2025-07-23T14:25:29-05:00 2024-09-30 450250958 Eide Bailly LLP 800 Nicollet Mall Ste 1300 Minneapolis MN 554027033 990 2023-10-01 480545923 Cloud County Health Center Inc CLOU 7852431234 155 W College Dr Concordia KS 66901 Ron Harrington CFO 7852431234 2025-07-22 1 1 Kim Hunwardsen CPA P00484560 6122536500 2025-07-22 2023 2025-03-06 01:10:19Z North Central Kansas Medical Center David Garnas 155 W College Dr Concordia KS 66901 22819412 0 X www.nckmed.com X 1970 KS Operation of critical access hospital 12 11 0 25 0 0 635984 16309 22896339 22763991 -1936 31181 -517 7931 23529870 22819412 2050 5164 0 0 13694404 13692323 0 0 0 10923331 11085782 24619785 24783269 -1089915 -1963857 49143712 48670649 38746190 40102067 10397522 8568582 X Cloud County Health Center is committed to providing quality health care services delivered in a caring and respectful manner through teamwork and professional excellence. 0 0 18849037 5164 22763991 Cloud County Health Center (dba NCK Medical Center) is a nonprofit acute care hospital located in Concordia, Kansas. The Health Center provides inpatient, outpatient, Rural Health Clinic and Emergency care services to residents of Cloud County and the surrounding area. The Health Center had a total of 233 discharges and 1,493 patient days. The Hospital had a total of 433 surgeries, 2,923 ED visits and 27,070 OP visits and the Family Care Center had 16,155 visits. In addition to providing Inpatient and Outpatient services, the hospital provides the following ancillary services: Lab, Imaging, Pharmacy, Respiratory Therapy, Rehab services, Sleep Lab services,and surgical procedures. Imaging services include all of the following areas: General X-ray, CT Scan, Nuclear Medicine, Ultrasound, Bone Density and Mammography services. 18849037 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 1 1 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 X 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 X 12 11 0 1 0 0 1 0 0 1 0 0 0 1 1 1 1 1 1 1 0 0 X Ron Harrington 7852431234 155 W College Drive Concordia KS 66901 X X Philip Gilliland Chairperson 1.00 0.00 X X 0 0 0 Kurt Kocher Vice Chairperson 1.00 1.00 X X 0 0 0 Chuck Lambertz Secretary 1.00 0.00 X X 0 0 0 Amy Lange Treasurer 1.00 0.00 X X 0 0 0 Joanne Balthazor Director 1.00 1.00 X 0 0 0 Quentin Breese Director 1.00 0.00 X 0 0 0 Darrell Gallegos Director 1.00 0.00 X 0 0 0 Darrel Hosie Director 1.00 0.00 X 0 0 0 Amber Knoettgen Director 1.00 0.00 X 0 0 0 Kent Otott Director 1.00 0.00 X 0 0 0 Sister Marilyn Wall Director 1.00 0.00 X 0 0 0 Justin Poore Chief of Staff (until Dec 2023) 40.00 0.00 X 0 0 0 Dorothy Breault Chief of Staff (beg Jan 2024) 40.00 0.00 X 0 0 0 David Garnas President 40.00 1.00 X 0 0 0 Ronald Harrington CFO 40.00 1.00 X 0 0 0 Daniel Garlow Physician 40.00 0.00 X 328184 0 32783 Shawna Huggans Advanced Practice Provider 40.00 0.00 X 194059 0 35280 Brandon Fraley Advanced Practice Provider 40.00 0.00 X 190545 0 17164 Layce Siemsen Advanced Practice Provider 40.00 0.00 X 183843 0 36496 Tiffany Naccarto Advanced Practice Provider 40.00 0.00 X 155608 0 8131 1052239 0 129854 21 0 1 1 0 4620 11689 16309 Patient Service Revenue 621400 21287742 21287742 Pharmacy Revenue 900099 1251334 1251334 Cafeteria Revenue 900099 107482 107482 117433 117433 22763991 31181 31181 Miscellaneous Revenue 900099 7931 7931 7931 22819412 22763991 0 39112 5164 5164 843108 342467 500641 10436791 8431507 2005284 373569 302033 71536 1255476 973246 282230 783379 609969 173410 6289 6289 18273 18273 3238 3238 1578598 1164002 414596 46681 35 46646 271704 262624 9080 261366 64007 197359 320411 10174 310237 74729 46594 28135 11144 2626 8518 1294207 865236 428971 3813229 2706172 1107057 100500 19895 80605 Medical and Patient Sup 2943237 2880751 62486 Food Costs 141331 5575 135756 Dues, Licenses, and Tax 71229 24106 47123 129616 129616 24783269 18849037 5934232 0 58523 98608 2195244 3075663 167986 284536 393113 339575 51523786 13219968 41800005 38303818 833378 975682 3695463 5592767 49143712 48670649 923213 795327 37822977 37186740 0 2120000 38746190 40102067 X 9564374 7593130 833148 975452 10397522 8568582 49143712 48670649 X -1963857 134917 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 1 3238 0 0 0 3238 0 Part II-B, Line 1: A portion of annual dues paid by Cloud County Health Center to the Kansas Hospital Association (KHA) has been identified as association lobbying activities by KHA. Cloud County Health Center does not directly participate in lobbying activities. 