2011-11-15T14:58:15-05:00 2010-12-31 BKD LLP 1201 Walnut Suite 1700 Kansas City MO 641062246 990 2010-01-01 481155548 MIAMI COUNTY MEDICAL CENTER INC MIAM 9137914461 2100 BAPTISTE DRIVE PAOLA KS 66071 TIERNEY L GRASSER 2011-11-15 true Michael J Engle 8162216300 2010 2016-03-07 17:11:31Z TIERNEY L GRASSER 20333 W 151ST STREET OLATHE KS 66061 26376904 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 5 176 44 0 0 5405 1332 24209514 22307375 264547 867610 99281 118059 24578747 23294376 102659 87994 0 0 9464815 9461454 0 0 0 11918871 10941209 21486345 20490657 3092402 2803719 38400159 42910451 8516371 8097661 29883788 34812790 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 15319095 87994 22307375 See schedule O 15319095 true false false true false false false false true true false false false true true false true false false false false false false false false true false true true true true false false false false false false false false true false false false false false false true false false false false true 25 0 true 176 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 0 0 0 THOMAS J DAVIES 1.0 X X 0 0 0 CHIP WOOD 1.0 X 0 0 0 STEVE MILLER 1.0 X 0 0 0 FRANK H DEVOCELLE 7.0 X 0 795378 449886 RODNEY D CORN 7.0 X 0 344571 92888 TIERNEY L GRASSER 9.0 X 0 427897 170498 GERALD WIESNER 40.0 X 160982 0 27754 PAUL W LUCE 40.0 X 119369 0 24209 STEVEN B MOON 40.0 X 113556 0 16141 393907 1567846 781376 3 false true false EMERGENCY MEDICAL CARE PA EMERGENCY SERVICES 1600000 SHARED MEDICAL SYSTEMS INC MRI SERVICES 288628 P1 GROUP INC HVAC MAINTENANCE 110945 KRAMER FRANK COLLECTION SERVICES 106337 4 1332 1332 Net Patient Service Revenue 900099 22307375 22307375 22307375 846538 846538 0 0 119418 143069 -23651 -23651 -23651 2960531 2749758 189701 210773 -189701 21072 21072 0 0 0 PURCHASE DISCOUNTS 900099 33860 33860 Cafeteria 722210 34439 34439 All Other Misc Revenue 900099 73411 73411 73411 73411 141710 23294376 22307375 0 985669 77744 77744 10250 10250 0 0 188736 146886 41850 29607 29607 7641128 5946810 1694318 118021 91852 26169 958505 745971 212534 525457 408944 116513 0 105148 105148 29859 29859 3840 3840 0 10092 10092 3090251 1085672 2004579 96340 96340 3170177 2739790 430387 0 0 378561 340927 37634 15287 15287 0 0 237739 213184 24555 0 1453795 1303638 150157 226288 202916 23372 Bad Debt Expense 1781486 1781486 Repairs & Maintenance 193330 80627 112703 Recruitment 950 950 Medicaid Assessment 83921 83921 Dues & Subscriptions 45420 17608 27812 18725 11262 7463 20490657 15319095 5171562 0 434966 363253 4846826 4247760 509362 801393 203553 168976 21231455 15214354 6998156 6017101 25212628 31122444 194668 189524 38400159 42910451 1905292 1834574 5483004 5216150 1128075 1046937 8516371 8097661 X 29858947 34785070 24841 27720 29883788 34812790 38400159 42910451 X 2803719 2125283 X false true true X false X false false false false false true 3840 false false false 3840 false 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 10013031 7953018 2060013 9132371 6915085 2217286 610614 346251 264363 6017101 0 DUE TO AFFILIATES 433762 INTEREST RATE SWAP 613175 1046937 23294376 20490657 2803719 2257312 -132029 2125283 4929002 305419703 2257312 279878107 282135419 23284284 10092 10092 23294376 264336960 243856395 243856395 20480565 10092 10092 20490657 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 