2022-08-15T13:53:54-05:00 2021-09-30 FORVIS LLP 1551 N WATERFRONT PKWY STE 300 WICHITA KS 672066601 990 2020-10-01 481226977 GREAT PLAINS OF REPUBLIC CO INC % DAVE DELLASEGA GREA 3166851523 250 NORTH ROCK ROAD SUITE 160 WICHITA KS 67206 JASON BARB CFO 3166851523 2022-08-15 true JASON BARB 999009999 SHAWNELL LINOT P01663908 3162652811 2 2020 2022-09-23 18:48:47Z DAVE DELLASEGA 250 NORTH ROCK ROAD SUITE 160 WICHITA KS 67206 23614292 false X WWW.RPHOSPITAL.ORG X 1999 KS TO OPERATE AN ACUTE CARE HOSPITAL THAT PROVIDES MEDICAL CARE TO THE GENERAL PUBLIC IN BELLEVILLE, KANSAS AND THE SURROUNDING RURAL COMMUNITIES IN REPUBLIC COUNTY. 8 7 202 10 0 2961020 6913771 13986122 16520477 7375 19092 205615 160952 17160132 23614292 0 0 0 0 8703133 9534382 0 0 0 6874279 8436715 15577412 17971097 1582720 5643195 16991482 16186685 12006886 5558894 4984596 10627791 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 15194420 0 16589039 REPUBLIC COUNTY HOSPITAL'S (RCH) PRIMARY PROGRAM IS THE DELIVERY OF HEALTHCARE AND RELATED SERVICES TO PATIENTS FROM REPUBLIC COUNTY AND CONTIGUOUS COUNTIES IN KANSAS OF CLOUD, JEWELL AND WASHINGTON. SERVICES INCLUDE INPATIENT ACUTE, SURGERY, OUTPATIENT, OBSTETRIC, EMERGENCY ROOM, INTERMEDIATE SWING BED (ISB) AND SKILLED NURSING CARE (SNF). REPUBLIC COUNTY HOSPITAL PROVIDES NEEDED HEALTH CARE SERVICES TO PATIENTS WHO COME TO OUR HOSPITAL FOR CARE, REGARDLESS OF THE PATIENT'S ABILITY TO PAY AND HAS A FINANCIAL ASSISTANCE PROGRAM FOR THOSE PATIENTS WITH LIMITED RESOURCES. SEE SCHEDULE O FOR CONTINUATION. 15194420 true true false true false false false false false false true false false false 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 true true false true 33 0 true 202 true false false false false false false false false false false false false X 8 7 true false false false true true true true true false false true true true true true true false false false X DAVE DELLASEGA 3166851523 250 NORTH ROCK ROAD STE 160 WICHITA KS 67206 X DAVE DELLASEGA PRESIDENT/SECRETARY/DIRECTOR 2.0 40.0 X X 0 207872 33322 BRENT MARTIN CHIEF OPERATING OFFICER 40.0 0.0 X 163692 0 48614 DURREL KELLEY VP OF OPERATIONS 2.25 40.0 X 0 129968 27425 FAYE JONES RISK MANAGER 40.0 0.0 X 113378 0 30739 BARRY BOTTGER CFO 40.0 0.0 X 110772 0 24982 REBECCA BROWN DON 40.0 0.0 X 107974 0 24791 DANIEL KELLY ADMINISTRATOR 40.0 0.0 X 18024 0 1117 DAVE RANKIN CHAIRMAN/DIRECTOR 0.25 2.25 X X 0 0 0 ROBERT HAMILTON SECRETARY/DIRECTOR 0.25 2.0 X X 0 0 0 JOHN TERRILL VICE PRESIDENT/DIRECTOR 0.25 2.25 X X 0 0 0 STEVE CARLSON TREASURER/DIRECTOR 0.25 2.25 X X 0 0 0 DR BARBARA BROWN APPLEGATE DIRECTOR 0.25 2.25 X 0 0 0 ARTHUR HENRICKSON DIRECTOR 0.25 2.25 X 0 0 0 CHARLES WESTIN DIRECTOR 0.25 2.25 X 0 0 0 DAVID-PAUL CAVAZOS ADMINISTRATOR 40.0 0.0 X 0 0 0 JASON BARB CFO 40.0 0.0 X 0 0 0 513840 337840 190990 4 false true false GPHA 250 N ROCK RD STE 160 WICHITA KS 67206 MANAGEMENT AND SERV 859127 PSYCHIATRIC MEDICAL CARE LLC PO BOX 734606 DALLAS TX 753734606 CONTRACT SERVICES 436593 PHILLIP ZAPPA 308 LEATHERWOOD CIRCLE MOUNTAIN HOME AR 72653 CONTRACT SERVICES 166411 LARRY TROSHYNSKI 630 W 101ST PLACE OVERLAND PARK KS 66212 CONTRACT SERVICES 191667 NOLAN BEAVERS 1371 US HWY 36 BELLEVILLE KS 66935 CONTRACT SERVICES 156995 8 6169206 744565 6913771 NET PATIENT SERVICE REVENUE 621300 16520477 16520477 16520477 19092 19092 0 0 7326 7326 0 7326 7326 0 0 0 0 0 0 0 0 0 0 EMPLOYEE/GUEST MEALS 722513 55848 55848 OUTSIDE SERVICES 621300 68562 68562 VENDING INCOME/REBATES 900099 495 495 28721 28721 153626 23614292 16589039 111482 0 0 0 0 182736 182736 0 7347697 6263861 1083836 500184 436352 63832 987861 739700 248161 515904 427442 