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GREAT PLAINS OF SMITH CO INC: Form 990, tax year 2019

View the entire original 990 at ProPublica ↗

Organization
GREAT PLAINS OF SMITH CO INC (EIN 48-1226830)
Tax period
2019-04-01 to 2020-03-31
Filed
2021-01-21
IRS object ID
202120219349301037
Schema version
2019v5.1
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Return2021-01-21T16:44:47-06:00ReturnTs
Tax Period End2020-03-31TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1BKD LLPBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line11551 N WATERFRONT PKWY STE 300AddressLine1Txt
CityWICHITACityNm
State AbbreviationKSStateAbbreviationCd
ZIP672066601ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2019-04-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN481226830EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1GREAT PLAINS OF SMITH CO INCBusinessNameLine1Txt
FieldValueIRS element (for citing)
In Care Of% DAVE DELLASEGAInCareOfNm
Business Name ControlGREABusinessNameControlTxt
Phone3166851523PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1250 NORTH ROCK ROAD STE 160AddressLine1Txt
CityWICHITACityNm
State AbbreviationKSStateAbbreviationCd
ZIP67206ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonDAVE DELLASEGAPersonNm
Person TitleCEOPersonTitleTxt
Phone3166851523PhoneNum
Signature2020-11-15SignatureDt
Discuss With Paid PreparerYes (true)DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonSHAWNELL LINOTPreparerPersonNm
PTINP01663908PTIN
Phone3162652811PhoneNum
FieldValueIRS element (for citing)
Tax2019TaxYr
Build TS2022-09-23 18:48:47ZBuildTS

Form 990 IRS990

Doing Business As Name DoingBusinessAsName

FieldValueIRS element (for citing)
Business Name Line1SMITH COUNTY MEMORIAL HOSPITALBusinessNameLine1Txt
FieldValueIRS element (for citing)
Principal OfficerDAVE DELLASEGAPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line1250 NORTH ROCK ROAD STE 160AddressLine1Txt
CityWICHITACityNm
State AbbreviationKSStateAbbreviationCd
ZIP67206ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$19,086,484GrossReceiptsAmt
Group Return For AffiliatesfalseGroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website AddressWWW.SCMHKS.ORGWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation1999FormationYr
Legal Domicile StateKSLegalDomicileStateCd
Activity Or MissionTHE OPERATION OF HOSPITAL FACILITIES FOR THE DELIVERY OF HEALTH CARE SERVICES, EDUCATION, AND WELLNESS WITHOUT REGARD TO RACE, CREED, COLOR, SEX OR FINANCIAL CIRCUMSTANCE.ActivityOrMissionDesc
Voting Members Governing Body8VotingMembersGoverningBodyCnt
Voting Members Independent7VotingMembersIndependentCnt
Total Employee170TotalEmployeeCnt
Total Volunteers8TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
PY Contributions Grants$2,614,738PYContributionsGrantsAmt
CY Contributions Grants$1,279,158CYContributionsGrantsAmt
PY Program Service Revenue$16,550,667PYProgramServiceRevenueAmt
CY Program Service Revenue$17,633,623CYProgramServiceRevenueAmt
PY Investment Income-$1,787,334PYInvestmentIncomeAmt
CY Investment Income$35,372CYInvestmentIncomeAmt
PY Other Revenue$309,407PYOtherRevenueAmt
CY Other Revenue$138,331CYOtherRevenueAmt
PY Total Revenue$17,687,478PYTotalRevenueAmt
CY Total Revenue$19,086,484CYTotalRevenueAmt
PY Grants And Similar Paid$0PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$0CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$8,202,726PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$8,405,196CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$10,363,459PYOtherExpensesAmt
CY Other Expenses$10,327,606CYOtherExpensesAmt
PY Total Expenses$18,566,185PYTotalExpensesAmt
CY Total Expenses$18,732,802CYTotalExpensesAmt
PY Revenues Less Expenses-$878,707PYRevenuesLessExpensesAmt
CY Revenues Less Expenses$353,682CYRevenuesLessExpensesAmt
Total Assets BOY$33,416,274TotalAssetsBOYAmt
Total Assets EOY$33,157,652TotalAssetsEOYAmt
Total Liabilities BOY$29,394,749TotalLiabilitiesBOYAmt
Total Liabilities EOY$28,836,264TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$4,021,525NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$4,321,388NetAssetsOrFundBalancesEOYAmt
Info In Schedule O Part IIIYes (X)InfoInScheduleOPartIIIInd
MissionTO 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.MissionDesc
Significant New Program SrvcfalseSignificantNewProgramSrvcInd
Significant ChangefalseSignificantChangeInd
Expense$15,300,672ExpenseAmt
Grant$0GrantAmt
Revenue$17,633,623RevenueAmt
DescGreat Plains of Smith County, Inc., dba Smith County Memorial Hospital delivers primary healthcare services to residents in an area that includes Smith County, Kansas. The service area also includes, to a lesser degree, Phillips, Jewell, and Osborne Counties in Kansas, as well as Franklin and Webster Counties in Nebraska. The primary healthcare services are delivered through a Rural Health Clinic and a Critical Access Hospital, including inpatient, outpatient, and skilled nursing (Swing Bed) services. SEE SCHEDULE O FOR CONTINUATION.Desc
Total Program Service Expenses$15,300,672TotalProgramServiceExpensesAmt
Described In Section501c3Yes (true)DescribedInSection501c3Ind
Schedule B RequiredYes (true)ScheduleBRequiredInd
Political Campaign ActyfalsePoliticalCampaignActyInd
Lobbying ActivitiesYes (true)LobbyingActivitiesInd
Subject To Proxy TaxfalseSubjectToProxyTaxInd
Donor Advised FundfalseDonorAdvisedFundInd
Conservation EasementsfalseConservationEasementsInd
Collections Of ArtfalseCollectionsOfArtInd
Credit CounselingfalseCreditCounselingInd
Donor Rstr Or Quasi EndowmentsYes (true)DonorRstrOrQuasiEndowmentsInd
Report Land Building EquipmentYes (true)ReportLandBuildingEquipmentInd
Report Investments Other SecfalseReportInvestmentsOtherSecInd
Report Program Related InvstfalseReportProgramRelatedInvstInd
Report Other AssetsfalseReportOtherAssetsInd
Report Other LiabilitiesfalseReportOtherLiabilitiesInd
Include FIN48 FootnotefalseIncludeFIN48FootnoteInd
Independent Audit Fincl StmtYes (true)IndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtYes (true)ConsolidatedAuditFinclStmtInd
School OperatingfalseSchoolOperatingInd
Foreign OfficefalseForeignOfficeInd
Foreign ActivitiesfalseForeignActivitiesInd
More Than5000 K To OrgfalseMoreThan5000KToOrgInd
More Than5000 K To IndividualsfalseMoreThan5000KToIndividualsInd
Professional FundraisingfalseProfessionalFundraisingInd
Fundraising ActivitiesfalseFundraisingActivitiesInd
Gaming ActivitiesfalseGamingActivitiesInd
Operate HospitalYes (true)OperateHospitalInd
Audited Financial Stmt AttYes (true)AuditedFinancialStmtAttInd
Grants To OrganizationsfalseGrantsToOrganizationsInd
Grants To IndividualsfalseGrantsToIndividualsInd
Schedule J RequiredYes (true)ScheduleJRequiredInd
Tax Exempt BondsfalseTaxExemptBondsInd
Engaged In Excess Benefit TransfalseEngagedInExcessBenefitTransInd
PY Excess Benefit TransfalsePYExcessBenefitTransInd
Loan OutstandingfalseLoanOutstandingInd
Grant To Related PersonfalseGrantToRelatedPersonInd
Business Rln With Org MemfalseBusinessRlnWithOrgMemInd
Business Rln With Fam MemfalseBusinessRlnWithFamMemInd
Business Rln With35 Ctrl EntfalseBusinessRlnWith35CtrlEntInd
Deductible Non Cash ContrifalseDeductibleNonCashContriInd
Deductible Art ContributionfalseDeductibleArtContributionInd
Terminate OperationsfalseTerminateOperationsInd
Partial LiquidationfalsePartialLiquidationInd
Disregarded EntityfalseDisregardedEntityInd
Related EntityYes (true)RelatedEntityInd
Related Organization Ctrl EntYes (true)RelatedOrganizationCtrlEntInd
Transaction With Control EntfalseTransactionWithControlEntInd
Trnsfr Exmpt Non Chrtbl Rltd OrgYes (true)TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted PrtshpfalseActivitiesConductedPrtshpInd
Schedule O RequiredYes (true)ScheduleORequiredInd
IRP Document25IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Backup Wthld ComplianceYes (true)BackupWthldComplianceInd
Employee170EmployeeCnt
Employment Tax Returns FiledYes (true)EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over LimitfalseUnrelatedBusIncmOverLimitInd
Foreign Financial AccountfalseForeignFinancialAccountInd
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTransInd
Taxable Party NotificationfalseTaxablePartyNotificationInd
Nondeductible ContributionsfalseNondeductibleContributionsInd
Quid Pro Quo ContributionsfalseQuidProQuoContributionsInd
Form8282 Property Disposed OffalseForm8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft CntrctfalseRcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft CntrctfalsePayPremiumsPrsnlBnftCntrctInd
Indoor Tanning ServicesfalseIndoorTanningServicesInd
Subj To Tax Rmnrtn Ex Prcht PymtfalseSubjToTaxRmnrtnExPrchtPymtInd
Subject To Excs Tax Net Invst IncfalseSubjectToExcsTaxNetInvstIncInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members8GoverningBodyVotingMembersCnt
Independent Voting Member7IndependentVotingMemberCnt
Family Or Business RlnYes (true)FamilyOrBusinessRlnInd
Delegation Of Mgmt DutiesfalseDelegationOfMgmtDutiesInd
Change To Org DocumentsfalseChangeToOrgDocumentsInd
Material Diversion Or MisusefalseMaterialDiversionOrMisuseInd
Members Or StockholdersYes (true)MembersOrStockholdersInd
Election Of Board MembersYes (true)ElectionOfBoardMembersInd
Decisions Subject To ApprovaYes (true)DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (true)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (true)MinutesOfCommitteesInd
Officer Mailing AddressfalseOfficerMailingAddressInd
Local ChaptersfalseLocalChaptersInd
Form990 Provided To Gvrn BodyYes (true)Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (true)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (true)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (true)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (true)WhistleblowerPolicyInd
Document Retention PolicyYes (true)DocumentRetentionPolicyInd
Compensation Process CEOfalseCompensationProcessCEOInd
Compensation Process OtherfalseCompensationProcessOtherInd
Investment In Joint VenturefalseInvestmentInJointVentureInd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

