590 | |
| DUES & SUBSCRIPTIONS | $45,705 | $17,158 | $28,547 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $55,263 | TotalAmt |
| Program Services | $40,329 | ProgramServicesAmt |
| Management And General | $14,934 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $11,299,728 | TotalAmt |
| Program Services | $9,599,651 | ProgramServicesAmt |
| Management And General | $1,700,077 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $220 | BOYAmt |
| EOY | $220 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $909,276 | BOYAmt |
| EOY | $1,672,426 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $13,243 | BOYAmt |
| EOY | $5,603 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,396,966 | BOYAmt |
| EOY | $1,913,395 | 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 | $193,606 | BOYAmt |
| EOY | $176,867 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $104,132 | BOYAmt |
| EOY | $112,692 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $12,139,139 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $8,353,931 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,172,532 | BOYAmt |
| EOY | $3,785,208 | 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 | $233,556 | BOYAmt |
| EOY | $225,926 | 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 | $510,000 | BOYAmt |
| EOY | $0 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,533,531 | BOYAmt |
| EOY | $7,892,337 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,052,361 | BOYAmt |
| EOY | $1,443,802 | 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 | $554,897 | BOYAmt |
| EOY | $453,930 | EOYAmt |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,607,258 | BOYAmt |
| EOY | $1,897,732 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,913,030 | BOYAmt |
| EOY | $5,989,002 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $13,243 | BOYAmt |
| EOY | $5,603 | 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 | $5,926,273 | BOYAmt |
| EOY | $5,994,605 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,533,531 | BOYAmt |
| EOY | $7,892,337 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $191,313 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | -$122,981 | OtherChangesInNetAssetsAmt |
| 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) |
|---|---|---|
| Consol And Sep Basis Fincl Stmt | Yes (X) | ConsolAndSepBasisFinclStmtInd |
| 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
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 C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Belongs Afflt Grp | Yes (X) | OrganizationBelongsAffltGrpInd |
| 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 | Yes (true) | 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 | $2,892 | GrantsOtherOrganizationsAmt |
| Direct Contact Legislators | false | DirectContactLegislatorsInd |
| Rallies Demonstrations | false | RalliesDemonstrationsInd |
| Other Activities | false | OtherActivitiesInd |
| Total Lobbying Expenditures | $2,892 | 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 ANNUAL DUES PAID TO KHA AND AHA ARE USED FOR LOBBYING. | ExplanationTxt |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Art Public Exhibition Amounts | ArtPublicExhibitionAmountsGrp | |
| Held Works Art | HeldWorksArtGrp | |
| CY Minus3 Yr Endwmt Fund | CYMinus3YrEndwmtFundGrp | |
| CY Minus4 Yr Endwmt Fund | CYMinus4YrEndwmtFundGrp |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | $0 | InvestmentCostOrOtherBasisAmt |
| Other Cost Or Other Basis | $44,744 | OtherCostOrOtherBasisAmt |
| Book Value | $44,744 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | $0 | InvestmentCostOrOtherBasisAmt |
| Other Cost Or Other Basis | $6,468,530 | OtherCostOrOtherBasisAmt |
| Depreciation | $3,990,123 | DepreciationAmt |
| Book Value | $2,478,407 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Leasehold Improvements | LeaseholdImprovementsGrp |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | $0 | InvestmentCostOrOtherBasisAmt |
| Other Cost Or Other Basis | $5,421,846 | OtherCostOrOtherBasisAmt |
| Depreciation | $4,197,255 | DepreciationAmt |
| Book Value | $1,224,591 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | $0 | InvestmentCostOrOtherBasisAmt |
| Other Cost Or Other Basis | $204,019 | OtherCostOrOtherBasisAmt |
| Depreciation | $166,553 | DepreciationAmt |
| Book Value | $37,466 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $3,785,208 | TotalBookValueLandBuildingsAmt |
| Total Rev Etc Audited Fincl Stmt | $11,426,294 | TotalRevEtcAuditedFinclStmtAmt |
| Other Revenue | -$64,747 | OtherRevenueAmt |
| Revenue Not Reported | -$64,747 | RevenueNotReportedAmt |
| Revenue Subtotal | $11,491,041 | RevenueSubtotalAmt |
| Total Revenue Per Form990 | $11,491,041 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $11,357,962 | TotExpnsEtcAuditedFinclStmtAmt |
