2025-05-14T14:16:24-05:00 2024-06-30 481026809 Wendling Noe Nelson & Johnson LLC 623 SW 10th Ave Suite 300 Topeka KS 66612 990 2023-07-01 481253246 Pawnee Valley Community Hospital Inc PAWN 6202853161 923 Carroll Ave Larned KS 67550 Shae Veach President 6202853161 2025-05-09 1 0 Eric L Otting P00298454 7852334226 2025-05-09 2023 2025-03-06 01:10:19Z Shae Veach 923 Carroll Ave Larned KS 67550 20040631 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 2 160 94 0 0 572117 46479 20743423 19767423 34183 54684 138228 172045 21487951 20040631 6574 12402 0 0 9393688 9974477 0 0 94232 10436744 9650333 19837006 19637212 1650945 403419 13655211 13833734 10957054 11222055 2698157 2611679 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 17489035 12402 19779473 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. 17489035 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 1 160 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 284429 86101 John Haas Vice President 0.50 X X 0 0 0 Michelle Beckner Treasurer 4.00 36.00 X X 0 394228 92172 Sarah Johnson Director 0.50 X 0 0 0 Edward Herrman Secretary 4.00 36.00 X X 0 813427 167091 Terry Siek Director 4.00 36.00 X 0 276253 62549 Melanie Urban Administrator 40.00 X 0 172236 35925 Crystal Hill Physician 40.00 X 272226 0 36884 Kurtis Herwich Physician 40.00 X 271378 0 18132 Arlo Reimer Physician 40.00 X 199109 0 21654 Dusty Atterbury Physician Assistant 40.00 X 153557 0 32836 Calvin Kruger Physician Assistant 40.00 X 152364 0 8747 1048634 1940573 562091 10 0 1 0 Hays Medical Center 2220 Canterbury Drive Hays KS 67601 Contract Services 3273470 Qualivis LLC PO Box 123847 Dallas TX 75312 Contract Labor 930398 Dobies Health Marketing 110 W 9th Street Suite 100 Kansas City MO 64105 Marketing Services 249525 LocumTenenscom PO Box 405547 Atlanta GA 30384 Contract Labor 176078 Trustmark Health Benefits Inc 62897 Collection Center Drive Chicago IL 60693 TPA Fees 132846 7 15717 30762 46479 Patient service revenue 622000 19288649 19288649 340b drug program 456110 444730 444730 Lab fairs 900099 28773 28773 5271 5271 19767423 54571 54571 12050 0 12050 12050 12050 113 0 113 113 113 Meals sold to employees and guest 622000 159995 159995 159995 20040631 19779473 0 214679 X 12402 12402 206559 206559 7843188 7324928 460601 57659 339024 318016 18539 2469 1016789 957930 51422 7437 568917 520275 44603 4039 2285000 2089633 179144 16223 33502 33502 88902 6000 82902 4537 4537 2386184 2081873 303559 752 154134 154134 104091 19283 84805 3 373685 278541 95144 399923 300462 98341 1120 23605 14161 7055 2389 44101 30887 12220 994 74055 74055 Pharmaceuticals 1865255 1865255 Medical supplies 650956 650956 Repairs & Maintenance 607740 556998 50254 488 Food & Dietary Supplies 206869 165495 41374 347794 221885 125250 659 19637212 17489035 2053945 94232 1048686 1319613 5390371 6353675 2087166 2752373 508126 475819 224526 164987 147105 4249231 2767267 13655211 13833734 1224497 1534032 150000 150000 9582557 9538023 10957054 11222055 X 2698157 2611679 2698157 2611679 13655211 13833734 X 403419 -489897 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 1 4537 0 0 0 4537 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. 2030752 -222460 1808292 1827260 203492 2030752 1624536 202724 1827260 1450099 174437 1624536 1437709 12390 1450099 0.55600 0.44400 0 1 1 0 Beneficial interest in net assets of foundation 2611679 Receivable from related party 556 Other receivables 120032 Estimated third-party payor settlements 35000 2767267 Due to Pawnee County 7885202 Due to Hays Medical Center, Inc. 1177821 Estimated third-party payor settlements 475000 9538023 X 19954153 -86478 -86478 20040631 0 20040631 19637212 0 19637212 0 19637212 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 70982 70982 0.00360 1127524 481707 645817 0.03290 1198506 481707 716799 0.03650 312 312 0.00000 2840401 1332418 1507983 0.07680 12402 12402 0.00060 2853115 1332418 1520697 0.07740 4051621 1814125 2237496 0.11390 1 661606 10343149 10525442 -182293 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 23 1 0 1 1 X https://pawneevalleyhospital.com/wp-content/uploads/2024/06/CHNA_2024_Pawne X http://www.pawneecountykansas.com/ X 1 23 1 https://pawneevalleyhospital.com/wp-content/uploads/2024/07/CHNA2024_ImpDet 0 1 X 130.000000000000 400.000000000000 X X X X X X 1 1 X X X 1 X https://pawneevalleyhospital.com/billing/#financial-assistance-policy X https://pawneevalleyhospital.com/billing/#financial-assistance-policy X X X X 1 X 0 X X X X 1 X 0 0 Pawnee Valley Community Hospital, Inc. Part V, Section B, Line 5: The CHNA was conducted in collaboration with the Pawnee County Health Department. A Town Hall meeting was conducted in February 2024 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, Country Living of Larned, The Center for Counseling & Consulation, Heart of Kansas Family Health Care, Larned Police Department, 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, local business owners, 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. (PVCH) conducted its fifth Community Health Needs Assessment (CHNA) along with the Pawnee County Health Department in 2024. 