2016-02-15T09:53:22-06:00 2015-03-31 BKD LLP 1551 N WATERFRONT PKWY STE 300 WICHITA KS 672066601 990 2014-04-01 481226830 GREAT PLAINS OF SMITH CO INC % MIKE HAND GREA 3166851523 250 NORTH ROCK ROAD STE 160 WICHITA KS 67206 MIKE HAND CFO AND SENIOR VICE PRESIDENT 3166851523 2016-02-15 true STEVEN L WEBB P00235405 3162652811 2014 2016-08-17 19:52:53Z SMITH COUNTY HOSPITAL MIKE HAND 250 NORTH ROCK ROAD STE 160 WICHITA KS 67206 11911281 false X WWW.SMITHCOHOSP.ORG X 1999 KS THE OPERATION OF HOSPITAL FACILITIES FOR THE DELIVERY OF HEALTH CARE SERVICES, EDUCATION, AND WELLNESS WITHOUT REGARD TO RACE, CREED, COLOR, SEX OR FINANCIAL CIRCUMSTANCE. 10 9 171 9 0 1531654 494094 10581419 11291658 35321 48402 86721 76964 12235115 11911118 0 0 0 0 6584323 6675272 0 108000 108000 5085641 5387032 11669964 12170304 565151 -259186 6685944 6856013 2066183 2433335 4619761 4422678 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 CIRCUMSTANCE. false false 10381845 0 11291658 SMITH COUNTY MEMORIAL HOSPITAL'S PURPOSE IS THE DELIVERY OF PRIMARY HEALTHCARE SERVICES TO A SERVICE AREA THAT INCLUDES SMITH COUNTY, KANSAS. THE SERVICE AREA ALSO INCLUDES, TO A LESSER DEGREE, PHILLIPS, JEWELL, AND OSBORNE COUNTIES IN KANSAS, AS WELL AS FRANKLIN AND WEBSTER COUNTIES IN NEBRASKA. THE PRIMARY HEALTHCARE SERVICES ARE DELIVERED THROUGH A RURAL HEALTH CLINIC, A CRITICAL ACCESS HOSPITAL INCLUDING INPATIENT, OUTPATIENT, AND SKILLED NURSING SERVICES, AS WELL AS LONG TERM CARE SERVICES. 10381845 true true false true false false false false false true true false false false true false true true false false false false false true false 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 52 0 true 171 true false false false false false false false false false false X 10 9 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 BETH MEYERES 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 THOMAS E KELLER DVM CHAIRMAN/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 JOHN TERRILL VICE PRESIDENT/DIRECTOR 0.25 2.25 X X 0 0 0 DAVE DELLASEGA PRESIDENT/CEO/DIRECTOR 2.0 40.0 X X 0 183501 24592 BILL NAVIS VICE PRESIDENT/DIRECTOR 0.25 2.25 X 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 LOGAN SPRUNGER VICE PRESIDENT/DIRECTOR 0.25 2.25 X X 0 0 0 MIKE HAND CFO 2.25 40.0 X 0 136809 28369 ALLEN VANDRIEL ADMINISTRATOR 40.0 0.0 X 121304 0 26023 FERRILL CONANT PHYSICIAN 40.0 0.0 X 305203 0 42618 ASHLEY BEHYMER PT 40.0 0.0 X 105127 0 19073 JUSTIN OVERMILLER PHYSICIAN 40.0 0.0 X 308778 0 42561 TAMARA WINDSCHEFFEL ARNP 40.0 0.0 X 150119 0 30835 MARK TOWNER PT 40.0 