88462 180846 180846 5940 5940 36711 36711 3680 3680 0 0 3258335 2789334 469001 0 53838 13518 40320 1101376 1012637 88739 0 0 386794 336692 50102 6884 5859 1025 0 22825 17410 5415 3547 3533 14 0 609740 545943 63797 117144 103772 13372 MEDICAL SUPPLIES 1728086 1728086 EQUIPMENT RENTAL & REPAIRS 309891 288345 21546 DUES & SUBSCRIPTIONS 34641 2645 31996 BAD DEBT EXPENSE 477308 477308 99129 1983 97146 17971097 15194420 2776677 0 9196654 7697820 191192 371798 0 0 1981885 3168339 0 0 0 0 2730 3086 204640 211983 102110 132614 18023283 13440261 4491001 4583022 0 0 0 0 0 0 0 0 821270 18023 16991482 16186685 5558473 5501884 0 0 4774046 0 0 0 0 0 0 0 1674367 57010 0 0 0 0 12006886 5558894 X 4919036 10439754 65560 188037 4984596 10627791 16991482 16186685 5643195 X false true X true true true X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false true 3680 false false false 3680 false SCHEDULE C, PART II-B, LINE 1F A PORTION OF THE ANNUAL DUES PAID TO KHA AND AHA ARE USED FOR LOBBYING. 0 14107 14107 0 7930898 7127277 803621 0 9418890 5836958 3581932 0 659388 476026 183362 4583022 23136984 -477308 -477308 23614292 23614292 17493789 17493789 477308 477308 17971097 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. SCHEDULE D, PART XI, LINE 2D PROVISION FOR UNCOLLECTIBLE ACCOUNTS (477,308) SCHEDULE D, PART XII, LINE 4B PROVISION FOR UNCOLLECTIBLE ACCOUNTS 477,308 true true X true X false true true false true true 81759 81759 0.00470 1317949 560726 757223 0.04330 1399708 560726 838982 0.04800 7792 7792 0.00040 425 425 8217 8217 0.00040 1407925 560726 847199 0.04840 false 477308 8809822 8809822 X true true 1 1 REPUBLIC COUNTY HOSPITAL 2420 G STREET BELLEVILLE KS 66935 WWW.RPHOSPITAL.ORG H079001 X X X X 1 REPUBLIC COUNTY HOSPITAL 1 false false true X X X X X X X X X 18 true false true true X SEE SCHEDULE H, PART V, SECTION C X true 18 true SEE SCHEDULE H, PART V, SECTION C false true X 200. 0. X X X X true true 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 THE ASSESSMENT PROCESS WAS INITIATED AND CHAIRED JOINTLY BY REPUBLIC COUNTY HOSPITAL AND THE REPUBLIC COUNTY HEALTH DEPARTMENT. ALL OF THE EDUCATIONAL, GOVERNMENTAL, CIVIC AND HEALTH RELATED ORGANIZATIONS WITHIN THE COMMUNITY WERE INVITED TO PARTICIPATE. SCHEDULE H, PART V, LINE 6B REPUBLIC COUNTY HEALTH DEPARTMENT SCHEDULE H, PART V, SECTION B, LINE 7A https://www.rphospital.org/getpage.php?name=Community_Health_Needs_Assessm ent SCHEDULE H, PART V, SECTION B, LINE 10A https://www.rphospital.org/getpage.php?name=Community_Health_Needs_Assessm ent SCHEDULE H, PART V, SECTION B, LINE 11 THE COMMUNITY HEALTH NEEDS ASSESSMENT IDENTIFIED THREE NEEDS TO PRIORITIZE. OTHER NEEDS WERE NOT ADDRESSED DUE TO A LACK OF FINANCIAL AND OTHER RESOURCES. THE THREE PRIORITIES ARE OUTLINED BELOW. FIRST, REPUBLIC COUNTY HOSPITAL (RCH) IS PROMOTING HEALTH, WELLNESS, AND CHRONIC DISEASE PREVENTION. RCH IS COLLABORATING WITH OTHER PROVIDERS IN THE COUNTY TO PROVIDE EDUCATION RESOURCES AND SUPPORTING THE REPUBLIC COUNTY HEALTH DEPARTMENT'S (RCHD) CHRONIC DISEASE RISK REDUCTION PROGRAM. SECONDLY, THE HOSPITAL IS IMPROVING ACCESS TO INFORMATION AND ASSISTANCE ACROSS MULTIPLE NEEDS AND POPULATIONS. THE HOSPITAL IS SUPPORTING THE REPUBLIC COUNTY RESOURCE COUNCIL IN KEEPING THE HEALTH SERVICES DIRECTORY CURRENT AND AVAILABLE TO THE PUBLIC. ADDITIONALLY, THE HOSPITAL IS WOKING WITH OTHER PROVIDERS TO ENHANCE AWARENESS FOR EXISTING PROGRAMS AND SERVICES. THIRDLY, THE HOSPITAL IS WORKING TO ESTABLISH A HEALTH PROMOTION TASK FORCE TO SUSTAIN ATTENTION IN PROMOTING HEALTHY LIVING. THIS IS BEING COMPLETED BY A TASK FORCE MADE UP OF MEMBERS FROM THE CHNA STEERING COMMITTEE. SCHEDULE H, PART V, SECTION B, LINE 16A, B & C https://www.rphospital.org/getpage.php?name=Financial_Assistance&sub=Patie nts%20%26%20Visitors 2 BELLEVILLE MEDICAL CLINIC PA 2337 G STREET BELLEVILLE KS 66935 MEDICAL CLINIC REPUBLIC COUNTY MEDICAL FAMILY PHYSICIAN 2337 G STREET BELLEVILLE KS 66935 MEDICAL 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, COLUMN F THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSE OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $477,308. 