2018-10-18T09:10:31-05:00 2017-12-31 BKD LLP 1551 N WATERFRONT PKWY STE 300 WICHITA KS 672066601 990 2017-01-01 481236156 GREAT PLAINS OF SABETHA INC % DAVE DELLASEGA GREA 3166851523 250 NORTH ROCK ROAD STE 160 WICHITA KS 67206 DAVE DELLASEGA CEO AND PRESIDENT 3166851523 2018-10-15 true STEVEN L WEBB P00235405 3162652811 4.53.77.173 48010220182915000001 2018-10-18 P 305047111E71B1EF7CF07F45C8273AFE2A22C5B3 8E791C5199A669DB93BD25988D8F907149AF4FD6 2017 2018-06-14 16:35:46Z DAVE DELLASEGA 250 NORTH ROCK ROAD STE 160 WICHITA KS 67206 12156973 false X WWW.SABETHAHOSPITAL.COM X 2000 KS ACUTE CARE HOSPITAL THAT PROVIDES MEDICAL CARE TO THE GENERAL PUBLIC IN SABETHA, KANSAS AND SURROUNDING RURAL COMMUNITIES. 8 7 153 23 0 444837 442968 10900423 11535377 15728 22384 113536 150358 11474524 12151087 0 0 0 0 7217280 7182268 0 0 0 4862473 4969745 12079753 12152013 -605229 -926 6586438 6272904 1641560 1456647 4944878 4816257 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 CIRCUMSTANCES. false false 10326478 0 11535377 SEE SCHEDULE O. 10326478 true true false true false false false false false false true false false true false false true true false false false false false false true 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 25 0 true 153 true false false false false false true true 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 THOMAS E KELLER DVM CHAIRMAN/DIRECTOR 0.25 2.25 X X 0 0 0 DAVE DELLASEGA PRESIDENT/CEO/DIRECTOR 2.0 40.0 X X 0 211212 30675 BILL NAVIS VICE PRESIDENT/DIRECTOR 0.25 2.25 X X 0 0 0 JOHN TERRILL VICE PRESIDENT/DIRECTOR 0.25 2.25 X X 0 0 0 ROBERT HAMILTON SECRETARY/DIRECTOR 0.25 2.25 X X 0 0 0 STEVE CARLSON TREASURER/DIRECTOR 0.25 2.25 X X 0 0 0 DAVE RANKIN DIRECTOR/CHAIRMAN 0.25 2.25 X X 0 0 0 DR BARBARA BROWN APPLEGATE DIRECTOR 0.25 2.25 X 0 0 0 ART HENRICKSON DIRECTOR 0.25 2.25 X 0 0 0 LORA KEY ADMINISTRATOR 40.0 0.0 X 101610 0 21476 MIKE HAND CFO 2.0 40.0 X 0 28635 3907 KEVIN KENNALLY PHYSICIAN 40.0 0.0 X 300841 0 47252 GREGG WENGER PHYSICIAN 40.0 0.0 X 190067 0 38064 JAMES LONGABAUGH PHYSICIAN 40.0 0.0 X 220666 0 33595 CHRISTIAN TRAMP PHYSICIAN 40.0 0.0 X 217419 0 48147 KERSTIN GLYNN PHYSICIAN 40.0 0.0 X 260745 0 45408 1291348 239847 268524 6 false true false MHS DATA CENTER INC 103 E 27TH SUITE A HAYS KS 67601 COMPUTER SUPPORT 442234 STORMONT VAIL HEALTHCARE 1500 SW 10TH STREET TOPEKA KS 66604 LAB SERVICES 111354 GREAT PLAINS HEALTH ALLIANCE PO BOX 366 PHILLIPSBURG KS 67661 MANAGEMENT 143348 SHARED MEDICAL SERVICES INC 209 LIMESTONE PASS COTTAGE GROVE WI 53527 MRI SERVICES 104190 STARS INC 201 S 4TH ST HIAWATHA KS 66434 PHYSCIAL THERAPY 100649 5 14041 378670 50257 1699 442968 NET PATIENT SERVICE REVENUE 621300 11138006 11138006 340(b) Pharmacy Revenue 621300 397371 397371 11535377 21884 21884 0 0 15150 15150 0 15150 15150 500 500 500 500 3280 14041 5886 -2606 -2606 0 0 0 0 0 0 EMPLOYEE/GUEST MEALS 722513 14309 14309 OUTSIDE SERVICES 621300 27303 27303 VENDOR REBATES 900099 11160 11160 85042 85042 137814 12151087 11535377 172742 0 0 0 0 123086 123086 0 5521353 4874639 646714 434856 377608 57248 728774 576236 152538 374199 318973 55226 118478 118478 502 502 35661 35661 2746 2746 0 0 1551060 1281293 269767 0 29563 13394 16169 212330 133342 78988 1595 1595 0 176204 163930 12274 15433 4808 10625 0 41641 34696 6945 9870 8722 1148 0 523785 474078 49707 138760 37112 101648 MEDICAL SUPPLIES & DRUGS 1444861 1444861 RENTAL EQUIPMENT & REPAIRS 337978 324565 13413 BAD DEBT EXPENSE 203253 203253 DUES & SUBSCRIPTIONS 47250 12714 34536 78775 42254 36521 12152013 10326478 1825535 0 23177 220 1338225 1354825 100547 98447 1490100 1515267 0 0 0 0 0 0 169189 182346 105396 120151 12273406 9909689 2832307 2363717 0 0 245777 249932 0 0 0 0 281720 387999 6586438 6272904 1289784 1291072 0 0 63872 8002 0 0 0 0 0 0 287904 157573 0 0 0 0 1641560 1456647 X 4940737 4816257 4141 0 0 0 4944878 4816257 6586438 6272904 X -926 -127695 X false true X true false X X true false false false false false true 2746 false false false 2746 false SCHEDULE C, PART II-B, LINE 1F A PORTION OF THE ANNUAL DUES PAID TO KHA AND AHA ARE USED FOR LOBBYING. 