KANSAS HEALTH INFORMATION EXCHANGE INC: Form 990, tax year 2012
View the entire original 990 at ProPublica ↗
- Organization
- KANSAS HEALTH INFORMATION EXCHANGE INC (EIN 27-4437709)
- Tax period
- 2012-07-01 to 2013-06-30
- Filed
- 2014-02-14
- IRS object ID
- 201410459349301236
- Schema version
- 2012v2.1
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2014-02-14T12:49:25-06:00 | Timestamp |
| Tax Period End Date | 2013-06-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 481066439 | EIN |
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BERBERICH TRAHAN & CO PA | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3630 SW BURLINGAME ROAD | AddressLine1 |
| City | TOPEKA | City |
| State | KS | State |
| ZIP Code | 666112050 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2012-07-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 274437709 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | KANSAS HEALTH INFORMATION EXCHANGE INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | KANS | NameControl |
| Phone | 7852335443 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | CURTIS STATE OFFICE BUILDING 1000 | AddressLine1 |
| Address Line2 | SW JACKSON NO 540 | AddressLine2 |
| City | TOPEKA | City |
| State | KS | State |
| ZIP Code | 666121368 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | AARON DUNKEL | Name |
| Title | DIRECTOR | Title |
| Phone | 7852335443 | Phone |
| Date Signed | 2014-02-14 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | REBECCA SHAW | Name |
| PTIN | P01275425 | PTIN |
| Phone | 7852343427 | Phone |
| Date Prepared | 2014-02-14 | DatePrepared |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2012 | TaxYear |
| Build TS | 2015-11-30 17:44:51Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | WILLIAM WALLACE | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | CURTIS STATE OFFICE BUILDING 1000 | AddressLine1 |
| Address Line2 | SW JACKSON | AddressLine2 |
| City | TOPEKA | City |
| State | KS | State |
| ZIP Code | 666121368 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 558368 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.KANHIT.ORG | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 2010 | YearFormation |
| State Legal Domicile | KS | StateLegalDomicile |
| Activity Or Mission Description | IMPROVE THE QUALITY AND EFFICIENCY OF HEALTH CARE IN KANSAS BY MANAGING THE DEPLOYMENT OF HEALTH INFORMATION TECHNOLOGY THROUGHOUT THE STATE AND FACILITATING THE EXCHANGE OF HEALTH INFORMATION AMONG HEALTH CARE PROVIDERS PURSUANT TO THE FEDERAL HITECH ACT AND RELATED GRANT FUNDING. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 11 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 11 | NbrIndependentVotingMembers |
| Total Nbr Employees | 0 | TotalNbrEmployees |
| Total Nbr Volunteers | 0 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 622900 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 554368 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 4000 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 4000 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 0 | InvestmentIncomePriorYear |
| Investment Income Current Year | 0 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 0 | OtherRevenuePriorYear |
| Other Revenue Current Year | 0 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 626900 | TotalRevenuePriorYear |
| Total Revenue Current Year | 558368 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 0 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 0 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 0 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 0 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 571098 | OtherExpensePriorYear |
| Other Expenses Current Year | 583609 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 571098 | TotalExpensesPriorYear |
| Total Expenses Current Year | 583609 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 55802 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | -25241 | RevenuesLessExpensesCY |
| Total Assets BOY | 127669 | TotalAssetsBOY |
| Total Assets EOY | 86399 | TotalAssetsEOY |
| Total Liabilities BOY | 71867 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 55838 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 55802 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 30561 | NetAssetsOrFundBalancesEOY |
