2023-02-14T08:52:51-06:00 2022-03-31 FORVIS LLP 1551 N WATERFRONT PKWY STE 300 WICHITA KS 672066601 990 2021-04-01 481226830 GREAT PLAINS OF SMITH CO INC % JASON BARB GREA 7852826845 PO BOX 349 SMITH CENTER KS 66967 JASON BARB CEO 3166851523 2022-12-15 true DAVE DELLASEGA 999009999 SHAWNELL LINOT P01663908 3162652811 2 2021 2023-03-07 01:45:13Z SMITH COUNTY MEMORIAL HOSPITAL JASON BARB 250 NORTH ROCK ROAD STE 160 WICHITA KS 67206 22282928 false X WWW.SCMHKS.ORG X 1999 KS THE OPERATION OF HOSPITAL FACILITIES FOR THE DELIVERY OF HEALTH CARE SERVICES, EDUCATION, AND WELLNESS WITHOUT REGARD TO RACE, CREED, COLOR, SEX OR FINANCIAL CIRCUMSTANCE. 8 7 188 8 0 4968472 1995344 18643887 19995796 44184 14941 126091 276847 23782634 22282928 0 0 0 0 9074468 10523981 0 0 0 11946023 12733596 21020491 23257577 2762143 -974649 40774688 35531329 33614200 29346878 7160488 6184451 X TO OPERATE HOSPITAL FACILITIES FOR THE DELIVERY OF HOSPITAL AND RELATED HEALTH CARE SERVICES, HEALTH RELATED EDUCATION, AS WELL AS THE PROMOTION OF HEALTH AND WELLNESS, WITHOUT REGARD TO RACE, CREED, COLOR, SEX OR FINANCIAL CIRCUMSTANCE. false false 19116906 0 19995796 Great Plains of Smith County, Inc., dba Smith County Memorial Hospital, delivers primary healthcare services to residents in an area that includes Smith County, Kansas. The service area also includes, to a lesser degree, Phillips, Jewell, and Osborne Counties in Kansas, as well as Franklin and Webster Counties in Nebraska. The primary healthcare services are delivered through a Critical Access Hospital, and a Provider Based Rural Health Clinic. SEE SCHEDULE O FOR CONTINUATION. 19116906 true true false true false false false false false true true false false true false false false true false false false false false false false false true true false false true false false false false false false false false false false false false false true true false true false true 19 0 true 188 true false false false false false false false false false false false false X 8 7 true false false false true true true true true false false true true true true true true false false false X JASON BARB 3166851523 250 NORTH ROCK ROAD STE 160 WICHITA KS 67206 X HANNAH HAACK PHYSICIAN 40.0 0.0 X 355158 0 52691 JUSTIN OVERMILLER PHYSICIAN 40.0 0.0 X 327422 0 55945 FERRILL CONANT PHYSICIAN 40.0 0.0 X 272095 0 42036 DAVE DELLASEGA PRESIDENT/SECRETARY/DIRECTOR 2.0 40.0 X X 0 209142 59769 LEAH WIEHL PHYSICIAN 40.0 0.0 X 196766 0 41356 ALLEN VANDRIEL ADMINISTRATOR 40.0 0.0 X 188251 0 36401 MARK TOWNER PHYSICAL THERAPIST 40.0 0.0 X 153880 0 37875 STEPHEN LEWIS CFO 40.0 0.0 X 140032 0 19860 DURREL KELLEY SENIOR VP OF OPERATIONS 2.0 40.0 X 0 127901 30947 JASON BARB CFO 2.0 40.0 X 0 46160 5528 DAVE RANKIN CHAIRMAN/DIRECTOR 0.25 2.25 X X 0 0 0 CHARLES WESTIN CHAIRMAN/DIRECTOR 0.25 2.25 X X 0 0 0 JOHN TERRILL VICE PRESIDENT/DIRECTOR 0.25 2.25 X X 0 0 0 STEVE CARLSON TREASURER/DIRECTOR 0.25 2.25 X X 0 0 0 DR BARBARA BROWN APPLEGATE DIRECTOR 0.25 2.25 X 0 0 0 ARTHUR HENRICKSON DIRECTOR 0.25 2.25 X 0 0 0 ROGER JOHN DIRECTOR 0.25 2.25 X 0 0 0 1633604 383203 382408 13 false true false GPHA 250 N ROCK RD STE 160 WICHITA KS 67206 BILLING SERVICE/MGMT 1258217 QUEST DIAGNOSTICS PO BOX 719 HAYS KS 67601 REFERENCE LAB 170759 WOUND CARE SPECIALISTS PO BOX 71849 CHICAGO IL 606941849 WOUND CARE 131275 MIDWEST ANESTHESIA ALLIANCE PO BOX 306 MEMPHIS MO 63555 CRNA SERVICES 394486 INTERSTAFF PO BOX 2138 SAN ANTONIO TX 77406 NURSE STAFFING 166368 5 1728230 267114 1995344 NET PATIENT SERVICE REVENUE 621300 18001699 18001699 340B PRESCRIPTION DRUG REVENUE 621300 1994097 1994097 19995796 14941 14941 0 0 2248 2248 0 2248 2248 0 0 0 0 0 0 0 0 0 0 EMPLOYEE/GUEST MEALS 722513 99875 99875 VENDOR REBATES 900099 20956 20956 All Other Misc Revenue 900099 153768 153768 153768 153768 274599 22282928 19995796 291788 X 0 0 0 0 209094 209094 0 8031733 6991663 1040070 602310 526235 76075 1133761 914308 