2017-10-11T13:56:50-05:00 2016-12-31 481026809 Wendling Noe Nelson & Johnson LLC 534 S Kansas Ave Suite 1500 Topeka KS 666033491 990 2016-01-01 486005089 William Newton Memorial Hospital WILL 6202212300 1300 E 5th Avenue Winfield KS 67156 Debbie Hockenbury Chief Financial Officer 6202212300 2017-09-28 1 Eric L Otting P00298454 7852334226 2017-09-28 98.172.114.81 2017-09-28 14:40:58 CD P C25D5B149A5DEB5B624D2ED84480DFAE7FBA67D7 F008BB08EB70EDC311476F7A876346CF87ED8437 2016 2021-01-29 14:40:06Z Debbie Hockenbury 1300 E 5th Avenue Winfield KS 67156 36355603 0 X www.wnhcares.org X 1927 KS Provide healthcare services to local area residents 5 5 353 67 0 0 291323 209769 33371558 35727364 12606 18813 403429 399657 34078916 36355603 0 0 0 0 16964475 18246057 0 0 40590 14975853 16981507 31940328 35227564 2138588 1128039 25910122 27003119 16258781 16223739 9651341 10779380 X William Newton Memorial Hospital is a team of skilled individuals dedicated to meeting the ever changing health care needs of the community through advances in leadership, education, technology and continuous improvement in the delivery of quality health care. We are committed to sound financial management and ethical practices. We care for those we serve with dignity, kindness and compassion. 0 0 29037746 35898064 Patient services, full range of inpatient and outpatient services. 29037746 1 1 0 1 0 0 0 0 0 1 1 0 0 0 1 1 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 62 0 1 353 1 0 0 0 0 0 0 0 0 0 0 X 5 5 0 0 0 0 0 0 0 1 0 0 0 0 1 1 1 1 1 1 1 0 X Debbie Hockenbury 6202212300 1300 E 5th Avenue Winfield KS 67156 Joan Cales Chairperson 1.00 X X 0 0 0 Diane Lawrence Vice Chairperson 1.00 X X 0 0 0 Steve McSpadden Trustee 1.00 X 0 0 0 Thomas Herlocker Trustee 1.00 X 0 0 0 Brenda Butters Trustee 1.00 X 0 0 0 J Ben Quinton CEO 40.00 1.00 X 284226 0 41397 Debbie Hockenbury CFO 40.00 1.00 X 135019 0 13720 James McDermott Physician 40.00 X 284001 0 40250 Christopher Morrissey Physician 40.00 X 421163 0 42556 Sapna Shah-Haque Physician 40.00 X 164707 0 26194 Wade Turner Physician 40.00 X 211005 0 35363 Douglas Moore Physician 40.00 X 267062 0 41195 1767183 0 240675 13 0 1 0 Acute Care Inc 1609 N Ankeny Blvd Suite 200 Ankeny IA 50023 ER Physicians 1466327 Via Christi Hospitals Wichita 8200 E Thorn Drive Wichita KS 67226 Radiation Contract 726720 Cascade Health Services 1045 Swift Avenue Kansas City MO 64116 Contract Nursing Services 422508 CPSI PO Box 850309 Mobile AL 36685 Computer Support Services 206007 Caring for Kansas 4059 Westbrook Ct Maize KS 67101 Contract Nursing Services 170594 8 161283 48486 209769 Net patient service revenue 621990 33808953 33808953 340b Pharmacy 446110 1559524 1559524 Occupational health 900099 307854 307854 Pharmacy 446110 51033 51033 35727364 18179 18179 149345 0 149345 149345 149345 634 0 634 634 634 Cafeteria and dietary 722210 62023 62023 Meals on wheels 624210 18223 18223 EHR incentive payments 900099 16024 16024 154042 154042 250312 36355603 35898064 0 247770 474894 474894 14252909 11793106 2425978 33825 1239355 1028661 210694 1169021 946280 218610 4131 1109878 891730 215514 2634 18942 18942 683483 683483 483097 37620 445477 347039 157944 189095 604807 488181 116626 19432 19432 179062 179062 2412262 2270449 141813 200402 100118 100284 Purchased medical servi 4424631 4424631 Medical supplies 3615348 3615348 Pharmacy Drugs 1835332 1835332 Repairs and Maintenance 899413 722889 176524 1258257 526963 731294 35227564 29037746 6149228 40590 21916 31211 4869806 4875891 5881288 5812911 435031 493430 1259499 2193365 40516967 27163039 12910968 13353928 531614 242383 25910122 27003119 2612773 2335941 4041404 3876920 9604604 10010878 16258781 16223739 X 9651341 10779380 9651341 10779380 25910122 27003119 1128039 0 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 1 8836 0 0 0 8836 0 Part II-B, Line 1: William Newton Memorial Hospital 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. 462938 462938 447577 15361 462938 447537 40 447577 443350 4187 447537 443250 100 443350 1.00000 0 1 1 101702 101702 25212151 16488349 8723802 14358037 10416540 3941497 845077 258150 586927 13353928 Net pension liability 9599202 Estimated third-party payor settlements 411676 10010878 X 36355603 0 36355603 0 36355603 35227564 0 35227564 0 35227564 Part V, Line 4: The intended use of the endowment funds is to provide continuing support to the Hospital. Part X, Line 2: The Hospital is exempt from federal income taxes pursuant to Section 115 of the Internal Revenue Code. Management is unaware of any uncertainties in income tax positions. 