2012-07-10T13:03:38-05:00 2011-09-30 Wendling Noe Nelson & Johnson LLC 534 S Kansas Ave Suite 1500 Topeka KS 666033491 990 2010-10-01 481169103 Salina Regional Health Center Inc SALI 7854527145 400 South Santa Fe Salina KS 67401 Joe Tallon 7854527145 2012-07-05 1 Gary D Knoll 7852334226 2012-07-05 2010 2016-02-24 21:20:13Z Joe Tallon 400 South Santa Fe Salina KS 67401 173586593 0 X www.srhc.com X 1995 KS To provide high quality acute medical care 15 14 1486 194 0 -82580 584794 706945 155680030 164838313 1298332 5723378 1842292 1653465 159405448 172922101 839292 1113362 0 0 65277163 68463804 0 0 0 82154464 85969599 148270919 155546765 11134529 17375336 321330106 329865213 79026766 79153195 242303340 250712018 To provide quality health care services in a healing and spiritual environment. 0 0 123791007 164424418 Salina Regional Health Center, Inc., is an IRS Section 501(c)(3) hospital which provides quality medical care regardless of race, creed, sex, national origin, handicap, or ability to pay. During the fiscal year, Salina Regional Health Center, Inc. discharged 8,357 inpatients resulting in 38,205 patient days, treated outpatients in 136,710 visits, and generated $163,120,784 in net patient service revenue. The amount of uncompensated care amounted to $22,724,061 of which $6,298,392 were charity care deductions and $16,425,669 were bad debt write offs. 140200 Salina Regional Health Center, Inc., provides scholarships to students attending nursing school. 1113362 Salina Regional Health Center, Inc., provides grants to further the activities of the Community Health Improvement Program (CHIP). 123791007 1 1 0 1 0 0 0 0 0 1 0 0 1 1 0 0 1 0 0 0 0 0 0 1 0 1 1 1 1 1 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 1 0 1 0 1 97 0 1 1486 1 1 1 0 0 0 0 0 0 0 0 0 X 15 14 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 0 X Joe Tallon VP FinanceCFO 7854527145 400 South Santa Fe Salina KS 67401 Tom Bell 2.00 X 0 0 0 Larry Britegam 2.00 X X 0 0 0 Kent Buer 2.00 X X 0 0 0 Trent Davis MD 2.00 X 0 0 0 Marty Ekrem 2.00 X 0 0 0 Robert Freelove MD 2.00 X 0 0 0 David Hadley 2.00 X 0 0 0 Sean Herrington MD 2.00 X 0 0 0 Rex Romeiser MD 2.00 X 0 0 0 Morrie Soderberg 2.00 X X 0 0 0 Betsy Wearing 2.00 X 0 0 0 Lee Young 2.00 X X 0 0 0 Micheal Terry 40.00 X X 386347 0 25654 Jim Maes 2.00 X 0 0 0 Larry Barnes 40.00 X 203508 0 16522 James Barker 40.00 X 182264 0 14374 Charles Grimwood 40.00 X 196720 0 21955 Jack Hinnenkamp 40.00 X 168399 0 15192 Joe Tallon 40.00 X 209023 0 20630 David Moody 40.00 X 175054 0 20170 Joel Phelps 40.00 X 256023 0 22559 John Kelemen 40.00 X 610542 0 26210 George S Jerkovich 40.00 X 274276 0 25986 Venkata Katasani 40.00 X 256525 0 16826 Guy Grabau 40.00 X 243187 0 10484 Jon Richards 40.00 X 220661 0 11104 3382529 0 247666 66 0 1 0 CPT Enterprises 2121 Crawford PL Salina KS 67401 Management Services 1205919 Anesthesia Associates of Central Kansas 520 South Santa Fe Salina KS 674021607 Anesthesia Services 994696 Emergency Physicians of Salina LLC 10975 Benson Dr Ste 250 Leawood KS 66210 Emergency Room Services 676855 J E Dunn Construction Co 1001 Locust Kansas City MO 64106 Construction 670292 Fresenius Medical Care PO Box 749959 Los Angeles CA 900749959 Medical Care 426869 18 706945 706945 Patient service 621990 163120784 163120784 Other operating 621990 1717529 1717529 164838313 5726210 5726210 177483 591378 -413895 -413895 -413895 56836 59668 -2832 -2832 -2832 33052 13446 19606 19606 Income from subsidiari 900099 2047754 2047754 2047754 172922101 164424418 0 7790738 1113362 1113362 2069589 2069589 54360799 49117403 5243396 2189444 1984850 204594 5942387 5264285 678102 3901585 3449468 452117 396123 396123 433888 28916 404972 178894 124172 54722 866211 818679 47532 382617 106025 276592 98573 50425 48148 2938532 2938532 12432425 4875179 7557246 1387431 288538 1098893 Bad Debt Expense 16425669 16425669 Medical Supplies 15809389 15728600 80789 Pharmaceuticals 8302656 8302656 Outside Services 5907033 4224194 1682839 Other Professional Fees 3395169 2593683 801486 17014989 9294903 7720086 155546765 123791007 31755758 