NINNESCAH VALLEY HEALTH SYSTEMS INC: Form 990, tax year 2011
View the entire original 990 at ProPublica ↗
- Organization
- NINNESCAH VALLEY HEALTH SYSTEMS INC (EIN 48-0761700)
- Tax period
- 2011-05-01 to 2012-04-30
- Filed
- 2013-03-13
- IRS object ID
- 201320729349300512
- Schema version
- 2011v1.5
- 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 K
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2013-03-13T12:39:52-05:00 | Timestamp |
| Tax Period End Date | 2012-04-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BKD LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1551 N WATERFRONT PKWY STE 300 | AddressLine1 |
| City | WICHITA | City |
| State | KS | State |
| ZIP Code | 672066601 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2011-05-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 480761700 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | NINNESCAH VALLEY HEALTH SYSTEMS INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| In Care Of Name | % KENT HUDSON | InCareOfName |
| Name Control | NINN | NameControl |
| Phone | 6205323147 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 367 | AddressLine1 |
| City | KINGMAN | City |
| State | KS | State |
| ZIP Code | 67068 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | GARY TILLER | Name |
| Title | CEO | Title |
| Date Signed | 2013-03-15 | DateSigned |
| Authorize Third Party | true | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | ELIZABETH S HOGAN | Name |
| Phone | 3162652811 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2011 | TaxYear |
| Build TS | 2016-02-25 16:41:14Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | KENT HUDSON | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 367 | AddressLine1 |
| City | KINGMAN | City |
| State | KS | State |
| ZIP Code | 67068 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 10281954 | GrossReceipts |
| Group Return For Affiliates | false | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.NVHSINC.COM | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1996 | YearFormation |
| State Legal Domicile | KS | StateLegalDomicile |
| Activity Or Mission Description | ACUTE CARE HOSPITAL ORGANIZED TO MEET THE PRIMARY HEALTH CARE NEEDS OF THE PEOPLE OF KINGMAN COUNTY AND THE SURROUNDING COMMUNITIES. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 7 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 7 | NbrIndependentVotingMembers |
| Total Nbr Employees | 178 | TotalNbrEmployees |
| Total Nbr Volunteers | 39 | TotalNbrVolunteers |
| Total Gross UBI | 12250 | TotalGrossUBI |
| Contributions Grants Prior Year | 26033 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 35290 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 9731335 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 9976419 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 19105 | InvestmentIncomePriorYear |
| Investment Income Current Year | 18880 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 275269 | OtherRevenuePriorYear |
| Other Revenue Current Year | 251365 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 10051742 | TotalRevenuePriorYear |
| Total Revenue Current Year | 10281954 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 2200 | 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 | 5684127 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 5897312 | 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 | 4806998 | OtherExpensePriorYear |
| Other Expenses Current Year | 4925554 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 10493325 | TotalExpensesPriorYear |
| Total Expenses Current Year | 10822866 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | -441583 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | -540912 | RevenuesLessExpensesCY |
| Total Assets BOY | 8535976 | TotalAssetsBOY |
| Total Assets EOY | 7870512 | TotalAssetsEOY |
| Total Liabilities BOY | 4568522 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 4434822 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 3967454 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 3435690 | NetAssetsOrFundBalancesEOY |
| Mission Description | ACUTE CARE HOSPITAL ORGANIZED TO MEET THE PRIMARY HEALTH CARE NEEDS OF THE PEOPLE OF KINGMAN COUNTY AND THE SURROUNDING COMMUNITIES. | MissionDescription |
| Significant New Program Services | false | SignificantNewProgramServices |
| Significant Change | false | SignificantChange |
| Expense | 8906414 | Expense |
| Revenue | 10027844 | Revenue |
| Description | HEALTH CARE SERVICES PROVIDED TO THE PEOPLE OF KINGMAN COUNTY AND THE SURROUNDING COMMUNITIES. DURING THE FISCAL YEAR 2012 THE HOSPITAL HAD 2,998 EMERGENCY ROOM VISITS, 4,007 IN-PATIENT DAYS AND CONDUCTED 797 SURGERIES. IN ADDITION, THE HOSPITAL PROVIDES A FAMILY CARE CLINIC IN THE NEIGHBORING COMMUNITY OF CUNNINGHAM. | Description |
| Total Program Service Expense | 8906414 | TotalProgramServiceExpense |
| Described In501 C3 | true | DescribedIn501C3 |
| Schedule B Required | true | ScheduleBRequired |
| Political Activities | false | PoliticalActivities |
| Lobbying Activities | true | LobbyingActivities |
| Subject To Proxy Tax | false | SubjectToProxyTax |
