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 | |||||
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Total |
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Calendar year
(or fiscal year beginning in)
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(a) 2017 | (b) 2018 | (c) 2019 | (d) 2020 | (e) 2021 | (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)
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(a) 2017 | (b) 2018 | (c) 2019 | (d) 2020 | (e) 2021 | (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) 2017 | (b) 2018 | (c) 2019 | (d) 2020 | (e) 2021 | (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) 2017 | (b) 2018 | (c) 2019 | (d) 2020 | (e) 2021 | (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 on 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) |
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| 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): |
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| 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 0.015 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 0.035 | 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 | 1 | |
|
2
Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity |
2 | |
| 3 Administrative expenses paid to accomplish exempt purposes of supported organizations | 3 | |
| 4 Amounts paid to acquire exempt-use assets | 4 | |
| 5 Qualified set-aside amounts (prior IRS approval required - provide details in Part VI) | 5 | |
| 6 Other distributions (describe in Part VI). See instructions | 6 | |
| 7Total annual distributions. Add lines 1 through 6. | 7 | |
|
8
Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions |
8 | |
| 9 Distributable amount for 2021 from Section C, line 6 | 9 | |
| 10 Line 8 amount divided by Line 9 amount | 10 | |
| Section E - Distribution Allocations (see instructions) |
(i) Excess Distributions |
(ii) Underdistributions Pre-2021 |
(iii) Distributable Amount for 2021 |
|
|---|---|---|---|---|
| 1 Distributable amount for 2021 from Section C, line 6 | ||||
|
2
Underdistributions, if any, for years prior to 2021 (reasonable cause required-- explain in Part VI). See instructions. |
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| 3 Excess distributions carryover, if any, to 2021: | ||||
| a From 2016....... | ||||
| b From 2017....... | ||||
| c From 2018....... | ||||
| d From 2019....... | ||||
| e From 2020....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2021 distributable amount | ||||
|
i
Carryover from 2016 not applied (see instructions) |
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| j Remainder. Subtract lines 3g, 3h, and 3i from line 3f. | ||||
| 4Distributions for 2021 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2021 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from line 4. | ||||
|
5
Remaining underdistributions for years prior to 2021, 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 2021. 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 2022. Add lines 3j and 4c. |
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| 8 Breakdown of line 7: | ||||
| a Excess from 2017..... | ||||
| b Excess from 2018..... | ||||
| c Excess from 2019..... | ||||
| d Excess from 2020..... | ||||
| e Excess from 2021..... | ||||
| 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 III, LINE 4A | Stormont-Vail HealthCare, Inc. provides quality medical health care regardless of race, creed, sex, national origin, handicap, age, or ability to pay. For the year ended September 30, 2022, 19,380 inpatients, 53,405 emergency room patients, 1,498 newborns, and 383 neonatal intensive care babies were served. Although reimbursement for services rendered is critical to the operation and stability of the Stormont Vail, it is recognized that not all individuals possess the ability to purchase essential medical services. Stormont Vail's mission is to serve the community with respect to providing health care services and health care education regardless of ability to pay. As part of this mission, Stormont Vail provides care to persons covered by Medicare and Medicaid. Following are some of the benefits provided at reduced rates for the fiscal year: In addition to the charity care provided, Stormont Vail also provided service to patients that resulted in uncollectible amounts as follows: Bad Debt Expense At Cost $ 9,287,460 Shortfall of Medicare Payments at Cost $100,839,843 Shortfall of Medicaid Payments at Cost $ 29,388,712 Stormont Vail also provides other heath care services and programs for the benefit of the community, free or at reduced rates. Examples of these include: 1. Subsidy of nursing education, medical education, and allied health education 2. Operating the regions only Level