2017-05-11T14:29:22-05:00 2016-06-30 481026809 Wendling Noe Nelson & Johnson LLC 534 S Kansas Ave Suite 1500 Topeka KS 666033491 990 2015-07-01 481253246 Pawnee Valley Community Hospital Inc PAWN 6202853161 923 Carroll Ave Larned KS 67550 George Harms Secretary/Treasurer 7856235000 2017-05-10 1 Heather R Eichem P01515553 7852334226 2017-05-10 2015 2021-01-29 14:40:06Z George Harms 923 Carroll Ave Larned KS 67550 18469944 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 2 158 99 0 0 907604 340563 17240485 17935656 4292 7026 169424 186699 18321805 18469944 901744 283287 0 0 7917015 8235368 0 0 0 6688940 6808332 15507699 15326987 2814106 3142957 7788872 9241754 6709764 8018579 1079108 1223175 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 11439829 283287 17958979 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. 11439829 1 1 0 1 0 0 0 0 0 1 0 0 0 1 1 1 1 1 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 1 0 0 1 158 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 36.00 X X 0 347293 98146 Shae Veach Vice President 4.00 36.00 X X 0 230678 72677 George Harms Secretary/Treasurer 4.00 36.00 X X 0 319973 89947 John Jeter MD Director 4.00 36.00 X 0 784745 156635 Larry Watts Director 4.00 36.00 X 0 303068 57360 David Sanger MD Director/Physician 40.00 X 234407 0 42722 John Settle Director 4.00 X 0 0 0 John Haas Director 4.00 X 0 0 0 John Hughes Administrator 40.00 X 0 129998 21301 Amanda Bickle APRN 40.00 X 162681 0 29345 Debbie Tomlinson APRN 40.00 X 167431 0 12744 Cristine Goodwin Physician 30.00 X 150135 0 29681 Christian Whittington Physician 40.00 X 251504 0 44075 Dusty Atterbury Physician Assistant 40.00 X 119267 0 33312 1085425 2115755 687945 9 0 1 0 Hays Medical Center 2220 Canterbury Drive Hays KS 67601 Contract Services 2957606 Quest Diagnostics PO Box 14730 St Louis MO 63150 Lab Services 192267 Anesthesiologist Associates of Hays PO Box 821 Hays KS 67601 Anethesia Services 154824 Docs Who Care 1337 S Foundatin Drive Olathe KS 66061 Emergency Room Physician Services 108554 4 283287 57276 86726 340563 Net patient service revenue 622000 17214947 17214947 340b drug program 900099 535237 535237 Outreach therapy services 900099 79657 79657 EHR incentive payments 900099 75517 75517 Lab fairs 900099 30298 30298 17935656 7026 7026 2100 0 2100 2100 2100 Meals sold to employees and guest 722210 163376 163376 Other miscellaneous revenue 900099 21223 21223 184599 18469944 17958979 0 170402 283287 283287 425375 260720 164655 6260737 5678856 581881 272400 247413 24987 822896 754627 68269 453960 404968 48992 2297752 2297752 16509 16509 44186 44186 1488550 1242402 246148 68343 3067 65276 58538 28198 30340 88947 53376 35571 360181 300427 59754 15930 11148 4782 6072 6072 91277 54766 36511 Pharmaceuticals 879744 879744 Medical supplies 407657 407657 Service contracts 243820 231297 12523 Dietary 169894 169894 570932 421910 149022 15326987 11439829 3887158 0 432300 518161 2592523 4775255 1745586 1720178 280864 260760 136365 160630 2601234 1806770 7788872 9241754 1054368 1024291 5655396 6994288 6709764 8018579 X 1079108 217338 1005837 1079108 1223175 7788872 9241754 X 3142957 -2998890 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 1 3030 0 0 0 3030 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. 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 426000 Other receivables 157595 Beneficial interest in net assets of foundation 1223175 1806770 Due to Pawnee County 6702379 Due to Hays Medical Center, Inc. 211909 Estimated third-party payor settlements 80000 6994288 X 18614010 144066 144066 18469944 0 18469944 15043700 0 15043700 283287 283287 15326987 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 X, Line 2: Management is not aware of any uncertainties in income tax positions. Part XI, Line 2d - Other Adjustments: Change in beneficial interest in net assets of Foundation 144,066. Part XII, Line 4b - Other Adjustments: Transfer of equipment to Pawnee County 283,287. 