2017-11-15T11:12:09-06:00 2016-12-31 481026809 Wendling Noe Nelson & Johnson LLC 534 S Kansas Ave Suite 1500 Topeka KS 666033491 990 2016-01-01 486099245 Labette County Medical Center LABE 6204214880 1902 S US Highway 59 Parsons KS 67357 Thomas Macaronas CFO 6204214880 2017-11-15 1 Heather R Eichem P01515553 7852334226 2017-11-15 98.172.114.81 2017-11-15 07:58:35 CS P C25D5B149A5DEB5B624D2ED84480DFAE7FBA67D7 C7F69BD11539B5342AA98FD5676A33A3D336D5E8 2016 2017-02-10 21:41:12Z Labette Health Thomas Macaronas 1902 S US Highway 59 Parsons KS 67357 64951330 0 X www.labettehealth.com X Government 1961 KS Medical care for the southeast Kansas region 9 7 656 60 0 0 1256172 1203933 61075057 62813002 495330 82758 879265 851524 63705824 64951217 6988 17979 0 0 29741686 31543702 0 0 191480 31120342 31141499 60869016 62703180 2836808 2248037 69057534 69476651 37004143 35175223 32053391 34301428 Focusing on the patient and providing exceptional healthcare through effective clinical and financial management. 0 0 53233321 17979 62825539 Labette County Medical Center operates physician clinics and provides inpatient and outpatient services to the residents of the southeastern Kansas area. 53233321 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 1 1 1 0 1 1 0 0 0 0 0 1 0 0 1 0 0 0 0 0 0 1 1 0 0 0 1 56 0 1 656 1 0 0 0 0 0 0 0 0 0 0 X 9 7 0 0 0 0 0 1 0 1 0 0 0 1 1 1 1 1 1 1 1 0 X Thomas Macaronas 6204214880 1902 S US Highway 59 Parsons KS 67357 Perry Sorrell President 1.00 X X 0 0 0 Dee Bohnenblust Vice President 1.00 X X 0 0 0 Melissa Morris Treasurer 1.00 X X 0 0 0 Marna George Secretary 1.00 X X 0 0 0 Wayne Gilmore OD Trustee 1.00 X 0 0 0 Jill Thomas Trustee 1.00 X 0 0 0 Ned Wall Trustee 1.00 X 0 0 0 Ronald Leonard DO Trustee 1.00 X 0 0 0 Robert Gibbs MD Trustee 1.00 X 19817 0 0 Thomas Macaronas CFO/COO 40.00 X 197296 0 25254 Brian Williams President/CEO 40.00 X 301035 0 18860 Douglas Stacy CIO 40.00 X 152968 0 17900 Kathi McKinney CNO 40.00 X 152622 0 15817 Michael Farris Physician 40.00 X 493804 0 24309 Trevor Bond Physician 40.00 X 429775 0 24018 Philip Gorman Anesthesiologist 40.00 X 380938 0 23670 Roxanne Olmstead Physician 40.00 X 414110 0 15962 Shawn Southwick Physician 40.00 X 388411 0 15846 2930776 0 181636 32 0 1 0 Medical Consultants of Kansas LLC PO Box 21 Mulvane KS 67110 Hospitalist services 630940 CPSI PO Box 850309 Mobile AL 36685 Computer support services 622620 Jerry Bouman DO 21004 Ness Road Parsons KS 67357 General surgeon 563717 Spencer Fane Britt & Browne LLP PO Box 872037 Kansas City MO 64187 Legal services 398267 Southeast KS Orthopedic Clinic PO Box 678 PArsons KS 67357 Physician services 391950 15 516872 681603 5458 1203933 Patient service revenue 621990 59530103 59530103 340b pharmacy revenue 621990 3042439 3042439 Fitness center 713940 114518 114518 EHR incentive payments 621990 71442 71442 54500 54500 62813002 70221 70221 232007 0 232007 232007 232007 12650 113 12537 12537 12537 Cafeteria meals 722210 282954 282954 Anesthesia services 900099 135859 135859 Leased employees 900099 68842 68842 131862 131862 619517 64951217 62825539 0 921745 13979 13979 4000 4000 905860 19817 886043 25436901 22767391 2558403 111107 629621 582510 44268 2843 2896480 2533980 350131 12369 1674840 1452358 215394 7088 529777 529777 6158168 5195319 948355 14494 347594 16474 321783 9337 249577 25472 216886 7219 273506 273506 1490319 1231378 258310 631 155722 125123 27127 3472 1813925 1465833 347004 1088 4645183 3692456 950404 2323 474225 264607 209606 12 Drugs and medical suppl 9950621 9950621 Repairs and maintenance 1622362 1276451 345820 91 Collection fees 1542765 1210186 332579 Food and paper goods 498888 498888 1388867 906478 462983 19406 62703180 53233321 9278379 191480 -276329 75448 24032011 23938821 9208395 9961036 50000 50000 357554 466247 1366341 1382647 609365 313389 87289620 56524634 32207300 30764986 1507536 1502897 1016541 69057534 69476651 5654766 5095802 24993 101597 25205244 25663001 5775742 4261496 343398 53327 37004143 35175223 X 30845944 32638430 1207447 1662998 32053391 34301428 69057534 69476651 2248037 0 X 0 1 X 0 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 12503 12503 0 Part II-B, Line 1: A portion of annual dues paid by Labette County Medical Center to various healthcare associations has been identified as lobbying activities by those associations. Labette County Medical Center does not participate in activities supporting a political candidate. 