2019-03-08T09:34:37-06:00 2018-04-30 BKD LLP 1551 N WATERFRONT PKWY STE 300 WICHITA KS 672066601 990 2017-05-01 480761700 NINNESCAH VALLEY HEALTH SYSTEMS INC % THAD TURNER NINN 6205323147 PO BOX 376 KINGMAN KS 67068 SHANNAN FLACH CEO 6205323147 2019-01-15 true SHAWNELL LINOT P01663908 3162652811 99.74.235.129 48010220190675000000 2019-03-08 P B98F5FB64AC52D24D812995DABA8F8EA82147269 317467770C39898C40CA0978F91E18CC850C4BAF 2017 2019-02-21 02:37:17Z KINGMAN COMMUNITY HOSPITAL SHANNAN FLACH PO BOX 376 KINGMAN KS 67068 12225701 false X WWW.KCHKS.COM X 1996 KS ACUTE CARE HOSPITAL ORGANIZED TO MEET THE PRIMARY HEALTH CARE NEEDS OF THE PEOPLE OF KINGMAN COUNTY AND THE SURROUNDING COMMUNITIES. 7 7 171 30 4200 -6831 11151 497892 10162320 11476759 9108 -20781 267797 242153 10450376 12196023 816 1000 0 0 6512152 7092561 0 0 0 4770905 5060462 11283873 12154023 -833497 42000 4938509 5322397 3482974 3807883 1455535 1514514 ACUTE CARE HOSPITAL ORGANIZED TO MEET THE PRIMARY HEALTH CARE NEEDS OF THE PEOPLE OF KINGMAN COUNTY AND THE SURROUNDING COMMUNITIES. false true 10323808 1000 11512141 HEALTH CARE SERVICES PROVIDED TO THE PEOPLE OF KINGMAN COUNTY AND THE SURROUNDING COMMUNITIES. DURING THE FISCAL YEAR 2018, THE HOSPITAL HAD 2,251 EMERGENCY ROOM VISITS, 1,754 IN-PATIENT DAYS, AND CONDUCTED 350 SURGERIES. IN ADDITION, THE HOSPITAL PROVIDES THREE RURAL HEALTH CLINICS. TWO OF THE CLINICS ARE WITHIN THE CITY OF KINGMAN AND ONE IS IN THE NEIGHBORING COMMUNITY OF CUNNINGHAM. 10323808 true true false true false false false false false false true false false true false false true false false false false false false false false false true true false false true true false false false false false false false false false false false false false false false true false false false true 26 0 true 171 true true true false false false false false false false false false X 7 7 false false false false false false false true true false false true true true true true true true true false X THAD TURNER 6205323147 750 WEST D AVENUE KINGMAN KS 67068 NEIL FREUND CHAIRMAN/DIRECTOR 1.0 0.0 X X 0 0 0 GREG SCHREINER VICE CHAIRMAN/DIRECTOR 1.0 0.0 X X 0 0 0 SONDRA NICKELL SECRETARY/DIRECTOR 1.0 0.0 X X 0 0 0 ROGER VANLANDINGHAM TREASURER/DIRECTOR 1.0 0.0 X X 0 0 0 TIM PRICE DIRECTOR 1.0 0.0 X 0 0 0 ANGIE MALONEY DIRECTOR 1.0 0.0 X 0 0 0 STEVE WITTY DIRECTOR 1.0 0.0 X 0 0 0 SHANNAN FLACH CEO 40.0 0.0 X 60979 0 3071 THAD TURNER FINANCIAL CONTROLLER 40.0 0.0 X 0 0 0 JAMES WAHLMEIER CEO 40.0 0.0 X 76972 0 1924 ERIC CHRISTENSEN CFO 40.0 0.0 X 49468 0 3102 ROBERT ULLOM PHYSICIAN 40.0 0.0 X 229569 0 9257 CHERIE MORRIS PHYSICIAN 40.0 0.0 X 206036 0 3600 VICTORIA MOOTS PHYSICIAN 40.0 0.0 X 163419 0 92 JANETTA FREEMAN PHYSICIAN ASSISTANT 40.0 0.0 X 122284 0 1083 KATHLEEN PRILLIMAN APRN 40.0 0.0 X 101183 0 5513 1009910 0 27642 5 false true false 0 489686 8206 497892 NET PATIENT SERVICE REVENUE 621300 9911471 9911471 340B PHARMACY REVENUE 446110 1565288 1565288 11476759 8190 