2019-05-15T15:10:42-05:00 2018-06-30 BKD LLP 1201 Walnut Suite 1700 Kansas City MO 641062246 990 2017-07-01 481253246 Pawnee Valley Community Hospital Inc % GEORGE HARMS TREASURER PAWN 6202853161 923 Carroll Ave Larned KS 67550 BRYCE YOUNG PRESIDENT 6202853161 2019-05-15 true Michael J Engle P00482834 8162216300 167.68.126.162 43372220191355000032 2019-05-15 P 2FDF6C8628F65582BED0B107C709513F48D8570B B63AEF58A3948584CFC9994E7E12F4E53EEB27F2 2017 2019-02-21 02:37:17Z BRYCE YOUNG 923 Carroll Ave Larned KS 67550 18737550 false X www.pawneevalleyhospital.com X 2001 KS Pawnee Valley Community Hospital, Inc. is a tax-exempt charitable organization under Section 501(c)(3) of the Internal Revenue Code and is licensed (see Schedule O) 6 2 152 94 0 580 152936 63086 17590974 18363867 20752 42474 181108 268123 17945770 18737550 28716 0 0 0 8409323 8616295 0 0 0 9536447 6709294 17974486 15325589 -28716 3411961 10623043 12730812 9269859 11368918 1353184 1361894 X Pawnee Valley Community Hospital, Inc. 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 (see Schedule O) false false 11403246 0 18363867 Patient care: Program services consist of routine and ancillary department healthcare services provided by a healthcare organization as described in 501(c)(3) of the IRS code. 11403246 true true false true false false false false false true false false false true true false false 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 true false false true 0 0 true 152 true false false false false false false false false false false X 6 2 false false false false true true true true true false false true true true true true true true true false X GEORGE HARMS TREASURER 7856235000 2220 CANTERBURY Hays KS 67601 Bryce Young President 4.0 40.0 X X 0 273220 85038 Shae Veach Vice President 4.0 40.0 X X 0 211544 69083 George Harms Treasurer 4.0 40.0 X X 0 279856 71874 Edward Herrman Director 4.0 40.0 X 0 68143 12388 David Sanger MD Director/Physician non-voting 40.0 0.0 X 284906 0 41713 John Haas Secretary 4.0 0.0 X X 0 0 0 Lynn Barger Director 4.0 0.0 X 0 0 0 John Jeter MD Director 4.0 40.0 X 0 573058 120521 Eric Lybarger Administrator 40.0 0.0 X 145396 0 21246 Kendra Barker Administrator 40.0 0.0 X 0 0 0 Christian Whittington Physician 40.0 0.0 X 320175 0 44213 MC Hill Physician 40.0 0.0 X 277486 0 38801 Debbie Tomlinson APRN 40.0 0.0 X 143008 0 11410 Calvin Kruger PHYSICIAN ASSISTANT 40.0 0.0 X 134215 0 9005 Amanda Bickle APRN 40.0 0.0 X 124503 0 28768 1429689 1405821 554060 11 false true false Hays Medical Center 2220 Canterbury Drive HAYS KS 67601 Contract Services 2877755 GE Healthcare 9900 W Innovation Drive WAUWATOSA WI 53226 Repairs/Maintenance 185855 Quest Diagnostics PO Box 14730 ST LOUIS MO 63150 Lab Services 150453 Anesthesiologist Associates of Hays PO Box 821 HAYS KS 67601 Anesthesia Services 125000 Wendling Noe Nelson Johnson 534 South Kansas Suite 1500 TOPEKA KS 66603 Accounting Services 115598 5 11223 51863 63086 Net patient service revenue 622000 17232535 17232535 340b drug program 900099 1089130 1089130 Outreach therapy services 900099 15063 15063 Lab fairs 900099 27139 27139 18363867 42048 42048 0 0 1600 1600 0 1600 1600 426 426 426 426 0 0 0 0 0 0 0 0 0 Meals sold to employees and guest 722210 156534 156534 ALL OTHER REVENUE 900099 109989 109989 109989 109989 266523 18737550 18363867 310597 0 0 0 0 420640 321153 99487 0 6485355 5836787 648568 299885 267486 32399 940311 838723 101588 470104 419316 50788 2218400 2218400 18357 18357 18340 18340 0 0 0 1226792 1029911 196881 0 64957 87 64870 131444 67160 64284 96345 57807 38538 0 607301 471122 136179 37331 25847 11484 0 0 2823 2823 0 0 94487 56692 37795 Pharmaceuticals 784884 784884 Medical Supplies 441383 441383 Dietary 176410 176410 Professional Fees/Dues/Subs 719694 605983 113711 70346 2495 67851 15325589 11403246 3922343 0 925211 1023480 5256421 5753164 0 0 2066682 3218449 0 0 0 0 0 0 284579 314443 151199 119222 0 0 0 122160 0 0 0 0 0 0 1938951 2179894 10623043 12730812 992734 981180 0 0 0 0 0 0 0 0 0 0 0 0 0 0 8277125 10387738 9269859 11368918 X 0 0 347347 356057 1005837 1005837 1353184 1361894 10623043 12730812 X 3411961 -3403251 X X false true X true false X false false false false false true 3436 false false false 3436 false Schedule C, Part II-B, Line 1f Pawnee Valley Community Hospital is a member of the Kansas Hospital Association and the American Hospital Association. Both of these organizations engage in lobbying activities for hospitals and health care as part of the services provided to members. 