2016-11-09T15:24:44-06:00 2015-12-31 481026809 Wendling Noe Nelson & Johnson LLC 534 S Kansas Ave Suite 1500 Topeka KS 666033491 990 2015-01-01 480684878 Southwest Medical Center SOUT 6206241651 PO Box 1340 Liberal KS 679011340 Amber Williams CFO 6206241651 2016-11-04 1 Heather R Eichem P01515553 7852334226 2016-11-04 2015 2017-02-10 21:41:12Z Amber Williams PO Box 1340 Liberal KS 679011340 44475412 0 X www.swmedcenter.com X 1963 KS The Medical Center is a county hospital dedicated to the provision of personalized and quality care of the sick and injured at a reasonable cost. 7 5 515 90 0 0 185162 237538 45417037 43714578 37808 103342 307453 419954 45947460 44475412 0 0 0 0 23145072 24749653 0 0 0 19632125 19667062 42777197 44416715 3170263 58697 60214156 62142897 19896655 35208201 40317501 26934696 The Medical Center is a county hospital dedicated to the provision of personalized and quality care of the sick and injured at a reasonable cost. 0 0 37738132 43934936 Southwest Medical Center provides necessary medical care to the community. It is the only facility in the area providing certain medical equipment and services. 37738132 1 1 0 1 0 0 0 0 0 1 1 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0 1 44 0 1 515 1 0 0 0 0 0 0 0 0 0 0 X 7 5 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 0 0 1 1 0 X Amber Williams CFO 6206296680 PO Box 1340 Liberal KS 679011340 Mark Schepers Chairman 1.00 X X 0 0 0 Ray E Allen MD Vice-Chairman 1.00 X X 40747 0 0 Gary Andrews Secretary 1.00 X X 0 0 0 Frederick Miller Treasurer 1.00 X X 0 0 0 Tammy Lenear Asst. Secretary/Treasurer 1.00 X X 0 0 0 Thomas Willis Trustee 1.00 X 0 0 0 Dennis Sander Trustee 1.00 X 0 0 0 William Ermann CEO 40.00 X 265414 0 36343 Amber Williams CFO 40.00 X 130224 0 17362 Jose Maeda Physician 40.00 X 571246 0 38919 Rory Howard Physician 40.00 X 496593 0 38914 Andrey Ilyasov Physician 40.00 X 469005 0 38926 Akshath Kamath Physician 40.00 X 323467 0 38583 Rama Chanda Physician 40.00 X 312592 0 38076 2609288 0 247123 18 0 1 0 Kansas Emergency Room Services PA 7032 Collection Center Drive Chicago IL 60693 ER services 837449 Account Recovery Specialist Inc 200 W Wyatt Earp Blvd Dodge City KS 67801 Collection services 587165 Guymon Physical Therapy and Wellness 302 Northridge Circle Guymon OK 73942 Physical therapy 390214 Medical Information Technology Meditech Circle Westwood MA 02090 IT services 216422 Quest Diagnostics PO Box 14730 St Louis MO 63150 Outside lab testing 215700 11 200000 37538 237538 Net patient service revenue 621990 43275931 43275931 Electronic health records incenti 900099 438647 438647 43714578 50842 50842 131467 0 131467 131467 131467 52500 0 52500 52500 52500 Cafeteria & dietary 722210 252096 252096 Miscellenous revenue 900099 36391 36391 288487 44475412 43934936 0 302938 496466 40747 455719 19188153 17324476 1863677 1237798 1129274 108524 2387681 2123268 264413 1439555 1261928 177627 42554 42554 2120 2120 738019 293259 444760 55593 10209 45384 978340 874224 104116 19170 5002 14168 1176385 1136699 39686 100982 71176 29806 64899 47591 17308 707230 707230 3611733 2593942 1017791 337371 188522 148849 Medical supplies 3970331 3970331 Purchased services 3235024 2588465 646559 Repair & maintenance 1628664 919596 709068 Pharmacy drugs and supp 1244958 1244958 1753689 1207235 546454 44416715 37738132 6678583 0 3074 3124 17638164 17869296 8765992 8333222 1457312 1602773 1636599 1672934 80419705 52139470 27616208 28280235 2862865 2203956 233942 2177357 60214156 62142897 3383891 4514316 15920000 15560000 212435 165240 380329 14968645 19896655 35208201 X 40317501 26934696 40317501 26934696 60214156 62142897 X 58697 -13441502 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 1 6755 0 0 0 6755 0 Part II-B, Line 1: Southwest Medical Center is a member of the Kansas Hospital Association. This organization engages in lobbying activities for hospital and general health care interests as part of the services provided to members. 