2023-10-02T15:33:27-05:00 2022-12-31 FORVIS LLP 1551 N WATERFRONT PKWY STE 300 WICHITA KS 672066601 990 2022-01-01 481226831 GREAT PLAINS OF CHEYENNE COUNTY INC % JASON BARB GREA 3166851523 250 NORTH ROCK ROAD STE 160 WICHITA KS 67206 JASON BARB CFO 3166851523 2023-05-15 true Dave Dellasega 999009999 SHAWNELL LINOT P01663908 3162652811 2 2022 2023-04-26 12:10:37Z JASON BARB 250 NORTH ROCK ROAD STE 160 WICHITA KS 67206 17649527 false X WWW.CHEYENNECOUNTYHOSPITAL.COM X 1999 KS TO OPERATE AN ACUTE CARE HOSPITAL THAT PROVIDES MEDICAL CARE TO THE GENERAL PUBLIC IN ST. FRANCIS, KANSAS AND SURROUNDING RURAL COMMUNITIES IN CHEYENNE COUNTY, KANSAS. 7 6 124 7 0 2564989 1420671 11604462 11995706 22148 45893 3308757 4187257 17500356 17649527 0 0 0 0 7807464 8448082 0 0 0 7789042 9162066 15596506 17610148 1903850 39379 7788947 7958360 1976625 2106659 5812322 5851701 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 15188608 0 11995706 Cheyenne County Hospital (CCH) is a Critical Care Access, Level IV Trauma 16 bed hospital providing emergency, acute and swing bed care to Cheyenne County and surrounding areas; it employs two full time physicians, three physician assistants (PA-C), 19 registered nurses (RN/PRN), a certified registered nurse anesthetist (CRNA), and other allied health professionals. SEE SCHEDULE O FOR CONTINUATION. 15188608 true true false true false false false false false false true false false true false false true 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 58 0 true 124 true false false false false false false false false false false false false X 7 6 true true 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 BENJAMIN BOSEN PHYSICIAN 40.0 0.0 X 446633 0 55971 HEATHER LICKE PHYSICIAN 40.0 0.0 X 410682 0 34007 JEFFREY PARSONS NURSE PRACTIONER 40.0 0.0 X 322703 0 10089 CURT COLSON PRESIDENT/DIRECTOR 0.25 40.0 X X 0 216245 60227 BOBBY RAMSEY ADMINISTRATOR 40.0 0.0 X 208285 0 24145 JASON BARB CFO 0.25 40.0 X 0 176924 49870 HEIDI TICE CFO 40.0 0.0 X 130934 0 28541 BRENDA HAYS NURSE 40.0 0.0 X 129728 0 20968 SHARA JOHNSON DEPARTMENT HEAD 40.0 0.0 X 115525 0 20898 DAVE DELLASEGA PRESIDENT/SECRETARY/DIRECTOR 0.25 40.0 X X 0 56610 18962 DURREL KELLEY SENIOR VP OF OPERATIONS 0.25 40.0 X X 0 55687 8928 ARTHUR HENDRICKSON DIRECTOR 0.25 2.25 X 0 0 0 CHARLES WESTIN CHARIMAN/DIRECTOR 0.25 2.25 X X 0 0 0 DR BARBARA BROWN APPLEGATE DIRECTOR 0.25 2.25 X 0 0 0 JOHN TERRILL CHARIMAN/DIRECTOR 0.25 2.25 X X 0 0 0 ROGER JOHN SECRETARY/DIRECTOR 0.25 2.25 X X 0 0 0 STEVE CARLSON TREASURER/DIRECTOR 0.25 2.25 X X 0 0 0 1764490 505466 332606 14 false true false MID KANSAS CRNA 404 W WEBSTER ST FRANCIS KS 67756 CONTRACTED CRNA 282406 KRUCIAL STAFFING PO BOX 25826 OVERLAND PARK KS 66225 CONTRACTED NURSING 267180 PSYCHIATRIC MEDICAL CARE LLC PO BOX 734606 DALLAS TX 753734606 SENIOR LIFE PROVIDER 463337 GPHA 250 NORTH ROCK ROAD STE 160 WICHITA KS 67206 MGMT, CBO, COMP SUPP 965881 DOCS WHO CARE 14710 SOUTH CHALET OLATHE KS 66061 LOCUM TENAN 133987 7 1092755 327916 1420671 PATIENT SERVICE REVENUE 621300 11995706 11995706 11995706 34589 34589 0 0 2162 2162 0 2162 2162 11304 11304 11304 11304 0 0 0 0 0 0 0 0 0 EMPLOYEE/GUEST MEALS 722513 28474 28474 HEALTH FAIR 900099 148595 148595 340B DRUG PRICING PROGRAM 446110 3910709 3910709 97317 97317 4185095 17649527 11995706 4233150 X 0 0 0 0 391906 391906 0 6290112 5677875 612237 472325 413262 59063 858025 660576 197449 435714 369477 66237 98695 98695 6762 6762 72307 72307 2129 2129 0 0 3304211 2635874 668337 0 36923 30 36893 535881 499756 36125 1681 1681 0 255719 207504 48215 12453 11683 770 0 54674 45426 9248 22088 18737 3351 0 386307 371427 14880 84950 76052 8898 MEDICAL SUPPLIES & DRUGS 3523354 3523149 205 0 EQUIPMENT RENTAL & MAINTENANCE 537202 516310 20892 0 RECRUITING 45979 41245 4734 0 DUES & SUBSCRIPTIONS 45889 11705 34184 0 134862 106839 28023 17610148 15188608 2421540 0 970413 1086754 2277126 2999681 0 0 2022834 1424273 0 0 0 0 0 0 208452 182070 6852 44447 7799299 6024928 1765494 1774371 0 0 0 0 6413 9165 0 0 531363 437599 7788947 7958360 1492692 1578060 0 0 317157 0 0 0 0 0 0 0 166776 528599 0 0 0 0 1976625 2106659 X 5624009 5765092 188313 86609 5812322 5851701 7788947 7958360 39379 X false true X true true true X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false true 2129 false false false 2129 false SCHEDULE C, PART II-B, LINE 1F A PORTION OF THE ANNUAL DUES PAID TO KHA AND AHA ARE USED FOR LOBBYING. 