2020-01-30T14:18:47-06:00 2019-06-30 481026809 Wendling Noe Nelson & Johnson LLC 534 S Kansas Ave Suite 1500 Topeka KS 666033491 990 2018-07-01 480764456 Nemaha Valley Community Hospital NEMA 7853366181 1600 Community Drive Seneca KS 66538 KILEY FLOYD CEO 7853366181 2020-01-20 1 Eric L Otting P00298454 7852334226 2020-01-20 98.172.114.81 2020-01-20 09:35:17 CS P F70217A3EE73BCABB6A56F724A4F612B152DA44C 85B802954380A5AFF914C6CC38FE89D630C83B3F 2018 2020-09-23 17:36:50Z Kiley Floyd 1600 Community Drive Seneca KS 66538 17524709 0 X nemvch.com X 1969 KS Nemaha Valley Community Hospital's mission statement is to provide personalized, compassionate healthcare while promoting wellness in the communities we serve. 14 12 184 34 0 0 575505 669920 17104876 16601554 101057 83961 100726 169274 17882164 17524709 0 0 0 0 10346231 10744987 0 0 13635 6203732 6604787 16549963 17349774 1332201 174935 17590531 17278050 10114470 9627054 7476061 7650996 Nemaha Valley Community Hospital's mission statement is to provide personalized, compassionate healthcare while promoting wellness in the communities we serve. 0 0 14863305 16756410 Nemaha Valley Community Hospital provides inpatient and outpatient hospital services and clinic services to patients in its service area. 14863305 1 1 0 1 0 0 0 0 0 0 1 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 1 0 0 0 1 26 0 1 184 1 0 0 0 0 0 0 0 0 0 0 0 0 X 14 12 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 0 1 1 0 0 X Connie Ingwerson 7853366181 1600 Community Drive Seneca KS 66538 Leroy Strathman Trustee 1.00 X 0 0 0 Ed Mohney Chairman 1.00 X X 0 0 0 Fred Henry Vice-Chairman 1.00 X X 0 0 0 Bill Love Trustee 1.00 X 0 0 0 Jim Runnebaum Trustee 1.00 X 0 0 0 Katie Nordhus Trustee 1.00 X 0 0 0 Steve Haverkamp Trustee 1.00 X 0 0 0 Dennis Henry Trustee 1.00 X 0 0 0 Leah Hermesch Trustee 1.00 X 0 0 0 Kris Enneking Secretary/Treasurer 1.00 X X 0 0 0 Mary Haverkamp Trustee 1.00 X 0 0 0 Dr Jarod Snyder Physician/Trustee 40.00 X 310889 0 32606 Dr James Lueger Physician/Trustee 1.00 X 40400 0 0 TJ Haverkamp Trustee 1.00 X 0 0 0 Kiley Floyd Chief Executive Officer 40.00 X 134435 0 19246 Connie Ingwerson Chief Financial Officer 40.00 X 106861 0 9247 William Bartkoski DO Physician 40.00 X 362177 0 24082 Harry Stewart CRNA 40.00 X 320282 0 47855 Dr Heather Cooper Physician 40.00 X 350903 0 19620 Dr Angela Stueve Physician 40.00 X 340710 0 32588 Lori Lueger APRN 40.00 X 161282 0 7060 2127939 0 192304 9 0 1 0 Cerner Corporation PO Box 959156 St Louis MO 63195 Patient Accounting System 417939 Medhost of Tennessee Inc 2739 Momemtum Place Chicago IL 60689 IT Maintenance 174625 Stormont Vail Healthcare 1500 SW 10th Avenue Topeka KS 66604 Lab Services 150404 Shared Medical Services Inc PO Box 330 Cottage Grove WI 53527 MRI Scans 114885 4 6146 456693 207081 669920 Patient service revenue 621110 15801097 15801097 340B retail drug program 446110 800457 800457 16601554 77862 77862 6099 0 6099 6099 6099 Outside services 624410 103785 103785 Miscellaneous 621110 44972 44972 Dietary Income 722210 20517 20517 169274 17524709 16756410 0 98379 658759 393048 265711 7704534 7008371 686714 9449 279156 251652 27178 326 1574706 1407140 165793 1773 527832 468081 59170 581 10580 10580 1160311 810486 349822 3 35251 11096 23908 247 131566 96956 34565 45 41669 31901 9768 149385 131724 17557 104 66172 46258 19913 1 343022 303266 39516 240 1222982 1056613 166039 330 134019 116901 17097 21 Supplies 2085911 1994116 91526 269 Equipment rental and ma 894651 608283 286332 36 Collection fees 123673 7205 116468 Dues and subscriptions 83752 43715 40035 2 121843 76493 45142 208 17349774 14863305 2472834 13635 121505 198795 6280225 7445890 1829348 1777767 266387 272677 269610 303418 20847801 13812237 7734314 7035564 19546 1069596 243939 17590531 17278050 2159470 1987054 7955000 7640000 10114470 9627054 X 7465377 7641798 10684 9198 7476061 7650996 17590531 17278050 174935 0 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 1 3850 0 0 0 3850 0 Part II-B, Line 1: Nemaha Valley Community Hospital is a member of the Kansas Hospital Association and the American Hospital Association. Both of these organizations engage in lobbying activities as part of the services provided to members. The above amount was estimated based on a percentage of membership dues. 54681 54681 11673169 7558810 4114359 9117366 6253427 2863939 2585 2585 7035564 X Part X, Line 2: The Hospital is a not-for-profit corporation as described in Section 501(c)(3) of the Internal Revenue Code and is exempt from federal taxes on related income pursuant to Sction 501(a) of the Code. 1 1 0 1 X 1 1 1 0 1 