2018-05-09T12:56:40-05:00 2017-06-30 481026809 Wendling Noe Nelson & Johnson LLC 534 S Kansas Ave Suite 1500 Topeka KS 666033491 990 2016-07-01 481253246 Pawnee Valley Community Hospital Inc PAWN 6202853161 923 Carroll Ave Larned KS 67550 George Harms Secretary/Treasurer 7856235000 2018-04-25 1 Heather R Eichem P01515553 7852334226 2018-04-25 2016 2022-09-23 18:48:47Z George Harms 923 Carroll Ave Larned KS 67550 17945770 0 X www.pawneevalleyhospital.com X 2001 KS Pawnee Valley Community Hospital, Inc. is a tax-exempt charitable organization under Section 501(c)(3) of the Internal Revenue Code and is licensed by the State of Kansas Department of Health and Environment. The purpose of the Organization is to improve the quality of life for the communities we serve through exceptional healthcare and service excellence. The Organization is striving to be the best Critical Access Hospital in rural America. 6 2 154 92 0 0 340563 152936 17935656 17590974 7026 20752 186699 181108 18469944 17945770 283287 28716 0 0 8235368 8409323 0 0 0 6808332 9536447 15326987 17974486 3142957 -28716 9241754 10623043 8018579 9269859 1223175 1353184 X Pawnee Valley Community Hospital, Inc. is a tax-exempt charitable organization under Section 501(c)(3) of the Internal Revenue Code and is licensed by the State of Kansas Department of Health and Environment. The purpose of the Organization is to provide healthcare facitities and services for the care and treatment of inpatients and outpatients who are acutely ill or who otherwise require medical care and related services. The core purpose of the Corporation is to improve the quality of life for the communities we serve through exceptional healthcare and service excellence. 0 0 13623973 28716 17616548 Patient care: Program services consist of routine and ancillary department healthcare services provided by a healthcare organization as described in 501(c)(3) of the IRS code. 13623973 1 1 0 1 0 0 0 0 0 1 0 0 0 1 1 0 1 1 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 1 154 1 0 0 0 0 0 0 0 0 0 0 X 6 2 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X George Harms Treasurer 7856235000 2220 Canterbury Hays KS 67601 Bryce Young President 4.00 40.00 X X 0 332241 95883 Shae Veach Vice President 4.00 40.00 X X 0 240646 73640 George Harms Secretary/Treasurer 4.00 40.00 X X 0 311382 78461 John Jeter MD Director 4.00 40.00 X 0 750080 148373 David Sanger MD Director/Physician 40.00 X 230407 0 41392 Lynn Barger Director 4.00 X 0 0 0 John Haas Director 4.00 X 0 0 0 Eric Lybarger Administrator 40.00 X 37723 0 4871 Amanda Bickle APRN 40.00 X 124469 0 28433 Debbie Tomlinson APRN 40.00 X 140766 0 11116 Cynthia Carter Registered Nurse 40.00 X 103472 0 16116 Christian Whittington Physician 40.00 X 273661 0 43017 Dusty Atterbury Physician Assistant 40.00 X 101983 0 31398 1012481 1634349 572700 12 0 1 0 Hays Medical Center 2220 Canterbury Drive Hays KS 67601 Contract Services 2957606 GE Healthcare 9900 W Innovation Drive Wauwatosa WI 53226 Repairs and Maintenance 160038 Quest Diagnostics PO Box 14730 St Louis MO 63150 Lab Services 158643 Anesthesiologist Associates of Hays PO Box 821 Hays KS 67601 Anethesia Services 150530 4 124220 28716 6097 152936 Net patient service revenue 622000 16665325 16665325 340b drug program 900099 859235 859235 Outreach therapy services 900099 39197 39197 Lab fairs 900099 27216 27216 EHR incentive payments 900099 1 1 17590974 20752 20752 1800 0 1800 1800 1800 Meals sold to employees and guest 722210 155534 155534 Other miscellaneous revenue 900099 23774 23774 179308 17945770 17616548 0 176286 28716 28716 455997 305898 150099 6406719 5880175 526544 280472 253350 27122 800848 736852 63996 465287 420319 44968 2425400 2425400 12509 12509 44761 44761 1566374 1293464 272910 59214 1327 57887 57838 27793 30045 88844 53306 35538 2788256 2337952 450304 9472 9312 160 3091 3091 91278 54767 36511 Pharmaceuticals 986834 986834 Medical supplies 359773 359773 Service contracts 299109 289216 9893 Dietary 174702 174702 0 568992 407126 161866 17974486 13623973 4350513 0 518161 925211 4775255 5256421 1720178 2066682 260760 284579 160630 151199 1806770 1938951 9241754 10623043 1024291 992734 6994288 8277125 8018579 9269859 X 217338 347347 1005837 1005837 1223175 1353184 9241754 10623043 X -28716 158725 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 1 4855 0 0 0 4855 0 Part II-B, Line 1: Pawnee Valley Community Hospital is a member of the Kansas Hospital Association and the American Hospital Association. Both of these organizations engage in lobbying activities for hospitals and health care as part of the services provided to members. 