9040 9040 3312290 2796349 515941 4223393 3066876 1156517 254576 161703 92873 1774371 DUE FROM THIRD PARTY 38884 340B AR 282249 OTHER CURRENT ASSETS 116466 437599 17649527 17649527 17649527 17610148 17610148 17610148 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 169344 169344 0.00960 988148 590821 397327 0.02260 1157492 590821 566671 0.03220 508071 365721 142350 0.00810 508071 365721 142350 0.00810 1665563 956542 709021 0.04030 false 385075 6487009 6487009 X true true 1 1 GREAT PLAINS OF CHEYENNE COUNTY INC 210 W FIRST STREET ST FRANCIS KS 67756 WWW.CHEYENNECOUNTYHOSPITAL.COM H012001 X X X X GREAT PLAINS OF CHEYENNE COUNTY INC 1 false false true X X X X X X X X X 20 true false true true X SEE SCHEDULE H, PART V, SECTION C X X true 20 true SEE SCHEDULE H, PART V, SECTION C false true X 200. 0. X 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, SECTION B, LINE 5 A PRIORITY OF THE PROGRAM IS TO SOLICIT INPUT FROM A BROAD CROSS SECTION OF THE COMMUNITY, NOT SIMPLY MEMBERS OF THE LOCAL HEALTHCARE SECTOR. THE MEETING PARTICIPANTS INCLUDED COMMUNITY RESIDENTS AND GOVERNMENTAL AND BUSINESS LEADERS WITHIN THE COMMUNITY. SCHEDULE H, PART V, SECTION B, LINE 6B THE ASSESSMENT PROCESS WAS INITIATED BY BOTH CHEYENNE COUNTY HOSPITAL AND CHEYENNE COUNTY HEALTH DEPARTMENT WITH THE CONSULTANT CAROL SLOPER. SCHEDULE H, PART V, LINE 7A HTTPS://WWW.CHEYENNECOUNTYHOSPITAL.COM/ABOUT_US/2020_COMMUNITY_HEALTH_NEED S_ASSESSMENT.ASPX SCHEDULE H, PART V, LINE 7D THE CHNA RESULTS WERE SHARED AT A TOWN HALL MEETING. SCHEDULE H, PART V, LINE 10A HTTPS://WWW.CHEYENNECOUNTYHOSPITAL.COM/ABOUT_US/2020_COMMUNITY_HEALTH_NEED S_ASSESSMENT.ASPX SCHEDULE H, PART V, LINE 11 A number of priorities were determined through the 2020 Community Health Needs Assessment (CHNA) and addressed by Cheyenne County Hospital. 1) Mental Health Services (Local Availability, Cost, Substance Recovery Services) One of the top priorities identified in the 2020 CHNA was access and local availability to behavioral and mental health services. In efforts to meet this need, Cheyenne County Hospital (CCH) obtained the necessary funding for High Plains Mental Health to provide on site services at CCH for the 2021 calendar year. Due to COVID restrictions, High Plains Mental Health provided remote services via the Zoom platform through the months of January and February 2021. On site services at the hospital resumed in March 2021. CCH will also continue to support and provide the on-site services of Senior Life Solutions which is in the lower level of Cheyenne County Clinic. 2) Health Care Providers (Retain, Recruit, Consistency, Availability, Quality) Another top priority noted in the assessment, was the need to address the concern of the limited number and availability of quality health care providers. This was a need that CCH Leadership and Board of Directors had already identified and were working towards. Recruiting for medical staff is a high priority at the facility, along with continually seeking solutions and options for the retention of staff. A very important aspect of hiring any new staff member is the importance of having them live in the area and become part of the local community. To address this need, CCH leadership and Board of Directors had implemented active recruiting efforts. Through those efforts, CCH has successfully recruited two new providers Dr. Benjamin Bosen, DO and Steve Allen, PA. 3) Retaining/Recruiting Jobs in Cheyenne County (Attract Youth, Economic Development) CCH Leadership and Board of Directors acknowledges that they may not be able to have a direct impact in meeting this need which may be better addressed through other local organizations. However, CCH has held job fairs, provided job shadowing opportunities for students from local schools, and offered student scholarships for graduating Seniors who are pursuing a career in the medical field. CCH has also partnered with Nex-Generation to provide high school and college students with internship opportunities at the hospital, health department, and clinic. Through this internship program, students will gain valuable insight into local career opportunities in the healthcare field and potentially encourage them to return home following college to pursue that career. 