849026 849026 55876787 33464236 22412551 30412528 23060398 7352130 151279 151279 30764986 Estimated third-party payor settlements 53327 53327 64937238 0 64937238 13979 13979 64951217 62689201 0 62689201 13979 13979 62703180 Part XI, Line 4b - Other Adjustments: Contribution to Foundation 13,979. Part XII, Line 4b - Other Adjustments: Contribution to Foundation 13,979. 1 1 1 X 1 X 1 1 0 0 534181 85756 448425 0.00720 7536841 4748575 2788266 0.04450 8071022 4834331 3236691 0.05170 79131 23345 55786 0.00090 4000 4000 0.00010 8569370 6600778 1968592 0.03140 2294 2294 0.00000 8654795 6624123 2030672 0.03240 16725817 11458454 5267363 0.08410 1 2855409 285541 19113715 18059788 1053927 X 1 1 1 1 Labette County Medical Center 1902 S U S Highway 59 Parsons KS 67657 X X X Labette County Medical Center 1 0 0 1 X X X X X X X X 15 1 1 1 1 X http://www.labettehealth.com/about-community-health-needs.html X 1 15 1 http://www.labettehealth.com/about-community-health-needs.html 0 1 X 150.000000000000 250.000000000000 X X X X 1 1 X X X 1 X http://www.labettehealth.com/ X http://www.labettehealth.com/ X http://www.labettehealth.com/ X X X X X X 1 X 0 X X X 1 X 0 0 Labette County Medical Center Part V, Section B, Line 5: The County Health rankings, along with a number of additional community health indicators from the Kansas Department of Health and Environment and other agencies, were reviewed to provide insight into the current situation of the community. Furthermore, the Medical Center asked for input from many key community members by way of community meetings, telephone interviews and e-mail correspondence. The individuals invited to these meetings included a Medical Center board member, local medical professionals, the City Manager, Chief of Police, members of the Chamber of Commerce, religious leaders, a County Commissioner, and the Recreation Commission. Labette County Medical Center Part V, Section B, Line 6a: Oswego Community Hospital Labette County Medical Center Part V, Section B, Line 6b: Labette County Public Health Department and Labette Center for Mental Health Labette County Medical Center Part V, Section B, Line 11: Labette County Medical Center, d/b/a Labette Health, is continually seeking feedback from the communities we serve via community based meetings, surveys and hospital/community committees. We encourage our providers and key staff to maintain active memberships in local organizations as another venue to assess the impact of our organization. Through internal committees, our staff and Board Members are apprised of and become part of solutions to improvement initiatives for county health rankings and social needs of the communities served. The hospital continues to improve outcomes by reducing readmissions and increasing patient safety, implementing inpatient hospice for those patients in need, continue our community education in the areas of diabetes and trauma injury, and increase our involvement with Meals on Wheels and the Summer Food Program for the school age population. The Labette Health Board of Trustees recently established a new organization called the Labette Health Patient and Family Advisory Council (PFAC). The Councils mission is to advise Labette Health to improve the quality of service and safety, improve systems of care, and to educate health care professionals and staff on the patients and families' perception of their healthcare experience. It is the desire of Administration that the Council will work as partners with Labette Health to: Strengthen communication and collaboration among patients, families, caregivers and staff; Promote patient and family advocacy and involvement; and,Propose and participate in programs, services and policies. The Council will be comprised of a broad base of 8-15 patients and/or family members including a Board of Trustee liaison and 4-6 staff members from Labette Health. Meeting will be monthly with Annual Priorities/Goals of Developing an annual plan to include goals and objectives to be drafted by co-chairs and brought to the Labette Health Quality Council for review, revision and approval; Provide at least an annual report to Labette Health Quality Council outlining successes, challenges and future plans; and, this plan and report will be filtered up to the Board of Trustees following Labette Health's Performance Improvement PlanIn 2016 we continued the development of our plans improving the access to patient care in Parsons, KS as well as in Independence, KS. Labette Health stepped up and finalized a plan and began construction of an Emergency Care Facility in Independence to serve the citizens of Independence in response to the loss of their hospital. 