2022-01-17T09:20:34-06:00 2021-03-31 BKD LLP 1551 N WATERFRONT PKWY STE 300 WICHITA KS 672066601 990 2020-04-01 481226830 GREAT PLAINS OF SMITH CO INC % DAVE DELLASEGA GREA 7852826845 PO BOX 349 SMITH CENTER KS 66967 DAVE DELLASEGA CEO 3166851523 2021-12-15 true DAVE DELLASEGA 999009999 SHAWNELL LINOT P01663908 3162652811 2 2020 2022-09-23 18:48:47Z X SMITH COUNTY MEMORIAL HOSPITAL DAVE DELLASEGA 250 NORTH ROCK ROAD STE 160 WICHITA KS 67206 23782634 false X WWW.SCMHKS.ORG X 1999 KS THE OPERATION OF HOSPITAL FACILITIES FOR THE DELIVERY OF HEALTH CARE SERVICES, EDUCATION, AND WELLNESS WITHOUT REGARD TO RACE, CREED, COLOR, SEX OR FINANCIAL CIRCUMSTANCE. 8 7 172 8 0 1279158 4968472 17633623 18643887 35372 44184 138331 126091 19086484 23782634 0 0 0 0 8405196 9074468 0 0 0 10327606 11946023 18732802 21020491 353682 2762143 33157652 40774688 28836264 33614200 4321388 7160488 X TO OPERATE HOSPITAL FACILITIES FOR THE DELIVERY OF HOSPITAL AND RELATED HEALTH CARE SERVICES, HEALTH RELATED EDUCATION, AS WELL AS THE PROMOTION OF HEALTH AND WELLNESS, WITHOUT REGARD TO RACE, CREED, COLOR, SEX OR FINANCIAL CIRCUMSTANCE. false false 17777446 0 18643887 Great Plains of Smith County, Inc., dba Smith County Memorial Hospital, delivers primary healthcare services to residents in an area that includes Smith County, Kansas. The service area also includes, to a lesser degree, Phillips, Jewell, and Osborne Counties in Kansas, as well as Franklin and Webster Counties in Nebraska. The primary healthcare services are delivered through a Critical Access Hospital, and a Provider Based Rural Health Clinic. SEE SCHEDULE O FOR CONTINUATION. 17777446 true true false true false false false false false true true false false true false false true true false false false false false false false false true true false false true false false false false false false false false false false false false false true true false true false true 40 0 true 172 true false false false false false false false false false false false false X 8 7 true false false false true true true true true false false true true true true true true false false false X DAVE DELLASEGA 3166851523 250 NORTH ROCK ROAD STE 160 WICHITA KS 67206 X HANNAH HAACK PHYSICIAN 40.0 0.0 X 339058 0 49774 JUSTIN OVERMILLER PHYSICIAN 40.0 0.0 X 325506 0 49774 FERRILL CONANT PHYSICIAN 40.0 0.0 X 253701 0 38951 LEAH WIEHL PHYSICIAN 40.0 0.0 X 208127 0 38841 DAVE DELLASEGA PRESIDENT/SECRETARY/DIRECTOR 2.0 40.0 X X 0 207871 33322 ALLEN VANDRIEL ADMINISTRATOR 40.0 0.0 X 168701 0 32977 TAMARA WINDSCHEFFEL ARNP 40.0 0.0 X 161633 0 31393 DURREL KELLEY SENIOR VP OF OPERATIONS 2.0 40.0 X 0 129966 27425 DAVE RANKIN CHAIRMAN/DIRECTOR 0.25 2.25 X X 0 0 0 ROBERT HAMILTON SECRETARY/DIRECTOR 0.25 2.25 X X 0 0 0 JOHN TERRILL VICE PRESIDENT/DIRECTOR 0.25 2.25 X X 0 0 0 STEVE CARLSON TREASURER/DIRECTOR 0.25 2.25 X X 0 0 0 DR BARBARA BROWN APPLEGATE DIRECTOR 0.25 2.25 X 0 0 0 ARTHUR HENRICKSON DIRECTOR 0.25 2.25 X 0 0 0 CHARLES WESTIN DIRECTOR 0.25 2.25 X 0 0 0 1456726 337837 302457 11 false true false GPHA 250 N ROCK RD STE 160 WICHITA KS 67206 BILLING SERVICE/MGMT 1142701 QUEST DIAGNOSTICS PO BOX 719 HAYS KS 67601 REFERENCE LAB 229439 WOUND CARE SPECIALISTS PO BOX 71849 CHICAGO IL 606941849 WOUND CARE 120700 3 4820877 147595 4968472 NET PATIENT SERVICE REVENUE 621300 16062302 16062302 340B PRESCRIPTION DRUG REVENUE 621300 2581585 2581585 18643887 44184 44184 0 0 191 191 0 191 191 0 0 0 0 0 0 0 0 0 0 EMPLOYEE/GUEST MEALS 722513 98743 98743 VENDOR REBATES 900099 24547 24547 All Other Misc Revenue 900099 2610 2610 2610 2610 125900 23782634 18643887 170275 0 0 0 0 201402 201402 0 6937485 6161105 776380 480968 436860 44108 983938 834588 149350 470675 401068 69607 135365 135365 14970 14970 151273 151273 3264 3264 0 0 2876029 2409169 466860 0 26938 2476 24462 426554 400276 26278 33425 15599 17826 0 300609 219960 80649 2581 1900 681 0 17336 11061 6275 753039 