2017-02-15T16:37:38-06:00 2016-03-31 BKD LLP 1551 N WATERFRONT PKWY STE 300 WICHITA KS 672066601 990 2015-04-01 481226830 GREAT PLAINS OF SMITH CO INC % MIKE HAND GREA 3166851523 250 NORTH ROCK ROAD STE 160 WICHITA KS 67206 DAVE DELLASEGA CEO 3166851523 2017-02-15 true STEVEN L WEBB P00235405 3162652811 2017-02-15 2015 2021-01-29 14:40:06Z SMITH COUNTY HOSPITAL MIKE HAND 250 NORTH ROCK ROAD STE 160 WICHITA KS 67206 14328773 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 7 184 9 0 494094 333298 11291658 13872408 48402 35493 76964 83418 11911118 14324617 0 0 0 0 6675272 7659519 108000 89000 89000 5387032 7003530 12170304 14752049 -259186 -427432 6856013 6750511 2433335 2752997 4422678 3997514 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 12786759 0 13872408 SMITH COUNTY MEMORIAL HOSPITAL'S PURPOSE IS THE DELIVERY OF PRIMARY HEALTHCARE SERVICES TO A SERVICE AREA THAT INCLUDES 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, A CRITICAL ACCESS HOSPITAL INCLUDING INPATIENT, OUTPATIENT, AND SKILLED NURSING SERVICES, AS WELL AS LONG TERM CARE SERVICES. 12786759 true true false true false false false false false true true false false false true false true true false false false false false true false false true true false false true false false false false false false false false false false false false false true true false false false true 50 0 true 184 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 MIKE HAND 3166851523 250 NORTH ROCK ROAD STE 160 WICHITA KS 67206 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 192576 27382 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 0.25 2.25 X 0 0 0 DR BARBARA BROWN APPLEGATE DIRECTOR 0.25 2.25 X 0 0 0 TERRY DESCHAINE DIRECTOR 0.25 2.25 X 0 0 0 MIKE HAND CFO 2.25 40.0 X 0 146913 32175 ALLEN VANDRIEL ADMINISTRATOR 40.0 0.0 X 119402 0 28822 JUSTIN OVERMILLER DR PHYSICIAN 40.0 0.0 X 303016 0 40874 FERRILL CONANT DR PHYSICIAN 40.0 0.0 X 300786 0 41603 TAMARA WINDSCHEFFEL ARNP 40.0 0.0 X 162114 0 33735 STACEY DIMITT PHYSICIAN 40.0 0.0 X 266795 0 26130 HANNAH HAACK PHYSICIAN 40.0 0.0 X 270033 0 27014 1422146 339489 257735 8 false true false MHS DATA CENTER 103 E 27TH SUITE A HAYS KS 67601 COMPUTER SERVICE 285896 GPHA PO BOX 366 PHILLIPSBURG KS 67661 MANAGEMENT SERVICES 132745 GPHA - CBO 250 N ROCK ROAD WICHITA KS 67206 CENTRALIZED BILLING 139770 QUEST DIAGNOSTICS PO BOX 719 HAYS KS 67601 REFERENCE LAB 124216 4 238003 95295 333298 NET PATIENT SERVICE REVENUE 621300 11692906 11692906 340B PRESCRIPTION DRUG REVENUE 621300 2179502 2179502 13872408 39649 39649 0 0 0 0 0 4156 -4156 -4156 -4156 0 0 0 EMPLOYEE/GUEST MEALS 722513 41796 41796 WELLNESS CENTER 713940 20323 20323 VENDOR REBATES 900099 4901 4901 16398 16398 83418 14324617 13872408 118911 0 0 0 0 189465 189465 0 5725896 5259256 466640 390210 356278 33932 972006 682245 289761 381942 336156 45786 115969 638 115331 0 76905 1040 75865 0 89000 89000 0 2086588 1791206 295382 0 5352 3234 2118 400511 349386 51125 4927 3970 957 0 184222 137456 46766 4103 3871 232 0 63185 41170 22015 7674 5484 2190 0 384902 275042 109860 87448 62488 24960 MEDICAL SUPPLIES 2673877 2673877 PROVISION FOR BAD DEBTS 489853 489853 EQUIPMENT RENTAL/MAINTENANCE 303209 268535 34674 DUES & SUBSCRIPTIONS 39731 16606 23125 75074 28968 46106 14752049 12786759 1876290 89000 201111 204169 1420300 1579873 0 0 1473789 1740206 0 0 0 0 0 0 143330 166182 592844 259977 9474814 6674710 3024639 2800104 0 0 0 0 0 0 0 0 0 0 6856013 6750511 2289170 2137934 0 0 0 0 0 0 0 0 0 0 74165 32493 0 0 70000 582570 2433335 2752997 X 3518645 3066082 28272 53403 875761 878029 4422678 3997514 6856013 6750511 -427432 2268 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false true 3399 false false false 3399 false SCHEDULE C, PART II-B, LINE 1F A PORTION OF THE ANNUAL DUES PAID TO KHA AND AHA ARE USED FOR LOBBYING. 