2014-11-14T07:12:36-06:00 2013-12-31 BKD LLP 1201 Walnut Suite 1700 Kansas City MO 641062246 990 2013-01-01 480577658 Hiawatha Hospital Association Inc % JENNY KNUDSON HIAW 7857422131 300 UTAH STREET Suite HIAWATHA KS 66434 JOHN MOORE CEO 7857422131 2014-11-17 true Michael J Engle P00482834 7857422131 2013 2015-11-30 17:44:51Z JOHN MOORE 300 UTAH STREET HIAWATHA KS 66434 26382392 false X www.hch-ks.org X 1945 KS AS A RURAL COMMUNITY HOSPITAL, HIAWATHA HOSPITAL'S PRIMARY GOAL IS TO PROVIDE MODERN, RELIABLE, AND AFFORDABLE HEALTH SERVICES THAT BEST MEET THE NEEDS OF OUR COMMUNITY RESIDENTS. 10 8 293 8 0 0 58393 105241 22690658 26132212 31804 16735 113873 111655 22894728 26365843 21726 17861 0 0 13103213 13907775 0 0 2101 10343832 11607099 23468771 25532735 -574043 833108 25398373 26745965 11230380 11791941 14167993 14954024 X SEE SCHEDULE O false false 21475182 17861 26132212 SEE SCHEDULE O 21475182 true true false true false false false false false false true false false true true false false true false false false false false false false false true true false true true true false false false false false false false false false false false false false false false true true true false false true 21 0 true 293 true false false false false false false false false false false X 10 8 true false false false false false false true true false false true true true true true true true false false KS X JENNY KNUDSON 7857426210 300 UTAH STREET HIAWATHA KS 66434 ANDY PETERSON TRUSTEE 1.0 X 0 0 0 LORI ELLIOT TRUSTEE 1.0 X 0 0 0 FONDA LAFRENZ TRUSTEE/SECRETARY/TREASURER 1.0 X X 4830 0 16 ERIC MCPEAK TRUSTEE/PRESIDENT 1.0 X X 0 0 0 HILLARY BOYE TRUSTEE 1.0 X 0 0 0 CHERYL RASMUSSEN TRUSTEE 1.0 X 0 0 0 GALEN MEYER TRUSTEE 1.0 X 0 0 0 NICK HRENCHER TRUSTEE/VICE PRESIDENT 1.0 X X 0 0 0 ERIK MADSEN TRUSTEE 1.0 X 0 0 0 DR PETE ROSA TRUSTEE/MD 40.0 X 291387 0 33224 JOHN MOORE ADMINISTRATOR/CEO 40.0 X 144164 0 24540 DR BYRON BIGHAM MD 40.0 X 259217 0 28793 DR STEFFEN SHAMBURG MD 40.0 X 407778 0 60040 DR JULIE ROSA MD 20.0 X 134359 0 17574 DR CROSBY GERNON MD 40.0 X 449226 0 44858 JEAN ABEITA PHARMACIST 40.0 X 117262 0 21938 1808223 0 230983 9 false true false STEVEN GUNNELS crna 459920 STARS INC THERAPY 423797 ORANGE COMMERCIAL credit CONTRACT NURSING 176625 ROCK PORT TELEPHONE IT CONTRACTING 313136 ICE TECHNOLOGIES EMR CONSULTING 167685 11 63898 24365 16978 105241 PATIENT SERVICE REVENUE 621110 22491475 22491475 OTHER PATIENT REVENUE 621110 30020 30020 340B PHARMACY 446110 1715854 1715854 EMR INCENTIVE REVENUE 621110 1894863 1894863 26132212 14735 14735 0 0 45835 16549 29286 0 29286 29286 2000 2000 2000 2000 0 0 0 CAFETERIA INCOME 722210 82369 82369 82369 26365843 26132212 128390 2667 2667 15194 15194 0 0 476071 417574 58497 0 10049041 8668887 1380154 370354 319554 50800 2299387 1755720 543667 712922 622741 90181 0 7781 7781 117265 117265 0 0 0 3372937 2874653 496183 2101 58183 31873 26310 446525 294123 152402 91529 44161 47368 0 470256 345194 