538104 214935 0 2336240 1669423 666817 144071 102950 41121 MEDICAL SUPPLIES 3539936 3539936 PROVISION FOR BAD DEBTS 883353 883353 EQUIPMENT RENTAL/MAINTENANCE 161788 116762 45026 DUES & SUBSCRIPTIONS 38571 9615 28956 100681 23241 77440 21020491 17777446 3243045 0 9870 3471181 2071052 3679899 0 0 3157766 3172658 0 0 0 0 0 0 258902 276263 109191 120669 30853911 6349211 26635178 24504700 0 0 0 0 0 0 0 0 915693 5549318 33157652 40774688 1666797 3224388 0 0 0 3709001 0 0 0 0 0 0 27169467 26680811 0 0 0 0 28836264 33614200 X 3443929 6188456 877459 972032 4321388 7160488 33157652 40774688 2762143 76957 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false true 3264 false false false 3264 false SCHEDULE C, PART II-B, LINE 1F A PORTION OF THE ANNUAL DUES PAID TO KHA AND AHA ARE USED FOR LOBBYING. 877459 66240 93680 65348 972031 936018 13269 -38761 33067 877459 910903 13076 41817 29778 936018 982411 17349 -27421 61436 910903 931434 49072 67637 65732 982411 0.00000 0.97180 0.02820 true false 395701 395701 19602101 3211133 16390968 6535868 2348717 4187151 4320241 789361 3530880 24504700 Due from Third Party 35765 FUNDS HELD BY ESCROW AGENT 5183013 OTHER RECEIVABLES 330540 5549318 22976238 76957 -883353 -806396 23782634 23782634 20137138 20137138 883353 883353 21020491 SCHEDULE D, PART V, LINE 4 THE INTENDED USE OF THE ENDOWMENT FUNDS IS TO SUPPORT THE CONTINUING OPERATIONS OF THE REPORTING ORGANIZATION. SCHEDULE D, PART X, LINE 2 MANAGEMENT HAS EVALUATED THEIR INCOME TAX POSITIONS UNDER THE GUIDANCE INCLUDED IN ASC 740. BASED ON THEIR REVIEW, MANAGEMENT HAS NOT IDENTIFIED ANY MATERIAL UNCERTAIN TAX POSITIONS TO BE RECORDED OR DISCLOSED IN THE FINANCIAL STATEMENTS. SCHEDULE D, PART XI, LINE 2D PROVISION FOR UNCOLLECTIBLE ACCOUNTS (883,353) SCHEDULE D, PART XII, LINE 4B PROVISION FOR UNCOLLECTIBLE ACCOUNTS 883,353 true true X true X false true true false true true 448 448 0.00000 857885 474625 383260 0.01900 858333 474625 383708 0.01900 22310 22310 0.00110 22310 22310 0.00110 880643 474625 406018 0.02010 false 883353 7853984 7853984 X true true 1 1 GREAT PLAINS OF SMITH CO INC 921 E HWY 36 SMITH CENTER KS 66967 WWW.SCMHKS.ORG H092001 X X X X RURAL HEALTH CLINIC GREAT PLAINS OF SMITH CO INC 1 false false true X X X X X X X X X 18 true false false true X SEE SCHEDULE H, PART V, SECTION C X true 18 true SEE SCHEDULE H, PART V, SECTION C false true X 200. 0. X X X true true X X X X true X SEE SCHEDULE H, PART V, SECTION C X SEE SCHEDULE H, PART V, SECTION C X SEE SCH H, PART V, SECTION C X X X X X X true X false X X X X true X false false SCHEDULE H, PART V, LINE 5 THE OBJECTIVE OF THE SMITH COUNTY COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) WAS TO DETERMINE HEALTH NEEDS FROM THE PERSPECTIVE OF THE COMMUNITY IN COLLABORATION WITH THE HEALTH CARE PROVIDERS IN THE COMMUNITY. PARTICIPANTS IN A TOWN HALL MEETING HELD AS PART OF THE CHNA INCLUDED COMMUNITY RESIDENTS, GOVERNMENTAL, CIVIC, AND BUSINESS LEADERS IN THE COMMUNITY. THE ATTENDANCE ROSTER CAN BE FOUND IN SECTION V A OF THE CHNA DOCUMENT. SCHEDULE H, PART V, LINE 7A HTTPS://WWW.SCMHKS.ORG/ABOUT-US/COMMUNITY-HEALTH-NEEDS-ASSESSMENT/ SCHEDULE H, PART V, LINE 10 https://www.scmhks.org/files/2019/04/2018-Plan-Implementation.pdf SCHEDULE H, PART V, LINE 11 THE CHNA CONDUCTED IN APRIL 2018 HIGHLIGHTED 7 ISSUES FOR SMITH COUNTY. THE ISSUES WERE: 1. BEHAVIORAL & MENTAL HEALTH 2. WELLNESS/DISEASE PREVENTION 3. DENTAL SERVICE ACCESS 4. POVERTY/AFFORDABLE INSURANCE 5. CHILD CARE AND DEVELOPMENT ACCESS 6. ALCOHOL AND DRUG PREVENTION 7. ELDER CARE/HOUSING THE ISSUES IDENTIFIED WERE REVIEWED BY GREAT PLAINS OF SMITH COUNTY, INC. LEADERSHIP AND GOVERNING BOARD, AND WERE PRIORITIZED INTO AN IMPLEMENTATION STRATEGY, WHICH WAS PUBLISHED LATER IN 2018. THE IMPLEMENTATION STRATEGY IS POSTED ON THE PUBLIC WEBSITE (WWW.SCMHKS.ORG). THE STRATEGY ADDRESSES ITEMS 1, 2, 6, AND 7 AS PRIORITIES THAT GREAT PLAINS OF SMITH