2018-11-05T15:20:17-06:00 2017-12-31 481026809 Wendling Noe Nelson & Johnson LLC 534 S Kansas Ave Suite 1500 Topeka KS 666033491 990 2017-01-01 480892178 Citizens Medical Center Inc CITI 7854627511 100 E College Drive Colby KS 67701 Greg Unruh CEO 7854627511 2018-11-01 1 Heather R Eichem P01515553 7852334226 2018-11-01 98.172.114.81 2018-11-01 06:59:12 CD P A2305A0D198B2FF4E8D11255ADD7E606F4830AA8 0247207EE51091EF4603DC88FB6D26F6A5F7CB3F 2017 2019-02-21 02:37:17Z Greg Unruh 100 E College Drive Colby KS 67701 35975751 0 X www.cmciks.com X 1979 KS Enhancing the lives of those we serve. 8 8 447 25 0 0 90259 313087 31824896 35211223 75179 60353 289186 334816 32279520 35919479 7500 7000 0 0 21432181 20829515 0 0 94639 12547245 13611264 33986926 34447779 -1707406 1471700 21508856 21896813 10930918 9838996 10577938 12057817 Enhancing the lives of those we serve. 0 0 29540261 7000 35535796 CMCI provided a wide range of healthcare services to residents of its service area. 3,571 patient days of inpatient care, 19,520 patient days of nursing facility care, 3,094 emergency room visits and 32,706 physician clinic visits were provided during the fiscal year. 29540261 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 1 1 0 0 0 0 0 0 0 0 0 1 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 41 0 1 447 1 0 0 0 0 0 0 0 0 0 0 X 8 8 0 0 0 0 1 1 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X Darcy Howard 7854627511 100 E College Drive Colby KS 67701 Mike Kersenbrock Trustee 4.00 X 0 0 0 Lon Frahm Vice Chair 4.00 X X 0 0 0 Janet Saddler Secretary 4.00 X X 0 0 0 AJ Hurst Treasurer 4.00 X X 0 0 0 Dorothy Kistler Trustee 4.00 X 0 0 0 Lori Stanley Trustee 4.00 X 0 0 0 Bob Standage Chair 4.00 X X 0 0 0 Teresa Crampton Trustee 4.00 X 0 0 0 Pat Erickson Trustee through February 2017 4.00 X 0 0 0 Gregory Unruh CEO 40.00 X 194069 0 30333 Darcy Howard CFO 40.00 X 138932 0 30674 Robert Erwin CRNA 40.00 X 242248 0 7041 Kelly Gabel Physician 40.00 X 381630 0 42003 Dereck Totten Physician 40.00 X 276964 0 29472 Brewster Kellogg Physician 40.00 X 372902 0 42835 Brenda Kopriva Physician 40.00 X 349409 0 40788 1956154 0 223146 27 0 1 0 Medical Recovery Servicers Associates L 1400 S 7 Highway STE C Blue Springs MO 60414 Billing 630430 Colby Anesthesia Services Inc 2287 K 25 Colby KS 67701 CRNA coverage 429000 CPSI PO Box 850309 Mobile AL 36685 Computer and financial support services 340853 Front Range Nuclear Services 213 S Ave C-1 Cheyenne WY 82007 Imaging services 174550 Wendling Noe Nelson & Johnson LLC 534 S Kansas Ave Suite 1500 Topeka KS 66603 Accounting and consulting services 161534 5 252563 12255 48269 313087 Net patient service revenue 621990 33307668 33307668 340B Drug program 621990 1632209 1632209 Clinical outreach 621400 271346 271346 35211223 4262 4262 14796 0 14796 14796 14796 112363 56272 56091 56091 56091 Miscellaneous 900099 211574 211574 Cafeteria & vending 621990 66334 66334 Pharmacy sales 446110 33878 33878 8234 8234 320020 35919479 35535796 0 70596 7000 7000 399635 399635 17082634 15182763 1829623 70248 598429 536020 59929 2480 1612631 1427522 178504 6605 1136186 989238 142371 4577 26181 26181 2860668 1878969 980887 812 38410 11820 26590 411725 288901 122592 232 660300 612209 46916 1175 91818 56703 34269 846 292926 292926 1886864 1736292 146232 4340 286908 139885 147023 Drugs 3410710 3410710 Medical supplies 1769392 1769392 0 Repairs and maintenance 935393 584284 349100 2009 Food expense 324878 324878 615091 290749 323027 1315 34447779 29540261 4812879 94639 113265 556510 537444 1254067 5057289 5195727 197756 161864 832069 682163 186497 425258 37837590 27373893 10697959 10463697 449409 474259 3437168 2683268 21508856 21896813 4191128 3330030 6724136 5748966 15654 760000 10930918 9838996 X 8605637 10149725 1602306 1538097 369995 369995 10577938 12057817 21508856 21896813 X 1471700 42524 -34345 X 0 1 X 1 0 X 0 0 0 0 0 1 7051 0 0 0 7051 0 Part II-B, Line 1: Citizens Medical Center, Inc., is a member of the Kansas Hospital Association and the American Hospital Association. These organizations engage in lobbying activities for hospital and general health care interests as part of the services provided to members. 