6 1 - Labette Health Physicians Group 1902 S Hwy 59 Bldg E Parsons KS 67357 Physician and rural health clinic 2 - St Paul Clinic 200 Carroll St Paul KS 66771 Rural health clinic 3 - Cherryvale Clinic 209 E Main Cherryvale KS 67335 Rural health clinic 4 - Express Care Clinic 2100 Commerce Dr Parsons KS 67357 Physician clinic 5 - Independence Clinic & Express Care 209 E Laurel St Independence KS 67301 Physician clinic/Rural health clinic 6 - Altamont Clinic 607 E 4th St Altamont KS 67330 Physician 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 Labette Health provides despite a financial loss to the organization. These services include outpatient physician clinics. Part II, Community Building Activities: N/A Part III, Line 4: Labette Health provides for accounts receivable that could become uncollectible in the future by establishing an allowance to reduce the carrying value of such receivables to their estimated net realizable value. Labette Health estimates this allowance based on the aging of its accounts receivable and its historical collection experience for each type of payor.Part III, Line 2:The provision for bad debts is related to accounts that have been deemed uncollectible during the year. The uncollectible amount is then written off pursuant to Labette Health's policy. The cost of bad debt expense was determined using the overall cost-to-charge ratio derived from Worksheet 2 applied to all charges that were deemed uncollectible during the year.Part III, Line 3:Bad debt expense attributable to patients eligible under Labette Health's financial assistance policy was determined using an estimated 10% of total bad debts. Labette Health 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 Labette Health'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. Any shortfalls are considered a community benefit. Part III, Line 9b: Labette Health's collection policy contains provisions on the collection practices for patients who are known to qualify for charity care or financial assistance. The charity care policy states that the patient must cooperate with Labette Health 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, Labette Health will conduct a pre-admission interview with the patient, the guarantor, and or 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: N/A Part VI, Line 3: All uninsured individuals are asked if they have any desire to complete a financial assistance application and/or are advised of the process to apply for Medicaid. When a patient has the desire or need to apply for Medicaid, Labette Health refers them to the Social Security Department to begin the application process. When a patient applies for Medicaid, they are asked to let Labette Health know of their decision and then their financial assistance application can be completed and processed after all information has been received. If an application is found to be incomplete, a letter is sent to the applicant advising them of the incomplete status and addressing the needed items for completion. During the social service intake/discharge planning process a social worker assists the uninsured in applying for any appropriate governmental program or Labette Health's financial assistance program. Part VI, Line 4: Based on the Stark II definition (the area composed of the lowest number of contiguous zip codes from which we draw at least 90% of our inpatients) the primary service area (PSA) has an approximate population of 34,000 people and the secondary service area (SSA) has an approximate population of 29,000 people. The total service area has an approximate populatoin of 64,000. Labette County has an approximate population of 21,000 and the city of Parsons has an approximate population of 12,000 people. The median income for the PSA is approximately $41,600 while the county and state median are $41,500 and $50,600 respectively. Within the PSA approximately 18.0% of the population is below 100% of the federal poverty guidelines and approximately 37.0% is below 200%. Area unemployment has been over 6.0% since