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GREAT PLAINS OF SABETHA INC: Form 990, tax year 2011

View the entire original 990 at ProPublica ↗

Organization
GREAT PLAINS OF SABETHA INC (EIN 48-1236156)
Tax period
2011-01-01 to 2011-12-31
Filed
2012-11-14
IRS object ID
201243199349305819
Schema version
2011v1.3
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)
Timestamp2012-11-14T15:41:23-06:00Timestamp
Tax Period End Date2011-12-31TaxPeriodEndDate

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 Line11551 N WATERFRONT PKWY STE 300AddressLine1
CityWICHITACity
StateKSState
ZIP Code672066601ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2011-01-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN481236156EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1GREAT PLAINS OF SABETHA INCBusinessNameLine1
FieldValueIRS element (for citing)
In Care Of Name% DAVE DELLASEGAInCareOfName
Name ControlGREANameControl
Phone7855432111Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1625 THIRD STREETAddressLine1
CityPHILLIPSBURGCity
StateKSState
ZIP Code676612138ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameDAVE DELLASEGAName
TitleCFOTitle
Date Signed2012-11-15DateSigned
Authorize Third PartytrueAuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameELIZABETH S HOGANName
Phone3162652811Phone
FieldValueIRS element (for citing)
Tax Year2011TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonROGER JOHNNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1625 THIRD STREETAddressLine1
CityPHILLIPSBURGCity
StateKSState
ZIP Code67661ZIPCode
FieldValueIRS element (for citing)
Gross Receipts9991537GrossReceipts
Group Return For AffiliatesfalseGroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteWWW.SABETHAHOSPITAL.COMWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation2000YearFormation
State Legal DomicileKSStateLegalDomicile
Activity Or Mission DescriptionACUTE CARE HOSPITAL THAT PROVIDES MEDICAL CARE TO THE GENERAL PUBLIC IN SABETHA, KANSAS AND SURROUNDING RURAL COMMUNITIES.ActivityOrMissionDescription
Nbr Voting Members Governing Body11NbrVotingMembersGoverningBody
Nbr Independent Voting Members10NbrIndependentVotingMembers
Total Nbr Employees149TotalNbrEmployees
Total Nbr Volunteers10TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Contributions Grants Prior Year122838ContributionsGrantsPriorYear
Contributions Grants Current Year157603ContributionsGrantsCurrentYear
Program Service Revenue Prior Year9292754ProgramServiceRevenuePriorYear
Program Service Revenue CY9685334ProgramServiceRevenueCY
Investment Income Prior Year10234InvestmentIncomePriorYear
Investment Income Current Year16149InvestmentIncomeCurrentYear
Other Revenue Prior Year122322OtherRevenuePriorYear
Other Revenue Current Year125853OtherRevenueCurrentYear
Total Revenue Prior Year9548148TotalRevenuePriorYear
Total Revenue Current Year9984939TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year0GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year5832855SalariesEtcPriorYear
Salaries Etc Current Year6004397SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year4107919OtherExpensePriorYear
Other Expenses Current Year4209778OtherExpensesCurrentYear
Total Expenses Prior Year9940774TotalExpensesPriorYear
Total Expenses Current Year10214175TotalExpensesCurrentYear
Revenues Less Expenses Prior Year-392626RevenuesLessExpensesPriorYear
Revenues Less Expenses CY-229236RevenuesLessExpensesCY
Total Assets BOY7779815TotalAssetsBOY
Total Assets EOY7697249TotalAssetsEOY
Total Liabilities BOY1351904TotalLiabilitiesBOY
Total Liabilities EOY1621837TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY6427911NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY6075412NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionTO OPERATE HOSPITAL FACILITIES FOR THE DELIVERY OF HOSPITAL AND RELATED HEALTH CARE SERVICES, HEALTH RELATED EDUCATION, AS WELL AS THE PROMOTION OF HEALTH AND WELLNESS, WITHOUT REGARD TO RACE, CREED, COLOR, SEX, OR FINANCIAL CIRCUMSTANCES.MissionDescription
Significant New Program ServicesfalseSignificantNewProgramServices
Significant ChangefalseSignificantChange
Expense8802141Expense
Grants0Grants
Revenue9738433Revenue
DescriptionThe hospital's primary function is the delivery of healthcare and wellness services to inpatients and outpatients in Nemaha County, specifically Sabetha and other surrounding communities. Inpatient care includes acute care, swing bed and intermediate swing bed. See Schedule O for continuation.Description
Total Program Service Expense8802141TotalProgramServiceExpense
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 EndowmentsfalseTermOrPermanentEndowments
Report Land Bldg EquiptrueReportLandBldgEquip
Report Invest Oth SecuritiesfalseReportInvestOthSecurities
Report Prog Rel InvestfalseReportProgRelInvest
Report Other AssetsfalseReportOtherAssets
Report Other LiabilitiesfalseReportOtherLiabilities
Report Fin48 FootnotetrueReportFin48Footnote
Independent Audit Financial StmttrueIndependentAuditFinancialStmt
Consolidated Audit Financial StmttrueConsolidatedAuditFinancialStmt
SchoolfalseSchool
Foreign OfficefalseForeignOffice
Foreign ActivitiesfalseForeignActivities
More Than5000 K To OrganizationsfalseMoreThan5000KToOrganizations
More Than5000 K To IndividualsfalseMoreThan5000KToIndividuals
Professional FundraisingfalseProfessionalFundraising
Fundraising ActivitiestrueFundraisingActivities
GamingfalseGaming
HospitaltrueHospital
Financial Stmt AttachedtrueFinancialStmtAttached
Grants To OrganizationsfalseGrantsToOrganizations
Grants To IndividualsfalseGrantsToIndividuals
Schedule J RequiredtrueScheduleJRequired
Tax Exempt BondsfalseTaxExemptBonds
Excess Benefit TransactionfalseExcessBenefitTransaction
Prior Excess Benefit TransactionfalsePriorExcessBenefitTransaction
Loan To Officer Or DQPfalseLoanToOfficerOrDQP
Grant To Related PersonfalseGrantToRelatedPerson
Bsnss Rltnshp With OrganizationfalseBsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family MemberfalseBsnssRltnshpThruFamilyMember
Officer Entity With Bsnss RltnshpfalseOfficerEntityWithBsnssRltnshp
Deductible Non Cash ContributionsfalseDeductibleNonCashContributions
Deductible Contributions Of ArtfalseDeductibleContributionsOfArt
TerminatedfalseTerminated
Partial LiquidationfalsePartialLiquidation
Disregarded EntityfalseDisregardedEntity
Related EntitytrueRelatedEntity
Related Org Controlled EntityfalseRelatedOrgControlledEntity
Transaction Related EntityfalseTransactionRelatedEntity
Transfers To Exempt Non Chrtbl OrgfalseTransfersToExemptNonChrtblOrg
Activities Conducted PartnershipfalseActivitiesConductedPartnership
Schedule O RequiredtrueScheduleORequired
Number Forms Transmitted With109619NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup WitholdingtrueComplianceWithBackupWitholding
Number Of Employees149NumberOfEmployees
Employment Tax Returns FiledtrueEmploymentTaxReturnsFiled
Unrelated Business IncomefalseUnrelatedBusinessIncome
Foreign Financial AccountfalseForeignFinancialAccount
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTrans
Taxable Party NotificationfalseTaxablePartyNotification
Non Deductible ContributionsfalseNonDeductibleContributions
Quid Pro Quo ContributionstrueQuidProQuoContributions
Quid Pro Quo DisclosuretrueQuidProQuoDisclosure
Form8282 Property Disposed OffalseForm8282PropertyDisposedOf
Funds To Pay PremiumsfalseFundsToPayPremiums
Premiums PaidfalsePremiumsPaid
Indoor Tanning ServicesfalseIndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members11NbrVotingGoverningBodyMembers
Number Independent Voting Members10NumberIndependentVotingMembers
Family Or Business RelationshipfalseFamilyOrBusinessRelationship
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 CEOfalseCompensationProcessCEO
Compensation Process OtherfalseCompensationProcessOther
Investment In Joint VenturefalseInvestmentInJointVenture
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

