2022-10-17T07:39:07-05:00 2021-12-31 481026809 Wendling Noe Nelson & Johnson LLC 623 SW 10th Ave Suite 300 Topeka KS 66612 990 2021-01-01 480576039 Clara Barton Hospital Association Inc CLAR 6206532114 250 West 9th Street Hoisington KS 675441799 James G Blackwell CEO 6206532114 2022-10-05 1 James Blackwell 999009999 Cameron L Werth P01797399 7852334226 2022-10-05 3 AAL1 IAL1 2021 2022-09-23 18:48:47Z James G Blackwell 250 West 9th Street Hoisington KS 675441799 38789770 0 X www.clarabartonhospital.com X 1946 KS Provision of inpatient and outpatient hospital services, primary care services, and surgical services to residents of our service area. 10 8 338 22 0 0 317334 5576596 25567343 31889931 317046 416414 537180 773038 26738903 38655979 1633 6446 0 0 16487738 19683452 0 0 91283 10431472 12791276 26920843 32481174 -181940 6174805 38717618 42373084 27755193 24424017 10962425 17949067 X Clara Barton Hospital Association is dedicated to meeting the health care needs and improving the quality of life for the community we serve. We continually pursue clinical excellence in an atmosphere of caring and compassion. We are deeply committed to serving all in need within our resources. 0 0 28471059 6446 32136307 Clara Barton Hospital Association provided a wide range of health care services to residents of its service area including 3,303 patient days of inpatient care, 24,535 outpatient hospital visits and 35,995 visits to our primary care and surgical clinics. 28471059 1 1 0 1 0 0 0 0 0 0 1 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 1 1 1 0 1 1 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 1 0 0 0 1 55 0 1 338 1 0 0 0 0 0 0 0 0 0 0 0 0 X 10 8 0 0 0 0 1 1 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X James G Blackwell 6206532114 250 West 9th Street Hoisington KS 675441799 Marla Mooney Vice-Chairperson thru Jan 2021 1.00 X X 0 0 0 Kathy Kaiser Secretary/Vice-Chairperson beg. Feb 2021 1.00 X X 0 0 0 Jim Carney Treasurer 1.00 X X 0 0 0 Lisa Beran Chairperson 1.00 X X 0 0 0 Doug Hubbard Director/Secretary beg, Feb 2021 1.00 X X 0 0 0 Jim Blackwell President/CEO/CFO 40.00 X X 196546 0 38899 Nathaniel Knackstedt Director/Chief of Staff 40.00 X 340013 0 38785 Tona King Director thru Feb 2021 1.00 X 0 0 0 Jonathan Kelly Director thru Aug 2021 1.00 X 0 0 0 Gary Shook Director 1.00 X 0 0 0 Karisa Cowan Director beg. Sept 2021 1.00 X 0 0 0 Kathy Burt Director beg. March 2021 1.00 X 0 0 0 Lois McLelland Director beg. Sept 2021 1.00 X 0 0 0 Kim Kindscher Director Feb 2021 - Aug 2021 1.00 X 0 0 0 Amanda Hoffman Pharmacist/COO 40.00 X 246476 0 42230 Taylor Bieberle Physician Assistant 40.00 X 176193 0 37790 Timothy Webb Physician 40.00 X 406204 0 32436 Patrick Stiles General Surgeon 40.00 X 947385 0 38864 Phillip Barnes Physician Assistant 40.00 X 168367 0 34468 Kyle Renner Physician 40.00 X 295744 0 45142 2776928 0 308614 16 0 1 0 Cerner Coporation PO Box 959156 St Louis MO 631959156 Computer support services 537627 Wichita Surgical Specialists 818 N Emporia Suite 200 Wichita KS 67214 Surgical services 497798 Affiliated Medical Services PO Box 12127 Wichita KS 672772127 Lab Services 287822 Shared Medical Services Inc 209 Limestone Pass Great Bend KS 67530 MRI and PET Services 282135 Daniel Brendan Rice 13710 E Ayesbury St Wichita KS 67228 ER Physician coverage 273627 12 28435 5420212 127949 5576596 Patient service revenue 622110 30221662 30221662 340b drug program revenue 622110 1668269 1668269 31889931 405086 405086 455963 455963 19570 0 19570 19570 19570 145119 133791 11328 11328 11328 All other 621990 189564 189564 Purchase discounts and rebates 621990 56812 56812 Cafeteria 722210 51129 51129 297505 38655979 32136307 0 943076 6446 6446 614815 379027 235788 15624299 14124958 1430208 69133 314590 287019 26150 1421 2146583 1946474 190613 9496 983165 879932 99005 4228 17533 17533 7840 7840 2550048 1994890 555023 135 103438 50993 52445 1398966 1171407 226849 710 552427 414320 138107 311626 258533 51977 1116 46963 44114 2846 3 131440 131440 1499754 1294060 201259 4435 187807 46911 140751 145 Pharmacy supplies 2341908 2341908 Medical supplies 1383815 1383815 340B