PAWNEE VALLEY COMMUNITY HOSPITAL INC: Form 990, tax year 2011

View the entire original 990 at ProPublica ↗

Organization: PAWNEE VALLEY COMMUNITY HOSPITAL INC (EIN 48-1253246)
Tax period: 2011-07-01 to 2012-06-30
Filed: 2013-05-14
IRS object ID: 201311349349307001
Schema version: 2011v1.2
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 D
Schedule H
Schedule J
Schedule O
Schedule R

Return header ReturnHeader

Field	Value	IRS element (for citing)
Timestamp	2013-05-14T16:10:24-05:00	Timestamp
Tax Period End Date	2012-06-30	TaxPeriodEndDate

Preparer Firm PreparerFirm

Field	Value	IRS element (for citing)
EIN	481026809	EIN

Preparer Firm Business Name PreparerFirmBusinessName

Field	Value	IRS element (for citing)
Business Name Line1	Wendling Noe Nelson & Johnson LLC	BusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

Field	Value	IRS element (for citing)
Address Line1	534 S Kansas Ave Suite 1500	AddressLine1
City	Topeka	City
State	KS	State
ZIP Code	666033491	ZIPCode

Field	Value	IRS element (for citing)
Return Type	990	ReturnType
Tax Period Begin Date	2011-07-01	TaxPeriodBeginDate

Filer Filer

Field	Value	IRS element (for citing)
EIN	481253246	EIN

Name Name

Field	Value	IRS element (for citing)
Business Name Line1	Pawnee Valley Community Hospital Inc	BusinessNameLine1

Field	Value	IRS element (for citing)
Name Control	PAWN	NameControl
Phone	6202853161	Phone

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	923 Carroll Ave	AddressLine1
City	Larned	City
State	KS	State
ZIP Code	67550	ZIPCode

Officer Officer

Field	Value	IRS element (for citing)
Name	John Jeter MD	Name
Title	President	Title
Phone	7856235000	Phone
Date Signed	2013-05-14	DateSigned
Authorize Third Party	1	AuthorizeThirdParty

Preparer Preparer

Field	Value	IRS element (for citing)
Name	Derek H Hart	Name
PTIN	P01054116	PTIN
Phone	7852334226	Phone
Date Prepared	2013-05-08	DatePrepared

Field	Value	IRS element (for citing)
Tax Year	2011	TaxYear
Build TS	2016-02-24 21:20:13Z	BuildTS

Form 990 IRS990

Field	Value	IRS element (for citing)
Name Of Principal Officer Person	John Jeter MD	NameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

Field	Value	IRS element (for citing)
Address Line1	923 Carroll Ave	AddressLine1
City	Larned	City
State	KS	State
ZIP Code	67550	ZIPCode