| Donor Advised Funds | false | DonorAdvisedFunds |
| Conservation Easements | false | ConservationEasements |
| Collections Of Art | false | CollectionsOfArt |
| Credit Counseling | false | CreditCounseling |
| Term Or Permanent Endowments | false | TermOrPermanentEndowments |
| Report Land Bldg Equip | true | ReportLandBldgEquip |
| Report Invest Oth Securities | false | ReportInvestOthSecurities |
| Report Prog Rel Invest | false | ReportProgRelInvest |
| Report Other Assets | false | ReportOtherAssets |
| Report Other Liabilities | true | ReportOtherLiabilities |
| Report Fin48 Footnote | true | ReportFin48Footnote |
| Independent Audit Financial Stmt | true | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | false | ConsolidatedAuditFinancialStmt |
| School | false | School |
| Foreign Office | false | ForeignOffice |
| Foreign Activities | false | ForeignActivities |
| More Than5000 K To Organizations | false | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividuals |
| Professional Fundraising | false | ProfessionalFundraising |
| Fundraising Activities | false | FundraisingActivities |
| Gaming | false | Gaming |
| Hospital | true | Hospital |
| Financial Stmt Attached | true | FinancialStmtAttached |
| Grants To Organizations | false | GrantsToOrganizations |
| Grants To Individuals | false | GrantsToIndividuals |
| Schedule J Required | false | ScheduleJRequired |
| Tax Exempt Bonds | true | TaxExemptBonds |
| Invest Tax Exempt Bonds | false | InvestTaxExemptBonds |
| Escrow Account | false | EscrowAccount |
| On Behalf Of Issuer | false | OnBehalfOfIssuer |
| Excess Benefit Transaction | false | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | false | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | false | LoanToOfficerOrDQP |
| Grant To Related Person | false | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | false | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | false | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | false | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | false | DeductibleNonCashContributions |
| Deductible Contributions Of Art | false | DeductibleContributionsOfArt |
| Terminated | false | Terminated |
| Partial Liquidation | false | PartialLiquidation |
| Disregarded Entity | false | DisregardedEntity |
| Related Entity | true | RelatedEntity |
| Related Org Controlled Entity | false | RelatedOrgControlledEntity |
| Transaction Related Entity | false | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | false | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | false | ActivitiesConductedPartnership |
| Schedule O Required | true | ScheduleORequired |
| Number Forms Transmitted With1096 | 24 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | true | ComplianceWithBackupWitholding |
| Number Of Employees | 178 | NumberOfEmployees |
| Employment Tax Returns Filed | true | EmploymentTaxReturnsFiled |
| Unrelated Business Income | true | UnrelatedBusinessIncome |
| Form990-T Filed | true | Form990-TFiled |
| Foreign Financial Account | false | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTrans |
| Taxable Party Notification | false | TaxablePartyNotification |
| Non Deductible Contributions | false | NonDeductibleContributions |
| Quid Pro Quo Contributions | false | QuidProQuoContributions |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | false | FundsToPayPremiums |
| Premiums Paid | false | PremiumsPaid |
| Indoor Tanning Services | false | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 7 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 7 | NumberIndependentVotingMembers |
| Family Or Business Relationship | false | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | false | DelegationOfManagementDuties |
| Changes To Organizing Docs | false | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuse |
| Members Or Stockholders | false | MembersOrStockholders |
| Election Of Board Members | false | ElectionOfBoardMembers |
| Decisions Subject To Approval | false | DecisionsSubjectToApproval |
| Minutes Of Governing Body | true | MinutesOfGoverningBody |
| Minutes Of Committees | true | MinutesOfCommittees |
| Officer Mailing Address | false | OfficerMailingAddress |
| Local Chapters | false | LocalChapters |
| Form990 Provided To Governing Body | true | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | true | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | true | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | true | RegularMonitoringEnforcement |
| Whistleblower Policy | true | WhistleblowerPolicy |
| Document Retention Policy | true | DocumentRetentionPolicy |
| Compensation Process CEO | true | CompensationProcessCEO |
| Compensation Process Other | true | CompensationProcessOther |
| Investment In Joint Venture | false | InvestmentInJointVenture |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | KENT HUDSON | NamePerson |
| Telephone Number | 6205323147 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 750 WEST D AVENUE | AddressLine1 |
| City | KINGMAN | City |
| State | KS | State |
| ZIP Code | 67068 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | X | InfoInScheduleOPartVII |
