2020-02-11T08:34:48-06:00 2019-03-31 BKD LLP 1551 N WATERFRONT PKWY STE 300 WICHITA KS 672066601 990 2018-04-01 481226830 GREAT PLAINS OF SMITH CO INC % DAVE DELLASEGA GREA 3166851523 250 NORTH ROCK ROAD STE 160 WICHITA KS 67206 DAVE DELLASEGA CEO 3166851523 2020-02-15 true SHAWNELL LINOT P01663908 3162652811 167.68.126.162 48010220200425000000 2020-02-11 P 2967532D7000F9E1FAA5B1B19B38C174EF97BACC BA21A7A7DF03597CAA95FF5B57CCAA395E7C7A92 2018 2020-09-22 18:59:49Z SMITH COUNTY MEMORIAL HOSPITAL DAVE DELLASEGA 250 NORTH ROCK ROAD STE 160 WICHITA KS 67206 19517688 false X WWW.SMITHCOHOSP.ORG X 1999 KS THE OPERATION OF HOSPITAL FACILITIES FOR THE DELIVERY OF HEALTH CARE SERVICES, EDUCATION, AND WELLNESS WITHOUT REGARD TO RACE, CREED, COLOR, SEX OR FINANCIAL CIRCUMSTANCE. 8 7 182 8 0 528951 2614738 14765182 16550667 29187 -1787334 301869 309407 15625189 17687478 0 0 0 0 8217183 8202726 0 0 0 7594935 10363459 15812118 18566185 -186929 -878707 29138369 33416274 24267071 29394749 4871298 4021525 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 15151921 0 16550667 GREAT PLAINS OF SMITH COUNTY, INC., DBA SMITH COUNTY MEMORIAL HOSPITAL DELIVERS PRIMARY HEALTHCARE SERVICES TO A SERVICE AREA THAT INCULDES 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. 15151921 true true false true false false false false false true true false false true false false true true false false false false false false false false true true false false true false false false false false false false false false false false false false true true false true false true 51 0 true 182 true false false false false false false false false false false false false X 8 7 true false false false true true true true true false false true true true true true true false false false X DAVE DELLASEGA 3166851523 250 NORTH ROCK ROAD STE 160 WICHITA KS 67206 X DAVE RANKIN CHAIRMAN/DIRECTOR 0.25 2.25 X X 0 0 0 DAVE DELLASEGA PRESIDENT/DIRECTOR 2.0 40.0 X X 0 210603 31502 BILL NAVIS VICE PRESIDENT/DIRECTOR 0.25 2.25 X X 0 0 0 JOHN TERRILL VICE PRESIDENT/DIRECTOR 0.25 2.25 X X 0 0 0 ROBERT HAMILTON SECRETARY/DIRECTOR 0.25 2.25 X X 0 0 0 STEVE CARLSON TREASURER/DIRECTOR 0.25 2.25 X X 0 0 0 DR BARBARA BROWN APPLEGATE DIRECTOR 0.25 2.25 X 0 0 0 ARTHUR HENRICKSON DIRECTOR 0.25 2.25 X 0 0 0 CHARLES WESTIN DIRECTOR 0.25 2.25 X 0 0 0 ALLEN VANDRIEL ADMINISTRATOR 40.0 0.0 X 148747 0 32753 DURREL KELLEY COO 2.0 40.0 X 0 167704 34071 JUSTIN OVERMILLER PHYSICIAN 40.0 0.0 X 314726 0 52228 HANNAH HAACK PHYSICIAN 40.0 0.0 X 308727 0 53479 FERRILL CONANT PHYSICIAN 40.0 0.0 X 304236 0 43032 STACEY DIMITT PHYSICIAN 40.0 0.0 X 249615 0 48133 LEAH WIEHL PHYSICIAN 40.0 0.0 X 231658 0 19312 1557709 378307 314510 9 false true false GPHA 250 N ROCK ROAD WICHITA KS 67206 BILLING SERVICE/MGMT 369298 MHS DATA CENTER 103 E 27TH SUITE A HAYS KS 67601 COMPUTER SERVICE 330866 AR SYSTEMS PO BOX 2521 TWIN FALLS ID 83303 CODING SERVICES 162041 QUEST DIAGNOSTICS PO BOX 719 HAYS KS 67601 REFERENCE LAB 160770 CRP HOLDINGS LLC 3445 N CAISEWAU