2022-12-12T07:29:01-06:00 2022-06-30 481026809 Wendling Noe Nelson & Johnson LLC 623 SW 10th Ave Suite 300 Topeka KS 66612 990 2021-07-01 480764456 Nemaha Valley Community Hospital NEMA 7853366181 1600 Community Drive Seneca KS 66538 KILEY FLOYD CEO 7853366181 2022-12-08 1 KILEY FLOYD 999009999 Eric L Otting P00298454 7852334226 2022-12-08 3 AAL1 IAL1 2021 2022-09-23 18:48:47Z Kiley Floyd 1600 Community Drive Seneca KS 66538 22545795 0 X nemvch.com X 1969 KS To provide personalized, compassionate healthcare while promoting wellness in the communities we serve. 11 10 181 41 0 0 4853063 1668665 17507021 20727561 41091 38594 109549 110975 22510724 22545795 0 0 0 0 11130452 12074676 0 0 54503 6974490 8887622 18104942 20962298 4405782 1583497 22222330 21885003 10128391 8222567 12093939 13662436 To provide personalized, compassionate healthcare while promoting wellness in the communities we serve. 0 0 18287776 20816905 Nemaha Valley Community Hospital provides inpatient and outpatient hospital services and clinic services to patients in its service area. 18287776 1 1 0 1 0 0 0 0 0 0 1 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 1 0 0 0 1 35 0 1 181 1 0 0 0 0 0 0 0 0 0 0 0 0 X 11 10 1 0 0 0 0 0 0 1 1 0 0 0 1 1 1 0 1 1 0 0 X Niki Buesing 7853366181 1600 Community Drive Seneca KS 66538 Fred Henry Chairman 1.00 X X 0 0 0 Justin Lueger Trustee 1.00 X 0 0 0 Katie Nordhus Trustee 1.00 X 0 0 0 Leah Hermesch Trustee 1.00 X 0 0 0 Mike Steinlage Treasurer 1.00 X X 0 0 0 Kris Enneking Vice-Chairman 1.00 X X 0 0 0 Mary Haverkamp Secretary 1.00 X X 0 0 0 Dr Heather Myers Physician/Trustee 40.00 X 356183 0 36965 Don Strathman Trustee 1.00 X 0 0 0 Dr James Lueger Trustee 1.00 X 0 0 0 TJ Haverkamp Trustee 1.00 X 0 0 0 Kiley Floyd CEO 40.00 X 153555 0 21565 Abbie Thomas Contract CFO (Thru Nov. 2021) 20.00 X 38183 0 9011 Niki Buesing Contract CFO (Beg. Dec. 2021) 40.00 X 0 0 0 Harry Stewart CRNA 40.00 X 355348 0 52601 Dr William Bartkoski Physician 40.00 X 362641 0 46877 Lori Lueger APRN 40.00 X 187917 0 23519 Dr Jarod Snyder Physician 40.00 X 347432 0 46693 Dr Angela Stueve Physician 40.00 X 324164 0 46196 2125423 0 283427 12 0 1 0 Rural Partners in Medicine 8181 Artista Place Suite 100 Broomfield CO 80021 Surgeon Services 540448 Cerner Corporation PO Box 959156 St Louis MO 63195 Patient Accounting System 444425 Stormont Vail Healthcare 1500 SW 10th Avenue Topeka KS 66604 Lab and Admin Contract Services 254824 Shared Medical Services Inc PO Box 330 Cottage Grove WI 53527 MRI Scans 122130 4 1273784 394881 1668665 Patient service revenue 621110 19389449 19389449 340B retail drug program 446110 1338112 1338112 20727561 38594 38594 Miscellaneous 621110 89344 89344 Dietary Income 722210 21631 21631 110975 22545795 20816905 0 60225 667327 380349 286978 9345749 8295980 1006906 42863 379237 337447 40036 1754 1016073 900755 110687 4631 666290 584536 78822 2932 8925 8024 901 1886180 1517491 368686 3 35649 15654 19995 94552 76031 18464 57 44526 38164 6362 165752 147221 18199 332 55011 39741 15268 2 323148 287020 35482 646 1319364 1159865 158640 859 156035 127408 28545 82 Supplies 3503834 3428648 75031 155 Equipment rental and ma 876712 729975 146580 157 Collection fees 142599 5485 137114 Grant Expense 100000 100000 175335 107982 67323 30 20962298 18287776 2620019 54503 1504 505 13570502 12310113 1533049 1847615 329903 385678 306270 274202 22920808 16778127 6217015 6142681 264087 924209 22222330 21885003 1545430 1254417 1592961 313150 6990000 6655000 10128391 8222567 X 12018028 13609501 75911 52935 12093939 13662436 22222330 21885003 X 1583497 -15000 X X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 1 3068 0 0 0 3068 0 Part II-B, Line 1: Nemaha Valley Community Hospital is a member of the Kansas Hospital Association and the American Hospital Association. Both of these organizations engage in lobbying activities as part of the services provided to members. The above amount was estimated based on a percentage of membership dues. 54681 54681 12084655 8813844 3270811 10008829 7964283 2044546 772643 772643 6142681 X Part X, Line 2: The Hospital is a not-for-profit corporation as described in Section 501(c)(3) of the Internal Revenue Code and is exempt from federal taxes on related income pursuant to Section 