2025-08-15T08:41:35+00:00 2024-09-30 440160260 Forvis Mazars LLP 1551 N Waterfront Pkwy Ste 300 Wichita KS 672066601 990 2023-10-01 481226977 Great Plains of Republic Co Inc GREA 3166851523 250 NORTH ROCK ROAD SUITE 160 WICHITA KS 67206 JASON BARB CFO 3166851523 2025-08-15 true Kevin Ensminger P01310558 3162652811 2025-08-15 2023 2025-03-06 01:10:19Z DANIEL KELLY 250 NORTH ROCK ROAD SUITE 160 WICHITA KS 67206 25091045 false X WWW.RPHOSPITAL.ORG X 1999 KS TO OPERATE AN ACUTE CARE HOSPITAL THAT PROVIDES MEDICAL CARE TO THE GENERAL PUBLIC IN BELLEVILLE, KANSAS AND THE SURROUNDING RURAL COMMUNITIES IN REPUBLIC COUNTY. 7 6 197 7 0 0 2601173 3143315 17808882 21559520 108925 117236 148902 267625 20667882 25087696 0 0 0 0 11277879 14582423 0 0 0 9456593 11371023 20734472 25953446 -66590 -865750 17156804 17660859 2945453 4315258 14211351 13345601 TO OPERATE HOSPITAL FACILITIES FOR THE DELIVERY OF HOSPITAL AND RELATED HEALTH CARE SERVICES, HEALTH RELATED EDUCATION, AS WELL AS THE PROMOTION OF HEALTH AND WELLNESS, WITHOUT REGARD TO RACE, CREED, COLOR, SEX OR FINANCIAL CIRCUMSTANCE. false false 23185934 21567350 Republic County Hospital's (RCH) primary program is the delivery of healthcare and related services to patients from Republic County and contiguous counties in Northcentral Kansas and Southcentral Nebraska. Services include inpatient acute, intermediate swing bed (ISB), surgery, obstetric, emergency room and outpatient care. Republic County Hospital provides needed health care services to patients who come to our hospital for care, regardless of the patient's ability to pay and has a financial assistance program for those patients with limited resources. Major accomplishments in FY 2024 (10/01/2023- 09/30/2024) include the following: 1) Hospital staff provides education to the community including smoking cessation, vaping education and works closely with area schools related to impact testing and head injuries occurring during sports/activities. 2) The hospital maintains the outpatient seniors group therapy program Senior Life Solutions. 3) Retained and recertified for our Level 4 Trauma certification. 4) Continues to update our website meeting the price transparency requirements for CMS and No Surprises Act requirements. 5) Provide ongoing Case Management services for our patients. 6) Hospital participates in open forum coffee for local chamber of commerce on a weekly basis. 7) Hospital also regularly serves as a clinical site for nursing students and Certified Nursing Assistant (CNA) students from a neighboring community college. 8) Continues to offer regular exercise programming for our community following referral and A-fit testing. 9) Continue to provide patient assistance and diabetic education with our certified diabetic educator. 10) RCH continues to provide a lactation program for the community and provides education and patient support to mothers in the community with an international board-certified lactation consultant. The hospital also provides Childbirth Education Classes. 11) Collaborates with the North Central Kansas Healthcare foundations through providing community education on the services we provide and offering a community health fair in conjunction with their annual radiothon fundraiser. 12) Supply appropriate patients discharging from our ED with flu kits. 13) The RCH BOT reviewed and approved our 2022 Community Health Needs Assessment and Implementation Strategy -for FY ending Sept. 2025. The CHNA and Implementation Strategy can be found on our hospital website. 14) Hospital staff lead a summer safety camp for kids in collaboration with multiple stakeholders across the community including EMS and Law enforcement. Staff also provide Safe Sitter Training and Farm Safety education with support from area schools and businesses. 15) RCH support families, caregivers and the community with Pregnancy/Infant Loss programming and Alzheimer's/Dementia support. 