2011-05-13T06:31:20-05:00 2010-06-30 Wendling Noe Nelson & Johnson LLC 534 S Kansas Ave Suite 1500 Topeka KS 666033491 990 2009-07-01 480774005 Promise Regional Medical Center Hutchinson PROM 6206652000 1701 E 23rd Hutchinson KS 67502 Shawnda Heimerman 6206652000 2011-05-12 1 Gary D Knoll 7852334226 2011-05-12 2009 2016-02-24 21:20:13Z Shawnda Heimerman 1701 E 23rd Hutchinson KS 67502 143748632 0 X www.promiseregional.com X 1969 KS A 199 bed acute care hospital with the mission to do everything possible to deliver an exceptional experience of care for every patient and family member, everytime, in every interaction. 17 14 1491 182 2457855 733509 3803017 775157 129621331 141582905 1935583 782562 5257495 572335 140617426 143712959 0 0 58457689 58387874 0 0 79003111 81521042 137460800 139908916 3156626 3804043 145613082 155757293 29648623 30665139 115964459 125092154 We must do everything possible to deliver an exceptional experience of care for every patient and family member, everytime, in every interaction. 0 0 119092976 138706964 Promise Regional Medical Center Hutchinson is currently licensed to operate 199 general acute beds. All program service expenses were incurred in furtherance of our mission. 119092976 1 1 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 1 0 0 1 0 0 0 0 0 0 0 1 0 0 0 0 0 1 0 0 0 1 60 0 1 1491 1 1 1 0 0 0 0 0 0 0 0 17 14 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 1 X Shawnda Heimerman AdminDir Fin Serv 6206652002 1701 E 23rd Hutchinson KS 67502 Ann Bush 1.00 X X 0 0 0 Kris Doswell 1.00 X X 0 0 0 Sue Darby 1.00 X X 0 0 0 John Deardoff 1.00 X X 0 0 0 Annasteen Blackim 1.00 X 0 0 0 Mike Evans 1.00 X 0 0 0 Verlin Janzen MD 1.00 X 0 0 0 John Jones 1.00 X 0 0 0 Evan Moodie 1.00 X 0 0 0 Gary Mundhenke 1.00 X 0 0 0 Christine Sanders MD 1.00 X 0 0 0 Mert Sellers 1.00 X 0 0 0 John Swearer 1.00 X 0 0 0 Kent Tyler 1.00 X 0 0 0 Rex Degner MD 1.00 X 0 0 0 Edward Hobart MD 1.00 X 0 0 0 Linda Harrison 40.00 X X 370443 0 20874 David Busatti 40.00 X 122006 0 15273 James McComas 40.00 X 160218 0 19999 Janet Hamous 40.00 X 146008 0 15654 Patricia Edwards 40.00 X 90166 0 14260 Ragu Tirukonda 40.00 X 161001 0 20225 Ronald Fenwick 40.00 X 144394 0 12810 William Giersch 40.00 X 142387 0 16499 Patrick Mowder 40.00 X 141824 0 18487 Clint Boor 40.00 X 130819 0 17626 1609266 0 171707 26 0 1 0 Rees Associates 9211 Lake Heffner Pkwy Oklahoma City OK 73120 Architects 812209 The Strategy Group 8415 East 21st St 200 Wichita KS 67206 Marketing 581648 Scott Sellers 2510 Linksland Hutchinson KS 67502 ER Physician 472950 Mark Ohlde 1300 Bristol Rd Hutchinson KS 67502 ER Physician 421163 Bryan K Henderson 2515 Lundman Hutchinson KS 67502 ER Physician 403040 23 153067 558618 63472 775157 Patient Revenue 900099 137739745 137739745 Non-Patient Lab 621500 1243229 1243229 Ambulance Services 621910 967219 967219 Pharmacy consulting an 900099 910295 910295 Cafeteria & dietary 900099 418086 418086 304331 304331 141582905 800936 800936 472519 472519 472519 472519 17299 33310 2363 -33310 14936 -18374 -18374 99816 99816 99816 143712959 138706964 2457855 1772983 1178875 1178875 45687092 36745604 8941488 1829101 1431422 397679 6022304 5008629 1013675 3670502 2899308 771194 282363 138133 144230 266825 266825 572086 51 572035 596853 208099 388754 2395681 10444 2385237 2265904 2181176 84728 71929 35493 36436 252940 252940 9691746 9691746 1123129 1102124 21005 Federal income tax paym 135000 135000 Medical supplies 19370308 19370308 Bad debts 14374247 14374247 Physician fees 8226682 7828985 397697 Pharmaceuticals 7933647 7933647 13961702 10133560 3828142 139908916 119092976 20815940 0 14456 8112932 15105329 15045159 21026298 18025194 4462721 4543347 1365101 1679261 165899025 95432344 65558752 70466681 700000 34873425 37344046 36379 3011294 145613082 155757293 14807298 16194588 3634 14635087 13551992 206238 914925 29648623 30665139 X 97390162 104401492 18574297 20690662 115964459 125092154 145613082 155757293 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1420204 1420204 55147132 24480951 30666181 26521310 17397814 9123496 71081070 46518917 24562153 11729309 7034662 4694647 70466681 Investment in Hutchinson VHA 118525 F Investment in Hutchinson Health Care Services 480000 C Investment in Hutchinson Ambulatory Surgery 20000 C Beneficial interest in net assets of Foundation 20516171 C Vanguard Index 500 Fund 4080567 F PIMCO Fund 9658162 F 34873425 Investment in Dialysis Center of Hutchinson 