1169777 96455 1266232 934796 234981 1169777 372016 1515575 952795 934796 142777 408437 179198 372016 1026228 883451 142777 1.00000 0 1 1 0 Estimated third-party payor settlements 462000 Other receivables 120560 Beneficial interest in net assets of foundation 1353184 Receivable from related party 3207 1938951 Due to Pawnee County 7615449 Due to Hays Medical Center, Inc. 639747 Estimated third-party payor settlements 21929 8277125 18075779 130009 130009 17945770 0 17945770 17945770 0 17945770 28716 28716 17974486 Part V, Line 4: Donations are requested for specific items or improvements to the Hospital. When a donation is received for that specific item, it is restricted for that use by the Board until the specific item or improvement is purchased. At any one time, one or more such projects can be in progress. Part XI, Line 2d - Other Adjustments: Change in beneficial interest in net assets of Foundation 130,009. Part XII, Line 4b - Other Adjustments: Transfer of equipment to Pawnee County 28,716. 1 1 1 X 130.000000000000 1 X 1 1 0 0 181652 181652 0.01010 971096 206143 764953 0.04260 1152748 206143 946605 0.05270 3071809 1474459 1597350 0.08890 0 0 3071809 1474459 1597350 0.08890 4224557 1680602 2543955 0.14160 1 575082 0 9017268 9235329 -218061 X 1 1 1 1 Pawnee Valley Community Hospital Inc 923 Carroll Avenue Larned KS 67550 X X X X Pawnee Valley Community Hospital Inc 1 0 0 1 X X X X X X X X X 14 1 0 1 1 X http://www.pawneevalleyhospital.com/ X http://www.pawneecountykansas.com/ X 1 14 0 1 0 1 X 130.000000000000 400.000000000000 X X X X X 1 1 X X X 1 X http://www.pawneevalleyhospital.com/ X http://www.pawneevalleyhospital.com/ X http://www.pawneevalleyhospital.com/ X X X X X 1 X 0 X X X X 1 X 0 0 Pawnee Valley Community Hospital, Inc. Part V, Section B, Line 5: The CHNA was conducted in collaboration with the Pawnee County Health Department. A Town Hall meeting was organized to provide an objective consensus building method of reviewing and prioritizing county health issues. During the Town Hall meeting, the group reflected on the size and seriousness of any health concerns cited and discussed current community health strengths. The group identified and ranked top community health concerns, and all Town Hall attendees were encouraged to continue to contribute ideas by going online and taking a feedback survey that addresses any additional thoughts related to the CHNA. All Town Hall priority-setting and score processes involved the input of a diverse group with knowledge and/or expertise in public health as well as persons who represent the broad interests of the community served by the hospital. Key stakeholders in attendance included representatives from: United Way, Welcome Inn Senior Center, Center for Counseling, Angels Care Home Health, Golden Belt Foundation, Larned City Council, Burdett City Council and Garfield City Council and Rozel Community, Pawnee County Sherriff's office, Larned Police Department, Pawnee County Health Department, County Commissioners, members of the Chamber of Commerce, members of the USD 495 School Board, school nurses of USD 495, local members of the media, local religious organizations and representative of Pawnee Valley Community Hospital. The CHNA was coordinated and produced by VVV Research & Development, Inc. from Olathe, Kansas. Pawnee Valley Community Hospital, Inc. Part V, Section B, Line 6b: Pawnee County, KS Pawnee Valley Community Hospital, Inc. Part V, Section B, Line 11: Annual description of the actions taken by the Hospital during the fiscal year to address the significant health needs identified throught the most recently conducted CHNA:1.) Build and/or Develop Exercise Facilities - 37 votes, 22.8%Construction on the Fort Larned USD #495 community fitness center is complete and is expected to be open to the public August 2017. Any Pawnee County taxpayer can get a membership to the fitness center for $25 a year.PVCH is planning their annual fun run for August 2017. The money raised will be used to help purchase physical education equipment and playground equipment for the new elementary school. The