FieldValueIRS element (for citing)
Name PersonDAVE DELLASEGANamePerson
Telephone Number3166851523TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1250 N ROCK RD STE 160AddressLine1
CityWICHITACity
StateKSState
ZIP Code67206ZIPCode
FieldValueIRS element (for citing)
Info In Schedule O Part VIIXInfoInScheduleOPartVII

Form990 Part VII Section A Form990PartVIISectionA (19 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationHighest Compensated EmployeeHighestCompensatedEmployee
STEVE CARLSON
CHAIRMAN/DIRECTOR0.25XX000
ROGER JOHN
PRESIDENT/CEO/DIRECTOR2.0XX011429826924
BETH MEYERES
VICE PRESIDENT/DIRECTOR0.25XX000
LOGAN SPRUNGER
VICE PRESIDENT/DIRECTOR0.25XX000
ROBERT HAMILTON
SECREATRY/DIRECTOR0.25XX000
THOMAS E KELLER DVM
TREASURER/DIRECTOR0.25XX000
FERD DIETZ
DIRECTOR0.25X000
BILL NAVIS
DIRECTOR0.25X000
DAVE RANKIN
DIRECTOR0.25X000
CURTIS ERICKSON
DIRECTOR0.25X000
JOHN TERRILL
DIRECTOR0.25X000
DR BARBARA BROWN
DIRECTOR0.25X000
DAVE DELLASEGA
CFO2.0X011113317933
LORA KEY
ADMINISTRATOR50.0X85663023366
KEVIN KENNALLY
PHYSICIAN40.0262820029620X
KERSTIN GLYNN
PHYSICIAN40.0220484028990X
JAMES LONGABAUGH
PHYSICIAN40.0192226026113X
CHRISTIAN TRAMP
PHYSICIAN40.0165729023000X
GREGG WENGER
PHYSICIAN40.0164755023028X
FieldValueIRS element (for citing)
Total Reportable Comp From Org1091677TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs225431TotalReportableCompFrmRltdOrgs
Total Other Compensation198974TotalOtherCompensation
Number Individuals GT100 K5NumberIndividualsGT100K
Formers ListedfalseFormersListed
Total Comp GT150 KtrueTotalCompGT150K
Compensation From Other SourcesfalseCompensationFromOtherSources

Contractor Compensation ContractorCompensation (4 entries)

Description Of ServicesDescriptionOfServicesCompensationCompensation
STORMONT VAIL HEALTHCARE
LAB SERVICES153413
GREAT PLAINS HEALTH ALLIANCE
MANAGEMENT SERVICES112593
SHARED MEDICAL SERVICES
MRI SERVICES108300
MIDWEST HEALTH SYSTEMS
IT SUPPORT SERVICES106335
FieldValueIRS element (for citing)
Number Of Contractors GT100 K4NumberOfContractorsGT100K
Fundraising Events17018FundraisingEvents
Government Grants15446GovernmentGrants
All Other Contributions125139AllOtherContributions
Total Contributions157603TotalContributions

