2023-12-12T15:47:00-06:00 2022-12-31 450250958 EIDE BAILLY LLP 18081 BURT ST STE 200 OMAHA NE 680224722 990 2022-01-01 480561974 AMBERWELL ATCHISON ASSOCIATION AMBE 9133605584 800 RAVEN HILL DRIVE ATCHISON KS 66002 CHASE DUDZINSKI CHIEF FINANCIAL OFFICER 9133605584 2023-12-12 1 CHASE DUDZINSKI XXX-XX-XXXX 1 WENDY R COOLEY CPA P01523804 4023302660 2023-12-12 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z AMBERWELL ATCHISON JEFFREY PERRY 800 RAVEN HILL DRIVE ATCHISON KS 66002 55505843 0 X WWW.AMBERWELLHEALTH.ORG X 1912 KS TO PROVIDE EXCELLENT HEALTH CARE AND IMPROVE THE QUALITY OF LIFE IN OUR COMMUNITY. 9 8 510 53 0 0 284716 3206022 15140035 51964954 65874 260882 2008 18738 15492633 55450596 0 0 0 0 8441127 31738983 0 0 0 6669327 24438379 15110454 56177362 382179 -726766 58039761 52494414 30798332 26333019 27241429 26161395 X AMBERWELL HEALTH PROVIDES COMPASSIONATE CARE WITH CLINICAL EXCELLENCE. 0 0 48334934 51964954 AMBERWELL ATCHISON ASSOCIATION D/B/A AMBERWELL ATCHISON (HOSPITAL) IS A CRITICAL ACCESS HOSPITAL (CAH) THAT PROVIDES RELATED INPATIENT, OUTPATIENT, EMERGENCY CARE, AND PHYSICIAN SERVICES TO PATIENTS IN AND AROUND ATCHISON, KANSAS.AMBERWELL ATCHISON PROVIDED ACUTE INPATIENT AND OUTPATIENT HEALTH SERVICES TO THE GENERAL PUBLIC. SERVICES INCLUDE BUT ARE NOT LIMITED TO: EMERGENCY SERVICES, HOME HEALTH AND HOSPICE, GENERAL INPATIENT ACUTE SERVICES, RADIOLOGY, & OBSTETRICS. THE NUMBER OF PATIENTS SERVED DURING THE YEAR ENDING 12/31/22 WAS 114,151.STATEMENT CONTINUED ON SCHEDULE OTHE 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, 2022 WERE APPROXIMATELY $1,003,000. 48334934 1 1 0 1 0 0 1 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 30 0 1 510 1 0 0 0 0 0 0 0 0 0 0 0 0 X 9 8 0 0 0 0 0 0 0 1 0 0 0 1 1 1 1 1 1 1 0 0 X CHASE DUDZINSKI 9133605584 800 RAVEN HILL DRIVE ATCHISON KS 66002 JONATHAN LECK PHYSICIAN 40.00 0.00 X 789055 0 17739 LYDIA FUNK CHAIRPERSON 1.00 0.00 X X 0 0 0 LARRY MEARS VICE CHAIRPERSON 1.00 0.00 X X 0 0 0 MELINDA PREGONT SECRETARY 1.00 0.00 X X 0 0 0 TODD GIGSTAD TREASURER 1.00 0.00 X X 0 0 0 CHARO KELLEY DIRECTOR 1.00 0.00 X 0 0 0 JORDAN HAWK DIRECTOR 1.00 0.00 X 0 0 0 LORIN AFFIELD DIRECTOR 1.00 0.00 X 0 0 0 JERRY HENRY DIRECTOR 1.00 0.00 X 0 0 0 JEFFREY PERRY PRESIDENT & CEO 40.00 1.00 X 519608 0 18104 JIM FRASER CFO (THRU 7/2022) 40.00 1.00 X 198128 0 21307 CHASE DUDZINSKI CFO 40.00 0.00 X 165681 0 23194 ALICIA SORENSEN CHIEF NURSING OFFICER 40.00 0.00 X 160151 0 35229 RODERICK WARREN PHYSICIAN 40.00 0.00 X 665846 0 23388 BRIAN DUNCAN PHYSICIAN 40.00 0.00 X 619574 0 28673 DARIN ALLEN PHYSICIAN 40.00 0.00 X 475567 0 38444 MCGARRETT GROTH PHYSICIAN 40.00 0.00 X 521895 0 34057 DONALD ABLES PHYSICIAN 40.00 0.00 X 332493 0 27785 4447998 0 267920 57 0 1 0 SPENCER FANE LLP PO BOX 872037 KANSAS CITY MO 641872037 LEGAL SERVICES 319043 SEIM JOHNSON LLP 18081 BURT STREET SUITE 200 OMAHA NE 680224722 AUDIT & TAX SERVICES 111826 2 250000 2949458 6564 3206022 NET PATIENT SERVICE REVENUE 621110 26420131 26420131 MEDICARE/MEDICAID 621110 23153101 23153101 PHARMACY REVENUE 621110 1427205 1427205 964517 964517 51964954 238705 238705 22177 22177 73985 55247 18738 18738 18738 55450596 51964954 0 279620 X 1948197 1002175 946022 25494691 22967383 2527308 330966 263461 67505 2206370 1685751 520619 1758759 1530659 228100 497445 497445 183708 183708 6518013 4262237 2255776 164201 164201 2911483 2806022 105461 1125059 1125059 980745 938258 42487 292397 292397 803409 781894 21515 3739321 3639213 100108 552452 206078 346374 MEDICAL SUPPLIES 5877271 5877271 DUES & SUBSCRIPTIONS 543206 543206 FOOD 216401 216401 COLLECTION FEES 33268 33268 56177362 48334934 7842428 0 8772526 7706798 13282133 6732949 7522170 7710055 1772010 2023900 741091 