2015-05-13T15:18:45-05:00 2014-06-30 481026809 Wendling Noe Nelson & Johnson LLC 534 S Kansas Ave Suite 1500 Topeka KS 666033491 990 2013-07-01 481253246 Pawnee Valley Community Hospital Inc PAWN 6202853161 923 Carroll Ave Larned KS 67550 Shea Veach President 7856235000 2015-05-12 1 Heather R Eichem P01515553 7852334226 2015-05-12 2013 2016-02-25 16:41:14Z Shea Veach 923 Carroll Ave Larned KS 67550 15379619 0 X www.pawneevalleyhospital.com X 2001 KS Pawnee Valley Community Hospital, Inc. is a tax-exempt charitable organization under Section 501(c)(3) of the Internal Revenue Code and is licensed by the State of Kansas Department of Health and Environment. The purpose of the Organization is to improve the quality of life for the communities we serve through exceptional healthcare and service excellence. The Organization is striving to be the best Critical Access Hospital in rural America. 5 0 133 88 0 0 9589 190261 13157124 15182064 6060 7294 0 0 13172773 15379619 0 179198 0 0 5575159 5961003 0 0 0 5881353 6339813 11456512 12480014 1716261 2899605 5634463 8019575 5634463 7610192 0 409383 X Pawnee Valley Community Hospital, Inc. is a tax-exempt charitable organization under Section 501(c)(3) of the Internal Revenue Code and is licensed by the State of Kansas Department of Health and Environment. The purpose of the Organization is to provide healthcare facitities and services for the care and treatment of inpatients and outpatients who are acutely ill or who otherwise require medical care and related services. The core purpose of the Corporation is to improve the quality of life for the communities we serve through exceptional healthcare and service excellence. 0 0 8845068 179198 15094134 Patient care: Program services consist of routine and ancillary department healthcare services provided by a healthcare organization as described in 501(c)(3) of the IRS code. 8845068 1 1 0 1 0 0 0 0 0 1 0 0 0 1 1 1 1 1 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 1 133 1 0 0 0 0 0 0 0 0 0 0 X 5 0 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X Shea Veach President 7856235000 2220 Canterbury Hays KS 67601 Shae Veach President 4.00 X X 0 153744 56341 Bryce Young Vice President 4.00 X X 0 255193 79252 Bill Overbey Secretary/Treasurer (thru January 2014) 4.00 X X 0 256963 79858 John Jeter MD Director 4.00 X 0 495981 129311 Matt Heyn Hospital Administrator 40.00 X X 0 145842 33725 George Harms Secretary/Treasurer 4.00 X X 0 0 0 Larry Watts Director 4.00 X 0 289255 67094 Amanda Bickle APRN 40.00 X 119530 0 30545 Stacy Trout PA 40.00 X 112074 0 3235 Cynthia Carter RN 40.00 X 110503 0 17195 342107 1596978 496556 3 0 1 0 Hays Medical Center 2220 Canterbury Drive Hays KS 67601 Contract Services 3232781 Quest Diagnostics PO Box 14730 St Louis MO 63150 Lab Services 184334 Shared Medical Services Inc PO Box 330 Cottage Grove WI 53527 MRI services 110885 Delta Healthcare Providers PO BOX 202940 Dallas TX 75320 Contract therapy 106618 4 179198 8198 2865 190261 Net patient service revenue 622000 14886827 14886827 Meals sold to non-patients 722210 135383 135383 Rental income 900099 87930 87930 Outreach therapy services 900099 31574 31574 Lab fairs 900099 29006 29006 11344 11344 15182064 6148 6148 1146 0 1146 1146 1146 15379619 15094134 0 95224 X 179198 179198 174888 174888 4613647 4050490 563157 165404 147307 18097 670369 592296 78073 336695 286755 49940 2107950 2107950 27671 27671 2594 2594 1661363 1448798 212565 88774 2550 86224 33328 24414 8914 73607 44164 29443 288961 241398 47563 17749 14040 3709 4613 4613 73383 44030 29353 Pharmaceuticals 599047 599047 Medical supplies 442890 442886 4 Minor equipment & suppl 173399 141668 31731 Dietary 154154 154154 590330 427260 163070 12480014 8845068 3634946 0 630 246579 2958801 4529204 2012785 2330522 242175 265762 110847 113774 309225 533734 5634463 8019575 862199 908936 4772264 6701256 5634463 7610192 X 409383 0 409383 5634463 8019575 X 2899605 -2490222 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 1 2167 0 0 0 2167 0 Part II-B, Line 1: Pawnee Valley Community Hospital is a member of the Kansas Hospital Association and the American Hospital Association. Both of these organizations engage in lobbying activities for hospitals and health care as part of the services provided to members. 