0 21517487 27975718 63438701 66195550 22691879 23902936 1195616 1224835 1944627 2195333 228465571 126658999 109776755 101806572 100765041 106564269 321330106 329865213 15879743 17086850 62487690 61770004 82155 34068 577178 262273 79026766 79153195 X 234165071 242626718 2175360 2219530 5962909 5865770 242303340 250712018 321330106 329865213 X 17375336 -8966658 X X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 22096 22096 0 Explanation of Other Lobbying Activities: Part II-B, Line 1i: A portion of annual dues paid by Salina Regional Health Center, Inc. to various healthcare organizations has been identified as association lobbying activities by those organizations. The amount reported as direct contact with legislators, their staff, government officials, or a legislative body represents the portion of dues identified as association lobbying activities by these organizations. Salina Regional Health Center, Inc. does not participate in activities supporting a political candidate. 6334691 6334691 98015073 37586385 60428688 124115807 89072614 35043193 101806572 Current portion of assets whose use is limited 3411498 Assets whose use is limited 82790131 Deferred financing costs 440308 Other assets 5891230 Assets held in trust 4951669 Investment in Salina Surgical Center, Inc. 4771881 Beneficial interest in net assets of Foundation 2748552 Other receivables 1559000 106564269 Other current liabilities 133097 Other long term liabilities 129176 262273 172922101 155546765 17375336 -9318105 351447 -8966658 8408678 171824352 -1097749 -1097749 172922101 0 172922101 154446849 13446 13446 154433403 1113362 1113362 155546765 Part XI, Line 8 - Other Adjustments: Net assets released from restrictions for capital 210,320. Intercompany transfers 191,929. Net assets released from restrictions for operations 2,167. Net assets released from restrictions for operations -2,167. Net assets released from restrictions for capital -210,320. Change in beneficial interest in net assets of Foundation 67,637. Change in fair value of assets held in trust -97,239. Change in beneficial interest in net assets of Foundation 100. Investment income 189,020. Part XII, Line 2d - Other Adjustments: Community Health Improvement Program (CHIP) donation -1,113,362. Net assets released from restrictions for operations 2,167. Fundraising events direct expenses 13,446. Part XIII, Line 2d - Other Adjustments: Fundraising events direct expenses 13,446. Part XIII, Line 4b - Other Adjustments: Community Health Improvement Program (CHIP) donation 1,113,362. Rummage Sales 14544 14544 5929 Holly Days 12788 12788 5876 1 5720 5720 1641 33052 33052 13446 13446 19606 1 1 1 X 1 X 1 1 1 0 1 1 3431 2280924 2280924 0.01640 10568 14729134 10004319 4724815 0.03400 13999 17010058 10004319 7005739 0.05040 26 3327 195324 195324 0.00140 20 103 2533315 2533315 0.01820 12 7798 15256314 7210545 8045769 0.05780 2 4537 4537 0.00000 13 1148248 1148248 0.00830 73 11228 19137738 7210545 11927193 0.08570 73 25227 36147796 17214864 18932932 0.13610 2 4919 4919 0.00000 2 57288 57288 0.00040 1 37 37 0.00000 2 1381 1381 0.00000 5 31550 31550 0.00020 2 289154 289154 0.00210 14 384329 384329 0.00270 1 5367909 591454 49523341 50986400 -1463059 X 1 1 1 1 Salina Regional Health Center Inc

400 South Santa Fe Salina KS 67401

X X X X Salina Regional Health Center Inc 1 1 1 200.000000000000 1 300.000000000000 1 X X X X X 1 1 X X X 1 X X X X 1 X X X X X X X 1 X 0 0 Part I, Line 7: Costing methodology used to determine ratio of patient care cost to charges is total operating expenses less bad debt, other operating revenue, Medicaid provider taxes and total community benefit expense divided by total charges less community benefit charges. Part I, Line 7, Column (f): The Bad Debt expense included on Form 990, Part IX, Line 25, Column (A), but subtracted for purposes of calculating the percentage in this column is $ 16425669. Part II: The Advancing Communities Together (ACT) priority-setting process identified Health, Education, and Financial Stability as key focus areas for community building initiatives in