2013-07-10T13:23:48-05:00 2012-09-30 481026809 Wendling Noe Nelson & Johnson LLC 534 S Kansas Ave Suite 1500 Topeka KS 666033491 990 2011-10-01 481169103 Salina Regional Health Center Inc SALI 7854527145 400 South Santa Fe Salina KS 67401 Joe Tallon 7854527145 2013-06-28 1 John R Helms P00203953 7852334226 2013-06-28 2011 2016-02-24 21:20:13Z Joe Tallon 400 South Santa Fe Salina KS 67401 185697231 0 X www.srhc.com X 1995 KS To provide high quality acute medical care 14 12 1445 200 0 -112138 706945 1026616 164838313 179755461 5723378 2397122 1653465 2149921 172922101 185329120 1113362 1766083 0 0 68463804 72754883 0 0 0 85969599 91423281 155546765 165944247 17375336 19384873 329865213 376263070 79153195 81569017 250712018 294694053 To provide quality health care services in a healing and spiritual environment. 0 0 134089058 1766083 179642598 Salina Regional Health Center, Inc., is an IRS Section 501(c)(3) hospital which provides quality medical care regardless of race, creed, sex, national origin, handicap, or ability to pay. During the fiscal year, Salina Regional Health Center, Inc. discharged 8,379 inpatients resulting in 39,776 patient days, treated outpatients in 144,502 visits, and generated $176,101,195 in net patient service revenue. The amount of uncompensated care amounted to $27,217,687 of which $8,433,791 were charity care deductions and $18,783,896 were bad debt write offs. 106295 Salina Regional Health Center, Inc., provides scholarships to students attending nursing school. 1409788 Salina Regional Health Center, Inc., provides grants to further the activities of the Community Health Improvement Program (CHIP). 134089058 1 1 0 1 0 0 0 0 0 0 1 0 0 0 0 1 0 1 0 0 0 0 0 0 1 0 1 1 1 1 1 1 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 1 1 1 1 0 1 113 0 1 1445 1 1 1 0 0 0 0 0 0 0 0 0 X 14 12 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 0 X Joe Tallon VP FinanceCFO 7854527145 400 South Santa Fe Salina KS 67401 Larry Britegam 2.00 X X 0 0 0 Kent Buer 2.00 X X 0 0 0 Marty Ekrem 2.00 X 0 0 0 Robert Freelove MD 2.00 X 0 0 0 David Hadley 2.00 X 0 0 0 Sean Herrington MD 40.00 X 349020 0 23826 Rex Romeiser MD 2.00 X 0 0 0 Morrie Soderberg 2.00 X X 0 0 0 Betsy Wearing 2.00 X 0 0 0 Lee Young 2.00 X X 0 0 0 Micheal Terry 40.00 X X 424714 0 60446 Brian Smith MD 4.00 X 15000 0 0 Jim Maes 2.00 X 0 0 0 Katie Platten 2.00 X 0 0 0 Larry Barnes 40.00 X 222607 0 51594 James Barker 40.00 X 194112 0 21751 Charles Grimwood 40.00 X 203093 0 23533 Jack Hinnenkamp 40.00 X 173984 0 16419 Joe Tallon 40.00 X 241027 0 21677 David Moody 40.00 X 180311 0 21407 Joel Phelps 40.00 X 265645 0 40396 Luanne E Smith 40.00 X 102700 0 16117 John Kelemen 40.00 X 685634 0 28949 George S Jerkovich 40.00 X 284270 0 24551 Jacob Breeding 40.00 X 382811 0 25579 Ali Manguoglu 40.00 X 371736 0 26776 Keir Swisher 40.00 X 342495 0 23594 4439159 0 426615 66 0 1 0 CPT Enterprises 2121 Crawford Pl Salina KS 67401 Management Services 1353709 Anesthesia Associates of Central KS PA 520 S Santa Fe Suite 260 Salina KS 67402 Anesthesia Services 989095 Emergency Physicians of Salina LLC 8717 W 110th Street Overland Park KS 66210 Emergency Room Services 558210 Fresenius Medical Care PO Box 749959 Los Angeles CA 900749959 Medical Care 465675 DMS Imaging 26273 Network Pl Chicago IL 606731262 Imaging Services 454323 13 962233 64383 1026616 Patient service 621990 176101195 176101195 EHR incentive payments 621990 2419431 2419431 Other operating 621990 1234835 1234835 179755461 2420261 2420261 215535 328398 -112863 -112863 -112863 250 23389 -23139 -23139 -23139 35821 16324 19497 19497 Income from subsidiari 900099 2207074 2207074 Other revenues 900099 36213 36213 2243287 185329120 179642598 0 4659906 1659788 1659788 106295 106295 2751737 431304 2320433 56949768 51637008 5312760 2206946 2007234 199712 6871580 6094827 776753 3974852 3477293 497559 749489 749489 627382 47326 580056 923023 389148 533875 3546100 1158579 2387521 2631595 2585848 45747 285841 90243 195598 103106 48851 54255 2927278 2927278 11129123 4363285 6765838 1735328 347747 1387581 Bad debt expense 18783896 18783896 Medical supplies 17578138 17578138 Pharmaceuticals 8997278 8997278 Professional fees other 5636795 3976144 1660651 15768909 10308826 5460083 165944247 134089058 31855189 0 27975718 5331 66195550 34554099 23902936 