2019-02-14T11:38:25-06:00 2018-03-31 BKD LLP 1551 N WATERFRONT PKWY STE 300 WICHITA KS 672066601 990 2017-04-01 481226830 GREAT PLAINS OF SMITH CO INC % DAVE DELLASEGA GREA 3166851523 250 NORTH ROCK ROAD STE 160 WICHITA KS 67206 DAVE DELLASEGA CEO 3166851523 2019-01-15 true SHAWNELL LINOT P01663908 3162652811 167.68.126.162 48010220190455000005 2019-02-14 P B98F5FB64AC52D24D812995DABA8F8EA82147269 1E18B200E692A862BC78DEF5BEBFB82C16DD5F39 2017 2019-02-21 02:37:17Z SMITH COUNTY MEMORIAL HOSPITAL DAVE DELLASEGA 250 NORTH ROCK ROAD STE 160 WICHITA KS 67206 15633606 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 7 191 8 0 1652845 528951 14606058 14765182 14079 29187 91704 301869 16364686 15625189 0 0 0 0 8093937 8217183 0 0 0 7224548 7594935 15318485 15812118 1046201 -186929 8738752 29138369 3639872 24267071 5098880 4871298 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 13411843 0 14765182 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. 13411843 true true false true false false false false false true true false false false true false true true false false false false false false false false true true false false true true false false false false false false false false false false false false false false false true true false false false true 57 0 true 191 true 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 TOM KELLER DVM CHAIRMAN/DIRECTOR 0.25 2.25 X X 0 0 0 DAVE DELLASEGA PRESIDENT/CEO/DIRECTOR 2.0 40.0 X X 0 211212 30675 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 DAVE RANKIN DIRECTOR/CHAIRMAN 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 DURREL KELLEY COO 2.0 40.0 X 0 166790 34566 ALLEN VANDRIEL ADMINISTRATOR 40.0 0.0 X 148720 0 33863 JUSTIN OVERMILLER PHYSICIAN 40.0 0.0 X 288865 0 50740 FERRILL CONANT PHYSICIAN 40.0 0.0 X 290848 0 42823 TAMARA WINDSCHEFFEL ARNP 40.0 0.0 X 167425 0 34967 STACEY DIMITT PHYSICIAN 40.0 0.0 X 267161 0 50951 HANNAH HAACK PHYSICIAN 40.0 0.0 X 274444 0 53840 1437463 378002 332425 8 false true false MHS DATA CENTER 103 E 27TH SUITE A HAYS KS 67601 COMPUTER SERVICE 475165 QUEST DIAGNOSTICS PO BOX 719 HAYS KS 67601 REFERENCE LAB 145912 CRP HOLDINGS LLC 3445 N CAISEWAU BLVD CHICAGO IL 606941849 WOUND CARE 145500 GREAT PLAINS HEALTH ALLIANCE 250 N ROCK RD SUITE 160 WICHITA KS 67206 BILLING SERVICE 137436 GREAT PLAINS HEALTH ALLIANCE PO BOX 366 PHILLIPSBURG KS 67661 MANAGEMENT FEES 144128 6 454479 74472 528951 NET PATIENT SERVICE REVENUE 621300 12633526 12633526 340B PRESCRIPTION DRUG REVENUE 621300 2131656 2131656 14765182 37604 37604 0 0 0 0 0 8417 -8417 -8417 -8417 0 0 0 0 0 0 0 0 0 EMPLOYEE/GUEST MEALS 722513 56057 56057 WELLNESS CENTER 713940 16208 16208 VENDOR REBATES 900099 78277 78277 151327 151327 301869 15625189 14765182 331056 0 0 0 0 184769 184769 0 6152075 5471731 680344 423955 381690 42265 1042878 869712 173166 413506 354318 59188 126626 126626 14676 14676 72312 72312 0 0 0 2321126 1656401 664725 0 14455 6202 8253 360922 317325 43597 