2014-04-25T11:08:18-05:00 2013-06-30 481026809 Wendling Noe Nelson & Johnson LLC 534 S Kansas Ave Suite 1500 Topeka KS 666033491 990 2012-07-01 480799105 McPherson Hospital Inc MCPH 6202412250 1000 Hospital Drive McPherson KS 674602326 Robert Monical 6202412250 2014-04-18 1 Heather R Eichem P01515553 7852334226 2014-04-18 2012 2015-11-30 17:44:51Z Robert Monical 1000 Hospital Drive McPherson KS 674602326 23283468 0 X N/A X 1972 KS Provision of acute hospital care to patients regardless of ability to pay. 12 11 355 128 0 0 886482 1201310 21497245 21394702 150042 250870 552941 420751 23086710 23267633 0 16500 0 0 12938719 12233959 0 0 0 10280618 11160253 23219337 23410712 -132627 -143079 21172672 20333449 3412831 2665043 17759841 17668406 To meet our community's need by providing superior health care and exceptional service for each person, every time. 0 0 19929249 16500 21438895 Provision of inpatient and outpatient hospital services. 19929249 1 1 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 0 0 0 0 0 0 0 0 0 1 1 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 38 0 1 355 1 0 0 0 0 0 0 0 0 0 0 X 12 11 0 1 0 0 1 1 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X Robert Monical President CEO 6202412250 1000 Hospital Drive McPherson KS 674602326 Dean Elliott 2.00 X 0 0 0 J David Ferrell 2.00 X 0 0 0 Bill Glazner 2.00 X X 0 0 0 Tim R Karstetter 2.00 X 0 0 0 Marsha Silver 2.00 X X 0 0 0 Paul Taliaferro 2.00 X X 0 0 0 Brent Wall 2.00 X 0 0 0 Samuel Claassen 40.00 X 205431 0 31240 Wade Gaeddert MD 2.00 X 0 0 0 Joan Reichenberger 2.00 X 0 0 0 Hope VonBorkenhagen 2.00 X 0 0 0 Shelley Overholt MD 2.00 X 0 0 0 Rob Monical 40.00 X X 0 0 0 George Halama 40.00 X 0 0 0 Tyler G Hughes MD 40.00 X 317249 0 32504 John Worden 40.00 X 131717 0 19422 Mary Blankenship 40.00 X 108626 0 17844 Clayton Fetsch 40.00 X 273184 0 35774 Robert Geiser 40.00 X 109595 0 10650 1145802 0 147434 7 0 1 0 Via Christi Health Inc 8200 E Thorn Wichita KS 67226 Management fees and CEO & CFO services 1584199 EMSC LLC 3521 Bayview Ct Wichita KS 67204 ER physician coverage 905674 Rehabvisions 11623 Arbor St Omaha NE 68144 Physical/occupational therapy 338487 Trimedx LLC 5451 Lakeview Parkway S Dr Indianapolis IN 46268 Clinical equipment servicer 241735 Shared Medical Services PO Box 330 Cotton Grove WI 53527 Mobile MRI services 180245 6 701592 499718 1201310 Patient Service Revenue 900099 20144616 20144616 EHR incentive payment 900099 1250000 1250000 Lab Services 621500 86 86 21394702 74558 74558 65300 0 65300 65300 65300 187647 4500 0 15835 187647 -11335 176312 176312 Nonpatient Meals 722210 190468 190468 Auxiliary 900099 71455 71455 Fitness Center 713940 49335 49335 44193 44193 355451 23267633 21438895 0 627428 16500 16500 238513 238513 10066587 9015051 1051536 256993 229648 27345 914928 819193 95735 756938 679469 77469 1020251 495000 525251 18050 18050 358929 5480 353449 33016 33016 169782 126125 43657 591374 443530 147844 453583 337874 115709 48872 35915 12957 21074 7467 13607 36974 27542 9432 1520003 1132250 387753 222345 71043 151302 Physician fees 2850521 2774380 76141 Medical supplies 1343954 1343954 Equipment rental & main 969050 923533 45517 Pharmacy supplies 596605 596605 905870 610177 295693 23410712 19929249 3481463 0 496 2154 4840676 2787562 3402133 4529288 582942 555742 168643 215549 28857523 20882592 8575150 7974931 2291513 2440002 497 1310622 1828221 21172672 20333449 2277831 2102174 1135000 440000 0 122869 3412831 2665043 X 16220594 16188012 673275 574478 865972 905916 17759841 17668406 21172672 20333449 X -143079 -95126 146770 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 957909 41166 149077 -82660 1065492 1001082 12198 19182 -74239 -314 957909 853047 47383 125329 -24677 1001082 513503 300373 43365 -4194 853047 432740 176152 -89424 -2647 -2318 513503 0.10800 0.74980 0.14220 1 1 1 16312 16312 14714470 10534301 4180169 12728875 9271232 3457643 1397866 1077059 320807 7974931 Other receivables 195527 Unamortized bond costs 625 Beneficial interest in net assets of the Foundation 1198039 Goodwill 32577 Estimated third-party payor settlements 401453 1828221 Estimated third-party payor settlements 122869 122869 X 23319277 -95126 146770 51644 23267633 0 23267633 23410712 0 23410712 0 23410712 Description of Intended Use of Endowment Funds: Part V, Line 4: Donor restricted and board designated funds for special projects and operating purposes. Description of Uncertain Tax Positions Under FIN 48: Part X, Line 2: Management is not aware of any uncertainties in income tax positions. Part XI, Line 2d - Other Adjustments: Change in beneficial interest in net assets of the Foundation 146,770. 1 1 1 X 1 X 1 1 1 0 0 423442 108852 314590 0.01340 2133865 893678 1240187 0.05300 2557307 1002530 1554777 0.06640 1425 1425 0.00010 84636 72638 11998 0.00050 7167472 5363774 1803698 0.07700 6276 6276 0.00030 7259809 5436412 1823397 0.07790 9817116 6438942 3378174 0.14430 1 925592 0 5150797 4771302 379495 X 1 1 1 1 McPherson Hospital Inc

1000 Hospital Drive McPherson KS 67460

