2013-11-13T15:38:25-06:00 2012-12-31 BKD LLP 1551 N WATERFRONT PKWY STE 300 WICHITA KS 672066601 990 2012-01-01 481236156 GREAT PLAINS OF SABETHA INC % MIKE HAND GREA 7855432111 625 THIRD STREET Suite PHILLIPSBURG KS 676612138 MIKE HAND 7855432111 2013-11-15 true ELIZABETH S HOGAN 3162652811 2012 2016-02-24 21:20:13Z ROGER JOHN 625 THIRD STREET PHILLIPSBURG KS 676612138 11021473 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. 11 10 155 25 0 157603 184866 9685334 10557332 16149 16510 125853 257559 9984939 11016267 0 0 0 0 6004397 6314946 0 0 0 4209778 4555671 10214175 10870617 -229236 145650 7697249 7451753 1621837 1374661 6075412 6077092 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 9338397 0 10733384 THE HOSPITAL'S PRIMARY FUNCTION IS THE DELIVERY OF HEALTHCARE 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. SEE SCHEDULE O FOR CONTINUATION. 9338397 true true false true false false false false false false true false false false false true 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 false false false true 20 0 true 155 true false false false false false true true false false false false X 11 10 false false false false true true true true true false false true true true true true true false false false X MIKE HAND 3166851523 250 N ROCK RD STE 160 WICHITA KS 67206 STEVE CARLSON 0.25 2.25 X X 0 0 0 ROGER JOHN 2.0 48.0 X X 0 117047 27982 BETH MEYERES 0.25 2.25 X X 0 0 0 LOGAN SPRUNGER 0.25 2.25 X X 0 0 0 ROBERT HAMILTON 0.25 2.25 X X 0 0 0 THOMAS E KELLER DVM 0.25 2.25 X 0 0 0 BILL NAVIS 0.25 2.25 X 0 0 0 DR BARBARA BROWN OD 0.25 2.25 X 0 0 0 CURTIS ERICKSON 0.25 2.25 X 0 0 0 DAVE RANKIN 0.25 2.25 X 0 0 0 JOHN TERRILL 0.25 2.25 X 0 0 0 DAVE DELLASEGA 2.0 48.0 X 0 110698 22720 LORA KEY 40.0 0.0 X 85725 0 25487 KEVIN KENNALLY 40.0 0.0 X 298690 0 43013 GREGG WENGER 40.0 0.0 X 173282 0 26786 JAMES LONGABAUGH 40.0 0.0 X 210976 0 31727 CHRISTIAN TRAMP 40.0 0.0 X 190843 0 36458 KERSTIN GLYNN 40.0 0.0 X 239502 0 39174 1199018 227745 253347 5 false true false MIDWEST HEALTH SYSTEMS COMPUTER SUPPORT 150807 STORMONT VAIL HEALTHCARE LAB SERVICES 135279 SHARED MEDICAL SERVICES MRI SERVICES 116700 GREAT PLAINS HEALTH ALLIANCE MANAGEMENT SERVICES 115534 4 10759 17525 156582 184866 NET PATIENT SERVICE REVENUE 621300 10557332 10557332 10557332 16510 16510 0 0 16500 16500 0 16500 16500 0 5906 10759 5206 700 700 0 0 EMPLOYEE/GUEST MEALS 722513 15331 15331 OUTSIDE SERVICES 621300 77052 77052 EHR INCENTIVE REVENUE 900099 99000 99000 48976 48976 240359 11016267 10733384 98017 0 0 0 0 111212 111212 0 4949816 4377643 572173 379572 333287 46285 540286 415814 124472 334060 288008 46052 97381 97381 1306 1306 34860 34860 0 0 0 1182764 1027368 155396 28501 11979 16522 208022 144471 63551 9969 3446 6523 0 226938 214491 12447 6568 5125 1443 0 40294 30185 10109 22054 20358 1696 0 676552 621038 55514 139182 41808 97374 MEDICAL SUPPLIES & DRUGS 1161716 1161716 EQUIPMENT RENTAL & MAINT. 