BLVD CHICAGO IL 606941849 WOUND CARE 137675 6 2592963 21775 2614738 NET PATIENT SERVICE REVENUE 621300 14049145 14049145 340B PRESCRIPTION DRUG REVENUE 621300 2501522 2501522 16550667 42876 42876 0 0 0 0 0 1830210 -1830210 -1830210 -1830210 0 0 0 0 0 0 0 0 0 EMPLOYEE/GUEST MEALS 722513 83786 83786 WELLNESS CENTER 713940 3605 3605 VENDOR REBATES 900099 47803 47803 174213 174213 309407 17687478 16550667 -1477927 0 0 0 0 180803 180803 0 6294938 5541867 753071 455904 404017 51887 857232 668934 188298 413849 349176 64673 128025 128025 7327 7327 80571 80571 0 0 0 2472408 1626621 845787 0 11972 2821 9151 1166664 902695 263969 6820 5772 1048 0 341717 249739 91978 5015 4805 210 0 43373 31288 12085 567153 405274 161879 0 1626384 1162176 464208 135339 96710 38629 0 MEDICAL SUPPLIES 2863893 2863893 PROVISION FOR BAD DEBTS 649006 649006 EQUIPMENT RENTAL/MAINTENANCE 157798 119240 38558 DUES & SUBSCRIPTIONS 46189 14082 32107 53805 53805 18566185 15151921 3414264 0 528429 21244 1718994 1665509 0 0 1706231 1747781 0 0 0 0 0 0 254260 245021 101519 88462 29661772 1795839 24491522 27865933 0 0 0 0 0 0 0 0 337414 1782324 29138369 33416274 3383917 1747863 0 0 0 0 20144154 0 0 0 0 0 0 27646886 0 0 739000 0 24267071 29394749 X 3960395 3085506 18362 14544 892541 921475 4871298 4021525 29138369 33416274 -878707 28934 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false true 3374 false false false 3374 false SCHEDULE C, PART II-B, LINE 1F A PORTION OF THE ANNUAL DUES PAID TO KHA AND AHA ARE USED FOR LOBBYING. 910903 13076 41817 29778 936018 982411 17349 -27421 61436 910903 931434 49072 67637 65732 982411 904033 45770 14884 33253 931434 835575 9959 75163 16664 904033 0.00000 0.98450 0.01550 true false 0 395701 395701 0 19602101 802630 18799471 0 6063809 8811396 5252413 0 3600161 181813 3418348 27865933 Due from Third Party 590000 FUNDS HELD BY ESCROW AGENT 983031 OTHER RECEIVABLES 209293 1782324 18897616 28934 -649006 -620072 19517688 -1830210 -1830210 17687478 19747389 19747389 -1181204 -1181204 18566185 SCHEDULE D, PART V, LINE 4 THE INTENDED USE OF THE ENDOWMENT FUNDS IS TO SUPPORT THE CONTINUING OPERATIONS OF THE REPORTING ORGANIZATION. SCHEDULE D, PART X, LINE 2 MANAGEMENT HAS EVALUATED THEIR INCOME TAX POSITIONS UNDER THE GUIDANCE INCLUDED IN ASC 740. BASED ON THEIR REVIEW, MANAGEMENT HAS NOT IDENTIFIED ANY MATERIAL UNCERTAIN TAX POSITIONS TO BE RECORDED OR DISCLOSED IN THE FINANCIAL STATEMENTS. SCHEDULE D, PART XI, LINE 2D PROVISION FOR UNCOLLECTIBLE ACCOUNTS (649,006) SCHEDULE D, PART XI, LINE 4B LOSS ON DISPOSAL OF ASSETS (1,830,210) SCHEDULE D, PART XII, LINE 4B PROVISION FOR UNCOLLECTIBLE ACCOUNTS 649,006 LOSS ON DISPOSAL OF ASSETS (1,830,210) true true X true X false true true false true true 107874 107874 0.00600 729690 340728 388962 0.02170 837564 340728 496836 0.02770 33614 33614 0.00190 33614 33614 0.00190 871178 340728 530450 0.02960 false 649006 6754204 6754204 X true true 1 1 GREAT PLAINS OF SMITH CO INC 614 SOUTH MAIN STREET SMITH CENTER KS 66967 WWW.SMITHCOHOSP.ORG H092001 X X X X RURAL HEALTH CLINIC LONG-TERM CARE UNIT GREAT PLAINS OF SMITH CO INC 1 false false true X X X X X X X X X 18 true false false true X SEE SCHEDULE H, PART V, SECTION C X true 18 true SEE SCHEDULE H, PART V, SECTION C false true X 200. 