501(a) of the Code. 1 1 0 1 X 1 1 0 1 1 105094 29880 75214 0.00360 1092247 795949 296298 0.01410 1197341 825829 371512 0.01770 4177031 3532791 644240 0.03070 221 221 0.00000 4177252 3532791 644461 0.03070 5374593 4358620 1015973 0.04840 1 313986 125594 7877063 7816243 60820 X 1 1 1 1 Nemaha Valley Community Hospital 1600 Community Drive Seneca KS 66538 X X X X Rural health clinic Nemaha Valley Community Hospital 1 0 0 1 X X X X X X X X X 20 1 1 0 1 X http://www.nemvch.com/resources X 1 20 1 http://www.nemvch.com/resources 0 1 X 200.000000000000 X X X X 1 1 X X X 1 X http://www.nemvch.com/resources/ X http://www.nemvch.com/resources/ X http://www.nemvch.com/resources/ X X X X X X 1 X 0 X X X X 1 X 0 0 Nemaha Valley Community Hospital Part V, Section B, Line 5: Community members were invited to attend a meeting in which their input was requested to determine the health needs of the community. The community members identified the health care needs that should be prioritized. These members included medical professionals, government employees, leaders of non-profit organizations, and hospital employees. Nemaha Valley Community Hospital Part V, Section B, Line 6a: Sabetha Community Hospital Nemaha Valley Community Hospital Part V, Section B, Line 11: To promote health education, the Hospital emphasized educational programs with a focus on hypertension, diabetes, smoking cessation, increased seat belt usage, and car seat safety.To improve access to mental health assistance, the Hospital has continued two tele-health mental health clinics that provide psychiatry & therapy for the young, the old, and Obstetric patients. The Hospital continued to educate the public about mental health issues through social and local media and promoted existing mental health services, facilities, and providers.To prevent alcohol abuse, the Hospital provided financial support for specific efforts related to activities in local schools. The Hospital also analyzed data from the county health rankings report to gain a better understanding of the needs within the area. The Hospital provided a board member for the United 4 Youth organization.To promote cancer care, the Hospital created a Facebook educational video on Mammograms and Facebook postings on breast cancer awareness. The Hospital provided education on assessing breast cancer risks and the importance of preventive health care visits in early cancer detection.To prevent obesity, the Hospital continued to educate business and industry on the benefits of offering wellness programs for their employees and suggested primary care and other providers to refer patients to nutritionists and diabetic educators. Finally, the Hospital provided educational programs titled "Prevent T2 Prediabetes and "Living Healthy with Diabetes."To prevent substance abuse, the Hospital continued to monitor prescription drug abuse by creating an alert system between physicians and pharmacies for drug abuse. The Hospital continued to participate in K-TRACS to identify abuse and participated in regional efforts for opioid management.To improve childcare, the Hospital conducted childcare support education such as teen babysitting classes. The Hospital continued to provide support for licensure such as CPR Classes and education on infection prevention and child immunizations. Part I, Line 7: This amount was determined by multiplying a cost-to-charge ratio derived from Worksheet 2 for the tax year. Part I, Line 7g: The net community benefit expense of subsidized health services include costs attributable to a rural health clinic in the amount of $543,200. Part II, Community Building Activities: N/A Part III, Line 4: Nemaha Valley Community Hospital provides for accounts receivable that could become uncollectible in the future by establishing an allowance to reduce the carrying value of such receivables to their estimated net realizable value. This estimate is based on the aging of its accounts receivable by payor and historical collection experience. See note A4 (page 7) of the audited financial statements regarding the allowance for uncollectible accounts.Part III Line 2:This amount was determined by multiplying a cost-to-charge ratio derived from Worksheet 2 for the tax year.Part III, Line 