Form990 Part VII Section A Form990PartVIISectionA (10 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation |
|---|---|---|---|---|---|---|
| GEORGE BURKET | ||||||
| CHAIRMAN/DIRECTOR | 1.0 | X | X | 0 | 0 | |
| BILL KLAVER | ||||||
| VICE CHAIRMAN/DIRECTOR | 1.0 | X | X | 0 | 0 | |
| PATTI BRACE | ||||||
| SECRETARY/DIRECTOR | 1.0 | X | X | 0 | 0 | |
| BOB WUNSCH | ||||||
| TREASURER/DIRECTOR | 1.0 | X | X | 0 | 0 | |
| SONDRA NICKELL | ||||||
| DIRECTOR | 1.0 | X | 0 | 0 | ||
| TIGER CRAIG | ||||||
| VICE CHAIRMAN/DIRECTOR | 1.0 | X | X | 0 | 0 | |
| NEIL FREUND | ||||||
| DIRECTOR | 1.0 | X | 0 | 0 | ||
| ROB DEWEESE | ||||||
| DIRECTOR | 1.0 | X | 0 | 0 | 0 | |
| KENT HUDSON | ||||||
| CFO | 40.0 | X | 60515 | 4309 | ||
| GARY TILLER | ||||||
| CEO | 40.0 | X | 123201 | 12971 | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 183716 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 17280 | TotalOtherCompensation |
| Number Individuals GT100 K | 1 | NumberIndividualsGT100K |
| Formers Listed | false | FormersListed |
| Total Comp GT150 K | false | TotalCompGT150K |
| Compensation From Other Sources | false | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (2 entries)
| Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|
| MARSHA STINEMAN | |
| ANESTHESIA - CRNA | 103800 |
| HIGH PLAINS PROVIDER INC | |
| ER COVERAGE | 108484 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 2 | NumberOfContractorsGT100K |
| Government Grants | 14932 | GovernmentGrants |
| All Other Contributions | 20358 | AllOtherContributions |
| Total Contributions | 35290 | TotalContributions |
Program Service Revenue ProgramServiceRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | NET PATIENT SERVICE REVENUE | Description |
| Business Code | 621300 | BusinessCode |
| Total Revenue Column | 9976419 | TotalRevenueColumn |
| Related Or Exempt Function Income | 9976419 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 9976419 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 15880 | TotalRevenueColumn |
| Exclusion | $15,880 | ExclusionAmount |
Income From Invest Bond Proceeds IncomeFromInvestBondProceeds
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Royalties Revenue RoyaltiesRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 84143 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 84143 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 84143 | TotalRevenueColumn |
| Exclusion | $84,143 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 3000 | Other |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 3000 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 3000 | TotalRevenueColumn |
| Exclusion | $3,000 | ExclusionAmount |
Net Income From Fundraising Events NetIncomeFromFundraisingEvents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Net Income From Gaming NetIncomeFromGaming
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Net Income Or Loss NetIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Other Revenue Misc OtherRevenueMisc (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | ExclusionExclusionAmount | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|---|
| AUXILIARY | 900099 | 41669 | $41,669 | |
| EMPLOYEE/GUEST MEALS | 722210 | 46281 | $46,281 | |
| INTEREST ON PATIENT ACCOUNTS | 900099 | 30480 | 30480 |
Miscellaneous Revenue MiscellaneousRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 48792 | TotalRevenueColumn |
| Related Or Exempt Function Income | 20945 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 12250 | UnrelatedBusinessRevenue |
| Exclusion | $15,597 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 167222 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 10281954 | TotalRevenueColumn |
| Related Or Exempt Function Income | 10027844 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 12250 | UnrelatedBusinessRevenue |
| Exclusion | $206,570 | ExclusionAmount |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Grants To Domestic Individuals GrantsToDomesticIndividuals
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Foreign Grants ForeignGrants
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Benefits To Members BenefitsToMembers
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 215201 | Total |
| Management And General | 215201 | ManagementAndGeneral |
Comp Disqual Persons CompDisqualPersons
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 4731433 | Total |
| Program Services | 3983430 | ProgramServices |
| Management And General | 748003 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 65643 | Total |
| Program Services | 50435 | ProgramServices |
| Management And General | 15208 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 513660 | Total |
| Program Services | 405398 | ProgramServices |
| Management And General | 108262 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 371375 | Total |
| Program Services | 285333 | ProgramServices |
| Management And General | 86042 | ManagementAndGeneral |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3685 | Total |
| Management And General | 3685 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 46560 | Total |
| Management And General | 46560 | ManagementAndGeneral |