1266232 -72582 1193650 1169777 96455 1266232 934796 234981 1169777 372016 1515575 952795 934796 142777 408437 179198 372016 0.00000 1.00000 0.00000 false true true AMOUNTS DUE FROM 3RD PARTY PAY 818000 BENEFICIAL INTEREST FOUNDATION 1361894 2179894 0 Pension Liability 122160 Due to University of Kansas Hospital Authority 220282 Due to Pawnee County 9247180 Due to Hays Medical Center 567116 Estimated amounts due to third-party payors 231000 10387738 Schedule D, Part V, Line 4 Donations are requested for specific items or improvements to the Hospital. When a donation is received for that specific item, it is restricted for that use by the Board until the specific item or improvement is purchased. At any one time, one or more such projects can be in progress. true true X true X 130. true X true true false false 115500 115500 0.00870 987919 565153 422766 0.03190 1103419 565153 538266 0.04060 4100 4100 0.00030 2789352 1349514 1439838 0.10870 2793452 1349514 1443938 0.10900 3896871 1914667 1982204 0.14960 true 483426 10232644 10570956 -338312 X true true 1 1 Pawnee Valley Community Hospital Inc 923 Carroll Avenue Larned KS 67550 X X X X Pawnee Valley Community Hospital Inc 1 false false true X X X X X X X X X 17 true false true true X see part v, section c X true 17 true see part v, section c false true X 130. 400. X X X X X true true X X X true X see part v, section c X see part v, section c X see part v, section c X X X X X true X false X X X X true X false false Schedule H, 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 representatives from: United Way, Welcome Inn Senior Center, Center for Counseling, Angels Care Home Health, Golden Belt Foundation, Larned City Council, Burdett City Council and Garfield City Council and Rozel Community, Pawnee County Sherriff's office, Larned Police Department, Pawnee County Health Department, County Commissioners, members of the Chamber of Commerce, members of the USD 495 School Board, school nurses of USD 495, local members of the media, local religious organizations and representative of Pawnee Valley Community Hospital. The CHNA was coordinated and produced by VVV Research & Development, Inc. from Olathe, Kansas. Schedule H, Part V, Section B, Line 6b Pawnee County, KS Schedule H, Part V, Section B, Line 7a https://pawneevalleyhospital.com/wp-content/uploads/2018/06/CommunityHealt hNeedsAssessnent_PawneeCo_2018.pdf Schedule H, Part V, Section B, Line 10a https://pawneevalleyhospital.com/wp-content/uploads/2018/09/CHNA-Improveme ntPlan-Pawnee-2018.pdf Schedule H, Part V, Section B, Line 11 Annual description of the actions taken by the Hospital during the fiscal year to address the significant health needs identified throughout the most recently conducted CHNA: 1.) Build and/or Develop Exercise Facilities - 37 votes, 22.8% Construction on the Fort Larned USD #495 community fitness center is complete and is expected to be open to the public August 2017. Any Pawnee County taxpayer can get a membership to the fitness center for $25 a year. PVCH is planning their annual fun run for August 2017. The money raised will be used to help purchase physical education equipment and playground equipment for the new elementary school. The community continues to support other local exercise entities such as spin class, taekwondo, Yoga, and an independently owned exercise gym. 2.) Expand Oncology Services - 25 votes, 15.4% We have explored the feasibility of offering oncology services and providers in Pawnee County and it was determined not to be feasible at this time. The services that PVCH provides to Oncology patients through our special nursing services department are Central Line Maintenance, Transfusions, Injections, non-chemo infusions, and removal of chemotherapy pumps. 