| Mission Description | TO ASSURE THE AVAILABILITY OF STATEWIDE HEALTH INFORMATION EXCHANGES IN THE STATE OF KANSAS AND TO CERTIFY AND REGULATE THOSE EXCHANGES. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 290265 | Expense |
| Revenue | 4000 | Revenue |
| Description | THE ORGANIZATION HAS DEVELOPED A CORPORATE AND COMMITTEE STRUCTURE WHICH WILL ENABLE IT TO DEVELOP POLICY AND ENGAGE VENDORS AND CONTRACTORS TO ESTABLISH AN INTER-OPERABLE ELECTRONIC HEALTH INFORMATION EXCHANGE THAT WILL SERVE ALL PROVIDERS OF KANSAS ENABLING THEM TO SHARE HEALTH INFORMATION AND TO RENDER CARE MORE EFFICIENTLY AND EFFECTIVELY. ULTIMATELY, ALL THE RESIDENTS OF KANSAS WILL BE BENEFITTED BY THIS EFFORT. | Description |
| Total Program Service Expense | 290265 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 0 | LobbyingActivities |
| Subject To Proxy Tax | 0 | SubjectToProxyTax |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 0 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 1 | ReportLandBldgEquip |
| Report Invest Oth Securities | 0 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 0 | ReportOtherAssets |
| Report Other Liabilities | 0 | ReportOtherLiabilities |
| Report Fin48 Footnote | 1 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 1 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 0 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 0 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 0 | Hospital |
| Grants To Organizations | 0 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 0 | ScheduleJRequired |
| Tax Exempt Bonds | 0 | TaxExemptBonds |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 0 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 0 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 0 | RelatedEntity |
| Related Org Controlled Entity | 0 | RelatedOrgControlledEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 0 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Number Of Employees | 0 | NumberOfEmployees |
| Unrelated Business Income | 0 | UnrelatedBusinessIncome |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributions |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 11 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 11 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 1 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 0 | MembersOrStockholders |
| Election Of Board Members | 0 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 0 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 0 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 0 | DocumentRetentionPolicy |
| Compensation Process CEO | 1 | CompensationProcessCEO |
| Compensation Process Other | 0 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | THE ORGANIZATION | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 7857838984 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | CURTIS STATE OFFICE BUILDING 1000 | AddressLine1 |
| City | TOPEKA | City |
| State | KS | State |
| ZIP Code | 666121368 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| No Listed Persons Compensated | X | NoListedPersonsCompensated |
Form990 Part VII Section A Form990PartVIISectionA (12 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation |
|---|---|---|---|---|---|---|
| KAREN S BRAMAN RPH MS | ||||||
| CHAIR | 15.00 | X | X | 0 | 0 | 0 |
| MICHAEL ATWOOD MD | ||||||
| SECRETARY/TREASURER | 10.00 | X | X | 0 | 0 | 0 |
| JOE DAVISON MD | ||||||
| VICE CHAIR | 10.00 | X | X | 0 | 0 | 0 |
| JENNIFER BRULL MD | ||||||
| DIRECTOR | 5.00 | X | 0 | 0 | 0 | |
| CINDY CHRISMAN-SMITH | ||||||
| DIRECTOR | 5.00 | X | 0 | 0 | 0 | |
| HELEN CONNORS RN PHD FAAN | ||||||
| DIRECTOR | 5.00 | X | 0 | 0 | 0 | |
| KENNETH MISHLER PHARMD RPH | ||||||
| DIRECTOR | 5.00 | X | 0 | 0 | 0 | |
| ROBERT MOSER MD | ||||||
| DIRECTOR | 5.00 | X | 0 | 0 | 0 | |
| JACKIE JOHN | ||||||
| DIRECTOR | 5.00 | X | 0 | 0 | 0 | |
| JERRY SLAUGHTER | ||||||
| DIRECTOR | 5.00 | X | 0 | 0 | 0 | |
| JONALAN SMITH PHARMD | ||||||
| DIRECTOR | 5.00 | X | 0 | 0 | 0 | |
| WILLIAM WALLACE | ||||||
| CEO | 40.00 | X | 0 | 0 | 0 | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 0 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 0 | TotalOtherCompensation |