| Other Expenses Included | $159,824 | OtherExpensesIncludedAmt |
| Expenses Not Reported | $159,824 | ExpensesNotReportedAmt |
| Expenses Subtotal | $11,198,138 | ExpensesSubtotalAmt |
| Other Expenses Not Included | $101,590 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $101,590 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $11,299,728 | 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 EQUITY IN EARNINGS SABETHA HEALTHCARE, INC. 33,619 SPECIAL EVENT EXPENSES 3,224 PROVISION FOR UNCOLLECTIBLE ACCOUNTS (101,590) ---------- TOTAL $ (64,747) |
| SCHEDULE D, PART XII, LINE 2D | TRANSFER TO CITY OF SABETHA 156,600 SPECIAL EVENT EXPENSES 3,224 ---------- TOTAL $ 159,824 |
| SCHEDULE D, PART XII, LINE 4B | PROVISION FOR UNCOLLECTIBLE ACCOUNTS 101,590 |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (true) | FinancialAssistancePolicyInd |
| Written Policy | Yes (true) | WrittenPolicyInd |
| FPG Reference Free Care | false | FPGReferenceFreeCareInd |
| 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 | $46,648 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $46,648 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00400 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $426,418 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $198,518 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $227,900 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02000 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $473,066 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $198,518 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $274,548 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02400 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 17 | ActivitiesOrProgramsCnt |
| Total Community Benefit Expns | $284,568 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $189,634 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $94,934 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00800 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 1 | ActivitiesOrProgramsCnt |
| Total Community Benefit Expns | $238 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $238 | NetCommunityBenefitExpnsAmt |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 3 | ActivitiesOrProgramsCnt |
| Persons Served | 11 | PersonsServedCnt |
| Total Community Benefit Expns | $3,821 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $3,821 | NetCommunityBenefitExpnsAmt |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 21 | ActivitiesOrProgramsCnt |
| Persons Served | 11 | PersonsServedCnt |
| Total Community Benefit Expns | $288,627 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $189,634 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $98,993 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00800 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 21 | ActivitiesOrProgramsCnt |
| Persons Served | 11 | PersonsServedCnt |
| Total Community Benefit Expns | $761,693 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $388,152 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $373,541 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.03200 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | false | BadDebtExpenseReportedInd |
| Bad Debt Expense | $101,591 | BadDebtExpenseAmt |
| Reimbursed By Medicare | $4,257,566 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $4,257,566 | CostOfCareReimbursedByMedcrAmt |
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 | SABETHA COMMUNITY HOSPITAL | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 14TH OREGON PO BOX 229 | AddressLine1Txt |
| City | SABETHA | CityNm |
| State Abbreviation | KS | StateAbbreviationCd |
| ZIP | 66534 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | WWW.SABETHAHOSPITAL.ORG | WebsiteAddressTxt |
| State License | H066002 | 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 | SABETHA COMMUNITY HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | false | 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 |
| Information Gaps | Yes (X) | InformationGapsInd |
| CHNA Conducted | 13 | CHNAConductedYr |
| Take Into Account Others Input | Yes (true) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | Yes (true) | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | false | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (true) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | WWW.SABETHAHOSPITAL.COM | OwnWebsiteURLTxt |
| Implementation Strategy Adopt | Yes (true) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 13 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (true) | StrategyPostedWebsiteInd |
| Strategy Website URL | WWW.SABETHAHOSPITAL.COM | StrategyWebsiteURLTxt |
| Strategy Attached | false | StrategyAttachedInd |
| 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 | 0. | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 300. | FPGFamilyIncmLmtDscntCarePct |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Other Criteria | Yes (X) | OtherCriteriaInd |
