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MIAMI COUNTY MEDICAL CENTER INC: Form 990, tax year 2012

View the entire original 990 at ProPublica ↗

Organization
MIAMI COUNTY MEDICAL CENTER INC (EIN 48-1155548)
Tax period
2012-01-01 to 2012-12-31
Filed
2013-11-15
IRS object ID
201303199349304525
Schema version
2012v2.1
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Timestamp2013-11-15T13:47:34-06:00Timestamp
Tax Period End Date2012-12-31TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1BKD LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line11201 Walnut Suite 1700AddressLine1
CityKansas CityCity
StateMOState
ZIP Code641062246ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2012-01-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN481155548EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1MIAMI COUNTY MEDICAL CENTER INCBusinessNameLine1
FieldValueIRS element (for citing)
In Care Of Name% TIERNEY L GRASSERInCareOfName
Name ControlMIAMNameControl
Phone9137914461Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line12100 BAPTISTE DRIVEAddressLine1
Address Line2SuiteAddressLine2
CityPAOLACity
StateKSState
ZIP Code66071ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameTIERNEY L GRASSERName
TitleSENIOR VP/FINANCETitle
Phone9137914461Phone
Date Signed2013-11-15DateSigned
Authorize Third PartytrueAuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameMichael J EngleName
Phone8162216300Phone
FieldValueIRS element (for citing)
Tax Year2012TaxYear
Build TS2016-02-25 16:41:14ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonTIERNEY L GRASSERNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line120333 W 151ST STREETAddressLine1
CityOLATHECity
StateKSState
ZIP Code66061ZIPCode
FieldValueIRS element (for citing)
Gross Receipts22151239GrossReceipts
Group Return For AffiliatesfalseGroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteWWW.OLATHEHEALTH.ORGWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1994YearFormation
State Legal DomicileKSStateLegalDomicile
Activity Or Mission DescriptionTO IMPROVE THE HEALTH OF ALL INDIVIDUALS IN THE COMMUNITIES WE SERVE BY PROVIDING COMPASSIONATE, QUALITY HEALTHCARE IN AN ENVIRONMENT OF TRUST AND COLLABORATION.ActivityOrMissionDescription
Nbr Voting Members Governing Body5NbrVotingMembersGoverningBody
Nbr Independent Voting Members5NbrIndependentVotingMembers
Total Nbr Employees180TotalNbrEmployees
Total Nbr Volunteers24TotalNbrVolunteers
Total Gross UBI254TotalGrossUBI
Contributions Grants Prior Year1105ContributionsGrantsPriorYear
Contributions Grants Current Year10603ContributionsGrantsCurrentYear
Program Service Revenue Prior Year21305362ProgramServiceRevenuePriorYear
Program Service Revenue CY20973770ProgramServiceRevenueCY
Investment Income Prior Year292532InvestmentIncomePriorYear
Investment Income Current Year937486InvestmentIncomeCurrentYear
Other Revenue Prior Year58243OtherRevenuePriorYear
Other Revenue Current Year61372OtherRevenueCurrentYear
Total Revenue Prior Year21657242TotalRevenuePriorYear
Total Revenue Current Year21983231TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year100176GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY203416GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year9621685SalariesEtcPriorYear
Salaries Etc Current Year9527171SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year11425796OtherExpensePriorYear
Other Expenses Current Year10244313OtherExpensesCurrentYear
Total Expenses Prior Year21147657TotalExpensesPriorYear
Total Expenses Current Year19974900TotalExpensesCurrentYear
Revenues Less Expenses Prior Year509585RevenuesLessExpensesPriorYear
Revenues Less Expenses CY2008331RevenuesLessExpensesCY
Total Assets BOY42410654TotalAssetsBOY
Total Assets EOY47588359TotalAssetsEOY
Total Liabilities BOY7306951TotalLiabilitiesBOY
Total Liabilities EOY6897391TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY35103703NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY40690968NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionMIAMI 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.MissionDescription
Significant New Program ServicesfalseSignificantNewProgramServices
Significant ChangefalseSignificantChange
Expense16076188Expense
Grants203416Grants
Revenue20974024Revenue
DescriptionSEE SCHEDULE ODescription
Total Program Service Expense16076188TotalProgramServiceExpense
Described In501 C3trueDescribedIn501C3
Schedule B RequiredtrueScheduleBRequired
Political ActivitiesfalsePoliticalActivities
Lobbying ActivitiestrueLobbyingActivities
Subject To Proxy TaxfalseSubjectToProxyTax
Donor Advised FundsfalseDonorAdvisedFunds
Conservation EasementsfalseConservationEasements
Collections Of ArtfalseCollectionsOfArt
Credit CounselingfalseCreditCounseling
Term Or Permanent EndowmentstrueTermOrPermanentEndowments
Report Land Bldg EquiptrueReportLandBldgEquip
Report Invest Oth SecuritiestrueReportInvestOthSecurities
Report Prog Rel InvestfalseReportProgRelInvest
Report Other AssetsfalseReportOtherAssets
Report Other LiabilitiestrueReportOtherLiabilities
Report Fin48 FootnotetrueReportFin48Footnote
Independent Audit Financial StmtfalseIndependentAuditFinancialStmt
Consolidated Audit Financial StmttrueConsolidatedAuditFinancialStmt
SchoolfalseSchool
Foreign OfficefalseForeignOffice
Foreign ActivitiesfalseForeignActivities
More Than5000 K To OrganizationsfalseMoreThan5000KToOrganizations
More Than5000 K To IndividualsfalseMoreThan5000KToIndividuals
Professional FundraisingfalseProfessionalFundraising
Fundraising ActivitiesfalseFundraisingActivities
GamingfalseGaming
HospitaltrueHospital
Financial Stmt AttachedtrueFinancialStmtAttached
Grants To OrganizationstrueGrantsToOrganizations
Grants To IndividualsfalseGrantsToIndividuals
Schedule J RequiredtrueScheduleJRequired
Tax Exempt BondstrueTaxExemptBonds
Invest Tax Exempt BondsfalseInvestTaxExemptBonds
Escrow AccountfalseEscrowAccount
On Behalf Of IssuerfalseOnBehalfOfIssuer
Excess Benefit TransactionfalseExcessBenefitTransaction
Prior Excess Benefit TransactionfalsePriorExcessBenefitTransaction
Loan To Officer Or DQPfalseLoanToOfficerOrDQP
Grant To Related PersonfalseGrantToRelatedPerson
Bsnss Rltnshp With OrganizationfalseBsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family MembertrueBsnssRltnshpThruFamilyMember
Officer Entity With Bsnss RltnshpfalseOfficerEntityWithBsnssRltnshp
Deductible Non Cash ContributionsfalseDeductibleNonCashContributions
Deductible Contributions Of ArtfalseDeductibleContributionsOfArt
TerminatedfalseTerminated
Partial LiquidationfalsePartialLiquidation
Disregarded EntityfalseDisregardedEntity
Related EntitytrueRelatedEntity
Related Org Controlled EntitytrueRelatedOrgControlledEntity
Transaction Related EntitytrueTransactionRelatedEntity
Transfers To Exempt Non Chrtbl OrgfalseTransfersToExemptNonChrtblOrg
Activities Conducted PartnershipfalseActivitiesConductedPartnership
Schedule O RequiredtrueScheduleORequired
Number Forms Transmitted With109625NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup WitholdingtrueComplianceWithBackupWitholding
Number Of Employees180NumberOfEmployees
Employment Tax Returns FiledtrueEmploymentTaxReturnsFiled
Unrelated Business IncomefalseUnrelatedBusinessIncome
Foreign Financial AccountfalseForeignFinancialAccount
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTrans
Taxable Party NotificationfalseTaxablePartyNotification
Non Deductible ContributionsfalseNonDeductibleContributions
Quid Pro Quo ContributionsfalseQuidProQuoContributions
Form8282 Property Disposed OffalseForm8282PropertyDisposedOf
Funds To Pay PremiumsfalseFundsToPayPremiums
Premiums PaidfalsePremiumsPaid
Indoor Tanning ServicesfalseIndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members5NbrVotingGoverningBodyMembers
Number Independent Voting Members5NumberIndependentVotingMembers
Family Or Business RelationshiptrueFamilyOrBusinessRelationship
Delegation Of Management DutiesfalseDelegationOfManagementDuties
Changes To Organizing DocsfalseChangesToOrganizingDocs
Material Diversion Or MisusefalseMaterialDiversionOrMisuse
Members Or StockholderstrueMembersOrStockholders
Election Of Board MemberstrueElectionOfBoardMembers
Decisions Subject To ApprovaltrueDecisionsSubjectToApproval
Minutes Of Governing BodytrueMinutesOfGoverningBody
Minutes Of CommitteestrueMinutesOfCommittees
Officer Mailing AddressfalseOfficerMailingAddress
Local ChaptersfalseLocalChapters
Form990 Provided To Governing BodytrueForm990ProvidedToGoverningBody
Conflict Of Interest PolicytrueConflictOfInterestPolicy
Annual Disclosure Covered PersonstrueAnnualDisclosureCoveredPersons
Regular Monitoring EnforcementtrueRegularMonitoringEnforcement
Whistleblower PolicytrueWhistleblowerPolicy
Document Retention PolicytrueDocumentRetentionPolicy
Compensation Process CEOtrueCompensationProcessCEO
Compensation Process OthertrueCompensationProcessOther
Investment In Joint VenturefalseInvestmentInJointVenture
States Where Copy Of Return Is FiledKSStatesWhereCopyOfReturnIsFiled
Upon RequestXUponRequest
Other Explain In Sch OXOtherExplainInSchO

