Attach to Form 990 or Form 990-EZ.
Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
| (i)Name of supported organization | (ii) EIN | (iii) Type of organization (described on lines 1- 9 above (see instructions)) | (iv) Is the organization listed in your governing document? | (v) Amount of monetary support (see instructions) | (vi) Amount of other support (see instructions) | |
|---|---|---|---|---|---|---|
| Yes | No | |||||
| Total | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2011 | (b) 2012 | (c) 2013 | (d) 2014 | (e) 2015 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any unusual grants.) .... | ||||||
| 2 | Tax revenues levied for the organization's benefit and either paid to or expended on its behalf....... | ||||||
| 3 | The value of services or facilities furnished by a governmental unit to the organization without charge.. | ||||||
| 4 | Total. Add lines 1 through 3 | ||||||
| 5 | The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f).. | ||||||
| 6 | Public support. Subtract line 5 from line 4. | ||||||
Calendar year
(or fiscal year beginning in) ![]() |
(a) 2011 | (b) 2012 | (c) 2013 | (d) 2014 | (e) 2015 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | ||||||
| 8 | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources... | ||||||
| 9 | Net income from unrelated business activities, whether or not the business is regularly carried on.. | ||||||
| 10 | Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.).. | ||||||
| 11 | Total support. Add lines 7 through 10. | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2011 | (b) 2012 | (c) 2013 | (d) 2014 | (e) 2015 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") . | 0 | 0 | 0 | 0 | 0 | 0 |
| 2 | Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose...... | 52,873,808 | 54,307,358 | 54,999,458 | 63,970,375 | 62,361,790 | 288,512,789 |
| 3 | Gross receipts from activities that are not an unrelated trade or business under section 513... | 0 | |||||
| 4 | Tax revenues levied for the organization's benefit and either paid to or expended on its behalf... | 0 | 0 | 0 | |||
| 5 | The value of services or facilities furnished by a governmental unit to the organization without charge.. | 0 | 0 | ||||
| 6 | Total. Add lines 1 through 5. | 52,873,808 | 54,307,358 | 54,999,458 | 63,970,375 | 62,361,790 | 288,512,789 |
| 7a | Amounts included on lines 1, 2, and 3 received from disqualified persons... | 15,279 | 15,279 | ||||
| b | Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year. | 0 | 0 | 0 | 0 | 0 | 0 |
| c | Add lines 7a and 7b.. | 0 | 0 | 0 | 0 | 15,279 | 15,279 |
| 8 | Public support. (Subtract line 7c from line 6.) | 288,497,510 | |||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2011 | (b) 2012 | (c) 2013 | (d) 2014 | (e) 2015 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | 52,873,808 | 54,307,358 | 54,999,458 | 63,970,375 | 62,361,790 | 288,512,789 |
| 10a | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | 7,948 | 4,005 | 2,303 | 3,290 | 3,956 | 21,502 |
| b | Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975. | 0 | |||||
| c | Add lines 10a and 10b. | 7,948 | 4,005 | 2,303 | 3,290 | 3,956 | 21,502 |
| 11 | Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on. | 0 | 0 | 0 | 0 | 0 | 0 |
| 12 | Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.) .. | 177,338 | 281,030 | 275,420 | 366,900 | 301,540 | 1,402,228 |
| 13 | Total support. (Add lines 9, 10c, 11, and 12.).. | 53,059,094 | 54,592,393 | 55,277,181 | 64,340,565 | 62,667,286 | 289,936,519 |
| Section A - Adjusted Net Income | (A) Prior Year |
(B) Current Year (optional) |
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| 1 | Net short-term capital gain | 1 | ||||
