2012-11-14T15:25:30-06:00 2011-12-31 BKD LLP 1201 Walnut Suite 1700 Kansas City MO 641062246 990 2011-01-01 481155548 MIAMI COUNTY MEDICAL CENTER INC % TIERNEY L GRASSER MIAM 9137914461 2100 BAPTISTE DRIVE PAOLA KS 66071 TIERNEY L GRASSER 2012-11-15 true 8162216300 2011 2016-02-24 21:20:13Z TIERNEY L GRASSER 20333 W 151ST STREET OLATHE KS 66061 29077509 false X WWW.OLATHEHEALTH.ORG X 1994 KS TO IMPROVE THE HEALTH OF ALL INDIVIDUALS IN THE COMMUNITIES WE SERVE BY PROVIDING COMPASSIONATE, QUALITY HEALTHCARE IN AN ENVIRONMENT OF TRUST AND COLLABORATION. 5 5 188 33 0 0 1332 1105 22307375 21305362 867610 292532 118059 58243 23294376 21657242 87994 100176 0 0 9461454 9621685 0 0 0 10941209 11425796 20490657 21147657 2803719 509585 42910451 42410654 8097661 7306951 34812790 35103703 X THE MISSION OF MIAMI COUNTY MEDICAL CENTER, INC. IS TO IMPROVE THE HEALTH OF ALL INDIVIDUALS IN THE COMMUNITIES WE SERVE BY PROVIDING COMPASSIONATE, QUALITY HEALTHCARE IN AN ENVIRONMENT OF TRUST AND COLLABORATION. false false 15758310 100176 21305362 SEE SCHEDULE O 15758310 true false false true false false false false false true true false false false true true false true false false false false false false false false true true true false true true false false false false false false false false true false false false false false false true false false false false true 29 0 true 188 true false false false false false false false false false false X 5 5 true false false false true true true true true false false true true true true true true true true false KS X TIERNEY L GRASSER 9137914461 20333 W 151ST STREET OLATHE KS 66061 X JACK TINNEL 2.0 X X THOMAS J DAVIES 1.0 X X CHIP WOOD 1.0 X STEVE MILLER 1.0 X X DENISE GERMAN 1.0 X X JOE MORLAND 1.0 X FRANK H DEVOCELLE 7.0 X 0 761736 305830 RODNEY D CORN 7.0 X 0 152251 8513 TIERNEY L GRASSER 9.0 X 0 403879 106123 GERALD WIESNER 40.0 X 165953 0 15733 CHERYL L ROSS 2.0 X 0 112848 10887 PAUL W LUCE 40.0 X 120887 0 20698 STEVEN B MOON 40.0 X 115434 14133 402274 1430714 481917 3 false true false EMERGENCY MEDICINE CARE PA EMERGENCY SERVICES 1666667 SHARED MEDICAL SYSTEMS INC MRI SERVICES 259877 P1 GROUP INC HVAC MAINTENANCE 144591 KRAMER FRANK COLLECTION SERVICES 113986 DE MINT ANESTHESIA SERVICE ANESTHESIA SERVICES 156197 5 1105 1105 Net Patient Service Revenue 900099 21305362 21305362 21305362 799448 799448 0 0 99213 197681 -98468 -98468 -98468 6715670 7222586 -506916 -506916 -506916 0 0 0 Puchase Discounts 900099 22810 22810 CAFETERIA 722210 28683 28683 REFERENCE LAB INCOME 621500 28675 28675 76543 76543 156711 21657242 21305362 350775 95176 95176 5000 5000 0 0 181686 141687 39999 30671 30671 7732927 6030493 1702434 119378 93096 26282 1021894 796920 224974 535129 417318 117811 0 72504 72504 29426 29426 3831 3831 0 12397 12397 3219899 1107179 2112720 83490 83490 741162 221900 519262 0 0 418600 373286 45314 19538 19538 0 0 225432 202148 23284 0 1510900 1354845 156055 262435 235329 27106 Bad Debt Expense 1376769 1376769 MEDICAL SUPPLIES 2534766 2534616 150 Loss on Term of IR Swap 556200 556200 Medicaid Assessment 83921 83921 274526 101756 172770 21147657 15758310 5389347 0 363253 435287 0 0 0 0 4247760 3808380 0 0 0 0 0 0 801393 636865 168976 139391 21679955 15725159 6017101 5954796 31122444 31196508 0 0 0 0 0 0 189524 239427 42910451 42410654 1834574 1960346 0 0 0 0 5216150 4934342 0 0 0 0 0 0 0 0 1046937 412263 8097661 7306951 X 34785070 35077587 27720 26116 0 0 34812790 35103703 42910451 42410654 X 509585 -218672 X false true true X false X false false false false false true 3831 false false false 3831 false 29909183 401968 -522248 26081 29762822 24241897 2406369 3273465 12548 29909183 15324746 3571697 5368894 23440 24241897 16823777 1922937 -3411104 10864 15324746 