Field	Value	IRS element (for citing)
Gross Receipts	12502927	GrossReceipts
Group Return For Affiliates	0	GroupReturnForAffiliates
Organization501c3	X	Organization501c3
Web Site	www.pawneevalleyhospital.com	WebSite
Type Of Organization Corporation	X	TypeOfOrganizationCorporation
Year Formation	2001	YearFormation
State Legal Domicile	KS	StateLegalDomicile
Activity Or Mission Description	Pawnee Valley Community Hospital, Inc. is a tax-exempt charitable organization under Section 501(c)(3) of the Internal Revenue Code and is licensed by the State of Kansas Department of Health and Environment. The purpose of the Organization is to provide healthcare to inpatients and outpatients who are acutely ill or who otherwise require medical care and related services. The Organization is striving to be the best Critical Access Hospital in rural America.	ActivityOrMissionDescription
Nbr Voting Members Governing Body	5	NbrVotingMembersGoverningBody
Nbr Independent Voting Members	0	NbrIndependentVotingMembers
Total Nbr Employees	114	TotalNbrEmployees
Total Nbr Volunteers	87	TotalNbrVolunteers
Total Gross UBI	0	TotalGrossUBI
Net Unrelated Business Txbl Income	0	NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year	93394	ContributionsGrantsPriorYear
Contributions Grants Current Year	0	ContributionsGrantsCurrentYear
Program Service Revenue Prior Year	10903508	ProgramServiceRevenuePriorYear
Program Service Revenue CY	12491037	ProgramServiceRevenueCY
Investment Income Prior Year	8093	InvestmentIncomePriorYear
Investment Income Current Year	11890	InvestmentIncomeCurrentYear
Other Revenue Prior Year	0	OtherRevenuePriorYear
Other Revenue Current Year	0	OtherRevenueCurrentYear
Total Revenue Prior Year	11004995	TotalRevenuePriorYear
Total Revenue Current Year	12502927	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	3739930	SalariesEtcPriorYear
Salaries Etc Current Year	4832801	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	6636374	OtherExpensePriorYear
Other Expenses Current Year	5963639	OtherExpensesCurrentYear
Total Expenses Prior Year	10376304	TotalExpensesPriorYear
Total Expenses Current Year	10796440	TotalExpensesCurrentYear
Revenues Less Expenses Prior Year	628691	RevenuesLessExpensesPriorYear
Revenues Less Expenses CY	1706487	RevenuesLessExpensesCY
Total Assets BOY	4821252	TotalAssetsBOY
Total Assets EOY	5312244	TotalAssetsEOY
Total Liabilities BOY	4821252	TotalLiabilitiesBOY
Total Liabilities EOY	5312244	TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY	0	NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY	0	NetAssetsOrFundBalancesEOY
Info In Schedule O Part III	X	InfoInScheduleOPartIII
Mission Description	Pawnee Valley Community Hospital, Inc. is a tax-exempt charitable organization under Section 501(c)(3) of the Internal Revenue Code and is licensed by the State of Kansas Department of Health and Environment. The purpose of the Organization is to provide healthcare facitities and services for the care and treatment of inpatients and outpatients who are acutely ill or who otherwise require medical care and related services. The core purpose of the Corporation is to help people be healthy.	MissionDescription
Significant New Program Services	0	SignificantNewProgramServices
Significant Change	0	SignificantChange
Expense	9469341	Expense
Revenue	12379141	Revenue
Description	Patient care: Program services consist of routine and ancillary department healthcare services provided by a healthcare organization as described in 501(c)(3) of the IRS code.	Description
Total Program Service Expense	9469341	TotalProgramServiceExpense
Described In501 C3	1	DescribedIn501C3
Schedule B Required	0	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	0	ReportLandBldgEquip
Report Invest Oth Securities	0	ReportInvestOthSecurities
Report Prog Rel Invest	0	ReportProgRelInvest
Report Other Assets	1	ReportOtherAssets
Report Other Liabilities	1	ReportOtherLiabilities
Report Fin48 Footnote	1	ReportFin48Footnote
Independent Audit Financial Stmt	0	IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt	1	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	1	Hospital
Financial Stmt Attached	1	FinancialStmtAttached
Grants To Organizations	0	GrantsToOrganizations
Grants To Individuals	0	GrantsToIndividuals
Schedule J Required	1	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	1	RelatedEntity
Related Org Controlled Entity	0	RelatedOrgControlledEntity
Transaction Related Entity	0	TransactionRelatedEntity
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	114	NumberOfEmployees
Employment Tax Returns Filed	1	EmploymentTaxReturnsFiled
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	5	NbrVotingGoverningBodyMembers
Number Independent Voting Members	0	NumberIndependentVotingMembers
Family Or Business Relationship	0	FamilyOrBusinessRelationship
Delegation Of Management Duties	0	DelegationOfManagementDuties
Changes To Organizing Docs	0	ChangesToOrganizingDocs
Material Diversion Or Misuse	0	MaterialDiversionOrMisuse
Members Or Stockholders	1	MembersOrStockholders
Election Of Board Members	1	ElectionOfBoardMembers
Decisions Subject To Approval	1	DecisionsSubjectToApproval
Minutes Of Governing Body	1	MinutesOfGoverningBody
Minutes Of Committees	1	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	1	DocumentRetentionPolicy
Compensation Process CEO	1	CompensationProcessCEO
Compensation Process Other	1	CompensationProcessOther
Investment In Joint Venture	0	InvestmentInJointVenture
Upon Request	X	UponRequest

The Books Are In Care Of TheBooksAreInCareOf

Field	Value	IRS element (for citing)
Name Person	William Overbey Treasurer	NamePerson
Telephone Number	7856235000	TelephoneNumber

Address US AddressUS

Field	Value	IRS element (for citing)
Address Line1	2220 Canterbury	AddressLine1
City	Hays	City
State	KS	State
ZIP Code	67601	ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (5 entries)

TitleTitle	Average Hours Per WeekAverageHoursPerWeek	Individual Trustee Or DirectorIndividualTrusteeOrDirector	OfficerOfficer	Reportable Comp From OrganizationReportableCompFromOrganization	Reportable Comp From Related OrgsReportableCompFromRelatedOrgs	Other CompensationOtherCompensation
John Jeter MD
President	4.00	X	X	0	468021	122926
Bryce Young
Vice President	4.00	X	X	0	243392	77470
William Overbey
Secretary/Treasurer	4.00	X	X	0	247271	76966
Shae Veach
Director	4.00	X		0	144878	48937
Matt Heyn
Administrator	40.00	X	X	97812	41678	29538