| Explained Basis | Yes (true) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (true) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Includes Publicity Measures | Yes (true) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | X | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | X | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | X | FAPSummaryOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Actions On Nonpayment | Yes (true) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | false | CollectionActivitiesInd |
| FAP Notified Upon Admission | Yes (X) | FAPNotifiedUponAdmissionInd |
| FAP Notified Before Discharge | Yes (X) | FAPNotifiedBeforeDischargeInd |
| FAP Notified All Patients | Yes (X) | FAPNotifiedAllPatientsInd |
| Documented Elig Determination | Yes (X) | DocumentedEligDeterminationInd |
| Nondis Emergency Care Policy | Yes (true) | NondisEmergencyCarePolicyInd |
| Lowest Negotiated Rates | Yes (X) | LowestNegotiatedRatesInd |
| Medicare Rates | Yes (X) | MedicareRatesInd |
| Amounts Generally Billed | false | AmountsGenerallyBilledInd |
| Gross Charges | false | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| SCHEDULE H, PART V, SECTION B, LINE 5 | A PRIORITY OF THE PROGRAM IS TO SOLICIT INPUT FROM A BROAD CROSS SECTION OF THE COMMUNITY, NOT SIMPLY MEMBERS OF THE LOCAL HEALTHCARE SECTOR. THE MEETING PARTICIPANTS INCLUDED COMMUNITY RESIDENTS AND GOVERNMENTAL AND BUSINESS LEADERS WITHIN THE COMMUNITY. |
| SCHEDULE H, PART V, SECTION B, LINE 6A | NEMAHA VALLEY COMMUNITY HOSPITAL |
| SCHEDULE H, PART V, SECTION B, LINE 11 | SABETHA COMMUNITY HOSPITAL INTENDS TO PROMOTE HEALTH AND WELLNESS THROUGH MONTHLY EDUCATIONAL CALENDARS, NEWS ARTICLES IN THE LOCAL NEWSPAPER, AND HOSTING EDUCATIONAL CLASSES AND EVENTS. ANOTHER PRIORITY IDENTIFIED BY THE CHNA WAS TO IMPROVE ACCESS TO MENTAL HEALTH ASSISTANCE. THE HOSPITAL HAS MET WITH KANZA MENTAL HEALTH TO WORK ON CREATING A BETTER RELATIONSHIP. THE SCREENING PROCESS IS NOW THROUGH VIDEO RATHER THAN IN PERSON, WHICH CREATES A SHORTER WAIT TIME FOR THE PATIENT. IMPROVING ACCESS TO INFORMATION AND ASSISTANCE WAS ALSO AN IDENTIFIED NEED OF THE COMMUNITY. THE COMMITTEE, AFTER MUCH RESEARCH, DECIDED TO TABLE THE COUNTY-WIDE APP DEVELOPMENT UNTIL WEBSITE IMPROVEMENTS WERE MADE, FUNDING OPTIONS WERE FOUND, AND AN ENTITY TO BE RESPONSIBLE FOR THE MAINTENANCE OF THE DATABASE COULD BE FOUND. |
| SCHEDULE H, PART V, SECTION B, LINE 13H | THE ORGANIZATION EMPLOYS A SLIDING SCALE DISCOUNT THAT TAKES INTO CONSIDERATION A PATIENT'S HOUSEHOLD INCOME AND QUALIFYING ASSETS. TO BE ELIGIBLE FOR FINANCIAL ASSISTANCE, A PATIENT'S HOUSEHOLD INCOME MUST BE BELOW 300% OF THE MOST RECENT FEDERAL POVERTY LEVEL AT THE DATE OF SERVICE. TO DETERMINE THE AMOUNT OF THE DISCOUNT, AN ASSET TEST IS ALSO UTILIZED. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SABETHA FAMILY PRACTICE | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1115 MAIN STREET | AddressLine1Txt |
| City | SABETHA | CityNm |
| State Abbreviation | KS | StateAbbreviationCd |
| ZIP | 66534 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | FAMILY CLINIC | FacilityTxt |
Supplemental Information Detail SupplementalInformationDetail (13 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| SCHEDULE H, PART I, LINE 3C | THE ORGANIZATION EMPLOYS A SLIDING SCALE DISCOUNT THAT TAKES INTO CONSIDERATION A PATIENT'S HOUSEHOLD INCOME AND QUALIFYING ASSETS. TO BE ELIGIBLE FOR FINANCIAL ASSISTANCE, A PATIENT'S HOUSEHOLD INCOME MUST BE BELOW 300% OF THE MOST RECENT FEDERAL POVERTY LEVEL AT THE DATE OF SERVICE. TO DETERMINE THE AMOUNT OF THE DISCOUNT, AN ASSET TEST IS ALSO UTILIZED. |
| 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 $101,591. |
| 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 III, LINE 2 | HOSPITAL CHARGES THAT ARE NOT COLLECTED AND ARE NOT APPROVED FOR FINANCIAL ASSISTANCE ARE CLASSIFIED AS BAD DEBTS FROM PATIENTS WHO WILL NOT PAY. SCHEDULE H, PART III, LINE 3 THE COSTING METHODOLOGY IS BASED ON THE ORGANIZATION'S MEDICARE COST-TO-CHARGE RATIO. WHILE WE RECOGNIZE THAT THERE WOULD BE SOME BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S CHARITY CARE POLICY, WE HAVE NO REASONABLE BASIS FOR ESTIMATING THIS FIGURE. IF ELIGIBILITY IS KNOWN, THE AMOUNT WOULD FALL UNDER CHARITY CARE AND NOT BAD DEBT. |
| SCHEDULE H, PART III, LINE 4 | NO SEPARATE BAD DEBT EXPENSE DISCLOSURE. ACCOUNTS ARE CONSIDERED DELINQUENT AND SUBSEQUENTLY WRITTEN OFF AS BAD DEBTS BASED ON INDIVIDUAL CREDIT EVALUATION AND SPECIFIC CIRCUMSTANCES OF THE ACCOUNT. DISCLOSURES ON PROVISION FOR DOUBTFUL ACCOUNT ARE RELATED TO DISCLOSURES REGARDING THE ALLOWANCE FOR DOUBTFUL ACCOUNTS WHICH IS SET FOR ALL NON-MEDICARE ACCOUNTS RECEIVABLE OVER 150 DAYS OLD. THE PROVISION FOR DOUBTFUL ACCOUNTS IS A SEPARATE EXPENSE ON THE STATEMENT OF OPERATIONS AND CHANGES IN NET ASSETS. |