4) Local Access to Health Care Specialists The 2020 CHNA also identified the need for local access to Health Care Specialists. CCH has already moved toward increased local access to specialty services and opportunities. Currently CCH offers Obstetric Services with both Dr. Heather Licke, MD and Dr. Benjamin Bosen, DO providing those services locally. CCH also offers an on-site cardiology clinic with Cardiologist Dr. Sean Denney, MD including on-site stress tests and cardiac rehab. Dr. Matthew Uyemura provides on-sight Ophthalmology services, including cataract surgeries on a monthly basis. Laparoscopic, Colorectal, and General surgery is offered twice a month with Dr. Charles Frankum, MD. The latest addition to the specialty services offered on-site at CCH are the Audiology services of Dr. Rachel McArthur. CCH will continue evaluate the feasibility of other possible services for it's patient population and is currently further developing both it's on-site wound care services and interventional pain management services. SCHEDULE H, PART V, LINE 16A HTTPS://WWW.CHEYENNECOUNTYHOSPITAL.COM/PATIENTS_VISITORS/FINANCIAL_ASSISTA NCE.ASPX SCHEDULE H, PART V, LINE 16B HTTPS://WWW.CHEYENNECOUNTYHOSPITAL.COM/PATIENTS_VISITORS/FINANCIAL_ASSISTA NCE.ASPX SCHEDULE H, PART V, LINE 16C HTTPS://WWW.CHEYENNECOUNTYHOSPITAL.COM/PATIENTS_VISITORS/FINANCIAL_ASSISTA NCE.ASPX 2 CHEYENNE COUNTY CLINIC - ST FRANCIS 221 W 1ST STREET ST FRANCIS KS 67756 OUTPATIENT CLINIC CHEYENNE COUNTY CLINIC - BIRD CITY 233 W 4TH STREET BIRD CITY KS 67731 OUTPATIENT CLINIC 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 UNDERINSURANCE STATUS. SCHEDULE H, PART I, LINE 7 THE COSTING METHODOLOGY USED TO CALCULATE THE AMOUNTS CONTAINED IN THE TABLE OF PART I, LINE 7, OF SCHEDULE H, IS A COST TO CHARGE RATIO. SCHEDULE H, PART I, LINE 7, COLUMN F NOT APPLICABLE DUE TO ADOPTION OF ASU 606 REVENUE FROM CONTRACTS WITH CUSTOMERS. 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 REASONABLE 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 ASU 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 CHARGES AND CHARGES NOT TO BE COLLECTED DUE TO FINANCIAL ASSISTANCE COMPUTATIONS ARE EXEMPT FROM COLLECTION POLICIES AND PRACTICES. THESE ACCOUNTS ARE REMOVED FROM THE COLLECTION CYCLE. SCHEDULE H, PART VI, LINE 2 Cheyenne County will continue to offer community health fairs to expose residents to health care resources and careers. In addition, the hospital partners with the schools in the county and nearby colleges to spread awareness on jobs that are available in healthcare on the local level. Cheyenne County is determined to grow our own providers and health care workers by spending time on open houses, job shadowing, and fostering our relationships with the schools and close by local hospitals. Cheyenne County Hospital conducts a community health needs assessment every three years to identify the most urgent needs of our county. Hospital leadership then creates a Community Health Improvement Plan and implementation strategy which is adopted by the hospital Board of Directors. The hospital leaders will use criteria such as urgency, severity, feasibility, disparities, or community established priorities to determine the needs in that will formally be address. In 2022, we continued COVID-19 community awareness and community education throughout the hospital, clinics, and County Health Department which included importance of COVID-19 vaccines. We continue to utilize local and surrounding area newspapers to share health information, hospital service education, employment opportunities, and news related information throughout the year. We also continue to update our hospital website and share information on our Facebook page on a regular basis. We run local radio ads year-round that share information regarding our providers and the services we provide. In 2022, we held a modified Health Fair that met COVID restrictions but also allowed us to continue serving our community. The mental health needs for all age groups in the country have made their mark on what we need to look at and accomplish in the next few years. Cheyenne County Hospital has successfully initiated an outpatient Geriatric Psych program that addresses personal loss, changes that all people of later years go through, depression, and other age change illnesses. We are taking on the role of spearhead as we are working on the local level