1167152 897 -4703 5250 1158096 899659 143359 125634 1500 1167152 808522 97137 6000 899659 814027 -1005 4500 808522 705759 111268 3000 814027 0.57010 0.42990 0 1 1 104046 104046 44417237 24773946 19643291 32626808 26166280 6460528 3271614 1199244 2072370 28280235 Unamortized premium 356049 Deferred inflows of resources - Pension 1097564 Net pension liability 13515032 14968645 X 44475412 0 44475412 0 44475412 44416715 0 44416715 0 44416715 Part V, Line 4: Southwest Medical Center Foundation, Inc.'s endowment consists of approximately five individual funds established for scholarships and general support of Southwest Medical Center. Part X, Line 2: Management is not aware of any uncertainties in income tax positions. 1 1 1 X 1 X 100.000000000000 1 1 0 0 629413 254786 374627 0.00840 5454276 3792640 1661636 0.03740 6083689 4047426 2036263 0.04580 51154 31534 19620 0.00040 7314450 3032190 4282260 0.09640 3125 3125 0.00010 7368729 3063724 4305005 0.09690 13452418 7111150 6341268 0.14270 1 2477703 201840 8778951 12046010 -3267059 X 1 1 1 1 Southwest Medical Center 315 W 15th Street Liberal KS 679011304 X X X Skilled nursing facility Southwest Medical Center 1 0 0 1 X X X X X X X X 13 1 0 0 1 X www.swmedcenter.com X 1 13 0 1 0 1 X 100.000000000000 100.000000000000 X X X 0 1 X X X X 1 X X X 1 X X 0 X X X X X 1 X 1 0 Southwest Medical Center Part V, Section B, Line 5: SWMC conducted twelve interviews with community leaders. These leaders represented a local government, hospital administration, faith-based organizations, the low-income population, a school district, a community health organization, the medically underserved population, and the senior population.SWMC also conducted two focus groups to gather information about health concerns from particular interest groups in Seward County to add to the richness of the quantitative information collected. The focus groups consisted of Hispanic and general adult community members. Southwest Medical Center Part V, Section B, Line 11: The Medical Center continues to discuss transition plans with providers nearing retirement to prevent a future gap in coverage. The Medical Center is actively recruiting several specialties to meet the needs of the community. To reduce cardiovascular disease, the employees of the Medical Center attended a variety of community events and conducted free blood pressure screenings. The Medical Center is also working to increase the cardiology outreach clinic to five days a week to help meet the cardiac needs of the community. To reduce diabetes, the Medical Center conducts educational events to inform the community about the causes of diabetes and how to treat it. The Medical Center has also started conducting free finger stick blood sugar screenings at a variety of community events. The Medical Center opened a wound care clinic that includes two hyperbaric oxygen therapy chambers to treat the chronic wounds suffered by patients who have diabetes. To continue increased maternal and child health, an employee of the Medical Center is still working with the Liberal Coalition for Families to help reduce teenage pregnancies. To continue to combat childhood obesity, the Medical Center is still actively participating in the Healthy Kids Fun Fair, an event that helps teach children how to eat and live healthy. Southwest Medical Center Part V, Section B, Line 16i: Forms of communicating the uncompensated care policy include, but are not limited to:1. Providing information about uncompensated care in patient financial brochures in patient rooms.2. Designating Patient Financial Services staff members to explain the uncompensated care policy to the patient.3. Making available to the public a copy of our uncompensated policy, application and eligibility criteria, upon request. Southwest Medical Center Part V, Section B, Line 20e: If patients are denied, the reason is documented in the account notes. Southwest Medical Center Part V, Section B, Line 22d: Southwest Medical Center charges all patients the gross charge amount for the services provided based on a set pricing structure regardless of the patient's payor type. The charges of FAP-eligible individuals are reduced by an amount based on the patient's medical indigency and financial condition. Southwest Medical Center Part V, Section B, Line 23: During the preparation of the 2015 990 tax return, the Medical Center discovered that there were a few isolated incidences during 2015 when FAP - eligible individuals were charged amounts in excess of amounts generally billed. The incidences were due to the Medical Center personnel's misunderstanding of the effective date of applicable 501(r) regulations. The Medical Center is in the final stages of implementing a financial assistance policy that will be fully compliant with the final 501(r) regulations released in December 2014. 