2021-02-15T10:41:17-06:00 2020-03-31 BKD LLP 1201 Walnut Suite 1700 Kansas City MO 641062246 990 2019-04-01 742826278 RURAL HEALTH RESOURCES OF JACKSON CO INC % BART KENTON RURA 7853642116 1110 COLUMBINE DRIVE HOLTON KS 66436 CARRIE SAIA CEO 7853649636 2021-02-15 true Michael J Engle P00482834 8162216300 2019 2022-09-23 18:48:47Z HOLTON COMMUNITY HOSPITAL CARRIE SAIA 1110 COLUMBINE DRIVE HOLTON KS 66436 20811187 false X WWW.HOLTONHOSPITAL.COM X 1997 KS TO PROVIDE HIGH QUALITY HEALTHCARE SERVICES TO ALL OF JACKSON COUNTY AND SURROUNDING COMMUNITIES WHILE CONSISTENTLY DEMONSTRATING PROFESSIONALISM WITH THE HOMETOWN TOUCH. 8 6 200 38 0 116538 1478348 17471969 19089021 112114 81404 264013 162414 17964634 20811187 0 0 0 0 9932923 10605816 0 0 34000 8627994 8994352 18560917 19600168 -596283 1211019 9560538 25346668 4088182 19050916 5472356 6295752 X TO PROVIDE PROFESSIONALISM, COMPASSION AND EXCELLENCE IN HEALTHCARE FOR A HEALTHIER COMMUNITY. false false 12736414 0 15895460 SEE SCHEDULE O. 3178753 0 3193561 THERE ARE 3 RURAL HEALTH CLINICS: 1 RURAL HEALTH CLINIC WITHIN THE SAME COMMUNITY WHERE THE HOSPITAL RESIDES, AND 2 RURAL HEALTH CLINICS LOCATED IN 2 SMALLER NEARBY COMMUNITIES. THE RURAL HEALTH CLINICS REPORTED 14,973 VISITS FROM 4/1/19 THROUGH 3/31/20. PROVIDERS FOR THE RURAL HEALTH CLINICS LIVE AND WORK IN THE SAME COMMUNITY AND ARE ACTIVELY INVOLVED IN COMMUNITY ACTIVITIES; OFFERING A LARGE VARIETY OF EDUCATIONAL SERVICES AS WELL AS CLINICAL SERVICES SUCH AS PROVIDING 2 LOCAL HIGH SCHOOLS A SPORTS MEDICINE CLINIC AND COVERAGE BY PROVIDERS AT HOME SPORTING EVENTS. 15915167 true true false true false false false false true true false false false true false true false false false false false false true false false true true false false true true false false false false false false false false true false false false false false false false false false false true 37 0 true 200 true false false false false false false false false false false false false X 8 6 false false false false false false false true true false false true true true true true true true false false KS X BART KENTON 7853649636 1110 COLUMBINE DRIVE HOLTON KS 66436 CLINT COLBERG PHYSICIAN 41.0 0.0 X 291338 0 37919 MALIA WARNERSTART 71 DIRECTOR/CHIEF OF MED STAFF 40.0 0.0 X 281851 0 42556 ERIN LOCKEND 0719 DIRECTOR/CHIEF OF MED STAFF 40.0 0.0 X 219432 0 17342 JOEL HUTCHINS PHYSICIAN 40.0 0.0 X 191281 0 14409 CARRIE SAIA CHIEF EXECUTIVE OFFICER 40.0 0.0 X 163762 0 28589 JOSHUA C MOULIN PHYSICIAN'S ASSISTANT 39.6 0.0 X 156047 0 26010 KAYLIE ZIMMERMAN APRN 40.0 0.0 X 133278 0 14730 JILL COLLINS APRN 40.0 0.0 X 122736 0 22019 BART KENTON CHIEF FINANCIAL OFFICER 40.0 0.0 X 101974 0 29534 BOBBI MCGRATH DIRECTOR/BOARD CHAIR 1.0 0.0 X X 0 0 0 CATHERINE E REEDEND 7 DIRECTOR 1.0 0.0 X 0 0 0 DAN BRENNER DIRECTOR/VICE CHAIR 1.0 0.0 X X 0 0 0 MARGARET PAGEL END 7 DIRECTOR 1.0 0.0 X 0 0 0 MICHAEL MOSIER DIRECTOR/SECRETARY 1.0 0.0 X X 0 0 0 CHAD BONTRAGER DIRECTOR 1.0 0.0 X 0 0 0 MARK AESCHLIMAN DIRECTOR 1.0 0.0 X 0 0 0 HEATHER SCHRICK DIRECTOR 1.0 0.0 X 0 0 0 GLORIA STAVROPOULOS DIRECTOR 1.0 0.0 X 0 0 0 1661699 0 233108 19 false true false PSYCHIATRIC MEDICAL CARE LLC N/A NASHVILLE TN 66606 PHYSICIAN CONSULTING 425257 GLENDAVNIC ANESTHESIA PLLC ANESTHESIA SERVICES 291670 ATHENAHEALTH ARSENAL WATERTOWN MA 02472 SUPPORT/SOFTWARE 636187 PREMIER SPECIALTY NETWORK SPECIALTY PHYSICIAN 456035 HMN ARCHITECTS INC ARCHITECT SERVICES 306837 10 73898 1404450 1478348 NET PATIENT SERVICE REVENUE 622110 17679471 17679471 340B REVENUE 623000 1409550 1409550 19089021 81404 81404 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Rebate Income 623000 71535 71535 CAFETERIA 623000 26433 26433 All Other Misc Revenue 64446 64446 64446 64446 162414 20811187 19089021 243818 X 0 0 0 0 901121 747552 153569 37098 37098 7644075 6223585 1420490 251878 222696 29182 1133825 952140 181685 637819 534082 103737 0 4279 4279 87539 87539 0 0 13153 13153 3562316 3140756 387560 34000 53126 4463 48663 667291 555167 112124 762067 13293 748774 0 343342 284830 58512 64525 49811 14714 0 0 107202 88933 18269 0 564556 468345 96211 117426 105410 12016 MEDICAL SUPPLIES 1647026 1647026 BAD DEBT EXPENSE 466474 466474 REPAIRS AND MANTENANCE 275786 203386 72400 DUES AND SUBSCRIPTIONS 62942 24472 38470 195302 145648 49654 19600168 15915167 3651001 