Program Service Revenue ProgramServiceRevenue

FieldValueIRS element (for citing)
DescriptionNET PATIENT SERVICE REVENUEDescription
Business Code621300BusinessCode
Total Revenue Column9685334TotalRevenueColumn
Related Or Exempt Function Income9685334RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Program Service Revenue9685334TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column16049TotalRevenueColumn
Exclusion$16,049ExclusionAmount

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)
Real13750Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real13750Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column13750TotalRevenueColumn
Exclusion$13,750ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Other100Other

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Other0Other

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Other100Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column100TotalRevenueColumn
Exclusion$100ExclusionAmount
FieldValueIRS element (for citing)
Gross Income Fundraising Events1909GrossIncomeFundraisingEvents
Fundraising Direct Expenses6598FundraisingDirectExpenses

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

FieldValueIRS element (for citing)
Total Revenue Column-4689TotalRevenueColumn
Exclusion-$4,689ExclusionAmount

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 ColumnTotalRevenueColumnExclusionExclusionAmountRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
EMPLOYEE/GUEST MEALS72221018280$18,280
OUTSIDE SERVICES6213005309953099
VENDOR REBATES9000998579$8,579

Miscellaneous Revenue MiscellaneousRevenue

FieldValueIRS element (for citing)
Total Revenue Column36834TotalRevenueColumn
Exclusion$36,834ExclusionAmount
FieldValueIRS element (for citing)
Total Other Revenue116792TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column9984939TotalRevenueColumn
Related Or Exempt Function Income9738433RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$88,903ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total0Total

Grants To Domestic Individuals GrantsToDomesticIndividuals

FieldValueIRS element (for citing)
Total0Total

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)
Total109029Total
Management And General109029ManagementAndGeneral

Comp Disqual Persons CompDisqualPersons

FieldValueIRS element (for citing)
Total0Total

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total4664261Total
Program Services4146175ProgramServices
Management And General518086ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total359327Total
Program Services310542ProgramServices
Management And General48785ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total542686Total
Program Services411105ProgramServices
Management And General131581ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total329094Total
Program Services281919ProgramServices
Management And General47175ManagementAndGeneral

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total93635Total
Management And General93635ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total2204Total
Management And General2204ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total27966Total
Management And General27966ManagementAndGeneral

Fees For Services Lobbying FeesForServicesLobbying

FieldValueIRS element (for citing)
Total0Total

Fees For Services Prof Fundraising FeesForServicesProfFundraising

FieldValueIRS element (for citing)
Total0Total

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total0Total

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total1155372Total
Program Services1023314ProgramServices
Management And General132058ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total28333Total
Program Services10090ProgramServices
Management And General18243ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total207398Total
Program Services146814ProgramServices
Management And General60584ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total0Total

Royalties Royalties

FieldValueIRS element (for citing)
Total0Total

Occupancy Occupancy

FieldValueIRS element (for citing)
Total218277Total
Program Services208470ProgramServices
Management And General9807ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total9739Total
Program Services6615ProgramServices
Management And General3124ManagementAndGeneral

Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials

FieldValueIRS element (for citing)
Total0Total

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total40868Total
Program Services31499ProgramServices
Management And General9369ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total21185Total
Program Services19623ProgramServices
Management And General1562ManagementAndGeneral

Payments To Affiliates PaymentsToAffiliates

FieldValueIRS element (for citing)
Total0Total

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total625101Total
Program Services574900ProgramServices
Management And General50201ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total149903Total
Program Services42729ProgramServices
Management And General107174ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
RENTAL EQUIPMENT & REPAIRS40153338822713306
BAD DEBT EXPENSE182457182457
LICENSES & TAXES19506184741032
DUES & SUBSCRIPTIONS397322055319179

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total986569Total
Program Services978635ProgramServices
Management And General7934ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total10214175Total
Program Services8802141ProgramServices
Management And General1412034ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY220BOY
EOY220EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY931724BOY
EOY975815EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

FieldValueIRS element (for citing)
BOY14208BOY
EOY15025EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY1278063BOY
EOY1458752EOY

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)
BOY211757BOY
EOY228701EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY128765BOY
EOY116343EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis11939104LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec7305362LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY4910663BOY
EOY4633742EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
BOY219415BOY
EOY233651EOY

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)
BOY85000BOY
EOY35000EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY7779815BOY
EOY7697249EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY947266BOY
EOY1106564EOY

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)
BOY0BOY
EOY0EOY

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)
BOY404638BOY
EOY515273EOY

Unsecured Notes Loans Payable UnsecuredNotesLoansPayable

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY1351904BOY
EOY1621837EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY6413703BOY
EOY6060387EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY14208BOY
EOY15025EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY6427911BOY
EOY6075412EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY7779815BOY
EOY7697249EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses-229236ReconcilationRevenueExpenses
Reconcilation Other Changes-123263ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or ReviewfalseAccountantCompileOrReview
FS AuditedtrueFSAudited
Audit CommitteetrueAuditCommittee
Financial Statement BothXFinancialStatementBoth
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 OrganizationstrueGrantsOtherOrganizations
Grants Other Organizations$2,108GrantsOtherOrganizationsAmount
Direct Contact LegislatorsfalseDirectContactLegislators
Rallies DemonstrationsfalseRalliesDemonstrations
Other ActivitiesfalseOtherActivities
Total Lobbying Expenditures IIB2108TotalLobbyingExpendituresIIB
Not Described In501c3falseNotDescribedIn501c3

