2013-01-31T11:41:33-06:00 2012-09-30 BKD LLP 1201 Walnut Suite 1700 Kansas City MO 641062246 990 2011-10-01 480545183 LINDSBORG COMMUNITY HOSPITAL % LARAINE GENGLER LIND 7852273308 605 WEST LINCOLN LINDSBORG KS 674562328 LARRY VAN DER WEGE 2013-02-15 true Michael J Engle 8162216300 2011 2016-02-25 16:41:14Z LARRY VAN DER WEGE 605 WEST LINCOLN LINDSBORG KS 674562328 6778723 false 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. 7 7 103 7 0 0 127161 185745 5774736 6531961 30284 19812 29503 41205 5961684 6778723 0 775 0 0 3289569 3862872 0 0 0 2692590 2931997 5982159 6795644 -20475 -16921 3875592 4187233 1749534 2437503 2126058 1749730 X SEE SCHEDULE O false false 4498877 0 6531961 SEE SCHEDULE O 4498877 true true false true false false false false false true false false false false true false true false false false false false false false false true true false false false false false false false false false false false false false false false false true false false false false true 12 0 true 103 true false false false false false false false false false false X 7 7 true false false false true true true true true false false true true true true true true true false false KS X LARAINE GENGLER 7852273308 605 WEST LINCOLN LINDSBORG KS 674562328 X JUDY BURCH 1.0 X X JUDY MURPHY 1.0 X X VIRGINIA SWISHER 1.0 X X DAVE SCHRAG 1.0 X JOEL WOODARD 1.0 X X CARLA SCOTT 1.0 X TOM BUFFINGTON 1.0 X LARAINE GENGLER 36.0 X 83299 0 3391 LARRY VAN DER WEGE 30.0 X 85790 0 3430 169089 0 6821 0 false false false 0 7161 178584 185745 NET PATIENT SERVICE REVENUES 621400 6531961 6531961 6531961 19812 19812 0 0 0 0 0 0 EMPLOYEE/GUEST MEALS 721000 35115 35115 WELLNESS CENTER 900099 6090 6090 41205 6778723 6531961 61017 0 775 775 0 0 181113 126779 54334 0 3064531 1781264 1283267 114953 91809 23144 282611 225711 56900 219664 175437 44227 0 35748 35748 61124 61124 0 0 0 1100357 632440 467917 419 419 882290 769936 112354 0 0 112775 88609 24166 14275 5816 8459 0 0 50265 40145 10120 0 246506 196875 49631 45284 36494 8790 EQUIPMENT RENTAL & MAINT 152267 130479 21788 DUES & SUBSCRIPTIONS 27864 10105 17759 MINOR EQUIPMENT 45337 28298 17039 BAD DEBT EXPENSE 157486 157486 6795644 4498877 2296767 0 122919 76677 646049 560985 0 0 689747 819278 0 0 0 0 0 0 151717 153484 37756 47311 7234501 5136615 1307755 2097886 312068 225314 0 0 0 0 0 0 607581 206298 3875592 4187233 555016 702534 0 0 0 0 0 0 0 0 0 0 1194518 1084304 0 650665 0 0 1749534 2437503 X 1849515 1487778 276543 261952 0 0 2126058 1749730 3875592 4187233 X -16921 -359407 X false true true X false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false