2016-11-15T11:07:27-06:00 2015-12-31 BKD LLP 1551 N WATERFRONT PKWY STE 300 WICHITA KS 672066601 990 2015-01-01 481236156 GREAT PLAINS OF SABETHA INC % MIKE HAND GREA 3166851523 250 NORTH ROCK ROAD STE 160 WICHITA KS 67206 MIKE HAND CFO 2016-08-15 true STEVEN L WEBB P00235405 3162652811 2015 2017-02-10 21:41:12Z MIKE HAND 250 NORTH ROCK ROAD STE 160 WICHITA KS 67206 12298517 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 8 160 60 0 212800 239347 10889871 11733327 -53 17104 388423 231809 11491041 12221587 0 0 0 0 6705988 7159088 0 0 0 4593740 5246648 11299728 12405736 191313 -184149 7892337 7481760 1897732 1805547 5994605 5676213 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 10564750 0 11812973 SEE SCHEDULE O. 10564750 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 false false true 33 0 true 160 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 MIKE HAND 3166851523 250 NORTH ROCK ROAD STE 160 WICHITA KS 67206 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 192576 27382 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 146913 32175 LORA KEY ADMINISTRATOR 40.0 0.0 X 94028 0 26346 KEVIN KENNALLY PHYSICIAN 40.0 0.0 X 320495 0 42440 GREGG WENGER PHYSICIAN 40.0 0.0 X 195685 0 31922 JAMES LONGABAUGH PHYSICIAN 40.0 0.0 X 224871 0 31862 CHRISTIAN TRAMP PHYSICIAN 40.0 0.0 X 238938 0 41831 KERSTIN GLYNN PHYSICIAN 40.0 0.0 X 266908 0 39837 1340925 339489 273795 5 false true false MHS DATA CENTER 103 E 27TH SUITE A HAYS KS 67601 COMPUTER SUPPORT 272033 STORMONT VAIL HEALTHCARE 1500 SW 10TH STREET TOPEKA KS 66604 LAB SERVICES 114014 GPHA PO BOX 366 PHILLIPSBURG KS 67661 MANAGEMENT 131531 SHARED MEDICAL SERVICES INC 209 LIMESTONE PASS COTTAGE GROVE WI 53527 MRI SERVICES 113100 STARS INC 201 S 4TH ST HIAWATHA KS 66434 PHYSICAL THERAPISTS 100547 5 12956 174715 51676 535 239347 NET PATIENT SERVICE REVENUE 621300 11733327 11733327 11733327 16546 16546 0 0 16500 16500 0 16500 16500 73267 72709 558 558 558 3775 12956 4221 -446 -3021 0 0 EMPLOYEE/GUEST MEALS 900099 16080 16080 OUTSIDE SERVICES 621300 21747 21747 VENDOR REBATES 900099 16107 16107 161821 57899 103922 215755 12221587 11812973 166692 0 0 0 0 120374 120374 0 5629914 4921016 708898 436298 382987 53311 597774 422486 175288 374728 322098 52630 109540 109540 727 727 34552 34552 0 0 0 1498177 1265781 232396 0 31811 14109 17702 230810 154828 75982 4336 640 3696 0 205321 195368 9953 18139 6908 11231 0 61731 49437 12294 12442 11485 957 0 623637 579572 44065 130152 38621 91531 MEDICAL SUPPLIES & DRUGS 1516599 1516599 0 0 RENTAL EQUIPMENT & REPAIRS 381452 363029 18423 0 BAD DEBT EXPENSE 265831 265831 0 0 DUES & SUBSCRIPTIONS 51064 19459 31605 0 70327 34496 35831 12405736 10564750 1840986 0 220 220 1672426 1148584 5603 72113 1913395 1987837 0 0 0 0 0 0 176867 156401 112692 113580 12197709 8831967 3785208 3365742 0 0 225926 237283 0 0 0 0 0 400000 7892337 7481760 1443802 1319730 0 0 0 72113 0 0 0 0 0 0 453930 413704 0 0 0 0 1897732 1805547 X 5989002 5676213 5603 0 0 0 5994605 5676213 7892337 7481760 X -184149 -134243 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED X true false false false false false true 3272 false false false 3272 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 4221052 2292237 5445157 4437889 1007268 204019 173026 30993 3365742 THIRD PARTY RECEIVABLE 400000 400000 11982334 -239253 -239253 12221587 12221587 12300726 160821 160821 12139905 265831 265831 12405736 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. 