35244 35244 6513289 4685553 1827736 5520854 5042540 478314 204019 181596 22423 2363717 THIRD PARTY RECEIVABLE 274364 OTHER CURRENT ASSETS 113635 387999 11982625 -168462 -168462 12151087 12151087 12111246 162486 162486 11948760 203253 203253 12152013 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 EQUITY IN EARNINGS SABETHA HEALTHCARE, INC. 28,905 SPECIAL EVENT EXPENSES 5,886 PROVISION FOR UNCOLLECTIBLE ACCOUNTS (203,253) ------------ TOTAL (168,462) SCHEDULE D, PART XII, LINE 2D TRANSFER TO CITY OF SABETHA 156,600 SPECIAL EVENT EXPENSES 5,886 ------------ TOTAL 162,486 SCHEDULE D, PART XII, LINE 4B PROVISION FOR UNCOLLECTIBLE ACCOUNTS 203,253 GOLF TOURNAMENT 17321 14041 3280 1760 1699 0 940 0 1487 0 17321 14041 3280 1760 1699 0 940 0 1487 5886 -2606 true true X true X false true true false true true 15929 15929 0.00130 364317 206895 157422 0.01320 380246 206895 173351 0.01450 56450 16720 39730 0.00330 3772 3772 0.00030 60222 16720 43502 0.00360 440468 223615 216853 0.01810 false 203253 4924622 4924622 X true true 1 1 SABETHA COMMUNITY HOSPITAL 14TH OREGON PO BOX 229 SABETHA KS 66534 WWW.SABETHAHOSPITAL.ORG H066002 X X X X SABETHA COMMUNITY HOSPITAL 1 false false true X X X X X X X X X 15 true true false true X SEE SCHEDULE H, PART V, SECTION C X true 15 true SEE SCHEDULE H, PART V, SECTION C false true X 200. 0. X 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, SECTION B, LINE 5 A PRIORITY OF THE PROGRAM IS TO SOLICIT INPUT FROM A BROAD CROSS SECTION OF THE COMMUNITY, NOT SIMPLY MEMBERS OF THE LOCAL HEALTHCARE SECTOR. THE MEETING PARTICIPANTS INCLUDED COMMUNITY RESIDENTS AND GOVERNMENTAL AND BUSINESS LEADERS WITHIN THE COMMUNITY. SCHEDULE H, PART V, SECTION B, LINE 6A NEMAHA VALLEY COMMUNITY HOSPITAL SCHEDULE H, PART V, LINE 7A http://www.sabethahospital.com/docs/Community_Needs_Assessment_2015_%281%2 9.pdf SCHEDULE H, PART V, LINE 10A http://www.sabethahospital.com/docs/CHN_Merged.pdf SCHEDULE H, PART V, LINE 11 SABETHA COMMUNITY HOSPITAL AND NEMAHA VALLEY COMMUNITY HOSPITAL PARTNERED IN JULY OF 2015 AND CONDUCTED A COMMUNITY HEALTH CARE NEEDS ASSESSMENT. A REVIEW OF THE 2012 CHNA PRIORITIES WAS CONDUCTED AND TWO OF THE MAIN PRIORITIES IDENTIFIED CONTINUE TO BE ADDRESSED AND ENHANCED; PRIORITY 1) PROMOTE HEALTH, WELLNESS, AND CHRONIC DISEASE PREVENTION; PRIORITY 2) IMPROVE ACCESS TO MENTAL HEALTH ASSISTANCE. PRIORITY 3) IMPROVE ACCESS TO INFORMATION AND ASSISTANCE ACROSS MULTIPLE NEEDS AND POPULATIONS, WAS CONSIDERED TOO BROAD AND UNMANAGEABLE. THE 2015 CHNA AS WELL AS THE 2012 CHNA IS POSTED ON THE SABETHA COMMUNITY HOSPITALS WEBSITE FOR EASY ACCESS BY THE COMMUNITIES. IN 2017, SCH COMMITTED TO FURTHERING THOSE PRIORITIES IN THE COMMUNITY THROUGH INVOLVEMENT OF THE MEDICAL STAFF, BOARD OF DIRECTORS, AND OTHER IDENTIFIED STAFF AND COMMUNITY MEMBERS. DURING 2017, THE HOSPITAL ADDRESSED PRIORITY #1 THROUGH ITS HOSPITAL WEBSITE AS WELL AS PROVIDING EDUCATIONAL INFORMATION THROUGH ITS MONTHLY OUTPATIENT CALENDARS AND THROUGH THE MULTIPLE CLINICS PROVIDED TO THE COMMUNITY. DURING 2017, THE PHYSICIAN CLINIC STARTED THE COLLABORATIVE AGREEMENT WITH KU MED FOR THE RE-POWER PROGRAM TO WORK WITH OBESE PATIENTS OVER