841042 59610680 43949593 15394868 15661087 10361785 9013556 193178 245853 0 514468 0 2044706 58039761 52494414 4213344 4882337 23139164 20871975 176843 25718 3268981 552989 30798332 26333019 X 26991429 25661395 250000 500000 27241429 26161395 58039761 52494414 -726766 -353268 0 X X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 7655 7655 0 PART II-B, LINE 1: THE AMOUNT INCLUDES A PERCENTAGE OF THE ANNUAL DUES PAID TO THE KANSAS HOSPITAL ASSOCIATION AND THE AMERICAN HOSPITAL ASSOCIATION THAT ARE ATTRIBUTABLE TO LOBBYING. X 1 3.00 1 0 964642 964642 37618914 28274321 9344593 16183582 13529320 2654262 4843542 2145952 2697590 15661087 DEFERRED COMPENSATION 552989 552989 X 55152575 -353268 55247 -298021 55450596 0 55450596 56232609 55247 55247 56177362 0 56177362 PART II, LINE 9: CONSERVATION EASEMENTS ARE REPORTED AT HISTORICAL COSTS AS LAND. PART X, LINE 2: THE HOSPITAL ACCOUNTS FOR UNCERTAINTIES IN ACCOUNTING FOR INCOME TAX ASSETS AND LIABILITIES USING GUIDANCE INCLUDED IN FASB ASC 740, INCOME TAXES. THE HOSPITAL RECOGNIZES THE EFFECT OF INCOME TAX POSITIONS ONLY IF THOSE POSITIONS ARE MORE LIKELY THAN NOT OF BEING SUSTAINED. AT DECEMBER 31, 2022, THE HOSPITAL HAD NO UNCERTAIN TAX POSITIONS ACCRUED. PART XI, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES 55,247. PART XII, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES 55,247. 1 1 X 1 X 1 X 1 1 1 0 1 1 1000300 1000300 0.01780 7558972 4706957 2852015 0.05080 8559272 4706957 3852315 0.06860 8559272 4706957 3852315 0.06860 1 1444115 233947 14649943 15194058 -544115 X 1 1 1 1 AMBERWELL ATCHISON ASSOCIATION 800 RAVEN HILL DRIVE ATCHISON KS 66002 WWW.AMBERWELLHEALTH.ORG H-003-001 X X X X 3 PROVIDER BASED RURAL HEALTH CLINICS AMBERWELL ATCHISON ASSOCIATION 1 0 0 1 X X X X X X X X X 22 1 0 1 1 X PART V, PAGE 8 X 1 22 1 PART V, PAGE 8 0 1 X 200.000000000000 200.000000000000 X X X X X 1 1 X X X 1 X HTTPS://AMBERWELLHEALTH.ORG/PATIENT-RESOURCES/ X HTTPS://AMBERWELLHEALTH.ORG/PATIENT-RESOURCES/ X HTTPS://AMBERWELLHEALTH.ORG/PATIENT-RESOURCES/ X X X X X 1 X 0 X X X X 1 X 0 0 AMBERWELL ATCHISON ASSOCIATION PART V, SECTION B, LINE 5: THE HOSPITAL CONDUCTED A TOWN HALL MEETING WITH KEY STAKE HOLDERS INVOLVED AND CONDUCTED ONLINE SURVEYS. THESE STAKE HOLDERS INCLUDED AMBERWELL ATCHISON, CITY OF ATCHISON, ATCHISON CHAMBER OF COMMERCE, MINNISTERIAL ALLIANCE, ATCHISON COMMUNITY HEALTH CLINIC, AND ATCHISON COUNTY HEALTH DEPARTMENT, AND HOPE FAMILY THERAPY, ATCHISON CHILD CARE ASSOCIATION, LOCAL AND COUNTY SCHOOL DISTRICTS, GUIDANCE CENTER, ATCHISON YMCA. THE ABOVE STAKE HOLDERS REPRESENT THE NEEDS OF THE BROADER COMMUNITY AND ITS SURROUNDING COUNTY'S. ALL DEMOGRAPHICS WOULD BE REPRESENTED BY THESE STAKE HOLDERS. THE CHNA PROCESS STARTED IN DECEMBER 2021 WITH VARIOUS MEETINGS HELD THROUGHOUT 2022. AMBERWELL ATCHISON ASSOCIATION PART V, SECTION B, LINE 6B: CITY OF ATCHISON, ATCHISON CHAMBER OF COMMERCE, MINNISTERIAL ALLIANCE, ATCHISON COMMUNITY HEALTH CLINIC, AND ATCHISON COUNTY HEALTH DEPARTMENT, AND HOPE FAMILY THERAPY, ATCHISON CHILD CARE ASSOCIATION, LOCAL AND COUNTY SCHOOL DISTRICTS, GUIDANCE CENTER, ATCHISON YMCA. AMBERWELL ATCHISON ASSOCIATION PART V, SECTION B, LINE 11: THE COMMUNITY HEALTH NEEDS ASSESSMENT WAS COMPLETED IN 2022. THE FOLLOWING NEEDS WERE IDENTIFIED AND WILL BE ADDRESSED OVER THE NEXT 3 YEARS.MENTAL HEALTH (DIAGNOSIS / TREATMENT / AFTERCARE). SPECIAL FOCUS ON AWARENESS AND ACCESS TO PROVIDERS:1. MAINTAIN A COMMUNITY INVENTORY OF SERVICES TO DOCUMENT THE AVAILABILITY OF MENTAL HEALTH RESOURCES, INCLUDING HOURS OF SERVICE. MAKE THE INVENTORY AVAILABLE TO THE PUBLIC AS NEEDED. DOCUMENT MENTAL HEALTH SERVICES BY AGE CATEGORIES. THE GUIDANCE CENTER / ACHC SCHOOLS, COLLEGES, CITY, COUNTY, K-EXT, HOPE, AMBERWELL, ACCC, ACHC, VALLEY HOPE, CLERGY. 