2023-05-08T13:38:07-05:00 2022-06-30 481026809 Wendling Noe Nelson & Johnson LLC 623 SW 10th Ave Suite 300 Topeka KS 66612 990 2021-07-01 480559088 Hays Medical Center Inc HAYS 7856235000 2220 Canterbury Drive Hays KS 67601 EDWARD HERRMAN CEO 7856235000 2023-05-05 1 EDWARD HERRMAN 999009999 Eric L Otting P00298454 7852334226 2023-05-05 0 AAL1 IAL1 2021 2023-04-26 12:10:37Z Edward Herrman 2220 Canterbury Drive Hays KS 67601 238825985 0 X www.haysmed.com X 1944 KS Hays Medical Center is a tax-exempt charitable organization under Section 501(c)(3) of the Internal Revenue Code and is licensed by the State of Kansas Department of Health and Environment. The purpose of the Organization is to provide healthcare facilities and services for the care and treatment of inpatients and outpatients who are acutely ill or who otherwise require medical care and related services. The core purpose of the Organization is to help people be healthy. The Organization is striving to become the best tertiary care center in rural America. 12 9 1794 129 0 0 6219584 8070104 207153531 211683373 5864510 17969085 1829035 1026569 221066660 238749131 50971 14783 0 0 113411430 117255057 0 0 281875 99159157 118080850 212621558 235350690 8445102 3398441 373847436 266498873 118881341 83631802 254966095 182867071 X Hays Medical Center is a tax-exempt charitable organization under Section 501(c)(3) of the Internal Revenue Code and is licensed by the State of Kansas Department of Health and Environment. The purpose of the Organization is to provide healthcare facilities and services for the care and treatment of inpatients and outpatients who are acutely ill or who otherwise require medical care and related services. The core purpose of the Organization is to help people be healthy. The Organization is striving to become the best tertiary care center in rural America. 0 0 212984044 14783 212709942 Patient Care Program services consist of routine and ancillary department healthcare services provided by a healthcare organization as defined in Section 501(c)(3) of the IRS code. Admissions: Acute-4,310, Newborn ICU-29, Newborn-544, Total admissions-4,883. Patient days: ICU/CPCU-7,206, Medical/Surgical-12,716, Obstetrics-1,086, Newborn ICU-338, Newborn-893, Total patient days-22,239. Other statistical information: Surgical procedures-7,731, Cardiac caths-1,613, Emergency room visits-12,001, Outpatient procedures-166,564, Medical oncology service visits-6,270, Clinic visits-150,301. 212984044 1 1 0 1 0 0 0 0 0 1 1 1 0 1 1 1 0 1 0 0 1 0 0 0 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 56 0 1 1794 1 0 0 0 0 0 0 0 0 0 0 0 0 X 12 9 0 0 1 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X Michelle Beckner 7856232350 2220 Canterbury Drive Hays KS 67601 Brian Lang Chair 0.50 X X 0 0 0 Alan Moore Vice Chair 0.50 X X 0 0 0 Kenneth Beran Treasurer 0.50 X X 0 0 0 Jayne Clarke Secretary 0.50 X X 0 0 0 Daniel Schippers Board Member 0.50 X 0 0 0 Wayne Kieffer Board Member 0.50 X 0 0 0 Mary Martin Board Member 0.50 X 0 0 0 Roger Dietz MD Physician/Board Member 40.00 X 324824 0 49253 Jana Horsfall Board Member 0.50 X 0 0 0 DG Bickle Board Member 0.50 X 0 0 0 Ernesto Lopez-Corona MD Physician/Board Member beg Jan 2022 40.00 X 568650 0 56561 Edward Herrman President & CEO 36.00 4.00 X X 714451 0 159447 Gulraiz Cheema Physician/Board Member thru Dec 2021 40.00 X 899925 0 54038 Brenda Dykstra Board Member thru Nov. 2021 0.50 X 0 0 0 Chris Ruder Board Member thru Nov. 2021 0.50 X 0 0 0 George Harms Chief Financial Officer 36.00 4.00 X 347401 0 96953 Terry Siek Chief Nursing Officer 36.00 4.00 X 273415 0 68253 Shae Veach VP Regional Development 36.00 4.00 X 294439 0 92303 Joannah Applequist Chief Legal Officer 36.00 4.00 X 307734 0 66804 Manmohan Biring Physician 40.00 X 1883086 0 55295 Robert Phillips Physician 40.00 X 1235364 0 29472 Max Decarvalho Physician 40.00 X 972067 0 47778 Douglas Tangel Physician 40.00 X 702056 0 48695 Mohammed Janif Physician 40.00 X 672213 0 48453 Bryce Young Former COO (key employee) 0.00 X 163726 0 0 9359351 0 873305 171 1 1 0 Quest Diagnostics Inc PO Box 772976 Chicago IL 606770276 Lab Services 4843465 Favorite Healthcare Staffing Inc PO Box 26225 Overland Park KS 66225 Contract Staffing 4540028 Weatherby Healthcare PO Box 972633 Dallas TX 753972633 Physician Services 3003306 