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.Substance Abuse (Drugs & Alcohol) - 16.3%Mental Health (Diagnosis, Placement, Aftercare, Access to Providers) - 14.0%Childcare (Accessible & Affordable) - 11.6%Provide Youth Activities - 8.5%Physician Recruitment (Primary Care-MD's, DO's) - 7.8%Health Education (Chronic/Prevention) - 6.2%Obesity (Exercise & Nutrition) - 5.4%Physical Activities for Adults - 5.4%Visiting Specialists (Onc, Ortho, CV, OBGYN, ENT, NEP, DERM) - 5.4%The Town Hall meeting also noted the Community's Health Strengths, which are listed below.Three family medicine clinicsEMT, Fire Dept and Hospital have strong collaborationThriving hospitalAccess to recreation and exerciseOpioids dispense is minimalQuality Health DeptBi-annual health fairQuality and affordable long-term careChildcare committee - improving childcareSeveral internet providers/strong connectionAvailable mental health/crisis servicesSchool programs for parent involvement and educationCommunity involvementState Hospital offers continuing educationOn the 2024 CHNA Implementation Plan, it is noted that several areas are not part of hospital mission critical operations and that PVCH will be a partner with others to address these needs. These needs and the lead partner are listed below.Substance Abuse (Drugs & Alcohol) - Center for Counseling and Pawnee County Health Dept.Mental Health (Diagnosis, Placement, Aftercare, Access to Providers) - Center for Counseling and Pawnee County Health Dept.Childcare (Accessible & Affordable) - Pawnee County Childcare CoalitionProvide Youth Activities - Pawnee Co Youth Initiative Foundation/Larned Rec CenterPhysical Activities for Adults - Pawnee Co Youth Initiative Foundation/Larned Rec CenterThe remaining CHNA Health Areas of Need will be addressed with PVCH as the lead partner. Updates to the progress are outlined below.Physician Recruitment (Primary Care-MD's, DO's) and Visiting Specialists (Onc, Ortho, CV, OBGYN, ENT, NEP, DERM) - Heart of Kansas recruited a family medicine physician to work at the Larned, KS clinic.Pawnee Valley Community Hospital recruited a Board-Certified Emergency Medicine Physician to replace the resigning Emergency Department Medical Director.The Pawnee Valley Community Family Medicine Clinic family medicine physician is engaged with the Kansas Osteopathic Medicine School to receive a medical student for rotation during 2025-2026 school year.Family medicine physician at Healthy Choice Clinic engaged with the Kansas Osteopathic Medicine School and received a medical student during the 2024-2025 school year. Rotation included Pawnee Valley Community Hospital.Added additional Specialty Care Clinic days for Cardiology Nurse Practitioner from HaysMed DeBakey Heart Institute.Pawnee Valley Community hospital is actively engaged in conversations and work to add the following additional specialty care services: Psychiatric Mental Health Nurse Practitioner Rheumatology Telehealth ServicesThe Pawnee Valley Community Family Medicine Clinic family medicine physician is partnered with the HaysMed Center Women's Health to provide an obstetrical shared care model. Health Education (Chronic/Prevention) - Pawnee Valley Community Hospital Family Medicine clinic implemented and is growing a Chronic Care Management Program with ChartSpan.Pawnee Valley Community Hospital engaged and trained a Pawnee Valley Community Hospital Family Medicine clinic family medicine nurse practitioner to teach Chronic Care Management classes quarterly.Pawnee Valley Community Hospital provided education on occupational therapy services and benefits via newspaper and social media to the community in addition to the Occupational Therapist attending civic group meetings to provide the education.Pawnee Valley Community Hospital initiated a vaccine campaign educating the community on vaccines and the important role they play in health prevention and public health.Obesity (Exercise & Nutrition)Pawnee Valley Community Hospital Family Medicine clinic initiated a women's health campaign which included obesity/weight loss services for women (education, medication treatment, exercise regimens, etc.) Pawnee Valley Community Hospital, Inc. Part V, Section B, Line 13h: The balance of the patient account is also considered. 