2015-10-27T12:58:17-05:00 2014-12-31 481026809 Wendling Noe Nelson & Johnson LLC 534 S Kansas Ave Suite 1500 Topeka KS 666033491 990 2014-01-01 480576039 Clara Barton Hospital Association Inc CLAR 6206532114 250 West 9th Street Hoisington KS 675441799 James G Blackwell Chief Executive Officer 6206532114 2015-10-09 1 Heather R Eichem P01515553 7852334226 2015-10-09 2014 2016-02-25 16:41:14Z James G Blackwell 250 West 9th Street Hoisington KS 675441799 19947883 0 X www.clarabartonhospital.org X 1946 KS Provision of inpatient and outpatient hospital services, primary care services, and surgical services to residents of our service area. 10 7 224 14 0 0 140112 629560 16864249 17915629 136642 241738 347188 712036 17488191 19498963 0 0 0 0 9750596 10961591 0 0 97017 7639474 7767920 17390070 18729511 98121 769452 12690483 12484332 5339164 4551108 7351319 7933224 X Clara Barton Hospital Association is dedicated to meeting the health care needs and improving the quality of life for the community we serve. We continually pursue clinical excellence in an atmosphere of caring and compassion. We are deeply committed to serving all in need within our resources. 0 0 16023115 18057003 Clara Barton Hospital Association provided a wide range of health care services to residents of its service area including 2,527 patient days of inpatient care, 20,364 outpatient hospital visits and 26,267 visits to our primary care and surgical clinics. 16023115 1 1 0 1 0 0 0 0 0 0 1 0 0 1 0 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 1 0 0 0 0 0 1 0 0 0 1 59 0 1 224 1 0 0 0 0 0 0 0 0 0 0 X 10 7 0 0 0 0 1 1 0 1 1 0 0 1 1 1 1 1 1 1 0 0 X James G Blackwell 6206532114 250 West 9th Street Hoisington KS 675441799 Curt J Colson President/CEO 40.00 X X 142653 0 34496 Jon Radke Director 1.00 X 0 0 0 Troy Bailey Chairman 1.00 X X 0 0 0 Mike Aylward Director 1.00 X 0 0 0 Nathaniel Knackstedt Director/Chief of Staff 40.00 X 232518 0 36827 Marla Mooney Vice-Chairman 1.00 X X 0 0 0 Karla Crissman Secretary 1.00 X X 0 0 0 Jim Carney Treasurer 1.00 X X 0 0 0 Lisa Beran Director 1.00 X 0 0 0 Doug Hubbard Director 1.00 X 0 0 0 James G Blackwell Vice President/CFO 40.00 X 114202 0 33557 Robin Durrett Physician 40.00 X 529526 0 38236 Timothy Webb Physician 40.00 X 343014 0 28247 Phillip Barnes Physician Assistant 40.00 X 121720 0 29952 Abelardo Sotelo Physician 40.00 X 378554 0 20055 Celeste M Meitner Pharmacist 40.00 X 112171 0 17361 1974358 0 238731 11 0 1 0 Hutton Construction 2229 S West St Wichita KS 67213 Construction services 1501014 Docs Who Care PA 1337 South Fountain Drive Olathe KS 66061 ER Physician coverage 618835 Aramark Uniform Services 115 N First St Burbank CA 91502 Laundry services 424750 Mobile Imaging Inc 3520 Lakin Ave Great Bend KS 67530 Sonography tech services 183199 Hutchinson Clinic PA PO Box 1187 Hutchinson KS 67504 Surgery and respiratory therapy services 173997 11 606341 13590 9629 629560 Patient service revenue 621990 17537076 17537076 340b drug program revenue 621990 378553 378553 17915629 199012 199012 484622 484622 13715 0 13715 13715 13715 480646 11000 448920 0 31726 11000 42726 42726 Cafeteria 722210 72325 72325 Purchase discounts and rebates 621990 66405 66405 Patient account interest 621990 25911 25911 49058 49058 213699 19498963 18057003 0 812400 594253 269345 324908 8496844 7374343 1052338 70163 169066 148710 18926 1430 1071298 953216 109009 9073 630130 533407 91803 4920 42273 42273 1825 1825 2671822 2436722 234932 168 46084 22416 23668 742789 634802 102278 5709 131166 131166 315767 270982 43572 1213 42640 36514 6125 1 194435 194435 743518 622771 117476 3271 119818 119818 Medical supplies 1043378 1043378 Pharmacy supplies 676987 676987 Repairs and maintenance 274855 256369 18100 386 Minor equipment 212781 139643 73131 7 507782 409075 98031 676 18729511 16023115 2609379 97017 987 14321 1796417 791942 1723828 1664688 100028 4500 487893 581001 220392 206425 14084283 9372563 3726964 4711720 3111883 2919048 5547 5547 1512044 1589640 12690483 12484332 1963536 1986019 3210611 2479782 165017 85307 5339164 4551108 X 6473147 7151501 603839 503419 274333 278304 7351319 7933224 12690483 12484332 X 769452 -100028 -87519 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 1 5957 0 0 0 5957 0 Part II-B, Line 1: Clara Barton Hospital Association, Inc., is a member of the Kansas Hospital Association and the American Hospital Association. Both of these organizations engage in lobbying activities for hospital and general health care interests as part of the services provided to members. 