1 1 1 X 120.000000000000 1 X 1 1 0 0 437025 75847 361178 0.01030 3666402 2107383 1559019 0.04430 4103427 2183230 1920197 0.05460 108237 7146 101091 0.00290 115568 0 115568 0.00330 5914592 3261273 2653319 0.07530 23656 23656 0.00070 6162053 3268419 2893634 0.08220 10265480 5451649 4813831 0.13680 1 988112 151181 10628111 10804065 -175954 X 1 0 1 1 William Newton Memorial Hospital 1300 E 5th Avenue Winfield KS 67156 X X X X William Newton Memorial Hospital 1 0 0 1 X X X X X X X X X 16 1 0 1 1 X http://www.wnhcares.org/ X https://www.datacounts.net/cowley_county X X 1 16 1 http://www.wnhcares.org/ 0 1 X 120.000000000000 200.000000000000 X X X X X X 1 1 X X X X 1 X http://www.wnhcares.org/ X http://www.wnhcares.org/ X http://www.wnhcares.org/ X X X X X X 1 X 0 X X X X 1 X 0 0 William Newton Memorial Hospital Part V, Section B, Line 5: During November 2015 through February 2016, the Hospital and Cowley County Health Department co-sponsored the community health needs assessment. On December 17, 2015, these organizations conducted a Community Health Needs Assessment meeting. Prior to this meeting, the participants were provided with a Pre-Meeting Needs Assessment Survey. The results of this survery were compiled and analyzed to identify needs in the community. The persons who represented the community throught the survey and/or the meeting were as follows: hospital staff, local government officials, county health department employees, religious leaders, local businessmen, local pharmacists, fire department staff, and other health related organizations. William Newton Memorial Hospital Part V, Section B, Line 6b: The Community Health Needs Assessment was conducted with the Cowley County Health Department. William Newton Memorial Hospital Part V, Section B, Line 7d: Community Health Needs Assessment was filed with the Cowley County Extension office. William Newton Memorial Hospital Part V, Section B, Line 11: For all organizations, providers, and agencies to promote one designated health topic per month using consistent messaging and resources as well as continue with the Community Health Improvement Plan (CHIP) Implementation. The goal is to create a community of culture and wellness.The Hospital also has a strategic team that meets annually to form a strategic plan for the Hospital that takes into account findings from the most recent community needs assessment. The strategic team recommends which findings to focus on during the year and how to address them. William Newton Memorial Hospital Part V, Section B, Line 13h: Homeless 6 1 - Health Professionals of Winfield 1230 East 6th Winfield KS 67156 Rural Health Clinic 2 - Physician Pavillion 1230 East 6th Winfield KS 67156 Outpatient Clinic 3 - Tallgrass Rural Health Clinic 300 W North St Sedan KS 67361 Rural Health Clinic 4 - Moline Community Rural Health Clinic 200 N Plum Moline KS 67353 Rural Health Clinic 5 - Cedar Vale Rural Health Clinic 508 Washington Cedar Vale KS 67024 Rural Health Clinic 6 - Dexter Community Rural Health Clinic 204 N Main St Dexter KS 67038 Rural Health Clinic Part I, Line 7: Amounts for financial assistance and certain other community benefit programs were obtained using known related charges and several cost to charge ratios. The cost to charge ratios used include the overall cost to charge ratio derived from Worksheet 2 as well as individual department cost to charge ratios identified for the calculation of subsidized health services information. Part I, Line 7g: Subsidized health services represent services that the hospital provides despite a financial loss to the organization. These services include cardiac rehab, home health, rural health clinics, physical therapy, occupational therapy, physician clinic, and audiology. Part III, Line 4: The Hospital provides for accounts receivable that could become uncollectible in the future by establishing an allowance to reduce the carrying value of such receivables to their estimated net realizable value. The Hospital estimates this allowance based on the aging of its accounts receivable and its historical collection experience.Part III, Line 2:The provision for bad debts are related to accounts that have been deemed uncollectible during the year. The uncollectible amount is then written off pursuant with Hospital policy. The cost of bad debts reported was determined using an overall cost to charge ratio multiplied by total bad debt expense, net of payments recovered through the State.Part III, Line 3:The provision for bad debts attributable to patients eligible under the organization's financial assistance policy was determined using an estimation of 15.3% of total bad debts. The US Census Bureau reports the persons below the federal poverty level in 2016 for Cowley County was 15.3%. William Newton Memorial Hospital takes steps to assist individuals who are believed to qualify for financial assistance prior to writing accounts off as uncollectible.The Hospital considers the bad debt expense attributed to patients eligible under the Hospital's financial assistance policy as community benefit. As a governmental hospital, we must provide necessary services regardless of the patient's ability to pay for that care. Making quality patient care available to all in our community, regardless of their economic means, qualifies bad debts as a community benefit. Part III, Line 8: The Hospital used the 2016 Medicare Cost Report to determine the Medicare revenue and related cost.The shortfall is a benefit to the Hospital's community since it represents health care provided at less than cost to elderly and needy residents of the Hospital's service area. Part III, Line 9b: The Hospital's collection policy and collection practices are the same for all patients. The Hospital does not pursue collection of balances for patients who qualify for charity care or financial assistance. To be considered for charity care, the charity care 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. The information gathered is reviewed 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 legal representative. Those patients who may qualify for financial assistance from a governmental program