8190 0 0 73492 73492 0 73492 73492 707 29678 -28971 -28971 -28971 0 0 0 0 0 0 0 0 0 INTEREST ON PATIENT ACCOUNTS 900099 16497 16497 EMPLOYEE/GUEST MEALS 900099 38856 38856 PHYSICIAN BILLING/PRACTICE MANAGEMENT 541200 4200 4200 109108 14685 94423 168661 12196023 11507941 4200 185990 0 1000 1000 0 0 284117 284117 0 5476722 4968468 508254 74680 61757 12923 856593 688560 168033 400449 317855 82594 0 12585 12585 74484 74484 0 0 0 1184541 944698 239843 25797 1370 24427 950019 878271 71748 0 0 238824 201150 37674 58667 24948 33719 0 0 75858 53483 22375 0 316397 251139 65258 75038 24207 50831 MEDICAL SUPPLIES 1149637 1149637 BAD DEBT EXPENSE 397315 397315 EQUIPMENT RENTAL & MAINT. 271520 247294 24226 FOOD 80574 80574 149206 32082 117124 12154023 10323808 1830215 0 0 0 191515 216445 0 0 1112000 1098777 0 0 0 0 0 0 213699 183301 47595 44319 12320824 9577765 3026923 2743059 37831 41089 0 0 96945 68753 0 0 212001 926654 4938509 5322397 1222239 1756934 0 0 0 0 1870000 1552059 0 0 0 0 165794 498890 0 0 224941 0 3482974 3807883 X 1366926 1405668 88609 108846 0 0 1455535 1514514 4938509 5322397 X 42000 16979 X false true X true false X false false false false false true 2588 false false false 2588 false SCHEDULE C, PART II-B, LINE 1F A PORTION OF THE ANNUAL DUES PAID TO KHA AND AHA ARE USED FOR LOBBYING. 74923 74923 5293085 3288282 2004803 6752334 6136462 615872 200482 153021 47461 2743059 DUE FROM THIRD PARTY 530000 OTHER RECEIVABLES 396634 ACCRUED INTEREST RECEIVABLE 20 DEFERRED FINANCING 0 926654 11798708 -397315 -397315 12196023 12196023 11756708 11756708 397315 397315 12154023 SCHEDULE D, PART X, LINE 2 THE SYSTEM HAS BEEN RECOGNIZED AS EXEMPT FROM INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND A SIMILAR PROVISION OF STATE LAW. HOWEVER, THE SYSTEM IS SUBJECT TO FEDERAL INCOME TAX ON ANY UNRELATED BUSINESS TAXABLE INCOME. THE SYSTEM RECOGNIZES THE FINANCIAL STATEMENT BENEFIT OF A TAX POSITION ONLY AFTER DETERMINING THAT THE RELEVANT TAX AUTHORITY WOULD MORE LIKELY THAN NOT SUSTAIN THE POSITION FOLLOWING AN AUDIT. SCHEDULE D, PART XI, LINE 2D PROVISION FOR UNCOLLECTIBLE ACCOUNTS (397,315) SCHEDULE D, PART XII, LINE 4B PROVISION FOR UNCOLLECTIBLE ACCOUNTS 397,315 true true X true X true X true true false false 4360 4360 0.00040 493089 89805 403285 0.03430 497449 89805 407645 0.03470 29969 10240 19729 0.00170 18900 18900 0.00160 48869 10240 38629 0.00330 546318 100045 446274 0.03800 true 397315 3408668 5493164 -2084496 X true true 1 1 KINGMAN COMMUNITY HOSPITAL 750 WEST D AVENUE KINGMAN KS 67068 WWW.KCHKS.COM H048001 X X X X 1 KINGMAN COMMUNITY HOSPITAL 1 false false true X X X X X X X X X 15 true false true true X SEE PART V, SECTION C X true 15 true SEE PART V, SECTION C false true X 100 200. true true X X X X true X SEE PART V, SECTION C X SEE PART V, SECTION C X SEE PART V, SECTION C X X X X X X true X false X X X X true X false false SCHEDULE H, PART V, SECTION B, LINE 5 THE HOSPITAL, LOCAL HEALTH DEPARTMENT AND