Fees For Services Lobbying FeesForServicesLobbying
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Prof Fundraising FeesForServicesProfFundraising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 950025 | Total |
| Program Services | 808942 | ProgramServices |
| Management And General | 141083 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 12943 | Total |
| Program Services | 2500 | ProgramServices |
| Management And General | 10443 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 249292 | Total |
| Program Services | 169478 | ProgramServices |
| Management And General | 79814 | ManagementAndGeneral |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Royalties Royalties
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 181631 | Total |
| Program Services | 143139 | ProgramServices |
| Management And General | 38492 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 70819 | Total |
| Program Services | 22993 | ProgramServices |
| Management And General | 47826 | ManagementAndGeneral |
Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 159964 | Total |
| Program Services | 122510 | ProgramServices |
| Management And General | 37454 | ManagementAndGeneral |
Payments To Affiliates PaymentsToAffiliates
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 544269 | Total |
| Program Services | 418171 | ProgramServices |
| Management And General | 126098 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 57675 | Total |
| Program Services | 12337 | ProgramServices |
| Management And General | 45338 | ManagementAndGeneral |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| MEDICAL SUPPLIES | 1275943 | 1275943 | |
| BAD DEBT EXPENSE | 600045 | 600045 | |
| EQUIPMENT RENTAL & MAINT. | 527202 | 444185 | 83017 |
| FOOD | 60353 | 60353 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 185148 | Total |
| Program Services | 101222 | ProgramServices |
| Management And General | 83926 | ManagementAndGeneral |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 10822866 | Total |
| Program Services | 8906414 | ProgramServices |
| Management And General | 1916452 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 30997 | BOY |
| EOY | 25255 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1597749 | BOY |
| EOY | 1155536 | EOY |
Pledges And Grants Receivable PledgesAndGrantsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1308151 | BOY |
| EOY | 1376644 | EOY |
Receivables From Officers Etc ReceivablesFromOfficersEtc
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Receivables From Disqual Persons ReceivablesFromDisqualPersons
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Other Notes Loans Receivable Net OtherNotesLoansReceivableNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 234421 | BOY |
| EOY | 239065 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 133480 | BOY |
| EOY | 65292 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 11663733 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 6843919 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4517307 | BOY |
| EOY | 4819814 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 324081 | BOY |
| EOY | 58772 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Investments Program Related InvestmentsProgramRelated
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 266705 | BOY |
| EOY | 124820 | EOY |
Intangible Assets IntangibleAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 123085 | BOY |
| EOY | 5314 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 8535976 | BOY |
| EOY | 7870512 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 699997 | BOY |
| EOY | 838575 | EOY |
Grants Payable GrantsPayable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Deferred Revenue DeferredRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 59334 | BOY |
| EOY | 41968 | EOY |
Tax Exempt Bond Liabilities TaxExemptBondLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3465000 | BOY |
| EOY | 2985000 | EOY |
Escrow Account Liability EscrowAccountLiability
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Loans From Officers Directors LoansFromOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 334191 | BOY |
| EOY | 539279 | EOY |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 10000 | BOY |
| EOY | 30000 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4568522 | BOY |
| EOY | 4434822 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3724756 | BOY |
| EOY | 3371618 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 242698 | BOY |
| EOY | 64072 | EOY |
Permanently Restricted Net Assets PermanentlyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3967454 | BOY |
| EOY | 3435690 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 8535976 | BOY |
| EOY | 7870512 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | -540912 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | 9148 | ReconcilationOtherChanges |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | false | AccountantCompileOrReview |
| FS Audited | true | FSAudited |
| Audit Committee | true | AuditCommittee |
| Financial Statement Separate | X | FinancialStatementSeparate |
| Federal Grant Audit Required | false | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