A THREE YEAR PROJECT PERIOD SIGNED IN 2015. DIABETIC EDUCATION AS WELL AS BREASTFEEDING EDUCATION CONTINUES TO BE A PRIORITY. SCH PARTNERED WITH NEMAHA VALLEY COMMUNITY HOSPITAL TO PROVIDE NEWBORN SUPPLIES TO MOM AND BABE UPON BIRTH. IN 2017, THE HOSPITAL CONDUCTED TWO MINI HEALTH FAIRS FOR MEN AND WOMEN. BOTH FOCUSED ON BLOOD PRESSURE, BLOOD SUGARS, NUTRITION, SKIN CANCER CHECKS, AND PHYSICIANS SPOKE AT BOTH EVENTS EMPHASIZING THE IMPORTANCE OF OVERALL GENERAL HEALTH. THROUGH THE HOSPICE PROGRAM, BEREAVEMENT SUPPORT GROUP MET DURING THE FALL, AND EDUCATION MATERIALS ARE PROVIDED FOR THOSE IN THE COMMUNITY WHO HAVE LOST LOVED ONES. THE HOSPITAL SOCIAL WORKER TAKES APPOINTMENTS DURING THE OPEN ENROLLMENT PERIOD TO HELP COMMUNITY MEMBERS WITH MEDICARE PART D ENROLLMENT, AND THROUGHOUT THE YEAR CONTINUES TO PROVIDE ENROLLMENT ASSISTANCE FOR MEDICAID, MEDICARE AND THIRD PARTY PAYERS TO LOCAL COMMUNITY MEMBERS. THE HOSPITAL TRAUMA PROGRAM CONDUCTED A CAR SEAT SAFETY CHECK IN DECEMBER TO AID IN THE SAFE TRANSPORTATION OF BABES AND TODDLERS. THE HOSPITAL CONTINUES TO PARTICIPATE IN THE HCAPS SURVEY AND RESULTS ARE REVIEWED WITH STAFF ANNUALLY. THE HOSPITAL IS PARTICIPATING IN THE KANSAS HEALTH ENGAGEMENT NETWORK 2.0. PRIORITY #2; IMPROVING ACCESS TO MENTAL HEALTH CONTINUES TO BE A CHALLENGE AS THERE IS SUCH A CRISIS IN THE NATION. THE HOSPITAL CONTINUES TO PARTNER WITH THE COMMUNITY MENTAL HEALTH CENTER UTILIZING THE CRISIS MENTAL HEALTH SCREENING TOOL USED WITHIN THE ED SETTING. FURTHER OPTIONS ARE BEING RESEARCHED BUT LIMITED RESOURCES AND SPACE ARE CONSTRAINTS. AS MENTIONED EARLIER PRIORITY #3; TO IMPROVE ACCESS TO INFORMATION AND ASSISTANCE RESOURCES - THE HOSPITAL DID UPDATE ITS WEBSITE AND POSTED THE DIRECTORY FROM THE 2012 CHNA WHICH REMAINS ON THE WEBSITE. THE HOME HEALTH AND HOSPICE SOCIAL MEDIA PAGE IS USED ALSO TO UPDATE THE COMMUNITY ON RESOURCES. THE SOCIAL WORKER AND PUBLIC RELATIONS DIRECTOR WORKS WITH A LOCAL GROUP THROUGH THE LIBRARY, DAYCARE, PARENTS AS TEACHERS, AND OTHER ORGANIZATIONS TO REMAIN UPDATED ON COMMUNITY RESOURCES AND NEEDS, AND TO SHARE HOSPITAL RESOURCES BACK TO THE COMMUNITY. SCHEDULE H, PART V, LINE 16A http://www.sabethahospital.com/docs/Financial_Assistance_Program_and_Colle ction_Policy_8-6-18.output.pdf SCHEDULE H, PART V, LINE 16B http://www.sabethahospital.com/docs/Payment_Assistance_Document.pdf SCHEDULE H, PART V, LINE 16C http://www.sabethahospital.com/docs/Plain_Language_Summary_Updated_8-6-18. pdf 1 SABETHA FAMILY PRACTICE 1115 MAIN STREET SABETHA KS 66534 FAMILY CLINIC 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 UNDERINSURANCE STATUS. SCHEDULE H, PART I, LINE 7 THE COSTING METHODOLOGY USED TO CALCULATE THE AMOUNTS CONTAINED 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 $203,253. 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 REASONABLE 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 7 OF THE AUDITED FINANCIALS UNDER NOTE 1. 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 CHARGES AND CHARGES NOT TO BE COLLECTED DUE TO FINANCIAL ASSISTANCE COMPUTATIONS ARE EXEMPTED FROM COLLECTION POLICIES AND PRACTICES. THOSE ACCOUNTS ARE REMOVED FROM THE COLLECTION CYCLE. SCHEDULE H, PART VI, LINE 2 Sabetha Community Hospital and Nemaha Valley Community Hospital continue to work on the Community Health Needs Assessment which identified three focused areas. In late 2017, SCH also began collecting data to update the current strategic plan using information from the current CHNA. Priority #1 was to promote health, wellness, and chronic disease prevention especially in the areas of hypertension, diabetes, smoking cessation