719202 719202 35482265 4184736 31297529 14769677 8937022 5832655 552642 98210 454432 38303818 Due from Salina Regional Health Center 4392986 Assets Limited As to Use 1199781 5592767 Estimated Third-Party Payor Settlements 2120000 2120000 X 25376087 2569226 -4620 2564606 22811481 7931 7931 22819412 27347331 2569226 2569226 24778105 5164 5164 24783269 Part X, Line 2: The Medical Center believes that it has appropriate support for any tax positions taken affecting its annual filing requirements, and as such, does not have any uncertain tax positions that are material to the financial statements. The Medical Center would recognize future accrued interest and penalties related to unrecognized tax benefits and liabilities in income tax expense if such interest and penalties are incurred. Part XI, Line 2d - Other Adjustments: Change in beneficial interest of Foundation -4,620. Part XI, Line 4b - Other Adjustments: Net Auxiliary Income 7,931. Part XII, Line 4b - Other Adjustments: Auxiliary expense 5,164. 1 1 X 1 X 1 X 1 1 1 0 0 370000 370000 0.01490 1957106 723730 1233376 0.04980 2327106 723730 1603376 0.06470 6714884 3801460 2913424 0.11760 6714884 3801460 2913424 0.11760 9041990 4525190 4516800 0.18230 1 1412814 0 9668774 9716007 -47233 1 1 1 1 Cloud County Health Center 155 W College Drive Concordia KS 66901 www.nckmed.com H015001 X X X X Provider based clinic Cloud County Health Center 1 0 0 1 X X X X X X X X X 21 1 0 0 1 X See Section C X X 1 21 1 See Section C 0 1 X 150.000000000000 200.000000000000 X X X X X 1 1 X X X 1 X nckmed.com/patient-and-visitors/financial-assistance X nckmed.com/patient-and-visitors/financial-assistance X nckmed.com/patient-and-visitors/financial-assistance X X X X X 1 X 0 X X X X 1 X 0 0 Cloud County Health Center Part V, Section B, Line 5: On April 28, 2022, the Community Health Needs Assessment Committee met and discussed ways to involve the community in addressing the most important health needs of Cloud County. The group decided to survey the community, asking for their input on priority of the following areas:- Obesity- Depression/Mental Health- Diabetes- Heart Disease- Tobacco Use Including vaping and chewing- Stroke- Trauma/Falls- Hypertension (high blood pressure)- High cholesterol- Substance Abuse- Transportation to Medical ServicesThe survey was launched through all forms of media for a period of six weeks. 118 surveys were received and tabulated. The Community Health Needs Assessment Committee met in July to review the results and discuss an implementation plan. The Committee consists of 25 members from various organizations in the community. Cloud County Health Center Part V, Section B, Line 11: The following community health priority areas were identified in the most recent CHNA. 1) Obesity 2) Depression/Mental Health 3) Diabetes 4) Heart Disease 5) Tobacco Use 6) Stroke 7) Trauma/Falls 8) Hypertension 9) High Cholesterol 10) Substance Abuse 11) Transportation to Medical ServicesAlthough all of the above are important and will be addressed as part of our regular operations, the hospital will focus on Obesity (including trauma/falls), Depression/Mental Health, and Substance Abuse, including Tobacco Use during fiscal years ending in 2023-2025. With assistance from other organizations, we will address the issues through the following steps:#1 - Provide Opportunities to Stabilize Mental Health We continue to educate the Community on these issues with education materials and through conversations with hospitals in Topeka when we have patients that need to be transferred out of the Emergency Department. The Health Center has been meeting quarterly with Pawnee Health to improve the process for these patients. #2 - Provide ways to decrease Obesity in the Community and include Education of Health issues leading to Obesity The Hospital started a Stepping On class for our senior population. They have a class twice a year, once in the Spring and the other in the Fall time frame. An instructor works with the senior community on ways to strengthen their motor skills and prevent falls at home. This program has been very successful and we are looking to add