17,108 NET ASSETS RELEASED - CAPITAL 7,128 UNREALIZED LOSS ON INTEREST RATE SWAP (159,144) CHANGE IN TEMPORARILY RESTRICTED NA 2,879 ---------- TOTAL $(132,029) OTHER - REVENUE INCLUDED ON LINE 1 BUT NOT ON FORM 990, PART VIII, LINE 12 SCHEDULE D, PART XII, LINE 2D RELATED ORGANIZATIONS' REVENUE 279,894,182 UNREALIZED LOSS ON INTEREST RATE SWAP (159,144) RENTAL EXPENSES 143,069 ---------- TOTAL $279,878,107 OTHER - EXPENSE INCLUDED ON LINE 1 BUT NOT ON FORM 990, PART IX, LINE 25 SCHEDULE D, PART XIII, LINE 2D RELATED ORGANIZATIONS' EXPENSES 243,713,326 RENTAL EXPENSES 143 069 ------------ TOTAL $243,856,395 true true X true X 250. true X 0 true true true false true true 1206 962317 0 962317 0.04700 1619 1856529 760114 1096415 0.05350 2825 2818846 760114 2058732 0.10050 472 3473 222 3251 0.00020 18 23457 0 23457 0.00110 187 49678 49678 0.00240 677 76608 222 76386 0.00370 3502 2895454 760336 2135118 0.10420 false 517509 0 5404026 6502012 -1097986 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 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 3B 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, INLUDING 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 A BILLING CYCLE THAT REPEATEDLY ADVISES RECIPIENTS THEY MAY APPLY FOR FINANCIAL ASSISTANCE AND PROVIDES INFORMATION ON HOW TO APPLY FOR FINANCIAL ASSISTANCE, IN ADDITION TO UTILIZING PROPENSITY TO PAY SOFTWARE TO HELP IDENTIFY PATIENTS THAT MAY BE IN NEED OF ASSISTANCE, BUT HAVE NOT COMPLETED AND PROVIDED AN APPLICATION.ACCOUNTS ARE CONSIDERED DELINQUENT AND SUBSEQUENTLY WRITTEN OFF AS BAD DEBTS BASED ON A BILLING CYCLE THT REPEATEDLY ADVISES RECIPIENTS THEY MAY APPLY FOR FINANCIAL ASSISTANCE AND PROVIDES INFORMATION ON HOW TO APPLY FOR FINANCIAL ASSISTANCE. IN ADDITION, MCMCI UTILIZES PROPENSITY TO PAY SOFTWARE TO HELP IDENTIFY PATIENTS THAT MAY BE IN NEED OF ASSISTANCE, BUT HAVE NOT COMPLETED OR PROVIDED A CHARITY CARE APPLICATION. BASED UPON THE SOFTWARE'S CRITERIA, INDIVIDUALS MAY QUALIFY FOR FINANCIAL ASSISTANCE WITHOUT COMPLETION OF THE ACTUAL APPLICATION. INDIVIDUAL PATIENT BALANCES WHO DO QUALIFY FOR FINANCIAL ASSISTANCE ARE NOT CONSIDERED BAD DEBT EXPENSE SUBJECT TO COLLECTIONS, BUT ARE CONSIDERED CHARITY CARE EXPENSE. AN OVERALL COST TO CHARGE RATIO IS USED TO CALCULATE THE BAD DEBT EXPENSE AT COST. 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 VICTIMS' COMPENSATION AND THEN HELPS THEM THROUGH THE APPLICATION PROCESS. THE USE OF PROPENSITY 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. NEEDS ASSESMENT SCHEDULE H, PART VI, LINE 2 MIAMI COUNTY MEDICAL CENTER, INC. (MCMCI) WORKS VERY CLOSELY WITH THE MIAMI COUNTY HEALTH DEPARTMENT IN ASSESSING THE HEALTH CARE NEEDS OF THE COMMUNITY. IN A MORE GRASSROOTS EFFORT, MCMCI ALSO USES QUESTIONNAIRES AT VARIOUS COMMUNITY-BASED HEALTH FAIRS AND PUBLIC EVENTS TO BETTER UNDERSTAND THE HEALTHCARE NEEDS. 