2017-03-09T15:53:20-06:00 2016-04-30 BKD LLP 1551 N WATERFRONT PKWY STE 300 WICHITA KS 672066601 990 2015-05-01 480761700 NINNESCAH VALLEY HEALTH SYSTEMS INC % JAMES WAHLMEIER NINN 6205323147 PO BOX 367 KINGMAN KS 67068 JAMES WAHLMEIER CEO 6205323147 2016-01-15 true STEVEN L WEBB P00235405 3162652811 2015 2021-01-29 14:40:06Z KINGMAN COMMUNITY HOSPITAL JAMES WAHLMEIER PO BOX 367 KINGMAN KS 67068 10437089 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 7000 -14600 29809 16155 10362370 10240561 8758 8302 221439 172071 10622376 10437089 0 200 0 0 6269275 6528569 0 0 0 4633899 4879269 10903174 11408038 -280798 -970949 6453820 5665466 3228311 3394836 3225509 2270630 ACUTE CARE HOSPITAL ORGANIZED TO MEET THE PRIMARY HEALTH CARE NEEDS OF THE PEOPLE OF KINGMAN COUNTY AND THE SURROUNDING COMMUNITIES. false false 9423472 200 10260748 HEALTH CARE SERVICES PROVIDED TO THE PEOPLE OF KINGMAN COUNTY AND THE SURROUNDING COMMUNITIES. DURING THE FISCAL YEAR 2016 THE HOSPITAL HAD 2,705 EMERGENCY ROOM VISITS, 2,911 IN-PATIENT DAYS AND CONDUCTED 416 SURGERIES. IN ADDITION, THE HOSPITAL PROVIDES A FAMILY CARE CLINIC IN THE NEIGHBORING COMMUNITY OF CUNNINGHAM. 9423472 true true false true false false false false false false true false false true true 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 25 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 KS X JAMES WAHLMEIER 6205323147 750 WEST D AVENUE KINGMAN KS 67068 NEIL FREUND CHAIRMAN/DIRECTOR 1.0 0.0 X X 0 0 0 HOWARD SILVEY DIRECTOR 1.0 0.0 X 0 0 0 TIM PRICE DIRECTOR 1.0 0.25 X 0 0 0 SONDRA NICKELL SECRETARY/DIRECTOR 1.0 0.0 X X 0 0 0 ANGIE MALONEY DIRECTOR 1.0 0.0 X 0 0 0 GREG SCHREINER VICE CHAIRMAN/DIRECTOR 1.0 0.0 X X 0 0 0 ROGER VANLANDINGHAM TREASURER/DIRECTOR 1.0 0.0 X X 0 0 0 EDWARD RILEY CEO 40.0 0.25 X 105800 0 7134 JIM WAHLMEIER CEO 40.0 0.0 X 12310 0 3827 KENT HUDSON CFO 40.0 0.0 X 35321 0 3753 ROBERT ULLOM PHYSICIAN 40.0 0.0 X 290830 0 13876 CHERIE MORRIS PHYSICIAN 40.0 0.0 X 186550 0 7391 JANETTE FREEMAN PHYSICIAN ASSISTANT 40.0 0.0 X 126449 0 0 757260 0 35981 4 false true false 0 11770 4385 16155 NET PATIENT SERVICE REVENUE 621300 9632586 9632586 340B PHARMACY REVENUE 446110 607975 607975 10240561 8302 8302 0 0 65764 65764 0 65764 65764 0 0 0 0 INTEREST ON PATIENT ACCOUNTS 722513 9610 9610 EMPLOYEE/GUEST MEALS 900099 39192 39192 PHYSICIAN BILLING/PRACTICE MANAGEMENT 541200 7000 7000 50505 10577 39928 106307 10437089 10260748 7000 153186 0 200 200 0 0 204782 204782 0 5311290 4531651 779639 70421 58841 11580 523958 421805 102153 418118 331880 86238 0 5696 5696 96876 96876 0 0 0 943621 755185 188436 20607 20607 414738 327089 87649 0 0 202951 165825 37126 67884 27035 40849 0 0 60034 45174 14860 0 501603 398145 103458 61319 16861 44458 MEDICAL SUPPLIES 1237023 1237023 BAD DEBT EXPENSE 582292 582292 EQUIPMENT RENTAL & MAINT. 478786 411716 67070 FOOD 79004 79004 126835 33746 93089 11408038 9423472 1984566 0 1488 0 893314 364718 0 0 1419150 1300060 0 0 0 0 0 0 271788 244694 66497 45560 12106016 8831327 3593397 3274689 51366 41870 0 0 86707 81260 0 0 70113 312615 6453820 5665466 634526 1009694 0 0 0 0 2435000 2155000 0 0 0 0 62785 61142 0 0 96000 169000 3228311 3394836 X 3137837 2196384 87672 74246 0 0 3225509 2270630 6453820 5665466 X -970949 16070 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false true 3967 false false false 3967 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 5133583 2917295 2216288 0 0 6658033 5779705 878328 239477 134327 105150 3274689 OTHER RECEIVABLES 255716 ACCRUED INTEREST RECEIVABLE 483 DEFERRED FINANCING 56416 312615 0 DUE TO THIRD PARTY PAYERS 169000 169000 9854797 -582292 -582292 10437089 10437089 10825746 10825746 582292 582292 11408038 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 (582,292) SCHEDULE D, PART XII, LINE 4B PROVISION FOR UNCOLLECTIBLE ACCOUNTS 582,292 true true true X true X true true false false 