and increased seatbelt usage. The hospital is working toward accomplishing this goal by partnering with the City of Sabetha on a health and wellness center. The plan is to provide education on diet and exercise to address obesity, diabetes, and hypertension. To further address weight loss and the effect of obesity on hypertension and diabetes, a weight loss program, RE-Power, through KU Med is in its second year and has been very successful in educating and helping patients with weight reduction. Sabetha Community Hospital is a Certified Diabetic Education Facility which was re-accredited in 2017. SCH also employs a Certified Diabetic educator who works with the current diabetes patients. The diabetic educator not only conducts education classes but has a SMART program which holds the diabetic accountable for their own care. In 2017, the hospital also implemented the low dose CT for lung cancer screening and partnered with the local Community Health agency to direct patients to a smoking cessation class. The hospital also employs a certified seatbelt technician who does car seat safety checks for newborn babes leaving the hospital but car seat safety checks in the community as well. The hospital continues to publish monthly information regarding the outpatient specialty clinics held at the hospital along with an article on a specified health topic. This information is published within local community papers, and also posted on the hospital website. SCH continues to offer pre-natal classes quarterly throughout the year. Breastfeeding education for mothers became an apparent need in the community and SCH was able to offer this support through a certified lactation consultant. SCH collaborated with Nemaha County Health Department to provide this service. SCH also continues to partner with Nemaha Valley Community Hospital to provide newborn supplies to mom and babe upon birth. This program helps those moms and babes who are in need of extra help at the start of the newborns life. The Level IV Trauma committee gave scholarships so that 6 community children could take swimming lessons offered at the public pool. Priority #2 identified improving access to mental health services. The hospital partners with the community mental health center helping to provide access to mental health services through a clinic setting and telehealth. Discussions have been initiated with a tertiary care center for tele psychiatry. Further options to expand mental health are being researched but resources and the availability of mental health professionals are limited. The hospital social worker throughout the year continues to provide enrollment assistance for patients who are seeking help enrolling with Medicaid, Medicare and third party payers. The social worker and public relations director works with a local group through the library, daycare, parents as teachers, and other organizations to remain updated on community resources and needs, and to share hospital resources back to the community. In addition, a resource directory is attached to the community health needs assessment on the SCH website. SCHEDULE H, PART VI, LINE 3 The following measures are used to publicize the program to the community and patients: 1. Posting the Financial Assistance Program, Financial Assistance Application and a summary of the Policy on the Sabetha Community Hospital website at the following location: www.sabethahospital.com 2. Providing paper copies of the Program, application and summary of the Program upon request in admissions and patient financial services at Sabetha Community Hospital. 