22,357 SPECIAL EVENT EXPENSES 4,221 PROVISION FOR UNCOLLECTIBLE ACCOUNTS (265,831) --------- TOTAL (239,253) SCHEDULE D, PART XII, LINE 2D TRANSFER TO CITY OF SABETHA 156,600 SPECIAL EVENT EXPENSES 4,221 -------- TOTAL 160,821 SCHEDULE D, PART XII, LINE 4B PROVISION FOR UNCOLLECTIBLE ACCOUNTS 265,831 GOLF TOURNAMENT 16731 12956 3775 2500 535 68 1118 0 16731 12956 3775 2500 535 68 1118 4221 -446 true true X false true X true true false true true 40415 40415 0.00330 391109 204667 186442 0.01540 431524 204667 226857 0.01870 127310 58795 68515 0.00560 259 259 4014 4014 0.00030 131583 58795 72788 0.00590 563107 263462 299645 0.02460 false 265831 4781864 4781864 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 false true X 0. 300. X X X true true 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 true X false X X X X true X 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/getpage.php?name=finassist&sub=Sabetha%20Ho spital 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 2015, 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 2015, 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. AT THE END OF 2015, THE PHYSICIAN CLINIC SIGNED A COLLABORATIVE AGREEMENT WITH KU MED FOR THE RE-POWER PROGRAM TO WORK WITH OBESE PATIENTS OVER A THREE YEAR PROJECT PERIOD. 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 2015, 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 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 $265,831. 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 (SCH) IS COMMITTED TO THE ACCESS OF CARE TO 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. ANOTHER NEED ASSESSED WAS THE IMPORTANCE OF EDUCATION TO THE PATIENT POPULATION ON THE USE OF THE PATIENT PORTAL. STAFF WORKS WITH PATIENTS TO HELP SET UP THEIR PORTALS AND EDUCATES THEM ABOUT ACCESS INTO THE PORTAL AND HOW INFORMATION IS UTILIZED. AT THE END OF 2015, THE PHYSICIAN CLINIC SIGNED A COLLABORATIVE AGREEMENT WITH KU MED FOR THE RE-POWER PROGRAM TO WORK WITH OBESE PATIENTS OVER A THREE YEAR PROJECT PERIOD. A PERINATAL CLASS, OFFERED QUARTERLY THROUGHOUT THE YEAR, AND BREASTFEEDING EDUCATION IS OFFERED TO NEW MOMS. SCH PARTNERED WITH NEMAHA VALLEY COMMUNITY HOSPITAL TO PROVIDE NEWBORN SUPPLIES TO MOMS AND BABES UPON BIRTH. THIS PROGRAM HELPS THOSE MOMS AND BABES WHO ARE IN NEED OF EXTRA HELP AT THE START OF THE NEWBORNS LIFE. IN 2015, THE HOSPITAL CONDUCTED TWO MINI HEALTH FAIRS FOR MEN AND WOMEN. BOTH FOCUSED ON BLOOD PRESSURE, BLOOD SUGARS, NUTRITION, AND SKIN CANCER CHECKS. PHYSICIANS SPOKE AT BOTH EVENTS EMPHASIZING THE IMPORTANCE OF OVERALL GENERAL HEALTH. THROUGH THE HOSPICE PROGRAM, BEREAVEMENT SUPPORT GROUPS MET DURING THE FALL, AND EDUCATION MATERIALS ARE PROVIDED FOR THOSE IN THE COMMUNITY WHO HAVE LOST LOVED ONES. THE HOME HEALTH AND HOSPICE SOCIAL MEDIA PAGE IS USED ALSO TO UPDATE THE COMMUNITY ON ITS RESOURCES. 