2014-11-17T09:03:52-06:00 2013-12-31 BKD LLP 1201 Walnut Suite 1700 Kansas City MO 641062246 990 2013-01-01 481155548 MIAMI COUNTY MEDICAL CENTER INC % TIERNEY L GRASSER MIAM 9137914461 2100 BAPTISTE DRIVE Suite PAOLA KS 66071 TIERNEY L GRASSER SENIOR VP/FINANCE 9137914461 2014-11-15 true Michael J Engle P00482834 9137914461 2013 2015-11-30 17:44:51Z TIERNEY L GRASSER 20333 W 151ST STREET OLATHE KS 66061 20990247 false X WWW.OLATHEHEALTH.ORG X 1994 KS TO IMPROVE THE HEALTH OF ALL INDIVIDUALS IN THE COMMUNITIES WE SERVE BY PROVIDING COMPASSIONATE, QUALITY HEALTHCARE IN AN ENVIRONMENT OF TRUST AND COLLABORATION. 5 5 173 25 0 0 10603 12681 20973770 19722005 937486 1047538 61372 35184 21983231 20817408 203416 50874 0 0 9527171 9399234 0 0 0 10244313 9822944 19974900 19273052 2008331 1544356 47588359 54395788 6897391 6263791 40690968 48131997 X MIAMI COUNTY MEDICAL CENTER, INC. IS FOCUSED ON IMPROVING THE HEALTH OF ALL INDIVIDUALS IN THE COMMUNITIES WE SERVE BY PROVIDING COMPASSIONATE, QUALITY HEALTHCARE IN AN ENVIRONMENT OF TRUST AND COLLABORATION. false false 15297246 50874 19722005 SEE SCHEDULE O 15297246 true true false true false false false false false true true true false false true false false true false false false false false false false false true true true true true true false false false false false false false false true false false false false false false true true true false false true 26 0 true 173 true false false false false false false false false false false X 5 5 true false false false true true true true true false false true true true true true true true true false KS X X TIERNEY L GRASSER 9137914461 20333 W 151ST STREET OLATHE KS 66061 JACK TINNEL TRUSTEE/CHAIRPERSON 2.0 1.0 X X 0 0 0 DENISE GERMAN TRUSTEE/VICE CHAIRPERSON 1.0 X X 0 0 0 STEVE MILLER TRUSTEE/SECRETARY/TREASURER 1.0 X X 0 0 0 JOE MORELAND TRUSTEE 1.0 X 0 0 0 CHIP WOOD TRUSTEE 1.0 5.0 X 0 0 0 FRANK H DEVOCELLE PRESIDENT/CEO 7.0 41.0 X 0 935868 14626 TIERNEY L GRASSER SENIOR VP/FINANCE 9.0 39.0 X 0 427839 117071 GERALD WIESNER VICE PRESIDENT/OPERATIONS 40.0 X 242850 0 3872 CHERYL L ROSS ASSISTANT SECRETARY 2.0 43.0 X 0 115872 11338 PAUL W LUCE VICE PRESIDENT/OPERATIONS 45.0 X 132337 0 17627 STACEY GRAY PHARMACY DIRECTOR 45.0 X 121862 0 7237 TERESA LEVIN NURSE MANAGER- SURGERY 45.0 X 98419 0 2500 595468 1479579 174271 3 false true false SW KS EMERGENCY PHYSICIANS LLP ER PHYSICIAN SERVICE 849654 SHARED MEDICAL SERVICES MRI SERVICES 196022 EMERGENCY MEDICINE CARE ER PHYSICIAN SERVICE 280000 P1 GROUP INC HVAC SERVICE 109067 DE MINT ANESTHESIA ANESTHESIA SERVICES 250665 5 12146 535 12681 Net Patient Service Revenue 900099 18251005 18251005 EMR REVENUE 900099 1471000 1471000 19722005 1043852 1043852 0 0 82386 165525 -83139 0 -83139 -83139 11000 7314 3686 3686 3686 0 0 0 PURCHASE DISCOUNTS 900099 16194 16194 Cafeteria 722210 22194 22194 All Other Misc Revenue 900099 79935 79935 79935 79935 118323 20817408 19722005 1082722 45624 45624 5250 5250 0 0 396687 301069 95618 43209 32794 10415 7367541 5591658 1775883 145685 110569 35116 958575 727519 231056 487537 370020 117517 0 33383 33383 36067 36067 4481 4481 0 16802 16802 3468048 2934586 533462 0 103159 103159 773269 187294 585975 0 0 390369 330623 59746 20444 4193 16251 0 0 205873 175187 30686 0 971236 826469 144767 128647 109472 19175 Bad Debt Expense 1890488 1890488 Medical Supplies 1520489 1520489 Medicaid Assessment 71942 71942 Dues & Subscriptions 42705 14881 27824 145542 47119 98423 19273052 15297246 3975806 0 1509325 1411355 0 0 0 0 3515792 2726245 0 0 0 0 0 0 720301 780833 220385 291512 23223371 17822364 5375936 5401007 32236046 39198750 3418953 4078795 0 0 0 0 591621 507291 47588359 54395788 1868803 1626810 0 0 0 0 4638366 4343945 0 0 0 0 0 0 0 0 390222 293036 6897391 6263791 X 40674545 48112844 16423 19153 0 0 40690968 48131997 47588359 54395788 X 1544356 5893943 2730 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false true 4481 false false 4481 false 34895600 681000 6961043 17730 