2017-09-20T09:04:10-05:00 2016-12-31 BKD LLP 1551 N WATERFRONT PKWY STE 300 WICHITA KS 672066601 990 2016-01-01 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 2014-05-15 true STEVEN L WEBB P00235405 3162652811 2017-08-15 2016 2022-09-23 18:48:47Z DAVE DELLASEGA 250 NORTH ROCK ROAD STE 160 WICHITA KS 67206 11480150 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. 9 8 157 16 0 239347 444837 11733327 10900423 17104 15728 231809 113536 12221587 11474524 0 0 0 0 7159088 7217280 0 0 0 5246648 4862473 12405736 12079753 -184149 -605229 7481760 6586438 1805547 1641560 5676213 4944878 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 10271545 10886871 SEE SCHEDULE O. 10271545 true true false true false false false false false false true false false false 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 false false true 25 0 true 157 true false false false false false true true false false false false X 9 8 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 201990 29280 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 0.25 2.25 X 0 0 0 DR BARBARA BROWN APPLEGATE DIRECTOR 0.25 2.25 X 0 0 0 TERRY DESCHAINE DIRECTOR 0.25 2.25 X 0 0 0 MIKE HAND CFO 2.0 40.0 X 0 163659 30575 LORA KEY ADMINISTRATOR 40.0 0.0 X 112407 0 28933 KEVIN KENNALLY PHYSICIAN 40.0 0.0 X 308786 0 45582 GREGG WENGER PHYSICIAN 40.0 0.0 X 208943 0 38439 JAMES LONGABAUGH PHYSICIAN 40.0 0.0 X 241609 0 33804 CHRISTIAN TRAMP PHYSICIAN 40.0 0.0 X 223793 0 42632 KERSTIN GLYNN PHYSICIAN 40.0 0.0 X 264835 0 46768 1360373 365649 296013 6 false true false MHS DATA CENTER 103 E 27TH SUITE A HAYS KS 67601 COMPUTER SUPPORT 389870 STORMONT VAIL HEALTHCARE 1500 SW 10TH STREET TOPEKA KS 66604 LAB SERVICES 115668 GREAT PLAINS HEALTH ALLIANCE PO BOX 366 PHILLIPSBURG KS 67661 MANAGEMENT 130259 SHARED MEDICAL SERVICES INC 209 LIMESTONE PASS COTTAGE GROVE WI 53527 MRI SERVICES 110055 4 15173 396161 33503 1446 444837 NET PATIENT SERVICE REVENUE 621300 10857450 10857450 340(B) PHARMACY REVENUE 621300 42973 42973 10900423 15728 15728 0 0 16025 16025 0 16025 16025 0 3175 15173 5626 -2451 -2451 0 0 0 0 0 0 EMPLOYEE/GUEST MEALS 900099 14994 14994 OUTSIDE SERVICES 621300 29421 29421 VENDOR REBATES 900099 12390 12390 43157 43157 99962 11474524 10900423 129264 0 0 0 0 141340 141340 0 5592375 4919458 672917 429788 391832 37956 674759 492427 182332 379018 323678 55340 113922 113922 4348 4348 35758 35758 0 0 0 1434375 1194136 240239 0 27320 12018 15302 204684 134610 70074 1595 1595 0 194212 183502 10710 16225 5530 10695 0 47365 40074 7291 14391 13146 1245 0 562937 517571 45366 130298 38219 92079 MEDICAL SUPPLIES & DRUGS 1373900 1373900 RENTAL EQUIPMENT & REPAIRS 372044 357036 15008 BAD DEBT EXPENSE 178524 178524 DUES & SUBSCRIPTIONS 49088 17841 31247 101487 78043 23444 12079753 10271545 1808208 0 220 23177 1148584 1338225 72113 100547 1987837 1490100 0 0 0 0 0 0 156401 169189 113580 105396 12224231 9391924 3365742 2832307 0 0 237283 245777 0 0 0 0 400000 281720 7481760 6586438 1319730 1289784 0 0 72113 63872 0 0 0 0 0 0 413704 287904 0 0 0 0 1805547 1641560 X 5676213 4940737 0 4141 0 0 5676213 4944878 7481760 6586438 X -605229 -126106 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED X true false false false false false true 3865 false false false 3865 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 4454779 2058510 5471679 4759835 711844 204019 177310 26709 2832307 11332120 -142404 -142404 11474524 11474524 12063455 162226 162226 11901229 178524 178524 12079753 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. 