III Neonatal Intensive Care Unit (NICU) serving a high percentage of medically indigent patients 3. Operating a Level II Trauma Center serving northeast Kansas 4. Organized support groups for a variety of topics including Cancer Support Group, Diabetes Adult Support Group and the Pregnancy and Infant Loss Support Group 5. Volunteer time was donated to Stormont Vail helping to reduce the cost of providing health care 6. Use of Pozez Education Center facilities for a variety of community groups and programs 7. Participated in numerous clinical research trials through the Clinical Research Department 8. Stormont-Vail West Behavioral Health Services operates a substance abuse program 9. Operated a Palliative Care program to provide comfort care to patients with chronic conditions 10. Provided support and education for patients with diabetes through the Diabetes Learning Center 11. Stormont-Vail is a regional network of 30+ locations in 11 communities in our region improving access to medical care in several cities that otherwise would not have access, particularly on weekends 12. Maternal Fetal Medicine program provided care and access to screenings and genetic counseling for women with at-risk pregnancies 13. Offered various parenting and childbirth preparation programs through Stormont-Vail's web site 14. The Health Connection program, which provides physician referral and after-hour access to a nurse, received 470,132 calls 15. Partnered with Building Blocks to provide childcare services to staff and the community 16. Connected with the community through the organization website, www.stormontvail.org 17. Partnered with Health Innovation Network of Kansas, a coalition of 15 hospitals sharing information, education and other needed services 18. Stormont Vail and its employees donated funds and staff time to the Meals on Wheels program including sponsoring a Meals on Wheels route 19. Stormont Vail and its employees donated funds and staff time to the United Way 20. Operated the Patient Center Medical Home concept to improve care with the focus on prevention and wellness 21. Work with others in the community to improve safety net services for under insured and uninsured 22. Provided staff to serve on the Board of Directors for the United Way of Topeka, Topeka Community Foundation, Go Topeka, and others 23. Provided transportation to patients who are unable to get to their health care appointments or need transportation to return home 24. Provided screening and coordination for participants for a drug program benefit to help patients obtain needed medication 25. Provided community leadership through Heartland Healthy Neighborhoods and associated workgroup participation 26. Donated office space, janitorial services, shredding, and phones to house the Shawnee County Medical Society HealthAccess program that helps coordinate donated care for low-income uninsured on behalf of the entire medical community 27. Partnered with United Way 211 so that individuals can dial 211 from any phone to speak with a referral specialist. Available in both English and Spanish 28. Provided resource information for financial assistance to individuals 29. Partnered with several organizations to provide mental health assistance 30. Food assistance resources were provided in collaboration with several organizations 31. Provided resource information on housing assistance for individuals that are having financial difficulties or have been evicted 32. Provided health & wellness resources |
| FORM 990, PART III, LINE 4A CONTINUED | In addition to these community contributions, Stormont-Vail provided supervised clinical experience for 1,131 students to the following entities: Name/Location Type of Students -------------- ---------------- 190th ARW Nursing/Anesthesia Student (1) 190th ARW Undergraduate RN or LPN (37) Atchison Hospital Regional Staff Student (1) Baker University Undergraduate RN or LPN (305) Barton Co Community College EMT Students (14) Barton Co Community College Medical Technology Student (1) Benedictine College Undergraduate RN or LPN (9) Coffey Health System Regional Regional Staff Student (1) Creighton University Inpatient OT Students (4) Emporia State University Undergraduate RN or LPN (18) Flint Hills Technical College Undergraduate RN or LPN (23) Fort Hays State University Nurse Practitioner Student (1) Fort Hays State University Outpatient ST Student (1) Fort Hays State University Undergraduate RN or LPN (1) Graceland University Nurse Practitioner Students (15) Hiawatha Community Hospital Regional Staff Students (3) Kansas City KS Community College Inpatient PTA Student (1) Kansas State University Athletic Trainer Student (1) Kansas State University Physician Assistant Students (7) Manhattan Technical College