16) Below please find: A Year in Review - RCH 2024 that list changes in roles, major accomplishments with surveys, accreditations and equipment upgrades and additional services. 2024 Year in Review: Republic County Hospital/Belleville Medical Clinic ENHANCEMENTS Fukuda Telemetry (Trauma) Designed Chemistry Analyzer (Ortho Vitros) operationalized Lab refrigeration all upgraded from residential to medical grade New phone system operationalizes at RCH and BMC Trauma Project at 50% completion_ under budget Pyxis operationalized with expanded footprint Cerner scheduling started PBRHC (Provider Based Rural Health Clinic) transition process PBRHC provider compensation plan implemented PBRHC provider employment agreements implemented BMC Staff migration completed 01Mar24 BMC asset buyout executed (contested) Dr. Lexia Zenger signed contract (11Jun24) - anticipated start October 2025 PBRHC Policy and procedure implemented PBRHC Emergency Preparedness plan implemented RHC accreditation achieved 11Sep24 KDHE RHC enrollment completed and sent to CMS (04Oct24) Senators Marshall and Moran contacted about the PIN timeline RCM rebuilt from $0 collections Physician documentation substantially improved Lab status changed from full service to RHC waived testing CLIA certification of lab KDHE certification of x-ray CLINIC/BMC ENHANCEMENTS Walk in clinic care added CR imaging converted to DR imaging (Pausch Bladeview) Ultrasound upgraded to Mindray TE X Phone system replaced Salto security locks expanded Centralized medication room completed Cerner transition commissioned and kicked off Clinic remodeling design and development substantially complete HVAC units replaced (2) PROJECTS/REPAIRS/REPLACEMENTS Fire Panel (Main) replaced IP shower project_ completed rooms 6, 7, 8, 9, 17 & 18 (OB) Lab Remodel completed (ceiling, LED lighting, floor, paint) Eupry remote temperature/condition monitoring system installed ISB room refresh (4-6 rooms) Pantry Sewer replaced Parking lots substantially patch and restriped Exterior signage addressed with project AED - placement and training for 10 new AED placements across Rp Co. communities ALLIANCES/AFFILIATIONS LEPC - Local Emergency Planning Commission (live drill, table top drills) Ministerial Alliance of Rp Co Rp Co Mental Health Coalition w/ RCHD, USD 109 and USD 426 Rp Co Resource Council Alzheimer's/Dementia Support w/ OCCK Senior Life Solutions Belleville Chamber and Mainstreet Rp Co Economic Development Sunflower Health Network Kansas Hospital Association KUMed - Cancer Screenings and Community Health Fair Nex Gen- Scholarship and Internship programs 23185934 true true false true false false false false false true false false false false false true false false false false false false false false false true true false false true false false false false false false false false false false false false false true true true true false true 34 0 true 197 true false false false false false false false false false false false false X 7 6 true false false false true true true true true false false true true true true true true false false false X JASON BARB 3166851523 250 NORTH ROCK ROAD STE 160 WICHITA KS 67206 CURT COLSON PRESIDENT/CEO/DIRECTOR 0.2 41.2 X X 0 217358 54774 JOHN TERRILL CHAIRMAN/DIRECTOR 0.2 1.2 X X 0 0 0 STEVE CARLSON TREASURER/DIRECTOR 0.2 1.2 X X 0 0 0 ALLEN VANDRIEL DIRECTOR BEG 05/24 0.2 1.2 X 0 0 0 ARTHUR HENDRICKSON DIRECTOR 0.2 1.2 X 0 0 0 DR BARBARA BROWN APPLEGATE DIRECTOR 0.2 1.2 X 0 0 0 ROGER JOHN SECRETARY/DIRECTOR 0.2 1.2 X 0 0 0 BARRY BOTTGER CFO 40.0 0.0 X 130650 0 27100 DANIEL KELLY ADMINISTRATOR 40.0 0.0 X 191070 0 30115 JASON BARB CFO 0.2 41.2 X 0 191413 50658 BRENT MARTIN COO 40.0 0.0 X 159789 0 49369 PHILLIP ZAPPA CRNA 40.0 0.0 X 318426 0 66108 REBECCA BROWN DON 40.0 0.0 X 120361 0 25272 TRISHA CHAMPLIN RN 40.0 0.0 X 107032 0 27681 1027328 408771 331077 6 false true false GPHA 250 N ROCK RD STE 160 WICHITA KS 67206 MANAGEMENT AND SERV 1040618 