0.99910 0.00000 0.00090 false false 1475439 1475439 10057263 8586362 1470901 9536639 6773788 2762851 610614 365009 245605 5954796 0 DUE TO AFFILIATES 412263 412263 21657242 21147657 509585 -840008 622940 -217068 292517 280513714 -840008 259708877 258868869 21644845 12397 12397 21657242 275251255 254115995 254115995 21135260 12397 12397 21147657 DESCRIBE THE INTENDED USES OF THE ORGANIZATION'S ENDOWMENT FUNDS SCHEDULE D, PART V, LINE 4 THE ENDOWMENT FUNDS ARE HELD FOR FUTURE CAPITAL AND EXPANSION NEEDS. IN ADDITION, THE FUNDS ALSO REPRESENT RESERVES FOR OPERATING NEEDS TO REMAIN FINANCIALLY STABLE. UNCERTAIN TAX POSITIONS DISCLOSURE 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. OTHER - RECONCILIATION OF REVENUE PER AUDITED F/S AND TAX RETURN CHANGE IN FAIR VALUE OF INTEREST RATE SWAP 613,175 NET ASSETS RELEASED- CAPITAL 9,765 -------- TOTAL $622,940 OTHER - REVENUE INCLUDED ON LINE 1 BUT NOT ON FORM 990, PART VIII, LINE 12 SCHEDULE D, PART XII, LINE 2D RELATED ORGANIZATIONS' REVENUE 259,688,036 RENTAL EXPENSES 197,681 CHANGE IN FAIR VALUE OF INTEREST RATE SWAP 379,360 LOSS ON TERMINATION OF INTEREST RATE SWAP (556,200) ------------- TOTAL $259,708,877 OTHER - EXPENSE INCLUDED ON LINE 1 BUT NOT ON FORM 990, PART IX, LINE 25 SCHEDULE D, PART XIII, LINE 2D RELATED ORGANIZATIONS' EXPENSES 254,474,514 RENTAL EXPENSES 197,681 LOSS ON TERMINATION OF INTEREST RATE SWAP (556,200) ------------- TOTAL $254,115,995 true true X false true X true true false true true 2307 1143 625475 0 625475 0.02960 5632 1846 2320105 685706 1634399 0.07730 7939 2989 2945580 685706 2259874 0.10690 5 298 7266 0 7266 0.00030 4 15 10387 10387 0.00050 2 75 26526 26526 0.00130 11 388 44179 0 44179 0.00210 7950 3377 2989759 685706 2304053 0.10900 false 453271 0 5952880 8294429 -2341549 X true true 1 1 MIAMI COUNTY MEDICAL CENTER INC

2100 BAPTISTE DRIVE PAOLA KS 66071

X X X MIAMI COUNTY MEDICAL CENTER INC 1 true false true 250. true X X X X X X X true true X true X false true X false false 2 LOUISBURG REHAB OF MIAMI CTY MEDICAL CTR

102 W CRESTVIEW CIRCLE LOUISBURG KS 66053

OUTPATIENT REHABILITATION CLINIC OSAWATOMIE REHAB OF MIAMI CTY MED CENTER

539 MAIN STREET OSAWATOMIE KS 66064

OUTPATIENT REHABILITATION CLINIC FAMILY INCOME LIMIT FOR ELIGIBILITY FOR DISCOUNTED CARE SCHEDULE H, PART I, LINE 3C MIAMI COUNTY MEDICAL CENTER, INC. (MCMCI) OFFERS DISCOUNTED CARE TO ALL INDIVIDUALS WITHOUT INSURANCE, SIMILAR TO MANAGED CARE DISCOUNTS. MCMCI'S UNINSURED DISCOUNT APPLIES TO ALL PATIENTS WITHOUT INSURANCE, REGARDLESS OF ABILITY TO PAY, INCLUDING ALL LOW INCOME INDIVIDUALS. SCHEDULE H, PART I, LINE 7, COLUMN F THE BAD DEBT EXPENSE IS NOT CONSIDERED A COMMUNITY BENEFIT EXPENSE AND IS NOT INCLUDED IN SCHEDULE H, PART I, LINE 7. 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 ACCOUNTING SYSTEM. BAD DEBT EXPENSE SCHEDULE H, PART III, LINE 4 THE SYSTEM REPORTS PATIENT ACCOUNTS RECEIVABLE FOR SERVICES RENDERED AT NET REALIZABLE AMOUNTS FROM THIRD-PARTY PAYERS, PATIENTS AND OTHERS. THE SYSTEM PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS BASED UPON A REVIEW OF OUTSTANDING RECEIVABLES, HISTORICAL COLLECTION INFORMATION AND EXISTING ECONOMIC CONDITIONS. THE SYSTEM BILLS THIRD-PARTY PAYERS DIRECTLY AND BILLS THE PATIENT WHEN THE PATIENT'S LIABILITY IS DETERMINED. PATIENT ACCOUNTS RECEIVABLE ARE DUE WHEN BILLED. ACCOUNTS ARE CONSIDERED DELINQUENT AND SUBSEQUENTLY WRITTEN OFF AS BAD DEBTS BASED ON CREDIT EVALUATION AND SPECIFIC CIRCUMSTANCES OF THE ACCOUNT. FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE SYSTEM ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR BAD DEBTS, IF NECESSARY (FOR EXAMPLE, FOR EXPECTED UNCOLLECTIBLE DEDUCTIBLES AND COPAYMENTS ON ACCOUNTS FOR WHICH THE THIRD-PARTY PAYER HAS NOT YET