2023-08-11T11:26:21-05:00 2022-09-30 450250958 Eide Bailly LLP 800 Nicollet Mall Ste 1300 Minneapolis MN 554027033 990 2021-10-01 480545923 Cloud County Health Center Inc CLOU 7852431234 155 W College Dr Concordia KS 66901 Ron Harrington Chief Financial Officer 7852431234 2023-08-11 1 Ron Harrington 999009999 Kim Hunwardsen CPA P00484560 6122536500 2023-08-11 3 AAL1 IAL1 2021 2023-04-26 12:10:37Z X North Central Kansas Medical Center Ron Harrington 155 W College Dr Concordia KS 66901 20058770 0 X www.nckmed.com X 1970 KS Operation of critical access hospital 12 11 0 50 0 0 1069633 1223487 18661904 18821707 -2149 6683 11398 6893 19740786 20058770 8565 2500 0 0 11301531 11815503 0 0 0 6447316 6501625 17757412 18319628 1983374 1739142 19458806 46728571 9332652 34564275 10126154 12164296 X Cloud County Health Center is committed to providing quality health care services delivered in a caring and respectful manner through teamwork and professional excellence. 0 0 14278930 2500 18821707 Cloud County Health Center (Health Center) is a nonprofit acute care hospital located in Concordia Kansas. The Health Center provides inpatient, outpatient, rural healht clinic and emergency care services to residents of Cloud County and the surrounding area. Health Center had a total of 253 discharges and 1,613 patient days. The hospital had a total of 275 surgeries, 2,639 ED visits and 22,190 OP visits and the Family Care Center had 15,121 visits. In addition to providing Inpatient and Outpatient services, the hospital provides the following ancillary services; Lab, Imaging, Pharmacy, Respiratory Therapy, Rehab services and Sleep Lab services. Imaging services include all of the following areas; General X-ray, CT Scan, Nuclear Medicine, Ultrasound, Bone Density and Mammography services. MRI services are provided on Sundays with a Mobile Unit. 14278930 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 1 1 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 X 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 X 12 11 0 1 0 0 1 0 0 1 0 0 0 1 1 1 1 1 1 1 0 0 X Ron Harrington 7852431234 155 W College Drive Concordia KS 66901 X Philip Gilliland Chairperson 1.00 0.00 X X 0 0 0 Kurt Kocher Vice Chair 1.00 1.00 X X 0 0 0 Charles Lambertz Secretary 1.00 0.00 X X 0 0 0 Amy Lange Treasurer 1.00 0.00 X X 0 0 0 Joanne Balthazor Director 1.00 1.00 X 0 0 0 Amber Knoettgen Director (Beg Feb 2022) 1.00 0.00 X 0 0 0 Ashley Hutchinson Director (Until Jan 2022) 1.00 0.00 X 0 0 0 Robb Rosenbaum Director 1.00 0.00 X 0 0 0 Darrel Hosie Director 1.00 0.00 X 0 0 0 Kent Otott Director 1.00 0.00 X 0 0 0 Quentin Breese Director 1.00 0.00 X 0 0 0 Sister Jean Rosemarynoski Director 1.00 0.00 X 0 0 0 Darrell Gallegos Director 1.00 0.00 X 0 0 0 Justin Poore Chief of Staff/Physician 40.00 0.00 X 0 0 0 David Garnas Adminstrator/CEO 40.00 1.00 X 0 0 0 Ronald Harrington CFO 40.00 1.00 X 0 0 0 Tiffany Naccarato Advanced Practice Provider 40.00 0.00 X 179600 0 9709 Shawna Huggans Advanced Practice Provider 40.00 0.00 X 187051 0 33750 Daniel Garlow Physician 40.00 0.00 X 259224 0 37720 Dorothy Breault Physician 40.00 0.00 X 238776 0 39034 Jeff McCroskey Advanced Practice Provider 40.00 0.00 X 143479 0 4937 1008130 0 125150 5 0 1 1 SALINA REGIONAL HEALTH CENTER 400 S SANTA FE SALINA KS 67401 PAYROLL AND OTHER REIMBURSEMENT 18993000 TREANORL 1040 VERMONT STREET LAWRENCE KS 660442920 ARCHITECTURE SERVICE 374921 CPSI PO BOX 11407 BIRMINGHAM AL 352466448 COMPUTER SERVICES 127891 GEARY ANESTHESIA ASSOCIATES 819 CRESTVIEW DR JUNCTION CITY KS 66441 ANESTHESIA SERVICES 121235 MEDICAL INFORMATION TECHNOLOGY INC PO BOX 74569 CHICAGO IL 60696 COMPUTER SERVICES 113848 5 11007 1211741 739 1223487 Patient Revenue 621400 17886568 17886568 Pharmacy Revenue 900099 824707 824707 Cafeteria 900099 58363 58363 52069 52069 18821707 6683 6683 Misc. revenue 900099 6893 6893 6893 20058770 18821707 0 13576 X 2500 2500 837433 374995 462438 9160422 7376591 1783831 350206 290665 59541 784643 582935 201708 682799 533625 149174 2103 2103 2307 2307 2056 2056 2004276 1671818 332458 75537 70 75467 377728 197006 180722 329120 213993 115127 318678 5472 313206 50181 30193 19988 1709 1709 21 21 452737 292059 160678 63454 17112 46342 Medical and Patient Sup 2360441 2289134 71307 Food Costs 102792 85050 17742 Dues, Licenses, and Tax 64921 20092 44829 293564 293564 18319628 14278930 4040698 0 44469 617164 1364400 2272138 156928 289348 111535 227600 55300178 14821757 13297754 40478421 842682 1146075 3641038 1697825 19458806 46728571 2835855 6654387 6496797 27551431 0 358457 9332652 34564275 X 9283702 11018451 842452 1145845 10126154 12164296 19458806 46728571 X 1739142 299000 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 2056 2056 0 Part II-B, Line 1: A portion of annual dues paid by Cloud County Health Center to the Kansas Hospital Association (KHA) has been identified as association lobbying activities by KHA. Cloud County Health Center does not directly participate in lobbying activities. 