The Books Are In Care Of TheBooksAreInCareOf

FieldValueIRS element (for citing)
Name PersonTIERNEY L GRASSERNamePerson
Telephone Number9137914461TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line120333 W 151ST STREETAddressLine1
CityOLATHECity
StateKSState
ZIP Code66061ZIPCode
FieldValueIRS element (for citing)
Info In Schedule O Part VIIXInfoInScheduleOPartVII

Form990 Part VII Section A Form990PartVIISectionA (12 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekAverage Hours Per Week RelatedAverageHoursPerWeekRelatedIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationHighest Compensated EmployeeHighestCompensatedEmployeeFormerFormer
JACK TINNEL
TRUSTEE/CHAIRPERSON2.01.0XX000
DENISE GERMAN
TRUSTEE / VICE CHAIRPERSON1.00.0XX000
STEVE MILLER
TRUSTEE/SEC/TREAS1.00.0XX000
JOE MORELAND
TRUSTEE1.00.0X000
CHIP WOOD
TRUSTEE1.04.0X000
FRANK H DEVOCELLE
PRESIDENT/CEO7.041.0X0337070220372
TIERNEY L GRASSER
SENIOR VP/FINANCE9.039.0X0406990121439
GERALD WIESNER
VICE PRESIDENT/OPERATIONS40.00.0X166708019880
CHERYL L ROSS
ASSISTANT SECRETARY2.043.0X011103514864
PAUL W LUCE
PATIENT CARE DIRECTOR45.00.0121906025756X
STACEY GRAY
PHARMACY DIRECTOR27.018.062389414892657X
RODNEY D CORN
SR VP/OPS/RESIGNED 3/4/110.00.001505240X
FieldValueIRS element (for citing)
Total Reportable Comp From Org351003TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs4080740TotalReportableCompFrmRltdOrgs
Total Other Compensation204968TotalOtherCompensation
Number Individuals GT100 K3NumberIndividualsGT100K
Formers ListedtrueFormersListed
Total Comp GT150 KtrueTotalCompGT150K
Compensation From Other SourcesfalseCompensationFromOtherSources

Contractor Compensation ContractorCompensation (4 entries)

Description Of ServicesDescriptionOfServicesCompensationCompensation
EMERGENCY MEDICINE CARE PA
EMERGENCY SERVICES1680000
SHARED MEDICAL SERVICES
MRI SERVICES193550
KRAMER FRANK PC
COLLECTION SERVICE139212
P1 GROUP INC
HVAC SERVICE137343
FieldValueIRS element (for citing)
Number Of Contractors GT100 K4NumberOfContractorsGT100K
Government Grants10205GovernmentGrants
All Other Contributions398AllOtherContributions
Total Contributions10603TotalContributions

Program Service Revenue ProgramServiceRevenue

FieldValueIRS element (for citing)
DescriptionNet Patient Service RevenueDescription
Business Code900099BusinessCode
Total Revenue Column20973770TotalRevenueColumn
Related Or Exempt Function Income20973770RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Program Service Revenue20973770TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column929547TotalRevenueColumn
Exclusion$929,547ExclusionAmount

Income From Invest Bond Proceeds IncomeFromInvestBondProceeds

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Royalties Revenue RoyaltiesRevenue

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real85518Real

Less Rental Expenses LessRentalExpenses

FieldValueIRS element (for citing)
Real168008Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real-82490Real
Personal0Personal

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column-82490TotalRevenueColumn
Exclusion-$82,490ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities7939Securities

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities7939Securities

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column7939TotalRevenueColumn
Exclusion$7,939ExclusionAmount

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Income From Gaming NetIncomeFromGaming

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Income Or Loss NetIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnExclusionExclusionAmountUnrelated Business RevenueUnrelatedBusinessRevenue
Puchase Discounts90009929913$29,913
Cafeteria72221026985$26,985
Reference Lab Income62150012292$12,038254

Miscellaneous Revenue MiscellaneousRevenue

FieldValueIRS element (for citing)
Total Revenue Column74672TotalRevenueColumn
Exclusion$74,672ExclusionAmount
FieldValueIRS element (for citing)
Total Other Revenue143862TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column21983231TotalRevenueColumn
Related Or Exempt Function Income20973770RelatedOrExemptFunctionIncome
Unrelated Business Revenue254UnrelatedBusinessRevenue
Exclusion$998,604ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total199416Total
Program Services199416ProgramServices

Grants To Domestic Individuals GrantsToDomesticIndividuals

FieldValueIRS element (for citing)
Total4000Total
Program Services4000ProgramServices

Foreign Grants ForeignGrants

FieldValueIRS element (for citing)
Total0Total

Benefits To Members BenefitsToMembers

FieldValueIRS element (for citing)
Total0Total

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total167127Total
Program Services129546ProgramServices
Management And General37581ManagementAndGeneral