true 1685 false false false 1685 false 10442 10442 2307063 1501273 805790 4009075 3384808 624267 907921 250534 657387 2097886 0 0 6778723 6795644 -16921 38438 -397845 -359407 -376328 7479236 38438 662075 700513 6778723 6778723 7675348 879704 879704 6795644 6795644 FIN 48 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. RECONCILIATION OF CHANGE IN NET ASSETS SCHEDULE D, PART XI, LINE 8 TRANSFER TO AFFILIATE $(397,845) RECONCILIATION OF REVENUES SCHEDULE D, PART XII, LINE 2D REVENUE FROM RELATED ORGANIZATIONS $ 662,075 RECONCILIATION OF EXPENSES SCHEDULE D, PART XIII, LINE 2D EXPENSES FROM RELATED ORGANIZATIONS $ 879,704 true true true X 125. true X true true false false 7143 7143 0.00110 203509 91009 112500 0.01690 210652 91009 119643 0.01800 120300 44060 76240 0.01150 5998 5998 0.00090 8146 8146 0.00120 775 775 0.00010 135219 44060 91159 0.01370 345871 135069 210802 0.03170 214 214 214 214 false 343934 227925 3701248 3687118 14130 X true true 1 1 LINDSBORG COMMUNITY HOSPITAL

605 WEST LINCOLN LINDSBORG KS 674562328

X X X LINDSBORG COMMUNITY HOSPITAL 1 true true 125. true 200. true X X true true X true false true X false false SCHEDULE H, PART I, LINE 7, COLUMN F THE AMOUNT OF BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSE OF CALCULATING THE PERCENTAGE IS $157,486. SCHEDULE H, PART I, LINE 7 THE COST TO CHARGE RATIO WAS DERIVED FROM WORKSHEET 2. SCHEDULE H, PART I, LINE 7G NONE OF THE AMOUNT ON SCHEDULE H, PART I, LINE 7G IS APPLICABLE TO PHYSICIAN CLINICS. BAD DEBT EXPENSE SCHEDULE H, PART III, LINE 4 THE ORGANIZATION REPORTS PATIENT ACCOUNTS RECEIVABLE FOR SERVICES RENDERED AT NET REALIZABLE AMOUNTS FROM THIRD-PARTY PAYERS, PATIENTS AND OTHERS. THE ORGANIZATION PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS BASED UPON A REVIEW OF OUTSTANDING RECEIVABLES, HISTORICAL COLLECTION INFORMATION AND EXISTING ECONOMIC CONDITIONS. AS A SERVICE TO THE PATIENT, THE ORGANIZATION BILLS THIRD-PARTY PAYERS DIRECTLY AND BILLS THE PATIENT WHEN THE PATIENT'S LIABILITY IS DETERMINED. PATIENT ACCOUNTS RECEIVABLE ARE DUE IN FULL WHEN BILLED. IF THE PATIENT ACCOUNTS RECEIVABLE IS PAID WITHIN THIRTY DAYS OF THE FIRST PATIENT DUE STATEMENT A 25% DISCOUNT MAY BE TAKEN. ACCOUNTS ARE CONSIDERED DELINQUENT AND SUBSEQUENTLY WRITTEN OFF AS BAD DEBTS WHEN THE PATIENT HAS RECEIVED FOUR STATEMENTS AND TWO COLLECTION LETTERS WITHOUT COMMUNICATION TO THE FACILITY. SPECIFIC CIRCUMSTANCES OF THE ACCOUNT MAY ALSO DETERMINE THE ACCOUNT TO BE DELINQUENT, I.E. AN ADDRESS THAT IS "MAIL RETURNED, ADDRESS NOT KNOWN." LINE 2: COST TO CHARGE RATIO DERIVED FROM WORKSHEET 