3. Posting notices about the Program in the emergency department, admitting areas, Clinic lobby and business office of Sabetha Community Hospital. 4. Distributing a plain language summary of the Program and offering a Financial Assistance application to patients before discharge from the hospital. 5. Informing patients about the Program in person or during billing and customer service phone contacts. 6. Providing notification of the Program in the patients' monthly billing statement which provides information and resources on how to apply for financial assistance. The Financial Assistance Program takes into consideration a patients household income and qualifying assets. The Financial Counselor consults with private pay patients to see if they qualify for the Hospitals financial assistance policy. If discovered during the accounts receivable collection process that a patient is having trouble paying bills, both the hospital and the clinic will inform the patient that financial assistance is available. As part of the financial assistance program all applicants must apply for Medicaid. To determine if the patient may qualify for financial assistance, the financial counselor gives patient forms to complete and asks to see bank statements, tax returns, etc. Computations based on current Federal Poverty Level Guidelines are completed to see if qualifications is appropriate and the percentage of charges to be written off is determined, based on family size and household income. All instances of financial assistance are approved by upper management of the Hospital. Information about Financial Assistance is posted on the hospital website and the Financial Assistance form can be downloaded from www.sabethahospital.com. SCHEDULE H, PART VI, LINE 4 Sabetha Community Hospital is a 25 bed Critical Access Hospital located in the city of Sabetha, Nemaha County Kansas. Currently, the population of the City of Sabetha is estimated at 2584. The primary service area for Sabetha Community Hospital includes portions of Nemaha, Brown and Jackson County, Kansas and several counties in Nebraska. For Nemaha County in 2017 there were 599 of inpatient discharges. Estimated population for Nemaha County is 10,241 according to the United States Census Bureau. People age 65 and over make up 27% of the countys total population. The racial and ethnic composition of Nemaha County is mostly white which is at 96.9%, Native American .6%, African Americans .8%, Asians .3% and Hispanics were 1.7% of the population. SCHEDULE H, PART VI, LINE 5 The hospital CEO continues to participate in an economic development committee providing a healthcare aspect to the group wanting to grow the community. In 2017, the hospital transitioned to Cerner Community Works and the community was educated on how patients electronic health records would be one record flowing from the physician office into the hospital setting. Also, patients would only have one patient portal to access with the Cerner record. The hospital provides wellness checks which include blood pressure checks, BMI, and blood work, if requested, for local area businesses along with educational sessions as requested. Another service to the local businesses is the provision of occupational assessment testing along with hearing screens. The OAS testing and hearing screens are done by certified hospital staff. During flu season, the hospital offers public flu immunization clinics at the local grocery store as well as providing immunization clinics at the local industries. The Wellness Coordinator of the hospital sits on the Wellness Council for the local school district. The hospital also promotes wellness