2024-05-10T14:31:36-05:00 2023-06-30 481026809 Wendling Noe Nelson & Johnson LLC 623 SW 10th Ave Suite 300 Topeka KS 66612 990 2022-07-01 481253246 Pawnee Valley Community Hospital Inc PAWN 6202853161 923 Carroll Ave Larned KS 67550 Shae Veach President 6202853161 2024-05-10 1 Shae Veach 999009999 0 Eric L Otting P00298454 7852334226 2024-05-10 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z Shae Veach 923 Carroll Ave Larned KS 67550 21487951 0 X www.pawneevalleyhospital.com X 2001 KS Pawnee Valley Community Hospital, Inc. 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 Organization is to improve the quality of life for the communities we serve through exceptional healthcare and service excellence. The Organization is striving to be the best Critical Access Hospital in rural America. 6 2 162 114 0 0 490693 572117 18175478 20743423 6116 34183 124149 138228 18796436 21487951 1557 6574 0 0 8649758 9393688 0 0 71020 8150669 10436744 16801984 19837006 1994452 1650945 12615152 13655211 10205836 10957054 2409316 2698157 X Pawnee Valley Community Hospital, Inc. 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 Organization is to provide healthcare 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 improve the quality of life for the communities we serve through exceptional healthcare and service excellence. 0 0 17778966 6574 20744423 Patient care: Program services consist of routine and ancillary department healthcare services provided by a healthcare organization as described in 501(c)(3) of the IRS code. 17778966 1 1 0 1 0 0 0 0 0 1 0 0 0 1 1 1 1 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 0 0 1 162 1 0 0 0 0 0 0 0 0 0 0 0 0 X 6 2 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X Michelle Beckner 7856232350 2220 Canterbury Drive Hays KS 67601 Shae Veach President 4.00 36.00 X X 0 253558 83537 George Harms Treasurer thru. Sept. 2022 4.00 36.00 X X 0 248555 71587 John Haas Vice President 0.50 X X 0 0 0 Sarah Johnson Director 0.50 X 0 0 0 Edward Herrman Secretary 4.00 36.00 X X 0 586768 141118 Terry Siek Director 4.00 36.00 X 0 234484 58979 Michelle Beckner Treasurer begin. Nov. 2022 4.00 36.00 X X 0 41108 5716 Melanie Urban Administrator 40.00 X 0 155760 37932 Crystal Hill Physician 40.00 X 307729 0 45352 Dusty Atterbury APRN 40.00 X 150588 0 34403 Calvin Kruger Physician Assistant 40.00 X 171935 0 11435 Stacy Trout Physician Assistant 40.00 X 165306 0 11061 Angela Beck APRN 40.00 X 152644 0 19089 Bryce Young Former President 0.00 X 0 1358172 0 948202 2878405 520209 9 1 1 0 Hays Medical Center 2220 Canterbury Drive Hays KS 67601 Contract Services 3924268 Favorite Healthcare Staffing Inc PO Box 26225 Overland Park KS 66225 Contract Staffing 1193896 Quest Diagnostics PO Box 772976 Chicago IL 60677 Lab Services 263524 Docs Who Care 800 W Frontier Lane Olathe KS 66061 Physician Services 253436 GE Precision Healthcare LLC PO Box 96483 Chicago IL 60693 Repairs and Maintenance 139844 8 30234 293310 248573 572117 Patient service revenue 622000 20256173 20256173 340b drug program 456110 437466 437466 Lab fairs 900099 49197 49197 587 587 20743423 34183 34183 1000 0 1000 1000 1000 Meals sold to employees and guest 622000 137228 137228 137228 21487951 20744423 0 171411 X 6574 6574 193150 193150 7487754 7059393 388543 39818 329388 312404 15259 1725 834479 796292 33790 4397 548917 506980 39138 2799 3050000 2816980 217465 15555 32684 32684 81526 81526 3369 3369 2882937 2591373 291402 162 243771 1038 242733 100088 22706 77382 293556 220167 73389 440617 331035 108348 1234 34830 24789 8751 1290 63085 54593 8492 78611 78611 Pharmaceuticals 1492085 1492085 Repairs & Maintenance 536196 503453 32386 357 Medical supplies 474944 474944 Food & Dietary Supplies 181689 145352 36337 446756 340197 102876 3683 19837006 17778966 1987020 71020 1046388 1048686 6402975 5390371 1644626 2087166 487240 508126 169253 224526 126183 147105 2738487 4249231 12615152 13655211 1358015 1224497 435040 150000 8412781 9582557 10205836 10957054 X 2409316 2698157 2409316 2698157 12615152 13655211 X 1650945 -1362104 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 1 3369 0 0 0 3369 0 Part II-B, Line 1: Pawnee Valley Community Hospital is a member of the Kansas Hospital Association and the American Hospital Association. Both of these organizations engage in lobbying activities for hospitals and health care as part of the services provided to members. 