34000 7419 58495 1885693 14138216 0 0 2523759 2595590 0 0 0 0 0 0 172562 197557 117508 148222 15317956 7371964 4414628 7945992 0 0 0 0 0 0 0 0 438969 262596 9560538 25346668 1247500 2451755 0 0 36730 5694 2230253 14615000 0 0 0 0 573699 1836525 0 0 0 141942 4088182 19050916 X 5012517 6223536 459839 72216 5472356 6295752 9560538 25346668 X 1211019 -387623 X false true X true true true X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false true false false false true 3663 true 4508 false false 8171 false SCHEDULE C, PART II-B, LINE 1F THIS AMOUNT REPRESENTS THE PORTION OF THE DUES PAID TO THE AMERICAN HOSPITAL ASSOCIATION AND THE KANSAS HOSPITAL ASSOCIATION THAT ARE FOR LOBBYING. SCHEDULE C, PART 11-B, LINE 1G CARRIE SAIA, CHEIF EXECUTIVE OFFICER, IS A REPRESENTATIVE FOR THE KANSAS HOSPITAL ASSOCIATION TO THE AMERICAN HOSPITAL ASSOCIATION AND HAS MEETINGS WITH LEGISLATORS IN TOPEKA, KANSAS AND WASHINGTON, D.C. 46266 1051 1051 46266 46266 318 318 46266 46266 318 318 46266 46266 374 374 46266 57846 389 389 57846 1.00000 false false 9983 9983 4595590 2437823 2157767 834572 397385 437187 3782619 3006508 776111 6095192 1530248 4564944 7945992 0 DUE TO THIRD PARTY 141942 141942 20228149 20228149 583038 583038 20811187 19017130 19017130 583038 583038 19600168 SCHEDULE D, PART V, LINE 4 THE PERMANENTLY DONOR RESTRICTED ENDOWMENT ONLY ALLOWS THE ORGANIZATION TO USE INTEREST INCOME FOR OPERATIONS. 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 AND PART XII, LINE 4B PROVISION FOR UNCOLLECTIBLE ACCOUNTS $ 466,474 LOSS ON EXTINGUISHMENT OF DEBT $ 116,564 -------- $ 583,038 X X X X X X X true HARVEY NONPROFIT DEVEL SEE PART IV false 34000 34000 Schedule G, Part I, Line 2b, column (ii) Consulted on public solicitation for direct mail, telephone, internet, email and grant writing. true true X true X true X true true false true true 27959 27959 0.00150 1094317 525731 568586 0.02990 1122276 525731 596545 0.03140 34329 16348 17981 0.00090 243575 243575 0.01280 12416 12416 0.00060 290320 16348 273972 0.01430 1412596 542079 870517 0.04570 705 705 0.00010 705 705 0.00010 false 466474 21015 8681856 9686152 -1004296 X true true 1 1 HOLTON COMMUNITY HOSPITAL 1110 COLUMBINE DRIVE HOLTON KS 66436 WWW.HOLTONCOMMUNITYHOSPITAL.COM H043001 X X X HOLTON COMMUNITY HOSPITAL 1 false false true X X X X X X X X X 18 true false true true X SEE PART V, SECTION C X X true 18 true SEE PART V, SECTION C false true X 100 200. X X true true X 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 HOLTON COMMUNITY HOSPITAL LEADERSHIP ALONG WITH JACKSON COUNTY HEALTH DEPARTMENT STARTED OFF BY ESTABLISHING A TIMELINE AND ROLES FOR THE CHNA. A CONSULTANT WAS HIRED TO ASSIST IN THE PROCESS. THIS GROUP THEN DEVELOPED A LIST OF INDIVIDUALS AND ENTITIES WITHIN JACKSON COUNTY THAT WOULD CONNECT WITH THE MAJORITY OF THE POPULATION OF JACKSON COUNTY. THE LIST INCLUDED PHYSICIANS, PUBLIC HEALTH OFFICIALS, OTHER HEALTHCARE PROVIDERS, CLERGY, COMMUNITY AND CIVIC LEADERS, EDUCATION STAFF, FAMILY CARE-GIVERS, AND MEMBERS OF AT-RISK POPULATIONS. A SURVEY WAS THEN CREATED CONSISTING OF 18 QUESTIONS TO ASSESS AREAS OF NEED WITHIN JACKSON COUNTY AND EMAILED TO THE LIST. PRESS RELEASES AND EMAIL REMINDERS WERE SENT TO HELP ENCOURAGE PARTICIPATION IN THE SURVEY PROCESS. A TOWN HALL MEETING WAS SET UP TO GET ADDITIONAL INPUT FROM THE COMMUNITY. THE DATE AND TIME WAS POSTED IN THE LOCAL NEWSPAPER AND FLYERS WERE PUT IN LOCAL BUSINESSES. SURVEY DATA WAS PRESENTED AT THE TOWN HALL MEETING WHICH WAS ATTENDED BY 36 INDIVIDUALS. IN ADDITION TO THE HOSPITAL AREAS OF HEALTHCARE REPRESENTED AT THE TOWN HALL MEETING WERE PROFESSIONALS IN THE AREAS OF FAMILY MEDICINE, VISION, MENTAL HEALTH, COMMUNITY HEALTH, AND LONG-TERM CARE. OTHERS ATTENDING WERE REPRESENTATIVES FROM THE LOCAL SCHOOLS, NEWSPAPER, BANKS, SEVERAL CIVIC ORGANIZATIONS AS WELL AS COMMUNITY MEMBERS. THROUGH INPUT FROM THE ATTENDEES INCLUDING A VOTING PROCESS BY EACH INDIVIDUAL, THE LIST OF NEEDS WAS NARROWED DOWN TO 8 ITEMS. SCHEDULE H, PART V, SECTION B, LINE 6B JACKSON COUNTY PUBLIC HEALTH DEPARTMENT KANZA MENTA HEALTH SERVICES NEKCAP-NORTHEAST KANSAS COMMUNITY ACTION PROGRAM KSU RESEARCH AND EXTENSION SCHEDULE H, PART V, SECTION B, LINE 7A THE COMPLETE CHNA CAN BE FOUND AT: HTTP://WWW.HOLTONHOSPITAL.COM/DOCS/JACKSON_COUNTY_CHA_2019.PDF. SCHEDULE H, PART V, SECTION B, LINE 7D COPIES ARE ALSO AVAILABLE AT ALL OTHER HEALTHCARE PROVIDERS IN THE COUNTY. SCHEDULE H, PART V, SECTION B, LINE 10A THE IMPLEMENTATION STRATEGY CAN BE FOUND AT: HTTP://WWW.HOLTONHOPSITAL.COM/DOCS/CHNA_IMPPLAN_JACKSONCOKS_2018.PDF SCHEDULE H, PART V, SECTION B, LINE 11 DURING THE COMMUNITY HEALTH NEEDS ASSESSMENT OF 2019 THE FOLLOWING WERE IDENTIFIED AS THE TOP CHALLENGES TO RESIDENTS OF JACKSON COUNTY. 