Comp Disqual Persons CompDisqualPersons

FieldValueIRS element (for citing)
Total34875Total
Program Services27033ProgramServices
Management And General7842ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total7655197Total
Program Services5933797ProgramServices
Management And General1721400ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total142305Total
Program Services110305ProgramServices
Management And General32000ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total983383Total
Program Services762252ProgramServices
Management And General221131ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total544284Total
Program Services421892ProgramServices
Management And General122392ManagementAndGeneral

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total0Total

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total33179Total
Management And General33179ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total37572Total
Management And General37572ManagementAndGeneral

Fees For Services Lobbying FeesForServicesLobbying

FieldValueIRS element (for citing)
Total3805Total
Management And General3805ManagementAndGeneral

Fees For Services Prof Fundraising FeesForServicesProfFundraising

FieldValueIRS element (for citing)
Total0Total

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total16873Total
Management And General16873ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total3203380Total
Program Services2703694ProgramServices
Management And General499686ManagementAndGeneral
Fundraising0Fundraising

Advertising Advertising

FieldValueIRS element (for citing)
Total103530Total
Management And General103530ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total774696Total
Program Services195509ProgramServices
Management And General579187ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total0Total

Royalties Royalties

FieldValueIRS element (for citing)
Total0Total

Occupancy Occupancy

FieldValueIRS element (for citing)
Total417012Total
Program Services353424ProgramServices
Management And General63588ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total24181Total
Program Services4440ProgramServices
Management And General19741ManagementAndGeneral

Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials

FieldValueIRS element (for citing)
Total0Total

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total0Total

Interest Interest

FieldValueIRS element (for citing)
Total216153Total
Program Services183934ProgramServices
Management And General32219ManagementAndGeneral

Payments To Affiliates PaymentsToAffiliates

FieldValueIRS element (for citing)
Total0Total

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total1279324Total
Program Services1088634ProgramServices
Management And General190690ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total137378Total
Program Services116901ProgramServices
Management And General20477ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
Bad Debt Expense18264341826434
Medical Supplies18482131848083130
Medicaid Assessment7897078970
Dues & Subscriptions449721681528157

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total198641Total
Program Services71109ProgramServices
Management And General127532ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total19974900Total
Program Services16076188ProgramServices
Management And General3898712ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY435287BOY
EOY1509325EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY3808380BOY
EOY3515792EOY

Receivables From Officers Etc ReceivablesFromOfficersEtc

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Receivables From Disqual Persons ReceivablesFromDisqualPersons

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY636866BOY
EOY720301EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY139391BOY
EOY220385EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis22308187LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec16932251LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY5954796BOY
EOY5375936EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY28694242BOY
EOY32236046EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
BOY2502265BOY
EOY3418953EOY

Investments Program Related InvestmentsProgramRelated

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Intangible Assets IntangibleAssets

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY239427BOY
EOY591621EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY42410654BOY
EOY47588359EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY1960346BOY
EOY1868803EOY

Grants Payable GrantsPayable

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Deferred Revenue DeferredRevenue

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY4934342BOY
EOY4638366EOY

Escrow Account Liability EscrowAccountLiability

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Loans From Officers Directors LoansFromOfficersDirectors

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Unsecured Notes Loans Payable UnsecuredNotesLoansPayable

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY412263BOY
EOY390222EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY7306951BOY
EOY6897391EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY35077587BOY
EOY40674545EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY26116BOY
EOY16423EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY35103703BOY
EOY40690968EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY42410654BOY
EOY47588359EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses2008331ReconcilationRevenueExpenses
Reconciliation Unrealized Invest3575982ReconciliationUnrealizedInvest
Reconcilation Other Changes2952ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or ReviewfalseAccountantCompileOrReview
FS AuditedtrueFSAudited

FS Audited Basis FSAuditedBasis

FieldValueIRS element (for citing)
Financial Statement ConsolidatedXFinancialStatementConsolidated
FieldValueIRS element (for citing)
Audit CommitteetrueAuditCommittee
Federal Grant Audit RequiredfalseFederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Hospital170b1 AiiiXHospital170b1Aiii

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
Total Grassroots LobbyingTotalGrassrootsLobbying
Total Direct LobbyingTotalDirectLobbying
Total Lobbying ExpendituresTotalLobbyingExpenditures
Other Exempt Purpose ExpendituresOtherExemptPurposeExpenditures
Total Exempt Purpose ExpendituresTotalExemptPurposeExpenditures
Lobbying NontaxableLobbyingNontaxableAmount
Grassroots NontaxableGrassrootsNontaxableAmount
Tot Lobbying Grassroot Minus Non TxTotLobbyingGrassrootMinusNonTx
Tot Lobby Expend Mns Lobbying NontxTotLobbyExpendMnsLobbyingNontx
VolunteersfalseVolunteers
Paid Staff Or ManagementfalsePaidStaffOrManagement
Media AdvertisementsfalseMediaAdvertisements
Mailings MembersfalseMailingsMembers
Publications Or BroadcastfalsePublicationsOrBroadcast
Grants Other OrganizationsfalseGrantsOtherOrganizations
Direct Contact LegislatorstrueDirectContactLegislators
Direct Contact Legislators$3,805DirectContactLegislatorsAmount
Rallies DemonstrationsfalseRalliesDemonstrations
Other ActivitiesfalseOtherActivities
Total Lobbying Expenditures IIB3805TotalLobbyingExpendituresIIB
Not Described In501c3falseNotDescribedIn501c3

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Art Public Exhibition AmtsArtPublicExhibitionAmts
Held Works Of Art AmtsHeldWorksOfArtAmts

Current Year CurrentYear

FieldValueIRS element (for citing)
Beginning Of Year Balance29762822BeginningOfYearBalance
Contributions670994Contributions
Investment Earnings Or Losses4469234InvestmentEarningsOrLosses
Other Expenditures7450OtherExpenditures
End Of Year Balance34895600EndOfYearBalance

Current Year Minus1 Year CurrentYearMinus1Year

FieldValueIRS element (for citing)
Beginning Of Year Balance29909183BeginningOfYearBalance
Contributions401968Contributions
Investment Earnings Or Losses-522248InvestmentEarningsOrLosses
Other Expenditures26081OtherExpenditures
End Of Year Balance29762822EndOfYearBalance

Current Year Minus2 Years CurrentYearMinus2Years

FieldValueIRS element (for citing)
Beginning Of Year Balance24241897BeginningOfYearBalance
Contributions2406369Contributions
Investment Earnings Or Losses3273465InvestmentEarningsOrLosses
Other Expenditures12548OtherExpenditures
End Of Year Balance29909183EndOfYearBalance

Current Year Minus3 Years CurrentYearMinus3Years

FieldValueIRS element (for citing)
Beginning Of Year Balance15324746BeginningOfYearBalance
Contributions3571697Contributions
Investment Earnings Or Losses5368894InvestmentEarningsOrLosses
Other Expenditures23440OtherExpenditures
End Of Year Balance24241897EndOfYearBalance