30,494 SPECIAL EVENT EXPENSES 5,626 PROVISION FOR UNCOLLECTIBLE ACCOUNTS (178,524) --------- TOTAL (142,404) SCHEDULE D, PART XII, LINE 2D TRANSFER TO CITY OF SABETHA 156,600 SPECIAL EVENT EXPENSES 5,626 -------- TOTAL 162,226 SCHEDULE D, PART XII, LINE 4B PROVISION FOR UNCOLLECTIBLE ACCOUNTS 178,524 GOLF TOURNAMENT 18348 15173 3175 2500 535 0 951 0 1640 0 18348 15173 3175 2500 535 0 951 0 1640 5626 -2451 true true X false true X true true false true true 47406 47406 0.00400 360329 210061 150268 0.01260 407735 210061 197674 0.01660 65732 17376 48356 0.00410 3506 3506 0.00030 69238 17376 51862 0.00440 476973 227437 249536 0.02100 false 178524 4775191 4775191 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 0. 300. 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://nemvch.com/uploads/documents/Community%20Needs%20Assessment%202015. 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 NUMBER THREE; 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 2016, 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 2016, 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 2016, 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 2016, 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 13H THE ORGANIZATION EMPLOYS A SLIDING SCALE DISCOUNT THAT TAKES INTO CONSIDERATION A PATIENT'S HOUSEHOLD INCOME AND QUALIFYING ASSETS. TO BE ELIGIBLE FOR FINANCIAL ASSISTANCE, A PATIENT'S HOUSEHOLD INCOME MUST BE BELOW 300% OF THE MOST RECENT FEDERAL POVERTY LEVEL AT THE DATE OF SERVICE. TO DETERMINE THE AMOUNT OF THE DISCOUNT, AN ASSET TEST IS ALSO UTILIZED. SCHEDULE H, PART V, LINE 16A http://www.sabethahospital.com/getpage.php?name=finassist&sub=Sabetha%20Ho spital 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/getpage.php?name=finassist&sub=Sabetha%20Ho spital 1 SABETHA FAMILY PRACTICE 1115 MAIN STREET SABETHA KS 66534 FAMILY CLINIC SCHEDULE H, PART I, LINE 3C THE ORGANIZATION EMPLOYS A SLIDING SCALE DISCOUNT THAT TAKES INTO CONSIDERATION A PATIENT'S HOUSEHOLD INCOME AND QUALIFYING ASSETS. TO BE ELIGIBLE FOR FINANCIAL ASSISTANCE, A PATIENT'S HOUSEHOLD INCOME MUST BE BELOW 300% OF THE MOST RECENT FEDERAL POVERTY LEVEL AT THE DATE OF SERVICE. TO DETERMINE THE AMOUNT OF THE DISCOUNT, AN ASSET TEST IS ALSO UTILIZED. 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 $178,524. 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 SCH IS COMMITTED TO PROVIDING ACCESS TO CARE FOR OUR PATIENTS BY PROVIDING MONTHLY OUTPATIENT SPECIALTY CLINICS SO THAT LOCAL PATIENTS DO NOT NEED TO TRAVEL 70 PLUS MILES TO SEE A SPECIALIST BUT CAN STAY WITHIN THEIR LOCAL COMMUNITY HEALTHCARE SYSTEM. INFORMATION REGARDING THE OUTPATIENT SPECIALTY CLINICS ALONG WITH MONTHLY EDUCATIONAL INFORMATION IS PUBLISHED WITHIN LOCAL COMMUNITY PAPERS, AND IT IS ALSO POSTED ON THE HOSPITAL WEBSITE. THE FIRST YEAR OF A COLLABORATIVE AGREEMENT WITH KU MED FOR THE RE-POWER PROGRAM PROVED TO BE VERY PRODUCTIVE. PATIENTS WERE IDENTIFIED AND ADMITTED TO THE PROGRAM WITH AN OVERALL HEALTH ASSESSMENT BEING CONDUCTED TO SERVE AS A BASELINE FOR THE WEIGHT LOSS PROGRAM. 