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 SERVICE OR EXPRESS THEY ARE EXPERIENCING A FINANCIAL HARDSHIP ARE ADVISED OF OUR ASSISTANCE POLICY AND ENCOURAGED TO APPLY. COMMUNITY INFORMATION SCHEDULE H, PART VI, LINE 3 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 IN KANSAS. THERE ARE NO OTHER HOSPITALS LOCATED IN THESE TWO COUNTIES, HOWEVER THERE ARE SEVERAL OTHER HOSPITALS LOCATED IN NEARBY METROPOLITAN AREAS INCLUDING OLATHE, KANSAS AND KANSAS CITY, MISSOURI. BELOW IS A TABLE DEMONSTRATING THE DEMOGRAPHICS OF BOTH MIAMI AND LINN COUNTIES AS OUTLINED BY THE U.S. CENSUS BUREAU: MIAMI COUNTY (APPROXIMATIONS) Total Population 32,787 Median Household Income $57,705 Median Household Income as a percentage of National Median Household Income 105% Percent of People below the Poverty Level 9.1% Percent of People 65+ 13.1% Estimated Miami County Population oN Medicare (based on age 65+) 4,295 Estimated Miami County Population on Medicaid (based on Poverty Level) 2,984 LINN COUNTY (APPROXIMATIONS) Total Population 9,656 Median Household Income $41,597 Median Household Income as a percentage of National Median Household Income 76% Percent of People below the Poverty Level 12.8% Percent of People 65+ 19.3% Estimated Linn County Population on Medicare (based on age 65+) 1,864 Estimated Linn County Population on Medicaid (based on Poverty Level) 1,224 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 TRI-KO ARE ALL ORGANIZATIONS LOCATED IN THE MCMCI SERVICE AREA TO PROVIDE ASSISTANCE TO PERSONS WITH DEVELOPMENTAL DISABILITIES. MCMCI SUPPORTS EACH OF THESE ORGANIZATIONS BY PROVIDING MEDICAL CARE TO THEIR RESIDENTS. PROMOTION OF COMMUNITY HEALTH SCHEDULE H, PART VI, LINE 5 IN ADDITION TO THE ACTIVITIES LISTED ABOVE, MIAMI COUNTY MEDICAL CENTER, INC. (MCMCI) IS A SIGNIFICANT SUPPORTER OF LOCAL, REGIONAL AND NATIONAL ORGANIZATIONS FOR HEART DISEASE, DIABETES, ARTHRITIS, CANCER, AND VARIOUS OTHER DISEASES. MCMCI ALSO PROVIDES ATHLETIC TRAINING SERVICES VALUED AT $46,296 FOR AREA HIGH SCHOOL ATHLETICS. AFFILIATED HEALTH CARE SYSTEM SCHEDULE H, PART VI, LINE 6 MIAMI COUNTY MEDICAL CENTER IS A PART OF OLATHE HEALTH SYSTEM, INC. (OHSI) WHICH CONSISTS OF TWO HOSPITALS AND A NETWORK OF 34 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 ALL STATES WHICH ORGANIZATION FILES A COMMUNITY BENEFIT REPORT: 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 15432 BOOK SPORTS MEDICINE CMTY WELLNESS SPRING HILL SCHOOLS 101 E SOUTH ST SPRING HILL KS 66083 480725304 GOVERNMENT 15432 BOOK SPORTS MEDICINE CMTY WELLNESS OSAWATOMIE SCHOOL DISTRICT 1200 TROJAN DRIVE OSAWATOMIE KS 66064 GOVERNMENT 15432 BOOK SPORTS MEDICINE CMTY WELLNESS YMCA 300 11th st Osawatomie KS 66064 310537179 501(C)(3) 6000 CMTY WELLNESS 5 0 SCHOLARSHIPS 12 10250 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 X X X X X false true false false false false false false false FRANK H DEVOCELLE 0 561099 0 185698 0 48581 0 415497 0 34389 0 1245264 0 185698 RODNEY D CORN 0 247881 0 55392 0 41298 0 72995 0 19893 0 437459 0 74088 TIERNEY L GRASSER 0 322307 0 67168 0 38422 0 142616 0 27882 0 598395 0 79848 GERALD WIESNER 151905 0 0 0 9077 0 11302 0 16452 0 188736 0 0 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 39 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 22 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 $ 24,803 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 IN 2010, THE BONUS AND INCENTIVE COMPENSATION WAS ACCRUED, BUT NOT PAID UNTIL 2011. THEREFORE, COLUMN (C) REFLECTS, THE ACCRUED INCENTIVE AMOUNTS FOR 2010, SERP PAYMENTS (SEE ABOVE FOR FURTHER EXPLANATION) AND OTHER DEFERRED COMPENSATION. ACCRUED TOTAL INCENTIVE SERP OTHER COLUMN C FRANK H DEVOCELLE $135,830 $267,908 $11,759 $415,497 RODNEY D