2022-05-16T10:54:15-05:00 2021-06-30 BKD LLP 1201 Walnut Suite 1700 KANSAS CITY MO 641062246 990 2020-07-01 481253246 PAWNEE VALLEY COMMUNITY HOSPITAL INC % GEORGE HARMS TREASURER PAWN 6202853161 923 CARROLL AVE LARNED KS 67550 SHAE VEACH PRESIDENT 6202853161 2022-05-16 true SHAE VEACH XXX-XX-XXXX April Arnold CPA P01559426 8162216300 2022-05-16 3 2020 2022-09-23 18:48:47Z SHAE VEACH 923 CARROLL AVE LARNED KS 67550 23026242 false 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 (SEE SCHEDULE O) 6 2 161 100 0 0 1024860 3731068 17126170 19063912 64318 9661 176866 221601 18392214 23026242 0 0 0 0 8795041 8974847 0 0 0 7223802 8019770 16018843 16994617 2373371 6031625 21161892 24523928 19201379 22505889 1960513 2018039 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 (SEE SCHEDULE O) false false 13295557 0 16773912 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. 13295557 true true false true false false false false false true false false false true true 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 true false false true 0 0 161 true false false false false false false false false false false false false X 6 2 false false false false true true true true true false false true true true true true true true true false X GEORGE HARMS TREASURER 7856235000 2220 CANTERBURY HAYS KS 67601 EDWARD HERRMAN DIRECTOR 4.0 40.0 X 0 566211 134845 CHRISTIAN WHITTINGTON MD DIRECTOR/PHYSICIAN-NONVOTING 40.0 0.0 X 361989 0 46768 GEORGE HARMS TREASURER 4.0 40.0 X X 0 284071 82716 MC HILL PHYSICIAN 40.0 0.0 X 273360 0 43237 SHAE VEACH PRESIDENT 4.0 40.0 X X 0 225143 75272 TERRY SIEK DIRECTOR 4.0 40.0 X 0 226935 58598 DUSTY ATTERBURY APRN 40.0 0.0 X 206226 0 38607 MELANIE URBAN ADMINISTRATOR 1.0 40.0 X 0 137947 33131 DAVID SHERRADEN PHYSICIAN ASSISTANT 40.0 0.0 X 148270 0 9965 CALVIN KRUGER PHYSICIAN ASSISTANT 40.0 0.0 X 148476 0 9754 STACY TROUT PHYSICIAN ASSISTANT 40.0 0.0 X 141632 0 9710 JOHN HAAS VICE PRESIDENT 4.0 0.0 X X 0 0 0 LYNN BARGER SECRETARY 4.0 0.0 X X 0 0 0 1279953 1440307 542603 7 false true false HAYS MEDICAL CENTER 2220 CANTERBURY DR HAYS KS 67601 MEDICAL SERVICES 2946663 QUEST DIAGNOSTICS PO BOX 772976 CHICAGO IL 60677 LABORATORY SERVICES 225039 GE HEALTHCARE PO BOX 96483 CHICAGO IL 60693 EQUIP. MAINTENANCE 173826 ANESTHESIOLOGIST ASSOCIATES OF HAYS PO BOX 821 HAYS KS 67601 ANESTHESIA SERVICES 118054 UNIVERSITY OF KANSAS HOSPITAL AUTHO PO BOX 955772 ST LOUIS MO 631955772 FINANCIAL SERVICES 227563 6 305685 3425383 3731068 Net patient service revenue 622000 18286137 18286137 340b drug program 900099 752318 752318 Outreach therapy services 900099 3499 3499 Lab fairs 900099 21958 21958 19063912 9661 9661 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Meals sold to employees and guest 722210 92828 92828 _ 0 0 _ 0 0 128773 0 128773 221601 23026242 19063912 231262 0 0 0 0 594789 389194 205595 0 6622213 6056844 565369 329195 293630 35565 938240 836876 101364 490410 437428 52982 2290000 2290000 0 99254 99254 3614 3614 0 0 1946075 1946075 92291 92291 129306 122334 6972 124051 74431 49620 0 489436 489436 18989 11225 7764 0 0 3300 3300 0 0 80328 48197 32131 Pharmaceuticals 1265797 1265797 Medical Supplies 1003807 1003807 Dietary 