2. INCREASE DEPRESSION SCREENINGS BY PRIMARY CARE PROVIDERS. EXPLORE DEVELOPING A TASK FORCE AMONG CARE COORDINATORS OF AGENCIES TO WORK TOGETHER TO ENSURE THAT PATIENTS ARE GETTING CARE THAT THEY NEED AND TO IDENTIFY WHAT BARRIERS EXIST. INCREASED COLLABORATION BETWEEN AGENCIES TO BENEFIT THE PATIENTS WE SERVE. 3. EXPAND MENTAL HEALTH TRAINING AND CREATE EDUCATION (MATERIALS / PRESENTATIONS) IN SCHOOLS AND COMMUNITY PROGRAMS TO DESTIGMATIZE MENTAL HEALTH ISSUES. 4. CONTINUE TO REFER MENTAL HEALTH PATIENTS TO THE GUIDANCE CENTER, ACHC, AMBERWELL, HEALTH DEPT, AND OTHERS. 5. INVESTIGATE GRANT WRITING TO FUND MENTAL HEALTH EDUCATION AND SERVICES. IF AVAILABLE, DESIGNATE COMMUNITY LEAD TO ATTAIN THE NECESSARY GRANT. 6. PROMOTE EXISTING MENTAL HEALTH SERVICES, FACILITIES, AND PROVIDERS. EDUCATE COMMUNITY ON PLACEMENT PROCESS AND OPTIONS THROUGH HOSPITAL PHYSICIANS, CLINICS, AND E.R. EXPAND ACCESS TO MENTAL HEALTH THROUGH ADDING ADDITIONAL MENTAL HEALTH PROFESSIONALS TO SERVE THE COMMUNITY. 7. CONTINUE TO CONTRACT WITH THE GUIDANCE CENTER TO SEND A MENTAL HEALTH SCREENER TO THE EMERGENCY DEPARTMENT TO ASSESS PATIENT-NEEDS AND TREATMENT OPTIONS AVAILABLE. 8. CONTINUED PARTNERSHIPS WITH AREA SCHOOLS AROUND MENTAL HEALTH EDUCATION AND SERVICES FOR BOTH STAFF AND STUDENTS.SUICIDE PREVENTION:1. PROMOTE NEW 988 SUICIDE PREVENTION NUMBER IN SCHOOLS AND ON SOCIAL MEDIA.2. COLLABORATE WITH SCHOOLS ON EDUCATIONAL SEMINARS FOR STUDENTS ABOUT MENTAL HEALTH ISSUES AND INCREASE INTERACTION WITH SCHOOL COUNSELORS.3. ESTABLISH SUPPORT GROUPS (SUCH AS FAMILIES WITH MENTAL HEALTH CRISES, GRIEF GROUP) LED BY A SOCIAL WORKER.4. RESEARCH GRANTING AGENCIES TO FUND SCHOOL EDUCATION AND SUPPORT PROGRAMS (GATES FOUNDATION, ROBERT WOOD JOHNSON FOUNDATION, HELMSLEY FOUNDATION).5. TRAIN EMERGENCY ROOM PERSONNEL ON HOW TO EFFECTIVELY FACILITATE MENTAL HEALTH COMMITTALS, TRANSPORTATION, AND OTHER RESPONSES.6. PARTICIPATE ON HINK BEHAVIORAL HEALTH TASKFORCE TO PROVIDE COMMUNITY AWARENESS FOR THE MENTAL HEALTH ISSUES AND SUICIDE OF FARMERS AND RANCHERS.SUBSTANCE ABUSE:1. CONTINUE TO DEVELOP MEANINGFUL COMMUNITY YOUTH ACTIVITIES TO KEEP CHILDREN BUSY AND SUPERVISED. RESEARCH PREVALENT ISSUES LEADING TO DRUG ABUSE BY ADOLESCENTS AND WORK TO ESTABLISH SYSTEMS TO COMBAT THOSE ISSUES.2. CONTINUE / PROMOTE DISCARDING OLD PRESCRIPTIONS SERVICE AT LOCAL POLICE DEPARTMENTS, PHARMACIES, AND AMBERWELL ATCHISON.3. CONTINUE "LIFE SKILLS PROGRAM" AT SCHOOLS IN ORDER TO PREVENT AND REDUCE UNDERAGE DRINKING, BINGE DRINKING TARGETING YOUTH IN GRADES 6-12.4. PARTNER WITH KHP FOR BEER GOGGLE SIMULATION, REACTION SIMULATION, AND PRESCRIPTION PILL ABUSE.5. PROMOTE AWARENESS AND EDUCATION ABOUT LEVELS OF INTOXICATION, DISTRIBUTING INFORMATION ABOUT EXCESSIVE AND BINGE DRINKING IN ALL AGES.6. DEVELOP PROGRAMS TO DESTIGMATIZE SEEKING DRUG AND ALCOHOL RECESSION ASSISTANCE.UNINSURED/UNDERINSURED:1. PROVIDE SLIDING SCALE FOR COST OF CARE TO UNINSURED, UNDERINSURED, AND VULNERABLE PATIENTS IN THE COMMUNITY.2. SUPPORT THE IMPLEMENTATION OF INSURANCE PROGRAM THROUGH THE CHAMBER TO HELP SMALL BUSINESSES PROVIDE INSURANCE.3. SUPPORT COMMUNITY AWARENESS OF MEDICAID EXPANSION D UTILIZE COMMUNITY HEALTH WORKERS TO PROVIDE EDUCATION, REFERRAL AND FOLLOW-UP, CASE MANAGEMENT, HOME VISITING, ETC. FOR THOSE AT HIGH RISK FOR POOR HEALTH OUTCOMES REGARDLESS OF THE ABILITY TO PAY.4. MAKE PRICING FOR HOSPITAL PROCEDURES AND OTHER HEALTH CARE SERVICES PUBLICLY AVAILABLE.5. PROVIDE HEALTH CARE SERVICES ON SCHOOL PREMISES TO STUDENTS.6. PROVIDE HEALTHCARE BENEFITS NAVIGATOR TO AID COMMUNITY MEMBERS UNDERSTAND INSURANCE OPTIONS AND GET THE BEST BENEFITS FOR THEIR PERSONAL SITUATION.7. SEEK