Attach to Form 990 or Form 990-EZ.
See separate instructions.| (i) Name of supported organization |
(ii) EIN |
(iii) Type of organization (described on lines 1- 9 above or IRC section (see instructions)) |
(iv) Is the organization in col. (i) listed in your governing document? |
(v) Did you notify the organization in col. (i) of your support? |
(vi) Is the organization in col. (i) organized in the U.S.? |
(vii) Amount of support? |
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| Yes | No | Yes | No | Yes | No | ||||
| Total | |||||||||
| Calendar year(or fiscal year beginning in) | (a) 2006 | (b) 2007 | (c) 2008 | (d) 2009 | (e) 2010 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .... | ||||||
| 2 | Tax revenues levied for the organization's benefit and either paid to or expended on its behalf....... | ||||||
| 3 | The value of services or facilities furnished by a governmental unit to the organization without charge.. | ||||||
| 4 | Total. Add lines 1 through 3.. | ||||||
| 5 | The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f).. | ||||||
| 6 | Public Support. Subtract line 5 from line 4. | ||||||
| Calendar year(or fiscal year beginning in) | (a) 2006 | (b) 2007 | (c) 2008 | (d) 2009 | (e) 2010 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | ||||||
| 8 | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | ||||||
| 9 | Net income from unrelated business activities, whether or not the business is regularly carried on.. | ||||||
| 10 | Other income. (Explain in Part IV.) Do not include gain or loss from the sale of capital assets.. | ||||||
| 11 | Total support (Add lines 7 through 10). | ||||||






| Calendar year(or fiscal year beginning in) | (a) 2006 | (b) 2007 | (c) 2008 | (d) 2009 | (e) 2010 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") . | ||||||
| 2 | Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose...... | ||||||
| 3 | Gross receipts from activities that are not an unrelated trade or business under section 513.. | ||||||
| 4 | Tax revenues levied for the organization's benefit and either paid to or expended on its behalf... | ||||||
| 5 | The value of services or facilities furnished by a governmental unit to the organization without charge.. | ||||||
| 6 | Total. Add lines 1 through 5. | ||||||
| 7a | Amounts included on lines 1, 2, and 3 received from disqualified persons... | ||||||
| b | Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year. | ||||||
| c | Add lines 7a and 7b.. | ||||||
| 8 | Public Support (Subtract line 7c from line 6.) | ||||||
| Calendar year (or fiscal year beginning in) | (a) 2006 | (b) 2007 | (c) 2008 | (d) 2009 | (e) 2010 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | ||||||
| 10a | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | ||||||
| b | Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975. | ||||||
| c | Add lines 10a and 10b. | ||||||
| 11 | Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on. | ||||||
| 12 | Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.) | ||||||
| 13 | Total support (Add lines 9, 10c, 11 and 12.). | ||||||




| Facts And Circumstances Test |
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| Explanation |
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Attach to Form 990 or 990-EZ.| Identifier | Return Reference | Explanation |
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| COMMUNITY BENEFIT REPORT | Part III | Via Christi Hospital Pittsburg, Inc. (VCH-P) is a member of Via Christi Health, Inc. (VCH). As a Catholic health system, VCH has its origins in faith-based responses to health needs of our communities, with a particular concern for those living in poverty and who are vulnerable. In addition to typical inpatient and outpatient services, VCH operates primary care clinics, a low income neighborhood outreach clinic, specialty hospitals and centers, home medical services, therapy centers, and long-term care villages. The obligation to reach out to those in need and to improve community health flows directly from VCH's identity as a faith-based healing ministry. VCH continues its tradition in providing community benefit because we are committed to: - Promoting and defending human dignity - Caring for persons living in poverty and other vulnerable populations - Promoting the common good - Stewarding resources responsibly According to the VCH's mission statement, "As a part of Via Christi Health, we share this Mission: Inspired by the Gospel and our Catholic tradition, we