FieldValueIRS element (for citing)
PersonDAVE DELLASEGAPersonNm
Phone3166851523PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1250 NORTH ROCK ROAD STE 160AddressLine1Txt
CityWICHITACityNm
State AbbreviationKSStateAbbreviationCd
ZIP67206ZIPCd
FieldValueIRS element (for citing)
Info In Schedule O Part VIIYes (X)InfoInScheduleOPartVIIInd

Form990 Part VII Section A Form990PartVIISectionAGrp (16 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtHighest Compensated EmployeeHighestCompensatedEmployeeIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndOfficerOfficerInd
JUSTIN OVERMILLER
PHYSICIAN40.00.0Yes (X)$313,960$0$48,678
FERRILL CONANT
PHYSICIAN40.00.0Yes (X)$292,330$0$41,039
HANNAH HAACK
PHYSICIAN40.00.0Yes (X)$281,050$0$48,821
LEAH WIEHL
PHYSICIAN40.00.0Yes (X)$260,185$0$44,175
DAVE DELLASEGA
PRESIDENT/DIRECTOR2.040.0$0$208,624$33,481Yes (X)Yes (X)
TAMARA WINDSCHEFFEL
ARNP40.00.0Yes (X)$162,884$0$32,028
DURREL KELLEY
SENIOR VP OF OPERATIONS2.040.0$0$160,492$32,685Yes (X)
ALLEN VANDRIEL
ADMINISTRATOR40.00.0$150,555$0$31,382Yes (X)
DAVE RANKIN
CHAIRMAN/DIRECTOR0.252.25$0$0$0Yes (X)Yes (X)
BILL NAVIS
VICE PRESIDENT/DIRECTOR0.252.25$0$0$0Yes (X)Yes (X)
JOHN TERRILL
VICE PRESIDENT/DIRECTOR0.252.25$0$0$0Yes (X)Yes (X)
ROBERT HAMILTON
SECRETARY/DIRECTOR0.252.25$0$0$0Yes (X)Yes (X)
STEVE CARLSON
TREASURER/DIRECTOR0.252.25$0$0$0Yes (X)Yes (X)
DR BARBARA BROWN APPL
DIRECTOR0.252.25$0$0$0Yes (X)
ARTHUR HENRICKSON
DIRECTOR0.252.25$0$0$0Yes (X)
CHARLES WESTIN
DIRECTOR0.252.25$0$0$0Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$1,460,964TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$369,116TotReportableCompRltdOrgAmt
Total Other Compensation$312,289TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K8IndivRcvdGreaterThan100KCnt
Former Ofcr Employees ListedfalseFormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (true)TotalCompGreaterThan150KInd
Compensation From Other SrcsfalseCompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (3 entries)

Address Line1ContractorAddress/USAddress/AddressLine1TxtCityContractorAddress/USAddress/CityNmState AbbreviationContractorAddress/USAddress/StateAbbreviationCdZIPContractorAddress/USAddress/ZIPCdServicesServicesDescCompensationCompensationAmt
GPHA
250 N ROCK ROADWICHITAKS67206MANAGEMENT AND CBO$862,575
SHARED MEDICAL SERVICES
209 LIMESTONE PASSCOTTAGE GROVEWI53527MOBILE MRI SERVICE$112,855
AR SYSTEMS
PO BOX 2521TWIN FALLSID83303CODING SERVICE$105,954
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K3CntrctRcvdGreaterThan100KCnt
Government Grants$1,252,861GovernmentGrantsAmt
All Other Contributions$26,297AllOtherContributionsAmt
Total Contributions$1,279,158TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (2 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
NET PATIENT SERVICE REVENUE621300$15,083,986$15,083,986
340B PRESCRIPTION DRUG REVENUE621300$2,549,637$2,549,637
FieldValueIRS element (for citing)
Total Program Service Revenue$17,633,623TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$35,372TotalRevenueColumnAmt
Exclusion$35,372ExclusionAmt

Incm From Invest Bond Proceeds IncmFromInvestBondProceedsGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Royalties Revenue RoyaltiesRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Rental Income Or Loss RentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Real$0RealAmt
Personal$0PersonalAmt

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt
FieldValueIRS element (for citing)
Fundraising Gross Income$0FundraisingGrossIncomeAmt
Fundraising Direct Expenses$0FundraisingDirectExpensesAmt

Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt
FieldValueIRS element (for citing)
Gaming Gross Income$0GamingGrossIncomeAmt
Gaming Direct Expenses$0GamingDirectExpensesAmt

Net Income From Gaming NetIncomeFromGamingGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt
FieldValueIRS element (for citing)
Gross Sales Of Inventory$0GrossSalesOfInventoryAmt
Cost Of Goods Sold$0CostOfGoodsSoldAmt

Net Income Or Loss NetIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Other Revenue Misc OtherRevenueMiscGrp (3 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtExclusionExclusionAmt
EMPLOYEE/GUEST MEALS722513$106,469$106,469
VENDOR REBATES900099$6,370$6,370
All Other Misc Revenue900099$25,492$25,492

Miscellaneous Revenue MiscellaneousRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$25,492TotalRevenueColumnAmt
Exclusion$25,492ExclusionAmt
FieldValueIRS element (for citing)
Other Revenue Total$138,331OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$19,086,484TotalRevenueColumnAmt
Related Or Exempt Func Income$17,633,623RelatedOrExemptFuncIncomeAmt
Exclusion$173,703ExclusionAmt

Grants To Domestic Orgs GrantsToDomesticOrgsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Grants To Domestic Individuals GrantsToDomesticIndividualsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Foreign Grants ForeignGrantsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Benefits To Members BenefitsToMembersGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$182,705TotalAmt
Management And General$182,705ManagementAndGeneralAmt

Comp Disqual Persons CompDisqualPersonsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$6,469,543TotalAmt
Program Services$5,746,409ProgramServicesAmt
Management And General$723,134ManagementAndGeneralAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$476,676TotalAmt
Program Services$410,324ProgramServicesAmt
Management And General$66,352ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$841,737TotalAmt
Program Services$703,596ProgramServicesAmt
Management And General$138,141ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$434,535TotalAmt
Program Services$371,916ProgramServicesAmt
Management And General$62,619ManagementAndGeneralAmt