LEGISLATION TO INCLUDE MENTAL HEALTH IN COVERED SERVICES UNDER HSAS, ETC.8. EXPLORE PATIENT ASSISTANCE PROGRAM TO HELP DELIVER NEEDED MEDICATIONS TO THE UNINSURED/UNDERINSURED AND LOW INCOME.POVERTY:1. CREATE AN INVENTORY OF ALL AGENCIES SERVING ATCHISON COUNTY. DISCOVER THE CAUSES OF ALL AGENCIES AND PROVIDE RESOURCE GUIDE TO COMMUNITY.2. RESEARCH ZONING MODELS IN OTHER U.S. CITIES FOR AFFORDABLE HOUSING POLICIES AND SOLUTIONS.3. RESEARCH AND SUPPORT EVIDENCED-BASED INTERGENERATIONAL POVERTY PROGRAMS OF PROVIDING POSITIVE SCHOOL ENVIRONMENT D PROVIDE EDUCATION TO FAMILIES, IMPROVE QUALITY OF FAMILY RELATIONSHIPS, TEACH KEY FAMILY MANAGEMENT SKILLS.4. SUPPORT LOCAL FOOD PANTRIES AND FOOD DISTRIBUTION THROUGH SALVATION ARMY.5. EXPLORE DEVELOPING AN INTERAGENCY REFERRAL SYSTEM THAT ALLOWS COORDINATION OF CARE MORE EFFECTIVELY.CHILDCARE SERVICES1. OFFER INCENTIVES IN THE FORM OF SUBSIDIES FOR LICENSED HOME DAYCARE PROVIDERS VIA CHILD CARE SUBSIDY PROGRAM IN KANSAS.2. PROVIDE AFTER SCHOOL ACTIVITIES FOR SCHOOL AGE CHILDREN THROUGHOUT THE COMMUNITY.3. SUPPORT NON-PROFIT CHILDCARE SERVICES THROUGH FUNDRAISING EFFORTS.4. OFFER EXTENDED CLINIC HOURS, IN EVENINGS AND WEEKENDS, FOR WORKING PARENTS.5. APPLY FOR CHILD CARE COMMUNITY PARTNERSHIP GRANT FOR KANSAS COMMUNITIES WORKING TO ADDRESS ACCESS TO AFFORDABLE, HIGH-QUALITY CHILDCARE.6. RESEARCH CREATING CHILDCARE COMMUNITY TASK FORCE TO HELP BUILD CHILDCARE CAPACITY, USING CHILDCARE AWARE OF KANSAS G PARTNER WITH LOCAL DAYCARE PROVIDERS AND HEALTH PROFESSIONALS FOR EARLY IDENTIFICATION OF CHILDREN WHO COULD BENEFIT FROM PRE-K PROGRAMS.ECONOMIC DEVELOPMENT AND HEALTHCARE TRANSPORTATION ARE NEEDS IDENTIFIED THAT THE HOSPITAL IS NOT ABLE TO ADDRESS EITHER BECAUSE IT IS OUT OF THEIR JURISDICTION OR DUE TO LACK OF FUNDING. AMBERWELL ATCHISON ASSOCIATION PART V, SECTION B, LINE 13H: A DISCOUNT IN 10% INCREMENTS (RANGING FROM 10% TO 100%) IS GIVEN ON INCOME UP TO 200% OF FEDERAL POVERTY GUIDELINES. THERE ARE INSTANCES WHEN A PATIENT MAY APPEAR ELIGIBLE FOR FINANCIAL DISCOUNTS, BUT THERE IS NO FINANCIAL ASSISTANCE FORM ON FILE OR LACK OF SUPPORTING DOCUMENTATION. IN THE EVENT THERE IS NO EVIDENCE TO SUPPORT A PATIENT'S ELIGIBILITY FOR FINANCIAL ASSISTANCE, AMBERWELL ATCHISON MAY USE OUTSIDE AGENCIES OR VENDORS IN DETERMINING ELIGIBILITY AND POTENTIAL DISCOUNT AMOUNTS. THESE RESOURCES MAY USE DEMOGRAPHIC AND HOUSEHOLD INFORMATION AND/OR CREDIT SCORING TECHNOLOGY TO DETERMINE THE PERCENT OF ASSISTANCE TO APPLY TO THE PATIENT'S ACCOUNT. SCHEDULE H, PART V, SECTION B, LINE 7A AND 10A: COMMUNITY HEALTH NEEDS ASSESSMENT AND IMPLEMENTATIONSTRATEGY WEBSITE:HTTPS://AMBERWELLHEALTH.ORG/COMMUNITY-HEALTH-NEEDS-ASSESSMENT/ PART I, LINE 3C: A DISCOUNT IN 10% INCREMENTS (RANGING FROM 10% TO 100%) IS GIVEN ON INCOME UP TO 200% OF FEDERAL POVERTY GUIDELINES. THERE ARE INSTANCES WHEN A PATIENT MAY APPEAR ELIGIBLE FOR FINANCIAL DISCOUNTS, BUT THERE IS NO FINANCIAL ASSISTANCE FORM ON FILE OR LACK OF SUPPORTING DOCUMENTATION. IN THE EVENT THERE IS NO EVIDENCE TO SUPPORT A PATIENT'S ELIGIBILITY FOR FINANCIAL ASSISTANCE, AMBERWELL ATCHISON MAY USE OUTSIDE AGENCIES OR VENDORS IN DETERMINING ELIGIBILITY AND POTENTIAL DISCOUNT AMOUNTS. THESE RESOURCES MAY USE DEMOGRAPHIC AND HOUSEHOLD INFORMATION AND/OR CREDIT SCORING TECHNOLOGY TO DETERMINE THE PERCENT OF ASSISTANCE TO APPLY TO THE PATIENT'S ACCOUNT. PART I, LINE 7: CHARITY CARE EXPENSE WAS CONVERTED TO COST ON LINE 7A BASED ON AN OVERALL COST TO CHARGE RATIO ADDRESSING ALL PATIENT SEGMENTS. UNREIMBURSED MEDICAID ON LINE 7B WAS CALCULATED USING THE COST-TO-CHARGE RATIO DERIVED FROM WORKSHEET 2. PART III, LINE 2: THE HOSPITAL DETERMINES ITS ESTIMATE OF IMPLICIT PRICE CONCESSIONS BASED ON ITS