program 852120 852120 Repairs and maintenance 503126 477820 24888 418 902465 516312 386110 43 32481174 28471059 3918832 91283 389199 446916 20872403 13987474 2605222 3728263 969364 990973 569286 596821 29547661 13745306 7257575 15802355 3779913 5452566 2274656 1367716 38717618 42373084 3839478 6691547 4629411 1112404 12751852 12520952 1392052 1099114 5142400 3000000 27755193 24424017 X 10397450 16715099 564975 1233968 10962425 17949067 38717618 42373084 X 6174805 242844 568993 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 1 5464 0 0 0 5464 0 Part II-B, Line 1: Clara Barton Hospital Association, 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. 1854765 1478486 376279 8672734 6717263 1955471 8866459 5549557 3316902 10153703 10153703 15802355 X 39461367 242844 -6449 236395 39224972 -568993 -568993 38655979 32474725 -6449 -6449 32481174 0 32481174 Part X, Line 2: Management is not aware of any uncertainties in income tax positions. Part XI, Line 2d - Other Adjustments: Contribution expense included in revenues on financial statements -6,449. Part XI, Line 4b - Other Adjustments: Change in beneficial interest in net assets of Foundation, net of transfers -568,993. Part XII, Line 2d - Other Adjustments: Contribution expense included in revenues on financial statements -6,449. 1 1 1 X 1 X 1 1 0 1 1 594992 594992 0.01830 2648544 1487281 1161263 0.03580 3243536 1487281 1756255 0.05410 85985 85985 0.00260 179710 179710 0.00550 8347600 6772912 1574688 0.04850 8613295 6772912 1840383 0.05660 11856831 8260193 3596638 0.11070 1 1338344 26767 9701917 9605858 96059 X 1 1 1 1 Clara Barton Hospital 250 West 9th Street Hoisington KS 675441799 H005003 X X X X Physician clinics & rural health clinics Clara Barton Hospital Association Inc 1 0 0 1 X X X X X X X X X 21 1 0 1 1 X https://clarabartonhospital.com/ X 1 21 1 https://clarabartonhospital.com/ 0 1 X 150.000000000000 300.000000000000 X X X X X 1 1 X X X 1 X https://clarabartonhospital.com/ X https://clarabartonhospital.com/ X https://clarabartonhospital.com/ X X X X X X 1 X 0 X X X X 1 X 0 0 Clara Barton Hospital Association, Inc. Part V, Section B, Line 5: The CHNA was conducted in collaboration with the Barton County Health Department. The Hospital reached out to members of the community with broad interests in the community served and special knowledge of or expertise in public health from groups such as local hospitals, public health community, free clinics, community based clinics, service providers, school leaders, and local government. A Town Hall meeting of 39 attendees was conducted. The Town Hall meeting reflected on the size and seriousness of any health concerns cited and discussed current community health strengths, as well as identifying and ranking top community health concerns. In addition to the Town Hall meeting, CHNA surveys were completed by Barton County residents. The survey was created to measure Barton County residents' views regarding health care perceptions of delivery, access, and health practices. Clara Barton Hospital Association, Inc. Part V, Section B, Line 6b: Barton County Health Department (located in Great Bend, KS - Barton County) Clara Barton Hospital Association, Inc. Part V, Section B, Line 11: The annual update below pertains to the CHNA and implementation strategy completed for the 2018 tax year, which is the third-annual update for the three-year cycle. Next year's annual update will pertain to the CHNA and implementation strategy completed for the 2021 tax year.1.Diabetic Education (Diet/Exercise) and Decreasing ObesityCBH continues to offer a full range of inpatient and outpatient nutrition services designed to help our patients achieve optimal health and feel their best. Our goal is to provide evidence-based nutrition care for treatment of acute and chronic illnesses and to promote nutritional health for adults and children who are either referred by their physician or taking steps on their own to improve their health. Whether someone simply wants to learn to eat healthier, or if they have special dietary needs, our registered dietitian will conduct an individualized nutrition