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 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 SEE PAGES 6 AND 7 OF THE AUDITED FINANCIALS UNDER NOTE 1. 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 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 The Republic County Hospital assesses the health care needs of the community it serves in an ongoing fashion. (1) As a former Joint Commission Accredited Hospital that still follows many of TJC's standards. One of the Leadership Standards is that the hospital provides services that meet patient needs, and that the needs of the population served guide decisions about which services will be provided directly or through referral, consultation, contractual arrangements or other agreements. We determine these needs in a variety of ways. (2) In 2019, a Community Health Needs Assessment was conducted by FORVIS. This assessment involved an extensive telephone survey (plus other extensive data collection) that addressed access to primary care health services, health insurance, travel distance for services, hospital services, County Health Services and other County health related services. The survey identified the top three health concerns in our County. The results of this survey were shared with other health care providers, and the public, and were used to address perceived lack of services in identified areas. (A copy of the results the CHNA and Implementation Strategies are available upon request and posted to our website, www.rphospital.org) We are currently working with VVV Consulting to complete our next CHNA by Fiscal Year Ending September 30th, 2022. (3) In addition to the Governing Board, the Hospital works in partnership with a local County Board of Trustees which serves as an advisory board for the community. In April of 2010 the Hospital contracted for a comprehensive assessment of the current and future need for long term care in our community and surrounding area. The results of this study have been instrumental in planning for the number of nursing home beds in the community. The local Board of Trustees and Hospital continue to identify partners to help insure the availability of adequate nursing home beds. (4) Republic County is one of a seven County Consortium that has received a multiyear grant from the Kansas Department of Health and Environment. Republic County hospital continues to work with the Mitchell County Community Foundation on the Chronic Disease Risk Reduction (CDRR) grant and the Health Equity grant. The purpose of the grant is to support the implementation of a coordinated approach to prevent and control diabetes, heart disease, and obesity and associated risk factors in seven communities in North Central Kansas. (5) An important component of the Hospital Mission and Vision is that of being a health resource to the community by advocating healthy behaviors, working in concert with other health care providers, promoting health services through education, and by recruiting and retaining qualified health professionals. (6) Services are also assessed through HCAHPS patient satisfaction survey processes. Board