Form990 Schedule C Part IV Form990ScheduleCPartIV

FieldValueIRS element (for citing)
IdentifierGRANTS TO OTHER ORGANIZATIONS FOR LOBBYING PURPOSESIdentifier
Return ReferenceSCHEDULE C, PART II-B, LINE 1FReturnReference
ExplanationAPPROXIMATELY 20% OF KANSAS HOSPITAL ASSOCIAITON (KHA) DUES ARE DEDICATED FOR LOBBYING PURPOSES AS DIRECTED BY THE KHA.Explanation

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Art Public Exhibition AmtsArtPublicExhibitionAmts
Held Works Of Art AmtsHeldWorksOfArtAmts
Current Year Minus3 YearsCurrentYearMinus3Years

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis35244OtherCostOrOtherBasis
Book Value35244BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis6397928OtherCostOrOtherBasis
Depreciation3194209Depreciation
Book Value3203719BookValue
FieldValueIRS element (for citing)
Leasehold ImprovementsLeaseholdImprovements

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis5322922OtherCostOrOtherBasis
Depreciation3966627Depreciation
Book Value1356295BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis183010OtherCostOrOtherBasis
Depreciation144526Depreciation
Book Value38484BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings4633742TotalOfBookValueLandBuildings
Federal Income Tax Liability0FederalIncomeTaxLiability
Total Of Amounts0TotalOfAmounts
Total Revenue9984939TotalRevenue
Total Expenses10214175TotalExpenses
Excess Or Deficit For Year-229236ExcessOrDeficitForYear
Other-$123,264OtherAmount
Total Adjustments-123264TotalAdjustments
Excess Or Deficit Per FS-352500ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt10033273TotRevenueEtcAuditedFinclStmt
Other Revenues48334OtherRevenues
Revenue Not Rptd F99048334RevenueNotRptdF990
Revenue Subtotal9984939RevenueSubtotal
Total Revenue Per Form9909984939TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt10385773TotExpensesEtcAuditedFinclStmt
Other Expenses Included171598OtherExpensesIncluded
Expenses Not Rptd F990171598ExpensesNotRptdF990
Expenses Subtotal10214175ExpensesSubtotal
Total Expenses Per Form99010214175TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (4 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
UNCERTAIN TAX POSITIONSSCHEDULE 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 NET ASSETSSCHEDULE D, PART XI, LINE 8OTHER CHANGES: EQUITY IN EARNINGS SABETHA HEALTHCARE, INC. 41,736 TRANSFER TO CITY OF SABETHA (165,000) ---------- TOTAL $ (123,264)
RECONCILIATION OF REVENUESCHEDULE D, PART XII, LINE 2DEQUITY IN EARNINGS SABETHA HEALTHCARE, INC. 41,736 SPECIAL EVENT EXPENSES 6,598 --------- TOTAL $ 48,334
RECONCILIATION OF EXPENSESSCHEDULE D, PART XIII, LINE 2DTRANSFER TO CITY OF SABETHA 165,000 SPECIAL EVENT EXPENSES 6,598 -------- TOTAL $ 171,598

Schedule G IRS990ScheduleG

Events Information EventsInformation

FieldValueIRS element (for citing)
Name Of Event1GOLF TOURNAMENTNameOfEvent1
Gross Receipts Event118927GrossReceiptsEvent1
Charitable Contributions Event117018CharitableContributionsEvent1
Gross Revenue Event11909GrossRevenueEvent1
Other Direct Expenses Event16598OtherDirectExpensesEvent1
Total Number Of Other Events0TotalNumberOfOtherEvents
Gross Receipts Total18927GrossReceiptsTotal
Charitable Contributions Total17018CharitableContributionsTotal
Gross Revenue Total Events1909GrossRevenueTotalEvents
Other Direct Expenses Total Events6598OtherDirectExpensesTotalEvents
Direct Expense Summary Events6598DirectExpenseSummaryEvents
Net Income Summary-4689NetIncomeSummary

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Charity Care PolicytrueCharityCarePolicy
Written PolicytrueWrittenPolicy
FPG Reference Free CaretrueFPGReferenceFreeCare
Pcent100XPcent100
FPG Reference Discounted CaretrueFPGReferenceDiscountedCare
Pcent200 DXPcent200D
Free Disc Care Medically IndigenttrueFreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity CaretrueAmountsBudgetedForCharityCare
Expenses Exceeded BudgetfalseExpensesExceededBudget
Annual Community Benefit ReportfalseAnnualCommunityBenefitReport

Charity Care At Cost CharityCareAtCost

FieldValueIRS element (for citing)
Total Community Benefit Expense83887TotalCommunityBenefitExpense
Direct Offsetting Revenue0DirectOffsettingRevenue
Net Community Benefit Expense83887NetCommunityBenefitExpense
Percent Of Total Expense0.00820PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

FieldValueIRS element (for citing)
Total Community Benefit Expense132802TotalCommunityBenefitExpense
Direct Offsetting Revenue0DirectOffsettingRevenue
Net Community Benefit Expense132802NetCommunityBenefitExpense
Percent Of Total Expense0.01300PercentOfTotalExpense

Total Charity Care TotalCharityCare

FieldValueIRS element (for citing)
Total Community Benefit Expense216689TotalCommunityBenefitExpense
Direct Offsetting Revenue0DirectOffsettingRevenue
Net Community Benefit Expense216689NetCommunityBenefitExpense
Percent Of Total Expense0.02120PercentOfTotalExpense