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 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. IN 2016, THE HOSPITAL CONDUCTED A BABYSITTING CLASS WITH 19 PARTICIPANTS. EDUCATION WAS PROVIDED FOR THEM ON NUTRITION, APPROPRIATE ACTIVITIES FOR INFANTS AND TODDLERS, AND EMERGENCY FIRST AID. THE LEVEL IV TRAUMA COMMITTEE GAVE SCHOLARSHIPS SO THAT 4 COMMUNITY CHILDREN COULD TAKE SWIMMING LESSONS OFFERED AT THE PUBLIC POOL. BEREAVEMENT SUPPORT GROUPS ARE CONDUCTED YEARLY, AND EDUCATION MATERIALS ARE PROVIDED FOR THOSE IN THE COMMUNITY WHO HAVE LOST LOVED ONES. THE HOSPITAL HAS A TRAINED CAR SEAT SPECIALIST WHO CONDUCTS CAR SEAT SAFETY CHECKS BEFORE INFANTS LEAVE THE HOSPITAL. THE HOSPITAL CONTINUES TO PARTICIPATE IN THE HCAPS SURVEY AND RESULTS ARE REVIEWED WITH STAFF ANNUALLY. THE HOSPITAL PARTICIPATED IN THE KANSAS HEALTH ENGAGEMENT NETWORK 2.0 UNTIL THE COMPLETION OF THAT PROJECT AND NOW PARTICIPATES IN KHIIN QUALITY PROJECT. THE HOSPITAL PARTNERS WITH THE COMMUNITY MENTAL HEALTH CENTER HELPING TO PROVIDE ACCESS TO MENTAL HEALTH SERVICES. FURTHER OPTIONS TO EXPAND MENTAL HEALTH ARE BEING RESEARCHED BUT RESOURCES AND THE AVAILABILITY OF MENTAL HEALTH PROFESSIONALS ARE LIMITED. HOSPITAL STAFF MEMBERS PROVIDE HELP TO COMMUNITY MEMBERS DURING THE MEDICARE PART D OPEN ENROLLMENT PERIOD. AND, 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 A SUMMARY OF THE PROGRAM IN THE PATIENTS' MONTHLY BILLING STATEMENT. THE FINANCIAL ASSISTANCE PROGRAM EMPLOYS A SLIDING SCALE DISCOUNT THAT 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 IS ESTIMATED AT 2800. THE PRIMARY SERVICE AREA FOR SABETHA COMMUNITY HOSPITAL INCLUDES PORTIONS OF NEMAHA, BROWN AND JACKSON COUNTY, KANSAS AND SEVERAL COUNTIES IN NEBRASKA. NEMAHA COUNTY PROVIDED 83% OF INPATIENT DISCHARGES FOR 2016. ESTIMATED POPULATION FOR NEMAHA COUNTY IS 10,277 ACCORDING TO THE UNITED STATES CENSUS BUREAU. PEOPLE AGE 65 AND OVER MAKE UP 20.1% OF THE COUNTYS TOTAL POPULATION. THE RACIAL AND ETHNIC COMPOSITION OF NEMAHA COUNTY IS MOSTLY WHITE WHICH IS AT 96.9%, NATIVE AMERICAN .7%, AFRICAN AMERICANS .7%, ASIANS .2% AND HISPANICS WERE 1.7% OF THE POPULATION. SCHEDULE H, PART VI, LINE 5 THE HOSPITAL CEO PARTICIPATED IN AN ECONOMIC DEVELOPMENT COMMITTEE PROVIDING A HEALTHCARE ASPECT TO THE GROUP WANTING TO GROW THE COMMUNITY. THE HOSPITAL PARTNERED WITH OTHER COMMUNITY PROVIDERS IN SPONSORING FIRE PREVENTION BOOKLETS TO THE ELEMENTARY STUDENTS TO PROMOTE FIRE SAFETY. IN 2016, THE HOSPITAL BEGAN TRAINING PHYSICIANS AND STAFF MEMBERS ON CERNER COMMUNITY WORKS AND EDUCATING THE COMMUNITY ON HOW THE TRANSITION WOULD AFFECT PATIENTS ELECTRONIC MEDICAL RECORDS AND THE PATIENT PORTAL. THE CERTIFIED DIABETIC NURSE EDUCATOR ALONG WITH THE REGISTERED DIETICIAN PROVIDE A SUPPORT GROUP TO DIABETIC PATIENTS PROMOTING LIFE STYLE CHANGES AND ACCOUNTABILITY IN THEIR DIABETIC JOURNEY. THE HOSPITAL PROVIDES WELLNESS CHECKS FOR LOCAL, AREA BUSINESSES ALONG WITH EDUCATION SESSIONS. 