| 2 | Recoveries of prior-year distributions | 2 | ||||
| 3 | Other gross income (see instructions) | 3 | ||||
| 4 | Add lines 1 through 3 | 4 | ||||
| 5 | Depreciation and depletion | 5 | ||||
| 6 | Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions) | 6 | ||||
| 7 | Other expenses (see instructions) | 7 | ||||
| 8 | Adjusted Net Income (subtract lines 5, 6 and 7 from line 4) | 8 | ||||
| Section B - Minimum Asset Amount | (A) Prior Year |
(B) Current Year (optional) |
||||
| 1 | Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year): | 1 | ||||
| a | Average monthly value of securities | 1a | ||||
| b | Average monthly cash balances | 1b | ||||
| c | Fair market value of other non-exempt-use assets | 1c | ||||
| d | Total (add lines 1a, 1b, and 1c) | 1d | ||||
| e |
Discount claimed for blockage or other factors (explain in detail in Part VI): |
|||||
| 2 | Acquisition indebtedness applicable to non-exempt use assets | 2 | ||||
| 3 | Subtract line 2 from line 1d | 3 | ||||
| 4 | Cash deemed held for exempt use. Enter 1-1/2% of line 3 (for greater amount, see instructions). | 4 | ||||
| 5 | Net value of non-exempt-use assets (subtract line 4 from line 3) | 5 | ||||
| 6 | Multiply line 5 by .035 | 6 | ||||
| 7 | Recoveries of prior-year distributions | 7 | ||||
| 8 | Minimum Asset Amount (add line 7 to line 6) | 8 | ||||
| Section C - Distributable Amount | Current Year | |||||
| 1 | Adjusted net income for prior year (from Section A, line 8, Column A) | 1 | ||||
| 2 | Enter 85% of line 1 | 2 | ||||
| 3 | Minimum asset amount for prior year (from Section B, line 8, Column A) | 3 | ||||
| 4 | Enter greater of line 2 or line 3 | 4 | ||||
| 5 | Income tax imposed in prior year | 5 | ||||
| 6 | Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions) | 6 | ||||
| Section D - Distributions | Current Year | |
|---|---|---|
| 1 Amounts paid to supported organizations to accomplish exempt purposes | ||
|
2
Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity |
||
| 3 Administrative expenses paid to accomplish exempt purposes of supported organizations | ||
| 4 Amounts paid to acquire exempt-use assets | ||
| 5 Qualified set-aside amounts (prior IRS approval required) | ||
| 6 Other distributions (describe in Part VI). See instructions | ||
| 7Total annual distributions. Add lines 1 through 6. | ||
|
8
Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions |
||
| 9 Distributable amount for 2015 from Section C, line 6 | ||
| 10 Line 8 amount divided by Line 9 amount | ||
| Section E - Distribution Allocations (see instructions) |
(i) Excess Distributions |
(ii) Underdistributions Pre-2015 |
(iii) Distributable Amount for 2015 |
|
|---|---|---|---|---|
|
1
Distributable amount for 2015 from Section C, line 6 |
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|
2
Underdistributions, if any, for years prior to 2015 (reasonable cause required--see instructions) |
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| 3 Excess distributions carryover, if any, to 2015: | ||||
| a | ||||
| b | ||||
| c | ||||
| d From 2013....... | ||||
| e From 2014....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2015 distributable amount | ||||
|
i
Carryover from 2010 not applied (see instructions) |
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| j Remainder. Subtract lines 3g, 3h, and 3i from 3f. | ||||
| 4Distributions for 2015 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2015 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from 4. | ||||
|
5
Remaining underdistributions for years prior to 2015, if any. Subtract lines 3g and 4a from line 2 (if amount greater than zero, see instructions) |
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|