PSYCHIATRIC MEDICAL CARE LLC PO BOX 734606 DALLAS TX 753734606 OUTPATIENT PSYCH SERVICES 544555 KURTIS KLECAN 1903 Q St Belleville KS 66935 ER CALL 187289 QUALIVIS PO BOX 1180 COLUMBIA SC 29201 CONTRACT NURSING 155607 LARRY TROSHYNSKI 1020 S 12TH TER LOUISBURG KS 66503 CONTRACT SERVICES 148775 11 2760260 383055 3143315 NET PATIENT SERVICE REVENUE 621300 21559520 21559520 0 0 0 0 21559520 89585 89585 10610 10610 0 10610 10610 31000 3349 0 27651 27651 27651 EMPLOYEE/GUEST MEALS 722513 82637 82637 VENDOR REBATES 900099 79525 79525 OUTSIDE SERVICES 621300 7830 7830 87023 0 0 87023 257015 25087696 21567350 0 377031 X 603338 603338 10929673 10423669 506004 841091 802441 38650 1433104 1383496 49608 775217 702525 72692 205004 205004 13672 13672 103591 103591 2562 2562 3418811 2883817 534994 0 42068 42068 1204608 1063751 140857 457556 450076 7480 8856 8687 169 50946 39355 11591 26654 25902 752 1296527 1270939 25588 201848 201848 MEDICAL SUPPLIES 3215308 3215308 BAD DEBT EXPENSE 505850 505850 EQUIPMENT RENTAL & REPAIRS 391498 389233 2265 DUES & SUBSCRIPTIONS 38487 7031 31456 187177 13854 173323 0 25953446 23185934 2767512 0 754123 762787 3570317 1568729 3282275 3805331 0 0 0 0 4382 5756 299226 449380 133983 197450 25479808 14872702 9092553 10607106 0 0 19945 264320 17156804 17660859 2560981 3733045 0 0 384472 582213 0 0 2945453 4315258 X 14186351 13020601 25000 325000 14211351 13345601 17156804 17660859 -865750 0 X false true X true true true X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false true 2562 false false false 2562 false Schedule C, Part II-B, Line 1f A PORTION OF THE ANNUAL DUES PAID TO KHA AND AHA ARE USED FOR LOBBYING. 14107 14107 10390107 7757888 2632219 12236174 6631858 5604316 2839420 482956 2356464 10607106 24581846 0 0 24581846 505850 505850 25087696 25447596 0 0 25447596 505850 505850 25953446 Schedule D, Part X, Line 2 UNCERTAIN TAX POSITIONS MANAGEMENT HAS EVALUATED THEIR INCOME TAX POSITIONS UNDER THE GUIDANCE INCLUDED IN ASC 740. BASED ON THEIR REVIEW, MANAGEMENT HAS NOT IDENTIFIED ANY MATERIAL UNCERTAIN TAX POSITIONS TO BE RECORDED OR DISCLOSED IN THE FINANCIAL STATEMENTS. Schedule D, Part XI, Line 4(b) Other revenues in form 990 not in audited financial statements PROVISION FOR UNCOLLECTIBLE ACCOUNTS - 505850 Schedule D, Part XII, Line 4(b) Other expenses in form 990 not in audited financial statements PROVISION FOR UNCOLLECTIBLE ACCOUNTS - 505850 true true X true X false true true true false true true 156377 0 156377 0.0060 1560357 603326 957031 0.0369 0 0 0 0.0 0 0 1716734 603326 1113408 0.0429 33008 0 33008 0.0013 0 0 0 0.0 0 0 0 0.0 0 0 0 0.0 3104 0 3104 0.0001 0 0 36112 0 36112 0.0014 0 0 1752846 603326 1149520 0.0443 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0 0 0 0 0.0 true 505850 10149603 10149603 0 X true true 1 1 REPUBLIC COUNTY HOSPITAL 2420 G STREET BELLEVILLE KS 66935 WWW.RPHOSPITAL.ORG H079001 X X X X 1 1 1 false false true X X X X X X X X X 23 true false true true X https://www.rphospital.org/getpage.php?name=Transparency&sub=About%20Us X true 23 true https://www.rphospital.org/getpage.php?name=Transparency&sub=About%20Us false true X 200.0 0.0 X X X X true true X X X true X https://www.rphospital.org/getpage.php?name=Financial_Assistance&sub=PATIENT%20INFORMATION X https://www.rphospital.org/getpage.php?name=Financial_Assistance&sub=PATIENT%20INFORMATION X https://www.rphospital.org/getpage.php?name=Financial_Assistance&sub=PATIENT%20INFORMATION 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 Facility 1, 1 Facility 1, 1 - REPUBLIC COUNTY HOSPITAL. THE ASSESSMENT PROCESS WAS INITIATED AND CHAIRED JOINTLY BY REPUBLIC COUNTY HOSPITAL AND THE REPUBLIC COUNTY HEALTH DEPARTMENT. ALL OF THE EDUCATIONAL, GOVERNMENTAL, CIVIC AND HEALTH RELATED ORGANIZATIONS WITHIN THE COMMUNITY WERE INVITED TO PARTICIPATE. Schedule H, Part V, Section B, Line 6b Facility 1, 1 Facility 1, 1 - REPUBLIC COUNTY HOSPITAL. REPUBLIC COUNTY HEALTH DEPARTMENT