554300 401937 152363 6404736 4674558 1730178 4428451 3679329 749122 2696796 616739 2080057 4711720 Beneficial interest in net assets of CBH Foundation 761723 Deferred financing costs 50365 Estimated third-party payor settlements 591935 Other receivables 108673 Advances to physicians 76944 1589640 X 19311416 -100028 -100028 19411444 87519 87519 19498963 18729511 0 18729511 0 18729511 Part X, Line 2: Management is not aware of any uncertainties in income tax positions. Part XI, Line 4b - Other Adjustments: Change in beneficial interest in net assets of Foundation, net of transfers 87,519. 1 1 1 X 1 X 1 1 0 0 277704 277704 0.01480 973943 467456 506487 0.02700 1251647 467456 784191 0.04180 4527 4527 0.00020 5527 5527 0.00030 1565475 1010555 554920 0.02960 950 950 0.00010 1576479 1010555 565924 0.03020 2828126 1478011 1350115 0.07200 1 339425 33943 7557390 7628127 -70737 X 1 1 1 1 Clara Barton Hospital 250 West 9th Street Hoisington KS 675441799 H005003 X X X X Physician clinics & rural health clinics Clara Barton Hospital Association Inc 1 0 0 1 X X X X X X X X X 12 1 1 1 1 X www.clarabartonhospital.org X 1 12 0 1 0 1 X 100.000000000000 300.000000000000 X X X X X 1 1 X X X X 1 X X X X X X X X 1 X 0 X X X X X 1 X 0 0 Clara Barton Hospital Association, Inc. Part V, Section B, Line 5: The CHNA was conducted in collaboration with Great Bend Regional, Ellinwood District Hospital, St. Rose's ASC, and the Barton County Health Department. The Hospital reached out to members of the community with broad interests in the community served and special knowledge of or expertise in public health from groups such as local hospitals, public health community, mental health community, free clinics, community based clinics, service providers, local residents, community leaders, opinion leaders, school leaders, business leaders, local government, faith-based organizations and persons (or organizations serving them), people with chronic conditions, uninsured community members, low income residents, and minority groups. A Town Hall meeting of 37 attendees was conducted. The Town Hall meeting reflected on the size and seriousness of any health concerns cited and discussed current community health strengths, as well as identifying and ranking top community health concerns. In addition to the Town Hall meeting, CHNA surveys were mailed to 2,000 randomly selected Barton County residents. 230 area households in the community completed the CHNA survey. The survey was created to measure Barton County residents' views regarding health care perceptions of delivery, access, and health practices. Clara Barton Hospital Association, Inc. Part V, Section B, Line 6a: Great Bend Regional (located in Great Bend, KS - Barton County), Ellinwood District Hospital (located in Ellinwood, KS - Barton County), and St. Rose's ASC (located in Great Bend, KS - Barton County) Clara Barton Hospital Association, Inc. Part V, Section B, Line 11: 1. Obesity / ExerciseCBH distributed educational materials regarding healthy food choices, nutrition, and ways to be active and increase exercise during an annual Hoisington Middle School Sixth Grade Health Fair.CBH contracted with a registered dietician who is available to meet with patients either in a one-on-one and/or group setting to provide nutritional consultation and education.CBH provided substantially discounted Lab Fairs on three occasions in 2014. During these lab fairs CBH also offered blood pressure checks. The lab tests that were offered are CMP, CBC, Lipid Profile, HgbA1C, TSH, PSA and Vitamin D.Clara Barton Medical Clinic (CBMC) offered the Virtual Lifestyle Management (VLM) program via the Kansas Department of Health and Environment (KDHE) for any patient 30 or more pounds overweight and with one or more of the following conditions: Type 2 diabetes or Pre-diabetes, Metabolic Syndrome, high cholesterol, obstructive sleep apnea, coronary artery disease. VLM is an online program with lessons on physical activity, nutrition, motivation and tracking tools. Personal coaching sand support was also available. CBMC had approximately 30 participants during 2014.2. Heart HealthCBH partnered with Cardiovascular Consultants of Kansas, P.A. and brought the cardiac services of Dr. Micheal Lloyd, DO to Hoisington's outreach specialty clinic twice each month.CBH partnered with Wichita Surgical Specialist bringing the cardio-thoracic services of Dr. Brett Grizzell, MD, to CBH's Surgical Services location in Great Bend Kansas