2012-09-25T13:39:55-05:00 2011-12-31 481026809 Wendling Noe Nelson & Johnson LLC 534 S Kansas Ave Suite 1500 Topeka KS 666033491 990 2011-01-01 486005089 William Newton Memorial Hospital WILL 6202212300 1300 E 5th Avenue Winfield KS 67156 Debbie Hockenbury 6202212300 2012-09-19 1 Eric L Otting P00298454 7852334226 2012-09-19 2011 2016-02-24 21:20:13Z Debbie Hockenbury 1300 E 5th Avenue Winfield KS 67156 27242683 0 X www.wnmh.org X 1927 KS Provide healthcare services to local area residents 5 5 337 88 0 0 511327 378522 25022237 25936499 34307 27801 427516 899861 25995387 27242683 0 0 0 0 13179630 13706646 0 0 18535 11763958 12478807 24943588 26185453 1051799 1057230 24002971 23642692 9663800 8246291 14339171 15396401 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 22271286 26593058 Patient services, full range of inpatient and outpatient services. 22271286 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 60 0 1 337 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 149287 0 14867 Danny Huckvale 40.00 X 102896 0 16560 Thomas Embers 40.00 X 105739 0 7138 James McDermott 40.00 X 254109 0 26349 Kelle Thompson 40.00 X 108307 0 7461 Robert Matthews 40.00 X 101621 0 0 821959 0 72375 6 0 1 0 Via Christi Financial Services 929 North St Francis Wichita KS 67214 Radiation Contract 799306 Acute Care Inc 1609 N Ankeny Blvd Suite 200 Ankeny IA 50023 ER Physicians 717828 CPSI PO Box 850309 Mobile AL 36685 Computer Support Services 416615 GE Medical Systems PO Box 641419 Dallas TX 75284 Equipment Service Contract 260010 Stockton Restoration Co PO Box 3802 Wichita KS 67201 Maintenance & Repair 189900 8 365352 13170 378522 Patient services reven 621990 25529792 25529792 Occupational Health 900099 328104 328104 Pharmacy 446110 78603 78603 25936499 27074 27074 165917 0 165917 165917 165917 727 0 727 727 727 EHR incentive payments 900099 467029 467029 Miscellaneous 900099 189530 189530 Cafeteria and dietary 722210 51142 51142 26243 26243 733944 27242683 26593058 0 271103 408450 408450 10746726 9129928 1602341 14457 781393 662239 119154 888606 744453 141261 2892 881471 748857 131428 1186 37974 37974 258668 45396 213272 520990 520990 18738 18738 437838 437838 1912819 1912819 147063 147063 Purchased Services 2724243 2502982 221261 Medical Supplies 2283187 2283187 0 Collection Fees and Bad 1403130 1092899 310231 Repairs and Maintenance 1077197 801925 275272 1656960 1369035 287925 26185453 22271286 3895632 18535 110286 65478 4650015 6469299 4364179 4362572 311803 280680 230444 215820 32090888 20041059 13360720 12049829 975524 199014 24002971 23642692 1592822 1782517 8070978 6463774 9663800 8246291 X 14339171 15396401 14339171 15396401 24002971 23642692 1057230 0 X X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 101702 101702 20081693 11276544 8805149 11620080 8491999 3128081 287413 272516 14897 12049829 27242683 26185453 1057230 1057230 26149784 0 26149784 1092899 1092899 27242683 25092554 0 25092554 1092899 1092899 26185453 Description of Uncertain Tax Positions Under FIN 48: Part X: The Hospital is exempt from federal income taxes pursuant to Section 115 of the Internal Revenue Code. Part XII, Line 4b - Other Adjustments: Reclassification of bad debts 1,092,899. Part XIII, Line 4b - Other Adjustments: Reclassification of bad debts 1,092,899. 1 1 1 X 120.000000000000 1 X 1 1 0 0 278279 114983 163296 0.00650 2153362 2038472 114890 0.00460 2431641 2153455 278186 0.01110 29268 29268 0.00120 149866 149866 0.00600 2414028 982870 1431158 0.05700 800 800 0.00000 2593962 982870 1611092 0.06420 5025603 3136325 1889278 0.07530 1 434085 65113 9688367 9817931 -129564 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 1 X X X 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 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 $ 1092899. 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 15.0% of total bad debts. The US Census Bureau reports the persons below the federal poverty level in 2010 for Cowley County was 15.0%. 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 2011 Medicare Cost Report to determine the Medicare revenue and related cost. Part III, Line 9b: The Hospital's collection policy does not contain a provision on the collection practices for patients who are known to qualify for charity care or financial assistance. To be considered for charity care, however, 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 15e: 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 16e: William Newton Memorial Hospital referred unpaid patient accounts to third party collection agencies and attorneys. William Newton Memorial Hospital Part V, Section B, Line 19d: William Newton Memorial Hospital maintains a set pricing structure for all medical services. Patients that are determined to not meet the eligibility requirements for free or discounted care are billed for the gross charge amount. Part VI, Line 2: The Hospital has not conducted a community needs assessment as it has not yet been required. The Hospital is making plans to complete an assessment when it is 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 2011 population of Cowley County, Kansas to be 36,272. 16.1% of the population is 65 years of age or older, median household income is $40,749, and 15.0% of the population is below poverty level compared to the State of Kansas average of 12.4%. 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 2011 US Census Bureau, Elk County's population was 2,811. 25.3% of the population is 65 years of age or older, median household income is $33,455, and 18.4% of the population is below poverty level. According to the 2011 US Census Bureau, Chautauque County's population was 3,584. 23.8% of the population is 65 years of age or older, median household income is $35,848, and 10.1% 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 2011 was approximately $152,000. 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 149287 0 0 0 0 0 10184 0 4683 0 164154 0 0 0 James McDermott 254109 0 0 0 0 0 17151 0 9198 0 280458 0 0 0 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 Form 990 is made available to the governing body for their review upon their 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 statement. 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 William Newton Healthcare Foundation Inc C 300000 William Newton Healthcare Foundation Inc C 31753