0.0 X 102918 0 25528 1093449 320310 239599 7 false true false MEDICAL SOLUTIONS CONTRACT NURSING 370832 MHS DATA CENTER COMPUTER SUPPORT 255520 GPHA MANAGEMENT 130669 GPHA - CBO CENTRALIZED BILLING 124453 QUEST DIAGNOSTICS REFERENCE LAB 110173 5 409959 84135 494094 NET PATIENT SERVICE REVENUE 621300 10761198 10761198 340B PRESCRIPTION DRUGS 621300 530460 530460 11291658 48565 48565 0 0 0 0 0 0 163 -163 -163 -163 0 0 0 EMPLOYEE & GUEST MEALS 722513 40641 40641 WELLNESS CENTER 713940 22370 22370 VENDOR REBATES 900099 9748 9748 4205 4205 76964 11911118 11291658 125366 0 0 0 0 149715 149715 0 5077882 4612237 465645 345985 306408 39577 751691 610008 141683 349999 308003 41996 109436 109436 8552 8552 84584 84584 0 108000 108000 0 2024591 1759172 265419 0 3431 1741 1690 434635 395513 39122 0 0 189830 137161 52669 2862 2427 435 0 45996 29411 16585 14113 9926 4187 0 433988 305231 128757 86433 60790 25643 MEDICAL SUPPLIES 1335888 1335888 EQUIPMENT RENTAL/MAINTENANCE 296368 269947 26421 PROVISION FOR BAD DEBTS 193673 193673 DUES & SUBSCRIPTIONS 28760 12366 16394 93892 31943 61949 12170304 10381845 1680459 108000 25213 201111 1081505 1420300 0 0 1673305 1473789 0 0 0 0 0 0 123640 143330 26472 592844 10103726 7079087 3420067 3024639 0 0 0 0 0 0 0 0 335742 0 6685944 6856013 1864427 2289170 0 0 0 0 0 0 0 0 0 0 201756 74165 0 0 0 70000 2066183 2433335 X 3784186 3518645 21917 28272 813658 875761 4619761 4422678 6685944 6856013 -259186 62103 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false true 3033 false false false 3033 false SCHEDULE C, PART II-B, LINE 1F A PORTION OF THE ANNUAL DUES PAID TO KHA AND AHA ARE USED FOR LOBBYING. 835575 9959 75163 16664 904033 790370 7624 75716 38135 835575 811365 12500 -11597 21898 790370 754849 2897 63746 10127 811365 734578 45471 20971 4229 754849 0.00000 0.96873 0.03127 true false 3750 3750 3861089 2214886 1646203 6132488 4766770 1365718 106399 97431 8968 3024639 0 DUE TO THIRD PARTY 70000 70000 11779548 62103 -193673 -131570 11911118 11911118 11976631 11976631 193673 193673 12170304 SCHEDULE D, PART V, LINE 4 THE INTENDED USE OF THE ENDOWMENT FUNDS IS TO SUPPORT THE CONTINUING OPERATIONS OF THE REPORTING ORGANIZATION. 