with the county government, law enforcement, schools, clergy to establish a long-lasting task force that will address the ongoing concerns of mental health issues of today and into the far-reaching future. We take great care to look at educating all staff on the delivery of mental health services. SCHEDULE H, PART VI, LINE 3 Cheyenne County Hospital's Financial Assistance Program includes both a charity care program and a sliding scale discount that takes into consideration a patient's household income and qualifying assets. A Cheyenne County Hospital financial counselor consults with private pay patients to see if they qualify for financial assistance. CCH has posted information regarding the availability of financial assistance throughout its facilities and on their website. If discovered during the accounts receivable collection process that a patient is having trouble paying bills, both the hospital, clinic and the centralized billing office will inform the patient that financial assistance is available. As part of the financial assistance program all applicants must apply for assistance with The Midland Group. The Midland Group focuses on helping patients find assistance through Medicaid or any other funding available to help meet patient needs. If after the initial interview there is consensus that the patient may qualify for financial assistance, the financial counselor provides to the patient the necessary forms in addition to soliciting supporting documentation for the request (patient bank statements, tax returns, etc.). Computations based on current Federal Poverty Level Guidelines are completed to see if qualifications are appropriate and the percentage of charges to be written off is determined based on family size and household income. Additionally, with the implementation of the Affordable Care Act health insurance information is made available for patients and their families regarding the Insurance Marketplace as well as instruction on how to contact a navigator for assistance. All instances of charity care are approved by the Administrator or designated representative of the Hospital. The sliding fee scale is limited to the clinic where the care was obtained. The clinic also has a prescription assistance program which leverages indigent drug programs offered by pharmaceutical companies. Additionally, the hospital has posted its' charge master on its website (www.cheyennecountyhospital.com) to ensure health consumers have a reasonable expectation of charges. SCHEDULE H, PART VI, LINE 4 Cheyenne County Hospital serves patients chiefly from the geographical boundaries of Cheyenne County, Kansas; this includes the primary population centers of St. Francis and Bird City. Additionally, patients from surrounding communities including McDonald, Atwood, Goodland, Kansas, as well as Burlington, Idalia, and Wray, Colorado, and Hagler and Benkelman, Nebraska patron our facility. Cheyenne County is the remote northwestern most county of Kansas and is bordered by Dundy County, Nebraska to the north; Yuma and Kit Carson Counties in Colorado to the West; Sherman County, Kansas to the south; and Rawlins County, Kansas to the east. We are equidistant between Denver, Colorado and Hays, Kansas; each being 180 miles away. Cheyenne County Hospital (CCH) is the last hospital westbound on US Highway 36 until reaching the Denver Metro Area. Cheyenne County has a population estimate of approximately 2,700 residents as of July 1, 2019, lower than the Kansas Rural Norm of 9,240. The percent change in population in Cheyenne County from April 1, 2010 to July 1, 2019 is -2.5%, higher than the Kansas Rural Norm of -2.0%. The percent of persons 65 years and over in Cheyenne County is 27.3%, higher than the Kansas Rural Norm of 20.9%. The percent of white alone persons in Cheyenne County is 97.0%, higher than the Kansas Rural Norm of 94.6%. The percent of Hispanic or Latino persons in Cheyenne County is 7.1%, higher than the Kansas Rural Norm of 4.6%. The percent of languages other than English spoken at home by persons age 5 years+ is 8.3%, higher than the Kansas Rural Norm of 3.9%. The percent of persons age 1 year+ living in the same house as one year ago in Cheyenne County is 92.1%, higher than the Kansas Rural Norm of 87.0%. The total veterans in Cheyenne County is 218, lower than the Kansas Rural Norm of 