Fees For Services Management FeesForServicesManagementGrp

FieldValueIRS element (for citing)
Total$119,490TotalAmt
Management And General$119,490ManagementAndGeneralAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$8,180TotalAmt
Management And General$8,180ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$132,489TotalAmt
Management And General$132,489ManagementAndGeneralAmt

Fees For Services Lobbying FeesForServicesLobbyingGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Fees For Services Prof Fundraising FeesForServicesProfFundraising

FieldValueIRS element (for citing)
Total$0TotalAmt

Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$2,491,061TotalAmt
Program Services$1,642,812ProgramServicesAmt
Management And General$848,249ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$29,426TotalAmt
Program Services$3,049ProgramServicesAmt
Management And General$26,377ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$406,613TotalAmt
Program Services$403,765ProgramServicesAmt
Management And General$2,848ManagementAndGeneralAmt

Information Technology InformationTechnologyGrp

FieldValueIRS element (for citing)
Total$19,956TotalAmt
Program Services$194ProgramServicesAmt
Management And General$19,762ManagementAndGeneralAmt

Royalties RoyaltiesGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$309,405TotalAmt
Program Services$226,078ProgramServicesAmt
Management And General$83,327ManagementAndGeneralAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$5,830TotalAmt
Program Services$5,809ProgramServicesAmt
Management And General$21ManagementAndGeneralAmt

Pymt Travel Entrtnmnt Pub Ofcl PymtTravelEntrtnmntPubOfclGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Conferences Meetings ConferencesMeetingsGrp

FieldValueIRS element (for citing)
Total$36,257TotalAmt
Program Services$14,988ProgramServicesAmt
Management And General$21,269ManagementAndGeneralAmt

Interest InterestGrp

FieldValueIRS element (for citing)
Total$764,831TotalAmt
Program Services$546,531ProgramServicesAmt
Management And General$218,300ManagementAndGeneralAmt

Payments To Affiliates PaymentsToAffiliatesGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$2,270,932TotalAmt
Program Services$1,622,756ProgramServicesAmt
Management And General$648,176ManagementAndGeneralAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$134,193TotalAmt
Program Services$95,891ProgramServicesAmt
Management And General$38,302ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmt
MEDICAL SUPPLIES$2,994,897$2,994,897
PROVISION FOR BAD DEBTS$325,627$325,627
EQUIPMENT RENTAL/MAINTENANCE$127,454$86,018$41,436
DUES & SUBSCRIPTIONS$71,616$37,779$33,837

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$79,349TotalAmt
Program Services$62,233ProgramServicesAmt
Management And General$17,116ManagementAndGeneralAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$18,732,802TotalAmt
Program Services$15,300,672ProgramServicesAmt
Management And General$3,432,130ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$21,244BOYAmt
EOY$9,870EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$1,665,509BOYAmt
EOY$2,071,052EOYAmt

Pledges And Grants Receivable PledgesAndGrantsReceivableGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$1,747,781BOYAmt
EOY$3,157,766EOYAmt

Receivables From Officers Etc ReceivablesFromOfficersEtcGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

FieldValueIRS element (for citing)
BOY$245,021BOYAmt
EOY$258,902EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$88,462BOYAmt
EOY$109,191EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$30,657,949LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$4,022,771LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$27,865,933BOYAmt
EOY$26,635,178EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Investments Other Securities InvestmentsOtherSecuritiesGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Investments Program Related InvestmentsProgramRelatedGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Intangible Assets IntangibleAssetsGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$1,782,324BOYAmt
EOY$915,693EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$33,416,274BOYAmt
EOY$33,157,652EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$1,747,863BOYAmt
EOY$1,666,797EOYAmt

Grants Payable GrantsPayableGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Deferred Revenue DeferredRevenueGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Escrow Account Liability EscrowAccountLiabilityGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Loans From Officers Directors LoansFromOfficersDirectorsGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp

FieldValueIRS element (for citing)
BOY$27,646,886BOYAmt
EOY$27,169,467EOYAmt

Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$29,394,749BOYAmt
EOY$28,836,264EOYAmt
FieldValueIRS element (for citing)
Organization Follows FASB117Yes (X)OrganizationFollowsFASB117Ind

No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp

FieldValueIRS element (for citing)
BOY$3,085,506BOYAmt
EOY$3,443,929EOYAmt

Donor Restriction Net Assets DonorRestrictionNetAssetsGrp

FieldValueIRS element (for citing)
BOY$936,019BOYAmt
EOY$877,459EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$4,021,525BOYAmt
EOY$4,321,388EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$33,416,274BOYAmt
EOY$33,157,652EOYAmt
FieldValueIRS element (for citing)
Reconcilation Revenue Expnss$353,682ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst-$53,819NetUnrlzdGainsLossesInvstAmt
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or ReviewfalseAccountantCompileOrReviewInd
FS AuditedYes (true)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Consol And Sep Basis Fincl StmtYes (X)ConsolAndSepBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit CommitteeYes (true)AuditCommitteeInd
Federal Grant Audit RequiredfalseFederalGrantAuditRequiredInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
HospitalYes (X)HospitalInd

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

FieldValueIRS element (for citing)
ContributorRESTRICTEDContributorNum

Contributor Business Name ContributorBusinessName

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor US Address ContributorUSAddress

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Total ContributionsRESTRICTEDTotalContributionsAmt

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
Total Grassroots LobbyingTotalGrassrootsLobbyingGrp
Total Direct LobbyingTotalDirectLobbyingGrp
Total Lobbying ExpendTotalLobbyingExpendGrp
Other Exempt Purpose ExpendOtherExemptPurposeExpendGrp
Total Exempt Purpose ExpendTotalExemptPurposeExpendGrp
Lobbying Nontaxable AmountLobbyingNontaxableAmountGrp
Grassroots NontaxableGrassrootsNontaxableGrp
Tot Lbbyng Grassroot Mns Non TxTotLbbyngGrassrootMnsNonTxGrp
Tot Lbby Expend Mns Lbbyng Non TxTotLbbyExpendMnsLbbyngNonTxGrp
VolunteersfalseVolunteersInd
Paid Staff Or ManagementfalsePaidStaffOrManagementInd
Media AdvertisementsfalseMediaAdvertisementsInd
Mailings MembersfalseMailingsMembersInd
Publications Or BroadcastfalsePublicationsOrBroadcastInd
Grants Other OrganizationsYes (true)GrantsOtherOrganizationsInd
Grants Other Organizations$3,708GrantsOtherOrganizationsAmt
Direct Contact LegislatorsfalseDirectContactLegislatorsInd
Rallies DemonstrationsfalseRalliesDemonstrationsInd
Other ActivitiesfalseOtherActivitiesInd
Total Lobbying Expenditures$3,708TotalLobbyingExpendituresAmt
Not Described Section501c3falseNotDescribedSection501c3Ind

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferenceSCHEDULE C, PART II-B, LINE 1FFormAndLineReferenceDesc
ExplanationA PORTION OF THE ANNUAL DUES PAID TO KHA AND AHA ARE USED FOR LOBBYING.ExplanationTxt

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Art Public Exhibition AmountsArtPublicExhibitionAmountsGrp
Held Works ArtHeldWorksArtGrp

CY Endwmt Fund CYEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$936,018BeginningYearBalanceAmt
Contributions$13,269ContributionsAmt
Investment Earnings Or Losses-$38,761InvestmentEarningsOrLossesAmt
Other Expenditures$33,067OtherExpendituresAmt
End Year Balance$877,459EndYearBalanceAmt

CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$910,903BeginningYearBalanceAmt
Contributions$13,076ContributionsAmt
Investment Earnings Or Losses$41,817InvestmentEarningsOrLossesAmt
Other Expenditures$29,778OtherExpendituresAmt
End Year Balance$936,018EndYearBalanceAmt

CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$982,411BeginningYearBalanceAmt
Contributions$17,349ContributionsAmt
Investment Earnings Or Losses-$27,421InvestmentEarningsOrLossesAmt
Other Expenditures$61,436OtherExpendituresAmt
End Year Balance$910,903EndYearBalanceAmt

CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$931,434BeginningYearBalanceAmt
Contributions$49,072ContributionsAmt
Investment Earnings Or Losses$67,637InvestmentEarningsOrLossesAmt
Other Expenditures$65,732OtherExpendituresAmt
End Year Balance$982,411EndYearBalanceAmt

CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$904,033BeginningYearBalanceAmt
Contributions$45,770ContributionsAmt
Investment Earnings Or Losses$14,884InvestmentEarningsOrLossesAmt
Other Expenditures$33,253OtherExpendituresAmt
End Year Balance$931,434EndYearBalanceAmt
FieldValueIRS element (for citing)
Board Designated Balance EOY0.00000BoardDesignatedBalanceEOYPct
Prmnnt Endowment Balance EOY0.98880PrmnntEndowmentBalanceEOYPct
Term Endowment Balance EOY0.01120TermEndowmentBalanceEOYPct
Endowments Held Unrelated OrgYes (true)EndowmentsHeldUnrelatedOrgInd
Endowments Held Related OrgfalseEndowmentsHeldRelatedOrgInd

Land LandGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$395,701OtherCostOrOtherBasisAmt
Book Value$395,701BookValueAmt

Buildings BuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$19,602,101OtherCostOrOtherBasisAmt
Depreciation$2,006,881DepreciationAmt
Book Value$17,595,220BookValueAmt
FieldValueIRS element (for citing)
Leasehold ImprovementsLeaseholdImprovementsGrp

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$6,339,906OtherCostOrOtherBasisAmt
Depreciation$1,536,576DepreciationAmt
Book Value$4,803,330BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$4,320,241OtherCostOrOtherBasisAmt
Depreciation$479,314DepreciationAmt
Book Value$3,840,927BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$26,635,178TotalBookValueLandBuildingsAmt
Total Rev Etc Audited Fincl Stmt$18,707,038TotalRevEtcAuditedFinclStmtAmt
Net Unrealized Gains Invst-$53,819NetUnrealizedGainsInvstAmt
Other Revenue-$325,627OtherRevenueAmt
Revenue Not Reported-$379,446RevenueNotReportedAmt
Revenue Subtotal$19,086,484RevenueSubtotalAmt
Total Revenue Per Form990$19,086,484TotalRevenuePerForm990Amt
Tot Expns Etc Audited Fincl Stmt$18,407,175TotExpnsEtcAuditedFinclStmtAmt
Expenses Subtotal$18,407,175ExpensesSubtotalAmt
Other Expenses Not Included$325,627OtherExpensesNotIncludedAmt
Expenses Not Rpt Fincl Stmt$325,627ExpensesNotRptFinclStmtAmt
Total Expenses Per Form990$18,732,802TotalExpensesPerForm990Amt

Supplemental Information Detail SupplementalInformationDetail (4 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
SCHEDULE D, PART V, LINE 4THE INTENDED USE OF THE ENDOWMENT FUNDS IS TO SUPPORT THE CONTINUING OPERATIONS OF THE REPORTING ORGANIZATION.
SCHEDULE D, PART X, LINE 2MANAGEMENT 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 2DPROVISION FOR UNCOLLECTIBLE ACCOUNTS (325,627)
SCHEDULE D, PART XII, LINE 4BPROVISION FOR UNCOLLECTIBLE ACCOUNTS 325,627

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Financial Assistance PolicyYes (true)FinancialAssistancePolicyInd
Written PolicyYes (true)WrittenPolicyInd
All Hospitals PolicyYes (X)AllHospitalsPolicyInd
FPG Reference Free CareYes (true)FPGReferenceFreeCareInd
Percent200Yes (X)Percent200Ind
FPG Reference Discounted CarefalseFPGReferenceDiscountedCareInd
Free Care Medically IndigentYes (true)FreeCareMedicallyIndigentInd
Financial Assistance BudgetYes (true)FinancialAssistanceBudgetInd
Expenses Exceed BudgetfalseExpensesExceedBudgetInd
Annual Community Bnft ReportYes (true)AnnualCommunityBnftReportInd
Report Publically AvailableYes (true)ReportPublicallyAvailableInd

Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp

FieldValueIRS element (for citing)
Total Community Benefit Expns$35,447TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$35,447NetCommunityBenefitExpnsAmt
Total Expense0.00190TotalExpensePct

Unreimbursed Medicaid UnreimbursedMedicaidGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$826,577TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$331,086DirectOffsettingRevenueAmt
Net Community Benefit Expns$495,491NetCommunityBenefitExpnsAmt
Total Expense0.02690TotalExpensePct

Total Financial Assistance Typ TotalFinancialAssistanceTyp

FieldValueIRS element (for citing)
Total Community Benefit Expns$862,024TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$331,086DirectOffsettingRevenueAmt
Net Community Benefit Expns$530,938NetCommunityBenefitExpnsAmt
Total Expense0.02880TotalExpensePct

Community Health Services CommunityHealthServicesGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$51,291TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$51,291NetCommunityBenefitExpnsAmt
Total Expense0.00280TotalExpensePct

Total Other Benefits TotalOtherBenefitsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$51,291TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$51,291NetCommunityBenefitExpnsAmt
Total Expense0.00280TotalExpensePct

Total Community Benefits TotalCommunityBenefitsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$913,315TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$331,086DirectOffsettingRevenueAmt
Net Community Benefit Expns$582,229NetCommunityBenefitExpnsAmt
Total Expense0.03160TotalExpensePct
FieldValueIRS element (for citing)
Bad Debt Expense ReportedfalseBadDebtExpenseReportedInd
Bad Debt Expense$325,627BadDebtExpenseAmt
Reimbursed By Medicare$7,090,474ReimbursedByMedicareAmt
Cost Of Care Reimbursed By Medcr$7,090,474CostOfCareReimbursedByMedcrAmt

Costing Methodology Used CostingMethodologyUsedGrp

FieldValueIRS element (for citing)
Cost To Charge RatioYes (X)CostToChargeRatioInd
FieldValueIRS element (for citing)
Written Debt Collection PolicyYes (true)WrittenDebtCollectionPolicyInd
Financial Assistance PrvsnYes (true)FinancialAssistancePrvsnInd
Hospital Facilities1HospitalFacilitiesCnt

Hospital Facilities HospitalFacilitiesGrp

FieldValueIRS element (for citing)
Facility1FacilityNum

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1GREAT PLAINS OF SMITH CO INCBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line1614 SOUTH MAIN STREETAddressLine1Txt
CitySMITH CENTERCityNm
State AbbreviationKSStateAbbreviationCd
ZIP66967ZIPCd
FieldValueIRS element (for citing)
Website AddressWWW.SCMHKS.ORGWebsiteAddressTxt
State LicenseH092001StateLicenseNum
Licensed HospitalYes (X)LicensedHospitalInd
General Medical And SurgicalYes (X)GeneralMedicalAndSurgicalInd
Critical Access HospitalYes (X)CriticalAccessHospitalInd
Emergency Room24 HrsYes (X)EmergencyRoom24HrsInd
OtherRURAL HEALTH CLINIC LONG-TERM CARE UNITOtherDesc

Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1GREAT PLAINS OF SMITH CO INCBusinessNameLine1Txt
FieldValueIRS element (for citing)
Facility1FacilityNum
First Licensed CY Or PYfalseFirstLicensedCYOrPYInd
Tax Exempt Hospital CY Or PYfalseTaxExemptHospitalCYOrPYInd
CHNA ConductedYes (true)CHNAConductedInd
Community DefinitionYes (X)CommunityDefinitionInd
Community DemographicsYes (X)CommunityDemographicsInd
Existing ResourcesYes (X)ExistingResourcesInd
How Data ObtainedYes (X)HowDataObtainedInd
Community Health NeedsYes (X)CommunityHealthNeedsInd
Other Health IssuesYes (X)OtherHealthIssuesInd
Community Hlth Needs Id ProcessYes (X)CommunityHlthNeedsIdProcessInd
Consulting ProcessYes (X)ConsultingProcessInd
Prior CHNA ImpactYes (X)PriorCHNAImpactInd
CHNA Conducted18CHNAConductedYr
Take Into Account Others InputYes (true)TakeIntoAccountOthersInputInd
CHNA Conducted With Other FcltsfalseCHNAConductedWithOtherFcltsInd
CHNA Conducted With Non FcltsfalseCHNAConductedWithNonFcltsInd
CHNA Report Widely AvailableYes (true)CHNAReportWidelyAvailableInd
Rpt Available On Own WebsiteYes (X)RptAvailableOnOwnWebsiteInd
Own Website URLSEE SCHEDULE H, PART V, SECTION COwnWebsiteURLTxt
Paper Copy Public InspectionYes (X)PaperCopyPublicInspectionInd
Implementation Strategy AdoptYes (true)ImplementationStrategyAdoptInd
Implementation Strategy Adpt18ImplementationStrategyAdptYr
Strategy Posted WebsiteYes (true)StrategyPostedWebsiteInd
Strategy Website URLSEE SCHEDULE H, PART V, SECTION CStrategyWebsiteURLTxt
Organization Incur Excise TaxfalseOrganizationIncurExciseTaxInd
Elig Criteria ExplainedYes (true)EligCriteriaExplainedInd
FPG Family Incm Lmt Free DscntYes (X)FPGFamilyIncmLmtFreeDscntInd
FPG Family Incm Lmt Free Care200.FPGFamilyIncmLmtFreeCarePct
FPG Family Incm Lmt Dscnt Care0.FPGFamilyIncmLmtDscntCarePct
Medical Indigency CriteriaYes (X)MedicalIndigencyCriteriaInd
Insurance Status CriteriaYes (X)InsuranceStatusCriteriaInd
Underinsurance Stat CriteriaYes (X)UnderinsuranceStatCriteriaInd
Explained BasisYes (true)ExplainedBasisInd
App Financial Asst ExplnYes (true)AppFinancialAsstExplnInd
Described InfoYes (X)DescribedInfoInd
Described Suprt DocYes (X)DescribedSuprtDocInd
Provided Hospital ContactYes (X)ProvidedHospitalContactInd
Provided Nonprofit ContactYes (X)ProvidedNonprofitContactInd
Includes Publicity MeasuresYes (true)IncludesPublicityMeasuresInd
FAP Available On WebsiteYes (X)FAPAvailableOnWebsiteInd
FAP Available On Website URLSEE SCHEDULE H, PART V, SECTION CFAPAvailableOnWebsiteURLTxt
FAP App Available On WebsiteYes (X)FAPAppAvailableOnWebsiteInd
FAP App Available On Website URLSEE SCHEDULE H, PART V, SECTION CFAPAppAvailableOnWebsiteURLTxt
FAP Summary On WebsiteYes (X)FAPSummaryOnWebsiteInd
FAP Summary On Website URLSEE SCH H, PART V, SECTION CFAPSummaryOnWebsiteURLTxt
FAP Avlbl On Request No ChargeYes (X)FAPAvlblOnRequestNoChargeInd
FAP App Avlbl On Request No ChrgYes (X)FAPAppAvlblOnRequestNoChrgInd
FAP Sum Avlbl On Request No ChrgYes (X)FAPSumAvlblOnRequestNoChrgInd
Notified FAP Copy Bill DisplayYes (X)NotifiedFAPCopyBillDisplayInd
Communtity Notified FAPYes (X)CommuntityNotifiedFAPInd
FAP TranslatedYes (X)FAPTranslatedInd
FAP Actions On NonpaymentYes (true)FAPActionsOnNonpaymentInd
Permit No ActionsYes (X)PermitNoActionsInd
Collection ActivitiesfalseCollectionActivitiesInd
Provided Written NoticeYes (X)ProvidedWrittenNoticeInd
Made Effort Orally NotifyYes (X)MadeEffortOrallyNotifyInd
Processed FAP ApplicationYes (X)ProcessedFAPApplicationInd
Made Presumptive Elig DetermYes (X)MadePresumptiveEligDetermInd
Nondis Emergency Care PolicyYes (true)NondisEmergencyCarePolicyInd
Prospective Medicare MedicaidYes (X)ProspectiveMedicareMedicaidInd
Amounts Generally BilledfalseAmountsGenerallyBilledInd
Gross ChargesfalseGrossChargesInd

Supplemental Information SupplementalInformationGrp (7 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
SCHEDULE H, PART V, LINE 5THE OBJECTIVE OF THE SMITH COUNTY COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) WAS TO DETERMINE HEALTH NEEDS FROM THE PERSPECTIVE OF THE COMMUNITY IN COLLABORATION WITH THE HEALTH CARE PROVIDERS IN THE COMMUNITY. PARTICIPANTS IN A TOWN HALL MEETING HELD AS PART OF THE CHNA INCLUDED COMMUNITY RESIDENTS, GOVERNMENTAL, CIVIC, AND BUSINESS LEADERS IN THE COMMUNITY. THE ATTENDANCE ROSTER CAN BE FOUND IN SECTION V A OF THE CHNA DOCUMENT.
SCHEDULE H, PART V, LINE 7AHTTPS://WWW.SCMHKS.ORG/ABOUT-US/COMMUNITY-HEALTH-NEEDS-ASSESSMENT/
SCHEDULE H, PART V, LINE 10https://www.scmhks.org/files/2019/04/2018-Plan-Implementation.pdf
SCHEDULE H, PART V, LINE 11THE CHNA CONDUCTED IN APRIL 2018 HIGHLIGHTED 7 ISSUES FOR SMITH COUNTY. THE ISSUES WERE: 1. BEHAVIORAL & MENTAL HEALTH 2. WELLNESS/DISEASE PREVENTION 3. DENTAL SERVICE ACCESS 4. POVERTY/AFFORDABLE INSURANCE 5. CHILD CARE AND DEVELOPMENT ACCESS 6. ALCOHOL AND DRUG PREVENTION 7. ELDER CARE/HOUSING THE ISSUES IDENTIFIED WERE REVIEWED BY GREAT PLAINS OF SMITH COUNTY, INC. LEADERSHIP AND GOVERNING BOARD, AND WERE PRIORITIZED INTO AN IMPLEMENTATION STRATEGY, WHICH WAS PUBLISHED LATER IN 2018. THE IMPLEMENTATION STRATEGY IS POSTED ON THE PUBLIC WEBSITE (WWW.SCMHKS.ORG). THE STRATEGY ADDRESSES ITEMS 1, 2, 6, AND 7 AS PRIORITIES THAT GREAT PLAINS OF SMITH COUNTY, INC. CAN DIRECTLY IMPACT USING RESOURCES OF THE HEALTH CARE COMMUNITY. ITEMS 3, 5, AND 7 ARE PRIORITIES THAT CANNOT BE ADDRESSED SOLELY BY GPSC, BUT WHICH WE CONTINUE TO WORK COLLABORATIVELY WITH OTHER ORGANIZATIONS AND PARTNERS TO ADDRESS. ITEM 4 WAS IDENTIFIED AS A DETERMINANT OF HEALTH STATUS WITHIN THE GPSC SERVICE AREA, BUT IS BEYOND THE PURVIEW OF GPSC TO ADDRESS. RATHER, IT IS VIEWED AS AN OVERALL ECONOMIC DEVELOPMENT PRIORITY.
SCHEDULE H, PART V, LINE 16AHTTPS://WWW.SCMHKS.ORG/SERVICES/FINANCIAL-ASSISTANCE/
SCHEDULE H, PART V, LINE 16BHTTPS://WWW.SCMHKS.ORG/SERVICES/FINANCIAL-ASSISTANCE/
SCHEDULE H, PART V, LINE 16CHTTPS://WWW.SCMHKS.ORG/SERVICES/FINANCIAL-ASSISTANCE-RESOURCES/
FieldValueIRS element (for citing)
Facility1FacilityNum

Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp

Oth Hlth Care Fclts OthHlthCareFcltsGrp

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1SMITH COUNTY FAMILY PRACTICEBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line1119 E PARLIAMENT STREETAddressLine1Txt
CitySMITH CENTERCityNm
State AbbreviationKSStateAbbreviationCd
ZIP66967ZIPCd
FieldValueIRS element (for citing)
FacilityFAMILY PRACTICEFacilityTxt