1) MENTAL HEALTH (DIAGNOSIS, PLACEMENT, AFTERCARE) 2) PUBLIC TRANSPORTATION 3) FOOD INSECURITY 4) AWARENESS OF HEALTHCARE SERVICES 5) POVERTY/EMPLOYMENT READINESS 6) LANGUAGE TRANSLATORS (GUATEMALAN, OTHERS) 7) SUBSTANCE ABUSE (METH, MARIJUANA, OPIOIDS) 8) OBESITY (NUTRITION/EXERCISE) A FOLLOW-UP MEETING WAS CONDUCTED TO FINALIZE AN IMPLEMENTATION STRATEGY TO ADDRESS THE IDENTIFIED NEEDS. ATTENDING WERE REPRESENTATIVES FROM THE JACKSON COUNTY PUBLIC HEALTH DEPARTMENT, KANZA MENTAL HEALTH SERVICES, NEKCAP- NORTHEAST KANSAS COMMUNITY ACTION PROGRAM, KSU RESEARCH AND EXTENSION, JACKSON COUNTY COMMISSION, AND THRIVE OF JACKSON COUNTY. DURING THE PROCESS, IT WAS FIRST DETERMINED WHETHER THE NEED WAS PART OF HOLTON COMMUNITY HOSPITALS MISSION OF CRITICAL OPERATIONS. AFTER THAT IT WAS THEN DETERMINED IF THE SPECIFIC ACTIONS IDENTIFIED TO ADDRESS EACH NEED WOULD BE PERFORMED BY HOLTON COMMUNITY HOSPITAL AND IF THE HOSPITAL WOULD ALLOCATE FUNDS TO THE ACTION. IN ADDITION TO THE ITEMS LISTED BELOW, THERE ARE SEVERAL COMMUNITY RELATED SPECIFIC ACTIONS THAT ARE LISTED ON OUR CHNA STRATEGIC PLAN. THE FOLLOWING ITEMS ARE DIRECTLY RELATED TO ACTIONS THAT THE HOSPITAL WILL ADDRESS AND DOLLAR AMOUNTS ALLOCATED TO THE SPECIFIC ACTIONS. 1) MENTAL HEALTH (DIAGNOSIS, PLACEMENT, AFTERCARE) A. Launch community education. Collaborate with community, elementary, middle, and high schools to educate students on mental health (destigmatize mental health conditions, suicide prevention and social media bullying). $450 B. Increase depression screenings by primary care physicians. Add trauma assessment for pediatrics and other mental health issues. $750 C. Explore development of senior life solutions program. $5,000 D. Explore / Expand USDA 2nd track Senior Life Solutions. $21,000 2) PUBLIC TRANSPORTATION - THIS IS NOT A PART OF HOLTON COMMUNITY HOSPITALS MISSION OF CRITICAL OPERATIONS. A. Develop a county transportation master plan. Work with local organizations to brainstorm ideas for transportation alternatives. B. Promote telemedicine and telehealth services when possible as an alternative to patient's traveling for care delivery. $1,000 C. Educate schedulers to consolidate appointments with different specialties on same day in order to minimize travel needed. 3) FOOD INSECURITY - This is not part of Holton Community Hospitals Mission of Critical Operations. A. Continue community backpack program, school food improvement initiatives and THRIVE donations. $1,000 B. Establish formal "Jackson Co Healthy Eating" program. Seek KS grant(s) to provide healthy eating bulletin to all local households and create a county event twice a year with speaker and panel. $500 C. Work with local employers to provide healthy lunch options for their staff. $972 D. Offer and promote nutrition and label reading education,gardening strategies and a community garden growth opportunities. Explore possible snap approval of local venders at farmer's markets. E. Encourage the utilization of dietician in primary care and specialty care settings. Recruit a dietician. $750 F. Offer free cooking classes, using produce from community gardens, and provide recipes for healthy dinners. $750 G. Establish relationship with schools to provide education to students and families about healthy eating strategies. Encourage healthy after school snacking. 