COMMUNITY PROVIDERS, ALONG WITH VARIOUS COMMUNITY LEADERS, PARTICIPATED IN COMMITTEE MEETINGS TO DETERMINE RELEVANT ISSUES AN PROPOSE AN ACTION PLAN TO IMPROVE LOCAL CIRCUMSTANCES. THE COMMITTEE THEN PRESENTED THEIR ACTION PLAN TO THE COMMUNITY FOR REVIEW AND IMPLEMENTATION. SCHEDULE H, PART V, SECTION B, LINE 6B KINGMAN COUNTY HEALTH DEPARTMENT SCHEDULE H, PART V, SECTION B, LINE 7A HTTP://WWW.KCHKS.COM/DOCS/2016_COMMUNITY_HEALTH_NEEDS_ASSESSMENT.PDF SCHEDULE H, PART V, SECTION B, LINE 10A HTTP://WWW.KCHKS.COM/DOCS/2016_COMMUNITY_HEALTH_NEEDS_ASSESSMENT.PDF SCHEDULE H, PART V, SECTION B, LINE 11 CHRONIC DISEASE PREVENTION AND MANAGEMENT: KINGMAN COMMUNITY HOSPITAL PROVIDED LAB AND RADIOLOGY SERVICES FOR THE CARE NET CLINIC (REDUCED COST OR FREE SERVICES) TO SERVE THE INDIGENT AND UNINSURED RESIDENTS OF KINGMAN COUNTY. THE HOSPITAL HAS ALSO DEVELOPED A PRESCRIPTION ASSISTANCE PROGRAM TO ASSIST COUNTY RESIDENTS TO OBTAIN AFFORDABLE MEDICATION. KINGMAN COMMUNITY HOSPITAL HAS PARTICIPATED IN HEALTH FAIRS HELD IN KINGMAN AND CUNNINGHAM, KANSAS. SERVICES INCLUDED ARE - LAB SERVICES, BLOOD PRESSURE SCREENINGS, THYROID AND CAROTID SCANS. HEALTH COMMUNICATION STRATEGIES: THE HOSPITAL PROVIDES DIRECT MAILINGS TO ALL KINGMAN COUNTY RESIDENTS AND THE RESIDENTS OF PRETTY PRAIRIE, KANSAS. THE HOSPITAL PRODUCES WEEKLY NEWSPAPER COLUMNS ON HEALTH STRATEGIES. WE HAVE EXPANDED OUR HOSPITAL WEBSITE TO INCLUDE HEALTH AND DISEASE TOPICS. SCHEDULE H, PART V, SECTION B, LINE 16A HTTP://WWW.KCHKS.COM/GETPAGE.PHP?NAME=FINANCIAL_ASSISTANCE SCHEDULE H, PART V, SECTION B, LINE 16B HTTP://WWW.KCHKS.COM/GETPAGE.PHP?NAME=FINANCIAL_ASSISTANCE SCHEDULE H, PART V, SECTION B, LINE 16C HTTP://WWW.KCHKS.COM/GETPAGE.PHP?NAME=FINANCIAL_ASSISTANCE 3 MEDICAL ARTS CENTER 760 WEST D AVENUE KINGMAN KS 67068 RURAL HEALTH CLINIC CUNNINGHAM CLINIC 112 N MAIN CUNNINGHAM KS 67035 RURAL HEALTH CLINIC DONLEY MEMORIAL CLINIC 437 CEDAR STREET KINGMAN KS 67068 RURAL HEALTH CLINIC SCHEDULE H, PART I, LINE 7, COLUMN F THE 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 $397,315. SCHEDULE H, PART I, LINE 7 THE 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. SCHEDULE H, PART III, SECTION A, LINE 2 IN EVALUATING THE COLLECTABILITY OF ACCOUNTS RECEIVABLE, THE SYSTEM ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYER SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR UNCOLLECTIBLE ACCOUNTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYER SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. SCHEDULE H, PART III, SECTION A, LINE 3 A COST TO CHARGE RATIO IS USED TO DETERMINE AMOUNTS OF BAD DEBT AT COST AND BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS UNDER THE CHARITY CARE POLICY. THE COST TO CHARGE RATIO IS MULTIPLIED BY THE CHARGES IN BAD DEBT. SCHEDULE H, PART III, SECTION A, LINE 4 THE BAD DEBT EXPENSE FOOTNOTE IS ON PAGE 7 OF THE ATTACHED FINANCIAL STATEMENTS. SCHEDULE H, PART III, SECTION B, LINE 8 SERVING PATIENTS WITH GOVERNMENT HEALTH