| SCHEDULE H, PART III, LINE 8 | THE COSTING METHODOLOGY USED TO CALCULATE THE AMOUNT ON LINE 6 IS A COST TO CHARGE RATIO. |
| SCHEDULE H, PART III, LINE 9B | ALL CHARITY CARE CHARGES AND CHARGES NOT TO BE COLLECTED DUE TO FINANCIAL ASSISTANCE COMPUTATIONS ARE EXEMPTED FROM COLLECTION POLICIES AND PRACTICES. THOSE ACCOUNTS ARE REMOVED FROM THE COLLECTION CYCLE. |
| SCHEDULE H, PART VI, LINE 2 | SABETHA COMMUNITY HOSPITAL AND NEMAHA VALLEY COMMUNITY HOSPITAL PARTNERED IN OCTOBER OF 2012 AND CONDUCTED A COMMUNITY HEALTH CARE NEEDS ASSESSMENT. NUMEROUS OBJECTIVES WERE IDENTIFIED BUT THE MAIN PRIORITIES TO BE ADDRESSED ARE 1) PROMOTE HEALTH, WELLNESS, AND CHRONIC DISEASE PREVENTION; 2) IMPROVE ACCESS TO MENTAL HEALTH ASSISTANCE; 3) IMPROVE ACCESS TO INFORMATION AND ASSISTANCE ACROSS MULTIPLE NEEDS AND POPULATIONS. THE CHNA IS POSTED ON THE SABETHA COMMUNITY HOSPITALS WEBSITE FOR EASY ACCESS BY THE COMMUNITIES. IN 2014, SCH COMMITTED TO FURTHERING THOSE PRIORITIES IN THE COMMUNITY THROUGH INVOLVEMENT OF THE MEDICAL STAFF, BOARD OF DIRECTORS, AND OTHER IDENTIFIED STAFF MEMBERS. DURING 2014, THE HOSPITAL UPDATED ITS WEBSITE AND THE HOME HEALTH AND HOSPICE AGENCY ADDED A SOCIAL MEDIA PAGE. TO ADDRESS PRIORITY #1; THE HOSPITAL PROVIDED EDUCATIONAL INFORMATION THROUGH ITS MONTHLY OUTPATIENT CALENDARS AND THROUGH THE MULTIPLE CLINICS PROVIDED TO THE COMMUNITY - A DERMATOLOGY AND BREASTFEEDING CLINIC WAS ADDED IN 2014. DIABETIC EDUCATION CONTINUES TO BE A PRIORITY AND THE DIABETIC EDUCATOR AND DIETICIAN PARTNERED WITH BCBS OF KANSAS TO PRESENT, "DIABETES AND YOU" TO THE COMMUNITY. THROUGH THE HOSPICE PROGRAM, BEREAVEMENT SUPPORT AND EDUCATION MATERIALS ARE PROVIDED FOR THOSE IN THE COMMUNITY WHO HAVE LOST LOVED ONES. IN NOVEMBER, MEDICARE PART D INFORMATIONAL MEETINGS WERE CONDUCTED FOR MEDICARE ELIGIBLE PATIENTS, AND THROUGHOUT THE YEAR THE HOSPITAL SOCIAL WORKER CONTINUES TO PROVIDE ENROLLMENT ASSISTANCE SUCH AS MEDICAID, MEDICARE AND THIRD PARTY PAYERS TO LOCAL COMMUNITY MEMBERS. THE HOSPITAL TRAUMA PROGRAM PROVIDED SAFETY EDUCATION AND ITEMS TO THE LOCAL GUN SAFETY EDUCATION CLASS. THE HOSPITAL CONTINUES TO PARTICIPATE IN THE HCAPS SURVEY AND RESULTS ARE REVIEWED WITH STAFF ANNUALLY. THE HOSPITAL IS PARTICIPATING IN THE KANSAS HEALTH ENGAGEMENT NETWORK AND HAS SUCCESSFULLY COMPLETED SEVERAL QUALITY PROJECTS. PRIORITY #2; SCH AND NVCH EXPLORED SEVERAL OPTIONS FOR BETTER ACCESS TO MENTAL HEALTH. DISCUSSIONS WERE HELD WITH THE COMMUNITY MENTAL HEALTH CENTER AND THE OUTCOME WAS A CRISIS MENTAL HEALTH SCREENING TOOL USED WITHIN THE ED. FURTHER OPTIONS WERE EXPLORED BUT FINANCIAL FEASIBILITY WAS A CONSTRAINT. AS MENTIONED EARLIER PRIORITY #3; TO IMPROVE ACCESS TO INFORMATION AND ASSISTANCE RESOURCES - THE HOSPITAL DID UPDATE ITS WEBSITE AND POSTED THE DIRECTORY FROM THE 2012 CHNA ON THE WEBSITE. THE HOME HEALTH AND HOSPICE SOCIAL MEDIA PAGE IS USED ALSO TO UPDATE THE COMMUNITY ON RESOURCES. THE SOCIAL WORKER WORKS WITH A LOCAL GROUP THROUGH THE LIBRARY, DAYCARE, PARENTS AS TEACHERS, AND OTHER ORGANIZATIONS TO REMAIN UPDATED ON COMMUNITY RESOURCES AND NEEDS, AND TO SHARE HOSPITAL RESOURCES BACK TO THE COMMUNITY. |
| SCHEDULE H, PART VI, LINE 3 | THE FOLLOWING MEASURES ARE USED TO PUBLICIZE THE PROGRAM TO THE COMMUNITY AND PATIENTS: 1. POSTING THE FINANCIAL ASSISTANCE PROGRAM, FINANCIAL ASSISTANCE APPLICATION AND A SUMMARY OF THE POLICY ON THE SABETHA COMMUNITY HOSPITAL WEBSITE AT THE FOLLOWING LOCATION: WWW.SABETHAHOSPITAL.COM 2. PROVIDING PAPER COPIES OF THE PROGRAM, APPLICATION AND SUMMARY OF THE PROGRAM UPON REQUEST IN ADMISSIONS AND PATIENT FINANCIAL SERVICES AT SABETHA COMMUNITY HOSPITAL. 3. POSTING NOTICES ABOUT THE PROGRAM IN THE EMERGENCY DEPARTMENT, ADMITTING AREAS, CLINIC LOBBY AND BUSINESS OFFICE OF SABETHA COMMUNITY HOSPITAL. 4. DISTRIBUTING A PLAIN LANGUAGE SUMMARY OF THE PROGRAM AND OFFERING A FINANCIAL ASSISTANCE APPLICATION TO PATIENTS BEFORE DISCHARGE FROM THE HOSPITAL. 5. INFORMING PATIENTS ABOUT THE PROGRAM IN PERSON OR DURING BILLING AND CUSTOMER SERVICE PHONE CONTACTS. 6. PROVIDING A SUMMARY OF THE PROGRAM IN THE PATIENTS' MONTHLY BILLING STATEMENT. THE FINANCIAL ASSISTANCE PROGRAM EMPLOYS A SLIDING SCALE DISCOUNT THAT TAKES INTO CONSIDERATION A PATIENT'S HOUSEHOLD INCOME AND QUALIFYING ASSETS. THE FINANCIAL COUNSELOR CONSULTS WITH PRIVATE PAY PATIENTS TO SEE IF THEY QUALIFY FOR THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY. IF DISCOVERED DURING THE ACCOUNTS RECEIVABLE COLLECTION PROCESS THAT A PATIENT IS HAVING TROUBLE PAYING BILLS, BOTH THE HOSPITAL AND THE CLINIC WILL INFORM THE PATIENT THAT FINANCIAL ASSISTANCE IS AVAILABLE. AS PART OF THE FINANCIAL ASSISTANCE PROGRAM ALL APPLICANTS MUST APPLY FOR MEDICAID. TO DETERMINE IF THE PATIENT MAY QUALIFY FOR FINANCIAL ASSISTANCE, THE FINANCIAL COUNSELOR GIVES PATIENT FORMS TO COMPLETE AND ASKS TO SEE BANK STATEMENTS, TAX RETURNS, ETC. COMPUTATIONS BASED ON CURRENT FEDERAL POVERTY LEVEL GUIDELINES ARE COMPLETED TO SEE IF QUALIFICATIONS IS APPROPRIATE AND THE PERCENTAGE OF CHARGES TO BE WRITTEN OFF IS DETERMINED, BASED ON FAMILY SIZE AND HOUSEHOLD INCOME. ALL INSTANCES OF FINANCIAL ASSISTANCE ARE APPROVED BY UPPER MANAGEMENT OF THE HOSPITAL. INFORMATION ABOUT FINANCIAL ASSISTANCE IS POSTED ON THE HOSPITAL WEBSITE AND THE FINANCIAL ASSISTANCE FORM CAN BE DOWNLOADED FROM WWW.SABETHAHOSPITAL.COM |