42519913 29762822 670994 4469234 7450 34895600 29909183 401968 -522248 26081 29762822 24241897 2406369 3273465 12548 29909183 15324746 3571697 5368894 23440 24241897 0.99990 0.00010 false false 1475439 1475439 10250025 9086266 1163759 10885293 8335632 2549661 612614 400466 212148 5401007 INVESTMENT IN SSGA 4078795 F 4078795 0 DUE TO AFFILIATES 293036 293036 327776108 5893943 302972047 308865990 18910118 16802 1890488 1907290 20817408 263791820 246426058 246426058 17365762 16802 1890488 1907290 19273052 SCHEDULE D, PART V, LINE 4 THE ENDOWMENT FUNDS ARE HELD FOR FUTURE CAPITAL AND EXPANSION NEEDS. IN ADDITION, THE FUNDS ALSO REPRESENT RESERVES FOR OPERATING NEEDS TO REMAIN FINANCIALLY STABLE. SCHEDULE D, PART X, LINE 2 MANAGEMENT HAS EVALUATED THEIR INCOME TAX POSITIONS UNDER THE GUIDANCE INCLUDED IN ASC 740. BASED ON THEIR REVIEW, MANAGEMENT HAS NOT IDENTIFIED ANY MATERIAL UNCERTAIN TAX POSITIONS TO BE RECORDED OR DISCLOSED IN THE FINANCIAL STATEMENTS. SCHEDULE D, PART XI, LINES 2D & 4B LINE 2D: RELATED ORGANIZATIONS' REVENUE $302,806,522 RENTAL EXPENSES $ 165,525 ------------ TOTAL $302,972,047 LINE 4B: BAD DEBT EXPENSE $ 1,890,448 SCHEDULE D, PART XII, LINES 2D & 4B LINE 2D: RELATED ORGANIZATIONS' EXPENSES $246,260,533 RENTAL EXPENSES $ 165,525 ------------ TOTAL $246,426,058 LINE 4B: BAD DEBT EXPENSE $ 1,890,488 true true X false true X true true true false true true 2277 1008 759662 759662 0.04370 5892 1739 1931466 805719 1125747 0.06480 8169 2747 2691128 805719 1885409 0.10850 5 607 6887 6887 0.00040 5 32 54662 54662 0.00310 7 28656 28656 0.00160 17 639 90205 90205 0.00510 8186 3386 2781333 805719 1975614 0.11360 2 4552 4552 0.00030 2 4552 4552 0.00030 true 643688 5238693 7419007 -2180314 X true true 1 1 MIAMI COUNTY MEDICAL CENTER INC 2100 BAPTISTE DRIVE PAOLA KS 66071 X X X MIAMI COUNTY MEDICAL CENTER 1 true X X X X X X X X 13 true false true X WWW.OLATHEHEALTH.ORG X X X X X X X X X true false true false true 200. true X X X X X X X X true true X X X X X X true false X X X X true X false false SCHEDULE H, PART V, SECTION B, LINE 3 AS PART OF THE COMMUNITY HEALTH NEEDS ASSESSMENT, MIAMI COUNTY MEDICAL CENTER CONDUCTED A TOWN HALL MEETING ON THURSDAY, NOVEMBER 1, 2012. THE COMMUNITY MEMBERS INVITED TO THIS TOWN HALL REPRESENT THE BROAD INTERESTS OF THE COMMUNITY SERVED BY THE HOSPITAL FACILITY, INCLUDING INDIVIDUALS WITH SPECIAL KNOWLEDGE AND EXPERTISE IN PUBLIC HEALTH. THIS INCLUDES PEOPLE REPRESENTING THE FOLLOWING GROUPS: LOCAL HOSPITAL, PUBLIC HEALTH COMMUNITY, MENTAL HEALTH COMMUNITY, FREE CLINICS, COMMUNITY-BASED CLINICS, SERVICE PROVIDERS, LOCAL RESIDENTS, COMMUNITY LEADERS, OPINIONLEADERS, 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. SECTION V OF THE CHNA PROVIDES A LIST OF THE TOWN HALL ATTENDEES AND NOTES FROM THE MEETING. ALL PRIORITY-SETTING AND SCORING PROCESSES AT THE TOWN HALL MEETING INVOLVED THE INPUT OF KEY STAKEHOLDERS IN ATTENDANCE. THE MEETING INCLUDED A DISCUSSION OF COMMUNITY HEALTH DATA; REFLECTION ON SIZE AND SERIOUSNESS OF ANY HEALTH CONCERNS; AND DISCUSSION OF CURRENT COMMUNITY HEALTH STRENGTHS. PARTICIPANTS WERE THEN ASKED TO RANK THE COMMUNITY HEALTH CONCERNS CITED DURING THE MEETING AND FROM THE PRIMARY AND SECONDARY RESEARCH ALREADY COMPLETED. (PRIMARY RESEARCH SURVEY WAS CONDUCTED DURING SEPTEMBER-NOVEMBER 2012 BY ETC INSTITUTE ON BEHALF OF OLATHE HEALTH SYSTEM.) SCHEDULE H, PART V, SECTION B, LINE 7 In the fall of 2013, MCMCI developed a Community Health Improvement Plan to address the top health-need priorities that were identified through the assessment described above. THE PLAN was approved by the MCMCI Board of Trustees in October 2013. This is a three-year plan, which begins implementation in 2014. THE PLAN speaks to each health need priority, outlining MCMCI's initiative(s) to address the need and the anticipated community impact. You can read the full Community Health Needs Assessment and Community Health Improvement Plan documents on our website at