2011-08-15T16:28:10-04:00 2010-09-30 BKD LLP 1201 Walnut Suite 1700 Kansas City MO 641062246 990 2009-10-01 480561974 Atchison Hospital Association ATCH 9133605584 800 Raven Hill Drive Atchison KS 66002 JOHN L JACOBSON 9133605584 2011-08-15 true Michael J Engle 8162216300 2009 2016-02-24 21:20:13Z JOHN L JACOBSON 800 RAVEN HILL DRIVE ATCHISON KS 66002 31937103 false X WWW.ATCHISONHOSPITAL.ORG X 1912 KS TO PROVIDE EXCELLENT HEALTH CARE AND IMPROVE THE QUALITY OF LIFE IN OUR COMMUNITY 7 7 356 6 0 0 1660877 122678 28307878 31165822 -32648 27408 656770 480725 30592877 31796633 3217000 0 0 0 15970492 17904607 0 0 0 19524289 18184122 38711781 36088729 -8118904 -4292096 62470726 50938335 49780337 41974964 12690389 8963371 TO PROVIDE EXCELLENT HEALTH CARE AND IMPROVE THE QUALITY OF LIFE IN OUR COMMUNITY false false 29380816 0 31165822 ATCHISON HOSPITAL PROVIDED ACUTE INPATIENT AND OUTPATIENT HEALTH SERVICES TO THE GENERAL PUBLIC. SERVICES INCLUDE BUT ARE NOT LIMITED TO: EMERGENCY SERVICES, HOME HEALTH & HOSPICE, GENERAL INPATIENT ACUTE SERVICES, RADIOLOGY & OBSTETRICS. NUMBER OF PEOPLE SERVED DURING FISCAL YEAR ENDING 09/30/2010 WERE 77,797. 29380816 true true false true false false false false false true false true false false false false false false false false true false false true true false false false false false false false false false false false false false false false true true false false true 19 0 true 356 true false false false false false false false false false 7 7 false false false false false false false true true false false true true true true true true true false false X JOHN L JACOBSON 9133605584 800 RAVEN HILL DRIVE ATCHISON KS 66002 JOHN L JACOBSON 40.0 X X 185225 0 38116 JOHN SETTICH 1.0 X X 0 0 0 BOB ADRIAN 1.0 X 0 0 0 MARK WINDSOR 1.0 X X 0 0 0 LOUISE REGENSTIEN 1.0 X 0 0 0 WILLIAM THORNTON 1.0 X 0 0 0 DENNIS GARRETT 1.0 X X 0 0 0 LORNE ARCHER 40.0 X 101561 0 9981 CHARLENE CLAUSE 40.0 X 112288 0 12869 CHAD JOHANNING MD 40.0 X 165184 0 5311 MICHAEL JONES MD 40.0 X 236284 0 16419 JON SIEBERT MD 40.0 X 214469 0 28495 AARON SINCLAIR MD 40.0 X 289497 0 16477 DINA SEIBERT MD 32.0 X 131121 0 16163 1435629 0 143831 14 false true false JE DUNN CONSTRUCTION 849446 MSI SYSTEMS CONSTRUCTION 491201 MARLATT CONSTRUCTION INC CONSTRUCTION 413285 WATERSTONE BENEFIT ADMIN TPA 339660 LABCORP REFERENCE LAB 249864 13 23200 12454 87024 122678 NET PATIENT SERVICE REVENUE 621400 31165822 31165822 31165822 911 911 26497 26497 0 90160 140470 -50310 -50310 -50310 0 0 0 0 DIETARY SERVICES 722210 102963 102963 AMBULANCE TAX APPORTIONMENT 621910 322000 322000 MEDIMATE REVENUE 621400 79706 79706 26366 26366 531035 31796633 31165822 0 508133 0 0 0 0 449028 449028 0 13580938 12178020 1402918 176045 150494 25551 2720309 2325479 394830 978287 836297 141990 0 125464 125464 99000 99000 0 0 0 1858880 1395565 463315 91810 68927 22883 3074275 3074275 280846 210847 69999 0 716438 537870 178568 117629 117629 0 0 1713907 1713907 0 3251046 2440742 810304 571365 428956 142409 BAD DEBT 5252061 5252061 IMPAIRMENT OF BUILDING 355148 355148 REPAIRS & MAINTENANCE 595808 447306 148502 DUES AND SUBSCRIPTIONS 46067 46067 MISCELLANEOUSE EXPENSE 34378 33977 401 36088729 29380816 6707913 0 390769 402074 2925199 381603 108507 52467 4957087 5256222 569426 586780 460879 344513 50307486 11279276 39385219 39028210 12491950 3383091 41986 35462 1139704 1467913 62470726 50938335 7135985 3089679 3217000 0 37135000 36030132 923644 1545440 1368708 1309713 49780337 41974964 X 12438668 8767689 251721 195682 12690389 8963371 62470726 50938335 X false true true X false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false true 6871 false false false 6871 false 1069320 1069320 15341417 10144689 5196728 123901 0 123901 30832021 1019885 29812136 2940827 114702 2826125 39028210 0 DUE TO AFFILIATE 1082106 ASSET RETIREMENT OBLIGATION 0 Deferred Compensation 227607 1309713 31796633 36088729 -4292096 621117 621117 -3670979 31931786 178253 178253 31753533 43100 43100 31796633 36232986 187357 187357 36045629 43100 43100 36088729 UNCERTAIN TAX POSITIONS DISCLOSURE 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 CONTRIBUTIONS FOR PROPERTY ACQUISITIONS $ 565,078 ASSETS RELEASED FROM RESTRICTION $ 56,039 --------- $ 621,117 RECONCILIATION OF REVENUE PER AUDITED FINANCIAL STATEMENTS SCHEDULE D, PART XII, LINES 2D & 4B LINE 2D: RENTAL PROPERTY EXPENSES $ 140,470 RELATED ORGANIZATION'S REVENUE $ 37,783 --------- $ 178,253 LINE 4B: ELIMINATIONS $ 43,100 RECONCILIATION OF EXPENSES PER AUDITED FINANCIAL STATEMENTS SCHEDULE D, PART XII, LINES 2D & 4B LINE 2D: RENTAL PROPERTY EXPENSES $ 140,470 RELATED ORGANIZATION'S EXPENSES $ 46,887 --------- $ 187,357 LINE 4B: ELIMINATIONS $ 43,100 true true true X true X true true true false false 549584 0 549584 0.01520 4342179 2486708 1855471 0.05140 4891763 2486708 2405055 0.06660 2636357 0 0 0.07310 2636357 0 0 0.07310 7528120 2486708 2405055 0.13970 false 2636357 0 13413364 14043137 -629773 X true true ATCHISON HOSPITAL