Community Health Services CommunityHealthServices

FieldValueIRS element (for citing)
Total Community Benefit Expense284450TotalCommunityBenefitExpense
Direct Offsetting Revenue193830DirectOffsettingRevenue
Net Community Benefit Expense90620NetCommunityBenefitExpense
Percent Of Total Expense0.00890PercentOfTotalExpense

Cash And In Kind Contributions CashAndInKindContributions

FieldValueIRS element (for citing)
Total Community Benefit Expense3823TotalCommunityBenefitExpense
Direct Offsetting Revenue0DirectOffsettingRevenue
Net Community Benefit Expense3823NetCommunityBenefitExpense
Percent Of Total Expense0.00040PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense288273TotalCommunityBenefitExpense
Direct Offsetting Revenue193830DirectOffsettingRevenue
Net Community Benefit Expense94443NetCommunityBenefitExpense
Percent Of Total Expense0.00930PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense504962TotalCommunityBenefitExpense
Direct Offsetting Revenue193830DirectOffsettingRevenue
Net Community Benefit Expense311132NetCommunityBenefitExpense
Percent Of Total Expense0.03050PercentOfTotalExpense
FieldValueIRS element (for citing)
Bad Debt Expense ReportedfalseBadDebtExpenseReported
Bad Debt Expense$182,457BadDebtExpenseAmount
Amount Attributable To0AmountAttributableTo
Amount Reimbursed By Medicare2486170AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare2486170CostOfCareReimbursedByMedicare

Costing Methodology Used CostingMethodologyUsed

FieldValueIRS element (for citing)
Cost To Charge RatioXCostToChargeRatio
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 Line1SABETHA COMMUNITY HOSPITALBusinessNameLine1

Address Address

FieldValueIRS element (for citing)
Address Line114TH OREGON PO BOX 229AddressLine1
CitySABETHACity
StateKSState
ZIP Code66534ZIPCode
FieldValueIRS element (for citing)
Licensed HospitalXLicensedHospital
General Medical And SurgicalXGeneralMedicalAndSurgical
Critical Access HospitalXCriticalAccessHospital
Er24 HoursXEr24Hours

Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1SABETHA COMMUNITY HOSPITALBusinessNameLine1
FieldValueIRS element (for citing)
Hospital Facility Number1HospitalFacilityNumber
Eligibility Criteria ExplainedtrueEligibilityCriteriaExplained
Uses FPG FreetrueUsesFPGFree
FPG Free Percent300.FPGFreePercent
Uses FPG DiscountedtrueUsesFPGDiscounted
FPG Discount Percent300.FPGDiscountPercent
Explains BasistrueExplainsBasis
Income LevelXIncomeLevel
Asset LevelXAssetLevel
Explains Application MethodtrueExplainsApplicationMethod
Includes Publicity MeasurestrueIncludesPublicityMeasures
Provided On AdmissionXProvidedOnAdmission
Actions On NonpaymenttrueActionsOnNonpayment
Collection ActivitiesfalseCollectionActivities
Notify Upon AdmissionXNotifyUponAdmission
Notify Before DischargeXNotifyBeforeDischarge
Notified All PatientsXNotifiedAllPatients
Documented DeterminationXDocumentedDetermination
Nondiscrim Emergency Care PolicytrueNondiscrimEmergencyCarePolicy
Used Other MethodXUsedOtherMethod
Amounts Generally BilledfalseAmountsGenerallyBilled
Gross ChargesfalseGrossCharges

Form990 Schedule H Part VI Form990ScheduleHPartVI (10 entries)