| SCHEDULE H, PART VI, LINE 4 | SABETHA COMMUNITY HOSPITAL IS A 25 BED CRITICAL ACCESS HOSPITAL LOCATED IN THE CITY OF SABETHA, NEMAHA COUNTY KANSAS. CURRENTLY THE POPULATION IS ESTIMATED AT 2800. THE PRIMARY SERVICE AREA FOR SABETHA COMMUNITY HOSPITAL INCLUDES PORTIONS OF NEMAHA, BROWN AND JACKSON COUNTY, KANSAS AND SEVERAL COUNTIES IN NEBRASKA. NEMAHA COUNTY PROVIDED 78.5% OF INPATIENT DISCHARGES FOR 2014. ESTIMATED POPULATION FOR NEMAHA COUNTY IS 10,161 ACCORDING TO THE KANSAS STATE RESEARCH AND EXTENSION ECONOMIC IMPACT STUDY. PEOPLE AGE 65 AND OVER MAKE UP 20.2% OF THE COUNTYS TOTAL POPULATION. THE RACIAL AND ETHNIC COMPOSITION OF NEMAHA COUNTY IS MOSTLY WHITE WHICH IS AT 97.1%, NATIVE AMERICAN .6%, AFRICAN AMERICANS .7%, ASIANS .2% AND HISPANICS WERE 1.4% OF THE POPULATION. |
| SCHEDULE H, PART VI, LINE 5 | SABETHA COMMUNITY HOSPITALS EMERGENCY ROOM/TRAUMA QUALITY ASSURANCE COMMITTEE MEETS MONTHLY TO MAINTAIN THE LEVEL IV TRAUMA CENTER DESIGNATION. THE COMMITTEE PROVIDED GUN LOCKS TO THE LOCAL FIREARMS GROUP DURING THEIR SAFETY EDUCATION CLASS AND FIRE PREVENTION BOOKLETS TO THE ELEMENTARY STUDENTS TO PROMOTE FIRE SAFETY. ALL CRITERIA WAS MET IN 2014 TO MAINTAIN THE DESIGNATION AS A STROKE READY FACILITY. SABETHA FAMILY PRACTICE CONTINUED TO PURSUE THE NCQA DESIGNATION. SFP IMPLEMENTED A PATIENT PORTAL TO TRY AND MEET CRITERIA FOR STAGE 2 MEANINGFUL USE OF THE ELECTRONIC RECORD. THE HOSPITAL ADDED A PATIENT PORTAL AS WELL AS MAINTAINING THE CURRENT MODULES FOR THE SIEMENS MEDSERIES 4 ELECTRONIC HEALTH RECORD. THROUGHOUT 2014, THE HOSPITAL MAINTAINED ITS CERTIFICATION AS A MEDICARE CERTIFIED DIABETIC EDUCATION FACILITY, AND THE CERTIFIED DIABETIC NURSE EDUCATOR ALONG WITH THE REGISTERED DIETICIAN PROVIDED A SUPPORT GROUP TO DIABETIC PATIENTS PROMOTING LIFE STYLE CHANGES AND ACCOUNTABILITY IN THEIR DIABETIC JOURNEY. SCH ALSO PARTNERED WITH BCBS OF KANSAS FOR A COMMUNITY DIABETIC EDUCATION EVENT. THE WELLNESS COORDINATOR OF THE HOSPITAL SITS ON THE WELLNESS COUNCIL FOR THE LOCAL SCHOOL DISTRICT. THE HOSPITAL ALSO PROMOTES WELLNESS AMONG EMPLOYEES BY PROVIDING A CORPORATE MEMBERSHIP TO THE COMMUNITY FITNESS ROOM. IN MARCH, EMPLOYEES AND THE COMMUNITY WERE ENCOURAGED TO PARTICIPATE IN THE ANNUAL WALK ACROSS KANSAS PROGRAM PROMOTED BY THE MEADOWLARK COUNTY EXTENSION OFFICE. MONTHLY OUTPATIENT CALENDARS FOCUSING ON HEALTH ISSUES ARE PUBLISHED AND SENT OUT TO THE COMMUNITY AND SURROUNDING AREAS. SABETHA COMMUNITY HOSPITAL GUILD MEMBERS VOLUNTEER TO COORDINATE EFFORTS TO HOLD BLOODMOBILE CLINICS AND THE HOSPITAL VOLUNTEER CORE CONTINUES TO REMAIN STRONG WITH COMMUNITY MEMBERS BEING UTILIZED IN MANY AREAS OF THE HOSPITAL. ANOTHER SERVICE TO THE COMMUNITY IS THE PROVISION OF OCCUPATIONAL ASSESSMENT TESTING ALONG WITH HEARING SCREENS. CERTIFIED STAFF IS AVAILABLE IN HOUSE TO PROVIDE THOSE SERVICES. STAFF WILL ALSO CONDUCT ERGONOMIC CHECKS AND BLOOD PRESSURE CHECKS WHEN REQUESTED AT THE LOCAL BUSINESSES AS WELL AS MINI HEALTH FAIRS AND WELLNESS EDUCATION. FIRST GRADE STUDENTS ARE INVITED TO ATTEND AN ANNUAL HOSPITAL TOUR GUIDING THEM THROUGH VARIOUS DEPARTMENTS OF THE HOSPITAL. DURING THE FLU SEASON, FLU CLINICS ARE OFFERED TO THE COMMUNITY AT THE HOSPITAL, AND HOSPITAL STAFF ALSO CONDUCTS FLU CLINICS AT THE LOCAL GROCERY STORE AS WELL AS ONSITE FLU VACCINATIONS FOR SEVERAL LOCAL BUSINESSES. HOSPITAL STAFF PROVIDES CPR TRAINING FOR PROFESSIONALS IN THE AREA. THE HOSPITAL PROVIDES PRENATAL CLASSES INCLUDING CPR TRAINING, BREASTFEEDING AND CARE OF A NEWBORN INFANT ON A QUARTERLY BASIS FOR EXPECTANT PARENTS. CARDIAC REHAB PHASE III IS OPEN TO THE COMMUNITY TO OFFER SUPPORT IN AN EXERCISE PROGRAM, ESPECIALLY FOR THOSE PATIENTS WHO HAVE GRADUATED FROM THE CARDIAC REHAB PHASE II PROGRAM. SOCIAL SERVICES AIDS THOSE IN THE COMMUNITY WHO ARE IN NEED OF ENROLLMENT ASSISTANCE, WHETHER IT BE FOR MEDICAID, MEDICARE, MEDICARE PART D SERVICES, OR OTHER INFORMATION REFERRAL ASSISTANCE. SOCIAL SERVICE AND SWINGBED DIRECTOR COORDINATE TRANSFER OF PATIENTS TO THE LOCAL DIALYSIS CENTER. ONE OF THE HOSPITAL PHYSICIANS SITS AS THE MEDICAL DIRECTOR FOR THE CITY OWNED AMBULANCE SERVICE AND THE HOSPITAL PROVIDES RNS AS NEEDED FOR EMERGENCY INDICATED TRANSFERS TO THE LOCAL TERTIARY CENTER. THE FIVE FAMILY PRACTICE PHYSICIANS SERVE AS MEDICAL DIRECTORS FOR THE HOME HEALTH AND HOSPICE AGENCY. THE CHIEF EXECUTIVE OFFICER OF SABETHA COMMUNITY HOSPITAL SERVES ON THE KANSAS HOSPITAL ASSOCIATIONS