BENEFITS, SUCH AS MEDICARE, IS A COMPONENT OF THE COMMUNITY BENEFIT STANDARD THAT TAX-EXEMPT HOSPITALS ARE HELD TO. THIS IMPLIES THAT SERVING MEDICARE PATIENTS IS A COMMUNITY BENEFIT AND THAT THE HOSPITAL OPERATES TO PROMOTE THE HEALTH OF THE COMMUNITY. THE SYSTEM USES MEDICARE COST REPORT METHODOLOGY, WHICH APPORTIONS ROUTINE COSTS (ROOM AND BOARD) BASED ON MEDICARE OR MEDICAID DAYS TO TOTAL DAYS AND APPORTIONS ANCILLARY COSTS BASED ON PROGRAM CHARGES TO TOTAL CHARGES. SCHEDULE H, PART III, SECTION C, LINE 9B AFTER FOLLOWING BILLING PROCEDURES AND DETERMINING NO INSURANCE COVERAGE APPLIES TO OUTSTANDING AMOUNTS DUE, THE FOLLOWING PROCEDURES ARE IN PLACE. THE 1ST STATEMENT IS SENT TO PATIENT AFTER 30 DAYS; 2ND STATEMENT IS SENT AFTER 60 DAYS; 3RD STATEMENT IS SENT AFTER 90 DAYS; FINAL STATEMENT IS SENT AFTER 120 DAYS; ACCOUNT IS SENT TO 3RD PARTY COLLECTION AGENCY IF NO PROGRESS ON THE ACCOUNT IS MADE. SCHEDULE H, PART VI, LINE 2 THE HOSPITAL DETERMINES THE NEEDS OF THE COMMUNITY IN VARIOUS WAYS. ONE WAY NEEDS ARE DETERMINED IS BY THE HOSPITAL STAFF REVIEWING STATISTICAL DATA FROM SOURCES SUCH AS KANSAS STATE UNIVERSITY, KANSAS HOSPITAL ASSOCIATION, CENSUS INFORMATION, AND KDHE. FROM THIS DATA THE ADMINISTRATION OF THE HOSPITAL CAN HAVE A BETTER UNDERSTANDING OF THE LOCAL POPULATION. ANOTHER WAY THE NEEDS ARE DETERMINED IS BY HOSPITAL STAFF JOINING AND PARTICIPATING IN LOCAL ORGANIZATIONS SUCH AS ROTARY CLUB, LIONS CLUB, LOCAL CHURCHES, AND OTHER COMMUNITY ORGANIZATIONS. FROM INVOLVEMENT IN THESE GROUPS HOSPITAL STAFF CAN GATHER INFORMATION ON COMMUNITY MEMBERS AND GROUPS WITH CONCERNS. THE KINGMAN COMMUNITY HOSPITAL AND THE KINGMAN COUNTY HEALTH DEPARTMENT CO-SPONSORED THE KANSAS RURAL HEALTH WORKS (KRHW) COMMUNITY HEALTH NEEDS ASSESSMENT. A BROADLY REPRESENTATIVE GROUP OF TWENTY-NINE KINGMAN COUNTY LEADERS MET OVER THE COURSE OF THREE MEETINGS TO IDENTIFY PRIORITIES AND DEVISE ACTION STRATEGIES. AFTER CONSIDERATION OF A HOST OF INFORMATION, LOCAL HEALTH-RELATED PRIORITIES WERE ESTABLISHED AND PUBLISHED. SCHEDULE H, PART VI, LINE 3 THE HOSPITAL POSTS SIGNS ABOUT THE AVAILABILITY OF THE CHARITY CARE PROGRAM IN THE HOSPITAL. ALL THE LOCAL PHYSICIANS KNOW ABOUT THE HOSPITAL'S CHARITY CARE PROGRAM SO THAT IF A PATIENT NEEDS SERVICES THEY CAN INFORM THE PATIENT ABOUT IT. THE HOSPITAL HAS A STAND WITH BROCHURES ON THE CHARITY CARE PROGRAM AS WELL AS BROCHURES ON OTHER PROGRAMS SUCH AS MEDICAID, CHILDREN'S MERCY, AND UNICARE. THE HOSPITAL EMPLOYS A PATIENT ADVOCATE WHO WILL HELP PATIENTS COMPLETE THE CHARITY CARE PROCESS AND ANSWER ANY QUESTIONS ABOUT THE PROGRAM. THIS EMPLOYEE WILL ALSO HELP PATIENTS WITH MEDICAID APPLICATIONS IF IT IS DETERMINED THAT THE PATIENT MIGHT QUALIFY FOR THIS PROGRAM. SCHEDULE H, PART VI, LINE 4 THE HOSPITAL IS LOCATED IN A RURAL COMMUNITY IN KINGMAN COUNTY KANSAS. THIS COUNTY IS IN SOUTH CENTRAL KANSAS. KINGMAN COUNTY HAS APPROXIMATELY 7,800 RESIDENTS WITH APPROXIMATELY 11% OF THE POPULATION