Field	Value	IRS element (for citing)
Total Reportable Comp From Org	97812	TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs	1145240	TotalReportableCompFrmRltdOrgs
Total Other Compensation	355837	TotalOtherCompensation
Number Individuals GT100 K	0	NumberIndividualsGT100K
Formers Listed	0	FormersListed
Total Comp GT150 K	1	TotalCompGT150K
Compensation From Other Sources	0	CompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1	CityAddressOfContractor/AddressUS/City	StateAddressOfContractor/AddressUS/State	ZIP CodeAddressOfContractor/AddressUS/ZIPCode	Description Of ServicesDescriptionOfServices	CompensationCompensation
Hays Medical Center
2220 Canterbury Drive	Hays	KS	67601	Contract Services	2207127
Docs Who Care
1337 S Fountain Drive	Olathe	KS	66061	ER Physician Coverage	789013
Allstaff Chartered
2000 Washington	Great Bend	KS	67530	Contract Nursing	279307
Quest Diagnostics
PO Box 14730	St Louis	MO	63150	Lab Service	199926
Shared Med Equipment Group LLC
PO Box 330	Cottage Grove	WI	53527	Equipment maintenance	135000

Field	Value	IRS element (for citing)
Number Of Contractors GT100 K	6	NumberOfContractorsGT100K

Program Service Revenue ProgramServiceRevenue (2 entries)

DescriptionDescription	Business CodeBusinessCode	Total Revenue ColumnTotalRevenueColumn	Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome	ExclusionExclusionAmount
Net patient service re	622000	12379141	12379141
Other operating revenu	900099	111896		$111,896

Field	Value	IRS element (for citing)
Total Program Service Revenue	12491037	TotalProgramServiceRevenue

Investment Income InvestmentIncome

Field	Value	IRS element (for citing)
Total Revenue Column	11589	TotalRevenueColumn
Exclusion	$11,589	ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

Field	Value	IRS element (for citing)
Other	301	Other

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

Field	Value	IRS element (for citing)
Other	0	Other

Gain Or Loss GainOrLoss

Field	Value	IRS element (for citing)
Other	301	Other

Net Gain Or Loss Investments NetGainOrLossInvestments

Field	Value	IRS element (for citing)
Total Revenue Column	301	TotalRevenueColumn
Exclusion	$301	ExclusionAmount

Total Revenue TotalRevenue

Field	Value	IRS element (for citing)
Total Revenue Column	12502927	TotalRevenueColumn
Related Or Exempt Function Income	12379141	RelatedOrExemptFunctionIncome
Unrelated Business Revenue	0	UnrelatedBusinessRevenue
Exclusion	$123,786	ExclusionAmount

Comp Current Officers Directors CompCurrentOfficersDirectors

Field	Value	IRS element (for citing)
Total	174300	Total
Management And General	174300	ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

Field	Value	IRS element (for citing)
Total	3626868	Total
Program Services	3180625	ProgramServices
Management And General	446243	ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

Field	Value	IRS element (for citing)
Total	131166	Total
Program Services	116024	ProgramServices
Management And General	15142	ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

Field	Value	IRS element (for citing)
Total	632160	Total
Program Services	555831	ProgramServices
Management And General	76329	ManagementAndGeneral

Payroll Taxes PayrollTaxes

Field	Value	IRS element (for citing)
Total	268307	Total
Program Services	226454	ProgramServices
Management And General	41853	ManagementAndGeneral

Fees For Services Management FeesForServicesManagement

Field	Value	IRS element (for citing)
Total	23616	Total
Management And General	23616	ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

Field	Value	IRS element (for citing)
Total	24789	Total
Management And General	24789	ManagementAndGeneral

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

Field	Value	IRS element (for citing)
Total	321	Total
Management And General	321	ManagementAndGeneral

Fees For Services Other FeesForServicesOther

Field	Value	IRS element (for citing)
Total	1981304	Total
Program Services	1809840	ProgramServices
Management And General	171464	ManagementAndGeneral

Advertising Advertising

Field	Value	IRS element (for citing)
Total	70198	Total
Program Services	2242	ProgramServices
Management And General	67956	ManagementAndGeneral

Office Expenses OfficeExpenses

Field	Value	IRS element (for citing)
Total	36128	Total
Program Services	23849	ProgramServices
Management And General	12279	ManagementAndGeneral