Current Year Minus4 Years CurrentYearMinus4Years

FieldValueIRS element (for citing)
Beginning Of Year Balance16823777BeginningOfYearBalance
Contributions1922937Contributions
Investment Earnings Or Losses-3411104InvestmentEarningsOrLosses
Other Expenditures10864OtherExpenditures
End Of Year Balance15324746EndOfYearBalance
FieldValueIRS element (for citing)
Board Designated EOY Balance0.99950BoardDesignatedEOYBalance
Term Endowment EOY Balance0.00050TermEndowmentEOYBalance
Endowments Held By Unrelated OrgsfalseEndowmentsHeldByUnrelatedOrgs
Endowments Held By Related OrgsfalseEndowmentsHeldByRelatedOrgs

Land Land

FieldValueIRS element (for citing)
Investment Cost Or Other Basis0InvestmentCostOrOtherBasis
Other Cost Or Other Basis1475439OtherCostOrOtherBasis
Book Value1475439BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis10057263OtherCostOrOtherBasis
Depreciation8961726Depreciation
Book Value1095537BookValue
FieldValueIRS element (for citing)
Leasehold ImprovementsLeaseholdImprovements

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis10157276OtherCostOrOtherBasis
Depreciation7588068Depreciation
Book Value2569208BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis618209OtherCostOrOtherBasis
Depreciation382457Depreciation
Book Value235752BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings5375936TotalOfBookValueLandBuildings
Financial DerivativesFinancialDerivatives
Closely Held Equity InterestsCloselyHeldEquityInterests

Other Securities OtherSecurities

FieldValueIRS element (for citing)
DescriptionINVESTMENT IN SSGADescription
Book Value3418953BookValue
Method Of ValuationFMethodOfValuation
FieldValueIRS element (for citing)
Total Of Book Value Securities3418953TotalOfBookValueSecurities
Federal Income Tax Liability0FederalIncomeTaxLiability

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
DescriptionDUE TO AFFILIATESDescription
Amount$390,222Amount
FieldValueIRS element (for citing)
Total Of Amounts390222TotalOfAmounts
Tot Revenue Etc Audited Fincl Stmt308043553TotRevenueEtcAuditedFinclStmt
Net Unrealized Gains Investments3575982NetUnrealizedGainsInvestments
Other Revenues284327647OtherRevenues
Revenue Not Rptd F990287903629RevenueNotRptdF990
Revenue Subtotal20139924RevenueSubtotal
Investment Expenses Not Included16873InvestmentExpensesNotIncluded
Other Revenues Not Included1826434OtherRevenuesNotIncluded
Revenue Not Rptd On Fin Stmt1843307RevenueNotRptdOnFinStmt
Total Revenue Per Form99021983231TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt261241363TotExpensesEtcAuditedFinclStmt
Other Expenses Included243109770OtherExpensesIncluded
Expenses Not Rptd F990243109770ExpensesNotRptdF990
Expenses Subtotal18131593ExpensesSubtotal
Investment Expenses Not Included216873InvestmentExpensesNotIncluded2
Other Expenses Not Included1826434OtherExpensesNotIncluded
Expenses Not Rptd On Fin Stmt1843307ExpensesNotRptdOnFinStmt
Total Expenses Per Form99019974900TotalExpensesPerForm990

Form990 Schedule D Part XIII Form990ScheduleDPartXIII (4 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
DESCRIBE THE INTENDED USES OF THE ORGANIZATION'S ENDOWMENT FUNDSSCHEDULE D, PART V, LINE 4THE ENDOWMENT FUNDS ARE HELD FOR FUTURE CAPITAL AND EXPANSION NEEDS. IN ADDITION, THE FUNDS ALSO REPRESENT RESERVES FOR OPERATING NEEDS TO REMAIN FINANCIALLY STABLE.
UNCERTAIN TAX POSITIONS DISCLOSURESCHEDULE D, PART X, LINE 2MANAGEMENT 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 REVENUE PER AUDITED FINANCIAL STATEMENTSSCHEDULE D, PART XI, LINES 2D & 4BLINE 2D: RELATED ORGANIZATIONS' REVENUE $ 284,159,639 RENTAL EXPENSES 168,008 ---------- TOTAL $ 284,327,647 LINE 4B: BAD DEBT EXPENSE $ 1,826,434
RECONCILIATION OF EXPENSES PER AUDITED FINANCIAL STATEMENTSSCHEDULE D, PART XII, LINES 2D & 4BLINE 2D: RELATED ORGANIZATIONS' EXPENSES $ 242,941,762 RENTAL EXPENSES 168,008 ------------ TOTAL $ 243,109,770 LINE 4B: BAD DEBT EXPENSE $ 1,826,434

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Charity Care PolicytrueCharityCarePolicy
Written PolicytrueWrittenPolicy
Policy Applied To All HospitalsXPolicyAppliedToAllHospitals
FPG Reference Free CarefalseFPGReferenceFreeCare
FPG Reference Discounted CaretrueFPGReferenceDiscountedCare
Pcent200 DXPcent200D
Free Disc Care Medically IndigenttrueFreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity CaretrueAmountsBudgetedForCharityCare
Expenses Exceeded BudgetfalseExpensesExceededBudget
Annual Community Benefit ReporttrueAnnualCommunityBenefitReport
Report Publically AvailabletrueReportPublicallyAvailable

Charity Care At Cost CharityCareAtCost

FieldValueIRS element (for citing)
Number Of Activities Or Programs1794NumberOfActivitiesOrPrograms
Persons Served1008PersonsServed
Total Community Benefit Expense700089TotalCommunityBenefitExpense
Direct Offsetting Revenue0DirectOffsettingRevenue
Net Community Benefit Expense700089NetCommunityBenefitExpense
Percent Of Total Expense0.03860PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

FieldValueIRS element (for citing)
Number Of Activities Or Programs5347NumberOfActivitiesOrPrograms
Persons Served1865PersonsServed
Total Community Benefit Expense2042004TotalCommunityBenefitExpense
Direct Offsetting Revenue795282DirectOffsettingRevenue
Net Community Benefit Expense1246722NetCommunityBenefitExpense
Percent Of Total Expense0.06870PercentOfTotalExpense

Unreimbursed Costs UnreimbursedCosts

FieldValueIRS element (for citing)
Persons Served0PersonsServed
Total Community Benefit Expense0TotalCommunityBenefitExpense
Direct Offsetting Revenue0DirectOffsettingRevenue
Net Community Benefit Expense0NetCommunityBenefitExpense
Percent Of Total Expense0.00000PercentOfTotalExpense

Total Charity Care TotalCharityCare

FieldValueIRS element (for citing)
Number Of Activities Or Programs7141NumberOfActivitiesOrPrograms
Persons Served2873PersonsServed
Total Community Benefit Expense2742093TotalCommunityBenefitExpense
Direct Offsetting Revenue795282DirectOffsettingRevenue
Net Community Benefit Expense1946811NetCommunityBenefitExpense
Percent Of Total Expense0.10730PercentOfTotalExpense

Community Health Services CommunityHealthServices

FieldValueIRS element (for citing)
Number Of Activities Or Programs8NumberOfActivitiesOrPrograms
Persons Served582PersonsServed
Total Community Benefit Expense29916TotalCommunityBenefitExpense
Direct Offsetting Revenue0DirectOffsettingRevenue
Net Community Benefit Expense29916NetCommunityBenefitExpense
Percent Of Total Expense0.00160PercentOfTotalExpense

