2021-05-17T13:40:58-05:00 2020-06-30 BKD LLP 1201 Walnut Suite 1700 KANSAS CITY MO 641062246 990 2019-07-01 481253246 PAWNEE VALLEY COMMUNITY HOSPITAL INC % GEORGE HARMS TREASURER PAWN 6202853161 923 CARROLL AVE LARNED KS 67550 SHAE VEACH PRESIDENT 6202853161 2021-05-15 true Michael J Engle P00482834 8162216300 2021-05-15 2019 2022-09-23 18:48:47Z SHAE VEACH 923 CARROLL AVE LARNED KS 67550 18392214 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 2 146 100 0 65083 1024860 18127681 17126170 97575 64318 211716 176866 18502055 18392214 0 0 0 0 8855968 8795041 0 0 0 6701222 7223802 15557190 16018843 2944865 2373371 15859560 21161892 14154358 19201379 1705202 1960513 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 11914906 0 17126170 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. 11914906 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 0 146 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 634084 119981 BRYCE YOUNG PRESIDENT 4.0 40.0 X X 0 334138 87232 GEORGE HARMS TREASURER 4.0 40.0 X X 0 342174 73069 CHRISTIAN WHITTINGTON MD DIRECTOR/PHYSICIAN-NONVOTING 40.0 0.0 X 355560 0 45837 MC HILL PHYSICIAN 40.0 0.0 X 276565 0 42225 DAVID SANGER PHYSICIAN 40.0 0.0 X 263226 0 44875 SHAE VEACH PRESIDENT 4.0 40.0 X X 0 235809 70847 DEBBIE TOMLINSON APRN 40.0 0.0 X 190238 0 15004 CALVIN KRUGER PHYSICIAN ASSISTANT 40.0 0.0 X 150746 0 10744 STACY TROUT PHYSICIAN ASSISTANT 40.0 0.0 X 144461 0 10388 KENDRA BARKER ADMINISTRATOR 0.0 40.0 X 0 95985 16875 MELANIE URBAN ADMINISTRATOR 0.0 40.0 X 0 62102 11681 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 1380796 1704292 548758 9 false true false HAYS MEDICAL CENTER 2220 CANTERBURY DR HAYS KS 67601 MEDICAL SERVICES 2846815 QUEST DIAGNOSTICS PO BOX 772976 CHICAGO IL 60677 LABORATORY SERVICES 147279 GE HEALTHCARE PO BOX 96483 CHICAGO IL 60693 EQUIP. MAINTENANCE 173070 University of Kansas Hospital Autho PO BOX 955772 ST LOUIS MO 631955772 FINANCIAL SERVICES 684000 4 72796 951385 679 1024860 Net patient service revenue 622000 16018610 16018610 340b drug program 900099 1083150 1083150 Outreach therapy services 900099 3047 3047 Lab fairs 900099 21363 21363 17126170 64143 64143 0 0 900 900 0 900 900 175 175 175 175 0 0 0 0 0 0 0 0 0 Meals sold to employees and guest 722210 125290 125290 _ 0 _ 0 50676 50676 175966 18392214 17126170 241184 0 0 0 0 581362 392932 188430 0 6537949 5942060 595889 321366 286647 34719 855350 762941 92409 499014 445102 53912 2346316 2346316 4171 4171 58172 58172 3469 3469 0 0 1740685 1476208 264477 40145 1238 38907 151154 100804 50350 115404 69242 46162 0 534072 413733 120339 56831 32882 23949 0 0 2759 2759 0 0 100469 60281 40188 Pharmaceuticals 1128380 1128380 Medical Supplies 507480 507480 Dietary 164042 