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HAYS MEDICAL CENTER INC: Form 990, tax year 2011

View the entire original 990 at ProPublica ↗

Organization
HAYS MEDICAL CENTER INC (EIN 48-0559088)
Tax period
2011-07-01 to 2012-06-30
Filed
2013-05-14
IRS object ID
201301349349305630
Schema version
2011v1.2
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Timestamp2013-05-14T16:10:24-05:00Timestamp
Tax Period End Date2012-06-30TaxPeriodEndDate

Preparer Firm PreparerFirm

FieldValueIRS element (for citing)
EIN481026809EIN

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1Wendling Noe Nelson & Johnson LLCBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1534 S Kansas Ave Suite 1500AddressLine1
CityTopekaCity
StateKSState
ZIP Code666033491ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2011-07-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN480559088EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1Hays Medical Center IncBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlHAYSNameControl
Phone7856235000Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line12220 Canterbury DriveAddressLine1
CityHaysCity
StateKSState
ZIP Code67601ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameJohn Jeter MDName
TitleCEOTitle
Phone7856235000Phone
Date Signed2013-05-14DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameDerek H HartName
PTINP01054116PTIN
Phone7852334226Phone
Date Prepared2013-05-08DatePrepared
FieldValueIRS element (for citing)
Tax Year2011TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonJohn Jeter MDNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line12220 Canterbury DriveAddressLine1
CityHaysCity
StateKSState
ZIP Code67601ZIPCode
FieldValueIRS element (for citing)
Gross Receipts213744977GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web Sitewww.haysmed.comWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1944YearFormation
State Legal DomicileKSStateLegalDomicile
Activity Or Mission DescriptionHays Medical Center is a tax-exempt charitable organization under Section 501(c)(3) of the Internal Revenue Code and is licensed by the State of Kansas Department of Health and Environment. The purpose of the Organization is to provide healthcare facilities and services for the care and treatment of inpatients and outpatients who are acutely ill or who otherwise require medical care and related services. The core purpose of the Organization is to help people be healthy. The Organization is striving to become the best tertiary care center in rural America.ActivityOrMissionDescription
Nbr Voting Members Governing Body15NbrVotingMembersGoverningBody
Nbr Independent Voting Members9NbrIndependentVotingMembers
Total Nbr Employees1656TotalNbrEmployees
Total Nbr Volunteers226TotalNbrVolunteers
Total Gross UBI3686TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year105703ContributionsGrantsPriorYear
Contributions Grants Current Year554519ContributionsGrantsCurrentYear
Program Service Revenue Prior Year189610055ProgramServiceRevenuePriorYear
Program Service Revenue CY209765102ProgramServiceRevenueCY
Investment Income Prior Year3355351InvestmentIncomePriorYear
Investment Income Current Year3283281InvestmentIncomeCurrentYear
Other Revenue Prior Year1162575OtherRevenuePriorYear
Other Revenue Current Year0OtherRevenueCurrentYear
Total Revenue Prior Year194233684TotalRevenuePriorYear
Total Revenue Current Year213602902TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year0GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year88224901SalariesEtcPriorYear
Salaries Etc Current Year97368988SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year96973972OtherExpensePriorYear
Other Expenses Current Year104049045OtherExpensesCurrentYear
Total Expenses Prior Year185198873TotalExpensesPriorYear
Total Expenses Current Year201418033TotalExpensesCurrentYear
Revenues Less Expenses Prior Year9034811RevenuesLessExpensesPriorYear
Revenues Less Expenses CY12184869RevenuesLessExpensesCY
Total Assets BOY242206552TotalAssetsBOY
Total Assets EOY250657314TotalAssetsEOY
Total Liabilities BOY101317411TotalLiabilitiesBOY
Total Liabilities EOY102200013TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY140889141NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY148457301NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionHays Medical Center is a tax-exempt charitable organization under Section 501(c)(3) of the Internal Revenue Code and is licensed by the State of Kansas Department of Health and Environment. The purpose of the Organization is to provide healthcare facilities and services for the care and treatment of inpatients and outpatients who are acutely ill or who otherwise require medical care and related services. The core purpose of the Organization is to help people be healthy. The Organization is striving to become the best tertiary care center in rural America.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense172645196Expense
Revenue198733070Revenue
DescriptionPatient Care Program services consist of routine and ancillary department healthcare services provided by a healthcare organization as defined in Section 501(c)(3) of the IRS code. Admissions: Acute-5,543, Newborn ICU-47, Newborn-686, Senior Focused Care-221, Rehabilitation-199, Total admissions-6,696. Patient days: ICU/CPCU-7,071, Medical/Surgical-14,341, Oncology-1,751, Obstetrics-1,766, Pediatrics-266, Senior Focused Care-2,412, Rehabilitation-2,045, Newborn ICU-369, Newborn-1,266, Total patient days-31,287. Other statistical information: Surgical procedures-8,591, Cardiac caths-1,762, Emergency room visits-13,644, Outpatient procedures-135,799, Medical oncology service visits-8,131, Clinic visits-145,464.Description
Total Program Service Expense172645196TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities0LobbyingActivities
Subject To Proxy Tax0SubjectToProxyTax
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments1TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities1ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets1ReportOtherAssets
Report Other Liabilities1ReportOtherLiabilities
Report Fin48 Footnote1ReportFin48Footnote
Independent Audit Financial Stmt0IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt1ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital1Hospital
Financial Stmt Attached1FinancialStmtAttached
Grants To Organizations0GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds1TaxExemptBonds
Invest Tax Exempt Bonds0InvestTaxExemptBonds
Escrow Account0EscrowAccount
On Behalf Of Issuer0OnBehalfOfIssuer
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member1BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp1OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity1RelatedOrgControlledEntity
Transaction Related Entity1TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With1096142NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees1656NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income1UnrelatedBusinessIncome
Form990-T Filed1Form990-TFiled
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members15NbrVotingGoverningBodyMembers
Number Independent Voting Members9NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs1ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders0MembersOrStockholders
Election Of Board Members0ElectionOfBoardMembers
Decisions Subject To Approval0DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other1CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

