2023-10-04T06:42:36-05:00 2022-12-31 481026809 Wendling Noe Nelson & Johnson LLC 623 SW 10th Ave Suite 300 Topeka KS 66612 990 2022-01-01 480576039 Clara Barton Hospital Association Inc CLAR 6206532114 250 West 9th Street Hoisington KS 675441799 Amanda Hoffman Chief Operating Officer 6206532114 2023-09-11 1 Amanda Hoffman 999009999 0 Cameron L Werth P01797399 7852334226 2023-09-11 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z Amanda Hoffman 250 West 9th Street Hoisington KS 675441799 42471563 0 X www.clarabartonhospital.com X 1946 KS Provision of inpatient and outpatient hospital services, primary care services, and surgical services to residents of our service area. 9 7 371 21 0 0 5576596 2046582 31889931 36983253 416414 270859 773038 1016193 38655979 40316887 6446 583 0 0 19683452 22767982 0 0 118620 12791276 15219047 32481174 37987612 6174805 2329275 42373084 40395254 24424017 21481989 17949067 18913265 X Clara Barton Hospital Association is dedicated to meeting the health care needs and improving the quality of life for the community we serve. We continually pursue clinical excellence in an atmosphere of caring and compassion. We are deeply committed to serving all in need within our resources. 0 0 33045073 583 37257319 Clara Barton Hospital Association provided a wide range of health care services to residents of its service area including 3,513 patient days of inpatient care, 26,355 outpatient hospital visits and 40,082 visits to our primary care and surgical clinics. 33045073 1 1 0 1 0 0 0 0 0 0 1 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0 1 50 0 1 371 1 0 0 0 0 0 0 0 0 0 0 0 0 X 9 7 0 0 0 0 1 1 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X Kristie Kaiser 6206532114 250 West 9th Street Hoisington KS 675441799 Patrick Stiles General Surgeon 40.00 X 820802 0 41186 Roxanne Stiles General Surgeon 40.00 X 560038 0 20560 Timothy Webb Physician 40.00 X 398701 0 34227 Kyle Renner Physician 40.00 X 368448 0 40828 Nathaniel Knackstedt Director/Chief of Staff 40.00 X 349635 0 43774 Amanda Hoffman Pharmacist/COO 40.00 X 268371 0 40839 Jim Blackwell President/CEO/CFO 40.00 X X 240062 0 45611 Kayla Johnson Physician 40.00 X 243455 0 39378 Lisa Beran Chairperson 1.00 X X 0 0 0 Kathy Kaiser Vice-Chairperson 1.00 X X 0 0 0 Lois McLelland Treasurer 1.00 X X 0 0 0 Karisa Cowan Secretary 1.00 X X 0 0 0 Doug Hubbard Director thru Feb. 2022 1.00 X 0 0 0 Gary Shook Director 1.00 X 0 0 0 Kathy Burt Director 1.00 X 0 0 0 Melissa Nech Director beg. Feb. 2022 1.00 X 0 0 0 3249512 0 306403 22 0 1 0 Wichita Surgical Specialists 818 N Emporia Suite 200 Wichita KS 67214 Surgical services 494998 Cerner Coporation PO Box 959156 St Louis MO 63195 Computer support services 474942 Allstaff Chartered 1704 K-96 Highway Great Bend KS 67530 Medical and Surgical staffing 378470 Daniel Brendan Rice 13710 E Ayesbury St Wichita KS 67228 ER Physician coverage 290014 Shared Medical Services Inc 209 Limestone Pass Cottage Grove WI 53527 MRI and PET Services 248334 14 585149 1198551 262882 2046582 Patient service revenue 622110 35120912 35120912 340b drug program revenue 456110 1862341 1862341 36983253 367245 367245 641804 641804 26240 0 26240 26240 26240 2054790 3500 2146756 7920 -91966 -4420 -96386 -96386 All other 621990 205481 205481 Cafeteria 722210 74083 74083 Purchase discounts and rebates 621990 68585 68585 348149 40316887 37257319 0 1012986 583 583 993359 707497 285862 17390820 15605667 1705670 79483 399569 363610 34058 1901 2829294 2538005 278410 12879 1154940 1026741 123117 5082 39640 39640 6250 6250 3120971 2495172 625406 393 113477 51977 61500 1915351 1686638 227373 1340 606467 454850 151617 364774 274057 87528 3189 64498 58348 6141 9 185762 185762 1801893 1450289 339244 12360 214148 52339 161392 417 Pharmacy supplies 2737604 2737604 Medical supplies 1620615 1620615 340B program 789979 789979 Repairs and maintenance 637979 590094 46344 1541 999639 541008 458605 26 37987612 33045073 4823919 118620 446916 473690 13987474 4914386 3728263 3785377 990973 1037616 596821 611752 38201297 14859196 15802355 23342101 5452566 5033094 1367716 1197238 42373084 40395254 6691547 5270770 1112404 12520952 12479982 1099114 731237 3000000 3000000 24424017 21481989 X 16715099 18214292 1233968 698973 17949067 18913265 42373084 40395254 X 2329275 -1030082 -334995 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 1 6148 0 0 0 6148 0 Part II-B, Line 1: Clara Barton Hospital Association, Inc., is a member of the Kansas Hospital Association and the American Hospital Association. Both of these organizations engage in lobbying activities for hospital and general health care interests as part of the services provided to members. 