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Nonprofiteer
← HIAWATHA HOSPITAL ASSOCIATION INC

Form 990 for tax year 2023

Filed by HIAWATHA HOSPITAL ASSOCIATION INC.

Totals

Total revenue
$29,460,437
Total expenses
$33,904,849
Contributions and grants received
$161,489
Grants paid
$0
Program service revenue
$29,299,685
Investment income
$5,298
Other revenue
-$6,035
Total assets, end of year
$20,078,246
Total liabilities, end of year
$8,677,416
Net assets or fund balances, end of year
$11,400,830
Program services expenses (Part IX)
$29,074,033
Management and general expenses
$4,830,816
Fundraising expenses
$0
Program service expenses (Part III)
$29,074,033

Program services were 85.8% of total expenses calculated — Part IX's program-services column over total expenses, both as filed.

Line items

Every line the filer filed in Parts VIII, IX and X, as filed and in filed order. Blank columns are left out, and the lines are not forced to add up to the totals above.

Revenue

Part VIII, the statement of revenue.

  • 1f · All other contributions, gifts and grants

    $161,489

  • 1g · Noncash contributions included above

    $70,000

  • 2a · Program service revenue: PATIENT SERVICE REVENUE

    total $28,586,634 · related or exempt $28,586,634

  • 2b · Program service revenue: PHARMACY REVENUE

    total $291,960 · related or exempt $291,960

  • 2c · Program service revenue: PHYSICAL THERAPY

    total $239,190 · related or exempt $239,190

  • 2d · Program service revenue: CAFETERIA

    total $39,965 · related or exempt $39,965

  • 2f · All other program service revenue

    total $141,936 · related or exempt $141,936

  • 3 · Investment income

    total $5,298 · excluded $5,298

  • 6a · Gross rents

    real property $1,165

  • 6b · Less rental expenses

    real property $7,200

  • 6c · Rental income or loss

    real property -$6,035

  • 6d · Net rental income or loss

    total -$6,035 · excluded -$6,035

Functional expenses

Part IX, the statement of functional expenses.

  • 5 · Compensation of officers, directors and key employees

    total $297,339 · management and general $297,339

  • 7 · Other salaries and wages

    total $14,533,022 · program services $13,477,533 · management and general $1,055,489

  • 8 · Pension plan contributions

    total $204,592 · program services $194,443 · management and general $10,149

  • 9 · Other employee benefits

    total $3,303,449 · program services $3,016,034 · management and general $287,415

  • 10 · Payroll taxes

    total $1,034,469 · program services $951,470 · management and general $82,999

  • 11b · Fees: legal

    total $49,388 · program services $78 · management and general $49,310

  • 11c · Fees: accounting

    total $215,490 · management and general $215,490

  • 11d · Fees: lobbying

    total $4,090 · management and general $4,090

  • 11g · Fees: other

    total $4,199,488 · program services $3,286,913 · management and general $912,575

  • 12 · Advertising and promotion

    total $125,105 · program services $14,650 · management and general $110,455

  • 13 · Office expenses

    total $1,290,870 · program services $1,247,427 · management and general $43,443

  • 14 · Information technology

    total $951,995 · program services $875,562 · management and general $76,433

  • 16 · Occupancy

    total $592,529 · program services $487,310 · management and general $105,219

  • 17 · Travel

    total $100,557 · program services $91,306 · management and general $9,251

  • 20 · Interest

    total $245,272 · program services $7,492 · management and general $237,780

  • 22 · Depreciation, depletion and amortization

    total $1,983,278 · program services $1,222,624 · management and general $760,654

  • 23 · Insurance

    total $277,159 · program services $119,114 · management and general $158,045

  • 24a · Other expenses: MEDICAL SUPPLIES

    total $2,793,095 · program services $2,793,086 · management and general $9

  • 24b · Other expenses: REPAIRS AND MAINTENANCE

    total $1,239,558 · program services $1,069,546 · management and general $170,012

  • 24c · Other expenses: DUES & SUBSCRIPTIONS

    total $376,720 · program services $214,987 · management and general $161,733

  • 24e · All other expenses

    total $87,384 · program services $4,458 · management and general $82,926

Balance sheet

Part X, book values.