the Salina area over the next few years. Community building activities reported in Part II address all these focus areas. Salina Regional Health Center, Inc. paid employees to build a Habitat for Humanity house. Representatives worked in economic development to address local downturns in employment during the recession. Salina Regional Health Center, Inc. played a leadership role in strategic planning for the local school district and one of our employees volunteers as President of the Board of Education. As the ACT prioritizing process continues in 2012, it is anticipated that an even greater emphasis will be placed on a specific aspect of community health. Part III, Line 4: Provisions are made for accounts receivable that could become uncollectible in the future by establishing an allowance to reduce the carrying value of such receivables to their estimated net realizable value. The Health Center estimates this allowance based on the aging of its accounts receivable and its historical collection experience for each type of payor. Part III, Line 8: Shortfall is total Medicare losses excluding those reported in subsidized services. The allowable Medicare costs were determined from our filed cost report Worksheet A less subsidized expenses included in Schedule H, Part I, Item 7(g), Subsidized health services. Part III, Line 9b: If patients are determined to be indigent or living on limited income through our financial assistance application process, the patient is referred to customer service who will help guide them through the necessary steps to complete the financial assistance program. Salina Regional Health Center, Inc. Part V, Section B, Line 15e: File against estates. Salina Regional Health Center, Inc. Part V, Section B, Line 16e: File against estates. Salina Regional Health Center, Inc. Part V, Section B, Line 19d: Deduction of 30%. Part VI, Line 2: A community health assessment was completed by several agencies located in Saline County and our community benefit committee reviewed these assessments. The community benefit committee meets at minimum, annually, to discuss issues. Representatives of Salina Regional Health Center, Inc. actively participated in the Advancing Communities Together (ACT) community priority-setting process in 2010, 2011 and 2012. Part VI, Line 3: At registration, the patient is informed of their rights for financial assistance if unable to produce valid insurance coverage. The patient is referred to a third party vendor to determine eligibility for governmental programs and if it is determined they do not qualify, they are screened under our financial assistance guidelines. We post our guidelines on our website as well. Part VI, Line 4: Salina Regional Health Center, Inc. is a rural sole community hospital serving 13 counties in north central Kansas. The total approximate population of the service area as of 2010 was 160,578 people, of which approximately 115,630 live in the primary service area. The primary service area experienced a 7.4% population growth between 1990 and 2000, although over the next few years the population is projected to have flat growth. The largest age group is 45-64 years of age and is currently 26.5% of the population. This segment is expected to grow 1.3% in the primary service area by 2013. The median age of the service area is 39.2 years, which is older than the national average of 36.7, and is projected to be 39.7 in 2013. Older patients require more physician visits than do younger patients, so Salina Regional Regional Center, Inc. is investing in physician recruitment for the entire service area.Hispanics comprise 5.5% of the primary service area population, so the hospital has developed a team of Spanish language translators. Spanish patient education materials are available. Residents in this service area have a level of education that is lower than the US and Kansas as a whole, so the hospital writes patient information at a 6th to 8th grade reading level. Median household income in the primary service area in 2008 was $44,916, which is lower than the US ($50,152) and Kansas ($47,911) medians. Only seven zip codes in the primary service area report a median income above the national median. A lack of available resources to the indigent is a challenge in this environment, so in addition to providing charity care the hospital has been and continues to support the Salina Family Healthcare Center, which provides care to the indigent. Our patient population is composed of 48% Medicare, 11% Medicaid, 33% Commercial, and 3% Tricare/Workers Compensation and 5% Uninsured. Part VI, Line 6: The governing board of Salina Regional Health Center, Inc. is comprised of volunteers intentionally selected to promote the betterment of the regional community. Demonstrating its' commitment to community benefit, this board has for over 15 years donated up to 10% of the hospital's end-of-year operating margin to the Community Health Investment Program (CHIP) of the Salina Regional Health Foundation. Salina Regional Health Center, Inc. administrators and governing board members assist the Foundation by participating in the CHIP Committee. In 2011, CHIP funded such projects as a children's center ($333,000), regional public health initiative ($100,000), nursing scholarships ($50,000), and healthy initiative program for children ($100,000). CHIP grants in 2011 totaled $659,138. Since the program's inception in 1994, the hospital has tithed $11,545,885 to the Community Health Investment Program.Salina Regional Health Center Inc. is a member of the Sunflower Health Network (SHN), an organization of 15-community and critical access hospitals scattered across the 13-county service area. A Salina Regional administrator led SHN strategic planning that resulted in regional health priorities, including improving access to specialist physician care, optimizing timeliness and safety of patient transfers, and sustaining the number of quality nurses in the region. As a result of this process, Salina Regional Health Center, Inc. has since invested in physician recruitment both to the Salina community and the greater service area through partnering with the SHN. We have added a trauma program to improve access to specialist care and optimize transfers. And we are providing access to computerized patient simulators to strengthen the quality of nurses in regional communities.The University of Kansas (KU) School of Medicine and Salina Regional Health Center, have forged a unique partnership to address the critical shortage of physicians in rural communities throughout Kansas. Salina Regional will be home to the first satellite location of the KU Medical School in a town the size of Salina, training 32 new physicians over the next four years. In addition to the high-quality medical school education, this partnership will help prepare students for the practice of medicine in rural communities and help address the shortage of physicians in rural Kansas. During the year Salina Regional Health Center donated $250,000 and spent $252,120 improving facilities and providing operational expenses to this partnership. 1 Salina Regional Health Foundation Inc 400 South Santa Fe Salina KS 67401 480949407 501(c)(3) 1113362 To further the activities of the Community Health Improvement Program (CHIP) Salina Regional Health Center, Inc., provides scholarships to students attending nursing school. 51 140200 X X X X X 0 0 0 0 0 1 0 0 0 Micheal Terry 309617 0 67024 0 9706 0 13317 0 12337 0 412001 0 0 0 Larry Barnes 186908 0 16600 0 0 0 9744 0 6778 0 220030 0 0 0 James Barker 167140 0 15124 0 0 0 3535 0 10839 0 196638 0 0 0 Charles Grimwood 174452 0 15922 0 6346 0 11071 0 10884 0 218675 0 0 0 Jack Hinnenkamp 154688 0 13711 0 0 0 9089 0 6103 0 183591 0 0 0 Joe Tallon 185649 0 17259 0 6115 0 10131 0 10499 0 229653 0 0 0 David Moody 160111 0 14597 0 346 0 9469 0 10701 0 195224 0 0 0 Joel Phelps 220027 0 29996 0 6000 0 11703 0 10856 0 278582 0 0 0 John Kelemen 605542 0 5000 0 0 0 13239 0 12971 0 636752 0 0 0 George S Jerkovich 273930 0 0 0 346 0 14842 0 11144 0 300262 0 0 0 Venkata Katasani 256525 0 0 0 0 0 7912 0 8914 0 273351 0 0 0 Guy