5293767 1409588 3884179 19494563 7201560 12293003 10183730 6248048 3935682 3229237 3229237 23342101 X 38951227 -1030082 -583 -1030665 39981892 334995 334995 40316887 37987029 -583 -583 37987612 0 37987612 Part X, Line 2: Management is not aware of any uncertainties in income tax positions. Part XI, Line 2d - Other Adjustments: Contribution expense included in revenues on financial statements -583. Part XI, Line 4b - Other Adjustments: Change in beneficial interest in net assets of Foundation, net of transfers 334,995. Part XII, Line 2d - Other Adjustments: Contribution expense included in revenues on financial statements -583. 1 1 1 X 1 X 1 1 0 1 1 527325 527325 0.01390 2911421 1640294 1271127 0.03350 3438746 1640294 1798452 0.04740 35379 35379 0.00090 187627 187627 0.00490 10325327 7898742 2426585 0.06390 10548333 7898742 2649591 0.06970 13987079 9539036 4448043 0.11710 1 1143775 22876 11592406 11588853 3553 X 1 1 1 1 Clara Barton Hospital 250 West 9th Street Hoisington KS 675441799 H005003 X X X X Physician clinics & rural health clinics Clara Barton Hospital Association Inc 1 0 0 1 X X X X X X X X X 21 1 0 1 1 X https://clarabartonhospital.com/ X 1 21 1 https://clarabartonhospital.com/ 0 1 X 150.000000000000 300.000000000000 X X X X X 1 1 X X X 1 X https://clarabartonhospital.com/ X https://clarabartonhospital.com/ X https://clarabartonhospital.com/ X X X X X X 1 X 0 X X X X 1 X 0 0 Clara Barton Hospital Association, Inc. Part V, Section B, Line 5: The CHNA was conducted in collaboration with the Barton County Health Department. The Hospital reached out to members of the community with broad interests in the community served and special knowledge of or expertise in public health from groups such as local hospitals, public health community, free clinics, community based clinics, service providers, school leaders, and local government. A Town Hall meeting of 39 attendees was conducted. The Town Hall meeting reflected on the size and seriousness of any health concerns cited and discussed current community health strengths, as well as identifying and ranking top community health concerns. In addition to the Town Hall meeting, CHNA surveys were completed by Barton County residents. The survey was created to measure Barton County residents' views regarding health care perceptions of delivery, access, and health practices. Clara Barton Hospital Association, Inc. Part V, Section B, Line 6b: Barton County Health Department (located in Great Bend, KS - Barton County) Clara Barton Hospital Association, Inc. Part V, Section B, Line 11: The annual update below pertains to the CHNA and implementation strategy completed for the 2021 tax year, which is the first-annual update for the three-year cycle. The Hospital also partnered with various community organizations to help address these needs.1. Nutrition/Healthy FoodCBH continues to offer a full range of patient and outpatient nutrition services designed to help our patients achieve optimal health and feel their best. Our goal is to provide evidence-based nutrition care for treatment of acute and chronic illnesses and to promote nutritional health for adults and children who are either referred by their physician or taking steps on their own to improve their health. Whether someone simply wants to learn to eat healthier, or if they have special dietary needs, our registered dietitian will conduct an individualized nutrition assessment and create an individualized plan just for that person.CBH sponsored a Super Chili Bowl Cookoff. CBH held a Veg Out Challenge encouraging all to eat as many different kinds of vegetables as they could for the month. CBH held a Water Challenge to encourage all to drink a gallon of water a day. Water boosts energy, curbs cravings to snack or overeat, improves bodily functions, and helps with weight loss.CBH promoted incorporating drinking tea into one's lifestyle during the month of July 2022. CBH held a Challenge to Create a Daily Workplace Wellness Routine. Many of the suggestions centered around healthy eating. CBH offers free fruit for patients and employees in the cafeteria.The Great Bend Rec hosted a free Stop 'N Learn Session titled "Healthy Air Fryer Cooking". Tips and tricks were given on how to use an air fryer successfully.The Walk Kansas program kicked off in March 2022.Donna Krug from the Extension Office presented "Shape up your Plate and "More Plants on the Plate" at the Great Bend Senior Center. She