Foulston Siefkin LLP 1551 N Waterfront Parkway Suite 1 Wichita KS 67206 Legal Fees 903124 Alliance Recruiting Resources PO Box 223901 Dallas TX 752223901 Physician Services 834569 37 882099 7187005 1000 8070104 Patient service revenue 621990 204617903 204617903 Services to CAH network and afill 900099 2468539 2468539 Retail pharmacy 446110 2360181 2360181 Fitness center 713940 1189185 1189185 1047565 1047565 211683373 1621999 1621999 286093 0 286093 286093 286093 16305503 118437 0 76854 16305503 41583 16347086 16347086 Cafeteria revenue 722210 587706 587706 Physician practice billing 900099 140589 140589 Shared savings from insurance com 900099 11367 11367 814 814 740476 238749131 212709942 0 17969085 X 14783 14783 4492262 2052724 2439538 93306506 86902868 6348527 55111 4052745 4045524 4527 2694 9360059 8642542 711778 5739 6043485 5523141 516718 3626 1159319 1159319 11005 11005 13859 13859 231533 231533 29857367 27329870 2502001 25496 485724 4464 481260 1085414 274970 803367 7077 6538376 4906574 1631802 2317629 1797451 515548 4630 395098 355038 40046 14 616444 570896 42100 3448 1510881 1179998 326955 3928 9536366 6659632 2867809 8925 1076704 1048121 28583 Pharmaceuticals 28994750 28994750 Medical Supplies 22418098 22418098 Repairs and maintenance 5250515 4903936 344443 2136 Taxes and assessments 1552869 1449227 103642 5028899 3909437 960411 159051 235350690 212984044 22084771 281875 261508 356576 78202301 25454311 28082109 26292754 5845483 5972701 6007041 8249356 258565084 198566402 62580041 59998682 127820362 79939745 48981068 43896381 16067523 16338367 373847436 266498873 50440404 29573004 26951435 3010882 50105000 41489502 942916 118881341 83631802 X 244716095 170927071 10250000 11940000 254966095 182867071 373847436 266498873 X 3398441 -22336678 -53160787 X X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 1 13859 0 0 0 13859 0 Part II-B, Line 1: Hays Medical Center, Inc., is a member of the Kansas Hospital Association and the American Hospital Association. Both of these organizations engage in lobbying activities for hospital and general health care interests as part of the services provided to members. 13716519 1549264 1229200 1130831 15364152 11952988 647679 1866539 750687 13716519 11177350 1258089 342717 825168 11952988 11240794 569494 292554 925492 11177350 11826332 1449394 757003 2791935 11240794 0.12340 0.73270 0.14390 0 1 1 992195 992195 85249002 57379212 27869790 159322274 130477192 28845082 13001613 10709998 2291615 59998682 75000 F Hedge funds 22419775 F Private equity fund 8172588 F Real estate limited partnership 7473657 F Limited partnership 5755361 F 43896381 Beneficial interest in net assets of foundations 11940000 Intercompany receivables 841896 Estimated third party payor settlements 1196020 Deferred financing costs 596377 Other receivables 1713853 Interest receivable 50221 16338367 Estimated third-party payor settlements 942916 942916 X Part V, Line 4: The endowed funds held by the Hays Medical Center Foundation are used to help meet both the immediate and long range health care needs of patients of Hays Medical Center, Inc. The Hays Medical Center Foundation provides grants and assistance to Hays Medical Center, Inc., for property and equipment acquisitions, education, and community health issues. Part X, Line 2: Management is not aware of any uncertainties in income tax positions. Central American/Caribbean 0 0 Investments 19728461 Switzerland 0 0 Investments 6914963 0 0 0 0 0 0 26643424 0 26643424 0 0 1 0 1 0 Part III Accounting Method: 1 1 X 1 X 130.000000000000 1 X 1 1 1 0 1 1 3822870 3822870 0.01620 11876561 6733647 5142914 0.02190 15699431 6733647 8965784 0.03810 1738885 1212739 526146 0.00220 976031 61609 914422 0.00390 69698821 37411096 32287725 0.13720 3183 3183 0.00000 72416920 38685444 33731476 0.14330 88116351 45419091 42697260 0.18140 1 383679 0 61564024 78207811 -16643787 X 1 1 2 1 Hays Medical Center Inc 2220 Canterbury Hays KS 67601 X X X 2 Pawnee Valley Community Hospital Inc 923 Carroll Ave Larned KS 67550 X X X X Hays Medical Center Inc 1 0 0 1 X X X X X X X X X 20 1 0 1 1 X https://www.haysmed.com/wp-content/uploads/2021/06/CHNA_2021_EllisCoKS_Hays X 1 20 1 https://www.haysmed.com/wp-content/uploads/2021/06/CHNA2021_ImpDetailPlan_H 0 1 X 130.000000000000 400.000000000000 X X X X X X 1 1 X X X 1 X