1 158083 158083 0.00910 648778 352584 296194 0.01710 806861 352584 454277 0.02620 6896 6150 746 0.00000 4081644 3044854 1036790 0.05980 398 398 0.00000 4088938 3051004 1037934 0.05980 4895799 3403588 1492211 0.08600 1 140095 56038 6410197 6427987 -17790 X 1 1 1 1 Nemaha Valley Community Hospital 1600 Community Drive Seneca KS 66538 X X X X Rural health clinic Nemaha Valley Community Hospital 1 0 0 1 X X X X X X X X X 18 1 1 0 1 X http://www.nemvch.com/resources X 1 18 1 http://www.nemvch.com/resources 0 1 X 200.000000000000 X X X X 1 1 X X X 1 X http://www.nemvch.com/resources/ X http://www.nemvch.com/resources/ X http://www.nemvch.com/resources/ X X X X X X 1 X 0 X X X X 1 X 0 0 Nemaha Valley Community Hospital Part V, Section B, Line 5: Community members were invited to attend a meeting in which their input was requested to determine the health needs of the community. The community members decided what the health care needs are and prioritized these needs. These members included medical professionals, government employees, leaders of non-profit organizations, and hospital employees. Nemaha Valley Community Hospital Part V, Section B, Line 6a: Sabetha Community Hospital Nemaha Valley Community Hospital Part V, Section B, Line 11: To promote health education with focus on hypertnesion, diabetes, smoking cessation, and increased seat belt usage, the Hospital provided education to the public through their annual Health Fair by having in-person talks and through social media posts to educate on health issues. To improve access to mental health assistance, the Hospital continued to provide an online screening tool for mental health diseases. The Hospital has continued two tele-health mental health clinics that provide psychiatry & therapy for the young and old. The Hospital continued to educate the public about mental health issues through social and local media. To prevent alcohol abuse, the Hospital provided financial support for specific efforts related to activities in local schools. To promote cancer care, the Hospital collaborated with local chapters of American Cancer Society to provide cancer screenings and awareness activities. The Hospital provided education to the community on ways to protect themselves from different forms of cancer such as proper sun care usage to prevent skin care, smoking cessation to prevent lung cancer etc. and also educated on importance of preventive health care visits in early cancer detection and successful treatments. To prevent obesity, the Hospital sponsored community activities that promote nutrition, physical fitness, and outdoor activities/exercise for the entire family. The Hospital collaborated with local restaurants to include carbs and calorie counts on their menu. The Hospital continued to educate business and industry on the benefits of offering wellness programs for their employees and also suggested primary care and other providers to refer patients to nutritionists and diabetic educators. To prevent obesity, the Hospital sponsored community activities that promote nutrition, physical fitness, and outdoor activities/exercise for the entire family. The Hospital collaborated with local restaurants to include carbs and calorie counts on their menu. The Hospital continued to educate business and industry on the benefits of offering wellness programs for their employees and also suggested primary care and other providers to refer patients to nutritionists and diabetic educators. To prevent substance abuse, the Hospital continued to monitor prescription drug abuse by creating an alert system between physicians and pharmacies for drug abuse. The Hospital continued to participate in Ktracks to identify abuse and participated in regional efforts for opioid management.To improve child care, the Hospital conducted child care support education such as teen babysitting classes. The Hospital continued to provide support for licensure such as CPR Classes. The Hospital continued to provide education on infection prevention and child immunizations. Part I, Line 7: This amount was determined by multiplying a cost-to-charge ratio derived from Worksheet 2 for the tax year. Part I, Line 7g: The net community benefit expense of subsidized health services include costs attributable to a rural health clinic in the amount of $853,789. Part II, Community Building Activities: N/A Part III, Line 4: Nemaha Valley Community Hospital provides for accounts receivable that could become uncollectible in the future by establishing an allowance to reduce the carrying value of such receivables to their estimated net realizable