also presented the educational program "Make a Med DASH to a Healthy Heart" at the Extension office meeting room.Great Bend Summer Street Stroll Farmers Market is downtown on the east side of the Courthouse square on Thursdays 4-7pm. The market also serves as the designated market for the Kansas Senior Farmers Market Nutrition Program for Barton County where seniors may redeem checks for locally grown fresh vegetables, fruit, herbs, and honey.Kids eat free in Great Bend and Hoisington through the Summer Food Service Program funded by the United States Department of Agriculture.USD 428 received a grant to add the Fresh Fruit and Vegetable Program in the elementary schools starting in October. The program is part of the United States Department of Agriculture's (USDA) fight against childhood obesity.Farm Bureau sponsored Kids Ag Day for Barton County 4th graders. Students learn about where food and other products they use on a daily basis come from. Donna Krug extension agent presented a nutrition education program to area 7th graders.The collaboration, which is funded through the CDC and KDHE and implemented by KU Med, provided 150 Thanksgiving Day Food Boxes to families in need across Barton County. Barton County participated in the Annual Cram the Van food drive. 54,599 pounds of food was collected and donated to our local food banks.2. TransportationClara Barton partnered with the Sunflower Diversified Public Transportation, the Hoisington Trolley, and Golden Belt Community Foundation to help provide better access and financial assistance for transportation in Barton County. Although public transportation has been available in some shape or form, the need to schedule rides in advance and hours of operation often created obstacles when these services were needed. In 2022, through the partnership with Sunflower Diversified General Transportation, a 6:00 PM ride is now available to the community and no scheduling is necessary. Not only did the timing of rides and the need to schedule in advance create barriers, but there were also community members who did not have the financial means to afford the ride. The Albert Gumbir endowment at Golden Belt Community Foundation stepped up to help break down this barrier. Punch tickets for Sunflower's Catch-a-ride and coupons for the Hoisington trolley are now available for those in need at no cost. Clara Barton has two care team management nurses who assist patients as needed to arrange transportation rides.Cardinal Cruiser bikes are now available in Hoisington as part of the bike sharing program. They are available for free checkout at one of four locations throughout Hoisington: the city billing office, the Hoisington Public Library, the Hoisington Rec Commission at the Activity Center and the Rodeway Inn & Suites. Using a shared document at those locations, the city will keep an updated list of which bikes have been checked in or out and from which location. Most of the bikes are of the standard single-speed variety, the city did mix it up with a side-by-side trike and two tandem bicycles.3. Mental HealthCBH continued partnership with the KU Alzheimer's Disease Center to improve assessment of Alzheimer patients and to provide care giver counseling on site once a month.CBH held a Self-Care challenge. Participants were asked to do small things daily that would make them feel better. CBH held an Improve your Mental Health Challenge. Participants who completed all the activities were rewarded with a 15-minute massage.Students at Hoisington High School held a wear yellow night at the girls and boys basketball games to raise awareness about teen suicide. Students involved in the Zero Reasons Why program let this event. Dropping 22 is a non-profit organization established in 2022. Dedicated to helping veterans, first responders, the military community and their families reduce their risk of suicide and improve their mental health so they can overcome trauma, depression, anxiety, and other stressors.USD 355 Ellinwood will be implementing the All Stars Program this year. The goal of this program is to prevent the use of alcohol, tobacco, marijuana, and other illicit substances. The program has been successfully implemented in USD 428, USD 431, USD 112 and Holy Family school. All-Starts is an evidence-based program that looks at delaying the onset of substance misuse, bullying, and promiscuity.The Center for Counseling & Consultation held a Mental Heal Awareness event at Jack Kilby Square. The event hosted several community partners who offered fun events and