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. THE HOSPITAL VOLUNTEER CORE CONTINUES TO REMAIN STRONG WITH COMMUNITY MEMBERS BEING UTILIZED IN MANY AREAS OF THE HOSPITAL. ANOTHER SERVICE TO THE COMMUNITY IS THE PROVISION OF OCCUPATIONAL ASSESSMENT TESTING ALONG WITH HEARING SCREENS. CERTIFIED STAFF IS AVAILABLE IN HOUSE TO PROVIDE THOSE SERVICES. STAFF WILL ALSO CONDUCT BLOOD PRESSURE CHECKS AND BLOOD WORK WHEN REQUESTED AT THE LOCAL BUSINESSES AS WELL AS WELLNESS EDUCATION LUNCH AND LEARN. FIRST GRADE STUDENTS ARE INVITED TO ATTEND AN ANNUAL HOSPITAL TOUR GUIDING THEM THROUGH VARIOUS DEPARTMENTS OF THE HOSPITAL. DURING THE FLU SEASON, FLU CLINICS ARE OFFERED TO THE COMMUNITY AT THE HOSPITAL, AND HOSPITAL STAFF ALSO CONDUCTS FLU CLINICS AT THE LOCAL GROCERY STORE AS WELL AS ONSITE FLU VACCINATIONS FOR SEVERAL LOCAL BUSINESSES. 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 KANSAS HOSPITAL ASSOCIATIONS POLICY AND ADVOCACY COMMITTEE, THE HEALTH INNOVATIONS NETWORK OF KANSAS BOARD, THE KANSAS HEALTH CARE COLLABORATIVE BOARD, THE KANSAS HOSPITAL ASSOCIATION KANCARE TECHNICAL ADVISORY GROUP, AND THE GOVERNORS KANCARE ADVISORY GROUP. 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 501C3 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 MANAGERS, 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 199666 0 0 0 2324 0 19610 0 9670 0 231270 0 0 MIKE HAND CFO 0 161885 0 0 0 1774 0 15599 0 14976 0 194234 0 0 KEVIN KENNALLY PHYSICIAN 305398 0 0 0 3388 0 25700 0 19882 0 354368 0 0 0 GREGG WENGER PHYSICIAN 206729 0 0 0 2214 0 21203 0 17236 0 247382 0 0 0 JAMES LONGABAUGH PHYSICIAN 239160 0 0 0 2449 0 23735 0 10069 0 275413 0 0 0 CHRISTIAN TRAMP PHYSICIAN 221236 0 0 0 2557 0 22618 0 20014 0 266425 0 0 0 KERSTIN GLYNN PHYSICIAN 262009 0 0 0 2826 0 25700 0 21068 0 311603 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 4 SABETHA COMMUNITY HOSPITAL CONTINUES ITS MISSION TO DELIVER CARE TO OUR PATIENTS AT THE RIGHT TIME, RIGHT PLACE, AND WITHIN THE STANDARD OF CARE. AS EVIDENCED BY THE ACA, ESSENTIAL HEALTH BENEFITS ARE A PRIORITY IN THE HEALTHCARE INDUSTRY. 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 AND FOR REDUCED SESSION FEES ARE ABLE TO UTILIZE 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. ALONG THE LINES OF THE SOCIAL ASPECT, ADDRESSING THE NEEDS OF MENTAL HEALTH AMONG THE ELDERLY POPULATION AS WELL AS YOUTH CONTINUES TO BE A PRIORITY. THE HOSPITAL PARTNERS WITH THE COMMUNITY MENTAL HEALTH CENTER TO PROVIDE ACCESS TO MENTAL HEALTH SERVICES WHICH IS ANOTHER KEY IN PROMOTING OVERALL HEALTH. THE PROVISION OF MENTAL HEALTH SERVICES IS A CHALLENGE BUT CONTINUES TO REMAIN A PRIORITY. ANOTHER LARGE PROGRAM WHICH THE HOSPITAL PROVIDES IS A BREASTFEEDING CLINIC. THIS CLINIC PROVIDES SUPPORT TO 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. ALONG WITH THE BREASTFEEDING PROGRAM, THE HOSPITAL ALSO PARTICIPATES IN 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 A BABY. ANOTHER IMPORTANT FACTOR IN BABES CARE IS ALSO A PROPERLY FITTED CAR SEAT, THE HOSPITAL PROVIDES A CA SEAT SPECIALIST TO MAKE SURE THE BABY IS SAFE WHEN LEAVING THE HOSPITAL. PROGRAMS IDENTIFIED THROUGH COMMUNITY HEALTH NEEDS ASSESSMENT ARE CONTINUALLY BEING ENHANCED AND ADDED TO AS WELL. THE IMPORTANCE OF DIABETIC EDUCATION AND SUPPORT FOR OUR PATIENTS CONTINUE TO BE A PRIMARY FOCUS FOR SCH. THE HOSPITAL