2013-11-15T16:37:55-06:00 2012-12-31 BKD LLP 1551 N WATERFRONT PKWY STE 300 WICHITA KS 672066601 990 2012-01-01 300078435 GREELEY COUNTY HEALTH SERVICES % BRENDA PARNELL INTERIM CFO GREE 6203764221 506 THIRD STREET Suite TRIBUNE KS 67879 KENNETH ZERR 6203764221 2013-11-15 true 3162652811 2012 2016-03-07 17:11:31Z STEVEN MANGAN 506 THIRD STREET TRIBUNE KS 67879 9943134 false X WWW.MYGCHS.COM X 2006 KS ADDRESS HEALTHCARE NEEDS THROUGH THE EFFECTIVE PARTNERING OF A COMPASSIONATE STAFF WITH QUALITY CARE. 5 5 166 17 0 555449 1076454 7750388 8399208 3732 4360 530439 463112 8840008 9943134 0 0 0 0 5648123 5862733 0 0 0 3688794 4100424 9336917 9963157 -496909 -20023 4804022 6174901 2135834 3526736 2668188 2648165 X SEE SCHEDULE O false false 3000204 2914986 A CRITICAL ACCESS HOSPITAL WITH 388 TOTAL ADMISSIONS IN 2012 4302155 4300981 PROVIDING RURAL HEALTH CLINIC/OUTPATIENT SERVICES INCLUDING 7,600 OUTPATIENT VISITS AND OVER 10,000 CLINIC VISITS 992890 1635016 PROVIDING LONG TERM CARE SERVICES FOR 9,860 RESIDENT PATIENT DAYS IN 2012 8295249 true true false true false false false false false false true false false false false true true false false false false false false false false false true true false false true false false false false false false false false false false false false true false false false false true 11 0 true 166 true false false false false false false false false false false X 5 5 true true false false false false false true true false false false true true true true true true true false X BRENDA PARNELL INTERIM CFO 6203764221 506 THIRD STREET TRIBUNE KS 67879 X STEVE MANGAN 1.0 X X 0 0 0 KENNETH ZERR 1.0 X X 0 0 0 SUSAN SCHNEIDER 1.0 X 0 0 0 DON SMITH 1.0 X 0 0 0 CINDY SCHNEIDER 1.0 X 0 0 0 DEBORAH LEHNER 40.0 X 0 0 0 JAMES L SMITH 40.0 X 0 0 0 SHEILA SCHEFFE MD 40.0 X 155552 0 18260 WENDEL ELLIS DO 40.0 X 384341 21507 RANDALL FAHRENHOLTZ MD 40.0 X 244855 40615 BRIAN MILLER 40.0 X 155552 18260 940300 0 98642 4 false true false QUORUM HEALTH RESOURCES MANAGEMENT SERVICES 594126 ANESTHESIA ASSOCIATES ANESTHESIA SERVICES 173097 2 970211 106243 1076454 NET PATIENT SERVICE REVENUE 621110 8399208 8399208 8399208 4360 4360 0 0 10537 10537 0 10537 10537 0 0 0 0 OUTSIDE SERVICES 621110 367895 367895 EMPLOYEE/GUEST MEALS 722513 62522 62522 MISC INCOME 900099 22158 22158 22158 22158 452575 9943134 8851783 14897 0 0 0 0 0 0 4727469 4261062 466407 225760 173779 51981 592143 412079 180064 317361 279173 38188 617679 617679 4984 4984 103499 103499 0 0 0 746839 744810 2029 18067 18067 205881 181440 24441 0 0 220615 207610 13005 46416 39271 7145 0 35791 20302 15489 24406 24406 0 421349 413946 7403 47511 47511 SUPPLIES 670588 670588 BAD DEBT EXPENSE 244583 244583 REPAIRS & MAINTENANCE 162992 156482 6510 MINOR EQUIPMENT 96937 33428 63509 432287 384779 47508 9963157 8295249 1667908 0 32023 265569 40131 181971 0 0 1363937 1635477 0 0 0 0 0 0 89202 126360 118709 91785 5937617 2128878 2971020 3808739 0 0 0 0 0 0 0 0 189000 65000 4804022 6174901 1316921 1863259 0 0 235958 341771 0 0 0 0 0 0 0 0 582955 1321706 0 0 2135834 3526736 X -69877 -35651 2738065 2683816 0 0 2668188 2648165 4804022 6174901 -20023 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false true 1933 false false false 1933 false false LOBBYING EXPENSES SCHEDULE C, PART II-B, LINE 1F A PORTION OF DUES PAID TO THE KHA AND AHA WAS FOR LOBBYING AND ADVOCACY. false false 49851 49851 3600737 1160561 2440176 2273372 962052 1311320 13657 6265 7392 3808739 0 0 X 9657205 -285929 -285929 9943134 9943134 9677228 9677228 285929 285929 9963157 UNCERTAIN TAX POSITIONS 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 SCHEDULE D, PART XI, LINE 2D BAD DEBT EXPENSE (244,583) RECLASSED TO EXPENSE (41,346) ------- (285,929) RECONCILIATION OF EXPENSES SCHEDULE D, PART XII, LINE 4B BAD DEBT EXPENSE 244,583 RECLASSED FROM REVENUE 41,346 ------- 285,929 true true true X true X true true true false false 128888 128888 0.01330 999747 1044575 -44828 0.00000 1128635 1044575 84060 0.01330 165263 165263 0.01700 165263 165263 0.01700 1293898 1044575 249323 0.03030 false 244583 3060149 3022038 38111 X true true 1 1 GREELEY COUNTY HEALTH SERVICES