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. AND IS WORKING ON MANY QUALITY INITIATIVES SUCH AS THE REDUCTION OF EARLY ELECTIVE DELIVERIES, REDUCTION OF CATHETER USE AND URINARY TRACT INFECTIONS. THE HOSPITAL PARTNERS WITH THE REGIONAL COMMUNITY MENTAL HEALTH CENTER UTILIZING THE CRISIS MENTAL HEALTH SCREENING TOOL USED WITHIN THE ED. FURTHER OPTIONS TO EXPAND MENTAL HEALTH ARE BEING RESEARCHED BUT RESOURCES AND THE AVAILABILITY OF MENTAL HEALTH PROFESSIONALS ARE LIMITED. 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 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. 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 THE 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 ARE 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 2,800. THE PRIMARY SERVICE AREA FOR SABETHA COMMUNITY HOSPITAL INCLUDES PORTIONS OF NEMAHA, BROWN, AND JACKSON COUNTIES, KANSAS AS WELL AS SEVERAL COUNTIES IN NEBRASKA. NEMAHA COUNTY PROVIDED 83% OF INPATIENT DISCHARGES FOR 2015. 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 SABETHA COMMUNITY HOSPITALS LEVEL IV TRAUMA PROGRAM WAS RECERTIFIED IN 2015. THE EMERGENCY ROOM/TRAUMA QUALITY ASSURANCE COMMITTEE CONTINUES TO MEET MONTHLY TO MAINTAIN THE LEVEL IV TRAUMA CENTER DESIGNATION AND THIS COMMITTEE WAS A CONDUIT FOR THE CAR SEAT SAFETY CHECK PROGRAM CONDUCTED IN DECEMBER. THE HOSPITAL ALSO PARTNERS WITH OTHER COMMUNITY PROVIDERS IN SPONSORING FIRE PREVENTION BOOKLETS TO THE ELEMENTARY STUDENTS TO PROMOTE FIRE SAFETY. SABETHA FAMILY PRACTICE ACHIEVED THE NCQA DESIGNATION IN 2015 HEAVILY EVALUATING PATIENTS ACCESS TO THE PRIMARY CARE PROVIDER AND MODELING THE PATIENT CENTERED MEDICAL HOME MODEL. IN 2015, THE HOSPITAL LEARNED THAT THEIR EHR VENDOR WAS ACQUIRED BY CERNER AND AT THE END OF 2015 A PROJECT TEAM LEADER WAS SELECTED AND CORE TEAMS APPOINTED TO BEGIN THE TRANSITIONING PROCESS TO THE CERNER ELECTRONIC RECORD. IN 2015, THE HOSPITAL RE-CERTIFIED AS A MEDICARE CERTIFIED DIABETIC EDUCATION FACILITY, AND 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. IN MARCH, EMPLOYEES AND THE COMMUNITY WERE ENCOURAGED TO PARTICIPATE IN THE ANNUAL WALK ACROSS KANSAS PROGRAM PROMOTED BY THE MEADOWLARK COUNTY EXTENSION OFFICE. 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 MINI HEALTH FAIRS AND WELLNESS EDUCATION. 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 CONDUCT FLU CLINICS AT THE LOCAL GROCERY STORE AS WELL AS ONSITE FLU VACCINATIONS FOR SEVERAL LOCAL BUSINESSES. HOSPITAL STAFF PROVIDE 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 189809 0 0 0 2767 0 18668 0 8714 0 219958 0 0 MIKE HAND CFO 0 144759 0 0 0 2154 0 14174 0 18001 0 179088 0 0 KEVIN KENNALLY PHYSICIAN 317334 0 0 0 3161 0 25700 0 16740 0 362935 0 0 0 GREGG WENGER PHYSICIAN 193576 0 0 0 2109 0 19446 0 12476 0 227607 0 0 0 JAMES LONGABAUGH PHYSICIAN 222409 0 0 0 2462 0 22094 0 9768 0 256733 0 0 0 CHRISTIAN TRAMP PHYSICIAN 236545 0 0 0 2393 0 24279 0 17552 0 280769 0 0 0 KERSTIN GLYNN PHYSICIAN 264120 0 0 0 2788 0 25700 0 14137 0 306745 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 HOSPITALS PRIMARY FUNCTION IS THE PROVISION AND DELIVERY OF QUALITY HEALTH CARE AND WELLNESS SERVICES TO INPATIENTS AND OUTPATIENTS IN NEMAHA COUNTY, SPECIFICALLY SABETHA AND OTHER SURROUNDING COMMUNITIES. INPATIENT CARE INCLUDES ACUTE