3:This amount was determined based on the overall income level of patients that submit all required documentation under the Hospital's financial assistance policy. As a tax-exempt hospital, we must provide necessary services regardless of the patient's ability to pay for that care. Making quality patient care available to all in our community, regardless of their economic means, qualifies this amount as a community benefit. Part III, Line 8: Medicare costs were obtained from the Hospital's as-filed Medicare cost report for the tax year. Any shortfalls are a benefit to the Hospital's community since it represents health care provided at less than cost to elderly and needy residents of the Hospital's service area. Part III, Line 9b: Nemaha Valley Community Hospital makes every effort to get correct financial and billing information and to educate patients on the eligibility requirements of charity care programs and payment options. Part VI, Line 2: N/A Part VI, Line 3: Notification associated with patient encounter. Part VI, Line 4: The community served is primarily residents who reside in Nemaha County Kansas and consists of approximately 2,139 residents. The median family income is $55,078. 7.00% of the community residents live below federal poverty level. Neighboring hospitals are located in Sabetha, Pawnee County, NE, and Hiawatha. They are approximately 21, 20, and 28 miles away respectively. Part VI, Line 5: The Hospital maintains a Facebook page which posts general health information topics and announces dates of general health-related group activities. The Hospital offers periodic diabetic educational programs and education programs for expectant mothers. The Hospital uses all excess funds to maintain and improve Hospital facilities and equipment and to insure the delivery of high quality patient care services. Part VI, Line 6: N/A X X 0 0 0 0 0 0 0 0 0 Dr William Bartkoski Physician 319093 0 43548 0 0 0 13050 0 33827 0 409518 0 0 0 Harry Stewart CRNA 355348 0 0 0 0 0 11721 0 40880 0 407949 0 0 0 Dr Jarod Snyder Physician 260862 0 86570 0 0 0 13050 0 33643 0 394125 0 0 0 Dr Heather Myers Physician/Trustee 305516 0 50667 0 0 0 13050 0 23915 0 393148 0 0 0 Dr Angela Stueve Physician 280376 0 43788 0 0 0 12537 0 33659 0 370360 0 0 0 Lori Lueger APRN 150082 0 37835 0 0 0 6506 0 17013 0 211436 0 0 0 Kiley Floyd CEO 143555 0 10000 0 0 0 7133 0 14432 0 175120 0 0 0 A City of Seneca Kansas 486026237 81712RAP4 2008-12-01 8835000 To refund notes payable and construction costs for an addition to Hospital 0 0 0 B City of Seneca Kansas 486026237 81712RBB4 2015-02-19 4455000 To refund a portion of 2008 series bond 0 0 0 A 5335000 8835000 498789 161535 6834436 1358153 2011 0 0 1 1 B 1300000 4455000 88270 4517530 2018 1 0 1 1 A 0 0 0 0 0 0 1 B 0 0 0 0 0 0 1 A 0 0 0 1 1 0 0 0 1 B 0 0 1 0 0 0 0 0 1 A 1 B 1 Date Rebate Computation Performed Issuer Name: City of Seneca, Kansas Date the Rebate Computation was Performed: 06/01/2018 Arlene Henry Family member of Fred Henry, Board Member 52145 Employment 0 Lynda Cross Family member of Mary Haverkamp and Mike Steinlage, Board Members 138812 Employment 0 Form 990, Part VI, Section A, line 2 Mary Haverkamp, Board Member, is a family relation to Mike Steinlage, Board Member. Form 990, Part VI, Section B, line 11b The Form 990 is presented to the finance committee of the board prior to filing. The document is made available to all other board members upon request. It is also reviewed by the CEO and CFO prior to filing. Form 990, Part VI, Section B, line 12c The board is required to annually sign conflict of interest statements. Form 990, Part VI, Section B, line 15a The CEO salary and compensation is approved by the Hospital's board and is based on information from a compensation study. Form 990, Part VI, Section C, line 19 Documents are available upon request. Form 990, Part XI, line 9: Transfer to Foundation -15,000. 990 Part XII Line 2c The Finance Committee selects the independent auditor of the financial statements. Nemaha Valley Health Care Foundation 1600 Community Drive Seneca KS 66538 481097250 Fundraising for the benefit of community healthcare KS 501(c)(3) Line 7 Nemaha Valley Community Hospital 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 0