4052 1766 2286 0 224020 167044 56976 3726 3290 436 0 76434 61669 14765 7586 5421 2165 0 414295 296046 118249 126435 90348 36087 MEDICAL SUPPLIES 2703567 2703567 PROVISION FOR BAD DEBTS 771991 771991 EQUIPMENT RENTAL/MAINTENANCE 271753 238175 33578 DUES & SUBSCRIPTIONS 41061 15147 25914 39898 39898 15812118 13411843 2400275 0 74535 528429 1640487 1718994 0 0 1479100 1706231 0 0 0 0 0 0 223019 254260 239896 101519 31170470 6678948 4561527 24491522 0 0 0 0 0 0 0 0 520188 337414 8738752 29138369 2127160 3383917 0 0 0 0 1512712 20144154 0 0 0 0 0 0 0 0 0 739000 3639872 24267071 X 4116470 3960395 49216 18362 933194 892541 5098880 4871298 8738752 29138369 -186929 -40653 X false true X true false X false false false false false true 3046 false false false 3046 false SCHEDULE C, PART II-B, LINE 1F A PORTION OF THE ANNUAL DUES PAID TO KHA AND AHA ARE USED FOR LOBBYING. 982411 17349 -27421 61436 910903 931434 49072 67637 65732 982411 904033 45770 14884 33253 931434 835575 9959 75163 16664 904033 790370 7624 75716 38135 835575 0.00000 0.97980 0.02020 true false 0 399451 399451 0 3598761 2316848 1281913 0 5449045 4253221 1195824 0 21723213 108879 21614334 24491522 0 Due to Third Party 739000 739000 14812545 -40653 -771991 -812644 15625189 15625189 15040127 15040127 771991 771991 15812118 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 (771,991) SCHEDULE D, PART XII, LINE 4B PROVISION FOR UNCOLLECTIBLE ACCOUNTS 771,991 true true X true X false true true false true true 152839 152839 0.01020 607208 370944 236264 0.01570 760047 370944 389103 0.02590 52904 52904 0.00350 52904 52904 0.00350 812951 370944 442007 0.02940 false 771991 3596688 3596688 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 16 true false false true X SEE SCHEDULE H, PART V, SECTION C X true 16 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 A PRIORITY OF THE PROGRAM IS TO SOLICIT INPUT FROM A BROAD CROSS SECTION OF THE COMMUNITY, NOT SIMPLY MEMBERS OF THE LOCAL HEALTHCARE SECTOR. THE MEETING PARTICIPANTS INCLUDED COMMUNITY RESIDENTS AND GOVERNMENTAL BUSINESS LEADERS WITHIN THE COMMUNITY. THIS INFORMATION CAN BE FOUND IN THE SMITH COUNTY, KS TOWN HALL ROSTER AS PART OF THE TOWN HALL ATTENDEES NOTES & FEEDBACK LOCATED IN THE DETAILED EXHIBITS OF THE CHNA. SCHEDULE H, PART V, LINE 7A HTTPS://WWW.SCMHKS.ORG/ABOUT-US/COMMUNITY-HEALTH-NEEDS-ASSESSMENT/ SCHEDULE H, PART V, LINE 10 HTTP://SCMH.BITBRILLIANT.COM/FILES/2018/08/IMPLEMENTATION-STRATEGY.PDF SCHEDULE H, PART V, LINE 11 THE CHNA CONDUCTED HIGHLIGHTED TWO PRIORITIES IN SMITH COUNTY; FIRST, UPDATING EXISTING FACILITIES TO CREATE A NEW HEALTH CARE CENTER WITH AN EXPANDED ARRAY OF PROGRAMS AND SERVICES. THE HOSPITAL IS BUILDING A COUNTY COALITION TO FOCUS ON THE FUTURE OF HEALTH CARE IN THE COUNTY. THE HOSPITAL PUT UP A WEBSITE TO REACH MORE PEOPLE, HIRED A FUNDRAISER TO RAISE CAPITAL FOR A NEW HEALTH CARE CENTER, AND HELD A HEALTH CARE EVENT FAIR. THE SECOND PRIORITY IS A FOCUS ON COMMUNITY HEALTH AND WELLNESS. TO MEET THIS NEED, SMITH COUNTY HOSPITAL IS PUTTING TOGETHER A COMMUNITY GARDEN AND REVITALIZING RECREATION IN SMITH COUNTY THROUGH LEADERSHIP BOARD MEETINGS, REGULAR MONTHLY MEETINGS, AND PUBLIC EVENTS AND FORUMS. 