741702 741702 2539464 2524938 14526 13308199 12276058 1032141 38710813 20761 38690052 40478421 Estimated third party payor settlemet 358457 358457 X 22467752 2415875 2415875 20051877 6893 6893 20058770 20733003 2415875 2415875 18317128 2500 2500 18319628 Part X, Line 2: The Health Center believes that it has appropriate support for any tax positions taken affecting its annual filing requirements, and as such, does not have any uncertain tax positions that are material to the financial statements. The Health Center would recognize future accrued interest and penalties related to unrecognized tax benefits and liabilities in income tax expense if such interest and penalties are incurred. Part XI, Line 4b - Other Adjustments: Net Auxiliary Income 6,893. Part XII, Line 4b - Other Adjustments: Auxiliary expense 2,500. 1 1 X 1 X 1 X 1 1 0 0 140000 140000 0.00760 1621439 469699 1151740 0.06290 1761439 469699 1291740 0.07050 5914725 2975315 2939410 0.16050 5914725 2975315 2939410 0.16050 7676164 3445014 4231150 0.23100 1 900579 8840890 8807976 32914 1 1 1 1 Cloud County Health Center 155 W College Drive Concordia KS 66901 www.nckmed.com H015001 X X X X Cloud County Health Center 1 0 0 1 X X X X X X X X X 21 1 0 0 1 X See Section C X 1 21 1 See Section C 0 1 X 150.000000000000 200.000000000000 X X X X 1 1 X X X 1 X nckmed.com/patient-and-visitors/financial-assistance X nckmed.com/patient-and-visitors/financial-assistance X nckmed.com/patient-and-visitors/financial-assistance X X X X X 1 X 0 X X X X 1 X 0 0 Cloud County Health Center Part V, Section B, Line 5: On April 28, 2022, the Community Health Needs Assessment Committee met and discussed ways to involve the community in addressing the most important health needs of Cloud County. The group decided to survey the community, asking for their input on priority of the following areas:- Obesity- Depression/Mental Health- Diabetes- Heart Disease- Tobacco Use Including vaping and chewing- Stroke- Trauma/Falls- Hypertension (high blood pressure)- High cholesterol- Substance Abuse- Transportation to Medical ServicesThe survey was launched through all forms of media for a period of six weeks. 118 surveys were received and tabulated. The Community Health Needs Assessment Committee met in July to review the results and discuss an implementation plan. The Committee consists of 25 members from various organizations in the community. Cloud County Health Center Part V, Section B, Line 7d: Can contact the Hospital or Health Department to obtain a copy. Cloud County Health Center Part V, Section B, Line 11: The following community health priority areas were identified in the most recent CHNA.1) Obesity2) Depression/Mental Health3) Diabetes4) Heart Disease5) Tobacco Use6) Stroke7) Trauma/Falls8) Hypertension9) High Cholesterol10) Substance Abuse11) Transportation to Medical ServicesAlthough all of the above are important and will be addressed as part of our regular operations, the hospital will focus on Obesity (including trauma/falls), Depression/Mental Health, and Substance Abuse, including Tobacco Use during fiscal years ending in 2023-2025. With assistance from other organizations, we will address the issues through the following steps:#1 - Provide Opportunities to Stabilize Mental HealthA) Publicize a new hotline number for suicide prevention and provide information in schools, libraries, the hospital, major employers, and ag industry companies.B) Develop more access to telehealth#2 - Provide ways to decrease Obesity in the Community and include Education of Health issues leading to ObesityA) Start Weight Watchers program in the communityB) Offer Community classes on weight managementC) Stepping On Program Provide classes at the hospital to help prevent falls/trauma