2011-05-11T15:06:06-05:00 2010-06-30 Wendling Noe Nelson & Johnson LLC 534 S Kansas Ave Suite 1500 Topeka KS 666033491 990 2009-07-01 480799105 Memorial Hospital Inc MEMO 6202412250 1000 Hospital Drive McPherson KS 674602326 James R Chromik 6202412250 2011-05-10 1 Gary D Knoll 7852334226 2011-05-10 2009 2016-02-24 21:20:13Z James R Chromik 1000 Hospital Drive McPherson KS 674602326 25444942 0 X N/A X 1972 KS Provision of acute hospital care to patients regardless of ability to pay. 13 11 380 117 0 0 860902 861733 24975196 23936245 59344 61650 508238 579293 26403680 25438921 0 0 13149246 13013155 0 0 12760110 12263164 25909356 25276319 494324 162602 21960447 21832703 4498300 3907510 17462147 17925193 To meet our community's need by providing superior health care and exceptional service for each person, every time. 0 0 22690457 24025801 Provision of inpatient and outpatient hospital services. 22690457 1 1 0 0 0 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 1 0 0 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0 1 65 0 1 380 1 0 0 0 0 0 0 0 0 0 13 11 0 0 1 0 1 1 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X Cindy L Brown VP of FinanceCFO 6202412250 1000 Hospital Drive McPherson KS 674602326 Dean Elliott 2.00 X 0 0 0 J David Ferrell 2.00 X 0 0 0 Clay Fetsch MD 40.00 X X 263986 0 28708 Bill Glazner 2.00 X 0 0 0 Dennis C Houghton 2.00 X X 0 0 0 Tim R Karstetter 2.00 X 0 0 0 Dawn Loving 2.00 X 0 0 0 Marsha Silver 2.00 X X 0 0 0 Paul Taliaferro 2.00 X 0 0 0 Brent Wall 2.00 X X 0 0 0 James R Chromik 40.00 X X 166336 0 18570 David Buller MD 2.00 X 0 0 0 James Prescott M D 2.00 X 0 0 0 Cindy Brown 40.00 X 101895 0 17797 Teresa Gehring 40.00 X 81221 0 19260 Jill Wenger 40.00 X 84297 0 19528 Patricia Goad 40.00 X 85443 0 8445 Tyler G Hughes MD 40.00 X 351471 0 29084 Samuel Claassen 40.00 X 159797 0 23436 John Worden 40.00 X 123720 0 15930 Mary Blankenship 40.00 X 106472 0 15092 1524638 0 195850 7 0 1 0 EMSC LLC 1985 Cougar Trail McPherson KS 67460 ER physician coverage 1294632 Contemporary Anesthesia Services 1436 N High Dr McPherson KS 67460 Anesthesia services 878288 National Therapeutic Assoc 11623 Arbor St Omaha NE 68144 Physical/occupational therapy 501745 Shared Medical Services PO Box 330 Cotton Grove WI 53527 Mobile MRI Services 288215 CPSI PO Box 850309 Mobile AL 366850309 Hardware/software/technical support 136337 7 697796 163937 861733 Patient Service Revenu 900099 23929871 23929871 Lab Services 621500 6374 6374 23936245 64476 64476 148362 148362 148362 148362 3195 6021 -2826 -2826 -2826 Nonpatient Meals 722210 211848 211848 Fitness Center 713940 66967 66967 Auxiliary 900099 62560 62560 89556 89556 430931 25438921 24025801 0 551387 907753 291970 615783 10097493 9142942 954551 276035 252212 23823 932277 867322 64955 799597 690980 108617 138069 119116 18953 39517 4800 34717 1223 1223 301788 222666 79122 276026 154054 121972 370597 370597 26515 18777 7738 138209 138209 1355297 1355297 228651 73056 155595 Physician fees 3487448 3319437 168011 Medical supplies 1547996 1538146 9850 Bad debts 1499578 1499578 Pharmacy supplies 843715 843715 Equipment rental & main 725495 706018 19477 1283040 1081565 201475 25276319 22690457 2585862 0 827 879 8052113 7553132 3251075 3525302 550023 538080 275888 329424 25898852 17190876 8930276 8707976 497 497 899748 1177413 21960447 21832703 1424967 1456855 14738 9033 3040000 2430000 18595 11622 4498300 3907510 X 16517800 16679784 418329 439018 526018 806391 17462147 17925193 21960447 21832703 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 8015 0 1261 0 0 -78 9198 10214 -2092 -107 8015 1.00000 1 0 16312 16312 10205530 6295560 3909970 10076599 7178155 2898444 5600411 3717161 1883250 8707976 Other Receivables 7840 Unamortized Bond Costs 19313 Beneficial interest in net assets of McPherson Healthcare Foundation 1009526 Goodwill 52455 Estimated third-party payor settlements 88279 1177413 25438921 25276319 162602 300444 300444 463046 25438303 0 25438303 618 618 25438921 25276319 0 25276319 0 25276319 Part V, Line 4: Description of Intended Use of Endowment Funds: Scholarships Part X: Description of Uncertain Tax Positions Under FIN 48: N/A Part XI, Line 8 - Other Adjustments: Change in beneficial interest in net assets of Foundation: 53919. Restricted investment income: 2595. Assets released for operations: -35987. Change in beneficial interest in net assets of Foundation-Permanent: 280373. Temporarily restricted contributions: 81082. Expenditure of restricted assets: -4900. Assets released for property and equipment: -76638. Part XII, Line 4b - Other Adjustments: Change in assets to be used for operation of medical library: 618. 1 1 1 X 1 X 175.000000000000 1 1 1 0 1 1 221640 75339 146301 0.00620 2065794 1107598 958196 0.04030 2287434 1182937 1104497 0.04650 9049 9049 0.00040 3163187 2692933 470254 0.01980 4016 4016 0.00020 3176252 2692933 483319 0.02040 5463686 3875870 1587816 0.06690 370 370 0.00000 370 370 1 783230 0 4789927 6355237 -1565310 X 1 1 Memorial Hospital Inc

1000 Hospital Drive McPherson KS 67460