additional classes in the future. Two programs have also continued, the TOPS program and the Stay Strong Program, an extension of Kansas State, to have pre- and post-surveys used to determine what degree of behavior has changed. #3 - Develop ways to decrease Substance abuse and Tobacco use We continue to provide education materials to patients, and we participate in the Great Smoke Out Day in November each year. We also provide education on smoking cessation classes and offer patients nicotine smoking patches within the Clinic and/or Emergency department. Education materials are also distributed in the community at various locations such as the Library, Senior Center, etc. Cloud County Health Center Part V, Section B, Line 13h: Presumptive eligibility may be used if the other options are not available. Cloud County Health Center Part V, Section B, Line 24: The hospital financial assistance policy does not cover elective procedures. The hospital may have charged FAP eligible patients gross charges for services that are not covered under the financial assistance policy. Part V, Section B, Line 7a nckmed.com/about/community-health-needs Part V, Section B, Line 10a nckmed.com/about/community-health-needs Part I, Line 3c: The methodology used to determine eligibility for financial assistance takes into consideration income, net assets, family size, medical indigency, insurance and underinsurance status. Presumptive eligibility may be used if the other options are not available. Part I, Line 7: Charity care expense was converted to cost on line 7A based on an overall cost-to-charge ratio addressing all patient segments. Line 7B, Medicaid, was determined based on the costing methods used to prepare the cost reports. Line 7G was obtained from the Medicare Cost Report. Part III, Line 2: The amount on line 2 represents implicit price concessions. The Organization determines its estimate of implicit price concession based on its historical collection experience with this class of patients. Part III, Line 4: The footnote to the organization's financial statements that describes implicit price concession is located in the audited financial statement report on page 13. Part III, Line 8: The Medicare payments are compared to the actual cost of providing the service as arrived at through the Medicare cost reports. Medical services are provided to patients with Medicare coverage regardless of whether or not a surplus or deficit is realized. Providing Medicare services promotes access to healthcare services which are vitally needed by our community.Hospital services reimbursed on a fee schedule are not included in the Medicare calculation per the 990 instructions. Had this been reported the Hospital would have a greater loss from Medicare services of $25,074.Medicare fee schedule revenue $30,738Medicare estimated costs of care relating to payments $(55,812)Net surplus (shortage) $(25,074) Part III, Line 9b: Collection practices do not apply to patients who have an approved payment plan in effect provided payments are kept current. Patients who have qualified for 100% financial assistance would not go to collection as their account balance would be reduced to zero prior to getting to the collection stage. Patients who qualify for less than 100% assistance may go to collection if their balance is not paid according to an agreed upon schedule. Accounts that are deemed to qualify for financial assistance while in collections will be removed from collections and returned to the business office. Part VI, Line 2: The hospital has an 18 member CHNA committee that meets quarterly at the hospital to discuss the healthcare needs in the community. Members include staff from the hospital, health department representatives, city and county government officials, school leaders and city business leaders. Part VI, Line 3: The hospital does the following to educate patients on the financial assistance offered at CCHC; (1) posts its financial assistance policy and financial assistance contact information on its website, in admissions areas, emergency rooms, and other areas of the organization's facilities in which eligible patients are likely to be present; (2) provides a copy of the policy, or a summary thereof, and financial assistance contact information to patients as part of the intake