2017-07-18T07:15:19-05:00 2016-09-30 450250958 Eide Bailly LLP 800 Nicollet Mall Ste 1300 Minneapolis MN 554027033 990 2015-10-01 480545183 Lindsborg Community Hospital Association LIND 7852273308 605 West Lincoln Lindsborg KS 674562328 Larry Van Der Wege Administrator 7852273308 2017-07-13 1 Kim Hunwardsen CPA P00484560 6122536500 2017-07-13 2015 2021-01-29 14:40:06Z Larry Van Der Wege 605 West Lincoln Lindsborg KS 674562328 8821203 0 X www.lindsborghospital.org X 1944 KS Operation of critical access hospital. 9 9 0 39 0 0 206470 90362 9413661 8712242 -5584 -38430 140622 12000 9755169 8776174 1633 0 0 0 5512184 5940221 0 0 2581 3181790 4982136 8695607 10922357 1059562 -2146183 5971923 5451209 1754086 2036600 4217837 3414609 X Partners caring for the health of the Smoky Valley communities. 0 0 9953317 8712242 Lindsborg Community Hospital (LCH) operates a critical access hospital in a community qualifying for such designation under federal law. The facilities are adequate for treatment or care of individuals suffering from mental or physical illness, disease, injury or deformity in an acute care, skilled nursing care, outpatient or emergency room setting. LCH cares for residents of the Smoky Valley with the operation of a 24/7 emergency room; 1,850 patients were seen in the 2016 fiscal year. 620 urgent care visits, 621 privately paid home health visits were made, and 314 cardiac rehab visits improved the health of community members. 4,250 meals on wheels were supplied to community members. Education was provided to Marquette and Lindsborg residents on breast cancer, colon cancer, smoking cessation, and the effects of sun exposure. Employees of the LCH partner with various community groups to provide assistance to the Midsummer's Committee, Hyllningsfest Committee, Chamber of Commerce, and Leadership Lindsborg to name a few. Staff also provide leadership with the Sunflower Health Network, KHA council, and the Sunflower (Kansas) HFMA Chapter. 9953317 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0 1 X 0 0 1 0 0 0 0 0 0 0 0 0 0 0 X 9 9 0 1 0 0 1 1 1 1 0 0 0 1 1 1 1 1 1 1 0 0 X Laraine Gengler 7852273308 605 West Lincoln Lindsborg KS 674562328 X Chuck Oleen President 1.00 X X 0 0 0 Robyn Johnson Vice President 1.00 X X 0 0 0 Judy Neuschafer Secretary 1.00 X X 0 0 0 Tom Buffington Treasurer 1.00 X X 0 0 0 Denise Peterson Director 1.00 X 0 0 0 Ryan Biegert Director 1.00 X 0 0 0 Dr Ben Dolezal Director 1.00 X 0 0 0 Mike Rose Director 1.00 X 0 0 0 Mary Ann Carlson Director 1.00 X 0 0 0 Larry Van Der Wege Administrator 40.00 X 0 0 0 Laraine Gengler CFO 40.00 X 0 0 0 0 0 0 0 0 0 0 Salina Regional Health Center 400 S Santa Fe Salina KS 67401 Payment for payroll and other reimbursem 10575000 Rehabvisions 11623 Arbor St Omaha NE 68144 PT, OT and ST services 432254 2 90362 90362 Net patient revenue 621400 8047773 8047773 Sales Tax Revenue 900099 307218 307218 EHR Payments 900099 103163 103163 Cafeteria 900099 5275 5275 248813 248813 8712242 6599 6599 12000 0 12000 12000 12000 45029 -45029 -45029 -45029 8776174 8712242 0 -26430 X 220838 220838 4687580 4439142 248438 138311 128703 9608 589329 554013 35316 304163 270843 33320 56024 56024 8355 8355 25441 25441 1903067 1903067 28782 28782 368777 295925 72852 193051 81965 111086 71687 71687 18106 11164 6942 16806 12594 4212 759 759 583111 478743 104368 37566 14984 22582 Medical and Patient Sup 867795 867718 77 Bad Debts 209759 209759 Food Costs 68052 66101 1951 Dues, Licenses and Taxe 37269 24338 12931 487729 457433 27715 2581 10922357 9953317 966459 2581 114656 1120932 520358 1993940 1679280 179819 179694 73557 83287 5994080 4136831 2003704 1857249 329042 1131290 156273 51 5971923 5451209 323867 304369 353839 230000 1076380 1502231 1754086 2036600 X 3774059 3154055 443778 260554 4217837 3414609 5971923 5451209 X -2146183 1342955 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 2576 2576 0 Part II-B, Line 1: The portion of annual dues paid to hospital and medical associations attributed to lobbying activities by the associations. 