235982 235982 18134801 12976313 5158488 16581411 12393901 4187510 2885396 2003679 881717 10463697 Interest receivable 684 Beneficial interest in net assets of foundations 1908092 Reinsurance proceeds recoverable 225000 Other receivables 274912 Estimated third-party payor settlements 274580 2683268 Estimated third-party payor settlements 760000 760000 X 35921929 42524 -40074 2450 35919479 0 35919479 34442050 0 34442050 5729 5729 34447779 Part X, Line 2: Management is not aware of any uncertainties in income tax positions. Part XI, Line 2d - Other Adjustments: Change in beneficial interest in net assets of foundations net of transfers -34,345. Bank fees and service charges included with investment income -5,729. Part XII, Line 4b - Other Adjustments: Bank fees and service charges included with investment income 5,729. 1 1 1 X 130.000000000000 1 X 1 1 0 0 388957 27154 361803 0.01050 4469183 3978913 490270 0.01420 4858140 4006067 852073 0.02470 80644 13000 67644 0.00200 9225460 7580733 1644727 0.04770 1200 1200 0.00000 9307304 7593733 1713571 0.04970 14165444 11599800 2565644 0.07440 1 830363 616051 8615691 8686209 -70518 X 1 1 1 1 Citizens Medical Center Inc 100 E College Drive Colby KS 67701 X X X X Nursing facility and rural health clinic Citizens Medical Center 1 0 0 1 X X X X X X X X X 15 1 0 1 1 X www.cmciks.com X 1 15 1 www.cmciks.com 0 1 X 130.000000000000 400.000000000000 X X X X 1 1 X X 1 X https://www.cmciks.com/medical-center/assistance X https://www.cmciks.com/medical-center/assistance X https://www.cmciks.com/medical-center/assistance X X X X X 1 X 0 X X X X 1 X 0 0 Citizens Medical Center Part V, Section B, Line 5: Each community has a wealth of expertise to be tapped to conduct the CHNA. For this purpose, town hall meetings are the perfect forum to gather community insight. Town hall sessions were organized to provide an objective consensus-building method of reviewing and prioritizing county health issues. All town hall priority-setting and scoring processes involved the input of key stakeholders in attendance. During the meetings, the topics of issue were addressed with round table discussions.The individuals and organizations comprising the town halls were critically important to the success of the CHNA. The following list outlines partners invited to each town hall meeting: local hospital, public health community, mental health community, community-based clinics, service providers, local residents, community leaders, opinion leaders, school leaders, business leaders, local government, faith-based organizations and person (or organizations serving them), people with chronic conditions, uninsured community members, low income residents, and minority groups. Citizens Medical Center Part V, Section B, Line 6b: Thomas County Health Department and Thomas County Commisoners/Representatives Citizens Medical Center Part V, Section B, Line 11: Increase availability of Child Daycare: To increase the availability of child daycare, Citizens Medical Center (CMC) opened a daycare facility - "Kids Port" - in June 2016, and had an enrollment of 9 children by December. They are licensed for 12 children and provided services for 17 children in 2017.Mental health: Mental health services continue to be limited, but CMCI is trying to improve the responsiveness and accessibility. In 2016, the Medical Center installed a mental health ITV cabinet in one of the private Emergency Rooms to help facilitate tele-med consultations. The community lost funding for ADAC, which provided services for alcohol and drug abuse. CMCI's current tele-med provider, Avera, is capable of doing mental health consults but is unable to make referrals in the state of Kansas due to legislation restrictions. Tele-med psych services with KU Med Wichita are being researched. CMCI is currently in process of hiring another social worker to assist with patient and staff needs.Cancer services: Northwest Kansas Cancer Center at CMCI had it's Open House for the Grand Opening on December 1, 2015. They saw 37 patients in 2015, 135 patients in 2016, and 176 patients in 2017. Three physicians service the community through the Colby office, Jocelyn De Yao, M.D., Dr. Anis Toumeh, M.D., and Jose Velasco, M.D.Education: CMCI has a registered diabetic educator and two series of four classes were offered in 2016 and 2017, with plans to continue in 2018. FCHC is working toward decreasing obesity and expanding preventative care. CMCI providers participate in a once a month program "Burn While You Learn" where the general public can take an afternoon stroll with a provider and discuss health topics or ask questions.Transportation: CMCI has developed a relationship with the local