Health Professions Education HealthProfessionsEducation

FieldValueIRS element (for citing)
Number Of Activities Or Programs4NumberOfActivitiesOrPrograms
Persons Served59PersonsServed
Total Community Benefit Expense206175TotalCommunityBenefitExpense
Direct Offsetting Revenue0DirectOffsettingRevenue
Net Community Benefit Expense206175NetCommunityBenefitExpense
Percent Of Total Expense0.01140PercentOfTotalExpense

Subsidized Health Services SubsidizedHealthServices

FieldValueIRS element (for citing)
Persons Served0PersonsServed
Total Community Benefit Expense0TotalCommunityBenefitExpense
Direct Offsetting Revenue0DirectOffsettingRevenue
Net Community Benefit Expense0NetCommunityBenefitExpense
Percent Of Total Expense0.00000PercentOfTotalExpense

Research Research

FieldValueIRS element (for citing)
Persons Served0PersonsServed
Total Community Benefit Expense0TotalCommunityBenefitExpense
Direct Offsetting Revenue0DirectOffsettingRevenue
Net Community Benefit Expense0NetCommunityBenefitExpense
Percent Of Total Expense0.00000PercentOfTotalExpense

Cash And In Kind Contributions CashAndInKindContributions

FieldValueIRS element (for citing)
Number Of Activities Or Programs2NumberOfActivitiesOrPrograms
Persons Served75PersonsServed
Total Community Benefit Expense15557TotalCommunityBenefitExpense
Direct Offsetting Revenue0DirectOffsettingRevenue
Net Community Benefit Expense15557NetCommunityBenefitExpense
Percent Of Total Expense0.00090PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

FieldValueIRS element (for citing)
Number Of Activities Or Programs14NumberOfActivitiesOrPrograms
Persons Served716PersonsServed
Total Community Benefit Expense251648TotalCommunityBenefitExpense
Direct Offsetting Revenue0DirectOffsettingRevenue
Net Community Benefit Expense251648NetCommunityBenefitExpense
Percent Of Total Expense0.01390PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

FieldValueIRS element (for citing)
Number Of Activities Or Programs7155NumberOfActivitiesOrPrograms
Persons Served3589PersonsServed
Total Community Benefit Expense2993741TotalCommunityBenefitExpense
Direct Offsetting Revenue795282DirectOffsettingRevenue
Net Community Benefit Expense2198459NetCommunityBenefitExpense
Percent Of Total Expense0.12120PercentOfTotalExpense

Health Improvement Advocacy HealthImprovementAdvocacy

FieldValueIRS element (for citing)
Number Of Activities Or Programs2NumberOfActivitiesOrPrograms
Persons Served4PersonsServed
Total Community Building Expense3228TotalCommunityBuildingExpense
Net Community Building Expense3228NetCommunityBuildingExpense
Percent Of Total Expense0.00020PercentOfTotalExpense

Total Total

FieldValueIRS element (for citing)
Number Of Activities Or Programs2NumberOfActivitiesOrPrograms
Persons Served4PersonsServed
Total Community Building Expense3228TotalCommunityBuildingExpense
Net Community Building Expense3228NetCommunityBuildingExpense
Percent Of Total Expense0.00020PercentOfTotalExpense
FieldValueIRS element (for citing)
Bad Debt Expense ReportedtrueBadDebtExpenseReported
Bad Debt Expense$513,585BadDebtExpenseAmount
Amount Reimbursed By Medicare5091445AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare7348180CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall-2256735MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

FieldValueIRS element (for citing)
Cost Accounting SystemXCostAccountingSystem
FieldValueIRS element (for citing)
Written Debt Collection PolicytrueWrittenDebtCollectionPolicy
Provision For Charity CaretrueProvisionForCharityCare
Number Of Hospital Facilities1NumberOfHospitalFacilities

Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA

FieldValueIRS element (for citing)
Facility Number1FacilityNumber

Name Name

FieldValueIRS element (for citing)
Business Name Line1MIAMI COUNTY MEDICAL CENTER INCBusinessNameLine1

Address Address

FieldValueIRS element (for citing)
Address Line12100 BAPTISTE DRIVEAddressLine1
CityPAOLACity
StateKSState
ZIP Code66071ZIPCode
FieldValueIRS element (for citing)
Licensed HospitalXLicensedHospital
General Medical And SurgicalXGeneralMedicalAndSurgical
Er24 HoursXEr24Hours

Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1MIAMI COUNTY MEDICAL CENTERBusinessNameLine1
FieldValueIRS element (for citing)
Hospital Facility Number1HospitalFacilityNumber
Eligibility Criteria ExplainedtrueEligibilityCriteriaExplained
Uses FPG FreefalseUsesFPGFree
Uses FPG DiscountedtrueUsesFPGDiscounted
FPG Discount Percent200.FPGDiscountPercent
Explains BasistrueExplainsBasis
Income LevelXIncomeLevel
Asset LevelXAssetLevel
Medical IndigencyXMedicalIndigency
Insurance StatusXInsuranceStatus
Uninsured DiscountXUninsuredDiscount
Medicaid MedicareXMedicaidMedicare
State RegulationXStateRegulation
Explains Application MethodtrueExplainsApplicationMethod
Includes Publicity MeasurestrueIncludesPublicityMeasures
Posted On WebsiteXPostedOnWebsite
Attached To InvoicesXAttachedToInvoices
Posted In Emergency RoomXPostedInEmergencyRoom
Posted In Admission OfficeXPostedInAdmissionOffice
Available On RequestXAvailableOnRequest
Actions On NonpaymenttrueActionsOnNonpayment
Collection ActivitiesfalseCollectionActivities
Notify Upon AdmissionXNotifyUponAdmission
Notify Before DischargeXNotifyBeforeDischarge
Notified All PatientsXNotifiedAllPatients
Documented DeterminationXDocumentedDetermination
Nondiscrim Emergency Care PolicytrueNondiscrimEmergencyCarePolicy
Average Negotiated RatesXAverageNegotiatedRates
Amounts Generally BilledfalseAmountsGenerallyBilled
Gross ChargesfalseGrossCharges

Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC

FieldValueIRS element (for citing)
Number Of Other Facilities2NumberOfOtherFacilities

Other Facilities OtherFacilities (2 entries)

Address Line1Address/AddressLine1CityAddress/CityStateAddress/StateZIP CodeAddress/ZIPCodeFacility TypeFacilityType
LOUISBURG REHAB OF MIAMI CTY MEDICAL CTR
102 W CRESTVIEW CIRCLELOUISBURGKS66053OUTPATIENT REHABILITATION CLINIC
OSAWATOMIE REHAB OF MIAMI CTY MED CENTER
539 MAIN STREETOSAWATOMIEKS66064OUTPATIENT REHABILITATION CLINIC