Schedule H, Part V, Section B, Line 11 Facility 1, 1 Facility 1, 1 - REPUBLIC COUNTY HOSPITAL. THE COMMUNITY HEALTH NEEDS ASSESSMENT IDENTIFIED NINE (9) SPECIFIC COMMUNITY HEALTH NEEDS. TWO OF THOSE NINE NEEDS (HOUSING AND CHILDCARE) WERE NOT ADDRESSED DUE TO A LACK OF FINANCIAL RESOURCES AND/OR DEEMED OUTSIDE THE SCOPE OF HOSPITAL MISSION OF CRITICAL OPPERATIONS. REPUBLIC COUNTY HOSPITAL (RCH) IS PROMOTING PHYSICAL AND MENTAL HEALTH, WELLNESS, AND CHRONIC DISEASE PREVENTION. RCH IS COLLABORATING WITH OTHER PROVIDERS IN THE COUNTY TO PROVIDE EDUCATION RESOURCES AND SUPPORTING THE REPUBLIC COUNTY HEALTH DEPARTMENT, REPUBLIC COUNTY RESOURCE COUNCIL AND SCHOOL DISTRICTS USD 109 AND 426 IN REPUBLIC COUNTY. RCH IS IMPROVING ACCESS TO INFORMATION AND ASSISTANCE ACROSS MULTIPLE NEEDS AND POPULATIONS. THE HOSPITAL IS SUPPORTING THE REPUBLIC COUNTY RESOURCE COUNCIL IN KEEPING THE HEALTH SERVICES DIRECTORY CURRENT AND AVAILABLE TO THE PUBLIC. ADDITIONALLY, RCH IS WORKING WITH OTHER PROVIDERS TO ENHANCE AWARENESS FOR EXISTING PROGRAMS AND SERVICES WHILE ALSO WORKING TO ESTABLISH SUSTAINABLE ATTENTION IN PROMOTING HEALTHY LIVING THROUGH PROGRAMMING SPECIFIC TO PATIENT POPULATIONS AND NEEDS AS OUTLINED IN THE RCH CHNA IMPLEMENTATION PLAN. 1 BELLEVILLE MEDICAL CLINIC 2337 G STREET BELLEVILLE KS 66935 MEDICAL CLINIC Schedule H, Part VI, Line 2 Needs Assessment The Republic County Hospital (RCH) assesses the health care needs of the community it serves in an ongoing fashion. RCH strives to provide services that meet patient needs, and that the needs of the population served guide decisions about which services will be provided directly or through referral, consultation, contractual arrangements or other agreements. We determine these needs in a variety of ways. In 2022, a Community Health Needs Assessment (CHNA) was conducted by VVV Consultants LLC. This assessment involved an extensive on-line survey and a town-hall meeting with community stakeholders (plus other extensive data collection) that addressed access to primary care health services, health insurance, travel distance for services, hospital services, county health department services and other county health related services. The survey identified the top nine community concerns, in which seven of the nine were identified as the top health concerns in Republic County. The results of this survey were shared with the public, community stakeholders and providers, and were used to address the perceived health related need in the identified areas. A copy of the results of the CHNA and the Implementation Strategy Plan, moving now into Year 3 of 3 (starting 10/1/24-9/30/25), as approved by our governing body, are available upon request and posted to our website, www.rphospital.org. An important component of the Hospital Mission and Vision is that of being a health resource to the community by advocating healthy behaviors, working in concert with other health care providers, promoting health services through education and by recruiting and retaining qualified health professionals. Services are also assessed through HCAHPS patient satisfaction survey processes. RCH Board of Trustee Meetings are open to the public and we have open communication with our patients and their physicians about the types and quality of services provided. Needs are also identified through community involvement and are brought to the hospital through the Patient and Family Advisory Council, which meets monthly. Schedule H, Part VI, Line 3 Patient Education of Eligibility for Assistance. Republic County Hospital has a written financial assistance/charity care policy and a credit policy that is included in the patient information brochure provided to all patients receiving care at RCH, including clinic visits, outpatient, swing bed, observation and inpatient care. The credit policy is also posted on the Hospital's website, www.rphospital.org. In addition to other payment options