219453 547083 463591 83492 139264 139264 17962 17962 228920 228920 2734 2734 0 0 3240432 2638168 602264 0 41088 1314 39774 585398 542752 42646 70732 23540 47192 0 411352 299433 111919 3698 3148 550 0 7853 7853 739395 528355 211040 0 2346884 1677029 669855 182309 130274 52035 MEDICAL SUPPLIES 4192599 4192599 EQUIPMENT RENTAL/MAINTENANCE 221712 132140 89572 DUES & SUBSCRIPTIONS 60389 29313 31076 _ 0 240875 23044 217831 23257577 19116906 4140671 0 3471181 3490371 3679899 4240078 0 153679 3172658 2404939 0 0 0 0 0 0 276263 302717 120669 126087 31011455 8696095 24504700 22315360 0 0 0 0 0 0 0 0 5549318 2498098 40774688 35531329 3224388 2291940 0 0 3709001 598459 0 0 0 0 0 0 26680811 26456479 0 0 0 0 33614200 29346878 X 6188456 5198905 972032 985546 7160488 6184451 40774688 35531329 -974649 -1388 X false true X true true true X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false true 2734 false false false 2734 false SCHEDULE C, PART II-B, LINE 1F A PORTION OF THE ANNUAL DUES PAID TO KHA AND AHA ARE USED FOR LOBBYING. 973031 171687 8634 166807 986545 877459 66240 93680 65348 972031 936018 13269 -38761 33067 877459 910903 13076 41817 29778 936018 982411 17349 -27421 61436 910903 0.00000 0.95710 0.04290 true false 395701 395701 19602101 4415385 15186716 6693412 3181346 3512066 4320241 1099364 3220877 22315360 Due from Third Party 455000 FUNDS HELD BY ESCROW AGENT 1552447 OTHER RECEIVABLES 490651 2498098 SCHEDULE D, PART V, LINE 4 THE INTENDED USE OF THE ENDOWMENT FUNDS IS TO SUPPORT THE CONTINUING OPERATIONS OF THE REPORTING ORGANIZATION. 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. true true X true X false true true false true true 304794 304794 0.01310 1358045 944991 413054 0.01780 1662839 944991 717848 0.03090 29362 29362 0.00130 29362 29362 0.00130 1692201 944991 747210 0.03220 false 248600 8500670 8500670 X true true 1 1 GREAT PLAINS OF SMITH CO INC 921 E HWY 36 SMITH CENTER KS 66967 WWW.SCMHKS.ORG H092001 X X X X RURAL HEALTH CLINIC GREAT PLAINS OF SMITH CO INC 1 false false true X X X X X X X X X 21 true false false true X SEE SCHEDULE H, PART V, SECTION C X true 21 true SEE SCHEDULE H, PART V, SECTION C false true X 200. 0. X X X true true X X X X true X SEE SCHEDULE H, PART V, SECTION C X SEE SCHEDULE H, PART V, SECTION C X SEE SCH H, PART V, SECTION C X X X X X X true X false X X X X true X false false SCHEDULE H, PART V, LINE 5 THE OBJECTIVE OF THE SMITH COUNTY COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) WAS TO DETERMINE HEALTH NEEDS FROM THE PERSPECTIVE OF THE COMMUNITY IN COLLABORATION WITH THE HEALTH CARE PROVIDERS IN THE COMMUNITY. PARTICIPANTS IN A TOWN HALL MEETING HELD AS PART OF THE CHNA INCLUDED COMMUNITY RESIDENTS, GOVERNMENTAL, CIVIC, AND BUSINESS LEADERS IN THE COMMUNITY. THE ATTENDANCE ROSTER CAN BE FOUND IN SECTION V A OF THE CHNA DOCUMENT. SCHEDULE H, PART V, LINE 7A HTTPS://WWW.SCMHKS.ORG/ABOUT-US/COMMUNITY-HEALTH-NEEDS-ASSESSMENT/ SCHEDULE H, PART V, LINE 10 HTTPS://WWW.SCMHKS.ORG/ABOUT-US/COMMUNITY-HEALTH-NEEDS-ASSESSMENT/ SCHEDULE H, PART V, LINE 11 THE CHNA CONDUCTED IN APRIL 2021 HIGHLIGHTED 10 ISSUES FOR SMITH COUNTY. THE ISSUES WERE: 1. DENTAL SERVICES 2. MENTAL HEALTH (DIAGNOSIS, PLACEMENT, AFTERCARE) 3. CHRONIC DISEASE MANAGEMENT 4. HOUSING 5. SPECIALITY SERVICES (OPTOMETRY AND PODIATRY) 6. AFFORDABLE INSURANCE/ACCESS TO MEDICAID 7. OBESITY (ACCESS TO EXERCISE) 8. DRUG & SUBSTANCE ABUSE 9. CHILD CARE 10. NURSING HOME/SENIOR CARE The issues identified were reviewed by leadership and the governing board of Great Plains of Smith County, Inc. They were prioritized into an implementation plan, which was published later in 2021. The CHNA report, along with the implementation plan are posted to the public website (www.scmhks.org). The strategy addresses each of the priorities identified, but only two of the ten issues were recognized as being solely within the purview of Great Plains of Smith