393997 364291 29706 BAD DEBT EXPENSE 210791 210791 DUES & SUBSCRIPTIONS 44171 18464 25707 70605 48114 22491 10870617 9338397 1532220 0 220 220 975815 744257 15025 6263 1458752 1849496 0 0 0 0 0 0 228701 226409 116343 113140 12192735 7971648 4633742 4221087 0 0 233651 220881 0 0 0 0 35000 70000 7697249 7451753 1106564 985718 0 0 0 0 0 0 0 0 0 0 515273 388943 0 0 0 0 1621837 1374661 X 6060387 6070829 15025 6263 0 0 6075412 6077092 7697249 7451753 X 145650 -143970 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED X true false false false false false true 2595 false false false 2595 false false GRANTS TO OTHER ORGANIZATIONS FOR LOBBYING PURPOSES SCHEDULE C, PART II-B, LINE 1F APPROXIMATELY 20% OF KANSAS HOSPITAL ASSOCIATION (KHA) DUES ARE DEDICATED FOR LOBBYING PURPOSES AS DIRECTED BY THE KHA. 35244 35244 6405253 3480715 2924538 5569228 4337761 1231467 183010 153172 29838 4221087 0 0 X 10825412 -190855 -190855 11016267 11016267 10823732 163906 163906 10659826 210791 210791 10870617 UNCERTAIN TAX POSITIONS 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. RECONCILIATION OF REVENUE SCHEDULE D, PART XI, LINE 2D EQUITY IN EARNINGS SABETHA HEALTHCARE, INC. 14,730 SPECIAL EVENT EXPENSES 5,206 PROVISION FOR UNCOLLECTIBLE ACCOUNTS (210,791) ---------- TOTAL $ (190,855) RECONCILIATION OF EXPENSES SCHEDULE D, PART XII, LINE 2D TRANSFER TO CITY OF SABETHA 158,700 SPECIAL EVENT EXPENSES 5,206 ---------- TOTAL $ 163,906 RECONCILIATION OF EXPENSES SCHEDULE D, PART XII, LINE 4B PROVISION FOR UNCOLLECTIBLE ACCOUNTS 210,791 GOLF TOURNAMENT 16665 10759 5906 2340 1280 1586 0 16665 10759 5906 2340 1280 1586 5206 700 true true true X true X true true false false 34021 0 34021 0.00320 130402 0 130402 0.01220 155759 0 155759 0.01460 320182 0 320182 0.03000 21 4977 300577 181604 118973 0.01120 1 14 38 38 3 228 4105 4105 0.00040 25 5219 304720 181604 123116 0.01160 25 5219 624902 181604 443298 0.04160 false 210791 2584217 2584217 X true true 1 1 SABETHA COMMUNITY HOSPITAL

14TH OREGON PO BOX 229 SABETHA KS 66534

X X X X SABETHA COMMUNITY HOSPITAL 1 true true 100 true 300. true X X true true X true false X X X X true X false false 1 SABETHA FAMILY PRACTICE

1115 MAIN STREET SABETHA KS 66534

FAMILY CLINIC 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 $210,791. 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. BAD DEBT EXPENSE SCHEDULE H, PART III, LINE 2A HOSPITAL CHARGES THAT ARE NOT COLLECTED AND ARE NOT APPROVED FOR FINANCIAL ASSISTANCE ARE CLASSIFIED AS BAD DEBTS FROM PATIENTS WHO WILL NOT PAY. BAD DEBT EXPENSE 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 ACCOUNT 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. COLLECTION PRACTICES 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. CHARGES FOR MEDICAL CARE SCHEDULE H, PART V, SECTION B, LINE 20 THE HOSPITAL DETERMINES THE MAXIMUM AMOUNTS THAT CAN BE CHARGED TO FAP-ELIGIBLE INDIVIDUALS