2016-08-09T11:01:22-05:00 2015-09-30 481026809 Wendling Noe Nelson & Johnson LLC 534 S Kansas Ave Suite 1500 Topeka KS 666033491 990 2014-10-01 480545183 Lindsborg Community Hospital Association LIND 7852273308 605 West Lincoln Lindsborg KS 674562328 Larry Van Der Wege CEO 7852273308 2016-08-02 1 Heather R Eichem P01515553 7852334226 2016-08-02 2014 2016-09-27 15:27:22Z Larry Van Der Wege 605 West Lincoln Lindsborg KS 674562328 9762315 0 X www.lindsborghospital.org X 1944 KS Operation of a critical access hospital for the care of individuals suffering from mental or physical illness, injury or deformity in an acute care, skilled nursing care, outpatient, or emergency setting. 9 9 0 48 0 0 136852 206470 9259935 9413661 -1981 -5584 93648 140622 9488454 9755169 2050 1633 0 0 5197149 5512184 0 0 0 2810580 3181790 8009779 8695607 1478675 1059562 5088407 5971923 1929901 1754086 3158506 4217837 X Operation of a critical access hospital in a community qualifying for such designation under federal law, for the provision of facilities for the diagnosis, treatment of 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. 0 0 7575852 1633 9547337 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. 1,877 patients were seen in the 2015 fiscal year. 753 urgent care visits, 683 privately paid home health visits were made, and 450 cardiac rehab visits improved the health of community members. 2,280 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. 7575852 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 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0 1 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 1 0 0 1 1 1 1 1 1 1 0 0 X Laraine Gengler 7852273308 605 West Lincoln Lindsborg KS 674562328 Chuck Oleen President 1.00 X X 0 0 0 Denise Peterson Director 1.00 X 0 0 0 Judy Neuschafer Secretary 1.00 X X 0 0 0 Robyn Johnson Vice-President 1.00 X X 0 0 0 Ryan Biegert Director 1.00 X 0 0 0 Tom Buffington Treasurer 1.00 X X 0 0 0 Mike Rose Director 1.00 X 0 0 0 Dr Ben Dolezal Director 1.00 X 0 0 0 Mary Ann Carlson Director 1.00 X 0 0 0 Joel Woodard Vice-President thru 12/31/14 1.00 X X 0 0 0 Judy Murphy Director 1.00 X 0 0 0 Erica Lysell Director 1.00 X 0 0 0 Larry Van Der Wege CEO 40.00 X 99678 0 2891 Laraine Gengler CFO 40.00 X 90522 0 5455 190200 0 8346 0 0 0 0 National Therapeutic Association Inc D 11623 Arbor Street Omaha NE 68144 PT, OT and ST services 359393 1 138452 68018 206470 Net patient service re 621400 9331097 9331097 EHR incentive payment 900099 82564 82564 9413661 1362 1362 12000 0 12000 12000 12000 200 7146 -6946 -6946 -6946 Employee/guest meals 900099 100920 100920 Medical record abstact 900099 259 259 Ambulance 621910 210 210 27233 27233 128622 9755169 9547337 0 1362 133 133 1500 1500 207901 207901 4413243 4080550 332693 151270 139892 11378 435316 387046 48270 304454 269363 35091 4855 4855 34842 34842 342264 259565 82699 90133 33560 56573 152721 63671 89050 79244 67793 11451 25733 16393 9340 2757 2252 505 19121 16358 2763 555361 475111 80250 40873 19453 21420 Pharmaceuticals 482037 482037 0 Professional fees - oth 426889 424931 1958 Medical supplies 325714 325714 Repairs 155023 154954 69 444223 350721 93502 8695607 7575852 1119755 0 109331 114656 995357 1120932 1417696 1993940 173714 179819 34605 73557 6136549 4132845 2027027 2003704 330677 329042 156273 5088407 5971923 323162 323867 476568 353839 483836 0 646335 1076380 1929901 1754086 X 2736562 3774059 421944 443778 3158506 4217837 5088407 5971923 1059562 -231 0 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 1 2395 0 0 0 2395 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 2515140 1506887 1008253 3353711 2374367 979344 257256 251591 5665 2003704 Estimated reimbursements payable 1076380 1076380 X Part X, Line 2: Management is not aware of any uncertainties in income tax positions. 1 1 1 X 1 X 1 1 0 0 52697 52697 0.00610 254080 196425 57655 0.00660 306777 196425 110352 0.01270 23075 121810 49570 72240 0.00830 27513 21687 5826 0.00070 3649 3649 0.00040 23075 152972 71257 81715 0.00940 23075 459749 267682 192067 0.02210 1 252473 5020790 5058376 -37586 X 1 1 1 1 Lindsborg Community Hospital 605 West Lincoln Lindsborg KS 674562328 X X X Lindsborg Community Hospital 1 0 0 1 X X X X X X X 12 1 1 1 1 X http://www.lindsborghospital.org/about/message_from_ceo.html X 1 12 1 http://www.lindsborghospital.org/about/message_from_ceo.html 0 0 1 X 200.000000000000 300.000000000000 X X X 1 1 X X X 1 X http://www.lindsborghospital.org/patients/financial_assistance.html X http://www.lindsborghospital.org/patients/financial_assistance.html X http://www.lindsborghospital.org/patients/financial_assistance.html X 1 0 X X X X 1 X 0 0 Lindsborg Community Hospital Part V, Section B, Line 5: The McPherson County Health Needs Assessment process included gathering opinions from local sources and quantitative from secondary sources. The steering committee was represented by local organizations: McPherson County Health Department, McPherson