506 THIRD STREET TRIBUNE KS 67879

HTTP://MYGCHS.COM X X X X GREELEY COUNTY HEALTH SERVICES 1 true true 200. true 200. true X X X X X true true X X X X true false X X X X true X false false 3 GREELEY COUNTY FAMILY PRACTICE

321 E HARPER TRIBUNE KS 67879

OUTPATIENT CLINIC WALLACE COUNTY FAMILY PRACTICE

504 E 6TH ST SHARON SPRINGS KS 67758

OUTPATIENT CLINIC GREELEY COUNTY LONG-TERM CARE

320 E GREELEY TRIBUNE KS 67879

LONG-TERM CARE PERCENTAGE CALCULATION SCHEDULE H, PART I, LINE 7, COLUMN F THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $244,583. COSTING METHODOLOGY 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 TO CHARGE RATIO. ESTIMATE OF BAD DEBT EXPENSE SCHEDULE H, PART III, SECTION A, LINE 2 THE HOSPITAL REPORTS PATIENT ACCOUNTS RECEIVABLE FOR SERVICES RENDERED AT NET REALIZABLE AMOUNTS FROM THIRD-PARTY PAYERS, PATIENTS AND OTHERS. THE HOSPITAL PROVIDES AN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS BASED UPON A REVIEW OF OUTSTANDING RECEIVABLES, HISTORICAL COLLECTION INFORMATION AND EXISTING ECONOMIC CONDITIONS. BAD DEBT EXPENSE SCHEDULE H, PART III, SECTION A, LINE 4 THE HOSPITAL HAS AGREEMENTS WITH THIRD-PARTY PAYERS THAT PROVIDE FOR PAYMENTS TO THE HOSPITAL AT AMOUNTS DIFFERENT FROM ITS ESTABLISHED RATES. NET PATIENT SERVICE REVENUE IS REPORTED AT THE ESTIMATED NET REALIZABLE AMOUNTS FROM PATIENTS, THIRD-PARTY PAYERS AND OTHERS FOR SERVICES RENDERED AND INCLUDES ESTIMATED RETROACTIVE REVENUE ADJUSTMENTS AND A PROVISION FOR UNCOLLECTIBLE ACCOUNTS. RETROACTIVE ADJUSTMENTS ARE CONSIDERED IN THE RECOGNITION OF REVENUE ON AN ESTIMATED BASIS IN THE PERIOD THE RELATED SERVICES ARE RENDERED AND SUCH ESTIMATED AMOUNTS ARE REVISED IN FUTURE PERIODS AS ADJUSTMENTS BECOME KNOWN. MEDICARE SCHEDULE H, PART III, SECTION B, LINE 8 THE ANNUAL MEDICARE COST REPORT IS THE SOURCE FOR THE COSTING METHODOLOGY FOR SCHEDULE H, PART III, SECTION B, LINE 6. COLLECTION PRACTICES SCHEDULE H, PART III, SECTION C, LINE 9B THE ACCOUNTS OF UNINSURED OR UNDERINSURED PATIENTS WHO HAVE APPLIED FOR MEDICAL ASSISTANCE OR FINANCIAL ASSISTANCE ARE HELD WITHOUT FURTHER COLLECTION ACTION, UNTIL THE APPLICATION PROCESS HAS BEEN COMPLETED. CHARGES FOR MEDICAL CARE SCHEDULE H, PART V, LINE 20 GREELEY COUNTY HEALTH SERVICES USES THE SAME GROSS CHARGE FOR ALL PATIENTS SEEKING EMERGENCY OR OTHER MEDICALLY NECESSARY