10442 10442 2626795 1598873 1027922 3099587 2286015 813572 257256 251943 5313 1857249 Estimated third party payor settlements 826739 Due to related parties 675492 1502231 X 9886965 1342284 1342284 8544681 231493 231493 8776174 10690192 0 10690192 232165 232165 10922357 Part X, Line 2: Lindsborg Community Hospital Association is organized as a Kansas not-for-profit corporation and has been recognized by the Internal Revenue Service (IRS) as exempt from federal income taxes under Internal Revenue Code Section 501(c)(3). Lindsborg Community Hosptial Association is annually required to file a Return of Organization Exempt from Income Tax (Form 990) with the IRS. In addition, the organization is subject to income tax on net income that is derived from business activites that are unrelated to its exempt purpose. In this case, the organization would file an Exempt Organization Business Income Tax Return (990T) with the IRS to report unrelated business taxable income. Lindsborg Community Hospital Assoication believes that it has appropriate support for any tax positions taken affecting its annual filing requirements, and as such, does not have any uncertain tax positions that are material to the financial statements. The organization would recognize future accrued interest and penalties related to unrecognized tax benefits and liabilities in income tax expense if such interest and penalities are incurred. Part XI, Line 2d - Other Adjustments: Intercompany transfer 1,342,284. Part XI, Line 4b - Other Adjustments: Bad Debts 209,759. Reclassification of revenue/expense accounts, net 19,824. Auxiliary revenue 1,910. Part XII, Line 4b - Other Adjustments: Bad Debts 209,759. Reclassification of revenue/expense accounts, net 19,824. Auxiliary expense 2,582. 1 1 X 1 X 1 X 1 1 0 0 26237 26237 0.00240 299316 126899 172417 0.01580 325553 126899 198654 0.01820 556 906 906 0.00010 6 33115 27329 5786 0.00050 3134562 817685 2316877 0.21210 2247 2247 0.00020 562 3170830 845014 2325816 0.21290 562 3496383 971913 2524470 0.23110 2560 2560 0.00020 2560 2560 0.00020 0 209759 9229 4620527 4653444 -32917 X 1 1 1 1 Lindsborg Community Hospital Association 605 W Lincoln St Lindsborg KS 67456 www.lindsborghospital.org H059001 X X X Lindsborg Community Hospital 1 0 0 1 X X X X X X X X 15 1 1 1 1 X See Part V, Page 7 X 1 15 1 See Part V, Page 7 0 0 1 X 200.000000000000 300.000000000000 X X X X X X 1 1 X X X 1 X www.lindsborghospital.org/patients/financial_assistance.html X www.lindsborghospital.org/patients/financial_assistance.html X www.lindsborghospital.org/patients/financial_assistance.html X X X X X X 1 X 0 X X X X 1 X 0 1 Lindsborg Community Hospital Part V, Section B, Line 6a: McPherson Hospital, McPherson, Kansas Mercy Hosptial, Moundridge, Kansas Lindsborg Community Hospital Part V, Section B, Line 6b: McPherson County Health Department Lindsborg Community Hospital Part V, Section B, Line 11: The Implementation Strategy being addressed is from July 2016. Health Issues - The CHNA identified a need for services that target obesity, heart disease, cancer, diabetes, substance abuse, and daily life stressors. Further development of work flows and order sets to improve performance in these areas continues. Screening questions have been added to clinic wellness exams and emergency department examinations for all age groups to identify individuals who may suffer from substance abuse. Education on many of these health issues has been performed since the inception of our implementation plan.Specific Populations with Inadequate Access to Care and Barriers to Care - The CHNA identified low income, elderly, young adults, disabled persons and children as having inadequate access to care. Identified barriers to care include the ability to pay, lack of insurance, transportation, lack of providers, and schedule limitations. LCH is working to address many of these needs through enhancement of our financial assistance policy. An automatic deduction of 30% of total charges has been adopted for those individuals without insurance. This discount is provided regardless of the completion of the financial assistance application. LCH has made an increased effort to identify and inform individuals about our Financial Assistance Policy, to encourage completion of application paperwork to provide for greater discounts. A fund has been established to pay for cancer screening services for those in our area without insurance. LCH has developed a process for school-aged children to have their activity health assessment forms completed. Provider staffing at the Family Health Care Clinic has been challenging, but needs have been met through temporary physicians and physician assistants. LCH is working with Salina Regional Health Center Emergency Department to staff the emergency department. Recruitment of physicians will continue until the open positions are filled. Perceived weaknesses in general areas - The CHNA identified the need for free fitness options, child care options, dietary education services and access to specialists. The Wellness Center is open to the public at no charge. Access to specialists will be enhanced through the affiliation between LCH and SRHC. Dietary consultations are available three days per week for inpatients and outpatients. Needs identified but not addressed - Child care options will not be addressed as it is beyond the scope and abilities of