2014-10-31T14:26:18-05:00 2013-12-31 481026809 Wendling Noe Nelson & Johnson LLC 534 S Kansas Ave Suite 1500 Topeka KS 666033491 990 2013-01-01 486005089 William Newton Memorial Hospital WILL 6202212300 1300 E 5th Avenue Winfield KS 67156 Debbie Hockenbury Chief Financial Officer 6202212300 2014-10-22 1 Eric L Otting P00298454 7852334226 2014-10-22 2013 2015-11-30 17:44:51Z Debbie Hockenbury 1300 E 5th Avenue Winfield KS 67156 27391970 0 X www.wnmh.org X 1927 KS Provide healthcare services to local area residents 5 5 357 86 0 0 223970 133222 24625012 26834260 28209 29641 1337341 394847 26214532 27391970 0 0 0 0 14285013 15606502 0 0 42893 11216354 11651469 25501367 27257971 713165 133999 24506532 23806995 8396966 7563430 16109566 16243565 X William Newton Memorial Hospital is a team of skilled individuals dedicated to meeting the ever changing 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 22005942 27037450 Patient services, full range of inpatient and outpatient services. 22005942 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0 1 0 0 0 1 63 0 1 357 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 Thomas Herlocker Chairman 1.00 X X 0 0 0 Joan Cales Vice Chairman 1.00 X X 0 0 0 Steve McSpadden Trustee 1.00 X 0 0 0 Brenda Butters Trustee 1.00 X 0 0 0 Don Drennan Trustee 1.00 X 0 0 0 J Ben Quinton CEO 40.00 X 179557 0 23143 Thomas Embers Assistant Administrator 40.00 X 120390 0 8454 Debbie Hockenbury CFO 40.00 X 92445 0 6669 Shona Salzman Assistant Administrator 40.00 X 83921 0 15544 Kristi Ball Chief Nursing Officer 40.00 X 94189 0 16302 James McDermott Physician 40.00 X 264142 0 26878 Christopher Morrissey Physician 40.00 X 318049 0 31297 Sapna Shah-Haque Physician 40.00 X 137075 0 14013 Wade Turner Physician 40.00 X 190318 0 26504 Douglas Moore Physician 40.00 X 280763 0 27555 1760849 0 196359 12 0 1 0 Acute Care Inc 1609 N Ankeny Blvd Ankeny IA 50023 ER Physicians 875754 Via Christi Hospitals Wichita 8200 E Thorn Drive Wichita KS 67226 Radiation Contract 873241 CPSI PO Box 850309 Mobile AL 36685 Computer Support Services 217204 Andreas Law Office 104 1/2 West 9th Suite 303 Winfield KS 67156 Collections & Legal Services 201265 Physician's Reference Lab Inc PO Box 875865 Kansas City MO 64187 Lab Contract Services 130233 6 108133 21610 3479 133222 Net patient service revenue 621990 26458852 26458852 Occupational health 900099 305560 305560 Pharmacy 446110 69848 69848 26834260 14045 14045 119093 0 119093 119093 119093 15596 0 15596 15596 15596 Cafeteria and dietary 722210 49149 49149 Meals on wheels 624210 23415 23415 203190 203190 275754 27391970 27037450 0 221298 667753 118529 549224 12108768 10024149 2051087 33532 976502 813405 163097 894630 724376 163548 6706 958849 793776 162418 2655 40090 40090 379234 379234 54 54 347211 12183 335028 331194 156092 175102 574802 468769 106033 18397 18397 263616 263616 2035525 1864843 170682 147794 95150 52644 Purchased medical servi 2653545 2653545 Medical supplies 2379076 2379076 General and Administrat 692228 499826 192402 Pharmacy Drugs 584087 584087 1204616 536069 668547 27257971 22005942 5209136 42893 105817 4211 4859278 5376199 3418026 4476524 357015 363773 338654 430445 34430999 21401687 14269579 13029312 1158163 126531 24506532 23806995 1880557 2418248 6516409 4985182 0 160000 8396966 7563430 X 16109566 16243565 16109566 16243565 24506532 23806995 133999 0 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 101702 101702 21729913 13504326 8225587 12302071 7618893 4683178 297313 278468 18845 13029312 Estimated third party settlements 160000 160000 X 27391970 0 27391970 0 27391970 27257971 0 27257971 0 27257971 Part X, Line 2: The Hospital is exempt from federal income taxes pursuant to Section 115 of the Internal Revenue Code. The Hospital is unaware of any uncertainties in income tax positions. 1 1 1 X 120.000000000000 1 X 1 1 0 1 1 282577 142499 140078 0.00510 1954553 1687659 266894 0.00980 2237130 1830158 406972 0.01490 113503 2760 110743 0.00410 340106 340106 0.01250 4794475 2627566 2166909 0.07950 1473 1473 0.00010 5249557 2630326 2619231 0.09620 7486687 4460484 3026203 0.11110 1 212588 38473 10011107 10279619 -268512 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 1 X X X X X X X X X 13 1 0 1 X http://www.wnmh.org/ X X X X X X X X X X 1 0 1 1 120.000000000000 1 200.000000000000 1 X X X X X X X 1 1 X X X 1 X X X X X 0 X X X X 1 X 0 0 William Newton Memorial Hospital Part V, Section B, Line 3: In November-December, 2012, the Hospital and Cowley County Health Department co-sponsored the community health needs assessment. A broad-based community steering committee was formed to analyze the information resources presented to determine relevant issues and propose an action plan to improve local circumstances. The steering committee held three meetings to identify and prioritize the