County, Inc. Those were items 3 and 5. Items 1, 2, 4, 6, 7, 8, 9, and 10 were identified as being only addressable through a collaborative approach involving other community partners. During the interval between completion of the CHNA and the end of the 2022 fiscal year, significant progress was demonstrated in addressing both item 3 and 5. The remaining 8 issues also had significant progress demonstrated through collaboration with outside agencies. SCHEDULE H, PART V, LINE 16A HTTPS://WWW.SCMHKS.ORG/SERVICES/FINANCIAL-ASSISTANCE/ SCHEDULE H, PART V, LINE 16B HTTPS://WWW.SCMHKS.ORG/SERVICES/FINANCIAL-ASSISTANCE/ SCHEDULE H, PART V, LINE 16C HTTPS://WWW.SCMHKS.ORG/SERVICES/FINANCIAL-ASSISTANCE-RESOURCES/ 1 SMITH COUNTY FAMILY PRACTICE 921 E HWY 36 SMITH CENTER KS 66967 FAMILY PRACTICE SCHEDULE H, PART I, LINE 3C THE ORGANIZATION USED THE FOLLOWING CRITERIA TO DETERMINE ELIGIBILITY FOR FINANCIAL ASSISTANCE: ASSET LEVEL, MEDICAL INDIGENCY, INSURANCE STATUS, AND UNDER INSURANCE STATUS. SCHEDULE H, PART VI, LINE 7 THE COSTING METHODOLOGY USED TO CALCULATE THE AMOUNTS IN THE TABLE OF PART I, LINE 7, OF SCHEDULE H, IS A COST TO CHARGE RATIO. SCHEDULE H, PART III, LINE 2 HOSPITAL CHARGES THAT ARE NOT COLLECTED AND ARE NOT APPROVED FOR FINANCIAL ASSISTANCE ARE CLASSIFIED AS BAD DEBTS FROM PATIENTS WHO WILL NOT PAY. SCHEDULE H, PART III, LINE 3 THE COSTING METHODOLOGY IS BASED ON THE ORGANIZATION'S MEDICARE COST-TO-CHARGE RATIO. WHILE WE RECOGNIZE THAT THERE WOULD BE SOME BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S CHARITY CARE POLICY, WE HAVE NO REASOBABLE BASIS FOR ESTIMATING THIS FIGURE. IF ELIGIBILITY IS KNOWN, THE AMOUNT WOULD FALL UNDER CHARITY CARE AND NOT BAD DEBT. SCHEDULE H, PART III, LINE 4 NOT APPLICABLE DUE TO ADOPTION OF ASC 606 REVENUE FROM CONTRACTS WITH CUSTOMERS. SCHEDULE H, PART III, LINE 8 THE COSTING METHODOLOGY USED TO CALCULATE THE AMOUNT ON LINE 6 IS A COST TO CHARGE RATIO. SCHEDULE H, PART III, LINE 9B ALL CHARITY CARE AND CHARGES NOT TO BE COLLECTED DUE TO FINANCIAL ASSISTANCE COMPUTATIONS ARE EXEMPTED FROM COLLECTION POLICIES AND PRACTICES. THESE ACCOUNTS ARE REMOVED FROM THE COLLECTION CYCLE. SCHEDULE H, PART VI, LINE 2 GREAT PLAINS OF SMITH COUNTY, INC. (GPSC) USES FORMAL AND IN FORMAL METHODS TO DETERMINE THE NEEDS OF THE COMMUNITIES IT SERVES. OUTSIDE FACILITATORS HAVE BEEN USED TO ASSIST WITH FORMAL COMMUNITY HEALTH NEEDS ASSESSMENT. THE FIRST OF THESE FORMAL ASSESSMENTS WAS PERFORMED IN 2012, FOLLOWED BY SUBSEQUENT ASSESSMENTS IN 2015 AND 2018. EACH OF THESE ASSESSMENTS INCLUDED SURVEYS MAILED TO MEMBERS OF THE COMMUNITY, FOLLOWED BY A PUBLIC FORUM DESIGNED TO GATHER INPUT IN AN INTERACTIVE FORMAT. FOLLOWING COMPLETION AND PUBLICATION OF EACH OF THE CHNAs, AN IMPLEMENTATION PLAN WAS DEVELOPED. IN 2021 THE SARS-COV-2 PANDEMIC AND ITS IMPACT ON THE COMMUNITY AND PUBLIC GATHERINGS NECESSITATED A CHANGE IN TACTICS FOR THE FOURTH COMMUNITY HEALTH NEEDS ASSESSMENT. INSTEAD OF A PUBLIC FORUM IN THE FORM OF A TOWN HALL MEETING, A VIRTUAL SESSION, PUBLICLY ADVERTISED AND WITH SPECIFIC INVITATIONS TO CERTAIN COMMUNITY LEADERS, WAS HELD. THE INPUT FROM THIS VIRTUAL SESSION WAS INCORPORATED IN TO A FINAL DOCUMENT WHICH WAS PUBLISHED IN MID-2021. LATER IN THE YEAR, AN IMPLEMENTAITON PLAN ADDRESSING THE IDENTIFIED NEEDS WAS COMPLETED AND PUBLISHED. SCHEDULE H, PART VI, LINE 3 Great Plains of Smith County, Inc. makes significant efforts to provide information to the public regarding the function of federal and state programs. We use frequent social media posts and newspaper articles to provide information about the Medicare and Medicaid programs, and the services they cover. We also publish a glossy, magazine-style report to the community three times per year to help educate the community about preventive health care, services available through GPSC, and topics related to insurance programs available in the community. For the past several