taxi service and the county transportation van to help with healthcare transportation and getting patients to their appointments. The county transportation service has purchased another van and has increased their availability to the public. CMCI has implemented a "Patient Assistance Program" where several volunteers are available to assist mobility challenged patients out of their vehicles and into the buildings.Recruit specialists: CMC is continually working to recruit new specialists. In 2015 - Thomas G. Mordick II, Ortho; Benjamin W. Sears, Ortho; Richard Markiewicz, Cardiology; Ernesto Lopez -Corona, Urology; Roberto R. Rodriguez, Hematology/Oncology; Sean D. Denney, Cardiology were recruited. In 2016 - Sean Baran, Ortho; was recruited. In 2017 - Muhammed J Ashraf, Cardiology; Ryan T. Borne, Internal Med; Gulraiz A. Cheema, Ortho; Manmohan S. Biring, Pulmonology; Philip Fitzpatrick, ENT; were recruited Citizens Medical Center Part V, Section B, Line 16j: The availability of financial assistance is published on the Medical Center's website. A plain language summary of the financial assistance policy is printed on each patient's statement. Information about financial assistance availability is given to patients each time they are spoken to by billing personnel. Information sheets summarizing the financial assistance policy and instructions on how to obtain more information is distributed to the Family Center for Health Care and the Thomas County Health Department. 2 1 - Prairie Senior Living Complex 1625 S Franklin Ave Colby KS 67701 Long-term care facility 2 - Family Center for Health Care 310 E College Dr Colby KS 67701 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 Medical Center provides despite a financial loss to the organization. These services include the operation of a clinic with visiting physicians in various specialties and a rural health clinic. Costs attributable to physician clinics included on line 7(g), column (c), were $7,590,144 and unreimbursed costs attributable to physician clinics included on line 7(g), column (e), were $1,176,012. Part II, Community Building Activities: N/A Part III, Line 4: See note A2 (page 8) of the audited financial statements regarding the allowance for uncollectible accounts.Part III, Line 2Bad debts at cost were determined by utilizing departmental cost-to-charge ratios for bad debts 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 bad debts in all other areas.Part III, Line 3Bad debt provisions attributable to patients eligible under the organization's financial assistance policy were determined using an estimated 74.16% of total bad debts. The Medical Center takes steps to assist individuals who are believed to qualify for financial assistance prior to writing accounts off as uncollectible. The Medical Center considers $616,051 of bad debt cost as community benefit. As a tax-exempt hospital, we must provide necessary services regardless of the patient's ability to pay for that care. Making quality patient care available to all in our community, regardless of their economic means, qualifies bad debts as a community benefit. Part III, Line 8: Medicare allowable costs were determined by using amounts from the Medical Center's Medicare cost report. The Medicare cost report apportions actual costs to the Medicare program using charges for ancillary services and patient days for nursing services. The Medical Center believes that all of the $70,518 Medicare shortfall should be considered as community benefit. The IRS Community Benefit Standard includes the provision of care to the elderly and Medicare patients. Medicare shortfalls must be absorbed by the Hospital in order to continue treating the elderly in our community. The Medical Center provides care regardless of this shortfall and thereby relieves the federal government of the burden of paying the full cost for Medicare beneficiaries. Part III, Line 9b: The financial assistance policy states that patients qualifying for charity care must complete a Financial Assistance Questionnaire and submit a copy of the patient's or relative's most recently-filed tax return. If charity care is considered appropriate by a committee, the patient's liability will be reduced by the approved amount. Any remaining balance on patient accounts is subject to the debt collection procedures articulated in the written policy. Part VI, Line 2: The Medical Center assesses the