2014-03-17T09:52:14-05:00 2013-04-30 BKD LLP 1551 N WATERFRONT PKWY STE 300 WICHITA KS 672066601 990 2012-05-01 480761700 NINNESCAH VALLEY HEALTH SYSTEMS INC % KENT HUDSON NINN 6205323147 PO BOX 367 Suite KINGMAN KS 67068 EDWARD RILEY 6205323147 2014-03-15 true ELIZABETH S HOGAN 3162652811 2012 2015-11-30 17:44:51Z KENT HUDSON PO BOX 367 KINGMAN KS 67068 11158619 false X WWW.KCHKS.COM X 1968 KS ACUTE CARE HOSPITAL ORGANIZED TO MEET THE PRIMARY HEALTH CARE NEEDS OF THE PEOPLE OF KINGMAN COUNTY AND THE SURROUNDING COMMUNITIES. 7 7 170 39 6300 0 35290 72679 9976419 10820253 18880 13101 251365 252586 10281954 11158619 -1000 0 0 0 5897312 5995746 0 0 0 4926554 4937004 10822866 10932750 -540912 225869 7870512 7502746 4434822 3859345 3435690 3643401 ACUTE CARE HOSPITAL ORGANIZED TO MEET THE PRIMARY HEALTH CARE NEEDS OF THE PEOPLE OF KINGMAN COUNTY AND THE SURROUNDING COMMUNITIES. false false 9079671 0 10874408 HEALTH CARE SERVICES PROVIDED TO THE PEOPLE OF KINGMAN COUNTY AND THE SURROUNDING COMMUNITIES. DURING THE FISCAL YEAR 2013 THE HOSPITAL HAD 3,368 EMERGENCY ROOM VISITS, 3,629 IN-PATIENT DAYS AND CONDUCTED 719 SURGERIES. IN ADDITION, THE HOSPITAL PROVIDES A FAMILY CARE CLINIC IN THE NEIGHBORING COMMUNITY OF CUNNINGHAM. 9079671 true true false true false false false false false false true false false false false true true false false false false false false false false false true true false false false true false false false false false false false false false false false false false false false true false false false true 22 0 true 170 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 KENT HUDSON 6205323147 750 WEST D AVENUE KINGMAN KS 67068 GEORGE BURKET 1.0 0.0 X X 0 0 0 BILL KLAVER 1.0 0.25 X 0 0 0 PATTI BRACE 1.0 0.25 X X 0 0 0 BOB WUNSCH 1.0 0.0 X X 0 0 0 SONDRA NICKELL 1.0 0.0 X X 0 0 0 TIGER CRAIG 1.0 0.0 X X 0 0 0 NEIL FREUND 1.0 0.0 X X 0 0 0 ROGER VANLANDINGHAM 1.0 0.0 X 0 0 0 TIM PRICE 1.0 0.25 X 0 0 0 HOWARD SILVEY 1.0 0.0 X 0 0 0 KENT HUDSON 40.0 0.0 X 60926 0 4227 GARY TILLER 40.0 0.0 X 123387 0 12382 184313 0 16609 1 false false false MARSHA STINEMAN ANESTHESIA - CRNA 142670 DOCS WHO CARE PHYS COVERAGE 107061 2 35000 18178 19501 72679 NET PATIENT SERVICE REVENUE 621300 10820253 10820253 10820253 13101 13101 0 0 79643 79643 0 79643 79643 0 0 0 0 AUXILIARY 900099 26029 26029 EMPLOYEE/GUEST MEALS 722513 42486 42486 INTEREST ON PATIENT ACCOUNTS 900099 30489 30489 73939 17366 6300 50273 172943 11158619 10868108 6300 211532 0 0 0 0 202878 202878 0 4770804 4083661 687143 64768 51409 13359 585197 471506 113691 372099 295349 76750 0 3685 3685 42034 42034 0 0 0 1170950 985480 185470 6358 6358 266278 165704 100574 0 0 174420 142411 32009 73707 23795 49912 0 0 80927 61154 19773 0 570586 452895 117691 96197 28399 67798 MEDICAL SUPPLIES 1294776 1294776 BAD DEBT EXPENSE 534720 534720 EQUIPMENT RENTAL & MAINT. 462564 399333 63231 FOOD 66782 66782 93020 22297 70723 10932750 9079671 1853079 0 25255 24580 1155536 925156 0 0 1376644 1610269 0 0 0 0 0 0 239065 246627 65292 83632 11740177 7399158 4819814 4341019 58772 85647 0 0 124820 89463 0 0 5314 96353 7870512 7502746 838575 696512 0 0 41968 0 2985000 2710000 0 0 0 0 539279 452833 0 0 30000 0 4434822 3859345 X 3371618 3571458 64072 71943 0 0 3435690 3643401 7870512 7502746 X 225869 -18158 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false true 2812 false false false 2812 false GRANTS TO OTHER ORGANIZATIONS FOR LOBBYING PURPOSES SCHEDULE C, PART II-B, LINE 1F A PORTION OF THE ANNUAL DUES PAID TO KHA AND AHA ARE USED FOR LOBBYING. 74923 74923 5126671 2350960 2775711 6374493 4941880 1432613 164090 106318 57772 4341019 0 0 X 10588899 -534720 -534720 11123619 35000 35000 11158619 10398030 10398030 534720 534720 10932750 UNCERTAIN TAX POSITIONS 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. RECONCILIATION OF REVENUE SCHEDULE D, PART XI, LINE 2D PROVISION FOR UNCOLLECTIBLE ACCOUNTS (534,720) RECONCILIATION OF REVENUE SCHEDULE D, PART XI, LINE 4B TRANSFER FROM RELATED ORGANIZATION 35,000 RECONCILIATION OF EXPENSES SCHEDULE D, PART XII, LINE 4B PROVISION FOR UNCOLLECTIBLE ACCOUNTS 534,720 true true true X true X true true false false 6625 6625 0.00060 213024 117368 95656 0.00870 219649 117368 102281 0.00930 42337 16333 26004 0.00240 3299 3299 0.00030 45636 16333 29303 0.00270 265285 133701 131584 0.01200 false 583818 146538 4889332 6322795 -1433463 X true true 1 1 KINGMAN COMMUNITY HOSPITAL