27232538 1224835 1186762 2195333 3951820 236754729 137781711 101806572 98973018 189179913 6377375 2681250 106564269 12120964 329865213 376263070 17086850 20535427 61770004 61022385 34068 11205 262273 0 79153195 81569017 X 242626718 285539705 2219530 2682844 5865770 6471504 250712018 294694053 329865213 376263070 X 19384873 24597162 X X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 22328 22328 0 Explanation of Lobbying Activities: Part II-B, Line 1: A portion of annual dues paid by Salina Regional Health Center, Inc. to various healthcare organizations has been identified as association lobbying activities by those organizations. The amount reported as direct contact with legislators, their staff, government officials, or a legislative body represents the portion of dues identified as association lobbying activities by these organizations. Salina Regional Health Center, Inc. does not participate in activities supporting a political candidate. 6334691 6334691 146333569 73414945 72918624 79729426 61683894 18045532 4357043 2682872 1674171 98973018 185329120 165944247 19384873 24597162 24597162 43982035 183650035 -1659588 -1659588 185309623 19497 19497 185329120 164264962 0 164264962 1679285 1679285 165944247 Description of Uncertain Tax Positions Under FIN 48: Part X: Management is not aware of any uncertainties in income tax positions. Part XI, Line 8 - Other Adjustments: Intercompany transfers 190,280. Change in fair value of assets held in trust 605,734. Temporarily restricted investment income 233,338. Change in beneficial interest in net assets of Foundation 418,489. Net unrealized gains on investments 23,149,321. Total to Schedule D, Part XI, Line 8: 24,597,162. Part XII, Line 2d - Other Adjustments: Community Health Improvement Program (CHIP) donation -1,409,788. KU Endowment donation -250,000. Net assets released from restrictions for operations 200. Part XII, Line 4b - Other Adjustments: Net fundraising events revenue 19,497. Part XIII, Line 4b - Other Adjustments: KU Endowment donation 250,000. Community Health Improvement Program (CHIP) donation 1,409,788. Net fundraising events revenue 19,497. Rummage Sales 15219 15219 4105 Holly Days 11295 11295 5288 1 9307 9307 6931 35821 35821 16324 16324 19497 1 1 1 X 1 X 1 1 1 0 1 1 3866 2874741 2874741 0.01950 11051 15123249 10508784 4614465 0.03140 14917 17997990 10508784 7489206 0.05090 30 190 151120 151120 0.00100 23 230 2312653 2312653 0.01570 14 8422 19492019 9254682 10237337 0.06960 2 2334 2334 0.00000 10 1432409 1432409 0.00970 79 8842 23390535 9254682 14135853 0.09600 79 23759 41388525 19763466 21625059 0.14690 3 5558 5558 0.00000 3 73191 73191 0.00050 1 4 417 417 0.00000 3 5305 5305 0.00000 1 292927 292927 0.00200 612 612 0.00000 15 378010 378010 0.00250 1 5035963 810050 52084483 54820696 -2736213 X 1 1 1 1 Salina Regional Health Center Inc

400 South Santa Fe Salina KS 67401

X X X X Salina Regional Health Center Inc 1 1 1 200.000000000000 1 300.000000000000 1 X X X X X 1 1 X X X 1 X X X X 0 1 X 0 0 Part I, Line 7: Costing methodology used to determine ratio of patient care cost to charges is total operating expenses less bad debt, Medicaid provider taxes and total community benefit expense divided by total charges less community benefit charges. Part I, Line 7, Column (f): The Bad Debt expense included on Form 990, Part IX, Line 25, Column (A), but subtracted for purposes of calculating the percentage in this column is $ 18783896. Part II: Advancing Communities Together (ACT) analyzed data and discussed with multiple agencies in July 2012 resulting in the following high-level list of community health improvement priorities (descending order of priority): teen sexual behavior, obesity (children, adult) and the outcomes of obesity (heart disease, stroke), domestic violence, serious injuries requiring hospital care, chronic lower respiratory disease, adult flu vaccination, and cancer. These priorities have since been further researched. A report is being made available to the general public in early 2013 and through community forums, on-line surveys and paper surveys; input from the broader community is being obtained. Salina Regional Health Center is collaborating with Salina-Saline County Health Department and Central Kansas Foundation to conduct a community health assessment