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 PROVISION FOR UNCOLLECTIBLE ACCOUNTS (193,673) SCHEDULE D, PART XII, LINE 4B PROVISION FOR UNCOLLECTIBLE ACCOUNTS 193,673 X X X true SOLUTIONS 4 FUNDRAISING 389 NW 1851 RD KINGSVILLE MO 64061 CAPITAL CAMPAIGN false 213970 108000 105970 213970 108000 105970 KS true true false true X true true false true true 106724 2035 104689 0.00870 370789 191137 179652 0.01500 477513 193172 284341 0.02370 74747 74747 0.00620 74747 74747 0.00620 552260 193172 359088 0.02990 false 193673 4424723 4424723 X true true NONE 1 1 GREAT PLAINS OF SMITH CO INC 625 THIRD STREET PHILLIPSBURG KS 67661 WWW.SMITHCOHOSP.ORG H092001 X X X X RURAL HEALTH CLINIC LONG-TERM CARE UNIT GREAT PLAINS OF SMITH CO INC 1 false false true X X X X X X X X X 13 true false false true X WWW.SMITHCOHOSP.ORG X WWW.KRHW.NET X true 13 true WWW.SMITHCOHOSP.ORG false false true X 0. 300. X X X X true true X X X true X WWW.SMITHCOHOSP.ORG X WWW.SMITHCOHOSP.ORG X WWW.SMITHCOHOSP.ORG X X X true X false X X X X true X X false false SCHEDULE H, PART V, LINE 5 A BROAD-BASED COMMUNITY STEERING COMMITTEE IS FORMED TO ANALYZE THE INFORMATION RESOURCES INICLUDED IN THE PACKET TO DETERMINE RELEVANT ISSUES AND PROPOSE AN ACTION PLAN TO IMPROVE LOCAL CIRCUMSTANCES. THE MEETING PARTICIPANTS ARE CHOSEN TO SOLICIT INPUT FROM A BROAD CROSS SECTION OF THE COMMUNITY, NOT SIMPLY MEMBERS OF THE LOCAL HEALTHCARE SECTOR. SEE THE CHNA AT WWW.SMITHCOHOSP.ORG FOR THOSE INVOLVED AND MORE INFORMATION. SCHEDULE H, PART V, LINE 11 THE CHNA CONDUCTED HIGHLIGHTED TWO PRIORITIES IN SMITH COUNTY; FIRST, UPDATING EXISTING FACILITIES TO CREATE A NEW HEALTH CARE CENTER WITH AN EXPANDED ARRAY OF PROGRAMS AND SERVICES. THE HOSPITAL IS BUILDING A COUNTY COALITION TO FOCUS ON THE FUTURE OF HEALTH CARE IN THE COUNTY. THE HOSPITAL PUT UP A WEBSITE TO REACH MORE PEOPLE, HIRED A FUNDRAISER TO RAISE CAPITAL FOR A NEW HEALTH CARE CENTER, AND HELD A HEALTH CARE EVENT FAIR. THE SECOND PRIORITY IS A FOCUS ON COMMUNITY HEALTH AND WELLNESS. TO MEET THIS NEED, SMITH COUNTY HOSPITAL IS PUTTING TOGETHER A COMMUNITY GARDEN AND REVITALIZING RECREATION IN SMITH COUNTY THROUGH LEADERSHIP BOARD MEETINGS, REGULAR MONTHLY MEETINGS, AND PUBLIC EVENTS AND FORUMS. 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. 1 SMITH COUNTY FAMILY PRACTICE 119 E PARLIAMENT STREET SMITH CENTER KS 66967 FAMILY PRACTICE 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 PURPOSE OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $193,673. 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 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 NO SEPARATE BAD DEBT EXPENSE DISCLOSURE. ACCOUNTS ARE CONSIDERED DELINQUENT AND SUBSEQUENTLY WRITTEN OFF AS BAD DEBTS BASED ON INDIVIDUAL CREDIT EVALUATION AND SPECIFIC CIRCUMSTANCES OF THE ACCOUNT. DISCLOSURES ON PROVISION FOR DOUBTFUL ACCOUNTS ARE RELATED TO DISCLOSURES REGARDING THE ALLOWANCE FOR DOUBTFUL ACCOUNTS WHICH IS SET FOR ALL NON-MEDICARE ACCOUNTS RECEIVABLE OVER 150 DAYS OLD. THE PROVISION FOR DOUBTFUL ACCOUNTS IS A SEPARATE EXPENSE ON THE STATEMENT OF OPERATIONS AND CHANGES IN NET ASSETS. 