2011-03-15T09:11:29-05:00 2010-04-30 BKD LLP 1551 N WATERFRONT PKWY STE 300 WICHITA KS 672066601 990 2009-05-01 480761700 NINNESCAH VALLEY HEALTH SYSTEMS INC NINN 6205323147 PO BOX 367 KINGMAN KS 67068 KENT HUDSON 2011-03-15 true 3162652811 2009 2016-02-24 21:20:13Z KENT HUDSON PO BOX 367 KINGMAN KS 67068 10419282 false X WWW.NVHSINC.COM X 1996 KS ACUTE CARE HOSPITAL ORGANIZED TO MEET THE PRIMARY HEALTH CARE NEEDS OF THE PEOPLE OF KINGMAN COUNTY AND THE SURROUNDING COMMUNITIES. 7 7 180 38 4200 58924 28793 9897049 10189128 55948 36848 307716 164513 10319637 10419282 3513 1041 0 0 5266271 5486103 0 0 0 4728419 4926275 9998203 10413419 321434 5863 10024426 9401767 5651667 5027840 4372759 4373927 ACUTE CARE HOSPITAL ORGANIZED TO MEET THE PRIMARY HEALTH CARE NEEDS OF THE PEOPLE OF KINGMAN COUNTY AND THE SURROUNDING COMMUNITIES. false false 8802648 1041 10232146 HEALTH CARE SERVICES PROVIDED TO THE PEOPLE OF KINGMAN COUNTY AND THE SURROUNDING COMMUNITIES. 8802648 true true false true false false false false false true true false false false false false false false false false true false false false true false false false false false false false false false false false false false false false true false false false true 27 0 true 180 true true true false false false false false false false false 7 7 false false false false false false false true true false true true true true true true true true true true false KS X KENT HUDSON 6205323147 750 WEST D KINGMAN KS 67068 BILL KLAVER 1.0 X X 0 0 0 DEB DURR 1.0 X X 0 0 0 BOB WUNSCH 1.0 X X 0 0 0 TIGER CRAIG 1.0 X 0 0 0 PATTI BRACE 1.0 X 0 0 0 ROB DEWEESE 1.0 X 0 0 0 GEORGE BURKET 1.0 X X 0 0 0 KENT HUDSON 40.0 X 59356 0 3421 GARY TILLER 40.0 X 125891 0 12508 185247 0 15929 1 false false false MARSHA STINEMAN CRNA 557 PARKWAY PRATT KS 67134 ANESTHESIA - CRNA 103800 1 18866 9927 28793 NET PATIENT SERVICE REVENUE 621400 10053814 10053814 OTHER OPERATING REVENUE 541200 135314 131114 4200 10189128 35548 35548 0 0 105567 105567 105567 105567 1300 1300 1300 1300 0 0 0 AUXILIARY 900099 15928 15928 MEALS 900099 43018 43018 58946 10419282 10227946 4200 158343 0 1041 1041 0 0 201167 201167 0 4561727 3915568 646159 59477 50271 9206 299317 252988 46329 364415 308010 56405 0 27603 27603 39152 39152 0 0 0 1056959 924216 132743 8086 8086 1639545 1538116 101429 0 0 174238 149199 25039 87909 28267 59642 0 0 171547 143376 28171 0 501215 423636 77579 53348 11815 41533 BAD DEBTS 538408 538408 REPAIRS & MAINTENANCE 510881 443838 67043 DUES & SUBSCRIPTIONS 33584 12753 20831 MISCELLANEOUS 83800 61146 22654 10413419 8802648 1610771 0 28657 21638 1546198 2007370 1419598 1541231 161814 184470 225435 221127 103294 117472 