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 UNDERINSURANCE STATUS. SCHEDULE H, PART I, LINE 7 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 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 $771,991. 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 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 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. FAVORED PROCEEDING WITH THE CONSTRUCTION PROJECT. THE BOARD OF TRUSTEES AND PBC BOARD, HEEDING THIS STRONG VOTE OF SUPPORT, HAVE MOVED FORWARD WITH THE FINANCING AND DEVELOPMENT OF PLANS FOR THE NEW FACILITY. 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 COUNTY BOARD OF COMMISSIONERS. THIS BOARD MAINTAINS RESPONSIBILITY FOR THE MAINTENANCE AND UPKEEP OF THE FACILITIES UTILIZED BY SMITH COUNTY MEMORIAL HOSPITAL AND SMITH COUNTY FAMILY PRACTICE. 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 FAMILY PRACTICE, OPERATED AS A DEPARTMENT OF SMITH COUNTY MEMORIAL HOSPITAL, OFFERS SPORTS PHYSICALS ANNUALLY TO STUDENTS AT TWO SCHOOL DISTRICTS IN THE COUNTY. THE PHYSICALS ARE PROVIDES AT A DEEPLY DISCOUNTED FEE, WITH THE PROCEEDS FROM THEM DONATED BACK TO THE SCHOOLS. THE 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. SMITH COUNTY MEMORIAL HOSPITAL WORKS CLOSELY WITH SMITH COUNTY EMS TO FACILITATE THE DELIVERY OF EMERGENCY MEDICAL SERVICES THROUGHOUT THE COUNTY. THIS INCLUDES PROVISION ON MEDICAL DIRECTION TO THE EMS AGENCY BY ONE OF OUR EMPLOYED PHYSICIANS. IN ADDITION, SMITH COUNTY MEMORIAL HOSPITAL MAINTAINS A TRAILER-BASED BIOHAZARD RESPONSE UNIT, WHICH CAN BE UTILIZED ANYWHERE IN THE COUNTY IT IS NEEDED. THE HOSPITAL ALSO PARTICIPATES ANNUALLY IN EMERGENCY PREPAREDNESS TRAINING IN CONJUNCTION WITH LAW ENFORCEMENT, FIRE, AND EMS PERSONNEL. 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/CEO/DIRECTOR 0 211212 0 0 0 0 0 20484 0 10191 0 241887 0 0 DURREL KELLEY COO 0 166790 0 0 0 0 0 16059 0 18507 0 201356 0 0 ALLEN VANDRIEL ADMINISTRATOR 148720 0 0 0 0 0 14360 0 19503 0 182583 0 0 0 JUSTIN OVERMILLER PHYSICIAN 288865 0 0 0 0 0 26200 0 24540 0 339605 0 0 0 FERRILL CONANT PHYSICIAN 290848 0 0 0 0 0 26200 0 16623 0 333671 0 0 0 TAMARA WINDSCHEFFEL ARNP 167425 0 0 0 0 0 16161 0 18806 0 202392 0 0 0 STACEY DIMITT PHYSICIAN 267161 0 0 0 0 0 25961 0 24990 0 318112 0 0 0 HANNAH HAACK PHYSICIAN 274444 0 0 0 0 0 26200 0 27640 0 328284 0 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. A SMITH COUNTY KANSAS PUBLIC BUILDING COMMISSION 271520447 000000000 2016-06-29 27250403 SEE PART VI false false false A 0 0 27251280 0 569130 0 466875 0 0 26214624 0 652 2018 false false false true A false false true true false 0.00000 0.00000 0.00000 false false false true A false true false false 0 false 0 