X X X McPherson Hospital Inc 1 1 X X X X X X X 12 1 1 1 X X X X X X X 0 0 1 1 200.000000000000 1 200.000000000000 1 X X X X 1 1 X X X X X X 1 0 X X X X 1 X 0 0 Part III, Line 4: See Note 3A (page 7) of the audited financial statements regarding the allowance for uncollectible accounts. Part III, Line 8: Amounts were obtained from the cost report filed with Medicare for the period ending June 30, 2013. 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 III, Line 3: McPherson 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 cannot be substantiated, McPherson Hospital Inc. has chosen to report zero dollars as bad debt expense attributable to charity care patients. Part III, Line 2: The Hospital's bad debt at cost was determined by applying an overall ratio of cost to charges. McPherson Hospital, Inc. Part V, Section B, Line 3: The assessment was achieved through the co-leadership of the director of the McPherson County Health Department. The McPherson County CHNA process included gathering opinions from local sources and quantitative data from secondary sources. A survey instrument was developed by the leadership of the participating hospitals and the public health department. The survey was distributed to individuals throughout the county, representing a broad spectrum of the population and their interests and professional and community endeavors. Included were individuals representing health care, law enforcement, family advocacy, United Way, civic leadership, education, religion, and seniors, among others. A total of 158 surveys were distributed with 106 returned for a 67% return rate. The identified weaknesses through the survey results were reviewed and prioritized by a workgroup comprised of a cross section of survey respondents from throughout the county. This group met to discuss survey results and explore relevant county secondary data from various sources. The workgroup was split into subgroups and asked to rank the top five health issues gleaned from the survey to arrive at a prioritized list. McPherson Hospital, Inc. Part V, Section B, Line 4: The leadership of McPherson Hospital in McPherson, Lindsborg Community Hospital in Lindsborg, Mercy Hospital in Moundridge, and the McPherson County Health Department chose to collaborate in creating the McPherson County CHNA. McPherson Hospital, Inc. Part V, Section B, Line 7: The identified needs not addressed specifically were daily life stressors and substance abuse. It is felt that the broad scope of daily life stressors makes it difficult to target a specific area that would have significant impact. However, the strategies outlined in the CHNA implementation strategy could have a positive effect on daily life stress with proper diet and exercise. Substance abuse was not addressed specifically as it is addressed by other organizations in the community and is not within the scope of available resources to affect meaningfully. Part VI, Line 2: McPherson Hospital, Inc. does not have a formal community needs assessment process, with the exception of the process utilized for the CHNA. 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: McPherson Hospital, Inc.'s primary service area is McPherson, Kansas, a rural community of approximately 13,000. According to the 2010 census, the per capita income for McPherson was $26,467. The percent of families below poverty level was 4.6. The percent of individuals below poverty level was 8.6. For the year ending June 30, 2013, 15 percent of the Hospital's inpatient admissions were Medicaid recipients and 4 percent were uninsured. Larger hospitals in Hutchinson, Salina, and Newton also provide services to the residents of McPherson. The distances between these facilities and McPherson 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: McPherson Hospital, Inc.'s governing body is comprised of individuals who reside in the primary service area. All Board members, with the exception 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. 1 Scholarship awards for local students pursuing education in the health care industry. 18 16500 X X X 0 0 0 0 0 0 0 0 0 Samuel Claassen 205431 0 0 0 0 0 10234 0 21006 0 236671 0 0 0 Tyler G Hughes MD 317249 0 0 0 0 0 12798 0 19706 0 349753 0 0 0 John Worden 131717 0 0 0 0 0 6250 0 13172 0 151139 0 0 0 Clayton Fetsch 273184 0 0 0 0 0 12798 0 22976 0 308958 0 0 0 A City of McPherson Kansas 486019780 582672BQ3 2003-10-28 2315000 Refunding of Series 1998 Bonds 0 0 0 A 1875000 2315000 100000 69725 2145275 1 0 1 1 A 0 0 0 0 0 0 0 A 0 0 0 0 0 0 0 0 0 Form 990, Part VI, Section A, line 3 The Hospital entered into a management agreement with Via Christi Health, Inc. (Via Christi) on January 1, 2011. Under the agreement, Via Christi is responsible for the daily management and administration of the Hospital, including the employment of the CEO and CFO. For the calendar year of 2012, McPherson Hospital reimbursed Via Christi $204,448 for Robert Monical, CEO's salary and benefits and $48,237 for Cindy Brown, CFO's salary and benefits. 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 McPherson 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. Changes in Net Assets or Fund Balances: Form 990, Part XI, line 9: Change in beneficial interest in net assets of Foundation 146,770. Review of financial statements FORM 990 PART XI, LINE 2C: The Finance Committee reviews the audit prior to submitting to the Board. MACCO Healthcare Inc 1000 Hospital Drive McPherson KS 67460 481059194 Sole Member of McPherson Hopsital, Inc. and McPherson Healthcare Fdn, Inc. KS 501(c)(3) 170(b)(1) (A)(vi) 0 McPherson Healthcare Foundation Inc 1016 N Main McPherson KS 67460 481043952 Raise funds to support the operation of McPherson Hopsital, Inc. KS 501(c)(3) 170(b)(1) (A)(vi) 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 McPherson Healthcare Foundation Inc C 59390