Information Technology InformationTechnology

Field	Value	IRS element (for citing)
Total	67106	Total
Program Services	40655	ProgramServices
Management And General	26451	ManagementAndGeneral

Occupancy Occupancy

Field	Value	IRS element (for citing)
Total	158706	Total
Program Services	107460	ProgramServices
Management And General	51246	ManagementAndGeneral

Travel Travel

Field	Value	IRS element (for citing)
Total	17647	Total
Program Services	13710	ProgramServices
Management And General	3937	ManagementAndGeneral

Interest Interest

Field	Value	IRS element (for citing)
Total	4720	Total
Program Services	4720	ProgramServices

Insurance Insurance

Field	Value	IRS element (for citing)
Total	38326	Total
Program Services	22996	ProgramServices
Management And General	15330	ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescription	TotalTotal	Program ServicesProgramServices	Management And GeneralManagementAndGeneral
Bad debts	1649703	1649703
Contract labor	398006	398006
Medical supplies	320165	320045	120
Pharmaceuticals	288974	288974

All Other Expenses AllOtherExpenses

Field	Value	IRS element (for citing)
Total	883930	Total
Program Services	708207	ProgramServices
Management And General	175723	ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

Field	Value	IRS element (for citing)
Total	10796440	Total
Program Services	9469341	ProgramServices
Management And General	1327099	ManagementAndGeneral
Fundraising	0	Fundraising

Cash Non Interest Bearing CashNonInterestBearing

Field	Value	IRS element (for citing)
BOY	560	BOY
EOY	560	EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

Field	Value	IRS element (for citing)
BOY	2678839	BOY
EOY	2764507	EOY

Accounts Receivable AccountsReceivable

Field	Value	IRS element (for citing)
BOY	1879340	BOY
EOY	1263463	EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

Field	Value	IRS element (for citing)
BOY	641	BOY
EOY	9199	EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

Field	Value	IRS element (for citing)
BOY	195512	BOY
EOY	316765	EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

Field	Value	IRS element (for citing)
BOY	66360	BOY
EOY	115912	EOY

Other Assets Total OtherAssetsTotal

Field	Value	IRS element (for citing)
BOY	0	BOY
EOY	841838	EOY

Total Assets TotalAssets

Field	Value	IRS element (for citing)
BOY	4821252	BOY
EOY	5312244	EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

Field	Value	IRS element (for citing)
BOY	4192561	BOY
EOY	942625	EOY

Other Liabilities OtherLiabilities

Field	Value	IRS element (for citing)
BOY	628691	BOY
EOY	4369619	EOY

Total Liabilities TotalLiabilities

Field	Value	IRS element (for citing)
BOY	4821252	BOY
EOY	5312244	EOY

Field	Value	IRS element (for citing)
Follow SFAS117	X	FollowSFAS117

Total Net Assets Fund Balances TotalNetAssetsFundBalances

Field	Value	IRS element (for citing)
BOY	0	BOY
EOY	0	EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

Field	Value	IRS element (for citing)
BOY	4821252	BOY
EOY	5312244	EOY

Field	Value	IRS element (for citing)
Info In Schedule O Part XI	X	InfoInScheduleOPartXI
Reconcilation Revenue Expenses	1706487	ReconcilationRevenueExpenses
Reconcilation Other Changes	-1706487	ReconcilationOtherChanges
Info In Schedule O Part XII	X	InfoInScheduleOPartXII
Method Of Accounting Accrual	X	MethodOfAccountingAccrual
Accountant Compile Or Review	0	AccountantCompileOrReview
FS Audited	1	FSAudited
Audit Committee	1	AuditCommittee
Financial Statement Consolidated	X	FinancialStatementConsolidated
Federal Grant Audit Required	0	FederalGrantAuditRequired

Schedule A IRS990ScheduleA

Field	Value	IRS element (for citing)
Hospital170b1 Aiii	X	Hospital170b1Aiii

Schedule D IRS990ScheduleD

Field	Value	IRS element (for citing)
Total Of Book Value Land Buildings	0	TotalOfBookValueLandBuildings

Other Assets OtherAssets

Field	Value	IRS element (for citing)
Description	Estimated third-party payor settlements	Description
Book Value	841838	BookValue

Field	Value	IRS element (for citing)
Total Book Value Other Assets	841838	TotalBookValueOtherAssets

Other Liabilities OtherLiabilities (3 entries)

DescriptionDescription	AmountAmount
Due to Pawnee County	$1,695,113
Due to Hays Medical Center, Inc.	$2,625,531
Estimated third-party payor settlements	$48,975