1827260 203492 2030752 1624536 202724 1827260 1450099 174437 1624536 1437709 12390 1450099 1193650 244059 1437709 0.50000 0.50000 0 1 1 0 Beneficial interest in net assets of foundation 2698157 Receivable from related party 246 Other receivables 145330 Estimated third-party payor settlements 1405498 4249231 Due to Pawnee County 8272621 Due to Hays Medical Center, Inc. 794329 Estimated third-party payor settlements 368502 Other long-term liabilities 147105 9582557 X 21776792 288841 288841 21487951 0 21487951 19837006 0 19837006 0 19837006 Part V, Line 4: Donations are requested for specific items or improvements to the Hospital. When a donation is received for a purpose, it is restricted for that use by the Board until the specific purpose has been met. Part X, Line 2: Management is not aware of any uncertain tax positions. Part XI, Line 2d - Other Adjustments: Change in beneficial interest in net assets of Foundation 1 1 X 1 X 130.000000000000 1 X 1 1 1 0 0 266745 266745 0.01340 1315577 478476 837101 0.04220 1582322 478476 1103846 0.05560 978 978 0.00000 3197287 1155116 2042171 0.10290 6574 6574 0.00030 3204839 1155116 2049723 0.10320 4787161 1633592 3153569 0.15880 1 254173 0 10354052 10553867 -199815 X 1 1 1 1 Pawnee Valley Community Hospital Inc 923 Carroll Avenue Larned KS 67550 X X X X Pawnee Valley Community Hospital Inc 1 0 0 1 X X X X X X X X X 20 1 0 1 1 X https://www.pawneevalleyhospital.com/wp-content/uploads/2021/07/June-29-CHN X http://www.pawneecountykansas.com/ X X 1 20 1 https://pawneevalleyhospital.com/wp-content/uploads/2022/01/CHNA2021_ImpDet 0 1 X 130.000000000000 400.000000000000 X X X X X X 1 1 X X X 1 X https://pawneevalleyhospital.com/billing/#financial-assistance-policy X https://pawneevalleyhospital.com/billing/#financial-assistance-policy X X X X 1 X 0 X X X X 1 X 0 0 Pawnee Valley Community Hospital, Inc. Part V, Section B, Line 5: The CHNA was conducted in collaboration with the Pawnee County Health Department. A Town Hall meeting was organized to provide an objective consensus building method of reviewing and prioritizing county health issues. During the Town Hall meeting, the group reflected on the size and seriousness of any health concerns cited and discussed current community health strengths. The group identified and ranked top community health concerns, and all Town Hall attendees were encouraged to continue to contribute ideas by going online and taking a feedback survey that addresses any additional thoughts related to the CHNA. All Town Hall priority-setting and score processes involved the input of a diverse group with knowledge and/or expertise in public health as well as persons who represent the broad interests of the community served by the hospital. Key stakeholders in attendance included Larned State Hospital, Pawnee County Attorney's Office, Reed Pharmacy, Country Living of Larned, Frick Vet, The Center for Counseling & Consulation, Heart of Kansas Family Health Care, Larned City Council, Pawnee County Sheriff's office, Pawnee County Health Department, County Commissioners, members of the Chamber of Commerce, members of the USD 495 School Board, local members of the media, local religious organizations and representatives of Pawnee Valley Community Hospital. The CHNA was coordinated and produced by VVV Research & Development, Inc. from Olathe, Kansas. Pawnee Valley Community Hospital, Inc. Part V, Section B, Line 6b: Pawnee County, KS Pawnee Valley Community Hospital, Inc. Part V, Section B, Line 7d: Available on Facebook Pawnee Valley Community Hospital, Inc. Part V, Section B, Line 11: Pawnee Valley Community Hospital, Inc. conducted its fourth Community Health Needs Assessment along with the Pawnee County Health Department in calendar year 2021. The Hospital and County Health Department will work with others in the community to address the needs that were identified in the survey. The needs that received the most votes are listed below. Mental Health (Diagnosis, Placement, Aftercare) - 16.5% Drug (Opioids) & Alcohol Abuse - 14.8% Access to Care After Hours - 8.7% Affordable Care - 7.8% Awareness of Health Services - 7.8% Teen Tobacco/Vaping - 7.8% Awareness of Exercise/Fitness Activities - 6.1% Insurance Coverage - 6.1% Women's Health (Maternal & Fetal, Breastfeeding, etc.) - 6.1%The Town Hall meeting also noted the Community's Health Strengths, which are listed below. Nutrition - Health Food Options Nursing Home/Senior Care Access to Services Growth Opportunity Charity Care Care Coordination/Leadership Recreational Activities Stable Health Services Health Department - Communication/Collaboration Ratio of ProvidersOn the 2020 CHNA Implementation Plan, it is noted that several areas are not part of hospital mission critical operations and that the Hospital will be a partner with others to address these needs. These needs and the lead partner are listed below.Mental Health (Diagnosis, Placement, Aftercare) - Mental Health Agency/Pawnee County Health DepartmentDrug (Opioids) & Alcohol Abuse - Mental Health Agency/Pawnee County Health Department Teen Tobacco/Vaping - Pawnee County Health Department Awareness of Exercise/Fitness Activities - Pawnee County Health DepartmentInsurance Coverage - No lead partner identified at this timeThe remaining CHNA Health Areas of Need will be addressed with Pawnee Valley Community Hospital as the lead partner. Updates to the progress are outlined below.Access to Care After Hours - Heart of Kansas (non-PVCH clinic) has extended clinic hours every Thursday evening which compliments our Tuesday evening. PVCH launched the patient portal for our family medicine clinic in April 2022, which allows access to healthcare results and messaging. PVCH continues to offer family telemedicine clinic visits. PVCH family medicine clinic implemented home visits in February 2023.Affordable Care - PVCH decreased the outpatient charges for physical therapy, occupational therapy, speech therapy, imaging charges and lab by 1/3 on July 1, 2021, and again by 1/3 in January 1, 2022. PVCH has a financial assistance program available to all patients meeting the program's guidelines. PVCH is an active participant along with KHA to support Medicaid expansion in Kansas. A Case Manager is actively working with acute and swing bed patients to transition away from Medicare Advantage programs that are not meeting their health coverage needs and assisting them with application for Medicaid, etc. if applicable.Awareness of Health Services - A Marketing/Communications/Community Relations position was added at PVCH in November 2021. PVCH has also contracted with a marketing firm to assist with understanding which services are of greatest need for our community. The firm identifed inpatient and outpatient rehab and inpatient respiratory therapy. A full marketing campaign for family medicine services and rehab services was kicked off in January 2023 and continues with radio, news articles, and social marketing. PVCH also participates in local Larned Area Chamber Coffee and After Hours to highlight our health services. Administration, providers, and associates attended more community events in Pawnee County and surrounding area to inform people of our services such as Coffee Hours in Great Bend and Burdett and United Way of Central Kansas events. A new website went live in August 2023 which highlights services and allows for increased search engine optimization (SEO) words, allowing our services to appear readily when people search with those words online.Women's Health (Maternal & Fetal, Breastfeeding, etc.) - PVCH added in 2022 a family medicine provider who has over 20 years of women's health services experience to our family medicine clinic. PVCH has initiated a weight loss program for women in 2022 and currently provides consultations and birth control options for women of all ages and annual women's health visits. Pawnee County Health Department currently provides maternal/fetal and breast feeding resources and education. Pawnee County Health Department has free home, Healthy Start Home Visit. Our providers will refer patients to them if they feel there is a need for a new mother. (Education and support in addition to breastfeeding support for expecting mothers). PVCH is actively working on the addition of a pediatric experienced nurse practitioner in our family medicine clinic and performing additional procedures including women's procedures in the family medicine clinic. Pawnee Valley Community Hospital, Inc. Part V, Section B, Line 13h: The balance of the patient account is also considered. 