the patient brochure, website and each billing statement sent to patients includes the statement "Republic County Hospital also offers a healthcare assistance program that provides medical care free, or at reduced rates, for patients who qualify based on income guidelines". The Hospital's Financial Counselor visits with private pay patients and patients with high deductibles to determine if they qualify for the RCH charity care/financial assistance program. RCH also provides Social Services who consult and assist with private pay or uninsured patients to determine if they qualify for assistance through the State Medicaid Program or other government programs. Our social services staff is a member of the Republic County Resource Council and assists in completing the applications for medical assistance and act as a resource for other health related services. Schedule H, Part VI, Line 4 Community Information Republic County Hospital is located in Belleville, Kansas and serves the residents of Republic County and surrounding area. The est. population of Republic County, by 2019 census, is 4,636 which is down 6.9% since 2010. The service area for the Hospital is Republic County and contiguous counties in Northcentral Kansas and Southcentral Nebraska. These Counties in Kansas are exclusively rural. Republic County has a population density of less than 8 people per square mile and 27.8% of the population is over the age of 65 years. The racial makeup of the county by 2019 census was 96.6% White, 2.6% Hispanic or Latin American and .8% Black or African American. 5.9% of the population was under 5 years of age and the per capita income in the past 12 months (in 2029 dollars) is $24,647. Specifically, 12.2% of Republic County households are living in poverty with 8.7% of the population experiencing severe housing problems. Approximately 60% of hospital services are delivered to patients 65 years of age or older. Complete demographics and other information are available on the Hospital Website in the CHNA section. Schedule H, Part VI, Line 5 Promotion of community health. Republic County Hospital participates in community building activities. The hospital is very active in community education on the benefits of immunizations for the prevention of influenza and pneumonia. We collaborate with the Republic County Health Department, Care Homes in the community and with our providers and pharmacies regarding immunization planning and distribution. The hospital serves as an integral part of our County Emergency Preparedness activities, currently 2 members of our RCH staff are appointed to the Local Emergency Planning Committee (LEPC) by the Commissioners of Republic County. The Hospital is an education provider for continuing education and in addition to other classes presents classes for CPR, ACLS, NRP and TNCC certifications. We work closely with area EMS in the delivery of emergency services. The hospital is an educational site for nursing students from the Cloud County Community College and we frequently have Medical Students in our facility for clinical clerkships and Family Practice Residents here for 4 to 6 week rural residencies. We are a clinical practice site for Medical Laboratory Technicians, Physician Assistant Students, various Allied Health Students and Advanced Practice Registered Nurse Students. Republic County Hospital collaborates with and assists in the leadership of the local North Central Kansas Health Care Foundation to support activities related to provider and staff recruitment, scholarships and enhancements to the healthcare infrastructure in Republic County. We also partner with Nex Generation - Round Up for Youth, Inc. where high school and college students are matched for both work study opportunities during the school year and summer internships in healthcare related fields. Currently, members of our administrative team actively serve as Board Members of the Republic