0. X X X true true X X X X true X SEE SCHEDULE H, PART V, SECTION C X SEE SCHEDULE H, PART V, SECTION C X SEE SCH H, PART V, SECTION C X X X X X X true X false X X X X true X false false SCHEDULE H, PART V, LINE 5 THE 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 7A HTTPS://WWW.SCMHKS.ORG/ABOUT-US/COMMUNITY-HEALTH-NEEDS-ASSESSMENT/ SCHEDULE H, PART V, LINE 10 HTTPS://WWW.SCMHKS.ORG/FILE/2019/04/2018-PLAN-IMPLEMENTATION.PDF SCHEDULE H, PART V, LINE 11 THE 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 16A HTTPS://WWW.SCMHKS.ORG/SERVICES/FINANCIAL-ASSISTANCE/ SCHEDULE H, PART V, LINE 16B HTTPS://WWW.SCMHKS.ORG/SERVICES/FINANCIAL-ASSISTANCE/ SCHEDULE H, PART V, LINE 16C HTTPS://WWW.SCMHKS.ORG/SERVICES/FINANCIAL-ASSISTANCE-RESOURCES/ 1 SMITH COUNTY FAMILY PRACTICE 119 E PARLIAMENT STREET SMITH CENTER KS 66967 FAMILY PRACTICE SCHEDULE H, PART I, LINE 3C THE ORGANIZATION USED THE FOLLOWING CRITERIA TO DETERMINE ELIGIBILITY FOR FINANCIAL ASSISTANCE: ASSET LEVEL, MEDICAL INDIGENCY, INSURANCE STATUS, AND UNDER INSURANCE STATUS. SCHEDULE H, PART I, LINE 7 THE 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 F THE 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 $649,006. SCHEDULE H, PART III, LINE 2 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 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 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 4 SEE PAGES 7 AND 8 OF THE AUDITED FINANCIALS UNDER NOTE 1. SCHEDULE H, PART III, LINE 8 THE COSTING METHODOLOGY USED TO CALCULATE THE AMOUNT ON LINE 6 IS A COST TO CHARGE RATIO. SCHEDULE H, PART III, LINE 9B ALL 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 2 GREAT 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 3 OUR 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 4 THE 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 5 SMITH 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 6 SMITH 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 7 N/A false false false false false false false false false DAVE DELLASEGA PRESIDENT/DIRECTOR 0 210603 0 0 0 0 0 20484 0 11018 0 242105 0 0 ALLEN VANDRIEL ADMINISTRATOR 148747 0 0 0 0 0 14684 0 18069 0 181500 0 0 0 JUSTIN OVERMILLER PHYSICIAN 314726 0 0 0 0 0 28469 0 23759 0 366954 0 0 0 HANNAH HAACK PHYSICIAN 308727 0 0 0 0 0 28223 0 25256 0 362206 0 0 0 FERRILL CONANT PHYSICIAN 304236 0 0 0 0 0 27549 0 15483 0 347268 0 0 0 STACEY DIMITT PHYSICIAN 249615 0 0 0 0 0 24577 0 23556 0 297748 0 0 0 LEAH WIEHL PHYSICIAN 231658 0 0 0 0 0 6111 0 13201 0 250970 0 0 0 DURREL KELLEY COO 0 167704 0 0 0 0 0 16059 0 18012 0 201775 0 0 FORM 990, PART VII; SCHEDULE J, PART I, LINE 3 COMPENSATION 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. FORM 990, PART III, LINE 4A 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. 