142777 408437 179198 372016 1026228 883451 142777 1.00000 0 1 1 0 Estimated third-party payor settlements 99867 Other receivables 14278 Reinsurance proceeds recoverable 7565 Receivable from Pawnee Valley Foundation 2641 Beneficial interest in net assets of foundation 409383 533734 Due to Pawnee County 4195896 Due to Hays Medical Center, Inc. 2340360 Estimated third-party payor settlements 165000 6701256 X 15609804 230185 230185 15379619 0 15379619 12300816 0 12300816 179198 179198 12480014 Part V, Line 4: Donations are requested for specific items or improvements to the Hospital. When a donation is received for that specific item, it is restricted for that use by the Board until the specific item or improvement is purchased. At any one time, one or more such projects can be in progress. Part X, Line 2: Management is not aware of any uncertainties in income tax positions. Part XI, Line 2d - Other Adjustments: Change in beneficial interest in net assets of Foundation 230,185. Part XII, Line 4b - Other Adjustments: Transfer of equipment to Pawnee County 179,198. 1 1 1 X 130.000000000000 1 X 1 1 1 0 0 160497 160497 0.01290 853335 258527 594808 0.04770 1013832 258527 755305 0.06060 925288 585700 339588 0.02720 7107 7107 0.00060 932395 585700 346695 0.02780 1946227 844227 1102000 0.08840 1 506306 35441 8435456 8487723 -52267 X 1 1 1 1 Pawnee Valley Community Hospital Inc 923 Carroll Avenue Larned KS 67550 X X X X Pawnee Valley Community Hospital Inc 1 1 X X X X X X X X X 12 1 0 1 X http://www.pawneevalleyhospital.com/ X http://www.pawneecountykansas.com/ X X X X X X X 1 0 1 1 130.000000000000 1 400.000000000000 1 X X X X X X X 1 1 X X X X X X X 1 0 X X X 1 X 0 0 Pawnee Valley Community Hospital, Inc. Part V, Section B, Line 3: The CHNA was conducted in collaboration with the Pawnee County Health Department. A Town Hall meeting was organized to provide an objective consensus building method of reviewing and prioritizing county health issues. During the Town Hall meeting, the group reflected on the size and seriousness of any health concerns cited and discussed current community health strengths. The group identified and ranked top community health concerns, and all Town Hall attendees were encouraged to continue to contribute ideas by going online and taking a feedback survey that addresses any additional thoughts related to the CHNA. All Town Hall priority-setting and scoring processes involved the input of a diverse group with knowledge and/or expertise in public health as well as persons who represent the broad interests of the community served by the hospital. Key stakeholders in attendance included representatives from: United Way, Welcome Inn Senior Center, Center for Counseling, Elder Care, Inc., Smith Dental Clinic, Pawnee County Sherriff's Office, Larned Police Department, Pawnee County Health Department, County Commissioners, members of the Chamber of Commerce, members of the USD 495 School Board, school nurses of USD 495, local members of the media, local religious organizations, city council members, and representatives of Pawnee Valley Community Hospital. The CHNA was coordinated and produced by VVV Research & Development, Inc. from Olathe, Kansas. Pawnee Valley Community Hospital, Inc. Part V, Section B, Line 7: Annual description of the actions taken by the Hospital during the fiscal year to address the significant health needs identified throught the most recently conducted CHNA:Community Wellness - Community Wellness was #1 on the health needs - areas of future focus survey with 50 votes, 22.7%. Comments from the Town Hall meeting included, "Community is desperately in need of a wellness facility." and "Community needs nutritional education." Being overweight/obese, smoking, drinking in excess, not exercising etc. can lead to poor health. Pawnee County's ranking in adult obesity is at 34% compared to Kansas' county average of 30%. Physical inactivity ranked 30% compared to Kansas' average of 28%. Heart disease and diabetes rank high in Pawnee County.According to the Town Hall meeting, developing a community wellness program and facility was the highest ranked request. In lieu of this, PVCH leadership and county officials believe that this is not something that the hospital and county should be solely involved in orchestrating. Rather, the