Supplemental Information Detail SupplementalInformationDetail (14 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
SCHEDULE H, PART I, LINE 3CTHE ORGANIZATION USED THE FOLLOWING CRITERIA TO DETERMINE ELIGIBILITY FOR FINANCIAL ASSISTANCE: ASSET LEVEL, MEDICAL INDIGENCY, INSURANCE STATUS, AND UNDER INSURANCE STATUS.
SCHEDULE H, PART VI, LINE 7THE COSTING METHODOLOGY USED TO CALCULATE THE AMOUNTS IN THE TABLE OF PART I, LINE 7, OF SCHEDULE H, IS A COST TO CHARGE RATIO.
SCHEDULE H, PART I, LINE 7, COLUMN FTHE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A) BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $325,627.
SCHEDULE H, PART III, LINE 2HOSPITAL 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 3THE 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 REASOBABLE 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 4SEE PAGE 37 OF THE AUDITED FINANCIALS UNDER NOTE 21.
SCHEDULE H, PART III, LINE 8THE COSTING METHODOLOGY USED TO CALCULATE THE AMOUNT ON LINE 6 IS A COST TO CHARGE RATIO.
SCHEDULE H, PART III, LINE 9BALL CHARITY CARE AND CHARGES NOT TO BE COLLECTED DUE TO FINANCIAL ASSISTANCE COMPUTATIONS ARE EXEMPTED FROM COLLECTION POLICIES AND PRACTICES. THESE ACCOUNTS ARE REMOVED FROM THE COLLECTION CYCLE.
SCHEDULE H, PART VI, LINE 2GREAT PLAINS OF SMITH COUNTY, INC. USES BOTH FORMAL AND INFORMAL METHODS TO DETERMINE THE NEEDS OF THE COMMUNITIES IT SERVES. FORMAL MECHANISMS PRIMARILY CENTER ON COMMUNITY HEALTH NEEDS ASSESSMENTS. THE THIRD ROUND OF CHNA WAS COMPLETED AND THE REPORT WAS ISSUED IN JUNE 2018. AN IMPLEMENTATION PLAN WAS DEVELOPED BASED ON THAT NEEDS ASSESSMENT. INFORMALLY, GPSC HAS USED PUBLIC FORUMS, PARTICULARLY ASSOCIATED WITH OUR CONSTRUCTION PROJECT FOR A REPLACEMENT FACILITY TO SEEK INPUT FROM ALL OF THE COMMUNITIES IN SMITH COUNTY. THE FEEDBACK RECEIVED FROM BOTH THE CHNA AND THE PUBLIC FORUMS HAS BEEN INCORPORATED INTO OUR PLANS FOR THE NEW FACILITY, WHICH WAS COMPLETED IN 2018. IN ADDITION, THE BOARD OF TRUSTEES OF SMITH COUNTY MEMORIAL HOSPITAL (OPERATED BY GPSC) SERVES AS A CONDUIT FOR INPUT FROM THE COMMUNITY ON A WIDE RANGE OF ISSUES. IN ADDITION TO INDIVIDUAL INTERACTIONS WITH CITIZENS THAT EACH OF THE TRUSTEES UNDERTAKES, THERE IS ALSO FREQUENT AND TRANSPARENT INTERACTION WITH THE SMITH COUNTY COMMISSIONERS, WHO APPOINT THE TRUSTEES.
SCHEDULE H, PART VI, LINE 3OUR FINANCIAL ASSISTANCE POLICY IS ROUTINELY UTILIZED IN COMMUNICATING WITH PATIENTS REGARDING THEIR FINANCIAL OBLIGATIONS TO US. EVERY BILLING STATEMENT SENT TO PATIENTS INCLUDES INFORMATION REGARDING THE FAP AND WHO TO CONTACT WITH QUESTIONS. EVERY TELEPHONE CONTACT WITH OUR PATIENT ACCOUNTS STAFF INCLUDES QUESTIONING OF PATIENTS REGARDING THE NEED FOR ASSISTANCE WITH APPLICATION FOR FINANCIAL ASSISTANCE. OUR FINANCIAL ASSISTANCE POLICY IS POSTED ON OUR PUBLIC WEBSITE, ALSO INCLUDING CONTACT INFORMATION.
SCHEDULE H, PART VI, LINE 4THE 2010 CENSUS SHOWED A POPULATION OF 3,853 INDIVIDUALS IN SMITH COUNTY, KANSAS. KANSAS VITAL STATISTICS ESTIMATES A POPULATION OF 3668 IN 2017. THE DEMOGRAPHIC BREAKDOWN OF THAT POPULATION SHOWS 27% OF THE TOTAL AGED 65 OR ABOVE. THIS COMPARES TO A STATEWIDE POPULATION OF 14% ABOVE THE AGE OF 65. THE POPULATION DENSITY OF SMITH COUNTY IS LESS THAN 6 PERSONS PER SQUARE MILE, CLASSIFYING THE COUNTY A FRONTIER. APPROXIMATELY 96% OF THE POPULATION ARE CLASSIFIED AS CAUCASIAN, APPROXIMATELY 2% HISPANIC, AND LESS THAN 1% BLACK. THE POPULATION IS 51% FEMALE, 49% MALE. THE AVERAGE HOUSEHOLD INCOME FOR THE COUNTY IS $53,074.
SCHEDULE H, PART VI, LINE 5SMITH COUNTY MEMORIAL HOSPITAL HAS A FIVE MEMBER BOARD OF TRUSTEES APPOINTED BY THE SMITH COUNTY BOARD OF COMMISSIONERS. THIS BOARD MAINTAINS RESPONSIBILITY FOR THE MAINTENANCE AND UPKEEP OF THE FACILITIES UTILIZED BY SMITH COUNTY MEMORIAL HOSPITAL. SMITH COUNTY MEMORIAL HOSPITAL, OPERATED BY GREAT PLAINS OF SMITH COUNTY, OPERATES A MEALS ON WHEELS PROGRAM IN SMITH CENTER. THIS PROGRAM PROVIDES ONE MEAL PER DAY CONSISTING OF A BALANCED DIET, PROVIDED AT REDUCED RATES TO MEMBERS OF THE COMMUNITY UNABLE TO COOK FOR THEMSELVES. CLIENTS OF THIS PROGRAM INCLUDE INDIVIDUALS LIVING IN THEIR OWN HOMES, AS WELL AS IN SEVERAL INCOME-SUBSIDIZED HOUSING FACILITIES OPERATED PRIVATELY OR BY THE PUBLIC HOUSING AUTHORITY IN SMITH CENTER. THE MEALS ARE PREPARED AND PACKAGED IN THE SCMH KITCHEN. THEY ARE DELIVERED BY COMMUNITY VOLUNTEERS. THE PRICE FOR THE MEALS IS DEEPLY DISCOUNTED, RESULTING IN PROVISION OF MEALS AT FAR LESS THAN THE COST OF THEIR PRODUCTION. SMITH COUNTY MEMORIAL HOSPITAL ALSO PROVIDES AN EDUCATIONAL PROGRAM FOR KINDERGARTEN STUDENTS IN ONE LOCAL SCHOOL DISTRICT EACH YEAR TO FAMILIARIZE THEM WITH DIFFERENT SERVICE AREAS OF THE HOSPITAL TO HELP ALLEVIATE ANXIETY IN THE EVENT THEY NEED TO USE OUR SERVICES. THIS PROGRAM INVOLVES A HALF-DAY FIELD TRIP TO THE HOSPITAL BY THE KINDERGARTEN STUDENTS TO VIEW THE FACILITIES AND HEAR A DESCRIPTION OF HOW THEY WOULD BE TREATED IF THEY HAD TO BE TREATED AT THE HOSPITAL. OTHER EDUCATIONAL PROGRAMS PROVIDED BY SMITH COUNTY MEMORIAL HOSPITAL INCLUDE STEPPING ON, A PROGRAM TARGETED AT SENIOR CITIZENS WHO ARE AT RISK OF FALLS. THE MULTI-WEEK PROGRAM, FACILITATED BY THE EMERGENCY DEPARTMENT SUPERVISOR AND AN OCCUPATIONAL THERAPIST, TEACHES PARTICIPANTS HOW TO STRETCH, EXERCISE, AND IMPROVE BALANCE. ANOTHER EDUCATIONAL PROGRAM THAT HAS SEEN WIDESPREAD EXPOSURE THIS YEAR IS STOP THE BLEED. THIS PROGRAM IS INTENDED TO TEACH MEMBERS OF THE PUBLIC HOW TO RESPOND TO INJURIES THAT INVOLVE LIFE-THREATENING BLEEDING. QUALIFIED INSTRUCTORS, LED BY THE PHYSICIAN MEDICAL DIRECTOR OF OUR EMERGENCY DEPARTMENT, TEACH PARTICIPANTS HOW TO USE TOURNIQUETS AND WOUND PACKING TO CONTROL BLEEDING. THE PROGRAM HAS BEEN OFFERED TO LOCAL FIRST RESPONDERS, AGRICULTURAL WORKERS ATTENDING A LOCAL AGRICULTURAL EXPO SPONSORED BY AN IMPLEMENT DEALERSHIP, AND SCHOOL DISTRICT EMPLOYEES. ADDITIONALLY, OUR EXECUTIVE CHEF, WHO IS ALSO A REGISTERED CLINICAL DIETICIAN, HAS BEGUN OFFERING EDUCATIONAL PROGRAMS TO THE COMMUNITY FOCUSING ON HEALTHY COOKING AND DIET MODIFICATION. SMITH COUNTY MEMORIAL HOSPITAL WORKS CLOSELY WITH SMITH COUNTY EMS TO FACILITATE THE DELIVERY OF EMERGENCY MEDICAL SERVICES IN THROUGHOUT THE COUNTY. THIS INCLUDES PROVISION ON MEDICAL DIRECTION TO THE EMS AGENCY BY ONE OF OUR EMPLOYED PHYSICIANS. THE HOSPITAL ALSO PARTICIPATES THE SMITH COUNTY LOCAL EMERGENCY PLANNING COUNCIL (LEPC) TO PLAN A COMMUNITY- WIDE RESPONSE TO EMERGENCY CONDITIONS. SMITH COUNTY MEMORIAL HOSPITAL PARTICIPATES IN EMERGENCY PREPAREDNESS DRILLS CONDUCTED AT THE COMMUNITY AND COUNTY LEVEL, IN ADDITION TO EXERCISING INTERNAL PROCESSES ANNUALLY. AS A CRITICAL ACCESS HOSPITAL, SMITH COUNTY MEMORIAL HOSPITAL PROVIDES 24- HOUR EMERGENCY MEDICAL CARE, IN ADDITION TO INPATIENT AND OUTPATIENT SERVICES. SMITH COUNTY MEMORIAL HOSPITAL IS THE ONLY HOSPITAL LOCATED IN SMITH COUNTY. WE HAVE AN OPEN MEDICAL STAFF, ACCEPTING MEMBERSHIP FROM A WIDE VARIETY OF LOCAL AND VISITING PROVIDERS. SCMH PROVIDES SPACE FOR THE REGIONAL COMMUNITY MENTAL HEALTH CENTER TO PROVIDE COUNSELING SERVICES TO RESIDENTS OF THE AREA ON A WEEKLY BASIS. TELEHEALTH SERVICES ARE USED FOR THE DELIVERY OF SPECIALTY MEDICAL SERVICES NOT AVAILABLE IN THE COMMUNITY, AND ARE PROVIDED FOR PUBLIC SERVICE EVENTS, SUCH AS MENTAL HEALTH HEARINGS, COURT ORDERED COUNSELING SESSIONS, ETC. SMITH COUNTY MEMORIAL HOSPITAL ALSO WORKS CLOSELY WITH HOSPICE SERVICES, INC., THE REGIONAL PROVIDER OF HOSPICE SERVICES.
SCHEDULE H, PART VI, LINE 6SMITH COUNTY MEMORIAL HOSPITAL IS OPERATED BY GREAT PLAINS OF SMITH CO., INC., A SUBSIDIARY OF GREAT PLAINS HEALTH ALLIANCE. GPHA IS A 501(C)(3) NOT FOR PROFIT ORGANIZATION WHICH PROVIDES MANAGEMENT, FINANCE, BILLING, INFORMATION SYSTEMS, AND PHARMACY SUPPORT SERVICES TO ITS AFFILIATED ORGANIZATIONS. GPHA DOES NOT PROVIDE SERVICES DIRECTLY TO PATIENTS, BUT PROVIDES ACCESS TO PROFESSIONALS AND SYSTEMS WHICH MIGHT NOT OTHERWISE BE AVAILABLE OR AFFORDABLE TO SMALL RURAL HOSPITALS. GPHA PROVIDES EDUCATION AND ASSISTANCE IN AREAS SUCH AS HIPAA PRIVACY AND SECURITY, MEDICARE AND MEDICAID REIMBURSEMENT RULES AND REGULATIONS, MEANINGFUL USE REQUIREMENTS FOR ELECTRONIC HEALTH RECORDS, ETC. GREAT PLAINS HEALTH ALLIANCE BRINGS TOGETHER ITS NETWORKED CRITICAL ACCESS HOSPITALS IN KANSAS AND NEBRASKA TO LEARN FROM EACH OTHER AND DEVELOP BEST PRACTICES IN CARE PROVISION, MANAGEMENT, AND GOVERNANCE. AFFILIATED HOSPITALS RECEIVE POLICY GUIDANCE REGARDING FINANCIAL ASSISTANCE TO PATIENTS, CORPORATE COMPLIANCE, CONFLICTS OF INTEREST, AND MANY OTHER AREAS. GUIDANCE IS ALSO PROVIDED TO THE GOVERNING BOARDS OF AFFILIATED HOSPITALS TO ASSIST THEM IN FULFILLING THEIR FIDUCIARY RESPONSIBILITIES.
SCHEDULE H, PART VI, LINE 7N/A