149669 149669 DUES & SUBSCRIPTIONS 153907 153907 169946 78323 91623 16994617 13295557 3699060 0 1115290 879 14496311 19450938 0 0 1960510 2361253 0 0 0 0 0 0 353021 399121 77523 153187 0 0 78725 140511 0 0 0 0 0 0 3080512 2018039 21161892 24523928 1252322 2001245 0 0 3328469 0 0 0 0 0 0 0 0 0 0 0 14620588 20504644 19201379 22505889 X 811559 979302 1148954 1038737 1960513 2018039 21161892 24523928 X 6031625 -5974099 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false true 3614 false false false 3614 false Schedule C, Part II-B, Line 1f 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. 1450099 174437 1624536 1437709 12390 1450099 1193650 244059 1437709 1266232 -72582 1193650 1169777 96455 1266232 1.00000 false true true Beneficial interest foundation 2018039 2018039 0 Pension Liability 140511 Due to Pawnee County 15409580 Due to Hays Medical Center 968257 EST. AMOUNTS DUE TO THIRD-PARTY 3986296 20504644 SCHEDULE D, PART V, LINE 4 DONATIONS ARE REQUESTED FOR SPECIFIC ITEMS OR IMPROVEMENTS TO THE HOSPITAL. WHEN A DONATION IS RECEIVED FOR THAT SPECIFIC ITEM, IT IS RESTRICTED FOR THAT USE BY THE BOARD UNTIL THE SPECIFIC ITEM OR IMPROVEMENT IS PURCHASED. AT ANY ONE TIME, ONE OR MORE SUCH PROJECTS CAN BE IN PROGRESS. true true X true X true X true true false true true 92541 92541 0.00580 1129104 490843 638261 0.03980 1221645 490843 730802 0.04560 1750 1750 0.00010 2500094 953875 1546219 0.09650 2501844 953875 1547969 0.09660 3723489 1444718 2278771 0.14220 true 700074 11374957 11543082 -168125 X true true 1 1 PAWNEE VALLEY COMMUNITY HOSPITAL INC 923 CARROLL AVE LARNED KS 67601 WWW.PAWNEEVALLEYHOSPITAL.COM H-073-002 X X X X PAWNEE VALLEY COMMUNITY HOSPITAL INC 1 false false true X X X X X X X X X 20 true false true true X SEE PART V, SECTION C true 20 true SEE PART V, SECTION C false true X 200. 300. X X X X X true true X X X true X see part v, section c X see part v, section c X see 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 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 REPRESENTATIVES FROM AIR MED CARE/EAGLE MED, CITY OF LARNED, COUNTRY LIVING OF LARNED, USD 495 FORT LARNED, FRICK VET, FUSION BANK, HEART OF KANSAS FAMILY HEALTH CENTER, LARNED AREA CHAMBER OF COMMERCE, LARNED STATE HOSPITAL, PAWNEE COUNTY HEALTH DEPARTMENT, PAWNEE COUNTY SHERIFF'S DEPARTMENT, AND REPRESENTATIVES OF PAWNEE VALLEY COMMUNITY HOSPITAL. THE CHNA WAS COORDINATED AND PRODUCED BY VVV CONSULTANTS, LLC FROM OLATHE, KANSAS. SCHEDULE H, PART V, SECTION B, LINE 6B PAWNEE COUNTY, KS SCHEDULE H, PART V, SECTION B, LINE 7A https://www.pawneevalleyhospital.com/wp-content/uploads/2021/07/June-29-CH NA_2021_PawneeCoKS_Report_Final_052021_Updated-003.pdf Schedule H, Part V, Section B, Line 10A https://www.pawneevalleyhospital.com/wp-content/uploads/2022/01/CHNA2021_I mpDetailPlan_PawneeCoKS_Release1-002.pdf Schedule H, 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 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 Providers Since the Community Health Needs Assessment was conducted toward the end of the fiscal year, most of the work in implementing the plan to address the needs will occur during the next few years. However, on the 2021 