IdentifierIdentifierExplanationExplanationReturn ReferenceReturnReference
SCHEDULE H, PART I, LINE 7, COLUMN FTHE 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 $182,457.
SCHEDULE 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 TO CHARGE RATIO.
BAD DEBT EXPENSENo separate bad debt expense disclosure. Accounts are considered delinquent and subsequently written off as bad debts based on individual credit evaluation and specific circumstances of the account. Disclosures on provision for doubtful account are related to disclosures regarding the allowance for doubtful accounts which is set for all non-Medicare accounts receivable over 150 days old. The provision for doubtful accounts is a separate expense on the statement of operations and changes in net assets. Hospital charges that are not collected and are not approved for financial assistance are classified as bad debts from patients who will not pay. Bad debts are a service to the community because many people cannot pay, but will not submit a charity care application due to the negative implications within the community.SCHEDULE H, PART III, LINE 4
COLLECTION PRACTICESALL CHARITY CARE CHARGES AND CHARGES NOT TO BE COLLECTED DUE TO FINANCIAL ASSISTANCE COMPUTATIONS ARE EXEMPTED FROM COLLECTION POLICIES AND PRACTICES. THOSE ACCOUNTS ARE REMOVED FROM THE COLLECTION CYCLE.SCHEDULE H, PART III, LINE 9B
CHARGES FOR MEDICAL CARETHE HOSPITAL DETERMINES THE MAXIMUM AMOUNTS THAT CAN BE CHARGED TO FAP-ELIGIBLE INDIVIDUALS FOR EMERGENCY OR OTHER MEDICALLY NECESSARY CARE USING GROSS CHARGES.SCHEDULE H, PART V, SECTION B, LINE 19
NEEDS ASSESSMENTIn 2009, Sabetha Community Hospital developed a three year strategic plan. The goals established through the strategic plan process continue to be reviewed on a regular basis by the Hospital Board of Directors. Community perceptions of the hospital were determined based on two focus groups, interviews of community leaders, health care providers, Board members, the five family physicians located in Sabetha and hospital department directors. As a result of this strategic plan several nutritional sessions and obstetrical classes were provided to the community. The Board of Directors is kept informed of regulatory and industry changes as the Board meets monthly. Results from patient satisfaction surveys are reviewed on regular intervals in order that hospital staff can identify issues which need to be addressed. The Hospital plans on conducting a community needs assessment in 2012 bringing in community leaders from local industry, city officials, schools, local consumers, and community health.SCHEDULE H, PART VI, LINE 2
PATIENT EDUCATION OF ELIGIBILITYThe Financial Assistance Program employs a sliding scale discount that takes into consideration a patients household income and qualifying assets. The Financial Counselor consults with private pay patients to see if they qualify for the Hospitals financial assistance policy. We also have posted in both the hospital and clinic lobbies that financial assistance is available and to apply you need to visit with the Financial Counselor at the Hospital. If discovered during the accounts receivable collection process that a patient is having trouble paying bills, both the hospital and the clinic will inform the patient that financial assistance is available. As part of the financial assistance program all applicants must apply for Medicaid. To determine if the patient may qualify for financial assistance, the financial counselor gives patient forms to complete and asks to see bank statements, tax returns, etc. Computations based on current Federal Poverty Level Guidelines are completed to see if qualifications is appropriate and the percentage of charges to be written off is determined, based on family size and household income. All instances of financial assistance are approved by upper management of the Hospital. Information about Financial Assistance is posted on the hospital website and the Financial Assistance form can be downloaded from www.sabethahospital.com.SCHEDULE H, PART VI, LINE 3
COMMUNITY INFORMATIONSabetha Community Hospital is a 25 bed Critical Access Hospital located in the city of Sabetha, Nemaha County Kansas. Currently the population is estimated at 2800. According to data collected during the strategic planning process, the primary service area for Sabetha Community Hospital includes portions of Nemaha and Brown Counties with Nemaha County providing 79% of all inpatients and Sabetha zip code alone contributing 69%. Nebraska and a few other counties provide a growing portion of the hospitals patient base. Brown and Nemaha counties account for 20,269 persons according to the 2007 U.S. Census estimate. In 2007, 92.5% of the the two-county population was white, 4.2% Native American, 2.1% Hispanic and 1.2% African-American. The 65 and older age group accounted for 19.5% of the population in 2007.SCHEDULE H, PART VI, LINE 4
PROMOTION OF COMMUNITY HEALTHThe hospital provides and promotes the health of the citizens of Sabetha and the surrounding region by providing the following. In January, the hospital sponsored a Healthy U class for the community which focuses on healthy eating and exercise. Promoting a life style change rather than another fad diet. The hospital also promotes wellness among employees by providing a corporate membership to the community fitness room and the Healthy U program is open to employees as well as the public. The hospital also helps sponsor a 5K run/walk to promote wellness. In March, employees and the community were encouraged to participate in the Annual Walk Across Kansas Program. In February, the hospital board approved the purchase of a true digital mammography machine. This is a great advancement in womens health for the community and the hospital was recognized in USA Today as one of the top 100 Hospitals for Patient Experience by Womens Certified in the small, rural hospital category. A hospital volunteer core with community members was created to enhance the stay of swing bed patients and the activities they are involved in during their stay. Another service to the community is the provision of occupational assessment testing along with hearing screens. Certified staff is available in house to provide those services. Sabetha Family Practice was awarded the two years Medical Home Pilot Project and will finish up with project in July of 2013. Two of the five physicians celebrated 30 years providing care in the Sabetha Community. First grade students are invited to attend an annual hospital tour guiding them through various departments of the hospital. The hospital Guild members volunteer to coordinate efforts to hold bloodmobile clinics. During the flu season flu clinics are offered at the hospital, and hospital staff conducts flu clinics at the local grocery store as well as onsite flu vaccinations for several local businesses. Hospital staff provides CPR training for professionals in the area. The hospital provides prenatal classes including CPR training on a quarterly basis. Hospital staff travels to surrounding communities to provide free blood pressure clinics. A registered dietician is available for diabetic consultations. Cardiac Rehab Phase III is open to the community to offer support in an exercise program, especially for those patients who have graduated from the Cardiac Rehab Phase II program. Social Services aids those in the community who are in need of enrollment assistance, whether it be for Medicaid, Medicare Part D services, or other information referral assistance. The hospital also provides Lifeline to the senior population in the region. One of the hospital physicians sits as the Medical Director for the city owned ambulance service.SCHEDULE H, PART VI, LINE 5
AFFILIATED HEALTH CARE SYSTEMSOrganization is affiliated with Great Plains Health Alliance, Inc. (GPHA), a non-profit 501c3 organization which provides management services and operational, finance and accounting support to the Hospital. GPHA does not provide services directly to patients, but does provide access to professionals that may not be affordable to the normal critical access hospital. GPHA provides education and assistance in areas such as HIPAA, Medicare reimbursement, meaningful use requirements for computer systems, etc. GPHA is an affiliation of Critical Access hospitals in Kansas and Nebraska that provides networking opportunities with other rural hospital, communities and leaders. GPHA provides policies and guidance to its Critical Access facilities regarding financial assistance, conflicts of interest, corporate compliance and many other areas. GPHA also provides educational sessions for Board Members, Business Office Mangers, Billers, Medical Records personnel, Director of Nursing and Administrators. GPHA is a vital link in allowing CAH hospitals to operate at a high quality within the cash constraints imposed by the Critical Access program.SCHEDULE H, PART VI, LINE 6