Hospital, Lindsborg Community Hospital, and Mercy Hospital, Moundridge. A survey instrument was developed by the local steering committee. In early April 2013, the survey was distributed to individuals throughout the county, representing a broad spectrum of the population and their interests and professional and community endeavors. Representatives from the following areas received surveys: private college, public education administrators, special education advocacy, United Way, senior care administrators, senior care advocacy, child advocacy, family advocacy, chiropractic care, churches and church ministry groups, Chamber of Commerce, city government, county government, hospital administration, retail, mental health, county foundations, health care workers, physicians, law enforcement, EMS, pharmacists, college research and extension, recreation commission, dental care, disability care and advocacy, thrift stores, and low income housing. A total of 158 surveys were distributed with 106 returned, or a 67% return rate. The survey sought opinions and perspectives on several key areas including specific health issues; specific populations; barriers to health care; perceived weaknesses in areas ranging from emergency care to quality of housing; promotion of health and wellness; and key improvements needed to provide better health for residents. Responses to survey items were tallied and results calculated to determine which items received the most responses, providing a list of the most important health issues based on perception. A comprehensive list of identified community needs from the survey, in order of perceived importance, was developed. After the data was analyzed, a workgroup was formed to explore the results and begin to prioritize identified needs. The workgroup included county-wide representatives from the following: physicians and health care; mental health; law enforcement; city government; senior advocacy; public health; Chamber of Commerce; community foundations; research and extension; United Way; poverty; public education; and hospitals from the county. Lindsborg Community Hospital Part V, Section B, Line 6a: McPherson Hospital in McPherson, Kansas and Mercy Hospital in Moundridge, Kansas Lindsborg Community Hospital Part V, Section B, Line 6b: McPherson County Health Department Lindsborg Community Hospital Part V, Section B, Line 11: 2015 Review for Health Issues: It is difficult to create a specific action plan for each issue, as there are many factors involved in each area. In 2015, as a part of the CHNA Action Plan and a part of meeting Physician Quality Reporting System measures, a number of data reports were developed. They included a wide range of health issues including: HgbA1c for diabetics, appropriate testing for children with pharyngitis, influenza immunizations, pneumonia immunizations for 65 year olds and older, screening mammography, colorectal cancer screening, screening for nephropathy in diabetics, screening BMI's, hypertension and imaging studies for low back pain. Identification of those with Medicare who qualify to receive an Initial Medicare Visit or an Annual Wellness Visits started in 2014 and were carried out in 2015 with approximately 100 visits performed. Electronic Medical Record reports have been developed to identify those who qualify and are in need of the Wellness Visit. One health issue to be addressed was substance abuse. In early 2015, screening questions were developed into the clinic wellness exam for all age groups. If a referral is needed, one is made with Central Kansas Foundation in Salina. Education on many of these health issues were performed since the inception of our action plan. In July of 2015 and May of 2016, a 7 week Stepping On program was provided free of charge to community members in Lindsborg. In November of 2015, it was provided in Marquette. The total number of participants has been 34 and the purpose is to reduce falls among senior citizens. In September of 2015, LCH sponsored a community Safety and Health Fair at the Sundstrom Conference Center. Free and reduced price lab testing and vaccinations were provided. Expired or unused prescription medications were taken for proper disposal. There were also booths with information on the following topics: ImPACT testing and sports concussions, breast cancer awareness, skin cancer awareness, gun safety and free locks, behavioral health, bicycle safety with helmet giveaway, carbon monoxide poisoning with detector giveaways, anti-tip devices for furniture and televisions with giveaways, McPherson County Health Department, health portal registrations and driving assessments. Weekly health education is also provided through the newspapers of The Lindsborg News Record and The Marquette Tribune. Similar education is provided regularly on the LCH Facebook page, on the LCH website and through the quarterly community newsletter. These will continue as education to our communities. 