CONDUCTS A SMART PROGRAM BRINGING ACCOUNTABILITY TO THE DIABETIC PATIENT. KU MED AND SCH PARTNERED TOGETHER TO CONDUCT A PILOT PROJECT TO PROMOTE WEIGHT LOSS IN A TARGETED GROUP OF PATIENTS. THIS PROGRAM CONTINUES FOR THREE YEARS BUT THIS FIRST YEAR HAS PROVEN TO BE SUCCESSFUL. CONTINUATION TO PROMOTE HEALTH, WELLNESS AND CHRONIC DISEASE PREVENTION REMAINS A PRIORITY. THROUGH 2016, SCH FOCUSED ON BUILDING A STRONG ELECTRONIC MEDICAL RECORD TO BETTER SERVE OUR PATIENT POPULATION ENHANCING PROVISION OF CARE TO THE YOUNG AS WELL AS THE OLD WITHIN OUR COMMUNITY AND SURROUNDING AREAS THAT WE SERVE. THE CURRENT EHR SYSTEM WAS BOUGHT OUT BY CERNER AND SO TRAINING BEGAN IN THE FALL TO TRANSITION TO CERNER COMMUNITY WORKS. SABETHA COMMUNITY HOSPITAL CONTINUED TO PARTICIPATE IN THE KANSAS HEALTH CARE COLLABORATIVE HEN 2.0 QUALITY PROJECTS UNTIL THE COMPLETION OF THAT PROJECT AND THEN JOINED KHC HIIN QUALITY PROJECT. THE HCAHPS SCORES ARE USED TO KEEP STAFF INFORMED OF PATIENT SATISFACTION AND AREAS OF IMPROVEMENT ENHANCING SCHS MISSION IS 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 ALSO 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 A 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 FINANCIAL 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 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 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. 30,494 TRANSFER TO CITY OF SABETHA (156,600) ---------- TOTAL $ (126,106) FORM 990 PART IX LINE 11G DESCRIPTION:CONTRACTED MEDICAL STAFF TOTAL FEES:939275 FORM 990 PART IX LINE 11G DESCRIPTION:BILLING/COLLECTIONS TOTAL FEES:126742 FORM 990 PART IX LINE 11G DESCRIPTION:LAB SERVICES TOTAL FEES:129534 FORM 990 PART IX LINE 11G DESCRIPTION:PHARMACY SERVICES TOTAL FEES:116942 FORM 990 PART IX LINE 11G DESCRIPTION:ADMINISTRATION/HUMAN RESOURCES TOTAL FEES:111625 FORM 990 PART IX LINE 11G DESCRIPTION:MAINTENANCE/HOUSEKEEPING TOTAL FEES:8385 FORM 990 PART IX LINE 11G DESCRIPTION:PLANT OPERATIONS TOTAL FEES:1872 GREAT PLAINS HEALTH ALLIANCE INC 250 N ROCK ROAD WICHITA KS 67206 480617739 MANAGEMENT KS 501(C)(3) 3 NA false GREAT PLAINS HEALTH CARE FOUNDATION INC 250 NORTH ROCK ROAD STE 160 WICHITA KS 67206 480955870 SUPPORT KS 501 (C)(3) 9 GPHA INC true GREAT PLAINS OF CHEYENNE COUNTY INC 250 NORTH ROCK ROAD STE 160 WICHITA KS 67206 481226831 HOSPITAL KS 501 (C)(3) 3 GPHA INC true GREAT PLAINS OF ELLINWOOD INC 250 NORTH ROCK ROAD STE 160 WICHITA KS 67206 481226976 HOSPITAL KS 501(C)(3) 3 GPHA INC true GREAT PLAINS OF OTTAWA COUNTY INC 250 NORTH ROCK ROAD STE 160 WICHITA KS 67206 481226856 HOSPITAL KS 501(C)(3) 3 GPHA INC true GREAT PLAINS OF REPUBLIC COUNTY INC 250 NORTH ROCK ROAD STE 160 WICHITA KS 67206 481226977 HOSPITAL KS 501(C)(3) 3 GPHA INC true GREAT PLAINS OF SABETHA COUNTY INC 250 NORTH ROCK ROAD STE 160 WICHITA KS 67206 481236156 HOSPITAL KS 501(C)(3) 3 GPHA INC true GREAT PLAINS OF SMITH COUNTY INC 250 NORTH ROCK ROAD STE 160 WICHITA KS 67206 481226830 HOSPITAL KS 501(C)(3) 3 GPHA INC true GREAT PLAINS OF SMITH COUNTY INC 250 NORTH ROCK ROAD STE 160 WICHITA KS 67206 481226830 HOSPITAL KS 501 (C) (3) 3 GPHA INC true false false false false false false false false false false false false true false true false false false false