2013-11-15T13:47:34-06:00 2012-12-31 BKD LLP 1201 Walnut Suite 1700 Kansas City MO 641062246 990 2012-01-01 481155548 MIAMI COUNTY MEDICAL CENTER INC % TIERNEY L GRASSER MIAM 9137914461 2100 BAPTISTE DRIVE Suite PAOLA KS 66071 TIERNEY L GRASSER 9137914461 2013-11-15 true Michael J Engle 8162216300 2012 2016-02-25 16:41:14Z TIERNEY L GRASSER 20333 W 151ST STREET OLATHE KS 66061 22151239 false X WWW.OLATHEHEALTH.ORG X 1994 KS TO IMPROVE THE HEALTH OF ALL INDIVIDUALS IN THE COMMUNITIES WE SERVE BY PROVIDING COMPASSIONATE, QUALITY HEALTHCARE IN AN ENVIRONMENT OF TRUST AND COLLABORATION. 5 5 180 24 254 1105 10603 21305362 20973770 292532 937486 58243 61372 21657242 21983231 100176 203416 0 0 9621685 9527171 0 0 0 11425796 10244313 21147657 19974900 509585 2008331 42410654 47588359 7306951 6897391 35103703 40690968 X MIAMI COUNTY MEDICAL CENTER, INC. IS FOCUSED ON IMPROVING THE HEALTH OF ALL INDIVIDUALS IN THE COMMUNITIES WE SERVE BY PROVIDING COMPASSIONATE, QUALITY HEALTHCARE IN AN ENVIRONMENT OF TRUST AND COLLABORATION. false false 16076188 203416 20974024 SEE SCHEDULE O 16076188 true true false true false false false false false true true true false false true true false true false false false false false false false false true true true false true true false false false false false false false false true false false false false false false true true true false false true 25 0 true 180 true false false false false false false false false false false X 5 5 true false false false true true true true true false false true true true true true true true true false KS X X TIERNEY L GRASSER 9137914461 20333 W 151ST STREET OLATHE KS 66061 X JACK TINNEL 2.0 1.0 X X 0 0 0 DENISE GERMAN 1.0 0.0 X X 0 0 0 STEVE MILLER 1.0 0.0 X X 0 0 0 JOE MORELAND 1.0 0.0 X 0 0 0 CHIP WOOD 1.0 4.0 X 0 0 0 FRANK H DEVOCELLE 7.0 41.0 X 0 3370702 20372 TIERNEY L GRASSER 9.0 39.0 X 0 406990 121439 GERALD WIESNER 40.0 0.0 X 166708 0 19880 CHERYL L ROSS 2.0 43.0 X 0 111035 14864 PAUL W LUCE 45.0 0.0 X 121906 0 25756 STACEY GRAY 27.0 18.0 X 62389 41489 2657 RODNEY D CORN 0.0 0.0 X 0 150524 0 351003 4080740 204968 3 true true false EMERGENCY MEDICINE CARE PA EMERGENCY SERVICES 1680000 SHARED MEDICAL SERVICES MRI SERVICES 193550 KRAMER FRANK PC COLLECTION SERVICE 139212 P1 GROUP INC HVAC SERVICE 137343 4 10205 398 10603 Net Patient Service Revenue 900099 20973770 20973770 20973770 929547 929547 0 0 85518 168008 -82490 0 -82490 -82490 7939 7939 7939 7939 0 0 0 Puchase Discounts 900099 29913 29913 Cafeteria 722210 26985 26985 Reference Lab Income 621500 12292 254 12038 74672 74672 143862 21983231 20973770 254 998604 199416 199416 4000 4000 0 0 167127 129546 37581 34875 27033 7842 7655197 5933797 1721400 142305 110305 32000 983383 762252 221131 544284 421892 122392 0 33179 33179 37572 37572 3805 3805 0 16873 16873 3203380 2703694 499686 0 103530 103530 774696 195509 579187 0 0 417012 353424 63588 24181 4440 19741 0 0 216153 183934 32219 0 1279324 1088634 190690 137378 116901 20477 Bad Debt Expense 1826434 1826434 Medical Supplies 1848213 1848083 130 Medicaid Assessment 78970 78970 