September 2016 compared to the state-wide average of 3.7%. The PSA multicultural composition reflects that as of 2016 15.1% of the population will be non-white. Based on the most current Primary Care Health Professional Underserved Area Report, Labette County was deemed as a low income population designation in October 2008, and all contiguous counties carry the same designation. The closest hospitals are located in Oswego, Neodesha, and Chanute and are approximately 19, 32 and 37 miles away respectively. Part VI, Line 5: The Board of Trustees is appointed by the County Commissioners and is comprised of 9 members, all of whom live in the county and are not employed by the Hospital. All employees sign a conflict of interest statement. Labette Health's medical staff is open with the exception of Radiology and Anesthesiology. Any profit margin, whether operational or in total, that Labette Health may experience is reinvested into operations. No one individual or one organization benefits from the profit margin but rather the institution and our patients are the beneficiaries. Part VI, Line 6: N/A 1 Labette Health Foundation Inc 1902 South Highway 59 Parsons KS 67357 481009259 501(c)(3) 13979 Independence facility construction costs Part I, Line 2: The Medical Center monitors the use of grant funds by requiring receipts and other supporting documenation before disbursing any requested funds. X X X 0 1 0 0 0 0 0 1 0 Thomas Macaronas CFO/COO 175496 0 21800 0 0 0 12453 0 12801 0 222550 0 0 0 Brian Williams President/CEO 290000 0 10000 0 1035 0 17500 0 1360 0 319895 0 0 0 Douglas Stacy CIO 147810 0 3850 0 1308 0 3143 0 14757 0 170868 0 0 0 Kathi McKinney CNO 146622 0 6000 0 0 0 9026 0 6791 0 168439 0 0 0 Michael Farris Physician 468722 0 7000 0 18082 0 8000 0 16309 0 518113 0 0 0 Trevor Bond Physician 389000 0 38333 0 2442 0 8000 0 16018 0 453793 0 0 0 Philip Gorman Anesthesiologist 343096 0 32250 0 5592 0 8000 0 15670 0 404608 0 0 0 Roxanne Olmstead Physician 329339 0 53133 0 31638 0 8000 0 7962 0 430072 0 0 0 Shawn Southwick Physician 387871 0 0 0 540 0 8000 0 7846 0 404257 0 0 0 Part I, Line 4b Brian Williams, current CEO, is eligible to receive IRC section 457(f) pension plan contributions of up to $30,000 annually at the discretion of the Board of Trustees. $10,000 was contributed to to Brian's IRC section 457(f) plan during 2016. Part I, Line 7 Physicians and anesthesiologists are eligible for incentive bonuses based on their production. A Labette County Kansas 486040264 505392BR0 2007-07-19 25463276 Refund Series A, 1996 bonds issued on 07/15/1996, construct/remodel facility 0 0 0 B Labette County Kansas 486040264 2016-12-29 9021000 Partial refund of Series A, 2007 bonds issued 0 0 0 A 25463276 1799483 474901 16954849 6244890 2010 1 0 1 1 B 9021000 180649 8840351 2010 0 1 1 1 A 0 0 0 0 0 0 0 B 0 0 0 0 0 0 0 A 0 0 0 1 0 0 0 0 1 B 0 0 0 1 0 0 0 0 1 A 1 B 1 Date Rebate Computation Performed Issuer Name: Labette County, Kansas Date the Rebate Computation was Performed: 09/10/2012 Robert Gibbs Trustee Recruiting assitance loan X 50000 50000 0 1 1 50000 Emily Brown Family member of Ned Wall, Trustee 73310 Employment 0 Form 990, Part VI, Section A, line 7a Members of the Board of Trustees are appointed by the Commissioners of Labette County, Kansas Form 990, Part VI, Section A, line 8b There are no committees with the authority to act on behalf of the governing body. Form 990, Part VI, Section B, line 11b Form 990 is reviewed by the CEO and CFO and is provided to the governing body prior to filing. 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 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 is responsible for determining the job performance standards for the CEO and fixing compensation according to the organization's policies. 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 request. Labette Health Regional Partnerships Inc 9401 Indian Creek Parkway Building Overland Park KS 66210 464050502 Operating a medical office building utilized for health care services KS 501(c)(3) Line 12a, I Labette County Medical Center 1 Southeast Kansas Regional Health Inc 1902 S US Highway 59 Parsons KS 67357 813739559 Provide healthcare facilities and services KS 501(c)(3) Line 12a, I Labette County Medical Center 1 0 0 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 Labette Health Regional Partnerships Inc D 359889 Actual amount owed