HISTORICAL COLLECTION EXPERIENCE WITH THIS CLASS OF PATIENTS. PART III, LINE 3: THE ESTIMATED AMOUNT OF THE ORGANIZATION'S IMPLICIT PRICE CONCESSIONS ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S CHARITY CARE POLICY IS CALCULATED BASED ON AN APPROXIMATE 16.2% OF INDIVIDUALS LIVING BELOW THE POVERTY LEVEL IN THE SERVICE AREA. PART III, LINE 4: THE FOOTNOTE TO THE ORGANIZATION'S FINANCIAL STATEMENTS CAN BE FOUND ON PAGES 10 AND 11 OF THE ATTACHED AUDITED FINANCIAL STATEMENTS. PART III, LINE 8: AMBERWELL ATCHISON PROVIDES SERVICES TO PATIENTS UNDER THE MEDICARE PROGRAM KNOWING THEY WILL NOT RECOVER ALL THE COSTS ASSOCIATED WITH PROVIDING THESE SERVICES. PROVIDING THESE SERVICES IS ESSENTIAL TO THESE PATIENTS AND THE COMMUNITY AND INCREASES THEIR ACCESS TO HEALTHCARE SERVICES. THEREFORE, THE MEDICARE SHORTFALL IS CONSIDERED A COMMUNITY BENEFIT.TOTAL REVENUE RECEIVED FROM MEDICARE IS THE GROSS REIMBURSEMENT PLUS SETTLEMENT. BOTH TOTAL REVENUE RECEIVED FROM MEDICARE AND THE MEDICARE ALLOWABLE COSTS ARE REPORTED FROM THE MEDICARE COST REPORT. THE MEDICARE COST REPORT IS COMPLETED BASED ON THE RULES AND REGULATIONS SET FORTH BY THE CENTERS FOR MEDICARE AND MEDICAID SERVICES. PART III, LINE 9B: THE HOSPITAL WILL NOT PURSUE EXTRAORDINARY COLLECTION ACTIVITIES ON PATIENTS FOR AT LEAST 120 DAYS FROM THE DATE OF THE FIRST STATEMENT AND PROVIDES PATIENTS 240 DAYS TO APPLY FOR ASSISTANCE. AFTER FINANCIAL ASSISTANCE DISCOUNTS HAVE BEEN APPLIED, ANY REMAINING SELF-PAY BALANCES WILL BE THE RESPONSIBILITY OF THE PATIENT/GUARANTOR, AND SUBJECT TO THE NORMAL STATEMENT PROCESS. THE PATIENT/GUARANTOR WILL RECEIVE A STATEMENT FROM OUR BILLING COMPANY. THEY WILL CONTINUE TO RECEIVE MONTHLY STATEMENTS FROM OUR BILLING COMPANY, AS WELL AS INTERMITTENT PHONE CALLS FOR APPROXIMATELY 120 DAYS UNTIL THE BALANCE IS PAID IN FULL OR A PAYMENT PLAN HAS BEEN SET UP. IF PAYMENT PLAN ARRANGEMENTS OR PAYMENT IN FULL HAVE NOT BEEN RECEIVED, THEY WILL RECEIVE A FINAL NOTICE, AND BE SUBJECT TO FURTHER COLLECTION PROCESSES. WE ENCOURAGE PAYMENT IN FULL BUT UNDERSTAND THAT IS NOT ALWAYS POSSIBLE AND OFFER PAYMENT PLANS.FINANCIAL ASSISTANCE MAY BE APPLIED ON ANY ACCOUNT(S) THAT HAS BEEN ASSIGNED TO AN OUTSIDE COLLECTION AGENCY. THE HOSPITAL CAN PLACE ACCOUNTS WITH A COLLECTION AGENCY WITHIN 120 DAYS, HOWEVER, THE COLLECTION AGENCY CANNOT BEGIN ANY EXTRAORDINARY COLLECTION ACTIONS AS DEFINED BY THE PATIENT PROTECTION AND AFFORDABLE CARE ACT SUBSECTION 501(R) SUCH AS LEGAL PROCESS, SELLING DEBT, REPORTING ADVERSE INFORMATION ON CREDIT BUREAUS, COMMENCE CIVIL ACTION, GARNISH WAGES, COMPLETE A LIEN OR CAUSE AN ARREST BEFORE THE FIRST 240 DAYS FROM THE DATE OF THE FIRST STATEMENT. ACCOUNTS ASSIGNED TO AN OUTSIDE AGENCY WILL BE REVIEWED ON A CASE-BY-CASE BASIS. PART VI, LINE 2: AMBERWELL ATCHISON ASSOCIATION HAS ACCESS TO THE KANSAS HEALTH INITIATIVE SURVEY ON HEALTH INDICATORS. BASED ON THESE INDICATORS, THE HOSPITAL DETERMINES THE NEEDS OF THE COMMUNITY AND WHAT PROGRAMS TO IMPLEMENT. PART VI, LINE 3: PATIENTS ARE GIVEN A PAMPHLET DESCRIBING THE POLICY FOR FINANCIAL ASSISTANCE WHEN THEY ARE ADMITTED. THE ADMITTING OFFICE ASKS THEM TO SPEAK WITH THE HOSPITAL FINANCIAL COUNSELOR IF THEY DO NOT HAVE INSURANCE. AFTER THE PATIENT RECEIVES THEIR STATEMENT IN THE MAIL, THEY CAN CALL IN AND TALK WITH THE FINANCIAL COUNSELOR. IF THE ACCOUNT GOES TO A COLLECTION COMPANY BECAUSE THE PATIENT DID NOT PAY OR TALK WITH THE FINANCIAL COUNSELOR, THE COLLECTION COMPANY WILL GIVE THEM THE PROPER APPLICATION TO FILL OUT TO SEE IF THEY ARE ELIGIBLE FOR FINANCIAL ASSISTANCE. PART VI, LINE 4: AMBERWELL ATCHISON SERVES THE COMMUNITY OF ATCHISON, KANSAS AND THE SURROUNDING ATCHISON COUNTY. AS OF JANUARY 2022, THERE ARE OVER 650 EMPLOYEES SERVING ACROSS 7 AMBERWELL LOCATIONS IN 6 COMMUNITIES IN THE NORTHEAST KANSAS AREA. AMBERWELL HEALTH IS COMMITTED TO INNOVATING RURAL HEALTH SOLUTIONS AND INVESTING IN PEOPLE, FACILITIES, AND EQUIPMENT TO ENSURE THAT ACCESS TO QUALITY, LOCAL HEALTHCARE CONTINUES IN OUR COMMUNITIES.THE HOSPITAL SERVES A COMMUNITY OF APPROXIMATELY 10,600 PEOPLE WITH A MEDIAN HOUSEHOLD INCOME OF $47,742. THE SURROUNDING COUNTY HAS A POPULATION OF AN ADDITIONAL 6,300 PEOPLE. 