697. The population per square mile in Cheyenne County is 2.7, lower than the Kansas Rural Norm of 11.8. The percent of child in single-parent households in Cheyenne County is 22.0%, lower than the Kansas Rural Norm of 25.2%. The percent of limited access to healthy foods in Cheyenne County is 37.0%, higher than the Kansas Rural Norm of 14.1%. SCHEDULE H, PART VI, LINE 5 The hospital provides for and promotes the health of the citizens of Cheyenne County by offering the following services: diabetes education/counseling, smoking prevention/cessation and control, COVID-19 screening and immunizations, health education for students, prenatal classes and numerous other tailored programs. Health fairs are offered both in the fall and spring each year through the County Health Department. Our professional staff, including two Physicians, three Nurse Practitioners, one Physician Assistant, RN's, LPN's and physical and respiratory therapy staff, provide community education on a variety of health issues in a variety of venues. During the flu season we offer numerous immunization clinics to provide much needed flu vaccinations to our populace. Prior to the start of the school year, we also offer free annual sports physicals to area athletes. We promote cancer awareness by supporting the annual Relay for Life activities in Cheyenne County. In conjunction with the community ambulance service the hospital sponsors CPR and NRP training for professionals in Cheyenne County. The CCH physical therapist conducts in-home safety assessments for county residents to prevent trips and falls as well as assessments to decide if patients can return to their homes. The Hospital maintains biohazard equipment that can be used in the event of toxic spills or biohazard emergencies in the County to include isolation rooms and showers. Equipment for airborne pathogens is also available. The Hospital annually participates in Emergency Preparedness Trainings with local police and firefighting units within the county and region. The Decontamination Team, which is comprised of hospital healthcare professionals, practices various drills and rehearsals to ensure preparedness. Cheyenne County started an outpatient geriatric psych service in the latter part of 2017. The service is called Senior Life Solutions which is an intensive outpatient psychiatric program designed to meet the needs of adults over the age of 65 in our community. CCH also partners with High Plains Mental Health to provide mental health counseling services to patients of all ages at the hospital campus. The program addresses issues such as depression and anxiety that can often be related to aging. The patient is offered services by an interdisciplinary team of caring, experienced, behavioral health professionals, which includes a psychiatrist, licensed therapist, and a registered nurse. Cheyenne County Hospital also participates in a variety of community building activities. The hospital makes its fitness equipment available to Cheyenne County citizens for a minimal monthly cost. The hospital is very active in community education on the benefits of immunizations for the prevention of influenza, pneumonia, and COVID-19. We work through the Cheyenne County Health Department, nursing home, rural health clinics and the local pharmacy to improve immunization rates. CCH additionally partners closely with the County EMS in the delivery of emergency services; approximately 50% of ambulatory services/transfers have a Cheyenne County Hospital employee on board. Additionally, with the assistance of federal and private grants, CCH helped launch a revolutionary program whereby patients with two or more chronic conditions and/or qualifying cardiac problems receive periodic assessments in their home by a local healthcare professional. CCH additionally serves as a rural rotation site for medical students and residents from various Kansas educational programs and has functioned as a didactic and clinical practice site for vocational institutions throughout the area. Furthermore, CCH continues to provide an annual scholarship program for graduating Cheyenne County students intending to pursue a vocation in healthcare. The Hospital participates in all government healthcare programs/plans which include the following: Medicare, KanCare (United, Sunflower and Amerigroup) and TriCare. The Hospital