2 LINE 3: ESTIMATED 35% MEDICARE SHORTFALL SCHEDULE H, PART III, LINE 8 ALL OF A SHORTFALL WOULD BE TREATED AS A COMMUNITY BENEFIT. THIS IS OUR COST OF PROVIDING SERVICES TO THE SMOKY VALLEY COMMUNITIES WHICH ARE LARGELY MEDICARE BENEFICIARIES. THE SOURCE OF REPORTING FOR THE AMOUNT ON LINE 7 IS THE 2012 MEDICARE COST REPORT. COLLECTION PRACTICES SCHEDULE H, PART III, LINE 9B A. SERVICES ELIGIBLE UNDER THE FINANCIAL ASSISTANCE POLICY. FOR PURPOSES OF THIS POLICY, "FINANCIAL ASSISTANCE" REFERS TO HEALTHCARE SERVICES PROVIDED WITHOUT CHARGE OR AT A DISCOUNT TO QUALIFYING PATIENTS. THE FOLLOWING HEALTHCARE SERVICES ARE ELIGIBLE FOR FINANCIAL ASSISTANCE: 1. EMERGENCY MEDICAL SERVICES PROVIDED IN AN EMERGENCY ROOM SETTING; 2. SERVICES FOR A CONDITION WHICH, IF NOT PROMPTLY TREATED, WOULD LEAD TO AN ADVERSE CHANGE IN THE HEALTH STATUS OF AN INDIVIDUAL; 3. NON-ELECTIVE SERVICES PROVIDING IN RESPONSE TO LIFE-THREATENING CIRCUMSTANCES IN A NON-EMERGENCY ROOM SETTING; AND 4. MEDICALLY NECESSARY SERVICES, EVALUATED ON A CASE-BY-CASE BASIS AT LINDSBORG COMMUNITY HOSPITAL'S DISCRETION. B. ELIGIBILITY FOR FINANCIAL ASSISTANCE. ELIGIBILITY FOR FINANCIAL ASSISTANCE WILL BE CONSIDERED FOR THOSE INDIVIDUALS WHO ARE UNINSURED, UNDERINSURED, INELIGIBLE FOR ANY GOVERNMENT HEALTH CARE BENEFIT PROGRAM, AND WHO ARE UNABLE TO PAY FOR THEIR CARE, BASED UPON A DETERMINATION OF FINANCIAL NEED IN ACCORDANCE WITH THIS POLICY. THE DETERMINATION OF FINANCIAL ASSISTANCE SHALL BE BASED ON AN INDIVIDUALIZED DETERMINATION OF FINANCIAL NEED, AND SHALL NOT TAKE INTO ACCOUNT AGE, GENDER, RACE, SOCIAL OR IMMIGRANT STATUS, SEXUAL ORIENTATION OR RELIGIOUS AFFILIATION. C. DETERMINATION OF FINANCIAL NEED 1. FINANCIAL NEED WILL BE DETERMINED IN ACCORDANCE WITH PROCEDURES THAT INVOLVE AN INDIVIDUAL ASSESSMENT OF FINANCIAL NEED; AND MAY A. INCLUDE AN APPLICATION PROCESS, IN WHICH THE PATIENT OR PATIENT'S GUARANTOR ARE REQUIRED TO COOPERATE AND SUPPLY PERSONAL, FINANCIAL AND OTHER INFORMATION AND DOCUMENTATION RELEVANT TO MAKING A DETERMINATION OF FINANCIAL NEED; B. INCLUDE REASONABLE EFFORTS BY LINDSBORG COMMUNITY HOSPITAL TO EXPLORE APPROPRIATE ALTERNATIVE SOURCES OF PAYMENT AND COVERAGE FROM PUBLIC AND PRIVATE PAYMENT PROGRAMS, AND TO ASSIST PATIENTS TO APPLY FOR SUCH PROGRAMS; C. TAKE INTO ACCOUNT THE PATIENT'S AVAILABLE ASSETS, AND ALL OTHER FINANCIAL RESOURCES AVAILABLE TO THE PATIENT; AND D. INCLUDE A REVIEW OF THE PATIENT'S OUTSTANDING ACCOUNTS RECEIVABLE FOR PRIOR SERVICES RENDERED AND THE PATIENT'S PAYMENT HISTORY. 