community's health needs and to develop an action plan to address these needs. Surveys were disbursed throughout the community to gather input from willing individuals regarding their health needs and their assessment of the current community health services provided. Three focus groups were also utilized by the steering committee to assist in identifying the health needs from a broad cross section of the community. Once all community input and data were collected and compiled, the steering committee created an action plan based on their assessment. The steering committee then presented their action plan to the community for review and possible implementation. William Newton Memorial Hospital Part V, Section B, Line 5d: Community Health Needs Assessment was filed with the Cowley County Extension office. William Newton Memorial Hospital Part V, Section B, Line 16e: William Newton Memorial Hospital may refer unpaid patient accounts to third party collection agencies and attorneys. William Newton Memorial Hospital Part V, Section B, Line 20d: William Newton Memorial Hospital maintains a set pricing structure for all medical services. Patients that meet the eligibility requirements for free or discounted care are billed for the gross charge amount, less eligible discount under the charity care policy. 6 Cedar Vale Rural Health Clinic 508 Washington Cedar Vale KS 67024 Rural Health Clinic Tallgrass Rural Health Clinic 300 W North St Sedan KS 67361 Rural Health Clinic Moline Community Rural Health Clinic 200 N Plum Moline KS 67353 Rural Health Clinic Dexter Community Rural Health Clinic 204 N Main St Dexter KS 67038 Rural Health Clinic Physician Pavillion 1230 East 6th Winfield KS 67156 Outpatient Clinic Health Professionals of Winfield 1230 East 6th Winfield KS 67156 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 are made up of services that the hospital provides despite a financial loss to the organization. These services include cardiac rehab, home health, rural health clinics, and physical therapy. 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 for each type of payor.Part III, Line 2The 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 the 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 3The provision for bad debts attributable to patients eligible under the organization's financial assistance policy were determined using an estimation of 18.1% of total bad debts. The US Census Bureau reports the persons below the federal poverty level in 2012 for Cowley County was 18.1%. William Newton Memorial Hospital takes steps to assist individuals who are believed to qualify for financial assistance prior to writing accounts off as uncollectible. Part III, Line 8: The Hospital used the 2013 Medicare Cost Report to determine the Medicare revenue and related cost. Part III, Line 9b: The Hospital's collection policy and collection practices are the same for 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 2013 population of Cowley County, Kansas to be 36,204. 16.6% of the population is 65 years of age or older, median household income is $41,905, and 18.1% of the population is below poverty level compared to the State of Kansas average of 13.2%. 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 2013 US Census Bureau estimates, Elk County's population was 2,655. 27.1% of the population is 65 years of age or older, median household income is $33,239, and 18.2% of the population is below poverty level. According to the 2013 US Census Bureau estimates, Chautauque County's population was 3,552. 25.9% of the population is 65 years of age or older, median household income is $37,039, and 15.3 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, and has been successful in recruiting physicians and physician assistants over the years. Ongoing recruitment is vital for the health of the community. Recruitment expense for 2013 was approximately $174,790. 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 only 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. X X 0 0 0 0 0 0 0 0 0 J Ben Quinton CEO 149557 0 30000 0 0 0 16244 0 6899 0 202700 0 0 0 James McDermott Physician 264142 0 0 0 0 0 17680 0 9198 0 291020 0 0 0 Christopher Morrissey Physician 318049 0 0 0 0 0 22099 0 9198 0 349346 0 0 0 Sapna Shah-Haque Physician 52075 0 85000 0 0 0 11713 0 2300 0 151088 0 0 0 Wade Turner Physician 183857 0 6461 0 0 0 17306 0 9198 0 216822 0 0 0 Douglas Moore Physician 255763 0 25000 0 0 0 19890 0 7665 0 308318 0 0 0 Christopher Morrissey Highest compensated employee Student loan repayment X 100000 70000 0 1 1 70000 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 11 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 Administrator/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 11a, I 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0