olathehealth.org/community. SCHEDULE H, PART V, SECTION B, LINE 10 MIAMI COUNTY MEDICAL CENTER, INC. (MCMCI) DOES NOT OFFER FREE CARE EXCEPT IN CASE OF DEATH. IN ALL OTHER CASES WE WILL DISCOUNT UP TO 99% OF TOTAL CHARGES FOR PATIENTS AT OR BELOW THE FEDERAL POVERTY GUIDELINES. ALL PATIENTS ARE EXPECTED TO CONTRIBUTE TO THEIR CARE IN ACCORDANCE WITH THEIR ABILITY. EXTRAORDINARY MEDICAL EXPENSES THAT EXCEED 25% OF ANNUAL HOUSEHOLD INCOME, EVEN IF ANNUAL HOUSEHOLD INCOME IS MORE THAN 200% OF THE FEDERAL POVERTY GUIDELINES, MAY ALSO BE ELIGIBLE FOR A FINANCIAL HARDSHIP DISCOUNT. SCHEDULE H, PART V, SECTION B, LINE 14 MIAMI COUNTY MEDICAL CENTER PUBLICIZED THE FINANCIAL ASSISTANCE POLICY BY PUBLICIZING THE FINANCIAL ASSISTANCE PROGRAM IN THE FOLLOWING MANNER. THE FINANICAL ASSISTANCE PROGRAM WAS PUBLICIZED ON THE HOSPITAL'S WEBSITE, ON EACH PATIENT BILL AND WITH SIGNS IN REGISTRATION AREAS AND IN PATIENT FINANCIAL SERVICES. APPLICATIONS ARE GIVEN TO PATIENTS DURING REGISTRATION UPON REQUEST OR CONCERN EXPRESSED ABOUT PAYMENT. SCHEDULE H, PART V, SECTION B, LINE 16 MIAMI COUNTY MEDICAL CENTER DOES NOT PERMIT ANY OF THE ACTIONS LISTED WITHOUT MAKING A REASONABLE EFFORT TO DETERMINE THE PATIENT'S ELIGIBILITY UNDER THE FACILITY'S FINANCIAL ASSISTANCE PROGRAM. 2 LOUISBURG REHAB OF MIAMI CTY MEDICAL CTR 102 W CRESTVIEW CIRCLE LOUISBURG KS 66053 OUTPATIENT REHABILITATION CLINIC OSAWATOMIE REHAB OF MIAMI CTY MED CENTER 539 MAIN STREET OSAWATOMIE KS 66064 OUTPATIENT REHABILITATION CLINIC SCHEDULE H, PART I, LINE 3A MIAMI COUNTY MEDICAL CENTER, INC. (MCMCI) DOES NOT OFFER FREE CARE EXCEPT IN CASE OF DEATH. IN ALL OTHER CASES WE WILL DISCOUNT UP TO 99% OF TOTAL CHARGES FOR PATIENTS AT OR BELOW THE FEDERAL POVERTY GUIDELINES. ALL PATIENTS ARE EXPECTED TO CONTRIBUTE TO THEIR CARE IN ACCORDANCE WITH THEIR ABILITY. EXTRAORDINARY MEDICAL EXPENSES THAT EXCEED 25% OF ANNUAL HOUSEHOLD INCOME, EVEN IF ANNUAL HOUSEHOLD INCOME IS MORE THAN 200% OF THE FEDERAL POVERTY GUIDELINES, MAY ALSO BE ELIGIBLE FOR A FINANCIAL HARDSHIP DISCOUNT. SCHEDULE H, PART I, LINE 3C MIAMI COUNTY MEDICAL CENTER, INC. (MCMCI) OFFERS DISCOUNTED CARE TO ALL INDIVIDUALS WITHOUT INSURANCE, SIMILAR TO MANAGED CARE DISCOUNTS. MCMCI'S UNINSURED DISCOUNT APPLIES TO ALL PATIENTS WITHOUT INSURANCE, REGARDLESS OF ABILITY TO PAY, INCLUDING ALL LOW INCOME INDIVIDUALS. SCHEDULE H, PART I, LINE 7, COLUMN F THE BAD DEBT EXPENSE IS NOT CONSIDERED A COMMUNITY BENEFIT EXPENSE AND IS NOT INCLUDED IN SCHEDULE H, PART I, LINE 7. THE AMOUNT EXCLUDED IS $1,890,488. SCHEDULE H, PART I, LINE 7 THE COSTING METHODOLOGY USED TO CALCULATE THE AMOUNTS CONTAINED IN THE TABLE OF PART I, LINE 7, OF SCHEDULE H, IS A COST ACCOUNTING SYSTEM. SCHEDULE H, PART II MIAMI COUNTY MEDICAL CENTER, INC. (MCMCI) IS COMMITTED TO IMPROVING THE COMMUNITY WE SERVE. OUR EMPLOYEES ARE INVOLVED IN A VARIETY OF ACTIVITIES IN OUR COMMUNITY THAT SUPPORT THE GENERAL ECONOMIC IMPROVEMENT OF OUR COMMUNITY; THE HEALTH, WELL BEING AND SAFETY OF OUR AREA'S RESIDENTS; AS WELL AS SUPPORTING PROGRAMS AND OTHER ORGANIZATIONS THAT REACH OUT TO OUR CITIZENS IN NEED. A FEW EXAMPLES OF MCMCI'S INVOLVEMENT IN 2013 INCLUDE: 1) INVOLVEMENT IN THE MIAMI COUNTY ECONOMIC DEVELOPMENT ADVISORY BOARD AND LOCAL CIVIC ORGANIZATIONS. 2) OUR SUPPORT OF JOHNSON COUNTY HEALTH PARTNERSHIPS, A CLINIC SERVING THE UNINSURED OF OUR COMMUNITY. 3) PARTICIPATION IN COMMUNITY ORGANIZATIONS AND EVENTS THROUGH DONATIONS AND BY PROVIDING HEALTH EDUCATION AND SERVICES. SOME OF THESE GROUPS INCLUDE BOYS SCOUTS OF AMERICA, MIAMI AND LINN COUNTY FAIRS, LOCAL CHAMBERS AND ROTARY CLUBS. 4) LEADERSHIP AND PARTICIPATION IN OUR AREA'S EMERGENCY PREPAREDNESS EFFORT BY COORDINATING EXTENSIVE DRILLS TO PRACTICE OUR RESPONSE TO POTENTIAL SITUATIONS. 