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 C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Grassroots Lobbying | TotalGrassrootsLobbying | |
| Total Direct Lobbying | TotalDirectLobbying | |
| Total Lobbying Expenditures | TotalLobbyingExpenditures | |
| Other Exempt Purpose Expenditures | OtherExemptPurposeExpenditures | |
| Total Exempt Purpose Expenditures | TotalExemptPurposeExpenditures | |
| Lobbying Nontaxable | LobbyingNontaxableAmount | |
| Grassroots Nontaxable | GrassrootsNontaxableAmount | |
| Tot Lobbying Grassroot Minus Non Tx | TotLobbyingGrassrootMinusNonTx | |
| Tot Lobby Expend Mns Lobbying Nontx | TotLobbyExpendMnsLobbyingNontx | |
| Volunteers | false | Volunteers |
| Paid Staff Or Management | false | PaidStaffOrManagement |
| Media Advertisements | false | MediaAdvertisements |
| Mailings Members | false | MailingsMembers |
| Publications Or Broadcast | false | PublicationsOrBroadcast |
| Grants Other Organizations | true | GrantsOtherOrganizations |
| Grants Other Organizations | $2,408 | GrantsOtherOrganizationsAmount |
| Direct Contact Legislators | false | DirectContactLegislators |
| Rallies Demonstrations | false | RalliesDemonstrations |
| Other Activities | false | OtherActivities |
| Total Lobbying Expenditures IIB | 2408 | TotalLobbyingExpendituresIIB |
| Not Described In501c3 | false | NotDescribedIn501c3 |
| Form4720 Filed4912 Tax | false | Form4720Filed4912Tax |
Form990 Schedule C Part IV Form990ScheduleCPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | LOBBYING ACTIVITIES | Identifier |
| Return Reference | SCHEDULE C, PART II-B, LINE 1F | ReturnReference |
| Explanation | A PORTION OF THE ANNUAL DUES PAID TO KHA AND AHA ARE USED FOR LOBBYING. | Explanation |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Art Public Exhibition Amts | ArtPublicExhibitionAmts | |
| Held Works Of Art Amts | HeldWorksOfArtAmts | |
| Current Year Minus3 Years | CurrentYearMinus3Years |
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 74923 | OtherCostOrOtherBasis |
| Book Value | 74923 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 5012364 | OtherCostOrOtherBasis |
| Depreciation | 2166598 | Depreciation |
| Book Value | 2845766 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Leasehold Improvements | LeaseholdImprovements |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 6356783 | OtherCostOrOtherBasis |
| Depreciation | 4578910 | Depreciation |
| Book Value | 1777873 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 219663 | OtherCostOrOtherBasis |
| Depreciation | 98411 | Depreciation |
| Book Value | 121252 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 4819814 | TotalOfBookValueLandBuildings |
| Federal Income Tax Liability | 0 | FederalIncomeTaxLiability |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | DUE TO THIRD PARTY PAYERS | Description |
| Amount | $30,000 | Amount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 30000 | TotalOfAmounts |
| Total Revenue | 10281954 | TotalRevenue |
| Total Expenses | 10822866 | TotalExpenses |
| Excess Or Deficit For Year | -540912 | ExcessOrDeficitForYear |
| Other | $9,148 | OtherAmount |
| Total Adjustments | 9148 | TotalAdjustments |
| Excess Or Deficit Per FS | -531764 | ExcessOrDeficitPerFS |
| Tot Revenue Etc Audited Fincl Stmt | 10281954 | TotRevenueEtcAuditedFinclStmt |
| Revenue Subtotal | 10281954 | RevenueSubtotal |
| Total Revenue Per Form990 | 10281954 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 10822866 | TotExpensesEtcAuditedFinclStmt |
| Expenses Subtotal | 10822866 | ExpensesSubtotal |
| Total Expenses Per Form990 | 10822866 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV (2 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| UNCERTAIN TAX POSITIONS | 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. |
| RECONCILIATION OF CHANGE IN NET ASSETS | SCHEDULE D, PART XI, LINE 8 | CHANGE IN INTEREST IN NET ASSETS OF KCHF $9,148 |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | true | CharityCarePolicy |
| Written Policy | true | WrittenPolicy |
| FPG Reference Free Care | true | FPGReferenceFreeCare |
| Pcent100 | X | Pcent100 |
| FPG Reference Discounted Care | true | FPGReferenceDiscountedCare |
| Pcent200 D | X | Pcent200D |
| Free Disc Care Medically Indigent | true | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | true | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | false | ExpensesExceededBudget |