COUNTY, INC. CAN DIRECTLY IMPACT USING RESOURCES OF THE HEALTH CARE COMMUNITY. ITEMS 3, 5, AND 7 ARE PRIORITIES THAT CANNOT BE ADDRESSED SOLELY BY GPSC, BUT WHICH WE CONTINUE TO WORK COLLABORATIVELY WITH OTHER ORGANIZATIONS AND PARTNERS TO ADDRESS. ITEM 4 WAS IDENTIFIED AS A DETERMINANT OF HEALTH STATUS WITHIN THE GPSC SERVICE AREA, BUT IS BEYOND THE PURVIEW OF GPSC TO ADDRESS. RATHER, IT IS VIEWED AS AN OVERALL ECONOMIC DEVELOPMENT PRIORITY. SCHEDULE H, PART V, LINE 16A HTTPS://WWW.SCMHKS.ORG/SERVICES/FINANCIAL-ASSISTANCE/ SCHEDULE H, PART V, LINE 16B HTTPS://WWW.SCMHKS.ORG/SERVICES/FINANCIAL-ASSISTANCE/ SCHEDULE H, PART V, LINE 16C HTTPS://WWW.SCMHKS.ORG/SERVICES/FINANCIAL-ASSISTANCE-RESOURCES/ 1 SMITH COUNTY FAMILY PRACTICE 921 E HWY 36 SMITH CENTER KS 66967 FAMILY PRACTICE SCHEDULE H, PART I, LINE 3C THE ORGANIZATION USED THE FOLLOWING CRITERIA TO DETERMINE ELIGIBILITY FOR FINANCIAL ASSISTANCE: ASSET LEVEL, MEDICAL INDIGENCY, INSURANCE STATUS, AND UNDER INSURANCE STATUS. SCHEDULE H, PART VI, LINE 7 THE COSTING METHODOLOGY USED TO CALCULATE THE AMOUNTS IN THE TABLE OF PART I, LINE 7, OF SCHEDULE H, IS A COST TO CHARGE RATIO. SCHEDULE H, PART I, LINE 7, COLUMN F THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A) BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $883,353. SCHEDULE H, PART III, LINE 2 HOSPITAL CHARGES THAT ARE NOT COLLECTED AND ARE NOT APPROVED FOR FINANCIAL ASSISTANCE ARE CLASSIFIED AS BAD DEBTS FROM PATIENTS WHO WILL NOT PAY. SCHEDULE H, PART III, LINE 3 THE COSTING METHODOLOGY IS BASED ON THE ORGANIZATION'S MEDICARE COST-TO-CHARGE RATIO. WHILE WE RECOGNIZE THAT THERE WOULD BE SOME BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S CHARITY CARE POLICY, WE HAVE NO REASOBABLE BASIS FOR ESTIMATING THIS FIGURE. IF ELIGIBILITY IS KNOWN, THE AMOUNT WOULD FALL UNDER CHARITY CARE AND NOT BAD DEBT. SCHEDULE H, PART III, LINE 4 SEE PAGE 35 OF THE AUDITED FINANCIALS UNDER NOTE 22. SCHEDULE H, PART III, LINE 8 THE COSTING METHODOLOGY USED TO CALCULATE THE AMOUNT ON LINE 6 IS A COST TO CHARGE RATIO. SCHEDULE H, PART III, LINE 9B ALL CHARITY CARE AND CHARGES NOT TO BE COLLECTED DUE TO FINANCIAL ASSISTANCE COMPUTATIONS ARE EXEMPTED FROM COLLECTION POLICIES AND PRACTICES. THESE ACCOUNTS ARE REMOVED FROM THE COLLECTION CYCLE. SCHEDULE H, PART VI, LINE 2 Great Plains of Smith County, Inc. (GPSC) uses formal and in formal methods to determine the needs of the communities it serves. Outside facilitators have been used to assist with formal Community Health Needs Assessments. The first of these formal assessments was completed in 2012, followed by subsequent assessments in 2015 and 2018. Each of these assessments included surveys mailed to members of the community, followed by a public forum designed to gather input in an interactive format. Following completion and publication of each of the CHNAs, an implementation plan was developed. In 2021, the SARS CoV-2 pandemic and its impact on the community and on public gatherings necessitates a change in tactics for the fourth Community Health Needs Assessment. Although not complete as of the end of the fiscal year, plans and work were underway for gathering input from the public using a virtual forum Following completion of the public input session, a needs assessment document will be published, as well as an implementation plan based on the needs identified in the study. The Board of Trustees of Smith County Memorial Hospital, which consists of five members appointed by the Smith County Board of Commissioners, is responsible for the delivery of healthcare through SCMH. The Board of Trustees has maintained a lease arrangement with Great Plains Health Alliance since 1951. This lease arrangement creates the Great Plains of Smith County, Inc. as the operating entity for the delivery of services. The Board of Trustees, although not directly involved in the governance of the delivery system, serve