800 RAVEN HILL DRIVE ATCHISON KS 66002

X X X X FAMILY MEDICAL CENTER OF TROY

311 W LOCUST TROY KS 66087

RURAL HEALTH CLINIC FAMILY MEDICAL CENTER OF EFFINGHAM

5120 MAIN ST EFFINGHAM KS 66023

RURAL HEALTH CLINIC 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 CALCULATED USING WORKSHEET 2. 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 $5,252,061. RCC. THE MAJORITY OF THESE ARE FROM PATIENTS THAT ENTER THE FACILITY SERVICE STREAM THROUGH THE EMERGENCY DEPARTMENT. AS A COMMUNITY HOSPITAL, WE TREAT ALL PATIENTS PRESENTING AT THE ED WITHOUT REGARD TO ABILITY TO PAY. THE MEDICARE SHORTFALL SHOULD NOT BE TREATED AS A COMMUNITY BENEFIT COST. THE COSTING METHODOLOGY CONSISTED OF INFORMATION FROM THE HOSPITAL'S ACCOUNTING SYSTEM AS WELL AS COSTS FROM THE MEDICARE COST REPORT. THE HOSPITAL DOES NOT PURSUE COLLECTION OF AMOUNTS DETERMINED TO BE CHARITY CARE. ACCESS TO KANSAS HEALTH INITIATIVE SURVEY ON HEALTH INDICATORS PAMPHLET AT ADMISSION, CONTACT WITH SELF-PAY COLLECTION AND COLLECTION AGENCY SERVICES NORTHEAST KANSAS AND SOUTHERN BUCHANAN COUNTY, MISSOURI HEALTH FAIR WITH EDUCATIONAL, COMMUNITY HEALTH/WELLNESS/SUPPORT ORGANIZATION INFORMATION, AND HEALTH SCREENINGS. OPEN MEDICAL STAFF, VOLUNTEER COMMUNITY BOARD, SURPLUS FUNDS ARE RE-INVESTED IN EQUIPMENT AND/OR NEW/EXPANSION OF HEALTH-RELATED PROGRAMS X true true X X X false true false false false false false true false JOHN L JACOBSON 170125 0 15100 0 0 0 28552 0 9564 0 223341 0 0 0 CHAD JOHANNING MD 162299 0 0 0 2885 0 0 0 5311 0 170495 0 0 0 MICHAEL JONES MD 236284 0 0 0 0 0 0 0 16419 0 252703 0 0 0 JON SIEBERT MD 214469 0 0 0 0 0 12100 0 16395 0 242964 0 0 0 AARON SINCLAIR MD 286292 0 0 0 3205 0 0 0 16477 0 305974 0 0 0 HEALTH OR SOCIAL CLUB DUES OR INITIATION FEES SCHEDULE J, PART I, LINE 1A SOCIAL CLUB DUES WERE PAID BY THE HOSPITAL FOR JOHN L. JACOBSON, LORNE ARCHER, AND CHARLENE CLAUSE AND WERE NOT INCLUDED IN THEIR W-2'S AS TAXABLE COMPENSATION BECAUSE THEY WERE USED 100% FOR BUSINESS. SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN SCHEDULE J, PART I, LINE 4B JOHN L. JACOBSON $ 23,052 Non-Fixed Payments for Officers or Directors SCHEDULE J, PART I, LINE 7 Officers are eligible for Bonus payments annually based on pre-determined goal attainment AND ACTUAL/BUDGET COMPARISON OF THE HOSPITAL. CITY OF ATCHISON 486025033 046687AW9 2008-09-23 10000000 REPLACEMENT OF FACILITIES false false CITY OF ATCHISON 486025033 046687AW9 2008-09-23 7500000 REDEMPTION OF SERIES 2007 BOND false false CITY OF ATCHISON 486025033 046687CA5 2009-06-30 17620000 REPLACEMENT OF FACILITIES false false 10000000 0 0 0 206983 0 0 2008 false false true true 7500000 0 0 0 156373 0 