FieldValueIRS element (for citing)
Name PersonWilliam Overbey CFONamePerson
Telephone Number7856235000TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line12220 Canterbury DriveAddressLine1
CityHaysCity
StateKSState
ZIP Code67601ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (26 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationOfficerOfficerKey EmployeeKeyEmployeeHighest Compensated EmployeeHighestCompensatedEmployeeFormerFormer
Nancy Curtis
Board Member0.50X000
Dennis Bieker
Secretary0.50X000X
Kenneth Beran
Treasurer0.50X000X
Darrell Werth MD
Physician/Board Member40.00X654495033073
Daniel Schippers
Chair0.50X000X
Tom McDonald MD
Board Member0.50X000
Jim Black DO
Board Member0.50X000
Gary Shorman
Board Member0.50X000
Ross Buckles DO
Physician/Board Member40.00X354055038206
Jayne Clarke
Board Member0.50X000
Sharon Dreher
Board Member0.50X000
Alan Moore
Board Member0.50X000
DG Bickle
Board Member0.50X000
Dr Kurt Rider
Physician/Board Member40.00X243601036538
John Jeter MD
President & CEO40.00X4680210122926X
John Lloyd
Physician/Board Member40.00X461068034573
William Overbey
Chief Financial Officer40.00247271076966X
Bryce Young
Chief Operating Officer40.00243392077470X
Dale Montgomery
VP Facilities40.00161889059210X
D Bruce Whittington
VP Human Resources40.00164904059692X
Christine Fisher
Physician40.00916962038438X
Alex De Carvalho
Physician40.00984091028891X
Jeffery Curtis
Physician40.00759245041438X
Vivek Sharma
Physician40.00774315031573X
Robert Bassett
Physician40.00810784015663X
Kenneth Lindsey
Former Chief Medical Officer40.0012549903705X
FieldValueIRS element (for citing)
Total Reportable Comp From Org7369592TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation698362TotalOtherCompensation
Number Individuals GT100 K104NumberIndividualsGT100K
Formers Listed1FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
Quest Diagnostics Inc
PO Box 14730St LouisMO631504730Lab Services5438681
Sovereign Medical Corporation
1582 Charlton RoadSan MarinoCA91108Pulmonology Services2010743
Inpatient Management Inc
1 McBride and Son Center Dr SuiteChesterfieldMO63005Hospitalists1229902
Health Facilities Group
PO Box 972651DallasTX75397Architect Fees1150322
Anesthesiologist Associates of Hays
PO Box 821HaysKS67601Anesthesia Services772847
FieldValueIRS element (for citing)
Number Of Contractors GT100 K36NumberOfContractorsGT100K
Related Organizations24140RelatedOrganizations
Government Grants523713GovernmentGrants
All Other Contributions6666AllOtherContributions
Total Contributions554519TotalContributions