5) PARTICIPATION IN THE PAOLA PATHWAYS ORGANIZATION, A GROUP WHO IS DEVELOPING WALKING/BICYCLING TRAILS IN AND AROUND PAOLA, AND THE MOUND CITY TRAIL PROJECT. SCHEDULE H, PART III, SECTION A, LINE 2 THE COSTING METHODOLOGY USED TO CALCULATE THE AMOUNTS CONTAINED IN THE TABLE OF PART III, LINE 2, OF SCHEDULE H, IS A COST ACCOUNTING SYSTEM. SCHEDULE H, PART III, SECTION A, LINE 4 SEE PAGE 9 OF THE ATTACHED AUDITED FINANCIAL STATEMENTS. SCHEDULE H, PART III, SECTION B, LINE 8 Part III, Line 8 Medicare allowable costs were calculated using a cost accounting system. Shortfalls arise from payments that are less than the costs to provide the services. We accept all Medicare patients knowing that the cost of providing the care may exceed the payment we receive from the Medicare program. The shortfall should be considered community benefit as Medicare shortfalls must be absorbed by the hospital in order to continue treating the elderly in our community. IT is also implied in Internal Revenue Service ruling 69-545 that treating Medicare patients is a community benefit. Revenue ruling 69-545 established the community benefit standard for tax-exempt hospitals and indicates that participation in publicly-financed programs, such as Medicare, is evidence that a hospital meets the community benefit standard. SCHEDULE H, PART III, SECTION C, LINE 9B BEFORE PLACEMENT WITH COLLECTION AGENCIES, MCMCI PATIENT FINANCIAL SERVICES OFFERS VARIOUS OPTIONS FOR PATIENTS WITH FINANCIAL DIFFICULTIES. IN ADDITION TO OFFERING OUR OWN FINANCIAL ASSISTANCE TO QUALIFYING INDIVIDUALS, MCMCI CONTRACTS WITH AN AGENCY THAT SCREENS INDIVIDUALS FOR ELIGIBILITY FOR PROGRAMS LIKE MEDICAID, DISABILITY, AND CRIME VICTIM'S COMPENSATION AND THEN HELPS THEM THROUGH THE APPLICATION PROCESS. THE USE OF PROPENSITY TO PAY (LIKELIHOOD TO PAY) SOFTWARE ALSO HELPS MCMCI IDENTIFY INDIVIDUALS THAT MAY NEED ASSISTANCE THAT HAVE NOT COMPLETED AN APPLICATION. MCMCI HAS LANGUAGE WRITTEN IN THEIR COLLECTION AGENCY CONTRACT THAT STATES, "IF THE COLLECTION AGENCY LEARNS A PATIENT/DEBTOR HAS NEITHER SUFFICIENT INCOME NOR ASSETS TO MEET HIS FINANCIAL OBLIGATION, THE AGENCY WILL NOT PURSUE COLLECTION ACTIVITIES AGAINST THE PATIENT/DEBTOR, UNLESS OR UNTIL THE AGENCY LEARNS THAT THE PATIENT/DEBTOR HAS INCOME OR ASSETS TO MEET THE OBLIGATION." IF THE COLLECTION AGENCY IS NOTIFIED BY THE PATIENT/DEBTOR THAT THIS CREATES AN UNDUE FINANCIAL HARDSHIP OR BURDEN DUE TO A CHANGE IN THEIR INCOME OR ASSETS, THE AGENCY WILL NOTIFY MCMCI AND AWAIT FURTHER DIRECTION FROM THE HOSPITAL. SCHEDULE H, PART VI, LINE 2 Miami County Medical Center, Inc. (MCMCI) is continually assessing the health needs of the communities it serves in a variety of ways. Informally, MCMCI is involved in multiple health fairs and other community outreach activities that involve screenings, questionnaires and general conversation that help us understand the needs of groups and individuals. The MCMCI community advisory group is represented by a diverse set of individuals who provide helpful input from the organizations and communities they represent. During 2012 and 2013, MCMCI also began a more formal process of assessment. In partnership with the Miami County Department of Health, and with the help of VVV Research and Development, MCMCI conducted a community health needs assessment for its primary service area (Miami County). This was done by performing research and collecting health data for the area, and actively seeking input from the community through a survey and town hall meetings. The research, survey and town hall meetings helped develop a clearer picture of our service areas and the health priorities of residents. Below are the top three health need priorities in the primary service areas of MCMCI. Health Need Priorities- MCMCI 1. Increase access to care by making available Urgent Care and Walk-In services for residents of Miami and Linn counties 2. Increase access to affordable pharmaceuticals 3. Decrease obesity rate among residents and increase access to healthy food In the fall of 2013, MCMCI developed a Community Health Improvement Plan to address the top health-need priorities that were identified through the assessment described above. It was approved by