as an important conduit for public input regarding the needs and delivery of healthcare by Great Plains of Smith County, Inc. SCHEDULE H, PART VI, LINE 3 Great Plains of Smith County, Inc. makes significant efforts to provide information to the public regarding the function of federal and state programs. We use frequent social media posts and newspaper articles to provide information about the Medicare and Medicaid programs, and the services they cover. For the past several years GPSC has arranged for an outside, non-partisan benefits advisor to present programs during the Medicare Open Enrollment Period. These programs are designed as purely educational offerings to assist beneficiaries in selecting the most beneficial Medicare related programs (especially supplemental plans) during the time when they can make their annual selection. Our Patient Care Advocate, a licensed Social Worker, provides individual assistance to uninsured patients in application for coverage under the KanCare (Kansas Medicaid) program. The Patient Advocate also assists patients with the initiation of applications for financial assistance under our Charity Care program. Every billing statement sent to patients contains information about our Financial Assistance Program, including instructions about how to initiate an application for assistance. Additionally, every telephone call made to patients regarding unpaid balances includes information regarding the option to apply for financial assistance. Our Financial Assistance Policy, along with the contact in formation and application forms, is accessible on our public website. SCHEDULE H, PART VI, LINE 4 The 2020 United States Census reported a total population in Smith County, Kansas of 3,570. This represents a decrease of 7.3% from the 2010 census of 3,853. The population density is approximately 4 persons per square mile, classifying the county as Frontier. Approximately 96% of the population of Smith County is reported as white, with less than 1% each reported as black, Asian, or native American. The population is nearly evenly divided between male and female. The median family income in Smith County was reported as $43,429, compared to a national median of $62,843. Despite this disparity in median income, the Census reported 11.6% of Smith County residents being below the poverty level, compared to 11.4% nationally. This indicates a higher population in the low-moderate income range, but above the poverty level. Of the residents less than 65 years of age in Smith County, 11.7% are reported as uninsured, compared to 10.2% nationally. These reported numbers on uninsured likely do not reflect the impact of the Covid-19 pandemic on the economy and employer-provided insurance. SCHEDULE H, PART VI, LINE 5 Great Plains of Smith County, Inc. maintains an open medical staff, striving for diversity to reflect the community and service area. The Smith County Memorial Hospital Board of Trustees, although not directly responsible for the governance of the operating entity, never the less serves as an important link to the community. The membership of the Board of Trustees represents the geographic diversity of Smith County, with members appointed to represent various regions and population centers of the county. Great Plains of Smith County, Inc. uses significant efforts to promote the health of the community. Among these efforts are communication regarding healthy lifestyle, disease prevention and detection, and community awareness. We use social media, our website, radio advertising, and newspaper articles and advertising to convey important information to the community. In addition to the topics addressed every year, the Covid-19 pandemic has created a need for increased communication with the community regarding the virus, its detection and treatment, and vaccination availability and delivery. We have worked collaboratively