10638394 5849764 4466991 4788630 2072439 519829 10024426 9401767 581907 795230 94065 76700 3640000 3465000 249300 241702 1086395 449208 5651667 5027840 X 4212573 4202532 160186 171395 4372759 4373927 10024426 9401767 X false true true X false X false false false RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false true 2582 false false false 2582 false 74923 74923 4888610 1777608 3111002 5444391 3990046 1454345 230470 82110 148360 4788630 DEFERRED DEBT ISSUANCE COSTS 125259 DUE FROM MEDICARE 0 INVESTMENT IN FOUNDATION 107639 INVESTMENT IN AUXILIARY 63756 ASSETS LIMITED AS TO USE 223175 519829 0 CAPITAL LEASE OBLIGATIONS 449208 CONSTRUCTION PAYABLE 0 449208 10419282 10413419 5863 -4695 -4695 1168 10419282 10419282 10419282 10413419 10413419 10413419 FIN 48 SCHEDULE D, PART X, LINE 2 MANAGEMENT HAS EVALUATED THEIR INCOME TAX POSITIONS UNDER THE GUIDANCE INCLUDED IN ASC 740. BASED ON THEIR REVIEW, MANAGEMENT HAS NOT IDENTIFIED ANY MATERIAL UNCERTAIN TAX POSITIONS TO BE RECORDED OR DISCLOSED IN THE FINANCIAL STATEMENTS. RECONCILIATION OF CHANGE IN NET ASSETS SCHEDULE D, PART XI, LINE 8 CHANGE IN INTEREST IN NET ASSETS OF FOUNDATION -$4,695 true true true X true X true true true false true false 34697 34697 0.00330 406605 216270 190335 0.01830 441302 216270 225032 0.02160 46265 21031 25234 0.00240 46265 21031 25234 0.00240 487567 237301 250266 0.02400 true 267984 133992 4782450 3737068 1045382 true true KINGMAN COMMUNITY HOSPITAL

750 WEST D AVENUE KINGMAN KS 67068

X X X N/A N/A THE COSTING METHODOLOGY USED TO CALCULATE THE AMOUNTS CONTAINED IN THE SCHEDULE H, PART I, LINE 7 TABLE IS A COST TO CHARGE RATIO. N/A THE AMOUNT OF BAD DEBT EXPENSE REMOVED FROM TOTAL EXPENSES FOR CALCULATING THE NET COMMUNITY BENEFIT EXPENSE PERCENTAGE WAS $538,408. THE SYSTEM REPORTS PATIENT ACCOUNTS RECEIVABLE FOR SERVICES RENDERED AT NET REALIZABLE AMOUNTS FROM THIRD-PARTY PAYERS, PATIENTS AND OTHERS. THE SYSTEM PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS BASED UPON A REVIEW OF OUTSTANDING RECEIVABLES, HISTORICAL COLLECTION INFORMATION AND EXISTING ECONOMIC CONDITIONS. AS A SERVICE TO THE PATIENT, THE SYSTEM BILLS THIRD-PARTY PAYERS DIRECTLY AND BILLS THE PATIENT WHEN THE PATIENT'S LIABILITY IS DETERMINED. PATIENT ACCOUNTS RECEIVABLE ARE DUE IN FULL WHEN BILLED. ACCOUNTS ARE CONSIDERED DELINQUENT AND SUBSEQUENTLY WRITTEN OFF AS BAD DEBTS BASED ON INDIVIDUAL CREDIT EVALUATION AND SPECIFIC CIRCUMSTANCES OF THE ACCOUNT. A COST TO CHARGE RATIO IS USED TO DETERMINE AMOUNTS OF BAD DEBT AT COST AND BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS UNDER THE CHARITY CARE POLICY. THE COST TO CHARGE RATIO IS MULTIPLIED BY THE CHARGES IN BAD DEBT