2015 Review for Specific Populations with Inadequate Access to Care:These will be addressed while discussing barriers to care.2015 Review Action Plan for Barriers to Care:Caring for those with low incomes and specifically those without insurance is something we will continue to do. Enhancement of our financial assistance policy, in accordance with 501(r) regulations, enabled us to provide care to those less financially able to afford care. An automatic deduction of 30% from total charges has been adopted for those individuals without insurance. LCH has also made an increased effort to identify and inform individuals about our Financial Assistance Policy, to encourage completion of application paperwork. For the fiscal year 2015 (Oct 1 - Sept 30), LCH provided $98,316 in charity care through the financial assistance policy. Also, $471,031 was the amount of care considered bad debt.Several years ago, LCH started the Pink Fund with a purpose to provide funding to pay for cancer screening services for those in our service area without insurance. In September of 2014, the purpose was expanded to provide grants of up to $500 for those in our service area with a diagnosis of cancer. In September of 2015, the name of the fund was changed to the Smoky Valley Cares Fund. As of this time, $1,115 has been granted for those with the diagnosis, to assist with healthcare and related costs of treating this dreaded disease. Up to $3,000 per year will be granted.In the Family Health Care Clinic (FHCC), LCH has developed the process for school-aged children to have their activity health assessment forms completed. One option is a $35 cash option. It provides just the health assessment and form completion (no medications, labs, etc) but is an economical option for families. This practice started in 2014 and will continue.Access to care in the Family Health Care Clinic has been challenged in 2015 and 2016 by the loss of Dr. Andrea Eden, Dr. Jody Bieker and Miranda Brown APRN. To assist in recruitment and retainment of provider staff in the FHCC, LCH is working with Salina Regional Health Center Emergency Department to staff the ED at LCH. The goal is to be able to staff the LCH ED with advanced practice providers through the SRHC ED 24/7 by the end of 2016. Recruitment of new physicians to LCH will continue until the two open positions are filled. In September of 2014, the FHCC began providing childhood immunizations. This service, along with our ability to accept new patients was specifically marketed to those in our service area receiving insurance through KanCare. This is the state Medicaid program. LCH has continued to provide Urgent Care on Saturday and Sunday afternoons. This service provides an avenue for treatment of urgent situations when one's primary care provider is unavailable. It is also at a cost much less than in an Emergency Department. In fiscal year 2015 753 visits were provided in the LCH Urgent Care clinic.2015 Review for Perceived Weaknesses in General Areas:Free fitness options has been attained at LCH as membership fees to the Wellness Center were eliminated starting September 1, 2013. Thus, any person 12 years of age and up can use the Wellness Center by signing a waiver form, without charge. The hours were also expanded to enable use from 5:30am to 10pm Monday - Friday and 8am to 10pm on weekends and holidays. A second recumbent stepper was purchased in the spring of 2015 to provide additional equipment and reduce wait times. In March of 2016, the Wellness Center was renovated with removal of old weight equipment and the addition of a multifunction Precor Tower for strength training. Child care options will not be addressed as it is beyond the scope and abilities of LCH. Access to specialists will be enhanced through the affiliation between LCH and SRHC. In April of 2015, Mary Ann Carlson, PA-C, began providing Behavioral Health consults in an office at LCH. She is available 3 days per week. In the fall of that year, Summer Olsen MS LCP NCAC I, began providing Behavioral Health counseling in the same office one day per week. In November of 2015, Diabetic Education started as a service at LCH. It is offered via telemedicine from a Diabetic Educator at Comcare in Salina. The patient is able access the web connection through our specialty clinic. In ClosingA number of areas are being addressed to improve the health of McPherson County and specifically, the LCH service area. Lindsborg Community Hospital Part V, Section B, Line 22d: Anyone qualifying for free care under the financial assitance policy (FAP) is not charged for services. Anyone qualifying for discounted care under the FAP will not be charged more than the lowest negotiated commercial rate. Part V, Section B, Line 16 Financial Assistance Policy Website Availability Lindsborg Community Hospital Part V, Section B, line 16a website: http://www.lindsborghospital.org/patients/financial_assistance.html Lindsborg Community Hospital Part V, Section