LCH. Lindsborg Community Hospital Part V, Section B, Line 13h: The methodology used to determine eligibility for financial assistance takes into consideration income, net assets, family size and resources available to pay for care. In addition, presumptive charity care may be applied in situations where all other avenues have been exhausted. Lindsborg Community Hospital Part V, Section B, Line 16i: The FAP application and plain language summary can be found at the URL listed on lines 16b and 16c by clicking on the link "Learn More - financial assistance program form." Lindsborg Community Hospital Part V, Section B, Line 22d: The facility uses the Lookback method in calculating Amounts Generally Billed. Lindsborg Community Hospital Part V, Section B, Line 24: The policy applies to medically necessary services only. PART V, Section B, LINE 7A: www.lindsborghospital.org/about/message_from_ceo.html Part V, Section B, Line 10a: www.lindsborghospital.org/about/message_from_ceo.html 1 1 - Family Health Care Clinic 605 W Lincoln St Lindsborg KS 67456 Physicians clinic Part I, Line 3c: The methodology used to determine eligibility for financial assistance takes into consideration income, net assets, family size and resources available to pay for care. In addition, presumptive charity care may be applied in situations where all other avenues have been exhausted. Part I, Line 7: The amount reported on Lines 7a is from the organization's cost accounting system taking all patient segments into account. The amounts reported on line 7b were determined using Worksheets 2 and 3. Amounts on lines 7e, 7f, and 7i are from the actual general ledger. Subsidized health services on line 7g were calculated utilizing the Medicare cost report. Part I, Ln 7 Col(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 $209,759. Part II, Community Building Activities: We provided health and education through the Lindsborg News-Record and the Marquette Tribune. Part III, Line 3: The estimated amount of charity care expense included in bad debt is based on the percentage of charity care to revenue times bad debt expense. Part III, Line 4: The footnote to the Organization's financial statements can be found on page ten of the attached audited financial statements. Part III, Line 8: The payments are compared to the actual cost of providing the service as arrived at through the Medicare cost reports. Medical services are provided to patients with Medicare coverage regardless of whether or not a surplus or deficit is realized. Providing Medicare services promotes access to healthcare services which are vitally needed by our community. Part III, Line 9b: Patients who qualify for financial assistance will be entered into the system with an insurance company of 1.FINASST which prevents the patient from entering into the collection practices as a statement is never issued. Part VI, Line 2: The needs assessment has been completed. We are guided by our providers, our partners in nursing home care, Bethany Home and Riverview Estates, our partners in education of youth, USD 400 and Bethany College, and our patients in the Smoky Valley. Part VI, Line 3: The Hospital's charity care policy is posted in patient waiting rooms in a three-ring note book. The contact information is not posted, but the employees of the Hospital have been instructed to direct anyone with questions regarding assistance to the Hospital's business office. Patients are educated by the financial services staff and social services staff who are able to provide assistance upon request and through our policies being posted to our website. Part VI, Line 4: The Organization serves the Smoky Valley Area including Lindsborg, Marquette, Falun, Roxbury, Gypsum, Assaria and other areas including McPherson, Salina, Smolan, Canton, and Galva. Approximately 8% of the Hospital's patients are uninsured or Medicaid patients. The community served by the Hospital is also served by two other hospitals, plus a Federally Qualified Health Center in Salina. Part VI, Line 5: The organization's governing body is comprised primarily of persons who reside in the organization's primary service area who are neither employees nor contractors of the organization nor family members thereof. The organization extends medical staff privileges to qualified physicians in its community for some or all of its departments. Surplus funds of the organization are returned to the organization to improve patient care through updated equipment and technology and care team member education. The organization operates an emergency room that is available 24/7 regardless of ability to pay. Through the assistance of a donor, the organization has trained 777 CNA students over