  • 1 · Cash, non-interest-bearing

    beginning of year $565 · end of year $858

  • 2 · Savings and temporary cash investments

    beginning of year $2,992,962 · end of year $1,386,231

  • 4 · Accounts receivable

    beginning of year $5,995,741 · end of year $4,021,764

  • 8 · Inventories for sale or use

    beginning of year $528,780 · end of year $389,495

  • 9 · Prepaid expenses and deferred charges

    beginning of year $233,271 · end of year $297,111

  • 10a · Land, buildings and equipment: cost or other basis

    $36,732,402

  • 10b · Land, buildings and equipment: accumulated depreciation

    $25,722,774

  • 10c · Land, buildings and equipment, net

    beginning of year $12,255,863 · end of year $11,009,628

  • 11 · Investments: publicly traded securities

    beginning of year $679,120 · end of year $678,631

  • 14 · Intangible assets

    beginning of year $261,000 · end of year $43,500

  • 15 · Other assets

    beginning of year $1,392,473 · end of year $2,251,028

  • 17 · Accounts payable and accrued expenses

    beginning of year $2,857,358 · end of year $3,418,802

  • 20 · Tax-exempt bond liabilities

    beginning of year $5,447,525 · end of year $5,111,959

  • 23 · Secured mortgages and notes payable

    beginning of year $312,084 · end of year $106,898

  • 25 · Other liabilities

    beginning of year $0 · end of year $39,757

  • 27 · Net assets without donor restrictions

    beginning of year $15,226,135 · end of year $10,781,723

  • 28 · Net assets with donor restrictions

    beginning of year $496,673 · end of year $619,107

Mission and programs · 2023

Mission

AMBERWELL HIAWATHA PROVIDES COMPASSIONATE CARE WITH CLINICAL EXCELLENCE.

Activities or mission (Part I)

PROVIDE MODERN, RELIABLE, AFFORDABLE HEALTH CARE THAT BEST MEETS THE NEEDS OF OUR COMMUNITY.

  • HIAWATHA HOSPITAL ASSOCIATION, INC. DBA AMBERWELL HEALTH HIAWATHA IS A CRITICAL ACCESS HOSPITAL (CAH) THAT PROVIDES RELATED INPATIENT, OUTPATIENT, EMERGENCY CARE, AND PHYSICIAN SERVICES TO PATIENTS IN HIAWATHA, KANSAS AND SURROUNDING AREAS. HIAWATHA COMMUNITY HOSPITAL'S PRIMARY GOAL IS TO PROVIDE QUALITY, MODERN, AFFORDABLE HEALTHCARE TO OUR COMMUNITY. IN 2023, WE PROVIDED SERVICE FOR 2,475 INPATIENT DAYS, 181 INPATIENT SURGERIES AND 672 OUTPATIENT SURGERIES. WE DELIVERED 75 BABIES AND PROVIDED OUTPATIENT SERVICES TO 65,037 PATIENTS. (STATEMENT CONTINUED ON SCHEDULE O)BY PROVIDING SERVICES LIKE OBSTETRICS AND 24 HOUR EMERGENCY SERVICES THAT NOT ALL SMALL RURAL HOSPITALS PROVIDE, EVEN THOUGH THE PROGRAMS ARE NOT ALWAYS PROFITABLE FOR THE HOSPITAL, WE STRONGLY FEEL THAT THESE SERVICES PROVIDE NECESSARY CARE TO ADDRESS OUR COMMUNITY'S OVERALL HEALTH WHILE PROMOTING OUR MISSION AS A CHARITABLE ORGANIZATION.THE HOSPITAL MAINTAINS A FINANCIAL ASSISTANCE POLICY FOR PATIENTS WHO ARE FINANCIALLY UNABLE TO PAY FOR THE HEALTHCARE SERVICES THEY RECEIVE. IT IS THE POLICY OF THE HOSPITAL NOT TO PURSUE COLLECTION OF AMOUNTS DETERMINED TO QUALIFY AS PATIENT FINANCIAL ASSISTANCE UNDER THE POLICY. ACCORDINGLY, THE HOSPITAL DOES NOT REPORT THESE AMOUNTS IN PATIENT SERVICE REVENUE. THE HOSPITAL DETERMINES THE COSTS ASSOCIATED WITH PROVIDING CHARITY CARE BY AGGREGATING THE DIRECT AND IN DIRECT COSTS, INCLUDING SALARIES, BENEFITS, SUPPLIES, AND OTHER OPERATING EXPENSES, BASED ON AN OVERALL COST TO CHARGE RATIO. THE COSTS OF CARING FOR THESE PATIENTS FOR THE YEAR ENDED DECEMBER 31, 2023 WAS APPROXIMATELY $67,000.