Dues & Subscriptions 44972 16815 28157 198641 71109 127532 19974900 16076188 3898712 0 435287 1509325 0 0 0 0 3808380 3515792 0 0 0 0 0 0 636866 720301 139391 220385 22308187 16932251 5954796 5375936 28694242 32236046 2502265 3418953 0 0 0 0 239427 591621 42410654 47588359 1960346 1868803 0 0 0 0 4934342 4638366 0 0 0 0 0 0 0 0 412263 390222 7306951 6897391 X 35077587 40674545 26116 16423 0 0 35103703 40690968 42410654 47588359 X 2008331 3575982 2952 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false true 3805 false false 3805 false 29762822 670994 4469234 7450 34895600 29909183 401968 -522248 26081 29762822 24241897 2406369 3273465 12548 29909183 15324746 3571697 5368894 23440 24241897 16823777 1922937 -3411104 10864 15324746 0.99950 0.00050 false false 0 1475439 1475439 10057263 8961726 1095537 10157276 7588068 2569208 618209 382457 235752 5375936 INVESTMENT IN SSGA 3418953 F 3418953 0 DUE TO AFFILIATES 390222 390222 308043553 3575982 284327647 287903629 20139924 16873 1826434 1843307 21983231 261241363 243109770 243109770 18131593 16873 1826434 1843307 19974900 DESCRIBE THE INTENDED USES OF THE ORGANIZATION'S ENDOWMENT FUNDS SCHEDULE D, PART V, LINE 4 THE ENDOWMENT FUNDS ARE HELD FOR FUTURE CAPITAL AND EXPANSION NEEDS. IN ADDITION, THE FUNDS ALSO REPRESENT RESERVES FOR OPERATING NEEDS TO REMAIN FINANCIALLY STABLE. UNCERTAIN TAX POSITIONS DISCLOSURE SCHEDULE D, PART X, LINE 2 MANAGEMENT HAS EVALUATED THEIR INCOME TAX POSITIONS UNDER THE GUIDANCE INCLUDED IN ASC 740. BASED ON THEIR REVIEW, MANAGEMENT HAS NOT IDENTIFIED ANY MATERIAL UNCERTAIN TAX POSITIONS TO BE RECORDED OR DISCLOSED IN THE FINANCIAL STATEMENTS. RECONCILIATION OF REVENUE PER AUDITED FINANCIAL STATEMENTS SCHEDULE D, PART XI, LINES 2D & 4B LINE 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 STATEMENTS SCHEDULE D, PART XII, LINES 2D & 4B LINE 2D: RELATED ORGANIZATIONS' EXPENSES $ 242,941,762 RENTAL EXPENSES 168,008 ------------ TOTAL $ 243,109,770 LINE 4B: BAD DEBT EXPENSE $ 1,826,434 true true X false true X true true false true true 1794 1008 700089 0 700089 0.03860 5347 1865 2042004 795282 1246722 0.06870 0 0 0 0 0.00000 7141 2873 2742093 795282 1946811 0.10730 8 582 29916 0 29916 0.00160 4 59 206175 0 206175 0.01140 0 0 0 0 0.00000 0 0 0 0 0.00000 2 75 15557 0 15557 0.00090 14 716 251648 0 251648 0.01390 7155 3589 2993741 795282 2198459 0.12120 2 4 3228 3228 0.00020 2 4 3228 3228 0.00020 true 513585 5091445 7348180 -2256735 X true true 1 1 MIAMI COUNTY MEDICAL CENTER INC

2100 BAPTISTE DRIVE PAOLA KS 66071

X X X MIAMI COUNTY MEDICAL CENTER 1 true false true 200. true X X X X X X X true true X X X X X true false X X X X true X false false 2 LOUISBURG REHAB OF MIAMI CTY MEDICAL CTR

102 W CRESTVIEW CIRCLE LOUISBURG KS 66053

OUTPATIENT REHABILITATION CLINIC OSAWATOMIE REHAB OF MIAMI CTY MED CENTER

539 MAIN STREET OSAWATOMIE KS 66064