Medical Technology Students (2) Manhattan Technical College Nursing Maryville University Nurse Practitioner Students (19) Mid American Nazarene University Nurse Practitioner Student (1) Missouri State University Inpatient OT Students (2) Missouri State University Inpatient PT Student (1) Neosho Community College Undergraduate RN or LPN (7) Non-Affiliated Observers Observers (50) Non-Affiliated Observers Observers-Clinic (12) Non-Affiliated Observers Observers-Medical Staff (2) Rockhurst University Inpatient PT Student (1) Seaman High School HS Work Program (8) Texas Wesleyan University Nurse Anesthesia Students (4) Union College Physician Assistant Student (1) University of Missouri-Columbia Nurse Practitioner Student (1) University of Missouri-KC Nurse Practitioner Students (5) University of Alabama Birmingham Nurse Practitioner Students (3) University of Kansas Nurse Practitioner Students (5) University of Kansas Pharmacy Students (16) University of Kansas Social Work Students (2) University of Kansas Undergraduate RN or LPN (3) University of Kansas Med Center Inpatient OT Student (1) University of Kansas Med Center Nurse Anesthesia Students (2) University of Kansas Med Center Nurse Practitioner Students (3) University of Kansas Med Center Undergraduate RN or LPN (2) University of Nebraska Med Center Physician Assistant Students (2) University of St. Mary Inpatient PT Student (1) University of St. Mary Nurse Practitioner Students (3) University of St. Mary Outpatient PT Students (2) Washburn Institute of Technology Phlebotomy Student (20) Washburn Institute of Technology Surgical Tech (15) Washburn Institute of Technology Undergraduate RN or LPN (116) Washburn University Inpatient PTA Student (2) Washburn University Kinesiology Student (5) Washburn University Medical Technology Student (1) Washburn University Nurse Practitioner Student (15) Washburn University Outpatient PT Student (3) Washburn University Psychology Student (1) Washburn University Rad Tech/MRI/CT Student (17) Washburn University Radiation Therapy Student (1) Washburn University Respiratory Therapy Student (17) Washburn University Social Work Student (4) Washburn University Ultrasound Student (2) Washburn University Undergraduate RN or LPN (289) Wichita State University Inpatient PT Student (1) Wichita State University Nurse Practitioner Student (1) Wichita State University Outpatient PT Student (2) Wichita State University Physician Assistant Student (14) |
| FORM 990, PART VI, SECTION B, LINE 11B | AN INDEPENDENT ACCOUNTING FIRM PREPARES AND REVIEWS THE 990. THE 990 IS THEN REVIEWED BY THE ORGANIZATION'S FINANCE AND AUDIT COMMITTEES. ANY QUESTIONS AND CONCERNS THE ORGANIZATION'S FINANCE AND AUDIT COMITTEES HAVE ARE ADDRESSED AND ANY CORRECTIONS OR CLARIFICATIONS THAT NEED TO BE MADE ARE MADE. THE FINAL FORM 990 WITH ALL REQUIRED SCHEDULES IS THEN PROVIDED TO ALL VOTING MEMBERS OF THE BOARD PRIOR TO FILING THE 990. |
| FORM 990, PART VI, SECTION B, LINE 12C | THE OFFICERS, DIRECTORS AND KEY EMPLOYEES SUBMIT CONFLICT OF INTEREST STATEMENTS TO THE CHAIRMAN OF THE AUDIT COMMITTEE OF STORMONT VAIL HEALTHCARE EACH YEAR. THE CHAIRMAN REVIEWS THE RESPONSES AND REPORTS TO THE AUDIT COMMITTEE FOR THEIR REVIEW AND DETERMINATION OF ANY APPROPRIATE ACTION TO BE TAKEN. THE CHAIRMAN ALSO THEN REPORTS THE RESULTS TO THE FULL BOARD OF DIRECTORS. |
| FORM 990, PART VI, SECTION B, LINE 15B | THE BOARD OF DIRECTORS HAS ESTABLISHED AN EXECUTIVE COMPENSATION COMMITTEE THAT IS CHARGED WITH THE OVERSIGHT AND REVIEW OF ALL EXECUTIVE COMPENSATION AND BENEFITS FOR THE CEO, SENIOR VICE PRESIDENTS AND VICE PRESIDENTS OF THE HEALTH SYSTEM. THE COMPENSATION IS REVIEWED ANNUALLY BY AN EXTERNAL INDEPENDENT CONSULTANT, GALLAGHER. GALLAGHER REVIEWS BASE COMPENSATION, INCENTIVE PROGRAMS AND TOTAL CASH COMPENSATION THAT ARE OFFERED ON AN ANNUAL BASIS TO ENSURE IT ALIGNS WITH FAIR MARKET VALUE AND COMPLIES WITH OUR ESTABLISHED COMPENSATION PHILOSOPHY. IN ADDITION, GALLAGHER ON A REGULAR BASIS REVIEWS THE EXECUTIVE BENEFIT PROGRAM TO ALSO ENSURE IT IS APPROPRIATE AND REASONABLE. GALLAGHER CONDUCTED A REVIEW IN 2022. |
| FORM 990, PART VI, SECTION C, LINE 19 | STORMONT VAIL HEALTHCARE MAKES THEIR FINANCIAL STATEMENTS AVAILABLE FOR PUBLIC INSPECTION AS PART OF THE FORM 990 INFORMATION RETURN. ANY CHANGES TO THE GOVERNING DOCUMENTS ARE INCLUDED WITH THE FORM 990 RETURN. AT THIS TIME, THE HEALTH CENTER DOES NOT MAKE THEIR CONFLICT OF INTEREST POLICY AVAILABLE TO THE PUBLIC. |
| FORM 990, PART XI, LINE 9 | Change in Pension Obligation $20,189,515 Earnings Equity Investments 3,311,205 Other Changes in Net Assets 9,662,518 Investment in Partnerships (33,551) ------------ Total $33,129,687 |
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| Software Version: |