3.) Improve Air Quality (Feed Lots) - 20 votes, 12.3% We plan to continue to look into improving air quality in Pawnee County. More research needs to be done to determine if it is feasible for PVCH to implement a plan to address air quality issues. 4.) Reduce Drug/Alcohol Abuse - 20 votes , 12.3% PVCH currently does education and discharge instructions in our Emergency Department for any patients that come in under the influence of drugs and/or alcohol. The Pawnee County Health Department and Pawnee Valley Community Hospital continues to partner with The Center for Counseling through an "Improving Health in Rural Counties" grant. The grant project focuses on public mental health awareness and utilization campaign focusing on (1) recognition and understanding of the importance of mental health and substance abuse issues; (2) public recognition of local behavior health resources/services (including substance use); and (3) increased utilization of those services. - Print and radio advertisements are ongoing to increase behavioral health awareness and assist with increasing understanding of available community resources. - A community behavioral health resource has been created to assist linking people to appropriate treatment. - Crisis mental health screenings are being performed by telemedicine to help make the screenings more accessible and get people to assistance more rapidly. - Mental health kiosks "Get a Checkup from the Neck Up" are available at the health department for people to take an anonymous screening (eight different categories) and results are given to the person and they are directed by information on the screen to access assistance. - Information is provided at community health fairs on mental health and substance use issues. The Pawnee County Commissioners signed a resolution on April 3rd, 2017 for the "Stepping Up Initiative". This initiative is to help reduce the number of people with mental illnesses in jails, including those with substance abuse, as three quarters of those with mental healtlh illness in jails also have substance abuse issues. The first community partner meeting for this initiative will be April 19th and includes the following: 1. Larned State Hospital 2. Law Enforcement 3. EMS 4. Pawnee Valley Community Hospital 5. The Center for Counseling 6. Pawnee County Ministerial Alliance 7. Community Corrections 8. Family Crisis Center 9. County Attorney 10. Public Health 11. Medical Provider The health department, as part of our comprehensive data collection, screens individuals accessing the health department for alcohol and substance abuse and then refers if help is needed. 5.) Provide Health Food Options - 14 votes, 8.6% Pawnee Valley Community Hospital is promoting healthy eating lifestyles focusing on food labels, healthy meal options, nutrition, and portion control. In 2016 PVCH signed the healthy Kansas hospital initiative. We are in the process of forming an internal committee and developing a policy. The plan is to then extend the committee to include community members and focus on what changes we can make in the community such as grocery store options and healthy meal options at local restaurants. We continue to offer diabetic education classes which is a two day session 6 times a year. Participants eat at the facility and go through the cafeteria line and are encouraged to make healthier food choices. PVCH continues to educate children at their annual sixth grade health fair and includes education on portion control, label reading, and exercise. The health department promotes the diabetes support group and sends out their meeting reminders each month. The diabetes support group discusses nutrition with people in attendance. 