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 CARITY CARE CHARGES NOT TO BE COLLECTED DUE TO FINANCIAL ASSISTANCE COMPUTATIONS ARE EXEMPT FROM COLLECTION POLICIES AND PRACTICES. THESE ACCOUNTS ARE REMOVED FROM THE COLLECTION CYCLE. SCHEDULE H, PART VI, LINE 2 GREAT PLAINS OF SMITH COUNTY, INC. USES SEVERAL MECHANISMS TO ASSESS THE NEEDS OF THE COMMUNITIES FOR HEALTHCARE. FIRST IS THE FORMAL COMMUNITY HEALTH NEEDS ASSESSMENT PROCESS. FOLLOWING THE CHNA PROCESS WITH RECOMMENDATIONS COMPLETED IN 2012, WE BEGAN PREPARING IN EARLY CALENDAR YEAR 2015 TO COMPLETE ROUND 2 OF A COMMUNITY HEALTH NEEDS ASSESSMENT. ALTHOUGH NOT COMPLETED DURING THE FISCAL YEAR ENDED MARCH 31, 2015, THE FORMAL ASSESSMENT WAS COMPLETED LATER IN THE CALENDAR YEAR. SECOND, WE UTILIZE A STEERING COMMITTEE ORGANIZED IN CONJUNCTION WITH OUR ONGOING CAPITAL CAMPAIGN TO PROVIDE INPUT FROM THE GREATER COMMUNITY REGARDING NEEDS OF THE COMMUNITY. THIS CAPITAL CAMPAIGN WAS INITIATED IN AUGUST 2014, AND THE STEERING COMMITTEE WAS ORGANIZED AT THAT TIME. BECAUSE THE PRIMARY PRIORITY IDENTIFIED DURING THE PREVIOUS CHNA WAS UPDATING OF FACILITIES, THIS STEERING COMMITTEE HAS PROVEN VERY BENEFICIAL. FINALLY, DURING THE PAST YEAR, MULTIPLE EFFORTS WERE UNDERTAKEN TO INCREASE COMMUNICATION WITH THE COMMUNITY. WE BEGAN PUBLISHING AND DISTRIBUTING A MONTHLY NEWSLETTER WITH INFORMATION ABOUT THE SERVICE OFFERINGS AT SCMH, ALONG WITH HEALTH IMPROVEMENT INFORMATION. WE ALSO ESTABLISHED A FACEBOOK PAGE, WHICH PROVIDES A NEAR CONTINUOUS STREAM OF INPUT FROM THE COMMUNITY. SCHEDULE H, PART VI, LINE 3 OUR FINANCIAL ASSISTANCE POLICY IS ROUTINELY UTILIZED IN COMMUNICATING WITH PATIENTS REGARDING THEIR FINANCIAL OBLIGATIONS TO US. EVERY BILLING STATEMENT SENT TO PATIENTS INCLUDES INFORMATION REGARDING THE FAP AND WHO TO CONTACT WITH QUESTIONS. EVERY TELEPHONE CONTACT WITH OUR PATIENT ACCOUNTS STAFF INCLUDES QUESTIONING OF PATIENTS REGARDING THE NEED FOR ASSISTANCE WITH THE APPLICATION FOR FINANCIAL ASSISTANCE. OUR FINANCIAL ASSISTANCE POLICY IS POSTED ON OUR PUBLIC WEBSITE AND INCLUDES CONTACT INFORMATION. SCHEDULE H, PART VI, LINE 4 THE 2010 CENSUS SHOWED A POPULATION OF 3,853 INDIVIDUALS IN SMITH COUNTY, KANSAS. KANSAS VITAL STATISTICS ESTIMATES A POPULATION OF 3,802 IN 2014. THE DEMOGRAPHIC BREAKDOWN OF THAT POPULATION SHOWS 27% OF THE TOTAL AGED 65 OR ABOVE. THIS COMPARES TO A STATEWIDE POPULATION