and develop a community health improvement plan. Across the early months of 2012, data was gathered, analyzed, and discussed by this collaborative group. Poster board presentations of the groups findings were prepared for presentation to a July 9, 2012 forum of representatives from a broader group of agencies that are involved in community development and health improvement. Participants included representatives of Salina Area United Way, Salina Family Healthcare, ComCare PA, Occupational Center of Central Kansas, Greater Salina Community Foundation, Salina Public Schools, Veridian Behavioral Health, Central Kansas Mental Health Center, Saline County Commission on Aging, Kansas State University Extension, City of Salina Parks and Recreation, Heartland Programs, North Central Kansas Regional Trauma Council, Salina Regional Health Center, The Volunteer Connection, Salina-Saline County Health Department, Central Kansas Foundation, and faith-based programs. The outcome of the meeting was buy-in to a process of getting broad community input into health improvement priorities, commitment to partner in the process, understanding of community health status data, and initial identification of priority issues to be addressed. Part III, Line 4: Provisions are made for accounts receivable that could become uncollectible in the future by establishing an allowance to reduce the carrying value of such receivables to their estimated net realizable value. The Health Center estimates this allowance based on the aging of its accounts receivable and its historical collection experience for each type of payor. Part III, Line 8: Shortfall is total Medicare losses excluding those reported in subsidized services. The allowable Medicare costs were determined from our filed cost report Worksheet A less subsidized expenses included in Schedule H, Part I, Item 7(g), Subsidized health services. Part III, Line 9b: If patients are determined to be indigent or living on limited income through our financial assistance application process, the patient is referred to customer service who will help guide them through the necessary steps to complete the financial assistance program. Salina Regional Health Center, Inc. Part V, Section B, Line 15e: File against estates. Salina Regional Health Center, Inc. Part V, Section B, Line 19d: Deduction of 30%. Part VI, Line 2: In addition to the community health assessment, SRHC analyzes hospital discharge data for all counties in the region. The Kansas Hospital Association inpatient discharge database includes data for all reporting hospitals. From this we determine usage trends that help us plan needed services. For example, a significant number of residents of north central Kansas have had to travel far out of the region to access neurosurgical services because SRHC only had one neurosurgeon. This assessment and other information led to SRHC's employment of a second neurosurgeon in 2012 and a third who will begin practice in 2013. Part VI, Line 3: At registration, the patient is informed of their rights for financial assistance if unable to produce valid insurance coverage. The patient is referred to a third party vendor to determine eligibility for governmental programs and if it is determined they do not qualify, they are screened under our financial assistance guidelines. We post our guidelines on our website as well. Part VI, Line 4: Salina Regional Health Center, Inc. is a rural sole community hospital serving a primary service area of Saline County and three immediately adjacent counties. For purposes of community health needs assessment, the principal community of SRHC is Saline County because the other three counties each have a local Critical Access Hospital within the county.The primary service area has a population of 71,901. When compared to the national population, this area is represented by an older population with a lower educational level and lower median income. Although the areas population grew 0.7% between 2010 and 2013, the growth was all in Saline County (4.7%) as the other counties experienced a decline. The primary service area population is expected to increase by 1.3% by 2018, which is lower than the rate of growth expected for Kansas (2.2%) and the U.S. (3.3%) for the same time period. The service area is less