https://www.haysmed.com/about-us/charity-care/ X https://www.haysmed.com/about-us/charity-care/ X https://www.haysmed.com/about-us/charity-care/ X X X X 1 X 0 X X X X 1 X 0 0 Pawnee Valley Community Hospital Inc 2 0 0 1 X X X X X X X X X 20 1 0 1 1 X https://www.pawneevalleyhospital.com/wp-content/uploads/2021/07/June-29-CHN X http://www.pawneecountykansas.com/ X 1 20 1 https://pawneevalleyhospital.com/wp-content/uploads/2022/01/CHNA2021_ImpDet 0 1 X 130.000000000000 400.000000000000 X X X X X X 1 1 X X X 1 X https://pawneevalleyhospital.com/billing/ X https://pawneevalleyhospital.com/billing/ X https://pawneevalleyhospital.com/billing/ X X X X 1 X 0 X X X X 1 X 0 0 Hays Medical Center, Inc. Part V, Section B, Line 5: The CHNA conducted in collaboration with the Ellis County Health Department identified significant health needs within the Ellis County and Hays Medical Center community. A town hall meeting was organized to provide an objective consensus building method of reviewing and prioritizing county health issues. During the Town Hall meetings, the group reflected on the size and seriousness of any health concerns cited and discussed current community health strengths. The group identified and ranked top community health concerns, and all Town Hall attendees and community members were encouraged to continue to contribute ideas by going online and taking a feedback survey that addresses any additional thoughts related to the CHNA. All Town Hall priority-setting and scoring processes involved the input of a diverse group with knowledge and/or expertise in public health as well as persons who represent the broad interest of the community served by the Hospital. Key stakeholders in attendance included representatives from: Ellis County Health Department, Ellis County EMS, Ellis County Sheriff's Office, First Care Clinic FQHC, Fort Hays State University, Early Childhood Connections, High Plains Mental Health, Kansas Department for Children and Families, City of Hays, and Hays Medical Center. The CHNA was coordinated and produced by VVV Consultants, LLC, from Olathe, Kansas. Pawnee Valley Community Hospital, Inc. Part V, Section B, Line 5: The CHNA was conducted in collaboration with the Pawnee County Health Department. A Town Hall meeting was organized to provide an objective consensus building method of reviewing and prioritizing county health issues. During the Town Hall meeting, the group reflected on the size and seriousness of any health concerns cited and discussed current community health strengths. The group identified and ranked top community health concerns, and all Town Hall attendees were encouraged to continue to contribute ideas by going online and taking a feedback survey that addresses any additional thoughts related to the CHNA. All Town Hall priority-setting and score processes involved the input of a diverse group with knowledge and/or expertise in public health as well as persons who represent the broad interests of the community served by the hospital. Key stakeholders in attendance included Larned State Hospital, Pawnee County Attorney's Office, Reed Pharmacy, County Living of Larned, Frick Vet, The Center for Counseling & Consulation, Heart of Kansas Family Health Care, Larned City Council, Pawnee County Sheriff's office, Pawnee County Health Department, County Commissioners, members of the Chamber of Commerce, members of the USD 495 School Board, local members of the media, local religious organizations and representatives of Pawnee Valley Community Hospital. The CHNA was coordinated and produced by VVV Research & Development, Inc. from Olathe, Kansas. Hays Medical Center, Inc. Part V, Section B, Line 6b: Ellis County, KS Pawnee Valley Community Hospital, Inc. Part V, Section B, Line 6b: Pawnee County, KS Hays Medical Center, Inc. Part V, Section B, Line 11: Hays Medical Center, Inc. conducted its fourth Community Health Needs Assessment along with the Ellis County Health Department in calendar year 2021. The Hospital and County Health Department will work with others in the community to address the needs that were identified in the survey. The needs that received the most votes are as follows: Drug & Alcohol Abuse - 13.9% Mental Health (Diagnosis, Placement, Aftercare) - 13.9% Owning Your Health/Awareness of Healthcare Services - 11.1% Access