2011-02-14T14:57:05-07:00 2010-06-30 990 2009-07-01 480559088 HAYS MEDICAL CENTER INC HAYS 7856235000 2220 Canterbury Drive Hays KS 67601 John Jeter 7856235523 2011-02-09 2009 2016-02-24 21:20:13Z John Jeter CEO 2220 Canterbury Dr Hays KS 67601 185319574 0 X www.haysmed.com X 1944 KS Hays Medical Center 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 Corporation is to provide health care facilities 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 help people be healthy. The Corporation is striving to become the best tertiary care center in rural America. 14 9 1543 210 4932 0 485029 697482 169481806 181500860 323936 2251997 -1016344 517536 169274427 184967875 0 0 0 0 80061748 87778078 0 0 0 83372507 87812824 163434255 175590902 5840172 9376973 177254743 192482750 70975372 71594488 106279371 120888262 Hays Medical Center 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 Corporation is to provide health care facilities 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 help people be healthy. The Corporation is striving to become the best tertiary care center in rural America. 0 0 150115229 181500860 Patient Care: Program services consist of routine and ancillary department healthcare services provided by a healthcare organization as defined in Section 501(c)(3) of the IRS code. Admissions: Acute-5,761; Newborn ICU-32; Newborn-715; Rehabilitation-169; Total admissions-6,677. Patient days: ICU/CPCU-7,567; Medical/Surgical-12,849; Oncology-1,593; Obstetrics-1,854; Pediatrics-599; Rehabilitation-1,707; Newborn ICU-311; Newborn-1,406; Total patient days-27,886. Other statistical information: Surgical procedures-7,600; Cardiac caths-871; Emergency room visits-13,029; Outpatient procedures-125,173; Medical oncology service visits-8,883; Clinic visits-123,758. 0 0 0 150115229 1 1 0 0 0 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 0 0 1 1 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 1 0 0 0 1 125 0 1 1543 1 1 0 0 0 0 0 0 0 0 0 14 9 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X William Overbey CFO 7856235000 2220 Canterbury Hays KS 67601 Nancy Curtis 0 X 0 0 0 Dennis L Bieker 0 X 0 0 0 Kenneth L Beran 0 X 0 0 0 January Fields-Meehan 40 X 528479 0 34060 John Lloyd 40 X 391304 0 28904 Ross Buckles DO 40 X 344406 0 25904 Tom McDonald MD 0 X 0 0 0 Daniel F Schippers 0 X 0 0 0 Jim Black DO 0 X 0 0 0 Jayne Clark 0 X 0 0 0 Gene Argo 0 X 0 0 0 Gary Shorman 0 X 0 0 0 Darrell D Werth MD 40 X 642463 0 28072 Sharon Dreher 0 X 0 0 0 John H Jeter MD 40 X 494362 0 118254 William Overbey 40 X 250691 0 67568 Dale Montgomery 40 X 168646 0 48606 Jodi Schmidt 40 X 180876 0 44531 Bryce Young 40 X 252344 0 66660 Kenneth Lindsey 40 X 322407 0 68645 Christine Fisher 40 X 1050528 0 26372 Jeffery Curtis 40 X 1048720 0 29372 Gary Benton 40 X 1094775 0 23529 Abdul Ahad Haleem 40 X 868709 0 21472 Alex De Carvalho 40 X 866981 0 23529 Richard Rajewski 40 X 186467 0 25040 Joel Fort 40 X 581384 0 26091 9273542 0 706609 90 1 1 0 Quest Diagnostics Inc PO Box 719 Hays KS 67601 Lab Services 3964661 Inpatient Management Inc 1 McBride and Son Center Dr Chesterfield MO 63005 Hospitalists program 1247800 Manmohan Biring MD 1582 Charlton Road San Marino CA 91108 Pulmonology services 762109 Anesthesiologist Assoc of Hays PO Box 821 Hays KS 67601 Anesthesiology Svcs 585890 Comp Health PO Box 972651 Dallas TX 75397 Physician coverage 544152 23 0 0 0 671601 25881 0 0 697482 Net patient service revenue 622000 171858875 171858875 0 0 Shared services 900099 7943226 0 0 7943226 Other operating revenue 900099 1693827 0 0 1693827 Nursing mother's resource center 452000 4932 0 4932 0 0 0 0 0 181500860 2246392 0 0 2246392 0 0 0 0 0 0 0 0 0 0 0 357304 0 351699 0 5605 5605 0 0 5605 0 Equity in gain of Hadley Foundation 900099 517594 0 0 517594 Benefit plan market adjustment 900099 -58 0 0 -58 0 0 0 0 517536 184967875 171858875 4932 12406586 4421048 0 4421048 0 0 67599130 60461374 7137756 0 3105149 2606791 498358 0 8287326 6617607 1669719 0 4365425 3664801 700624 0 92068 0 92068 0 594191 0 594191 0 77165 0 77165 0 0 0 0 0 80140 0 80140 0 16158435 14415324 1743111 0 1137707 682624 455083 0 1883985 1472924 411061 0 239396 166819 72577 0 650016 384059 265957 0 2441992 2441992 0 0 10450111 7577202 2872909 0 1250197 1001941 248256 0 Supplies 