value. This estimate is based on the aging of its accounts receivable by payor and historical collection experience. See note A4 (page 7) of the audited financial statements regarding the allowance for uncollectible accounts.Part III Line 2:This amount was determined by multiplying a cost-to-charge ratio derived from Worksheet 2 for the tax year.Part III, Line 3:This amount was determined based on the overall income level of patients that submit all required documentation under the Hospital's financial assistance policy. As a tax-exempt hospital, we must provide necessary services regardless of the patient's ability to pay for that care. Making quality patient care available to all in our community, regardless of their economic means, qualifies this amount as a community benefit. Part III, Line 8: Medicare costs were obtained from the Medical Center's as-filed Medicare cost report for the tax year. The shortfall is a benefit to the Medical Center's community since it represents health care provided at less than cost to elderly and needy residents of the Medical Center's service area. Part III, Line 9b: Nemaha Valley Community Hospital makes every effort to get correct financial and billing information and to educate patients on the eligibility requirements of charity care programs and payment options. Part VI, Line 2: N/A Part VI, Line 3: Notification associated with patient encounter. Part VI, Line 4: The community served is primarily residents who reside in Nemaha County Kansas and consists of approximately 2,000 residents. The median family income is $41,667. 9.0% of the community residents live below federal poverty level, and 3.5% of the community residents live below 50% of the federal poverty level. Neighboring hospitals are located in Sabetha, Pawnee County, NE, and Hiawatha. They are approximately 21, 20, and 28 miles away respectively. Part VI, Line 5: The Hospital maintains a Facebook page which posts general health information topics and announces dates of general health-related group activities. The Hospital offers periodic diabetic educational programs and education programs for expectant mothers. The Hospital uses all excess funds to maintain and improve Hospital facilities and equipment and to insure the delivery of high quality patient care services. Part VI, Line 6: N/A X X 0 0 0 0 0 0 0 0 0 Dr Jarod Snyder Physician/Trustee 255181 0 55708 0 0 0 11319 0 21287 0 343495 0 0 0 Kiley Floyd Chief Executive Officer 129435 0 5000 0 0 0 5985 0 13261 0 153681 0 0 0 William Bartkoski DO Physician 301406 0 60771 0 0 0 0 0 24082 0 386259 0 0 0 Harry Stewart CRNA 320282 0 0 0 0 0 9805 0 38050 0 368137 0 0 0 Dr Heather Cooper Physician 249052 0 101851 0 0 0 5088 0 14532 0 370523 0 0 0 Dr Angela Stueve Physician 282060 0 58650 0 0 0 11319 0 21269 0 373298 0 0 0 Lori Lueger APRN 122860 0 38422 0 0 0 5669 0 1391 0 168342 0 0 0 A City of Seneca Kansas 486026237 81712RAP4 2008-12-01 8835000 To refund notes payable and construction costs for an addition to Hospital 0 0 0 B City of Seneca Kansas 486026237 81712RBB4 2015-02-19 4455000 To refund a portion of 2008 series bond 0 0 0 A 5335000 8835000 498789 161535 6834436 1358153 2011 0 0 1 1 B 315000 4455000 88270 4517530 2018 1 0 1 1 A 0 0 0 0 0 0 1 B 0 0 0 0 0 0 1 A 0 0 0 1 1 0 0 0 1 B 0 0 1 0 0 0 0 0 1 A 1 B 1 Date Rebate Computation Performed Issuer Name: City of Seneca, Kansas Date the Rebate Computation was Performed: 06/01/2018 Margie Heinen Family member of Dennis Henry, Board Member 67310 Employment 0 Mary Strathman Family member of Dennis Henry, Board Member 38724 Employment 0 Denise Kohake Family member of Judy Deters, Board Member 15823 Employment 0 Lynda Cross Family member of Mary Haverkamp, Board Member 121560 Employment 0 0 Form 990, Part VI, Section B, line 11b The 990 is presented to the finance committee of the board prior to filing. The document is made available to all other board members upon request. Form 990, Part VI, Section B, line 12c The board is required to annually sign conflict of interest statements. Form 990, Part VI, Section B, line 15a The CEO salary and compensation is approved by the Hospital's board. Form 990, Part VI, Section C, line 19 Documents are available upon request. 990 Part XII Line 2c The 990 is presented to the finance committee of the board prior to filing. The document is made available to all board members upon request. Nemaha Valley Health Care Foundation 1600 Community Drive Seneca KS 66538 481097250 Fundraising for the benefit of community healthcare KS 501(c)(3) Line 7 Nemaha Valley Community Hospital 1 0 0 1 0 0 0 0 0 0 0 0 1 0 1 1 0 0 0 0