the last 15 years through a partnership with Bethany Home. The students receive the training at no cost to themselves. The organization makes available to the surrounding area a wellness center open seven days a week without fees. Kalli Weibert Daughter of Laraine Gengler, CFO 51918 Employment 0 Form 990, Part V, Line 1a, Number reported in Box 3 of Form 1096: Lindsborg Community Hospital Association has independent contractors, however, Salina Regional Health Center, the management company, pays all the independent contractors directly. The actual expense of each independent contractor is directly charged to the assigned entity. Form 990, Part V, Line 2a, Number of employees on W-3: Lindsborg Community Hospital Association has its own employees, however, Salina Regional Health Center, the management company, pays all compensation and employee benefits. The actual compensation of each employee is directly charged to their assigned entity. Salaries are reported on line 7 of Part IX. Form 990, Part VI, Section A, line 3 The Hospital entered into a management and operating agreement with Salina Regional Health Center (SRHC) effective October 1, 2012. Under the agreement, SRHC is responsible for the daily management and operation of the Hospital, including the employment of all staff needed to manage and operate Lindsborg Community Hospital. For tax year 2015, SRHC paid $116,000 for Larry Van Der Wege, the Hospital Administrator's salary and benefits, and $104,838 for Laraine Gengler, the Hospital CFO's salary and benefits. Form 990, Part VI, Section A, line 6 Lindsborg Community Health Care Foundation, Inc. a not-for-profit, 501c3 organization, is the sole member of Lindsborg Community Hospital. Form 990, Part VI, Section A, line 7a Lindsborg Community Health Care Foundation, Inc. being the sole member of Lindsborg Community Hospital, has the right to elect all board members. Form 990, Part VI, Section A, line 7b Lindsborg Community Health Care Foundation, Inc. is the sole member, and has the right to approve Lindsborg Community Hospital's by laws, articles of incorporation, and Board of Directors. Form 990, Part VI, Section A, line 8b There are no committees with broad authority to act on behalf of the governing body. Form 990, Part VI, Section B, line 11 The 990 is reviewed internally, and the Form 990 is made available to the board for review prior to filing. Form 990, Part VI, Section B, line 12c At the time of hire or election (in the case of directors) and annually thereafter, the officers, directors, and key employees provide the applicable conflict of interest disclosures which are completed to identify any relationships, positions, or circumstances in which it is believed a conflict may arise. If a conflict arises, the officer or director abstains from the vote of the conflicted position. The annual monitoring and review is part of the Organization's compliance plan. If a conflict is identified, it is either addressed by the board or referred to the management company for resolution. A report is submitted to the executive board concerning any interest disclosed. Form 990, Part VI, Section B, line 15a The Organization's process for determining Administrator's compensation begins with an initiative lead by the Executive Compensation Committee (ECC) of Salina Regional Health Center (SRHC). The ECC compares compensation and salary data provided by Integrated Health Strategies (IHS) for overall reasonableness of base compensation and total compensation for all SRHC executive staff. The ECC reviews the data and makes a recommendation to the SRHC board of trustees in a closed executive meeting. The process was last completed in 2016. Lindsborg Community Hospital's Administrator's salary is then set by the President/CEO of SRHC. The Lindsborg Community Hospital CFO's salary is set by Salina Regional Hospital Vice President of Finance using an annual salary survey and is increased using the same percentage as all other employees. Form 990, Part VI, Section C, line 19 The Organization makes its governing documents and conflict of interest policy available to the public upon written request. Form 990, Part IX, line 11g Contract Labor: Program service expenses 1,884,445. Management and general expenses 0. Fundraising expenses 0. Total expenses 1,884,445. Service Contracts: Program service expenses 18,622. Management and general expenses 0. Fundraising expenses 0. Total expenses 18,622. Form 990, Part XI, line 9: Intercompany Transfers 1,342,284. Change in auxiliary 671. Lindsborg Community Health Care Foundation Inc 605 W Lincoln Lindsborg KS 67456 480947732 Hospital support KS 501(c)(3) Line 7 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0