community continues to support other local exercise entities such as spin class, taekwondo, Yoga and an independently owned exercise gym.2.) Expand Oncology Services - 25 votes, 15.4%We have explored the feasibility of offering oncology services and providers in Pawnee County and it was determined not to be feasible at this time. The services that PVCH provides to Oncology patients through our special nursing services department are Central Line Maintenance, Transfusions, Injections, non-chemo infusions, and removal of chemotherapy pumps.3.) Improve Air Quality (Feed Lots) - 20 votes, 12.3%.We plan to continue to look into improving air quality in Pawnee County. More research needs to be done to determine if it is feasible for PVCH to implement a plan to address air quality issues.4.) Reduce Drug/Alcohol Abuse - 20 votes, 12.3%.PVCH currently does education and discharge instructions in our Emergency Department for any patients that come in under the influence of drugs and/or alcohol.The Pawnee County Health Department and Pawnee Valley Community Hospital continues to partner with The Center for Counseling through an "Improving Health in Rural Counties" grant. The grant project focuses on public mental health awareness and utilization campaign focusing on (1) recognition and understanding of the importance of mental health and substance abuse issues; (2) public recognition of local behavior health resources/services (including substance use); and (3) increased utilization of those services.- Print and radio advertisements are ongoing to increase behavioral health awareness and assist with increasing understanding of available community resources.- A community behavioral health resource has been created to assist linking people to appropriate treatment.- Crisis mental health Screenings are being performed by telemedicine to help make the screenings more accessible and get people to assistance more rapidly.- Mental health kiosks "Get a Checkup from the Neck Up" are available at the health department for people to take an anonymous screening (eight different categories) and results are given to the person and they are directed by information on the screen to access assistance.- Information is provided at community health fairs on mental health and substance use issues.The Pawnee County Commissioners signed a resolution on April 3rd, 2017 for the "Stepping Up Initiative". This initiative is to help reduce the number of people with mental illnesses in jails, including those with substance abuse, as three quarters of those with mental health illness in jails also have substance abuse issues. The first community partner meeting for this initiative will be April 19th and includes the following: 1. Larned State Hospital 2. Law Enforcement 3. EMS 4. Pawnee Valley Community Hospital 5. The Center for Counseling 6. Pawnee County Ministerial Alliance 7. Community Corrections 8. Family Crisis Center 9. County Attorney 10. Public Health 11. Medical ProviderThe health department, as part of our comprehensive data collection, screens individuals accessing the health department for alcohol and substance abuse and then refers if help is needed.5.) Provide Health Food Options - 14 votes, 8.6%.Pawnee Valley Community Hospital is promoting healthy eating lifestyles focusing on food labels, healthy meal options, nutrition, and portion control. In 2016 PVCH signed the healthy Kansas hospital initiative. We are in the process of forming an internal committee and developing a policy. The plan is to then extend the committee to include community members and focus on what changes we can make in the community such as grocery store options and healthy meal options at local restaurants. We continue to offer diabetic education classes which is a two day session 6 times a year. Participants eat at the facility and go through the cafeteria line and are encouraged to make healthier food choices.PVCH continues to educate children at their annual sixth grade health fair and includes education on portion control, label reading, and exercise.The health department promotes the diabetes support group and sends out their meeting reminders each month. The diabetes support group discusses nutrition with people in attendance.6.) Increase Access to Home Health/Hospice - 11 votes, 6.8%.PVCH continues to be a partner with the Kansas Heart and