FOR EMERGENCY OR OTHER MEDICALLY NECESSARY CARE USING GROSS CHARGES. NEEDS ASSESSMENT SCHEDULE H, PART VI, LINE 2 IN OCTOBER OF 2012, SABETHA COMMUNITY HOSPITAL ALONG WITH NEMAHA VALLEY COMMUNITY HOSPITAL AND COMMUNITY AND COUNTY WIDE PARTNERS ALONG WITH CONSUMERS HELD THREE MEETINGS TO DEVELOP THE THREE YEAR COMMUNITY HEALTH CARE NEEDS ASSESSMENT. NUMEROUS OBJECTIVES WERE IDENTIFIED BUT THE MAIN PRIORITIES TO BE ADDRESSED ARE 1) PROMOTE HEALTH, WELLNESS, AND CHRONIC DISEASE PREVENTION; 2) IMPROVE ACCESS TO MENTAL HEALTH ASSISTANCE; 3) IMPROVE ACCESS TO INFORMATION AND ASSISTANCE ACROSS MULTIPLE NEEDS AND POPULATIONS. AS A RESULT OF THE CHNA, THREE COMMITTEES WERE FORMED AND HAVE BEEN WORKING EXTENSIVELY ON ALL PRIORITIES IDENTIFIED. THE CHNA WAS PRESENTED TO THE BOARD OF DIRECTORS AND WAS APPROVED IN DECEMBER 2012 WITH PERIODIC UPDATES ON PROGRESS. THE HOSPITAL CONTINUES TO PARTICIPATE IN THE HCAPS SURVEY AND RESULTS ARE REVIEWED WITH STAFF ANNUALLY. SABETHA COMMUNITY HOSPITAL RECEIVED AN AWARD FROM THE NATIONAL RURAL HEALTH ASSOCIATION FOR BEING ONE OF THE TOP 20 CAHS IN THE NATION FOR PATIENT PERSPECTIVE. THE HOSPITAL IS PARTICIPATING IN THE KANSAS HEALTH ENGAGEMENT NETWORK AND IDENTIFIED AND HAS SUCCESSFULLY COMPLETED SEVERAL QUALITY PROJECTS SUCH AS THE CAUTI PROJECT REDUCING CATHETER ASSOCIATED URINARY TRACT INFECTIONS AND THE REDUCTION OF EARLY ELECTIVE DELIVERIES. PATIENT EDUCATION OF ELIGIBILITY SCHEDULE H, PART VI, LINE 3 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. WE ALSO HAVE POSTED IN BOTH THE HOSPITAL AND CLINIC LOBBIES THAT FINANCIAL ASSISTANCE IS AVAILABLE AND TO APPLY YOU NEED TO VISIT WITH THE FINANCIAL COUNSELOR AT THE HOSPITAL. 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 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 IS 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 COMMUNITY INFORMATION 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 2800. ACCORDING TO DATA COLLECTED DURING THE COMMUNITY HEALTH NEEDS ASSESSMENT, THE PRIMARY SERVICE AREA FOR SABETHA COMMUNITY HOSPITAL INCLUDES PORTIONS OF NEMAHA, BROWN AND JACKSON COUNTIES WITH NEMAHA COUNTY PROVIDING 78.6%, BROWN 6.6%, JACKSON 1.4%, AND OTHER AREAS WHICH WOULD INCLUDE NEBRASKA AND OTHER COUNTIES 6.0% OF INPATIENT DISCHARGES FOR 2011. IN 2010, AN ESTIMATED 10,083 PEOPLE LIVE IN NEMAHA COUNTY. PEOPLE AGE 35 TO 54 YEARS MAKE UP THE LARGEST PORTION OF THE POPULATION WITH 26.7% AND OF THAT GROUP 51.5 % WERE MALE AND 48.5% WERE FEMALE. THE RACIAL AND ETHNIC COMPOSITION OF NEMAHA COUNTY IS WHITES MAKE UP 97.1%, NATIVE AMERICAN .6%, AFRICAN AMERICANS .7%, ASIANS .2% AND HISPANICS WERE 1.4% OF THE POPULATION. MEDICARE USERS MAKE UP 21% OF THE COUNTYS TOTAL POPULATION. PROMOTION OF COMMUNITY HEALTH SCHEDULE H, PART VI, LINE 5 IN THE EARLY PART OF 2012, SABETHA COMMUNITY HOSPITAL ADDED SHERRI WESSEL, PA, TO OUR TEAM OF PROVIDERS ROUNDING OUT THE MEDICAL STAFF. THE