development and on-going maintenance of a wellness program and facility should be collaborative with other agencies and entities. We identified a key list of organizations that were considered to be part of the wellness coalition to identify and develop a plan. The following is a list of candidates for the coalition: PRIDE, PVCH, PVCH Foundation, USD 495, USD 495 Foundation, Recreation Commission, Pawnee County Health Department, City of Larned, Chamber of Commerce, CHO, Pawnee County Extension Office and Pawnee County Economic Development Commission.The Wellness Coalition has reached out to several different entities (i.e. YMCA) to come to Larned/Pawnee County to develop a wellness center in the community. Although several entities looked at Larned as a potential site for a wellness facility, no serious proposals from these inquiries.Medical Oncology Services - Medical Oncology Services was #5 on the health needs - areas of future focus survey with 25 votes, 11.4%. Comments included, "We have a lot of people in Pawnee County with cancer. A cancer treatment center would be really helpful." ; "There is a need for more specialized service appropriate for the size of town that Larned is." ; and "Specialty services are lacking including OB, Cancer, and Mental Health." The age adjusted cancer mortality rate per 100,000 population is significantly higher than the NW KS 10 counties and Kansas: Pawnee County 195.9, NW KS 10 169.8 and Kansas 188.In order to implement an effective oncology service line, many factors must come together. The following information outlined the plans for implementation of the PVCH oncology service line. We have had the great fortune of being able to partner with the Dreiling/Schmidt Cancer Institute at HMC. In lieu of this partnership, we were able to establish an outreach clinic with Dr. Abuerreish heading up the program. It is vitally important to maintain the relationship with both primary care medical staff as well as specialists. This will ensure consistent continuity for our patients as they move through the continuum of their cancer treatment course. There are many additional components that need to be implemented at PVCH prior to providing cancer treatment services. PVCH leadership had originally established that the program would start once we were in the new facility - spring of 2013. A task force committee was established with members from both PVCH and Dreiling/Schmidt Cancer Institute. The committee functioned as the backbone for developing all operational plans for the cancer therapy service line. This included, but was not limited to, a financial feasibility analysis, budget preparation, hiring experienced human resources, purchasing equipment, developing policies and procedures, advertising, and patient follow-up. It is important to note that if the financial proforma didn't show favorable profitability than we would not proceed with the program. The overall success of the program will be measured by community and patient feedback as well as volume growth. Additionally, the success is highly dependent on community and physician support. It will be important to advertise the oncology service line to regional primary care and medical oncologists. After further analysis by the committee and the hospital, it was shown that offering oncology services at PVCH was outside of the scope of services PVCH could offer to the community.Mental Health & Counseling - Mental Health & Counseling was #3 on the health needs - areas of future focus survey with 29 votes, 12.7%. Comments included, "Specialty services are lacking including mental health." ; "Local psycho-social/emotional counseling services - A lot of families that move into Larned seem to struggle with functioning at a productive level. The poor functioning of the adults is trickling down to produce children with low functioning mental capabilities, poor coping skills and increased emotional/behavioral issues. These children are then set up to repeat the cycle." ; "Yes, mental health needs are not met for those in the community. We as community members must travel for services." ; and "Difficult to acquire care for mental health."Research data showed:Alzheimer's disease - Pawnee county 33.6%; Kansas 28%. Inadequate social support - Pawnee