throughout the pandemic with the local Public Health Department, County Board of Health, Administration and School Board of the local school district, and the Recreation Commission on issues related to the pandemic. Our Director of Communications has been instrumental in assisting other entities with providing information to their constituencies. Early in the pandemic, GPSC Worked extensively and cooperatively with the long term care facilities in the community to provide testing for residents and staff. Federal grant funding channeled to GPSC was used to support much of this activity, and we provided the required accounting support for reporting of the use of these funds. During the pandemic, it became obvious that the nurse administrator of the public health department, who had been serving as the County Health Officer, was overwhelmed by the demands of the position, GPSC administration and medical staff met with the County Commissioners (acting as the County Board of Health) and reached an agreement for one of our employed physicians to serve as the County Health Officer. Although the pandemic disrupted many of the ongoing outreach offerings that GPSC had traditionally, other services continued unabated. Among these services and offerings are the Meals on Wheels program, telehealth services, cardiac and pulmonary rehabilitation programs, and education programs. The Meals on Wheels program is now completely manages by GPSC, including preparation and packaging of meals that are provided at a deeply discounted cost to homebound members of the community. GPSC has also assumed the responsibility for scheduling and coordinating the volunteer delivery drivers for the meals. Although access to facilities was limited for a period of time due to the pandemic, the Cardiac Rehabilitation and Pulmonary Rehabilitation programs have now resumed activity, providing service to growing numbers of beneficiaries. Education programs that have continued include healthy diet programs, childbirth education programs for expectant parents, as well as training and certification programs in a variety of basic and advanced lifesaving techniques. These include Basic Life Support (CPR), Advanced Cardiovascular Life Support, Pediatric Advanced Life Support, Neonatal Resuscitation, Trauma Nurse Core Curriculum, and Basic and Advanced Fetal Monitoring courses. The utilization of telehealth services to expand the availability of services, particularly behavioral health services, have seen significant increases in use during the past year. In general, when we become aware of a need for additional services to the community and service area, we take steps to assure development and delivery of programs to address the needs. SCHEDULE H, PART VI, LINE 6 SMITH COUNTY MEMORIAL HOSPITAL IS OPERATED BY GREAT PLAINS OF SMITH CO., INC., A SUBSIDIARY OF GREAT PLAINS HEALTH ALLIANCE. GPHA IS A 501(C)(3) NOT FOR PROFIT ORGANIZATION WHICH PROVIDES MANAGEMENT, FINANCE, BILLING, INFORMATION SYSTEMS, AND PHARMACY SUPPORT SERVICES TO ITS AFFILIATED ORGANIZATIONS. GPHA DOES NOT PROVIDE SERVICES DIRECTLY TO PATIENTS, BUT PROVIDES ACCESS TO PROFESSIONALS AND SYSTEMS WHICH MIGHT NOT OTHERWISE BE AVAILABLE OR AFFORDABLE TO SMALL RURAL HOSPITALS. GPHA PROVIDES EDUCATION AND ASSISTANCE IN AREAS SUCH AS HIPAA PRIVACY AND SECURITY, MEDICARE AND MEDICAID REIMBURSEMENT RULES AND REGULATIONS, MEANINGFUL USE REQUIREMENTS FOR ELECTRONIC HEALTH RECORDS, ETC. GREAT PLAINS HEALTH ALLIANCE BRINGS TOGETHER ITS NETWORKED CRITICAL ACCESS HOSPITALS IN KANSAS AND NEBRASKA TO LEARN FROM EACH OTHER AND DEVELOP BEST PRACTICES IN CARE PROVISION, MANAGEMENT, AND GOVERNANCE. AFFILIATED HOSPITALS RECEIVE POLICY GUIDANCE REGARDING FINANCIAL ASSISTANCE TO PATIENTS, CORPORATE COMPLIANCE, CONFLICTS OF INTEREST, AND MANY OTHER AREAS. GUIDANCE IS ALSO PROVIDED TO THE GOVERNING BOARDS OF AFFILIATED HOSPITALS TO ASSIST THEM IN FULFILLING