Meetings are open to the public and we have open communication with our patients and their physicians about the types and quality of services provided. (7) In September 2013 a County Wide Health Promotion Task Force was developed to sustain attention and initiatives promoting healthy living. (8) In the Fall of 2019 the Community Health Needs Assessment Implementation Strategies were presented and was approved by the Governing Board as required by law. (9) Needs identified through community involvement are brought to the hospital through the Patient and Family Advisory Council. (10) Using the Community Health Needs Assessment that was conducted by FORVIS for FY ending September 30th, 2019, community and stakeholder input a Community Health Implementation Strategy for 2020-2022 was developed, approved by the Board of Trustees, and is posted on the Republic County Hospital website as noted above in item #2. The Implementation Strategy Annual Review was most recently approved by the Governing Board August 30th, 2021 as required by Law. SCHEDULE H, PART VI, LINE 3 The Republic County Hospital has a written financial assistance/charity care policy and a credit policy that is included in the patient information brochure received by all inpatients and outpatient surgery patients. The credit policy is also posted on the Hospital's website, www.rphospital.org. In addition to other payment options the patient brochure, website and each billing statement sent to patients includes the statement "Republic County Hospital also offers a healthcare assistance program that provides medical care free, or at reduced rates, for patients who qualify based on income guidelines". The Hospital's Financial Counselor visits with private pay patients and patients with high deductibles to determine if they qualify for the Hospital charity care/financial assistance program. The hospital also employs a Social Services worker who consults and assists private pay or uninsured patients to determine if they qualify for assistance through the State Medicaid Program or other government programs. This employee is a member of the County Resource Council. The Social Services worker will assist in completing the applications for medical assistance and act as a resource for other health related services. SCHEDULE H, PART VI, LINE 4 Republic County Hospital is located in Belleville, Kansas (2010 census 1,991 pop.; estimated population in 2021 is 1,864) and serves the residents of Republic County and surrounding area. The population of Republic County, by 2010 census, is 4,980; estimated population in 2021 is 4,662. The service area for the Hospital is Republic County and contiguous counties in Northcentral Kansas and Southcentral Nebraska. These Counties in Kansas are exclusively rural. Republic County has a population density of less than 8 people per square mile and more than 27% of the population is over the age of 65. The racial makeup of the county by 2000 census was 98.56% White, .26% Black or African American, .21% Native American, .19% Asian and .94% Hispanic or Latin American. 26.10% of the population was aged 65 or over. Median income for a household in republic County for 2021 est. is $50,411. Specifically, 37% of republic county households are below the $35,000 level in household income as compared to 29% of Kansas households. Approximately 60% of hospital services are delivered to patients 65 years of age or older. Complete demographics and other information are available on the Hospital Website in the CHNA section. SCHEDULE H, PART VI, LINE 5 Republic County Hospital participates in community building activities. The