once a month. CBH actively sought to provide affordable access to highly-specialized healthcare. Services included Nuclear Medicine Stress Testing, Cardiac Rehab , and Pulmonary Rehab.CBH provided substantially discounted Lab Fairs on three occasions in 2014. During these lab fairs CBH also offered blood pressure checks. The lab tests that were offered are CMP, CBC, Lipid Profile, HgbA1C, TSH, PSA and Vitamin D.CBH participated in the CMS Quality Core Measures monitoring cardiac services provided for in the Emergency Room Department.CBH in collaboration with Ellis County Extension Agent, and Barton County Extension Agent hosted an educational seminar entitled "Seafood at its Best". The seminar provided education on how seafood can be an important part of a healthy diet and has Omega-3 fats that help support a healthy heart, nervous system and reduce cancer risks. It included tip for selecting, preparing, and cooking seafood.3. Economic Development (Advocacy)CBH actively sought additional health care services in attempt to bring advanced medicine and specialized services to Hoisington and surrounding communities.CBH was the second largest employer in Hoisington in 2014 with 191 total employees. An average of about half of the total employee reside in Hoisington. When applying the economic multiplier of .34, the total employment impact in Barton County and surrounding communities are 255 jobs. CBH was an active member of and supported the ongoing efforts of City of Hoisington, Hoisington and Great Bend Chambers of Commerce.5. Teen Pregnancy RateCBH and clinics worked closely with Barton County Health Department and refers most patient inquiries to them for servicesCBMC providers offered birth control counseling to all patients seeking birth control, including teens.6. Access to Care (Underinsured)CBH operated Rural Health Clinics in Hoisington and Russell, Kansas. RHC's provide improved access to primary care in underserved rural areas.CBMC & Russell Family Medical Care (RFMC) offered a Sliding Fee Scale for patient with incomes equal to or less than 300% of the Federal Poverty Guideline.Prescription Assistance in the form of Medication Samples and Prescription Discount Cards were available on a non-emergent basis.CBH offered 24/7 emergency care services. Providers were on-call 24/7. CBH & Clinics pursued and integrated Electronic Medical Records. This allowed better coordination of care among providers and access to records. 7. Diabetic EducationConsultations with a Registered Dietician were available by appointment to the community.Consultations with Diabetic Educators providing education on diet, exercise were available to CBMC patients on a bi-monthly basis. CBMC participated in the Chronic Disease Electronic Management System (CDEMS) as part of the Kansas Quality of Care Project through the Kansas Department of Health and Environment (KDHE) in an effort to help track and monitor diabetes.8. Awareness of ServicesCBH used its limited resources to fund marketing efforts regarding our patient care services. 2014 Marketing/Advertising was ongoing in Television, Radio and Newspaper advertisements.Clara Barton Hospital's Board of Directors, Hospital Leadership, Physicians and staff participated in numerous Community Activities including:Health FairsLadies Night Out"Chamber Coffee'sUSD 431 Sports and Scholarship Activities9. Behavioral / Substance AbuseCBH & Clinics partnered with Hutchinson Clinic to bring Physical Medicine/Pain Management services to Hoisington for patients with chronic pain.CBH & Clinics partnered with Hays Medical Center's Psychiatric Associates Clinic where primary focus is on psychiatric evaluations, medication management, individual and family therapy.CBH collaborated relationships with The Center for Counseling & Consultation in Great Bend to identify ways to work together to provide better access for patients.CBH distributed educational materials on tobacco, drug, and alcohol abuse during an annual Hoisington Middle School Sixth Grade Health Fair.10. Health Care Transport (out of county)The need for health care transport was not addressed during 2014. Due to limited resources CBH did not have the ability to fund an additional transportation service, but continued to monitor and remain in collaboration with the community.There is a local transportation van accessible to the community for healthcare, shopping, and personal transportation needs. However, it did not provide out of county transportation in 2014. Clara