assessment and create an individualized plan just for that person. Reasons why individuals may seek the assistance of a Registered Dietitian: Chronic Disease, Gut Health, Disordered Eating, Women's Health, Athletes, Patients interested in Bariatric Surgery, Practical Lifestyle Advice.CBH has representation on several boards that focus on diet and exercise such as the Health for Life Coalitions, Be Well Barton County and Kansas Healthy Hospitals.CBH remains dedicated to providing our community nutrition expertise. During 2021 we very actively looked to hire an additional Registered Dietitian. One was found and is slated to start in January 2022.Through out the year CBH posts healthy recipes on our Facebook to share with the community.Quarterly Lab fairs are offered to the public at a discounted rate.Clara Barton offers a full range of both inpatient and outpatient nutrition services designed to help patients achieve optimal health.April 28, 2021, CBH hosted a community wide event for National Walk at Lunch Day.May 2021, bike sharrows were painted on streets in Great Bend to encourage biking and to make it safer for the community. May 2021 the Cottonwood Extension office share information on "Kids and Vegetables". Topics included how to keep snacks healthy. How to follow the MyPlate food guide system for healthy eating. How to involve kids in selecting and preparing their healthy snacks. June 2021 the Cottonwood Extension office shared information on "Fluids important to manage heat, humidity safely". Topics included staying hydrated as the temperature climbs. Why water is important and how much you should drink. The effects of excessive water loss or dehydration as well as the signs of heat exhaustion.During the Barton County Fair, July 2021, nutritious smoothie recipes were shared with attendees. A blender bike was brought in. A bike with an apparatus above the wheel holding the blender. Participants could hop on the bike and blend up a smoothie. The blender bike was brought in to support and encourage children and families to eat well and be active.Tuesday October 5, 2021, the Hoisington Library hosted an educational program about fermenting vegetables. The program shared the different methods of fermenting vegetables and the health benefits of including a small amount of fermented food in a healthy daily meal plan. 2. Provide SpecialistsCBH continues to partner with Wichita Urology to bring Dr. Andrew Jensen twice a month. With Salina Regional Neurosurgery to bring Dr. Scott Boswell once a month and Rheumatologist Dr. Kenneth Baxa six times a month. Central Kansas Orthopedic Group to bring the orthopedic services of Dr. Randall Hildebrand to the community twice a month, once for clinic and once for surgical procedures. With the Hutchinson Clinic to bring Dr. Costy Mattar a cardiology specialist twice a month, OB/GYN services of Dr. Christine Sanders monthly, Pulmonologist Dr. Humayun Ashraf once a month, Podiatrist Andrea Drieling monthly and Dr. Curt Thompson a diagnostic radiology specialist weekly. With the Wichita Surgical Specialists to bring Dr. Brett Grizzell specializing in cardiothoracic surgery monthly. With Abay Neuroscience of Wichita to bring Dr. Matthew Henry monthly. With Maternal - Fetal Associates of Kansas to bring Dr. Evans, MD - Perinatology monthly. With Cardiovascular Consultants of Wichita to bring Cardiologist Dr. Bassem Chehab, MD twice a month.June of 2021 CBH expanded its pediatric care services with the addition of Pediatrician Dr. Kayla Johnson.Dr. Roxanne Stiles joined our surgical practice August 2021. 