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Severance PaymentfalseSeverancePaymentInd
Supplemental Nonqual Rtr PlanfalseSupplementalNonqualRtrPlanInd
Equity Based Comp ArrngmfalseEquityBasedCompArrngmInd
Comp Based On Revenue Of Flng OrgfalseCompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related OrgsfalseCompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng OrgfalseCompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd OrgsfalseCompBsdNetEarnsRltdOrgsInd
Any Non Fixed PaymentsfalseAnyNonFixedPaymentsInd
Initial Contract ExceptionfalseInitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (8 entries)

TitleTitleTxtBase Compensation Filing OrgBaseCompensationFilingOrgAmtCompensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmtBonus Filing OrganizationBonusFilingOrganizationAmountBonus Related OrganizationsBonusRelatedOrganizationsAmtOther Compensation Filing OrgOtherCompensationFilingOrgAmtOther Compensation Rltd OrgsOtherCompensationRltdOrgsAmtDeferred Compensation Flng OrgDeferredCompensationFlngOrgAmtDeferred Comp Rltd OrgsDeferredCompRltdOrgsAmtNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmtNontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmtTotal Compensation Filing OrgTotalCompensationFilingOrgAmtTotal Compensation Rltd OrgsTotalCompensationRltdOrgsAmtComp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmtComp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt
DAVE DELLASEGA
PRESIDENT/DIRECTOR$0$208,541$0$0$0$83$0$20,484$0$12,997$0$242,105$0$0
DURREL KELLEY
SENIOR VP OF OPERATIONS$0$160,275$0$0$0$217$0$15,277$0$17,408$0$193,177$0$0
ALLEN VANDRIEL
ADMINISTRATOR$148,887$0$0$0$1,668$0$15,257$0$16,125$0$181,937$0$0$0
JUSTIN OVERMILLER
PHYSICIAN$311,706$0$0$0$2,254$0$27,200$0$21,478$0$362,638$0$0$0
FERRILL CONANT
PHYSICIAN$290,019$0$0$0$2,311$0$27,200$0$13,839$0$333,369$0$0$0
HANNAH HAACK
PHYSICIAN$279,124$0$0$0$1,926$0$27,200$0$21,621$0$329,871$0$0$0
TAMARA WINDSCHEFFEL
ARNP$161,493$0$0$0$1,391$0$16,436$0$15,592$0$194,912$0$0$0
LEAH WIEHL
PHYSICIAN$258,259$0$0$0$1,926$0$26,537$0$17,638$0$304,360$0$0$0

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferenceFORM 990, PART VII; SCHEDULE J, PART I, LINE 3FormAndLineReferenceDesc
ExplanationCOMPENSATION FOR DAVE DELLASEGA AND DURRELL KELLEY IS PROVIDED BY GREAT PLAINS HEALTH ALLIANCE, A RELATED ORGANIZATION. GREAT PLAINS HEALTH ALLIANCE'S BOARD OF DIRECTORS ANNUALLY APPROVE THE COMPENSATION FOR MR. DELLASEGA AND MR. KELLEY. 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.ExplanationTxt