1 1 1 X 130.000000000000 1 X 1 1 0 0 168964 168964 0.01100 948092 334539 613553 0.04000 1117056 334539 782517 0.05100 2821509 1742924 1078585 0.07040 5420 5420 0.00040 2826929 1742924 1084005 0.07080 3943985 2077463 1866522 0.12180 1 606288 42440 8536326 8728901 -192575 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://http://www.pawneevalleyhospital.com/ X http://http://www.pawneevalleyhospital.com/ X http://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:Build and/or develop Exercise Facilities was #1 on the health needs Priorities- with 37 votes, 22.8%. Pawnee Valley Community Hospital supported USD #495 in 2015 to pass a bond for a new elementary school and renovations to the high school. Because of the CHNA and the school districts involvement and listening to the needs of Pawnee County, they have incorporated an exercise facility, in the renovations to the high school, which will be open to the public. The wellness center is expected to be open to the public August 2017.PVCH once again had their annual fun run in June 2016. The money raised was used to help purchase equipment for high school athletes. The 2017 fun run will be geared towards younger children. The plan is to have an obstacle course along with a walk and run. The proceeds from the event will go towards purchasing gym/PE equipment for the new elementary school. LA Psycle, opened its doors in 2015 for the community to sign up for spin classes. This program continues to grow. Pride Committee added a second walking trail to the community in 2015. This walking trail goes around Camp Pawnee. PVCH staff has done community presentations for heart disease awareness. In February 2016 at half time of a local basketball game, hospital staff with the help of Larned high school students did a "Flash Mob" to promote CPR. Expand Oncology Treatment was #2 on the health needs priorities - with 25 votes, 15.4%. In order to implement an effective oncology service line, many factors must come together. 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. We have had the great fortune of being able to partner with the Dreiling/Schmidt Cancer Institute at HaysMed. It is vitally important to maintain the relationship with both primary care medical staff as well as specialists. This will ensure consistent continuity for our patients as they move through the continuum of their cancer treatment course. 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.Improve Quality Air Flow was #3 on health needs priorities - with 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.Reducing Drug/Alcohol Abuse was #4 on health needs priorities - with 20 votes, 12.3%. The Pawnee County Health Department and Pawnee Valley Community Hospital continue 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 Hospital2. Law Enforcement3. EMS4. Pawnee Valley Community Hospital5. The Center for Counseling6. Pawnee County Ministerial Alliance7. Community Corrections8. Family Crisis Center9. County Attorney10. Public Health11. 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. Provide Healthy Food Options was #5 on health needs priorities - with 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. In 2016 a healthy snack and drink vending machine was added to the ER waiting room. Candy bars and sweet snacks have been eliminated from the grab and go section of the cafeteria. We continue to offer diabetic education classes and have increased the class to a two day session. 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 provides educational booths on healthy food at the Pawnee County fair each summer. We provide clients with appropriate educational materials on healthy eating and refer to food and nutrition education programs such as WIC. We also refer to the local food bank and participate in the Bob Box program through the Kansas Food Bank and refer children and families to the summer lunch program and the backpack buddies program. Schools are doing a good job with providing healthy food options at concession stands as well as local convenience stores readily have healthy foods in accessible locations in the stores to encourage fresh fruits and healthy foods.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. Increase Access to Home Health/Hospice was #6 on health needs priorities with 11 votes, 6.8%. Continuing to look at the feasibility and what we can do to increase access to home health/hospice. We will continue to promote existing agencies and educate patients of services available. PVCH has partnered with the Kansas Heart and Stroke Collaborative and 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. In August 2016 a contract from Gentiva Hospice was reviewed by the Utilization Review Committee. It was determined that it is not financially feasible at this time but will be re-evaluated in the future.Offer Nursing Home - Dementia Services was #7 on health needs priorities with 11 votes, 6.8%. Country Living Assisted Living facility in Pawnee County recently opened an addition to their memory care unit adding 4 additional beds for a total of 12 beds dedicated to dementia patients. We will continue to work on identifying nursing home dementia services in Pawnee County and educate entities and individuals who may be in need of these services. 