Program Service Revenue ProgramServiceRevenue (5 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncomeExclusionExclusionAmountUnrelated Business RevenueUnrelatedBusinessRevenue
Net patient service re621990196766585196766585
Shared services9000998729108$8,729,108
Other operating revenu9000992299238$2,299,238
EHR incentive payments900099196648519664850
Nursing mother's resou44619936863686
FieldValueIRS element (for citing)
Total Program Service Revenue209765102TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column3292532TotalRevenueColumn
Exclusion$3,292,532ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Other132824Other

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Other142075Other

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Other-9251Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column-9251TotalRevenueColumn
Exclusion-$9,251ExclusionAmount

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column213602902TotalRevenueColumn
Related Or Exempt Function Income198733070RelatedOrExemptFunctionIncome
Unrelated Business Revenue3686UnrelatedBusinessRevenue
Exclusion$14,311,627ExclusionAmount

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total3629938Total
Program Services1909244ProgramServices
Management And General1720694ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total75254264Total
Program Services64450681ProgramServices
Management And General10803583ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total3018770Total
Program Services2767228ProgramServices
Management And General251542ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total10712851Total
Program Services9152882ProgramServices
Management And General1559969ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total4753165Total
Program Services4017434ProgramServices
Management And General735731ManagementAndGeneral

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total1347172Total
Management And General1347172ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total986991Total
Management And General986991ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total92063Total
Management And General92063ManagementAndGeneral

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total191757Total
Management And General191757ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total22272344Total
Program Services19506531ProgramServices
Management And General2765813ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total456754Total
Program Services23360ProgramServices
Management And General433394ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total562606Total
Program Services424097ProgramServices
Management And General138509ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total1445793Total
Program Services894301ProgramServices
Management And General551492ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total2063751Total
Program Services1628703ProgramServices
Management And General435048ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total325907Total
Program Services235539ProgramServices
Management And General90368ManagementAndGeneral

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total929464Total
Program Services604288ProgramServices
Management And General325176ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total2763661Total
Program Services2763661ProgramServices

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total10327529Total
Program Services8082324ProgramServices
Management And General2245205ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total1219225Total
Program Services998034ProgramServices
Management And General221191ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
Medical Supplies1949263419334495158139
Pharmaceuticals14501093144976663427
Bad debts1293718112937181
Repairs and maintenance39063123430569475743

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total8226808Total
Program Services4986978ProgramServices
Management And General3239830ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total201418033Total
Program Services172645196ProgramServices
Management And General28772837ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY6185BOY
EOY6285EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY5003500BOY
EOY7283364EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY31647122BOY
EOY30875563EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY4191623BOY
EOY4450389EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY3918946BOY
EOY3757425EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis194340201LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec124031786LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY63207348BOY
EOY70308415EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
EOY87193639EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
BOY104984451BOY
EOY16322244EOY

Intangible Assets IntangibleAssets

FieldValueIRS element (for citing)
BOY598000BOY
EOY538200EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY28649377BOY
EOY29921790EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY242206552BOY
EOY250657314EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY20244515BOY
EOY23112767EOY

Deferred Revenue DeferredRevenue

FieldValueIRS element (for citing)
EOY97346EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY80229741BOY
EOY78169536EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY843155BOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY0BOY
EOY820364EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY101317411BOY
EOY102200013EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY133957250BOY
EOY142082350EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY6931891BOY
EOY6374951EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY140889141BOY
EOY148457301EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY242206552BOY
EOY250657314EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses12184869ReconcilationRevenueExpenses
Reconcilation Other Changes-4616709ReconcilationOtherChanges
Info In Schedule O Part XIIXInfoInScheduleOPartXII
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee1AuditCommittee
Financial Statement ConsolidatedXFinancialStatementConsolidated
Federal Grant Audit Required1FederalGrantAuditRequired
Federal Grant Audit Performed1FederalGrantAuditPerformed

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Hospital170b1 AiiiXHospital170b1Aiii

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule D IRS990ScheduleD

Current Year CurrentYear

FieldValueIRS element (for citing)
Beginning Of Year Balance8947679BeginningOfYearBalance
Contributions167515Contributions
Investment Earnings Or Losses427208InvestmentEarningsOrLosses
Other Expenditures61622OtherExpenditures
Administrative Expenses0AdministrativeExpenses
End Of Year Balance9480780EndOfYearBalance