educational opportunities for all ages. The Central Kansas Community Corrections celebrated National Recovery Month with an event called Recovery Out Loud, Every Voice Matters. This event was a platform for anyone wanting to share their stories about substance use disorder, or for anyone recovering from mental health issues or trauma to do so.Barton County held the 10th annual "Golden Belt Glow 4 Life" 5krun/walk to help raise money to promote suicide awareness and prevention at Veteran's Park in Great Bend. The event was put on by The Central Kansas Partnership Suicide Prevention Task Force.The Great Bend Recreation Commission held a class on how to stay focused on healthy habits and how to manage stress. Presentation was done by Donna Krug and Monique Koerner.Seventy teenagers participated in an exercise called "Crisis Orientation". This program was hosted by #Zero Reasons Why of Central Kansas. #ZRW is a teen-led suicide prevention program that is sponsored locally by the Center for Counseling Consultation, 5815 Broadway in Great Bend.The Center for Counseling & Consultation in Great Bend announced that everyone at The Center has taken the CALM course, and it has been integrated into their daily practices. CALM stands for Counseling to Assess Lethal Means for suicide, such as medications and guns.4. Child CareGPS Kids Club opened its second group daycare home in Hoisington to help alleviate the daycare shortage. Spaces in a group daycare home are limited to 8-12 children, depending on the number of infants in care. Advanced Barton County Childcare was established by Great Bend Economic Development, Inc. (ABCC). This organization was born from conversations with businesses where they expressed that lack of childcare was a major barrier to hiring employees. ABCC was awarded $500,000 grant from the Patterson Family Foundation for the construction of a new $1.6 million childcare facility in Great Bend. With this grant, ABCC has secured 95% of the funds needed for the project. When built the facility will serve 59 children. Ground-breaking for this project is July 2023. When this facility is completed they look to build another in either Ellinwood, Hoisington or Claflin. Clara Barton Hospital Association, Inc. Part V, Section B, Line 11: The City of Hoisington acquired five apartment complexes called the Windgate apartments in 2021. The city proposed raising funds to renovate two of the structures and turn them into daycare homes. Some funds were secured, and much time and work went into the project but May 2022 the governing body did not feel this site and solution was the best fit for our daycare needs. It was decided to demolish the buildings and join forces with ABCC.Patrick Crowdis, the Superintendent of the Hoisington school district USD 431, is working with ABCC. The vision is to build a daycare center where they can service upwards to 50 children. A building site close to Roosevelt Elementary School in Hoisington has been identified for a new construction build. He will be working with ABCC to start to securing funding. 5. Chronic Comorbidities (Obesity, Heart Disease, High Blood Pressure, Diabetes, Cancer)Clara Barton kicked off 2022 with our Eat Well Live Well program. Eight hours of PTO can be earned for those employees that participate and complete several wellness initiatives throughout the year. In January 2022, Clara Barton Hospital hired a full time Registered Dietician. Olinda Harbaugh provides both inpatient and outpatient nutrition services designed to help patients reach their optimal health. Persons interested in managing a chronic disease such as diabetes, obesity, high cholesterol, etc., or those that are confused about diet trends, or those who need that extra help to be held accountable for their goals are all encouraged to make an appointment. CBH added a full-time phlebotomist to the staff of the Great Bend Clinic making it easier to get lab work completed and extended service to non-Clara Barton patients. CBH started installing Continuous Glucose Monitors (CGM's) for patients in the clinic and continued to offer weight checks and blood pressure checks. Quarterly Lab fairs are offered to the public at a discounted rate the 3rd Saturday of the month. The dates this year were 1/15/22, 4/16/22, 7/16/22 and 10/15/2022.CBH received certification as a Patient-Centered Medical Home by the National Committee for Quality Assurance (NCQA). This certification establishes a model of care that is patient-focused, improving the quality of care, enhancing patient experience, building