| Annual Community Benefit Report | false | AnnualCommunityBenefitReport |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 22932 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 0 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 22932 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00210 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 499783 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 167642 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 332141 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.03070 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 522715 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 167642 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 355073 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.03280 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 38638 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 20744 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 17894 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00170 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 38638 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 20744 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 17894 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00170 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 561353 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 188386 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 372967 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.03450 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | false | BadDebtExpenseReported |
| Bad Debt Expense | $339,673 | BadDebtExpenseAmount |
| Amount Attributable To | 155621 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 5070415 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 6191685 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | -1121270 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | X | CostToChargeRatio |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | true | WrittenDebtCollectionPolicy |
| Provision For Charity Care | true | 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 | KINGMAN COMMUNITY HOSPITAL | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 750 WEST D AVENUE | AddressLine1 |
| City | KINGMAN | City |
| State | KS | State |
| ZIP Code | 67068 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | X | LicensedHospital |
| 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 | KINGMAN COMMUNITY HOSPITAL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
| CHNA Conducted | false | CHNAConducted |
| Eligibility Criteria Explained | true | EligibilityCriteriaExplained |
| Uses FPG Free | true | UsesFPGFree |
| FPG Free Percent | 100 | FPGFreePercent |
| Uses FPG Discounted | true | UsesFPGDiscounted |
| FPG Discount Percent | 200. | FPGDiscountPercent |
| Explains Basis | true | ExplainsBasis |
| Income Level | X | IncomeLevel |
| Explains Application Method | true | ExplainsApplicationMethod |
| Includes Publicity Measures | true | IncludesPublicityMeasures |
| Attached To Invoices | X | AttachedToInvoices |
| Posted In Emergency Room | X | PostedInEmergencyRoom |
| Available On Request | X | AvailableOnRequest |
| Actions On Nonpayment | true | ActionsOnNonpayment |
| Collection Activities | false | CollectionActivities |
| Notified All Patients | X | NotifiedAllPatients |
| Documented Determination | X | DocumentedDetermination |
| Nondiscrim Emergency Care Policy | true | NondiscrimEmergencyCarePolicy |
| Used Other Method | X | UsedOtherMethod |
| Amounts Generally Billed | false | AmountsGenerallyBilled |
| Gross Charges | false | GrossCharges |
Form990 Schedule H Part VI Form990ScheduleHPartVI (10 entries)
| IdentifierIdentifier | ExplanationExplanation | Return ReferenceReturnReference |
|---|---|---|
| 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 $600,045. | |
| 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. | |
| BAD DEBT EXPENSE | THE SYSTEM REPORTS PATIENT ACCOUNTS RECEIVABLE FOR SERVICES RENDERED AT NET REALIZABLE AMOUNTS FROM THIRD-PARTY PAYERS, PATIENTS AND OTHERS. THE SYSTEM 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 SYSTEM 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. A cost to charge ratio is used to determine amounts of bad debt at cost and bad debt expense attributable to patients under the charity care policy. The cost to charge ratio is multiplied by the charges in bad debt. Bad debt is not included as a community benefit. | SCHEDULE H, PART III, LINE 4 |
| MEDICARE | SERVING PATIENTS WITH GOVERNMENT HEALTH BENEFITS, SUCH AS MEDICARE, IS A COMPONENT OF THE COMMUNITY BENEFIT STANDARD THAT TAX-EXEMPT HOSPITALS ARE HELD TO. THIS IMPLIES THAT SERVING MEDICARE PATIENTS IS A COMMUNITY BENEFIT AND THAT THE HOSPITAL OPERATES TO PROMOTE THE HEALTH OF THE COMMUNITY. THE SYSTEM USES MEDICARE COST REPORT METHODOLOGY, WHICH APPORTIONS ROUTINE COSTS (ROOM AND BOARD) BASED ON MEDICARE OR MEDICAID DAYS TO TOTAL DAYS AND APPORTIONS ANCILLARY COSTS BASED ON PROGRAM CHARGES TO TOTAL CHARGES. | SCHEDULE H, PART III, LINE 8B |
| COLLECTION PRACTICES | WHEN A PATIENT HAS INDICATED OR DEMONSTRATED AN INABILITY TO PAY, AN APPROPRIATE HOSPITAL REPRESENTATIVE WILL PROVIDE THE PATIENT WITH A CHARITY CARE APPLICATION. THE HOSPITAL REPRESENTATIVE WILL PROVIDE ASSISTANCE IN COMPLETING THE APPLICATION TO HELP ENSURE THE APPLICATION IS COMPLETE AND INCLUDES ALL REQUIRED DOCUMENTATION. APPLICATIONS MUST BE COMPLETE IN THEIR ENTIRETY BEFORE CHARITY CARE CAN BE CONSIDERED. THOSE PATIENTS WHO MAY QUALIFY FOR FINANCIAL ASSISTANCE FROM A GOVERNMENTAL PROGRAM (I.E. MEDICAID) SHOULD BE REFERRED TO THE APPROPRIATE AGENCY PRIOR TO CONSIDERATION FOR CHARITY CARE. AN APPLICATION FOR FINANCIAL ASSISTANCE FROM AN OUTSIDE AGENCY SHOULD BE OBTAINED PRIOR TO CHARITY CARE APPROVAL. | SCHEDULE H, PART III, LINE 9B |