6.) Increase Access to Home Health/Hospice - 11 votes, 6.8% PVCH continues to be a partner with the Kansas Heart and Stroke Collaborative and we have a part time staff member that goes into the home and checks on the patient and makes sure they are following the guidelines provided by their physician, pertaining to heart and stroke. PVCH has obtained an agreement with Golden Belt Home Health and Hospice for respite care. 7.) Offer Nursing Home Dementia Services - 11 votes, 6.8% Country Living Assisted Living facility in Pawnee County will be operating another building for "Memory Care" in November 2017. Number of beds dedicated to memory care is based on availability and need of care level of the patient. Staff is trained with dementia and Alzheimer's training. Country Living is a member of the Alzheimer's association. Schedule H, Part V, Section B, Line 13b Financial assistance may be given for catastrophic medical expenses, even if patient's income exceeds the Federal poverty guidelines. Schedule H, Part V, Section B, Line 16a https://www.pawneevalleyhospital.com/wp-content/uploads/2018/12/Financial- Assistance-Policy-PVCH11-2018.pdf Schedule H, Part V, Section B, Line 16b https://www.pawneevalleyhospital.com/wpcontent/uploads/2019/02/BUS136.pdf and https://www.pawneevalleyhospital.com/wpcontent/uploads/2019/02/BUS116a.pdf Schedule H, Part V, Section B, Line 16c https://www.pawneevalleyhospital.com/billing/financial-assistance-policy-s ummary/ 1 Pawnee Valley Medical Associates 713 W 11th St Larned KS 67550 Family Medicine Schedule H, Part I, Line 7 A cost-to-charge ratio derived from Worksheet 2 was used to determine financial assistance at cost and the cost of subsidized health services. A cost-to-charge ratio derived from Worksheet 2 was used to determine the costs of serving Medicaid beneficiaries. Schedule H, Part I, Line 7g Subsidized health services community benefit expenses include $983,269 of expenses attributable to physician clinics that have net operating losses. Schedule H, Part III, Line 2 Costing methodology: A cost-to-charge ratio derived from Worksheet 2 was used to calculate bad debt expense at cost. Schedule H, Part III, Line 4 The footnote from the hospital's financial statements follows: The Hospital reports patient accounts receivable for services rendered at net realizable amounts from third-party payers, patients and others. The Hospital provides an allowance for uncollectible accounts based upon a review of outstanding receivables, historical collection information and existing economic conditions. Schedule H, Part III, Line 8 The Medicare cost report was the costing methodology used to determine the allowable Medicare costs pertaining to Medicare net revenue. Allowable costs of care reported on line 6 were determined using amounts from Worksheet D, Part V and Worksheet D-1 in the Pawnee Valley Community Hospital, Inc., Medicare cost report for fiscal year ended June 30, 2018. Schedule H, Part III, Line 9b Whenever possible, the customer service representatives (CSR's) of Pawnee Valley Community Hospital try to determine the estimated self-pay balance prior to the patient receiving services. Charity care eligibility is first considered at this point in time. In addition, if full payment is not received or payment is not made with 30 days, the CSR contacts the patient. If it is determined that at least a two-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. Schedule H, Part VI, Line 3 Information regarding the Pawnee Valley Community Hospital, Inc. charity care program is located on the Pawnee Valley Community Hospital and Hays Medical Center, Inc. website for patients and community members to view, and the financial assistance application is also on the HMC website to print off and complete. A financial assistance policy summary is included with every statement that is sent to an uninsured patient. In addition, if a customer service representative contacts a patient about a bill and in visiting with them they determine that patient could possibly qualify for the hospital's charity care policy, the CSR will send the application to the patient as well. Schedule H, Part VI, Line 4 Pawnee Valley Community Hospital, Inc. is located in Larned, Kansas, which has a population of approximately 4,050 people, as of the 2010 census. The median household income of Larned was $43,250. Approximately 