2025-05-15T15:33:11-07:00 2024-12-31 990 2024-01-01 480576046 JEFFERSON COUNTY MEMORIAL HOSPITAL INC JEFF 9139334020 408 Delaware Winchester KS 66097 Jason Johnson CFO 9139334020 2025-05-15 1 2024 2025-03-06 01:10:19Z X FW Huston Medical Center Heidi Pickerell 408 Delaware St Winchester KS 66097 9038929 0 X www.fwhuston.com X 1956 KS Promote and provide healthcare to the residents and surrounding community of Jefferson County, Kansas 8 8 123 0 88324 0 1927429 71968 7635983 8871832 164017 35456 46666 59673 9774095 9038929 0 0 0 0 5804306 6430280 0 0 417172 2495853 3010608 8300159 9440888 1473936 -401959 6019835 7228344 933205 2543673 5086630 4684671 Promote and provide quality healthcare for the general commuinty of Jefferson County 0 0 6526011 9038929 Provide healthcare to the residents of Jefferson County through the operation of a hospital, nursing facility, assisted living center, primary care clinic, 24 hour emergency department. Provide financial assistance to patients unable to pay for medically necessary healthcare. 0 0 0 6526011 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 0 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 15 0 1 123 1 0 0 0 0 0 0 0 0 X 8 8 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X Jason Johnson 9139334202 408 Delaware Winchester KS 66097 Dr Chelsea Willis Physician 40 0 X X X 315707 0 0 Ron Ross Physician's Assistant 50 0 X 219242 0 0 Heidi Pickerell CEO 40 0 X X 183179 0 0 Shelby Sprang Nurse Practioner 40 0 X 143006 0 0 Jason Johnson CFO 40 0 X X 135484 0 0 Melody Keirns COO 40 0 X X 129943 0 0 Kari Houk Director of Nursing 40 0 X 129680 0 0 Cathryn Palenske Nurse Practioner 40 0 X 121251 0 0 Traci Noll Director of Ancillary Services 40 0 X 107492 0 0 Doug Walbridge President 2 0 X X 0 0 0 Mary Ann Noll Vice President 2 0 X X 0 0 0 Jay O'Neill Secretary/Treasurer 1 0 X X 0 0 0 Mike Schwinn Director 1 0 X 0 0 0 Ron Ellis Director 1 0 X 0 0 0 Dave Taylor Director 1 0 X 0 0 0 Tammy Gigstad Director 1 0 X 0 0 0 Baretta Schmeissner Director 1 0 X 0 0 0 1484984 0 0 12 0 1 0 Zack Group 6600 College Blvd Suite 300 Overland Park KS 66211 Provide contract nursing services 260490 Medservices Personnel 4404 Nicklaus Dr Lawrence KS 66047 Contract Nursing Services 171434 R & A Glass 13134 State Hwy 116 Cummings KS 66016 Glass Replacement Contractor 140205 Athena Health PO Box 415615 Boston MA 022415615 Electronic Health Records Vendor 131129 4 0 0 0 53000 11689 7279 0 71968 Net Patient Revenue non-government 900099 2817003 2817003 0 0 Net Patient Revenue government(M'care/M'caid) 900099 6054829 6054829 0 0 0 0 0 0 8871832 35456 0 35456 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Jail Laundry 900099 37761 0 37761 0 Cafeteria 900099 15107 0 15107 0 Other Misc, Med Records, etc 900099 6805 6805 0 0 0 0 0 0 59673 9038929 8878637 88324 0 X 0 0 0 0 0 0 0 0 1484987 928887 556100 0 0 0 0 0 4088984 3083521 1005463 0 55146 39017 16129 0 389620 294864 94756 0 411543 310632 100911 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1325869 1171122 154747 0 10356 2596 7760 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 20850 7350 13500 0 0 0 0 0 20350 14001 6349 0 32223 0 32223 0 0 0 0 0 268293 0 0 268293 148879 0 0 148879 Equipment Rent, Dues, Supplies, Drugs, Food, misc 955590 673229 282361 0 Utilities 200554 64 200490 0 Repairs 27644 728 26916 0 9440888 6526011 2497705 417172 1533346 3052398 2287722 1937471 0 112683 146416 110800 94385 6582483 4584809 1975284 1997674 0 0 0 0 0 6019835 7228344 73950 956167 0 0 0 0 0 0 0 0 0 0 250837 417147 608418 1170359 933205 2543673 X 5086630 4684671 0 0 5086630 4684671 6019835 7228344 -401959 0 0 0 0 0 X 1 X 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 39007 0 39007 3526877 0 2434385 1092492 0 0 0 0 3016599 0 2150424 866175 0 0 0 0 1997674 9038929 0 0 0 0 0 9038929 0 0 0 9038929 9440888 0 0 0 0 0 9440888 0 0 0 9440888 1 1 1 X 1 X 99 1 0 0 0 0 13747 0 13747 0.002 0 0 493354 0 493354 0.052 0 0 0 0 0 0 0 0 507101 0 507101 0.054 0 0 0 0 0 0.000 0 0 507101 0 507101 0.054 0 0 0 5339861 5339861 0 X 1 1 1 1 Jeffereson County Memorial Hospital Inc FW Huston Medical Center 408 Delaware Winchester KS 66097 www.fwhuston.com H044001 X X Jeffereson County Memorial Hospital Inc FW Huston Medical Center 1 0 0 1 X X X X X X X X X 22 1 0 1 1 X www.fwhuston.com X 1 19 1 www.fwhuston.com 0 0 1 X 99 50 X 1 1 X X X X 1 X www.fwhuston.com X www.fwhuston.com X www.fwhuston.com X X X X X 1 X 0 X X X X 1 X X 0 0 Schedule H, Part V, Section B, Line 5-Jeffereson County Memorial Hospital Inc The assessment was made widely available to all the community through print and digital media. The assessment was anonymous and had multiple means of completion by both the hospital and our local CHNA partner. Schedule H, Part V, Section B, Line 6b-Jeffereson County Memorial Hospital Inc The CHNA was coordinated with the Jefferson County Health Department Schedule H, Part V, Section B, Line 11-Jeffereson County Memorial Hospital