will be referred to the appropriate program, prior to consideration for charity care. Part VI, Line 2: The Hospital conducts a community needs assessment once every 3 years as required by law. The analysis includes community surveys and community focus group meetings to hear directly from citizens what they believe are the needs. Additionally, the Hospital works in conjunction with the Cowley County Health Department to identify patterns of migration for services that might be in need for potential new services. Part VI, Line 3: William Newton Memorial Hospital educates patients about its charity care policies by signage at the registration desk and business office counter. When possible, the Hospital will conduct a pre-admission interview with the patient, the guarantor, and/or his/her legal representative to determine eligibility for charity care. If a pre-admission interview is not possible, the interview is conducted upon admission or as soon as possible thereafter. In the case of an emergency admission, the Hospital's evaluation of charity care qualification, or payment alternatives does not take place until the required medical care has been provided. Identification of potential eligible patients can take place at any time during the rendering of services or during the collection process. Patients who may qualify for financial assistance from a governmental program are referred to the appropriate program, such as Medicaid, prior to consideration for charity care. All patients who inquire about assistance are referred to the credit/collections manager for complete explanation of options. Part VI, Line 4: The Hospital's primary service area is Cowley County, Kansas. Cowley County is a rural community located 135 miles west of the Missouri state line and touches the Oklahoma border. The US Census Bureau estimates the 2016 population of Cowley County, Kansas to be 35,753. 17.4% of the population is 65 years of age or older, median household income is $43,860, and 15.3% of the population is below poverty level compared to the State of Kansas average of 13.0%. There is one other acute care hospital located in Cowley County. William Newton has four rural health clinics in both Elk and Chautauque Counties. These counties neighbor Cowley County on the east and northeast side. According to the 2016 US Census Bureau estimates, Elk County's population was 2,547. 29.1% of the population is 65 years of age or older, median household income is $36,458, and 17.6% of the population is below poverty level. According to the 2016 US Census Bureau estimates, Chautauque County's population was 3,374. 25.5% of the population is 65 years of age or older, median household income is $37,993, and 16.8% of the population is below poverty level. Part VI, Line 5: The administration of William Newton Hospital conducts extensive physician recruitment for the greater good of the broader community. Ongoing recruitment is vital for the health of the community. Recruitment expense for 2016 was approximately $285,000. Community Health Fair, outreach programs, public education and newsletters are some examples of other activities the Hospital does to support health in the community. The Hospital also operates four rural health clinics in Elk and Chautauqua Counties in Kansas. These clinics provide the primary source of health care to these communities. The Hospital provides access to health information to the community through the Hospital's web page. The Hospital's governing body is comprised of persons who reside in the primary service area who are neither employees nor contractors of the Hospital, nor family members thereof. Part VI, Line 6: The Hospital is not part of an affiliated health care system. X X 0 0 0 0 0 0 0 0 0 J Ben Quinton CEO 213645 0 70581 0 0 0 24327 0 17070 0 325623 0 0 0 James McDermott Physician 283826 0 175 0 0 0 25761 0 14489 0 324251 0 0 0 Christopher Morrissey Physician 404286 0 16877 0 0 0 24327 0 18229 0 463719 0 0 0 Sapna Shah-Haque Physician 164707 0 0 0 0 0 13417 0 12777 0 190901 0 0 0 Wade Turner Physician 206202 0 4803 0 0 0 19030 0 16333 0 246368 0 0 0 Douglas Moore Physician 266887 0 175 0 0 0 24327 0 16868 0 308257 0 0 0 Form 990, Part VI, Section A, line 8b All business takes place during board meetings, and due to the size of the organization, it is not necessary to establish standing committees. Form 990, Part VI, Section B, line 11b A copy of the Form 990 is made available to board members upon request. Form 990, Part VI, Section B, line 12c A conflict of interest disclosure form is provided with a copy of the current conflict of interest policy. This disclosure is completed by each Member upon election and annually thereafter. Form 990, Part VI, Section B, line 15 The Board of Trustees is responsible for determining the job performance standards for the CEO and determining compensation according to the organizations policies. 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 request. Form 990, Part XII, line 2C, Financial Statement Reporting The Hospital's Board of Trustees meets with the auditor and approves the audited financial statements. William Newton Healthcare Foundation Inc 1300 E 5th Street Winfield KS 67156 205069172 Fundraising for the benefit of William Newton Hospital KS 501(c)(3) Line 12a, I 0 0 0 1 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 0