0 2008 true false true true 17620000 0 0 0 396323 0 0 2009 false false true true false false false false true 0.00000 0.00000 0.00000 true false false false false true 0.00000 0.00000 0.00000 true false false false false true 0.00000 0.00000 0.00000 true false false false false false false false false false false false false false false false false false false FORM 990 REVIEW PROCESS FORM 990, PART VI, SECTION B, LINE 11A AN INDEPENDENT ACCOUNTING FIRM PREPARES AND REVIEWS THE 990. THE 990 IS THEN REVIEWED BY THE ORGANIZATION'S MANAGEMENT. ANY QUESTIONS AND CONCERNS THE ORGANIZATION'S MANAGEMENT HAVE ARE ADDRESSED AND ANY CORRECTIONS OR CLARIFICATIONS ARE MADE. THE 990 IS THEN REVIEWED BY THE HOSPITAL FINANCE COMMITTEE. ANY QUESTIONS AND CONCERNS THE FINANCE COMMITTEE HAVE ARE ADDRESSED AND ANY CORRECTIONS OR CLARIFICATIONS ARE MADE. THE 990 IS THEN REVIEWED BY THE BOARD OF DIRECTORS, ANY CORRECTIONS OR CONCERNS THE BOARD HAVE ARE ADDRESSED PRIOR TO FILING. CONFLICT OF INTEREST POLICY FORM 990, PART VI, SECTION B, LINE 12C AT THE TIME OF ELECTION OR HIRE AND ANNUALLY THEREAFTER, THE GOVERNING BOARD MEMBERS, OFFICERS, AND KEY EMPLOYEES SHALL PROVIDE THE APPLICABLE CONFLICT OF INTEREST DISCLOSURES WHICH SHALL BE COMPLETED TO IDENTIFY ANY RELATIONSHIPS, POSITIONS, OR CIRCUMSTANCES IN WHICH IT IS BELIEVED A CONFLICT MAY ARISE. IF A CONFLICT ARISES, THE BOARD MEMBER ABSTAINS FROM THE VOTE OF THE CONFLICTED POSITION. COMPENSATION REVIEW FORM 990, PART VI, SECTION B, LINES 15A & B LINE 15A: IN 2010, THE ORGANIZATION CONSULTED AN INDEPENDENT FIRM TO PREPARE A COMPENSATION DATA STUDY. THE INDEPENDENT BOARD OF DIRECTORS TOOK THE INFORMATION FROM THE COMPENSATION STUDY AND USED IT TO REVIEW AND ADJUST THE CEO'S COMPENSATION. ANY DECISION THAT IS MADE IN REGARDS TO THE CEO'S COMPENSATION IS DOCUMENTED BY THE BOARD OF DIRECTORS. LINE 15B: THE CEO AND HUMAN RESOURCE DIRECTOR CONDUCTS AN ANNUAL REVIEW OF OTHER OFFICERS AND KEY EMPLOYEES' COMPENSATION BASED ON COMPARABLE DATA OF OTHER ORGANIZATION OF A SIMILAR SIZE AND INDUSTRY. AVAILABILITY OF DOCUMENTS FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE NOT MADE AVAILABLE TO THE PUBLIC. AVERAGE HOURS WORKED PER WEEK AT RELATED ORGANIZATION FORM 990, PART VII HOURS WORKED FOR RELATED ORGANIZATIONS -------------------------------------- JOHN L. JACOBSON 1 LORNE ARCHER 2 RIVERBEND REGIONAL HEALTHCARE FOUNDATION 800 RAVEN HILL DRIVE ATCHISON KS 66002 480955489 SUPPORT KS 501(C)(3) 11B NA false false false false true false false false false false false false true true false false false true RIVERBEND REGIONAL HEALTHCARE FOUNDATION R 475000 RIVERBEND REGIONAL HEALTHCARE FOUNDATION E 9500000