THEIR FIDUCIARY RESPONSIBILITIES. SCHEDULE H, PART VI, LINE 7 N/A false false false false false false false false false DAVE DELLASEGA PRESIDENT/SECRETARY/DIRECTOR 0 204936 0 0 0 2935 0 20567 0 12755 0 241193 0 0 DURREL KELLEY SENIOR VP OF OPERATIONS 0 127708 0 0 0 2258 0 12224 0 15201 0 157391 0 0 ALLEN VANDRIEL ADMINISTRATOR 167004 0 0 0 1697 0 16300 0 16677 0 201678 0 0 0 JUSTIN OVERMILLER PHYSICIAN 323324 0 0 0 2182 0 27700 0 22074 0 375280 0 0 0 HANNAH HAACK PHYSICIAN 336903 0 0 0 2155 0 27700 0 22074 0 388832 0 0 0 FERRILL CONANT PHYSICIAN 251462 0 0 0 2239 0 24570 0 14381 0 292652 0 0 0 LEAH WIEHL PHYSICIAN 206262 0 0 0 1865 0 20561 0 18280 0 246968 0 0 0 TAMARA WINDSCHEFFEL ARNP 160136 0 0 0 1497 0 15513 0 15880 0 193026 0 0 0 FORM 990, PART VII; SCHEDULE J, PART I, LINE 3 COMPENSATION FOR DAVE DELLASEGA AND DURRELL KELLEY IS PROVIDED BY GREAT PLAINS HEALTH ALLIANCE, A RELATED ORGANIZATION. GREAT PLAINS HEALTH ALLIANCE'S BOARD OF DIRECTORS ANNUALLY APPROVE THE COMPENSATION FOR MR. DELLASEGA AND MR. KELLEY. THE AMERICAN COLLEGE HEALTHCARE EXECUTIVES AND THE KANSAS HOSPITAL ASSOCIATION ALSO HAVE COMPARABLE COMPENSATION DATA THAT CAN BE USED BY THE BOARD. A COMPENSATION REVIEW WAS DONE WHEN DAVE DELLASEGA TOOK OVER AS CEO AND WAS CONDUCTED BY THE BOARD, BUT SINCE THAT TIME THERE HAS BEEN NO FORMAL COMPENSATION REVIEW. FORM 990, PART III, LINE 4A The largest program services measured by expenses are: 1. Smith County Memorial Hospital - This 16 bed Critical Access Hospital provides a wide variety of inpatient and outpatient medical services to residents of the service area. Included among these services are the following: a. Inpatient Care - i. Acute and Observation (outpatient) care for patients with medical and surgical conditions. This includes neonatal, pediatric, adult, and geriatric patients. ii. Skilled Swing Bed care for patients requiring post-acute care, especially skilled nursing and rehabilitation services. iii. Private Pay custodial care is provided on a limited basis. Much of this care is provided to patients who have elected Hospice benefits but do not have family members able care for them in the home. b. Obstetrical Care including prenatal education, monitoring and diagnostic services during the prenatal period, as well as labor and delivery services during the perinatal period. This includes surgical care for scheduled and urgent c-sections needed for delivery. c. Emergency Care available 24 hours per day by a staff of specially trained Registered Nurses, Advanced Practice Registered Nurses, Physician Assistants, and physicians. All Emergency Department staff are certified in various types of advanced life support programs, including Advanced Cardiovascular Life Support, Pediatric Advance Life Support, and advanced trauma care courses. This facility is certified as a Level IV Trauma Center, and is certified as a stroke care center. Telehealth services are available in each of the trauma rooms, connecting instantly to Registered Nurses and board certified Emergency Physicians at a dedicated response center in South Dakota. This telehealth service also provides evaluation of patients suffering from crisis level behavioral health emergency services. d. Ancillary diagnostic and therapeutic services. These include: i. Laboratory with staff available 24 hours per day to perform a wide variety of chemistry, hematology, coagulation, urinalysis, blood gas, as well as basic microbiology tests. Blood banking is also available. A contracted reference laboratory performs more complex testing, and pathology services. ii. Diagnostic Imaging services include digital x-ray, CT Scan, Diagnostic Ultrasound, Echocardiography, portable Fluoroscopy, Mammography, and Bone Density. Mobile services provided under contract include MRI and Nuclear Imaging. iii. Anesthesia and Pain Management services are provided in the Emergency, ambulatory surgery, and