Current Year Minus1 Year CurrentYearMinus1Year

FieldValueIRS element (for citing)
Beginning Of Year Balance8608848BeginningOfYearBalance
Contributions119796Contributions
Investment Earnings Or Losses287574InvestmentEarningsOrLosses
Other Expenditures68539OtherExpenditures
End Of Year Balance8947679EndOfYearBalance

Current Year Minus2 Years CurrentYearMinus2Years

FieldValueIRS element (for citing)
Beginning Of Year Balance8099830BeginningOfYearBalance
Contributions332063Contributions
Investment Earnings Or Losses234201InvestmentEarningsOrLosses
Other Expenditures57246OtherExpenditures
End Of Year Balance8608848EndOfYearBalance

Current Year Minus3 Years CurrentYearMinus3Years

FieldValueIRS element (for citing)
Beginning Of Year Balance7649441BeginningOfYearBalance
Contributions249859Contributions
Investment Earnings Or Losses226379InvestmentEarningsOrLosses
Other Expenditures25849OtherExpenditures
End Of Year Balance8099830EndOfYearBalance
FieldValueIRS element (for citing)
Board Designated EOY Balance0.61800BoardDesignatedEOYBalance
Permanent Endowment EOY Balance0.33700PermanentEndowmentEOYBalance
Term Endowment EOY Balance0.04500TermEndowmentEOYBalance
Endowments Held By Unrelated Orgs0EndowmentsHeldByUnrelatedOrgs
Endowments Held By Related Orgs1EndowmentsHeldByRelatedOrgs
Are Related Orgs Listed Schedule R1AreRelatedOrgsListedScheduleR

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis350356OtherCostOrOtherBasis
Book Value350356BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis58326727OtherCostOrOtherBasis
Depreciation31942920Depreciation
Book Value26383807BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis116517524OtherCostOrOtherBasis
Depreciation87115309Depreciation
Book Value29402215BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis19145594OtherCostOrOtherBasis
Depreciation4973557Depreciation
Book Value14172037BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings70308415TotalOfBookValueLandBuildings

Other Securities OtherSecurities (3 entries)

DescriptionDescriptionBook ValueBookValueMethod Of ValuationMethodOfValuation
Hedge funds8838983F
Private equity funds3613983F
Real estate limited partnership3869278F
FieldValueIRS element (for citing)
Total Of Book Value Securities16322244TotalOfBookValueSecurities

Other Assets OtherAssets (8 entries)

DescriptionDescriptionBook ValueBookValue
Cash whose use is limited by Board or indenture agreement11893689
Interest receivable whose use is limited by Board or indenture agreement235337
Interest in net assets of Hadley Foundation6374951
Other receivables2273238
Debt issue costs952279
Other long-term assets4867671
Third party payor settlements650543
Intercompany receivables2674082
FieldValueIRS element (for citing)
Total Book Value Other Assets29921790TotalBookValueOtherAssets

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
DescriptionEstimated third-party payor settlementsDescription
Amount$820,364Amount
FieldValueIRS element (for citing)
Total Of Amounts820364TotalOfAmounts
Total Revenue213602902TotalRevenue
Total Expenses201418033TotalExpenses
Excess Or Deficit For Year12184869ExcessOrDeficitForYear
Net Unrealized GL On Investments-4059769NetUnrealizedGLOnInvestments
Other-$556,940OtherAmount
Total Adjustments-4616709TotalAdjustments
Excess Or Deficit Per FS7568160ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt200665721TotRevenueEtcAuditedFinclStmt
Revenue Not Rptd F9900RevenueNotRptdF990
Revenue Subtotal200665721RevenueSubtotal
Other Revenues Not Included12937181OtherRevenuesNotIncluded
Revenue Not Rptd On Fin Stmt12937181RevenueNotRptdOnFinStmt
Total Revenue Per Form990213602902TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt188480852TotExpensesEtcAuditedFinclStmt
Expenses Not Rptd F9900ExpensesNotRptdF990
Expenses Subtotal188480852ExpensesSubtotal
Other Expenses Not Included12937181OtherExpensesNotIncluded
Expenses Not Rptd On Fin Stmt12937181ExpensesNotRptdOnFinStmt
Total Expenses Per Form990201418033TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (5 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
Description of Intended Use of Endowment Funds:Part V, Line 4:The endowed funds held by the Hays Medical Center Foundation are used to help meet both the immediate and long range health care needs of patients of Hays Medical Center, Inc. The Hays Medical Center Foundation provides grants and assistance to Hays Medical Center, Inc., for property and equipment acquisitions, education, and community health issues.
Description of Uncertain Tax Positions Under FIN 48:Part X:Management is not aware of any uncertainties in income tax positions.
Part XI, Line 8 - Other Adjustments:Change in beneficial interest in net assets of Hadley Foundation -556,940.
Part XII, Line 4b - Other Adjustments:Bad debt expense treated as a reduction of net patient service revenue
Part XIII, Line 4b - Other Adjustments:Bad debt expense treated as a reduction of net patient service revenue

