2024-08-14T16:11:54-05:00 2023-09-30 450250958 Eide Bailly LLP 800 Nicollet Mall Ste 1300 Minneapolis MN 554027033 990 2022-10-01 480545923 Cloud County Health Center Inc CLOU 7852431234 155 W College Dr Concordia KS 66901 Ron Harrington CFO 7852431234 2024-08-14 1 1 Kim Hunwardsen CPA P00484560 6122536500 2024-08-14 2022 2024-08-08 14:25:15Z North Central Kansas Medical Center David Garnas 155 W College Dr Concordia KS 66901 23552398 0 X www.nckmed.com X 1970 KS Operation of critical access hospital 12 11 0 25 0 0 1223487 635984 18821707 22896339 6683 -1936 6893 -517 20058770 23529870 2500 2050 0 0 11815503 13694404 0 0 0 6501625 10923331 18319628 24619785 1739142 -1089915 46728571 49143712 34564275 38746190 12164296 10397522 X Cloud County Health Center is committed to providing quality health care services delivered in a caring and respectful manner through teamwork and professional excellence. 0 0 18941108 2050 22896339 Cloud County Health Center (Health Center) is a nonprofit acute care hospital located in Concordia, Kansas. The Health Center provides inpatient, outpatient, Rural Health Clinic and Emergency care services to residents of Cloud County and the surrounding area. Health Center had a total of 234 discharges and 1,524 patient days. The hospital had a total of 352 surgeries, 2,950 ED visits and 25,300 OP visits and the Family Care Center had 16,442 visits. In addition to providing Inpatient and Outpatient services, the hospital provides the following ancillary services: Lab, Imaging, Pharmacy, Respiratory Therapy, Rehab services, and Sleep Lab services. Imaging services include all of the following areas: General X-ray, CT Scan, Nuclear Medicine, Ultrasound, Bone Density and Mammography services. A new MRI unit was installed in November 2022 when we moved to our new hospital facility. 18941108 1 1 0 1 0 0 0 0 0 0 1 0 0 1 0 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 0 0 0 1 X 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 X 12 11 0 1 0 0 1 0 0 1 0 0 0 1 1 1 1 1 1 1 0 0 X Ron Harrington 7852431234 155 W College Drive Concordia KS 66901 X Philip Gilliland Chairperson 1.00 0.00 X X 0 0 0 Kurt Kocher Vice Chairperson 1.00 0.10 X X 0 0 0 Charles Lambertz Secretary 1.00 0.00 X X 0 0 0 Amy Lange Treasurer 1.00 0.00 X X 0 0 0 Joanne Balthazor Director 1.00 0.10 X 0 0 0 Quentin Breese Director 1.00 0.00 X 0 0 0 Darrell Gallegos Director 1.00 0.00 X 0 0 0 Darrel Hosie Director 1.00 0.00 X 0 0 0 Amber Knoettgen Director 1.00 0.00 X 0 0 0 Kent Otott Director 1.00 0.00 X 0 0 0 Sister Jean Rosemarynoski Director 1.00 0.00 X 0 0 0 Justin Poore Chief of Staff/Physician 40.00 0.00 X 0 0 0 David Garnas Adminstrator/CEO 40.00 0.00 X 0 0 0 Ronald Harrington CFO 40.00 0.10 X 0 0 0 Dorothy Breault Physician 40.00 0.00 X 268487 0 39462 Brandon Fraley Advanced Practice Provider 40.00 0.00 X 158148 0 10294 Daniel Garlow Physician 40.00 0.00 X 284012 0 31949 Shawna Huggans Advanced Practice Provider 40.00 0.00 X 185007 0 32666 Tiffany Naccarato Advanced Practice Provider 40.00 0.00 X 179692 0 8985 1075346 0 123356 5 0 1 1 Salina Regional Health Center 400 South Santa Fe Salina KS 67401 Payroll and Other Reimbursement 21843000 Qualivis LLC PO Box 123847 Dallas TX 753129847 Contract Labor 386663 Lindsborg Laundry 304 E Lincoln St Lindsborg KS 67456 Laundry Services 278637 Treanorhl 1040 Vermont Street Lawrence KS 66044 Architechture Services 253033 Integrated Solutions PO Box 871854 Kansas City MO 64187 Computer Services 192992 9 367229 268755 635984 Patient service revenue 621400 21246438 21246438 Pharmacy Revenue 900099 1006359 1006359 Cafeteria revenue 900099 81948 81948 561594 561594 22896339 20592 20592 22528 -22528 -22528 -22528 Miscellaneous revenue 900099 -517 -517 -517 23529870 22896339 0 -2453 2050 2050 846392 382494 463898 10602196 8708045 1894151 327506 294411 33095 1134850 872649 262201 783460 624558 158902 3917 3917 11386 11386 3037 3037 2095937 1053946 1041991 57833 57833 421287 278942 142345 289678 83113 206565 359893 283685 76208 75043 45730 29313 1558 1480 78 977453 770478 