ADDITION OF THIS PA PROVIDED ADDITIONAL COVERAGE FOR THE HOSPITALS 24/7 EMERGENCY ROOM DEPARTMENT. THE EMERGENCY ROOM/TRAUMA QUALITY ASSURANCE COMMITTEE WORKED ON CRITERIA TO BECOME A LEVEL IV TRAUMA CENTER AND WAS DESIGNATED BY THE KANSAS DEPARTMENT OF HEALTH AND ENVIRONMENT IN MARCH AS A LEVEL IV. THE QUALITY ASSURANCE COORDINATOR ALONG WITH THE DIRECTOR OF NURSING AND MEDICAL STAFF ALSO MET CRITERIA TO BECOME A STROKE READY FACILITY. SABETHA FAMILY PRACTICE COMPLETED THE SECOND PHASE OF THE MEDICAL HOME PILOT PROJECT AND WILL FINISH UP WITH THAT PROJECT IN JULY OF 2013. DURING 2012, THE STAFF AT THE FIVE PHYSICIANS FAMILY PRACTICE OFFICE WORKED DILIGENTLY THROUGHOUT THE YEAR TO REACH STAGE 1 OF MEANINGFUL USE FOR THE ELECTRONIC RECORD AND WAS NOTIFIED THAT THEY HAD REACHED THEIR GOAL. DURING THIS TIME, PATIENTS WITHIN THE COMMUNITY WERE KEPT INFORMED OF THE PROCESS CHANGE AND AT THE COMPLETION OF EACH PATIENTS VISIT ARE NOW ABLE TO RECEIVE A CLINICAL SUMMARY. THE HOSPITAL ALSO ADDED ADDITIONAL TECHNOLOGY TO ENHANCE THE PATIENT EXPERIENCE WITH A NEW LAB PROGRAM, MEDICATION DISPENSING SYSTEM AND A LEGAL ELECTRONIC MEDICAL RECORD. CONNECTION TO THE KANSAS HEALTH INFORMATION EXCHANGE WAS COMPLETED IN THE FALL AND PATIENTS WERE NOTIFIED OF THEIR RIGHTS UNDER KHIN. ONE GOAL OF THE HOSPITAL FOR 2012 WAS TO ADD A DIABETES COUNSELING AND EDUCATION CLASS FOR DIABETIC PATIENTS. A CERTIFIED DIABETIC NURSE EDUCATOR WAS ADDED TO STAFF AND ALONG WITH THE REGISTERED DIETICIAN BEGAN WORK ON ACCREDITATION SO THAT SABETHA COMMUNITY HOSPITAL WOULD BECOME A DIABETIC CERTIFIED FACILITY. A SUPPORT GROUP WAS FORMED FOR DIABETIC PATIENTS PROMOTING LIFE STYLE CHANGES AND ACCOUNTABILITY IN THEIR DIABETIC JOURNEY. 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 AND THE WELLNESS COORDINATOR MAINTAINS A FITNESS CALENDAR FOR EMPLOYEES WHO CHOOSE TO JOIN THE WELLNESS PROGRAM. IN MARCH, EMPLOYEES AND THE COMMUNITY WERE ENCOURAGED TO PARTICIPATE IN THE ANNUAL WALK ACROSS KANSAS PROGRAM. MONTHLY OUTPATIENT CALENDARS FOCUSING ON HEALTH ISSUES ARE PUBLISHED AND SENT OUT TO THE COMMUNITY AND SURROUNDING AREAS. SABETHA COMMUNITY HOSPITAL GUILD MEMBERS VOLUNTEER TO COORDINATE EFFORTS TO HOLD BLOODMOBILE CLINICS AND 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 ERGONOMIC CHECKS AND BLOOD PRESSURE CHECKS WHEN REQUESTED AT THE LOCAL BUSINESSES. IN 2012, THE PHYSICAL THERAPY AND OCCUPATIONAL THERAPY DEPARTMENT ADDED A BALANCE MASTER SYSTEM TO AID STROKE PATIENTS OR INJURED ATHLETES ALONG WITH OTHER DIAGNOSIS. 