Inc The CHNA was coordinated with the Jefferson County Health Department H-V-B, Line 11 Access to high quality healthcare services at any time. Mental healthcare for senior citizens. Nutritional service. Affordable housing, Mitigation of prescription drug abuse/opiod overdose. Care of individuals with or at risk for chronic disease, specifically high blood pressure, diabetes, lung disease, and elevated cholseterol. Local economic growth. Primary and secondary prevention of common health concerns with health promotion activities. Through new approaches and program development are in progress, increased marketing and community education efforts of available services will be primary focus for the improvement plan and implementation to ensure county residents know of the services accessible to them to meet many of the needs listed. Schedule H, Part I, Line 7 Based on billed revenue, total expenses, contractuals, per worksheets 1, 2, and 3. Schedule H, Part III, Section A, Line 4 Bad debt is calculated based on the amount written off according ot FAP. Schedule H, Part III, Section B, Line 8 We are cost reimbursed for Medicare related costs, so there is no shortfall. This is based on the annual medicare cost report. Schedule H, Part III, Section C, Line 9b Financial assistance policies are posted strategically throughout the facility. Upon check in patients are advised of services available and how to access them. We also post the assistance available online and in the local media Schedule H, Part VI, Line 2 We do the required community needs health assessment every 3 years. Using the results of this we assess how we can fill the needs. In addition, we collaborate with local health care organizations to determine if additional services could benefit the community, such as specilty clinics. Schedule H, Part VI, Line 3 Financial assistance policies are posted strategically throughout the facility. Upon check in patients are advised of services available and how to access them. We also post the assistance available online and in the local media Schedule H, Part VI, Line 4 We are the only hospital in Jefferson County. Jefferson County is a rural community with an approximate population of 18,000. We offer emergency services in an area that many would have to travel over an hour to receive. The community consists of a high elderly population, as well as many in indigent situations. Schedule H, Part VI, Line 5 We provide services where ther are otherwise none available. We work to inform the community of our services through health fairs, email campaigns, online notices, facebook, newspaper advertising and outreach programs. X X X X 0 0 0 0 0 0 0 0 0 Dr Chelsea Willis Physician 315707 0 0 0 0 0 0 0 0 0 315707 0 0 0 Ron Ross Physician's Assistant 219242 0 0 0 0 0 0 0 0 0 219242 0 0 Heidi Pickerell CEO 183180 0 0 0 0 0 0 0 0 0 183180 0 0 0 Form 990, Part VI, Section B, Line 11b The governing board is provided a copy of the 990 Income Tax return prior to the filing for review. Any questions or concerns are addressed prior to submittal. Form 990, Part VI, Section B, Line 12c At all meetings questions about conflicts are raised, and if any exist are addressed. Form 990, Part VI, Section B, Line 15 Any changes to compensation of key employees are presented to the board for review. Changes must be approved by the board before implementation. The board is responsible for the CEO's annual performance evaluation. Comparative salary information is provided to the board to determine competitive salary ranges for adequacy of annual salary. Form 990, Part VI, Section C, Line 19 The governing documents, conflict of interest policy, and financial statements are maintained at the hospital and are available for review by the public upon request. The requestor is provided a secure, private area to review. Form 990, Part IX, Line 11g Purchased services for a variety of services, such as contract nursing, rehab, telehealth ed services, etc. Jefferson County Memorial Hospital Foundation Inc 408 Delaware Winchester KS 66097 481044983 Promote Healthcare in Jefferson County KS 501(c)(3) PF N/A 0 0 1 0 0 0 0 0 0 0 0 0 0 1 0 0 1 1 0 1 Jefferson County Memorial Hospital Foundation Inc p 192309 Purchase of drugs and supplies from the foundation's pharmacy. Jefferson County Memorial Hospital Foundation Inc q 321213 We pay payroll, payroll expenses, insurance, and miscellaneous expenses, and the foundation reimburses these expenses monthly. Jefferson County Memorial Hospital Foundation Inc c 53000 The foundation donated cash toward a capital improvement project from fundraiser. Schedule R, Part I The hospital pays the payroll for the foundation, as well as purchases various supplies, insurance, etc. The foundation reimburses the hospital monthly for any expenses. The foundation owns a pharmacy which provides supplies, such as drugs, medical supplies, etc. The hospital reimburses the foundation monthly for any expenses.