Attach to Form 990 or Form 990-EZ.
Go to
www.irs.gov/Form990 for instructions and the latest information.
| (i) Name of supported organization | (ii) EIN | (iii) Type of organization (described on lines 1- 10 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 |
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Calendar year (or fiscal year beginning in) ![]() |
(a) 2015 | (b) 2016 | (c) 2017 | (d) 2018 | (e) 2019 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") .. | ||||||
| 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) 2015 | (b) 2016 | (c) 2017 | (d) 2018 | (e) 2019 | (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) 2015 | (b) 2016 | (c) 2017 | (d) 2018 | (e) 2019 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") . | ||||||
| 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 | ||||||
| 3 | Gross receipts from activities that are not an unrelated trade or business under section 513 ..... | ||||||
| 4 | Tax revenues levied for the organization's benefit and either paid to or expended on its behalf... | ||||||
| 5 | The value of services or facilities furnished by a governmental unit to the organization without charge | ||||||
| 6 | Total. Add lines 1 through 5 | ||||||
| 7a | Amounts included on lines 1, 2, and 3 received from disqualified persons | ||||||
| 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. | ||||||
| c | Add lines 7a and 7b.. | ||||||
| 8 | Public support. (Subtract line 7c from line 6.) | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2015 | (b) 2016 | (c) 2017 | (d) 2018 | (e) 2019 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | ||||||
| 10a | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | ||||||
| b | Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975. | ||||||
| c | Add lines 10a and 10b. | ||||||
| 11 | Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on. | ||||||
| 12 | Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.) .. | ||||||
| 13 | Total support. (Add lines 9, 10c, 11, and 12.).. | ||||||
| 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 2019 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-2019 |
(iii) Distributable Amount for 2019 |
|
|---|---|---|---|---|
| 1 Distributable amount for 2019 from Section C, line 6 | ||||
|
2
Underdistributions, if any, for years prior to 2019 (reasonable cause required-- explain in Part VI). See instructions. |
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| 3 Excess distributions carryover, if any, to 2019: | ||||
| a From 2014....... | ||||
| b From 2015....... | ||||
| c From 2016....... | ||||
| d From 2017....... | ||||
| e From 2018....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2019 distributable amount | ||||
|
i
Carryover from 2014 not applied (see instructions) |
||||
| j Remainder. Subtract lines 3g, 3h, and 3i from 3f. | ||||
| 4Distributions for 2019 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2019 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from 4. | ||||
|
5
Remaining underdistributions for years prior to 2019, if any. Subtract lines 3g and 4a from line 2. If the amount is greater than zero, explain in Part VI. See instructions. |
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|
6
Remaining underdistributions for 2019. Subtract lines 3h and 4b from line 1. If the amount is greater than zero, explain in Part VI. See instructions. |
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|
7 Excess distributions carryover to 2020. Add lines 3j and 4c. |
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| 8 Breakdown of line 7: | ||||