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 AT THE HOSPITAL, AND HOSPITAL STAFF CONDUCTS FLU CLINICS AT THE LOCAL GROCERY STORE AS WELL AS ONSITE FLU VACCINATIONS FOR SEVERAL LOCAL BUSINESSES. HOSPITAL STAFF PROVIDES CPR TRAINING FOR PROFESSIONALS IN THE AREA. THE HOSPITAL PROVIDES PRENATAL CLASSES INCLUDING CPR TRAINING 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 PART D SERVICES, OR OTHER INFORMATION REFERRAL ASSISTANCE. THE HOSPITAL ALSO PROVIDES LIFELINE TO THE SENIOR POPULATION IN THE REGION. ONE OF THE HOSPITAL PHYSICIANS SITS AS THE MEDICAL DIRECTOR FOR THE CITY OWNED AMBULANCE SERVICE AND ALSO SERVES AS THE MEDICAL DIRECTOR FOR A LOCAL NURSING HOME. ANOTHER PHYSICIAN SERVES AS A MEDICAL DIRECTOR FOR A NURSING HOME AS WELL AS THE LOCAL HOME HEALTH AND HOSPICE AGENCY. THE CHIEF EXECUTIVE OFFICER OF SABETHA COMMUNITY HOSPITAL SERVES ON THE BOARD OF KANSAS HEALTH SERVICE CORPORATION WORKERS COMPENSATION FUND, THE KANSAS HOSPITAL ASSOCIATIONS POLICY AND ADVOCACY COMMITTEE, THE HEALTH INNOVATIONS NETWORK OF KANSAS BOARD, AND THE KANSAS HEALTH CARE COLLABORATIVE BOARD. SABETHA COMMUNITY HOSPITAL TAKES ITS COMMITMENT TO THE COMMUNITY VERY SERIOUSLY AND PARTICIPATES IN EMERGENCY DRILLS, ALWAYS MONITORING PATIENT AND EMPLOYEE SAFETY, RISK MANAGEMENT, QUALITY ASSURANCE, HIPAA AND CORPORATE COMPLIANCE. THE HOSPITAL PROVIDES AN AVENUE FOR NURSING STUDENTS THROUGH THE HOSPITAL AFFILIATION WITH HIGHLAND COMMUNITY COLLEGE AND SOUTHEAST COMMUNITY COLLEGE, BEATRICE, NEBRASKA. MEDICAL STUDENTS IN THE RURAL RESIDENCY PROGRAM AT KANSAS UNIVERSITY MEDICAL SCHOOL ARE ABLE TO FOLLOW THE FAMILY PHYSICIANS, PHYSICAL THERAPY STUDENTS THROUGH AFFILIATION WITH KANSAS CITY KANSAS COMMUNITY COLLEGE AND INDIAN HILLS COMMUNITY COLLEGE, AND OCCUPATIONAL THERAPY STUDENTS THROUGH WASHBURN UNIVERSITY AFFILIATION ALL DO CLINICAL ROTATIONS. 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. AFFILIATED HEALTH CARE SYSTEMS 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. COMMUNITY BENEFIT REPORT SCHEDULE H, PART VI, LINE 7 N/A FACILITY REPORTING GROUP SCHEDULE H, PART VI, LINE 8 N/A false false false false false false false false false KEVIN KENNALLY 298690 0 0 0 0 0 24200 0 18813 0 341703 0 0 0 GREGG WENGER 173282 0 0 0 0 0 16528 0 10257 0 200067 0 0 0 JAMES LONGABAUGH 210976 0 0 0 0 0 20298 0 11430 0 242704 0 0 0 CHRISTIAN TRAMP 190843 0 0 0 0 0 18284 0 18174 0 227301 0 0 0 KERSTIN GLYNN 239502 0 0 0 0 0 23150 0 16023 0 278675 0 0 0 COMPENSATION FROM A RELATED ORGANIZATION FORM 990, PART VII; SCHEDULE J, PART I, LINE 3 COMPENSATION FOR ROGER JOHN 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. JOHN AND MR. DELLASEGA. PROGRAM SERVICE ACCOMPLISHMENTS FORM 990, PART III, LINE 4 THE HOSPITAL ADDED SEVERAL NEW COMPONENTS IN 2012 TO ENHANCE THE DELIVERY OF HEALTH CARE. SABETHA COMMUNITY HOSPITAL WAS DESIGNATED AS A LEVEL IV TRAUMA CENTER AND STROKE READY FACILITY. SCH WAS ALSO RECOGNIZED BY THE NATIONAL RURAL HEALTH ASSOCIATION AS BEING ONE OF THE TOP 20 CRITICAL ACCESS HOSPITALS IN THE NATION FOR PATIENT PERSPECTIVE. SEVERAL COMPONENTS OF THE ELECTRONIC MEDICAL RECORD WAS ADDED IN 2012 SUCH AS THE NEW LAB SYSTEM TO INTERFACE WITH THE LEGAL MEDICAL RECORD AND THE UPGRADE TO THE MEDICATION DISPENSING SYSTEM TO POSITION THE HOSPITAL FOR THE 2013 