    Expenses $29,074,033 · Revenue $29,299,685

As filed on the 2023 return. The filer continues this part on Schedule O, which is not shown here.

Listed in Part VII

  • Greg Rodvelt

    PRESIDENT

    Total calculated
    $0
    Hours/week
    0.25

  • Del Elffner

    VICE PRESIDENT

    Total calculated
    $0
    Hours/week
    0.25 + 1 related

  • John Moore

    SECRETARY/TREASURER

    Total calculated
    $0
    Hours/week
    0.25

  • Eric Ingmire

    DIRECTOR

    Total calculated
    $0
    Hours/week
    0.25

  • Willie Geisendorf

    DIRECTOR

    Total calculated
    $0
    Hours/week
    0.25

  • Howard Elliott

    DIRECTOR

    Total calculated
    $0
    Hours/week
    0.25

  • Jason Smith

    DIRECTOR

    Total calculated
    $0
    Hours/week
    0.25

  • Jeffrey Perry

    CEO

    Total calculated
    $230,000
    From this org
    $230,000
    From related orgs
    $0
    Other
    $0
    Hours/week
    20

    Schedule J breakdown matched by us

    Base
    $230,000
    Bonus
    $0
    Other
    $0
    Deferred
    $0
    Nontaxable benefits
    $0
    Filer's total
    $230,000

  • Sharese Moser

    DIRECTOR OF FINANCE -UNTIL AUGUST

    Total calculated
    $67,338
    From this org
    $66,093
    From related orgs
    $0
    Other
    $1,245
    Hours/week
    40

  • Chase Dudzinski

    CFO

    Total calculated
    $280,465
    From this org
    $250,652
    From related orgs
    $0
    Other
    $29,813
    Hours/week
    20

    Schedule J breakdown matched by us

    Base
    $244,568
    Bonus
    $6,084
    Other
    $0
    Deferred
    $7,672
    Nontaxable benefits
    $22,491
    Filer's total
    $280,815

  • Dr Crosby Gernon

    RADIOLOGIST

    Total calculated
    $442,238
    From this org
    $398,484
    From related orgs
    $0
    Other
    $43,754
    Hours/week
    40

    Schedule J breakdown matched by us

    Base
    $398,484
    Bonus
    $0
    Other
    $0
    Deferred
    $6,525
    Nontaxable benefits
    $37,978
    Filer's total
    $442,987

  • Dr Mariah Kriwiel

    PHYSICIAN

    Total calculated
    $426,975
    From this org
    $389,419
    From related orgs
    $0
    Other
    $37,556
    Hours/week
    40

    Schedule J breakdown matched by us

    Base
    $387,419
    Bonus
    $2,000
    Other
    $0
    Deferred
    $326
    Nontaxable benefits
    $37,978
    Filer's total
    $427,723

  • Dr Jessica Jarvis

    PHYSICIAN

    Total calculated
    $419,303
    From this org
    $375,771
    From related orgs
    $0
    Other
    $43,532
    Hours/week
    40