32407367 31886487 520880 0 Bad debts 11522687 11522687 0 0 Repairs & maintenance 3310522 2896376 414146 0 Rent 2039033 1634702 404331 0 Taxes & assessments 992347 0 992347 0 2485465 681519 1803946 175590902 150115229 25475673 0 5735 5885 9543410 9397817 0 0 27284566 27864083 3648507 3910829 2895849 3392473 169439884 105757101 65919616 63682783 67957060 84228880 177254743 192482750 17725372 19744488 0 0 53250000 51850000 0 0 70975372 71594488 X 101027650 115118946 5251721 5769316 0 0 106279371 120888262 177254743 192482750 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 8603284 332063 234201 0 57246 0 9112302 8152895 249859 226379 0 25849 0 8603284 0.65 0.35 0 0 1 1 0 350356 350356 0 55883852 26850438 29033414 0 0 0 0 0 104352357 75381286 28971071 0 8853319 3525377 5327942 63682783 Assets whose use is limited by Board for capital improvements 67974150 Interest in net assets of Hadley Foundation 5769316 Funds held by Trustee 3223274 Other long-term assets 3805340 Other receivables 2430134 Debt Issue Costs 951317 Unamortized bond premium & discount 75349 84228880 184967875 175590902 9376973 0 0 0 0 2 2 9376975 181594960 0 0 0 0 0 181594960 0 3372915 3372915 184967875 175584896 0 0 0 0 0 175584896 0 6006 6006 175590902 SchD_P05_S00_L04 Schedule D, Part V, Line 4 The endowed funds held by the Hays Medical Center Foundation are used to help meet both the immediate and long range health care needs of patients of Hays Medical Center. The Hays Medical Center Foundation provides grants and assistance to Hays Medical Center for property and equipment acquisitions, education, and community health issues. SchD_P11_S00_L08 Schedule D, Part XI, Line 8 Rounding SchD_P12_S00_L04b Schedule D, Part XII, Line 4b Gifts and bequests-680,601; investment income-2,243,251; Gain on disposal of assets-5,605; Interest in change in net assets of Hadley Foundation-517,595; Audit reclassifications-(74,137) SchD_P13_S00_L04b Schedule D, Part XIII, Line 4b Investment management fees-80,140; Audit reclassifications (74,134) 1 1 1 X 1.25 1 X 1 1 1 0 1 1 2715006 0 2715006 0.0165 4511370 0 4511370 0.0275 0 0 7226376 0 7226376 0.0440 229630 0 229630 0.0014 590403 0 590403 0.0036 9282383 0 9282383 0.0566 32474 32474 0.0002 0 0 10134890 0 10134890 0.0618 0 0 17361266 0 17361266 0.1058 116133 116133 0.0007 0 0 116133 0 116133 0.0007 0 4474842 330158 57428476 53703728 3724748 X 1 1 Hays Medical Center

2220 Canterbury Hays KS 67601

X X X Pawnee Valley Community Hospital Inc

923 Carroll Ave Larned KS 67550

X X X X Hays Medical Center's cost accounting system was used to calculate subsidized health services, health professions education, and community health improvement services. A cost-to-charge ratio was computed and used to calculate charity care and unreimbursed Medicaid reported on line 7. Physician clinic net costs included in subsidized health services totaled $7,235,705. Bad debt expense of $11,522,687 is included in Part IX line 25. This amount was subtracted from total expenses when computing the denominator for the percentage calculated for line 7(f). Bad debt expense was calculated using the same cost-to-charge ratio computed for charity care and unreimbursed Medicaid. The estimate for the amount of bad debt expense attributable to patients that would qualify for charity care is based upon a report obtained from the collection agency showing indigent patients that have been referred to collection. The following is the information contained in the footnotes regarding patients accounts receivable in the audited consolidated financial statements of Hays Medical Center. Patient service revenue is recorded at HMC's established rates with contractual adjustments from third-party payors, charity allowances and other discounts deducted to arrive at net patient service revenue. Patient accounts receivable represent an estimate of net realizable amounts due from patients, third-party payors, and others for unpaid patient services, which is determined on historical payment experience. Retroactively calculated contractual adjustments arising under reimbursement agreements with Medicare and other third-party payors are accrued on an estimated basis in the periods the related services are rendered and adjusted in future periods as final settlements