relationships between patients and providers, and providing additional clinic services to better serve patient needs.Clara Barton Medical Center has a care management team who works with patients to manage their medications and works with them and their other care professionals to make sure they are receiving the continuation of care they need.The construction of a public walking/fitness trail surrounding the Great Bend Clinic was completed in March 2022. Clara Barton held/sponsored National Walk at Lunch Day. The walk was held at the Great Bend and Hoisington Clinic Locations. This event encourages residents to get out and walk.Clara Barton held a Control Your Blood Pressure Challenge. Participants calculated the age of their heart by answering 8 questions on the following website https://www1.nyc.gov/site/doh/health/health-topics/heart-age-calculator.page. Clara Barton and several other businesses sponsored a Turkey Trot 5K fun run. Throughout the year, Clara Barton posted healthy recipes to our facebook to share with the community.Clara Barton offers a full range of both inpatient and outpatient nutrition services designed to help patients achieve optimal health. The Great Bend Recreation Commission held an 8-week program in Great Bend called Stay Strong Stay Healthy. The program is designed to increase an aging adult's access to a safe, structured, and effective strength training program. Participants learn exercises to improve their strength, flexibility, and balance.#Zero Reasons Why sponsored a Color Run/Walk in Hoisington. Construction was completed in Hoisington for the new city pool. The City of Hoisington added a new splash pad to the pool in September 2022.6. Educate Public on the Services Offered in the CommunitySydney Dolezal, Michelle Moshier and Chantell McKenzie did a radio talk show to share with the public the transportation partnership developed with Sunflower Transportation, the Hoisington Trolley, and the Golden Belt Community Foundation to provide better access and financial assistance for transportation in Barton County.Clara Barton Medical Center has a Social Determinants Resource List and a Community Resource List available to give to patients or community members needing assistance.Diabetes Educator Olinda Harbaugh held a free public demonstration on how to make homemade salad dressings and educated the public about the cardiovascular benefits associated with oils and what foods they enhance.Diabetes Educator Olinda Harbaugh held a free public demonstration on how to make "traditional" smoothies and smoothie bowls and educated the public on how to incorporate protein powders and other foods high in nutrients and antioxidants into the smoothies. Clara Barton Medical Center is now offering Lactation Consultations at the Hoisington clinic location. The Certified Lactation Counselor (CLC) certification is the premier National Certification in Lactation Management in the United States. CLC certification means that a person has received training and competency verification in breastfeeding and human lactation support, including assessing the latching and feeding process, providing corrective interventions, counseling mothers, understanding, and applying knowledge of milk production, including in special circumstances and other commonly encountered situations.The Great Bend Recreation Commission hosted a free Stop 'N Learn Session titled "Make A Med Dash To A Healthy Heart". The program focused on heart disease, its known causes and lifestyle factors including nutrition and physical activity. Participants learned why the Mediterranean Eating Style and the DASH Diet are both delicious and heart healthy.The Barton County Health Department held a Community Baby Shower downtown at Jack Kilby Square. The free event showcased 23 vendors, including those from the Clara Barton, Family Crisis Center, Untied Healthcare Community Plan, Great Bend Public Library, United Way of Central Kansas and Sunflower Early Education all educating those attending.KDOT shared information with the community in celebration of National Pedestrian Safety Month. They encouraged communities to identify and improve walking areas and promoted the health benefits of walking.The Barton Health Department sent their mobile lab out into the community to give information on why the flu vaccine is the very best way to prevent the flu and to give vaccinations.The Center for Counseling & Consultation in Great Bend announced their new jail program. This program is designed to open a dialogue with jail personnel and those who are incarcerated to help support those who want to obtain mental-health services such as management, therapy, and medication. They will also help with resources such as Medicaid, food stamps, housing, and employment when they are released from jail.Low-Income Energy Assistance Program was announced to the community. This program offers financial assistance to families struggling to pay their heating bills during the cold winter months. Clara Barton Hospital Association, Inc. Part V, Section B, Line 20e: CBH notified all uninsured patients about the Hospital's FAP by letter, orally, and on patient statements. 