false true A true SCHEDULE K, PART I, LINE A, COLUMN (E) THE BONDS WERE ISSUED AS A DRAW-DOWN LOAN PURSUANT TO REGULATIONS 1.150-1(C)(4)(I). THE ISSUE PRICE REPORTED REPRESENTS THE AMOUNT OF BOND PROCEEDS DRAWN AS OF 12/31/2018. SCHEDULE K, PART I, LINE A, COLUMN (F) ACQUIRE, CONSTRUCT, EQUIP, AND FURNISH REPLACEMENT HOSPITAL. SCHEDULE K, PART II, COLUMN A, LINE 3 THE BONDS WERE ISSUED AS A DRAW-DOWN LOAN PURSUANT TO REGULATIONS 1.150-1(C)(4)(I). THIS AMOUNT DOES NOT EQUAL PART I, LINE A, COLUMN (E) DUE TO INVESTMENT EARNINGS THROUGH 12/31/2018. SCHEDULE K, PART II, COLUMN A, LINE 10 THIS AMOUNT REPRESENTS THE TOTAL BOND PROCEEDS USED FOR CAPITAL EXPENDITURES AS OF 12/31/2018. SCHEDULE K, PART II, COLUMN A, LINE 12 THIS AMOUNT REPRESENTS THE BOND PROCEEDS REMAINING IN THE PROJECT FUND AS OF 12/31/2018. FORM 990, PART III, LINE 4A SMITH COUNTY MEMORIAL HOSPITAL PROVIDES INPATIENT AND OUTPATIENT MEDICAL CARE IN A CRITICAL ACCESS HOSPITAL. THE SERVICES PROVIDED TO RESIDENTS OF THE SERVICE AREA INCLUDE THE FOLLOWING: a. INPATIENT HOSPITAL CARE ENCOMPASSING ACUTE CARE FOR MEDICAL AND SOME SURGICAL PATIENTS. b. SKILLED AND PRIVATE PAY NURSING AND REHABILITATIVE CARE TO INPATIENTS DELIVERED THROUGH OUR SWING BED PROGRAM. 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. 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. 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. 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 PRACTICE PHYSICIANS AND ADVANCED PRACTICE REGISTERED NURSES. SERVICES ARE PROVIDED TO PRENATAL, POSTPARTUM, PEDIATRIC, ADULT, AND GERIATRIC PATIENTS. FOUR BOARD CERTIFIED FAMILY MEDICINE PHYSICIANS AND THREE 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. 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:1168774 FORM 990 PART IX LINE 11G DESCRIPTION:BILLING/COLLECTIONS TOTAL FEES:551671 FORM 990 PART IX LINE 11G DESCRIPTION:LAB SERVICES TOTAL FEES:232538 FORM 990 PART IX LINE 11G DESCRIPTION:PHARMACY SERVICES TOTAL FEES:149222 FORM 990 PART IX LINE 11G DESCRIPTION:ADMINISTRATION/HUMAN RESOURCES TOTAL FEES:107878 FORM 990 PART IX LINE 11G DESCRIPTION:MAINTENANCE/HOUSEKEEPING TOTAL FEES:76508 FORM 990 PART IX LINE 11G DESCRIPTION:DIETARY SERVICES TOTAL FEES:16400 FORM 990 PART IX LINE 11G DESCRIPTION:PLANT OPERATIONS TOTAL FEES:18135 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 N ROCK ROAD STE 160 WICHITA KS 67206 481226833 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 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 REPUBLIC COUNTY INC 250 N ROCK ROAD STE 160 WICHITA KS 67206 481226977 HOSPITAL KS 501(C)(3) 3 GPHA INC true GREAT PLAINS OF CHEYENNE COUNTY INC 250 N ROCK ROAD STE 160 WICHITA KS 67206 481226831 HOSPITAL KS 501(C)(3) 3 GPHA INC true SCMH QALICB INC 921 EAST HIGHWAY 36 SMITH CENTER KS 66967 823936808 FINANCING KS 501(C)(3) 3 GPHA INC true false false false false false false false false false false true false true false true false false false false