OF 14% ABOVE THE AGE OF 65. THE POPULATION DENSITY OF SMITH COUNTY IS LESS THAN 6 PERSONS PER SQUARE MILE, CLASSIFYING THE COUNTY A FRONTIER. APPROXIMATELY 96% OF THE POPULATION IS CLASSIFIED AS CAUCASIAN, APPROXIMATELY 2% HISPANIC, AND LESS THAN 1% BLACK. THE POPULATION IS 51% FEMALE, 49% MALE. THE AVERAGE HOUSEHOLD INCOME FOR THE COUNTY IS $53,074. SCHEDULE H, PART VI, LINE 5 SMITH COUNTY MEMORIAL HOSPITAL HAS A FIVE MEMBER BOARD OF TRUSTEES APPOINTED BY THE COUNTY BOARD OF COMMISSIONERS. THIS BOARD MAINTAINS RESPONSIBILITY FOR THE MAINTENANCE AND UPKEEP OF THE FACILITIES UTILIZED BY SMITH COUNTY MEMORIAL HOSPITAL, SMITH COUNTY LONG TERM CARE, AND SMITH COUNTY FAMILY PRACTICE. SMITH COUNTY MEMORIAL HOSPITAL, OPERATED BY GREAT PLAINS OF SMITH COUNTY, OPERATES A MEALS ON WHEELS PROGRAM IN SMITH CENTER. THIS PROGRAM PROVIDES ONE MEAL PER DAY CONSISTING OF A BALANCED DIET, PROVIDED AT REDUCED RATES TO MEMBERS OF THE COMMUNITY UNABLE TO COOK FOR THEMSELVES. CLIENTS OF THIS PROGRAM INCLUDE INDIVIDUALS LIVING IN THEIR OWN HOMES, AS WELL AS IN SEVERAL INCOME-SUBSIDIZED HOUSING FACILITIES OPERATED PRIVATELY OR BY THE PUBLIC HOUSING AUTHORITY IN SMITH CENTER. SMITH COUNTY FAMILY PRACTICE, OPERATED AS A DEPARTMENT OF SMITH COUNTY MEMORIAL HOSPITAL, OFFERS FREE SPORTS PHYSICALS ANNUALLY TO STUDENTS AT TWO SCHOOL DISTRICTS IN THE COUNTY. THE HOSPITAL ALSO PROVIDES AN EDUCATIONAL PROGRAM FOR KINDERGARTEN STUDENTS IN ONE LOCAL SCHOOL DISTRICT EACH YEAR TO FAMILIARIZE THEM WITH DIFFERENT SERVICE AREAS OF THE HOSPITAL TO HELP ALLEVIATE ANXIETY IN THE EVENT THEY NEED TO USE OUR SERVICES. IN CONJUNCTION WITH THE SMITH COUNTY EXTENSION AGENCY, SMITH COUNTY MEMORIAL HOSPITAL SPONSORS AND PROMOTES AN EXERCISE ENCOURAGEMENT PROGRAM CALLED WALK KANSAS. IN SEPTEMBER EACH YEAR, THE HOSPITAL SPONSORS A FUN RUN/WALK IN THE COMMUNITY TO ENCOURAGE WELLNESS AMONG RESIDENTS AND VISITORS IN TOWN FOR THE ANNUAL OLD SETTLERS DAY CELEBRATION. THE HOSPITAL ALSO SPONSORS A HEALTH FAIR EACH FALL IN CONJUNCTION WITH THE SMITH COUNTY EXTENSION AGENCY, OFFERING EDUCATION ON A VARIETY OF HEALTH RELATED TOPICS. GARDNER WELLNESS CENTER, OPERATED AS A PART OF SMITH COUNTY MEMORIAL HOSPITAL, PROVIDES MONITORED EXERCISE TO MEMBERS OF THE COMMUNITY. SMITH COUNTY MEMORIAL HOSPITAL WORKS CLOSELY WITH SMITH COUNTY EMS TO FACILITATE THE DELIVERY OF EMERGENCY MEDICAL SERVICES IN THROUGHOUT THE COUNTY. THIS INCLUDES PROVISION ON MEDICAL DIRECTION TO THE EMS AGENCY BY ONE OF OUR EMPLOYED PHYSICIANS. IN ADDITION, SMITH COUNTY MEMORIAL HOSPITAL MAINTAINS A TRAILER BASED BIOHAZARD