injuriesD) Community exercise activities - Develop bike trails/walking trails in the community#3 - Develop ways to decrease Substance abuse and Tobacco useA) Promote Great American Smokeout Day annuallyB) Utilize health fairs to publicize dangers of substance abuseDue to timing, the hospital focused on the needs identified in the prior CHNA during fiscal year ended 2022, as follows:#1 - Accessibility and Availability to Healthcare - A new state-of-the-art facility will open in November 2022. The Hospital received approval from USDA on funding for the new replacement facility and broke ground in March 2021. We continued to offer increased the hours in our Family Care Clinic and walk-in clinic hours until 6:00 p.m., Monday thru Friday. Each day we have a dedicated provider scheduled for walk-in patients. The clinic continued its relationship with the high school USD 333 and the community college to provide annual physicals for their student athletes. Tele-health services were also available and increased during the fiscal year for the Clinic.#2 - Promoting Healthier Lifestyles - We continued to promote awareness of heart disease through increased advertising in our community in the newspaper, on the radio and our website. We participated in Wear RED Day in February to help raise awareness of heart disease as the leading cause of death among Americans. We promoted increased community activity of the bike trails, walking trails in the city of Concordia and made our Physical Therapy equipment available after hours in the hospital.#3 - Received funding for a fixed MRI at our new facility when it opens in November 2022. The hospital will now have MRI services scheduled 5 days a week and emergency services on weekends instead of the mobile MRI truck one day per week on Sundays. We provided increased services in the community to treat patients with trauma, stroke, hypertension, high cholesterol, etc. Cloud County Health Center Part V, Section B, Line 24: The hospital financial assistance policy does not cover elective procedures. The hospital may have charged FAP eligible patients gross charges for services that are not covered under the financial assistance policy. Part V, Section B, Line 7a nckmed.com/about/community-health-needs Part V, Section B, Line 10a nckmed.com/about/community-health-needs 1 1 - Family Care Center Clinic 155 W College Drive Concordia KS 66901 Rural health clinic Part I, Line 3c: The methodology used to determine eligibility for financial assistance takes into consideration income, net assets, family size, medical indigency, insurance and underinsurance status. Presumptive eligibility may be used if the other options are not available. 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. Line 7B, Medicaid, was determined based on the costing methods used to prepare the cost reports. Line 7G was obtained from the Medicare Cost Report. Part I, Line 7g: Rural health clinic revenue of $1,727,645 and expense of $3,682,373 are included on line 7g. The net cost of rural health clinic subsidized services is $1,954,728. Part III, Line 2: The amount on line 2 represents implicit price concessions. The Organization determines its estimate of implicit price concession based on its historical collection experience with this class of patients. Part III, Line 4: The footnote to the organization's financial statements that describes implicit price concession is located in the audited financial statement report on pages 11-12. Part III, Line 8: The payments are compared to the actual cost of providing the service as arrived at through the Medicare cost reports. Medical services are provided to patients with Medicare coverage regardless of whether or not a surplus or deficit is realized. Providing Medicare services promotes access to healthcare services which are vitally needed by our community. Part III, Line 9b: Collection practices do not apply to patients who have an approved payment plan in effect provided payments are kept current. Patients who have qualified for 100% financial assistance would not go to collection as their account balance would be reduced to zero prior to getting to the collection stage. Patients who qualify for less than 100% assistance may go to collection if their balance is not paid according to an agreed upon schedule. Accounts that are deemed to qualify for financial assistance while