X X X 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 3Memorial Hospital, Inc. is unable to determine the amount of bad debt expense attributable to patients eligible under its charity care policy for the year covered by this return. Suggested methods for estimation were either not in place or proved to be unreliable. For example, the number of financial assistance applications distributed but not returned was not tracked. Using demographic data to estimate an amount did not provide reasonable results. Rather than provide an estimate that can't be substantiated, Memorial Hospital Inc. has chosen to report zero dollars as bad debt expense attributable to charity care patients. Part III, Line 8: Amounts were obtained from the cost report filed with Medicare for the period ending June 30, 2010. The total amount of shortfall between Medicare revenue received and relating allowable costs is considered community benefit. Part III, Line 9b: Patients who have qualified for financial assistance are considered qualified for six months. Updated information must be provided for any subsequent account balances. Patients who have qualified for partial financial assistance are to make payment arrangements for any remaining balance according to the policies that apply to other patients. Part VI, Line 2: Memorial Hospital, Inc. does not have a formal community needs assessment process at this time. Part VI, Line 3: All self-pay patients are screened by a contractor for eligibility under federal, state, or local government programs. Notice of the Hospital's financial assistance program is posted in patient registration areas and on the Hospital's website. The availability of financial assistance is also communicated to patients with the first billing statement and at any time during the collection process if an inability to pay is expressed by the patient/guarantor. Part VI, Line 4: Memorial Hospital, Inc.'s primary service area is McPherson, Kansas, a rural community of approximately 14,000. According to the 2000 census, the per capita income for McPherson was $20,152. The percent of families below poverty level was 4.6. The percent of individuals below poverty level was 7.1. For the year ending June 30, 2010, 15 percent of the Hospital's inpatient admissions were Medicaid recipients and 6 percent were uninsured. Larger hospitals in Hutchinson, Salina, and Newton also provide services to the residents of McPherson. The distances between these facilities and Memorial Hospital, Inc. are approximately 23, 29, and 28 miles respectively. There are no federally-designated medically underserved areas or populations in McPherson. Part VI, Line 5: The community building activities promote the health of McPherson by developing community responses for potential disasters and by servicing the needy of the community through participation in the United Way. Part VI, Line 6: Memorial Hospital, Inc.'s governing body is comprised of individuals who reside in the primary service area. All Board members, with the excepiton of the CEO and one physician, are not employed by the Hospital. Annually, all trustees sign a conflict of interest statement and disclose any potential conflicts of interest. With limited exceptions for hospital-based services, the Hospital extends medical staff privileges to all qualified physicians in the community. Surplus funds are used by the Hospital to update facilities and equipment, recruit needed physicians and staff, and otherwise improve patient care. X X X 0 0 0 0 0 0 0 0 0 Clay Fetsch MD 263986 0 0 0 0 0 12188 0 16520 0 292694 0 134351 0 James R Chromik 166336 0 0 0 0 0 4895 0 13675 0 184906 0 81245 0 Tyler G Hughes MD 351471 0 0 0 0 0 12564 0 16520 0 380555 0 175736 0 Samuel Claassen 159797 0 0 0 0 0 6916 0 16520 0 183233 0 79956 0 City of McPherson Kansas 486019780 582672BQ3 2003-10-28 2315000 Refunding of Series 1998 Bonds 0 0 2315000 150000 69725 2003 1 0 1 1 0 0 0 0 0 0 Cindy Brown-VP of FinanceCFO Spousal Relationship Employee 0 Ronald Brown RN BSN-Staff Nurse Spousal Relationship Employee 0 Form 990, Part VI, Section A, line 4 The organization's bylaws were updated in the fiscal year ending June 30, 2010. Form 990, Part VI, Section A, line 6 Organization's sole member is MACCO Healthcare, Inc. Form 990, Part VI, Section A, line 7a MACCO Healthcare, Inc. approves members of the governing body of the organization (Memorial Hospital, Inc.). Form 990, Part VI, Section B, line 11 A copy of the Form 990 is provided to members of the organization's Finance Committee with an opportunity to comment or ask questions prior to filing. Form 990, Part VI, Section B, line 12c The conflict of interest policy is reviewed annually by the governing body. Updated individual disclosure forms are also required annually. Form 990, Part VI, Section B, line 15 Organization participates annually in salary surveys sponsored by the State Hospital Association and uses MGMA and other national references in establishing physician compensation. Terms of employment contracts are approved by the governing body. 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 written request. FORM 990 PART XI, LINE 2C: Review of financial statements The Finance Committee reviews the audit prior to submitting to the Board. Schedule K, Part I Bond Issues: Bond (a) Issuer Name: City of McPherson, Kansas (f) Description of Purpose: Refunding of Series 1998 Bonds (8) Reporting period for the bond information is July 1, 2009 through June 30, 2010. MACCO Healthcare Inc 1000 Hospital Drive McPherson KS 67460 481059194 Sole Member of Memorial Hopsital, Inc. and McPherson Healthcare FDN, Inc. KS 501(c)(3) 170(b)(1) (A)(vi) McPherson Healthcare Foundation Inc 1016 N Main McPherson KS 67460 481043952 Raise Funds to support the operation of Memorial Hopsital, Inc. KS 501(c)(3) 170(b)(1) (A)(vi) 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 McPherson Healthcare Foundation Inc C 48717 McPherson Healthcare Foundation Inc O 18580