among employees by providing a corporate membership to the community fitness room. Hospital staff is also encouraged to donate blood during the quarterly blood drives. Hospital staff provides CPR training for professionals in the area. The hospital provides prenatal classes including CPR training, breastfeeding and care of a newborn infant on a quarterly basis for expectant parents. Cardiac Rehab Phase III is open to the community to offer support in an exercise program, especially for those patients who have graduated from the Cardiac Rehab Phase II program. Social Services aids those in the community who are in need of enrollment assistance, whether it be for Medicaid, Medicare, Medicare Part D services, or other information referral assistance. Social Service and swingbed director coordinate transfer of patients to the local dialysis center. One of the hospital physicians sits as the Medical Director for the city owned ambulance service and the hospital provides RNs as needed for emergency indicated transfers to the local tertiary center. The five family practice physicians serve as medical directors for the Home Health and Hospice Agency. The Chief Executive Officer of Sabetha Community Hospital serves on the Health Innovations Network of Kansas Board, the Kansas Hospital Association KanCare Technical Advisory Group, and the Governors KanCare Advisory Group. Various staff serves on the local civic groups. Sabetha Community Hospital takes its commitment to the community very seriously and participates in emergency drills, always monitoring patient and employee safety, educating staff on risk management, quality assurance, infection control issues, blood born pathogens, HIPAA and Corporate Compliance. The hospital provides an avenue for nursing students to do rotations through the hospital with its affiliation with Highland Community College and Southeast Community College, Beatrice, Nebraska. Medical students in the rural residency program at Kansas University School of Medicine are able to do clinical rotations with the family physicians. Physical therapy students through affiliation with Kansas City Kansas Community College and Indian Hills Community College, occupational therapy students through Washburn University affiliation, and social service students from Kansas State University all do clinical rotations at the hospital as well. Hospital Administration works closely with the High School counselor in the administration of local scholarships to nursing students and to those who are going into a healthcare career. Hospital staff participate in Senior Career Day at the local high school and every year middle school and high school students job shadow at the hospital to encourage careers in healthcare. SCHEDULE H, PART VI, LINE 6 Organization is affiliated with Great Plains Health Alliance, Inc. (GPHA), a non-profit 501(c)(3) organization which provides management services and operational, finance and accounting support to the Hospital. GPHA does not provide services directly to patients, but does provide access to professionals that may not be affordable to the normal critical access hospital. GPHA provides education and assistance in areas such as HIPAA, Medicare reimbursement, meaningful use requirements for computer systems, etc. GPHA is an affiliation of Critical Access hospitals in Kansas and Nebraska that provides networking opportunities with other rural hospital, communities and leaders. GPHA provides policies and guidance to its Critical Access facilities regarding financial assistance, conflicts of interest, corporate compliance, HIPAA Privacy and Security and