CARE, SWING BED AND INTERMEDIATE SWING BED. OUTPATIENT SERVICES INCLUDE OBSERVATION CARE, 24/7 EMERGENCY CARE ALONG WITH SPECIALTY PHYSICIANS CLINICS AND NUMEROUS ANCILLARY SERVICES. THE EVALUATION OF COVERAGE FOR THE EMERGENCY ROOM WAS ONE OF THE TOP PRIORITIES FOR 2015. THE ABILITY TO NEGOTIATE WITH THE FIVE PRIMARY CARE PHYSICIANS WITHIN THE SYSTEM WAS PARAMOUNT TO ENABLING THE PROVISION OF EXCELLENT QUALITY CARE WITHIN THE EMERGENCY DEPARTMENT. THE SCH LEVEL IV CENTER PROGRAM WAS RE-SURVEYED AND RE-DESIGNATED IN FEBRUARY 2015 PROVIDING AN ADDITIONAL ELEMENT FOR TRAUMA PATIENTS BROUGHT TO THE ER. MANY PROGRAMS IDENTIFIED THROUGH COMMUNITY 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 AND THE HOSPITAL WAS RECERTIFIED AS A DIABETIC EDUCATION FACILITY IN 2015. BREASTFEEDING AND THE IMPLEMENTATION OF THE HIGH FIVE PROGRAM REMAINS IN THE FOREFRONT OF THE PERINATAL COMMITTEE. OVER FIFTY SOME MOMS AND BABES WERE SERVED BY THE CURRENT LACTATION COUNSELOR WHO IS CONTINUING EDUCATION TO BECOME A LACTATION CONSULTANT. SCH PARTNERED WITH A NEIGHBORING HOSPITAL TO CONDUCT THE 2015 COMMUNITY HEALTH NEEDS ASSESSMENT. CONTINUATION TO PROMOTE HEALTH, WELLNESS AND CHRONIC DISEASE PREVENTION REMAINED A PRIORITY. THROUGH THIS SCH THEN CONDUCTED SEVERAL MINI HEALTH FAIRS. FOR THE WOMEN, THE HEALTH FAIR FOCUSED ON WOMENS HEALTH ISSUES, HEART ISSUES, BLOOD PRESSURES, BLOOD SUGARS, SKIN CANCER CHECKS, DIETARY INFORMATION, MAMMOGRAMS AND SELF-BREAST EXAMS. FOR THE MEN, MENS HEALTH ISSUES ALONG WITH DIABETIC COUNSELING, BLOOD SUGAR CHECKS, NUTRITION FOR MEN, BLOOD PRESSURE CHECKS, AND SKIN CANCER SCREENINGS WERE PROVIDED. ACCESS TO MENTAL HEALTH CONTINUES TO BE A CHALLENGE AND REMAINS A PRIORITY. ANOTHER IMPORTANT FOCUS FOR SCH IS TO CONTINUE TO BUILD 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 TRANSITION TO A NEW EHR IS BEGINNING. SABETHA COMMUNITY HOSPITAL CONTINUES TO PARTICIPATE IN THE KANSAS HEALTH CARE COLLABORATIVE HEN 2.0 QUALITY PROJECTS. THE HCAHPS SCORES ARE USED TO KEEP STAFF INFORMED OF PATIENT SATISFACTION AND AREAS OF IMPROVEMENT. 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 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. 22,357 TRANSFER TO CITY OF SABETHA (156,600) ---------- TOTAL $ (134,243) FORM 990 PART IX LINE 11G DESCRIPTION:CONTRACTED MEDICAL STAFF TOTAL FEES:1047724 FORM 990 PART IX LINE 11G DESCRIPTION:BILLING/COLLECTIONS TOTAL FEES:129436 FORM 990 PART IX LINE 11G DESCRIPTION:LAB SERVICES TOTAL FEES:129210 FORM 990 PART IX LINE 11G DESCRIPTION:PHARMACY SERVICES TOTAL FEES:87996 FORM 990 PART IX LINE 11G DESCRIPTION:ADMINISTRATION/HUMAN RESOURCES TOTAL FEES:101450 FORM 990 PART IX LINE 11G DESCRIPTION:MAINTENANCE/HOUSEKEEPING TOTAL FEES:851 FORM 990 PART IX LINE 11G DESCRIPTION:PLANT OPERATIONS TOTAL FEES:1510 GREAT PLAINS HEALTH ALLIANCE INC 250 NORTH ROCK ROAD STE 160 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 KIOWA COUNTY INC 250 NORTH ROCK ROAD STE 160 WICHITA KS 67206 481226833 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 PHILLIPS COUNTY INC 250 NORTH ROCK ROAD STE 160 WICHITA KS 67206 481226829 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 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