1 1 - Pawnee Valley Hospital Family Medicine 713 W 11th St Larned KS 67550 Family Medicine Part I, Line 7: A cost-to-charge ratio derived from Worksheet 2 was used to determine financial assistance at cost and the cost of subsidized health services. A cost-to-charge ratio derived from Worksheet 2 was used to determine the costs of serving Medicaid beneficiaries. Part I, Line 7g: Subsidized health services community benefit expenses include $1,869,006 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, 2024. Part III, Line 9b: Whenever possible, the customer service representatives (CSR's) of Pawnee Valley Community Hospital try to determine the estimated self-pay balance prior to the patient receiving services. Charity care eligibility is first considered at this point in time. In addition, if full payment is not received or payment is not made with 30 days, the patient will receive a statement that includes instructions on how to obtain a FAP application. If the patient contacts the CSR and it is determined that at least a one-year payment plan cannot be established with the patient, the CSR will mail a FAP application upon request or direct the patient to the website to print one 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 $63,625. Approximately 12.8% of the total population was below the poverty line. Approximately 7.4% of the hospital's revenue is from services provided to patients eligible for Medicaid. Pawnee Valley Community Hospital, Inc. is the only hospital in Larned, Kansas. It mainly serves the communities in Pawnee County, Kansas. Part VI, Line 5: Pawnee Valley Community Hospital, Inc. promotes the health of the community by extending medical privileges to most qualified, local physicians. Part VI, Line 6: Pawnee Valley Community Hospital, Inc. is not part of an affiliated health care system. 0 1 0 0 0 0 0 0 0 Edward Herrman Secretary 0 685170 0 81491 0 46766 0 133169 0 33922 0 980518 0 0 Michelle Beckner Treasurer 0 313223 0 30391 0 50614 0 58602 0 33570 0 486400 0 0 Shae Veach President 0 241040 0 24926 0 18463 0 55716 0 30385 0 370530 0 0 Terry Siek Director 0 232775 0 26047 0 17431 0 52945 0 9604 0 338802 0 0 Crystal Hill Physician 231365 0 20000 0 20861 0 13252 0 23632 0 309110 0 0 0 Kurtis Herwich Physician 235000 0 14000 0 22378 0 8700 0 9432 0 289510 0 0 0 Arlo Reimer Physician 186539 0 10000 0 2570 0 3354 0 18300 0 220763 0 0 0 Melanie Urban Administrator 0 146267 0 24326 0 1643 0 8836 0 27089 0 208161 0 0 Dusty Atterbury Physician Assistant 139542 0 1221 0 12794 0 7855 0 24981 0 186393 0 0 0 Calvin Kruger Physician Assistant 144472 0 3061 0 4831 0 7595 0 1152 0 161111 0 0 0 Part I, Line 3 A related organization uses a compensation committee, independent compensation consultant, written employment contract, and approval by the board or compensation committee to establish the compensation of the Hospital's Administrator. Part I, Line 4b Contributions to the plan: Edward Herrman - $116,669 Michelle Beckner - $48,750 Shae Veach - $41,128 Terry Siek - $39,114 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 January 2024. 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 639,972. Management and general expenses 0. Fundraising expenses 0. Total expenses 639,972. Medical provider fees: Program service expenses 226,959. Management and general expenses 0. Fundraising expenses 0. Total expenses 226,959. Laboratory services: Program service expenses 156,050. Management and general expenses 2,152. Fundraising expenses 0. Total expenses 158,202. Consulting services: Program service expenses 0. Management and general expenses 14,450. Fundraising expenses 0. Total expenses 14,450. Recruiting fees: Program service expenses 1,981. Management and general expenses 2,003. Fundraising expenses 0. Total expenses 3,984. Other non-provider medical professional fees: Program service expenses 358,452. Management and general expenses 0. Fundraising expenses 0. Total expenses 358,452. Collection and billing fees: Program service expenses 108,173. Management and general expenses 101,324. Fundraising expenses 0. Total expenses 209,497. Other purchased services: Program service expenses 590,286. Management and general expenses 183,630. Fundraising expenses 752. Total expenses 774,668. Form 990, Part XI, line 9: Change in beneficial interest in net assets of foundation -86,478. Transfers to Pawnee County -403,419. Form 990. Part XII, Line 2c Hays Medical Center, Inc. has a Compliance committee that is responsible for the oversight of Pawnee Valley Community Hospital, Inc.'s financial statement audit and the selection process of an independent auditor. HaysMed Partners Inc (HMed) 2220 Canterbury Dr Hays KS 67601 270877152 Management contract for Pawnee Valley Community Hospital KS 501(c)(3) Line 3 Hays Medical Center Inc 1 Hays Medical Center Inc 2220 Canterbury Dr Hays KS 67601 480559088 Hospital KS 501(c)(3) Line 3 0 Pawnee Valley Community Hospital Foundation 923 Carroll Ave Larned KS 67550 455333776 Support the activities and mission of the Hospital KS 501(c)(3) Line 12a Pawnee Valley Community Hospital 1 0 0 1 0 1 0 0 0 0 0 1 0 1 0 1 1 1 0 0 Pawnee Valley Community Hospital Foundation O 69797 FMV