years GPSC has arranged for an outside, non-partisan benefits advisor to present programs during the Medicare Open Enrollment Period. These programs are designed as purely educational offerings to assist beneficiaries in selecting the most beneficial Medicare related programs (especially supplemental plans) during the time when they can make their annual selection. Our Patient Care Advocate, a licensed Social Worker, provides individual assistance to uninsured patients in application for coverage under the KanCare (Kansas Medicaid) program. The Patient Advocate also assists patients with the initiation of applications for financial assistance under our Charity Care program. Every billing statement sent to patients contains information about our Financial Assistance Program, including instructions about how to initiate an application for assistance. Additionally, every telephone call made to patients regarding unpaid balances includes information regarding the option to apply for financial assistance. Our Financial Assistance Policy, along with the contact in formation and application forms, is accessible on our public website. SCHEDULE H, PART VI, LINE 4 The 2020 United States Census reported a total population in Smith County, Kansas of 3,570. This represents a decrease of 7.3% from the 2010 census of 3,853. The population density is approximately 4 persons per square mile, classifying the county as Frontier. Approximately 96% of the population of Smith County is reported as white, with less than 1% each reported as black, Asian, or native American. The population is nearly evenly divided between male and female. The median family income in Smith County was reported as $43,429, compared to a national median of $62,843. Despite this disparity in median income, the Census reported 11.6% of Smith County residents being below the poverty level, compared to 11.4% nationally. This indicates a higher population in the low-moderate income range, but above the poverty level. Of the residents less than 65 years of age in Smith County, 11.7% are reported as uninsured, compared to 10.2% nationally. These reported numbers on uninsured likely do not reflect the impact of the Covid-19 pandemic on the economy and employer-provided insurance. SCHEDULE H, PART VI, LINE 5 Great Plains of Smith County, Inc. maintains an open medical staff, striving for diversity to reflect the community and service area. The Smith County Memorial Hospital Board of Trustees, although not directly responsible for the governance of the operating entity, never the less serves as an important link to the community. The membership of the Board of Trustees represents the geographic diversity of Smith County, with members appointed to represent various regions and population centers of the county. Great Plains of Smith County, Inc. uses significant efforts to promote the health of the community. Among these efforts are communication regarding healthy lifestyle, disease prevention and detection, and community awareness. We use social media, our website, radio advertising, and newspaper articles and advertising to convey important information to the community. In addition to the topics addressed every year, the Covid-19 pandemic has created a need for increased communication with the community regarding the virus, its detection and treatment, and vaccination availability and delivery. We have worked collaboratively throughout the pandemic with the local Public Health Department, County Board of Health, Administration and School Board of the local school district, and the Recreation Commission on issues related to the pandemic. Our Director of Communications has been instrumental in assisting other entities with providing information to their constituencies. Early in the pandemic, GPSC Worked extensively and cooperatively with the long term care facilities in the community to provide testing