164042 DUES AND SUBSCRIPTIONS 160141 103617 56524 110112 27317 82795 16018843 11914906 4103937 0 953811 1115290 9895444 14496311 0 0 2633556 1960510 0 0 0 0 0 0 361167 353021 137416 77523 0 0 172964 78725 0 0 0 0 0 0 1705202 3080512 15859560 21161892 1187172 1252322 0 0 0 3328469 0 0 0 0 0 0 0 0 0 0 12967186 14620588 14154358 19201379 X 644756 811559 1060446 1148954 1705202 1960513 15859560 21161892 X 2373371 -2118060 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false true 3469 false false false 3469 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. 1437709 12390 1450099 1193650 244059 1437709 1266232 -72582 1193650 1169777 96455 1266232 934796 234981 1169777 1.00000 false true true Beneficial interest foundation 1960512 AMOUNTS DUE FROM THIRD-PARTY 1120000 3080512 0 Pension Liability 78725 DUE TO UNIV. OF KS HOSPITAL 839000 Due to Pawnee County 11221644 Due to Hays Medical Center 280547 EST. AMOUNTS DUE TO THIRD-PARTY 2200672 14620588 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 130. true X true true true false false 163736 163736 0.01020 1213171 507114 706056 0.04410 1376907 507114 869792 0.05430 4372 4372 0.00030 2626586 1199742 1426844 0.08910 2630958 1199742 1431216 0.08940 4007865 1706856 2301008 0.14370 true 1324928 11484960 11753572 -268612 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 17 true false true true X SEE PART V, SECTION C X true 17 true SEE PART V, SECTION C false true X 130. 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: UNITED WAY, WELCOME INN SENIOR CENTER, CENTER FOR COUNSELING, ANGELS CARE HOME HEALTH, GOLDEN BELT FOUNDATION, LARNED CITY COUNCIL, BURDETT CITY COUNCIL AND GARFIELD CITY COUNCIL AND ROZEL COMMUNITY, PAWNEE COUNTY SHERRIFF'S OFFICE, LARNED POLICE DEPARTMENT, PAWNEE COUNTY HEALTH DEPARTMENT, COUNTY COMMISSIONERS, MEMBERS OF THE CHAMBER OF COMMERCE, MEMBERS OF THE USD 495 SCHOOL BOARD, SCHOOL NURSES OF USD 495, LOCAL MEMBERS OF THE MEDIA, LOCAL RELIGIOUS ORGANIZATIONS AND REPRESENTATIVE OF PAWNEE VALLEY COMMUNITY HOSPITAL. THE CHNA WAS COORDINATED AND PRODUCED BY VVV RESEARCH AND DEVELOPMENT, INC. FROM OLATHE, KANSAS. SCHEDULE H, PART V, SECTION B, LINE 6B PAWNEE COUNTY, KS SCHEDULE H, PART V, SECTION B, LINE 7A HTTP://WWW.PAWNEEVALLEYHOSPITAL.COM/WP-CONTENT/UPLOADS/2018/09/CHNA-IMPROV EMENTPLAN-PAWNEE-2018.PDF Schedule H, Part V, Section B, Line 10A HTTPS://PAWNEEVALLEYHOSPITAL.COM/WPCONTENT/UPLOADS/2018/09/CHNA-IMPROVEMEn TPLAN-PAWNEE-2018.PDF Schedule H, Part V, Section B, Line 11 ANNUAL DESCRIPTION OF THE ACTIONS TAKEN BY THE HOSPITAL DURING THE FISCAL YEAR TO ADDRESS THE SIGNIFICANT HEALTH NEEDS IDENTIFIED THROUGHOUT THE MOST RECENTLY CONDUCTED CHNA: 1-MENTAL HEALTH: THE HEART OF KANSAS CLINIC OFFERS BEHAVIORAL