904033 45770 14884 33253 931434 835575 9959 75163 16664 904033 790370 7624 75716 38135 835575 811365 12500 -11597 21898 790370 754849 2897 63746 10127 811365 0.94270 0.05730 true false 3750 3750 3861089 2334428 1526661 5371040 4240508 1130532 238935 99774 139161 2800104 0 Due to Third Party 582570 582570 13837032 2268 -489853 -487585 14324617 14324617 14262196 14262196 489853 489853 14752049 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 (489,853) SCHEDULE D, PART XII, LINE 4B PROVISION FOR UNCOLLECTIBLE ACCOUNTS 489,853 X X X true SOLUTIONS 4 FUNDRAISING CAPITAL CAMPAIGN false 711347 84000 627347 HARVEY FUNDRAISING CAPITAL CAMPAIGN false 42342 5000 37342 753689 89000 664689 KS true true X false true X true true false true true 144745 416 144329 0.01010 394102 161402 232701 0.01630 538847 161818 377030 0.02640 74777 74777 0.00520 74777 74777 0.00520 613624 161818 451807 0.03160 false 489853 4423573 4423573 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 false true false true X 0. 300. X X X X true true 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 true X false X X X X true X 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 THE TOWN HALL ATTENDEES NOTES & FEEDBACK LOCATED IN THE DETAIL EXHIBITS OF THE CHNA. SCHEDULE H, PART V, LINE 7A http://www.smithcohosp.org/docs/SmithCo_CHNA.pdf SCHEDULE H, PART V, LINE 7D ALSO SHARED THE RESULTS AT A TOWN HALL MEETING. 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 13H THE ORGANIZATION EMPLOYS A SLIDING SCALE DISCOUNT THAT TAKES INTO CONSIDERATION A PATIENT'S HOUSEHOLD INCOME AND QUALIFYING ASSETS. TO BE ELIGIBLE FOR FINANCIAL ASSISTANCE, A PATIENT'S HOUSEHOLD INCOME MUST BE BELOW 300% OF THE MOST RECENT FEDERAL POVERTY LEVEL AT THE DATE OF SERVICE. TO DETERMINE THE AMOUNT OF THE DISCOUNT, AN ASSET TEST IS ALSO UTILIZED. SCHEDULE H, PART V, LINE 16A http://www.smithcohosp.org/docs/Financial%20Assistance/FC_12_Financial_Ass istance_Policy%20FINAL.pdf SCHEDULE H, PART V, LINE 16B http://www.smithcohosp.org/docs/Financial%20Assistance/Financial%20Assista nce%20Application.pdf SCHEDULE H, PART V, LINE 16C http://www.smithcohosp.org/docs/Financial%20Assistance/Plain%20Language%20 Financial%20Assistance%20Summary.pdf 1 SMITH COUNTY FAMILY PRACTICE 119 E PARLIAMENT STREET SMITH CENTER KS 66967 FAMILY PRACTICE SCHEDULE H, PART I, LINE 3C THE ORGANIZATION EMPLOYS A SLIDING SCALE DISCOUNT THAT TAKES INTO CONSIDERATION A PATIENT'S HOUSEHOLD INCOME AND QUALIFYING ASSETS. TO BE ELIGIBLE FOR FINANCIAL ASSISTANCE, A PATIENT'S HOUSEHOLD INCOME MUST BE BELOW 300% OF THE MOST RECENT FEDERAL POVERTY LEVEL AT THE DATE OF SERVICE. TO DETERMINE THE AMOUNT OF THE DISCOUNT, AN ASSET TEST IS ALSO UTILIZED. 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 $489,853. 