3. Improve Assessment/Placement for Mental HealthFebruary 2021 CBH received their annual recertification as a Patient-Centered Medical Home by the national Committee for Quality Assurance (NCQA). This certification establishes a model of care that is patient-focused, improving the quality of care, enhancing patient experience, building relationships between patients and providers, and providing additional clinic services to better serve patient needs. This includes a quality measure tracking the number of PHQ-9 assessments that are completed.CBH continued our partnership with the KU Alzheimer's Disease Center to improve assessment of Alzheimer patients and to provide care giver counceling once a month. CBH offers Behavioral & Mental Health Therapy for children and adults. July 2021 The Golden Belt Community Foundation awarded a $25,000 grant to the Zero Reasons Why project in our community. The goal is to reduce youth suicide rates. Superintendents from all Golden Belt schools meet to get a better understanding of the program and how they might incorporate it in their schools. Joining as partners in this program are the Behavioral Health Advisory Committee; Juvenile Justice Authority; and Suicide Prevention Task Force of the Central Kansas Partnership.Fall of 2021 Hoisington High School Students started the Zero Reasons Why Program. This is a teen-led campaign to reduce teen suicide and emphasize that mental health is as important as physical health. Other schools getting involved include: Central Plains, Stafford, St John-Hudson, Ellinwood, Sterling, Chase-Raymond, Lyons, Great Bend, Fort Larned and Pawnee Heights.Luna, a Bernese Mountain Therapy Dog and her handler Glen stops by CBH on a weekly basis to visit patients providing love and comfort.Saturday, September 18, 2021 the community held the Golden Belt Glow Run for Life 5k/1 mile run at Veterans memorial Park in Great Bend. This event is an awareness and remembrance event that raises awareness for suicide prevention. The Cottonwood extension District Facebook page has started including segments for "Wellness Wednesday" These posts are short videos created by the staff at High Plains mental Health, that address mental health topics.4. Develop Substance Abuse Education (Alcohol & Tobacco)A Tobacco Free City Park ordinance was passed in the City of Hoisington February 2021. This includes all forms of tobacco as well as e-cigarettes. April 2021 New Tobacco Free Park Signage was placed in both Great Bend and Hoisington Parks.Rise Up Central Ks has been very active in the community providing resources to prevent, overcome, and abstain from substance misuse. September 2021 Barton County Commission approved a Recovery Proclamation. September 2021 held a Narcan March at Jack Kilby Bandshell. The event included recovery out loud, speakers and luminaries.Antibiotic Stewardship is a coordinated program designed to promote the appropriate use of antimicrobials. Goals of this program include improving patient outcomes, decreasing the spread of infection, and reducing bacterial resistance. Drug resistant bacteria develop from the misuse of antibiotics and can result in life-threatening infections. Taking steps to encourage proper antibiotic use helps to slow bacterial resistance, decrease adverse health effects, and ensure that life-saving medications remain available. At CBH our focus on antibiotic stewardship directly correlates with the principals of community health and wellness. CBH continue efforts in developing complete antibiotic stewardship program that promote the proper use of antibiotic medications. Our stewardship efforts demonstrate a commitment to our patients by improving safety, outcomes, and a dedication to quality of care.During 2021 the All-Stars program continued in our local school systems. The programs are designed to help students talk about the benefits of avoiding drugs and alcohol. One of its goals is to reduce use and abuse, especially of gateway drugs: alcohol, cigarettes, marijuana and inhalants. Free Naloxone Training offered February 2021 - Participants learned how to recognize and respond to signs of an overdose and how to administer Naloxone. Clara Barton Hospital Association, Inc. Part V, Section B, Line 11: CBH again partnered with the Great Bend Health department to host a community baby shower for pregnant mothers in need. Education was provided on Smoking Cessation, Safe Sleep and Breast Feeding.CBH continues to participate in the Kan-Quit cessation program. 