the MCMCI Board of Trustees in October 2013. This is a three-year plan, which begins implementation in 2014. It speaks to each health need priority, outlining MCMCI's initiative(s) to address the need and the anticipated community impact. You can read the full Community Health Needs Assessment and Community Health Improvement Plan documents on our website at olathehealth.org/community. SCHEDULE H, PART VI, LINE 3 PATIENTS OF MIAMI COUNTY MEDICAL CENTER, INC. (MCMCI) ARE MADE AWARE OF ALL OPPORTUNITIES AVAILABLE FOR FINANCIAL ASSISTANCE IN A VARIETY OF WAYS. THERE ARE SIGNS IN THE REGISTRATION AREAS TO NOTIFY PATIENTS AND VISITORS OF THE AVAILABILITY OF ASSISTANCE PROGRAMS. EVERY BILLING STATEMENT CONTAINS A NOTICE OF THE AVAILABILITY OF FINANCIAL ASSISTANCE AND HOW TO OBTAIN ADDITIONAL INFORMATION OR APPLY. APPLICATIONS AND INSTRUCTIONS ARE AVAILABLE ON THE MEDICAL CENTER'S WEBSITE, IN BOTH ENGLISH AND SPANISH. PATIENT ACCESS, PATIENT FINANCIAL SERVICES AND SOCIAL WORKERS ARE TRAINED TO PROVIDE APPLICATIONS TO PATIENTS IF THEY EXPRESS ANY CONCERN REGARDING ABILITY TO PAY FOR SERVICES, OR MAY BE REFERRED TO AN AGENCY THE MEDICAL CENTER CONTRACTS WITH TO HELP INDIVIDUALS THROUGH THE APPLICATION PROCESS FOR PROGRAMS LIKE MEDICAID AND DISABILITY. PATIENTS THAT CALL OUR PATIENT FINANCIAL SERVICES DEPARTMENT EXPRESSING CONCERNS ABOUT BEING ABLE TO PAY FOR THEIR SERVICES OR EXPRESS THAT THEY ARE EXPERIENCING A FINANCIAL HARDSHIP ARE ADVISED OF OUR ASSISTANCE POLICY AND ENCOURAGED TO APPLY. SCHEDULE H, PART VI, LINE 4 Miami County Medical Center, Inc. (MCMCI) serves the people of Miami and Linn Counties in Kansas. Miami and Linn Counties are both located in rural areas of the state of Kansas and are both federally designated medically underserved areas of Kansas. MCMC is the only hospital in these two counties. However, there are several other hospitals located in nearby metropolitan areas, including Olathe and Overland Park, Kansas, and Kansas City, Missouri. In addition to the general health care services provided by the hospital and its associated physicians, MCMCI serves a diverse population of mentally disable patients. The Osawatomie State Hospital, Lake Mary Center, Medicalodge of Paola and the Tri-Ko are all organizations located in the service area. MCMCI supports each of these organizations by providing medical care to their residents. Below is a listing of economic levels for area residents. Time period: 2006 - 2010 Source: factfinder2.census.gov People Living Below Poverty Level Miami County: 9.0% Linn County: 10.1% Young Children Living Below Poverty Level Miami County: 14.5% Linn County: 12.8% Uninsured Adult Population Rate (2009) Miami County: 9.6% Linn County: 11.5% SCHEDULE H, PART VI, LINE 5 In addition to the items listed above, Miami County Medical Center takes a very active role in support of local, regional and national not-for-profit organizations with a focus on improving health and supporting those in need. MCMCI provides support financially and through volunteering time and talents to multiple area organizations. MCMCI provides athletic trainers to area school sports programs. MCMCI staff members are involved in several health fairs and/or community screenings each year. The community health fairs are organized in conjunction with a variety of other area agencies, such as: Miami County Emergency Medical Services, local school districts, county agencies and several others. SCHEDULE H, PART VI, LINE 6 MIAMI COUNTY MEDICAL CENTER IS A PART OF OLATHE HEALTH SYSTEM,INC. (OHSI) THIS CONSISTS OF TWO HOSPITALS AND A NETWORK OF 33 CLINICS. OHSI AND ITS AFFILIATES, INCLUDING MIAMI COUNTY MEDICAL CENTER, TAKE A LEADERSHIP ROLE IN PROMOTING THE HEALTH OF THE COMMUNITIES SERVED. OHSI HOSPITALS AND CLINICS ARE VERY INVOLVED WITH COMMUNITY OUTREACH EDUCATION AND SCREENING PROGRAMS ACROSS THE ENTIRE SERVICE AREA. WE COLLABORATE WITH AREA COMPANIES AND OTHER HEALTH-RELATED SERVICE PROVIDERS TO PROVIDE EDUCATION AND