Barton Hospital Association, Inc. Part V, Section B, Line 20e: Clara Barton Hospital Association, Inc., notified all uninsured patients about the Hospital's charity care program by letter. Clara Barton Hospital Association, Inc. Part V, Section B, Line 22d: Maximum amounts that can be charged were determined by calculating the amounts generally billed (AGB). AGB is calculated based on the look back method for Medicare and commercial payors. Part V, Section B, Line 16 Financial Assistance Policy Website Availability Clara Barton Hospital Association, Inc. Part V, Section B, line 16a website: www.clarabartonhospital.org Clara Barton Hospital Association, Inc. Part V, Section B, line 16b website: www.clarabartonhospital.org Clara Barton Hospital Association, Inc. Part V, Section B, line 16c website: www.clarabartonhospital.org 5 Clara Barton Medical Clinic 252 W 9th Street Hoisington KS 67544 Rural health clinic Clara Barton Surgical & Specialty Clinic 351 W 10th Street Hoisington KS 67544 Physician clinic Russell Family Medical Care 410 N Main Street Suite C Russell KS 67665 Rural health clinic Clara Barton Orthopedic Clinic 352 W 10th Street Hoisington KS 67544 Physician clinic Clara Barton Hospital Surgical Clinic 1301 Jackson Street Great Bend KS 67530 Physician clinic Part I, Line 7: Financial assistance at cost was determined by utilizing departmental cost-to-charge ratios for financial assistance provided in areas that are reported as subsidized health services. An overall cost-to-charge ratio derived from Worksheet 2 was used to determine the cost of financial assistance provided for services not reported as subsidized health services.Unreimbursed Medicaid costs were also determined using a blend of cost-to-charge ratios for certain services and an overall cost-to-charge ratio derived from Worksheet 2 for all other services.The cost of providing subsidized health services was determined using a cost-to-charge ratio for each service.Actual costs and revenues were utilized for all other items reported on line 7. Part I, Line 7g: Subsidized health services are comprised of services that the Hospital provides despite a financial loss to the organization. These services include the operation of a 24-hour emergency room. Part III, Line 4: The Hospital recognizes patient service revenue associated with services provided to patients who have third-party payor coverage on the basis of contractual rates for the services rendered. For uninsured patients that do not qualify for charity care, the Hospital recognizes revenue on the basis of its standard rates for services provided. On the basis of historical experience, a significant portion of the Hospital's uninsured patients will be unable or unwilling to pay for the services provided. Thus, the Hospital records a significant provision for bad debts related to uninsured patients in the period the services are provided.Part III, Line 2:Bad debt expense at cost was determined by utilizing departmental cost-to-charge ratios for financial assistance provided in areas that are reported as subsidized health services. An overall cost-to-charge ratio derived from Worksheet 2 was applied to the charges deemed uncollectible during the year for all other services.Part III, Line 3:Bad debt expense attributable to patients eligible under the organization's financial assistance policy was determined using an estimated 10% of total bad debts. The Hospital takes steps to assist individuals who are believed to qualify for financial assistance prior to writing accounts off as uncollectible.All non-reimbursed costs for treatment of patients in our community provides a community benefit since patients unwilling or unable to pay have received a valuable service at no cost or at a reduced cost to them. This improves the health of our community as a whole. Part III, Line 8: Medicare allowable costs were determined by using amounts from the Hospital's Medicare cost report as filed with the Medicare Administrative Contractor. The Medicare cost report apportions actual costs to the Medicare program using charges for ancillary services and patient days for nursing services. Caring for Medicare patients fulfills a community need and relieves a government burden as these patients typically have low or fixed income. Medicare does not provide sufficient reimbursement to cover the cost of providing care for these patients as a result any shortfall should be included as a community benefit. Part III, Line 9b: The collection 