4) AWARENESS OF HEALTHCARE SERVICES A. Continue HCH marketing activities. Promote existing healthcare services, facilities and specialists. Increase marketing activities to generate community interest and awareness. $5,400 B. Educate community about existing HC services using digital tool (Facebook / Website). Advertise on the radio and in the newspapers. Create fliers of different services and programs and hang in schools, churches, and other community gathering places. $500 C. Create comprehensive Jackson County Resource Guide on dedicated community website. Create options to set appointments /see openings. $250 D. Send hospital leadership and staff to local events, activities, and programs to promote and publicize facilities and services. Organize who goes where and when. $960 E. Start up and host lunch and learn where healthcare staff are able to describe their services to a different demographic of individuals than those that would be able to attend an evening dinner (consider breakfast options as well). $500 F. Promote and support free sports physicals. $900 5) POVERTY/EMPLOYMENT READINESS - This is not part of Holton Community Hospitals Mission of Critical Operations. A. Promote and advertise surrounding area college job fairs to high school students and the unemployed such as the Washburn Tech Program. $1 B. Continue to partner with churches and other community programs to develop soup kitchen/food pantry for those in need. 6) LANGUAGE TRANSLATORS (GUATEMALAN, OTHERS) - This is not part of Holton Community Hospitals Mission of Critical Operations. A. Launch HCH Translator service. B. Explore resources needed to clarify an employee translator. C. Research and evaluate different translation services that allow access to remote translation services (i.e. you call in and translation is done via the telephone) $720 D. Dedicate a resource in the area to act as a translator for the healthcare organizations (i.e. a community member who speaks both Guatemalan and English) $1 E. Provide the resources needed and dedicate 2-5 hospital staff members to learn the necessary translation languages 7) SUBSTANCE ABUSE (METH, MARIJUANA, OPIOIDS) - This is not part of Holton Community Hospitals Mission of Critical Operations. A. Continue to monitor prescription drug abuse. Support area physicians in discouraging prescription drug abuse. Create alert system between physicians and pharmacies for drug abuse. B. Continue training substance abuse - law enforcements. Administer ER Nar Policy / Promote Nar Can Community Education series. C. Continue / promote Discarding Old Prescriptions service at local police departments, focus on opioids. Expand take back day (yearly) to quarterly. $30 D. Expand school educational program (DARE) to educate on drug abuse and its consequences. E. Partner with local police authorities to develop a plan for helping those using drugs illegally. Include treatment of addiction in these plans. F. Support substance abuse counseling for community members. Educate the schools and local community organizations on signs of drug abuse. Establish resource list available for addiction treatment. G. Expand screening brief intervention referral and treatment (SBIRT). Expand outpatient programs for substance abuse. 8) OBESITY (NUTRITION/EXERCISE). A. Sponsor community activities that promote physical fitness/exercise for the entire family such as: Walk Holton JACO. Sponsor a community-wide "fitness challenge" all ages. $500 B. Create community educational series focusing on cooking demos, food labels, grocery store tours, restaurants healthy meals portions options, health fairs, classes, speakers etc. C. Launch diabetic educational services. Partner with providers and Jackson County Health Dept. to launch. $450 allocated D. Educate local businesses and industries on the benefits of offering wellness programs for their employees. E. Work with economic development groups to provide education and fitness activities for community members. F. Start "Awareness Program" to educate elementary/middle school children and their families about obesity. G. Continue to provide education to employers through worksite health fairs and educational programs, including various screenings. SCHEDULE H, PART V, SECTION B, LINE 16A THE FAP CAN BE FOUND AT: http://www.holtonhospital.com/getpage.php?name=financial_policy&sub=Patien t%20Info SCHEDULE H, PART V, SECTION B, LINE 16B THE FAP APPLICATION CAN BE FOUND AT: HTTP://WWW.HOLTONHOSPITAL.COM/DOCS/F.PDF SCHEDULE H, PART V, SECTION B, LINE 16C THE PLAIN LANGUAGE SUMMARY CAN BE FOUND AT: http://www.holtonhospital.com/getpage.php?name=financial_assistance&sub=Pa tient%20Info 3 FAMILY PRACTICE ASSOCIATES - HOLTON 1100 COLUMBINE DRIVE HOLTON KS 66436 RURAL HEALTH CLINIC FAMILY PRACTICE ASSOCIATES - HOYT 117 W 3RD HOYT KS 66440 RURAL HEALTH CLINIC FAMILY PRACTICE