125062 64376 56709 7667 0 0 456105 381741 74364 0 1777717 1178431 599286 158412 87581 70831 BAD DEBT EXPENSE 518568 518568 REPAIRS & MAINTENANCE 633076 540791 92285 DUES & SUBSCRIPTIONS 171801 120436 51365 MEDICAL SUPPLIES 2864010 2864010 398558 334574 63984 25532735 21475182 4055452 2101 286 286 5154075 3992590 50121 49607 2924348 4083209 0 0 0 0 0 0 506334 486471 196833 215682 30055663 15437792 15545204 14617871 0 0 0 0 0 0 0 0 1021172 3300249 25398373 26745965 2232855 2558255 0 0 0 0 4335000 4145000 0 0 0 0 4662525 4588686 0 0 0 500000 11230380 11791941 X 14102888 14889433 65105 64591 0 0 14167993 14954024 25398373 26745965 X 833108 -47077 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 5509 5509 25527226 25532735 1000000 250000 false 967803 1000000 1000000 1000000 3967803 5951705 4082 4401 4425 5509 18417 241951 250000 250000 250000 991951 1487927 4082 4401 4425 5509 18417 769309 769309 17196663 7426352 9770311 10826055 7447140 3378915 1263636 564300 699336 14617871 DUE FROM THIRD-PARTY PAYERS 3218726 BOND ISSUANCE COSTS 80523 DEPOSITS 1000 3300249 0 LINE OF CREDIT 500000 500000 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. true true true X true X true false false 366520 366520 0.01470 2974331 1504499 1469832 0.05880 160289 73821 86468 0.00350 3501140 1578320 1922820 0.07700 60928 16630 44298 0.00180 1120 1120 0.00010 13030 4523 8506 0.00030 5000 5000 0.00020 80078 21153 58924 0.00240 3581218 1599473 1981744 0.07940 7152 7152 0.00030 1266 1266 0.00010 8418 8418 0.00040 false 518568 10371 12099443 12489030 -389587 X true true 1 1 HIAWATHA HOSPITAL ASSOCIATION 300 UTAH STREET HIAWATHA KS 66434 hch-ks.org H-007-001 X X X X HIAWATHA HOSPITAL ASSOCIATION true X X X X X X X X X 13 true false true X HCH-KS.ORG X X X X X X true false true true 150. true 250. true X X X X X X true true X X X X true false X X X true X false false SCHEDULE H, PART V, LINE 3 A committee was formed to provide guidance on creating the survey and feedback on prioritizing the survey results. The members were chosen carefully in hopes of getting a wide cross section of individuals with community and health knowledge. The following are the individuals serving on that committee: John Moore CEO/Administrator Hiawatha Community Hospital; Jenny Knudson Controller HCH, Hiawatha Foundation Economic Development Board Member; Karla Harter Nursing Director Brown County Health Department; Dr Pete Rosa Director of Medical Staff HCH, Primary Care Physician at Highland Family Practice, School board member; Sheri Wessel, PA Director of New You weight loss clinic HCHFP, Resident Nemaha County; Dr Crosby Gernon Hiawatha City Mayor, Radiologist HCH; Lynn Dierking, RN Director HCH Home Health Agency; Karen Wilson Executive Director Northeast Kansas Area Agency on Aging which also administrates KanCare enrollment, and Resident of Doniphan County; Lynne Ladner Hiawatha City Administrator, Hiawatha Foundation for Economic Development board member; Kristin