HEALTH CARE IN LARNED TWO DAYS A WEEK. PAWNEE COUNTY HEALTH DEPARTMENT PROVIDED EDUCATION ON MENTAL HEALTH AT THE 2019 FALL HEALTH FAIRS AND THE 2019 4-H FAIR. THE CENTER FOR COUNSELING AND CONSULTATION HAS COUNSELORS AVAILABLE IN LARNED TWO DAYS A WEEK (WEDNESDAY AND THURSDAY) FOR MENTAL HEALTH ISSUES. IN ADDITION THE CENTER FOR COUNSELING AND CONSULTATION ALSO OFFERS SUBSTANCE ABUSE COUNSELING IN LARNED ON FRIDAYS. PAWNEE VALLEY COMMUNITY HOSPITAL FOUNDATION HOSTED A MENTAL HEALTH EVENT,"THE MANY FACES OF MENTAL HEALTH" ON MARCH 19, 2019. EVENT FOCUSED ON TEENS AND MENTAL HEALTH. JEFF YALDEN CAME AND SPOKE AT THE EVENT. DURING THE DAY THE STUDENTS OF LARNED MIDDLE SCHOOL, LARNED HIGH SCHOOL, AND PAWNEE HEIGHTS ATTENDED THE EVENT. DURING THE EVENING THE EVENT WAS OPEN TO THE COMMUNITY, WITH OVER 300 ATTENDEES. CENTER FOR COUNSELING HAS HOSTED MENTAL FIRST AID COURSES WITHIN PAWNEE COUNTY. WITH COVID-19 PRECAUTIONS, NO NEW EVENTS WERE HELD DURING FY 2020 TO FOCUS ON MENTAL HEALTH. 2-AWARENESS OF LOCAL HC SERVICES: PAWNEE VALLEY COMMUNITY HOSPITAL HAS HIRED FOR A PART-TIME POSITION. THE DUTIES OF THIS POSITION INCLUDE MARKETING THE HOSPITAL SERVICES THROUGH MANY MARKETING AVENUES. THE PAWNEE COUNTY HEALTH DEPARTMENT GIVES ALL WIC CLIENTS A PAWNEE COUNTY RESOURCE LIST. SERVICES AVAILABLE VIA PAWNEE COUNTY HEALTH DEPARTMENT ARE LISTED ON THE COUNTY WEBSITE. 3-OPIOIDS CRISIS: PAWNEE VALLEY COMMUNITY HOSPITAL OFFERS A PAIN CLINIC AND HAS DEVELOPED POLICIES PERTAINING TO PRESCRIBING OPIOIDS. THIS PAIN CLINIC DOES NOT OFFER OPIOIDS, BUT RATHER, PROVIDES EPIDURAL STEROID INJECTIONS. PAWNEE COUNTY HEALTH DEPARTMENT PROVIDED EDUCATION ON OPIOID USAGE AT THE 2019 SPRING AND FALL HEALTH FAIRS AND THE 2019 4-H FAIR. THE CENTER FOR COUNSELING AND CONSULTATION AS MENTIONED ABOVE HAS COUNSELING SERVICES AVAILABLE ON FRIDAYS IN LARNED FOR SUBSTANCE ABUSE. 4-WOMEN'S HEALTH: IN 2018, PAWNEE VALLEY COMMUNITY HOSPITAL ESTABLISHED MAMMOGRAPHY WITHIN THE FACILITY. THE OPTION OF HAVING SPECIALTY OUT-REACH CLINIC CONTINUES TO BE ASSESSED BUT WAS DELAYED DUE TO COVID-19. PAWNEE COUNTY HEALTH DEPARTMENT CONTINUES TO OFFER THE FAMILY PLANNING SERVICE. 5-POVERTY/EMPLOYMENT READINESS, SCHOOL LUNCHES: CITY OF LARNED HAS ESTABLISHED THE "CIRCLES" PROGRAM. NOON LIONS CLUB HAS DONATED FUNDS TO ASSIST WITH THIS PROGRAM. THROUGH VIDEO, PAWNEE COUNTY IS ACTIVELY WORKING ON PROMOTING JOB OPPORTUNITIES AT LSH AND PAWNEE COUNTY. JOB OPENINGS CAN BE POSTED ON THE PAWNEE COUNTY CHAMBER WEBSITE. 6-HC SUPPORT GROUPS (CHRONIC DISEASE, WELLNESS, ETC.): PAWNEE VALLEY COMMUNITY HOSPITAL HAS A PART-TIME HEALTH COACH POSITION AND HOSTS A QUARTERLY DIABETIC EDUCATION COURSE. PAWNEE COUNTY HEALTH DEPARTMENT OFFERS A BREASTFEEDING SUPPORT/PEER COUNSELING GROUP, FACILITATES A DIABETIC SUPPORT GROUP WITH THE LOCAL WELCOME INN, OFFERS METABOLIC SCREENING, AND HEALTH COACHING. 