OUTPATIENT REHABILITATION CLINIC FINANCIAL ASSISTANCE ELIGIBILITY CRITERIA FOR PROVIDING FREE CARE SCHEDULE H, PART I, LINE 3A MIAMI COUNTY MEDICAL CENTER, INC. (MCMCI) DOES NOT OFFER FREE CARE EXCEPT IN CASE OF DEATH. IN ALL OTHER CASES WE WILL DISCOUNT UP TO 99% OF TOTAL CHARGES FOR PATIENTS AT OR BELOW THE FEDERAL POVERTY GUIDELINES. ALL PATIENTS ARE EXPECTED TO CONTRIBUTE TO THEIR CARE IN ACCORDANCE WITH THEIR ABILITY. EXTRAORDINARY MEDICAL EXPENSES THAT EXCEED 25% OF ANNUAL HOUSEHOLD INCOME, EVEN IF ANNUAL HOUSEHOLD INCOME IS MORE THAN 200% OF THE FEDERAL POVERTY GUIDELINES, MAY ALSO BE ELIGIBLE FOR A FINANCIAL HARDSHIP DISCOUNT. FINANICAL ASSISTANCE ELIGIBILITY CRITERIA FOR PROVIDING DISCOUNTED CARE SCHEDULE H, PART I, LINE 3C MIAMI COUNTY MEDICAL CENTER, INC. (MCMCI) OFFERS DISCOUNTED CARE TO ALL INDIVIDUALS WITHOUT INSURANCE, SIMILAR TO MANAGED CARE DISCOUNTS. MCMCI'S UNINSURED DISCOUNT APPLIES TO ALL PATIENTS WITHOUT INSURANCE, REGARDLESS OF ABILITY TO PAY, INCLUDING ALL LOW INCOME INDIVIDUALS. FINANCIAL ASSISTANCE AND CERTAIN OTHER COMMUNITY BENEFITS AT COST SCHEDULE H, PART I, LINE 7, COLUMN F THE BAD DEBT EXPENSE IS NOT CONSIDERED A COMMUNITY BENEFIT EXPENSE AND IS NOT INCLUDED IN SCHEDULE H, PART I, LINE 7. THE AMOUNT EXCLUDED IS $1,826,434.00 FINANCIAL ASSISTANCE AND OTHER CERTAIN COMMUNITY BENEFITS AT COST SCHEDULE H, PART I, LINE 7 THE COSTING METHODOLOGY USED TO CALCULATE THE AMOUNTS CONTAINED IN THE TABLE OF PART I, LINE 7, OF SCHEDULE H, IS A COST ACCOUNTING SYSTEM. COMMUNITY BUILDING ACTIVITIES SCHEDULE H, PART II MIAMI 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 EXPENSE SCHEDULE H, PART III, SECTION A, LINE 2 THE COSTING METHODOLOGY USED TO CALCULATE THE AMOUNTS CONTAINED IN THE TABLE OF PART III, LINE 2, OF SCHEDULE H, IS A COST ACCOUNTING SYSTEM. BAD DEBT EXPENSE SCHEDULE H, PART III, SECTION A, LINE 4 Accounts 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 SHORTFALL SCHEDULE H, PART III, SECTION B, LINE 8 Part III, Line 8 Medicare allowable costs were calculated using a cost accounting system. Shortfalls arise from payments that are less than the costs to provide the services. We accept all Medicare patients knowing that the cost of providing the care may exceed the payment we receive from the Medicare program. The shortfall should be considered community benefit as Medicare shortfalls must be absorbed by the hospital in order to continue treating the elderly in our community. IT is also implied in Internal Revenue Service ruling 69-545 that treating Medicare patients is a community benefit. Revenue ruling 69-545 established the community benefit standard for tax-exempt hospitals and indicates that participation in publicly-financed programs, such as Medicare, is evidence that a hospital meets the community benefit standard. COLLECTION PRACTICES SCHEDULE H, PART III, SECTION C, LINE 9B BEFORE PLACEMENT WITH COLLECTION AGENCIES, MCMCI PATIENT FINANCIAL SERVICES OFFERS VARIOUS OPTIONS FOR PATIENTS WITH FINANCIAL DIFFICULTIES. IN ADDITION TO OFFERING OUR OWN FINANCIAL ASSISTANCE TO QUALIFYING INDIVIDUALS, MCMCI CONTRACTS WITH AN AGENCY THAT SCREENS INDIVIDUALS FOR ELIGIBILITY FOR PROGRAMS LIKE MEDICAID, DISABILITY, AND CRIME VICTIM'S COMPENSATION AND THEN HELPS THEM THROUGH THE APPLICATION PROCESS. THE USE OF PROPENSITY