1 1 - Pawnee Valley Hospital Family Medicine 713 W 11th St Larned KS 67550 Family Medicine Part I, Line 7: A cost-to-charge ratio derived from Worksheet 2 was used to determine financial assistance at cost and the cost of subsidized health services. A cost-to-charge ratio derived from Worksheet 2 was used to determine the costs of serving Medicaid beneficiaries. Part I, Line 7g: Subsidized health services community benefit expenses include $2,157,088 of expenses attributable to physician clinics that have net operating losses. Part III, Line 4: See Note B (pages 8-11) of the hospital's financial statements for a description of how the hospital calculated bad debt expensePart III Line 2:Costing methodology: A cost-to-charge ratio derived from Worksheet 2 was used to calculate bad debt expense at cost. Part III, Line 8: The Medicare cost report was the costing methodology used to determine the allowable Medicare costs pertaining to Medicare net revenue. Allowable costs of care reported on line 6 were determined using amounts from Worksheet D, Part V and Worksheet D-1 in the Pawnee Valley Community Hospital, Inc., Medicare cost report for fiscal year ended June 30, 2023. Part III, Line 9b: Whenever possible, the customber service representatives (CSR's) of Pawnee Valley Community Hospital 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 with 30 days, the patient will receive a statement that includes a copy of the FAP. If the patient contacts the CSR and it is determined that at least a two-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. Part VI, Line 3: Information regarding the Pawnee Valley Community Hospital, Inc. charity care program is located on the Pawnee Valley Community Hospital and Hays Medical Center, Inc. website for patients and community members to view, and the financial assistance application is also on the HMC website to print off and complete. In addition, if a customer service representative 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, the CSR will send the application to the patient as well. Part VI, Line 4: Pawnee Valley Community Hospital, Inc. is located in Larned, Kansas, a town in Pawnee County, Kansas, which has a population of approximately 6,300 people, as of the 2020 census. The median household income of Pawnee County was $54,100. Approximately 14.6% of the total population was below the poverty line. Approximately 9.0% of the hospital's revenue is from services provided to patients eligible for Medicaid. Pawnee Valley Community Hospital, Inc. is the only hospital in Larned, Kansas. It mainly serves the communities in Pawnee County, Kansas. Part VI, Line 5: Pawnee Valley Community Hospital, Inc. promotes the health of the community by extending medical privileges to most qualified, local physicians. Part VI, Line 6: Pawnee Valley Community Hospital, Inc. is not part of an affiliated health care system. 1 1 0 0 0 0 0 0 0 Bryce Young Former President 0 0 0 0 0 1358172 0 0 0 0 0 1358172 0 0 Edward Herrman Secretary 0 584336 0 107 0 2325 0 107525 0 33593 0 727886 0 0 Crystal Hill Physician 259903 0 20116 0 27710 0 17976 0 27376 0 353081 0 0 0 Shae Veach President 0 242717 0 0 0 10841 0 54434 0 29103 0 337095 0 0 George Harms Treasurer thru. Sept. 2022 0 202710 0 0 0 45845 0 52864 0 18723 0 320142 0 0 Terry Siek Director 0 232921 0 0 0 1563 0 49290 0 9689 0 293463 0 0 Melanie Urban Administrator 0 142235 0 13055 0 470 0 9664 0 28268 0 193692 0 0 Dusty Atterbury APRN 135884 0 444 0 14260 0 9237 0 25166 0 184991 0 0 0 Calvin Kruger Physician Assistant 143839 0 619 0 27477 0 10289 0 1146 0 183370 0 0 0 Stacy Trout Physician Assistant 144765 0 6420 0 14121 0 9906 0 1155 0 176367 0 0 0 Angela Beck APRN 116418 0 104 0 36122 0 9279 0 9810 0 171733 0 0 0 Part I, Line 3 A related organization uses a compensation committee, independent compensation