Boltz Nurse Practioner at White Cloud Health Station that serves Iowa Sac & Fox Tribal Nation in Northern Brown County; Michelle Shamburg, PA Health Care Provider Kickapoo Tribal Nation in southern Brown County; Wendy Shoemaker, EMT New You weight loss clinic. The committee helped formulate questions for the survey. Once the survey was complete, the group met to review the findings, add their own input, prioritize projects and give input on devising an implementation strategy. SCHEDULE H, PART V, LINE 5D THE CHNA WAS DISTRIBUTED TO THE INDIVIDUALS INVOLVED IN ITS CREATION FOR DISPLAY AND DISSEMINATION HOWEVER THEY PLEASED. SCHEDULE H, PART V, LINE 12I SPECIAL CONSIDERATIONS MAY BE MADE FOR COLLEGE STUDENTS. 3 HIAWATHA COMMUNITY HOSPITAL HOME HEALTH 300 UTAH STREET HIAWATHA KS 66434 HOME HEALTH AGENCY HIAWATHA COMM HOSP FAM PRACTICE CLINIC 300 OREGON STREET 2ND FLOOR HIAWATHA KS 66434 RURAL HEALTH CLINIC HIAWATHA COMM HOSPITAL HIGHLAND CLINIC 415 S MAIN STREET HIAWATHA KS 66434 RURAL HEALTH CLINIC SCHEDULE H, PART I, LINE 7, COLUMN F THE AMOUNT OF BAD DEBT EXPENSE REMOVED FROM TOTAL EXPENSES FOR CALCULATING THE NET COMMUNITY BENEFIT EXPENSE PERCENTAGE WAS $518,568. SCHEDULE H, PART I, LINE 7 THE HOSPITAL USES THE COST-TO-CHARGE RATIO. THIS METHOD WAS USED TO CALCULATE THE FIGURES IN THE TABLE AND WAS DETERMINED BY COMPARING PATIENT CARE COST TO PATIENT CARE CHARGES. SCHEDULE H, PART I, LINE 7G The weight loss clinic is our subsidized service. We do receive minimal payment from insurance and patients on the services, but the cost is far geater than our income. The clinic takes a balanced approach to solving patient weight issues. The clinic evaluates reasons that make it difficult to lose weight, or keep it off, including metabolism, environment and motivation. A participant will spend time with a physician, dietitican, personal trainer, therapist, and a pharmacist if needed. The physician helps the patient set a realistic healthy weight goal, and evaluates any potential underlying medical reasons for the extra weight. The registered dietician helps the patient set up a healthy balanced meal and snack plan. The personal trainer devises an exercise plan that will help meet the weight goal while addressing any areas of physical limitation. The therapist will help the patient evaluate any underlying behaviors that may be contributing to the extra weight. The pharmacist can review the patient's medication list for possible medications that may impede progress, and also is available for any patient that is a good candidate for weight loss medication therapy. The individuals are provided a group of peers going through the program for support. Once the patient has started on their regimen, there are follow up visits to monitor progress and refine personal program to help the individual meet their goal. This project is important to us as many of the health related issues that face our community and were identified in the community