to BH Workforce - 9.7% Child Care Options - 8.3% Food Insecurity/Nutrition - 8.3% Access to Health Funding - 6.9% Nursing Home/Senior Care - 5.6% Poverty/Employment Readiness - 5.6% Suicide - 5.6%The Town Hall meeting also noted the Community's Health Strengths, which are as follows: Emergency & Ambulance Services Specialty Services Available Robust Medical System (Birth - Death) Usage of Telehealth/Telemedicine School Nurse Clinic Access Hospice Services Infant Care (Neonatal) Patient Referral (PC)In the 2020 CHNA Implementation Plan, it is noted that several areas are not part of hospital mission critical operations and that the Medical Center will be a partner with others to address these needs. These needs and the lead partner are listed below.Drug & Alcohol Abuse - the lead partners are Smokey Hill Foundation and Valley Hope - Hays Medical Center's goal, in collaboration with other community partners, is to reduce substance abuse among target populations through early detection and intervention. We have been able to develop a system of care to address substance abuse with the Smokey Hill Foundation and Valley Hope and support collaborating agencies that address substance use issues through primary care and other medical services for jointly served patients. Mental Health (Diagnosis, Placement, Aftercare) - the lead partner is High Plains Mental Health - Camber Health recently opened an Inpatient and Outpatient youth acute mental health treatment facility in Hays. The new facility treats youth 6-18 who are experiencing depression, anxiety, suicidal thoughts, the impacts of trauma, and other mental health conditions. Hays Medical Center worked with Camber on the building, which HaysMed owns, that houses the facility. Access to Behavioral Health Workforce - the lead partner is High Plains Mental Health - High Plains Mental Health works closely with Fort Hays State University and other organizations to help identify Behavioral Health workforce in the region to provide the workforce needed. This initiative will continue to evolve as the unemployment rate in Ellis County is so low. Hays Medical Center, Inc. Part V, Section B, Line 11: Child Care Options - the lead partners are City of Hays and Ellis County - A child care task force was developed with stakeholders in the community that continues to collaborate on a variety of different opportunities to provide childcare and access to childcare. Hays Medical Center is in the process of building a Childcare facility that will hold 70 infants and toddlers and be located on-site. HaysMed has also donated land to Grow Hays that will develop a Senior Center that will house a Childcare Center on the land. Food Insecurity/Nutrition - the lead partners are Catholic Health Initiatives & Schools - The extension of the Public Health Emergency has been beneficial to children in the school system. The Community works closely with the local food pantry to ensure adequate food is secured and filled as needed. Nursing Home/Senior Care - the lead partners are City of Hays and Ellis CountyPoverty/Employment Readiness - the lead partners are City of Hays and Ellis CountySuicide - the lead partner is High Plains Mental Health - High Plains Mental Health has contracted to expand services through telemedicine in the region and Ellis County. This has helped to alleviate some of the needs, but they continually look to provide other resources that are useful in schools, hospitals, and other area agencies. Hays Medical Center is dedicated to continually learning, engaging, and fulfilling the health needs of the community we serve. As a result of this commitment the following is the description of the actions taken during the most recent fiscal year to address the significant health needs identified through the CHNA for which HaysMed is a lead partner.Updates to the progress are outlined below.Owning Your Health/Awareness of Healthcare Services Affordable Care - As a result of feedback from the CHNA, the Imagine Ellis County Coalition was formed comprising stakeholders from Hays Medical Center, private business, local county and city government, school representatives, and elected officials. Imagine Ellis County is an engaged group of Ellis County citizens collaborating on a vision for the future. An area of focus and planning