for residents and staff. Federal grant funding channeled to GPSC was used to support much of this activity, and we provided the required accounting support for reporting of the use of these funds. During the pandemic, it became obvious that the nurse administrator of the public health department, who had been serving as the County Health Officer, was overwhelmed by the demands of the position, GPSC administration and medical staff met with the County Commissioners (acting as the County Board of Health) and reached an agreement for one of our employed physicians to serve as the County Health Officer. Although the pandemic disrupted many of the ongoing outreach offerings that GPSC had traditionally, other services continued unabated. Among these services and offerings are the Meals on Wheels program, telehealth services, cardiac and pulmonary rehabilitation programs, and education programs. The Meals on Wheels program is now completely managed by GPSC, including preparation and packaging of meals that are provided at a deeply discounted cost to homebound members of the community. GPSC has also assumed the responsibility for scheduling and coordinating the volunteer delivery drivers for the meals. Although access to facilities was limited for a period of time due to the pandemic, the Cardiac Rehabilitation and Pulmonary Rehabilitation programs have now resumed activity, providing service to growing numbers of beneficiaries. Education programs that have continued include healthy diet programs, childbirth education programs for expectant parents, as well as training and certification programs in a variety of basic and advanced lifesaving techniques. These include Basic Life Support (CPR), Advanced Cardiovascular Life Support, Pediatric Advanced Life Support, Neonatal Resuscitation, Trauma Nurse Core Curriculum, and Basic and Advanced Fetal Monitoring courses. The utilization of telehealth services to expand the availability of services, particularly behavioral health services, have seen significant increases in use during the past year. In general, when we become aware of a need for additional services to the community and service area, we take steps to assure development and delivery of programs to address the needs. SCHEDULE H, PART VI, LINE 6 SMITH COUNTY MEMORIAL HOSPITAL IS OPERATED BY GREAT PLAINS OF SMITH CO., INC., A SUBSIDIARY OF GREAT PLAINS HEALTH ALLIANCE. GPHA IS A 501(C)(3) NOT FOR PROFIT ORGANIZATION WHICH PROVIDES MANAGEMENT, FINANCE, BILLING, INFORMATION SYSTEMS, AND PHARMACY SUPPORT SERVICES TO ITS AFFILIATED ORGANIZATIONS. GPHA DOES NOT PROVIDE SERVICES DIRECTLY TO PATIENTS, BUT PROVIDES ACCESS TO PROFESSIONALS AND SYSTEMS WHICH MIGHT NOT OTHERWISE BE AVAILABLE OR AFFORDABLE TO SMALL RURAL HOSPITALS. GPHA PROVIDES EDUCATION AND ASSISTANCE IN AREAS SUCH AS HIPAA PRIVACY AND SECURITY, MEDICARE AND MEDICAID REIMBURSEMENT RULES AND REGULATIONS, MEANINGFUL USE REQUIREMENTS FOR ELECTRONIC HEALTH RECORDS, ETC. GREAT PLAINS HEALTH ALLIANCE BRINGS TOGETHER ITS NETWORKED CRITICAL ACCESS HOSPITALS IN KANSAS AND NEBRASKA TO LEARN FROM EACH OTHER AND DEVELOP BEST PRACTICES IN CARE PROVISION, MANAGEMENT, AND GOVERNANCE. AFFILIATED HOSPITALS RECEIVE POLICY GUIDANCE REGARDING FINANCIAL ASSISTANCE TO PATIENTS, CORPORATE COMPLIANCE, CONFLICTS OF INTEREST, AND MANY OTHER AREAS. GUIDANCE IS ALSO PROVIDED TO THE GOVERNING BOARDS OF AFFILIATED HOSPITALS TO ASSIST THEM IN FULFILLING THEIR FIDUCIARY RESPONSIBILITIES. SCHEDULE H, PART VI, LINE 7 N/A false false false false false false false false false DAVE DELLASEGA PRESIDENT/SECRETARY/DIRECTOR 0 206439 0 0 0 2703 0 20695 0 39074 0 268911 0 0 ALLEN VANDRIEL ADMINISTRATOR 186205 0 0 0 2046 0 18275 0 18126 0 224652 0 0 0 STEPHEN LEWIS CFO 138709 0 0 0 1323 0 2393 0 17467 0 159892 0 0 0 DURREL KELLEY SENIOR VP OF OPERATIONS 0 126271 0 0 0 1630 0 12293 0 18654 0 158848 0 0 HANNAH HAACK PHYSICIAN 352753 0 0 0 2405 0 