| Number Individuals GT100 K | 0 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 0 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation
Name Of Contractor NameOfContractor
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | KANSAS HEALTH INSTITUTE | BusinessNameLine1 |
Address Of Contractor AddressOfContractor
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 212 SW 8TH AVENUE NO 300 | AddressLine1 |
| City | TOPEKA | City |
| State | KS | State |
| ZIP Code | 66603 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description Of Services | LEASED EMPLOYEES | DescriptionOfServices |
| Compensation | 363289 | Compensation |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 1 | NumberOfContractorsGT100K |
| Government Grants | 554368 | GovernmentGrants |
| Total Contributions | 554368 | TotalContributions |
Program Service Revenue ProgramServiceRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | APPLICATION FEES | Description |
| Business Code | 900099 | BusinessCode |
| Total Revenue Column | 4000 | TotalRevenueColumn |
| Related Or Exempt Function Income | 4000 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 4000 | TotalProgramServiceRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 558368 | TotalRevenueColumn |
| Related Or Exempt Function Income | 4000 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $0 | ExclusionAmount |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 363289 | Total |
| Program Services | 119885 | ProgramServices |
| Management And General | 243404 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 80310 | Total |
| Program Services | 40155 | ProgramServices |
| Management And General | 40155 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 9785 | Total |
| Management And General | 9785 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 51573 | Total |
| Program Services | 51573 | ProgramServices |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 14031 | Total |
| Program Services | 14031 | ProgramServices |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 15979 | Total |
| Program Services | 15979 | ProgramServices |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 9270 | Total |
| Program Services | 9270 | ProgramServices |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2309 | Total |
| Program Services | 2309 | ProgramServices |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 20209 | Total |
| Program Services | 20209 | ProgramServices |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 16814 | Total |
| Program Services | 16814 | ProgramServices |
Other Expenses OtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | MISCELLANEOUS | Description |
| Total | 40 | Total |
| Program Services | 40 | ProgramServices |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 583609 | Total |
| Program Services | 290265 | ProgramServices |
| Management And General | 293344 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 8475 | BOY |
| EOY | 584 | EOY |
Pledges And Grants Receivable PledgesAndGrantsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 59138 | BOY |
| EOY | 50909 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 8624 | BOY |
| EOY | 1466 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 62088 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 28648 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 51432 | BOY |
| EOY | 33440 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 127669 | BOY |
| EOY | 86399 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 71867 | BOY |
| EOY | 55838 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 71867 | BOY |
| EOY | 55838 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 55802 | BOY |
| EOY | 30561 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 55802 | BOY |
| EOY | 30561 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 127669 | BOY |
| EOY | 86399 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expenses | -25241 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | 0 | ReconcilationOtherChanges |
| Info In Schedule O Part XII | X | InfoInScheduleOPartXII |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 1 | AccountantCompileOrReview |
Accountant Compile Or Review Basis AccountantCompileOrReviewBasis
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Statement Separate | X | FinancialStatementSeparate |
| Field | Value | IRS element (for citing) |