centers around a comprehensive guide of resources available in Ellis County and sponsored by the United Way of Ellis County. The awareness of health care services available can be located at Health Services (elliscountykshelp.com). Hays Medical Center's Center for Health Improvement has started a number of different programs to engage the community including:Walk with a Doc LiveWell - Senior focused exercise programDiabetes SolutionYouth Performance TrainingWeight Loss SolutionsCOVID Recovery ProgramAccess to Health Funding - Hays Medical Center has led efforts and continues to collaborate with Grow Hays, Imagine Ellis County, United Way of Ellis County, and the Chamber of Commerce to provide workshops and opportunities for funding of health related programs. The most recent presentation highlighted the Kansas Commerce Department Community Service Tax Credit program and the Community Development Block Grants. Pawnee Valley Community Hospital, Inc. Part V, Section B, Line 11: Pawnee Valley Community Hospital, Inc. conducted its fourth Community Health Needs Assessment along with the Pawnee County Health Department in calendar year 2021. The Hospital and County Health Department will work with others in the community to address the needs that were identified in the survey. The needs that received the most votes are listed below. Mental Health (Diagnosis, Placement, Aftercare) - 16.5% Drug (Opioids) & Alcohol Abuse - 14.8% Access to Care After Hours - 8.7% Affordable Care - 7.8% Awareness of Health Services - 7.8% Teen Tobacco/Vaping - 7.8% Awareness of Exercise/Fitness Activities - 6.1% Insurance Coverage - 6.1% Women's Health (Maternal & Fetal, Breastfeeding, etc.) - 6.1%The Town Hall meeting also noted the Community's Health Strengths, which are listed below. Nutrition - Health Food Options Nursing Home/Senior Care Access to Services Growth Opportunity Charity Care Care Coordination/Leadership Recreational Activities Stable Health Services Health Department - Communication/Collaboration Ratio of ProvidersOn the 2020 CHNA Implementation Plan, it is noted that several areas are not part of hospital mission critical operations and that the Hospital will be a partner with others to address these needs. These needs and the lead partner are listed below.Mental Health (Diagnosis, Placement, Aftercare) - Mental Health Agency/Pawnee County Health DepartmentDrug (Opioids) & Alcohol Abuse - Mental Health Agency/Pawnee County Health Department Teen Tobacco/Vaping - Pawnee County Health Department Awareness of Exercise/Fitness Activities - Pawnee County Health DepartmentInsurance Coverage - No lead partner identified at this timeThe remaining CHNA Health Areas of Need will be addressed with Pawnee Valley Community Hospital as the lead partner. Updates to the progress are outlined below.Access to Care After Hours - Heart of Kansas (non-PVCH clinic) has extended clinic hours every Thursday evening which compliments our Tuesday evening. PVCH launched the patient portal for our family medicine clinic in April 2022, which allowas access to healthcare results and messaging. PVCH continues to offer family telemedicine clinic visits.Affordable Care - PVCH decreased the outpatient charges physical therapy, occupational therapy, speech therapy, imaging charges and lab charges by 1/3 on July 1, 2021, and again by 1/3 in January 1, 2022. PVCH has a finanical assistance program available to all patients meeting the program's guidlines. PVCH is an active participant along with KHA to support Medicaid expansion in Kansas.Awareness of Health Services - PVCH has contracted with a marketing firm to assist with understanding which services are of greatest need for our community. The firm identifed inpatient and outpatient rehab and inpatient respiratory PVCH also participates in local Larned Area Chamber Coffee and After Hours to highlight our health services.Women's Health (Maternal & Fetal, Breastfeeding, etc.) - PVCH added in 2022 a family medicine provider who has over 20 years of women's health services experience to our family medicine clinic. PVCH has initiated a weight loss program for women in 2022 and currently provides consultations and birth control options for women of all ages and annual women's health visits. Pawnee County Health Department currently provides maternal/fetal and breast feeding resources and education. Hays Medical Center, Inc. Part V, Section B, Line 13h: The balance of the patient account is also considered. Pawnee Valley Community Hospital, Inc. Part V, Section B, Line 13h: The balance of the patient account is also considered. 