2016-11-14T10:17:14-06:00 2015-12-31 481026809 Wendling Noe Nelson & Johnson LLC 534 S Kansas Ave Suite 1500 Topeka KS 666033491 990 2015-01-01 486099245 Labette County Medical Center LABE 6204214880 1902 S US Highway 59 Parsons KS 67357 Thomas Macaronas CFO 6204214880 2016-11-11 1 Heather R Eichem P01515553 7852334226 2016-11-11 2015 2017-02-10 21:41:12Z Labette Health Thomas Macaronas 1902 S US Highway 59 Parsons KS 67357 63707079 0 X www.labettehealth.com X Government 1961 KS Medical care for the southeast Kansas region 9 7 631 52 0 0 739894 1256172 56454973 61075057 -510318 495330 806539 879265 57491088 63705824 10188 6988 0 0 30216036 29741686 0 0 192714 30914889 31120342 61141113 60869016 -3650025 2836808 67841752 69057534 38625169 37004143 29216583 32053391 Focusing on the patient and providing exceptional healthcare through effective clinical and financial management. 0 0 51227009 6988 61489742 Labette County Medical Center operates physician clinics and provides inpatient and outpatient services to the residents of the southeastern Kansas area. 51227009 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 0 0 1 1 0 0 0 0 0 1 0 0 1 0 0 0 0 0 0 1 1 0 0 0 1 45 0 1 631 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 Treasurer 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 15701 0 12000 Vince Schibi Trustee through 01/08/2015 1.00 X 0 0 0 Thomas Macaronas CFO/COO 40.00 X 202881 0 21430 Jodi Schmidt President/CEO through 01/04/2015 40.00 X 133833 0 20827 Brian Williams President/CEO beginning 09/01/2015 40.00 X 103692 0 413 Douglas Stacy CIO 40.00 X 152369 0 19628 Michael Farris Physician 40.00 X 480844 0 19792 Trevor Bond Physician 40.00 X 449878 0 19689 Philip Gorman Anesthesiologist 40.00 X 427824 0 19598 Paras Shah Physician 40.00 X 378428 0 18575 Shawn Southwick Physician 40.00 X 362790 0 19303 2708240 0 171255 39 0 1 0 CPSI PO Box 850309 Mobile AL 36685 Computer support services 688437 Medical Consultants of Kansas LLC PO Box 20077 Wichita KS 67208 Hospitalist services 677898 Jerry Bouman DO 21004 Ness Road Parsons KS 67357 General surgeon 606340 Claims Professionally Reviewed LLC 1412 SW Eagles Parkway Grain Valley MO 64029 Coding services 393722 Spencer Fane Britt & Browne LLP PO Box 872037 Kansas City MO 64187 Legal services 366232 11 462491 769599 24082 1256172 Patient service revenue 621990 58632001 58632001 340b pharmacy revenue 621990 1758360 1758360 EHR incentive payments 621990 506177 506177 Fitness center 713940 122696 122696 55823 55823 61075057 80645 80645 237806 0 237806 237806 237806 415940 1255 414685 414685 414685 Cafeteria meals 722210 268080 268080 Other 621990 233044 233044 Leased employees 900099 140335 140335 641459 63705824 61489742 0 959910 2988 2988 4000 4000 569635 27701 541934 24558434 21917817 2532916 107701 603923 563513 37641 2769 2389453 2111363 267715 10375 1620241 1418326 194946 6969 883925 883925 100370 10190 90180 264891 24443 232470 7978 184794 27196 150618 6980 245750 245750 1412660 1166855 245208 597 104923 87500 15940 1483 1710817 1382512 327279 1026 4595534 3652990 940246 2298 474137 290449 183676 12 Drugs and medical suppl 10014207 10014207 Purchased services 6143744 5002357 1122101 19286 Repairs and maintenance 1707075 1401567 305444 64 Collection fees 1285018 866533 418485 1992497 1254502 712819 25176 60869016 51227009 9449293 192714 1138430 -276329 16758152 24032011 9384778 9208395 50000 50000 371610 357554 1345985 1366341 608665 609365 86470110 54262810 36448190 32207300 1735942 1502897 67841752 69057534 5880361 5654766 60004 24993 25235780 25205244 7253751 5775742 195273 343398 38625169 37004143 X 28861396 30845944 355187 1207447 29216583 32053391 67841752 69057534 2836808 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 12249 12249 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 55584962 30805049 24779913 29930592 23457761 6472831 105530 105530 32207300 Estimated third-party payor settlements 343398 343398 63705824 0 63705824 0 63705824 60869016 0 60869016 0 60869016 1 1 1 X 1 X 1 1 0 0 741041 84874 656167 0.01080 6980272 3366529 3613743 0.05940 7721313 3451403 4269910 0.07020 72896 20505 52391 0.00090 4000 4000 0.00010 8895007 6163220 2731787 0.04490 3084 3084 