community health care needs primarily from responses from patients, community members, and health professionals. The Medical Center will take into account concerns or requests for services that are expressed by all patients and community members. Also, the Medical Center considers requests made by health professionals who include, but are not limited to, physicians, mid-level providers, social workers, nurses, and dieticians. Part VI, Line 3: All uninsured and under-insured patients are identified and screened upon admission by the Patient Financial Advisor. During this interview process, payment terms are discussed. If the patient appears to not have the ability to pay, they are asked to complete a financial questionnaire and provide a copy of their most recently filed tax return for determining their ability to pay under the Medical Center's financial assistance policy. If, during this interview process, it appears that a patient may qualify for assistance under state or federal assistance programs, they are referred to CMCI's Social Services Department for assistance in completing the applicable applications. Part VI, Line 4: The Medical Center is located in Colby, KS and serves the nine-county region of northwest Kansas, several of which are medically underserved. There are a total of eight small hospitals serving this nine-county region; however, CMCI provides many services that are unavailable in the smaller hospitals. The closest hospitals to the Medical Center are located in Oakley, Atwood, and Hoxie. These hospitals are approximately 23, 30, and 36 miles from Colby, respectively. The highest concentration of population for the service area is located in Colby, KS. Colby has a population of approximately 5,400 people. The median household income for the city is approximately $48,600. A major portion of the population that the Medical Center serves is Medicare-eligible citizens who live on a fixed income. Part VI, Line 5: The Medical Center is a grantee of the Kansas Department of Health & Environment, Kansas Quality of Care Project, and participates in programs identified by the state as needed to help improve the health of residents of our state and local area. Kansas Promoting Health Program is a chronic disease support group and is a program in which the Medical Center has trained facilitators and offers classes. 1 Scholarships 7 7000 Part 1, Line 2 The Medial Center mointors the use of grant funds by sending nursing scholarship funds to the Kansas Board of Regents to ensure that the funds are used for the intended purpose and by requiring scholarship recipients to show proof of satisfactory course work. X X X 0 0 0 0 0 0 0 0 0 Gregory Unruh CEO 194069 0 0 0 0 0 10299 0 20034 0 224402 0 0 0 Darcy Howard CFO 138932 0 0 0 0 0 6916 0 23758 0 169606 0 0 0 Robert Erwin CRNA 242248 0 0 0 0 0 4861 0 2180 0 249289 0 0 0 Kelly Gabel Physician 381630 0 0 0 0 0 15609 0 26394 0 423633 0 0 0 Dereck Totten Physician 274466 0 2498 0 0 0 7952 0 21520 0 306436 0 0 0 Brewster Kellogg Physician 367959 0 4943 0 0 0 15880 0 26955 0 415737 0 0 0 Brenda Kopriva Physician 349409 0 0 0 0 0 14496 0 26292 0 390197 0 0 0 Form 990, Part VI, Section A, line 6 The Medical Center is a not-for-profit corporation with 22 members at December 31, 2017. Form 990, Part VI, Section A, line 7a The Medical Center's corporate members elect the governing body. Form 990, Part VI, Section B, line 11b Form 990 is provided to the Chief Executive Officer who e-mails notices to members of the Board of Trustees that the Form 990 is available for review prior to filing the return. Form 990, Part VI, Section B, line 12c A conflict of interest disclosure form is provided with a copy of the current conflict of interest policy. This disclosure form is completed by each member of the Board of Trustees upon election and annually thereafter. Form 990, Part VI, Section B, line 15 The Board of Trustees reviews the compensation of the CEO and senior management. The Medical Center relies on a joint wage salary report published by the Kansas Hospital and Missouri Hospital Associations, as well as any and all available local data. Form 990, Part VI, Section C, line 19 The Medical Center 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 net assets of foundations net of transfers -34,345. Med-Serv Inc 100 E College Drive Colby KS 67701 480994564 Inactive KS C 1.00000 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0