inpatient surgical setting by a dedicated Certified Registered Nurse Anesthetist. iv. Respiratory Therapy and Pulmonary Function are available, including acute inpatient and Emergency Department assistance with airway management, supplemental Oxygen and aerosol therapy, short term mechanical ventilation, and assistance with neonatal resuscitation. v. Physical and Occupational Therapy, as well as Speech Language Pathology are available for inpatient and outpatient care. vi. Cardiac and Pulmonary Rehabilitation services are provided to patients on a scheduled basis. Patients recovering from cardiac events or surgery, and patients with chronic pulmonary disease benefit from these services. vii. Wound Care services are available through a contract service on a weekly basis. GPSC medical staff and nursing staff from the Rural Health Clinic help staff this clinic, which provides debridement and care for slow-healing wounds, as well as the application of skin substitute products to promote healing. viii. Diagnostic Sleep Services including both attended and home sleep studies and CPAP titration are provided under a contract arrangement. ix. Dietary Services to inpatients and outpatients are provided by a staff led by a Registered Clinical Dietician who is also our Executive Chef. Tailoring of meals to meet the therapeutic needs and desires of our inpatients, coupled with education regarding healthier food choices are provided to every inpatient. The Food Services staff also provide and package the meals for the Meals on Wheels program. 2. Smith County Family Practice - This Certified Rural Health Clinic provides primary care services to pediatric, adult and geriatric patients for a full range of medical conditions. Staffed by five board certified Family Medicine Physicians as well as Physician Assistants and Advanced Practice Registered Nurses. In addition to primary care services delivered in the RHC, these providers staff the Emergency Department and inpatient and outpatient areas of the CAH. They also provide services to patients (residents) in skilled nursing and ICF long term care facilities in Smith, Osborne, and Phillips counties. Physicians also serve as Medical Directors for two skilled nursing facilities, for Smith County EMS, and as the County Health Officer. 3. 340B Pharmacy Services - Great Plains of Smith County, Inc. utilizes the 340B program operated under the auspices of the Health Resources and Services Administration (HRSA) to obtain drugs and pharmaceuticals for use in the outpatient setting at Smith County Memorial Hospital (the CAH) as well as through contracted arrangements with four area retail pharmacies. The discounted pricing available under this program (although under threat currently by unilateral action by some drug manufacturers) allows us to offset the cost of delivery of services within our service area. FORM 990, PART VI, SECTION A, LINE 2 DAVE DELLASEGA AND DURREL KELLEY HAVE A BUSINESS RELATIONSHIP. THEY ARE BOTH EMPLOYED BY, AND ALSO OFFICERS OF, A RELATED 501(C)(3) ORGANIZATION, GREAT PLAINS HEALTH ALLIANCE. FORM 990, PART VI, SECTION A, LINE 6 GREAT PLAINS HEALTH ALLIANCE, INC., A NOT-FOR-PROFIT 501(C)(3) ORGANIZATION, IS THE SOLE MEMEBER OF GREAT PLAINS OF SMITH CO., INC. FORM 990, PART VI, SECTION A, LINE 7A GREAT PLAINS HEALTH ALLIANCE, INC., BEING THE SOLE MEMBER, HAS THE RIGHT TO ELECT AND APPROVE ALL THE BOARD MEMBERS. FORM 990, PART VI, SECTION A, LINE 7B GREAT PLAINS HEALTH ALLIANCE, INC. (GPHA) IS THE SOLE MEMBER AND HAS THE AUTHORITY TO APPROVE THE ARTICLES OF INCORPORATION, BYLAWS, ELECTION TO OR REMOVAL FROM THE BOARD OF DIRECTORS, THE ANNUAL OPERATING AND CAPITAL BUDGETS, AND THE LONG RANGE OR STRATEGIC PLANS. FORM 990, PART VI, SECTION B, LINE 11B THE 990 IS PREPARED AND REVIEWED BY AN INDEPENDENT ACCOUNTING FIRM. THE 990 IS THEN PROVIDED TO THE CHIEF EXECUTIVE OFFICER FOR REVIEW AND APPROVAL. AN