serve as a healing presence with special concern for our neighbors, who are vulnerable." The financial information in this report was prepared in accordance with the Catholic Health Association's (CHA) A Guide for Planning and Reporting Community Benefit Guidelines. Per these Guidelines, we report the net expense for community benefit services, i.e., the total community benefit expense minus any associated revenue from patients, residents, payers, and other external sources. The CHA Guidelines reflect a conservative approach to reporting quantifiable community benefit. The goal of the Guidelines is to produce community benefit financial reports that reflect true costs and that describe community benefit activities that increase access to health care and improve community health for all. The following are VCH-P definitions for quantifiable community benefits reports below. Charity Care - Free or discounted health services provided to persons who cannot afford to pay and who meet VCH's criteria for financial assistance. Charity care is reported in terms of costs, not charges. Charity care does not include bad debt. Government Sponsored Means-Tested Health Care - Includes unpaid costs of public programs for low-income persons - the shortfall created when VCH receives payments that are less than the cost of caring for public program beneficiaries. This payment shortfall is not the same as a contractual allowance, which is the full difference between charges and government payments. Health Professions Education - Helping to prepare future health care professionals is a distinguishing characteristic of not-for-profit health care and constitutes a significant community benefit. This category includes programs and financial assistance for physicians and medical students, nurses and nursing students, interns, and other health professionals. For fiscal year ended September 30, 2011 ---------------------------------------- Community Benefit (VCH-P and Subsidiaries): 1)Charity care - at cost $6.8 million 2)Government sponsored health care - net expense $(3.8) million Unpaid cost of public indigent care programs (includes Medicaid, SCHIP, other safety net programs; does not include Medicare shortfall) 3)Community Benefit Programs - net expense $0.5 million 4)Total Quantifiable Community Benefit $3.5 million Listed below are just a few of the community benefit programs offered by VCH-P. This is not a complete listing but a sampling of how the hospital gives back to the community while meeting current needs. Targeted Population Health Fairs & Screenings are conducted annually for children, seniors, and the broader community. During FY2011, over 1,872 people were served for a cost of nearly $6,377 by having their blood pressure checked, eyes examed, hearing tested, feet examined, sport physicals and labs drawn, or given recommendations for establishing a medical home with either a physician and/or the area FQHC clinic. Support Groups & Educational Presentations are hosted (e.g. cancer, stroke, breast cancer, rehab services, etc) and numerous educational presentations (e.g. arthritis exercise class, smoking prevention, personal actions toward health, stroke, etc) were given in the Pittsburg area. In FY2011, over 1,550 attendees participated in these events at a cost of over $15,000. Transportation is a real concern for rural communities, and Cherokee and Crawford Counties are no exceptions. Having affordable and reliable transportation for medical appointments is critical, especially for elderly patients who may be unable to drive or who have no other alternatives. CareVan, a popular transportation program owned and operated by VCH-P provided transportation assistance over 10,265 times in FY2011 at a cost of $216,141. Health Profession Education of area physicians, nurses, physician assistants, nursing students, and other health care professionals who are either looking for continuing education credits, wanting more hands-on training, or are in need of field practicum placements, etc are welcomed at VCH-P for additional training opportunities. Over 100 health care professionals and/or students hoping to enter the health care field were offered training opportunities through the various programs offered by VCH-P at a cost of nearly $84,000. Response to Joplin Tornado - In partnership with Pittsburg State University and Catholic Charities of Southwest Missouri, VCH-P provided volunteer assistance with Case Management and help set up a Comprehensive