CARE REGARDLESS OF THE PRIMARY PAYOR AND/OR FAP ELIGIBILITY. ALL FAP-ELIGIBLE PATIENTS RECEIVE A SLIDING FEE SCHEDULE DISCOUNT BETWEEN 20% AND 100% BASED ON INCOME GUIDELINES. NEEDS ASSESSMENT SCHEDULE H, PART VI, LINE 2 GREELEY COUNTY HEALTH SERVICES USES LOCAL AND STATE BASED DATA TO ASSIST ITS MEDICAL STAFF IN ASSESSING THE HEALTH CARE NEEDS OF THE COMMUNITIES IT SERVES AND PROVIDES BASIC FAMILY BASED PRIMARY CARE. PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE SCHEDULE H, PART VI, LINE 3 ALL PATIENTS PRESENTING TO OUR FACILITY WHO ARE UNINSURED/UNDERINSURED ARE PRESENTED WITH THE OPPORTUNITY FOR FINANCIAL ASSISTANCE. A PATIENT FINANCIAL ASSISTANCE COUNSELOR IS AVAILABLE FULL TIME FOR INQUIRIES & CONSULTING REGARDING ALL AVAILABLE FINANCIAL AID PROGRAMS. COMMUNITY INFORMATION SCHEDULE H, PART VI, LINE 4 THE COMMUNITY IS A FRONTIER, RURAL COMMUNITY IN WESTERN KANSAS. THE RURAL POPULATION AMONG THE THREE COUNTIES SERVED BY THE FACILITY IS APPROXIMATELY 3,000 PEOPLE. THE SERVICE AREA COVERS 8,000 SQUARE MILES. THE AREA IS PREDOMINANTLY AGRICULTURAL BASED. PROMOTION OF COMMUNITY HEALTH SCHEDULE H, PART VI, LINE 5 THE FACILITY DOES HAVE AN OPEN MEDICAL STAFF WITH SUPPORTING MID-LEVEL PRACTITIONERS, A COUNTY GOVERNMENT APPOINTED COMMUNITY BOARD THAT RECEIVES APPROXIMATELY 3% SUPPORT FROM LOCAL TAX APPROPRIATIONS, AND HOLDS NUMEROUS COMMUNITY ACTIVITIES SUCH AS HEALTH FAIRS, FREE FLU SHOT CLINICS, AND NUMEROUS HEALTH AND WELLNESS ACTIVITIES TO PROMOTE COMMUNITY HEALTH. AFFILIATED HEALTH CARE SYSTEM SCHEDULE H, PART VI, LINE 6 N/A COMMUNITY BENEFIT REPORT SCHEDULE H, PART VI, LINE 7 N/A X X false false false false false false false false false SHEILA SCHEFFE MD 155552 0 11074 0 7186 0 173812 0 0 0 WENDEL ELLIS DO 384341 0 0 21507 0 405848 0 0 0 RANDALL FAHRENHOLTZ MD 244855 18124 0 22491 0 285470 0 0 0 BRIAN MILLER 155552 11074 0 7186 0 173812 0 0 0 ORGANIZATION'S MISSION FORM 990, PART III, LINE 1 GREELEY COUNTY HEALTH SERVICES STRIVES TO ADDRESS THE HEALTHCARE NEEDS OF THE REGION THROUGH THE EFFECTIVE PARTNERING OF A COMPASSIONATE STAFF WITH QUALITY CARE ROOTED IN THE CONTINUOUS PURSUIT OF BEST PRACTICES. WE UTILIZE APPROPRIATE TECHNOLOGY TO MINIMIZE THE EFFECTS OF CHRONIC DISEASE, FOCUS ON PROVIDING PREVENTIVE MEDICINE AND TREAT EACH PATIENT'S MIND, BODY AND SOUL WITHIN THE FAMILY MEDICINE SPECTRUM