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Severance PaymentfalseSeverancePayment
Supplemental Nonqual Retire PlanfalseSupplementalNonqualRetirePlan
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 (5 entries)

Base 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
KEVIN KENNALLY
2628200000021306083140292440000
KERSTIN GLYNN
2204840000021248077420249474000
JAMES LONGABAUGH
1922260000018423076900218339000
CHRISTIAN TRAMP
1657290000015766072340188729000
GREGG WENGER
1647550000015678073500187783000

Form990 Schedule J Part III Form990ScheduleJPartIII

FieldValueIRS element (for citing)
IdentifierCOMPENSATION FROM A RELATED ORGANIZATIONIdentifier
Return ReferenceFORM 990, PART VII; SCHEDULE J, PART I, LINE 3ReturnReference
ExplanationCOMPENSATION FOR ROGER JOHN AND DAVE DELLASEGA IS PROVIDED BY GREAT PLAINS HEALTH ALLIANCE, A RELATED ORGANIZATION. GREAT PLAINS HEALTH ALLIANCE'S BOARD OF DIRECTORS ANNUALLY APPROVE THE COMPENSATION FOR MR. JOHN AND MR. DELLASEGA.Explanation

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (22 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
PROGRAM SERVICE ACCOMPLISHMENTSFORM 990, PART III, LINE 4The hospital added a digital mammography machine in 2011 and was recognized by Womens Health as being one of the top 100 hospitals in the small, rural hospital category. Community Education on digital mammography was the primary focus for 2011. Patients were educated on the importance of getting a mammogram and breast exam annually. Mammography Techs spoke to community groups to increase awareness of the importance of early detection in diagnosing breast cancer and the increased survival rate. Also during 2011, information technology was a priority and the continued move to meaningful use of the electronic health record. Internal committees were formed to aid in the collection of data and determining new process to better enhance the patient experience.
MEMBERSFORM 990, PART VI, SECTION A, LINE 6GREAT PLAINS HEALTH ALLIANCE, INC., A NOT-FOR-PROFIT, 501(C)(3) ORGANIZATION, IS THE SOLE MEMBER OF GREAT PLAINS OF SABETHA, INC.
MEMBERS MAY ELECT GOVERNING BODYFORM 990, PART VI, SECTION A, LINE 7AGREAT PLAINS HEALTH ALLIANCE, INC., BEING THE SOLE MEMBER, HAS THE RIGHT TO ELECT AND APPROVE ALL THE BOARD MEMBERS.
GOVERNING BODY DECISIONS SUBJECT TO APPROVAL OF MEMBERSFORM 990, PART VI, SECTION A, LINE 7BGREAT PLAINS HEALTH ALLIANCE, INC. (GPHA) IS THE SOLE MEMBER AND HAS THE AUTHORITY TO APPROVE THE ARTICLES OF INCORPORATION, BYLAWS, ELECTION TO OR REMOVAL FROM THE BOARD OF DIRECTORS, THE ANNUAL OPERATING AND CAPITAL BUDGETS, AND THE LONG RANGE OR STRATEGIC PLANS.
FORM 990 REVIEW PROCESSFORM 990, PART VI, SECTION B, LINE 11BTHE 990 IS PREPARED AND REVIEWED BY AN INDEPENDENT ACCOUNTING FIRM. THE 990 IS THEN PROVIDED TO THE CHIEF FINANCIAL OFFICER FOR REVIEW AND APPROVAL. AN ELECTRONIC DRAFT OF THE 990 WITH ALL REQUIRED SCHEDULES IS THEN PROVIDED TO THE FULL BOARD FOR REIVEW PRIOR TO FILING THE 990 WITH THE IRS.
CONFLICT OF INTEREST POLICYFORM 990, PART VI, SECTION B, LINE 12CTHE ORGANIZATION IS REQUIRED TO ADOPT GPHA'S CONFLICT OF INTEREST POLICY. ALL BOARD MEMBERS, OFFICERS AND EMPLOYEES ARE SUBJECT TO THE CONFLICT OF INTEREST POLICY AND SIGN AN ANNUAL ACKNOWLEDGEMENT THAT THEY HAVE READ, UNDERSTAND AND COMPLIED WITH THE GPHA CONFLICT OF INTEREST POLICY. UNDER THE POLICY, ANY MEMBER WHO HAS A DIRECT OR INDIRECT (VIA FAMILY) FINANCIAL INTEREST IS CHARACTERIZED AS AN INTERESTED PERSON. INTERESTED PERSONS ARE REQUIRED TO DISCLOSE FINANCIAL INTERESTS WITH COMPANIES DOING BUSINESS WITH GPHA. THE INTERESTED PERSON MUST RECUSE THEMSELVES FROM FURTHER DISCUSSIONS OF THE TRANSACTION AND LEAVE THE ROOM. THE REMAINING NON-INTERESTED MEMBERS DECIDE IF A CONFLICT OF INTEREST EXISTS. THE BOARD CHAIR MAY APPOINT ANOTHER DISINTERESTED PARTY TO DISCUSS THE TRANSACTION OR THE REMAINING BOARD MEMBERS MAY VOTE TO ENTER INTO OR ABSTAIN FROM THE SUSPECT TRANSACTION. FAILURE TO DISCLOSE FINANCIAL INTERESTS BY INTERESTED BOARD MEMBERS WILL RESULT IN DISCIPLINARY ACTION, INCLUDING SANCTIONING BY BOARD. ALL CONFLICTS OF INTEREST AND THEIR ULTIMATE RESOLUTION ARE DOCUMENTED IN THE BOARD MINUTES. THE BOARD CONDUCTS PERIODIC REVIEWS TO DETERMINE THAT CONFLICTS ARE BEING IDENTIFIED AND RESOLVED ACCORDING TO POLICY DOCUMENTATION. REVIEWS BY OUTSIDE EXPERTS ARE PERMITTED, BUT NOT REQUIRED.
COMPENSATION REVIEWFORM 990, PART VI, SECTION B, LINES 15A & BTHERE IS NO FORMAL REVIEW BY INDEPENDENT SOURCES, BUT THE ORGANIZATION'S BUDGET AND THE GPHA BUDGET IS APPROVED BY THE BOARD. AS A HISTORICAL PRACTICE, RAISES OF THE PRESIDENT/CEO AND CHIEF FINANCIAL OFFICER ARE LIMITED TO $3,000 ANNUALLY SINCE THESE INDIVIDUALS EACH EARN OVER $100,000 ANNUALLY.
AVAILABILITY OF DOCUMENTSFORM 990, PART VI, SECTION C, LINE 19THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. THE COMPANY'S KANSAS ANNUAL REPORT IS ALSO AVAILABLE UPON REQUEST FROM THE KANSAS SECRETARY OF STATE.
OTHER CHANGES IN NET ASSETSFORM 990, PART XI, LINE 5EQUITY IN EARNINGS SABETHA HEALTHCARE, INC. 41,736 TRANSFER TO CITY OF SABETHA (165,000) ---------- TOTAL $ (123,264)
HOURS DEVOTED FOR RELATED ORGANIZATIONFORM 990 PART VIINAME:STEVE CARLSON TITLE:CHAIRMAN/DIRECTOR HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATIONFORM 990 PART VIINAME:ROGER JOHN TITLE:PRESIDENT/CEO/DIRECTOR HOURS:48
HOURS DEVOTED FOR RELATED ORGANIZATIONFORM 990 PART VIINAME:BETH MEYERES TITLE:VICE PRESIDENT/DIRECTOR HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATIONFORM 990 PART VIINAME:LOGAN SPRUNGER TITLE:VICE PRESIDENT/DIRECTOR HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATIONFORM 990 PART VIINAME:ROBERT HAMILTON TITLE:SECREATRY/DIRECTOR HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATIONFORM 990 PART VIINAME:THOMAS E. KELLER, D.V.M. TITLE:TREASURER/DIRECTOR HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATIONFORM 990 PART VIINAME:FERD DIETZ TITLE:DIRECTOR HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATIONFORM 990 PART VIINAME:BILL NAVIS TITLE:DIRECTOR HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATIONFORM 990 PART VIINAME:DAVE RANKIN TITLE:DIRECTOR HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATIONFORM 990 PART VIINAME:CURTIS ERICKSON TITLE:DIRECTOR HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATIONFORM 990 PART VIINAME:JOHN TERRILL TITLE:DIRECTOR HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATIONFORM 990 PART VIINAME:DR. BARBARA BROWN TITLE:DIRECTOR HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATIONFORM 990 PART VIINAME:DAVE DELLASEGA TITLE:CFO HOURS:46

