2012-11-14T11:30:30-06:00 2011-12-31 BKD LLP 1551 N WATERFRONT PKWY STE 300 WICHITA KS 672066601 990 2011-01-01 300078435 GREELEY COUNTY HEALTH SERVICES % JAMES L SMITH CFO GREE 6203764221 506 THIRD STREET TRIBUNE KS 67879 JAMES L SMITH 2012-11-15 true ELIZABETH S HOGAN 3162652811 2011 2016-02-24 21:20:13Z JAMES L SMITH 506 THIRD STREET TRIBUNE KS 67879 8840008 false X WWW.MYGCHS.COM X 2006 KS ADDRESS HEALTHCARE NEEDS THROUGH THE EFFECTIVE PARTNERING OF A COMPASSIONATE STAFF WITH QUALITY CARE. 5 5 162 5 0 0 638973 555449 8204297 7750388 2523 3732 648880 530439 9494673 8840008 0 0 0 0 6493409 5648123 0 0 0 3598419 3688794 10091828 9336917 -597155 -496909 5072991 4804022 1907894 2135834 3165097 2668188 X SEE SCHEDULE O false false 1501379 2487856 A CRITICAL ACCESS HOSPITAL WITH 342 TOTAL ADMISSIONS IN 2011 4504136 4492911 PROVIDING RURAL HEALTH CLINIC/OUTPATIENT SERVICES 1896478 1283407 PROVIDING LONG TERM CARE SERVICES FOR 9,380 RESIDENT PATIENT DAYS IN 2011 7901993 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 false true 20 0 true 162 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 true true true false true true true true false X JAMES L SMITH CFO 6203764221 506 THIRD STREET TRIBUNE KS 67879 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 104500 0 33994 JAMES L SMITH 40.0 X 105557 0 26996 WILLIAM HARTLEY 40.0 X 16917 0 4364 SHEILA SCHEFFE MD 40.0 X 170675 0 14993 WENDEL ELLIS DO 40.0 X 331706 0 34668 RANDALL FAHRENHOLTZ MD 40.0 X 240691 0 46792 BRIAN MILLER 40.0 X 104383 0 13830 ROBIN LIU MD 40.0 X 147761 0 14533 1222190 0 190170 7 false true false QUORUM HEALTH RESOURCES MANAGEMENT SERVICES 342228 ANESTHESIA ASSOCIATES ANESTHESIA SERVICES 187760 2 467451 87998 555449 NET PATIENT SERVICE REVENUE 621110 7750388 7750388 7750388 3732 3732 0 0 1862 1862 1862 1862 0 0 0 0 OUTSIDE SERVICES 621110 450908 450908 EMPLOYEE/GUEST MEALS 900099 62878 62878 MISCELLANEOUS INCOME 900099 14791 14791 528577 8840008 8264174 0 20385 0 0 0 0 292328 292328 0 4274043 3965864 308179 305283 283271 22012 471192 437217 33975 305277 283265 22012 342228 342228 16781 16781 113482 113482 0 0 0 929093 862101 66992 66733 7325 59408 963207 893755 69452 0 0 255320 236910 18410 35457 32900 2557 0 25715 23861 1854 52627 48832 3795 0 335062 310902 24160 87872 71412 16460 BAD DEBT EXPENSE 176212 176212 REPAIRS & MAINTENANCE 132295 122756 9539 EQUIPMENT RENTAL 52703 48903 3800 MINOR EQUIPMENT 47869 44417 3452 56138 52090 4048 9336917 7901993 1434924 0 243213 32023 73858 40131 0 0 1223799 1363937 0 0 0 0 0 0 106133 89202 153907 118709 4681684 1710664 3262081 2971020 0 0 0 0 0 0 0 0 10000 189000 5072991 4804022 1410558 1316921 0 0 15000 235958 0 0 0 0 0 0 0 0 482336 582955 0 0 1907894 2135834 X 235352 -69877 2929745 2738065 0 0 3165097 2668188 5072991 4804022 -496909 X false true true X false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false false true 472 472 false false LOBBYING EXPENSES SCHEDULE C, PART II-B, LINE 1i A PORTION OF DUES PAID TO THE KHA AND AHA WAS FOR LOBBYING AND ADVOCACY. false false 49851 49851 3600737 1004320 2596417 11585 5514 6071 1019511 700830 318681 0 0 0 2971020 0 0 8840008 9336917 -496909 -496909 8611169 8611169 228839 228839 8840008 9108078 9108078 228839 228839 9336917 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 XII, LINE 4B BAD DEBT EXPENSE $176,212 RECLASSED TO EXPENSE 52,627 ------- $228,839 RECONCILIATION OF EXPENSES SCHEDULE D, PART XIII, LINE 4B BAD DEBT EXPENSE $176,212 RECLASSED FROM REVENUE 52,627 ------- $228,839 true true true X true X true true true false false 182773 182773 0.01960 910251 960998 -50747 0.00000 1093024 960998 132026 0.01960 1500 1500 0.00020 1500 1500 0.00020 1094524 960998 133526 0.01980 4 250 1500 4 250 1500 false 176212 3152059 3120538 31521 X true true 1 1 GREELEY COUNTY HEALTH SERVICES

506 THIRD STREET TRIBUNE KS 67879

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 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 $176,212. 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. BAD DEBT EXPENSE SCHEDULE H, PART III, SECTION A, LINE 4 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. 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 19 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. X X false false false false false false false false false SHEILA SCHEFFE MD 170675 0 0 0 0 0 8134 0 6859 0 185668 0 WENDEL ELLIS DO 331706 0 0 0 0 0 11850 0 22818 0 366374 0 RANDALL FAHRENHOLTZ MD 240691 0 0 0 0 0 28134 0 18658 0 287483 0 ROBIN LIU MD 147761 0 0 0 0 0 6988 0 7545 0 162294 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. 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 IS THEN PROVIDED TO THE ENTIRE BOARD BEFORE FILING WITH THE IRS. 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 NA