OF CARE. FAMILY RELATIONSHIP FORM 990, PART VI, SECTION A, LINE 2 SUSAN SCHNEIDER AND CINDY SCHNEIDER HAVE A FAMILY RELATIONSHIP. MANAGEMENT DUTIES FORM 990, PART VI, SECTION A, LINE 13 GREELEY COUNTY HEALTH SERVICES HOLDS A MANAGEMENT CONTRACT WITH QUORUM HEALTH RESOURCES OF BRENTWOOD, TENNESSEE. QUORUM HEALTH RESOURCES APPOINTS A CHIEF EXECUTIVE OFFICER AND A CHIEF FINANCIAL OFFICER TO MANAGE DAY-TO-DAY OPERATIONS AND FINANCIAL RESPONSIBILITIES. DURING 2012, DEBORAH LEHNER SERVED AS THE TOP MANAGEMENT OFFICIAL AND JAMES L. SMITH SERVED AS THE TOP FINANCIAL OFFICAL FOR GREELEY COUNTY HEALTH SERVICES. DEBORAH LEHNER RECEIVED TOTAL COMPENSATION OF $142,002 FROM QUORUM HEALTH RESOURCES AND JAMES L. SMITH RECEIVED TOTAL COMPENSATION OF $135,204. THIS COMPENSATION IS INCLUDED IN THE MANAGEMENT FEE PAID TO QUORUM HEALTH RESOURCES AND REPORTED ON PART VII, SECTION B, OF THE 990. FORM 990 REVIEW PROCESS FORM 990, PART VI, SECTION B, LINE 11B AN INDEPENDENT ACCOUNTING FIRM PREPARES THE FORM 990. THE CFO THEN REVIEWS THE COMPLETE FORM 990 AND ALL REQUIRED SCHEDULES. ANY QUESTIONS OR CONCERNS ARE ADDRESSED AND ANY NECESSARY CHANGES ARE MADE PRIOR TO FILING. THE FORM 990 WITH ALL REQUIRED SCHEDULES WILL BE PROVIDED TO THE ENTIRE BOARD SUBSEQUENT TO FILING WITH THE IRS. CONFLICT OF INTEREST POLICY FORM 990, PART VI, SECTION B, LINE 12C THE CONFLICT OF INTEREST POLICY APPLIES TO ALL BOARD MEMBERS AND OFFICERS. IT IS REVIEWED ANNUALLY BY THE BOARD MEMBERS AND OFFICERS. ANY POTENTIAL CONFLICTS OF INTEREST THAT ARE DISCLOSED ARE REVIEWED BY THE BOARD CHAIRMAN TO DETERMINE IF AN ACTUAL CONFLICT OF INTEREST EXISTS. INDIVIDUALS WITH A POTENTIAL CONFLICT OF INTEREST ARE PROHIBITED FROM VOTING OR PARTICIPATING IN DISCUSSIONS REGARDING THE POTENTIAL CONFLICT. COMPENSATION REVIEW FORM 990, PART VI, SECTION B, LINES 15A & 15B THE BOARD OF DIRECTORS AND QUORUM HEALTH RESOURCES REVIEW BOTH THE CEO'S AND CFO'S COMPENSATION ANNUALLY. COMPARISON DATA FROM SIMILAR ORGANIZATIONS IS USED TO DETERMINE ANY PAY INCREASES. ALL DELIBERATIONS AND DECISIONS ARE DOCUMENTED. AVAILABILITY OF DOCUMENTS FORM 990, PART VI, SECTION C, LINE 19 THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND AUDITED FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. SOUTHWIND HEALTH RESOURCES 514 BROADWAY TRIBUNE KS 67879 262767444 HEALTHCARE KS 0 0 NA