PAID, OR FOR PAYERS 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 SYSTEM 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 OR PROVIDED BY POLICY) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. AN OVERALL COST TO CHARGE RATIO IS USED TO CALCULATE THE BAD DEBT EXPENSE. COLLECTION PRACTICES SCHEDULE H, PART III, LINE 9B BEFORE PLACEMENT WITH COLLECTION AGENCIES, MCMCI PATIENT FINANCIAL SERVICES OFFERS VARIOUS OPTIONS FOR PATIENTS WITH FINANCIAL DIFFICULTIES. IN ADDITION TO OFFERING OUR OWN FINANCIAL ASSISTANCE TO QUALIFYING INDIVIDUALS, MCMCI CONTRACTS WITH AN AGENCY THAT SCREENS INDIVIDUALS FOR ELIGIBILITY FOR PROGRAMS LIKE MEDICAID, DISABILITY, AND CRIME VICTIM'S COMPENSATION AND THEN HELPS THEM THROUGH THE APPLICATION PROCESS. THE USE OF PROPENSITY TO PAY (LIKELIHOOD TO PAY) SOFTWARE ALSO HELPS MCMCI IDENTIFY INDIVIDUALS THAT MAY NEED ASSISTANCE THAT HAVE NOT COMPLETED AN APPLICATION. MCMCI HAS LANGUAGE WRITTEN IN THEIR COLLECTION AGENCY CONTRACT THAT STATES, "IF THE COLLECTION AGENCY LEARNS A PATIENT/DEBTOR HAS NEITHER SUFFICIENT INCOME NOR ASSETS TO MEET HIS FINANCIAL OBLIGATION, THE AGENCY WILL NOT PURSUE COLLECTION ACTIVITIES AGAINST THE PATIENT/DEBTOR, UNLESS OR UNTIL THE AGENCY LEARNS THAT THE PATIENT/DEBTOR HAS INCOME OR ASSETS TO MEET THE OBLIGATION." IF THE COLLECTION AGENCY IS NOTIFIED BY THE PATIENT/DEBTOR THAT THIS CREATES AN UNDUE FINANCIAL HARDSHIP OR BURDEN DUE TO A CHANGE IN THEIR INCOME OR ASSETS, THE AGENCY WILL NOTIFY MCMCI AND AWAIT FURTHER DIRECTION FROM THE HOSPITAL. SCHEDULE H, PART V, SECTION B, LINE 9 MIAMI COUNTY MEDICAL CENTER, INC. (MCMCI) DOES NOT OFFER FREE CARE EXCEPT IN THE CASE OF DEATH AND NO ASSETS OR INSURANCE ARE AVAILABLE. IN ALL OTHER CASES WE WILL DISCOUNT UP TO 99.9% OF TOTAL CHARGES FOR PATIENTS AT OR BELOW THE FEDERAL POVERTY GUIDELINES. ALL PATIENTS ARE EXPECTED TO CONTRIBUTE TO THEIR CARE IN ACCORDANCE WITH THEIR ABILITY. SCHEDULE H, PART V, SECTION B, LINE 13G MIAMI COUNTY MEDICAL CENTER (MCMCI) PUBLICIZED THE FINANCIAL ASSISTANCE POLICY BY PUBLICIZING THE FINANCIAL ASSISTANCE PROGRAM IN THE FOLLOWING MANNER; THE FINANICAL ASSISTANCE PROGRAM WAS PUBLICIZED ON THE HOSPITAL'S WEBSITE, ON EACH PATIENT BILL AND WITH SIGNS IN REGISTRATION AREAS AND IN PATIENT FINANCIAL SERVICES. APPLICATIONS ARE GIVEN TO PATIENTS DURING REGISTRATION UPON REQUEST. SCHEDULE H, PART V, SECTION B, LINE 15E MIAMI COUNTY MEDICAL CENTER (MCMCI) DOES NOT PERMIT ANY OF THE ACTIONS LISTED WITHOUT MAKING A REASONABLE EFFORT TO DETERMINE THE PATIENT'S ELIGIBILITY UNDER THE FACILITY'S FINANCIAL ASSISTANCE PROGRAM. SCHEDULE H, PART V, SECTION B, LINE 19D THE HOSPITAL UTILIZED A DISCOUNT OF 50% FOR UNINSURED AND FINANCIAL ASSISTANCE ELIGIBLE INDIVIDUALS BASED ON AN OVERALL WRITE-OFF PERCENTAGE FOR COMMERCIAL PAYORS. NEEDS ASSESSMENT SCHEDULE H, PART VI, LINE 2 Miami County Medical Center, Inc. (MCMCI) is continually assessing the health needs of the communities it serves in a variety of ways. Informally, MCMCI is involved in multiple health fairs and other community outreach activities that involve screenings, questionnaires and general conversation that help us understand the needs of groups and individuals. The MCMCI community advisory group is represented by a diverse set of individuals who provide helpful input from the organizations and communities they represent. MCMCI has also been very involved with the Miami County Health Department and other area agencies in collaboration on health needs assessment and delivery of services. During 2011 MCMCI began to prepare a more formal process of assessment through a broad-based survey of residents of the service area, and town hall meetings open to the public planned for 2012. The results of these efforts will