Service Center. In addition, the hospital took in many of the injured patients due to the total destruction of St. John's Hospital in Joplin and assisted with the various needs of displaced families who had loved ones admitted to the hospital. In-Kind Donations - Service on community boards that are health related (e.g. Prescription Assistance Liaison Program, Project Warmth, etc), and/or sharing of hospital space to conduct health related not-for-profit business is another area in which VCH-P gives back to the community. In fiscal year 2011, VCH-P contributed just over $166,430 through financial and in-kind contributions. Community Benefit Operations - Community benefit staff uses and trains others to use the Community Benefit Inventory Social Accountability (CBISA) software, developed by Lyon Software and used by over 1,700 hospitals throughout the country. CBISA software follows the reporting guidelines adopted by Catholic Health Association and does not include bad debt or unpaid Medicare reimbursements as community benefit. Overall, VCH-P combined community benefit programs (not counting traditional charity care and/or unpaid reimbursement of Medicaid) accounted for $531,416 contributed to the geographical area of Pittsburg, Kansas during FY2011. |
| FORM 990 REVIEW | PART VI, SECTION B, QUESTION 11B | THE AUDIT COMMITTEE REVIEWS AND APPROVES THE FORM 990 PRIOR TO THE DATE OF FILING. THE AUDIT COMMITTEE REPORTS ON THE REVIEW TO THE BOARD OF TRUSTEES AND ASSURES THAT THE BOARD HAS THE OPPORTUNITY TO REVIEW THE FINAL FORM 990 AS FILED. A COPY OF FORM 990 IS PROVIDED TO THE BOARD OF TRUSTEES VIA A SECURE EMAIL PRIOR TO FILING WITH THE IRS. |
| CONFLICT OF INTEREST POLICY | PART VI, SECTION B, QUESTION 12C | THE CONFLICT OF INTEREST POLICY IS MONITORED/ENFORCED AS PART OF THE SYSTEM-WIDE PROCEDURES AND IS NOT HANDLED AT THE ORGANIZATION LEVEL. THE POLICY IS MONITORED AND ENFORCED AS FOLLOWS: 1) AT TIME OF APPOINTMENT AND ANNUALLY THEREAFTER, ALL INTERESTED PERSONS, INCLUDING BOARD AND COMMITTEE MEMBERS, COMPLETE A DISCLOSURE STATEMENT WHICH ADDRESSES ACTUAL OR POTENTIAL CONFLICTS OF INTEREST. 2) THE DISCLOSURE STATEMENT IS DONE ELECTRONICALLY AND THE RETURN OF THE COMPLETED STATEMENT IS A CONDITION OF CONTINUED APPOINTMENT, EMPLOYMENT, OR PARTICIPATION WITH THE ORGANIZATION. 3) ALL ACTUAL OR POTENTIAL CONFLICTS ARE REVIEWED, INVESTIGATED, AND RESOLVED BY THE CHIEF GOVERNANCE OFFICER AND THE CORPORATE RESPONSIBILITY OFFICER, WITH THE RESULTS SHARED WITH THE CHIEF EXECUTIVE OF THE ORGANIZATION. 4) PERIODIC REVIEWS ARE CONDUCTED BY GOVERNANCE, COMPLIANCE, AND INTERNAL AUDIT TO ENSURE THE ORGANIZATION IS OPERATING CONSISTENT WITH THE POLICY AND ENFORCING THE POLICY'S TERMS. |
| COMPENSATION REVIEW | PART VI, SECTION B, QUESTION 15A AND 15B | Via Christi Hospital Pittsburg, Inc. uses the policies established by Via Christi Health, Inc. (VCH). VCH has established a common philosophy, strategy, and processes for executive compensation to be used throughout the Via Christi Health System. VCH's philosophy, strategy, and process for executive compensation are described next. Through the oversight of the VCH Executive Compensation Committee, executive compensation is competitively positioned at its stated market position when compared to the compensation paid by relevant organizations (comparably-sized health systems, hospitals, and long-term care providers). VCH recognizes its responsibility to ensure that its executive compensation program is appropriate in view of its mission and tax-exempt status and that its compensation levels and expenditures are reasonable and not excessive. To ensure these ends, the VCH Executive Compensation Committee has established and approved the executive compensation philosophy for VCH and all related entities. It will also approve all changes in the compensation package for VCH executives in advance. On an annual basis, the Committee conducts a comprehensive review of total compensation for all executives. It also reviews and approves "off-cycle" compensation transactions as needed. In their review, the Committee considers the following factors: * Market data from independent compensation surveys and sources that reflect comparable positions in organizations of similar size and scope * Difficulties in recruiting and retaining executives * Skills, experience, and performance history of individual executives * Critical business or strategic issues that the organization may face * Market position for total