2023-05-08T13:38:07-05:00 2022-06-30 481026809 Wendling Noe Nelson & Johnson LLC 623 SW 10th Ave Suite 300 Topeka KS 66612 990 2021-07-01 481253246 Pawnee Valley Community Hospital Inc PAWN 6202853161 923 Carroll Ave Larned KS 67550 Shae Veach President 6202853161 2023-05-05 1 Shae Veach 999009999 Eric L Otting P00298454 7852334226 2023-05-05 0 AAL1 IAL1 2021 2023-04-26 12:10:37Z Shae Veach 923 Carroll Ave Larned KS 67550 18796436 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 2 162 118 0 0 3731068 490693 19063912 18175478 9661 6116 221601 124149 23026242 18796436 0 1557 0 0 8974847 8649758 0 0 94258 8019770 8150669 16994617 16801984 6031625 1994452 24523928 12615152 22505889 10205836 2018039 2409316 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 15143321 1557 18176478 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. 15143321 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 294439 92303 George Harms Treasurer 4.00 36.00 X X 0 347401 96953 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 714451 159447 Terry Siek Director 4.00 36.00 X 0 273415 68253 Lynn Barger Director thru March 2022 0.50 X 0 0 0 Melanie Urban Administrator 40.00 X 0 145421 42522 Crystal Hill Physician 40.00 X 284336 0 46919 Christian Whittington Physician 40.00 X 266238 0 40352 Dusty Atterbury APRN 40.00 X 176582 0 40411 Calvin Kruger Physician Assistant 40.00 X 162754 0 10875 David Sherraden Physician Assistant 40.00 X 150144 0 39596 Bryce Young Former President 0.00 X 0 163726 0 1040054 1938853 637631 10 1 1 0 Hays Medical Center 2220 Canterbury Drive Hays KS 67601 Contract Services 2281644 Favorite Healthcare Staffing Inc PO Box 26225 Overland Park KS 66225 Contract Staffing 736667 GE Precision Healthcare LLC PO Box 96483 Chicago IL 60693 Repairs and Maintenance 218133 Quest Diagnostics PO Box 772976 Chicago IL 60677 Lab Services 187692 Docs Who Care 800 W Frontier Lane Olathe KS 66061 Physician Services 158121 5 28923 383532 78238 490693 Patient service revenue 622000 17515512 17515512 340b drug program 446110 626302 626302 Lab fairs 900099 24815 24815 8849 8849 18175478 6116 6116 1000 0 1000 1000 1000 Meals sold to employees and guest 722210 123149 123149 123149 18796436 18176478 0 129265 X 1557 1557 192632 192632 6946535 6543772 338420 64343 347356 329012 15132 3212 663500 640068 17183 6249 499735 460705 34532 4498 1467395 1352791 101397 13207 35864 35864 84558 84558 2931 2931 3013904 2773556 240238 110 72100 2106 69994 104523 22089 82420 14 165581 124141 41440 370607 278371 91199 1037 19251 16639 2608 4 48996 39004 9991 1 52882 52882 Pharmaceuticals 1115688 1115688 Medical supplies 545138 545138 0 0 Repairs & Maintenance 424787 393512 30930 345 Minor Equipment and Sup 181249 149630 31567 52 445215 302660 141369 1186 16801984 15143321 1564405 94258 879 1046388 19450938 6402975 2361253 1644626 399121 487240 153187 169253 140511 126183 2018039 2738487 24523928 12615152 2001245 1358015 435040 20504644 8412781 22505889 10205836 X 2018039 2409316 2018039 2409316 24523928 12615152 X 1994452 -1603175 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 1 2931 0 0 0 2931 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. 1624536 202724 1827260 1450099 174437 1624536 1437709 12390 1450099 1193650 244059 1437709 1266232 -72582 1193650 0.55000 0.45000 0 1 1 0 Beneficial interest in net assets of foundation 2409316 Receivable from related party 1672 Other receivables 46990 Estimated third-party payor settlements 280509 2738487 Due to Pawnee County 6939779 Due to Hays Medical Center, Inc. 813868 Estimated third-party payor settlements 532424 Other long-term liabilities 126710 8412781 X 19187713 391277 391277 18796436 0 18796436 16801984 0 16801984 0 16801984 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 186257 186257 0.01110 950796 357518 593278 0.03530 1137053 357518 779535 0.04640 2663284 1094264 1569020 0.09340 1557 1557 0.00010 2664841 1094264 1570577 0.09350 3801894 1451782 2350112 0.13990 1 203716 0 9933936 9991132 -57196 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 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/ X https://pawneevalleyhospital.com/billing/ X https://pawneevalleyhospital.com/billing/ 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 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.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 finanical assistance program available to all patients meeting the program's guidlines. PVCH is an active participant along with KHA to support Medicaid expansion in Kansas.Awareness of Health Services - PVCH has 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. PVCH also participates in local Larned Area Chamber Coffee and After Hours to highlight our health services.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 Valley Community Hospital, Inc. Part V, Section B, Line 13h: The balance of the patient account is also considered. 1 1 - Pawnee Valley Medical Associates 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 $1,751,596 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, 2022. 