2. IT IS PREFERRED BUT NOT REQUIRED THAT A REQUEST FOR FINANCIAL ASSISTANCE AND A DETERMINATION OF FINANCIAL NEED OCCUR PRIOR TO RENDERING OF SERVICES. HOWEVER, THE DETERMINATION MAY BE DONE AT ANY POINT IN THE COLLECTION CYCLE. THE NEED FOR PAYMENT ASSISTANCE SHALL BE RE-EVALUATED AT EACH SUBSEQUENT TIME OF SERVICES IF THE LAST FINANCIAL EVALUATION WAS COMPLETED MORE THAN A YEAR PRIOR, OR AT ANY TIME ADDITIONAL INFORMATION RELEVANT TO THE ELIGIBILITY OF THE PATIENT FOR FINANCIAL ASSISTANCE BECOMES KNOWN. 3. LINDSBORG COMMUNITY HOSPITAL'S VALUES OF HUMAN DIGNITY AND STEWARDSHIP SHALL BE REFLECTED IN THE APPLICATION PROCESS, FINANCIAL NEED DETERMINATION AND GRANTING OF FINANCIAL ASSISTANCE. REQUESTS FOR FINANCIAL ASSISTANCE SHALL BE PROCESSED PROMPTLY AND LINDSBORG COMMUNITY HOSPITAL SHALL NOTIFY THE PATIENT OR APPLICANT IN WRITING WITHIN 30 DAYS OF RECEIPT OF A COMPLETED APPLICATION. D. PRESUMPTIVE FINANCIAL ASSISTANCE ELIGIBILITY. THERE ARE INSTANCES WHEN A PATIENT MAY APPEAR ELIGIBLE FOR FINANCIAL ASSISTANCE BUT THERE IS NO FINANCIAL ASSISTANCE FORM ON FILE DUE TO A LACK OF SUPPORTING DOCUMENTATION. OFTEN THERE IS ADEQUATE INFORMATION PROVIDED BY THE PATIENT OR THROUGH OTHER SOURCES, WHICH COULD PROVIDE SUFFICIENT EVIDENCE TO PROVIDE THE PATIENT WITH FINANCIAL ASSISTANCE. IN THE EVENT THERE IS NO EVIDENCE TO SUPPORT A PATIENT'S ELIGIBILITY FOR FINANCIAL ASSISTANCE, LINDSBORG COMMUNITY HOSPITAL COULD USE OUTSIDE AGENCIES IN DETERMINING ESTIMATE INCOME AMOUNTS FOR THE BASIS OF DETERMINING FINANCIAL ASSISTANCE ELIGIBILITY AND POTENTIAL DISCOUNT AMOUNTS. ONCE DETERMINED, DUE TO THE INHERENT NATURE OF THE PRESUMPTIVE CIRCUMSTANCES, THE ONLY DISCOUNT THAT CAN BE GRANTED IS A 100% WRITE OFF OF THE ACCOUNT BALANCE. PRESUMPTIVE ELIGIBILITY MAY BE DETERMINED ON THE BASIS OF INDIVIDUAL LIFE CIRCUMSTANCES THAT MAY INCLUDE: 1. STATE-FUNDED PRESCRIPTION PROGRAMS; 2. HOMELESS OR RECEIVED CARE FROM A HOMELESS CLINIC; 3. PARTICIPATION IN WOMEN, INFANTS, AND CHILDREN PROGRAMS (WIC); 4. FOOD STAMP ELIGIBILITY; 5. SUBSIDIZED SCHOOL LUNCH PROGRAM ELIGIBILITY; 6. ELIGIBILITY FOR OTHER STATE OR LOCAL ASSISTANCE PROGRAMS THAT ARE UNFUNDED (E.G. MEDICAID SPEND-DOWN); 7. LOW INCOME/SUBSIDIZED HOUSING IS PROVIDED AS A VALID ADDRESS; 8. PATIENT IS DECEASED WITH NO KNOWN ESTATE. MAXIMUM AMOUNTS CHARGED TO FAP-ELIGIBLE INDIVIDUALS SCHEDULE H, PART V, LINE 19 ANYONE QUALIFYING FOR FREE CARE UNDER THE FINANCIAL ASSISTANCE POLICY (FAP) IS NOT CHARGED FOR SERVICES. ANYONE QUALIFYING FOR DISCOUNTED CARE UNDER THE FAP WILL NOT BE CHARGED MORE THAN THE LOWEST NEGOTIATED COMMERICAL RATE. NEEDS ASSESMENT SCHEDULE H, PART VI, LINE 2 A NEEDS ASSESSMENT HAS NOT 