AND/OR AMOUNTS IN CHARITY CARE. THE SYSTEM USES MEDICARE COST REPORT METHODOLOGY, WHICH APPORTIONS ROUTINE COSTS (ROOM AND BOARD) BASED ON MEDICAID OR MEDICAID DAYS TO TOTAL DAYS AND APPORTIONS ANCILLARY COSTS BASED ON PROGRAM CHARGES TO TOTAL CHARGES. WHEN A PATIENT HAS INDICATED OR DEMONSTRATED AN INABILITY TO PAY, AN APPROPRIATE HOSPITAL REPRESENTATIVE WILL PROVIDE THE PATIENT WITH A CHARITY CARE APPLICATION. THE HOSPITAL REPRESENTATIVE WILL PROVIDE ASSISTANCE IN COMPLETING THE APPLICATION TO HELP ENSURE THE APPLICATION IS COMPLETE AND INCLUDES ALL REQUIRED DOCUMENTATION. APPLICATIONS MUST BE COMPLETE IN THEIR ENTIRETY BEFORE CHARITY CARE CAN BE CONSIDERED. THOSE PATIENTS WHO MAY QUALIFY FOR FINANCIAL ASSISTANCE FROM A GOVERNMENTAL PROGRAM (I.E. MEDICAID) SHOULD BE REFERRED TO THE APPROPRIATE AGENCY PRIOR TO CONSIDERATION FOR CHARITY CARE. AN APPLICATION FOR FINANCIAL ASSISTANCE FROM AN OUTSIDE AGENCY SHOULD BE OBTAINED PRIOR TO CHARITY CARE APPROVAL. THE HOSPITAL DETERMINES THE NEEDS OF THE COMMUNITY IN VARIOUS WAYS. ONE WAY NEEDS ARE DETERMINED IS BY THE HOSPITAL STAFF REVIEWING STATISTICAL DATA FROM SOURCES SUCH AS KANSAS STATE UNIVERSITY, KANSAS HOSPITAL ASSOCIATION, CENSUS INFORMATION, AND KDHE. FROM THIS DATA THE ADMINISTRATION OF THE HOSPITAL CAN HAVE A BETTER UNDERSTANDING OF THE LOCAL POPULATION. ANOTHER WAY THE NEEDS ARE DETERMINED IS BY HOSPITAL STAFF JOINING AND PARTICIPATING IN LOCAL ORGANIZATIONS SUCH AS ROTARY CLUB, LIONS CLUB, LOCAL CHURCHES, AND OTHER COMMUNITY ORGANIZATIONS. FROM INVOLVEMENT IN THESE GROUPS, HOSPITAL STAFF CAN GATHER INFORMATION ON COMMUNITY NEEDS WHICH CAN BE PROVIDED BY THE HOSPITAL. IN ADDITION, HOSPITAL STAFF AND ADMINISTRATION IS OPEN AND AVAILABLE TO VISIT WITH ALL COMMUNITY MEMBERS AND GROUPS WITH CONCERNS. FOR INSTANCE, RECENTLY A LOCAL GROUP OF CITIZENS WAS TRYING TO ORGANIZE A FREE CLINIC TO BE OPEN ON WEEKENDS. THE HOSPITAL'S STAFF OFFERED ITS EXPERTISE IN HELPING SET UP THE CLINIC, AS WELL AS DONATING EQUIPMENT TO THE CLINIC AND LAB/RADIOLOGY SERVICES TO PATIENTS IN NEED. THE HOSPITAL POSTS SIGNS ABOUT THE AVAILABILITY OF THE CHARITY CARE PROGRAM IN THE HOSPITAL. ALL THE LOCAL PHYSICIANS KNOW ABOUT THE HOSPITAL'S CHARITY CARE PROGRAM SO THAT IF A PATIENT NEEDS SERVICES THEY CAN INFORM THE PATIENT ABOUT IT. THE HOSPITAL HAS A STAND WITH BROCHURES ON THE CHARITY CARE PROGRAM AS WELL AS BROCHURES ON OTHER PROGRAMS SUCH AS MEDICAID, CHILDREN'S MERCY, AND UNICARE. THE HOSPITAL EMPLOYS A PATIENT ADVOCATE WHO WILL HELP PATIENTS COMPLETE THE CHARITY CARE PROCESS AND ANSWER ANY QUESTIONS ABOUT THE PROGRAM. THIS EMPLOYEE WILL ALSO HELP PATIENTS WITH MEDICAID APPLICATIONS IF IT IS DETERMINED THAT