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 receiveing 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 $51,000. Approximately 14.9% of the total population was below the poverty line. Approximately 6.3% 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: As of December 1, 2021, Pawnee Valley Community Hospital, Inc. is no longer part of the University of Kansas Hospital Authority health care system. 1 1 0 0 0 0 0 0 0 Edward Herrman Secretary 0 572500 0 120057 0 21894 0 122833 0 36614 0 873898 0 0 George Harms Treasurer 0 294643 0 49598 0 3160 0 70506 0 26447 0 444354 0 0 Shae Veach President 0 237449 0 41679 0 15311 0 60341 0 31962 0 386742 0 0 Terry Siek Director 0 232879 0 38972 0 1564 0 57473 0 10780 0 341668 0 0 Crystal Hill Physician 251000 0 21250 0 12086 0 16575 0 30344 0 331255 0 0 0 Christian Whittington Physician 191730 0 15000 0 59508 0 15739 0 24613 0 306590 0 0 0 Dusty Atterbury APRN 132206 0 450 0 43926 0 10868 0 29543 0 216993 0 0 0 David Sherraden Physician Assistant 137981 0 450 0 11713 0 9471 0 30125 0 189740 0 0 0 Melanie Urban Administrator 0 138270 0 450 0 6701 0 9187 0 33335 0 187943 0 0 Calvin Kruger Physician Assistant 143297 0 450 0 19007 0 9738 0 1137 0 173629 0 0 0 Bryce Young Former President 0 0 0 0 0 163726 0 0 0 0 0 163726 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 Severance payments: Bryce Young - $163,726 Contributions to the plan: Edward Herrman - $105,433 George Harms - $53,106 Shae Veach - $43,088 Terry Siek - $41,052 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 April 2022. 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 1,076,981. Management and general expenses 89. Fundraising expenses 1. Total expenses 1,077,071. Medical professional fees: Program service expenses 495,083. Management and general expenses 0. Fundraising expenses 0. Total expenses 495,083. Laboratory services: Program service expenses 249,155. Management and general expenses 5,192. Fundraising expenses 0. Total expenses 254,347. Consulting services: Program service expenses 0. Management and general expenses 1,320. Fundraising expenses 0. Total expenses 1,320. Recruiting fees: Program service expenses 0. Management and general expenses 23,307. Fundraising expenses 0. Total expenses 23,307. Non-medical professional fees: Program service expenses 272,923. Management and general expenses 8. Fundraising expenses 0. Total expenses 272,931. Collection and billing fees: Program service expenses 73,637. Management and general expenses 102,170. Fundraising expenses 0. Total expenses 175,807. Other purchased services: Program service expenses 605,777. Management and general expenses 108,152. Fundraising expenses 109. Total expenses 714,038. Form 990, Part XI, line 9: Change in beneficial interest in net assets of foundation 391,277. Transfers to Pawnee County -1,994,452. 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 Kansas University Hospital Authority 1 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 University of Kansas Hospital Authority 3901 Rainbow Boulevard Kansas City KS 66160 481202402 Hospital KS N/A 0 St Rose Health Center 3515 Broadway Great Bend KS 67530 472117443 Health Center KS 501(c)(3) Line 3 Kansas University Hospital Authority 1 Turning Point The Center for Hope 8900 State Line Road Ste 240 Leawood KS 66206 431900039 Healthcare KS 501(c)(3) Line 7 Kansas University Hospital Authority 1 Kansas University Physicians Inc 3901 Rainbow Boulevard Kansas City MO 66160 481163756 Healthcare KS 501(c)(3) Line 10 Kansas University Physicians 1 KU Medwest Ambulatory Surgery 7405 Renner Road Shawnee KS 66217 020664568 Healthcare KS Kansas University Hospital Authority 0 0 UKH Sports Med LLC 2330 Shawnee Mission Pkwy Westwood KS 66205 463123647 Healthcare KS Kansas University Hospital Authority 0 0 KH Alliance LLC 4000 Cambridge Street Kansas City KS 66160 472838147 Healthcare KS Kansas University Hospital Authority 0 0 Kansas Clinical Improvement Collaborative LLC 1809 East 27th Street Hays KS 67601 812776361 Healthcare KS Kansas University Hospital Authority 0 0 Kansas Primary Care Alliance 2330 Shawnee Mission Pkwy Westwood KS 66205 463164140 Healthcare KS Kansas University Hospital Authority 0 0 UKHS Great Bend LLC 2330 Shawnee Mission Pkwy Westwood KS 66205 830516935 Healthcare KS Kansas University Hospital Authority 0 0 UKHS Sports Performance Center 2330 Shawnee Mission Pkwy Westwood KS 66205 830888634 Healthcare KS Kansas University Hospital Authority 0 0 UKHS Great Bend Physicians LLC 2330 Shawnee Mission Pkwy Westwood KS 66205 831255734 Healthcare KS Kansas University Hospital Authority Great Bend 0 0 Jayhawk Primary Care Inc 2300 Shawnee Mission Parkway Ste 31 Westwood KS 66205 481159444 Healthcare KS Kansas University Hospital Authority C 1 Mid-America Cardiology Associates 4000 Cambridge Street Ste G600 Kansas City KS 66160 480980010 Healthcare KS Kansas University Hospital Authority C 1 University of Kansas Physicians Inc 2300 Shawnee Mission Parkway Ste 20 Westwood KS 66205 471214865 Healthcare KS Kansas University Hospital Authority C 1 UKHA Program Support Inc 2300 Shawnee Mission Parkway Ste 20 Westwood KS 66205 455571151 Healthcare KS Kansas University Hospital Authority C 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 84863 FMV