5.9% of families were below the poverty line, and 7.4% of the total population was below the poverty line. Approximately 8.6% of the hospital's revenue is from services provided to patients eligible for Medicaid. Pawnee Valley Community Hospital, Inc. is the only hospital in Larned, Kansas. It mainly serves the community of Larned. Schedule H, Part VI, Line 5 Pawnee Valley Community Hospital, Inc. promotes the health of the community by extending medical privileges to most qualified, local physicians. Schedule H, Part VI, Line 6 Pawnee Valley Community Hospital, Inc. is a component unit of Hays Medical Center, Inc. As of January 1, 2017, Hays Medical Center, Inc. became a component unit of the University of Kansas Hospital Authority. true true false false false false false false false Bryce Young President 0 273220 0 0 0 0 0 57845 0 27193 0 358258 0 0 Shae Veach Vice President 0 195390 0 0 0 16154 0 43242 0 25841 0 280627 0 0 George Harms Treasurer 0 279856 0 0 0 0 0 56552 0 15322 0 351730 0 0 David Sanger MD Director/Physician non-voting 245572 0 25000 0 14334 0 16200 0 25513 0 326619 0 0 0 John Jeter MD Director 0 570992 0 569 0 1497 0 102168 0 18353 0 693579 0 0 Eric Lybarger Administrator 96008 0 0 0 49388 0 2277 0 18969 0 166642 0 0 0 Christian Whittington Physician 243075 0 15000 0 62100 0 16200 0 28013 0 364388 0 0 0 MC Hill Physician 245381 0 15000 0 17105 0 12208 0 26593 0 316287 0 0 0 Debbie Tomlinson APRN 142639 0 311 0 58 0 8646 0 2764 0 154418 0 0 0 Amanda Bickle APRN 124088 0 207 0 208 0 3923 0 24845 0 153271 0 0 0 Form 990, Schedule J, Part I, Line 3 A related organization uses a compensation committee, independent compensation consultant, written employment contract, and approval by the board or compensation committee to establish the compensation of the Hospital's Administrator. Form 990, Schedule J, Part I, Line 4a ERIC LYBARGER $43,762 Form 990, Schedule J, Part I, Line 4b Contributions to the plan: John Jeter, M.D. - $85,968 Bryce Young - $41,991 George Harms - $42,148 Shae Veach - $30,195 Edward Herrman - $9,692 Form 990, Part I, Line 1 by the state of Kansas Department of Health and Environment. The purpose of the Organization is to improve the quality of life for the communities we service through exceptional healthcare and service excellence. The Organization is striving to be the best Critical Access Hospital in rural America. Form 990, Part III, Line 1 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 Corporation is to improve the quality of life for the communities we serve through exceptional healthcare and service excellence. Form 990, Part VI, Section A, Line 6 The organization has one member, HaysMed Partners, Inc., which became the sole member as of March 1, 2010. HaysMed Partners, Inc., is a wholly-owned subsidiary of Hays Medical Center, Inc. Form 990, Part VI, Section A, Line 7a The Board members of HaysMed Partners, Inc., the sole member of Pawnee Valley Community Hospital, appoint the Board members of Pawnee Valley Community Hospital, Inc. Form 990, Part VI, Section A, Line 7b HaysMed Partners, Inc., the sole member of Pawnee Valley Community Hospital, elects the Board members of Pawnee Valley Community Hospital. Form 990, Part VI, Section B, Line 11b Form 990 was reviewed with the Board members 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 used to monitor and enforce compliance with the policy. Form 990, Part VI, Section B, Lines 15a & 15b The hospital administrator and officers' salaries are reviewed annually by an independent consulting group and the Board members. Form 990, Part VI, Section C, Line 19 These documents are not made available to the public. Form 990, Part XI, Line 9 Transfers to Pawnee County $ 3,535,460 Change in assets held by foundation $ 132,209 ------------ Total $ 3,403,251 Form 990, Part XII, Line 2c The Pawnee Valley Community Hospital, Inc. board is responsible for the oversight of Pawnee Valley Community Hospital, Inc's., financial statement audit and the selection process of an independent accountant. 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