16.9% OF THE POPULATION LIVE BELOW THE FEDERAL POVERTY LEVEL (1.57K OUT OF 9.25K PEOPLE), A NUMBER THAT IS HIGHER THAN THE NATIONAL AVERAGE OF 12.8%.PRIMARY CARE PHYSICIANS IN ATCHISON COUNTY, KS SEE AN AVERAGE OF 2,296 PATIENTS PER YEAR. THIS REPRESENTS A 13.4% INCREASE FROM THE PREVIOUS YEAR (2,024 PATIENTS). THE PERCENTAGE OF UNINSURED INDIVIDUALS DECLINED TO 7.64%. 92.4% OF THE POPULATION OF ATCHISON, KS HAS HEALTH COVERAGE, WITH 52.3% ON EMPLOYEE PLANS, 12.9% ON MEDICAID, 12% ON MEDICARE, 12.3% ON NON-GROUP PLANS, AND 2.8% ON MILITARY OR VA PLANS.THE MOST COMMON EMPLOYMENT SECTORS ARE EDUCATIONAL SERVICES, MANUFACTURING, AND RETAIL TRADE. PART VI, LINE 5: AMBERWELL ATCHISON IS GOVERNED BY A 9-MEMBER, VOLUNTEER BOARD OF DIRECTORS THAT REPRESENT KEY AREAS WITHIN ATCHISON COUNTY AS WELL AS THE MEDICAL STAFF. THE HOSPITAL APPLIES SURPLUS FUNDS TO EQUIPMENT AND BUILDING UPGRADES TO ENSURE THE HEALTH CARE NEEDS OF THE COMMUNITY IS SERVED. AMBERWELL HEALTH OPERATES AN EMERGENCY ROOM AVAILABLE TO ALL REGARDLESS OF ABILITY TO PAY.AMBERWELL ATCHISON BELIEVES COMMUNITY BENEFIT GOES BEYOND HOSPITAL VISITS AND EMERGENCY CARE. IT MEANS GETTING INVOLVED AND WORKING TO IMPROVE THE HEALTH OF OUR COMMUNITY; IT MEANS HELPING OTHERS PURSUE GOOD HEALTH THROUGH DONATIONS, EDUCATION AND VOLUNTEERISM. THE FOLLOWING IS A SUMMARY OF THE NUMEROUS ACTIVITIES, INITIATIVES AND EVENTS THAT HAVE BEEN IMPLEMENTED IN SUPPORT OF PROVIDING COMMUNITY BENEFITS TO THE RESIDENTS IN THE ATCHISON COMMUNITY AND REGION. LIVE WELL LIVE ATCHISON, IS A HOSPITAL INITIATIVE THAT INVOLVES PARTNERSHIPS WITH THE KANSAS HEALTH INITIATIVE, ATCHISON COUNTY SCHOOLS, BENEDICTINE COLLEGE, CITY AND COUNTY GOVERNMENTS, STATE REPRESENTATIVES, FAITH-BASED CHURCHES, THE HEALTH DEPARTMENT, COUNTY EXTENSION OFFICE AND AREA BUSINESSES, HEALTH AND SERVICE AGENCIES, AS WELL AS COMMUNITY AND CIVIC ORGANIZATIONS. THE GROUP IS WORKING TOWARD IMPROVING THE HEALTH BEHAVIORS AND LIFESTYLE OF ATCHISON COUNTY. AMBERWELL ATCHISON'S "BEST CARE COMMUNITY HEALTH FAIR," IS AN ANNUAL EVENT BY THE HOSPITAL AND HELD AT THE ATCHISON ELEMENTARY SCHOOL. HOSPITAL EMPLOYEES AS WELL AS COMMUNITY HEALTH AGENCIES, ORGANIZATIONS, LOCAL AND REGIONAL AREA RESPONDERS AND PHYSICIAN PRACTICES, PROVIDE HEALTH SCREENINGS, INTERACTIVE EDUCATIONAL, SAFETY AND FITNESS ACTIVITIES. AMBERWELL ATCHISON SUPPORTS THE ATCHISON COMMUNITY HEALTH CLINIC, A FEDERAL QUALIFIED HEALTH CLINIC, BY SUBSIDIZING THE CLINIC'S FACILITIES RENT FREE, GENERAL MAINTENANCE AND SNOW REMOVAL. THE HOSPITAL CONDUCTS AND SPONSORS SUPPORT GROUPS AND CLASSES THAT PROVIDE ONGOING EDUCATION AND COUNSELING SUCH AS GRIEF SUPPORT, BIRTHING AND CHILDCARE CLASSES. ADDITIONALLY, THE HOSPITAL OFFERS A HOSPICE VOLUNTEER PROGRAM. THE HOSPITAL ALSO PROVIDES SPONSORSHIP AND DONATIONS TO VARIOUS ORGANIZATIONS, LOCAL SCHOOLS AND NURSING HOMES, AS WELL AS COMMUNITY INITIATIVES SUCH AS: RELAY FOR LIFE, AMELIA EARHART FESTIVAL, BEAUTIFICATION OF OUR CITY, FARM SAFETY DAYS, JOGGIN' FOR THE NOGGIN', PARTICIPATION IN LOCAL AND REGIONAL HEALTH FAIRS AND PHYSICIAN SUPPORT AT LOCAL HIGH SCHOOL AND COLLEGE ATHLETIC EVENTS. AMBERWELL ATCHISON'S CARE TEAM, AN EMPLOYEE GROUP THAT GENERATES INITIATES FUNDRAISERS AND DONATES EARNED PROCEEDS TO