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. Pawnee Valley Community Hospital, Inc. Part V, Section B, Line 22d: The hospital used the look-back method based on actual paid claims by Medicare and all other private health insurers paying claims to the hospital. 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 $1,949,466 of expenses attributable to physician clinics that have net operating losses. Part III, Line 4: The footnote from the hospital's financial statements follows:Accounts receivable are reduced by an allowance for uncollectible accounts. In evaluating the collectability of accounts receivable, the Hospital analyzes its past history and identifies trends for each of its major payor sources of revenue to estimate the appropriate allowance for uncollectible accounts and provision for bad debts. Management regularly reviews data about these major payor sources of revenue in evaluating the sufficiency of the allowance for uncollectible accounts. For receivables associated with services provided to patients who have third-party coverage, the Hospital analyzes contractually due amounts and provides an allowance for uncollectible accounts and a provision for bad debts, if necessary (for example, for expected uncollectible deductibles and copayments on accounts for which the third-party payor has not yet paid, or for payors who are known to be having financial difficulties that make the realization of amounts due unlikely). For receivables associated with self-pay patients (which includes both patients without insurance and patients with deductible and copayment balances due for which third-party coverage exists for part of the bill), the Hospital records a significant provision for bad debts in the period of service on the basis of its past experience, which indicates that many patients are unable or unwilling to pay the portion of their bill for which they are financially responsible. The difference between the standard rates (or the discounted rates if negotiated) and the amounts actually collected after all reasonable collection efforts have been exhausted is charged off against the allowance for uncollectible accounts.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 3:Methodology for bad debt cost for financial assistance eligible: The estimate for the amount of bad debt expense attributable to patients eligible under the FAP is based upon the experience of a related organization. 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, 2016. 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 not a part of an affiliated health care system. 0 Pawnee County 715 Broadway Larned KS 67550 486007542 283287 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. 1 0 1 0 0 0 1 1 0 0 Bryce Young President 0 273065 0 74228 0 0 0 68431 0 29715 0 445439 0 0 Shae Veach Vice President 0 189274 0 37943 0 3461 0 45732 0 26945 0 303355 0 0 George Harms Secretary/Treasurer 0 252293 0 67680 0 0 0 63797 0 26150 0 409920 0 0 John Jeter MD Director 0 554238 0 208446 0 22061 0 130202 0 26433 0 941380 0 0 Larry Watts Director 0 215637 0 87431 0 0 0 42730 0 14630 0 360428 0 0 David Sanger MD Director/Physician 216074 0 0 0 18333 0 14185 0 28537 0 277129 0 0 0 John Hughes Administrator 0 121346 0 8652 0 0 0 2628 0 18673 0 151299 0 0 Amanda Bickle APRN 123234 0 167 0 39280 0 3926 0 25419 0 192026 0 0 0 Debbie Tomlinson APRN 145839 0 251 0 21341 0 10133 0 2611 0 180175 0 0 0 Cristine Goodwin Physician 148148 0 0 0 1987 0 1479 0 28202 0 179816 0 0 0 Christian Whittington Physician 205235 0 0 0 46269 0 15192 0 28883 0 295579 0 0 0 Dusty Atterbury Physician Assistant 89767 0 167 0 29333 0 7564 0 25748 0 152579 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. - $114,302 Bryce Young - $52,531 George Harms - $47,897 Shae Veach - $33,292 Larry Watts - $26,830 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. X Healing garden 1 86726 Cash paid 0 0 0 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 11 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: Increase in amount due to Pawnee County -1,355,277. Transfers to Pawnee County -1,787,679. Change in beneficial interest in net assets of foundation 144,066. 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 2220 Canterbury Dr Hays KS 67601 270877152 Owns management contract for Pawnee Valley Community Hospital KS 501(c)(3) 170(b)(1)(A)(iii) 0 Hays Medical Center Inc 2220 Canterbury Dr Hays KS 67601 480559088 Hospital KS 501(c)(3) 170(b)(1)(A)(iii) 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) 509(A)(3), Type I 0 0 0 1 0 1 0 0 0 0 0 1 1 1 0 1 1 1 0 0