be available by year-end 2012. MCMCI will present a recommendation for a Community Health Improvement Process to its Board of Trustees by mid-2013. PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE SCHEDULE H, PART VI, LINE 3 PATIENTS OF MIAMI COUNTY MEDICAL CENTER, INC. (MCMCI) ARE MADE AWARE OF ALL OPPORTUNITIES AVAILABLE FOR FINANCIAL ASSISTANCE IN A VARIETY OF WAYS. THERE ARE SIGNS IN THE REGISTRATION AREAS TO NOTIFY PATIENTS AND VISITORS OF THE AVAILABILITY OF ASSISTANCE PROGRAMS. EVERY BILLING STATEMENT CONTAINS A NOTICE OF THE AVAILABILITY OF FINANCIAL ASSISTANCE AND HOW TO OBTAIN ADDITIONAL INFORMATION OR APPLY. APPLICATIONS AND INSTRUCTIONS ARE AVAILABLE ON THE MEDICAL CENTER'S WEBSITE, IN BOTH ENGLISH AND SPANISH. PATIENT ACCESS, PATIENT FINANCIAL SERVICES AND SOCIAL WORKERS ARE TRAINED TO PROVIDE APPLICATIONS TO PATIENTS IF THEY EXPRESS ANY CONCERN REGARDING ABILITY TO PAY FOR SERVICES, OR MAY BE REFERRED TO AN AGENCY THE MEDICAL CENTER CONTRACTS WITH TO HELP INDIVIDUALS THROUGH THE APPLICATION PROCESS FOR PROGRAMS LIKE MEDICAID AND DISABILITY. PATIENTS THAT CALL OUR PATIENT FINANCIAL SERVICES DEPARTMENT EXPRESSING CONCERNS ABOUT BEING ABLE TO PAY FOR THEIR SERVICES OR EXPRESS THAT THEY ARE EXPERIENCING A FINANCIAL HARDSHIP ARE ADVISED OF OUR ASSISTANCE POLICY AND ENCOURAGED TO APPLY. COMMUNITY INFORMATION SCHEDULE H, PART VI, LINE 4 Miami County Medical Center, Inc. (MCMCI) serves the people of Miami and Linn Counties in Kansas. Miami and Linn Counties are both located in rural areas of the state of Kansas and are both federally designated medically underserved areas of Kansas. MCMCI is the only hospital in these two counties. However, there are several other hospitals located in nearby metropolitan areas, including Olathe and Overland Park, Kansas, and Kansas City, Missouri. In addition to the general health care services provided by the hospital and its associated physicians, MCMCI serves a diverse population of mentally disabled patients. The Osawatomie State Hospital, Lake Mary Center, Medicalodge of Paola and the Tri-Ko are all organizations located in the service area. MCMCI supports each of these organizations by providing medical care to their residents. Below is a listing of economic levels for area residents. Time period: 2006 - 2010 Source: factfinder2.census.gov People Living Below Poverty Level Miami County: 5.7% Linn County: 10.3% Young Children Living Below Poverty Level Miami County: 10.6% Linn County: 12.1% Uninsured Adult Population Rate (2009) Miami County: 14.8% Linn County: 18.8% PROMOTION OF COMMUNITY HEALTH SCHEDULE H, PART VI, LINE 5 In addition to the items listed above, Miami County Medical Center takes a very active role in support of local, regional and national not-for-profit organizations with a focus on improving health and supporting those in need. MCMCI provides support financially and through volunteering time and talents to multiple area organizations. MCMCI provides athletic trainers to area school sports programs. MCMCI staff members are involved in several health fairs and/or community screenings each year. The community health fairs are organized in conjunction with a variety of other area agencies, such as: Miami County Emergency Medical Services, local school districts, county agencies. AFFILIATED HEALTH CARE SYSTEM SCHEDULE H, PART VI, LINE 6 MIAMI COUNTY MEDICAL CENTER IS A PART OF OLATHE HEALTH SYSTEM, INC. (OHSI) THIS CONSISTS OF TWO HOSPITALS AND A NETWORK OF 38 CLINICS. OHSI AND ITS AFFILIATES, INCLUDING MIAMI COUNTY MEDICAL CENTER, TAKE A LEADERSHIP ROLE IN PROMOTING THE HEALTH OF THE COMMUNITIES SERVED. OHSI HOSPITALS AND CLINICS ARE VERY INVOLVED WITH COMMUNITY OUTREACH EDUCATION AND SCREENING PROGRAMS ACROSS THE ENTIRE