2013-03-13T12:39:52-05:00 2012-04-30 BKD LLP 1551 N WATERFRONT PKWY STE 300 WICHITA KS 672066601 990 2011-05-01 480761700 NINNESCAH VALLEY HEALTH SYSTEMS INC % KENT HUDSON NINN 6205323147 PO BOX 367 KINGMAN KS 67068 GARY TILLER 2013-03-15 true ELIZABETH S HOGAN 3162652811 2011 2016-02-25 16:41:14Z KENT HUDSON PO BOX 367 KINGMAN KS 67068 10281954 false X WWW.NVHSINC.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 7 178 39 12250 26033 35290 9731335 9976419 19105 18880 275269 251365 10051742 10281954 2200 0 0 0 5684127 5897312 0 0 0 4806998 4925554 10493325 10822866 -441583 -540912 8535976 7870512 4568522 4434822 3967454 3435690 ACUTE CARE HOSPITAL ORGANIZED TO MEET THE PRIMARY HEALTH CARE NEEDS OF THE PEOPLE OF KINGMAN COUNTY AND THE SURROUNDING COMMUNITIES. false false 8906414 10027844 HEALTH CARE SERVICES PROVIDED TO THE PEOPLE OF KINGMAN COUNTY AND THE SURROUNDING COMMUNITIES. DURING THE FISCAL YEAR 2012 THE HOSPITAL HAD 2,998 EMERGENCY ROOM VISITS, 4,007 IN-PATIENT DAYS AND CONDUCTED 797 SURGERIES. IN ADDITION, THE HOSPITAL PROVIDES A FAMILY CARE CLINIC IN THE NEIGHBORING COMMUNITY OF CUNNINGHAM. 8906414 true true false true false false false false false false true false false false true 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 false true 24 0 true 178 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 X GEORGE BURKET 1.0 X X 0 0 BILL KLAVER 1.0 X X 0 0 PATTI BRACE 1.0 X X 0 0 BOB WUNSCH 1.0 X X 0 0 SONDRA NICKELL 1.0 X 0 0 TIGER CRAIG 1.0 X X 0 0 NEIL FREUND 1.0 X 0 0 ROB DEWEESE 1.0 X 0 0 0 KENT HUDSON 40.0 X 60515 4309 GARY TILLER 40.0 X 123201 12971 183716 0 17280 1 false false false MARSHA STINEMAN ANESTHESIA - CRNA 103800 HIGH PLAINS PROVIDER INC ER COVERAGE 108484 2 14932 20358 35290 NET PATIENT SERVICE REVENUE 621300 9976419 9976419 9976419 15880 15880 0 0 84143 84143 84143 84143 3000 3000 3000 3000 0 0 0 AUXILIARY 900099 41669 41669 EMPLOYEE/GUEST MEALS 722210 46281 46281 INTEREST ON PATIENT ACCOUNTS 900099 30480 30480 48792 20945 12250 15597 167222 10281954 10027844 12250 206570 0 0 0 0 215201 215201 0 4731433 3983430 748003 65643 50435 15208 513660 405398 108262 371375 285333 86042 0 3685 3685 46560 46560 0 0 0 950025 808942 141083 12943 2500 10443 249292 169478 79814 0 0 181631 143139 38492 70819 22993 47826 0 0 159964 122510 37454 0 544269 418171 126098 57675 12337 45338 MEDICAL SUPPLIES 1275943 1275943 BAD DEBT EXPENSE 600045 600045 EQUIPMENT RENTAL & MAINT. 527202 444185 83017 FOOD 60353 60353 185148 101222 83926 10822866 8906414 1916452 0 30997 25255 1597749 1155536 0 0 1308151 1376644 0 0 0 0 0 0 234421 239065 133480 65292 11663733 6843919 4517307 4819814 324081 58772 0 0 266705 124820 0 0 123085 5314 8535976 7870512 699997 838575 0 0 59334 41968 3465000 2985000 0 0 0 0 334191 539279 0 0 10000 30000 4568522 4434822 X 3724756 3371618 242698 64072 0 0 3967454 3435690 8535976 7870512 X -540912 9148 X false true true X false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false true 2408 false false false 2408 false false LOBBYING ACTIVITIES SCHEDULE C, PART II-B, LINE 1F A PORTION OF THE ANNUAL DUES PAID TO KHA AND AHA ARE USED FOR LOBBYING. 74923 74923 5012364 2166598 2845766 6356783 4578910 1777873 219663 98411 121252 4819814 0 DUE TO THIRD PARTY PAYERS 30000 30000 10281954 10822866 -540912 9148 9148 -531764 10281954 10281954 10281954 10822866 10822866 10822866 UNCERTAIN TAX POSITIONS SCHEDULE D, PART X, LINE 2 MANAGEMENT HAS EVALUATED THEIR INCOME TAX POSITIONS UNDER THE GUIDANCE INCLUDED IN ASC 740. BASED ON THEIR REVIEW, MANAGEMENT HAS NOT IDENTIFIED ANY MATERIAL UNCERTAIN TAX POSITIONS TO BE RECORDED OR DISCLOSED IN THE FINANCIAL STATEMENTS. RECONCILIATION OF CHANGE IN NET ASSETS SCHEDULE D, PART XI, LINE 8 CHANGE IN INTEREST IN NET ASSETS OF KCHF $9,148 true true true X true X true true false false 22932 0 22932 0.00210 499783 167642 332141 0.03070 522715 167642 355073 0.03280 38638 20744 17894 0.00170 38638 20744 17894 0.00170 561353 188386 372967 0.03450 false 339673 155621 5070415 6191685 -1121270 X true true 1 1 KINGMAN COMMUNITY HOSPITAL

750 WEST D AVENUE KINGMAN KS 67068

X X X KINGMAN COMMUNITY HOSPITAL 1 false true true 100 true 200. true X true true X X X true false X X true X false false 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 $600,045. 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 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. 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 is not included as a community benefit. MEDICARE SCHEDULE H, PART III, LINE 8B 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. CHARGES FOR MEDICAL CARE SCHEDULE H, PART V, SECTION B, LINE 19D 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. For instance, recently a local group of citizens was trying to organize a free clinic to be open on weekends. The hospital's staff offered its expertise in helping set up the clinic, as well as donating equipment to the clinic and lab/radiology services to patients in need. 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. KINGMAN COUNTY KANSAS PUBLIC BUILDING COMMISSION 300493481 495739AZ7 2012-02-28 3250000 REFUND 7/15/2008 BOND ISSUE false false false 0 0 3250000 0 0 0 65000 0 0 0 3185000 0 2008 true false true true false false false false 0.00000 0.00000 0.00000 true false false false 0 false 0 false true X FORM 990 REVIEW PROCESS FORM 990, PART VI, SECTION B, LINE 11A 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 BY-LAWS 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 ISSURE 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 5 CHANGE IN INTEREST IN NET ASSETS OF KCHF $9,148. HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:BILL KLAVER TITLE:VICE CHAIRMAN/DIRECTOR HOURS: HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:PATTI BRACE TITLE:SECRETARY/DIRECTOR HOURS: 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