6
Remaining underdistributions for 2015. Subtract lines 3h and 4b from line 1 (if amount greater than zero, see instructions) |
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|
7 Excess distributions carryover to 2016. Add lines 3j and 4c. |
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| 8 Breakdown of line 7: | ||||
| a | ||||
| b | ||||
| c Excess from 2013....... | ||||
| d From 2014....... | ||||
| e From 2015....... | ||||
| Facts And Circumstances Test |
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| Return Reference | Explanation |
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| Software ID: | |
| Software Version: |
Attach to Form 990 or 990-EZ.
Information about Schedule O (Form 990 or 990-EZ) and its instructions is at| Return Reference | Explanation |
|---|---|
| FORM 990, PART III, LINE 4A | OLATHE MEDICAL SERVICES, INC. (OMSI) PROVIDES PHYSICIAN AND ANCILLARY SERVICES IN OLATHE, KANSAS AND SURROUNDING AREAS WHICH INCLUDE RURAL AND MEDICALLY UNDERSERVED COUNTIES IN KANSAS. IN 2015, OMSI PROVIDED PHYSICIAN AND ANCILLARY SERVICES AS FOLLOWS: PROGRAM NAME NUMBER OF VISITS PRIMARY CARE PHYSICIAN SERVICES 308,103 SPECIALISTS PHYSICIAN SERVICES 118,412 OMSI'S CONTRIBUTIONS TO THE HEALTH OF THE COMMUNITIES INCLUDES: CHARITY AND UNCOMPENSATED CARE OLATHE MEDICAL SERVICE'S MISSION IS TO PROVIDE QUALITY AND COMPASSIONATE HEALTH CARE SERVICES TO INDIVIDUALS IN THE COMMUNITIES IT SERVES. OLATHE MEDICAL SERVICES PROVIDES HEALTH CARE TO INDIVIDUALS WHO HAVE INADEQUATE RESOURCES TO AFFORD THE SERVICES AND ARE UNINSURED OR UNDERINSURED OR PARTICIPATE IN GOVERNMENTAL HEALTH PROGRAMS FOR THE POOR, ELDERLY OR DISABLED. UNCOMPENSATED CARE TO THE POOR INCLUDES THE COST OF PROVIDING CARE TO PATIENTS WHO MEET THE GUIDELINES OF THE OLATHE MEDICAL SERVICES' CHARITY CARE PROGRAM AND THE COST OF PROVIDING CARE IN EXCESS OF REIMBURSEMENT TO PARTICIPANTS IN THE MEDICAID PROGRAM AND OTHER INDIGENT PUBLIC PROGRAMS SUCH AS FREE CLINICS. CHARITY CARE PROVIDED AT COST $251,000 MEDICAID COST IN EXCESS OF PAYMENTS $3,005,000 PROVISION OF CARE IN RURAL HEALTH CLINICS OLATHE MEDICAL SERVICES, INC. HAS 5 RURAL HEALTH CLINICS OPERATING IN AREAS DESIGNATED AS MEDICALLY UNDERSERVED. THESE CLINICS HELP MEET THE NEEDS OF THEIR RESPECTIVE COMMUNITIES BY PROVIDING PRIMARY CARE PHYSICIANS AND MID-LEVEL PROVIDERS, LAB SERVICES AND X-RAY SERVICES. RURAL HEALTH CARE CLINICS COST IN EXCESS OF PAYMENTS $1,568,000 EDUCATIONAL SUPPORT IN ADDITION TO PROVIDING UNCOMPENSATED CARE FOR PATIENTS IN NEED, OLATHE MEDICAL SERVICES PROVIDES OTHER HEALTH CARE RELATED BENEFITS TO THE COMMUNITIES IT SERVES BY PROVIDING EDUCATION FOR A VARIETY OF MEDICAL PROFESSIONALS, INCLUDING MEDICAL STUDENTS' HEALTH CARE SCREENINGS, NURSING STUDENTS, MID-LEVEL PROVIDERS, AND PHYSICIANS. THE COST OF THIS SUPPORT IS $127,000. |
| FORM 990, PART VI, SECTION A, LINE 2 | FRANK H. DEVOCELLE AND TIERNEY L. GRASSER HAVE A BUSINESS RELATIONSHIP WITH EACH OTHER. THEY SERVE AS OFFICERS OF RELATED FOR PROFIT COMPANIES. DAVID R. GABOURY, CHIP WOOD, FRANK H. DEVOCELLE, TIERNEY L. GRASSER, JAMES L. WETZEL, AND CHERYL L. ROSS HAVE A BUSINESS RELATIONSHIP. THE BUSINESS RELATIONSHIP IS AN EMPLOYER/EMPLOYEE RELATIONSHIP, WHERE CHIP WOOD AND DAVID GABOURY ARE BOARD MEMBERS OF OLATHE MEDICAL CENTER, INC. AND FRANK DEVOCELLE, TIERNEY GRASSER, JAMES WETZEL, AND CHERYL ROSS ARE EMPLOYED BY OLATHE MEDICAL CENTER, INC. |
| FORM 990, PART VI, SECTION A, LINE 6 | OLATHE MEDICAL CENTER, INC., A NOT-FOR-PROFIT, 501 (C) (3) ORGANIZATION, IS THE SOLE MEMBER OF OLATHE MEDICAL SERVICES, INC. |
| FORM 990, PART VI, SECTION A, LINE 7A | OLATHE MEDICAL CENTER, INC. IS THE SOLE MEMBER OF OLATHE MEDICAL SERVICES, INC. AND HAS THE RIGHT TO ELECT OR APPOINT ALL THE BOARD OF TRUSTEES. |