TO PAY (LIKELIHOOD TO PAY) SOFTWARE ALSO HELPS MCMCI IDENTIFY INDIVIDUALS THAT MAY NEED ASSISTANCE THAT HAVE NOT COMPLETED AN APPLICATION. MCMCI HAS LANGUAGE WRITTEN IN THEIR COLLECTION AGENCY CONTRACT THAT STATES, "IF THE COLLECTION AGENCY LEARNS A PATIENT/DEBTOR HAS NEITHER SUFFICIENT INCOME NOR ASSETS TO MEET HIS FINANCIAL OBLIGATION, THE AGENCY WILL NOT PURSUE COLLECTION ACTIVITIES AGAINST THE PATIENT/DEBTOR, UNLESS OR UNTIL THE AGENCY LEARNS THAT THE PATIENT/DEBTOR HAS INCOME OR ASSETS TO MEET THE OBLIGATION." IF THE COLLECTION AGENCY IS NOTIFIED BY THE PATIENT/DEBTOR THAT THIS CREATES AN UNDUE FINANCIAL HARDSHIP OR BURDEN DUE TO A CHANGE IN THEIR INCOME OR ASSETS, THE AGENCY WILL NOTIFY MCMCI AND AWAIT FURTHER DIRECTION FROM THE HOSPITAL. FINANCIAL ASSISTANCE POLICY FOR PROVIDING FREE CARE SCHEDULE H, PART V, SECTION B, LINE 10 MIAMI COUNTY MEDICAL CENTER, INC. (MCMCI) DOES NOT OFFER FREE CARE EXCEPT IN CASE OF DEATH. IN ALL OTHER CASES WE WILL DISCOUNT UP TO 99% OF TOTAL CHARGES FOR PATIENTS AT OR BELOW THE FEDERAL POVERTY GUIDELINES. ALL PATIENTS ARE EXPECTED TO CONTRIBUTE TO THEIR CARE IN ACCORDANCE WITH THEIR ABILITY. EXTRAORDINARY MEDICAL EXPENSES THAT EXCEED 25% OF ANNUAL HOUSEHOLD INCOME, EVEN IF ANNUAL HOUSEHOLD INCOME IS MORE THAN 200% OF THE FEDERAL POVERTY GUIDELINES, MAY ALSO BE ELIGIBLE FOR A FINANCIAL HARDSHIP DISCOUNT. BILLING AND COLLECTIONS POLICY SCHEDULE H, PART V, SECTION B, LINE 16 MIAMI COUNTY MEDICAL CENTER DOES NOT PERMIT ANY OF THE ACTIONS LISTED WITHOUT MAKING A REASONABLE EFFORT TO DETERMINE THE PATIENT'S ELIGIBILITY UNDER THE FACILITY'S FINANCIAL ASSISTANCE PROGRAM. NEEDS ASSESSMENT SCHEDULE H, PART VI, LINE 2 Miami County Medical Center, Inc. (MCMCI) is continually assessing the health needs of the communities it serves in a variety of ways. Informally, MCMCI is involved in multiple health fairs and other community outreach activities that involve screenings, questionnaires and general conversation that help us understand the needs of groups and individuals. The MCMCI community advisory group is represented by a diverse set of individuals who provide helpful input from the organizations and communities they represent. During 2012, 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 ASSISTANCE SCHEDULE H, PART VI, LINE 3 PATIENTS 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 INFORMATION SCHEDULE H, PART VI, LINE 4 Miami County Medical Center, Inc. (MCMCI) serves the people of Miami and Linn Counties in Kansas. Miami and Linn Counties are both located in rural areas of the state of Kansas and are both federally designated medically underserved areas of Kansas. MCMC is the only hospital in these two counties. However, there are several other hospitals located in nearby metropolitan areas, including Olathe and Overland Park, Kansas, and Kansas City, Missouri. In addition to the general health care services provided by the hospital and its associated physicians, MCMCI serves a diverse population of mentally disable patients. The Osawatomie State Hospital, Lake Mary Center, Medicalodge of Paola and