process; (3) includes the policy, or a summary thereof, along with financial assistance contact information, in patient bills; and/or (4) discusses with the patient the availability of various government benefits, such as Medicaid or state programs, and assists the patient with qualification for such programs, where applicable. Part VI, Line 4: CCHC is located in Concordia, KS. Concordia is the county seat of Cloud County. It is a rural community with an estimated population of 5,111 as of the 2020 census data. Concordia is home to Cloud County Community College located just off Highway 81 that runs through Concordia. The College has two campuses: Concordia and Junction City, KS. Concordia is located in North Central Kansas. Concordia is surrounded by other Healthcare facilities in all directions. To the North in Belleville, KS is Republic County Hospital located 18 miles north of Concordia, KS. To the East is Clay County which has Clay County Medical Center approx. 45 miles from Concordia. To the South is Ottawa County approx. 33 miles which has a facility is Minneapolis, KS. Then to the West is Mitchell County approx. 32 miles and has a Critical Access hospital in Beloit, KS. The population in Concordia has seen a decline since 1970 when the population was 7,221. The latest 5 year survey from 2016 to 2020 with American Community Survey shows the following median household income was $44,185 and the median family income was $48,333. Approximately 13.6% of the population was below the poverty line, including 13.1% of those under the age of 18 and 4.9% of those ages 65 and over. Part VI, Line 5: The Hospital has a Family Care Clinic located on the 1st floor of the Hospital. The Clinic is open from 8:30am till 6:00pm Monday through Friday. The Clinic has walk-in appointments available daily, as each day a different provider in the Clinic does the walk-in appointments. The Clinic also has a Specialty Clinic schedule with the following specialties coming to the clinic monthly: Dermatology - every Monday Ophthalmology - every other Tuesday Neurology - every other Tuesday Urology - once a month Audiology - every other Wednesday Nephrology - every other Wednesday OB/GYN - every other Thursday Pediatric Neurology - once a month Rheumatology - 2 days a month on Thursday & Friday Orthopedics - 3 or 4 days a month Pulmonology - once a month ENT - once a month Endocrinology - added in 2024 - once a monthThe Clinic has two outreach locations located in Clyde and Jamestown. The Clyde location is open at least 15 days a month and the Jamestown location is open every other Thursday.The hospital's Board of Trustees is made up of members from all parts of the county, including local business leaders and retired individuals from Concordia and the surrounding communities.The services offered at CCHC include the following: IP Acute services IP ICU services IP swing bed services - patients requiring Therapy services or IV antibiotic services ED Services Family Care Center Clinic Specialty Clinic Services Ancillary services including the following: Physical Therapy, Occupational Therapy and Speech Pathology services Radiology Services including Ultrasound, Nuclear Medicine, CT Scan and Fixed MRI Services Laboratory Respiratory Therapy Cardiac Rehab Services Sleep Lab Services Operating Room OP Procedures Anti Coag Clinic Outpatient Services, including IV Therapy, Blood Transfusions, and wound care services Part VI, Line 6: CCHC is an affiliate of Salina Regional Health Center (SRHC) through a management and operating agreement. SRHC provides Accounting, Marketing, Administrative, IT, Payroll, HR, Purchasing and Revenue Cycle services. SRHC also helps support our community by employing Specialty physicians that travel to our location to provide healthcare. 