Stroke Collaborative and we have a part time staff member that goes into the home and checks on the patient and makes sure they are following the guidelines provided by their physician, pertaining to heart and stroke.PVCH has obtained an agreement with Golden Belt Home Health and Hospice for respite care.7.) Offer Nursing Home Dementia Services - 11 votes, 6.8%.Country Living Assisted Living facility in Pawnee County will be opening another building for "Memory Care" in November 2017. Number of beds dedicated to memory care is based on availability and need of care level of the patient. Staff is trained with dementia and Alzheimer's training. Country Living is a member of the Alzheimer's association. Pawnee Valley Community Hospital, Inc. Part V, Section B, Line 13b: Financial assistance may be given for catastrophic medical expenses, even if patient's income exceeds the Federal poverty guidelines. 1 1 - Pawnee Valley Medical Associates 713 W 11th St Larned KS 67550 Family Medicine Part I, Line 7: A cost-to-charge ratio derived from Worksheet 2 was used to determine financial assistance at cost and the cost of subsidized health services. A cost-to-charge ratio derived from Worksheet 2 was used to determine the costs of serving Medicaid beneficiaries. Part I, Line 7g: Subsidized health services community benefit expenses include $486,330 of expenses attributable to physician clinics that have net operating losses. Part III, Line 4: The footnote from the hospital's financial statements follows:The 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 net realizable value. The Hospital estimates this allowance based on the aging of its accounts receivable and its historical collection experience for each type of payor.Part III Line 2:Costing methodology: A cost-to-charge ratio derived from Worksheet 2 was used to calculate bad debt expense at cost. Part III, Line 8: The Medicare cost report was the costing methodology used to determine the allowable Medicare costs pertaining to Medicare net revenue. Allowable costs of care reported on line 6 were determined using amounts from Worksheet D, Part V and Worksheet D-1 in the Pawnee Valley Community Hospital, Inc., Medicare cost report for fiscal year ended June 30, 2017. Part III, Line 9b: Whenever possible, the customer service representatives (CSR's) of Pawnee Valley Community Hospital try to determine the estimated self-pay balance prior to the patient receiving services. Charity care eligibility is first considered at this point in time. In addition, if full payment is not received or payment is not made with 30 days, the CSR contacts the patient. If it is determined that at least a two-year payment plan cannot be established with the patient, the CSR will screen for charity care and request that the charity care application be completed by the patient. Part VI, Line 3: Information regarding the Pawnee Valley Community Hospital, Inc. charity care program is located on the Pawnee Valley Community Hospital and Hays Medical Center, Inc. website for patients and community members to view, and the financial assistance application is also on the HMC website to print off and complete. A financial assistance policy summary is included with every statement that is sent to an uninsured patient. In addition, if a customer service representative contacts a patient about a bill and in visiting with them they determine that patient could possibly qualify for the hospital's charity care policy, the CSR will send the application to the patient as well. Part VI, Line 4: Pawnee Valley Community Hospital, Inc. is located in Larned, Kansas, which has a population of approximately 4,050 people, as of the 2010 census. The median household income of Larned was $43,250. Approximately 5.9% of families were below the poverty line, and 7.4% of the total population was below the poverty line. Approximately 8.1% of the hospital's revenue is from services provided to patients eligible for Medicaid. Pawnee Valley Community Hospital, Inc. is the only hospital in Larned, Kansas. It mainly serves the community of Larned. Part VI, Line 5: Pawnee Valley Community Hospital, Inc. promotes the health of the community by extending medical privileges to most qualified, local physicians. Part VI, Line 6: Pawnee Valley Community Hospital, Inc. is a component unit of Hays Medical Center, Inc. As of January 1, 2017, Hays Medical Center, Inc. became a component unit of the University of Kansas Hospital Authority. 