ethnically diverse compared to the U.S. overall. The majority of residents are Caucasian (83.5%) followed by Hispanic (9%) and Black (3%). Spanish patient education materials are available at SRHC and the hospital has developed a team of Spanish translators. Recognizing the relatively lower educational level in the community, the hospital writes patient information at a 6th to 8th grade reading level. Median household income in the primary service area in 2013 is projected to be $45,392, compared to a Kansas median of $48,219 and national median of $49,297. A lack of available resources to the indigent is a challenge in this environment, so in addition to providing charity care the hospital has been and continues to support the Salina Family Healthcare Center, which provides care to the indigent. Our patient population is composed of 50% Medicare, 11% Medicaid, 31% Commercial, 3% Tricare/Workers Compensation, and 5% uninsured. Part VI, Line 5: The governing board of Salina Regional Health Center, Inc. is comprised of volunteers intentionally selected to promote the betterment of the region we serve. Demonstrating its commitment to community benefit, this board has for nearly 20 years donated an average of 10% of the hospitals end-of-year operating margin to the Community Health Invest Program (CHIP) of the Salina Regional Health Foundation. Salina Regional Health Center, Inc. administrators and governing board members assist the Foundation by participating in the CHIP Committee.In 2012, CHIP funded such projects as the Donna L. Vanier Childrens Center ($333,000), Salina Area United Way (to match Salina Regional Health Center employee contributions), and Kansas Wesleyan University for nursing student scholarships ($50,000). CHIP grants in 2012 totaled $552,197.18. Since the programs inception in 1994, the hospital has tithed $9,904,282 to the Community Health Investment Program.Salina Regional Health Center, Inc. is a member of the Sunflower Health Network (SHN), an organization of SRHC and 14 Critical Access Hospitals (CAHs) distributed across 14 counties. A Salina Regional administrator led SHN strategic planning that resulted in regional health priorities, including improving access to specialist physician care, optimizing timeliness and safety of patient transfers, and sustaining the number of quality nurses in the region. As a result of this process, Salina Regional Health Center, Inc. invested in hiring physician recruiters for both the Salina community and the larger region. In 2012 Salina Regional Health Center, Inc. was verified by the American College of Surgeons as a Level III trauma center, the only designated Level III trauma center in the north central Kansas region. Salina Regional also provides access to computerized patient simulators and other nursing education modalities to strengthen the quality of nurses in regional communities. Salina Regional Health Center began a partnership with The University of Kansas School of Medicine in 2010 to open a medical school campus in Salina. The intent is to develop students who will live and practice medicine in smaller-town Kansas to help alleviate the rural physician shortage. The eight students in the inaugural class completed their first year of medical school in 2012. Salina Regional Health Center is investing $1 million over a four-year period to help defray faculty and operating costs. The hospital also invested several hundred thousand dollars to renovate a building on the hospital campus. The building is provided to KU rent-free for as long as the medical school campus exists. 1 Salina Regional Health Foundation Inc 400 South Santa Fe Salina KS 67401 480949407 501(c)(3) 1409788 To further the activities of the Community Health Improvement Program (CHIP) KU Endowment 3901 Rainbow Blvd Kansas City KS 661607804 480547734 501(c)(3) 250000 Support KU School of Medicine - Salina campus Salina Regional Health Center, Inc., provides scholarships to students attending nursing school. 