THE PATIENT MIGHT QUALIFY FOR THIS PROGRAM. THE HOSPITAL IS LOCATED IN A RURAL COMMUNITY IN KINGMAN COUNTY, WHICH IS IN SOUTH CENTRAL KANSAS. KINGMAN COUNTY HAS APPROXIMATELY 7,800 RESIDENTS WITH APPROXIMATELY 11% OF THE POPULATION FALLING UNDER THE POVERTY GUIDELINES, AND 20% BEING OVER THE AGE OF 65. THE HOSPITAL IS THE ONLY HOSPITAL LOCATED IN THE COUNTY, WITH THE NEXT CLOSEST HOSPITAL BEING OVER 20 MILES AWAY. N/A THE HOSPITAL FURTHERS ITS EXEMPT PURPOSE BY PROMOTING THE HEALTH OF THE COMMUNITY IN SEVERAL WAYS. THE HOSPITAL EXTENDS MEDICAL STAFF PRIVILEDGES TO ALL QUALIFIED PHYSICIANS IN THE COMMUNITY. THE HOSPITAL ALSO RECRUITS AND PROVIDES SPACE TO SPECIALISTS SO THEY CAN CONDUCT CLINICS AND PROVIDE SERVICES FOR PATIENTS IN THE COMMUNITY. THE HOSPITAL ALSO PROVIDES FREE FLU SHOTS TO THE COMMUNITY AS WELL AS OFFERING FREE CLINICS AND SCREENINGS THROUGHOUT THE YEAR. N/A KINGMAN COUNTY KANSAS PUBLIC BUILDING COMMISSION 486004151 000495739 2008-07-15 3900000 KINGMAN COUNTY KS PUBLIC BLDG false false 3900000 165997 2272000 0 145852 0 1316151 2009 true false true true false false false false false 0.00000 0.00000 0.00000 true false false false false false false POLICIES FORM 990, PART VI, SECTION B LINE 11B THE BOARD OF DIRECTORS IS PROVIDED WITH AN ELECTRONIC COPY OF THE FORM 990 BEFORE IT IS FILED WITH THE IRS. LINE 12C BOARD MEMBERS AND OFFICERS AT THE TIME OF HIRE AND ANNUALLY THEREAFTER ARE REMINDED OF THE CONFLICT OF INTEREST GUIDELINES COVERED IN THE CORPORATION'S GOVERNING BODY BY-LAWS AND ARE ASKED TO SIGN A CONFLICT OF INTEREST STATEMENT. ANY CONFLICT OF INTEREST MUST BE DISCLOSED TO THE BOARD AND/OR CEO. ANY MEMBER WITH A CONFLICT OF INTEREST SHALL ABSENT THEMSELVES FROM THE DISCUSSION OF THE ISSUE BEFORE THE BOARD AND MUST ABSTAIN FROM VOTING ON ANY ISSUE IN WHICH THEY HAVE A CONFLICT. LINE 15A/B ALL RAISES ARE APPROVED BY THE BOARD OF DIRECTORS. EVERY THREE TO FIVE YEARS SALARIES AND WAGES ARE COMPARED TO THE KANSAS HOSPITAL ASSOCIATION'S SALARY AND WAGE SURVEY FOR REASONABLENESS. IN THIS CIRCUMSTANCE THE BOARD DESIGNATES THE HUMAN RESOURCE DIRECTOR TO REVIEW THE SURVEY AND MAKE ANY ADJUSTMENTS NECESSARY. FOR THE YEARS WHEN THE SURVEY IS NOT USED, THE BOARD OF DIRECTORS APPROVES AN ACROSS THE PAY SCALE WAGE INCREASE OF A CERTAIN PERCENTAGE. ALL EMPLOYEES RECEIVE THE SAME PERCENTAGE INCREASE APPROVED BY THE BOARD. ALL FULL-TIME EMPLOYEES RECEIVE THE SAME EMPLOYEE BENEFIT PACKAGE. DISCLOSURE FORM 990, PART VI, SECTION C LINE 19 THE ORGANIZATION DOES NOT MAKE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY OR FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC. 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