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. PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE SCHEDULE H, 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. COMMUNITY INFORMATION SCHEDULE H, 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. PROMOTION OF COMMUNITY HEALTH SCHEDULE H, PART VI, LINE 5 ONE OF THE BENEFITS WE PROVIDE TO MEMBERS OF THE COMMUNITY IS OUR CAN PROGRAM. THE CAN PROGRAM EDUCATES COMMUNITY MEMBERS THAT ARE LOOKING TO BE MORE INVOLVED IN HEALTHCARE. THROUGH THE YEARS THAT WE HAVE PROVIDED THIS PROGRAM WE HAVE HAD CAN STUDENTS THAT WANTED TO BECOME A CNA AS AN OPTION FOR A NEW CAREER, TO BECOME MORE EDUCATED IN CARING FOR A LOVED ONE OR TO SEE IF HEALTHCARE IS THE RIGHT FIELD FOR THEM WHEN FURTHERING THEIR EDUCATION. THE MAJORITY OF THE HOSPITAL'S BOARD CONSISTS OF INDIVIDUALS RESIDING IN THE COMMUNITIES SERVED BY THE HOSPITAL. IF THE HOSPITAL HAS ANY SURPLUS FUNDS, THESE FUNDS ARE USED TO IMPROVE PATIENT CARE THROUGH INVESTING IN NEW TECHNOLOGIES. EMPLOYEES OF THE LCH/LRHC ARE ON A COMMUNITY WELLNESS CENTER COMMITTEE. THE PURPOSE OF THE COMMITTEE IS TO TRY AND CREATE A PARTNER WITH ANOTHER ORGANIZATION THAT WILL PROVIDE MEMBERS OF THE SMOKY VALLEY COMMUNITIES A PLACE TO DEVELOP A HEALTHY WAY OF LIFE. ORGANIZATION'S MISSION FORM 990, PART III, LINE 1 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 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. PROGRAM SERVICE DESCRIPTION FORM 990, PART III, LINE 4A 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. 2,024 PATIENTS WERE SEEN IN THE 2012 FISCAL YEAR. 260 URGENT CARE VISITS, 669 PRIVATELY PAID HOME HEALTH VISITS WERE MADE, AND 332 CARDIAC REHAB VISITS IMPROVED THE HEALTH OF COMMUNITY MEMBERS. 1,351 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. BUSINESS RELATIONSHIPS FORM 990, PART VI, SECTION A, LINE 2 DAVE SCHRAG AND VIRGINIA SWISHER HAVE A BUSINESS RELATIONSHIP WITH EACH OTHER. MEMBERS FORM 990, PART VI, SECTION A, LINE 6 LINDSBORG COMMUNITY HEALTH CARE FOUNDATION, A NOT-FOR-PROFIT, 501(C)(3) ORGANIZATION, IS THE SOLE MEMBER OF LINDSBORG COMMUNITY HOPSITAL. MEMBERS MAY ELECT GOVERNING BODY FORM 990, PART VI, SECTION A, LINE 7A LINDSBORG COMMUNITY HEALTH CARE FOUNDATION BEING THE SOLE MEMBER OF LINDSBORG COMMUNITY HOSPITAL HAS THE RIGHT TO ELECT ALL THE BOARD OF TRUSTEES. GOVERNING BODY DECISIONS SUBJECT TO APPROVAL OF MEMBERS FORM 990, PART VI, SECTION A, LINE 7B LINDSBORG COMMUNITY HEALTH CARE FOUNDATION IS THE SOLE MEMBER, AND HAS THE RIGHT TO APPROVE LINDSBORG COMMUNITY HOSPITAL'S BYLAWS, ARTICLES OF INCORPORATION AND BOARD OF TRUSTEES. FORM 990 REVIEW