| a Excess from 2015..... | ||||
| b Excess from 2016..... | ||||
| c Excess from 2017..... | ||||
| d Excess from 2018..... | ||||
| e Excess from 2019..... | ||||
| 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.
Go to www.irs.gov/Form990 for the latest information.
| Return Reference | Explanation |
|---|---|
| FORM 990, PART I, LINE 1 | TO OPERATE A GENERAL HOSPITAL FOR THE PROVISION OF FACILITIES FOR THE DIAGNOSIS, TREATMENT, OR CARE OF INDIVIDUALS SUFFERING FROM PHYSICAL ILLNESS, DISEASE, INJURY, OR DEFORMITY IN PRATT CO AND ADJACENT AREAS. FORM 990, PART III, LINE 1 TO OPERATE A GENERAL HOSPITAL FOR THE PROVISION OF FACILITIES FOR THE DIAGNOSIS, TREATMENT OR CARE OF INDIVIDUALS SUFFERING FROM PHYSICAL ILLNESS, DISEASE, INJURY, OR DEFORMITY WITHIN PRATT COUNTY AND ADJACENT AREAS. SUCH DIAGNOSIS, CARE AND TREATMENT SHALL BE PROVIDED TO ALL PERSONS, REGARDLESS OF RACE, CREED, COLOR, SEX, OR ABILITY TO PAY. FORM 990, PART III, LINE 4A IN 2018, PRMC PROVIDED $208,312 IN CHARITY CARE AND DONATED $9,330 TO LOCAL CHARITIES AND COMMUNITY EVENTS, AS WELL AS HELPED TO EDUCATE AND TRAIN FUTURE CAREGIVERS SEEKING DEGREES IN THE HEALTH CARE FIELD. PRMC PLAYS A VITAL ECONOMIC ROLE IN THE PRATT COMMUNITY. AS THE LARGEST EMPLOYER IN THE COUNTY, PRMC EMPLOYS 440 PEOPLE WITH FULL AND PART-TIME JOBS. IN FY18, PRMC PAID $27,365,676 IN SALARIES AND BENEFITS, AND PURCHASED OVER $2 MILLION IN LOCAL PRODUCTS AND SERVICES AND PAID $1,277,117 FOR UTILITIES. PRMC BRINGS VALUE TO THE PRATT COMMUNITY THROUGH PROVIDING QUALITY HEALTH CARE AND JOBS. THE HOSPITAL PROUDLY PROVIDES FOUR FAMILY PRACTICE PHYSICIANS, FIVE INTERNAL MEDICINE PHYSICIANS, A RURAL HEALTH CLINIC FAMILY PHYSICIAN, A GASTROENTEROLOGIST, A HEMATOLOGIST/ONCOLOGIST, AN INTERVENTIONAL PAIN MANAGEMENT SPECIALIST, A RADIOLOGIST, A GYNECOLOGICAL SURGEON, A GENERAL SURGEON, A PODIATRIST/FOOT AND ANKLE SURGEON AND TWO ORTHOPEDIC SURGEONS. PRMC HAS BEEN SUCCESSFUL AT MEETING HIGH QUALITY HEALTH CARE NEEDS FOR THE PAST 60 YEARS. IT IS PRMC'S VISION TO CONTINUE TO MEET THOSE EXPECTATIONS AND BECOME THE HEALTH CARE PROVIDER OF CHOICE FOR SOUTH-CENTRAL AND WESTERN KANSAS. FORM 990, PART VI, SECTION A, LINE 6 PRATT HEALTH FOUNDATION (THE FOUNDATION), A KANSAS NONPROFIT CORPORATION, IS THE SOLE MEMBER OF PRATT REGIONAL MEDICAL CENTER CORPORATION (PRMC). THE FOUNDATION IS DESIGNATED AS THE SOLE MEMBER SO LONG AS IT SHALL CONTINUE TO QUALIFY AS A TAX EXEMPT, NONPROFIT ENTITY RECOGNIZED UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. |
| FORM 990, PART VI, SECTION A, LINE 7A | THE GOVERNING BODY OF PRATT REGIONAL MEDICAL CENTER CORPORATION (PRMC) IS ABLE TO NOMINATE NEW MEMBERS TO ITS GOVERNING BODY. PRATT HEALTH FOUNDATION, BEING THE SOLE MEMBER OF PRMC, RETAINS THE RIGHT TO APPROVE SUCH NEW MEMBERS OF THE GOVERNING BODY OF PRMC. |
| FORM 990, PART VI, SECTION A, LINE 7B | THE FOUNDATION, BEING THE SOLE MEMBER OF PRMC, HAS THE RIGHT TO APPROVE THE ARTICLES OF INCORPORATION, BYLAWS AND THE BOARD OF DIRECTORS. |
| FORM 990, PART VI, SECTION B, LINE 11B | AN INDEPENDENT ACCOUNTING FIRM PREPARES AND REVIEWS THE FORM 990. THE 990 IS THEN PROVIDED TO THE CFO AND ACCOUNTING PERSONNEL FOR REVIEW. ANY QUESTIONS OR CONCERNS THE CFO AND ACCOUNTING PERSONNEL HAVE ARE ADDRESSED AND ANY CORRECTIONS OR CLARIFICATIONS ARE MADE, IF NEEDED. THE FINAL FORM 990 WITH ALL REQUIRED SCHEDULES IS THEN PROVIDED TO ALL VOTING MEMBERS OF THE BOARD PRIOR TO FILING THE 990 WITH THE IRS. |