compensation The adequacy, competitiveness, and cost of the VCH total executive compensation program are reviewed on an ongoing basis and changes are made as the Committee determines appropriate. The executive compensation program will be maintained such that it will fall within the safe harbor guidelines established by the Intermediate Sanctions regulations. The Committee also employs the services of an independent compensation consultant to prepare market analysis to aid and support the Committee's actions, provide documentation of market trends for budget setting purposes, review annual compensation changes to ensure "reasonableness" and provide attestation, and provide consultation on all executive compensation issues. The Committee also relies on third-party validation of performance measures used in the determination of compensation. |
| GOVERNING DOCUMENTS | PART VI, SECTION C, QUESTION 19 | VIA CHRISTI HOSPITAL PITTSBURG, INC.'S GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE AVAILABLE TO THE PUBLIC UPON REQUEST. |
| MEMBERS | PART VI, SECTION A, Q6, 7A, AND 7B | VIA CHRISTI HEALTH, INC. IS THE SOLE MEMBER. THE MEMBER MAY APPROVE AND REMOVE INDIVIDUALS ON THE BOARD OF TRUSTEES. ARTICLE 2 OF THE BYLAWS PROVIDE THE MEMBER WITH THE FOLLOWING POWERS: *DEFINE, APPROVE, CHANGE, OR INTERPRET THE MISSION, VALUES, PURPOSE, AND PHILOSPHY OF THE CORPORATION. *APPROVE THE ARTICLES OF INCORPORATION, THE BYLAWS, AND ANY AMENDMENTS THERETO OF THE CORPORATION. *APPOINT AND REMOVE THE MEMBERS OF THE BOARD OF TRUSTEES OF THE CORPORATION. *APPOINT AND REMOVE THE PRESIDENT AND CEO OF THE CORPORATION. *SUBJECT TO CANONICAL REQUIREMENTS, ESTABLISH THE OVERALL DEBT LIMIT FOR THE CORPORATION AND APPROVE THE INCURRENCE OF DEBT IN EXCESS OF THAT LIMIT. *APPROVE THE DISSOLUTION, MERGER, CONSOLIDATION, OR SALE OF ALL OR SUBSTANTIALLY ALL OF THE ASSETS OF VIA CHRISTI HOSPITAL PITTSBURG, INC. *APPROVE AND REMOVE, WITH OR WITHOUT CAUSE, THE INDEPENDENT AUDITING FIRM FOR VIA CHRISTI HOSPITAL PITTSBURG, INC. *RECEIVE AND APPROVE OPERATING AND CAPITAL BUDGETS AND FINANCIAL REPORTS OF VIA CHRISTI HOSPITAL PITTSBURG, INC. *APPROVE FINANCING THROUGH PARTICIPATION IN THE OBLIGATED GROUP OF VIA CHRISTI HEALTH SYSTEM. *REVIEW AND APPROVE REAL AND PERSONAL PROPERTY TRANSACTIONS CONSISTENT WITH PROVISION OF CANON LAW. |
| RELATED TAX-EXEMPT ORGANIZATIONS | SCHEDULE R, PART II | VIA CHRISTI HOSPITAL PITTSBURG, INC. IS CONTROLLED BY VIA CHRISTI HEALTH, INC. VIA CHRISTI HEALTH, INC. IS JOINTLY SPONSORED AND CONTROLLED BY ASCENSION HEALTH AND MARIAN HEALTH SYSTEM, WHICH IN TURN ARE SPONSORED BY THE SISTERS OF THE SORROWFUL MOTHER, FOUR PROVINCES OF THE DAUGHTERS OF CHARITY, THE CONGREGATION OF ST. JOSEPH, AND THE SISTERS OF ST. JOSEPH OF CARONDELET. DUE TO SUCH SPONSORSHIP AND CONTROL, AND IN THE INTEREST OF INCREASED CLARITY AND TRANSPARENCY, BOTH ASCENSION HEALTH AND MARIAN HEALTH SYSTEM ARE BEING LISTED AS RELATED ORGANIZATIONS ON SCHEDULE R. |
| RECONCILIATION OF NET ASSETS | PART XI, QUESTION 5 | Unrealized Loss (1,605,829) Partnership Adj 44,592 ------------ (2,723,400) |
| Bad Debt Expense | Parts VIII and IX | In July 2011, the FASB issued ASU 2011-07, Health Care Entities (Topic 954): Presentation and Disclosure of Patient Services Revenue, Provision for Bad Debts, and the Allowance for Doubtful Accounts for Certain Health Care Entities. ASU 2011-07 includes amendments to FASB's ASC Topic 954, Health Care Entities. The objective of the update is to provide financial statement users with greater transparency about a health care entity's net patient service revenue and the related allowance for doubtful accounts. The amendments requires health care entities that recognize significant amounts of patient service revenue at the time services are rendered, even though they do not immediately assess the patients' ability to pay, to present the provision for bad debts related to patient service revenue as a deduction from patient service revenue (net of contractual allowances and discounts) on their statement of operations. The Heath System elected to adopt this standard as of September 30, 2011, which did not have a significant impact on the consolidated financial statements. |
| HOURS DEVOTED FOR RELATED ORGANIZATION | FORM 990 PART VII | NAME:RANDALL PETERSON TITLE:EX-OFFICIO HOURS:49 |
| HOURS DEVOTED FOR RELATED ORGANIZATION | FORM 990 PART VII | NAME:SR. MARIE VERONICA JANOUSEK TITLE:TRUSTEE HOURS:19 |
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