SCREENINGS TO THE PUBLIC. OHSI POSITIONS ITSELF AS NOT ONLY A PROVIDER OF CARE, BUT A RESOURCE FOR EDUCATION AND PREVENTION. SCHEDULE H, PART VI, LINE 7 MCMCI IS NOT REQUIRED TO FILE A COMMUNITY BENEFIT REPORT WITH THE STATE, BUT WE MAKE OUR REPORT AVAILABLE TO ANYONE INTERESTED AT WWW.OLATHEHEALTH.ORG. true PAOLA USD #368 PO BOX 268 PAOLA KS 66071 480720746 GOVERNMENT 12064 BOOK SPORTS MEDICINE CMTY WELLNESS SPRING HILL USD #230 101 E SOUTH ST SPRING HILL KS 66083 480723504 GOVERNMENT 21496 BOOK SPORTS MEDICINE CMTY WELLNESS OSAWATOMIE USD #367 1200 TROJAN DRIVE OSAWATOMIE KS 66064 GOVERNMENT 12064 BOOK SPORTS MEDICINE CMTY WELLNESS 3 SCHOLARSHIPS 7 5250 SCHEDULE I, PART I, LINE 2 SCHEDULE I, PART II MIAMI COUNTY MEDICAL CENTER, INC. PROVIDED SPORTS TRAINERS TO LOCAL HIGH SCHOOLS. SCHEDULE I, PART III FOR ALL SCHOLARSHIPS, THE ORGANIZATION CAREFULLY SELECTS THE RECIPIENTS OF THE FUNDS AND A CHECK IS WRITTEN DIRECTLY TO THE ORGANIZATION OR INDIVIDUAL. X true true true true false false false false false false false FRANK H DEVOCELLE PRESIDENT/CEO 0 737614 0 160010 0 38243 0 0 0 14626 0 950494 0 0 TIERNEY L GRASSER SENIOR VP/FINANCE 0 334671 0 63891 0 29277 0 97325 0 19746 0 544910 0 16662 GERALD WIESNER VICE PRESIDENT/OPERATIONS 89251 0 0 0 153600 0 0 0 3872 0 246722 0 0 0 SCHEDULE J, PART I, LINE 1A SOCIAL CLUB DUES WERE PAID BY THE HOSPITAL FOR GERALD WIESNER AND WERE INCLUDED IN HIS W-2 AS TAXABLE COMPENSATION. FORM 990, PART VII; SCHEDULE J, PART I, LINE 3 AND PART II THE COMPENSATION REPORTED FOR GERALD WIESNER AND PAUL LUCE WAS REVIEWED AND APPROVED BY THE COMPENSATION COMMITTEE OF THE BOARD OF OLATHE MEDICAL CENTER, INC. THE SOLE MEMBER OF MIAMI COUNTY MEDICAL CENTER INC. THE COMPENSATION COMMITTEE IS COMPRISED OF INDEPENDENT BOARD MEMBERS, WHICH INCLUDES A BOARD MEMBER FROM MIAMI COUNTY MEDICAL CENTER, INC. THE COMMITTEE UTILIZED AN INDEPENDENT COMPENSATION CONSULTANT AND THIRD PARTY SALARY SURVEYS IN THE ESTABLISHMENT OF MR. WIESNER'S AND MR. LUCE'S COMPENSATION. FORM 990, PART VII; SCHEDULE J, PART I, LINE 3 AND PART II THE COMPENSATION BEING REPORTED FOR FRANK H DEVOCELLE AND TIERNEY L GRASSER IS FROM OLATHE MEDICAL CENTER, INC., A RELATED TAX EXEMPT ORGANIZATION AND THE SOLE MEMBER OF MIAMI COUNTY MEDICAL CENTER, INC. OLATHE MEDICAL CENTER, INC. USES A COMPENSATION COMMITTEE COMPRISED OF INDEPENDENT BOARD MEMBERS TO ESTABLISH COMPENSATION AND BENEFITS FOR ALL OFFICERS OF OLATHE MEDICAL CENTER, INC. AND ITS AFFILIATED CORPORATIONS. THE COMPENSATION COMMITTEE APPROVES AND ESTABLISHES ALL COMPENSATION AND BENEFITS FOR OFFICERS OF OLATHE MEDICAL CENTER, INC. AND ITS AFFILIATED COMPANIES. THE COMMITTEE UTILIZED AN INDEPENDENT COMPENSATION CONSULTANT, A WRITTEN CONTRACT FOR THE CEO AND COMPENSATION SURVEYS TO ESTABLISH FAIR MARKET VALUE SALARIES AND BENEFITS FOR OLATHE MEDICAL CENTER, INC. AND ITS AFFILIATES' OFFICERS. SCHEDULE J, PART I, LINE 4B & PART II THE COMPENSATION REPORTED FOR GERALD WIESNER INCLUDES A $148,998 SEVERANCE PAYMENT. SCHEDULE J, PART I, LINE 4B & PART II A SERP IS PROVIDED TO TIERNEY L GRASSER, SENIOR VICE PRESIDENT/FINANCE WHICH IS FUNDED OVER A SHORT TIME PERIOD BASED UPON THE IMPLEMENTATION DATE OF THE SERP IN 2005. MS. GRASSER'S CAREER SERVICE AT OLATHE MEDICAL CENTER, INC. AND ITS AFFILIATED ENTITIES IS CURRENTLY AT 25 YEARS, MOST OF WHICH DID NOT INCLUDE FUNDING FOR THE SERP BENEFIT. A MAJORITY OF THE DEFERRED COMPENSATION IS DUE TO FUNDING OF THE SERP BENEFIT FOR PRIOR YEARS OF SERVICE. IN 2013, THERE WAS A PAYOUT OF $19,932 AND AN ACCRUAL OF $97,325. A CITY OF OLATHE KANSAS 486034756 679390GX6 2008-02-27 5311403 SEE PART VI false false false A 930000 0 5311403 0 0 0 22312 0 0 0 5289091 0 2008 true false true true A false false true true false 0 false false false true A false true false false 0 false 0 false true A true SCHEDULE K, PART I, LINE A, COLUMN E THE ISSUE PRICE OF THE ENTIRE ISSUE IS $29,451,544. A PORTION OF THE ISSUE PRICE, EQUAL TO $24,140,141 IS ALLOCABLE TO OLATHE MEDICAL