2 1 - HaysMed Convenient Care Walk-in Clinic 3216 Vine Street Suite 20 Hays KS 67601 Convenient care services 2 - Hays Family Medicine 2509 Canterbury Hays KS 67601 Family medicine Part I, Line 7: Hays Medical Center, Inc.'s, cost accounting system was used to calculate community health improvement services, health professions education, and subsidized health services costs. A cost-to-charge ratio derived from Worksheet 2 was used to calculate financial assistance at cost and the community benefit expense attributable to serving Medicaid beneficiaries. Part I, Line 7g: Subsidized health services community benefit expenses include $67,341,503 of expenses attributable to physician clinics that have net operating losses. Part III, Line 4: See Note B (pages 11-14 of the financial statements) for a description of the Medical Center's bad debt expensePart III, Line 2:Costing methodology: A cost-to-charge ratio derived from Worksheet 2 was used to calculate bad debt expense at cost. Part III, Line 8: The Medicare cost report was the costing methodology used to determine Medicare allowable costs. Allowable costs of care reported on line 6 were determined using amounts from Worksheet D, Part V and Worksheet D-1 in the Hays Medical Center, Inc., Medicare cost report for the fiscal year ended June 30, 2022. Part III, Line 9b: Whenever possible, the customer service representatives (CSR's) of Hays Medical Center, Inc., try to determine the estimated self-pay balance prior to the patient receiving services. FAP eligibility is first considered at this point in time. In addition, if full payment is not received or if payment is not made within 30 days, the patient will receive a statement that includes a copy of the FAP. If the patient contacts the CSR and it is determined that at least a 2-year payment plan cannot be established with the patient, the CSR will screen for charity care and request that the charity care application be completed by the patient. Part VI, Line 3: Information regarding the Hays Medical Center, Inc., charity care program is located on the Hays Medical Center, Inc., website for patients and community members to view, and the financial assistance application is also on the website to print off and complete. In addition, if a customer service representative of Hays Medical Center, Inc., contacts a patient about a bill and in visiting with them they determine that the patient could possibly qualify for the Hospital's charity care policy, they will send the application to the patient as well. Part VI, Line 4: Hays Medical Center, Inc., is located in Hays, Kansas, which has a population of approximately 21,000 people per the 2020 population census performed by the U.S. Census Bureau. One of the State of Kansas Regents universities is also located in Hays, Kansas, so the population includes many college-aged students. The median household income of Hays, Kansas, is approximately $50,900. Approximately 17.6% of the population was below the poverty line. Almost 7% of the Hospital's revenue is from services provided to patients eligible for Medicaid. Hays Medical Center, Inc., is the only hospital in the city of Hays. In addition, since this is a rural area and because it is the only hospital providing tertiary level care in the region, Hays Medical Center, Inc., provides certain services to the whole western half of the State of Kansas. Part VI, Line 5: Hays Medical Center, Inc., promotes the health of the community by extending medical privileges to most qualified, local physicians. In addition, the majority of the Board of Directors live and work in the city of Hays, but they are not employed by Hays Medical Center, Inc. Part VI, Line 6: Hays Medical Center was part of the University of Kansas affiliated health care system through November 2021. Hays Medical Center separated from the affiliation with the University of Kansas agreement on November 30, 2021 and are no longer a part of this affiliated health care system. 