POLICY AND ADVOCACY COMMITTEE, THE HEALTH INNOVATIONS NETWORK OF KANSAS BOARD, THE KANSAS HEALTH CARE COLLABORATIVE BOARD, THE KANSAS HOSPITAL ASSOCIATION KANCARE TECHNICAL ADVISORY GROUP, AND THE GOVERNORS KANCARE ADVISORY GROUP. SABETHA COMMUNITY HOSPITAL TAKES ITS COMMITMENT TO THE COMMUNITY VERY SERIOUSLY AND PARTICIPATES IN EMERGENCY DRILLS, ALWAYS MONITORING PATIENT AND EMPLOYEE SAFETY, EDUCATING STAFF ON RISK MANAGEMENT, QUALITY ASSURANCE, INFECTION CONTROL ISSUES, BLOOD BORN PATHOGENS, HIPAA AND CORPORATE COMPLIANCE. THE HOSPITAL PROVIDES AN AVENUE FOR NURSING STUDENTS TO DO ROTATIONS THROUGH THE HOSPITAL WITH ITS AFFILIATION WITH HIGHLAND COMMUNITY COLLEGE AND SOUTHEAST COMMUNITY COLLEGE, BEATRICE, NEBRASKA. MEDICAL STUDENTS IN THE RURAL RESIDENCY PROGRAM AT KANSAS UNIVERSITY SCHOOL OF MEDICINE ARE ABLE TO DO CLINICAL ROTATIONS WITH THE FAMILY PHYSICIANS. PHYSICAL THERAPY STUDENTS THROUGH AFFILIATION WITH KANSAS CITY KANSAS COMMUNITY COLLEGE AND INDIAN HILLS COMMUNITY COLLEGE, OCCUPATIONAL THERAPY STUDENTS THROUGH WASHBURN UNIVERSITY AFFILIATION AND SOCIAL SERVICE STUDENTS FROM KANSAS STATE UNIVERSITY ALL DO CLINICAL ROTATIONS AT THE HOSPITAL AS WELL. HOSPITAL ADMINISTRATION WORKS CLOSELY WITH THE HIGH SCHOOL COUNSELOR IN THE ADMINISTRATION OF LOCAL SCHOLARSHIPS TO NURSING STUDENTS AND TO THOSE WHO ARE GOING INTO A HEALTHCARE CAREER. HOSPITAL STAFF PARTICIPATE IN SENIOR CAREER DAY AT THE LOCAL HIGH SCHOOL AND EVERY YEAR MIDDLE SCHOOL AND HIGH SCHOOL STUDENTS JOB SHADOW AT THE HOSPITAL TO ENCOURAGE CAREERS IN HEALTHCARE. |
| SCHEDULE H, PART VI, LINE 6 | THE ORGANIZATION IS AFFILIATED WITH GREAT PLAINS HEALTH ALLIANCE, INC. (GPHA), A NON-PROFIT 501C3 ORGANIZATION WHICH PROVIDES MANAGEMENT SERVICES AND OPERATIONAL, FINANCE AND ACCOUNTING SUPPORT TO THE HOSPITAL. GPHA DOES NOT PROVIDE SERVICES DIRECTLY TO PATIENTS, BUT DOES PROVIDE ACCESS TO PROFESSIONALS THAT MAY NOT BE AFFORDABLE TO THE NORMAL CRITICAL ACCESS HOSPITAL. GPHA PROVIDES EDUCATION AND ASSISTANCE IN AREAS SUCH AS HIPAA, MEDICARE REIMBURSEMENT, MEANINGFUL USE REQUIREMENTS FOR COMPUTER SYSTEMS, ETC. GPHA IS AN AFFILIATION OF CRITICAL ACCESS HOSPITALS IN KANSAS AND NEBRASKA THAT PROVIDES NETWORKING OPPORTUNITIES WITH OTHER RURAL HOSPITAL, COMMUNITIES AND LEADERS. GPHA PROVIDES POLICIES AND GUIDANCE TO ITS CRITICAL ACCESS FACILITIES REGARDING FINANCIAL ASSISTANCE, CONFLICTS OF INTEREST, CORPORATE COMPLIANCE, HIPAA PRIVACY AND SECURITY AND MANY OTHER AREAS. GPHA ALSO PROVIDES EDUCATIONAL SESSIONS FOR BOARD MEMBERS, BUSINESS OFFICE MANGERS, BILLERS, MEDICAL RECORDS PERSONNEL, DIRECTOR OF NURSING AND ADMINISTRATORS. GPHA IS A VITAL LINK IN ALLOWING CAH HOSPITALS TO OPERATE AT A HIGH QUALITY WITHIN THE CASH CONSTRAINTS IMPOSED BY THE CRITICAL ACCESS PROGRAM. |
| SCHEDULE H, PART VI, LINE 7 | N/A |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| 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 (7 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | 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 |
|---|---|---|---|---|---|---|---|---|---|---|
| DAVE DELLASEGA | ||||||||||
| PRESIDENT/CEO/DIRECTOR | $0 | $184,141 | $0 | $17,850 | $0 | $11,422 | $0 | $213,413 | $0 | $0 |
| MIKE HAND | ||||||||||
| CFO | $0 | $136,809 | $0 | $13,165 | $0 | $19,983 | $0 | $169,957 | $0 | $0 |
| KEVIN KENNALLY | ||||||||||
| PHYSICIAN | $276,982 | $0 | $25,200 | $0 | $19,832 | $0 | $322,014 | $0 | $0 | $0 |
| GREGG WENGER | ||||||||||
| PHYSICIAN | $187,822 | $0 | $18,296 | $0 | $10,812 | $0 | $216,930 | $0 | $0 | $0 |
| JAMES LONGABAUGH | ||||||||||
| PHYSICIAN | $225,714 | $0 | $22,175 | $0 | $12,050 | $0 | $259,939 | $0 | $0 | $0 |
| CHRISTIAN TRAMP | ||||||||||
| PHYSICIAN | $217,340 | $0 | $22,033 | $0 | $18,847 | $0 | $258,220 | $0 | $0 | $0 |
| KERSTIN GLYNN | ||||||||||
| PHYSICIAN | $250,627 | $0 | $25,104 | $0 | $16,850 | $0 | $292,581 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | FORM 990, PART VII; SCHEDULE J, PART I, LINE 3 | FormAndLineReferenceDesc |
| Explanation | COMPENSATION FOR MIKE HAND AND DAVE DELLASEGA IS PROVIDED BY GREAT PLAINS HEALTH ALLIANCE, A RELATED ORGANIZATION. GREAT PLAINS HEALTH ALLIANCE'S BOARD OF DIRECTORS ANNUALLY APPROVE THE COMPENSATION FOR MR. HAND AND MR. DELLASEGA. | ExplanationTxt |
Schedule M IRS990ScheduleM
| Field | Value | IRS element (for citing) |
|---|---|---|
| Works Of Art | WorksOfArtGrp | |
| Art Historical Treasures | ArtHistoricalTreasuresGrp | |
| Art Fractional Interest | ArtFractionalInterestGrp | |
| Books And Publications | BooksAndPublicationsGrp | |
| Clothing And Household Goods | ClothingAndHouseholdGoodsGrp | |
| Cars And Other Vehicles | CarsAndOtherVehiclesGrp | |
| Boats And Planes | BoatsAndPlanesGrp | |
| Intellectual Property | IntellectualPropertyGrp | |
| Securities Publicly Traded | SecuritiesPubliclyTradedGrp | |
| Securities Closely Held Stock | SecuritiesCloselyHeldStockGrp | |