SERVICE AREA. WE COLLABORATE WITH AREA COMPANIES AND OTHER HEALTH-RELATED SERVICE PROVIDERS TO PROVIDE EDUCATION AND SCREENINGS TO THE PUBLIC. OHSI POSITIONS ITSELF AS NOT ONLY A PROVIDER OF CARE, BUT A RESOURCE FOR EDUCATION AND PREVENTION. STATE FILING OF COMMUNITY BENEFIT REPORT SCHEDULE H, PART VI, LINE 7 MCMCI IS NOT REQUIRED TO FILE A COMMUNITY BENEFIT REPORT WITH THE STATE, BUT WE MAKE OUR REPORT AVAILABLE TO ANYONE INTERESTED AT WWW.OLATHEHEALTH.ORG. true LAKEMARY ENDOWMENT 100 LAKEMARY DRIVE PAOLA KS 66071 237423516 501(C)(3) 7500 CMTY WELLNESS SCHOOL DISTRICT #368 PO BOX 268 PAOLA KS 66071 480720746 GOVERNMENT 23024 BOOK SPORTS MEDICINE CMTY WELLNESS SCHOOL DISTRICT #230 101 E SOUTH ST SPRING HILL KS 66083 480723504 GOVERNMENT 22702 BOOK SPORTS MEDICINE CMTY WELLNESS SCHOOL DISTRICT #367 1200 TROJAN DRIVE OSAWATOMIE KS 66064 GOVERNMENT 23024 BOOK SPORTS MEDICINE CMTY WELLNESS YMCA OF GREATER KC 3100 BROADWAY SUITE 1020 KC MO 64111 440546002 501(C)(3) 6000 CMTY WELLNESS 5 PROCESS FOR MONITORING THE USE OF GRANTS IN THE U.S. SCHEDULE I, PART I, LINE 2 MIAMI COUNTY MEDICAL CENTER, INC. PROVIDED SPORTS TRAINERS TO LOCAL HIGH SCHOOLS. FOR ALL SCHOLARSHIPS, THE ORGANIZATION CAREFULLY SELECTS THE RECIPIENTS OF THE FUNDS AND A CHECK IS WRITTEN DIRECTLY TO THE ORGANIZATION OR INDIVIDUAL. X true true false true false false false false false false false FRANK H DEVOCELLE 0 560037 0 149413 0 52286 0 289337 0 16493 0 1067566 0 135830 RODNEY D CORN 0 82791 0 35864 0 33596 0 6189 0 2324 0 160764 0 35864 TIERNEY L GRASSER 0 300499 0 66387 0 36993 0 84888 0 21235 0 510002 0 57728 GERALD WIESNER 149188 0 9702 0 7063 0 2000 0 13733 0 181686 0 9702 0 SOCIAL CLUB DUES OR INITIATION FEES SCHEDULE J, PART I, LINE 1A SOCIAL CLUB DUES WERE PAID BY THE HOSPITAL FOR GERALD WIESNER AND WERE NOT INCLUDED IN HIS W-2 AS TAXABLE COMPENSATION BECAUSE IT WAS 100% BUSINESS USE. ESTABLISHMENT OF OFFICER COMPENSATION FORM 990, PART VII; SCHEDULE J, PART I, LINE 3 AND PART II THE COMPENSATION BEING REPORTED FOR GERALD WIESNER WAS REVIEWED AND APPROVED BY THE COMPENSATION COMMITTEE OF THE BOARD OF OLATHE MEDICAL CENTER, INC. THE SOLE MEMBER OF MIAMI COUNTY MEDICAL CENTER INC. THE COMPENSATION COMMITTEE IS COMPRISED OF INDEPENDENT BOARD MEMBERS, WHICH INCLUDES A BOARD MEMBER FROM MIAMI COUNTY MEDICAL CENTER, INC. THE COMMITTEE UTILIZED AN INDEPENDENT COMPENSATION CONSULTANT AND THIRD PARTY SALARY SURVEYS IN THE ESTABLISHMENT OF MR. WIESNER'S COMPENSATION. COMPENSATION FROM A RELATED ORGANIZATION FORM 990, PART VII; SCHEDULE J, PART I, LINE 3 AND PART II THE COMPENSATION BEING REPORTED FOR FRANK H DEVOCELLE, RODNEY D CORN AND TIERNEY L GRASSER BY A RELATED ORGANIZATION IS FROM OLATHE MEDICAL CENTER, INC. THE SOLE MEMBER OF MIAMI COUNTY MEDICAL CENTER, INC. OLATHE MEDICAL CENTER, INC. USES A COMPENSATION COMMITTEE COMPRISED OF INDEPENDENT BOARD MEMBERS TO ESTABLISH COMPENSATION AND BENEFITS FOR ALL OFFICERS OF OLATHE MEDICAL CENTER, INC. AND ITS AFFILIATED CORPORATIONS. THE COMPENSATION COMMITTEE APPROVES AND ESTABLISHES ALL COMPENSATION AND BENEFITS FOR OFFICERS OF OLATHE MEDICAL CENTER, INC. AND ITS AFFILIATED COMPANIES. THEY UTILIZED AN INDEPENDENT COMPENSATION CONSULTANT, A WRITTEN CONTRACT FOR THE CEO AND COMPENSATION SURVEYS TO ESTABLISH FAIR MARKET VALUE SALARIES AND BENEFITS FOR OLATHE MEDICAL CENTER, INC. AND ITS AFFILIATES' OFFICERS. SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN SCHEDULE J, PART I, LINE 4B & PART II A SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP) IS PROVIDED TO FRANK H DEVOCELLE WHICH IS FUNDED OVER A SHORT TIME PERIOD BASED UPON THE IMPLEMENTATION DATE OF THE SERP IN 2005. MR. DEVOCELLE'S CAREER SERVICE AT OLATHE MEDICAL CENTER, INC. AND ITS AFFILIATED ENTITIES IS CURRENTLY