0 Pawnee County 715 Broadway Larned KS 67550 486007542 28716 Cash paid Transfer of equipment and landhold improvements Pawnee County owns all fixed assets (land, building, equipment) used by the Hospital. To expedite the purchase of equipment and obtain favorable purchasing terms, the Hospital purchased equipment on behalf of the County. The Pawnee Valley Community Hospital Foundation reimbursed the Hospital for the purchase. The Hospital then transferred ownership of the equipment to Pawnee County. The Foundation also paid for a landhold improvement. This improvement was given to the Hospital who then transferred ownership to Pawnee County. 0 1 0 0 0 1 1 0 0 Bryce Young President 0 265759 0 66482 0 0 0 67126 0 28757 0 428124 0 0 Shae Veach Vice President 0 186000 0 33877 0 20769 0 47575 0 26065 0 314286 0 0 George Harms Secretary/Treasurer 0 251161 0 60221 0 0 0 62901 0 15560 0 389843 0 0 John Jeter MD Director 0 542748 0 185472 0 21860 0 125434 0 22939 0 898453 0 0 David Sanger MD Director/Physician 216073 0 0 0 14334 0 13745 0 27647 0 271799 0 0 0 Amanda Bickle APRN 122193 0 276 0 2000 0 3917 0 24516 0 152902 0 0 0 Debbie Tomlinson APRN 137890 0 276 0 2600 0 8514 0 2602 0 151882 0 0 0 Christian Whittington Physician 211811 0 0 0 61850 0 15900 0 27117 0 316678 0 0 0 Part I, Line 3 A related organization uses a compensation committee, independent compensation consultant, written employment contract, and approval by the board or compensation committee to establish the compensation of the Hospital's Administrator. Part I, Line 4b Contributions to the plan: John Jeter, M.D. - $109,534 Bryce Young - $51,226 George Harms - $47,001 Shae Veach - $34,067 Part I, Line 6 A portion of the Administrator's incentive compensation is determined by net earnings exceeding budget for the fiscal year. A portion of incentive compensation for officers and key employees of Hays Medical Center, Inc., a related organization, is determined by net earnings exceeding budget for the fiscal year. Form 990, Part VI, Section A, line 6 The organization has one member, HaysMed Partners, Inc., which became the sole member as of March 1, 2010. HaysMed Partners, Inc., is a wholly-owned subsidiary of Hays Medical Center, Inc. Form 990, Part VI, Section A, line 7a The Board members of HaysMed Partners, Inc., the sole member of Pawnee Valley Community Hospital, appoint the Board members of Pawnee Valley Community Hospital, Inc. Form 990, Part VI, Section A, line 7b HaysMed Partners, Inc., the sole member of Pawnee Valley Community Hospital, elects the Board members of Pawnee Valley Community Hospital. Form 990, Part VI, Section B, line 11b Form 990 was reviewed with the Board members prior to filing. Form 990, Part VI, Section B, line 12c Officers, directors & key employees, along with all associates, are required to complete a conflict of interest statement annually. The statements are used to monitor and enforce compliance with the policy. Form 990, Part VI, Section B, line 15 The hospital administrator and officers' salaries are reviewed annually by an independent consulting group and the Board members. Form 990, Part VI, Section C, line 19 These documents are not made available to the public. Form 990, Part XI, line 9: Change in beneficial interest in net assets of foundation 130,009. Transfers to Pawnee County 28,716. Form 990. Part XII, Line 2c Hays Medical Center, Inc., has an audit committee that is responsible for the oversight of Pawnee Valley Community Hospital, Inc's., financial statement audit and the selection process of an independent accountant. HaysMed Partners Inc (HMed) 2220 Canterbury Dr Hays KS 67601 270877152 Owns management contract for Pawnee Valley Community Hospital KS 501(c)(3) Line 3 0 Hays Medical Center Inc 2220 Canterbury Dr Hays KS 67601 480559088 Hospital KS 501(c)(3) Line 3 0 Pawnee Valley Community Hospital Foundation 923 Carroll Ave Larned KS 67550 455333776 Support the activities and mission of the Hospital KS 501(c)(3) Line 12a 0 University of Kansas Hospital Authority 3901 Rainbow Boulevard Kansas City KS 66160 481202402 Hospital KS 0 St Rose Health Center 2220 Canterbury Dr Hays KS 67601 472117443 Outpatient health center KS 501(c)(3) Line 3 0 0 0 1 0 1 0 0 0 0 0 1 1 1 0 1 1 1 0 0