| Secur Prtnrshp Trust Intrsts | SecurPrtnrshpTrustIntrstsGrp | |
| Securities Miscellaneous | SecuritiesMiscellaneousGrp | |
| Qualified Contrib Hist Struct | QualifiedContribHistStructGrp | |
| Qualified Contrib Other | QualifiedContribOtherGrp |
Real Estate Residential RealEstateResidentialGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Non Cash Checkbox | Yes (X) | NonCashCheckboxInd |
| Contribution | 1 | ContributionCnt |
| Noncash Contributions Rpt F990 | $72,778 | NoncashContributionsRptF990Amt |
| Method Of Determining Revenues | FMV | MethodOfDeterminingRevenuesTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real Estate Commercial | RealEstateCommercialGrp | |
| Real Estate Other | RealEstateOtherGrp | |
| Collectibles | CollectiblesGrp | |
| Food Inventory | FoodInventoryGrp | |
| Drugs And Medical Supplies | DrugsAndMedicalSuppliesGrp | |
| Taxidermy | TaxidermyGrp | |
| Historical Artifacts | HistoricalArtifactsGrp | |
| Scientific Specimens | ScientificSpecimensGrp | |
| Archaeological Artifacts | ArchaeologicalArtifactsGrp | |
| Form8283 Received | 0 | Form8283ReceivedCnt |
| Any Property That Must Be Held | false | AnyPropertyThatMustBeHeldInd |
| Review Process Unusual NC Gifts | false | ReviewProcessUnusualNCGiftsInd |
| Third Parties Used | false | ThirdPartiesUsedInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE M, PART I, LINE 19 | FormAndLineReferenceDesc |
| Explanation | THE NUMBER REPORTED IN COLUMN (B) FOR REAL ESTATE - RESIDENTIAL (LINE 15) IS THE NUMBER OF CONTRIBUTIONS. | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (16 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART III, LINE 4 | THE HOSPITALS PRIMARY FUNCTION IS THE DELIVERY OF HEALTHCARE AND WELLNESS SERVICES TO INPATIENTS AND OUTPATIENTS IN NEMAHA COUNTY, SPECIFICALLY SABETHA AND OTHER SURROUNDING COMMUNITIES. INPATIENT CARE INCLUDES ACUTE CARE, SWING BED AND INTERMEDIATE SWING BED. OUTPATIENT SERVICES ARE ALSO AN IMPORTANT COMPONENT IN MEETING THE COMMUNITYS NEEDS AS WELL. DURING 2014, THE IMAGING DEPARTMENT OF THE HOSPITAL UPDATED THE CT SCANNER ENHANCING DIAGNOSTIC PROCEDURES FOR THE PHYSICIANS, AND THE HOSPITAL ADDED COMPUTERIZED PHYSICIAN ORDER ENTRY AND PHARMACY/MEDICATION RECONCILIATION ADMINISTRATION MODULES TO THE ELECTRONIC HEALTH RECORD. AN IMPORTANT FOCUS FOR SCH IS TO CONTINUE TO BUILD A STRONG ELECTRONIC MEDICAL RECORD TO BETTER SERVE OUR PATIENT POPULATION ENHANCING PROVISION OF CARE TO THE YOUNG AS WELL AS THE OLD WITHIN OUR COMMUNITY AND SURROUNDING AREAS THAT WE SERVE. SABETHA COMMUNITY HOSPITAL CONTINUES TO MAINTAIN ITS LEVEL IV TRAUMA CENTER DESIGNATION AS WELL AS BEING A STROKE READY FACILITY. THE HOSPITAL PARTNERED WITH A TERTIARY CENTER ON A TELEMEDICINE PILOT PROJECT FOR THE EMERGENCY ROOM. SABETHA COMMUNITY HOSPITAL ALSO PARTICIPATED IN THE KANSAS HEALTH CARE COLLABORATIVE HEALTH ENGAGEMENT NETWORK QUALITY PROJECTS. WITH THE COOPERATION OF THE MEDICAL STAFF AND SURGEONS ALONG WITH SCH STAFF, THE HOSPITAL WAS ABLE TO REDUCE EARLY ELECTIVE DELIVERIES BY 100%. THE HOSPITAL ALSO ACHIEVED A REDUCTION IN URINARY CATHETER DAYS BY PARTICIPATING IN THE CAUTI PROJECT THROUGH THE KANSAS HEN. THE HOSPITAL PARTICIPATES IN CMS HCAHPS AND USES THOSE SCORES TO KEEP STAFF INFORMED OF PROVISION OF CARE TO OUR PATIENTS. |
| FORM 990, PART VI, SECTION A, LINE 2 | DAVE DELLASEGA AND MIKE HAND HAVE A BUSINESS RELATIONSHIP. THEY ARE BOTH EMPLOYED BY, AND ALSO OFFICERS OF, A RELATED 501(C)(3) ORGANIZATION, GREAT PLAINS HEALTH ALLIANCE. |
| FORM 990, PART VI, SECTION A, LINE 6 | GREAT PLAINS HEALTH ALLIANCE, INC., A NOT-FOR-PROFIT, 501(C)(3) ORGANIZATION, IS THE SOLE MEMBER OF GREAT PLAINS OF SABETHA, INC. |
| FORM 990, PART VI, SECTION A, LINE 7A | GREAT PLAINS HEALTH ALLIANCE, INC., BEING THE SOLE MEMBER, HAS THE RIGHT TO ELECT AND APPROVE ALL THE BOARD MEMBERS. |
| FORM 990, PART VI, SECTION A, LINE 7B | GREAT PLAINS HEALTH ALLIANCE, INC. (GPHA) IS THE SOLE MEMBER AND HAS THE AUTHORITY TO APPROVE THE ARTICLES OF INCORPORATION, BYLAWS, ELECTION TO OR REMOVAL FROM THE BOARD OF DIRECTORS, THE ANNUAL OPERATING AND CAPITAL BUDGETS, AND THE LONG RANGE OR STRATEGIC PLANS. |
| FORM 990, PART VI, SECTION B, LINE 11B | THE 990 IS PREPARED AND REVIEWED BY AN INDEPENDENT ACCOUNTING FIRM. THE 990 IS THEN PROVIDED TO THE CHIEF FINANCIAL OFFICER FOR REVIEW AND APPROVAL. AN ELECTRONIC DRAFT OF THE 990 WITH ALL REQUIRED SCHEDULES IS THEN PROVIDED TO THE FULL BOARD FOR REIVEW PRIOR TO FILING THE 990 WITH THE IRS. |