AT 40 YEARS, MOST OF WHICH DID NOT INCLUDE FUNDING FOR THE SERP BENEFIT. A MAJORITY OF THE DEFERRED COMPENSATION IS DUE TO FUNDING OF THE SERP BENEFIT FOR PRIOR YEARS OF SERVICE. A SERP is also provided to Tierney L Grasser which is funded over a short time period based upon the implementation date of the SERP in 2005. Ms. Grasser's career service at Olathe Medical Center, Inc. and its affiliated entities is currently at 23 years, most of which did not include funding for the SERP benefit. A majority of the deferred compensation is due to funding of the SERP benefit for prior years of service. Certain physicians participate in a deferred compensation benefit plan. OFFICER SERP FRANK H DEVOCELLE $267,908 (AT LEAST 90% ATTRIBUTABLE TO UNDER FUNDING IN PRIOR YEARS) TIERNEY L GRASSER $ 68,226 (AT LEAST 85% ATTRIBUTABLE TO UNDER FUNDING IN PRIOR YEARS) RODNEY D CORN $ 4,134 COMPENSATION REPORTED IN PRIOR YEAR FORM 990 SCHEDULE J, PART II, COLUMN F COMPENSATION IS REPORTED ON THE FORM 990 IN THE YEAR THAT THE COMPENSATION IS EARNED BY OR AWARDED TO AN INDIVIDUAL, EVEN IF THE COMPENSATION IS NOT PAID TO THE INDIVIDUAL, IS NOT FULLY VESTED, OR IS SUBJECT TO SUBSTANTIAL RISK OF FORFEITURE. IF COMPENSATION IS EARNED OR AWARDED IN ONE YEAR BUT PAID IN A LATER YEAR, THEN THE COMPENSATION IS GENERALLY REPORTED A SECOND TIME ON THE FORM 990 IN THE YEAR THE COMPENSATION IS PAID TO THE INDIVIDUAL. AS A RESULT OF THE REPORTING REQUIREMENT, AN ORGANIZATION COULD BE REQUIRED TO REPORT THE SAME COMPENSATION AMOUNTS ON THE FORM 990 FOR TWO CONSECUTIVE YEARS. The amounts reported in column F: include incentive amounts and capital accumulation amounts which were reported in previous 990s as deferred compensation. RETIREMENT AND OTHER DEFERRED COMPENSATION SCHEDULE J, PART II, COLUMN C COLUMN (C) REFLECTS SERP PAYMENTS (SEE ABOVE FOR FURTHER EXPLANATION) AND OTHER DEFERRED COMPENSATION. TOTAL SERP OTHER COLUMN C FRANK H DEVOCELLE $267,908 $ 21,429 $289,337 RODNEY D CORN 4,134 2,055 6,189 TIERNEY L GRASSER 68,226 16,662 84,888 GERALD WIESNER -0- 2,000 2,000 CITY OF OLATHE KANSAS 486034756 679390GX6 2008-02-27 5311403 SEE SCHEDULE O false false false 350000 0 5311403 0 0 0 22312 0 0 0 5289091 0 2008 true false true true false false false false 0 true false false false 0 false 0 false false X SEE SCHEDULE L PART V BUSINESS TRANSACTIONS WITH INTERESTED PERSONS SCHEDULE L, PART IV TRANSACTION 1 (A) HEIDI HANSON (B) HEIDI HANSON IS THE DAUGHTER OF FRANK H DEVOCELLE, AN OFFICER OF MCMCI (C) $30,671 (D) HEIDI HANSON IS AN EMPLOYEE OF MCMCI (E) NO PROGRAM SERVICE ACCOMPLISHMENTS FORM 990, PART III, LINE 4A Miami County Medical Center, Inc. operates an acute care hospital in Paola, Kansas. Miami County Medical Center, Inc. carries out its mission by providing quality and compassionate inpatient, outpatient, and emergency care services to residents in Miami County, Kansas and surrounding area. Miami County Medical Center, Inc. is a Joint Commission accredited hospital and is licensed for 39 beds and currently staffs 18 inpatient beds. Program services expenses are all related to the provision of healthcare services. In 2011, Miami County Medical Center, Inc. provided 1,213 days of inpatient care, provided 56,563 outpatient procedures, and 9,286 emergency visits to the community. Educational Support In addition to providing uncompensated care for patients in need, the Medical Center provides other health care related benefits to the communities it serves by providing 24-hour emergency rooms open every day to the public regardless of ability to pay. The Medical Center also provides education for a variety of medical professionals, health care screenings and education programs for the general public and support group