73749 Agency funds 774124 Capital Lease 67052 914925 143712959 139908916 3804043 1035063 4288589 5323652 9127695 146920246 1035063 2172224 3207287 143712959 0 143712959 139908916 0 139908916 0 139908916 Part X: Description of Uncertain Tax Positions Under FIN 48: N/A Part XI, Line 8 - Other Adjustments: Net assets released from restrictions for purchase of property and equipment: 432905. Transfers between affiliates: 1739319. Contributions and grants received: 642984. Investment income: 497. Repayment of contribution restricted for property and equipment: -83499. Change in beneficial interest in net assets of foundations: 2210069. Net assets released from restrictions used for operations: -220781. Net assets released from restrictions for purchase of property and equipment: -432905. Part XII, Line 2d - Other Adjustments: Transfer from affiliate: 1739319. Net assets released from restrictions used for property & equipment: 432905. Schedule D, Part X Dialysis Center of Hutchinson Schedule D, Part XI, Line 8 Change in beneficial interest in net assets of foundation. Schedule D, Part XII, Line 4b Transfer from Affiliate Schedule D, Part XIII, Line 4b Transfer to Affiliates 1 1 1 X 1 X 225.000000000000 1 1 0 0 497429 0 497429 0.00400 8066336 3579378 4486958 0.03570 8563765 3579378 4984387 0.03970 133265 7955 125310 0.00100 8916995 4515444 4401551 0.03510 30628 30628 0.00020 9080888 4523399 4557489 0.03630 17644653 8102777 9541876 0.07600 1297 1297 0.00000 1297 1297 1 5344836 37412 54237188 57100145 -2862957 X 1 1 Promise Regional Medical Center

1701 E 23rd Hutchinson KS 67502

X X X Part III, Line 4: Provisions are made 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 allowance is estimated based on the aging of accounts receivable and historical collection experience for each type of payor. Part III, Line 8: Amounts were obtained from the cost report filed with Medicare for the period ending June 30, 2010. The shortfall is a result of unreimbursed costs incurred while providing care for Medicare patients. Part III, Line 9b: When a patient account is assigned to a collection agency, the agency will inform the patient of the Promise Regional's charity care policy and will assist the patient in contacting the Medical Center to apply for assistance. During the process of determining eligibility, collection efforts will be suspended providing the patient cooperates with the eligibility process. Part VI, Line 2: The Medical Center was a funding sponsor of the 2009-2010 Health Risk Behaviors-Reno County survey in collaboration with the Kansas Health Foundation, Hutchinson Community Foundation, and the Reno County Health Department and Home Health Agency. The survey measures and sets target goals for seven leading health indicators for the county the Medical Center serves. A member of the Medical Center's Executive Team serves on the Advisory Board of the Reno County Health Department. This board is currently forming sub-committees and an action plan for response to the survey and Methodology to obtain the specified goals.Additionally, the Medical Center formed two internal response teams to focus on tobacco use cessation and reducing childhood obesity. Both of these teams are collaborating with several local organizations such as the Boys and Girls Club and the Health Department. Part VI, Line 3: The Medical Center posts notices of charity care in Admissions, the Emergency Department, Financial Services, and on the Promise Regional website. Patients are given a written notice indicating the policy at the time of their admission via the Conditions of Admission form. In case of an emergency, the patient will be notified as soon as possible of the existence of charity care. English translation of this notice will be made available to Spanish-speaking patients. The Medical Center has trained front line staff to answer charity care questions or direct such questions to the appropriate party. Written information regarding the Medical Center's charity care policy as well as other payment options will be made available to any person who requests such information via mail, phone or in person. Part VI, Line 4: Promise Regional Medical Center is located in Reno County, Kansas in the city of Hutchinson. Reno County has an approximate population of 64,500 residents with population being 68% urban residents and 32% rural residents. The estimated average annual household income is $39,000. Approximately 11% of the population is below the federal poverty annual income level. Of those individuals approximately 14% are under the age of 18 and 9% are 65 or over. Medicare services account for approximately 55% of all of the Medical Center's gross revenue, while Medicaid and self-pay services account for approximately 12% of the Medical Centers gross revenue. Promise Regional Medical Center is the only community based hospital in Reno County and is governed by a Board of Directors in which new members are nominated and selected from the community at large. The Medical Center is deeply invested in the quality of health care deliver and community well-being. Promise Regional Medical Center aims to be the first and best choice for health care in the surrounding region. Other medical facilities surrounding the Medical Center are located in Halstead, Moundridge, and McPherson. The distances between the Medical Center and these facilities are 23, 24, and 26 miles respectively. There are also two large medical facilities located in Wichita and are approximately 53 and 54 miles away. Part VI, Line 5: At this time, Promise Regional Medical Center does not have programs that directly address the root causes of health problems, however the management team is (as a part of their job description) required to participate in community volunteer activities that focus on these issues. As of this writing, members of the management team currently serve on the following notable local, state, and national boards and committees: Reno County Cancer Council Red Cross Board Hutchinson Area Student Services Health Clinic American Red Cross, Hutchinson Chapter American Heart Association-Flint Hills Division Board of Directors Executive Leadership Team for Hutchinson Heart Walk Health Strategies/Life Strategies Foundation Board of Directors Kansas Health Ethics Board Arthritis Foundation (Kansas/Missouri chapter) Hospice & Home Care of Reno County Reno County Transportation Committee Hutchinson Community College Associate Degree Nursing Program Advisory Committee Hutchinson Community College-RHIT Advisory Board AmbucsMany of these boards and committees have a direct and/or indirect impact on the root causes of health issues in our county and surrounding area. Part VI, Line 6: Promise Regional Medical Center is the only community based hospital in Reno County and is governed by a Board of Directors which new members are nominated and selected from the community at large. Corporation By-Laws state: "It is the intent and purpose of these By-Laws that the members of the Board shall constitute a balance representation of the community and the Medical Staff". The board meets monthly with the purpose of guiding the Medical Center and assuring quality medical care for all patients regardless of their ability to pay for services.Medical Staff privileges are granted by a combined vote of the Medical Executive Committee and Promise Regional Medical Center's Board of Directors. Qualified physicians from Reno County and the surrounding area are encouraged to apply for privileges and are only rejected for licensure or other issues related to quality of care or moral character.All surplus funds are applied towards investments in plant or equipment to provide state of the art care in the most modern, patient friendly environment possible. Our latest investments include a 64-slice Dual Source CT Scanner, a Tomotherapy Radiation Oncology Unit, and a complete remodel of our Cardiovascular pre- and post-procedure area.Promise Regional Medical Center has a strong vision for the future. We're deeply invested in the quality of health care delivery and community well-being. Our standard for and commitment to excellence is nothing less than a promise: to be the first and best choice for health care in the surrounding region. Our Mission Statement and Core Values reflect our community minded focus:Promise Regional Medical Center Mission Statement:We must do everything possible to deliver an exceptional experience of care for every patient and family member, every time, in ever interaction.Core Values: Commitment to love our patients "First, Best, Most." Exceptional Care Excellence Highest Integrity Regional Leader in Care Community Minded Employer of Choice Legacy BuildersPromise Regional Medical Center proudly serves the needs of our community and makes every effort to deliver the best care possible. As an exempt entity, we