Grabau 208207 0 34980 0 0 0 0 0 10484 0 253671 0 0 0 Jon Richards 213276 0 7126 0 259 0 0 0 11104 0 231765 0 0 0 Part I, Line 6 The compensation committee of the board determines bonus and incentive payments based on a balanced scorecard which includes financial, patient satisfication, and quality data. In addition, a compensation review is performed by an independent outside consultant. City of Salina Kansas 486017228 794770DP9 2006-04-07 65053116 Extinguish Series 1999 Revenue Bonds and to construct a new patient tower 0 0 0 65053116 4325188 23036195 570534 37121199 2010 0 1 1 1 Lee Young Chairman Board of Truste President of Salina Regional Health Enterprises, Inc., a related org. 0 Charlie Grimwood OfficerVP Region Vice President of Salina Regional Health Enterprises, Inc., a related org. 0 Larry Britegam Vice Chairman Board Secretary of Salina Regional Health Enterprises, Inc., a related org. 0 Joel Phelps OfficerCOO of SRHC I Treasurer of Salina Regional Health Enterprises, Inc., a related org. 0 Kent Buer Secretary Board of Trust Director of Salina Regional Health Enterprises, Inc., a related org. 0 0 Lee Young Chairman Board of Truste President of Salina Regional Health Properties, Inc., a related org. 0 Charlie Grimwood OfficerVP Region Vice President of Salina Regional Health Properties. Inc., a related org. 0 Larry Britegam Vice Chairman Board Secretary of Salina Regional Health Properties, Inc., a realted org. 0 Joel Phelps OfficerCOO of SRHC I Treasurer of Salina Regional Health Properties, Inc., a related org. 0 Kent Buer Secretary Board of Trust Director of Salina Regional Health Properties, Inc., a related org. 0 Joel Phelps OfficerCOO of SRHC I Director of Hospice of Salina, Inc., a related org. 0 Micheal Terry OfficerPresidentCE Director of Hospice of Salina Inc., a related org. 0 0 Micheal Terry OfficerPresidentCE Member of Salina Regional Health Foundation Board of Trustees a related org 0 0 Jack Hinnenkamp OfficerVP Facilit Director of Salina Regional Health Properties, Inc., a related org. 0 Lee Young Chairman Board of Truste Member of Salina Regional Health Foundation Board of Trustees a related org 0 Bennie Salkil Employee of SRHC In CEO of Hospice of Salina, Inc., a related org. 0 Form 990, Part VI, Section B, line 11 The Form 990 is provided to the Board of Trustees for review prior to filing. Form 990, Part VI, Section B, line 12c A conflict of interest questionnaire is required to be completed annually, and upon election, and is reviewed by legal counsel. Form 990, Part VI, Section B, line 15 An independent compensation firm is obtained to complete an annual review and analysis of all the administrative staff members. The compiled report is forwarded to the Compensation Committee of the Board that reviews the analysis and approves the report. Form 990, Part VI, Section C, line 19 The Organization makes its governing documents, conflict of interest policy, and audited financial statements available to the public upon written request. All Other Functional Expenses Form 990, Part X, line 24f Computer Expenses: Program service expenses 913,198. Management and general expenses 2,202,399. Fundraising expenses 0. Total expenses 3,115,597. Phyisican Professional Fees: Program service expenses 2,724,549. Management and general expenses 46,500. Fundraising expenses 0. Total expenses 2,771,049. Utilities: Program service expenses 1,890,574. Management and general expenses 2,649. Fundraising expenses 0. Total expenses 1,893,223. Other Supplies & Expenses: Program service expenses 568,967. Management and general expenses 719,997. Fundraising expenses 0. Total expenses 1,288,964. Recruitment Expenses: Program service expenses 14,402. Management and general expenses 1,209,176. Fundraising expenses 0. Total expenses 1,223,578. Medicaid Assessment: Program service expenses 0. Management and general expenses 1,203,106. Fundraising expenses 0. Total expenses 1,203,106. Educational Expenses: Program service expenses 91,209. Management and general expenses 1,070,879. Fundraising expenses 0. Total expenses 1,162,088. Food