Form990 Schedule H Part VI Form990ScheduleHPartVI (17 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
FINANCIAL ASSISTANCE ELIGIBILITY CRITERIA FOR PROVIDING FREE CARESCHEDULE H, PART I, LINE 3AMIAMI 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.
FINANICAL ASSISTANCE ELIGIBILITY CRITERIA FOR PROVIDING DISCOUNTED CARESCHEDULE H, PART I, LINE 3CMIAMI 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.
FINANCIAL ASSISTANCE AND CERTAIN OTHER COMMUNITY BENEFITS AT COSTSCHEDULE H, PART I, LINE 7, COLUMN FTHE 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 $1,826,434.00
FINANCIAL ASSISTANCE AND OTHER CERTAIN COMMUNITY BENEFITS AT COSTSCHEDULE H, PART I, LINE 7THE COSTING METHODOLOGY USED TO CALCULATE THE AMOUNTS CONTAINED IN THE TABLE OF PART I, LINE 7, OF SCHEDULE H, IS A COST ACCOUNTING SYSTEM.
COMMUNITY BUILDING ACTIVITIESSCHEDULE H, PART IIMIAMI COUNTY MEDICAL CENTER, INC. IS COMMITTED TO IMPROVING THE COMMUNITY WE SERVE, BY CONTRIBUTING TO COMMUNITY ORGANIZATIONS THAT HELP THOSE IN NEED IN THE COMMUNITY.
BAD DEBT EXPENSESCHEDULE H, PART III, SECTION A, LINE 2THE COSTING METHODOLOGY USED TO CALCULATE THE AMOUNTS CONTAINED IN THE TABLE OF PART III, LINE 2, OF SCHEDULE H, IS A COST ACCOUNTING SYSTEM.
BAD DEBT EXPENSESCHEDULE H, PART III, SECTION A, LINE 4Accounts receivable are reduced by an allowance for doubtful accounts. In evaluating the collectability of accounts receivable, the System analyzes its history and identifies trends for each of its major payer sources of revenue to estimate the appropriate allowance for doubtful accounts and provision for bad debts. Management regularly reviews data about these major payer sources of revenue in evaluating the sufficiency of the allowance for doubtful accounts. For receivables associated with services provided to patients who have third-party coverage, the System analyzes contractually due amounts and provides an allowance for doubtful accounts and a provision for bad debts, if necessary (for example, for expected uncollectible deductibles and copayments on accounts for which the third-party payer has not yet paid, or for payers who are known to be having financial difficulties that make the realization of amounts due unlikely). For receivables associated with self-pay patients (which includes both patients without insurance and patients with deductible and copayment balances due for which third-party coverage exists for part of the bill), the System records a significant provision for bad debts in the period of service on the basis of its past experience, which indicates that many patients are unable or unwilling to pay the portion of their bill for which they are financially responsible. The difference between the standard rates (or the discounted rates if negotiated or provided by policy) and the amounts actually collected after all reasonable collection efforts have been exhausted is charged off against the allowance for doubtful accounts. The System's allowance for doubtful accounts for self-pay patients increased from 57% of self-pay accounts receivable at December 31, 2011, to 70% of self-pay accounts receivable at December 31, 2012. In addition, the System's write-offs increased approximately $4,903,000 from approximately $11,737,000 for the year ended December 31, 2011, to approximately $16,640,000 for the year ended December 31, 2012. Both increases were the result of negative trends experienced in the collection of amounts from self-pay patients in fiscal year 2012.
MEDICARE SHORTFALLSCHEDULE H, PART III, SECTION B, LINE 8Part 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.
COLLECTION PRACTICESSCHEDULE H, PART III, SECTION C, LINE 9BBEFORE 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.
FINANCIAL ASSISTANCE POLICY FOR PROVIDING FREE CARESCHEDULE H, PART V, SECTION B, LINE 10MIAMI 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.
BILLING AND COLLECTIONS POLICYSCHEDULE H, PART V, SECTION B, LINE 16MIAMI 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.
NEEDS ASSESSMENTSCHEDULE H, PART VI, LINE 2Miami 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, 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 this 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 MIAMI COUNTY MEDICAL CENTER HAS COMLETED A COMMUNITY HEALTH IMPROVEMENT PLAN (CHIP) TO ADDRESS THE HEALTH NEED PRIORITIES THAT WERE IDENTIFIED THROUGH THE COMMUNITY HEALTH NEEDS ASSESSMENT REPORT. BOTH REPORTS CAN BE FOUND ON OUR WEBSITE AT OLATHEHEALTH.ORG/COMMUNITY.
PATIENT EDUCATION OF ELIBILITY FOR ASSISTANCESCHEDULE H, PART VI, LINE 3PATIENTS OF MIAMI COUNTYMEDICAL 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.
COMMUNITY INFORMATIONSCHEDULE H, PART VI, LINE 4Miami 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: 5.7% Linn County: 10.3% Young Children Living Below Poverty Level Miami County: 10.6% Linn County: 12.1% Uninsured Adult Population Rate (2009) Miami County: 14.8% Linn County: 18.8%
PROMOTION OF COMMUNITY HEALTHSCHEDULE H, PART VI, LINE 5In 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.
AFFILIATED HEALTH CARE SYSTEMSCHEDULE H, PART VI, LINE 6MIAMI 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.
STATE FILING OF COMMUNITY BENEFIT REPORTSCHEDULE H, PART VI, LINE 7MCMCI 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.

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Records MaintainedtrueRecordsMaintained

Recipient Table RecipientTable (5 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEIN Of RecipientEINOfRecipientIRC SectionIRCSectionAmount Of Cash GrantAmountOfCashGrantPurpose Of GrantPurposeOfGrantAmount Of Non Cash AssistanceAmountOfNonCashAssistanceMethod Of ValuationMethodOfValuationDescription Of Non Cash AssistanceDescriptionOfNonCashAssistance
LAKEMARY ENDOWMENT
100 LAKEMARY DRIVEPAOLAKS66071237423516501(C)(3)7500CMTY WELLNESS
SCHOOL DISTRICT #368
PO BOX 268PAOLAKS66071480720746GOVERNMENTCMTY WELLNESS23024BOOKSPORTS MEDICINE
SCHOOL DISTRICT #230
101 E SOUTH STSPRING HILLKS66083480723504GOVERNMENTCMTY WELLNESS20846BOOKSPORTS MEDICINE
SCHOOL DISTRICT #367
1200 TROJAN DRIVEOSAWATOMIEKS66064GOVERNMENTCMTY WELLNESS23024BOOKSPORTS MEDICINE
YMCA OF GREATER KC
3100 BROADWAY SUITE 1020KCMO64111440546002501(C)(3)6000CMTY WELLNESS
FieldValueIRS element (for citing)
Total Nbr Of501 C3 And Govt Grants5TotalNbrOf501C3AndGovtGrants
Total Nbr Of Other Organizations0TotalNbrOfOtherOrganizations

Form990 Schedule I Part IV Form990ScheduleIPartIV

FieldValueIRS element (for citing)
IdentifierPROCESS FOR MONITORING THE USE OF GRANTS IN THE U.S.Identifier
Return ReferenceSCHEDULE I, PART I, LINE 2ReturnReference
ExplanationSCHEDULE 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.Explanation

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Club Dues Or FeesXClubDuesOrFees
Written Policy Re T And E ExpensestrueWrittenPolicyReTAndEExpenses
Substantiation RequiredtrueSubstantiationRequired
Severance PaymentfalseSeverancePayment
Supplemental Nonqual Retire PlantrueSupplementalNonqualRetirePlan
Equity Based Comp ArrangementfalseEquityBasedCompArrangement
Comp Based On Revenue Of Filing OrgfalseCompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related OrgsfalseCompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing OrgfalseCompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate OrgsfalseCompBasedNetEarningsRelateOrgs
Any Non Fixed PaymentsfalseAnyNonFixedPayments
Initial Contract ExceptionfalseInitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (4 entries)