County Economic Development Corporation, Belleville Chamber and Mainstreet and USD 109 Board of Education. The hospital sponsors and holds an annual community health fair to educate the community on current and ongoing health issues. The hospital also takes seriously its efforts at promoting the mental health for seniors in its community in partnership with the Senior Life Solutions program in Republic County. Republic County Hospital is a 25 bed Critical Access Hospital (CAH) which also provides Level IV Trauma care. This includes 24-hour Emergency Care which can often result in providing financially subsidizes services. The Republic County Hospital staff includes 6 providers who cover the needs our hospital which also includes our on-campus provider based rural health clinic. The hospital participates in government health care plans and is the only hospital in Republic County. Our medical staff currently includes 3 primary care family practice physicians, 3 mid-level practitioners, 13 specialized clinicians providing services on our healthcare campus minimizing the need for members of our community to travel long distances for these specialty medical services and 1 physician providing specialized care via telehealth. We promote community health through health fairs, supporting public services, education and wellness classes in collaboration and support of various health education opportunities across our community. The hospital works closely with a regional hospice provider in the provision Hospice services. The hospital also provides Diabetic Education, Women's Health Education, Childbirth Education, Lactation support, Safe Sitter Training, Farm Safety / First Aide, Senior Fitness Programming and Alzheimer's/Dementia support to our patients, families and the community we serve. Schedule H, Part VI, Line 6 Affiliated health care system Republic County Hospital is affiliated with Great Plains Health Alliance, Inc. (GPHA), a non-profit 501 (c)(3) organization which provides management services and operational, finance and accounting support to the Hospital. GPHA does not provide services directly to patients, but it does provide access to professionals that may not be affordable to independently structured critical access hospital. GPHA provides education and assistance in areas such as HIPAA, Medicare reimbursement, meaningful use requirements for computer system, etc. GPHA is an affiliation of Critical Access Hospitals in Kansas and Nebraska that provides networking opportunities with other rural hospitals, communities and other health care organizations. GPHA provides policies and guidance to its Critical Access facilities regarding financial assistance, conflicts of interest, corporate compliance and many other areas. GPHA also provides educational sessions for Board Members, Business Office Managers, Billers, Medical Records personnel, Clinicians, along with Department and Organization Leadership. GPHA is a vital link in allowing CAH hospitals to operate at a high quality within the cash constraints imposed by the Critical Access program. Schedule H, Part I, Line 3c Eligibility criteria for free or discounted care THE ORGANIZATION USED THE FOLLOWING CRITERIA TO DETERMINE ELIGIBILITY FOR FINANCIAL ASSISTANCE: ASSET LEVEL, MEDICAL INDIGENCY, INSURANCE STATUS, AND UNDERINSURANCE STATUS. Schedule H, Part I, Line 7 Costing Methodology used to calculate financial assistance THE COSTING METHODOLOGY USED TO CALCULATE THE AMOUNTS CONTAINED IN THE TABLE OF PART I, LINE 7, OF SCHEDULE H, IS A COST TO CHARGE RATIO. Schedule H, Part III, Line 2 Bad debt expense - methodology used to estimate amount HOSPITAL CHARGES THAT ARE NOT COLLECTED AND ARE NOT APPROVED FOR FINANCIAL ASSISTANCE ARE CLASSIFIED AS BAD DEBTS FROM PATIENTS WHO WILL NOT PAY. Schedule H, Part III, Line 3 Bad Debt Expense Methodology THE COSTING METHODOLOGY IS BASED ON THE ORGANIZATION'S MEDICARE COST-TO-CHARGE RATIO. WHILE