the Tri-Ko are all organizations located in the service area. MCMCI supports each of these organizations by providing medical care to their residents. Below is a listing of economic levels for area residents. Time period: 2006 - 2010 Source: factfinder2.census.gov People Living Below Poverty Level Miami County: 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 HEALTH SCHEDULE H, PART VI, LINE 5 In addition to the items listed above, Miami County Medical Center takes a very active role in support of local, regional and national not-for-profit organizations with a focus on improving health and supporting those in need. MCMCI provides support financially and through volunteering time and talents to multiple area organizations. MCMCI provides athletic trainers to area school sports programs. MCMCI staff members are involved in several health fairs and/or community screenings each year. The community health fairs are organized in conjunction with a variety of other area agencies, such as: Miami County Emergency Medical Services, local school districts, county agencies and several others. AFFILIATED HEALTH CARE SYSTEM SCHEDULE H, PART VI, LINE 6 MIAMI COUNTY MEDICAL CENTER IS A PART OF OLATHE HEALTH SYSTEM,INC. (OHSI) THIS CONSISTS OF TWO HOSPITALS AND A NETWORK OF 33 CLINICS. OHSI AND ITS AFFILIATES, INCLUDING MIAMI COUNTY MEDICAL CENTER, TAKE A LEADERSHIP ROLE IN PROMOTING THE HEALTH OF THE COMMUNITIES SERVED. OHSI HOSPITALS AND CLINICS ARE VERY INVOLVED WITH COMMUNITY OUTREACH EDUCATION AND SCREENING PROGRAMS ACROSS THE ENTIRE SERVICE AREA. WE COLLABORATE WITH AREA COMPANIES AND OTHER HEALTH-RELATED SERVICE PROVIDERS TO PROVIDE EDUCATION AND SCREENINGS TO THE PUBLIC. OHSI POSITIONS ITSELF AS NOT ONLY A PROVIDER OF CARE, BUT A RESOURCE FOR EDUCATION AND PREVENTION. STATE FILING OF COMMUNITY BENEFIT REPORT SCHEDULE H, PART VI, LINE 7 MCMCI IS NOT REQUIRED TO FILE A COMMUNITY BENEFIT REPORT WITH THE STATE, BUT WE MAKE OUR REPORT AVAILABLE TO ANYONE INTERESTED AT WWW.OLATHEHEALTH.ORG. true LAKEMARY ENDOWMENT 100 LAKEMARY DRIVE PAOLA KS 66071 237423516 501(C)(3) 7500 CMTY WELLNESS SCHOOL DISTRICT #368 PO BOX 268 PAOLA KS 66071 480720746 GOVERNMENT 23024 BOOK SPORTS MEDICINE CMTY WELLNESS SCHOOL DISTRICT #230 101 E SOUTH ST SPRING HILL KS 66083 480723504 GOVERNMENT 20846 BOOK SPORTS MEDICINE CMTY WELLNESS SCHOOL DISTRICT #367 1200 TROJAN DRIVE OSAWATOMIE KS 66064 GOVERNMENT 23024 BOOK SPORTS MEDICINE CMTY WELLNESS YMCA OF GREATER KC 3100 BROADWAY SUITE 1020 KC MO 64111 440546002 501(C)(3) 6000 CMTY WELLNESS 5 0 PROCESS FOR MONITORING THE USE OF GRANTS IN THE U.S. SCHEDULE I, PART I, LINE 2 SCHEDULE I, PART II MIAMI COUNTY MEDICAL CENTER, INC. PROVIDED SPORTS TRAINERS TO LOCAL HIGH SCHOOLS. SCHEDULE I, PART III FOR ALL SCHOLARSHIPS, THE ORGANIZATION CAREFULLY SELECTS THE RECIPIENTS OF THE FUNDS AND A CHECK IS WRITTEN DIRECTLY TO THE ORGANIZATION OR INDIVIDUAL. X true true false true false false false false false false false FRANK H DEVOCELLE 0 827087 0 119614 0 2424001 0 0 0 20372 0 3391074 0 2074339 RODNEY D CORN 0 0 0 0 0 150524 0 0 0 0 0 