are determined. Medicare is HMC's most significant third-party payor. The Medicare cost finding was the costing methodology used to determine the above costs. Allowable costs of care reported on line 6 were determined using amounts from Worksheets D and D-1 in the Hays Medical Center Medicare cost report for the fiscal year ended June 30, 2010. Whenever possible, the customer service representatives (CSR's) of Hays Medical Center 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 within 30 days, the CSR contacts the patient. If it is determined that at least a 2 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. Hays Medical Center is in the process of performing an assessment of the health care needs of the communities it serves; however, this is assessment is not yet completed. Information regarding the Hays Medical Center charity care program is located on the Hays Medical Center website for patients and community members to view, and the financial assistance application is also on the website to print off and complete. In addition, if a customer service representative of Hays Medical Center 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, they will send the application to the patient as well. Hays Medical Center is located in Hays, Kansas, which has a population of approximately 20,000 people, as of the last census. One of the State of Kansas' Regents universities is also located in Hays, so the population includes many college-aged students. The median household income of Hays was $31,501. The number of families below poverty level were 315 or 6.7%; however, the number of individuals below the poverty line were 2,817 or 14.9% of the population. Approximately 6% of the hospital's revenue is from services provided to patients eligible for Medicaid. Hays Medical Center is the only hospital in the city of Hays. In addition, since this is a rural area and because it is the only hospital providing tertiary level care in the region, Hays Medical Center provides certain services to the whole western half of the State of Kansas. Hays Medical Center helps to support the First Care Clinic in Hays, KS. This clinic was established to help lower income individuals receive health care at a reduced cost. This support helps to increase the number of individuals in Hays, KS who receive quality health care. Hays Medical Center promotes the health of the community by extending medical privileges to most qualified, local physicians. In addition, the majority of the Board of Directors live and work in the city of Hays, but they are not employed by Hays Medical Center. Hays Medical Center is not a part of an affiliated health care system. X X 1 1 X X X X 0 1 0 0 0 1 0 0 0 John H Jeter MD 367852 0 109150 0 17360 0 105898 0 12356 0 612616 0 0 0 Kenneth Lindsey 264800 0 43851 0 13756 0 56820 0 11825 0 391052 0 0 0 Bryce Young 200454 0 46847 0 5043 0 52065 0 14595 0 319004 0 0 0 William Overbey 200554 0 46871 0 3266 0 52081 0 15487 0 318259 0 0 0 Jodi Schmidt 142202 0 24337 0 14337 0 32932 0 11599 0 225407 0 0 0 Dale Montgomery 132402 0 24336 0 11908 0 33875 0 14731 0 217252 0 0 0 January Fields-Meehan 442000 0 68595 0 17884 0 13475 0 20585 0 562539 0 0 0 John Lloyd 322000 0 63627 0 5677 0 13475 0 15429 0 420208 0 0 0 Ross Buckles DO 183846 0 144870 0 15690 0 13475 0 12429 0 370310 0 0 0 Joel Fort 350000 0 228494 0 2890 0 13475 0 12616 0 607475 0 0 0 Richard Rajewski 167769 0 13630 0 5068 0 10373 0 14667 0 211507 0 0 0 Darrell D Werth MD 529070 0 96513 0 16880 0 13475 0 14597 0 670535 0 0 0 Gary Benton 540000 0 553660 0 1115 0 13475 0 10054 0 1118304 0 0 0 Christine Fisher 600000 0 449688 0 840 0 13475 0 12897 0 1076900 0 0 0 Jeffery Curtis 600000 0 448720 0 0 0 13475 0 15897 0 1078092 0 0 0 Abdul Ahad Haleem 500000 0 341009 0 27700 0 8575 0 12897 0 890181 0 0 0 Alex De Carvalho 500000 0 364981 0 2000 0 13475 0 10054 0 890510 0 0 0 SchJ_P01_S00_L01a Schedule J, Part I, Line 1a Benefits identified include tax indemnification on health claims and health club dues. Both benefits are available to CEO and included in taxable income. SchJ_P01_S00_L03 Schedule J, Part I, Line 3 The CEO, officers, and key employees' salaries are reviewed annually by an independent consulting group and the Compensation Committee, which is made up