sponsorships. Sports Net Miami County Medical Center provides Athletic Training staff for area high schools and junior high schools during the school year through its Sports Net program. In 2011, $68,750 of Athletic Trainer services was provided to the schools in the Medical Center's service area. Contributions Miami County Medical Center supports a variety of social, education, and civic healthcare related organizations within its service area. In 2011, $26,426 was contributed to various agencies and charitable organizations and $5,000 in scholarships. BUSINESS RELATIONSHIPS FORM 990, PART VI, SECTION A, LINE 2 FRANK H DEVOCELLE, RODNEY D CORN AND TIERNEY L GRASSER HAVE A BUSINESS RELATIONSHIP WITH EACH OTHER. THEY SERVE AS AN OFFICER OR DIRECTOR FOR OLATHE HEALTH DEVELOPMENT CORPORATION, HEALTH ACCESS, INC. OR OLATHE MEDICAL CENTER DOCTOR'S BUILDING CONDOMINIUM OWNERS ASSOCIATION, WHICH ARE RELATED FOR PROFIT COMPANIES. MEMBER FORM 990, PART VI, SECTION A, LINE 6 OLATHE MEDICAL CENTER, INC., A NOT-FOR-PROFIT, 501(C)(3) ORGANIZATION, IS THE SOLE MEMBER OF MIAMI COUNTY MEDICAL CENTER, INC. MEMBER MAY ELECT GOVERNING BODY FORM 990, PART VI, SECTION A, LINE 7A OLATHE MEDICAL CENTER, INC. BEING THE SOLE MEMBER OF MIAMI COUNTY MEDICAL CENTER, INC. HAS THE RIGHT TO ELECT ALL THE BOARD OF TRUSTEES. GOVERNING BODY DECISIONS SUBJECT TO APPROVAL OF MEMBER FORM 990, PART VI, SECTION A, LINE 7B OLATHE MEDICAL CENTER, INC. IS THE SOLE MEMBER, AND HAS THE RIGHTS TO APPROVE MIAMI COUNTY MEDICAL CENTER, INC.'S BYLAWS AND ARTICLES OF INCORPORATION AND ALSO APPROVE MIAMI COUNTY MEDICAL CENTER'S BOARD MEMBERS AND CERTAIN CAPITAL EXPENDITURES. FORM 990 REVIEW PROCESS FORM 990, PART VI, SECTION B, LINE 11B The tax return form 990 is reviewed by the Audit and compliance Committee of the Olathe Medical Center, Inc. (Miami County Medical Center's sole member) board on behalf of all of its affiliates prior to filing the return with the Internal Revenue Service. The Audit & Compliance Committee is comprised of independent Board members of Olathe Medical Center, Inc. The final form 990 with all required schedules is then provided to all board members for review prior to filing the form 990. CONFLICT OF INTEREST POLICY FORM 990, PART VI, SECTION B, LINE 12C The purpose of the Organization's Conflict of Interest Policy is to protect the organization's interest when it is contemplating a decision or entering into a transaction or arrangement that might benefit the private interest of any person in a position of authority over the organization, or might result in a possible excess benefit transaction. Corporate officers and members of the Board of Trustees review the Conflict of Interest Policy and complete a Disclosure of Information Form annually. A summary of the annual disclosures of information is provided to the full Board for review at least one time per year. The conflict of interest policy calls for any interested person to disclose the existence of a financial relationship or competitive interest in connection with any pending transaction or arrangement. The individual is given the opportunity to disclose all material facts to the Trustees considering the proposed transaction or arrangement that gave rise to the disclosure. When a transaction involves an interested party, the following procedures are followed: 1. The interested party leaves the meeting after providing any material facts or discussion regarding the matter that gives rise to the interest unless requested to stay by the remaining board or committee members. 2. If appropriate, the Board may appoint a non-interested person or committee to investigate alternatives to the proposed transaction; 3. The interested trustee may not vote in the matter that gives rise to the interest. 