Field	Value	IRS element (for citing)
Total Of Amounts	4369619	TotalOfAmounts
Total Revenue	12502927	TotalRevenue
Total Expenses	10796440	TotalExpenses
Excess Or Deficit For Year	1706487	ExcessOrDeficitForYear
Other	-$1,706,487	OtherAmount
Total Adjustments	-1706487	TotalAdjustments
Excess Or Deficit Per FS	0	ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt	10853224	TotRevenueEtcAuditedFinclStmt
Revenue Not Rptd F990	0	RevenueNotRptdF990
Revenue Subtotal	10853224	RevenueSubtotal
Other Revenues Not Included	1649703	OtherRevenuesNotIncluded
Revenue Not Rptd On Fin Stmt	1649703	RevenueNotRptdOnFinStmt
Total Revenue Per Form990	12502927	TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt	9146737	TotExpensesEtcAuditedFinclStmt
Expenses Not Rptd F990	0	ExpensesNotRptdF990
Expenses Subtotal	9146737	ExpensesSubtotal
Other Expenses Not Included	1649703	OtherExpensesNotIncluded
Expenses Not Rptd On Fin Stmt	1649703	ExpensesNotRptdOnFinStmt
Total Expenses Per Form990	10796440	TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (4 entries)

IdentifierIdentifier	Return ReferenceReturnReference	ExplanationExplanation
Description of Uncertain Tax Positions Under FIN 48:	Part X:	Management is not aware of any uncertainties in income tax positions.
Part XI, Line 8 - Other Adjustments:		Increase in amount due to Pawnee County -1,066,422. Transfers to Pawnee County -640,065. Total to Schedule D, Part XI, Line 8: -1,706,487.
Part XII, Line 4b - Other Adjustments:		Bad debts treated as net patient service revenue in financial statements 1,649,703.
Part XIII, Line 4b - Other Adjustments:		Bad debts treated as net patient service revenue in financial statements 1,649,703.

Schedule H IRS990ScheduleH

Field	Value	IRS element (for citing)
Charity Care Policy	1	CharityCarePolicy
Written Policy	1	WrittenPolicy
FPG Reference Free Care	1	FPGReferenceFreeCare

Other Percentage OtherPercentage

Field	Value	IRS element (for citing)
Other	X	Other
Free Other Percentage	125.000000000000	FreeOtherPercentage

Field	Value	IRS element (for citing)
FPG Reference Discounted Care	1	FPGReferenceDiscountedCare
Pcent400	X	Pcent400
Free Disc Care Medically Indigent	1	FreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity Care	1	AmountsBudgetedForCharityCare
Expenses Exceeded Budget	0	ExpensesExceededBudget
Annual Community Benefit Report	1	AnnualCommunityBenefitReport
Report Publically Available	0	ReportPublicallyAvailable

Charity Care At Cost CharityCareAtCost

Field	Value	IRS element (for citing)
Total Community Benefit Expense	132291	TotalCommunityBenefitExpense
Net Community Benefit Expense	132291	NetCommunityBenefitExpense
Percent Of Total Expense	0.01450	PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

Field	Value	IRS element (for citing)
Total Community Benefit Expense	746236	TotalCommunityBenefitExpense
Direct Offsetting Revenue	607942	DirectOffsettingRevenue
Net Community Benefit Expense	138294	NetCommunityBenefitExpense
Percent Of Total Expense	0.01510	PercentOfTotalExpense

Total Charity Care TotalCharityCare

Field	Value	IRS element (for citing)
Total Community Benefit Expense	878527	TotalCommunityBenefitExpense
Direct Offsetting Revenue	607942	DirectOffsettingRevenue
Net Community Benefit Expense	270585	NetCommunityBenefitExpense
Percent Of Total Expense	0.02960	PercentOfTotalExpense

Subsidized Health Services SubsidizedHealthServices

Field	Value	IRS element (for citing)
Total Community Benefit Expense	970253	TotalCommunityBenefitExpense
Direct Offsetting Revenue	567770	DirectOffsettingRevenue
Net Community Benefit Expense	402483	NetCommunityBenefitExpense
Percent Of Total Expense	0.04400	PercentOfTotalExpense

Cash And In Kind Contributions CashAndInKindContributions

Field	Value	IRS element (for citing)
Total Community Benefit Expense	7600	TotalCommunityBenefitExpense
Net Community Benefit Expense	7600	NetCommunityBenefitExpense
Percent Of Total Expense	0.00080	PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

Field	Value	IRS element (for citing)
Total Community Benefit Expense	977853	TotalCommunityBenefitExpense
Direct Offsetting Revenue	567770	DirectOffsettingRevenue
Net Community Benefit Expense	410083	NetCommunityBenefitExpense
Percent Of Total Expense	0.04480	PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