28200 0 24491 0 407849 0 0 0 JUSTIN OVERMILLER PHYSICIAN 325017 0 0 0 2405 0 31942 0 24003 0 383367 0 0 0 FERRILL CONANT PHYSICIAN 269671 0 0 0 2424 0 26410 0 15626 0 314131 0 0 0 LEAH WIEHL PHYSICIAN 194712 0 0 0 2054 0 19656 0 21700 0 238122 0 0 0 MARK TOWNER PHYSICAL THERAPIST 152301 0 0 0 1579 0 14638 0 23237 0 191755 0 0 0 FORM 990, PART VII; SCHEDULE J, PART I, LINE 3 COMPENSATION FOR DAVE DELLASEGA, DURRELL KELLEY, AND JASON BARB IS PROVIDED BY GREAT PLAINS HEALTH ALLIANCE, A RELATED ORGANIZATION. GREAT PLAINS HEALTH ALLIANCE'S BOARD OF DIRECTORS ANNUALLY APPROVE THE COMPENSATION FOR MR. DELLASEGA, MR. KELLEY, AND MR. BARB. THE AMERICAN COLLEGE HEALTHCARE EXECUTIVES AND THE KANSAS HOSPITAL ASSOCIATION ALSO HAVE COMPARABLE COMPENSATION DATA THAT CAN BE USED BY THE BOARD. A COMPENSATION REVIEW WAS DONE WHEN DAVE DELLASEGA TOOK OVER AS CEO AND WAS CONDUCTED BY THE BOARD, BUT SINCE THAT TIME THERE HAS BEEN NO FORMAL COMPENSATION REVIEW. FORM 990, PART III, LINE 4A The largest program services measured by expenses are: 1. Smith County Memorial Hospital - This 16 bed Critical Access Hospital provides a wide variety of inpatient and outpatient medical services to residents of the service area. Included among these services are the following: a. Inpatient Care - i. Acute and Observation (outpatient) care for patients with medical and surgical conditions. This includes neonatal, pediatric, adult, and geriatric patients. ii. Skilled Swing Bed care for patients requiring post-acute care, especially skilled nursing and rehabilitation services. iii. Private Pay custodial care is provided on a limited basis. Much of this care is provided to patients who have elected Hospice benefits but do not have family members able care for them in the home. b. Obstetrical Care including prenatal education, monitoring and diagnostic services during the prenatal period, as well as labor and delivery services during the perinatal period. This includes surgical care for scheduled and urgent c-sections needed for delivery. c. Emergency Care available 24 hours per day by a staff of specially trained Registered Nurses, Advanced Practice Registered Nurses, Physician Assistants, and physicians. All Emergency Department staff are certified in various types of advanced life support programs, including Advanced Cardiovascular Life Support, Pediatric Advanced Life Support, and advanced trauma care courses. This facility is certified as a Level IV Trauma Center, and is certified as a stroke care center. Telehealth services are available in each of the trauma rooms, connecting instantly to Registered Nurses and board certified Emergency Physicians at a dedicated response center in South Dakota. This telehealth service also provides evaluation of patients suffering from crisis level behavioral health emergency services. d. Ancillary diagnostic and therapeutic services. These include: i. Laboratory with staff available 24 hours per day to perform a wide variety of chemistry, hematology, coagulation, urinalysis, blood gas, as well as basic microbiology tests. Blood banking is also available. A contracted reference laboratory performs more complex testing. Pathology services are also provided through a contracted service. ii. Diagnostic Imaging services include digital x-ray, CT scan, Diagnostic Ultrasound, Echocardiography, portable Fluoroscopy, Mammography, and Bone Density. Mobile services provided under contract include MRI and Nuclear Imaging. iii. Anesthesia services are provided in the Emergency, ambulatory surgery, and inpatient surgical settings by a dedicated Certified Registered Nurse Anesthetist (CRNA). A separate pain management service was under development at the end of the fiscal year. iv. Respiratory Therapy and Pulmonary Function are available, including acute inpatient and Emergency Department assistance with airway management, supplemental Oxygen and aerosol therapy, short