4 1 - Clara Barton Medical Clinic 252 W 9th Street Hoisington KS 67544 Rural health clinic 2 - Clara Barton Surgical Clinic 252 W 9th Street Suite B Hoisington KS 67544 Physician clinic 3 - Russell Family Medical Care 410 N Main Street Suite C Russell KS 67665 Rural health clinic 4 - Clara Barton Medical Clinic 906 McKinley Street Great Bend KS 67530 Rural health clinic Part I, Line 7: Financial assistance at cost was determined by utilizing departmental cost-to-charge ratios for financial assistance provided in areas that are reported as subsidized health services. An overall cost-to-charge ratio derived from Worksheet 2 was used to determine the cost of financial assistance provided for services not reported as subsidized health services.Unreimbursed Medicaid costs were also determined using a blend of cost-to-charge ratios for certain services and an overall cost-to-charge ratio derived from Worksheet 2 for all other services.The cost of providing subsidized health services was determined using a cost-to-charge ratio for each service.Actual costs and revenues were utilized for all other items reported on line 7. Part I, Line 7g: Subsidized health services are comprised of services that the Hospital provides despite a financial loss to the organization. These services include the operation of a 24-hour emergency room, physician clinics, diabetic and dietician services, and various therapy services. The amount of costs attributed to physician clinics amount to $6,134,336. Part III, Line 4: The Hospital recognizes patient service revenue associated with services provided to patients who have third-party payor coverage on the basis of contractual rates for the services rendered. For uninsured patients that do not qualify for charity care, the Hospital recognizes revenue on the basis of its standard rates for services provided. On the basis of historical experience, a significant portion of the Hospital's uninsured patients will be unable or unwilling to pay for the services provided. Thus, the Hospital records a significant provision for bad debts related to uninsured patients in the period the services are provided.Part III, Line 2:Bad debt expense at cost was determined by utilizing departmental cost-to-charge ratios for financial assistance provided in areas that are reported as subsidized health services. An overall cost-to-charge ratio derived from Worksheet 2 was applied to the charges deemed uncollectible during the year for all other services.Part III, Line 3:Bad debt expense attributable to patients eligible under the organization's financial assistance policy was determined using an estimated 2% of total bad debts. The Hospital takes steps to assist individuals who are believed to qualify for financial assistance prior to writing accounts off as uncollectible.All non-reimbursed costs for treatment of patients in our community provides a community benefit since patients unwilling or unable to pay have received a valuable service at no cost or at a reduced cost to them. This improves the health of our community as a whole. Part III, Line 8: Medicare allowable costs were determined by using amounts from the Hospital's Medicare cost report as filed with the Medicare Administrative Contractor. The Medicare cost report apportions actual costs to the Medicare program using charges for ancillary services and patient days for nursing services. Caring for Medicare patients fulfills a community need and relieves a government burden as these patients typically have low or fixed income. Therefore, any shortfall should be included as a community benefit. Part III, Line 9b: The collection policy states that the patient must cooperate with the Hospital to provide the information and documentation necessary to apply for other existing financial resources that may be available to pay for health care services, such as Medicaid. Then the information is gathered and assessed in order to determine