206975 3406437 2685125 721312 82391 15061 67330 Medical and Patient Sup 2837288 2782902 54386 Food Costs 130627 3610 127017 Dues, Licenses, and Tax 82014 34292 47722 87552 15500 72052 24619785 18941108 5678677 0 617164 58523 2272138 2195244 289348 167986 227600 393113 51206746 9406741 40478421 41800005 1146075 833378 1697825 3695463 46728571 49143712 6654387 923213 27551431 37822977 358457 0 34564275 38746190 X 11018451 9564374 1145845 833148 12164296 10397522 46728571 49143712 X -1089915 -676859 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 3037 3037 0 Part II-B, Line 1: A portion of annual dues paid by Cloud County Health Center to the Kansas Hospital Association (KHA) has been identified as association lobbying activities by KHA. Cloud County Health Center does not directly participate in lobbying activities. 719202 719202 35358864 1938768 33420096 14613318 7416871 7196447 515362 51102 464260 41800005 Due from Salina Regional Health Center 1995486 Estimated Third-Party Payor Settlements 1699977 3695463 X 26456051 3292393 -366729 2925664 23530387 -517 -517 23529870 27910128 3292393 3292393 24617735 2050 2050 24619785 Part X, Line 2: The Medical Center believes that it has appropriate support for any tax positions taken affecting its annual filing requirements, and as such, does not have any uncertain tax positions that are material to the financial statements. The Medical Center would recognize future accrued interest and penalties related to unrecognized tax benefits and liabilities in income tax expense if such interest and penalties are incurred. Part XI, Line 2d - Other Adjustments: Change in beneficial interest of Foundation -366,729. Part XI, Line 4b - Other Adjustments: Net Auxiliary Income -517. Part XII, Line 4b - Other Adjustments: Auxiliary expense 2,050. 1 1 X 1 X 1 X 1 1 1 0 0 280000 280000 0.01140 2280631 813905 1466726 0.05960 2560631 813905 1746726 0.07100 6675254 3139625 3535629 0.14360 6675254 3139625 3535629 0.14360 9235885 3953530 5282355 0.21460 1 1145353 0 10526453 10604956 -78503 1 1 1 1 Cloud County Health Center 155 W College Drive Concordia KS 66901 www.nckmed.com H015001 X X X X Cloud County Health Center 1 0 0 1 X X X X X X X X X 21 1 0 0 1 X See Section C X X 1 21 1 See Section C 0 1 X 150.000000000000 200.000000000000 X X X X X 1 1 X X X 1 X nckmed.com/patient-and-visitors/financial-assistance X nckmed.com/patient-and-visitors/financial-assistance X nckmed.com/patient-and-visitors/financial-assistance X X X X X 1 X 0 X X X X 1 X 0 0 Cloud County Health Center Part V, Section B, Line 5: On April 28, 2022, the Community Health Needs Assessment Committee met and discussed ways to involve the community in addressing the most important health needs of Cloud County. The group decided to survey the community, asking for their input on priority of the following areas:- Obesity- Depression/Mental Health- Diabetes- Heart Disease- Tobacco Use Including vaping and chewing- Stroke- Trauma/Falls- Hypertension (high blood pressure)- High cholesterol- Substance Abuse- Transportation to Medical ServicesThe survey was launched through all forms of media for a period of six weeks. 118 surveys were received and tabulated. The Community Health Needs Assessment Committee met in July to review the results and discuss an implementation plan. The Committee consists of 25 members from various organizations in the community. Cloud County Health Center Part V, Section B, Line 11: The following community health priority areas were identified in the most recent CHNA. 1) Obesity 2) Depression/Mental Health 3) Diabetes 4) Heart Disease 5) Tobacco Use 6) Stroke 7) Trauma/Falls 8) Hypertension 9) High Cholesterol 10) Substance Abuse 11) Transportation to Medical ServicesAlthough all of the above are important and will be addressed as part of our regular operations, the hospital will focus on Obesity (including trauma/falls), Depression/Mental Health, and Substance Abuse, including Tobacco Use during fiscal years ending in 2023-2025. With assistance from other organizations, we will address the issues through the following steps:#1 - Provide Opportunities to Stabilize Mental Health We continue to educate the Community on these issues with education materials and through conversations with Hospitals in Topeka when we have patients that need to be transferred out of the Emergency Department. The Health Center continually works to develop more telehealth access for Pawnee, Health Department, and the Schools in the District.