benefit survey were issues that would improve with weight loss. SCHEDULE H, PART II, LINES 2 & 7 ECONOMIC DEVELOPMENT - HHA EMPLOYEE REPRESENTS THE HOSPITAL ON THE HIAWATHA ECONOMIC DEVELOPMENT COUNCIL TO DISCUSS THE HOSPITAL'S INVOLVEMENT IN IMPROVING THE COMMUNITY'S ECONOMIC HEALTH AND DEVELOPMENT. COMMUNITY HEALTH IMPROVEMENT ADVOCACY - HHA EMPLOYEE SERVES ON THE BOARD OF A LOCAL COMMUNITY DAY CARE FACILITY, HHA EMPLOYEE SERVES AS SCHOOL BOARD MEMBER, AND THE HOSPITAL OPERATED A WEIGHT LOSS CLINIC TO BETTER SUPPORT THE HOSPITAL'S COMMUNITY AND HEALTHY LIVING. SCHEDULE H, PART III, LINE 4 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 doubtful accounts based upon a review of outstanding receivables, historical collection information, and existing economic conditions. As a service to the patient, the Hospital bills third-party payers directly and bills the patient when the patient's liability is determined. Patient accounts receivable are due in full when billed. Accounts are considered delinquent and subsequently written off as bad debts based on individual credit evaluation and specific circumstances of the account. Line 2 is THE ORGANIZATION'S BAD DEBT FIGURE NET OF COLLECTIONS AND THEN MULTIPLIED BY THE ORGANIZATION'S COST TO CHARGE RATIO. THE ORGANIZATION FIGURED 2% OF THOSE BELONG IN CHARITY CARE BUT WERE INELIGIBLE BECAUSE THEY WOULDN'T COMPLETE PAPERWORK OR THE BUSINESS OFFICE DIDN'T HAVE ENOUGH INFORMATION TO BE ABLE TO SEND THEM TO PRESUMPTIVE CHARITY CARE. SCHEDULE H, PART III, LINE 8 Lines 5 & 6 came from the cost report. The shortfall comes from cuts to the Medicare program. Due to budget constraints, Medicare pays less for services, but we continue to provide the same level of care. SCHEDULE H, PART III, LINE 9B ON EACH STATEMENT WE STATE THAT WE HAVE A CHARITY CARE POLICY. FOR 3 MONTHS A STATEMENT IS SENT. AFTER 3RD STATEMENT, A COLLECTION LETTER GOES OUT WITH A CHARITY CARE APPLICATION. THE FOLLOWING MONTH IT IS LISTED ON THE BAD DEBT LIST. AT THE END OF THE FOLLOWING MONTH THE ACCOUNT IS WRITTEN OFF TO BAD DEBT AND SENT TO COLLECTIONS, OR LITIGATION. IF IT GOES TO LITIGATION, NOTIFICATION IS MADE THROUGH CERTIFIED MAIL. ANOTHER CHARITY CARE APPLICATION IS SENT ALONG WITH THE NOTIFICATION LETTER. SCHEDULE H, PART VI, LINE 2 EVERY THREE YEARS, USING STATISTICAL DATA FROM THE US CENSUS AND RELIABLE HEALTH STATS FOR THE AREA, A COMMUNITY SURVEY IS CREATED THAT ENCOURAGES FREE TEXT RESPONSES. BASED ON THE RESPONSES OF THE COMMUNITY, A PLAN IS DEVELOPED THAT PRIORITIZES THE AREAS THAT THE HOSPITAL CAN MOST ASSIST IN MEETING THE COMMUNITY IDENTIFIED NEEDS. SCHEDULE H, PART VI, LINE 3 THE HOSPITAL'S SOCIAL SERVICES DEPARTMENT SPEAKS WITH PATIENTS REGARDING ELIGIBILITY FOR CHARITY CARE, MEDICAID, AND VARIOUS OTHER ASSISTANCE PROGRAMS THAT ARE AVAILABLE. OUR BUSINESS OFFICE MANAGER ALSO SPEAKS WITH PATIENTS REGARDING THE AVAILABILITY FOR DISABILITY DETERMINATION. PROVIDERS OFTEN BRING UP OUR CHARITY CARE