750 WEST D AVENUE KINGMAN KS 67068

WWW.KCHKS.COM X X X KINGMAN COMMUNITY HOSPITAL 1 true X X X X X X X X X 13 true false true X X X X X X X X X true false true true 100 true 200. true X true true X X X true false X X true X false false 2 MEDICAL ARTS CENTER

760 WEST DE AVENUE KINGMAN KS 67068

MEDICAL CLINIC CUNNINGHAM CLINIC

112 N MAIN CUNNINGHAM KS 67035

MEDICAL CLINIC PERCENT OF TOTAL EXPENSE 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 $534,720. COSTING METHODOLOGY 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. BAD DEBT ESTIMATE METHODOLOGY 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. BAD DEBT EXPENSE SCHEDULE H, PART III, LINE 4 THE SYSTEM REPORTS PATIENT ACCOUNTS RECEIVABLE FOR SERVICES RENDERED AT NET REALIZABLE AMOUNTS FROM THIRD-PARTY PAYERS, PATIENTS AND OTHERS. THE SYSTEM PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS BASED UPON A REVIEW OF OUTSTANDING RECEIVABLES, HISTORICAL COLLECTION INFORMATION AND EXISTING ECONOMIC CONDITIONS. AS A SERVICE TO THE PATIENT, THE SYSTEM BILLS THIRD-PARTY PAYERS DIRECTLY AND BILLS THE PATIENT WHEN THE PATIENT'S LIABILITY IS DETERMINED. PATIENT ACCOUNTS RECEIVABLE ARE DUE IN FULL WHEN BILLED. ACCOUNTS ARE CONSIDERED DELINQUENT AND SUBSEQUENTLY WRITTEN OFF AS BAD DEBTS BASED ON INDIVIDUAL CREDIT EVALUATION AND SPECIFIC CIRCUMSTANCES OF THE ACCOUNT. LIABILITY IS DETERMINED. PATIENT ACCOUNTS RECEIVABLE ARE DUE IN FULL WHEN BILLED. ACCOUNTS ARE CONSIDERED DELINQUENT AND SUBSEQUENTLY WRITTEN OFF AS BAD DEBTS BASED ON INDIVIDUAL CREDIT EVALUATION AND SPECIFIC CIRCUMSTANCES OF THE ACCOUNT. MEDICARE 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. COLLECTION PRACTICES 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. APPLICATIONS MUST BE COMPLETE IN THEIR ENTIRETY BEFORE CHARITY CARE CAN BE CONSIDERED. 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. AN APPLICATION FOR FINANCIAL ASSISTANCE FROM AN OUTSIDE AGENCY SHOULD BE OBTAINED PRIOR TO CHARITY CARE APPROVAL. INPUT FROM COMMUNITY REPRESENTATIVES SCHEDULE H, PART V, SECTION B, LINE 3 THE LOCAL HEALTH DEPARTMENT AND COMMUNITY PROVIDERS, ALONG WITH VARIOUS COMMUNITY LEADERS, PARTICIPATED IN THE THREE SCHEDULED STEERING COMMITTE MEETINGS TO DETERMINE RELEVANT ISSUES AND PROPOSE AN ACTION PLAN TO IMPROVE LOCAL CIRCUMSTANCES. THE STEERING COMMITTEE THEN PRESENTS THEIR ACTION PLAN TO THE COMMUNITY FOR REVIEW AND POSSIBLE IMPLEMENTATION. WEBSITE ADDRESS FOR CHNA SCHEDULE H, PART V, SECTION B, LINE 5 THE COMMUNITY HEALTH NEEDS ASSESSMENT CAN BE FOUND UNDER THE "ABOUT US" TAB ON KINGMAN COMMUNITY HOSPITAL'S WEBSITE: WWW.KCHKS.COM CHARGES FOR MEDICAL CARE SCHEDULE H, PART V, SECTION B, LINE 20 THE SAME STANDARD RATE IS USED FOR ALL PATIENTS, INCLUDING PATIENTS WITH INSURANCE AND PRIVATE PAY PATIENTS. PATIENTS ELIGIBLE UNDER THE FINANCIAL ASSISTANCE POLICY RECEIVE EITHER A FULL OR PARTIAL WRITEOFF. DEPENDING ON THE PERSON'S FAMILY SIZE AND INCOME, THE HOSPITAL'S POLICY GUIDELINES STATE THE PERCENTAGE THAT WILL BE WRITTEN OFF. THE PATIENT THEN OWES THE BALANCE IF THEY ONLY QUALIFY FOR A PARTIAL REDUCTION. NEEDS ASSESSMENT 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 NEEDS WHICH CAN BE PROVIDED BY THE HOSPITAL. IN