    Schedule J breakdown matched by us

    Base
    $364,862
    Bonus
    $10,909
    Other
    $0
    Deferred
    $6,280
    Nontaxable benefits
    $38,001
    Filer's total
    $420,052

  • Dr Anna Cleland-Leighton

    PHYSICIAN

    Total calculated
    $317,723
    From this org
    $274,364
    From related orgs
    $0
    Other
    $43,359
    Hours/week
    40

    Schedule J breakdown matched by us

    Base
    $266,364
    Bonus
    $8,000
    Other
    $0
    Deferred
    $6,129
    Nontaxable benefits
    $37,978
    Filer's total
    $318,471

  • Robin Alexander

    CRNA

    Total calculated
    $311,163
    From this org
    $273,014
    From related orgs
    $0
    Other
    $38,149
    Hours/week
    40

    Schedule J breakdown matched by us

    Base
    $270,931
    Bonus
    $2,083
    Other
    $0
    Deferred
    $935
    Nontaxable benefits
    $37,964
    Filer's total
    $311,913

Compensation is as filed in Part VII: reportable pay from this organization and from related organizations, other compensation, and hours per week. The total, marked calculated, is our sum of the three dollar columns, with a blank column counted as $0; the form itself has no total. On a Form 990-EZ the columns are Part IV's instead, and on a Form 990-PF Part VIII's — compensation, contributions to benefit plans, and expense account — and the total sums those. A Schedule J breakdown is as filed: base pay, bonus, other, deferred compensation and nontaxable benefits from this organization, with any from related organizations beside each, and the filer's own total. It is shown with the Part VII listing of the same name on the same return. The form gives no key between the two, so that pairing is ours, and is marked matched by us.

Schedule J

Answered yes

  • 3 · Compensation survey or study
  • 3 · Approval by the board or compensation committee
  • 5a · Pay contingent on this organization's revenues

Answered no

  • 4a · Severance or change-of-control payment
  • 4b · Supplemental nonqualified retirement plan
  • 4c · Equity-based compensation arrangement
  • 5b · Pay contingent on a related organization's revenues
  • 6a · Pay contingent on this organization's net earnings
  • 6b · Pay contingent on a related organization's net earnings
  • 7 · Other non-fixed payments
  • 8 · Paid under the initial-contract exception

The filer's explanations (Part III)

PART I, LINE 5
THE PROVIDERS ARE PAID A PERFORMANCE BONUS BASED ON PRODUCTIVITY AND CONSIDERATION OF REVENUES.
FORM 990, SCHEDULE J, PART II UNRELATED ORGANIZATION COMPENSATION:
CHASE DUDZINSKI IS THE CFO FOR HIAWATHA HOSPITAL ASSOCIATION AND AMBERWELL HEALTH ASSOCIATION, AN UNRELATED ORGANIZATION. AMBERWELL HEALTH ASSOCIATION ISSUES THE W-2 FOR THE CFO. COMPENSATION AND BENEFITS ARE PAID FOR SERVICES TO BOTH HOSPITALS. HIAWATHA HOSPITAL ASSOCIATION REIMBURSES AMBERWELL HEALTH ASSOCIATION 30% OF CHASE'S COMPENSATION AND BENEFITS.

Part I's answers as filed. A line not listed was left unanswered; on lines 1a and 3 that means the box was not checked.

Grants on this return

No itemized grants to organizations on this return.

Related organizations on this return

Schedule R Part II: tax-exempt organizations related to the filer by control. It does not record shared board members or money.

Taxable family on this return

Schedule R Parts I, III and IV, as filed. These record ownership and control, not shared board members or money moved.

Related corporations and trusts

Part IV: related organizations taxable as a corporation or trust.

  • CHARITABLE REMAINDER TRUST (1)

    T · TRUST · KS · controlled entity

    Directly controlled by HHA

Provenance

Return type
form_990
Tax year
2023
Filed
14 November 2024
IRS schema version
2023v5.1
Source object
202403199349310245

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