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (16 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990, PART III, LINE 4AThe largest program services measured by expenses are: 1. Smith County Memorial Hospital This entity provides inpatient and outpatient medical care in a Critical Access Hospital. The services provided to residents of the service area include the following: a. Emergency care available 24 hours per day by a staff of Registered Nurses, Advanced Practice Registered Nurses, and Physicians. All Emergency Department staff are certified in various types of advanced life support techniques, including Advanced Cardiovascular Life Support, Pediatric Advanced Life Support, and advanced Trauma care courses. The facility is designated as a Level IV Trauma Center and is a participant in the Kansas Clinical Improvement Collaborative (KCIC). Plans are underway at year end to implement a telemedicine support system for the Emergency Department using a service called eEmergency, operated by Avera Health System in South Dakota. b. Inpatient hospital care encompassing acute care for medical and some surgical patients. c. Obstetrical care, including prenatal education of expectant mothers, monitoring of the prenatal course, delivery and postpartum care of mothers and babies, whether delivered vaginally or by caesarean section, and postpartum assistance and education to mothers. d. Skilled and private pay nursing and rehabilitative care to inpatients delivered through our Swing Bed program e. Inpatient and outpatient surgical services. Surgical procedures with the exception of caesarean sections, are primarily scheduled services. Surgical and anesthesia staff are available 24 hours per day, however, in the event that an emergent caesarean section or other surgical procedure is required. f. Specialty physician services provided by visiting providers in an outpatient clinic setting. Provision of these services allows beneficiaries in our service area to access services provided by a broad array of specialty providers without the need for travel to distant locations. g. Ancillary diagnostic and therapeutic services including a full service Laboratory, Diagnostic Imaging, Physical, Occupational, and Speech Therapies, Cardiac and Pulmonary Rehabilitation, and Sleep Diagnostics. Laboratory and Imaging services are available 24 hours per day for emergent cases. h. Wound Care services are provided on an outpatient basis to patients with wounds that do not heal difficulty. Debridement, artificial skin substitute application, specialized dressings, and antibiotic therapy are provided to patients with wounds that do not easily heal. i. Dietary services to inpatients and outpatients. Smith County Memorial Hospital employs an Executive Chef, who is dual credentialed as a Licensed Clinical Dietician. This Chef places a very strong emphasis on healthy meal preparation for hospital patients. He also presents programs to the public regarding healthy cooking techniques and recipes to assist participants in modification of dietary habits. This department is also the provider of all meals for the Meals on Wheels program in the community, provided at a deeply discounted price. 2. Smith County Family Practice This entity provides primary care services using the services of board certified Family Medicine physicians, Advanced Practice Registered Nurses, and Physician Assistants. Services are provided to prenatal, postpartum, pediatric, adult, and geriatric patients. Four Board Certified Family Medicine physicians, five Advanced Practice Registered Nurses (nurse practitioners), and one Physician Assistant provide these services. In addition to services in the Rural Health Clinic, the providers also serve patients in the Critical Access Hospital (including the emergency department), the outpatient treatment areas, and in skilled nursing and ICF long term care facilities in Smith County and surrounding areas. Medical Direction to Smith County EMS, as well as to two skilled nursing facilities in the community are provided by employed physicians. Medical Direction to Smith County EMS, as well as to two skilled nursing facilities in the community are provided by employed physicians.
FORM 990, PART VI, SECTION A, LINE 2DAVE DELLASEGA AND DURREL KELLEY 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 MEMEBER OF GREAT PLAINS OF SMITH CO., INC.
FORM 990, PART VI, SECTION A, LINE 7AGREAT 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 7BGREAT 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 11BTHE 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 12CTHE 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 & BTHE 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 19THE 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 11GDESCRIPTION:CONTRACTED MEDICAL STAFF TOTAL FEES:1238404
FORM 990 PART IX LINE 11GDESCRIPTION:BILLING/COLLECTIONS TOTAL FEES:322753
FORM 990 PART IX LINE 11GDESCRIPTION:LAB SERVICES TOTAL FEES:206885
FORM 990 PART IX LINE 11GDESCRIPTION:PHARMACY SERVICES TOTAL FEES:153075
FORM 990 PART IX LINE 11GDESCRIPTION:ADMINISTRATION/HUMAN RESOURCES TOTAL FEES:518280
FORM 990 PART IX LINE 11GDESCRIPTION:MAINTENANCE/HOUSEKEEPING TOTAL FEES:25682
FORM 990 PART IX LINE 11GDESCRIPTION:DIETARY SERVICES TOTAL FEES:700
FORM 990 PART IX LINE 11GDESCRIPTION:PLANT OPERATIONS TOTAL FEES:25282

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (10 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdExempt Code SectionExemptCodeSectionTxtPublic Charity StatusPublicCharityStatusTxtBusiness Name Line1DirectControllingEntityName/BusinessNameLine1TxtControlled OrganizationControlledOrganizationInd
GREAT PLAINS HEALTH ALLIANCE INC
250 N ROCK ROAD STE 160WICHITAKS67206480617739MANAGEMENTKS501(C)(3)3NAfalse
GREAT PLAINS HEALTH CARE FOUNDATION INC
250 NORTH ROCK ROAD STE 160WICHITAKS67206480955870SUPPORTKS501(C)(3)10GPHA INCYes (true)
GREAT PLAINS OF ELLINWOOD INC
250 NORTH ROCK ROAD STE 160WICHITAKS67206481226976HOSPITALKS501(C)(3)3GPHA INCYes (true)
GREAT PLAINS OF KIOWA COUNTY INC
250 NORTH ROCK ROAD STE 160WICHITAKS67206481226833HOSPITALKS501(C)(3)3GPHA INCYes (true)
GREAT PLAINS OF OTTAWA COUNTY INC
250 NORTH ROCK ROAD STE 160WICHITAKS67206481226856HOSPITALKS501(C)(3)3GPHA INCYes (true)
GREAT PLAINS OF SABETHA COUNTY INC
250 NORTH ROCK ROAD STE 160WICHITAKS67206481236156HOSPITALKS501(C)(3)3GPHA INCYes (true)
GREAT PLAINS OF REPUBLIC COUNTY INC
250 NORTH ROCK ROAD STE 160WICHITAKS67206481226977HOSPITALKS501(C)(3)3GPHA INCYes (true)
GREAT PLAINS OF CHEYENNE COUNTY INC
250 NORTH ROCK ROAD STE 160WICHITAKS67206481226831HOSPITALKS501(C)(3)3GPHA INCYes (true)
SCMH QALICB INC
921 E HIGHWAY 36SMITH CENTERKS66967823936808FINANCINGKS501(C)(3)3GPHA INCYes (true)
GPHA EMPLOYEE BENEFITS TRUST
250 NORTH ROCK ROAD STE 160WICHITAKS67206476918582HEALTH PLANKS501(C)(9)GPHA INCYes (true)
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts RyltsfalseReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth OrgfalseGiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth OrgfalseGiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other OrgfalseLoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth OrgfalseLoansOrGuaranteesFromOthOrgInd
Div Related OrganizationfalseDivRelatedOrganizationInd
Asset Sale To Other OrgfalseAssetSaleToOtherOrgInd
Asset Purchase From Other OrgfalseAssetPurchaseFromOtherOrgInd
Asset ExchangefalseAssetExchangeInd
Rental Of Facilities To Oth OrgfalseRentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth OrgYes (true)RentalOfFcltsFromOthOrgInd
Perform Of Services For Oth OrgfalsePerformOfServicesForOthOrgInd
Perform Of Services By Other OrgYes (true)PerformOfServicesByOtherOrgInd
Sharing Of FacilitiesfalseSharingOfFacilitiesInd
Paid Employees SharingYes (true)PaidEmployeesSharingInd
Reimbursement Paid To Other OrgfalseReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other OrgfalseReimbursementPaidByOtherOrgInd
Transfer To Other OrgYes (true)TransferToOtherOrgInd
Transfer From Other OrgfalseTransferFromOtherOrgInd

Transactions Related Org TransactionsRelatedOrgGrp

Other Organization Name OtherOrganizationName

FieldValueIRS element (for citing)
Business Name Line1GPHA EMPLOYEE BENEFITS TRUSTBusinessNameLine1Txt
FieldValueIRS element (for citing)
Transaction TypeRTransactionTypeTxt
Involved$753,430InvolvedAmt
Method Of Amount DeterminationFMVMethodOfAmountDeterminationTxt