| CHARGES FOR MEDICAL CARE | DEPENDING ON THE PERSON'S FAMILY SIZE AND INCOME, THE HOSPITAL'S POLICY GUIDELINES STATE THE PERCENTAGE THAT WILL BE WRITTEN OFF. THE PATIENT THEN OWES THE BALANCE IF THEY ONLY QUALIFY FOR A PARTIAL REDUCTION. | SCHEDULE H, PART V, SECTION B, LINE 19D |
| NEEDS ASSESSMENT | The hospital determines the needs of the community in various ways. One way needs are determined is by the hospital staff reviewing statistical data from sources such as Kansas State University, Kansas Hospital Association, census information, and KDHE. From this data the administration of the hospital can have a better understanding of the local population. Another way the needs are determined is by hospital staff joining and participating in local organizations such as Rotary Club, Lions Club, local churches, and other community organizations. From involvement in these groups hospital staff can gather information on community needs which can be provided by the hospital. In addition, hospital staff and administration is open and available to visit with all community members and groups with concerns. For instance, recently a local group of citizens was trying to organize a free clinic to be open on weekends. The hospital's staff offered its expertise in helping set up the clinic, as well as donating equipment to the clinic and lab/radiology services to patients in need. | SCHEDULE H, PART VI, LINE 2 |
| PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE | The hospital posts signs about the availability of the charity care program in the hospital. All the local physicians know about the hospital's charity care program so that if a patient needs services they can inform the patient about it. The hospital has a stand with brochures on the charity care program as well as brochures on other programs such as Medicaid, Children's Mercy, and Unicare. The hospital employs a patient advocate who will help patients complete the charity care process and answer any questions about the program. This employee will also help patients with Medicaid applications if it is determined that the patient might qualify for this program. | SCHEDULE H, PART VI, LINE 3 |
| COMMUNITY INFORMATION | THE HOSPITAL IS LOCATED IN A RURAL COMMUNITY IN KINGMAN COUNTY, WHICH IS IN SOUTH CENTRAL KANSAS. KINGMAN COUNTY HAS APPROXIMATELY 7,800 RESIDENTS WITH APPROXIMATELY 11% OF THE POPULATION FALLING UNDER THE POVERTY GUIDELINES, AND 20% BEING OVER THE AGE OF 65. THE HOSPITAL IS THE ONLY HOSPITAL LOCATED IN THE COUNTY, WITH THE NEXT CLOSEST HOSPITAL BEING OVER 20 MILES AWAY. | SCHEDULE H, PART VI, LINE 4 |
| PROMOTION OF COMMUNITY HEALTH | The hospital furthers its exempt purpose by promoting the health of the community in several ways. The hospital extends medical staff privileges to all qualified physicians in the community. The hospital also recruits and provides space to specialists so they can conduct clinics and provide services for patients in the community. The hospital also provides free flu shots to the community as well as offering free clinics and screenings throughout the year. | SCHEDULE H, PART VI, LINE 5 |
Schedule K IRS990ScheduleK
Form990 Schedule K Part I Form990ScheduleKPartI
Issuer Name IssuerName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | KINGMAN COUNTY KANSAS PUBLIC BUILDING COMMISSION | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Issuer EIN | 300493481 | IssuerEIN |
| CUSIP Number | 495739AZ7 | CUSIPNumber |
| Date Issued | 2012-02-28 | DateIssued |
| Issue Price | 3250000 | IssuePrice |
| Description Of Purpose | REFUND 7/15/2008 BOND ISSUE | DescriptionOfPurpose |
| Defeased | false | Defeased |
| On Behalf Of Issuer | false | OnBehalfOfIssuer |
| Pool Financing | false | PoolFinancing |
Form990 Schedule K Part II Form990ScheduleKPartII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Amount Retired | 0 | AmountRetired |
| Amount Bond Defeased | 0 | AmountBondDefeased |
| Total Proceeds | 3250000 | TotalProceeds |
| Amount In Reserve Fund | 0 | AmountInReserveFund |
| Capitalized Interest | 0 | CapitalizedInterest |
| Refunding Escrow | 0 | RefundingEscrow |
| Issuance Costs From Proceeds | 65000 | IssuanceCostsFromProceeds |
| Credit Enhancement | 0 | CreditEnhancement |
| Working Capital Expenditures | 0 | WorkingCapitalExpenditures |
| Capital Expenditures | 0 | CapitalExpenditures |
| Other Spent Proceeds | 3185000 | OtherSpentProceeds |
| Amount Unspent | 0 | AmountUnspent |
| Year Of Subst Completion | 2008 | YearOfSubstCompletion |
| Current Refunding | true | CurrentRefunding |
| Advance Refunding | false | AdvanceRefunding |
| Final Allocation Made | true | FinalAllocationMade |
| Adequate Books And Recds Maintaind | true | AdequateBooksAndRecdsMaintaind |
Form990 Schedule K Part III Form990ScheduleKPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Owning Bond Financed Property | false | OwningBondFinancedProperty |
| Any Lease Arrangements | false | AnyLeaseArrangements |
| Mngment Cntrct Bond Financd Prprty | false | MngmentCntrctBondFinancdPrprty |
| Any Research Agreements | false | AnyResearchAgreements |
| Prcntge Prvt Business Use By Others | 0.00000 | PrcntgePrvtBusinessUseByOthers |
| Percentage Of Prvt Business Re UBI | 0.00000 | PercentageOfPrvtBusinessReUBI |