county - 20%; Kansas 16%. Uninsured - Pawnee county 17%; Kansas 15%. Number of mental health persons served increasing over a three year period: 149 to 176 - an 18% increase. Pawnee County has at least 10 Foster Care Homes providing out of home care for children removed from homes. A multitude of organizations provide some type of mental health and counseling services. These services can be divided between primarily role such as the Center for Counseling and Consultation, secondary role such as school counselors, social workers employed in medical setting, and tertiary where clients are assisted with and referred to mental health services. At this time, most entities that provide any type of mental and behavioral services find themselves in a situation where any added services must also come with the funding to support them. Keeping this in mind, a work plan was developed that addressed goals to lay the ground work for improving and enhancing the capacity for mental health services using the current agencies' capabilities and resources. Based on this information, Pawnee County had several opportunities to work towards better mental health care. These included: 1) Enhancing mental health for Pawnee County infants and children birth through school age by increasing the number of infants and children screened using the Ages and Stages Social/Emotional Tool; 2) Enhancing the mental health of Pawnee County women who are pregnant or post-partum by increasing the number of pregnant and post-partum women screened using the Edenburg screening tool; and 3) Improving primary mental service access for Pawnee County residents by decreasing the barriers to mental health services in Pawnee County.The following are the outlined areas to be addressed and why the Hospital was not able to address those needs: OB Services - offering OB Services is outside of the scope of services that we can provide as a critical access hospital. We do, however, how have Dr. Goodwin offering pre-natal care for expecting mothers in the community. Nutrition Education - we were planning on addressing this area with the Wellness Facility. When we were unable to move forward with the Wellness Facility, we were not able to move this initiative forward.Home Health & Hospice - after further analysis it was determined that this initiative was outside of the hospital's scope and available manpower.Dental Services for the Uninsured - with a limited amount of dentists in the county, we were unable to provide this service to the community in the scope that the community was wanting it to happen.Increase Selection of Healthy Eating Options - we were planning on addressing this area with the Wellness Facility. When we were unable to move forward with the Wellness Facility, we were not able to move this initiative forward. Pawnee Valley Community Hospital, Inc. Part V, Section B, Line 14g: Pawnee Valley Community Hospital, Inc. (PVCH) will proactively seek out applicants who may be in need of financial assistance. PVCH will post notice of this policy to all patients/guarantors through its registration, pre-registration, and financial counseling process. This policy will also be posted in prominent areas of the hospital. Pawnee Valley Community Hospital, Inc. Part V, Section B, Line 20d: The hospital used the look-back method based on actual paid claims by Medicare and all other private health insurerspaying claims to the hospital. Part I, Line 7: A cost-to-charge ratio derived from Worksheet 2 was used to determine financial assistance at cost and the cost of subsidized health services. A cost-to-charge ratio derived from Worksheet 2 was used to determine the costs of serving Medicaid beneficiaries. Part III, Line 4: The footnote from the hospital's financial statements follows:Accounts receivable are reduced by an allowance for uncollectible accounts. In evaluating the collectability of accounts receivable, the Hospital analyzes its past history and identifies trends for each of its major payor sources of revenue to estimate the appropriate allowance for uncollectible accounts and provision for bad debts. Management regularly reviews data about these major payor sources of revenue in evaluating the sufficiency of the allowance for uncollectible accounts. For receivables associated