1 0 0 0 0 0 0 0 0 Daniel Garlow Physician 220431 0 107753 0 0 0 15195 0 20536 0 363915 0 0 0 Shawna Huggans Advanced Practice Provider 194059 0 0 0 0 0 9132 0 26605 0 229796 0 0 0 Layce Siemsen Advanced Practice Provider 115257 0 68586 0 0 0 9664 0 27013 0 220520 0 0 0 Brandon Fraley Advanced Practice Provider 108914 0 81631 0 0 0 8768 0 8558 0 207871 0 0 0 Tiffany Naccarto Advanced Practice Provider 113592 0 0 0 42016 0 4769 0 3625 0 164002 0 0 0 Part I, Line 4a Tiffany Naccarto received a severance payment of $42,016. Schedule J, Part III Daniel Garlow, Shawna Huggans, Tiffany Naccarato, Layce Siemsen, and Brandon Fraley were paid by an unrelated organization, Salina Regional Health Center, for medical services performed. See Schedule J, Part II and Form 990 Part VII for amounts paid for these services. Form 990, Part V, Line 1a, Number reported in Box 3 of Form 1096: Cloud County Health Center, Inc. has independent contractors, however, Salina Regional Health Center, the management company, pays all the independent contractors directly. The actual expense of each independent contractor is directly charged to the assigned entity. Form 990, Part V, Line 2a, Number of employees on W-3: Under a management agreement, Salina Regional Health Center (SRHC) is responsible for the daily management and operation of the hospital, including employment of all staff. All payroll and benefits are paid by SRHC and payroll reporting is done by SRHC. Allocable compensation by individual is charged to Cloud County Health Center, Inc. and is shown on lines 5-7 of Part IX. Form 990, Part VI, Section A, line 3 The Hospital entered into a management and operating agreement with Salina Regional Health Center (SRHC) effective May 1, 2016. Under the agreement, SRHC is responsible for the daily management and operation of the Hospital, including the employment of all staff needed to manage and operate Cloud County Health Center. For calendar year-end 12/31/2023, SRHC paid the following in compensation and benefits for individuals listed in Part VII: Ronald Harrington $173,873 David Garnas $305,285 Justin Poore $381,713 Dorothy Breault $312,655 Form 990, Part VI, Section A, line 6 The Health Center's Board of Trustees is the sole member of the Health Center. Form 990, Part VI, Section A, line 8b The organization does not have committees with broad authority to act on behalf of the governing board. Form 990, Part VI, Section B, line 11b Form 990 is reviewed by the President & CFO. A copy of the return is provided to board members prior to filing with the IRS. Form 990, Part VI, Section B, line 12c The Health Center requires the trustees and key employees to sign an annual conflict of interest form. On the form they designate if they have any conflicts. Potential conflicts of interest are presented to the Board of Directors. The Board determines whether a conflict exists. If a conflict exists, the effected person will be required to abstain from voting on the matter. Form 990, Part VI, Section B, line 15a The Organization's process for determining the President's compensation begins with an initiative led by the Executive Compensation Committee (ECC) of Salina Regional Health Center (SRHC). The ECC compares compensation and salary data provided by Integrated Health Strategies (IHS) for overall reasonableness of base compensation and total compensation for all SRHC executive staff. The ECC reviews the data and makes a recommendation to the SRHC board of trustees in a closed executive meeting. This process occurs every October. Cloud County Health Center's President's salary is then set by the President/CEO of SRHC. The Cloud County Health Center CFO's salary is set by Salina Regional Hospital Vice President of Finance using an annual salary survey and is increased using the same percentage as all other employees. Form 990, Part VI, Section C, line 19 The organization's governing documents, conflict of interest policy, and financial statements are available to the public upon request. Form 990, Part VII, Section B, Independent Contractors Cloud County Health Center, Inc. has independent contractors, however, Salina Regional Health Center, the management company, pays all the independent contractors directly. The actual expense of each independent contractor is directly charged to the assigned entity. However, due to software limitations, CCHC is unable to obtain independent contractor information and feels it's appropriate to report no independent contractors on Part VII. Form 990, Part XI, line 9: Net Income From Auxiliary -2,767. Change in Beneficial Interest in Net Assets of the Foundation 137,684. Cloud County Foundation for Health Care Inc 155 W College Drive Concordia KS 66901 480966856 support community health and welfare KS 501(c)(3) Line 7 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0