1 Grow Hays 219 West 10th Hays KS 67601 481048442 501(c)(3) 10000 0 Cash paid Improve community served by the Medical Center 1 Part I, Line 2: The Medical Center has implemented processes to ensure that all contributions are approved by the appropriate authorizing individual. It only disburses contributions to approved reputable organizations. 1 X X X X 1 1 0 0 0 1 0 0 0 Manmohan Biring Physician 550589 0 1077605 0 254892 0 17400 0 37895 0 1938381 0 0 0 Robert Phillips Physician 1198216 0 1250 0 35898 0 17400 0 12072 0 1264836 0 0 0 Max Decarvalho Physician 696288 0 265003 0 10776 0 17400 0 30378 0 1019845 0 0 0 Gulraiz Cheema Physician/Board Member thru Dec 2021 637541 0 251611 0 10773 0 17400 0 36638 0 953963 0 0 0 Edward Herrman President & CEO 572500 0 120057 0 21894 0 122833 0 36614 0 873898 0 0 0 Douglas Tangel Physician 641800 0 34979 0 25277 0 17400 0 31295 0 750751 0 0 0 Mohammed Janif Physician 617256 0 50375 0 4582 0 17400 0 31053 0 720666 0 0 0 Ernesto Lopez-Corona MD Physician/Board Member beg Jan 2022 559056 0 1364 0 8230 0 17400 0 39161 0 625211 0 0 0 George Harms Chief Financial Officer 294643 0 49598 0 3160 0 70506 0 26447 0 444354 0 0 0 Shae Veach VP Regional Development 237449 0 41679 0 15311 0 60341 0 31962 0 386742 0 0 0 Joannah Applequist Chief Legal Officer 257225 0 39336 0 11173 0 62297 0 4507 0 374538 0 0 0 Roger Dietz MD Physician/Board Member 311574 0 1250 0 12000 0 17400 0 31853 0 374077 0 0 0 Terry Siek Chief Nursing Officer 232879 0 38972 0 1564 0 57473 0 10780 0 341668 0 0 0 Bryce Young Former COO (key employee) 0 0 0 0 163726 0 0 0 0 0 163726 0 0 0 Part I, Lines 4a-b Severance payments: Bryce Young - $163,726 Contributions to plan: Edward Herrman - $105,433 George Harms - $53,106 Terry Siek - $41,052 Shae Veach - $43,088 Joannah Applequist - $44,897 Part I, Line 6 A portion of incentive compensation for officers and key employees is determined by net earnings exceeding budget for the fiscal year. Form 990, Part VI, Section A, line 4 When the Medical Center transitioned from the University of Kansas Hospital Authority in December 2021, the Medical Center adopted new governing documents to match their new governing situation. Form 990, Part VI, Section B, line 11b The Form 990 is prepared and reviewed by an independent accounting firm. It is then reviewed by the organization's officers and accounting personnel. Their questions and concerns are addressed and either corrected or clarified in the Form 990. The final Form 990 is then provided to the board for review prior to filing. Form 990, Part VI, Section B, line 12c Officers, directors & key employees, along with all associates, are required to complete a conflict of interest statement annually. The statements are reviewed by the Board, the Compliance Officer, and Governance Director, as well. When conflict of interest issues arise during a Board meeting, the board members with the conflict are asked to remove themselves from discussion or from the room entirely. They are not allowed to vote on that particular issue. Form 990, Part VI, Section B, line 15 The CEO's, officers', and key employees' salaries are reviewed annually by an independent consulting group and the Compensation Committee, which is made up of members of the Board. They base the review on salary comparisons obtained by the consulting group from peer hospitals in similiar geographic regions. The last review was conducted in April 2022. Form 990, Part VI, Section C, line 19 These documents are not made available to the public. Form 990, Part IX, line 11g Contract labor: Program service expenses 12,847,250. Management and general expenses 21,585. Fundraising expenses 173. Total expenses 12,869,008. Medical professional fees: Program service expenses 5,597,826. Management and general expenses 0. Fundraising expenses 0. Total expenses 5,597,826. Laboratory services: Program service expenses 5,655,601. Management and general expenses 0. Fundraising expenses 25,203. Total expenses 5,680,804. Consulting services: Program service expenses 190,354. Management and general expenses 181,458. Fundraising expenses 3. Total expenses 371,815. Recruiting fees: Program service expenses 44,462. Management and general expenses 111,845. Fundraising expenses 1. Total expenses 156,308. Non-medical professional fees: Program service expenses 2,050,861. Management and general expenses 