IMPLEMENTATION OF THE PHARMACY AND MEDICATION ADMINISTRATION MODULE. IN LATE 2012 THE HOSPITAL CONNECTED WITH KANSAS HEALTH INFORMATION NETWORK AND BEGAN TRANSMITTING PATIENT INFORMATION INTO THE NETWORK. KEEPING PATIENTS INFORMED OF THEIR RIGHTS UNDER KHIN WAS A HIGH PRIORITY. A DISCHARGE INSTRUCTION MODULE (EXIT CARE) WAS ADDED TO HELP PATIENTS WHEN THEY ARE DISMISSED FROM THE HOSPITAL. WRITTEN INSTRUCTIONS WILL HELP AS A GUIDE TO CARE AT HOME OR FOR THE PATIENT CAREGIVER. DIABETIC EDUCATION WAS ALSO A HIGH PRIORITY AND THE HOSPITAL HIRED A DIABETIC EDUCATOR AND BEGAN WORK ON APPLYING TO BECOME A CERTIFIED DIABETIC EDUCATION FACILITY. MEMBERS 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. MEMBERS MAY ELECT GOVERNING BODY 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. GOVERNING BODY DECISIONS SUBJECT TO APPROVAL OF 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 REVIEW PROCESS 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 REIVEW PRIOR TO FILING THE 990 WITH THE IRS. CONFLICT OF INTEREST POLICY 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. COMPENSATION REVIEW FORM 990, PART VI, SECTION B, LINES 15A & B THERE IS NO FORMAL REVIEW BY INDEPENDENT SOURCES, BUT THE ORGANIZATION'S BUDGET AND THE GPHA BUDGET IS APPROVED BY THE BOARD. AS A HISTORICAL PRACTICE, RAISES OF THE PRESIDENT/CEO AND CHIEF FINANCIAL OFFICER ARE LIMITED TO $3,000 ANNUALLY SINCE THESE INDIVIDUALS EACH EARN OVER $100,000 ANNUALLY. AVAILABILITY OF DOCUMENTS 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. OTHER CHANGES IN NET ASSETS FORM 990, PART XI, LINE 9 EQUITY IN EARNINGS SABETHA HEALTHCARE, INC. 14,730 TRANSFER TO CITY OF SABETHA (158,700) ---------- TOTAL $ (143,970) GREAT PLAINS HEALTH ALLIANCE INC 625 THIRD STREET PHILLIPSBURG KS 67661 480617739 MANAGEMENT KS 501(C)(3) 3 NA false GREAT PLAINS HEALTH CARE FOUNDATION INC 625 THIRD STREET PHILLIPSBURG KS 67661 480955870 SUPPORT KS 501(C)(3) 9 GPHA INC false GREAT PLAINS OF CHEYENE COUNTY INC 625 THIRD STREET PHILLIPSBURG KS 67661 481226831 HOSPITAL KS 501(C)(3) 3 GPHA INC false GREAT PLAINS OF ELLINWOOD INC 625 THIRD STREET PHILLIPSBURG KS 67661 481226976 HOSPITAL KS 501(C)(3) 3 GPHA INC false GREAT PLAINS OF KIOWA COUNTY INC 625 THIRD STREET PHILLIPSBURG KS 67661 481226833 HOSPITAL KS 501(C)(3) 3 GPHA INC false GREAT PLAINS OF OTTAWA COUNTY INC 625 THIRD STREET PHILLIPSBURG KS 67661 481226856 HOSPITAL KS 501(C)(3) 3 GPHA INC false GREAT PLAINS OF PHILLIPS COUNTY INC 625 THIRD STREET PHILLIPSBURG KS 67661 481226829 HOSPITAL KS 501(C)(3) 3 GPHA INC false GREAT PLAINS OF REPUBLIC COUNTY INC 625 THIRD STREET PHILLIPSBURG KS 67661 481226977 HOSPITAL KS 501(C)(3) 3 GPHA INC false GREAT PLAINS OF SMITH COUNTY INC 625 THIRD STREET PHILLIPSBURG KS 67661 481226830 HOSPITAL KS 501(C)(3) 3 GPHA INC false false false false false false false false false false false false false true false false false false false false