4. In order to approve the transaction, the Board must first find, by a majority vote of the trustees then in office, without counting the vote of the interested trustee, a. That the proposed transaction is in the Organization's best interests and for its own benefit, and b. That, after reasonable investigation, the board has determined that the organization cannot obtain a more advantageous transaction with reasonable efforts under the circumstances. COMPENSATION REVIEW FORM 990, PART VI, SECTION B, LINES 15A & B The compensation committee of the Olathe Medical Center, Inc. board, which is comprised of independent members of the board of Olathe Medical Center, Inc. and its affiliates, including a Miami County Medical Center, Inc. board member, reviews and approves the CEO and other officers and key employees of the corporation's compensation in accordance with their compensation policy. The compensation committee reviews third party salary surveys and also utilizes written contracts for the ceo to determine the fair market value of the current compensation, salary ranges and benefits. Compensation for such officers is approved by the committee and information of their findings is available to all board members at their request. AVAILABILITY OF DOCUMENTS FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE NOT AVAILABLE TO THE PUBLIC. OTHER CHANGES IN NET ASSETS FORM 990, PART XI, LINE 5 CHANGE IN FAIR VALUE OF INTEREST RATE SWAP 613,175 NET ASSETS RELEASED- CAPITAL 9,765 UNREALIZED LOSS ON INVESTMENTS (840,008) CHANGE IN TEMPORARILY RESTRICTED NA (1,604) --------- TOTAL $(218,672) BOND ISSUE PRICE SCHEDULE K, PART I, LINE A, COLUMN E THE ISSUE PRICE OF THE ENTIRE ISSUE IS $29,451,544. A PORTION OF THE ISSUE PRICE, EQUAL TO $24,140,141 IS ALLOCABLE TO OLATHE MEDICAL CENTER, INC. THE REMAINDER OF THE ISSUE PRICE, EQUAL TO $5,311,403, IS ALLOCABLE TO MIAMI COUNTY MEDICAL CENTER, INC., WHICH IS CONTROLLED BY OLATHE MEDICAL CENTER, INC., ITS SOLE MEMBER. BOND DESCRIPTION OF PURPOSE SCHEDULE K, PART I, LINE A, COLUMN F REFUND SERIES 2004A BONDS ISSUED 07/29/2004 AND REFUND SERIES 2004B BONDS ISSUED 07/29/2004. HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:JACK TINNEL TITLE:TRUSTEE/CHAIRPERSON HOURS:1 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:THOMAS J DAVIES TITLE:TRUSTEE RESIGNED 5/18/11 HOURS:4 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:CHIP WOOD TITLE:TRUSTEE HOURS:3 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:FRANK H DEVOCELLE TITLE:PRESIDENT/CEO HOURS:43 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:RODNEY D CORN TITLE:SR VP/OPS/RESIGNED 3/4/11 HOURS:43 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:TIERNEY L GRASSER TITLE:SENIOR VP/FINANCE HOURS:41 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:CHERYL L ROSS TITLE:ASSISTANT SECRETARY HOURS:43 OLATHE MEDICAL CENTER INC 20333 W 151ST ST OLATHE KS 66061 480577664 HOSPITAL KS 501(C)(3) 3 OHSI false OLATHE HEALTH SYSTEM INC 20333 W 151ST ST OLATHE KS 66061 480979845 SUPPORT ORG KS 501(C)(3) 11B NA false OLATHE MEDICAL SERVICES INC 20333 W 151ST ST OLATHE KS 66061 481088982 CLINICS KS 501(C)(3) 9 OMCI false OLATHE MEDICAL CENTER CHARITABLE FDN 20333 W 151ST ST OLATHE KS 66061 481136010 SUPPORT OMCI KS 501(C)(3) 7 OMCI false HEALTH ACCESS INC 20333 W 151ST ST OLATHE KS 66061 742855334 HEALTH INSURANCE KS OMCI C CORPORATION OMC DOCTOR'S BLDG CONDO OWNERS ASSOC INC 20333 W 151ST ST OLATHE KS 66061 481244766 REAL ESTATE KS OMCI C CORPORATION OLATHE HEALTH DEVELOPMENT CORPORATION 20333 W 151ST ST OLATHE KS 66061 363445097 MEDICAL SERVICES KS OHSI C CORPORATION false false true false false false false true true true false true true true true true true true