Field	Value	IRS element (for citing)
Total Community Benefit Expense	1856380	TotalCommunityBenefitExpense
Direct Offsetting Revenue	1175712	DirectOffsettingRevenue
Net Community Benefit Expense	680668	NetCommunityBenefitExpense
Percent Of Total Expense	0.07440	PercentOfTotalExpense

Field	Value	IRS element (for citing)
Bad Debt Expense Reported	0	BadDebtExpenseReported
Bad Debt Expense	$604,707	BadDebtExpenseAmount
Amount Attributable To	42329	AmountAttributableTo
Amount Reimbursed By Medicare	6510497	AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare	6446036	CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall	64461	MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

Field	Value	IRS element (for citing)
Other	X	Other

Field	Value	IRS element (for citing)
Written Debt Collection Policy	1	WrittenDebtCollectionPolicy
Provision For Charity Care	1	ProvisionForCharityCare
Number Of Hospital Facilities	1	NumberOfHospitalFacilities

Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA

Field	Value	IRS element (for citing)
Facility Number	1	FacilityNumber

Name Name

Field	Value	IRS element (for citing)
Business Name Line1	Pawnee Valley Community Hospital Inc	BusinessNameLine1

Address Address

Field	Value	IRS element (for citing)
Address Line1	923 Carroll Avenue	AddressLine1
City	Larned	City
State	KS	State
ZIP Code	67550	ZIPCode

Field	Value	IRS element (for citing)
Licensed Hospital	X	LicensedHospital
General Medical And Surgical	X	GeneralMedicalAndSurgical
Critical Access Hospital	X	CriticalAccessHospital
Er24 Hours	X	Er24Hours

Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB

Hospital Facility Name HospitalFacilityName

Field	Value	IRS element (for citing)
Business Name Line1	Pawnee Valley Community Hospital Inc	BusinessNameLine1

Field	Value	IRS element (for citing)
Hospital Facility Number	1	HospitalFacilityNumber
Eligibility Criteria Explained	1	EligibilityCriteriaExplained
Uses FPG Free	1	UsesFPGFree
FPG Free Percent	125.000000000000	FPGFreePercent
Uses FPG Discounted	1	UsesFPGDiscounted
FPG Discount Percent	400.000000000000	FPGDiscountPercent
Explains Basis	1	ExplainsBasis
Income Level	X	IncomeLevel
Asset Level	X	AssetLevel
Uninsured Discount	X	UninsuredDiscount
Medicaid Medicare	X	MedicaidMedicare
Explains Application Method	1	ExplainsApplicationMethod
Includes Publicity Measures	1	IncludesPublicityMeasures
Posted On Website	X	PostedOnWebsite
Posted In Admission Office	X	PostedInAdmissionOffice
Available On Request	X	AvailableOnRequest
Other Publicity	X	OtherPublicity
Actions On Nonpayment	1	ActionsOnNonpayment
Collection Activities	0	CollectionActivities
Nondiscrim Emergency Care Policy	1	NondiscrimEmergencyCarePolicy
Lowest Negotiated Rates	X	LowestNegotiatedRates
Amounts Generally Billed	0	AmountsGenerallyBilled
Gross Charges	0	GrossCharges

Form990 Schedule H Part VI Form990ScheduleHPartVI (11 entries)