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 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 CARITY 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 VI, LINE 2 GREAT PLAINS OF SMITH COUNTY, INC. USES SEVERAL MECHANISMS TO ASSESS THE NEEDS OF THE COMMUNITIES FOR HEALTHCARE. FIRST IS THE FORMAL COMMUNITY HEALTH NEEDS ASSESSMENT PROCESS. ROUND 2 OF A COMMUNITY HEALTH NEEDS ASSESSMENT WAS COMPLETED DURING THE FISCAL YEAR. THE FINAL REPORT, AVAILABLE ON OUR WEBSITE, WAS ISSUED IN JUNE 2015. SECOND, WE UTILIZE A STEERING COMMITTEE ORGANIZED IN CONJUNCTION WITH OUR ONGOING CAPITAL CAMPAIGN TO PROVIDE INPUT FROM THE GREATER COMMUNITY REGARDING NEEDS OF THE COMMUNITY. THIS CAPITAL CAMPAIGN WAS INITIATED IN AUGUST 2014, AND THE STEERING COMMITTEE WAS ORGANIZED AT THAT TIME. BECAUSE THE PRIMARY PRIORITY IDENTIFIED DURING THE PREVIOUS CHNA (COMPLETED IN 2012) WAS UPDATING OF FACILITIES, THIS STEERING COMMITTEE HAS PROVEN VERY BENEFICIAL. OTHER METHODS OF COMMUNICATION WITH THE PUBLIC INCLUDE PUBLISHING AND DISTRIBUTION OF A MONTHLY NEWSLETTER (THE SMITH), WHICH CONTAINS A VARIETY OF INFORMATION ON TOPICS RELATED TO THE HEALTH SYSTEM, HEALTH INSURANCE, AND LIFESTYLE. WE ALSO MAINTAIN A PUBLIC WEBSITE, CURRENTLY UNDER REVISION AND UPDATE, WHICH PROVIDES INFORMATION INCLUDING CONTACT INFORMATION, SPECIALTY PROVIDER CLINIC SCHEDULES, ETC. WE ALSO USE SOCIAL MEDIA, INCLUDING A FACEBOOK PAGE TO DISSEMINATE INFORMATION AND EVENTS. DURING THE PAST TWO YEARS, TWO INITIATIVES WERE UNDERTAKEN WHICH INVOLVED A GREAT DEAL OF FACE TO FACE CONTACT WITH THE COMMUNITY. IN NOVEMBER 2014, A QUESTION WAS PLACED ON THE ELECTION BALLOT REQUESTING SUPPORT FOR AN INCREASE IN SALES TAX FOR HOSPITAL OPERATIONS. IN PREPARATION FOR THIS ELECTION, TOWN HALL MEETINGS WERE HOSTED IN EACH COMMUNITY IN THE COUNTY TO EXPLAIN HOSPITAL OPERATIONS, FUNDING, AND TAX SUPPORT. THE TOWN HALL MEETINGS WERE WELL ATTENDED, AND RESULTED IN AN OVERWHELMINGLY FAVORABLE VOTE (MORE THAN 70% IN FAVOR). SPURRED IN PART BY THE RESULTS OF THE 2012 COMMUNITY HEALTH NEEDS ASSESSMENT (AND REITERATED IN THE 2015 ROUND 2 CHNA), THE BOARD OF TRUSTEES MOVED FORWARD WITH PLANS TO IMPROVE HOSPITAL FACILITIES. A FACILITY MASTER PLAN EXPLORED AND COMPARED RENOVATION WITH CONSTRUCTION OF A REPLACEMENT FACILITY. THE BOARD DETERMINED THAT CONSTRUCTION OF A REPLACEMENT FACILITY IS THE MORE COST EFFECTIVE ALTERNATIVE. AS FINANCING OPTIONS FOR THE PROJECT WERE EXPLORED, IT BECAME OBVIOUS THAT THE BEST FINANCING ALTERNATIVE WAS THE USE OF REVENUE BONDS ISSUED BY AN ALREADY-EXISTING PUBLIC BUILDING COMMISSION, COUPLED WITH A LONG TERM LOAN FROM THE US DEPARTMENT OF AGRICULTURE RURAL DEVELOPMENT PROGRAM. THE USE OF PBC BOND FUNDING FOR CONSTRUCTION FINANCING DOES NOT INCLUDE A PROVISION FOR A PUBLIC VOTE ON THE ISSUE. HOWEVER, THE BOARD OF TRUSTEES AND THE PBC BOARD DESIRED TO GAIN INPUT FROM THE PUBLIC REGARDING SUPPORT FOR THE PROPOSED PROJECT. A SERIES OF MORE THAN 10 TOWN HALL MEETINGS, SOME OF THEM BROADCAST ON THE LOCAL ACCESS CABLE TELEVISION CHANNEL, WERE HOSTED TO EXPLAIN THE PROJECT AND FINANCING. FOLLOWING THE PUBLIC EDUCATION CAMPAIGN, A MAIL BALLOT WAS DISTRIBUTED TO ALL VOTERS IN THE COUNTY. THE RETURN RATE FOR THE BALLOTS (MORE THAN 50%) WAS HIGHER THAN ELECTION OFFICIALS PREDICTED. MORE THAN 80% OF THE VOTERS WHO RETURNED BALLOTS 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 THE APPLICATION FOR FINANCIAL ASSISTANCE. OUR FINANCIAL ASSISTANCE POLICY IS POSTED ON OUR PUBLIC WEBSITE AND INCLUDES 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 3,802 IN 2014. 