WE RECOGNIZE THAT THERE WOULD BE SOME BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S CHARITY CARE POLICY, WE HAVE NO REASONABLE BASIS FOR ESTIMATING THIS FIGURE. IF ELIGIBILITY IS KNOWN, THE AMOUNT WOULD FALL UNDER CHARITY CARE AND NOT BAD DEBT. Schedule H, Part III, Line 4 Bad debt expense - financial statement footnote NOT APPLICABLE DUE TO ADOPTION OF ASC 606 REVENUE CONTRACTS WITH CUSTOMERS. Schedule H, Part III, Line 8 Community benefit & methodology for determining medicare costs THE COSTING METHODOLOGY USED TO CALCULATE THE AMOUNT ON LINE 6 IS A COST TO CHARGE RATIO. Schedule H, Part III, Line 9b Collection practices for patients eligible for financial assistance ALL CHARITY CARE CHARGES NOT TO BE COLLECTED DUE TO FINANCIAL ASSISTANCE COMPUTATIONS ARE EXEMPT FROM COLLECTION POLICIES AND PRACTICES. THESE ACCOUNTS ARE REMOVED FROM THE COLLECTION CYCLE. Schedule H, Part V, Section B, Line 16a FAP website 1 - REPUBLIC COUNTY HOSPITAL: Line 16a URL: https://www.rphospital.org/getpage.php?name=Financial_Assistance&sub=PATIENT%20INFORMATION; Schedule H, Part V, Section B, Line 16b FAP Application website 1 - REPUBLIC COUNTY HOSPITAL: Line 16b URL: https://www.rphospital.org/getpage.php?name=Financial_Assistance&sub=PATIENT%20INFORMATION; Schedule H, Part V, Section B, Line 16c FAP plain language summary website 1 - REPUBLIC COUNTY HOSPITAL: Line 16c URL: https://www.rphospital.org/getpage.php?name=Financial_Assistance&sub=PATIENT%20INFORMATION; Schedule H, Part VI, Line 7 State filing of community benefit report KS false false false false false false false false false CURT COLSON PRESIDENT/CEO/DIRECTOR 0 213765 0 0 0 3593 0 21263 0 33511 0 272132 0 0 DANIEL KELLY ADMINISTRATOR 188558 0 0 0 2512 0 18382 0 11733 0 221185 0 0 0 BARRY BOTTGER CFO 129003 0 0 0 1647 0 12684 0 14416 0 157750 0 0 0 JASON BARB CFO 0 190135 0 0 0 1278 0 18538 0 32120 0 242071 0 0 BRENT MARTIN COO 158997 0 0 0 792 0 16524 0 32845 0 209158 0 0 0 PHILLIP ZAPPA CRNA 316156 0 0 0 2270 0 32200 0 33908 0 384534 0 0 0 Schedule J, Part I, Line 3 Form 990, Part VII ANNUAL COMPENSATION REVIEWS ARE COMPLETED BY THE CEO AND CHIEF FINANCIAL OFFICER USING RECOMMENDATIONS PROVIDED BY DEPARTMENT MANAGERS AND CURRENT MARKET CONDITIONS. ALL EXECUTIVE EMPLOYEE SALARIES, INCLUDING THE PRESIDENT/CEO, ARE APPROVED BY THE GPHA BOARD OF DIRECTORS. THE AMERICAN COLLEGE HEALTHCARE EXECUTIVES AND THE KANSAS HOSPITAL ASSOCIATION ALSO HAS COMPARABLE COMPENSATION DATA THAT CAN BE USED BY THE BOARD. THE CEO RETAINS DOCUMENTATION IN ADDITION TO THAT IN THE BOARD MINUTES. Form 990, Part VI, Line 2 JASON BARB AND CURT COLSON 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, Line 15a & 15B THE CEO AND CFO 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, Line 6 Classes of members or stockholders GREAT PLAINS HEALTH ALLIANCE, INC., A NOT FOR-PROFIT, 501(C)(3) ORGANIZATION, IS THE SOLE MEMBER OF GREAT PLAINS OF REPUBLIC CO., INC. Form 990, Part VI, Line 7a Members or stockholders electing members of governing body GREAT PLAINS HEALTH ALLIANCE, INC., BEING THE SOLE MEMBER, HAS THE RIGHT TO ELECT AND APPROVE ALL THE BOARD MEMBERS. Form 990, Part VI, Line 7b Decisions requiring approval by members or stockholders GREAT PLAINS HEALTH ALLIANCE, INC (GPHA) IS THE SOLE MEMBER AND HAS THE AUTHORITY TO APPROVE THE ARTICLES OF INCORPORATION, BYLAWS, ELECTION TO OR REMOVAL FROM THE BOARD OF DIRECTORS, THE ANNUAL OPERATING AND CAPITAL BUDGETS, AND THE LONG RANGE OR STRATEGIC PLANS. Form 990, Part VI, Line 11b Review of form 990 by governing body THE 990 IS PREPARED AND REVIEWED BY AN INDEPENDENT ACCOUNTING FIRM. THE 990 IS THEN PROVIDED TO THE CHIEF EXECUTIVE OFFICER FOR REVIEW AND APPROVAL. AN ELECTRONIC DRAFT OF THE 990 WITH ALL REQUIRED SCHEDULES IS THEN PROVIDED TO THE FULL BOARD FOR REVIEW PRIOR TO FILING THE 990 WITH THE IRS. Form 990, Part VI, Line 12c Conflict of interest policy THE ORGANIZATION IS REQUIRED TO ADOPT GPHA'S CONFLICT