48 106295 X X X X X 0 0 0 0 0 1 0 0 0 Sean Herrington MD 288025 0 59077 0 1918 0 12250 0 11576 0 372846 0 0 0 Micheal Terry 334714 0 90000 0 0 0 46227 0 14219 0 485160 0 0 0 Larry Barnes 203113 0 19494 0 0 0 43645 0 7949 0 274201 0 0 0 James Barker 177965 0 16147 0 0 0 9923 0 11828 0 215863 0 0 0 Charles Grimwood 185203 0 17544 0 346 0 10998 0 12535 0 226626 0 0 0 Jack Hinnenkamp 159347 0 14637 0 0 0 9176 0 7243 0 190403 0 0 0 Joe Tallon 197056 0 18971 0 25000 0 9979 0 11698 0 262704 0 0 0 David Moody 164382 0 15583 0 346 0 9769 0 11638 0 201718 0 0 0 Joel Phelps 232799 0 32846 0 0 0 28189 0 12207 0 306041 0 0 0 John Kelemen 643096 0 40923 0 1615 0 12250 0 16699 0 714583 0 0 0 George S Jerkovich 283425 0 500 0 345 0 12250 0 12301 0 308821 0 0 0 Jacob Breeding 344265 0 37450 0 1096 0 12250 0 13329 0 408390 0 0 0 Ali Manguoglu 367736 0 4000 0 0 0 12250 0 14526 0 398512 0 0 0 Keir Swisher 284039 0 58154 0 302 0 12250 0 11344 0 366089 0 0 0 Part I, Line 6 The compensation committee of the board determines bonus and incentive payments based on a balanced scorecard which includes financial, patient satisfication, and quality data. In addition, a compensation review is performed by an independent outside consultant. City of Salina Kansas 486017228 794770DP9 2006-04-07 65053116 Extinguish Series 1999 Revenue Bonds and to construct a new patient tower 0 0 0 65053116 4325188 23036195 570534 37121199 2010 0 1 1 1 Stacie Maes Family member of Jim Maes, Trustee 40115 Employment 0 Salina Surgical Center 4 Board of directors are employees and/or trustees of SRHC 100890 Provide employees and supplies 0 Form 990, Part VI, Section B, line 11 The Form 990 is provided to the Board of Trustees for review prior to filing. Form 990, Part VI, Section B, line 12c A conflict of interest questionnaire is required to be completed upon election and annually. The questionnaire is reviewed by legal counsel. Form 990, Part VI, Section B, line 15 An independent compensation firm is obtained to complete an annual review and analysis of all the administrative staff members. The compiled report is forwarded to the Compensation Committee of the Board that reviews the analysis and approves the report. Form 990, Part VI, Section C, line 19 The Organization makes its governing documents, conflict of interest policy, and audited financial statements available to the public upon written request. Changes in Net Assets or Fund Balances: Form 990, Part XI, line 5: Intercompany transfers 190,280. Change in fair value of assets held in trust 605,734. Temporarily restricted investment income 233,338. Change in beneficial interest in net assets of Foundation 418,489. Net unrealized gains on investments 23,149,321. Total to Form 990, Part XI, Line 5: 24,597,162. Audit Committee Form 990, Part XII, Line 2C: The audit committee assumes the responsibility for the oversight of the audited financial statements, review of the Form 990 and Form 990-T, and selection of the independent accounting firm. Salina Regional Health Foundation Inc 400 South Santa Fe Salina KS 67401 480949407 Advancement of healthcare, health & medical education, research, & welfare KS 501(c)(3) 170(b)(1)(A)(vi) 0 Salina Regional Health Properties Inc 400 South Santa Fe Salina KS 67401 481154675 Own and Operate medical office buildings for section 501(c)(3) organizations KS 501(c)(2) 0 Hospice of Salina Inc 730 Holly Lane Salina KS 67402 481131570 Provide hospice care and support services to the terminally ill and their KS 501(c)(3) 509(a) 0 Salina Surgery Properties LLC 401 South Santa Fe Salina KS 67401 481200039 Construct & own surgical facility KS Related 220478 1866044 0 0 Salina Surgical Center LLC 401 South Santa Fe Salina KS 67401 481199515 Medical Services, Ambulatory Surgery KS Related 2526207 4251131 0 0 Salina Regional Home Medical Services LLC 520 South Santa Fe Suite 140 Salina KS 67401 481221623 Home Medical Services KS Salina Regional Health Center Inc Related 184074 499891 0 0 Salina Regional Health Enterprises Inc 400 South Santa Fe Salina KS 67402 481056225 Provide mgmt services to hospitals in N. Central KS area KS Salina Regional Health Center Inc C -25911 64243 1.00000 0 1 1 0 0 0 0 1 0 1 0 0 0 1 0 1 0 0 Salina Regional Health Properties Inc H 191929 Cash received Salina Regional Health Properties Inc J 738851 Cash paid Salina Regional Health Properties Inc N 136414 Actual cost Salina Regional Health Properties Inc P 38116 Actual cost Hospice of Salina Inc H 641000 Cash paid Hospice of Salina Inc P 165905 Actual cost Hospice of Salina Inc N 266707 Actual cost Salina Surgical Center LLC P 227526 Markup of cost