CENTER, INC. THE REMAINDER OF THE ISSUE PRICE, EQUAL TO $5,311,403, IS ALLOCABLE TO MIAMI COUNTY MEDICAL CENTER, INC., WHICH IS CONTROLLED BY OLATHE MEDICAL CENTER, INC., ITS SOLE MEMBER. SCHEDULE K, PART I, LINE A, COLUMN F REFUND SERIES 2004A BONDS ISSUED 07/29/2004 AND REFUND SERIES 2004B BONDS ISSUED 07/29/2004. HEIDI HANSON DAUGHTER OF PRESIDENT 43209 SALARY false SCHEDULE L, PART IV HEIDI HANSON IS THE DAUGHTER OF FRANK H DEVOCELLE, AN OFFICER OF MCMCI HEIDI HANSON IS AN EMPLOYEE OF MCMCI. FORM 990, PART III, LINE 4A Miami County Medical Center, Inc. operates an acute care hospital in Paola, Kansas. Miami County Medical Center, Inc. carries out its mission by providing quality and compassionate inpatient, outpatient, and emergency care services to residents in Miami County, Kansas and surrounding area. Miami County Medical Center, Inc. is a Joint Commission accredited hospital and is licensed for 39 beds and currently staffs 18 inpatient beds. Program services expenses are all related to the provision of healthcare services. In 2013, Miami County Medical Center, Inc. provided 1,042 days of inpatient care, provided 51,764 outpatient procedures, and 9,512 emergency visits to the community. Educational Support In addition to providing uncompensated care for patients in need, the Medical Center provides other health care related benefits to the communities it serves by providing 24-hour emergency rooms open every day to the public regardless of ability to pay. The Medical Center also provides education for a variety of medical professionals, health care screenings and education programs for the general public and support group sponsorships. Sports Net Miami County Medical Center provides Athletic Training staff for area high schools and junior high schools during the school year through its Sports Net program. In 2013, $45,624 of Athletic Trainer services was provided to the schools in the Medical Center's service area. Contributions Miami County Medical Center supports a variety of social, education, and civic healthcare related organizations within its service area. In 2013, $26,654 was contributed to various agencies and charitable organizations and $5,250 in scholarships. FORM 990, PART VI, SECTION A, LINE 2 FRANK H DEVOCELLE AND TIERNEY L GRASSER HAVE A BUSINESS RELATIONSHIP WITH EACH OTHER. THEY SERVE AS AN OFFICER OR DIRECTOR FOR OLATHE HEALTH DEVELOPMENT CORPORATION OR OLATHE MEDICAL CENTER DOCTOR'S BUILDING CONDOMINIUM OWNERS ASSOCIATION, WHICH ARE RELATED FOR PROFIT COMPANIES. CHIP WOOD, FRANK H DEVOCELLE, TIERNEY L GRASSER, AND CHERYL L ROSS HAVE BUSINESS RELATIONSHIPS. FORM 990, PART VI, SECTION A, LINE 6 OLATHE MEDICAL CENTER, INC., A NOT-FOR-PROFIT, 501(C)(3) ORGANIZATION, IS THE SOLE MEMBER OF MIAMI COUNTY MEDICAL CENTER, INC. FORM 990, PART VI, SECTION A, LINE 7A OLATHE MEDICAL CENTER, INC. BEING THE SOLE MEMBER OF MIAMI COUNTY MEDICAL CENTER, INC. HAS THE RIGHT TO ELECT ALL THE BOARD OF TRUSTEES. FORM 990, PART VI, SECTION A, LINE 7B OLATHE MEDICAL CENTER, INC. IS THE SOLE MEMBER, AND HAS THE RIGHTS TO APPROVE MIAMI COUNTY MEDICAL CENTER, INC.'S BYLAWS AND ARTICLES OF INCORPORATION AND ALSO APPROVE MIAMI COUNTY MEDICAL CENTER'S BOARD MEMBERS AND CERTAIN CAPITAL EXPENDITURES. FORM 990, PART VI, SECTION B, LINE 11B The tax return form 990 is reviewed by the Audit and compliance Committee of the Olathe Medical Center, Inc. (Miami County Medical Center's sole member) board on behalf of all of its affiliates prior to filing the return with the Internal Revenue Service. The Audit & Compliance Committee is comprised of independent Board members of Olathe Medical Center, Inc. The final form 990 with all required schedules is then provided to all board members for review prior to filing the form 990. FORM 990, PART VI, SECTION B, LINE 12C The purpose of the Organization's Conflict of Interest Policy is to protect the organization's interest when it is contemplating a decision or entering into a transaction or