5 1 - Dr Gerald Lane DO 2381 N Kansas Ave Liberal KS 67901 Ophthalmologist 2 - Family Practice 305 W 15th Street Liberal KS 67901 Family practice 3 - Internal Medicine Clinic 305 W 15th Street Liberal KS 67901 Internal medicine 4 - General Surgery Clinic 555 W 15th Street Liberal KS 67901 General Surgeons 5 - Sleep Disorders Laboratory 101 E 11th Street Liberal KS 67901 Sleep studies Part I, Line 7: Amounts for Financial Assistance and Certain Other Community Benefits programs were obtained using known related charges and several cost to charge ratios. The cost to charge ratios used include the overall cost to charge ratio derived from Worksheet 2 as well as individual department cost to charge ratios identified for the calculation of subsidized health services information. Part I, Line 7g: Subsidized Health Services are made up of services that the Hospital provides despite a financial loss to the organization. These services include skilled nursing services, physical therapy, and physician clinics. Part III, Line 4: The Medical Center 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 estimated net realizable value. The Medical Center estimates this allowance based on the aging of its accounts receivable and its historical collection experience for each type of payor.Part III, Line 2Provisions for bad debts are related to accounts that have been deemed uncollectible during the year. The uncollectible amount is then written off pursuant with Hospital policy. The cost of the bad debts reported was determined using the cost to charge ratio and total bad debt expense.Part III, Line 3The estimate of provisions for bad debts attributable to patients eligible under the organization's financial assistance policy was determined using the amount of charges included in incomplete charity care applications multiplied by the Medical Center's cost to charge ratio. It is our belief that the portion of the Medical Center's bad debt expense attributable to patients eligible under the Medical Center's financial assistance policy should be included as community benefit. As a not-for-profit, patient care is provided to all, regardless of ability to pay for that care. Making quality patient care available to all in our community, regardless of their economic means, qualifies bad debts as a community benefit. Part III, Line 8: Amounts were obtained from the cost report filed with Medicare for the period ending December 31, 2015. The Medicare shortfall should be considered a community benefit because our mission is to promote health in the community and we do not limit the care available to any patients, including those covered by Medicare. We are relieving a government burden by providing care to Medicare patients. Tax-exempt hospitals are expected to participate in the Medicare program. Part III, Line 9b: The Hospital's collection policy does not contain a provision on the collection practices for patients who are known to qualify for charity care or financial assistance. To be considered for charity care, however, the charity care policy states that the patient must cooperate with the Hospital to provide the information and documentation necessary to apply for other existing financial resources that may be available to pay for health care services, such as Medicaid. Then the information is gathered and assessed in order to determine eligibility for charity care. Whenever possible, prior to admission, the Hospital will conduct a pre-admission interview with the patient, the guarantor, and/or legal representative. Those patients who may qualify for financial assistance from a governmental program will be referred to the appropriate program, prior to the consideration for charity care. Part VI, Line 2: SWMC conducts a community needs assessment approximately every 3 years. The analysis includes community focus group meetings to hear directly from citizens what they believe are the needs. Additionally, SWMC monitors Kansas Hospital Association patient origin and destination data to look for patterns of migration for services that might be made