5. Provide Sex Education in Schools (Decrease Teenage Pregnancy, Decrease Unmarried Mothers)During 2021 the All-Stars program continued in our local school systems. The programs are designed to help students talk about the benefits of avoiding drugs and alcohol, but it also seeks to help students avoid other risky behaviors, such as early sexual experience, fighting and bulling.Prevention education and services are provided by the Barton County Health Department. They include services such as sex education, birth control counseling, physical exams, pap tests, disease screening, sexual and reproductive health, family planning etc.6. Improve Immunization RatesFebruary 2021 CBH received their annual recertification as a Patient-Centered Medical Home by the national Committee for Quality Assurance (NCQA). This certification establishes a model of care that is patient-focused, improving the quality of care, enhancing patient experience, building relationships between patients and providers, and providing additional clinic services to better serve patient needs. This includes a quality measure for Immunizations.Flu vaccines and covid vaccines are offered anytime in all of CBH clinics. In addition the following opportunities were made available to the community:CBH hosted a Drive-Thru for Covid Vaccines from 8:00 - 10:00 3/10/2021.CBH hosted a Walk-in COVID Vaccine Clinic during our Lab Fair from 7:00 - 9:00 4/17/2021.CBH hosted a Drive-Thru for Covid Vaccines from 8:00 - 10:00 4/21/2021.CBH hosted a Drive-Thru for Flu Vaccines from 8:00 - 10:00 10/9/2021.CBH hosted a Vaccine Clinic 11/3/2021 from 7:00 - 11:00. Vaccines available included: Flu, Covid and Covid booster. Free breakfast was given to everyone attending this event.CBH Staff went directly to the schools in Hoisington to give faculty and students vaccinations as well as several community worksites.7. Provide Senior Physical Activity at a Reasonable PriceThe Hoisington activity center charges a small one-time life-time fee of $20 for anyone who lives in the Hoisington school district USD 431. The City of Hoisington offers several free parks where residents can walk, run, and play. Bicentennial Park offers a 1-mile outdoor walking trail along with tennis courts, horseshoe pits, pickleball courts and a dog park.CBH offers a walking loop around the hospital campus. 2.5 laps is a mile. The loop also offers 5 pieces of exercise equipment geared towards Physical Therapy rehab and the Seniors.Great Bend Recreation Center offers reduced (daily, monthly, six month and yearly) rates for seniors. Walking is free to the public. Senior Activities are available most of the time for free. Veterans' Memorial Park in Great Bend offers a 1-mile fitness trail, tennis courts, a fitness station with workout equipment, a dog park and fishing. Club 1 Fitness is the largest health club in Great Bend. It offers a comprehensive weight room, cardio equipment, an Olympic size swimming pool and offers over 40 group fitness classes, including many for the Senior age group. Memberships are discounted for Seniors. Hoisington is in the process of establishing a bike share program. During 2021 bikes were purchased, bike station sites were selected and erected. Public access will be given in 2022. Bikes will be stationed near the city office, Rodeway Inn & Suites Hotel and the Hoisington Activity Center. Free to the public. Clara Barton Hospital Association, Inc. Part V, Section B, Line 20e: CBH notified all uninsured patients about the Hospital's FAP by letter, orally, and on patient statements. 4 1 - Clara Barton Medical Clinic 252 W 9th Street Hoisington KS 67544 Rural health clinic 2 - Clara Barton Surgical & Specialty Clinic 351 W 10th Street Hoisington KS 67544 Physician clinic 3 - Russell Family Medical Care 410 N Main Street Suite C Russell KS 67665 Rural health clinic 4 - Clara Barton Medical Clinic 1301 Jackson Street Great Bend KS 67530 Rural health clinic Part I, Line 7: Financial assistance at cost was determined by utilizing departmental cost-to-charge ratios for financial assistance provided in areas that are reported as subsidized health services. An overall cost-to-charge ratio derived from Worksheet 2 was used to determine the cost of financial assistance provided for services not