arrangement that might benefit the private interest of any person in a position of authority over the organization, or might result in a possible excess benefit transaction. Corporate officers and members of the Board of Trustees review the Conflict of Interest Policy and complete a Disclosure of Information Form annually. A summary of the annual disclosures of information is provided to the full Board for review at least one time per year. The conflict of interest policy calls for any interested person to disclose the existence of a financial relationship or competitive interest in connection with any pending transaction or arrangement. The individual is given the opportunity to disclose all material facts to the Trustees considering the proposed transaction or arrangement that gave rise to the disclosure. When a transaction involves an interested party, the following procedures are followed: 1. The interested party leaves the meeting after providing any material facts or discussion regarding the matter that gives rise to the interest unless requested to stay by the remaining board or committee members. 2. If appropriate, the Board may appoint a non-interested person or committee to investigate alternatives to the proposed transaction; 3. The interested trustee may not vote in the matter that gives rise to the interest. 4. In order to approve the transaction, the Board must first find, by a majority vote of the trustees then in office, without counting the vote of the interested trustee, a. That the proposed transaction is in the Organization's best interests and for its own benefit, and b. That, after reasonable investigation, the board has determined that the organization cannot obtain a more advantageous transaction with reasonable efforts under the circumstances. FORM 990, PART VI, SECTION B, LINES 15A & B The compensation committee of the Olathe Medical Center, Inc. board, which is comprised of independent members of the board of Olathe Medical Center, Inc. and its affiliates, including a Miami County Medical Center, Inc. board member, reviews and approves the CEO and other officers and key employees of the corporation's compensation in accordance with their compensation policy. The compensation committee reviews third party salary surveys, uses independent consultants, and also utilizes written contracts for the ceo to determine the fair market value of the current compensation, salary ranges and benefits. Compensation for such officers is approved by the committee and information of their findings is available to all board members at their request. FORM 990, PART VI, SECTION C, LINE 18 THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE NOT AVAILABLE TO THE PUBLIC. FORM 990, PART XI, LINE 5 CHANGE IN TEMPORARILY RESTRICTED NET ASSETS $2,730 FORM 990 PART IX LINE 11G DESCRIPTION:MEDICAL PROFESSIONAL FEES TOTAL FEES:1934067 FORM 990 PART IX LINE 11G DESCRIPTION:OTHER CONTRACT SERVICES TOTAL FEES:1533981 OLATHE MEDICAL CENTER INC 20333 W 151ST ST OLATHE KS 66061 480577664 HOSPITAL KS 501(C)(3) 3 OHSI true OLATHE HEALTH SYSTEM INC 20333 W 151ST ST OLATHE KS 66061 480979845 SUPPORT ORG KS 501(C)(3) 11B NA false OLATHE MEDICAL SERVICES INC 20333 W 151ST ST OLATHE KS 66061 481088982 CLINICS KS 501(C)(3) 9 OMCI true OLATHE MEDICAL CENTER CHARITABLE FDN 20333 W 151ST ST OLATHE KS 66061 481136010 FUNDRAISING KS 501(C)(3) 7 OMCI true OMC DOCTOR'S BLDG CONDO OWNERS ASSOC INC 20333 W 151ST ST OLATHE KS 66061 481244766 REAL ESTATE KS OMCI C CORPORATION true OLATHE HEALTH DEVELOPMENT CORPORATION 20333 W 151ST ST OLATHE KS 66061 363445097 MEDICAL SERVI KS OHSI C CORPORATION true false false false false false false false false false false false false true true true true true false false OLATHE MEDICAL SERVICES INC N 82396 COST OLATHE MEDICAL SERVICES INC Q 67213 COST OLATHE MEDICAL CENTER INC M 168235 COST OLATHE MEDICAL CENTER INC N 345431 COST OLATHE MEDICAL CENTER INC O 2747364 COST OLATHE MEDICAL CENTER INC Q 3346543 COST