| FORM 990, PART VI, SECTION B, LINE 12C | THE ORGANIZATION IS REQUIRED TO ADOPT GPHA'S CONFLICT OF INTEREST POLICY. ALL BOARD MEMBERS, OFFICERS AND EMPLOYEES ARE SUBJECT TO THE CONFLICT OF INTEREST POLICY AND SIGN AN ANNUAL ACKNOWLEDGEMENT THAT THEY HAVE READ, UNDERSTAND AND COMPLIED WITH THE GPHA CONFLICT OF INTEREST POLICY. UNDER THE POLICY, ANY MEMBER WHO HAS A DIRECT OR INDIRECT (VIA FAMILY) FINANCIAL INTEREST IS CHARACTERIZED AS AN INTERESTED PERSON. INTERESTED PERSONS ARE REQUIRED TO DISCLOSE FINANCIAL INTERESTS WITH COMPANIES DOING BUSINESS WITH GPHA. THE INTERESTED PERSON MUST RECUSE THEMSELVES FROM FURTHER DISCUSSIONS OF THE TRANSACTION AND LEAVE THE ROOM. THE REMAINING NON-INTERESTED MEMBERS DECIDE IF A CONFLICT OF INTEREST EXISTS. THE BOARD CHAIR MAY APPOINT ANOTHER DISINTERESTED PARTY TO DISCUSS THE TRANSACTION OR THE REMAINING BOARD MEMBERS MAY VOTE TO ENTER INTO OR ABSTAIN FROM THE SUSPECT TRANSACTION. FAILURE TO DISCLOSE FINANCIAL INTERESTS BY INTERESTED BOARD MEMBERS WILL RESULT IN DISCIPLINARY ACTION, INCLUDING SANCTIONING BY BOARD. ALL CONFLICTS OF INTEREST AND THEIR ULTIMATE RESOLUTION ARE DOCUMENTED IN THE BOARD MINUTES. THE BOARD CONDUCTS PERIODIC REVIEWS TO DETERMINE THAT CONFLICTS ARE BEING IDENTIFIED AND RESOLVED ACCORDING TO POLICY DOCUMENTATION. REVIEWS BY OUTSIDE EXPERTS ARE PERMITTED, BUT NOT REQUIRED. |
| FORM 990, PART VI, SECTION B, LINES 15A & B | THE CEO AND CFO ARE COMPENSATED BY GREAT PLAINS HEALTH ALLIANCE, A RELATED ORGANIZATION. GPHA'S BOARD USES COMPARABILITY DATA IN SETTING THEIR SALARIES, AND DOCUMENTATION IS RETAINED OF THE BOARD'S DELIBERATIONS AND DECISIONS. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. THE COMPANY'S KANSAS ANNUAL REPORT IS ALSO AVAILABLE UPON REQUEST FROM THE KANSAS SECRETARY OF STATE. |
| FORM 990, PART XI, LINE 9 | EQUITY IN EARNINGS SABETHA HEALTHCARE, INC. 33,619 TRANSFER TO CITY OF SABETHA (156,600) ---------- TOTAL $ (122,981) |
| FORM 990 PART IX LINE 11G | DESCRIPTION:CONTRACTED MEDICAL STAFF TOTAL FEES:969841 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:BILLING/COLLECTIONS TOTAL FEES:123057 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:LAB SERVICES TOTAL FEES:46426 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:PHARMACY SERVICES TOTAL FEES:76514 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:ADMINISTRATION/HUMAN RESOURCES TOTAL FEES:81216 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:MAINTENANCE/HOUSEKEEPING TOTAL FEES:1086 |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (9 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|---|
| GREAT PLAINS HEALTH ALLIANCE INC | ||||||||||
| 250 NORTH ROCK ROAD STE 160 | WICHITA | KS | 67206 | 480617739 | MANAGEMENT | KS | 501 (C)(3) | 3 | NA | false |
| GREAT PLAINS HEALTH CARE FOUNDATION INC | ||||||||||
| 250 NORTH ROCK ROAD STE 160 | WICHITA | KS | 67206 | 480955870 | SUPPORT | KS | 501 (C)(3) | 9 | GPHA INC | Yes (true) |
| GREAT PLAINS OF CHEYENNE CO INC | ||||||||||
| 250 NORTH ROCK ROAD STE 160 | WICHITA | KS | 67206 | 481226831 | HOSPITAL | KS | 501 (C)(3) | 3 | GPHA INC | Yes (true) |
| GREAT PLAINS OF ELLINWOOD INC | ||||||||||
| 250 NORTH ROCK ROAD STE 160 | WICHITA | KS | 67206 | 481226976 | HOSPITAL | KS | 501 (C)(3) | 3 | GPHA INC | Yes (true) |
| GREAT PLAINS OF KIOWA CO INC | ||||||||||
| 250 NORTH ROCK ROAD STE 160 | WICHITA | KS | 67206 | 481226833 | HOSPITAL | KS | 501 (C)(3) | 3 | GPHA INC | Yes (true) |
| GREAT PLAINS OF OTTAWA CO INC | ||||||||||
| 250 NORTH ROCK ROAD STE 160 | WICHITA | KS | 67206 | 481226856 | HOSPITAL | KS | 501 (C)(3) | 3 | GPHA INC | Yes (true) |
| GREAT PLAINS OF PHILLIPS CO INC | ||||||||||
| 250 NORTH ROCK ROAD STE 160 | WICHITA | KS | 67206 | 481226829 | HOSPITAL | KS | 501 (C)(3) | 3 | GPHA INC | Yes (true) |
| GREAT PLAINS OF REPUBLIC CO INC | ||||||||||
| 250 NORTH ROCK ROAD STE 160 | WICHITA | KS | 67206 | 481226977 | HOSPITAL | KS | 501 (C)(3) | 3 | GPHA INC | Yes (true) |
| GREAT PLAINS OF SMITH CO INC | ||||||||||
| 250 NORTH ROCK ROAD STE 160 | WICHITA | KS | 67206 | 481226830 | HOSPITAL | KS | 501 (C)(3) | 3 | GPHA INC | Yes (true) |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | false | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | false | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | false | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | false | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | false | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | false | DivRelatedOrganizationInd |
| Asset Sale To Other Org | false | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | false | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | false | AssetExchangeInd |
| Rental Of Facilities To Oth Org | false | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | false | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | false | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (true) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | false | SharingOfFacilitiesInd |
| Paid Employees Sharing | false | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | false | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | false | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | false | TransferToOtherOrgInd |
| Transfer From Other Org | false | TransferFromOtherOrgInd |