hospital is very active in community education on the benefits of vaccinations and immunizations for COVID 19, influenza and pneumonia. We work closely with the County Health Department, Nursing Homes in the community and with local physicians and pharmacies to improve vaccination and immunization rates. The hospital is very active in and is an integral part of our County Emergency Preparedness activities. The Hospital is an education provider for continuing education and in addition to other classes presents classes for CPR, ACLS, NRP and TNCC certifications. We work closely with the County EMS in the delivery of emergency services. The hospital is an educational site for nursing students from the Cloud County Community College and we frequently have Medical Students in our facility for clinical clerkships and Family Practice Residents here for month long rural residencies. We are also a clinical practice site for medical laboratory technicians, Physician Assistant Students, Allied Health Students and Advanced Practice Registered Nurse Students. We provide scholarships for students enrolled in health professional studies. The hospital makes contributions to the local North Central Kansas Health Care Foundation to support activities related to physician recruitment. The Chief Executive Officer participates as a Board Member of the Republic County Economic Development Corporation. The hospital sponsors and holds a community health fair to educate the community on current and ongoing health issues. We have fully implemented an electronic health record that can be shared with other providers to improve care and reduce health care costs. The hospital also takes seriously its efforts at promoting the mental health of seniors in its community by establishing the Senior Life Solutions program in Republic County. Republic County Hospital is a 25 bed Critical Access Hospital and Level 4 Trauma rated facility. The Hospital provides 24 hour Emergency Room Care and financially subsidizes this service. The Hospital contracts with the local physicians and since the cost of the coverage far exceeds the income generated through the ER, we consider this to be a heavily subsidized service. The hospital participates in all government health care plans and is the only hospital in Republic County. We have an open medical staff and have several specialist physicians holding outpatient clinics in our community preventing the need for persons in our community to travel long distances for these specialty medical services. We promote community health through health fairs, public service announcements, classes and through sponsorship of other health educational classes. The hospital works closely with a regional hospice provider in the provision Hospice services. The hospital provides Childbirth Education Classes and Breastfeeding support to our patients and community. SCHEDULE H, PART VI, LINE 6 Organization is affiliated with Great Plains Health Alliance, Inc. (GPHA), a non-profit 501(c)(3) organization which provides management services and operational, finance and accounting support to the Hospital. GPHA does not provide services directly to patients, but it does provide access to professionals that may not be affordable to the normal critical access hospital. GPHA provides education and assistance in areas such as HIPAA, Medicare reimbursement, meaningful use requirements for computer system, etc. GPHA is an affiliation of Critical Access Hospitals in Kansas and Nebraska that provides networking opportunities with other rural hospitals, communities and other health care organizations. GPHA provides