term mechanical ventilation, and assistance with neonatal resuscitation. v. Physical and Occupational Therapy, as well as Speech Language Pathology are available for inpatient and outpatient care. vi. Cardiac and Pulmonary Rehabilitation services are provided to patients on a scheduled basis. Patients recovering from cardiac events or surgery, and patients with chronic pulmonary disease benefit from these services. vii. Wound Care services are available through a contract service on a weekly basis. GPSC medical staff and nursing staff from the Rural Health Clinic help staff this clinic, which provides debridement and care for slow-healing wounds, as well as the application of skin substitute products to promote healing. viii. Diagnostic Sleep Services including both attended and home sleep studies and CPAP titration are provided under a contract arrangement. ix. Dietary Services to inpatients and outpatients are provided by a staff led by a Registered Clinical Dietician who is also our Executive Chef. Tailoring of meals to meet the therapeutic needs and desires of our inpatients, coupled with education regarding healthier food choices are provided to every inpatient. The Food Services staff also provide and package the meals for the Meals on Wheels program. x. Outpatient Specialty Clinic Services are provided at the CAH by a wide variety of providers. These arrangements allow us to offer specialty services to residents of the area without the need for travel to distant locations. Services provided at SCMH include Cardiology (3 providers), Pulmonology, Nephrology, General Surgery (2 providers), Podiatry, Orthopedic Surgery, Urology, OB/GYN, and Dermatology. 2. Smith County Family Practice - This Certified Rural Health Clinic provides primary care services to pediatric, adult and geriatric patients for a full range of medical conditions. Staffed by five board certified Family Medicine Physicians as well as Physician Assistants and Advanced Practice Registered Nurses. In addition to primary care services delivered in the RHC, these providers staff the Emergency Department and inpatient and outpatient areas of the CAH. They also provide services to patients (residents) in skilled nursing and ICF long term care facilities in Smith and Osborne counties. Physicians also serve as Medical Directors for two skilled nursing facilities, for Smith County EMS, and as the County Health Officer. 3. 340B Pharmacy Services - Great Plains of Smith County, Inc. utilizes the 340B program operated under the auspices of the Health Resources and Services Administration (HRSA) to obtain drugs and pharmaceuticals for use in the outpatient setting at Smith County Memorial Hospital (the CAH) as well as through contracted arrangements with three area retail pharmacies. The discounted pricing available under this program (although under threat currently by unilateral action by some drug manufacturers) allows us to offset the cost of delivery of services within our service area. FORM 990, PART VI, SECTION A, LINE 2 DAVE DELLASEGA, DURREL KELLEY, AND JASON BARB HAVE A BUSINESS RELATIONSHIP. THEY ARE ALL EMPLOYED BY, AND ALSO OFFICERS OF, A RELATED 501(C)(3) ORGANIZATION, GREAT PLAINS HEALTH ALLIANCE. FORM 990, PART VI, SECTION A, LINE 6 GREAT PLAINS HEALTH ALLIANCE, INC., A NOT-FOR-PROFIT 501(C)(3) ORGANIZATION, IS THE SOLE MEMEBER OF GREAT PLAINS OF SMITH CO., INC. FORM 990, PART VI, SECTION A, LINE 7A GREAT PLAINS HEALTH ALLIANCE, INC., BEING THE SOLE MEMBER, HAS THE RIGHT TO ELECT AND APPROVE ALL THE BOARD MEMBERS. FORM 990, PART VI, SECTION A, LINE 7B GREAT PLAINS HEALTH ALLIANCE, INC. (GPHA) IS THE SOLE MEMBER AND HAS THE AUTHORITY TO APPROVE THE ARTICLES OF INCORPORATION, BYLAWS, ELECTION TO OR REMOVAL FROM THE BOARD OF DIRECTORS, THE ANNUAL OPERATING AND CAPITAL BUDGETS, AND THE LONG RANGE OR STRATEGIC PLANS. FORM 990, PART VI, SECTION B, LINE 11B THE 990 IS PREPARED AND