#2 - Provide ways to decrease Obesity in the Community and include Education of Health issues leading to Obesity The hospital started a Stepping On class for our senior population. They have a class twice a year, once in the Spring and the other in the Fall time frame. An instructor works with the senior community on ways to strengthen their motor skills and prevent falls at home. Two programs have begun, TOPS program in January of 2023 and the Stay Strong Program, an extension of Kansas State, to have pre- and post-surveys used to determine what degree of behavior has changed. #3 - Develop ways to decrease Substance abuse and Tobacco use We continue to provide education materials to patients, and we participate in the Great Smoke Out Day each year. We also provide education on smoking cessation classes and offer patients nicotine smoking patches within the Clinic and/or Emergency department. Cloud County Health Center Part V, Section B, Line 13h: Presumptive eligibility may be used if the other options are not available. Cloud County Health Center Part V, Section B, Line 24: The hospital financial assistance policy does not cover elective procedures. The hospital may have charged FAP eligible patients gross charges for services that are not covered under the financial assistance policy. Part V, Section B, Line 7a nckmed.com/about/community-health-needs Part V, Section B, Line 10a nckmed.com/about/community-health-needs 1 1 - Family Care Center Clinic 155 W College Drive Concordia KS 66901 Rural health clinic Part I, Line 3c: The methodology used to determine eligibility for financial assistance takes into consideration income, net assets, family size, medical indigency, insurance and underinsurance status. Presumptive eligibility may be used if the other options are not available. Part I, Line 7: Charity care expense was converted to cost on line 7A based on an overall cost-to-charge ratio addressing all patient segments. Line 7B, Medicaid, was determined based on the costing methods used to prepare the cost reports. Line 7G was obtained from the Medicare Cost Report. Part I, Line 7g: Rural health clinic revenue of $1,877,759 and expense of $4,392,254 are included on line 7g. The net cost of rural health clinic subsidized services is $2,514,495. Part III, Line 2: The amount on line 2 represents implicit price concessions. The Organization determines its estimate of implicit price concession based on its historical collection experience with this class of patients. Part III, Line 4: The footnote to the organization's financial statements that describes implicit price concession is located in the audited financial statement report on page 13. Part III, Line 8: The Medicare payments are compared to the actual cost of providing the service as arrived at through the Medicare cost reports. Medical services are provided to patients with Medicare coverage regardless of whether or not a surplus or deficit is realized. Providing Medicare services promotes access to healthcare services which are vitally needed by our community. Part III, Line 9b: Collection practices do not apply to patients who have an approved payment plan in effect provided payments are kept current. Patients who have qualified for 100% financial assistance would not go to collection as their account balance would be reduced to zero prior to getting to the collection stage. Patients who qualify for less than 100% assistance may go to collection if their balance is not paid according to an agreed upon schedule. Accounts that are deemed to qualify for financial assistance while in collections will be removed