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (9 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Controlled OrgControlledOrg
GREAT PLAINS HEALTH ALLIANCE INC
625 THIRD STREETPHILLIPSBURGKS67661480617739MANAGEMENTKS501(C)(3)3NAfalse
GREAT PLAINS HEALTH CARE FOUNDATION INC
625 THIRD STREETPHILLIPSBURGKS67661480955870SUPPORTKS501(C)(3)9GPHA INCfalse
GREAT PLAINS OF ELLINWOOD INC
625 THIRD STREETPHILLIPSBURGKS67661481226976HOSPITALKS501(C)(3)3GPHA INCfalse
GREAT PLAINS OF KIOWA COUNTY INC
625 THIRD STREETPHILLIPSBURGKS67661481226833HOSPITALKS501(C)(3)3GPHA INCfalse
GREAT PLAINS OF OTTAWA COUNTY INC
625 THIRD STREETPHILLIPSBURGKS67661481226856HOSPITALKS501(C)(3)3GPHA INCfalse
GREAT PLAINS OF PHILLIPS COUNTY INC
625 THIRD STREETPHILLIPSBURGKS67661481226829HOSPITALKS501(C)(3)3GPHA INCfalse
GREAT PLAINS OF CHEYENNE COUNTY INC
625 THIRD STREETPHILLIPSBURGKS67661481226831HOSPITALKS501(C)(3)3GPHA INCfalse
GREAT PLAINS OF REPUBLIC COUNTY INC
625 THIRD STREETPHILLIPSBURGKS67661481226977HOSPITALKS501(C)(3)3GPHA INCfalse
GREAT PLAINS OF SMITH COUNTY INC
625 THIRD STREETPHILLIPSBURGKS67661481226830HOSPITALKS501(C)(3)3GPHA INCfalse
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
Sale Of Assets To Other OrgfalseSaleOfAssetsToOtherOrg
Purchase Of Assets From Other OrgfalsePurchaseOfAssetsFromOtherOrg
Exchange Of AssetsfalseExchangeOfAssets
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 FacilitiesfalseSharingOfFacilities
Sharing Of Paid EmployeesfalseSharingOfPaidEmployees
Reimbursement Paid To Other OrgfalseReimbursementPaidToOtherOrg
Reimbursement Paid By Other OrgfalseReimbursementPaidByOtherOrg
Other Transfer To Other OrgfalseOtherTransferToOtherOrg
Other Transfer From Other OrgfalseOtherTransferFromOtherOrg