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 IS 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, SMITH COUNTY LONG TERM CARE, 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 FREE SPORTS PHYSICALS ANNUALLY TO STUDENTS AT TWO SCHOOL DISTRICTS IN THE COUNTY. THE PHYSICALS ARE PROVIDED 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. IN CONJUNCTION WITH THE SMITH COUNTY EXTENSION AGENCY, SMITH COUNTY MEMORIAL HOSPITAL SPONSORS AND PROMOTES AN EXERCISE ENCOURAGEMENT PROGRAM CALLED WALK KANSAS. IN SEPTEMBER EACH YEAR, THE HOSPITAL SPONSORS A FUN RUN/WALK IN THE COMMUNITY TO ENCOURAGE WELLNESS AMONG RESIDENTS AND VISITORS IN TOWN FOR THE ANNUAL OLD SETTLERS DAY CELEBRATION. THE HOSPITAL ALSO SPONSORS A HEALTH FAIR EACH FALL IN CONJUNCTION WITH THE SMITH COUNTY EXTENSION AGENCY, OFFERING EDUCATION ON A VARIETY OF HEALTH RELATED TOPICS. GARDNER WELLNESS CENTER, OPERATED AS A PART OF SMITH COUNTY MEMORIAL HOSPITAL, PROVIDES MONITORED EXERCISE TO MEMBERS OF THE COMMUNITY. 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. 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, OUTPATIENT, AND LONG TERM CARE 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 BEHAVIORAL HEALTH AGENCY TO PROVIDE COUNSELING SERVICES 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 189809 0 0 0 2767 0 18668 0 8714 0 219958 0 0 MIKE HAND CFO 0 144759 0 0 0 2154 0 14174 0 18001 0 179088 0 0 JUSTIN OVERMILLER DR PHYSICIAN 300847 0 0 0 2169 0 25700 0 15174 0 343890 0 0 0 FERRILL CONANT DR PHYSICIAN 298560 0 0 0 2226 0 25700 0 15903 0 342389 0 0 0 TAMARA WINDSCHEFFEL ARNP 160814 0 0 0 1300 0 15698 0 18037 0 195849 0 0 0 STACEY DIMITT PHYSICIAN 264956 0 0 0 1839 0 5406 0 20724 0 292925 0 0 0 HANNAH HAACK PHYSICIAN 268193 0 0 0 1840 0 4099 0 22915 0 297047 0 0 0 FORM 990, PART VII; SCHEDULE J, PART I, LINE 3 COMPENSATION FOR MIKE HAND AND DAVE DELLASEGA IS PROVIDED BY GREAT PLAINS HEALTH ALLIANCE, A RELATED ORGANIZATION. GREAT PLAINS HEALTH ALLIANCE'S BOARD OF DIRECTORS ANNUALLY APPROVE THE COMPENSATION FOR MR. HAND AND MR. DELLASEGA. 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 VI, SECTION A, LINE 2 DAVE DELLASEGA AND MIKE HAND 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 FINANCIAL 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 THEMESELVES 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 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, 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:1353807 FORM 990 PART IX LINE 11G DESCRIPTION:BILLING/COLLECTIONS TOTAL FEES:198765 FORM 990 PART IX LINE 11G DESCRIPTION:LAB SERVICES TOTAL FEES:214058 FORM 990 PART IX LINE 11G DESCRIPTION:PHARMACY SERVICES TOTAL FEES:133594 FORM 990 PART IX LINE 11G DESCRIPTION:ADMINISTRATION/HUMAN RESOURCES TOTAL FEES:92990 FORM 990 PART IX LINE 11G DESCRIPTION:MAINTENANCE/HOUSEKEEPING TOTAL FEES:62318 FORM 990 PART IX LINE 11G DESCRIPTION:PLANT OPERATIONS TOTAL FEES:12707 FORM 990 PART IX LINE 11G DESCRIPTION:DIETARY SERVICES TOTAL FEES:18349 GREAT PLAINS HEALTH ALLIANCE INC 250 NORTH 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) 9 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 PHILLIPS COUNTY INC 250 NORTH ROCK ROAD STE 160 WICHITA KS 67206 481226829 HOSPITAL KS 501 (C) (3) 3 GPHA INC true GREAT PLAINS OF SABETHA 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 false false false false false false false false false false true false true false false false false false false