RESPONSE UNIT, WHICH CAN BE UTILIZED ANYWHERE IN THE COUNTY IT IS NEEDED. THE HOSPITAL ALSO PARTICIPATES ANNUALLY IN EMERGENCY PREPAREDNESS TRAINING IN CONJUNCTION WITH LAW ENFORCEMENT, FIRE, AND EMS PERSONNEL. AS A CRITICAL ACCESS HOSPITAL, SMITH COUNTY MEMORIAL HOSPITAL PROVIDES 24 HOUR EMERGENCY MEDICAL CARE, IN ADDITION TO INPATIENT, OUTPATIENT, AND LONG TERM CARE SERVICES. SMITH COUNTY MEMORIAL HOSPITAL IS THE ONLY HOSPITAL LOCATED IN SMITH COUNTY. WE HAVE AN OPEN MEDICAL STAFF, ACCEPTING MEMBERSHIP FROM A WIDE VARIETY OF LOCAL AND VISITING PROVIDERS. SCMH PROVIDES SPACE FOR THE REGIONAL BEHAVIORAL HEALTH AGENCY TO PROVIDE COUNSELING SERVICES ON A WEEKLY BASIS. TELEHEALTH SERVICES ARE USED FOR THE DELIVERY OF SPECIALTY MEDICAL SERVICES NOT AVAILABLE IN THE COMMUNITY, AND ARE PROVIDED FOR PUBLIC SERVICE EVENTS, SUCH AS MENTAL HEALTH HEARINGS, COURT ORDERED COUNSELING SESSIONS, ETC. SMITH COUNTY MEMORIAL HOSPITAL ALSO WORKS CLOSELY WITH HOSPICE SERVICES, INC, THE REGIONAL PROVIDER OF HOSPICE SERVICES. SCHEDULE H, PART VI, LINE 6 SMITH COUNTY MEMORIAL HOSPITAL IS OPERATED BY GREAT PLAINS OF SMITH CO., INC., A SUBSIDIARY OF GREAT PLAINS HEALTH ALLIANCE. GPHA IS A 501(C)(3) NOT FOR PROFIT ORGANIZATION WHICH PROVIDES MANAGEMENT, FINANCE, BILLING, INFORMATION SYSTEMS, AND PHARMACY SUPPORT SERVICES TO ITS AFFILIATED ORGANIZATIONS. GPHA DOES NOT PROVIDE SERVICES DIRECTLY TO PATIENTS, BUT PROVIDES ACCESS TO PROFESSIONALS AND SYSTEMS WHICH MIGHT NOT OTHERWISE BE AVAILABLE OR AFFORDABLE TO SMALL RURAL HOSPITALS. GPHA PROVIDES EDUCATION AND ASSISTANCE IN AREAS SUCH AS HIPAA PRIVACY AND SECURITY, MEDICARE AND MEDICAID REIMBURSEMENT RULES AND REGULATIONS, MEANINGFUL USE REQUIREMENTS FOR ELECTRONIC HEALTH RECORDS, ETC. GREAT PLAINS HEALTH ALLIANCE BRINGS TOGETHER ITS NETWORKED CRITICAL ACCESS HOSPITALS IN KANSAS AND NEBRASKA TO LEARN FROM EACH OTHER AND DEVELOP BEST PRACTICES IN CARE PROVISION, MANAGEMENT, AND GOVERNANCE. AFFILIATED HOSPITALS RECEIVE POLICY GUIDANCE REGARDING FINANCIAL ASSISTANCE TO PATIENTS, CORPORATE COMPLIANCE, CONFLICTS OF INTEREST, AND MANY OTHER AREAS. GUIDANCE IS ALSO PROVIDED TO THE GOVERNING BOARDS OF AFFILIATED HOSPITALS TO ASSIST THEM IN FULFILLING THEIR FIDUCIARY RESPONSIBILITIES. SCHEDULE H, PART VI, LINE 7 N/A false false false false false false false false false DAVE DELLASEGA PRESIDENT/CEO/DIRECTOR 0 181141 2360 0 17850 0 6742 0 208093 0 0 FERRILL CONANT PHYSICIAN 304475 0 728 25200 0 17418 0 347821 0 0 0 JUSTIN OVERMILLER PHYSICIAN 308778 0 25200 0 17361 0 351339 0 0 0 MIKE HAND CFO 0 133966 2843 