PROCESS FORM 990, PART VI, SECTION B, LINE 11B AN INDEPENDENT ACCOUNTING FIRM PREPARES AND REVIEWS THE 990. THE 990 IS THEN REVIEWED BY THE ORGANIZATION'S CEO AND CFO. ANY QUESTIONS OR CONCERNS THE ORGANIZATION'S CEO AND CFO HAVE ARE ADDRESSED AND ANY CORRECTIONS OR CLARIFICATIONS THAT NEED TO BE MADE ARE MADE. THE 990 IS THEN PROVIDED TO THE BOARD OF TRUSTEES FOR THEIR REVIEW PRIOR TO FILING THE 990. ANY QUESTIONS OR CONCERNS THE BOARD OF DIRECTORS MAY HAVE 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 990. CONFLICT OF INTEREST POLICY AT THE TIME OF HIRE OR ELECTION (IN THE CASE OF TRUSTEES) AND ANNUALLY THEREAFTER, THE OFFICERS, TRUSTEES, AND KEY EMPLOYEES SHALL PROVIDE THE APPLICABLE CONFLICT OF INTEREST DISCLOSURES WHICH SHALL BE COMPLETED TO IDENTIFY ANY RELATIONSHIPS, POSITIONS, OR CIRCUMSTANCES IN WHICH IT IS BELIEVED A CONFLICT MAY ARISE. IF A CONFLICT ARISES, THE OFFICER, TRUSTEE, OR KEY EMPLOYEE ABSTAINS FROM THE VOTE OF THE CONFLICTED POSITION. ANNUAL MONITORING AND REVIEW PROCEDURE SHALL BE PART OF THE ORGANIZATION'S COMPLIANCE PLAN. AN APPROPRIATE REPORT SHALL BE SUBMITTED TO THE EXECUTIVE BOARD CONCERNING ANY INTEREST DISCLOSED. COMPENSATION REVIEW FORM 990, PART VI, SECTION B, LINES 15A & B THE ORGANIZATION'S PROCESS FOR DETERMINING CEO COMPENSATION BEGINS WITH AN INITIATIVE LEAD BY THE PRESIDENT OF THE BOARD. THE PRESIDENT COMPARES COMPENSATION AND SALARY DATA PROVIDED BY THE KANSAS HOSPITAL ASSOCIATION. THE PRESIDENT REVIEWS THE DATA AND MAKES A RECOMMENDATION TO THE BOARD OF TRUSTEES IN A CLOSED EXECUTIVE MEETING WHERE THE COMPENSATION IS THEN VOTED UPON BY ALL INDEPENDENT MEMBERS OF THE BOARD. THIS PROCESS WAS LAST COMPLETED IN 2010. THE CFO'S SALARY IS SET BY THE CEO USING AN ANNUAL SALARY SURVEY. THE CFO'S SALARY IS INCREASED USING THE SAME PERCENTAGE AS ALL OTHER EMPLOYEES. AVAILABILITY OF ORGANIZATION DOCUMENTS 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. OTHER CHANGES IN NET ASSETS FORM 990, PART XI, LINE 5 UNREALIZED GAIN ON INVESTMENTS $ 38,438 TRANSFER TO AFFILIATE $ (397,845) ------------ $ (359,407) HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:LARAINE GENGLER TITLE:CFO HOURS:5 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:LARRY VAN DER WEGE TITLE:CEO HOURS:11 LINDSBORG COMMUNITY HEALTH CARE FDTN INC 605 W LINCOLN LINDSBORG KS 67456 480947732 SUPPORT HOSP KS 501(C)(3) 7 NA false LINDSBORG COMMUNITY RURAL HEALTH CLINIC 601 W LINCOLN LINDSBORG KS 67456 481126826 HEALTH CLINIC KS 501(C)(3) 9 LCHCF false false true true true false false false false false false true false false true false false true false