PROGRAM WITH PATIENTS AT TIME OF TREATMENT. A CHARITY CARE PAMPHLET IS AVAILABLE AT ADMISSIONS AND APPLICATIONS ARE OFTEN HANDED OUT AT TIME OF ADMISSION FOR OUTPATIENT SERVICES. THE CHARITY CARE POLICY IS ALSO PUBLISHED ON OUR WEBSITE. THE FACT THAT WE HAVE A CHARITY CARE PROGRAM IS PRINTED ON THE BOTTOM OF EVERY STATEMENT THAT GOES OUT. THE CHARITY CARE APPLICATION IS PRINTED ON THE BACK OF ALL COLLECTION LETTERS AND PRE-LITIGATION CERTIFIED LETTERS. SCHEDULE H, PART VI, LINE 4 OUR GEOGRAPHIC AREA INCLUDES ALL OF BROWN COUNTY AND PARTS OF DONIPHAN, ATCHISON, AND NEMAHA COUNTIES IN KANSAS AND PARTS OF RICHARDSON COUNTY NEBRASKA. 55% OF OUR COMMUNITY IS 45 YEARS OLD AND UNDER. 26% IS AGE 45 TO 64. 19% OF THE POPULATION IS OVER 65 YEARS OF AGE. 26% OF THE COMMUNITY HOUSEHOLDS ARE BELOW THE POVERTY LEVEL FOR A FAMILY OF FOUR. SCHEDULE H, PART VI, LINE 5 AS A TAX EXEMPT, NOT FOR PROFIT ENTITY, HIAWATHA COMMUNITY HOSPITAL'S PURPOSE IS TO PROVIDE THE BEST SERVICES POSSIBLE IN A MANNER THAT IS ACCESSIBLE TO ALL INDIVIDUALS. OFFERING OUR SERVICES AT NO, OR REDUCED COST TO THOSE WHO MEET OUR CHARITY REQUIREMENTS IS A CORNERSTONE OF OUR MISSION. AS THE ECONOMIC CLIMATE IN THE COMMUNITY CHANGED, SO DID OUR CHARITY CARE SERVICES. IN 2010 WE BEGAN A PRESUMPTIVE CHARITY CARE PROGRAM THAT ALLOWS US TO GRANT CHARITY CARE TO THOSE INDIVIDUALS WHO QUALIFY BUT WON'T COMPLETE THE REQUIRED PAPERWORK WE NEED TO SUBSTANTIATE THE NEED FOR ASSISTANCE. ALSO SUPPPORTING OUR STATUS IS OUR COMMITMENT TO PROVIDE QUALITY SERVICE AND STAFF. TO THAT END, THE HIAWATHA COMMUNITY HOSPITAL PROVIDES SCHOLARSHIPS FOR EDUCATION IN HEALTH RELATED FIELDS. ANOTHER MANNER IN WHICH WE SUPPORT OUR NOT FOR PROFIT STATUS IS THROUGH PUBLIC HEALTH EDUCATIONAL PROGRAMS FOR THE COMMUNITY. WE PROVIDE DIABETES, HYPERTENSION AND SMOKING CESSATION EDUCATION. WE ALSO RUN A WEIGHT LOSS CLINIC. true SCHOLARSHIPS 5 15194 SCHEDULE I, PART III 1) COMMUNITY SCHOLARSHIP - HCH HAS GIVEN SCHOLARSHIPS TO COMMUNITY MEMBERS PURSUING A DEGREE IN THE MEDICAL FIELD. AFTER THE SCHOLARSHIP IS APPROVED BY HOSPITAL CEO, THE TUITION IS PAID TO THE SCHOOL, THE STUDENT OR THE STUDENT LOAN HOLDER. X X false false false false false true false false false DR PETE ROSA TRUSTEE/MD 224392 0 66995 0 0 0 13802 0 19421 0 324610 0 0 0 JOHN MOORE ADMINISTRATOR/CEO 144164 0 0 0 0 0 6220 0 18320 0 168704 0 0 0 DR BYRON BIGHAM MD 229492 0 29725 0 0 0 9872 0 18921 0 288010 0 0 0 DR STEFFEN SHAMBURG MD 352778 0 55000 0 0 0 43118 0 16921 0 467817 0 0 0 DR JULIE ROSA MD 104417 0 29941 0 0 0 17574 0 0 0 151933 0 0 0 DR CROSBY GERNON MD 434226 0 15000 0 0 0 27919 0 16939 0 494084 0 0 0 SCHEDULE J, PART I, LINE 6A The family physicians that are contracted with the hospital to provide services in our rural health care clinic and our radiologist are all eligible for additional compensation beyond their base pay rate. Each physician's expenses and revenues are tracked through their own department. Periodically throughout