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 the patient's 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: The Hospital works closely with the Barton County Health Department and Kansas Department of Health and Environment to identify trends in the community. Education and information is provided to the public. For example information on West Nile, chicken pox, and whooping cough. The Hospital also trends data in the hospital and clinics to identify emerging issues. The Hospital has provided, a fall prevention program, "Stepping "On," for interested elderly members of Hoisington and surrounding areas. The Hospital also trends trauma data in the emergency room and as a result provided literature to the public on fall prevention. "Lights Out" stroke education was provided to the public at football games in Hoisington and Claflin in the fall of 2014. Part VI, Line 3: There is signage posted at admissions desk. Patients are referred to a financial counselor at admission if they do not have insurance. The financial counselor also works with a Medicaid helper to try and get qualified patients register for the Medicaid program. Effort is made during billing of deductible and co-payment to see if patient can qualify for charity care. Part VI, Line 4: The community being served is located in central Kansas and consists of approximately 2,800 residents. The average household income is $32,993. 15.4% of the community residents live below federal poverty level, and 4.7% of the community residents live below 50% of the federal poverty level. Neighboring hospitals include facilities in Ellinwood and Great Bend. They are approximately 18 and 11 miles away respectively. Part VI, Line 5: The Hospital's Board of Directors is elected from the community at large. This allows independent individuals who reside in the primary service area to serve as a director. The Hospital also extends medical staff privileges to all qualified physicians in the community. Any surplus in funds is retained by the Hospital and aids in improving overall patient care and facility maintenance. X X X 0 0 0 0 0 0 0 0 0 Curt J Colson President/CEO 142653 0 0 0 0 0 4281 0 30215 0 177149 0 0 0 Nathaniel Knackstedt Director/Chief of Staff 213090 0 19428 0 0 0 6376 0 30451 0 269345 0 0 0 Robin Durrett Physician 498323 0 31203 0 0 0 7800 0 30436 0 567762 0 0 0 Timothy Webb Physician 308951 0 34063 0 0 0 7800 0 20447 0 371261 0 0 0 Phillip Barnes Physician Assistant 107418 0 14302 0 0 0 0 0 29952 0 151672 0 0 0 Abelardo Sotelo Physician 378554 0 0 0 0 0 6936 0 13119 0 398609 0 0 0 A Hoisington Public Building Commission 471454939 43466QAG4 2014-08-06 2487003 Refund outstanding bonds issued on 12/19/2000, 2/27/2003 and 3/23/2006 0 0 0 A 2487076 24050 2462953 2006 1 0 1 1 A 0 0 0 0 0 0 0 A 0 0 0 1 0 0 0 0 0 A 0 Date Rebate Computation Performed Issuer Name: Hoisington Public Building Commission Date the Rebate Computation was Performed: 08/06/2014 Schedule K, Part II, Line 3, Total proceeds of issue The difference between Part II, Line 3 and Part I, Column (e) represent year-to-date investment earnings on bond proceeds. Anita Blackwell Spouse of James G. Blackwell, current officer 51233 Employment arrangement 0 Cardinal Pharmacy 100% owned by Marla Mooney, current officer 169880 Dispensing fees remitted in accordance with 340B drug program agreement 0 Form 990, Part VI, Section A, line 6 Members of Clara Barton Hospital Foundation, Inc., are automatically members of Clara Barton Hospital Association, Inc. Form 990, Part VI, Section A, line 7a Members of Clara Barton Hospital Association, Inc., elect members of the governing body. Form 990, Part VI, Section B, line 11 Form 990 provided to governing body and reviewed prior to filing. Form 990, Part VI, Section B, line 12c A conflict of interest disclosure form is provided to each Board Member and is reviewed annually. Form 990, Part VI, Section B, line 15a The organization uses the KHA Salary Survey as a guide for determining CEO compensation with Board of Directors approval. The KHA Salary Survey is used by the CEO when determining compensation for other officers and key employees. 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 written request. Form 990, Part XI, line 9: Change in beneficial interest in Foundation net of transfers -87,519. Clara Barton Hospital Foundation Inc PO Box 25 Hoisington KS 67544 481077460 Provide support to Clara Barton Hospital KS 501(c)(3) Line 7 N/A 0 0 1 1 0 0 0 0 0 0 0 0 1 0 1 1 0 1 0 0