eligibility for charity care. Whenever possible, prior to admission, the Hospital will conduct a pre-admission interview with the patient, the guarantor, and/or the patient's legal representative. Those patients who may qualify for financial assistance from a governmental program will be referred to the appropriate program, prior to the consideration for charity care. Part VI, Line 2: The Hospital works closely with the Barton County Health Department and Kansas Department of Health and Environment to identify trends in the community. Education and information is provided to the public, including information on West Nile, chicken pox, and whooping cough, for example. The Hospital also trends data in the hospital and clinics to identify emerging issues. The Hospital has provided, a fall prevention program, "Stepping On", for interested elderly members of Hoisington and surrounding areas. The Hospital also trends trauma data in the emergency room and as a result provided literature to the public on fall prevention. Part VI, Line 3: There is signage posted at admissions desk. Patients are referred to a financial counselor at admission if they do not have insurance. The financial counselor also works with a Medicaid helper to try and get qualified patients registered for the Medicaid program. Effort is made during billing of deductible and co-payment to see if patient can qualify for charity care. Part VI, Line 4: The community being served is located in central Kansas and consists of approximately 2,700 residents. The average household income is $48,672. 12.4% of the community residents live below federal poverty level. Neighboring hospitals include facilities in Ellinwood and Great Bend. They are approximately 18 and 11 miles away respectively. Part VI, Line 5: The Hospital's Board of Directors is elected from the community at large. This allows independent individuals who reside in the primary service area to serve as a director. The Hospital also extends medical staff privileges to all qualified physicians in the community. Any surplus in funds is retained by the Hospital and aids in improving overall patient care and facility maintenance. X X X 0 0 0 0 0 0 0 0 0 Patrick Stiles General Surgeon 446059 0 374743 0 0 0 9150 0 32036 0 861988 0 0 0 Roxanne Stiles General Surgeon 449796 0 110242 0 0 0 9150 0 11410 0 580598 0 0 0 Timothy Webb Physician 325890 0 72811 0 0 0 9150 0 25077 0 432928 0 0 0 Kyle Renner Physician 310468 0 57980 0 0 0 8699 0 32129 0 409276 0 0 0 Nathaniel Knackstedt Director/Chief of Staff 302039 0 47596 0 0 0 11740 0 32034 0 393409 0 0 0 Amanda Hoffman Pharmacist/COO 268371 0 0 0 0 0 8762 0 32077 0 309210 0 0 0 Jim Blackwell President/CEO/CFO 239834 0 228 0 0 0 12001 0 33610 0 285673 0 0 0 Kayla Johnson Physician 241937 0 1518 0 0 0 7249 0 32129 0 282833 0 0 0 A Hoisington Public Building Commission 471454939 43466QBA6 2020-10-15 12569466 Renovate and expand the Hospital 0 0 0 A 12582778 565260 216638 11651896 148795 189 0 0 0 1 A 0 0 0 0 0 0 0 A 0 0 1 0 0 0 0 0 1 A 1 Schedule K, Part II, Line 3, Total proceeds of issue The difference between Part II, Line 3 and Part I, Column (e) represent year-to-date investment earnings on bond proceeds. Anita Blackwell Spouse of James G. Blackwell, current officer 74738 Employment arrangement 0 Form 990, Part VI, Section A, line 6 Members of Clara Barton Hospital Foundation, Inc. are automatically members of Clara Barton Hospital Association, Inc. Form 990, Part VI, Section A, line 7a Members of Clara Barton Hospital Association, Inc. elect members of the governing body. Form 990, Part VI, Section B, line 11b The Form 990 is provided to governing body and reviewed prior to filing. Form 990, Part VI, Section B, line 12c A conflict of interest disclosure form is provided to each Board Member and is reviewed annually. Form 990, Part VI, Section B, line 15 The organization uses the KHA Salary Survey as a guide for determining CEO compensation with Board of Directors approval. The KHA Salary Survey is used by the CEO when determining compensation for other officers and key employees. Form 990, Part VI, Section C, line 19 The organization makes its governing documents, conflict of interest policy, and financial statements available to the public upon written request. Form 990, Part XI, line 9: Change in beneficial interest in Foundation net of transfers -334,995. Clara Barton Hospital Foundation Inc PO Box 25 Hoisington KS 67544 481077460 Provide support to Clara Barton Hospital KS 501(c)(3) Line 7 N/A 0 0 1 1 0 0 0 0 0 0 0 0 1 0 1 1 0 0 0 0