109,325. Fundraising expenses 103. Total expenses 2,160,289. Collection and billing fees: Program service expenses 8. Management and general expenses 758,396. Fundraising expenses 0. Total expenses 758,404. Other purchased services: Program service expenses 943,508. Management and general expenses 1,319,392. Fundraising expenses 13. Total expenses 2,262,913. Form 990, Part XI, line 9: Loss on KU Med Segregation -54,850,787. Change in beneficial interest in foundations 1,690,000. Part XII, Line 3c When affiliated with the University of Kansas Hospital, the University of Kansas Hospital selected the auditor of the University of Kansas Hospital System, which included Hays Medical Center. When the Medical Center transitioned from the University of Kansas Hospital in December 2021, the Compliance committee assumed oversight of the audit. Form 990, Part VII, Line 1a Brenda Dykstra and Chris Ruder were employed by the University of Kansas, a related entity. Due to the Medical Center no longer being affiliated with the University of Kansas, the Medical Center is unable to obtain the related party compensation for these individuals. Hays Medical Center Foundation 2220 Canterbury Hays KS 67601 481179684 Provide grants and allocations to Hays Medical Center, Inc. KS 501(c)(3) Line 11a, I Hays Medical Center Inc 1 HaysMed Partners Inc 2220 Canterbury Hays KS 67601 270877152 Management contract for Pawnee Valley Community Hospital KS 501(c)(3) Line 3 Hays Medical Center Inc 1 Pawnee Valley Community Hospital Inc 2220 Canterbury Hays KS 67601 481253246 Hospital operated by Hays Medical Center KS 501(c)(3) Line 3 HaysMed Partners Inc 1 Hadley Foundation Inc 1200 Main Hays KS 67601 481107034 Support for Hays Medical Center KS 501(c)(3) Line 11c, III-FI N/A 0 Kansas University Hospital Authority 3901 Rainbow Boulevard Kansas City KS 66160 481202402 Hospital KS N/A 0 St Rose Health Center 3515 Broadway Great Bend KS 67530 472117443 Health Center KS 501(c)(3) Line 3 University of Kansas Hospital Authority 1 Turning Point The Center for Hope 8900 State Line Road Ste 240 Leawood KS 66206 431900039 Healthcare KS 501(c)(3) Line 7 Kansas University Hospital Authority 1 Kansas University Physicians Inc 3901 Rainbow Boulevard Kansas City MO 66160 481163756 Healthcare KS 501(c)(3) Line 10 Kansas University Physicians 1 KU Medwest Ambulatory Surgery 7405 Renner Road Shawnee KS 66217 020664568 Healthcare KS Kansas University Hospital Authority 0 0 UKH Sports Med LLC 2330 Shawnee Mission Pkwy Westwood KS 66205 463123647 Healthcare KS Kansas University Hospital Authority 0 0 KH Alliance LLC 4000 Cambridge Street Kansas City KS 66160 472838147 Healthcare KS Kansas University Hospital Authority 0 0 Kansas Clinical Improvement Collaborative LLC 1809 East 27th Street Hays KS 67601 812776361 Healthcare KS Kansas University Hospital Authority 0 0 Kansas Primary Care Alliance 2330 Shawnee Mission Pkwy Westwood KS 66205 463164140 Healthcare KS Kansas University Hospital Authority 0 0 UKHS Great Bend LLC 2330 Shawnee Mission Pkwy Westwood KS 66205 830516935 Healthcare KS Kansas University Hospital Authority 0 0 UKHS Sports Performance Center 2330 Shawnee Mission Pkwy Westwood KS 66205 830888634 Healthcare KS Kansas University Hospital Authority 0 0 UKHS Great Bend Physicians LLC 2330 Shawnee Mission Pkwy Westwood KS 66205 831255734 Healthcare KS Kansas University Hospital Authority Great Bend 0 0 Jayhawk Primary Care Inc 2300 Shawnee Mission Parkway Ste 31 Westwood KS 66205 481159444 Healthcare KS Kansas University Hospital Authority C 0 Mid-America Cardiology Associates 4000 Cambridge Street Ste G600 Kansas City KS 66160 480980010 Healthcare KS Kansas University Hospital Authority C 0 University of Kansas Physicians Inc 2300 Shawnee Mission Parkway Ste 20 Westwood KS 66205 471214865 Healthcare KS Kansas University Hospital Authority C 0 UKHA Program Support Inc 2300 Shawnee Mission Parkway Ste 20 Westwood KS 66205 455571151 Healthcare KS Kansas University Hospital Authority C 0 0 0 1 1 1 0 0 0 0 1 0 1 1 1 1 0 1 1 0 Hays Medical Center Foundation C 882099 FMV Hays Medical Center Foundation Q 307445 FMV Pawnee Valley Community Hospital Inc D 1385192 FMV Pawnee Valley Community Hospital Inc L 626307 FMV Pawnee Valley Community Hospital Inc O 264519 FMV Pawnee Valley Community Hospital Inc Q 1466686 FMV