TitleTitleBase Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
FRANK H DEVOCELLE
PRESIDENT/CEO0827087011961402424001000203720339107402074339
RODNEY D CORN
SR VP/OPS/RESIGNED 3/4/1100000150524000001505240153209
TIERNEY L GRASSER
SENIOR VP/FINANCE03229020561170279710948690265700528429018981
GERALD WIESNER
VICE PRESIDENT/OPERATIONS15398801043002290025000173800186588000

Form990 Schedule J Part III Form990ScheduleJPartIII (5 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
SOCIAL CLUB DUES OR INITIATION FEESSCHEDULE J, PART I, LINE 1ASOCIAL CLUB DUES WERE PAID BY THE HOSPITAL FOR GERALD WIESNER AND WERE NOT INCLUDED IN HIS W-2 AS TAXABLE COMPENSATION BECAUSE IT WAS 100% BUSINESS USE.
ESTABLISHMENT OF OFFICER COMPENSATIONFORM 990, PART VII; SCHEDULE J, PART I, LINE 3 AND PART IITHE COMPENSATION REPORTED FOR GERALD WIESNER 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 COMPENSATION.
COMPENSATION FROM A RELATED ORGANIZATIONFORM 990, PART VII; SCHEDULE J, PART I, LINE 3 AND PART IITHE 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.
SUPPLEMENTAL NONQUALIFIED RETIREMENT PLANSCHEDULE J, PART I, LINE 4B & PART IIA SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP) WAS PREVIOUSLY PROVIDED TO FRANK H DEVOCELLE, PRESIDENT AND CEO. INCLUDED IN HIS COMPENSATON IN 2012 IS $2,389,228 IN SERP PAYOUT WHICH REPRESENTS THE VALUE NO LONGER SUBJECT TO A SUBSTANTIAL RISK OF FORFEITURE AND REPRESENTS HIS 40 YEARS OF SERVICE TO THE ORGANIZATION. $2,074,339 OF THIS AMOUNT HAS PREVIOUSLY BEEN REPORTED IN MR. DEVOCELLE'S COMPENSATION AS SUPPLEMENTAL INCOME IN PREVIOUS YEARS' 990 TAX RETURNS. The total compensation of $150,524 for Rodney D. Corn is a SERP payout. Mr. Corn left the Organization in 2011 and met the requirements for payment in 2012. $153,209 of this amount has previously been reported in Mr. Corn's compensation as supplemental income in previous years. 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 24 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 2012, THERE WAS A PAYOUT OF $23,554 AND AN ACCRUAL OF $94,869.
COMPENSATION REPORTED IN PRIOR YEAR FORM 990SCHEDULE J, PART II, COLUMN FCOMPENSATION IS REPORTED ON THE FORM 990 IN THE YEAR THAT THE COMPENSATION IS EARNED BY OR AWARDED TO AN INDIVIDUAL, EVEN IF THE COMPENSATION IS NOT PAID TO THE INDIVIDUAL, IS NOT FULLY VESTED, OR IS SUBJECT TO SUBSTANTIAL RISK OF FORFEITURE. IF COMPENSATION IS EARNED OR AWARDED IN ONE YEAR BUT PAID IN A LATER YEAR, THEN THE COMPENSATION IS GENERALLY REPORTED A SECOND TIME ON THE FORM 990 IN THE YEAR THE COMPENSATION IS PAID TO THE INDIVIDUAL. AS A RESULT OF THE REPORTING REQUIREMENT, AN ORGANIZATION COULD BE REQUIRED TO REPORT THE SAME COMPENSATION AMOUNTS ON THE FORM 990 FOR TWO DIFFERENT YEARS. The amounts reported in column F: include incentive amounts and capital accumulation amounts which were reported in previous 990s as deferred compensation.

Schedule K IRS990ScheduleK

Form990 Schedule K Part I Form990ScheduleKPartI

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd

Issuer Name IssuerName

FieldValueIRS element (for citing)
Business Name Line1CITY OF OLATHE KANSASBusinessNameLine1
FieldValueIRS element (for citing)
Issuer EIN486034756IssuerEIN
CUSIP Number679390GX6CUSIPNumber
Date Issued2008-02-27DateIssued
Issue Price5311403IssuePrice
Description Of PurposeSEE PART VIDescriptionOfPurpose
DefeasedfalseDefeased
On Behalf Of IssuerfalseOnBehalfOfIssuer
Pool FinancingfalsePoolFinancing

Form990 Schedule K Part II Form990ScheduleKPartII

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Amount Retired640000AmountRetired
Amount Bond Defeased0AmountBondDefeased
Total Proceeds5311403TotalProceeds
Amount In Reserve Fund0AmountInReserveFund
Capitalized Interest0CapitalizedInterest
Refunding Escrow0RefundingEscrow
Issuance Costs From Proceeds22312IssuanceCostsFromProceeds
Credit Enhancement0CreditEnhancement
Working Capital Expenditures0WorkingCapitalExpenditures
Capital Expenditures0CapitalExpenditures
Other Spent Proceeds5289091OtherSpentProceeds
Amount Unspent0AmountUnspent
Year Of Subst Completion2008YearOfSubstCompletion
Current RefundingtrueCurrentRefunding
Advance RefundingfalseAdvanceRefunding
Final Allocation MadetrueFinalAllocationMade
Adequate Books And Recds MaintaindtrueAdequateBooksAndRecdsMaintaind

Form990 Schedule K Part III Form990ScheduleKPartIII

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Owning Bond Financed PropertyfalseOwningBondFinancedProperty
Any Lease ArrangementsfalseAnyLeaseArrangements
Mngment Cntrct Bond Financd PrprtytrueMngmentCntrctBondFinancdPrprty
Engage Bond Counsel ContractstrueEngageBondCounselContracts
Any Research AgreementsfalseAnyResearchAgreements
Prcntge Prvt Business Use By Others0PrcntgePrvtBusinessUseByOthers
Bond Iss Meet Prvt Security Pay TestfalseBondIssMeetPrvtSecurityPayTest
Change In Use Bond Financed PropfalseChangeInUseBondFinancedProp
Remedial Action TakenfalseRemedialActionTaken
Non Qualified Bond Remed ProcdrstrueNonQualifiedBondRemedProcdrs

Form990 Schedule K Part IV Form990ScheduleKPartIV

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Form8038 T FiledfalseForm8038TFiled
Exception To RebatetrueExceptionToRebate
Variable Rate IssuefalseVariableRateIssue
Hedge Identified In Books And RecdsfalseHedgeIdentifiedInBooksAndRecds

Name Of Hedge Provider NameOfHedgeProvider

FieldValueIRS element (for citing)
Business Name Line10BusinessNameLine1
FieldValueIRS element (for citing)
Gross Proceeds Invested In GICfalseGrossProceedsInvestedInGIC

Name Of GIC Provider NameOfGICProvider

FieldValueIRS element (for citing)
Business Name Line10BusinessNameLine1
FieldValueIRS element (for citing)
Gross Proceeds InvestedfalseGrossProceedsInvested
Written Proc To Monitor ReqstrueWrittenProcToMonitorReqs

Form990 Schedule K Part V Form990ScheduleKPartV

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Proc To Undertk Corrective ActiontrueProcToUndertkCorrectiveAction

Form990 Schedule K Part VI Form990ScheduleKPartVI (2 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
BOND ISSUE PRICESCHEDULE K, PART I, LINE A, COLUMN ETHE 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.
BOND DESCPIPTION OF PURPOSESCHEDULE K, PART I, LINE A, COLUMN FREFUND SERIES 2004A BONDS ISSUED 07/29/2004 AND REFUND SERIES 2004B BONDS ISSUED 07/29/2004.