ASSOCIATES - WETMORE 323 SECOND STREET WETMORE KS 66550 RURAL HEALTH CLINIC SCHEDULE H, PART I, LINE 3C INSURANCE STATUS AND UNDERINSURANCE STATUS ARE OTHER FACTORS USED IN THE ELIGIBILITY CRITERIA EXPLAINED IN THE FAP FOR PROVIDING FREE AND DISCOUNTED CARE. SCHEDULE H, PART I, LINE 7 THE COSTING METHODOLOGY USED TO CALCUATE THE AMOUNT CONTAINED IN THE TABLE OF SCHEDULE H, PART I, LINE 7 IS THE COST-TO-CHARGE RATIO. SCHEDULE H, PART I, LINE 7, COLUMN F THE AMOUNT OF BAD DEBT EXPENSE REMOVED FROM TOTAL EXPENSES FOR CALCUATING THE NET COMMUNITY BENEFITS EXPENSE PERCENTAGE WAS $466,474. SCHEDULE H, PART II BY SERVING ON THE UNITED WAY ADVISORY COMMITTEE OUR EMPLOYEE CAN HELP DECIDE/DIRECT THE UNITED WAY FUNDS IN OUR COMMUNITY. SCHEDULE H, PART III, SECTION A, LINE 2 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 DOUBTFUL ACCOUNTS BASED UPON A REVIEW OF OUTSTANDING RECEIVABLES, HISTORICAL COLLECTION INFORMATION AND EXISTING ECONOMIC CONDITIONS. AS A SERVICE TO THE PATIENT, THE HOSPITAL BILLS THIRD-PARTY PAYERS DIRECTLY AND BILLS THE PATIENT WHEN THE PATIENT'S LIABILITY IS DETERMINED. PATIENT ACCOUNTS RECEIVABLE ARE DUE IN ACCORDANCE WITH A PREDETERMINED PAYMENT PLAN BASED ON THE VALUE OF THE PATIENT'S BALANCE. ACCOUNTS ARE CONSIDERED DELINQUENT AND SUBSEQUENTLY WRITTEN OFF AS BAD DEBT BASED ON INDIVIDUAL CREDIT EVALUATION AND SPECIFIC CIRCUMSTANCES OF THE ACCOUNT. SCHEDULE H, PART III, SECTION A, LINE 3 BAD DEBT EXPENSE (AT COST) IDENTIFIED THE PROVISION FOR UNCOLLECTIBLES FROM 3/31/20 AUDITED STATEMENT OF OPERATIONS. MULTIPLIED THAT AMOUNT BY THE COST TO CHARGE RATIO. CHARITY CARE (AT COST): LOGS MAINTAINED BY CASH COLLECTOR. LOG CONTAINS DATA OF THE DOLLAR AMOUNT TURNED TO BAD DEBT WHERE A CHARITY CARE APPLICATION WAS SENT BUT NOT RETURNED AND WHEN CHARITY CARE APPLICATION WAS RETURNED BUT PATIENT DID NOT FULFILL FINANCIAL OBLIGATION. SUBSEQUENTLY, MULTIPLIED THAT AMOUNT BY THE COST-TO-CHARGE RATIO IDENTIFIED IN SCHEDULE H, PART I. SCHEDULE H, PART III, SECTION A, LINE 4 SEE PAGE 9 OF THE ATTACHED AUDITED FINANCIAL STATEMENTS. SCHEDULE H, PART III, SECTION B, LINE 8 SERVING PATIENTS WITH GOVERNMENT HEATH BENEFITS, SUCH AS MEDICARE, IS A COMPONENT OF THE COMMUNITY BENEFIT STANDARD TAHT TAX-EXEMPT HOSPITALS ARE HELD TO. THIS IMPLIES THAT SERVING MEDICARE PATIENTS IS A COMMUNITY BENEFIT AND THAT THE HOSPITAL OPERATES TO PROMOTE THE HEALTH OF THE COMMUNITY. SCHEDULE H, PART III, SECTION C, LINE 9B FOR INDIVIDUALS WHO HAVE FINANCIAL DIFFICULTIES, THE HOSPITAL USES REASONABLE EFFORTS TO DETERMINE FINANCIAL ASSISTANCE ELIGIBILITY. THESE EFFORTS INCLUDE PROVIDING THE INDIVIDUAL WITH A PLAIN LANGUAGE SUMMARY (BROCHURE) OF THE FINANCIAL ASSISTANCE PROGRAM, A NOTICE ON ALL PATIENT BILLING STATEMENTS AND OTHER WRITTEN COMMUNICATIONS REGARDING BILLINGS, ORAL COMMUNICATIONS REGARDING AMOUNT DUE, AND OTHER MEANS AVAILABLE TO THE HOSPITAL TO IDENTIFY INDIVIDUALS WHO MAY BE ELIGIBLE FOR INSURANCE COVERAGE OR FINANCIAL ASSISTANCE. THE HOSPITAL WILL NOT ENGAGE IN EXTRAORDINARY COLLECTIONS ACTIONS (ECA) AGAINST AN INDIVIDUAL UNTIL IT IS DETERMINED THAT THE INDIVIDUAL HAS THE INCOME TO PAY OR THE INDIVIDUAL HAS NOT COOPERATED IN AN EFFORT TO ESTABLISH FINANCIAL ASSISTANCE ELIGIBILITY. IF A FINANCIAL ASSISTANCE APPLICATION HAS NOT BEEN SUBMITTED BY THE 120TH DAY AFTER THE HOSPITAL PROVIDED THE INDIVIDUAL WITH THE FIRST PATIENT BILLING STATEMENT, THE HOSPITAL MAY ENGAGE IN EXTRAORDINARY COLLECTIONS ACTIONS (ECA). IF AN APPLICATION IS SUBMITTED WITHIN THE 240TH DAY AFTER THE FIRST PATIENT BILLING STATEMENT, THE HOSPITAL WILL DISCONTINUE ECA UNTIL IT IS DETERMINED IF THE INDIVIDUAL IS ELIGIBLE FOR FINANCIAL ASSISTANCE. SCHEDULE H, PART VI, LINE 2 OUR CURRENT 12-BED HOSPITAL IS LOCATED WITHIN THE OUTER REGION OF THE HOLTON CITY LIMITS. OUR EXPANDED FACILITIES ALLOW US TO PROVIDE A BROAD RANGE OF HEALTHCARE SERVICES TO ALL MEMBERS OF OUR COMMUNITY WITHOUT REGARD TO AGE, RACE, SEX OR FINANCIAL CONSTRAINTS. WE REGULARLY EVALUATE THE SERVICES WE PROVIDE TO SEE IF THEY ARE BEING UTILIZED AND TO SEE WHAT ADDITIONAL SERVICES CAN BE PROVIDED. WE UTILIZE OUR COMMUNITY HEALTH NEEDS ASSESSMENT AND PATIENT FAMILY ADVISORY COMMITTEE INPUT TO DETERMINE IF ADDITIONAL SERVICES NEED TO BE PROVIDED. WE ARE COMMITTED TO PROVIDING QUALITY HEALTHCARE TO ALL MEMBERS OF OUR COMMUNITY. BECAUSE