of members of the Board. SchJ_P01_S00_L04 Schedule J, Part I, Line 4 Officers and key employees are eligible to participate in a non-qualified retirement plan. Contributions from employer are contributed to the plan on an annual basis. Contributions to the plan for listed persons are included on Schedule J as a component of deferred compensation. Contribution amounts for listed persons for FYE 6-30-10 were: Officers-$114,529 ; key employees-$136,719 . SchJ_P01_S00_L06 Schedule J, Part I, Line 6 A portion of incentive compensation for officers and key employees is determined by net earnings exceeding budget for the fiscal year. Kansas Development Finance Authority 481066589 48543BGR3 2003-11-12 16000878 Construction 0 0 Kansas Development Finance Authority 481066589 48543BJE9 2005-11-22 17950000 Construction and equipment 0 0 Kansas Development Finance Authority 481066589 48543BJD1 2005-11-22 23635944 Construction 0 0 16665728 1200024 0 0 726489 0 15939215 2005 0 0 1 1 17950000 0 0 0 826616 0 17124934 2006 0 1 1 1 23635944 2023250 0 0 316000 0 23319944 2006 0 1 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 Blue Cross Blue Shield of Kansas Gary Shorman is a director on BCBS board 53800000 Insurance reimbursements on patient accounts 0 Eagle Communications Gary Shorman is CEO and employee/owner 115539 Payments for cable/internet services 1 Jeter Law Firm LLP Family member of John Jeter CEO 5562 Payment for legal services 0 F990_P04_S00_L20 Form 990, Part IV, Line 20 Beginning March 1, 2010, HaysMed Partners, Inc, a related organization to Hays Medical Center, signed an agreement with Pawnee County, KS commissioners to operate Pawnee Valley Community Hospital in Larned, KS. Hays Medical Center provides several services, such as accounting, information technology, etc, that it directly bills Pawnee Valley Community Hospital for; however, the ownership of the assets and the liability for any losses of Pawnee Valley Community Hospital remains with Pawnee County, KS. Due to this arrangement, Pawnee Valley Community Hospital is reported as a related organization, but its financial and other information is reported on its own, separate Form 990. F990_P05_S00_L03b Form 990, Part V, Line 3b Hays Medical Center received an extension to file the 2009 Form 990-T. The return will be filed by the extended due date of May 15, 2011. F990_P06_S0B_L11 Form 990, Part VI, Section B, Line 11 Form 990 was reviewed with the officers and the Board Finance committee. F990_P06_S0B_L12c Form 990, Part VI, Section B, Line 12c Officers, directors, and 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. F990_P06_S0B_L15 Form 990, Part VI, Section B, Line 15 The CEO, officers and key employees' salaries are reviewed annually by an independent consulting group and the Compensation Committee, which is made up of members of the Board. F990_P06_S0C_L19 Form 990, Part VI, Section C, Line 19 These documents are not made available to the public. Financial statements are released to bond holders on a quarterly basis. SchB_P01_S00_L00 Schedule B, Part I Hays Medical Center is a pass-thru for several grants that are distributed to outreaching hospitals. Total grant monies received by Hays Medical Center during the fiscal year ended 6/30/10 for this purpose were $141,744. SchL_P04_S00_L00 Schedule L, Part IV The insurance reimbursements received by Hays Medical Center Inc from Blue Cross Blue Shield of Kansas only represents approximately 2% of Blue Cross Blue Shield's annual disbursements. Hays Medical Center Foundation 2220 Canterbury Hays KS 67601 481179684 Provide grants and allocations to Hays Medical Center Inc. for property, equip and community health KS 501(c)(3) 509(a)(3) Type 1 N/A HaysMed Partners Inc 2220 Canterbury Hays KS 67601 270877152 Owns management contract for Pawnee Valley Community Hospital KS 501(c)(3) 170(b)(1)(A)(iii) N/A Pawnee Valley Community Hospital Inc 2220 Canterbury Hays KS 67601 481253246 Hospital operated by Hays Medical Center KS 501(c)(3) 170(b)(1)(A)(iii) N/A 0 0 1 1 0 0 0 0 0 0 1 0 1 1 0 1 0 0 Hays Medical Center Foundation c 671601 Pawnee Valley Community Hospital Inc k 109361 Pawnee Valley Community Hospital Inc n 60556 Pawnee Valley Community Hospital Inc d 1543054 Hays Medical Center Foundation p 157957