Schedule L IRS990ScheduleL

Form990 Schedule L Part IV Form990ScheduleLPartIV

Name Of Interested Person NameOfInterestedPerson

FieldValueIRS element (for citing)
Name PersonHEIDI HANSONNamePerson
FieldValueIRS element (for citing)
RelationshipDAUGHTER OF PRESIDENTRelationship
Amount Of Transaction34875AmountOfTransaction
Description Of TransactionSALARYDescriptionOfTransaction
Sharing Of RevenuesfalseSharingOfRevenues

Form990 Schedule L Part V Form990ScheduleLPartV

FieldValueIRS element (for citing)
IdentifierBUSINESS TRANSACTIONS WITH INTERESTED PERSONSIdentifier
Return ReferenceSCHEDULE L, PART IVReturnReference
ExplanationHEIDI HANSON IS THE DAUGHTER OF FRANK H DEVOCELLE, AN OFFICER OF MCMCI HEIDI HANSON IS AN EMPLOYEE OF MCMCI.Explanation

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (12 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
PROGRAM SERVICE ACCOMPLISHMENTSFORM 990, PART III, LINE 4AMiami 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 2012, Miami County Medical Center, Inc. provided 1,202 days of inpatient care, provided 54,780 outpatient procedures, and 10,019 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 2012, $66,894 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 2012, $33,522 was contributed to various agencies and charitable organizations and $4,000 in scholarships.
BUSINESS RELATIONSHIPSFORM 990, PART VI, SECTION A, LINE 2FRANK 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.
MEMBERFORM 990, PART VI, SECTION A, LINE 6OLATHE MEDICAL CENTER, INC., A NOT-FOR-PROFIT, 501(C)(3) ORGANIZATION, IS THE SOLE MEMBER OF MIAMI COUNTY MEDICAL CENTER, INC.
MEMBER MAY ELECT GOVERNING BODYFORM 990, PART VI, SECTION A, LINE 7AOLATHE MEDICAL CENTER, INC. BEING THE SOLE MEMBER OF MIAMI COUNTY MEDICAL CENTER, INC. HAS THE RIGHT TO ELECT ALL THE BOARD OF TRUSTEES.
GOVERNING BODY DECISIONS SUBJECT TO APPROVAL OF MEMBERFORM 990, PART VI, SECTION A, LINE 7BOLATHE 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 REVIEW PROCESSFORM 990, PART VI, SECTION B, LINE 11BThe 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.
CONFLICT OF INTEREST POLICYFORM 990, PART VI, SECTION B, LINE 12CThe 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.
COMPENSATION REVIEWFORM 990, PART VI, SECTION B, LINES 15A & BThe 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.
AVAILABILITY OF DOCUMENTSFORM 990, PART VI, SECTION C, LINE 18THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE NOT AVAILABLE TO THE PUBLIC.
OTHER CHANGES IN NET ASSETSFORM 990, PART XI, LINE 5NET ASSETS RELEASED- CAPITAL $ 12,645 CHANGE IN TEMPORARILY RESTRICTED NET ASSETS $ ( 9,693) ----------- TOTAL $ 2,952
OTHER FEES FOR SERVICES FOR NON-EMPLOYEESFORM 990 PART IX LINE 11GDESCRIPTION:MEDICAL PROFESSIONAL FEES TOTAL FEES:1743287
OTHER FEES FOR SERVICES FOR NON-EMPLOYEESFORM 990 PART IX LINE 11GDESCRIPTION:OTHER CONTRACT SERVICES TOTAL FEES:1460093

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (4 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Controlled OrgControlledOrg
OLATHE MEDICAL CENTER INC
20333 W 151ST STOLATHEKS66061480577664HOSPITALKS501(C)(3)3OHSItrue
OLATHE HEALTH SYSTEM INC
20333 W 151ST STOLATHEKS66061480979845SUPPORT ORGKS501(C)(3)11BNAfalse
OLATHE MEDICAL SERVICES INC
20333 W 151ST STOLATHEKS66061481088982CLINICSKS501(C)(3)9OMCItrue
OLATHE MEDICAL CENTER CHARITABLE FDN
20333 W 151ST STOLATHEKS66061481136010FUNDRAISINGKS501(C)(3)7OMCItrue

Form990 Schedule R Part IV Form990ScheduleRPartIV (2 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivityPrimaryActivityLegal Domicile StateLegalDomicileStateBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Type Of EntityTypeOfEntityControlled OrgControlledOrg
OMC DOCTOR'S BLDG CONDO OWNERS ASSOC INC
20333 W 151ST STOLATHEKS66061481244766REAL ESTATEKSOMCIC CORPORATIONtrue
OLATHE HEALTH DEVELOPMENT CORPORATION
20333 W 151ST STOLATHEKS66061363445097MEDICAL SERVIKSOHSIC CORPORATIONtrue
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents RoyaltiesfalseReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other OrgfalseGiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other OrgfalseGiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other OrgfalseLoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other OrgfalseLoansOrGuaranteesFromOtherOrg
Dividends Related OrganizationfalseDividendsRelatedOrganization
Sale Of Assets To Other OrgfalseSaleOfAssetsToOtherOrg
Purchase Of Assets From Other OrgfalsePurchaseOfAssetsFromOtherOrg
Exchange Of AssetstrueExchangeOfAssets
Rental Of Facilities To Other OrgsfalseRentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other OrgsfalseRentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other OrgsfalsePerformOfServicesForOtherOrgs
Perform Of Services By Other OrgstruePerformOfServicesByOtherOrgs
Sharing Of FacilitiestrueSharingOfFacilities
Sharing Of Paid EmployeestrueSharingOfPaidEmployees
Reimbursement Paid To Other OrgtrueReimbursementPaidToOtherOrg
Reimbursement Paid By Other OrgtrueReimbursementPaidByOtherOrg
Other Transfer To Other OrgfalseOtherTransferToOtherOrg
Other Transfer From Other OrgfalseOtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable (6 entries)

Transaction TypeTransactionTypeAmount InvolvedAmountInvolvedMethod Of Amt DeterminationMethodOfAmtDetermination
OLATHE MEDICAL SERVICES INC
N87238COST
OLATHE MEDICAL SERVICES INC
Q74695COST
OLATHE MEDICAL CENTER INC
M183720COST
OLATHE MEDICAL CENTER INC
N93996COST
OLATHE MEDICAL CENTER INC
O2800443COST
OLATHE MEDICAL CENTER INC
Q3107011COST