ExplanationExplanation	IdentifierIdentifier	Return ReferenceReturnReference
Part I, Line 7: A cost-to-charge ratio derived from Worksheet 2 was used to determine financial assistance at cost and the cost of subsidized health services. A cost-to-charge ratio derived from Worksheet 2 was used to determine the costs of serving Medicaid managed care organization beneficiaries and costs from the Medicaid cost report filed with the state Medicaid agency were used to determine the costs of serving traditional Medicaid beneficiaries.
Part I, L7 Col(f): Bad debt expense of $1,649,703 is included in Part IX line 25. This amount was subtracted from total expenses when computing the denominator for the percentage calculated for line 7(f).
Part III, Line 4: Bad debt expense was calculated using a cost-to-charge ratio derived from Worksheet 2. The estimate for the amount of bad debt expense attributable to patients eligible under the FAP is based upon the experience of a related organization. The hospital's financial statements are included in a consolidated set of audited financial statements. The footnote from these financial statements follows:Accounts receivable are reduced by an allowance for uncollectible accounts. In evaluating the collectability of accounts receivable, the HaysMed Group analyzes its past history and identifies trends for each of its major payor sources of revenue to estimate the appropriate allowance for uncollectible accounts and provision for bad debts. Management regularly reviews data about these major payor sources of revenue in evaluating the sufficiency of the allowance for uncollectible accounts. For receivables associated with services provided to patients who have third-party coverage, the HaysMed Group analyzes contractually due amounts and provides an allowance for uncollectible accounts and a provision for bad debts, if necessary (for example, for expected uncollectible deductibles and copayments on accounts for which the third-party payor has not yet paid, or for payors who are known to be having financial difficulties that make the realization of amounts due unlikely). For receivables associated with self-pay patients (which includes both patients without insurance and patients with deductible and copayment balances due for which third-party coverage exists for part of the bill), the HaysMed Group records a significant provision for bad debts in the period of service on the basis of its past experience, which indicates that many patients are unable or unwilling to pay the portion of their bill for which they are financially responsible. The difference between the standard rates (or the discounted rates if negotiated) and the amounts actually collected after all reasonable collection efforts have been exhausted is charged off against the allowance for uncollectible accounts.
Part III, Line 8: The Medicare cost report was the costing methodology used to determine the allowable Medicare costs pertaining to Medicare net revenue. Allowable costs of care reported on line 6 were determined using amounts from Worksheet D, Part V and Worksheet D-1 in the Pawnee Valley Community Hospital, Inc., Medicare cost report for fiscal year ended June 30, 2012.
Part III, Line 9b: Whenever possible, the customer service representatives (CSR's) of Pawnee Valley Community Hospital try to determine the estimated self-pay balance prior to the patient receiving services. Charity care eligibility is first considered at this point in time. In addition, if full payment is not received or payment is not made with 30 days, the CSR contacts the patient. If it is determined that at least a two-year payment plan cannot be established with the patient, the CSR will screen for charity care and request that the charity care application be completed by the patient.
Part V, Section B, Line 13g: Pawnee Valley Community Hospital, Inc. (PVCH) will proactively seek out applicants who may be in need of financial assistance. PVCH will post notice of this policy to all patients/guarantors through its registration, pre-registration, and financial counseling process. This policy will also be posted in prominent areas of the hospital.	Pawnee Valley Community Hospital, Inc.
Part VI, Line 3: Information regarding the Pawnee Valley Community Hospital, Inc. charity care program is located on the Hays Medical Center, Inc. website for patients and community members to view, and the financial assistance application is also on the website to print off and complete. In addition, if a customer service representative contacts a patient about a bill and in visiting with them they determine that patient could possibly qualify for the hospital's charity care policy, the CSR will send the application to the patient as well.
Part VI, Line 4: Pawnee Valley Community Hospital, Inc. is located in Larned, Kansas, which has a population of approximately 4,050 people, as of the 2010 census. The median household income of Larned was $46,464. Approximately 5.9% of families were below the poverty line, and 7.4% of the total population was below the poverty line. Approximately 8.9% of the hospital's revenue is from services provided to patients eligible for Medicaid. Pawnee Valley Community Hospital, Inc. is the only hospital in Larned, Kansas. It mainly serves the community of Larned.
Part VI, Line 5: Pawnee Valley Community Hospital, Inc. promotes the health of the community by extending medical privileges to most qualified, local physicians.
Part VI, Line 6: Pawnee Valley Community Hospital, Inc. is not a part of an affiliated health care system.
Pawnee Valley Community Hospital, has completed its assessment of the health care needs of the communities it serves, and is in the process of making the study available to the public.		Sch H - Part VI - Line 2

Schedule J IRS990ScheduleJ

Field	Value	IRS element (for citing)
Independent Consultant	X	IndependentConsultant
Board Or Committee Approval	X	BoardOrCommitteeApproval
Severance Payment	0	SeverancePayment
Supplemental Nonqual Retire Plan	1	SupplementalNonqualRetirePlan
Equity Based Comp Arrangement	0	EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org	0	CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs	0	CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org	1	CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs	1	CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments	0	AnyNonFixedPayments
Initial Contract Exception	0	InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (5 entries)

Base Compensation Filing OrgBaseCompensationFilingOrg	Comp Based On Related OrgsCompBasedOnRelatedOrgs	Bonus Filing OrgBonusFilingOrg	Bonus Related OrgsBonusRelatedOrgs	Other Compensation Filing OrgOtherCompensationFilingOrg	Other Compensation Related OrgsOtherCompensationRelatedOrgs	Deferred Comp Filing OrgDeferredCompFilingOrg	Deferred Comp Related OrgsDeferredCompRelatedOrgs	Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg	Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs	Total Compensation Filing OrgTotalCompensationFilingOrg	Total Compensation Related OrgsTotalCompensationRelatedOrgs	Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg	Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
John Jeter MD
0	408709	0	44543	0	14769	0	97963	0	24963	0	590947	0	0
Bryce Young
0	219371	0	19388	0	4633	0	49739	0	27731	0	320862	0	0
William Overbey
0	216282	0	19119	0	11870	0	49235	0	27731	0	324237	0	0
Shae Veach
0	136257	0	5312	0	3309	0	24728	0	24209	0	193815	0	0
Matt Heyn
97812	23678	0	18000	0	0	3276	1462	20003	4797	121091	47937	0	0

