2013-11-12T08:08:53-06:00 2013-06-30 481026809 Wendling Noe Nelson & Johnson LLC 534 S Kansas Ave Suite 1500 Topeka KS 666033491 990 2012-07-01 480764456 Nemaha Valley Community Hospital NEMA 7853366181 1600 Community Drive Seneca KS 66538 Stan Regehr 7853366181 2013-11-08 1 Eric L Otting P00298454 7852334226 2013-11-08 2012 2016-02-24 21:20:13Z Stan Regehr 1600 Community Drive Seneca KS 66538 11489739 0 X nemvch.org X 1969 KS The Nemaha Valley Community Hospital provides an acute care hospital to the surrounding area. 10 9 159 0 0 0 73961 94729 10350361 11322949 21660 18587 59775 53474 10505757 11489739 0 0 0 0 6108815 6400507 0 0 671 4514689 4448672 10623504 10849179 -117747 640560 13852059 14713342 9122539 9288874 4729520 5424468 The Nemaha Valley Community Hospital is dedicated to providing quality health care and other related services in a compassionate manner sufficient to meet the primary health care needs of its patrons within the scope of its resources and staff. 0 0 9626496 11351338 Nemaha Valley Community Hospital provides inpatient and outpatient hospital services and clinic services to patients in its service area. 9626496 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 1 0 0 0 1 23 0 1 159 1 0 0 0 0 0 0 0 0 0 0 X 10 9 0 0 0 0 1 1 0 1 1 0 0 0 1 1 1 0 1 1 0 0 X Connie Ingwerson 7853366181 1600 Community Drive Seneca KS 66538 Kathy O'Brien 1.00 X X 0 0 0 Joyce Schmitz 1.00 X X 0 0 0 Judy Deters 1.00 X 0 0 0 Dr William Bartkoski 40.00 X 219283 0 15048 Jim Runnebaum 1.00 X X 0 0 0 Steve Haverkamp 1.00 X 0 0 0 Dennis Henry 1.00 X 0 0 0 Ed Mohney 1.00 X 0 0 0 Leroy Strathman 1.00 X 0 0 0 Steve Kramer 1.00 X 0 0 0 Stan Regehr 40.00 X 151857 0 6060 Connie Ingwerson 40.00 X 78530 0 4521 Dr Jody Bieker 40.00 X 204263 0 27864 Dr James Lueger 40.00 X 214283 0 14250 Karen Hynek 40.00 X 105575 0 9335 Dr Angela Stueve 40.00 X 220303 0 28476 1194094 0 105554 6 0 1 0 Harry Stewart PO Box 147 Seneca KS 66538 Anesthesia Services 318216 Healthcare Management Services 2739 Momemtum Place Chicago IL 60689 IT Maintenance 245917 Stormont Vail Healthcare 1500 SW 10th Avenue Topeka KS 66604 Lab Services 136955 Shared Medical Services PO Box 330 Cottage Grove WI 53527 MRI Scans 115345 4 35865 58864 94729 Patient service revenue 621990 10546822 10546822 Electronic Health Record Incentiv 621990 776127 776127 11322949 18587 18587 Miscellaneous 621990 28389 28389 Dietary Income 621990 25085 25085 53474 11489739 11351338 0 43672 242878 242878 5088851 4613598 475253 130143 118131 12012 622381 545529 76852 316254 274307 41947 9518 9518 16432 8676 7756 40060 39731 329 193006 193006 59657 43446 16211 577553 577553 836186 778535 57651 105167 105167 Supplies 1054074 1025045 29029 Professional fees 891639 782952 108016 671 Equipment rental and ma 484791 382242 102549 Miscellaneous 85017 83484 1533 95572 55094 40478 10849179 9626496 1222012 671 278632 121204 3489148 4139439 4980 200 1266160 1161014 241504 221319 221276 236546 16860945 8743248 8287076 8117697 63283 715923 13852059 14713342 712539 1013874 8410000 8275000 9122539 9288874 X 4729520 5370080 54388 4729520 5424468 13852059 14713342 X 640560 54388 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 54681 54681 11442718 5222584 6220134 5363546 3520664 1842882 8117697 11489739 0 11489739 0 11489739 10849179 0 10849179 0 10849179 1 1 1 X 1 X 1 1 1 0 1 1 72649 72649 0.00670 364636 132022 232614 0.02140 437285 132022 305263 0.02810 63397 14270 49127 0.00450 4851 4851 0.00040 68248 14270 53978 0.00490 505533 146292 359241 0.03300 194412 77765 5370298 5587964 -217666 X 1 1 1 1 Nemaha Valley Community Hospital

1600 Community Drive Seneca KS 66538

X X X X Nemaha Valley Community Hospital 1 1 X X X X X X X X 12 1 1 1 X X X X X X X X X 0 0 1 0 1 200.000000000000 1 X X X X X 1 1 X X X X 1 X X X 1 X X X X X 1 X 0 0 Part II: N/A Part III, Line 4: Nemaha Valley Community 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. This estimate is based on the aging of its accounts receivable by payor and historical collection experience. Part III, Line 8: The Hospital provides service to all patients in their service area, regardless of the patient's ability to pay, and any shortfall absorbed by the Hospital is a benefit to the community. Part III, Line 9b: Nemaha Valley Community Hospital makes every effort to get correct financial and billing information and to educate patients on the eligibility requirements of charity care programs and payment options. Nemaha Valley Community Hospital Part V, Section B, Line 3: Community members were invited to attend three meetings in which their input was requested to determine the health needs of the community. The community members decided what the health care needs are and prioritized these needs. Nemaha Valley Community Hospital Part V, Section B, Line 4: Sabetha Community Hospital, Inc. Nemaha Valley Community Hospital Part V, Section B, Line 7: The scope of one specific need identified was too large and the sponsors of the health needs assessment are unable to address it at this time due to financial constraints. Nemaha Valley Community Hospital Part V, Section B, Line 10: The hospital's Financial Assistance policy makes financial assistance available to all patients who qualify under Federal Poverty Guidelines (FPG). Discounts begin for patients whose income is up to 200 percent of FPG. The hospital's assistance begins at a 20 percent discount of amounts generally billed and increases to a 90 percent discount for patients at or below 100 percent of the FPG. Part VI, Line 2: A Community Health Needs Assessment was conducted in October 2012. The health care needs of the commmunity were identified during this assessment through input of the community members who participated in multiple meetings held to gather this information. Part VI, Line 3: Notification associated with patient encounter. Part VI, Line 4: The community served is primarily residents who reside in Nemaha County Kansas and consists of approximately 2,000 residents. The median family income is $42,617. 15.5% of the community residents live below federal poverty level, and 1.9% of the community residents live below 50% of the federal poverty level. Neighboring hospitals are located in Sabetha, Pawnee County, NE, and Hiawatha. They are approximately 15, 20, and 28 miles away respectively. Part VI, Line 5: The Hospital notifies the public in quarterly newsletters about services available at the hospital. The Hospital offers periodic diabetic educational programs and education programs for expectant mothers. The Hospital uses all excess funds to maintain and improve Hospital facilities and equipment and to insure the delivery of high quality patient care services. Part VI, Line 6: N/A X X 0 0 0 0 0 0 0 0 0 Dr William Bartkoski 219283 0 0 0 0 0 10527 0 4521 0 234331 0 0 0 Stan Regehr 136857 0 15000 0 0 0 6060 0 0 0 157917 0 0 0 Dr Jody Bieker 204263 0 0 0 0 0 9293 0 18571 0 232127 0 0 0 Dr James Lueger 214283 0 0 0 0 0 9729 0 4521 0 228533 0 0 0 Dr Angela Stueve 220303 0 0 0 0 0 9905 0 18571 0 248779 0 0 0 A City of Seneca Kansas 486026237 81712RAP4 2008-12-01 8835000 To refund notes payable and construction costs for an addition to Hospital 0 0 0 A 560000 8852850 498789 161472 6834436 1358153 2011 0 1 1 1 A 0 0 0 0 0 0 0 A 0 0 0 0 0 0 0 0 0 Sara Kramer Daughter of Board Member/Daughter-in-law of Board Member 39662 Employed by Nemaha Valley Community Hospital as the Director of the dietary department. 0 Tina Palic Daughter of Board Member 73502 Employed by Nemaha Valley Community Hospital as the Director of the occupational/physical therapy department. 0 Form 990, Part VI, Section A, line 6 The hospital is a not-for-profit corporation with 10 members at December 31, 2012. Form 990, Part VI, Section A, line 7a The Medical Center's corporate members elect the governing body. Form 990, Part VI, Section B, line 11 The 990 is not formally presented to the board prior to filing. The document is made available upon request. Form 990, Part VI, Section B, line 12c The board in required to annually sign conflict of interest statements. Form 990, Part VI, Section B, line 15a The CEO salary and compensation is approved by the hospital's board. Form 990, Part VI, Section C, line 19 Documents are available upon request. Changes in Net Assets or Fund Balances: Form 990, Part XI, line 9: Temporarily restricted net assets, contributions and grants 54,388. Financial Statement Reporting FORM 990 PART XI, Line 2C The board is responsible for the oversight of the financial statement audit and selection of the independent accountant. The independent accountant presents the financial statements and related communications to the Board for their approval. Nemaha Valley Health Care Foundation 1600 Community Drive Seneca KS 66538 481097250 Fundraising for the benefit of Nemaha Valley Community Hospital KS 501(c)(3) 509(a) Nemaha Valley Community Hospital 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Nemaha Valley Community Hospital Foundation C 50000 Actual amount