in collections will be removed from collections and returned to the business office. Part VI, Line 2: The hospital has an 18 member CHNA committee that meets quarterly at the hospital to discuss the healthcare needs in the community. Members include staff from the hospital, health department representatives, city and county government officials, school leaders and city business leaders. Part VI, Line 3: The hospital does the following to educate patients on the financial assistance offered at CCHC; (1) posts its financial assistance policy and financial assistance contact information on its website, in admissions areas, emergency rooms, and other areas of the organization's facilities in which eligible patients are likely to be present; (2) provides a copy of the policy, or a summary thereof, and financial assistance contact information to patients as part of the intake process; (3) includes the policy, or a summary thereof, along with financial assistance contact information, in patient bills; and/or (4) discusses with the patient the availability of various government benefits, such as Medicaid or state programs, and assists the patient with qualification for such programs, where applicable. Part VI, Line 4: CCHC is located in Concordia, KS. Concordia is the county seat of Cloud County. It is a rural community with an estimated population of 5,111 per the 2020 Census data. Concordia is home to Cloud County Community College located just off highway 81 in Concordia. Concordia is surrounded by Healthcare facilities in all directions. To the north in Belleville, KS is Republic County Hospital located 18 miles from Concordia, KS. To the east is Clay County which has Clay County Medical Center approx. 45 miles from Concordia, KS. To the south is Ottawa County approx. 33 miles from Concordia, KS. Ottawa County has a facility in Minneapolis, KS. Then to the west is Mitchell County approx. 32 miles from Concordia, KS. Mitchell County has a facility in Beloit, KS. CCHC gets about 80% of its patients from Concordia, 6% from Clyde, 5% from Jamestown, 2% from Glasco and 1% from both Aurora and Miltonvale. Also, the hospital sees about 4% of its patients from Belleville and Beloit combined. The median income for a household is $44,185. The per capita income for the city is $22,715. About 13.6% of the population were below the poverty line. Part VI, Line 5: The hospital has a Rural Health Clinic within the hospital and provides services Monday through Friday from 8:30 am. till 6:00 pm. Monday thru Friday. The Clinic has outreach locations in Clyde and Jamestown. The physicians see patients in Clyde on Wednesday and Thursday mornings and every other Tuesday morning in Jamestown. The hospital has a total of 7 providers of which 3 are physicians and 4 are mid-level providers. The hospital operates an emergency department 24 hours per day, 7 days per week.The hospital's Board of Trustees is made up of members from all parts of the county, including local business leaders and retired individuals from Concordia and the surrounding communities.The services offered at CCHC include the following:IP Acute servicesIP ICU servicesIP swing bed services - patients requiring Therapy services or IV antibiotic servicesED services FCC Family Care Clinic Specialty Clinic ServicesAncillary services including the following:Physical Therapy, Occupational Therapy and Speech Pathology services,Radiology services including ultrasound, nuclear medicine, CT scan and mobile MRI servicesLaboratoryRespiratory TherapyCardiac Rehab ServicesSleep Lab servicesOperating Room OP proceduresAnti Coag ClinicOutpatient Services Including IV Therapy and Blood Transfusions Part VI, Line 6: CCHC has been part of an affiliation with Salina Regional Health Center (SRHC) since May 2016. CCHC staff are employees of SRHC and adhere to the same polices as SRHC staff. CCHC is on the same EMR system as SRHC which helps to provide a continuity of care for our patients in our communities. Contracts and purchasing agreements are beneficial for both organizations in the areas of pricing and terms of the agreements. SRHC helps support our community by sending specialists to our clinic monthly. They also provide subject matter experts that CCHC can call upon with questions. 