ADDITION, HOSPITAL STAFF AND ADMINISTRATION IS OPEN AND AVAILABLE TO VISIT WITH ALL COMMUNITY MEMBERS AND GROUPS WITH CONCERNS. IN AUGUST, 2012, 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 IN JANUARY 2013. PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE 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. COMMUNITY INFORMATION SCHEDULE H, PART VI, LINE 4 THE HOSPITAL IS LOCATED IN A RURAL COMMUNITY IN KINGMAN COUNTY, WHICH 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, WITH THE NEXT CLOSEST HOSPITAL BEING OVER 20 MILES AWAY. PROMOTION OF COMMUNITY HEALTH 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. AFFILIATED HEALTH CARE SYSTEM SCHEDULE H, PART VI, LINE 6 N/A STATE FILING OF CUMMUNITY BENEFIT REPORT SCHEDULE H, PART VI, LINE 7 N/A - COMMUNITY BENEFIT REPORT IS NOT FILED WITH STATE OF KANSAS. FACILITY REPORTING GROUP(S) SCHEDULE H, PART VI, LINE 8 N/A A KINGMAN COUNTY KANSAS PUBLIC BUILDING COMMISSION 300493481 495739AZ7 2012-02-28 3250000 REFUND 7/15/2008 BOND ISSUE false false false A 0 0 3250000 0 0 0 65000 0 0 0 3185000 0 2008 true false true true A false false false false 0.00000 0.00000 0.00000 false false false true A false false false false false false 0 false 0 false true A true FORM 990 REVIEW PROCESS 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. CONFLICT OF INTEREST POLICY 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. COMPENSATION REVIEW FORM 990, PART VI, SECTION B, LINES 15A & B ALL RAISES ARE APPROVED BY THE BOARD OF DIRECTORS. EVERY THREE TO FIVE YEARS SALARIES AND WAGES ARE COMPARED TO THE KANSAS HOSPITAL ASSOCIATION'S SALARY AND WAGE SURVEY FOR REASONABLENESS. IN THIS CIRCUMSTANCE THE BOARD DESIGNATES THE HUMAN RESOURCE DIRECTOR TO REVIEW THE SURVEY AND MAKE ANY ADJUSTMENTS NECESSARY. FOR THE YEARS WHEN THE SURVEY IS NOT USED, THE BOARD OF DIRECTORS APPROVES AN ACROSS THE PAY SCALE WAGE INCREASE OF A CERTAIN PERCENTAGE. ALL EMPLOYEES RECEIVE THE SAME PERCENTAGE INCREASE APPROVED BY THE BOARD. ALL FULL-TIME EMPLOYEES RECEIVE THE SAME EMPLOYEE BENEFIT PACKAGE. AVAILABILITY OF DOCUMENTS 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. OTHER CHANGES IN NET ASSETS FORM 990, PART XI, LINE 9 CHANGE IN INTEREST IN NET ASSETS OF KCHF 16,842 TRANSFER FROM A RELATED ORGANIZATION (35,000) ---------- 18,158 OTHER FEES FOR SERVICES FOR NON-EMPLOYEES FORM 990 PART IX LINE 11G DESCRIPTION:PURCHASED SERVICES TOTAL FEES:874271 OTHER FEES FOR SERVICES FOR NON-EMPLOYEES FORM 990 PART IX LINE 11G DESCRIPTION:PHYSICIAN FEES TOTAL FEES:189061 OTHER FEES FOR SERVICES FOR NON-EMPLOYEES FORM 990 PART IX LINE 11G DESCRIPTION:PHYSICIAN RECRUITMENT TOTAL FEES:49147 OTHER FEES FOR SERVICES FOR NON-EMPLOYEES FORM 990 PART IX LINE 11G DESCRIPTION:PATHOLOGY FEES TOTAL FEES:34435 OTHER FEES FOR SERVICES FOR NON-EMPLOYEES FORM 990 PART IX LINE 11G DESCRIPTION:COLLECTION FEES TOTAL FEES:21526 OTHER FEES FOR SERVICES FOR NON-EMPLOYEES FORM 990 PART IX LINE 11G DESCRIPTION:OTHER FEES TOTAL FEES:2510 KINGMAN COMMUNITY HOSPITAL FOUNDATION 750 AVENUE D WEST KINGMAN KS 67068 481095031 SUPPORT NVHS KS 501(C)(3) 11D NA false false false true false false false false false false false false false false false false false false false false