WE ARE A SMALL TOWN HOSPITAL, A MAJORITY OF OUR PATIENTS HAVE A STRONG BOND WITH OUR STAFF. THIS ALLOWS US TO PROVIDE CARE THAT EXTENDS BEYOND JUST MEDICAL NEEDS. THE COST AND DIFFICULTY IN SEEKING CARE IN OTHER AREAS FOR OUR ELDERLY AND POOR POPULATION REINFORCES THE NEED FOR A STRONG COMMUNITY HOSPITAL. WE STRIVE TO MEET THIS NEED BY PROVIDING ALL SERVICES POSSIBLE. WE HAVE BEEN DISTRIBUTING PATIENT SATISFACTION SURVEYS THROUGHOUT OUR SURGICAL, INPATIENT, OUTPATIENT, RURAL HEALTH CLINIC, EMERGENCY ROOM AND REHABILITATION SERVICES FOR APPROXIMATELY 6 YEARS. THE RESULTS OF THESE SURVEYS ARE COMPILED MONTHLY AND ARE USED TO BETTER OUR PATIENT SERVICES. WE HAVE ALSO ESTABLISHED A SURGICAL OVERSIGHT COMMITTEE THAT MEETS MONTHLY ON HOW TO IMPROVE SERVICES AND PROCESSES IN THE SURGERY DEPARTMENT. LISTED BELOW ARE SOME OF THE SERVICES PROVIDED BY HOLTON COMMUNITY HOSPITAL. HOLTON COMMUNITY HOSPITAL IS PROUD TO BE A CERTIFIED 'STROKE READY' FACILITY. OUR REHABILITATION SERVICES DEPARTMENT PROVIDES A FULL-COMPLIMENT OF OCCUPATIONAL AND PHYSICAL THERAPIES, INCLUDING A LYMPHEDEMA MANAGEMENT PROGRAM AND SPEECH THERAPY. OUR CARDIOVASCULAR SERVICES DEPARTMENT PROVIDES CARDIAC REHAB, AS WELL AS PERFORMS PULMONARY FUNCTION PROCEDURES AND STRESS TESTS, AND PROVIDES ONE-ON-ONE CERTIFIED DIABETES EDUCATION AND TOBACCO CESSATION COUNSELING. THE SURGERY DEPARTMENT PROVIDES 24/7 SURGICAL SERVICES. WE HAVE A LARGE VARIETY OF SPECIALTY PHYSICIANS WHO TREAT PATIENTS IN THE FACILITY AS WELL AS PERFORM NUMEROUS SURGICAL PROCEDURES. THE RADIOLOGY DEPARTMENT, IN COLLABORATION WITH ST. FRANCIS HOSPITAL, PROVIDES MOBILE NUCLEAR MEDICINE TESTING ON SITE. THE FACILITY ALSO CONTRACTS WITH SHARED MEDICAL SERVICES, INC. TO PROVIDE ON-SITE MOBILE MRI TESTING. THE RADIOLOGY DEPARTMENT IS ALSO VERY PROUD TO HAVE A 32-SLICE CT SCANNER WHICH PROVIDES HIGH RESOLUTION IMAGES. A CT SCANNER WITH THIS CAPABILITY IS A RARITY IN A HOSPITAL OF OUR SIZE. OUR HOSPITAL OFFERS A FULL-SERVICE, 24-7 EMERGENCY DEPARTMENT WITH A PHYSICIAN AVAILABLE AT ALL TIMES. WE HAVE TRANSFER AGREEMENTS WITH SURROUNDING HOSPITALS FOR THOSE PATIENTS WHO PRESENT TO THE HOSPITAL EMERGENCY DEPARTMENT AND REQUIRE CARE BEYOND OUR CAPABILITIES. OUR 12-BED IN-PATIENT UNIT PROVIDES CARE TO MEDICAL-SURGICAL PATIENTS, SUB-ACUTE PATIENTS, PEDIATRICS AND GERIATRICS. WE PROVIDE OBSTETRICAL AND NEWBORN CARE PATIENT SERVICES WHICH IS BECOMING INCREASINGLY RARE AMONG RURAL HOSPITALS. WE ARE ALSO LICENSED TO PROVIDE SWINGBED SERVICES. THIS ALLOWS PATIENTS TO RECEIVE TRANSITIONAL INPATIENT REHABILIATION AND RECOVERY SERVICES. HOLTON COMMUNITY HOSPITAL HAS A FULL-SERVICE HOME HEALTH AND HOSPICE PROGRAM. OUR AWARD-WINNING HOSPICE DELIVERS END OF LIFE CARE TO PATIENTS OF PROVIDERS THROUGHOUT NORTHEAST KANSAS. OUR RURAL HEALTH CLINIC (FAMILY PRACTICE ASSOCIATES) HAS THREE LOCATIONS IN HOLTON, HOYT AND WETMORE, KANSAS. OUR MIX OF THREE PHYSICIANS, TWO PHYSICIAN ASSISTANTS AND THREE ADVANCED REGISTERED NURSE PRACTITIONERS ALLOWS OUR COMMUNITY MEMBERS TO FIND A PROVIDER THAT BEST SERVES THEIR HEALTH CARE NEEDS. SEEING A NEED FOR SPORTS MEDICINE SERVICES WITHIN OUR LOCAL COMMUNITY, A CONTRACTUAL AGREEMENT WAS REACHED WITH A LOCAL SCHOOL SYSTEM. OUR PHYSICIAN'S ASSISTANT, ALSO A REGISTERED PHYSICAL THERAPIST, OFFERS SPORTS MEDICINE SERVICES 2 AFTERNOONS PER WEEK AT HOLTON HIGH SCHOOL. HE ALSO ATTENDS ALL HOME GAMES, AND AWAY GAMES AS NEEDED, TO ASSIST WITH POSSIBLE INJURIES THAT MIGHT OCCUR. SCHEDULE H, PART VI, LINE 3 HOLTON COMMUNITY HOSPITAL POSTS SIGNS AT ITS REGISTRATION LOCATIONS REGARDING THE AVAILABILITY OF OUR FINANCIAL ASSISTANCE PROGRAM. THE FAP POLICY IS ALSO AVAILABLE AT SEVERAL LOCATIONS IN THE COMMUNITY. THE AVAILABILITY OF A FINANCIAL ASSISTANCE PROGRAM IS ALSO IDENTIFIED ON ALL HOSPITAL PATIENT SERVICE RELATED LETTERS AND GUARANTOR STATEMENTS. ONCE A PATIENT CALLS TO INQUIRE ABOUT THE FINANCIAL ASSISTANCE PROGRAM THE PATIENT FINANCIAL COUNSELOR WORKS ONE-ON-ONE WITH THE PATIENTS OUTLINING THE REQUIREMENTS, DOCUMENTS NEEDED AND EXPLAINS OUR FINANCIAL ASSISTANCE PROGRAM IN DETAIL. SCHEDULE H, PART VI, LINE 4 JACKSON COUNTY IS LOCATED IN THE NORTHEASTERN PART OF KANSAS LOCATED ON US HIGHWAY 75. HOLTON COMMUNITY HOSPITAL AND FAMILY PRACTICE ASSOCIATES PHYSICIAN'S CLINIC ARE THE PREMIERE HEALTHCARE PROVIDERS IN OUR