0 0 0 0 0 0 0 0 0 Daniel Garlow Physician 220894 0 38330 0 0 0 0 12616 0 28003 259224 40619 0 0 Dorothy Breault Physician 206874 0 31902 0 0 0 0 12347 0 29592 238776 41939 0 0 Shawna Huggans Advanced Practice Provider 184051 0 3000 0 0 0 0 9630 0 24493 187051 34123 0 0 Tiffany Naccarato Advanced Practice Provider 176600 0 3000 0 0 0 0 8919 0 789 179600 9708 0 0 Schedule J, Part III Dorothy Breault, Daniel Garlow Shawna Huggans, Jeff McCroskey, and Tiffany Naccarato were paid by an unrelated organization, Salina Regional Health Center, for medical services performed. See Schedule J, Part II and Form 990 Part VII for amounts paid for these services. Form 990, Part V, Line 1a, Number reported in Box 3 of Form 1096: Cloud County Health Center, Inc. has independent contractors, however, Salina Regional Health Center, the management company, pays all the independent contractors directly. The actual expense of each independent contractor is directly charged to the assigned entity. Form 990, Part V, Line 2a, Number of employees on W-3: Under a management agreement, Salina Regional Health Center (SRHC) is responsible for the daily management and operation of the hospital, including employment of all staff. All payroll and benefits are paid by SRHC and payroll reporting is done by SRHC. Allocable compensation by individual is charged to Cloud County Health Center, Inc. and is shown on line 7 of Part IX. Form 990, Part VI, Section A, line 3 The Hospital entered into a management and operating agreement with Salina Regional Health Center (SRHC) effective May 1, 2016. Under the agreement, SRHC is responsible for the daily management and operation of the Hospital, including the employment of all staff needed to manage and operate Cloud County Health Center. For calendar yearend 12/31/2021, SRHC paid the following in compensation and benefits for individuals listed in Part VII: Ronald Harrington $188,903 David Garnas $271,645 Justin Poore $329,088 Form 990, Part VI, Section A, line 6 The Health Center's Board of Trustees is the sole member of the Health Center. Form 990, Part VI, Section A, line 8b The organization does not have committees with broad authority to act on behalf of the governing board. Form 990, Part VI, Section B, line 11b Form 990 is reviewed by the President & CFO. A copy of the return is provided to board members prior to filing with the IRS. Form 990, Part VI, Section B, line 12c The Health Center requires the trustees and key employees to sign an annual conflict of interest form. On the form they designate if they have any conflicts. Potential conflicts of interest are presented to the Board of Directors. The Board determines whether a conflict exists. If a conflict exists, the effected person will be required to abstain from voting on the matter. Form 990, Part VI, Section B, line 15a The Organization's process for determining the President's compensation begins with an initiative led by the Executive Compensation Committee (ECC) of Salina Regional Health Center (SRHC). The ECC compares compensation and salary data provided by Integrated Health Strategies (IHS) for overall reasonableness of base compensation and total compensation for all SRHC executive staff. The ECC reviews the data and makes a recommendation to the SRHC board of trustees in a closed executive meeting. The process was last completed in 2020. Cloud County Health Center's President's salary is then set by the President/CEO of SRHC. The Cloud County Health Center CFO's salary is set by Salina Regional Hospital Vice President of Finance using an annual salary survey and is increased using the same percentage as all other employees. 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 IX, line 11g Contract Labor: Program service expenses 1,194,182. Management and general expenses 197,528. Fundraising expenses 0. Total expenses 1,391,710. Service Contracts: Program service expenses 477,636. Management and general expenses 134,892. Fundraising expenses 0. Total expenses 612,528. Credit Card Fees: Program service expenses 0. Management and general expenses 38. Fundraising expenses 0. Total expenses 38. Form 990, Part XI, line 9: Net Income From Auxiliary -4,393. Change in Beneficial Interest in Net Assets of the Foundation 303,393. Cloud County Foundation for Health Care Inc 155 W College Drive Concordia KS 66901 480966856 support community health and welfare KS 501(c)(3) Line 7 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1