has received designation from the Medicare Program as a Critical Access Hospital and is the only Hospital in Cheyenne County. Supported by our own medical staff, the Hospital provides 24-hour Emergency Room Care and is a designated Level IV Trauma center. Additionally, multiple specialty physicians provide outpatient care in our facility which greatly mitigates the need for persons in our community to travel long distances for their unique medical needs. To compliment these outpatient services, as mentioned, CCH developed a growing telemedicine program in 2016 which has further enabled local access to expanded scopes of practice. Education promoted by the Hospital throughout the county also provides residents with vital information on how to minimize their afflictions and maximize their quality of life through proactive preventative care. SCHEDULE H, PART VI, LINE 6 The organization is affiliated with Great Plains Health Alliance, Inc. (GPHA), a non-profit 501(c) (3) organization, which provides management services and operational, financial, and accounting support to the Hospital. GPHA is an affiliation of Critical Access hospitals in Kansas and Nebraska that provides networking opportunities with other rural hospitals, communities, and leaders. Although GPHA does not provide services directly to patients, it does provide access to healthcare professionals that may otherwise be cost prohibitive. GPHA provides education and assistance in areas such as Corporate Compliance, HIPAA, Medicare reimbursement, Meaningful Use, hospital finance and many other areas. Additional education/training opportunities are extended through GPHA to Board Members, Business Office Managers, Billers, Medical Records personnel, Directors of Nursing, Administrators, etc. GPHA serves as a vital link to allowing critical access hospitals the ability to offer high quality medicine in frontier population areas. SCHEDULE H, PART VI, LINE 7 N/A false false false false false false false false false BOBBY RAMSEY ADMINISTRATOR 206488 0 0 0 1797 0 20239 0 3906 0 232430 0 0 0 HEIDI TICE CFO 129525 0 0 0 1409 0 12482 0 16059 0 159475 0 0 0 BENJAMIN BOSEN PHYSICIAN 442927 0 0 0 3706 0 29700 0 26271 0 502604 0 0 0 HEATHER LICKE PHYSICIAN 406659 0 0 0 4023 0 29700 0 4307 0 444689 0 0 0 JEFFREY PARSONS NURSE PRACTIONER 321125 0 0 0 1578 0 0 0 10089 0 332792 0 0 0 BRENDA HAYS NURSE 128505 0 0 0 1223 0 12302 0 8666 0 150696 0 0 0 JASON BARB CFO 0 174587 0 0 0 2337 0 2692 0 47178 0 226794 0 0 CURT COLSON PRESIDENT/DIRECTOR 0 213737 0 0 0 2508 0 18997 0 41230 0 276472 0 0 FORM 990, PART VII; SCHEDULE J, PART I, LINE 3 COMPENSATION FOR DURREL KELLEY, DAVE DELLASEGA, JASON BARB, AND CURT COLSON IS PROVIDED BY GREAT PLAINS HEALTH ALLIANCE, A RELATED ORGANIZATION. GREAT PLAINS HEALTH ALLIANCE'S BOARD OF DIRECTORS ANNUALLY APPROVE THE COMPENSATION FOR MR. KELLEY, MR. DELLASEGA, MR. BARB, AND MR. COLSON. 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 Cheyenne County Hospital's aim is to provide safe, high quality, team based healthcare to Cheyenne County, Kansas and surrounding areas. CCH is a critical access hospital serving a frontier area population (population density of 2.70) and has been designated as a Medically Underserved Area since 2005. We provide a variety of care including primary care in two rural health clinics, inpatient care (including acute care), observation, swing bed, intermediate swing bed services and obstetrics. In addition we provide a variety of outpatient and diagnostic procedures and have general surgery performed onsite. We provide 24/7 coverage of an Emergency Room that is staffed with our own providers. Cheyenne County Hospital's most expensive entities in 2022 included our pharmacy with $3,332,734 total expenses. Of this, $2,369,171 was 340b expenses. The pharmacy expense increased this year due to contracting our pharmacy services, which added $16k in expenses for 2022. Our nursing department with $1,988,236 in expenses, which includes $396k for contract nurses. The rural health clinic with $1,753,992 in expenses which includes $65k for contract providers to cover the RHC. Our success by way of these capacities is reflected in the number of patients served, as highlighted below, and the innovative ways with which we continue to find new ways to meet the evolving needs of our patients. Pharmacy: Pharmacy was