0 13165 0 15204 0 165178 0 0 TAMARA WINDSCHEFFEL ARNP 148806 0 1313 14343 0 16492 0 180954 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 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 MEMEBER OF GREAT PLAINS OF SMITH CO., INC. FORM 990, PART VI, SECTION A, LINE 7A GREAT PLAINS HEALTH ALLIANCE, INC., BEING THE SOLE MEMBER, HAS THE RIGHT TO ELECT AND APPROVE ALL THE BOARD MEMBERS. FORM 990, PART VI, SECTION A, LINE 7B GREAT PLAINS HEALTH ALLIANCE, INC. (GPHA) IS THE SOLE MEMBER AND HAS THE AUTHORITY TO APPROVE THE ARTICLES OF INCORPORATION, BYLAWS, ELECTION TO OR REMOVAL FROM THE BOARD OF DIRECTORS, THE ANNUAL OPERATING AND CAPITAL BUDGETS, AND THE LONG RANGE OR STRATEGIC PLANS. FORM 990, PART VI, SECTION B, LINE 11B THE 990 IS PREPARED AND REVIEWED BY AN INDEPENDENT ACCOUNTING FIRM. THE 990 IS THEN PROVIDED TO THE CHIEF 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 THEMESELVES 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 IX LINE 11G DESCRIPTION:CONTRACTED MEDICAL STAFF TOTAL FEES:1336274 FORM 990 PART IX LINE 11G DESCRIPTION:BILLING/COLLECTIONS TOTAL FEES:209662 FORM 990 PART IX LINE 11G DESCRIPTION:LAB SERVICES TOTAL FEES:229825 FORM 990 PART IX LINE 11G DESCRIPTION:PHARMACY SERVICES TOTAL FEES:89027 FORM 990 PART IX LINE 11G DESCRIPTION:ADMINISTRATION/HUMAN RESOURCES TOTAL FEES:43619 FORM 990 PART IX LINE 11G DESCRIPTION:MAINTENANCE/HOUSEKEEPING TOTAL FEES:59122 FORM 990 PART IX LINE 11G DESCRIPTION:PLANT OPERATIONS TOTAL FEES:40911 FORM 990 PART IX LINE 11G DESCRIPTION:DIETARY SERVICES TOTAL FEES:16151 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 ELLINWOOD INC 250 NORTH ROCK ROAD STE 160 WICHITA KS 67661 481226976 HOSPITAL KS 501(C)(3) 3 GPHA INC true GREAT PLAINS OF KIOWA CO INC 250 NORTH ROCK ROAD STE 160 WICHITA KS 67206 481226833 HOSPITAL KS 501(C)(3) 3 GPHA INC true GREAT PLAINS OF OTTAWA CO INC 250 NORTH ROCK ROAD STE 160 WICHITA KS 67206 481226856 HOSPITAL KS 501(C)(3) 3 GPHA INC true GREAT PLAINS OF PHILLIPS CO INC 250 NORTH ROCK ROAD STE 160 WICHITA KS 67206 481226829 HOSPITAL KS 501(C)(3) 3 GPHA INC true GREAT PLAINS OF SABETHA INC 250 NORTH ROCK ROAD STE 160 WICHITA KS 67206 481236156 HOSPITAL KS 501(C)(3) 3 GPHA INC true GREAT PLAINS OF REPUBLIC CO INC 250 NORTH ROCK ROAD STE 160 WICHITA KS 67206 481226977 HOSPITAL KS 501(C)(3) 3 GPHA INC true GREAT PLAINS OF CHEYENNE CO INC 250 NORTH ROCK ROAD STE 160 WICHITA KS 67206 481226831 HOSPITAL KS 501(C)(3) 3 GPHA INC true false false false false false false false false false true false true false false false false false false