the year, if their respective departments are showing a positive net income, then they are eligible to receive additional compensation. The amount of net revenue to be distributed mid year is decided between the physicians and the Administrator. By the year end, 100% of the net revenue will be distributed as long as it doesn't exceed the annual maximum compensation amounts in the physician's respective contracts. To determine what each physician's portion of the distribution will be, income statements are run by physician that include allocations for building expenses and expenses and revenues from mid-levels. A CITY OF HIAWATHA 483025665 428545BD8 2007-03-29 5175000 SEE SCHEDULE K, PART V false false false A 1030000 0 5175000 0 0 0 105804 0 0 5069196 0 0 2007 true false true true A false false false true true 0 false false false true A false false false false false false 0 false 0 false false A false DESCRIPTION OF PURPOSE REFINANCE EXISTING BOND TO BUILD FORM 990, PART III, LINE 1 HIAWATHA COMMUNITY HOSPITAL'S HIGHEST PRIORITY IS THE PROVISION OF QUALITY HEALTH CARE TO OUR PATIENTS THROUGHOUT NORTHEAST KANSAS. COMPREHENSIVE SERVICES INCLUDE PRIMARY, SECONDARY, AND LONG-TERM CARE. TO CARRY OUT THIS MISSION, HEALTH PROFESSIONALS WITHIN THE HOSPITAL CONTINUALLY WORK TOGETHER TO IMPROVE PATIENT CARE AND EDUCATION. THIS TEAM APPROACH ASSURES THAT OUR PATIENTS WILL BENEFIT FROM THE MOST UP-TO-DATE MEDICAL PRACTICES AVAILABLE. THE HOSPITAL CAN ONLY CONTINUE TO EXIST TO SERVE ITS MISSION THROUGH SOUND FINANCIAL MANAGEMENT AND STRATEGIC PLANNING. THEREFORE, THE PRINCIPLES OF COST EFFECTIVENESS AND EFFICIENCY GOVERN THE DEVELOPMENT OF HEALTH CARE POLICY FOR THE HOSPITAL. EXTERNAL AND INTERNAL ASSESSMENTS ARE DONE TO DETERMINE EVOLUTIONARY NEEDS AND TO RESPOND TO THE DEMANDS OF EVER-CHANGING TECHNOLOGY. HIAWATHA COMMUNITY HOSPITAL FEELS A STRONG COMMITMENT TO ITS EMPLOYEES AND STRIVES ALWAYS TO TREAT THEM FAIRLY, RESPONSIBLY, AND WITH A SENSE OF CONCERN FOR THEIR WELL-BEING. THE PROVISION OF COMPREHENSIVE CONTINUING EDUCATION IS ESSENTIAL TO MAINTAIN ADEQUATE SKILL LEVELS AND FOSTER A SENSE OF PRIDE AND PROFESSIONALISM. AS A COMMUNITY HOSPITAL, HIAWATHA COMMUNITY HOSPITAL RECOGNIZES ITS RESPONSIBILITY TO PROVIDE PUBLIC HEALTH EDUCATION AND, AS SUCH, STRIVES TO SERVE AS A REGIONAL HEALTH RESOURCE CENTER. MEDICAL AND PROFESSIONAL STAFF ARE ENCOURAGED TO PARTICIPATE IN COMMUNITY ACTIVITIES AND EDUCATION. FORM 990, PART III, LINE 4A AS A TAX-EXEMPT, NOT-FOR-PROFIT ENTITY, HIAWATHA COMMUNITY HOSPITAL'S PURPOSE IS TO PROVIDE THE BEST SERVICES POSSIBLE IN A MANNER THAT IS ACCESSIBLE TO ALL INDIVIDUALS. OFFERING OUR SERVICES AT NO OR REDUCED COST TO THOSE WHO MEET OUR CHARITY REQUIREMENTS IS A CORNERSTONE OF OUR MISSION. TO ENSURE THAT AS MANY INDIVIDUALS AS POSSIBLE ARE DEEMED ELIGIBLE FOR CHARITY CARE, WE IMPLEMENTED A PRESUMPTIVE CHARITY CARE PROGRAM. THIS PROGRAM WILL VERIFY PATIENT FINANCIAL SITUATIONS ALLOWING US TO INCLUDE