with services provided to patients who have third-party coverage, the Hospital analyzes contractually due amounts and provides an allowance for uncollectible accounts and a provision for bad debts, if necessary (for example, for expected uncollectible deductibles and copayments on accounts for which the third-party payor has not yet paid, or for payors who are known to be having financial difficulties that make the realization of amounts due unlikely). For receivables associated with self-pay patients (which includes both patients without insurance and patients with deductible and copayment balances due for which third-party coverage exists for part of the bill), the Hospital records a significant provision for bad debts in the period of service on the basis of its past experience, which indicates that many patients are unable or unwilling to pay the portion of their bill for which they are financially responsible. The difference between the standard rates (or the discounted rates if negotiated) and the amounts actually collected after all reasonable collection efforts have been exhausted is charged off against the allowance for uncollectible accounts.Part III Line 2:Costing methodology: A cost-to-charge ratio derived from Worksheet 2 was used to calculate bad debt expense at cost.Part III Line 3:Methodology for bad debt cost for financial assistance eligible: The estimate for the amount of bad debt expense attributable to patients eligible under the FAP is based upon the experience of a related organization. Part III, Line 8: The Medicare cost report was the costing methodology used to determine the allowable Medicare costs pertaining to Medicare net revenue. Allowable costs of care reported on line 6 were determined using amounts from Worksheet D, Part V and Worksheet D-1 in the Pawnee Valley Community Hospital, Inc., Medicare cost report for fiscal year ended June 30, 2014. Part III, Line 9b: Whenever possible, the customer service representatives (CSR's) of Pawnee Valley Community Hospital try to determine the estimated self-pay balance prior to the patient receiving services. Charity care eligibility is first considered at this point in time. In addition, if full payment is not received or payment is not made with 30 days, the CSR contacts the patient. If it is determined that at least a two-year payment plan cannot be established with the patient, the CSR will screen for charity care and request that the charity care application be completed by the patient. Part VI, Line 3: Information regarding the Pawnee Valley Community Hospital, Inc. charity care program is located on the Pawnee Valley Community Hospital and Hays Medical Center, Inc. website for patients and community members to view, and the financial assistance application is also on the HMC website to print off and complete. In addition, if a customer service representative contacts a patient about a bill and in visiting with them they determine that patient could possibly qualify for the hospital's charity care policy, the CSR will send the application to the patient as well. Part VI, Line 4: Pawnee Valley Community Hospital, Inc. is located in Larned, Kansas, which has a population of approximately 4,050 people, as of the 2010 census. The median household income of Larned was $46,464. Approximately 5.9% of families were below the poverty line, and 7.4% of the total population was below the poverty line. Approximately 7.4% of the hospital's revenue is from services provided to patients eligible for Medicaid. Pawnee Valley Community Hospital, Inc. is the only hospital in Larned, Kansas. It mainly serves the community of Larned. Part VI, Line 5: Pawnee Valley Community Hospital, Inc. promotes the health of the community by extending medical privileges to most qualified, local physicians. Part VI, Line 6: Pawnee Valley Community Hospital, Inc. is not a part of an affiliated health care system. 0 Pawnee County 715 Broadway Larned KS 67550 486007542 179198 Cash paid Transfer of equipment Pawnee County owns all fixed assets (land, building, equipment) used by the Hospital. To expedite the purchase of equipment and obtain favorable purchasing terms, the Hospital purchased equipment on behalf of the County. The Pawnee Valley Community Hospital Foundation reimbursed the Hospital for the purchase. The Hospital then transferred ownership of the equipment to Pawnee County. 