from collections and returned to the business office. Part VI, Line 2: The hospital has an 18 member CHNA committee that meets quarterly at the hospital to discuss the healthcare needs in the community. Members include staff from the hospital, health department representatives, city and county government officials, school leaders and city business leaders. Part VI, Line 3: The hospital does the following to educate patients on the financial assistance offered at CCHC; (1) posts its financial assistance policy and financial assistance contact information on its website, in admissions areas, emergency rooms, and other areas of the organization's facilities in which eligible patients are likely to be present; (2) provides a copy of the policy, or a summary thereof, and financial assistance contact information to patients as part of the intake process; (3) includes the policy, or a summary thereof, along with financial assistance contact information, in patient bills; and/or (4) discusses with the patient the availability of various government benefits, such as Medicaid or state programs, and assists the patient with qualification for such programs, where applicable. Part VI, Line 4: CCHC is located in Concordia, KS. Concordia is the county seat of Cloud County. It is a Rural community with an estimated population of 5,111 per the 2020 census data. The population has decreased since 1980 when the estimated population was 6,847. Current estimated population as of 2022 was 5,054.Concordia is home to Cloud County Community College located just off highway 81 in Concordia.Concordia is surrounded by healthcare facilities in all directions. To the North in Belleville, KS is Republic County Hospital located 18 miles north of Concordia, KS. To the East is Clay County which has Clay County Medical Center that is approx. 45 miles from Concordia. To the South is Ottawa County approx. 33 miles which has a facility in Minneapolis, KS. Then, to the West is Mitchell County approx. 32 miles and has a facility in Beloit, KS. Part VI, Line 5: The Hospital has a Rural Health Clinic within the hospital and provides services Mon thru Fri from 8:30am till 6:00pm. The Clinic has two outreach locations located in Clyde and Jamestown. The Clyde clinic which was recently remodeled is now open four mornings a week, Monday thru Thursday and offers three private clinic rooms. The Jamestown location is open the 1st and 3rd Thursdays of the month in the mornings serviced by a Physician Assistant. The hospital has a total of 7 providers of which 3 are physicians and 4 are mid-level providers. The hospital operates an emergency department 24 hours per day, 7 days per week. The hospital's Board of Trustees is made up of members from all parts of the county, including local business leaders and retired individuals from Concordia and the surrounding communities.The services offered at CCHC include the following: IP Acute services IP ICU services IP swing bed services - patients requiring Therapy services or IV antibiotic services ED Services FCC Family Care Clinic Specialty Clinic Services Ancillary services including the following: Physical Therapy, Occupational Therapy and Speech Pathology services, Radiology Services including Ultrasound, Nuclear Medicine, CT Scan and Fixed MRI Services Laboratory Respiratory Therapy Cardiac Rehab Services Sleep Lab Services Operating Room OP Procedures Anti Coag Clinic Outpatient Services, including IV Therapy and Blood Transfusions Part VI, Line 6: CCHC is affiliated with Salina Regional Medical Center (SRMC). SRMC helps support our community by sending up Specialists to our Clinic monthly. Also, they provide subject matter experts that CCHC can call upon with questions in specific areas. They also help with Purchasing and Service contracts on equipment. SRMC also provides Accounting, Payroll, and HR services for CCHC. 0 0 0 0 0 0 0 0 0 Daniel Garlow Physician 213195 0 70817 0 0 0 14285 0 19754 0 318051 0 0 0 Dorothy Breault Physician 201267 0 67220 0 0 0 11874 0 29615 0 309976 0 0 0 Shawna Huggans