|---|---|---|
| FS Audited | 0 | FSAudited |
| Audit Committee | 1 | AuditCommittee |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Publicly Supported Org170b1 Avi | X | PubliclySupportedOrg170b1Avi |
Gifts Grants Contrib Received170 GiftsGrantsContribReceived170
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus2 Years | 88732 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 622900 | CurrentTaxYearMinus1Year |
| Current Tax Year | 554368 | CurrentTaxYear |
| Total | 1266000 | Total |
Total170 Total170
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus2 Years | 88732 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 622900 | CurrentTaxYearMinus1Year |
| Current Tax Year | 554368 | CurrentTaxYear |
| Total | 1266000 | Total |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total170 | 1266000 | PublicSupportTotal170 |
| Total Support | 1266000 | TotalSupport |
| Gross Receipts From Admissions Etc | 8000 | GrossReceiptsFromAdmissionsEtc |
| First5 Years170 | X | First5Years170 |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| 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) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule D IRS990ScheduleD
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 62088 | OtherCostOrOtherBasis |
| Depreciation | 28648 | Depreciation |
| Book Value | 33440 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 33440 | TotalOfBookValueLandBuildings |
| Footnote In Part XIII | X | FootnoteInPartXIII |
| Tot Revenue Etc Audited Fincl Stmt | 558368 | TotRevenueEtcAuditedFinclStmt |
| Revenue Not Rptd F990 | 0 | RevenueNotRptdF990 |
| Revenue Subtotal | 558368 | RevenueSubtotal |
| Revenue Not Rptd On Fin Stmt | 0 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 558368 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 583609 | TotExpensesEtcAuditedFinclStmt |
| Expenses Not Rptd F990 | 0 | ExpensesNotRptdF990 |
| Expenses Subtotal | 583609 | ExpensesSubtotal |
| Expenses Not Rptd On Fin Stmt | 0 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 583609 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIII Form990ScheduleDPartXIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: | Identifier |
| Return Reference | PART X, LINE 2: | ReturnReference |
| Explanation | MANAGEMENT HAS EVALUATED THE ORGANIZATION'S TAX POSITIONS AND CONCLUDED THAT THE ORGANIZATION HAD TAKEN NO UNCERTAIN TAX POSITIONS THAT REQUIRE ADJUSTMENT TO THE FINANCIAL STATEMENTS. | Explanation |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (7 entries)
| Return ReferenceReturnReference | ExplanationExplanation |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 3 | THE ORGANIZATION HAS NOT DELEGATED CONTROL TO A MANAGEMENT COMPANY. HOWEVER, THE STAFF OF THE ORGANIZATION ARE EMPLOYEES OF ANOTHER 501(C)(3) ORGANIZATION LOCATED IN THE FORMER OFFICE SPACE. THE TWO ORGANIZATIONS HAVE AN ADMINISTRATIVE AGREEMENT TO PROVIDE PEOPLE AND SERVICES TO ASSIST IN THE OPERATIONS OF THE ORGANIZATION. THE TWO ORGANIZATIONS ARE NOT RELATED. THERE IS NO CONTROL OF ONE OVER THE OTHER. THE BOARD OF DIRECTORS OF THE ORGANIZATIONS ARE ENTIRELY SEPARATE. THE CEO'S ANNUAL SALARY PER CONTRACT IS $157,000, OF WHICH $157,000 WAS EXPENSED DURING THIS FISCAL PERIOD. NO OTHER OFFICERS OR DIRECTORS WAS COMPENSATED BY THE ORGANIZATION. |
| FORM 990, PART VI, SECTION A, LINE 8B | THERE IS NO OTHER COMMITTEE WITH AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY. |
| FORM 990, PART VI, SECTION B, LINE 11 | A COPY OF THE RETURN IS PROVIDED TO THE BOARD FOR REVIEW PRIOR TO FILING. |
| FORM 990, PART VI, SECTION B, LINE 12C | THE CONFLICT OF INTEREST POLICY REQUIRES ALL EMPLOYEES AND MEMBERS OF THE BOARD OF DIRECTORS TO SIGN THE POLICY. THE POLICY REQUIRES THEM TO BE UPDATED EVERY YEAR. |
| FORM 990, PART VI, SECTION B, LINE 15A | THE SALARY RANGE FOR THE CEO WAS DETERMINED BY THE KANSAS DEPARTMENT OF HEALTH AND ENVIRONMENT WHEN IT SUBMITTED THE ORIGINAL GRANT PROPOSAL. THE RANGE WAS CONFIRMED BY THE KHIE FINANCE COMMITTEE. THE SALARY OFFER WAS MADE BY THE EXECUTIVE COMMITEE TO THE CEO AND IS INCLUDED IN HIS CONTRACT. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION DOES NOT MAKE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC. |
| NO CHANGE FROM PRIOR YEAR. |
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