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 Department - Drug (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 Department - Insurance Coverage - No lead partner identified at this time The remaining CHNA Health Areas of Need will be addressed with Pawnee Valley Community Hospital as the lead partner in fiscal years 2022 and 2023. Schedule H, Part V, Section B, Line 13B FINANCIAL ASSISTANCE MAY BE GIVEN FOR CATASTROPHIC MEDICAL EXPENSES, EVEN IF PATIENT'S INCOME EXCEEDS THE FEDERAL POVERTY GUIDELINES. Schedule H, Part V, Section B, Line 16A https://www.pawneevalleyhospital.com/wp-content/uploads/2022/01/Financial- Assistance-Policy-PVCH.pdf Schedule H, Part V, Section B, Line 16B https://www.pawneevalleyhospital.com/wp-content/uploads/2021/12/BUS116a-1. pdf SCHEDULE H, PART V, SECTION B, LINE 16C https://www.pawneevalleyhospital.com/billing/financial-assistance-policy-s ummary/ 1 PAWNEE VALLEY MEDICAL PAVILION 713 W 11TH ST LARNED KS 67550 FAMILY MEDICINE SCHEDULE H, 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. SCHEDULE H, PART I, LINE 7G SUBSIDIZED HEALTH SERVICES COMMUNITY BENEFIT EXPENSES INCLUDE $892,409 OF EXPENSES ATTRIBUTABLE TO PHYSICIAN CLINICS THAT HAVE NET OPERATING LOSSES. SCHEDULE H, PART III, LINE 2 COSTING METHODOLOGY: A COST-TO-CHARGE RATIO DERIVED FROM WORKSHEET 2 WAS USED TO CALCULATE BAD DEBT EXPENSE AT COST. SCHEDULE H, PART III, LINE 4 THE FOOTNOTE FROM THE HOSPITAL'S FINANCIAL STATEMENTS FOLLOWS: THE HOSPITAL REPORTS PATIENT ACCOUNTS RECEIVABLE FOR SERVICES RENDERED AT NET REALIZABLE AMOUNTS FROM THIRD-PARTY PAYERS, PATIENTS AND OTHERS. THE HOSPITAL PROVIDES AN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS BASED UPON A REVIEW OF OUTSTANDING RECEIVABLES, HISTORICAL COLLECTION INFORMATION AND EXISTING ECONOMIC CONDITIONS. Schedule H, 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, 2021. Schedule H, 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 CSR contacts the patient. If 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. Schedule H, Part VI, Line 2 AN EFFORT TO UNDERSTAND AND CREATE A HEALTHIER COMMUNITY REQUIRES COLLABORATION AND INPUT FROM MANY COMMUNITY STAKEHOLDERS. THROUGH DATA RESEARCH AND KEY CONVERSATIONS IN THE PAWNEE COUNTY AREA, THIS CHNA PULLS TOGETHER COMMUNITY FINDINGS AND ADDRESSES TOP HEALTH PRIORITIES TO HELP IMPROVE COMMUNITY HEALTH OVER THE NEXT THREE YEARS. THE HOSPITAL ALSO ASSESSES COMMUNITY NEEDS ON AN ANNUAL BASIS IN NUMEROUS WAYS, INCLUDING THROUGH ITS COMPREHENSIVE, DATA DRIVEN, AND ANNUAL STRATEGIC PLANNING PROCESS HEADED BY THE HEALTH SYSTEM. THE HOSPITAL OBTAINS MARKET DATA THROUGH ITS ANNUAL STRATEGIC PLANNING PROCESS. WITH THIS DATA, THE HOSPITAL IDENTIFIES SERVICES RECEIVED BY THE RESIDENTS OF OUR COMMUNITY (DEFINED BY OUR PRIMARY AND SECONDARY SERVICE AREAS). ANY PREDOMINANT SERVICES NOT CURRENTLY OFFERED BY THE HOSPITAL ARE CONSIDERED DURING STRATEGIC PLANNING. THE HOSPITAL ALSO WORKS CLOSELY WITH THE PUBLIC HEALTH COMMISSION AND THE SCHOOL DISTRICT WHEN ASSESSING THESE NEEDS. ANOTHER ELEMENT OF THE COMMUNITY NEEDS ASSESSMENT INVOLVES ANNUALLY UPDATING THE HOSPITAL'S PROVISION OF CARE PLAN AND ITS CRITICAL ACCESS HOSPITAL ANNUAL REPORT. FINALLY, THE HOSPITAL AND RELATED HEALTH SYSTEM ARE ACTIVELY ENGAGED IN A VARIETY OF FORMAL HEALTH PROFESSIONALS EDUCATION PROGRAMS. Schedule H, 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. A financial assistance policy summary is included with every statement that is sent to an uninsured patient. 