COUNTY. LIKE OTHER RURAL HOSPITALS, HCH SERVES A HIGHER PERCENTAGE OF ELDERLY AND CHILDREN LIVING IN POVERTY WHILE THE COUNTY EXPERIENCES HIGHER LEVELS OF UNEMPLOYMENT AND LOWER INCOMES. ACCORDING TO A REPORT GENERATED BY THE KANSAS RURAL HEALTH OPTIONS PROJECT, RURAL INDIVIDUALS REPORT POORER OVERALL HEALTH AND MORE CHRONIC HEALTH CONDITIONS. ADDITIONALLY, RURAL COUNTIES SEE A HIGHER RATE OF UNINSURED INDIVIDUALS AND HAVE FEWER HEALTH CARE SERVICES AVAILABLE TO THEM. FINALLY, PEOPLE IN RURAL COMMUNITIES ARE MORE LIKELY TO DERIVE PART OF THEIR INCOME FROM THE HEALTHCARE INDUSTRY (EITHER DIRECTLY OR INDIRECTLY). COUNTY HEALTH RANKINGS WEBSITE STATE THAT THE POPULATION OF JACKSON COUNTY WAS ESTIMATED TO BE 13,280 IN 2020 AND DENSITY OF 21 PERSONS PER SQUARE MILE. JACKSON COUNTY POPULATION CONSISTS OF 24.9% UNDER 18 YEARS OF AGE AND 19.1% OF PERSONS 65 YEARS OF AGE AND ABOVE. JACKSON COUNTY HOLDS THE DESIGNATION OF BEING A HEALTH PROFESSIONAL SHORTAGE AREA (HPSA). THIS DESIGNATION COMES FROM THE KANSAS DEPARTMENT OF HEALTH AND ENVIRONMENT (KDHE) AND IDENTIFIES AREAS OF THE STATE THAT ARE MEDICALLY UNDERSERVED. AS PUBLISHED IN COUNTY HEALTH RANKINGS 2020 THERE IS ONLY 1 PRIMARY CARE PROVIDER PER 1,480 RESIDENTS IN THE COUNTY, BELOW THE STATE'S AVERAGE OF 1 PER 1,290 RESIDENTS. ADDITIONALLY, THIS SAME WEBSITE NOTED THAT IN 2020 MORE THAN 12% OF ADULTS IN OUR COUNTY HAS NO HEALTH INSURANCE. THE SAME WEBSITE REPORTS THAT 15% OF JACKSON COUNTY, KANSAS CHILDREN UNDER THE AGE OF 18 WERE LIVING AT OR BELOW THE POVERTY LINE. ALSO, REPORTED FOR THE SAME PERIOD 30% OF JACKSON COUNTY CHILDREN LIVED IN SINGLE PARENT HOUSEHOLDS. ALSO, THE MEDIAN HOUSEHOLD INCOME OF JACKSON COUNTY RESIDENTS WAS APPROXIMATELY $56,300, COMPARED TO THE STATE'S MEDIAN INCOME OF $58,200. ALSO 8.5% OF JACKSON COUNTY RESIDENTS ARE AMERICAN INDIAN AS COMPARED TO A KANSAS AVERAGE OF 1.2%. ADDITIONALLY, IN A RECENT SURVEY (2019) COMPLETED BY THE UNIVERSITY OF WISCONSIN POPULATION HEALTH INSTITUTE AND THE ROBERT WOOD JOHNSON FOUNDATION, JACKSON COUNTY RANKED 52ND IN THE STATE ON THE HEALTH OF OUR COUNTY. JACKSON COUNTY SCORES BELOW STATE BENCHMARKS IN HEALTH CARE, LENGTH OF LIFE, HEALTHY BEHAVIORS, AND PHYSICAL ENVIRONMENT FACTORS. SCHEDULE H, PART VI, LINE 5 HOSPITAL EMPLOYEES ARE ENCOURAGED TO PARTICIPATE IN LOCAL COMMUNITY ACTIVITIES. EMPLOYEES ARE MEMBERS OF THE LOCAL CHAMBER OF COMMERCE, SERVE AS BOARD MEMBERS WITH SEVERAL LOCAL ORGANIZATIONS, AND ARE BOARD MEMBERS OF A STATE ORGANIZATION PROMOTING THE PATIENT FINANCIAL SERVICES SEGMENT OF HEALTHCARE. EMPLOYEES ARE INVOLVED ON SEVERAL LEVELS WITH YOUTH PROGRAMS. EMPLOYEES PROVIDE INSERVICE TRAINING TO VARIOUS LOCAL AGENCIES ON HEALTH ORIENTED SUBJECTS SUCH AS MEDICAL ADMINISTRATION. X X X X false false false false false false false false ERIN LOCKEND 0719 DIRECTOR/CHIEF OF MED STAFF 219432 0 0 0 0 0 8529 0 8813 0 236774 0 0 0 MALIA WARNERSTART 719 DIRECTOR/CHIEF OF MED STAFF 281851 0 0 0 0 0 11200 0 31356 0 324407 0 0 0 CARRIE SAIA CHIEF EXECUTIVE OFFICER 163762 0 0 0 0 0 6737 0 21852 0 192351 0 0 0 JOEL HUTCHINS PHYSICIAN 191281 0 0 0 0 0 7076 0 7333 0 205690 0 0 0 JOSHUA C MOULIN PHYSICIAN'S ASSISTANT 156047 0 0 0 0 0 6367 0 19643 0 182057 0 0 0 CLINT COLBERG PHYSICIAN 291338 0 0 0 0 0 11200 0 26719 329257 0 0 0 A CITY OF HOLTON KS 486030368 2015-03-04 3535579 SEE PART VI false false false B CITY OF HOLTON KS 486030368 436580AA2 2019-10-10 14615000 SEE PART VI false false false A 3535579 0 3535579 0 0 0 63992 0 0 956659 2514928 0 true false true true B 0 0 14615000 0 82209 0 195178 0 0 2474549 0 11863064 true false false true A false false true true false 0 false false false true B false false true true false 0 false false false true A false true true false 0 false 0 false true B false true false false 0 false 0 false true A true B true PART I, ROW A, COLUMN F Construct, furnish and equip additions to the hospital facility and a rural health clinic and refund Series 1997L Bonds. The Series 1997L Bonds were originally issued on 9/15/1997. PART II, COLUMN A, LINE 3 Any investment earnings earned during the project period were used to pay cash management fees and as a result have not been reported. PART II, COLUMN A, LINE 11 Amount of bond proceeds used to redeem the Series 1997L Bonds on 3/13/2015. PART III PART III WAS NOT COMPLETED FOR