the largest expense for 2022 with $3,332,734 total expenses. Of this, $2,369,171 was 340b expenses. Nursing: The second largest expense by department for 2022 was nursing. Not only in service to the more than 225 acute inpatients, 51 swing bed admissions, and 41 obstetric admissions in 2022, nursing was instrumental in overseeing key facility services such as Hospital Pharmacy (which included the cost saving 340B program), Infection Control, Case Management, Utilization Review, Education and other outpatient services. Nursing was a key voice on the county's Rural Healthcare Task Force whose major achievement was leveraging federal and private grant dollars to establish a program by which routine and affordable in-home visits can be extended to Cheyenne County's most vulnerable chronically ill patients. Additionally, the nursing department staffed CCH's 24-hour emergency room, providing compassionate care to the more than 949 patients presenting to the ER in 2022 regardless of their ability to pay. In sum, as the primary front line staff for the facility, the nursing department was essential to CCH's ability to extend quality care to approximately 2,700 residents of Cheyenne County. Rural Health Clinic: Our Rural Health Clinic (RHC) is designated as a Safety Net Clinic by the State of Kansas. The clinic served 8,624 patient visits in 2022, focusing on activities concerned with prevention and treatment of common medical problems in an outpatient setting. Care is delivered by primary care practitioners to individuals who present for service regardless of their ability to pay. Expense is often a barrier to care in our community and for that reason the rural health clinic remains responsive to a population often with fixed incomes. In 2022, the RHC was awarded a Primary Care Clinic grant of $106,537. This critical funding assisted the clinic in providing access to quality, community-based healthcare, reducing health disparities for our county's underserved populations, and providing access to prescription drugs for patients that could not otherwise afford medication. As evidence of our commitment to provide quality healthcare to our patient base, in June of 2015 the CCH Rural Health Clinic achieved a Level III certification as a Patient Centered Medical Home (PCMH) from the National Committee for Quality Assurance. Unquestionably, this national accreditation speaks to the commitment of our providers and staff to deliver outstanding medical attention to our patients and the significant process improvements induced by the endeavor is evidence of the clinic's commitment to overcoming traditional rural healthcare barriers. FORM 990, PART VI, SECTION A, LINE 2 DAVE DELLASEGA, DURREL KELLEY, JASON BARB, AND CURT COLSON 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 MEMBER OF GREAT PLAINS OF CHEYENNE COUNTY, 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 FINANCIAL 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:2389046 FORM 990 PART IX LINE 11G DESCRIPTION:BILLING/COLLECTIONS TOTAL FEES:424459 FORM 990 PART IX LINE 11G DESCRIPTION:LAB SERVICES TOTAL FEES:70495 FORM 990 PART IX LINE 11G DESCRIPTION:PHARMACY SERVICES TOTAL FEES:166482 FORM 990 PART IX LINE 11G DESCRIPTION:ADMIN/HUMAN RESOURCES TOTAL FEES:93659 FORM 990 PART IX LINE 11G DESCRIPTION:MAINTENANCE/HOUSEKEEPING TOTAL FEES: FORM 990 PART IX LINE 11G DESCRIPTION:PLANT OPERATIONS TOTAL FEES:150219 FORM 990 PART IX LINE 11G DESCRIPTION:DIETARY SERVICES TOTAL FEES:9851 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 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 ELLINWOOD INC 250 N ROCK ROAD STE 160 WICHITA KS 67206 481226976 HOSPITAL KS 501(C)(3) 3 GPHA INC true GREAT PLAINS HEALTH ALLIANCE 250 N ROCK ROAD STE 160 WICHITA KS 67037 480617739 MANAGEMENT KS 501(C)(3) 3 NA false 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 REPUBLIC COUNTY INC 250 N ROCK ROAD STE 160 WICHITA KS 67037 481226977 HOSPITAL KS 501(C)(3) 3 GPHA INC true GREAT PLAINS OF SMITH COUNTY INC 250 N ROCK ROAD STE 160 WICHITA KS 67206 481226820 HOSPITAL KS 501(C)(3) 3 GPHA INC true GPHA EMPLOYEE BENEFITS TRUST 250 N ROCK ROAD STE 160 WICHITA KS 67037 476918582 HEALTH PLAN KS 501(C)(9) GPHA INC true false false false false false false false false false false false false true false true false false true false GPHA EMPLOYEE BENEFITS TRUST R 720057 ACTUAL