2013-10-23T11:03:18-05:00 2012-12-31 481026809 Wendling Noe Nelson & Johnson LLC 534 S Kansas Ave Suite 1500 Topeka KS 666033491 990 2012-01-01 486005089 William Newton Memorial Hospital WILL 6202212300 1300 E 5th Avenue Winfield KS 67156 Debbie Hockenbury 6202212300 2013-10-15 1 Eric L Otting P00298454 7852334226 2013-10-15 2012 2016-02-24 21:20:13Z Debbie Hockenbury 1300 E 5th Avenue Winfield KS 67156 26214532 0 X www.wnmh.org X 1927 KS Provide healthcare services to local area residents 5 5 350 85 0 0 378522 223970 25936499 24625012 27801 28209 899861 1337341 27242683 26214532 0 0 0 0 13706646 14285013 0 0 40348 12478807 11216354 26185453 25501367 1057230 713165 23642692 24506532 8246291 8396966 15396401 16109566 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 20663331 25740252 Patient services, full range of inpatient and outpatient services. 20663331 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 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 68 0 1 350 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 Don Drennan 1.00 X 0 0 0 Joan Cales 1.00 X 0 0 0 Brenda Butters 1.00 X 0 0 0 Thomas Herlocker 1.00 X X 0 0 0 Steve McSpadden 1.00 X X 0 0 0 Richard Vaught 40.00 X 182001 0 17576 Danny Huckvale 40.00 X 109107 0 14435 Thomas Embers 40.00 X 129456 0 9440 Debbie Hockenbury 40.00 X 85832 0 6290 Kristi Ball 40.00 X 105344 0 17364 Shona Salzman 40.00 X 82176 0 15657 James McDermott 40.00 X 258720 0 27548 Kelle Thompson 40.00 X 110036 0 8217 Robert Matthews 40.00 X 101321 0 7467 Christopher Morrissey 40.00 X 169213 0 15671 1333206 0 139665 8 0 1 0 Via Christi Financial Services 8200 E Thorn Drive Wichita KS 67226 Radiation Contract 944736 Acute Care Inc 1609 N Ankeny Blvd Ankeny IA 50023 ER Physicians 807882 Wellness Inc One Vantage Way Suite D-100 Nashville TN 73228 Remodeling Contractors 591994 Mechanical Systems Inc PO Box 3029 Wichita KS 67201 Remodeling Contractors 556907 CPSI PO Box 850309 Mobile AL 36685 Computer Support Services 292876 9 209421 10245 4304 223970 Patient services reven 621990 24193565 24193565 Occupational Health 900099 351382 351382 Pharmacy 446110 80065 80065 24625012 24941 24941 146979 0 146979 146979 146979 3268 0 3268 3268 3268 EHR incentive payments 900099 914495 914495 Cafeteria and dietary 722210 47124 47124 Meals on wheels 624210 27998 27998 200745 200745 1190362 26214532 25740252 0 250310 795466 129724 665742 10819820 8947335 1841125 31360 864858 716727 148131 867644 695269 166103 6272 937225 775028 159481 2716 40734 40734 288966 47593 241373 538372 538372 19422 19422 314976 314976 1963852 1963852 144319 144319 Purchased Services 3022222 2729847 292375 Medical Supplies 2136068 2136068 Repairs and Maintenance 825054 568834 256220 General and Administrat 652587 394524 258063 1269782 685760 584022 25501367 20663331 4797688 40348 65478 105817 6469299 4859278 4362572 3418026 280680 357015 215820 338654 34063621 19794042 12049829 14269579 199014 1158163 23642692 24506532 1782517 1880557 6463774 6516409 8246291 8396966 X 15396401 16109566 15396401 16109566 23642692 24506532 713165 0 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 101702 101702 21702464 11787813 9914651 11972042 7730985 4241057 287413 275244 12169 14269579 X 26214532 0 26214532 0 26214532 25501367 0 25501367 0 25501367 Description of Uncertain Tax Positions Under FIN 48: 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 0 259477 124530 134947 0.00530 1962423 1639747 322676 0.01270 2221900 1764277 457623 0.01800 87778 790 86988 0.00340 209045 960 208085 0.00820 2501727 1016020 1485707 0.05830 1325 1325 0.00010 2799875 1017770 1782105 0.07000 5021775 2782047 2239728 0.08800 1 159756 26839 9028089 9157072 -128983 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 1 120.000000000000 1 200.000000000000 1 X X X X X X X 1 1 X X 1 X X X X 0 X X X X 1 X 0 0 5 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 Part I, Line 6a: William Newton Memorial Hospital has not yet prepared a community benefit report. 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, and rural health clinics. Part II: N/A 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 16.8% of total bad debts. The US Census Bureau reports the persons below the federal poverty level in 2011 for Cowley County was 16.8%. 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 2012 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. 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 17e: William Newton Memorial Hospital referred 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. Part VI, Line 2: The Hospital is in the process of completing a community health needs assessment as required by law. 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 2012 population of Cowley County, Kansas to be 36,288. 16.2% of the population is 65 years of age or older, median household income is $40,924, and 16.8% of the population is below poverty level compared to the State of Kansas average of 12.6%. 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 2012 US Census Bureau estimates, Elk County's population was 2,720. 26.4% of the population is 65 years of age or older, median household income is $34,246, and 19.3% of the population is below poverty level. According to the 2012 US Census Bureau estimates, Chautauque County's population was 3,571. 24.8% of the population is 65 years of age or older, median household income is $35,791, and 14.7% 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 2012 was approximately $104,000. 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 hospitals web page. The hospitals 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 Richard Vaught 182001 0 0 0 0 0 13283 0 4293 0 199577 0 0 0 James McDermott 258720 0 0 0 0 0 18350 0 9198 0 286268 0 0 0 Christopher Morrissey 169213 0 0 0 0 0 11838 0 3833 0 184884 0 0 0 Christopher Morrissey Highest compensated employee Student loan repayment X 100000 91667 0 1 1 91667 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 deteriming 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. Financial Statement Reporting Form 990, Part XII, line 2C 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) 170(b)(1) 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 William Newton Healthcare Foundation Inc C 209421