| Total Private Business Use | 0.00000 | TotalPrivateBusinessUse |
| Post Issuance Compliance Procdrs | true | PostIssuanceComplianceProcdrs |
Form990 Schedule K Part IV Form990ScheduleKPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form8038 T Filed | false | Form8038TFiled |
| Variable Rate Issue | false | VariableRateIssue |
| Hedge Identified In Books And Recds | false | HedgeIdentifiedInBooksAndRecds |
Name Of Hedge Provider NameOfHedgeProvider
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | 0 | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Proceeds Invested In GIC | false | GrossProceedsInvestedInGIC |
Name Of GIC Provider NameOfGICProvider
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | 0 | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Proceeds Invested | false | GrossProceedsInvested |
| Exception To Rebate | true | ExceptionToRebate |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Fed Tax Requirements Compliance | X | FedTaxRequirementsCompliance |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (7 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| FORM 990 REVIEW PROCESS | FORM 990, PART VI, SECTION B, LINE 11A | THE FORM 990 IS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM. THE CFO REVIEWS A DRAFT OF THE 990 AND ALL REQUIRED SCHEDULES. THE ENTIRE BOARD IS THEN PROVIDED WITH AN ELECTRONIC COPY OF THE FORM 990 AND ALL REQUIRED SCHEDULES PRIOR TO FILING WITH THE IRS. |
| CONFLICT OF INTEREST POLICY | FORM 990, PART VI, SECTION B, LINE 12C | BOARD MEMBERS AND OFFICERS AT THE TIME OF HIRE AND ANNUALLY THEREAFTER ARE REMINDED OF THE CONFLICT OF INTEREST GUIDELINES COVERED IN THE CORPORATION'S GOVERNING BODY BY-LAWS AND ARE ASKED TO SIGN A CONFLICT OF INTEREST STATEMENT. ANY CONFLICT OF INTEREST MUST BE DISCLOSED TO THE BOARD AND/OR CEO. ANY MEMBER WITH A CONFLICT OF INTEREST SHALL ABSENT THEMSELVES FROM THE DISCUSSION OF THE ISSURE BEFORE THE BOARD AND MUST ABSTAIN FROM VOTING ON ANY ISSUE IN WHICH A CONFLICT IS PRESENT. |
| COMPENSATION REVIEW | FORM 990, PART VI, SECTION B, LINES 15A & B | ALL RAISES ARE APPROVED BY THE BOARD OF DIRECTORS. EVERY THREE TO FIVE YEARS SALARIES AND WAGES ARE COMPARED TO THE KANSAS HOSPITAL ASSOCIATION'S SALARY AND WAGE SURVEY FOR REASONABLENESS. IN THIS CIRCUMSTANCE THE BOARD DESIGNATES THE HUMAN RESOURCE DIRECTOR TO REVIEW THE SURVEY AND MAKE ANY ADJUSTMENTS NECESSARY. FOR THE YEARS WHEN THE SURVEY IS NOT USED, THE BOARD OF DIRECTORS APPROVES AN ACROSS THE PAY SCALE WAGE INCREASE OF A CERTAIN PERCENTAGE. ALL EMPLOYEES RECEIVE THE SAME PERCENTAGE INCREASE APPROVED BY THE BOARD. ALL FULL-TIME EMPLOYEES RECEIVE THE SAME EMPLOYEE BENEFIT PACKAGE. |
| AVAILABILITY OF DOCUMENTS | FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION DOES NOT MAKE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY OR FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC. |
| OTHER CHANGES IN NET ASSETS | FORM 990, PART XI, LINE 5 | CHANGE IN INTEREST IN NET ASSETS OF KCHF $9,148. |
| HOURS DEVOTED FOR RELATED ORGANIZATION | FORM 990 PART VII | NAME:BILL KLAVER TITLE:VICE CHAIRMAN/DIRECTOR HOURS: |
| HOURS DEVOTED FOR RELATED ORGANIZATION | FORM 990 PART VII | NAME:PATTI BRACE TITLE:SECRETARY/DIRECTOR HOURS: |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII
Name Of Disregarded Entity NameOfDisregardedEntity
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | KINGMAN COMMUNITY HOSPITAL FOUNDATION | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 750 AVENUE D WEST | AddressLine1 |
| City | KINGMAN | City |
| State | KS | State |
| ZIP Code | 67068 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 481095031 | EIN |
| Primary Activities | SUPPORT NVHS | PrimaryActivities |
| Legal Domicile State | KS | LegalDomicileState |
| Exempt Code Section | 501(C)(3) | ExemptCodeSection |
| Public Charity Status | 11D | PublicCharityStatus |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | NA | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Controlled Org | false | ControlledOrg |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | false | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | false | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | true | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | false | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | false | LoansOrGuaranteesFromOtherOrg |
| Sale Of Assets To Other Org | false | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | false | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | false | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | false | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | false | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | false | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | false | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | false | SharingOfFacilities |
| Sharing Of Paid Employees | false | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | false | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | false | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | false | OtherTransferToOtherOrg |
| Other Transfer From Other Org | false | OtherTransferFromOtherOrg |
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