150524 0 153209 TIERNEY L GRASSER 0 322902 0 56117 0 27971 0 94869 0 26570 0 528429 0 18981 GERALD WIESNER 153988 0 10430 0 2290 0 2500 0 17380 0 186588 0 0 0 SOCIAL CLUB DUES OR INITIATION FEES SCHEDULE J, PART I, LINE 1A SOCIAL 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 COMPENSATION FORM 990, PART VII; SCHEDULE J, PART I, LINE 3 AND PART II THE 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 ORGANIZATION FORM 990, PART VII; SCHEDULE J, PART I, LINE 3 AND PART II THE COMPENSATION BEING REPORTED FOR FRANK H DEVOCELLE AND TIERNEY L GRASSER IS FROM OLATHE MEDICAL CENTER, INC., A RELATED TAX EXEMPT ORGANIZATION AND THE SOLE MEMBER OF MIAMI COUNTY MEDICAL CENTER, INC. OLATHE MEDICAL CENTER, INC. USES A COMPENSATION COMMITTEE COMPRISED OF INDEPENDENT BOARD MEMBERS TO ESTABLISH COMPENSATION AND BENEFITS FOR ALL OFFICERS OF OLATHE MEDICAL CENTER, INC. AND ITS AFFILIATED CORPORATIONS. THE COMPENSATION COMMITTEE APPROVES AND ESTABLISHES ALL COMPENSATION AND BENEFITS FOR OFFICERS OF OLATHE MEDICAL CENTER, INC. AND ITS AFFILIATED COMPANIES. THE COMMITTEE UTILIZED AN INDEPENDENT COMPENSATION CONSULTANT, A WRITTEN CONTRACT FOR THE CEO AND COMPENSATION SURVEYS TO ESTABLISH FAIR MARKET VALUE SALARIES AND BENEFITS FOR OLATHE MEDICAL CENTER, INC. AND ITS AFFILIATES' OFFICERS. SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN SCHEDULE J, PART I, LINE 4B & PART II A 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 990 SCHEDULE J, PART II, COLUMN F COMPENSATION 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. A CITY OF OLATHE KANSAS 486034756 679390GX6 2008-02-27 5311403 SEE PART VI false false false A 640000 0 5311403 0 0 0 22312 0 0 0 5289091 0 2008 true false true true A false false true true false 0 false false false true A false true false false 0 false 0 false true A true BOND ISSUE PRICE SCHEDULE K, PART I, LINE A, COLUMN E THE ISSUE PRICE OF THE ENTIRE ISSUE IS $29,451,544. A PORTION OF THE ISSUE PRICE, EQUAL TO $24,140,141 IS ALLOCABLE TO OLATHE MEDICAL CENTER, INC. THE REMAINDER OF THE ISSUE PRICE, EQUAL TO $5,311,403, IS ALLOCABLE TO MIAMI COUNTY MEDICAL CENTER, INC., WHICH IS CONTROLLED BY OLATHE MEDICAL CENTER, INC., ITS SOLE MEMBER. BOND DESCPIPTION OF PURPOSE SCHEDULE K, PART I, LINE A, COLUMN F REFUND SERIES 2004A BONDS ISSUED 07/29/2004 AND REFUND SERIES 2004B BONDS ISSUED 07/29/2004. HEIDI HANSON DAUGHTER OF PRESIDENT 34875 SALARY false BUSINESS TRANSACTIONS WITH INTERESTED PERSONS SCHEDULE L, PART IV HEIDI HANSON IS THE DAUGHTER OF FRANK H DEVOCELLE, AN OFFICER OF MCMCI HEIDI HANSON IS AN EMPLOYEE OF MCMCI. PROGRAM SERVICE ACCOMPLISHMENTS FORM 990, PART III, LINE 4A Miami County Medical Center, Inc. operates an acute care hospital in Paola, Kansas. Miami County Medical Center, Inc. carries out its mission by providing quality and compassionate inpatient, outpatient, and emergency care services to residents in Miami County, Kansas and surrounding area. Miami County Medical Center, Inc. is a Joint Commission accredited hospital and is licensed for 39 beds and currently staffs 18 inpatient beds. Program services