| FORM 990, PART VI, SECTION A, LINE 7B | OLATHE MEDICAL CENTER, INC. IS THE SOLE MEMBER, AND HAS THE RIGHT TO APPROVE OLATHE MEDICAL SERVICES, INC.'S BYLAWS AND ARTICLES OF INCORPORATION AND ALSO APPROVE OLATHE MEDICAL SERVICES' BOARD MEMBERS AND HAVE AUTHORITY OVER CERTAIN TRANSACTIONS. |
| FORM 990, PART VI, SECTION B, LINE 11B | THE TAX RETURN FORM 990 IS REVIEWED BY THE AUDIT AND COMPLIANCE COMMITTEE OF THE OLATHE MEDICAL CENTER, INC. (OLATHE MEDICAL SERVICES, INC.'S SOLE MEMBER) BOARD ON BEHALF OF ALL OF ITS AFFILIATES PRIOR TO FILING THE RETURN WITH THE INTERNAL REVENUE SERVICE. THE AUDIT AND COMPLIANCE COMMITTEE IS COMPRISED OF INDEPENDENT BOARD MEMBERS OF OLATHE MEDICAL CENTER, INC. THE FINAL FORM 990 WITH ALL REQUIRED SCHEDULES IS THEN PROVIDED TO ALL BOARD MEMBERS FOR REVIEW PRIOR TO FILING THE FORM 990. |
| FORM 990, PART VI, SECTION B, LINE 12C | THE PURPOSE OF THE ORGANIZATIONS CONFLICT OF INTEREST POLICY IS TO PROTECT THE ORGANIZATIONS INTEREST WHEN IT IS CONTEMPLATING A DECISION OR ENTERING INTO A TRANSACTION OR ARRANGEMENT THAT MIGHT BENEFIT THE PRIVATE INTEREST OF ANY PERSON IN A POSITION OF AUTHORITY OVER THE ORGANIZATION, OR MIGHT RESULT IN A POSSIBLE EXCESS BENEFIT TRANSACTION. CORPORATE OFFICERS AND MEMBERS OF THE BOARD OF TRUSTEES REVIEW THE CONFLICT OF INTEREST POLICY AND COMPLETE A DISCLOSURE OF INFORMATION FORM ANNUALLY. A SUMMARY OF THE ANNUAL DISCLOSURES OF INFORMATION IS PROVIDED TO THE FULL BOARD FOR REVIEW AT LEAST ONE TIME PER YEAR. THE CONFLICT OF INTEREST POLICY CALLS FOR ANY INTERESTED PERSON TO DISCLOSE THE EXISTENCE OF A FINANCIAL RELATIONSHIP OR COMPETITIVE INTEREST IN CONNECTION WITH ANY PENDING TRANSACTION OR ARRANGEMENT. THE INDIVIDUAL IS GIVEN THE OPPORTUNITY TO DISCLOSE ALL MATERIAL FACTS TO THE TRUSTEES CONSIDERING THE PROPOSED TRANSACTION OR ARRANGEMENT THAT GAVE RISE TO THE DISCLOSURE. WHEN A TRANSACTION INVOLVES AN INTERESTED PARTY, THE FOLLOWING PROCEDURES ARE FOLLOWED: 1. THE INTERESTED PARTY LEAVES THE MEETING AFTER PROVIDING ANY MATERIAL FACTS OR DISCUSSION REGARDING THE MATTER THAT GIVES RISE TO THE INTEREST UNLESS REQUESTED TO STAY BY THE REMAINING BOARD OR COMMITTEE MEMBERS. 2. IF APPROPRIATE, THE BOARD MAY APPOINT A NON-INTERESTED PERSON OR COMMITTEE TO INVESTIGATE ALTERNATIVES TO THE PROPOSED TRANSACTION; 3. THE INTERESTED TRUSTEE MAY NOT VOTE ON THE MATTER THAT GIVES RISE TO THE INTEREST. 4. IN ORDER TO APPROVE THE TRANSACTION, THE BOARD MUST FIRST FIND, BY A MAJORITY VOTE OF THE TRUSTEES THEN IN OFFICE, WITHOUT COUNTING THE VOTE OF THE INTERESTED TRUSTEE, a. THAT THE PROPOSED TRANSACTION IS IN THE ORGANIZATIONS BEST INTERESTS AND FOR ITS OWN BENEFIT, AND b. THAT, AFTER REASONABLE INVESTIGATION, THE BOARD HAS DETERMINED THAT THE ORGANIZATION CANNONT OBTAIN A MORE ADVANTAGEOUS TRANSACTION WITH EFFORTS UNDER THE CIRCUMSTANCES. |
| FORM 990, PART VI, SECTION B, LINE 15A & 15B | THE COMPENSATION COMMITTEE OF THE OLATHE MEDICAL CENTER, INC. (OLATHE MEDICAL SERVICES, INC.'S SOLE MEMBER) IS COMPRISED OF INDEPENDENT MEMBERS OF THE BOARD OF OLATHE MEDICAL CENTER, INC. ANNUALLY, THE COMPENSATION COMMITTEE REVIEWS AND APPROVES THE COMPENSATION OF OTHER OFFICERS IN ACCORDANCE WITH THEIR COMPENSATION POLICY. THE COMPENSATION COMMITTEE REVIEWS THIRD PARTY SALARY SURVEYS, USES INDEPENDENT CONSULTANTS AND ALSO UTILIZES THE WRITTEN CONTRACT FOR THE OTHER OFFICERS TO DETERMINE THE FAIR MARKET VALUE OF THE CURRENT COMPENSATION, SALARY RANGES AND BENEFITS. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE NOT AVAILABLE TO THE PUBLIC. |
| FORM 990, PART XI, LINE 9 | TRANSFER FROM AFFILIATE $ 26,048,001 |
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