understand our obligation and duty to the people we serve. Part VI, Line 7: X 1 1 X X X X X 0 0 0 0 0 0 0 0 0 Linda Harrison 320440 0 50003 0 0 0 17354 0 3520 0 391317 0 152361 0 James McComas 160218 0 0 0 0 0 10903 0 9096 0 180217 0 83194 0 Janet Hamous 146008 0 0 0 0 0 6558 0 9096 0 161662 0 71500 0 Ragu Tirukonda 158739 0 2262 0 0 0 11129 0 9096 0 181226 0 84001 0 Ronald Fenwick 144394 0 0 0 0 0 9290 0 3520 0 157204 0 74632 0 William Giersch 134219 0 8168 0 0 0 10143 0 6356 0 158886 0 63140 0 Patrick Mowder 140365 0 1459 0 0 0 9391 0 9096 0 160311 0 71406 0 Part I, Line 1a Country club and social club dues are paid for Linda Harrison, CEO. Mert Sellers Owner of 5% of Luminous Neon, Supplier 39910 Purchase of signs and services 0 Rex Degner MD Member of reno Pathology Assoc. P. A. 300000 Physicians fees lab work 0 Form 990, Part VI, Section B, line 11 A copy of Form 990 is made available to the governing board prior to it being filed. Form 990, Part VI, Section B, line 12c All employees are required to sign a compliance certification at least annually stating that they acknowledge that the Corporate Compliance Program and Corporate Code of Conduct have been explained and that they are in compliance with its requirements - which include conflict of interest. Board of Directors are also required annually to sign a Form 990 Board questionnaire. Form 990, Part VI, Section B, line 15 Executive compensation is handled with the assistance of an independent compensation consultant who works with the Board of Directors to establish executive pay and benefits. A national consulting firm was engaged to conduct a comprehensive wage study, which included executive level positions. They gathered and analyzed comparative compensation data and made a recommendation to the chairperson of the board for use with the executieve board, which serves as the compensation committee. The CEO base pay is determined by the Board based on market data and executive performance. The CEO bonus is determined by the Board based on hospital and CEO performance, in accordance with the guidelines outlined in the employment agreement. Form 990, Part VI, Section C, line 19 The Organization provides Form 990 to the public upon request. The Organization does not currently provide access to governing documents, conflict of interest policy or financial statements. Form 990, part XI, line 2c FINANCIAL STATEMENT REPORTING The Finance Committee is responsible for oversight of the financial statement audit and approval of the accounting firm performing the audit. Hospice of Reno County 1701 E 23rd Hutchinson KS 67502 480927101 Hospice and Home Care KS 501(c)(3) 7 Promise Regional Medical Center Hutchinson Inc Horizons Mental Health Center 1600 N Lorraine Hutchinson KS 67501 480970362 Licensed community mental health center KS 501(c)(3) 3 Promise Regional Medical Center Hutchinson Inc Main Line Inc 1701 E 23rd Hutchinson KS 67502 486111813 Leases personal and real property to 501(c)(3) organization KS 501(c)(3) 11b Promise Regional Medical Center Hutchinson Inc Living Center Inc 1901 E 23rd Hutchinson KS 67502 481066643 Long term care facility KS 501(c)(3) 9 Promise Regional Medical Center Hutchinson Inc Promise Regional Medical Center Hutchinson Foundation 1701 E 23rd Hutchinson KS 67502 480891435 To raise funds to facilitate the accomplishment of the health care mission KS 501(c)(3) 11b Promise Regional Medical Center Hutchinson Inc Hutchinson Health Care Services Inc 803 E 30th Hutchinson KS 67502 480970364 Durable Medical Equipment KS Promise Regional Medical Center Hutchinson Inc C -487767 2181345 1.00000 0 0 0 0 0 0 1 0 1 0 0 0 1 1 1 0 1 1 Horizons Mental Health Center N 130531 Horizons Mental Health Center O 28670 Hutchinson Health Care Services Inc N 109878 Hutchinson Health Care Services Inc M 2789 Hutchinson Health Care Services Inc O 12120 Hospice of Reno County N 169971 Hospice of Reno County O 16108 Living Center Inc N 540697 Living Center Inc O 28156 Living Center Inc I 260681 Main Line Inc N 74178 Main Line Inc M 507 Main Line Inc O 4709 Promise Regional Medical Center Hutchinson Foundation N 48157 Promise Regional Medical Center Hutchinson Foundation M 253 Promise Regional Medical Center Hutchinson Foundation O 88 Main Line Inc R 2000000 Promise Regional Medical Center Hutchinson Foundation R 54972 Hutchinson Health Care Services Inc G 67640 Promise Regional Medical Center Hutchinson Foundation Q 305738