available locally as a new service. Part VI, Line 3: PFS refers self pay patients to Midland Professionals and Midland assists them in seeing if they are eligible for any federal, state, or local programs. The collectors send out charity care paperwork to patients as they are calling and collecting or if a patient calls for the packet. Part VI, Line 4: SWMC's total service area is rural and is made up of southwest Kansas and the neighboring areas of Oklahoma, Colorado and New Mexico. SWMC's primary service area, however, is Seward County, KS, which has a population of approximately 23,200. According to the U.S. Census Bureau this population is 60% Hispanic, has a median household income of $48,621, and 15.7% of all people in Seward County are below the Federal poverty level.SWMC is a County owned hospital and is the only hospital in the county. It therefore provides care to all patients regardless of their ability to pay. 6.9% of services provided by SWMC are provided to Uninsured patients while an additional 12.3% is provided to Medicaid patients. Part VI, Line 5: SWMC's seven Board of Trustees members are appointed by the Seward County Board of County Commissioners. Trustees are required to reside in Seward County, KS, and cannot be employed by the Hospital. SWMC extends medical staff privileges to all qualified physicians in the community who so desire to have such privileges.All surplus funds are reinvested back into the Hospital to fund capital needs and additional services that are identified as needed to continue to provide high quality services to the community. SWMC works with other community agencies, including the Seward County Health Department, to provide educational programs to the public throughout the year and an annual Health Fair that provides laboratory testing and health screening to over 697 participants. SWMC provides clinical training facilities for many area educational institutions' nursing, respiratory therapy, and radiology students. This includes Seward County Community College, Fort Hays State University, the University of Kansas, Oklahoma State University, Texas Tech University and others, all without any financial compensation. X X X 0 0 0 0 0 0 0 0 0 William Ermann CEO 264353 0 1061 0 0 0 22632 0 13711 0 301757 0 0 0 Jose Maeda Physician 507681 0 63565 0 0 0 25122 0 13797 0 610165 0 0 0 Rory Howard Physician 426729 0 69864 0 0 0 25122 0 13792 0 535507 0 0 0 Andrey Ilyasov Physician 388170 0 80835 0 0 0 25122 0 13804 0 507931 0 0 0 Akshath Kamath Physician 302346 0 21121 0 0 0 25122 0 13461 0 362050 0 0 0 Rama Chanda Physician 298604 0 13988 0 0 0 25122 0 12954 0 350668 0 0 0 A Seward County Kansas 486009370 818427ER3 2010-05-27 18167463 Expand and renovate facilities, purchase equipment, and fund debt. 0 0 0 A 2110000 18178603 1085932 213247 148667 16144131 1005550 667122 2012 0 1 1 1 A 0 0 0 0 0 0 0 A 0 0 0 0 0 0 0 0 1 A 1 Schedule K, Part II The difference between Part I, column (e) and Part II, line 3 is due to the accumulation of investment income. Chelsea Pipkin Daughter of board member 78584 Employment 0 Form 990, Part VI, Section B, line 11 The Form 990 is reviewed by the CFO and Controller. Form 990, Part VI, Section B, line 12c A conflict of interest policy disclosure form is provided with a copy of the current conflict of interest policy. This disclosure is completed by each Trustee upon election and annually thereafter. Form 990, Part VI, Section B, line 15 The Board of Trustees is responsible for deteriming the job performance standards for the Administrator/CEO and determining compensation according to the organizations policies. Form 990, Part VI, Section C, line 19 The organization makes its governing documents, conflict of interest policy, and financial statements available to the public upon request. Form 990, Part XI, line 9: Prior period adjustment to recognize net pension liability -13,441,502. Form 990, Part XI, Line 2C The organization has an audit committee that is responsible for the oversight of the financial statement audit and selection of the independent accountant. Southwest Medical Center Foundation PO Box 1340 Liberal KS 67901 480908781 Fundraising for the benefit of Southwest Medical Center KS 501(c)(3) Line 11d, III-O 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0