CORN 35,864 24,803 12,328 72,995 TIERNEY L GRASSER 57,728 68,226 16,662 142,616 GERALD WIESNER 9,702 -0- 1,600 11,302 CITY OF OLATHE KANSAS 486034756 679390GX6 2008-02-27 5311403 SEE SCHEDULE K, PART V false false false 75000 0 5311403 0 0 0 22312 0 0 0 5289091 0 2008 true false true true false false false false false 0.00000 0.00000 0.00000 true false false false false false false false false BOND ISSUES SCH K, PART I, LINE A A-(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. A-(f)- REFUND SERIES 2004A BONDS ISSUED 7/29/2004 AND REFUND SERIES 2004B BONDS ISSUED 7/29/2004. PROCEEDS SCH K, PART II, COLUMN A LINES 11 & 14- OTHER THAN ISSUANCE COSTS, THE ENTIRE PROCEEDS WERE USED TO CURRENTLY REFUND SERIES 2004A BONDS ISSUED 7/29/2004 AND REFUND SERIES 2004B BONDS ISSUED 7/29/2004 SEE SCHEDULE L PART V BUSINESS TRANSACTIONS WITH INTERESTED PERSONS SCHEDULE L, PART IV TRANSACTION 5 (A) HEIDI HANSON (B) HEIDI HANSON IS THE DAUGHTER OF FRANK H DEVOCELLE, AN OFFICER OF MCMCI (C) $29,607 (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 2010, Miami County Medical Center, Inc. provided 1,572 days of inpatient care, provided 59,464 outpatient procedures, and 9,786 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 2010, $42,296 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 2010, $33,172 was contributed to various agencies and charitable organizations and $10,250 in scholarships. ATTACHMENT OF AUDITED FINANCIAL STATEMENTS FORM 990, PART IV, LINE 20B PER THE IRS' FORM 990 INSTRUCTIONS, AN ORGANIZATION OPERATING ONE OR MORE HOSPITALS AT ANY TIME DURING THE YEAR MUST ATTACH A COPY OF ITS AUDITED FINANCIAL STATEMENTS TO THE TAX RETURN IF ITS TAX YEAR BEGAN AFTER MARCH 23, 2010. MIAMI COUNTY MEDICAL CENTER'S AUDITED FINANCIAL STATEMENTS ARE NOT ATTACHED BECAUSE ITS TAX YEAR BEGAN ON JANUARY 1, 2010. 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 follow 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 UNREALIZED GAIN ON INVESTMENTS 2,257,312 CHANGE IN FAIR VALUE OF INTEREST RATE SWAP 17,108 NET ASSETS RELEASED- CAPITAL 7,128 UNREALIZED LOSS ON INTEREST RATE SWAP (159,144) CHANGE IN TEMPORARILY RESTRICTED NA 2,879 ----------- TOTAL $2,125,283 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/SECRETARY/TREASURER 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:SENIOR VP/OPERATIONS HOURS:43 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:TIERNEY L GRASSER TITLE:SENIOR VP/FINANCE HOURS:41 OLATHE MEDICAL CENTER INC 20333 W 151ST ST OLATHE KS 66061 480577664 HOSPITAL KS 501(C)(3) 3 OHSI OLATHE HEALTH SYSTEM INC 20333 W 151ST ST OLATHE KS 66061 480979845 SUPPORT ORG KS 501(C)(3) 11B NA OLATHE MEDICAL SERVICES INC 20333 W 151ST ST OLATHE KS 66061 481088982 CLINICS KS 501(C)(3) 9 OMCI OLATHE MEDICAL CENTER CHARITABLE FDN 20333 W 151ST ST OLATHE KS 66061 481136010 SUPPORT OMCI KS 501(C)(3) 7 OMCI HEALTH ACCESS INC 20333 W 151ST ST OLATHE KS 66061 742855334 HEALTH INSURANCE KS NA C CORPORATION 0 0 0.00000 OMC DOCTOR'S BLDG CONDO OWNERS ASSOC INC 20333 W 151ST ST OLATHE KS 66061 481244766 REAL ESTATE KS NA C CORPORATION 0 0 0.00000 OLATHE HEALTH DEVELOPMENT CORPORATION 20333 W 151ST ST OLATHE KS 66061 363445097 MEDICAL SERVICES KS NA C CORPORATION 0 0 0.00000 false false true false false false false true true true false true true true true true true true