Services & related Supplies: Program service expenses 988,886. Management and general expenses 97,548. Fundraising expenses 0. Total expenses 1,086,434. Supplies: Program service expenses 614,684. Management and general expenses 45,383. Fundraising expenses 0. Total expenses 660,067. Equipment Rentals & related maintenance costs: Program service expenses 560,055. Management and general expenses 12,383. Fundraising expenses 0. Total expenses 572,438. Repairs: Program service expenses 390,572. Management and general expenses 103,554. Fundraising expenses 0. Total expenses 494,126. Printing: Program service expenses 124,765. Management and general expenses 204,121. Fundraising expenses 0. Total expenses 328,886. Dues & Subscriptions: Program service expenses 114,681. Management and general expenses 210,770. Fundraising expenses 0. Total expenses 325,451. Telephone: Program service expenses 88,146. Management and general expenses 188,919. Fundraising expenses 0. Total expenses 277,065. Postage & Shipping: Program service expenses 39. Management and general expenses 251,009. Fundraising expenses 0. Total expenses 251,048. Non-Medical Minor Equipment Expense: Program service expenses 176,194. Management and general expenses 7,662. Fundraising expenses 0. Total expenses 183,856. Licenses & Taxes: Program service expenses 33,982. Management and general expenses 120,518. Fundraising expenses 0. Total expenses 154,500. Bond Administration Fees: Program service expenses 0. Management and general expenses 23,513. Fundraising expenses 0. Total expenses 23,513. Changes in Net Assets or Fund Balances: Form 990, Part XI, line 5: Net unrealized losses on investments: -9,318,105. Net assets released from restrictions for capital 210,320. Intercompany transfers 191,929. Net assets released from restrictions for operations 2,167. Net assets released from restrictions for operations -2,167. Net assets released from restrictions for capital -210,320. Change in beneficial interest in net assets of Foundation 67,637. Change in fair value of assets held in trust -97,239. Change in beneficial interest in net assets of Foundation 100. Investment income 189,020. Total to Form 990, Part XI, Line 5: -8,966,658. Audit Committee Form 990, Part XII, Line 2C: The audit committee assumes the responsibility for the oversight of the audited financial statements, review of the Form 990 and Form 990-T and selection of the independent accounting firm. Salina Regional Health FoundationInc 400 South Santa Fe Salina KS 67401 480949407 Advancement of healthcare, health & medical education, research, & welfare KS 501(c)(3) 170(b)(1)(A)(vi) 0 Salina Regional Health Properties Inc 400 South Santa Fe Salina KS 67401 481154675 Own and Operate medical office buildings for section 501(c)(3) organizations KS 501(c)(2) 0 Hospice of Salina Inc 730 Holly Lane Salina KS 67402 481131570 Provide hospice care and support services to the terminally ill and their KS 501(c)(3) 509(a) 0 Salina Surgery Properties LLC 401 South Santa Fe Salina KS 67401 481200039 Construct & own surgical facility KS Related 399096 1972120 0 0 Salina Surgical Center LLC 401 South Santa Fe Salina KS 67401 481199515 Medical Services, Ambulatory Surgery KS Related 9725730 4463928 0 0 Salina Regional Home Medical Services LLC 520 South Santa Fe Suite 140 Salina KS 67401 481221623 Home Medical Services KS Salina Regional Health Center Inc Related 53391 315817 0 0 Salina Regional Health Enterprises Inc 400 South Santa Fe Salina KS 67402 481056225 Provide mgmt services to hospitals in N. Central KS area KS N/A C 0 1 1 0 0 0 0 0 0 1 0 0 0 1 0 1 0 0 Hospice of Salina Inc B 545000 Salina Regional Health Properties Inc J 766393 Salina Regional Health Foundation Inc B 1113362 Salina Regional Health Properties Inc P 6328 Hospice of Salina Inc P 563767 Salina Surgical Center LLC P 200336 Salina Regional Health Foundation Inc C 111443 Salina Regional Health Properties Inc P 1794 Salina Regional Health Properties Inc P 9736 Salina Regional Health Properties Inc N 129710 Hospice of Salina Inc N included in P above