expenses are all related to the provision of healthcare services. In 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 RELATIONSHIPS FORM 990, PART VI, SECTION A, LINE 2 FRANK H DEVOCELLE AND TIERNEY L GRASSER HAVE A BUSINESS RELATIONSHIP WITH EACH OTHER. THEY SERVE AS AN OFFICER OR DIRECTOR FOR OLATHE HEALTH DEVELOPMENT CORPORATION OR OLATHE MEDICAL CENTER DOCTOR'S BUILDING CONDOMINIUM OWNERS ASSOCIATION, WHICH ARE RELATED FOR PROFIT COMPANIES. MEMBER FORM 990, PART VI, SECTION A, LINE 6 OLATHE MEDICAL CENTER, INC., A NOT-FOR-PROFIT, 501(C)(3) ORGANIZATION, IS THE SOLE MEMBER OF MIAMI COUNTY MEDICAL CENTER, INC. MEMBER MAY ELECT GOVERNING BODY FORM 990, PART VI, SECTION A, LINE 7A OLATHE MEDICAL CENTER, INC. BEING THE SOLE MEMBER OF MIAMI COUNTY MEDICAL CENTER, INC. HAS THE RIGHT TO ELECT ALL THE BOARD OF TRUSTEES. GOVERNING BODY DECISIONS SUBJECT TO APPROVAL OF MEMBER FORM 990, PART VI, SECTION A, LINE 7B OLATHE MEDICAL CENTER, INC. IS THE SOLE MEMBER, AND HAS THE RIGHTS TO APPROVE MIAMI COUNTY MEDICAL CENTER, INC.'S BYLAWS AND ARTICLES OF INCORPORATION AND ALSO APPROVE MIAMI COUNTY MEDICAL CENTER'S BOARD MEMBERS AND CERTAIN CAPITAL EXPENDITURES. FORM 990 REVIEW PROCESS FORM 990, PART VI, SECTION B, LINE 11B The tax return form 990 is reviewed by the Audit and compliance Committee of the Olathe Medical Center, Inc. (Miami County Medical Center's sole member) board on behalf of all of its affiliates prior to filing the return with the Internal Revenue Service. The Audit & Compliance Committee is comprised of independent Board members of Olathe Medical Center, Inc. The final form 990 with all required schedules is then provided to all board members for review prior to filing the form 990. CONFLICT OF INTEREST POLICY FORM 990, PART VI, SECTION B, LINE 12C The purpose of the Organization's Conflict of Interest Policy is to protect the organization's interest when it is contemplating a decision or entering into a transaction or arrangement that might benefit the private interest of any person in a position of authority over the organization, or might result in a possible excess benefit transaction. Corporate officers and members of the Board of Trustees review the Conflict of Interest Policy and complete a Disclosure of Information Form annually. A summary of the annual disclosures of information is provided to the full Board for review at least one time per year. The conflict of interest policy calls for any interested person to disclose the existence of a financial relationship or competitive interest in connection with any pending transaction or arrangement. The individual is given the opportunity to disclose all material facts to the Trustees considering the proposed transaction or arrangement that gave rise to the disclosure. When a transaction involves an interested party, the following procedures are followed: 1. The interested party leaves the meeting after providing any material facts or discussion regarding the matter that gives rise to the interest unless requested to stay by the remaining board or committee members. 