43168 4426 38742 0.00360 509928 155709 354219 0.03270 553096 160135 392961 0.03630 49948 13126 36822 0.00340 15300 15300 0.00140 65248 13126 52122 0.00480 618344 173261 445083 0.04110 true 582292 383178 4772728 6137564 -1364836 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 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 true 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 PROVERS, ALONG WITH VARIOUS COMMUNITY LEADERS, PARTICIPATED IN COMMITTEE MEETINGS TO DETERMINE RELEVANT ISSUES AND 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 11 THE ACTION PLAN ADDRESSING THE SIGNIFICANT NEEDS IDENTIFIED IN THE CHNA WAS PRESENTED TO THE COMMUNITY FOR REVIEW AND IMPLEMENTATION. PRIORITY #1 OF HEALTH PROVIDER COLLABORATION AND COMMUNICATION HAS BEEN IMPLEMENTED BY WEEKLY NEWSPAPER ADVERTISEMENTS, EXPANSION OF OUR WEBSITE, AND A DIRECT MAILING TO THE COUNTY RESIDENTS. PRIORITY #2 WILL SUSTAIN PUBLIC TRANSPORTATION ASSISTANCE THROUGH THE CITY AND COUNTY COLLABORATION AND ALTERNATIVE SOURCES OF FUNDING. PRIORITY #3 OF PHYSICIAN RECRUITMENT AND RETENTION HAS BEEN IMPLEMENTED BY RECRUITING FAMILY PRACTICE PHYSICIANS AND A GENERAL SURGEON AND ORTHOPEDIC SURGEON STARTING MONTHLY CLINICS. CHRONIC DISEASE PREVENTION AND MANAGEMENT IS THE 4TH PRIORITY. THE HOSPITAL PROVIDES LAB AND RADIOLOGY SERVICES. A PRESCRIPTION ASSISTANCE PROGRAM WAS DEVELOPED, BIOMETRIC SCREENS ARE AVAILABLE FOR COUNTY EMPLOYEES AND CHENEY COOP EMPLOYEES ONCE A YEAR, AND THE HOSPITAL HAS PARTICIPATED IN HEALTH FAIRS IN KINGMAN AND CUNNINGHAM, KANSAS. SCHEDULE H, PART V, SECTION B, LINE 7A http://www.kchks.com/docs/2016_Community_Health_Needs_Assessment.pdf?sub=C ommunity+Health+Needs+Assessment SCHEDULE H, PART V, SECTION B, LINE 10A http://www.kchks.com/docs/2016_Community_Health_Needs_Assessment.pdf?sub=C ommunity+Health+Needs+Assessment 2 MEDICAL ARTS CENTER 760 WEST D AVENUE KINGMAN KS 67068 MEDICAL CLINIC CUNNINGHAM CLINIC 112 N MAIN CUNNINGHAM KS 67035 MEDICAL 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 $582,292. 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, 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, 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, LINE 4 THE BAD DEBT EXPENSE FOOTNOTE IS ON PAGE 7 OF THE ATTACHED FINANCIAL STATEMENTS. SCHEDULE H, PART III, 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, LINE 9B WHEN A PATIENT HAS INDICATED OR DEMONSTRATED AN INABILITY TO PAY, AN APPROPRIATE HOSPITAL REPRESENTATIVE WILL PROVIDE THE PATIENT WITH A CHARITY CARE APPLICATION. THE HOSPITAL REPRESENTATIVE WILL PROVIDE ASSISTANCE IN COMPLETING THE APPLICATION TO HELP ENSURE THE APPLICATION IS COMPLETE AND INCLUDES ALL REQUIRED DOCUMENTATION. THOSE PATIENTS WHO MAY QUALIFY FOR FINANCIAL ASSISTANCE FROM A GOVERNMENTAL PROGRAM (I.E. MEDICAID) SHOULD BE REFERRED TO THE APPROPRIATE AGENCY PRIOR TO CONSIDERATION FOR CHARITY CARE. IF THE PATIENT DOES NOT QUALIFY FOR FINANCIAL ASSISTANCE THEN THE HOSPITAL WILL ASSIST PATIENT IN AN APPROPRIATE PAYMENT PLAN. 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 WITHIN 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 290830 0 6474 0 7402 0 304706 0 0 0 CHERIE MORRIS PHYSICIAN 186550 0 0 0 7391 0 193941 0 0 0 A KINGMAN COUNTY KANSAS PUBLIC BUILDING COMMISSION 300493481 495739AZ7 2012-02-28 3250000 RUFUND 7/15/2008 BOND ISSUE false false false A 1095000 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 VI, SECTION B, LINE 11B THE FORM 990 IS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM. THE CFO 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, LINES 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 16,070. KINGMAN COMMUNITY HOSPITAL FOUNDATION 750 W D AVENUE KINGMAN KS 67068 481095031 SUPPORT NVHS KS 501 (C) (3) 11D NA false false false false false false false false false false false false false false false false false false false false