reported as subsidized health services.Unreimbursed Medicaid costs were also determined using a blend of cost-to-charge ratios for certain services and an overall cost-to-charge ratio derived from Worksheet 2 for all other services.The cost of providing subsidized health services was determined using a cost-to-charge ratio for each service.Actual costs and revenues were utilized for all other items reported on line 7. Part I, Line 7g: Subsidized health services are comprised of services that the Hospital provides despite a financial loss to the organization. These services include the operation of a 24-hour emergency room, physician clinics, diabetic and dietician services, and various therapy services. The amount of costs attributed to physician clinics amount to $4,627,050. Part III, Line 4: The Hospital recognizes patient service revenue associated with services provided to patients who have third-party payor coverage on the basis of contractual rates for the services rendered. For uninsured patients that do not qualify for charity care, the Hospital recognizes revenue on the basis of its standard rates for services provided. On the basis of historical experience, a significant portion of the Hospital's uninsured patients will be unable or unwilling to pay for the services provided. Thus, the Hospital records a significant provision for bad debts related to uninsured patients in the period the services are provided.Part III, Line 2:Bad debt expense at cost was determined by utilizing departmental cost-to-charge ratios for financial assistance provided in areas that are reported as subsidized health services. An overall cost-to-charge ratio derived from Worksheet 2 was applied to the charges deemed uncollectible during the year for all other services.Part III, Line 3:Bad debt expense attributable to patients eligible under the organization's financial assistance policy was determined using an estimated 2% of total bad debts. The Hospital takes steps to assist individuals who are believed to qualify for financial assistance prior to writing accounts off as uncollectible.All non-reimbursed costs for treatment of patients in our community provides a community benefit since patients unwilling or unable to pay have received a valuable service at no cost or at a reduced cost to them. This improves the health of our community as a whole. Part III, Line 8: Medicare allowable costs were determined by using amounts from the Hospital's Medicare cost report as filed with the Medicare Administrative Contractor. The Medicare cost report apportions actual costs to the Medicare program using charges for ancillary services and patient days for nursing services. Caring for Medicare patients fulfills a community need and relieves a government burden as these patients typically have low or fixed income. Therefore, any shortfall should be included as a community benefit. Part III, Line 9b: The collection policy states that the patient must cooperate with the Hospital to provide the information and documentation necessary to apply for other existing financial resources that may be available to pay for health care services, such as Medicaid. Then the information is gathered and assessed in order to determine eligibility for charity care. Whenever possible, prior to admission, the Hospital will conduct a pre-admission interview with the patient, the guarantor, and/or the patient's legal representative. Those patients who may qualify for financial assistance from a governmental program will be referred to the appropriate program, prior to the consideration for charity care. Part VI, Line 2: The Hospital works closely with the Barton County Health Department and Kansas Department of Health and Environment to identify trends in the community. Education and information is provided to the public, including information on West Nile, chicken pox, and whooping cough, for example. The Hospital also trends data in the hospital and clinics to identify emerging issues. The Hospital has provided, a fall prevention program, "Stepping On", for interested elderly members of Hoisington and surrounding