many other areas. GPHA also provides educational sessions for Board Members, Business Office Mangers, Billers, Medical Records personnel, Director of Nursing and Administrators. GPHA is a vital link in allowing CAH hospitals to operate at a high quality within the cash constraints imposed by the Critical Access program. SCHEDULE H, PART VI, LINE 7 N/A false false false false false false false false false DAVE DELLASEGA PRESIDENT/CEO/DIRECTOR 0 208212 0 0 0 3000 0 20484 0 10191 0 241887 0 0 KEVIN KENNALLY PHYSICIAN 297321 0 0 0 3520 0 26200 0 21052 0 348093 0 0 0 GREGG WENGER PHYSICIAN 187619 0 0 0 2448 0 19391 0 18673 0 228131 0 0 0 JAMES LONGABAUGH PHYSICIAN 217940 0 0 0 2726 0 21734 0 11861 0 254261 0 0 0 CHRISTIAN TRAMP PHYSICIAN 214810 0 0 0 2609 0 22133 0 26014 0 265566 0 0 0 KERSTIN GLYNN PHYSICIAN 257704 0 0 0 3041 0 20294 0 25114 0 306153 0 0 0 FORM 990, PART VII; SCHEDULE J, PART I, LINE 3 COMPENSATION FOR MIKE HAND AND DAVE DELLASEGA IS PROVIDED BY GREAT PLAINS HEALTH ALLIANCE, A RELATED ORGANIZATION. GREAT PLAINS HEALTH ALLIANCE'S BOARD OF DIRECTORS ANNUALLY APPROVE THE COMPENSATION FOR MR. HAND AND MR. DELLASEGA. 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 One of the largest programs Sabetha Community Hospital provides to patients is the Cardiac Rehab Phase III program in which members of the community are able to come to the hospital and for reduced session fees utilizing cardio pulmonary exercise equipment. Not only does this program address the importance of continual exercise and the health benefits associated, but also brings with it a social aspect to those who participate providing social interaction much needed within the elderly population. Addressing the needs of mental health among the elderly population as well as youth continues to be a priority but problematic. This is not new because it is a problem nationwide. The hospital partners with the Community Mental Health Center to provide access to mental health services within the community whether it be in a clinic setting or through telehealth services. Again, this is another key in promoting overall health in our community. Another large program which the hospital provides is a breastfeeding clinic. In 2017 the hospital partnered with Community Health to provide breastfeeding support for moms and babes. Some may be first time mothers or have multiple children already, but a certified lactation consultant provides support to mothers who are having problems breastfeeding their infant. The goal driving this program is to enhance the bonding between mother and infant and to give that infant the best start in life as possible. The High Five program is used as guideline to help provide standard of care. The hospital has also partnered with a neighboring facility to provide Babies Best Start which is a program that helps those mothers who are not able to afford diapers, clothing, or the needed necessities to care for baby. Another important factor in babes care is also a properly fitted car seat. The hospital provides a certified car seat specialist to make sure the baby is safe when leaving the hospital. The importance of diabetic education and support for our patients continue to be a primary focus for SCH. The hospital is a Certified Diabetic Education facility, and during 2017 that program was reaccredited. The hospital conducts a SMART Program by the certified diabetic educator which brings accountability to the diabetic patient. KU Med and SCH partnered together to conduct weight loss program, RE-Power, to a targeted group of patients. This program has proven to be very successful and will continue