7-PEDIATRIC CARE: PAWNEE VALLEY COMMUNITY HOSPITAL AND PAWNEE COUNTY HEALTH DEPARTMENT WORK TOGETHER TO SCREEN CHILDREN FOR LEAD. IF A CHILD IS SEEN AT PAWNEE VALLEY MEDICAL ASSOCIATES AND IS IN NEED OF LEAD SCREENING, THEY ARE REFERRED TO THE HEALTH DEPARTMENT FOR TESTING. PAWNEE VALLEY COMMUNITY HOSPITAL CONTINUES TO EVALUATE THE NEED AND OPTIONS FOR A PEDIATRICIAN WEEKLY OR BIWEEKLY. 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/2018/12/FINANCI AL-ASSISTANCE-POLICY-PVCH11-2018.PDF Schedule H, Part V, Section B, Line 16B https://www.pawneevalleyhospital.com/wp-content/uploads/2019/02/BUS136.pdf AND https://www.pawneevalleyhospital.com/wp-content/uploads/2019/02/BUS116a.pd f 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 $848,766 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, 2020. 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 8.6% 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 BRYCE YOUNG PRESIDENT 0 284565 0 45362 0 4211 0 60468 0 26764 0 421370 0 0 SHAE VEACH PRESIDENT 0 201497 0 23489 0 10823 0 45498 0 25349 0 306656 0 0 GEORGE HARMS TREASURER 0 278936 0 43592 0 19646 0 58882 0 14187 0 415243 0 0 EDWARD HERRMAN DIRECTOR 0 529369 0 100000 0 4715 0 96646 0 23335 0 754065 0 0 CHRISTIAN WHITTINGTON MD DIRECTOR/PHYSICIAN-NONVOTING 267061 0 20058 0 68441 0 16800 0 29037 0 401397 0 0 0 MC HILL PHYSICIAN 252415 0 20000 0 4150 0 15900 0 26325 0 318790 0 0 0 DEBBIE TOMLINSON APRN 175158 0 0 0 15080 0 11478 0 3526 0 205242 0 0 0 CALVIN KRUGER PHYSICIAN ASSISTANT 138569 0 0 0 12177 0 9035 0 1709 0 161490 0 0 0 STACY TROUT PHYSICIAN ASSISTANT 139065 0 0 0 5396 0 8662 0 1726 0 154849 0 0 0 DAVID SANGER PHYSICIAN 242350 0 20000 0 876 0 15900 0 28975 0 308101 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: Bryce Young $43,668 George Harms $42,082 Shae Veach $31,040 Edward Herrman $79,846 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 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 & 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, LINES 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. 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 ($ 2,373,368) Change in assets held by foundation $ 255,308 ------------ Total ($ 2,118,060) 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 2220 CANTERBURY DR HAYS KS 67601 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 HAYS MEDICAL CENTER INC E 193767 FMV HAYS MEDICAL CENTER INC M 493313 FMV HAYS MEDICAL CENTER INC O 386742 FMV PVCH FOUNDATION O 75575 FMV UKHS GREAT BEND LLC O 63092 FMV HAYS MEDICAL CENTER INC P 2300000 FMV UKHA P 155000 FMV