2011-11-04T10:21:22-05:00 2010-12-31 Wendling Noe Nelson & Johnson LLC 534 S Kansas Ave Suite 1500 Topeka KS 666033491 990 2010-01-01 486005089 William Newton Memorial Hospital WILL 6202212300 1300 E 5th Avenue Winfield KS 67156 Danny Huckvale 6202212300 2011-11-01 1 Eric L Otting 7852334226 2011-11-01 2010 2016-03-07 17:11:31Z Danny Huckvale 1300 E 5th Avenue Winfield KS 67156 25995387 0 X www.wnmh.org X 1927 KS Provide healthcare services to local area residents 5 5 346 70 0 0 978142 511327 25897898 25022237 45636 34307 0 427516 26921676 25995387 0 0 0 0 13513580 13179630 0 0 20131 12426092 11763958 25939672 24943588 982004 1051799 24478791 24002971 11191419 9663800 13287372 14339171 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 20700826 51653 25209992 Patient services, full range of inpatient and outpatient services. 20700826 1 1 0 0 0 0 0 0 0 1 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 60 0 1 346 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 Richard Vaught 6202212300 1300 E 5th Avenue Winfield KS 67156 Don Drennan 1.00 X 0 0 0 Jane Duncan 1.00 X 0 0 0 Dorothy Flottman 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 150407 0 9181 Danny Huckvale 40.00 X 101327 0 6684 Thomas Embers 40.00 X 104684 0 6433 James McDermott 40.00 X 249084 0 15322 Kelle Thompson 40.00 X 102709 0 6514 Robert Matthews 40.00 X 98894 0 6292 708211 0 44134 5 0 1 0 Acute Care Inc 1609 N Ankeny Blvd Suite 200 Ankeny IA 50023 ER Physicians 663125 GE Medical Systems PO Box 641419 Dallas TX 75284 Equipment Service Contract 560415 VIA Christi Financial Services 929 North St Francis Wichita KS 67214 Radiation Contract 513000 CPSI PO Box 850309 Mobile AL 36685 Computer Support Services 259459 Andreas Law Firm 104 1/2 West 9th Suite 303 Winfield KS 67156 Legal Fees 194927 10 459674 51653 511327 Patient services reven 621990 24643447 24643447 Occupational Health 900099 292941 292941 Pharmacy 446110 85849 85849 25022237 33957 33957 164321 164321 164321 164321 350 350 350 350 Miscellaneous 900099 187755 187755 Cafeteria and dietary 722210 51850 51850 Meals on wheels 624210 23590 23590 263195 25995387 25209992 0 274068 389095 389095 10326752 8229390 2081682 15680 666775 530466 136309 930712 719282 208294 3136 866296 690352 174629 1315 38294 38294 239546 44867 194679 487166 487166 19400 19400 719668 719668 1809408 1809408 151638 151638 Purchased Services 2339591 2103752 235839 Medical Supplies 2264675 2264675 Collection Fees and Bad 1293413 1293413 Repairs and Maintenance 835864 577046 258818 Pharmacy Drugs 695749 695749 869546 516192 353354 24943588 20700826 4222631 20131 127580 110286 3901898 4650015 3871612 4364179 372637 311803 134158 230444 31755034 18394314 14883515 13360720 1187391 975524 24478791 24002971 1660631 1592822 9480788 8070978 50000 11191419 9663800 X 7884645 9049429 5402727 5289742 13287372 14339171 24478791 24002971 1051799 0 X X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 101702 101702 20066451 10824871 9241580 11299468 7357080 3942388 287413 212363 75050 13360720 25995387 24943588 1051799 0 1051799 24981095 0 24981095 1014292 1014292 25995387 23929296 0 23929296 1014292 1014292 24943588 Part XII, Line 4b - Other Adjustments: Reclassification of bad debts 1,014,292. Part XIII, Line 4b - Other Adjustments: Reclassification of bad debts 1,014,292. 1 1 1 X 120.000000000000 1 X 1 1 0 0 195369 136899 58470 0.00240 1947895 1667818 280077 0.01170 2143264 1804717 338547 0.01410 233698 233698 0.00980 204454 1771 202683 0.00850 2382971 1036695 1346276 0.05630 350 350 0.00000 2821473 1038466 1783007 0.07460 4964737 2843183 2121554 0.08870 1 273187 42890 9271305 9383775 -112470 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 1 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 $ 1014292. 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 2Provisions 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 3Provisions for bad debts attributable to patients eligible under the organization's financial assistance policy were determined using an estimation of 15.7% of total bad debts. The US Census Bureau reports the persons below the federal poverty level in 2009 for Cowley County was 15.7%. 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 2010 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 is gathered and assessed in order 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 the consideration for charity care. William Newton Memorial Hospital Part V, Section B, Line 15e: William Newton Memorial Hospital is permitted to 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. William Newton Memorial Hospital Part V, Section B, Line 21: Under the Provision for Charity Care Policy, William Newton Memorial Hospital determines discount eligibility based on a patient's family income level in comparison with the Federal Poverty Guideline gross income level. If it is determined that a patient's family income is greater than 200% of the Federal Poverty Guideline gross income level, then the patient is not considered eligible to receive a discount on the medical services received and will be billed the gross amount for those services. It is the purpose of the Hospital to provide quality health care at the lowest possible cost to the patient. Part VI, Line 2: The Hospital currently does not conduct a community needs assessment. Part VI, Line 3: William Newton Memorial Hospital educates patients 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. 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 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. Those 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. Any patient who asks about assistance will be referred to the credit/collections manager for complete explanation of options. Part VI, Line 4: The hospital mainly serves 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 2010 population of Cowley County, Kansas to be 36,311. 14.2% of the population is 65 years of age or older, median household income is $38,100, and 15.7% of the population is below poverty level compared to the State of Kansas average of 13.2%. 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 norteast side. According to the 2010 US Census Bureau, Elk County's populations was 2,882. 23.8% of the population is 65 years of age or older, median household income is $31,233, and 19.3% of the population is below poverty level. According to the 2010 US Census Bureau, Chautauque County's populations was 3,669. 24.2% of the population is 65 years of age or older, median household income is $34,874, and 15.8% of the population is below poverty level. Part VI, Line 6: The administration of William Newton Hospital has accomplished extensive physician recruitment for the greater good of the broader community, and has been sucessful in recruiting physicians and physician assistants over the years. Ongoing recruitment is vital for the health of the community. The recruitment expense for 2010 was approximately $187,500. Community Health Fair, outreach programs, public education and newsletters are some examples of 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 therof. X X 0 0 0 0 0 0 0 0 0 Richard Vaught 150407 0 0 0 0 0 9181 0 0 0 159588 0 0 0 James McDermott 249084 0 0 0 0 0 15322 0 0 0 264406 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 it 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 459674