Advanced Practice Provider 183007 0 2000 0 0 0 9554 0 23255 0 217816 0 0 0 Tiffany Naccarato Advanced Practice Provider 177692 0 2000 0 0 0 8985 0 143 0 188820 0 0 0 Brandon Fraley Advanced Practice Provider 109560 0 48588 0 0 0 7966 0 2421 0 168535 0 0 0 Schedule J, Part III Daniel Garlow, Dorothy Breault, Shawna Huggans, Tiffany Naccarato, and Brandon Fraley were paid by an unrelated organization, Salina Regional Health Center, for medical services performed. See Schedule J, Part II and Form 990 Part VII for amounts paid for these services. Form 990, Part V, Line 1a, Number reported in Box 3 of Form 1096: Cloud County Health Center, Inc. has independent contractors, however, Salina Regional Health Center, the management company, pays all the independent contractors directly. The actual expense of each independent contractor is directly charged to the assigned entity. Form 990, Part V, Line 2a, Number of employees on W-3: Under a management agreement, Salina Regional Health Center (SRHC) is responsible for the daily management and operation of the hospital, including employment of all staff. All payroll and benefits are paid by SRHC and payroll reporting is done by SRHC. Allocable compensation by individual is charged to Cloud County Health Center, Inc. and is shown on line 7 of Part IX. Form 990, Part VI, Section A, line 3 The Hospital entered into a management and operating agreement with Salina Regional Health Center (SRHC) effective May 1, 2016. Under the agreement, SRHC is responsible for the daily management and operation of the Hospital, including the employment of all staff needed to manage and operate Cloud County Health Center. For calendar year-end 12/31/2022, SRHC paid the following in compensation and benefits for individuals listed in Part VII: Ronald Harrington $166,200 David Garnas $300,428 Justin Poore $360,243 Form 990, Part VI, Section A, line 6 The Health Center's Board of Trustees is the sole member of the Health Center. Form 990, Part VI, Section A, line 8b The organization does not have committees with broad authority to act on behalf of the governing board. Form 990, Part VI, Section B, line 11b Form 990 is reviewed by the President & CFO. A copy of the return is provided to board members prior to filing with the IRS. Form 990, Part VI, Section B, line 12c The Health Center requires the trustees and key employees to sign an annual conflict of interest form. On the form they designate if they have any conflicts. Potential conflicts of interest are presented to the Board of Directors. The Board determines whether a conflict exists. If a conflict exists, the effected person will be required to abstain from voting on the matter. Form 990, Part VI, Section B, line 15a The Organization's process for determining the President's compensation begins with an initiative led by the Executive Compensation Committee (ECC) of Salina Regional Health Center (SRHC). The ECC compares compensation and salary data provided by Integrated Health Strategies (IHS) for overall reasonableness of base compensation and total compensation for all SRHC executive staff. The ECC reviews the data and makes a recommendation to the SRHC board of trustees in a closed executive meeting. This process occurs every October. Cloud County Health Center's President's salary is then set by the President/CEO of SRHC. The Cloud County Health Center CFO's salary is set by Salina Regional Hospital Vice President of Finance using an annual salary survey and is increased using the same percentage as all other employees. Form 990, Part VI, Section C, line 19 The organization's governing documents, conflict of interest policy, and financial statements are available to the public upon request. Form 990, Part XI, line 9: Net Income From Auxiliary 2,567. Change in Beneficial Interest in Net Assets of the Foundation -679,426. Cloud County Foundation for Health Care Inc 155 W College Drive Concordia KS 66901 480966856 support community health and welfare KS 501(c)(3) Line 7 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0