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. G. 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. H. THIS DEPARTMENT IS ALSO THE PROVIDER OF ALL MEALS FOR THE MEALS ON WHEELS PROGRAM IN THE COMMUNITY. SMITH COUNTY FAMILY PRACTICE PROVIDES PRIMARY CARE SERVICES USING THE SERVICES OF BOARD CERTIFIED FAMILY MEDICINE PHYSICIANS AND ADVANCED PRACTICE REGISTERED NURSES. SERVICES ARE PROVIDED TO PRENATAL, POSTPARTUM, PEDIATRIC, ADULT, AND GERIATRIC PATIENTS. FOUR BOARD CERTIFIED FAMILY MEDICINE PHYSICIANS AND FIVE ADVANCED PRACTICE REGISTERED NURSES (NURSE PRACTITIONERS) 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. FORM 990, PART VI, SECTION A, LINE 2 DAVE 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 7A GREAT 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 7B 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, SECTION B, LINE 11B 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, SECTION B, LINE 12C 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, SECTION B, LINES 15A & B THE 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 19 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 IX LINE 11G DESCRIPTION:CONTRACTED MEDICAL STAFF TOTAL FEES:1130503 FORM 990 PART IX LINE 11G DESCRIPTION:BILLING/COLLECTIONS TOTAL FEES:659270 FORM 990 PART IX LINE 11G DESCRIPTION:LAB SERVICES TOTAL FEES:244117 FORM 990 PART IX LINE 11G DESCRIPTION:PHARMACY SERVICES TOTAL FEES:166617 FORM 990 PART IX LINE 11G DESCRIPTION:ADMINISTRATION/HUMAN RESOURCES TOTAL FEES:183340 FORM 990 PART IX LINE 11G DESCRIPTION:MAINTENANCE/HOUSEKEEPING TOTAL FEES:69866 FORM 990 PART IX LINE 11G DESCRIPTION:DIETARY SERVICES TOTAL FEES:7563 FORM 990 PART IX LINE 11G DESCRIPTION:PLANT OPERATIONS TOTAL FEES:11132 GREAT PLAINS HEALTH ALLIANCE INC 250 N ROCK ROAD STE 160 WICHITA KS 67206 480617739 MANAGEMENT KS 501(C)(3) 3 NA false GREAT PLAINS HEALTH CARE FOUNDATION INC 250 NORTH ROCK ROAD STE 160 WICHITA KS 67206 480955870 SUPPORT KS 501(C)(3) 10 GPHA INC true GREAT PLAINS OF ELLINWOOD INC 250 NORTH ROCK ROAD STE 160 WICHITA KS 67206 481226976 HOSPITAL KS 501(C)(3) 3 GPHA INC true GREAT PLAINS OF KIOWA COUNTY INC 250 NORTH ROCK ROAD STE 160 WICHITA KS 67206 481226833 HOSPITAL KS 501(C)(3) 3 GPHA INC true GREAT PLAINS OF OTTAWA COUNTY INC 250 NORTH ROCK ROAD STE 160 WICHITA KS 67206 481226856 HOSPITAL KS 501(C)(3) 3 GPHA INC true GREAT PLAINS OF SABETHA COUNTY INC 250 NORTH ROCK ROAD STE 160 WICHITA KS 67206 481236156 HOSPITAL KS 501(C)(3) 3 GPHA INC true GREAT PLAINS OF REPUBLIC COUNTY INC 250 NORTH ROCK ROAD STE 160 WICHITA KS 67206 481226977 HOSPITAL KS 501(C)(3) 3 GPHA INC true GREAT PLAINS OF CHEYENNE COUNTY INC 250 NORTH ROCK ROAD STE 160 WICHITA KS 67206 481226831 HOSPITAL KS 501(C)(3) 3 GPHA INC true SCMH QALICB INC 921 E HIGHWAY 36 SMITH CENTER KS 66967 823936808 FINANCING 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 true false false true false GPHA EMPLOYEE BENEFITS TRUST R 949029 FMV