FALLING UNDER THE POVERTY GUIDELINES, AND 20% BEING OVER THE AGE OF 65. THE HOSPITAL IS THE ONLY HOSPITAL LOCATED IN THE COUNTY AND THE NEXT CLOSEST HOSPITAL IS OVER 20 MILES AWAY. SCHEDULE H, PART VI, LINE 5 THE HOSPITAL FURTHERS ITS EXEMPT PURPOSE BY PROMOTING THE HEALTH OF THE COMMUNITY IN SEVERAL WAYS. THE HOSPITAL EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN THE COMMUNITY. THE HOSPITAL ALSO RECRUITS AND PROVIDES SPACE TO SPECIALISTS SO THEY CAN CONDUCT CLINICS AND PROVIDE SERVICES FOR PATIENTS IN THE COMMUNITY. THE HOSPITAL ALSO PROVIDES FREE FLU SHOTS TO THE COMMUNITY AS WELL AS OFFERING FREE CLINICS AND SCREENINGS THROUGHOUT THE YEAR. X X false false false false false false false false false ROBERT ULLOM PHYSICIAN 229569 0 0 0 0 0 5657 0 3600 0 238826 0 0 0 CHERIE MORRIS PHYSICIAN 206036 0 0 0 0 0 0 0 3600 0 209636 0 0 0 VICTORIA MOOTS PHYSICIAN 163419 0 0 0 0 0 0 0 92 0 163511 0 0 0 A KINGMAN COUNTY KANSAS PUBLIC BUILDING COMMISSION 300493481 495739AZ7 2012-02-28 3250000 REFUND 7/15/2008 BOND ISSUE false false false A 1665000 0 3250000 0 0 0 65000 0 0 0 3185000 0 2008 true false true true A false false false false 0 false false false true A false false true false false false 0 false 0 false true A true FORM 990, PART III, LINE 3 NINNESCAH VALLEY HEALTH SYSTEMS, INC. DISCONTINUED THEIR HOME HEALTH SERVICES AS OF NOVEMBER 30, 2017. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM. THE FINANCIAL CONTROLLER REVIEWS A DRAFT OF THE 990 AND ALL REQUIRED SCHEDULES. THE ENTIRE BOARD IS THEN PROVIDED WITH AN ELECTRONIC COPY OF THE FORM 990 AND ALL REQUIRED SCHEDULES PRIOR TO FILING WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C BOARD MEMBERS AND OFFICERS AT THE TIME OF HIRE AND ANNUALLY THEREAFTER ARE REMINDED OF THE CONFLICT OF INTEREST GUIDELINES COVERED IN THE CORPORATION'S GOVERNING BODY BYLAWS AND ARE ASKED TO SIGN A CONFLICT OF INTEREST STATEMENT. ANY CONFLICT OF INTEREST MUST BE DISCLOSED TO THE BOARD AND/OR CEO. ANY MEMBER WITH A CONFLICT OF INTEREST SHALL ABSENT THEMSELVES FROM THE DISCUSSION OF THE ISSUE BEFORE THE BOARD AND MUST ABSTAIN FROM VOTING ON ANY ISSUE IN WHICH A CONFLICT IS PRESENT. FORM 990, PART VI, SECTION B, LINE 15A & B ALL RAISES ARE APPROVED BY THE BOARD OF DIRECTORS. SALARIES AND WAGES ARE COMPARED ANNUALLY TO THE KANSAS HOSPITAL ASSOCIATION'S SALARY AND WAGE SURVEY FOR REASONABLENESS. THE BOARD DESIGNATES THE HUMAN RESOURCE DIRECTOR TO REVIEW THE SURVEY AND MAKE ANY ADJUSTMENTS NECESSARY. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION DOES NOT MAKE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY OR FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC. FORM 990, PART XI, LINE 9 CHANGE IN INTEREST IN NET ASSETS OF KCHF 16,979 KINGMAN COMMUNITY HOSPITAL FOUNDATION 750 W D AVENUE KINGMAN KS 67068 481095031 SUPPORT NVHS KS 501(C)(3) 12D NA false false false false false false false false false false false false false false false false false false false false