THEM IN THE CHARITY CARE PROGRAM EVEN IF THEY DON'T WANT TO COMPLETE THE PAPERWORK THEMSELVES. WE FEEL THAT THIS PROGRAM IS A GREAT WAY TO GET INDIVIUALS IN NEED THE CARE THEY DESERVE WITHOUT ADDED FINANCIAL STRESS. ALSO SUPPORTING OUR TAX-EXEMPT STATUS IS OUR COMMITMENT TO PROVIDE QUALITY SERVICE AND STAFF. TO THAT END, THE HIAWATHA COMMUNITY HOSPITAL DISTRIBUTED OVER $15,000 IN SCHOLARSHIPS IN 2013. ANOTHER MANNER IN WHICH WE SUPPORT OUR NOT-FOR-PROFIT STATUS IS THROUGH PUBLIC HEALTH EDUCATIONAL PROGRAMS FOR THE COMMUNITY. WE PROVIDE DIABETES, HYPERTENSION, AND SMOKING CESSATION EDUCATION. FINALLY, IN ADDRESSING COMMUNITY CONCERN FOR SAFE PLACES FOR CHILDREN, WE DONATED $5,000 TO THE NOT-FOR-PROFIT COMMUNITY DAY CARE FACILITY IN TOWN. FORM 990, PART VI, SECTION A, LINE 2 DR. PETE ROSA AND DR. JULIE ROSA HAVE A FAMILY RELATIONSHIP. FORM 990, PART VI, SECTION B, LINE 11B AN INDEPENDENT ACCOUNTING FIRM PREPARES AND REVIEWS THE 990. THE 990 IS THEN REVIEWED BY THE ORGANIZATION'S OFFICERS AND ACCOUNTING PERSONNEL. ANY QUESTIONS OR CONCERNS THE ORGANIZATION'S OFFICERS AND ACCOUNTING PERSONNEL HAVE ARE ADDRESSED AND ANY CORRECTIONS OR CLARIFICATIONS THAT NEED TO BE MADE ARE MADE. THE FINAL FORM 990 WITH ALL REQUIRED SCHEDULES IS THEN PROVIDED TO ALL VOTING MEMBERS OF THE BOARD PRIOR TO FILING THE 990. FORM 990, PART VI, SECTION B, LINE 12C All employees and decision makers for the Hospital are covered under this policy. Conflicts are either reviewed by the Corporate Compliance Officer or the Board President. At Board meetings, the Board Chair is appraised of all conflicts of interest and then asks the member to abstain from discussing and voting on topics of conflict. FORM 990, PART VI, SECTION B, LINE 15A THE DIRECTOR OF HUMAN RESOURCES PERIODICALLY PROVIDES THE PRESIDENT OF THE BOARD OF DIRECTORS WITH A COMPENSATION SURVEY COMPILED BY THE KANSAS HOSPITAL ASSOCIATION. THE SURVEY DELINEATES COMPENSATION PACKAGES FOR ADMINISTRATORS AT HOSPITALS THAT ARE SIMILAR TO HIAWATHA. BASED ON THAT SURVEY, THE ADMINISTRATOR'S PERFORMANCE, AND THE PERFORMANCE OF THE HOSPITAL, THE BOARD SETS THE ADMINISTRATOR'S SALARY. FOR 2013, NO RAISES WERE GIVEN, SO THERE WAS NO ANNUAL OFFICIAL REVIEW. FORM 990, PART VI, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART XI, LINE 9 CHANGE IN FOUNDATION ASSETS $ (46,563) CHANGE IN ESTATE RECEIVABLE $ ( 514) ---------- TOTAL $ (47,077) FORM 990 PART IX LINE 11G DESCRIPTION:CONTRACT SERVICES TOTAL FEES:3269615 FORM 990 PART IX LINE 11G DESCRIPTION:CONSULTING FEES TOTAL FEES:7590 FORM 990 PART IX LINE 11G DESCRIPTION:COLLECTION EXPENSE TOTAL FEES:83122 FORM 990 PART IX LINE 11G DESCRIPTION:MISCELLANEOUS FEES TOTAL FEES:12610 HIAWATHA HOSPITAL ASSOCIATION FOUNDATION 300 UTAH STREET HIAWATHA KS 66434 481223766 FUNDRAISING KS 501(C)(3) 11D HHA false CHARITABLE REMAINDER TRUST (1) TRUST KS NA false false false true false false false false false false false false false false true true false false false true