consultant, written employment contract, and approval by the board or compensation committee to establish the compensation of the Hospital's Administrator. Part I, Lines 4a-b Executive benefit plan distribution: Bryce Young - $1,358,172 Contributions to the plan: Edward Herrman - $89,225 George Harms - $37,760 Shae Veach - $38,881 Terry Siek - $35,207 Form 990, Part VI, Section A, line 6 The organization has one member, HaysMed Partners, Inc., which became the sole member as of March 1, 2010. HaysMed Partners, Inc., is a wholly-owned subsidiary of Hays Medical Center, Inc. Form 990, Part VI, Section A, line 7a The Board members of HaysMed Partners, Inc., the sole member of Pawnee Valley Community Hospital, appoint the Board members of Pawnee Valley Community Hospital, Inc. Form 990, Part VI, Section A, line 7b HaysMed Partners, Inc., the sole member of Pawnee Valley Community Hospital, elects the Board members of Pawnee Valley Community Hospital. Form 990, Part VI, Section B, line 11b The Form 990 is prepared and reviewed by an independent accounting firm. It is then reviewed by the organization's officers and accounting personnel. Their questions and concerns are addressed and either corrected or clarified in the Form 990. The final Form 990 is then provided to the board for review prior to filing. Form 990, Part VI, Section B, line 12c Officers, directors & key employees, along with all associates, are required to complete a conflict of interest statement annually. The statements are reviewed by the Board, the Compliance Officer, and Governance Director, as well. When conflict of interest issues arise during a Board meeting, the board members with the conflict are asked to remove themselves from discussion or from the room entirely. They are not allowed to vote on that particular issue. Form 990, Part VI, Section B, line 15 The hospital administrator and officers' salaries are reviewed annually by an independent consulting group and the Board members. They base the review on salary comparisons obtained by the consulting group from peer hospitals in similiar geographic regions. The last review was conducted in March 2023. Form 990, Part VI, Section C, line 19 These documents are not made available to the public. Form 990, Part IX, line 11g Contract labor: Program service expenses 1,117,044. Management and general expenses 0. Fundraising expenses 0. Total expenses 1,117,044. Medical professional fees: Program service expenses 375,870. Management and general expenses 0. Fundraising expenses 0. Total expenses 375,870. Laboratory services: Program service expenses 126,152. Management and general expenses 3,788. Fundraising expenses 0. Total expenses 129,940. Recruiting fees: Program service expenses 49,688. Management and general expenses 55,246. Fundraising expenses 0. Total expenses 104,934. Non-medical professional fees: Program service expenses 307,372. Management and general expenses 37. Fundraising expenses 0. Total expenses 307,409. Collection and billing fees: Program service expenses 100,436. Management and general expenses 101,247. Fundraising expenses 0. Total expenses 201,683. Other purchased services: Program service expenses 514,811. Management and general expenses 131,084. Fundraising expenses 162. Total expenses 646,057. Form 990, Part XI, line 9: Change in beneficial interest in net assets of foundation 288,841. Transfers to Pawnee County -1,650,945. Form 990. Part XII, Line 2c Hays Medical Center, Inc. has a Compliance committee that is responsible for the oversight of Pawnee Valley Community Hospital, Inc.'s financial statement audit and the selection process of an independent auditor. HaysMed Partners Inc (HMed) 2220 Canterbury Dr Hays KS 67601 270877152 Management contract for Pawnee Valley Community Hospital KS 501(c)(3) Line 3 Hays Medical Center Inc 1 Hays Medical Center Inc 2220 Canterbury Dr Hays KS 67601 480559088 Hospital KS 501(c)(3) Line 3 0 Pawnee Valley Community Hospital Foundation 923 Carroll Ave Larned KS 67550 455333776 Support the activities and mission of the Hospital KS 501(c)(3) Line 12a Pawnee Valley Community Hospital 1 0 0 1 0 1 0 0 0 0 0 1 1 1 0 1 1 0 0 0 Pawnee Valley Community Hospital Foundation O 50863 FMV