policies and guidance to its Critical Access facilities regarding financial assistance, conflicts of interest, corporate compliance and many other areas. GPHA also provides educational sessions for board Members, Business Office Managers, Billers, Medical Records personnel and Administrators. GPHA is a vital link in allowing CAH hospitals to operate at a high quality within the cash constraints imposed by the Critical Access program. SCHEDULE H, PART VI, LINE 7 N/A false false false false false false false false false DAVE DELLASEGA PRESIDENT/SECRETARY/DIRECTOR 0 204937 0 0 0 2935 0 20567 0 12755 0 241194 0 0 DURREL KELLEY VP OF OPERATIONS 0 127708 0 0 0 2258 0 12224 0 15201 0 157391 0 0 BRENT MARTIN CHIEF OPERATING OFFICER 162049 0 0 0 1643 0 15569 0 33045 0 212306 0 0 0 FORM 990, PART VII; SCHEDULE J, PART I, LINE 3 COMPENSATION FOR DURREL KELLEY AND DAVE DELLASEGA 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 AND MR. DELLASEGA. 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 Major accomplishments in FY 2021 include the following: 1) RCH has and continues to support the Republic County Health Dept and the citizens of Republic County through the COVID 19 pandemic. Our involvement has been multifaceted from organizing and assisting with community planning to mitigation, testing, with administering the vaccine and other approved treatments. 2) The hospital attested to Meaningful Use Stage 3. 3) Hospital staff provides education to the community including smoking cessation and works closely with area schools on prevention of head injuries occurring during sports. 4) The hospital maintains the outpatient seniors group therapy program Senior Life Solutions. 5) Retained and recertified for our Level 4 Trauma certification. 6) Continues to update our website and met the price transparency requirements for CMS. 7) Continue Case Management services for our patients. 8) Hospital participates in open forum coffee for local chamber of commerce on a weekly basis. 9) Hospital also regularly serves as a clinical site for nursing students and Certified Nursing Assistant (CNA) students from a neighboring community college. 10) Continues to offer support to the meals on wheels program for our community. 11) Continue to provide patient assistance with a certified diabetic educator. 12) RCH continues to provide a breastfeeding program for the community and provides education and patient support to breast feeding mothers in the community with an international board-certified lactation consultant. The hospital provides Childbirth Education Classes. The hospital provides infant seats to all newborn upon discharge from the hospital. The department is very active in fund raising for support of department activities. 13) Collaborates with the North Central Kansas Healthcare foundations physician recruitment radiothon providing community education on the services we provide. 14) Supplied patients discharging from our ED with flu kits. 15) The RCH BOT reviewed and approved our 2021 Community Health Needs Assessment - Implementation Strategy - Annual Review for FY ending Sept. 2021. The CHNA - Implementation Strategy and Annual Review can be found on our hospital website. 