2015-11-13T16:06:06-06:00 2014-12-31 481026809 Wendling Noe Nelson & Johnson LLC 534 S Kansas Ave Suite 1500 Topeka KS 666033491 990 2014-01-01 486099245 Labette County Medical Center LABE 6204214880 1902 S US Highway 59 Parsons KS 67357 Thomas Macaronas CFO 6204214880 2015-11-13 1 Heather R Eichem P01515553 7852334226 2015-11-13 2014 2016-03-07 17:11:31Z Labette Health Thomas Macaronas 1902 S US Highway 59 Parsons KS 67357 58045182 0 X www.labettehealth.com X Government 1961 KS Medical care for the southeast Kansas region 9 8 629 55 0 0 908824 739894 58001475 56454973 -52692 -510318 663892 806539 59521499 57491088 104096 10188 0 0 29380216 30216036 0 0 198801 31250432 30914889 60734744 61141113 -1213245 -3650025 70762094 67841752 37895486 38625169 32866608 29216583 Focusing on the patient and providing exceptional healthcare through effective clinical and financial management. 0 0 51249558 10188 55900879 Labette County Medical Center operates physician clinics and provides inpatient and outpatient services to the residents of the southeastern Kansas area. 51249558 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 33 0 1 629 1 0 0 0 0 0 0 0 0 0 0 X 9 8 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 Vince Schibi President 1.00 X X 0 0 0 Perry Sorrell Vice President 1.00 X X 0 0 0 Marna George Secretary 1.00 X X 0 0 0 Melissa Morris Treasurer 1.00 X X 0 0 0 Wayne Gilmore OD Trustee 1.00 X 0 0 0 Dee Bohnenblust 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 12000 0 0 Thomas Macaronas CFO/COO 40.00 X 179930 0 20635 Jodi Schmidt President/CEO 40.00 X 231821 0 54644 Kathi McKinney CNO 40.00 X 153752 0 13597 Javine McLaughlin Physician 40.00 X 479360 0 19486 Michael Farris Physician 40.00 X 536913 0 20062 Logan Kracht Physician 40.00 X 372462 0 19213 Philip Gorman Anesthesiologist 40.00 X 384779 0 19319 Terrence Coffey Anesthesiologist 40.00 X 482087 0 14551 2833104 0 181507 36 0 1 0 CPSI PO Box 850309 Mobile AL 36685 Computer support services 726432 Jerry Bouman DO 21004 Ness Road Parsons KS 67357 General surgeon 656840 Medical Consultants of Kansas LLC PO Box 20077 Wichita KS 67208 Hospitalist services 651815 Spencer Fane Britt & Browne LLP PO Box 872037 Kansas City MO 64187 Legal services 387989 Claims Professionally Reviewed LLC 1412 SW Eagles Parkway Grain Valley MO 64029 Coding services 295849 13 40943 661377 37574 739894 Patient service revenue 621990 54569776 54569776 EHR incentive payments 621990 963917 963917 340b pharmacy revenue 621990 640848 640848 Fitness center 713940 122617 122617 Rehab services 621990 103315 103315 54500 54500 56454973 43776 43776 230576 0 230576 230576 230576 554094 -554094 -554094 -554094 Cafeteria meals 722210 275411 275411 Leased employees 900099 156452 156452 Other 621990 114600 114600 29500 29500 575963 57491088 55900879 0 850315 6188 6188 4000 4000 682088 13900 668188 24683405 21891962 2661123 130320 635198 605913 25678 3607 2581496 2260669 307370 13457 1633849 1415966 209454 8429 504483 504483 100317 3327 96990 208856 16437 185106 7313 246729 28071 213457 5201 274243 274243 1479119 1259982 218655 482 142887 112614 28128 2145 1745934 1458379 287555 4889579 4000164 887459 1956 440275 251072 189193 10 Drugs and medical suppl 10213135 10213135 Purchased services 6173074 4998024 1164278 10772 Repairs and maintenance 1732762 1427589 305105 68 Collection fees 718182 23810 694372 2045314 1258356 771917 15041 61141113 51249558 9692754 198801 -476743 1138430 16272156 16758152 11361308 9384778 208461 50000 391671 371610 1269765 1345985 659121 608665 86611007 50162817 38573506 36448190 556772 1946077 1735942 70762094 67841752 5584250 5880361 23679 60004 25266317 25235780 6754377 7253751 266863 195273 37895486 38625169 X 31226044 28861396 1640564 355187 32866608 29216583 70762094 67841752 -3650025 0 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 13082 13082 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 55529358 28047501 27481857 30021933 22115316 7906617 210690 210690 36448190 Estimated third-party payor settlements 195273 195273 58015682 0 58015682 -524594 -524594 57491088 61665707 524594 524594 61141113 0 61141113 Part XI, Line 4b - Other Adjustments: Loss on sale of assets -554,094. Earnings in LLC 29,500. Part XII, Line 2d - Other Adjustments: Loss on sale of assets 554,094. Earnings in LLC -29,500. 