for another year. Continuation of promoting health, wellness and chronic disease prevention remains a priority. Discussions began with the City of Sabetha for the hospital to manage the new health and wellness center being built hoping to bring a health and wellness aspect to exercising. In 2017, the hospital implemented the low dose CT lung scan for those screening for lung cancer, and partnered with Community Health for resources to smoking cessation classes. In 2017, SCH transitioned to the Cerner electronic medical record which also encompasses the physician clinic making a strong continuity of care for the patient from the doctors office to the hospital setting whether it be inpatient or outpatient care. Transitioning to Cerner also created one patient portal for the hospital and physician clinic making it much easier for the patient to access their own personal health information. Building a strong electronic medical record to better serve our patient population focuses on the goal of enhancing provision of care to the young as well as the old within our community and surrounding areas that we serve. Sabetha Community Hospital continues to participate in the Kansas Health Care Collaborative HIIN as well as reporting for MBQIP. The HCAHPS scores are monitored and used to keep staff informed of patient satisfaction. The Hospital was awarded through the National Offices of Rural Health a Performance Leadership Award. And, SCHs mission remains to provide quality of health and care given in our communities. FORM 990, PART VI, SECTION A, LINE 2 DAVE DELLASEGA AND MIKE HAND HAVE A BUSINESS RELATIONSHIP. THEY ARE BOTH EMPLOYED BY, AND 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 MEMBER OF GREAT PLAINS OF SABETHA, 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 CFO 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 XI, LINE 9 EQUITY IN EARNINGS SABETHA HEALTHCARE, INC. 28,905 TRANSFER TO CITY OF SABETHA (156,600) ---------- TOTAL $ (127,695) FORM 990 PART IX LINE 11G DESCRIPTION:CONTRACTED MEDICAL STAFF TOTAL FEES:997609 FORM 990 PART IX LINE 11G DESCRIPTION:BILLING/COLLECTIONS TOTAL FEES:119820 FORM 990 PART IX LINE 11G DESCRIPTION:LAB SERVICES TOTAL FEES:160977 FORM 990 PART IX LINE 11G DESCRIPTION:PHARMACY SERVICES TOTAL FEES:115956 FORM 990 PART IX LINE 11G DESCRIPTION:ADMINISTRATION/HUMAN RESOURCES TOTAL FEES:148267 FORM 990 PART IX LINE 11G DESCRIPTION:MAINTENANCE/HOUSEKEEPING TOTAL FEES:8431 GREAT PLAINS HEALTH ALLIANCE INC 250 N ROCK RD STE 160 WICHITA KS 67206 480617739 MANAGEMENT KS 501(C)(3) 3 NA false GREAT PLAINS HEALTH CARE FOUNDATION INC 250 NORTH ROCK RD STE 160 WICHITA KS 67206 480955870 SUPPORT KS 501(C)(3) 10 GPHA INC true GREAT PLAINS OF CHEYENNE COUNTY INC 250 NORTH ROCK RD STE 160 WICHITA KS 67206 481226831 HOSPITAL KS 501(C)(3) 3 GPHA INC true GREAT PLAINS OF ELLINWOOD INC 250 NORTH ROCK RD STE 160 WICHITA KS 67206 481226976 HOSPITAL KS 501(C)(3) 3 GPHA INC true GREAT PLAINS OF OTTAWA COUNTY INC 250 NORTH ROCK RD STE 160 WICHITA KS 67206 481226856 HOSPITAL KS 501(C)(3) 3 GPHA INC true GREAT PLAINS OF REPUBLIC COUNTY INC 250 NORTH ROCK RD STE 160 WICHITA KS 67206 481226977 HOSPITAL KS 501(C)(3) 3 GPHA INC true GREAT PLAINS OF SMITH COUNTY INC 250 NORTH ROCK RD STE 160 WICHITA KS 67206 481226830 HOSPITAL KS 501(C)(3) 3 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 GPHA EMPLOYEE BENEFITS TRUST 250 N ROCK ROAD STE 160 WICHITA KS 67206 476918582 HEALTH PLAN KS 501(C)(9) GPHA INC true false false false false false false false false false false false false true false true false false true false GPHA EMPLOYEE BENEFITS TRUST R 632363 ACTUAL