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. Schedule H, Part VI, Line 4 Pawnee Valley Community Hospital, Inc. is located in Larned, Kansas, which has a population of approximately 4,050 people, as of the 2010 census. The median household income of Larned was $43,250. Approximately 5.9% of families were below the poverty line, and 7.4% of the total population was below the poverty line. Approximately 8.2% 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 community of Larned. Schedule H, Part VI, Line 5 Pawnee Valley Community Hospital, Inc. promotes the health of the community by extending medical privileges to most qualified, local physicians. SCHEDULE H, PART VI, LINE 6 Pawnee Valley Community Hospital, Inc. is a component unit of Hays Medical Center, Inc. As of January 1, 2017, Hays Medical Center, Inc. became a component unit of the University of Kansas Hospital Authority. false true false false false false false false false SHAE VEACH PRESIDENT 0 213835 0 0 0 11308 0 46860 0 28412 0 300415 0 0 GEORGE HARMS TREASURER 0 280931 0 116 0 3024 0 60600 0 22116 0 366787 0 0 EDWARD HERRMAN DIRECTOR 0 560388 0 0 0 5823 0 102600 0 32245 0 701056 0 0 CHRISTIAN WHITTINGTON MD DIRECTOR/PHYSICIAN-NONVOTING 272748 0 20000 0 69241 0 17100 0 29668 0 408757 0 0 0 MELANIE URBAN ADMINISTRATOR 0 136985 0 800 0 162 0 8448 0 24683 0 171078 0 0 TERRY SIEK DIRECTOR 0 226444 0 0 0 491 0 47853 0 10745 0 285533 0 0 MC HILL PHYSICIAN 245000 0 20000 0 8360 0 15900 0 27337 0 316597 0 0 0 DUSTY ATTERBURY APRN 122299 0 1078 0 82849 0 12784 0 25823 0 244833 0 0 0 CALVIN KRUGER PHYSICIAN ASSISTANT 139123 0 1078 0 8275 0 8893 0 861 0 158230 0 0 0 DAVID SHERRADEN PHYSICIAN ASSISTANT 138956 0 893 0 8421 0 5304 0 4661 0 158235 0 0 0 STACY TROUT PHYSICIAN ASSISTANT 140549 0 985 0 98 0 8492 0 1218 0 151342 0 0 0 Form 990, Schedule J, 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. Form 990, Schedule J, Part I, Line 4b CONTRIBUTIONS TO THE PLAN: TERRY SIEK $34,181 GEORGE HARMS $43,500 SHAE VEACH $33,000 EDWARD HERRMAN $85,500 Form 990, Part I, Line 1 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 SERVICE THROUGH EXCEPTIONAL HEALTHCARE AND SERVICE EXCELLENCE. THE ORGANIZATION IS STRIVING TO BE THE BEST CRITICAL ACCESS HOSPITAL IN RURAL AMERICA. Form 990, Part III, Line 1 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. FORM 990, PART IV, LINE 20B THE AUDITED FINANCIAL STATEMENTS FOR THE CURRENT YEAR WERE NOT COMPLETE AT THE TIME OF FILING. THE HOSPITAL HAS ATTACHED THE PRIOR YEAR AUDIT REPORT TO THE RETURN. ONCE THE CURRENT YEAR AUDIT REPORT IS COMPLETE, THE HOSPITAL WILL AMEND THE RETURN. 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. ANY QUESTIONS AND CONCERNS THEY HAVE ARE ADDRESSED AND ANY CORRECTIONS OR CLARIFICATIONS ARE MADE. 