OF INTEREST POLICY. ALL BOARD MEMBERS, OFFICERS, AND EMPLOYEES ARE SUBJECT TO THE CONFLICT OF INTEREST POLICY AND SIGN AN ANNUAL ACKNOWLEDGEMENT THAT THEY HAVE READ, UNDERSTAND AND COMPLIED WITH THE GPHA CONFLICT OF INTEREST POLICY. UNDER THE POLICY, ANY MEMBER WHO HAS A DIRECT OR INDIRECT (VIA FAMILY) FINANCIAL INTEREST IS CHARACTERIZED AS AN INTERESTED PERSON. INTERESTED PERSONS ARE REQUIRED TO DISCLOSE FINANCIAL INTERESTS WITH COMPANIES DOING BUSINESS WITH GPHA. THE INTERESTED PERSON MUST RECUSE THEMSELVES FROM FURTHER DISCUSSIONS OF THE TRANSACTION AND LEAVE THE ROOM. THE REMAINING NON-INTERESTED MEMBERS DECIDE IF A CONFLICT OF INTEREST EXISTS. THE BOARD CHAIR MAY APPOINT ANOTHER DISINTERESTED PARTY TO DISCUSS THE TRANSACTION OR THE REMAINING BOARD MEMBERS MAY VOTE TO ENTER INTO OR ABSTAIN FROM THE SUSPECT TRANSACTION. FAILURE TO DISCLOSE FINANCIAL INTERESTS BY INTERESTED BOARD MEMBERS WILL RESULT IN DISCIPLINARY ACTION, INCLUDING SANCTIONING BY BOARD. ALL CONFLICTS OF INTEREST AND THEIR ULTIMATE RESOLUTION ARE DOCUMENTED IN THE BOARD MINUTES. THE BOARD CONDUCTS PERIODIC REVIEWS TO DETERMINE THAT CONFLICTS ARE BEING IDENTIFIED AND RESOLVED ACCORDING TO POLICY DOCUMENTATION. REVIEWS BY OUTSIDE EXPERTS ARE PERMITTED, BUT NOT REQUIRED. Form 990, Part VI, Line 19 Required documents available to the public THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. THE COMPANY'S KANSAS ANNUAL REPORT IS ALSO AVAILABLE UPON REQUEST FROM THE KANSAS SECRETARY OF STATE. Form 990, Part VIII, Line 11d Other Miscellaneous Revenue OTHER REVENUE - Total Revenue: 87023, Related or Exempt Function Revenue: , Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: 87023; Form 990, Part IX, Line 11g Other Fees CONTRACTED MEDICAL STAFF - Total Expense: 2063125, Program Service Expense: 2057281, Management and General Expenses: 5844, Fundraising Expenses: ; ADMINISTRATION/HUMAN RESOURCES - Total Expense: 532851, Program Service Expense: 249243, Management and General Expenses: 283608, Fundraising Expenses: ; LAB SERVICES - Total Expense: 270313, Program Service Expense: 270313, Management and General Expenses: , Fundraising Expenses: ; PHARMACY SERVICES - Total Expense: 199199, Program Service Expense: 199199, Management and General Expenses: , Fundraising Expenses: ; BILLING/COLLECTIONS - Total Expense: 235001, Program Service Expense: , Management and General Expenses: 235001, Fundraising Expenses: ; PLANT OPERATIONS - Total Expense: 103307, Program Service Expense: 103307, Management and General Expenses: , Fundraising Expenses: ; MAINTENANCE/HOUSEKEEPING - Total Expense: 14101, Program Service Expense: 3560, Management and General Expenses: 10541, Fundraising Expenses: ; DIETARY SERVICES - Total Expense: 914, Program Service Expense: 914, Management and General Expenses: , Fundraising Expenses: ; GREAT PLAINS HEALTH ALLIANCE 250 N ROCK ROAD STE 160 WICHITA KS 67206 480617739 MANAGEMENT KS 501(c)(3) 3 N/A false GREAT PLAINS HEALTH CARE FOUNDATION INC 250 N ROCK ROAD STE 160 WICHITA KS 67206 480955870 SUPPORT KS 501(c)(3) 10 GPHA INC true GREAT PLAINS OF SABETHA COUNTY INC 250 N ROCK ROAD STE 160 WICHITA KS 67206 481236156 HOSPITAL KS 501(c)(3) 3 GPHA INC true GREAT PLAINS OF OTTAWA COUNTY INC 250 N ROCK ROAD STE 160 WICHITA KS 67206 481226856 HOSPITAL KS 501(c)(3) 3 GPHA INC true GREAT PLAINS OF SMITH COUNTY INC 250 N ROCK ROAD STE 160 WICHITA KS 67206 481226830 HOSPITAL KS 501(c)(3) 3 GPHA INC true GREAT PLAINS OF CHEYENNE COUNTY 250 N ROCK ROAD STE 160 WICHITA KS 67206 481226831 HOSPITAL KS 501(c)(3) 3 GPHA INC true GREAT PLAINS OF ELLINWOOD INC 250 N ROCK ROAD STE 160 WICHITA KS 67206 481226976 HOSPITAL KS 501(c)(3) 3 GPHA INC true GPHA EMPLOYEE BENEFITS TRUST 250 N ROCK ROAD STE 160 WICHITA KS 67206 476918582 HEALTH PLAN KS 501(c)(9) GPHA INC true false false false false false false false false false false true false true false false false false true false GPHA Employee Benefit Plan R 1261218 FMV