2. If appropriate, the Board may appoint a non-interested person or committee to investigate alternatives to the proposed transaction; 3. The interested trustee may not vote in the matter that gives rise to the interest. 4. In order to approve the transaction, the Board must first find, by a majority vote of the trustees then in office, without counting the vote of the interested trustee, a. That the proposed transaction is in the Organization's best interests and for its own benefit, and b. That, after reasonable investigation, the board has determined that the organization cannot obtain a more advantageous transaction with reasonable efforts under the circumstances. COMPENSATION REVIEW FORM 990, PART VI, SECTION B, LINES 15A & B The compensation committee of the Olathe Medical Center, Inc. board, which is comprised of independent members of the board of Olathe Medical Center, Inc. and its affiliates, including a Miami County Medical Center, Inc. board member, reviews and approves the CEO and other officers and key employees of the corporation's compensation in accordance with their compensation policy. The compensation committee reviews third party salary surveys, uses independent consultants, and also utilizes written contracts for the ceo to determine the fair market value of the current compensation, salary ranges and benefits. Compensation for such officers is approved by the committee and information of their findings is available to all board members at their request. AVAILABILITY OF DOCUMENTS FORM 990, PART VI, SECTION C, LINE 18 THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE NOT AVAILABLE TO THE PUBLIC. OTHER CHANGES IN NET ASSETS FORM 990, PART XI, LINE 5 NET ASSETS RELEASED- CAPITAL $ 12,645 CHANGE IN TEMPORARILY RESTRICTED NET ASSETS $ ( 9,693) ----------- TOTAL $ 2,952 OTHER FEES FOR SERVICES FOR NON-EMPLOYEES FORM 990 PART IX LINE 11G DESCRIPTION:MEDICAL PROFESSIONAL FEES TOTAL FEES:1743287 OTHER FEES FOR SERVICES FOR NON-EMPLOYEES FORM 990 PART IX LINE 11G DESCRIPTION:OTHER CONTRACT SERVICES TOTAL FEES:1460093 OLATHE MEDICAL CENTER INC 20333 W 151ST ST OLATHE KS 66061 480577664 HOSPITAL KS 501(C)(3) 3 OHSI true OLATHE HEALTH SYSTEM INC 20333 W 151ST ST OLATHE KS 66061 480979845 SUPPORT ORG KS 501(C)(3) 11B NA false OLATHE MEDICAL SERVICES INC 20333 W 151ST ST OLATHE KS 66061 481088982 CLINICS KS 501(C)(3) 9 OMCI true OLATHE MEDICAL CENTER CHARITABLE FDN 20333 W 151ST ST OLATHE KS 66061 481136010 FUNDRAISING KS 501(C)(3) 7 OMCI true OMC DOCTOR'S BLDG CONDO OWNERS ASSOC INC 20333 W 151ST ST OLATHE KS 66061 481244766 REAL ESTATE KS OMCI C CORPORATION true OLATHE HEALTH DEVELOPMENT CORPORATION 20333 W 151ST ST OLATHE KS 66061 363445097 MEDICAL SERVI KS OHSI C CORPORATION true false false false false false false false false true false false false true true true true true false false OLATHE MEDICAL SERVICES INC N 87238 COST OLATHE MEDICAL SERVICES INC Q 74695 COST OLATHE MEDICAL CENTER INC M 183720 COST OLATHE MEDICAL CENTER INC N 93996 COST OLATHE MEDICAL CENTER INC O 2800443 COST OLATHE MEDICAL CENTER INC Q 3107011 COST