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 AND 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 15A & 15B 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 SIMILAR GEOGRAPHIC REGIONS. THE LAST REVIEW WAS CONDUCTED IN APRIL 2020. FORM 990, PART VI, SECTION C, LINE 19 THESE DOCUMENTS ARE NOT MADE AVAILABLE TO THE PUBLIC. Form 990, Part XI, Line 9 Transfers to Pawnee County ($ 6,031,624) Change in assets held by foundation $ 57,525 ------------ Total ($ 5,974,099) Form 990, Part XII, Line 2c THE PAWNEE VALLEY COMMUNITY HOSPITAL, INC. BOARD AND THE HEALTH SYSTEM AUDIT COMMITTEE ARE RESPONSIBLE FOR THE OVERSIGHT OF PAWNEE VALLEY COMMUNITY HOSPITAL INC.'S, FINANCIAL STATEMENT AUDIT AND THE SELECTION PROCESS OF AN INDEPENDENT ACCOUNTANT. HAYSMED PARTNERS INC 2220 CANTERBURY DR HAYS KS 67601 270877152 MANAGEMENT KS 501(C)(3) 3 HMC true HAYS MEDICAL CENTER INC 2220 CANTERBURY DR HAYS KS 67601 480559088 HOSPITAL KS 501(C)(3) 3 UKHA true PAWNEE VALLEY COMMUNITY HOSPITAL FDN 923 CARROLL AVE LARNED KS 67550 455333776 SUPPORT KS 501(C)(3) 12A PVCH true UNIVERSITY OF KANSAS HOSPITAL AUTHORITY 3901 RAINBOW BLVD KANSAS CITY KS 66160 481202402 HOSPITAL KS N/A false ST ROSE HEALTH CENTER 3515 Broadway Great Bend KS 67530 472117443 HEALTH CENTER KS 501(C)(3) 3 UKHA true TURNING POINT THE CENTER FOR HOPE 8900 STATE LINE ROAD STE 240 LEAWOOD KS 66206 431900039 HEALTHCARE KS 501(C)(3) 7 UKHA true KANSAS UNIVERSITY PHYSICIANS INC 3901 RAINBOW BLVD 4070 DELP KANSAS CITY MO 66160 481163756 HEALTHCARE KS 501(C)(3) 10 UKP true KU MEDWEST AMBULATORY SURGERY 7405 RENNER ROAD SHAWNEE KS 66217 020664568 HEALTHCARE KS UKHA false UKH SPORTS MED LLC 2330 SHAWNEE MISSION PKWY STE 200 WESTWOOD KS 66205 463123647 HEALTHCARE KS UKHA false KH ALLIANCE LLC 4000 CAMBRIDGE STREET KANSAS CITY KS 66160 472838147 HEALTHCARE KS UKHA false KANSAS CLINICAL IMPROVEMENT COLLABORATIV 112 SW 7TH STREET SUITE 3C TOPEKA KS 66603 812776361 HEALTHCARE KS UKHA false KANSAS PRIMARY CARE ALLIANCE LLC 2330 SHAWNEE MISSION PKWY SUITE 200 WESTWOOD KS 66205 463164140 HEALTHCARE KS UKHA false UKHS GREAT BEND LLC 2330 SHAWNEE MISSION PKWY STE 312 WESTWOOD KS 66205 830516935 HEALTHCARE KS UKHA false UKHS SPORTS PERFORMANCE CENTER LLC 2330 SHAWNEE MISSION PKWY STE 312 WESTWOOD KS 66205 830888634 HEALTHCARE KS UKHA false UKHS GREAT BEND PHYSICIANS LLC 2330 SHAWNEE MISSION PKWY STE 312 WESTWOOD KS 66205 831255734 HEALTHCARE KS UKHS GREAT BEND false JAYHAWK PRIMARY CARE INC 2300 SHAWNEE MISSION PARKWAY STE 3 WESTWOOD KS 66205 481159444 HEALTHCARE KS UKHA C-CORP true MID-AMERICA CARDIOLOGY ASSOCIATES INC 4000 CAMBRIDGE STREET STE G600 KANSAS CITY KS 66160 480980010 HEALTHCARE MO UKHA C-CORP true UNIVERSITY OF KANSAS PHYSICIANS INC 2330 SHAWNEE MISSION PKWY STE 200 WESTWOOD KS 66205 471214865 HEALTHCARE KS UKHA C-CORP true UKHA PROGRAM SUPPORT INC 2330 SHAWNEE MISSION PKWY STE 200 WESTWOOD KS 66205 455571151 REAL ESTATE KS UKHA C-CORP true false false true false true false false false false false true true true false true true true false false PVCH Foundation C 305685 FMV HAYS MEDICAL CENTER INC E 126287 FMV University of Kansas Health System E 807862 FMV HAYS MEDICAL CENTER INC M 480170 FMV Hays Medical Center Inc O 300578 FMV PVCH Foundation O 79724 FMV Hays Medical Center Inc P 2290000 FMV