VARIOUS LOCAL CHARITIES. THE HOSPITAL AS WELL AS THE ATCHISON HOSPITAL AUXILIARY, EACH HOSTS COMMUNITY BLOOD DRIVES THROUGHOUT THE YEAR. THE HOSPITAL PROVIDES COMMUNITY EDUCATION AND CAREER DEVELOPMENT TO ORGANIZATIONS, SCHOOLS AND COLLEGES THROUGHOUT THE AREA THROUGH SPEAKING ENGAGEMENTS, CAREER FAIRS, CLASS IN-SERVICES AND HOSPITAL TOURS. IN ADDITION, HOSPITAL EMPLOYEES VOLUNTEER THEIR SERVICE WITH COMMUNITY NOT-FOR-PROFIT AND CIVIC ORGANIZATIONS AND COMMITTEES, INCLUDING THE CHAMBER OF COMMERCE, WORKFORCE DEVELOPMENT, ROTARY, LIONS CLUB, YMCA, GUIDANCE CENTER MENTAL HEALTH CENTER AND THE MULTIDISCIPLINARY CHILD TEAM AND THE BOY SCOUTS. THE HOSPITAL OFFERS A JOB SHADOWING PROGRAM WHICH OFFERS TEENS EXPOSURE TO A VARIETY OF CAREERS WITHIN THE MEDICAL PROFESSION. X 1 1 X X X X 0 0 0 0 0 0 0 0 0 JONATHAN LECK PHYSICIAN 599204 0 189689 0 162 0 8788 0 8951 0 806794 0 0 0 RODERICK WARREN PHYSICIAN 665684 0 0 0 162 0 6140 0 17248 0 689234 0 0 0 BRIAN DUNCAN PHYSICIAN 559457 0 59949 0 168 0 0 0 28673 0 648247 0 0 0 MCGARRETT GROTH PHYSICIAN 494371 0 27325 0 199 0 6247 0 27810 0 555952 0 0 0 JEFFREY PERRY PRESIDENT & CEO 392938 0 126508 0 162 0 9150 0 8954 0 537712 0 0 0 DARIN ALLEN PHYSICIAN 475305 0 100 0 162 0 6962 0 31482 0 514011 0 0 0 DONALD ABLES PHYSICIAN 332319 0 0 0 174 0 9150 0 18635 0 360278 0 0 0 JIM FRASER CFO (THRU 7/2022) 198128 0 0 0 0 0 3266 0 18041 0 219435 0 0 0 ALICIA SORENSEN CHIEF NURSING OFFICER 159990 0 0 0 161 0 5045 0 30184 0 195380 0 0 0 CHASE DUDZINSKI CFO 145552 0 20000 0 129 0 3125 0 20069 0 188875 0 0 0 PART I, LINE 1A SOCIAL CLUB DUES WERE PAID BY THE HOSPITAL FOR JEFF PERRY AND WERE NOT INCLUDED IN HIS W-2 AS TAXABLE COMPENSATION BECAUSE THEY WERE USED 100% FOR BUSINESS. PART 1, LINE 1A: SOCIAL CLUB DUES WERE PAID BY THE HOSPITAL FOR JEFF PERRY AND WERE NOT INCLUDED IN HIS W-2 AS TAXABLE COMPENSATION BECAUSE THEY WERE USED 100% FOR BUSINESS. PART 1, LINE 7: VARIOUS EMPLOYED PHYSICIANS ARE PROVIDED THE OPPORTUNITY FOR BONUS POTENTIAL. IN THEIR CONTRACT WITH THE HOSPITAL ARE TIERS BASED ON CURRENT MEDICAL GROUP MANAGEMENT ASSOCIATION REGIONAL DATA. IF THE PHYSICIANS ANNUALIZED NET QUALIFIED PATIENT CHARGES EXCEEDS THE TIER, A PERCENTAGE OF THEIR NET QUALIFIED PATIENT CHARGES ARE ELIGIBLE FOR BONUS SUBJECT TO THEIR ANNUAL BASE COMPENSATION. A CITY OF ATCHISON KANSAS 486025033 046687CM9 2017-06-06 8835000 SEE PART VI. 0 0 0 B CITY OF ATCHISON KANSAS 486025033 046687CR8 2017-06-06 3400000 SEE PART VI. 0 0 0 C CITY OF ATCHISON KANSAS 486025033 046687CV9 2017-10-19 5910000 SEE PART VI. 0 0 0 D CITY OF ATCHISON KANSAS 486025033 046687DG1 2019-10-30 4255000 SEE PART VI. 0 0 0 A 8835000 79515 8755485 1 0 1 1 B 400000 3400000 30600 3369400 1 0 1 1 C 95000 5910000 117700 5792300 0 1 1 1 D 830000 4280982 80961 1844906 1710768 618365 2023 0 1 0 1 A 0 0 1 1 0 0.00000 0.00000 0.00000 0 0 1 B 0 0 1 0 0 0.00000 0.00000 0.00000 0 0 1 C 0 0 1 1 0 0.00000 0.00000 0.00000 0 0 1 D 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 A 0 0 0 1 0 0 0 0 1 B 0 0 0 1 0 0 0 0 1 C 0 0 0 1 0 0 0 1 1 D 0 0 0 0 0 0 0 0 1 A 1 B 1 C 1 D 1 DATE REBATE COMPUTATION PERFORMED ISSUER NAME: CITY OF ATCHISON, KANSAS DATE THE REBATE COMPUTATION WAS PERFORMED: 06/01/2022 ISSUER NAME: CITY OF ATCHISON, KANSAS DATE THE REBATE COMPUTATION WAS PERFORMED: 06/01/2022 ISSUER NAME: CITY OF ATCHISON, KANSAS DATE THE REBATE COMPUTATION WAS PERFORMED: 10/01/2022 PART I, LINE A, COLUMN (F): CURRENT REFUND A PORTION OF THE 2008A BONDS. THE 2008A BONDS WERE ORIGINALLY ISSUED ON 9/23/2008. PART I, LINE B, COLUMN (F): CURRENT REFUND A PORTION OF THE 2009 BONDS. THE 2009 BONDS WERE ORIGINALLY ISSUED ON 6/30/2009. PART I, LINE C, COLUMN (F): ADVANCE REFUND REMAINING PORTION OF THE 2009 