B, line 16b website: http://www.lindsborghospital.org/patients/financial_assistance.html Lindsborg Community Hospital Part V, Section B, line 16c website: http://www.lindsborghospital.org/patients/financial_assistance.html 1 Family Health Care Clinic 605 W Lincoln St Lindsborg KS 67456 Physicians clinic Part III, Line 4: See Note A5 (page 9) of the Salina Regional Health Center, Inc. and Subsidiaries audited financial statements regarding the allowance for uncollectible accounts. Part III, Line 2: The Hospital's bad debt at cost was determined by applying an overall cost to charge ratio. Part III, Line 3: Lindsborg Community Hospital is unable to determine the amount of bad debt expense attributable to patients under its financial assistance policy. Suggested methods of estimation were not in place. For example, the number of financial assistance applications distibuted but not returned was not tracked. Rather than provide an estimate that cannot be substantiated, Lindsborg Community Hospital has chosen to report zero dollars as bad debt expense attributable to charity care patients. Part III, Line 8: Amounts were obtained from the cost report filed with Medicare for the period ended September 30, 2015. The total amount of the shortfall is considered a community benefit, representing our cost of providing services to the Smoky Valley communities. Part III, Line 9b: Patients who have qualified for financial assistance are considered qualified for one year. Updated information must be provided for any subsequent account balances. Patients who have qualified for partial financial assistance are to make payment arrangements for any remaining balance according to the policies that apply to other patients. Part VI, Line 2: A 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 notebook. 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 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 Medicare patients. The community served by the Hospital is also served by two other hospitals, plus a FQHC in Salina. A City of Lindsborg Kansas 486019638 535596FH8 2009-10-15 545000 Refunding of 2000 series bonds. 0 0 0 A 265000 545000 545000 0 1 0 1 A 0 0 1 0 0 0 0 0 0 A 0 Kalli Weibert Daughter of Laraine Gengler, CFO 52384 Employment 0 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 the calendar year of 2014, SRHC paid $102,569 for Larry Van Der Wege, the Hospital CEO's salary and benefits, and $95,977 for Laraine Gengler, the Hospital CFO's salary and benefits. These amounts are included on Form 990, Part VII, Columns D and F. Form 990, Part VI, Section A, line 6 Lindsborg Community Health Care Foundation, Inc., a not-for-profit, 501(c)(3) 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 B, line 11 An independent accounting firm prepares and reviews the Form 990. The Form 990 is then reviewed by the Organization's CEO and CFO. Any questions or concerns of the Organization's CEO and CFO are addressed and any corrections or clarifications that need to be made are made. The Form 990 is then provided to the Board of Directors for their review prior to filing the Form 990. Any questions or concerns of the Board of Directors are addressed and any corrections or clarifications that need to be made are made. The final Form 990 with all required schedules is then provided to all voting members of the board prior to filing the Form 990. 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, director, or key employee abstains from the vote of the conflicted position. The annual monitoring and review is part of the Organization's compliance plan. 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 (HIS) 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 where the compensation for the President/CEO of SRHC is then voted upon by all independent members of the board. This process was last completed in 2013. Lindsborg Community Hospital CEO's salary is then set by the President/CEO of SRHC. The Lindsborg Community Hospital CFO's salary is set by Lindsborg Community Hospital CEO 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's governing documents, conflict of interest policy, and financial statements are available to the public upon request. Form 990, Part XI, Line 2C: The selection of an independent accountant for the audit of Salina Regional Health Center, Inc. and Subsidiaries is determined by Salina Regional Health Center's audit committee. Lindsborg Community Hospital is part of the consolidated financial statements of Salina Regional Health Center. Lindsborg Community Hospital did not have a separate financial statement audit in the current fiscal year. A decision to have a separate audit in any future year will be made by Salina Regional Health Center's audit committee or Lindsborg Community Hospital's Board of Directors. Lindsborg Community Health Care Foundation Inc 605 W Lincoln Lindsborg KS 67456 480947732 To support the hospital KS 501(c)(3) Line 7 N/A 0 0 0 1 0 0 0 0 0 0 0 0 1 0 1 1 0 0 0 0