Form990 Schedule J Part III Form990ScheduleJPartIII (3 entries)

Return ReferenceReturnReference	ExplanationExplanation
Part I, Line 3	The hospital Administrator's salary is reviewed annually by an independent consulting group and the Board of Directors.
Part I, Line 4b	John Jeter, M.D. - $67,988 Bryce Young - $36,264 William Overbey - $35,760 Shae Veach - $21,235
Part I, Line 6	A portion of the Administrator's incentive compensation is determined by net earnings exceeding budget for the fiscal year. A portion of incentive compensation for officers and key employees of Hays Medical Center, Inc., a related organization, is determined by net earnings exceeding budget for the fiscal year.

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (9 entries)

Return ReferenceReturnReference	ExplanationExplanation	IdentifierIdentifier
Form 990, Part VI, Section A, line 6	The organization has one member, HaysMed Partners, Inc., which became the sole member as of March 1, 2010. HaysMed Partners, Inc., is a wholly-owned subsidiary of Hays Medical Center, Inc.
Form 990, Part VI, Section A, line 7a	The Board members of HaysMed Partners, Inc., the sole member of Pawnee Valley Community Hospital, appoint the Board members of Pawnee Valley Community Hospital, Inc.
Form 990, Part VI, Section A, line 7b	HaysMed Partners, Inc., the sole member of Pawnee Valley Community Hospital, elects the Board members of Pawnee Valley Community Hospital.
Form 990, Part VI, Section B, line 11	Form 990 was reviewed with the Board members prior to filing.
Form 990, Part VI, Section B, line 12c	Officers, directors & key employees, along with all associates, are required to complete a conflict of interest statement annually. The statements are used to monitor and enforce compliance with the policy.
Form 990, Part VI, Section B, line 15	The hospital administrator and officers' salaries are reviewed annually by an independent consulting group and the Board members.
Form 990, Part VI, Section C, line 19	These documents are not made available to the public.
Form 990, Part XI, line 5:	Increase in amount due to Pawnee County -1,066,422. Transfers to Pawnee County -640,065. Total to Form 990, Part XI, Line 5: -1,706,487.	Changes in Net Assets or Fund Balances:
Form 990. Part XII, Line 2c	Hays Medical Center, Inc., has an audit committee that is responsible for the oversight of Pawnee Valley Community Hospital, Inc's., financial statement audit and the selection process of an independent accountant.	Financial Statements and Reporting

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (2 entries)

Address Line1AddressUS/AddressLine1	CityAddressUS/City	StateAddressUS/State	ZIP CodeAddressUS/ZIPCode	EINEIN	Primary ActivitiesPrimaryActivities	Legal Domicile StateLegalDomicileState	Exempt Code SectionExemptCodeSection	Public Charity StatusPublicCharityStatus	Controlled OrgControlledOrg
HaysMed Partners Inc
2220 Canterbury Dr	Hays	KS	67601	270877152	Owns management contract for Pawnee Valley Community Hospital	KS	501(c)(3)	170(b)(1)(A)(iii)	0
Hays Medical Center Inc
2220 Canterbury Dr	Hays	KS	67601	480559088	Hospital	KS	501(c)(3)	170(b)(1)(A)(iii)	0

Field	Value	IRS element (for citing)
Receipt Of Int Ann Rents Royalties	0	ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org	0	GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org	0	GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org	0	LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org	1	LoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other Org	0	SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org	0	PurchaseOfAssetsFromOtherOrg
Exchange Of Assets	0	ExchangeOfAssets
Rental Of Facilities To Other Orgs	1	RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs	0	RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs	0	PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs	1	PerformOfServicesByOtherOrgs
Sharing Of Facilities	0	SharingOfFacilities
Sharing Of Paid Employees	1	SharingOfPaidEmployees
Reimbursement Paid To Other Org	1	ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org	0	ReimbursementPaidByOtherOrg
Other Transfer To Other Org	0	OtherTransferToOtherOrg
Other Transfer From Other Org	0	OtherTransferFromOtherOrg