0.00010 8974987 6183725 2791262 0.04600 16696300 9635128 7061172 0.11620 1 2456130 245613 20051573 19108836 942737 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 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 X X X 1 X 0 X 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: During 2015, Labette Health continued to focus on refining community data, using its findings to address the needs of our PSA and SSA. In addition, the Board of Trustees successfully conducted and completed an intense CEO search. Other patient and community focused efforts during 2015 included improving the access to patient care in Parsons as well as Independence, KS. Labette Health also stepped up and began to develop a plan to offer Emergency Care to the citizens of Independence in response to the loss of their Hospital. The Hospital also improved outcomes by reducing readmissions and increasing patient safety, implemented inpatient hospice for those patients in need, continued our community education in the areas of diabetis and trauma injury provider education, and increased our involvment with Meals on Wheels and the Summer Food program for the school age population. Labette County Medical Center Part V, Section B, Line 22d: The maximum amounts that can be charged by Labette Health to FAP-eligible individuals for emergency or other medically necessary care is calculated by multiplying gross charges for such care by the amounts generally billed percentage. This percentage is calculated annually as follows: Sum of all claims paid in full (including payments from beneficiaries and insureds) by Medicare fee-for-service and private payors during the prior fiscal year divided by the sum of gross charges for those claims. 5 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 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 37,000 people and the secondary service area (SSA) has an approximate population of 55,000 people. Labette County has an approximate population of 21,000 and the city of Parsons has an approximate population of 10,000 people. The median income for the PSA is approximately $42,400 while the county and state median are $41,400 and $52,000 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 4.4%. The PSA multicultural composition reflects that as of 2015 14.7% 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 X X X 0 1 0 0 0 0 0 1 0 Thomas Macaronas CFO/COO 202881 0 0 0 0 0 10711 0 10719 0 224311 0 0 0 Jodi Schmidt President/CEO through 01/04/2015 33456 0 0 0 100377 0 20000 0 827 0 154660 0 72427 0 Douglas Stacy CIO 152369 0 0 0 0 0 9101 0 10527 0 171997 0 0 0 Michael Farris Physician 469360 0 0 0 11484 0 8000 0 11792 0 500636 0 0 0 Trevor Bond Physician 410884 0 0 0 38994 0 8000 0 11689 0 469567 0 0 0 Philip Gorman Anesthesiologist 357866 0 36000 0 33958 0 8000 0 11598 0 447422 0 0 0 Paras Shah Physician 350845 0 0 0 27583 0 8000 0 10575 0 397003 0 0 0 Shawn Southwick Physician 362250 0 0 0 540 0 8000 0 11303 0 382093 0 0 0 Part I, Line 4b Jodi Schmidt, former CEO, was eligible to receive IRC section 457(f) pension plan contributions of up of $30,000 annually at the discretion of the Board of Trustees. She terminated employment during 2015 and received a payout from this plan in the amount of $100,068. 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. No contributions were made to Brian's IRC section 457(f) plan during 2015. 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 A 25463276 1799483 474901 16954849 6244890 2010 1 0 1 1 A 0 0 0 0 0 0 0 A 0 0 0 1 0 0 0 0 1 A 1 Date Rebate Computation Performed Issuer Name: Labette County, Kansas Date the Rebate Computation was Performed: 09/10/2012 Schedule K, Part II The difference between Part I, column (e) and Part II, line 3 is due to the accumulation of investment income. Robert Gibbs Trustee Recruiting assitance loan X 50000 50000 0 1 1 50000 Emily Brown Family member of Ned Wall, Trustee 74619 Employment 0 Brenda Schibi Family member of Vince Schibi, Trustee through 01/08/2015 42375 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 11 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 11a, 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 364175 Actual amount owed