BONDS. THE 2009 BONDS WERE ORIGINALLY ISSUED ON 6/30/2009. PART I, LINE D, COLUMN (F): CURRENT REFUND TAXABLE BANK LOAN. THE TAXABLE BANK LOAN WAS ORIGINALLY ISSUED ON 7/21/2015. RENOVATIONS AND EQUIPMENT FOR HOSPITAL FACILITIES. PART II, COLUMN C, LINE 11: THIS AMOUNT REPRESENTS $5,786,846 OF BOND PROCEEDS USED TO ADVANCE REFUND A PORTION OF THE 2009 BONDS AND $4,954 ALLOCATED TO PAY INTEREST ON THE BONDS. PART II, COLUMN D, LINE 3: AMOUNT DOES NOT EQUAL THE ISSUE PRICE AS A RESULT OF INTEREST EARNED ON THE BOND PROCEEDS DURING THE PROJECT PERIOD. PART II, COLUMN D, LINE 11: THIS AMOUNT IS COMPRISED OF $1,709,258 OF BOND PROCEEDS THAT WERE USED TO CURRENT REFUND THE TAXABLE BANK LOAN WITH EXCHANGE BANK & TRUST ON 10/30/2019 AND $1,510 OF UNSPENT PROCEEDS ON DEPOSIT IN THE COST OF ISSUANCE FUND THAT WAS ALLOCATED TO PAY INTEREST ON THE BONDS. PART II, COLUMN D, LINE 13: THE NEW MONEY PORTION OF THE PROJECT HAS NOT BEEN COMPLETED AS OF FISCAL YEAR END. PART II, COLUMN D, LINE 16: THE NEW MONEY PORTION OF THE PROJECT WAS NOT COMPLETED AS OF THE FISCAL YEAR END. THE FINAL WRITTEN ALLOCATION WILL BE COMPLETED AS OF THE NEXT FISCAL YEAR END. PART III, COLUMN D: NOT ALL OF THE PROJECT WAS PLACED-IN-SERVICE AS OF THE FISCAL YEAR END. PART IV, COLUMN C, LINE 6: PROCEEDS WERE DEPOSITED AND HELD IN A YIELD RESTRICTED ESCROW FOR THE REFUNDED BOND BEYOND THE AVAILABLE TEMPORARY PERIOD. ALL SUCH PROCEEDS HAVE BEEN SPENT. FORM 990, PART VI, SECTION A, LINE 8B THE ORGANIZATION DOES NOT HAVE COMMITTEES WITH AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY. FORM 990, PART VI, SECTION B, LINE 11B AN INDEPENDENT ACCOUNTING FIRM PREPARES AND REVIEWS THE FORM 990. THE FORM 990 IS THEN REVIEWED BY THE ORGANIZATION'S MANAGEMENT. ANY QUESTIONS OR CONCERNS THE ORGANIZATION'S MANAGEMENT HAS ARE ADDRESSED AND ANY CORRECTIONS OR CLARIFICATIONS ARE MADE. THE FORM 990 IS THEN PROVIDED TO THE BOARD PRIOR TO FILING WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C AT THE TIME OF THE 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. FORM 990, PART VI, SECTION B, LINE 15A IN 2019, THE ORGANIZATION ENGAGED ITS LEGAL COUNSEL TO PREPARE A COMPENSATION DATA STUDY. IN ADDITION TO VARIOUS DATA COLLECTED, OTHER HOSPITALS' 990'S WERE REVIEWED AND COMBINED IN THE COMPENSATION STUDY. THE HOSPITAL'S LEGAL COUNSEL REVIEWED THE STUDY WITH THE BOARD OF DIRECTORS TO ADJUST THE PRESIDENT & CEO'S COMPENSATION. ANY DECISION THAT IS MADE IN REGARDS TO THE PRESIDENT & CEO'S COMPENSATION IS DOCUMENTED BY THE BOARD OF DIRECTORS. THE CEO AND HUMAN RESOURCE DIRECTOR CONDUCT AN ANNUAL REVIEW OF OTHER OFFICERS AND KEY EMPLOYEES' COMPENSATION BASED ON COMPARABLE DATA OF OTHER ORGANIZATIONS OF SIMILAR SIZE AND INDUSTRY. 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. FORM 990, PART IX, LINE 11G OTHER SERVICE FEES: PROGRAM SERVICE EXPENSES 4,262,237. MANAGEMENT AND GENERAL EXPENSES 2,255,776. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 6,518,013. FORM 990, PART XI, LINE 2C: AN INDEPENDENT ACCOUNTING FIRM AUDITS THE ORGANIZATION'S FINANCIAL STATEMENTS. THE ORGANIZATION HAS A COMMITTEE THAT ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF ITS FINANCIAL STATEMENTS AND SELECTION OF AN INDEPENDENT ACCOUNTANT. THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. AMBERWELL HEALTH LLC 800 RAVEN HILL DRIVE ATCHISON KS 66002 873578396 CENTRALIZED OFFICE FOR AFFILIATES KS 0 0 AMBERWELL ATCHISON ASSOCIATION AMBERWELL HEALTH FOUNDATION 800 RAVEN HILL DRIVE ATCHISON KS 66002 480955489 SUPPORT AMBERWELL ATCHISON ASSOCIATION KS 501(C)(3) LINE 12B, II AMBERWELL ATCHISON ASSOCIATION 1 0 0 1 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 AMBERWELL HEALTH FOUNDATION C 250000 CASH TRANSFERRED