1 1 1 X 1 X 1 1 1 0 0 796127 78467 717660 0.01170 7376260 3573571 3802689 0.06220 8172387 3652038 4520349 0.07390 69871 20303 49568 0.00080 4000 4000 0.00010 7907164 5255441 2651723 0.04340 300 300 0.00000 7981335 5275744 2705591 0.04430 16153722 8927782 7225940 0.11820 1 2736127 246251 19387056 19526225 -139169 X 1 1 1 Labette County Medical Clinic LLC Rental of real estate 1.00000 0.00000 0.00000 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 13 1 0 0 1 X http://www.labettehealth.com/about-community-health-needs.html X 1 13 0 1 0 1 X 150.000000000000 250.000000000000 X X X X 1 1 X X X 1 X X 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 in 2011 by a group of more than 30 providers, social service agencies, church and business leaders. The Public Health and Mental Health offices were key partners in the process as was Oswego Community Hospital, law enforcement and EMS. A detailed list of the participants follows:KLKC- -News ManagerCity of Parsons ManagerPresident Commercial BankCity of Parsons CommissionerKAMU memberDirector of Economic DevelopmentAPRN City of AltamontMedical Center Board of Trustees PresidentRN School Nurse, School District #503RN-Administrator Health DepartmentSuperintendent, School District #503Prominent Community MembersStella Wells FoundationCommunity Health ClinicVice President-McCarty Office SuppliesPresident, Labette Community CollegeLabette Center for Mental HealthPhysician, Wound Care Clinic Auxiliary Labette HealthCaptain-EMS Labette HealthKnowledgeable Community MemberVice President Great Southern BankExecutive Director, Labette Center for Mental HealthDentist-Free Dental ClinicPresident, Community National Bank Director of Nursing-Labette Community CollegeKU/KS Agricultural Extension - Parsons State Hospital Labette County Medical Center Part V, Section B, Line 11: During 2014, Labette Health focused its energies on obtaining accurate community information and utilizing this information to develop a robust implementation strategy to address the needs of its service area. Therefore, Labette Health was unable to undertake any substantial actions to address the significant needs identified in the most recently conducted CHNA. At the end of 2014, Labette Health was in the process of finalizing its most recently completed CHNA and implementation strategy and plans on addressing the needs identified in 2015 and beyond. 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. Part V, Section B, Line 16 Financial Assistance Policy Website Availability Labette County Medical Center Part V, Section B, line 16a website: http://www.labettehealth.com/ Labette County Medical Center Part V, Section B, line 16b website: http://www.labettehealth.com/ 4 Labette Health Physicians Group 1902 S Hwy 59 Bldg E Parsons KS 67357 Physician and rural health clinic St Paul Clinic 200 Carroll St Paul KS 66771 Rural health clinic Cherryvale Clinic 209 E Main Cherryvale KS 67335 Rural health clinic Express Care Clinic 2100 Commerce Dr Parsons KS 67357 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 9% 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 comuunity 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. The total amount of shortfall is 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 22,000 and the city of Parsons has an approximate population of 11,000 people. The median income for the PSA is approximately $41,500 while the county and state median are $35,000 and $52,000 respectively. Within the PSA approximately 16.5% of the population is below 100% of the federal poverty guidelines and approximately 37.0% is below 200%. Area unemployment has been over 9.0% since September 2010 compared to the state-wide average of 6.9%. The PSA multicultural composition reflects that by 2014 13.4% 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 170567 0 0 0 9363 0 10711 0 9924 0 200565 0 0 0 Jodi Schmidt President/CEO 193951 0 0 0 37870 0 44720 0 9924 0 286465 0 0 0 Kathi McKinney CNO 121212 0 0 0 32540 0 8521 0 5076 0 167349 0 0 0 Javine McLaughlin Physician 386192 0 42387 0 50781 0 8000 0 11486 0 498846 0 0 0 Michael Farris Physician 480460 0 0 0 56453 0 8000 0 12062 0 556975 0 0 0 Logan Kracht Physician 311328 0 31914 0 29220 0 8000 0 11213 0 391675 0 0 0 Philip Gorman Anesthesiologist 334827 0 36000 0 13952 0 8000 0 11319 0 404098 0 0 0 Terrence Coffey Anesthesiologist 360154 0 37000 0 84933 0 8000 0 6551 0 496638 0 0 0 Part I, Line 4b Jodi Schmidt, 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. $24,720 in contributions to the CEO's IRC section 457(f) plan were made in 2014. 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 1788636 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 0 A 1 Date Rebate Computation Performed Issuer Name: Labette County, Kansas Date the Rebate Computation was Performed: 09/10/2012 Robert Gibbs Trustee Recruiting assitance loan X 50000 50000 0 1 1 50000 Brenda Schibi Family member of Vince Schibi, Officer 44718 Employment 0 Emily Brown Family member of Ned Wall, Trustee 71262 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 Labette County Medical Clinic LLC PO Box 612 Parsons KS 67357 480925312 Rental of Office Space KS Labette County Medical Center Related 3744 1 1 1.00000 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 385204 Actual amount owed