16) Below please find the: A Year in Review - RCH 2021 that list changes in roles, major accomplishments with surveys, accreditations and equipment upgrades and additional services. FORM 990, PART VI, SECTION A, LINE 2 DAVE DELLASEGA, DURREL KELLEY, AND JASON BARB HAVE A BUSINESS RELATIONSHIP. THEY ARE BOTH 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 REPUBLIC CO., INC. FORM 990, PART VI, SECTION A, LINE 7A GREAT PLAINS HEALTH ALLIANCE, INC., BEING THE SOLE MEMBER, HAS THE RIGHT TO ELECT AND APPROVE ALL THE BOARD MEMBERS. FORM 990, PART VI, SECTION A, LINE 7B GREAT PLAINS HEALTH ALLIANCE, INC. (GPHA) IS THE SOLE MEMBER AND HAS THE AUTHORITY TO APPROVE THE ARTICLES OF INCORPORATION, BYLAWS, ELECTION TO OR REMOVAL FROM THE BOARD OF DIRECTORS, THE ANNUAL OPERATING AND CAPITAL BUDGETS, AND THE LONG RANGE OR STRATEGIC PLANS. FORM 990, PART VI, SECTION B, LINE 11B THE 990 IS PREPARED AND REVIEWED BY AN INDEPENDENT ACCOUNTING FIRM. THE 990 IS THEN PROVIDED TO THE CHIEF EXECUTIVE OFFICER FOR REVIEW AND APPROVAL. AN ELECTRONIC DRAFT OF THE 990 WITH ALL REQUIRED SCHEDULES IS THEN PROVIDED TO THE FULL BOARD FOR REVIEW PRIOR TO FILING THE 990 WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION IS REQUIRED TO ADOPT GPHA'S CONFLICT OF INTEREST POLICY. ALL BOARD MEMBERS, OFFICERS, AND EMPLOYEES ARE SUBJECT TO THE CONFLICT OF INTEREST POLICY AND SIGN AN ANNUAL ACKNOWLEDGEMENT THAT THEY HAVE READ, UNDERSTAND AND COMPLIED WITH THE GPHA CONFLICT OF INTEREST POLICY. UNDER THE POLICY, ANY MEMBER WHO HAS A DIRECT OR INDIRECT (VIA FAMILY) FINANCIAL INTEREST IS CHARACTERIZED AS AN INTERESTED PERSON. INTERESTED PERSONS ARE REQUIRED TO DISCLOSE FINANCIAL INTERESTS WITH COMPANIES DOING BUSINESS WITH GPHA. THE INTERESTED PERSON MUST RECUSE THEMSELVES FROM FURTHER DISCUSSIONS OF THE TRANSACTION AND LEAVE THE ROOM. THE REMAINING NON-INTERESTED MEMBERS DECIDE IF A CONFLICT OF INTEREST EXISTS. THE BOARD CHAIR MAY APPOINT ANOTHER DISINTERESTED PARTY TO DISCUSS THE TRANSACTION OR THE REMAINING BOARD MEMBERS MAY VOTE TO ENTER INTO OR ABSTAIN FROM THE SUSPECT TRANSACTION. FAILURE TO DISCLOSE FINANCIAL INTERESTS BY INTERESTED BOARD MEMBERS WILL RESULT IN DISCIPLINARY ACTION, INCLUDING SANCTIONING BY BOARD. ALL CONFLICTS OF INTEREST AND THEIR ULTIMATE RESOLUTION ARE DOCUMENTED IN THE BOARD MINUTES. THE BOARD CONDUCTS PERIODIC REVIEWS TO DETERMINE THAT CONFLICTS ARE BEING IDENTIFIED AND RESOLVED ACCORDING TO POLICY DOCUMENTATION. REVIEWS BY OUTSIDE EXPERTS ARE PERMITTED, BUT NOT REQUIRED. FORM 990, PART VI, SECTION B, LINES 15A & B THE CEO AND COO 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:2083328 FORM 990 PART IX LINE 11G DESCRIPTION:BILLING/COLLECTIONS TOTAL FEES:102145 FORM 990 PART IX LINE 11G DESCRIPTION:LAB SERVICES TOTAL FEES:425526 FORM 990 PART IX LINE 11G DESCRIPTION:PHARMACY SERVICES TOTAL FEES:229763 FORM 990 PART IX LINE 11G DESCRIPTION:ADMINISTRATION/HUMAN RESOURCES TOTAL FEES:360394 FORM 990 PART IX LINE 11G DESCRIPTION:MAINTENANCE/HOUSEKEEPING TOTAL FEES:14152 FORM 990 PART IX LINE 11G DESCRIPTION:PLANT OPERATIONS TOTAL FEES:42457 FORM 990 PART IX LINE 11G DESCRIPTION:DIETARY SERVICES TOTAL FEES:570 GREAT PLAINS HEALTH ALLIANCE 250 N ROCK ROAD STE 160 WICHITA KS 67206 480617739 MANAGEMENT KS 501(C)(3) 3 NA false 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 KIOWA COUNTY INC 250 N ROCK ROAD STE 160 WICHITA KS 67206 481226833 HOSPITAL KS 501(C)(3) 3 GPHA INC true GREAT PLAINS OF OTTAWA COUNTY INC 250 N ROCK ROAD STE 160 WICHITA KS 67206 481226856 HOSPITAL KS 501(C)(3) 3 GPHA INC true GREAT PLAINS OF SMITH COUNTY INC 250 N ROCK ROAD STE 160 WICHITA KS 67206 481226830 HOSPITAL KS 501(C)(3) 3 GPHA INC true GREAT PLAINS OF CHEYENNE COUNTY 250 N ROCK ROAD STE 160 WICHITA KS 67206 481226831 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 GPHA EMPLOYEE BENEFITS TRUST 250 N ROCK ROAD STE 160 WICHITA KS 67206 476918582 HEALTH PLAN KS 501(C)(9) GPHA INC true false false false false false false false false false false true false true false false false false true false GPHA EMPLOYEE BENEFITS TRUST R 854948 FMV