REVIEWED BY AN INDEPENDENT ACCOUNTING FIRM. THE 990 IS THEN PROVIDED TO THE CHIEF EXECUTIVE OFFICER FOR REVIEW AND APPROVAL. AN ELECTRONIC DRAFT OF THE 990 WITH ALL REQUIRED SCHEDULES IS THEN PROVIDED TO THE FULL BOARD FOR REVIEW PRIOR TO FILING THE 990 WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION IS REQUIRED TO ADOPT GPHA'S CONFLICT OF INTEREST POLICY. ALL BOARD MEMBERS, OFFICERS, AND EMPLOYEES ARE SUBJECT TO THE CONFLICT OF INTEREST POLICY AND SIGN AN ANNUAL ACKNOWLEDGEMENT THAT THEY HAVE READ, UNDERSTAND AND COMPLIED WITH THE GPHA CONFLICT OF INTEREST POLICY. UNDER THE POLICY, ANY MEMBER WHO HAS A DIRECT OR INDIRECT (VIA FAMILY) FINANCIAL INTEREST IS CHARACTERIZED AS AN INTERESTED PERSON. INTERESTED PERSONS ARE REQUIRED TO DISCLOSE FINANCIAL INTERESTS WITH COMPANIES DOING BUSINESS WITH GPHA. THE INTERESTED PERSON MUST RECUSE THEMSELVES FROM FURTHER DISCUSSIONS OF THE TRANSACTION AND LEAVE THE ROOM. THE REMAINING NON-INTERESTED MEMBERS DECIDE IF A CONFLICT OF INTEREST EXISTS. THE BOARD CHAIR MAY APPOINT ANOTHER DISINTERESTED PARTY TO DISCUSS THE TRANSACTION OR THE REMAINING BOARD MEMBERS MAY VOTE TO ENTER INTO OR ABSTAIN FROM THE SUSPECT TRANSACTION. FAILURE TO DISCLOSE FINANCIAL INTERESTS BY INTERESTED BOARD MEMBERS WILL RESULT IN DISCIPLINARY ACTION, INCLUDING SANCTIONING BY BOARD. ALL CONFLICTS OF INTEREST AND THEIR ULTIMATE RESOLUTION ARE DOCUMENTED IN THE BOARD MINUTES. THE BOARD CONDUCTS PERIODIC REVIEWS TO DETERMINE THAT CONFLICTS ARE BEING IDENTIFIED AND RESOLVED ACCORDING TO POLICY DOCUMENTATION. REVIEWS BY OUTSIDE EXPERTS ARE PERMITTED, BUT NOT REQUIRED. FORM 990, PART VI, SECTION B, LINES 15A & B THE CEO, COO, AND CFO ARE COMPENSATED BY GREAT PLAINS HEALTH ALLIANCE, A RELATED ORGANIZATION. GPHA'S BOARD USES COMPARABILITY DATA IN SETTING THEIR SALARIES, AND DOCUMENTATION IS RETAINED OF THE BOARD'S DELIBERATIONS AND DECISIONS. 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. THE COMPANY'S KANSAS ANNUAL REPORT IS ALSO AVAILABLE UPON REQUEST FROM THE KANSAS SECRETARY OF STATE. FORM 990 PART IX LINE 11G DESCRIPTION:CONTRACTED MEDICAL STAFF TOTAL FEES:2122225 FORM 990 PART IX LINE 11G DESCRIPTION:BILLING/COLLECTIONS TOTAL FEES:443647 FORM 990 PART IX LINE 11G DESCRIPTION:LAB SERVICES TOTAL FEES:212664 FORM 990 PART IX LINE 11G DESCRIPTION:PHARMACY SERVICES TOTAL FEES:234542 FORM 990 PART IX LINE 11G DESCRIPTION:ADMIN/HUMAN RESOURCES TOTAL FEES:150488 FORM 990 PART IX LINE 11G DESCRIPTION:MAINTENANCE/HOUSEKEEPING TOTAL FEES:48386 FORM 990 PART IX LINE 11G DESCRIPTION:PLANT OPERATIONS TOTAL FEES:28480 GREAT PLAINS HEALTH CARE FOUNDATION INC 250 N ROCK ROAD STE 160 WICHITA KS 67206 480955870 SUPPORT KS 501(C)(3) 10 GPHA INC true GREAT PLAINS HEALTH ALLIANCE INC 250 N ROCK ROAD STE 160 WICHITA KS 67206 480617739 MANAGEMENT KS 501(C)(3) 3 NA false GREAT PLAINS OF ELLINWOOD INC 250 N ROCK ROAD STE 160 WICHITA KS 67206 481226976 HOSPITAL KS 501(C)(3) 3 GPHA INC true GREAT PLAINS OF OTTAWA COUNTY INC 250 N ROCK ROAD STE 160 WICHITA KS 67206 481226856 HOSPITAL KS 501(C)(3) 3 GPHA INC true GREAT PLAINS OF SABETHA COUNTY INC 250 N ROCK ROAD STE 160 WICHITA KS 67206 481236156 HOSPITAL KS 501(C)(3) 3 GPHA INC true GREAT PLAINS OF REPUBLIC COUNTY INC 250 N ROCK ROAD STE 160 WICHITA KS 67206 481226977 HOSPITAL KS 501(C)(3) 3 GPHA INC true GREAT PLAINS OF CHEYENNE COUNTY INC 250 N ROCK ROAD STE 160 WICHITA KS 67206 481226831 HOSPITAL KS 501(C)(3) 3 GPHA INC true GPHA EMPLOYEE BENEFITS TRUST 250 N ROCK ROAD STE 160 WICHITA KS 67206 476918582 HEALTH PLAN KS 501(C)(9) GPHA INC true CHARITABLE REMAINDER TRUST (1) CHARITABLE TRUST KS GP OF SMITH CTY true CHARITABLE REMAINDER TRUST (1) CHARITABLE TRUST KS GP OF SMITH CTY true CHARITABLE REMAINDER TRUST (3) CHARITABLE TRUST KS GP OF SMITH CTY true false false false false false false false false false false true false true false true false false true false GPHA EMPLOYEE BENEFITS TRUST R 902320 FMV