| FORM 990, PART VI, SECTION B, LINE 12C | AT THE TIME OF HIRE (OR ELECTION IN THE CASE OF BOARD MEMBERS) AND ANNUALLY THEREAFTER, THE CFO OR HIS/HER DESIGNEE SHALL PROVIDE TO THE BOARD AND TO ALL EXECUTIVE OFFICERS A COPY OF THE CONFLICT OF INTEREST POLICY AND THE APPLICABLE CONFLICT DISCLOSURE FORM AND QUESTIONNAIRE, WHICH SHALL BE COMPLETED TO IDENTIFY ANY RELATIONSHIPS, POSITIONS OR CIRCUMSTANCES WITH RESPECT TO WHICH IT IS BELIEVED A CONFLICT MAY ARISE. EACH MEMBER SHALL DISCLOSE FULLY AND FRANKLY ANY AND ALL ACTUAL OR POTENTIAL CONFLICTS OF DUALITY OR INTEREST OR RESPONSIBILITY, WHETHER INDIVIDUAL, PERSONAL OR BUSINESS, WHICH MAY EXIST OR APPEAR AS TO THE ORGANIZATION OR ANY SYSTEM ENTITY OR ANY MATTER OF BUSINESS WHICH MAY COME BEFORE THE BOARD. THE BOARD CHAIRMAN REVIEWS ANY POTENTIAL CONFLICTS, AND DETERMINES WHETHER A CONFLICT IS PRESENT. A CONFLICTED INDIVIDUAL MUST ABSTAIN FROM VOTING IN THE MATTER OF WHICH A CONFLICT HAS BEEN IDENTIFIED BY THE BOARD CHAIRMAN. |
| FORM 990, PART VI, SECTION B, LINE 15A & B | CONSISTENT WITH THE POLICY AND COMPENSATION PRACTICE WITHIN PRATT REGIONAL MEDICAL CENTER (PRMC), THE PRESIDENT AND CEO IS SUBJECT TO AN ANNUAL REVIEW BY THE PRMC BOARD OF DIRECTORS. REASONABLE COMPENSATION: IT IS THE OBLIGATION OF THE PRMC BOARD OF DIRECTORS TO SEE THAT ITS PRESIDENT AND CEO IS PAID A REASONABLE LEVEL OF COMPENSATION. THE FULL AMOUNT OF ALL DIRECT AND INDIRECT COMPENSATION IS CONSIDERED. COMPENSATION LEVELS ARE REVIEWED AND APPROVED EITHER BY THE BOARD OF DIRECTORS OF PRMC OR BY A COMPENSATION COMMITTEE MADE UP OF BOARD MEMBERS. APPROVAL PROCESS: A SPECIFIC COMPENSATION ARRANGEMENT MUST BE APPROVED EITHER BY THE BOARD OF DIRECTORS OR BY A COMPENSATION COMMITTEE TO WHICH COMPENSATION DECISION(S) HAVE BEEN DELEGATED BY ACTION OF THE BOARD OF DIRECTORS. IF A COMMITTEE IS USED IT IS TO BE COMPRISED OF DISINTERESTED BOARD MEMBERS. COMPARISONS: THE BOARD OR COMMITTEE USES COMPARATIVE DATA THAT LOOKS AT COMPARABLE SOURCES TO DETERMINE THE REASONABLENESS OF COMPENSATION. COMPARATIVE DATA INCLUDES: COMPENSATION PAID BY SIMILAR ORGANIZATIONS, AVAILABILITY OF SIMILAR SERVICES WITHIN THE GEOGRAPHIC AREA, ACTUAL WRITTEN OFFERS FROM SIMILAR INSTITUTIONS COMPETING FOR THE SERVICES OF THE PRESIDENT AND CEO. DOCUMENTATION: THE BOARD OR COMMITTEE ADEQUATELY DOCUMENTS THE BASIS FOR ITS DETERMINATION THAT THE COMPENSATION ARRANGEMENT IS REASONABLE AT THE TIME THE DECISION IS MADE. RECORDS INCLUDE THE TERMS OF THE ARRANGEMENT THAT WAS APPROVED AND THE DATE IT WAS APPROVED, THE BOARD OR COMMITTEE MEMBERS PRESENT DURING THE DECISION OF THE ARRANGEMENT AND THOSE WHO VOTED IN FAVOR OF IT, COMPARABILITY DATA RELIED UPON AND HOW IT WAS OBTAINED, THE ACTIONS TAKEN WITH RESPECT TO CONSIDERATION OF THE TRANSACTION OR ARRANGEMENT BY ANY MEMBER OF THE BOARD OR COMMITTEE THAT HAD A CONFLICT OF INTEREST. IT IS THE RESPONSIBILITY OF THE PRESIDENT AND CEO TO ASSURE THE BOARD THIS SAME PROCESS IS FOLLOWED AND DOCUMENTED REGARDING COMPENSATION OF THE CFO AND VICE PRESIDENTS OF THE MEDICAL CENTER. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. |
| FORM 990, PART XI, LINE 9 | CHANGE IN INTEREST IN NET ASSETS OF PHF 62,439 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:CONTRACTED MEDICAL STAFF TOTAL FEES:8644658 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:BILLING/COLLECTIONS TOTAL FEES:184706 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:OTHER CONTRACTED SERVICES TOTAL FEES:676676 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:ADMINISTRATION/HUMAN RESOURCES TOTAL FEES:405196 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:PLANT OPERATIONS TOTAL FEES:116850 |
| Software ID: | |
| Software Version: |