1 0 0 1 0 0 0 1 1 0 0 Shae Veach President 0 150223 0 0 0 3521 0 31235 0 25106 0 210085 0 0 Bryce Young Vice President 0 252835 0 0 0 2358 0 52325 0 26927 0 334445 0 0 Bill Overbey Secretary/Treasurer (thru January 20 0 256872 0 0 0 91 0 52931 0 26927 0 336821 0 0 John Jeter MD Director 0 487508 0 0 0 8473 0 104651 0 24660 0 625292 0 0 Matt Heyn Hospital Administrator 0 131605 0 14237 0 0 0 8076 0 25649 0 179567 0 0 Larry Watts Director 0 284616 0 0 0 4639 0 49440 0 17654 0 356349 0 0 Amanda Bickle APRN 117096 0 2434 0 0 0 6883 0 23662 0 150075 0 0 0 Part I, Line 3 A related organization uses a compensation committee, independent compensation consultant, written employment contract, and approval by the board or compensation committee to establish the compensation of the Hospital's Administrator. Part I, Line 4b John Jeter, M.D. - $73,126 Bryce Young - $38,300 William Overbey - $38,906 Shae Veach - $22,713 Larry Watts - $42,692 Part I, Line 6 A portion of the Administrator's incentive compensation is determined by net earnings exceeding budget for the fiscal year. A portion of incentive compensation for officers and key employees of Hays Medical Center, Inc., a related organization, is determined by net earnings exceeding budget for the fiscal year. Form 990, Part VI, Section A, line 6 The organization has one member, HaysMed Partners, Inc., which became the sole member as of March 1, 2010. HaysMed Partners, Inc., is a wholly-owned subsidiary of Hays Medical Center, Inc. Form 990, Part VI, Section A, line 7a The Board members of HaysMed Partners, Inc., the sole member of Pawnee Valley Community Hospital, appoint the Board members of Pawnee Valley Community Hospital, Inc. Form 990, Part VI, Section A, line 7b HaysMed Partners, Inc., the sole member of Pawnee Valley Community Hospital, elects the Board members of Pawnee Valley Community Hospital. Form 990, Part VI, Section B, line 11 Form 990 was reviewed with the Board members prior to filing. Form 990, Part VI, Section B, line 12c Officers, directors & key employees, along with all associates, are required to complete a conflict of interest statement annually. The statements are used to monitor and enforce compliance with the policy. Form 990, Part VI, Section B, line 15 The hospital administrator and officers' salaries are reviewed annually by an independent consulting group and the Board members. Form 990, Part VI, Section C, line 19 These documents are not made available to the public. Form 990, Part IX, line 11g Medical professional fees: Program service expenses 857,551. Management and general expenses 521. Fundraising expenses 0. Total expenses 858,072. Laboratory professional fees: Program service expenses 247,922. Management and general expenses 0. Fundraising expenses 0. Total expenses 247,922. Other purchased services: Program service expenses 199,296. Management and general expenses 118,937. Fundraising expenses 0. Total expenses 318,233. Other professional fees: Program service expenses 144,029. Management and general expenses 50,864. Fundraising expenses 0. Total expenses 194,893. Collection agency services: Program service expenses 0. Management and general expenses 42,243. Fundraising expenses 0. Total expenses 42,243. Form 990, Part XI, line 9: Increase in amount due to Pawnee County -1,347,933. Transfers to Pawnee County -1,551,672. Change in beneficial interest in net assets of foundation 409,383. Form 990. Part XII, Line 2c Hays Medical Center, Inc., has an audit committee that is responsible for the oversight of Pawnee Valley Community Hospital, Inc's., financial statement audit and the selection process of an independent accountant. HaysMed Partners Inc 2220 Canterbury Dr Hays KS 67601 270877152 Owns management contract for Pawnee Valley Community Hospital KS 501(c)(3) 170(b)(1)(A)(iii) 0 Hays Medical Center Inc 2220 Canterbury Dr Hays KS 67601 480559088 Hospital KS 501(c)(3) 170(b)(1)(A)(iii) 0 Pawnee Valley Community Hospital Foundation 923 Carroll Ave Larned KS 67550 455333776 Support the activities and mission of the Hospital KS 501(c)(3) 509(A)(3), Type I 0 0 0 1 0 1 0 0 0 0 1 1 0 1 0 1 1 0 0 0 Pawnee Valley Community Hospital Foundation C 179198 Cash paid