ELECTRONIC DRAFT OF THE 990 WITH ALL REQUIRED SCHEDULES IS THEN PROVIDED TO THE FULL BOARD FOR REVIEW PRIOR TO FILING THE 990 WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION IS REQUIRED TO ADOPT GPHA'S CONFLICT OF INTEREST POLICY. ALL BOARD MEMBERS, OFFICERS, AND EMPLOYEES ARE SUBJECT TO THE CONFLICT OF INTEREST POLICY AND SIGN AN ANNUAL ACKNOWLEDGEMENT THAT THEY HAVE READ, UNDERSTAND AND COMPLIED WITH THE GPHA CONFLICT OF INTEREST POLICY. UNDER THE POLICY, ANY MEMBER WHO HAS A DIRECT OR INDIRECT (VIA FAMILY) FINANCIAL INTEREST IS CHARACTERIZED AS AN INTERESTED PERSON. INTERESTED PERSONS ARE REQUIRED TO DISCLOSE FINANCIAL INTERESTS WITH COMPANIES DOING BUSINESS WITH GPHA. THE INTERESTED PERSON MUST RECUSE THEMSELVES FROM FURTHER DISCUSSIONS OF THE TRANSACTION AND LEAVE THE ROOM. THE REMAINING NON-INTERESTED MEMBERS DECIDE IF A CONFLICT OF INTEREST EXISTS. THE BOARD CHAIR MAY APPOINT ANOTHER DISINTERESTED PARTY TO DISCUSS THE TRANSACTION OR THE REMAINING BOARD MEMBERS MAY VOTE TO ENTER INTO OR ABSTAIN FROM THE SUSPECT TRANSACTION. FAILURE TO DISCLOSE FINANCIAL INTERESTS BY INTERESTED BOARD MEMBERS WILL RESULT IN DISCIPLINARY ACTION, INCLUDING SANCTIONING BY BOARD. ALL CONFLICTS OF INTEREST AND THEIR ULTIMATE RESOLUTION ARE DOCUMENTED IN THE BOARD MINUTES. THE BOARD CONDUCTS PERIODIC REVIEWS TO DETERMINE THAT CONFLICTS ARE BEING IDENTIFIED AND RESOLVED ACCORDING TO POLICY DOCUMENTATION. REVIEWS BY OUTSIDE EXPERTS ARE PERMITTED, BUT NOT REQUIRED. FORM 990, PART VI, SECTION B, LINES 15A & B THE CEO AND COO ARE COMPENSATED BY GREAT PLAINS HEALTH ALLIANCE, A RELATED ORGANIZATION. GPHA'S BOARD USES COMPARABILITY DATA IN SETTING THEIR SALARIES, AND DOCUMENTATION IS RETAINED OF THE BOARD'S DELIBERATIONS AND DECISIONS. 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. THE COMPANY'S KANSAS ANNUAL REPORT IS ALSO AVAILABLE UPON REQUEST FROM THE KANSAS SECRETARY OF STATE. FORM 990 PART IX LINE 11G DESCRIPTION:CONTRACTED MEDICAL STAFF TOTAL FEES:1878867 FORM 990 PART IX LINE 11G DESCRIPTION:BILLING/COLLECTIONS TOTAL FEES:372904 FORM 990 PART IX LINE 11G DESCRIPTION:LAB SERVICES TOTAL FEES:266783 FORM 990 PART IX LINE 11G DESCRIPTION:PHARMACY SERVICES TOTAL FEES:175231 FORM 990 PART IX LINE 11G DESCRIPTION:ADMINISTRATION/HUMAN RESOURCES TOTAL FEES:87630 FORM 990 PART IX LINE 11G DESCRIPTION:MAINTENANCE/HOUSEKEEPING TOTAL FEES:72450 FORM 990 PART IX LINE 11G DESCRIPTION:PLANT OPERATIONS TOTAL FEES:22164 GREAT PLAINS HEALTH ALLIANCE INC 250 N ROCK ROAD STE 160 WICHITA KS 67206 480617739 MANAGEMENT KS 501(C)(3) 3 NA false GREAT PLAINS HEALTH CARE FOUNDATION INC 250 N ROCK ROAD STE 160 WICHITA KS 67206 480955870 SUPPORT KS 501(C)(3) 10 GPHA INC true GREAT PLAINS OF ELLINWOOD INC 250 N ROCK ROAD STE 160 WICHITA KS 67206 481226976 HOSPITAL KS 501(C)(3) 3 GPHA INC true GREAT PLAINS OF OTTAWA COUNTY INC 250 N ROCK ROAD STE 160 WICHITA KS 67206 481226856 HOSPITAL KS 501(C)(3) 3 GPHA INC true GREAT PLAINS OF SABETHA COUNTY INC 250 N ROCK ROAD STE 160 WICHITA KS 67206 481236156 HOSPITAL KS 501(C)(3) 3 GPHA INC true GREAT PLAINS OF REPUBLIC COUNTY INC 250 N ROCK ROAD STE 160 WICHITA KS 67206 481226977 HOSPITAL KS 501(C)(3) 3 GPHA INC true GREAT PLAINS OF CHEYENNE COUNTY INC 250 N ROCK ROAD STE 160 WICHITA KS 67206 481226831 HOSPITAL KS 501(C)(3) 3 GPHA INC true GPHA EMPLOYEE BENEFITS TRUST 250 N ROCK ROAD STE 160 WICHITA KS 67206 476918582 HEALTH PLAN KS 501(C)(9) GPHA INC true GREAT PLAINS OF KIOWA COUNTY INC 250 NORTH ROCK ROAD STE 160 WICHITA KS 67206 481226833 HOSPITAL KS 501(C)(3) 3 GPHA INC true CHARITABLE REMAINDER TRUST (1) CHARITABLE TRUST KS GP OF SMITH CTY true CHARITABLE REMAINDER TRUST (1) CHARITABLE TRUST KS GP OF SMITH CTY true CHARITABLE REMAINDER TRUST (3) CHARITABLE TRUST KS GP OF SMITH CTY true false false false false false false false false false false true false true false true false false true false GPHA EMPLOYEE BENEFITS TRUST R 765721 FMV