areas. The Hospital also trends trauma data in the emergency room and as a result provided literature to the public on fall prevention. Part VI, Line 3: There is signage posted at admissions desk. Patients are referred to a financial counselor at admission if they do not have insurance. The financial counselor also works with a Medicaid helper to try and get qualified patients registered for the Medicaid program. Effort is made during billing of deductible and co-payment to see if patient can qualify for charity care. Part VI, Line 4: The community being served is located in central Kansas and consists of approximately 2,700 residents. The average household income is $47,566. 12.6% of the community residents live below federal poverty level. Neighboring hospitals include facilities in Ellinwood and Great Bend. They are approximately 18 and 11 miles away respectively. Part VI, Line 5: The Hospital's Board of Directors is elected from the community at large. This allows independent individuals who reside in the primary service area to serve as a director. The Hospital also extends medical staff privileges to all qualified physicians in the community. Any surplus in funds is retained by the Hospital and aids in improving overall patient care and facility maintenance. 1 Clara Barton Hospital Foundation 250 W Ninth Street Hoisington KS 67544 481077460 6446 0 Cash paid General purpose funds from memorials and lab/book fair proceeds. 1 Part I, Line 2: The Hospital monitors grants by remitting only management approved amounts directly to the organizations supported. X X X 0 0 0 0 0 0 0 0 0 Patrick Stiles General Surgeon 445283 0 502102 0 0 0 8700 0 30164 0 986249 0 0 0 Timothy Webb Physician 343844 0 62360 0 0 0 8700 0 23736 0 438640 0 0 0 Nathaniel Knackstedt Director/Chief of Staff 293158 0 46855 0 0 0 8700 0 30085 0 378798 0 0 0 Kyle Renner Physician 282989 0 12755 0 0 0 14994 0 30148 0 340886 0 0 0 Amanda Hoffman Pharmacist/COO 245946 0 530 0 0 0 7518 0 34712 0 288706 0 0 0 Jim Blackwell President/CEO/CFO 196092 0 454 0 0 0 7122 0 31777 0 235445 0 0 0 Taylor Bieberle Physician Assistant 158927 0 17266 0 0 0 3876 0 33914 0 213983 0 0 0 Phillip Barnes Physician Assistant 144102 0 24265 0 0 0 4717 0 29751 0 202835 0 0 0 A Hoisington Public Building Commission 471454939 43466QBA6 2020-10-15 12569466 Renovate and expand the Hospital 0 0 0 A 12572534 361822 216638 4921489 7072585 0 0 0 1 A 0 0 0 0 0 0 0 A 0 0 1 0 0 0 0 0 1 A 1 Schedule K, Part II, Line 3, Total proceeds of issue The difference between Part II, Line 3 and Part I, Column (e) represent year-to-date investment earnings on bond proceeds. Anita Blackwell Spouse of James G. Blackwell, current officer 74259 Employment arrangement 0 Cardinal Pharmacy Partially owned by Marla Mooney, officer through Jan. 2021 496234 Dispensing fees remitted in accordance with 340B drug program agreement 0 Form 990, Part VI, Section A, line 6 Members of Clara Barton Hospital Foundation, Inc. are automatically members of Clara Barton Hospital Association, Inc. Form 990, Part VI, Section A, line 7a Members of Clara Barton Hospital Association, Inc. elect members of the governing body. Form 990, Part VI, Section B, line 11b Form 990 provided to governing body and reviewed prior to filing. Form 990, Part VI, Section B, line 12c A conflict of interest disclosure form is provided to each Board Member and is reviewed annually. Form 990, Part VI, Section B, line 15 The organization uses the KHA Salary Survey as a guide for determining CEO compensation with Board of Directors approval. The KHA Salary Survey is used by the CEO when determining compensation for other officers and key employees. Form 990, Part VI, Section C, line 19 The organization makes its governing documents, conflict of interest policy, and financial statements available to the public upon written request. Form 990, Part XI, line 9: Change in beneficial interest in Foundation net of transfers 568,993. Clara Barton Hospital Foundation Inc PO Box 25 Hoisington KS 67544 481077460 Provide support to Clara Barton Hospital KS 501(c)(3) Line 7 N/A 0 0 1 1 0 0 0 0 0 0 0 0 1 0 1 1 0 0 0 0