THE REFUNDING PORTION WHICH FINANCED PROJECTS PRIOR TO JANUARY 1, 2003. SEE SCHEDULE L PART V FORM 990, SCHEDULE L, PART IV TRANSACTION (1) (A) BARBARA WHEELER (B) BARBARA WHEELER IS THE MOTHER OF BOARD MEMBER HEATHER SCHRICK. (C) $37,098 (D) BARBARA WHEELER IS AN EMPLOYEE OF RURAL HEALTH RESOURCES OF JACKSON COUNTY. (E) NO FORM 990, PART III, LINE 4A RURAL HEALTH RESOURCES OF JACKSON COUNTY (RHRJC) IS A 12-BED CRITICAL ACCESS HOSPITAL IN A SMALL RURAL COMMUNITY. RHRJC OFFERS A WIDE RANGE OF SERVICES INCLUDING PHYSICAL THERAPY, OCCUPATIONAL THERAPY, SPEECH THERAPY, REGISTERED DIETICIAN SERVICES, MRI, MRA, NUCLEAR MEDICINE, CT SCAN ALONG WOTHER RADIOLOGY SERVICES, SURGERY, LABORATORY, A CERTIFIED DIABETIC EDUCATION PROGRAM, CARDIOVASCULAR SERVICES, CERTIFIED LYMPHEDEMA PROGRAM, OUTPATIENT GERIATRIC PSYCHOLOGY, AND ROUND CARE SERVIES AS WELL AVARIETY OF SPECIALTY PROVIDER SERVICES. THE HOSPITAL STAFF IS A CERTIFIED 'STROKE READY' FACILITY AND TRAINED TO TEACH OUTREACH SERVICES UNDER THE NATIONAL ARTHRITIS FOUNDATION EXERCISE PROGRAM. THE HOSPITAL ALSO OFFERS HOME HEALTH AND HOSPICE SERVICES. THE HOSPITAL PROVIDED 24/7 EMERGENCY ROOM SERVICES WITH 2,994 EMERGENCY ROOM VISITS RECORDED FROM 4/1/19 THROUGH 3/31/20. EMERGECNY ROOM SERVICES ARE SUPPORTED BY STAFF TRAINED IN ADVANCED CARDIACLIFE SUPPORT, CPR, EMERGENCY NURSING PEDIATRICS, TRAUMA NURSING CORE CURRICULUM, AND PEDIATRIC ADVANCED LIFE SUPPORT. THE HOSPITAL IDENTIFIED 12,893 INPATIENT HOURS AND 4,435 OBSERVATION HOURS FROM 4/1/19 THROUGH 3/31/20. FORM 990, PART VI, SECTION A, LINE 1A THE CLASS C DIRECTOR SHALL BE THE CHIEF OF MEDICAL STAFF AND SERVE (1) YEAR TERM. THE CLASS C DIRECTOR SHALL BE ENTITLED TO PARTICIPATE AND VOTE ON ALL MATTERS EXCEPT FOR: (A) EMPLOYEE COMPENSATION AND (B) EMPLOYEE PERSONNEL MATTERS. FORM 990, PART VI, SECTION B, LINE 11B AN INDEPENDENT ACCOUNTING FIRM PREPARES AND REVIEWS THE FORM 990. THE 990 IS THEN REVIEWED BY THE CEO AND CFO OF RURAL HEALTH RESOURCES OF JACKSON COUNTY (RHRJC). ANY QUESTIONS OR CONCERNS THAT ARISE ARE ADDRESSED WITH THE ACCOUNTING FIRM AND CORRECTIONS, CLARIFICATIONS OR REVISIONS ARE MADE AS NECESSARY. THE FINAL 990 WITH ALL REQUIRED SCHEDULES IS THEN PROVIDED TO ALL VOTING MEMBERS OF THE BOARD OF RHRJC PRIOR TO THE FILING OF THE 990. FORM 990, PART VI, SECTION B, LINE 12C UPON HIRE (OR IN THE CASE OF ELECTION OF BOARD MEMBERS) AND ANNUALLY THEREAFTER, THE CEO OR DESIGNEE(S) SHALL PROVIDE TO THE BOARD, STAFF AND EMPLOYED PROVIDERS OF RURAL HEALTH RESOURCES OF JACKSON COUNTY (RHRJC) A COPY OF THE CONFLICT OF INTEREST POLICY AND THE APPLICABLE CONFLICT OF INTEREST DISCLOSURE FORM. THESE DOCUMENTS WILL BE COMPLETED TO IDENTIFY ANY RELATIONSHIPS, POSITIONS, OR CIRCUMSTANCES IN WHICH IT IS BELIEVED A CONFLICT MAY ARISE. THE ANNUAL MONITORING AND REVIEW PROCESS WILL BE PART OF RHRJC'S CORPORATE COMPLIANCE PLAN. ANY POTENTIAL CONFLICT OF INTEREST CONCERNS THAT ARISE SHALL BE REPORTED BY THE CEO TO THE BOARD CHAIR. SHOULD THE CONCERN INVOLVE THE BOARD CHAIR, THE BOARD VICE-CHAIR WILL BE INFORMED INSTEAD. EACH BOARD MEMBER, STAFF MEMBER OR EMPLOYED PROVIDER SHALL FULLY DISCLOSE ANY AND ALL ACTUAL OR POTENTIAL CONFLICTS, DUALITY OF INTEREST OR RESPONSIBILITY INVOLVING INDIVIDUAL, PERSONAL, OR BUSINESS ISSUES WHICH MAY EXIST. IF THERE IS A CONFLICT, THE CONFLICTED INDIVIDUALS ABSTAIN FROM VOTING. FORM 990, PART VI, SECTION B, LINE 15A ANNUALLY AT THE EMPLOYEE REVIEW PERIOD (USUALLY DURING AUGUST AND SEPTEMBER) THE BOARD OF DIRECTORS IS SUPPLIED WITH A SALARY SURVEY FROM THE KANSAS HOSPITAL ASSOCIATION FOR THE CURRENT YEAR. THE BOARD THEN EVALUATES THE CEO SALARY SURVEY TO DETERMINE IF THE CEO'S SALARY IS APPROPRIATE AND WHAT ANNUAL PAY ADJUSTMENT IS APPROPRIATE FOR THE CURRENT YEAR. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. FORM 990, PART XI, LINE 9 Changes in net assets with donor restrictions ($387,623) FORM 990 PART IX LINE 11G DESCRIPTION:NURSING TOTAL FEES:350004 FORM 990 PART IX LINE 11G DESCRIPTION:MRI TOTAL FEES:173690 FORM 990 PART IX LINE 11G DESCRIPTION:ER PROVIDERS ON CALL FEES TOTAL FEES:415087 FORM 990 PART IX LINE 11G DESCRIPTION:COLLECTION COMPANY FEES TOTAL FEES:37184 FORM 990 PART IX LINE 11G DESCRIPTION:MISC. MANAGEMENT SERVICES TOTAL FEES:270328 FORM 990 PART IX LINE 11G DESCRIPTION:MISC. MEDICAL SERVICES TOTAL FEES:2316023