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Charity Care Policy1CharityCarePolicy
Written Policy1WrittenPolicy
Policy Applied To All HospitalsXPolicyAppliedToAllHospitals
FPG Reference Free Care1FPGReferenceFreeCare

Other Percentage OtherPercentage

FieldValueIRS element (for citing)
OtherXOther
Free Other Percentage125.000000000000FreeOtherPercentage
FieldValueIRS element (for citing)
FPG Reference Discounted Care1FPGReferenceDiscountedCare
Pcent400XPcent400
Free Disc Care Medically Indigent1FreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity Care1AmountsBudgetedForCharityCare
Expenses Exceeded Budget0ExpensesExceededBudget
Annual Community Benefit Report1AnnualCommunityBenefitReport
Report Publically Available1ReportPublicallyAvailable

Charity Care At Cost CharityCareAtCost

FieldValueIRS element (for citing)
Total Community Benefit Expense2149704TotalCommunityBenefitExpense
Net Community Benefit Expense2149704NetCommunityBenefitExpense
Percent Of Total Expense0.01140PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

FieldValueIRS element (for citing)
Total Community Benefit Expense9223490TotalCommunityBenefitExpense
Direct Offsetting Revenue6600548DirectOffsettingRevenue
Net Community Benefit Expense2622942NetCommunityBenefitExpense
Percent Of Total Expense0.01390PercentOfTotalExpense

Total Charity Care TotalCharityCare

FieldValueIRS element (for citing)
Total Community Benefit Expense11373194TotalCommunityBenefitExpense
Direct Offsetting Revenue6600548DirectOffsettingRevenue
Net Community Benefit Expense4772646NetCommunityBenefitExpense
Percent Of Total Expense0.02530PercentOfTotalExpense

Community Health Services CommunityHealthServices

FieldValueIRS element (for citing)
Total Community Benefit Expense1892121TotalCommunityBenefitExpense
Direct Offsetting Revenue1511767DirectOffsettingRevenue
Net Community Benefit Expense380354NetCommunityBenefitExpense
Percent Of Total Expense0.00200PercentOfTotalExpense

Health Professions Education HealthProfessionsEducation

FieldValueIRS element (for citing)
Total Community Benefit Expense795243TotalCommunityBenefitExpense
Direct Offsetting Revenue90759DirectOffsettingRevenue
Net Community Benefit Expense704484NetCommunityBenefitExpense
Percent Of Total Expense0.00370PercentOfTotalExpense

Subsidized Health Services SubsidizedHealthServices

FieldValueIRS element (for citing)
Total Community Benefit Expense52486168TotalCommunityBenefitExpense
Direct Offsetting Revenue44929197DirectOffsettingRevenue
Net Community Benefit Expense7556971NetCommunityBenefitExpense
Percent Of Total Expense0.04010PercentOfTotalExpense

Cash And In Kind Contributions CashAndInKindContributions

FieldValueIRS element (for citing)
Total Community Benefit Expense26750TotalCommunityBenefitExpense
Net Community Benefit Expense26750NetCommunityBenefitExpense
Percent Of Total Expense0.00010PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense55200282TotalCommunityBenefitExpense
Direct Offsetting Revenue46531723DirectOffsettingRevenue
Net Community Benefit Expense8668559NetCommunityBenefitExpense
Percent Of Total Expense0.04590PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense66573476TotalCommunityBenefitExpense
Direct Offsetting Revenue53132271DirectOffsettingRevenue
Net Community Benefit Expense13441205NetCommunityBenefitExpense
Percent Of Total Expense0.07120PercentOfTotalExpense

Health Improvement Advocacy HealthImprovementAdvocacy

FieldValueIRS element (for citing)
Total Community Building Expense82500TotalCommunityBuildingExpense
Net Community Building Expense82500NetCommunityBuildingExpense
Percent Of Total Expense0.00040PercentOfTotalExpense

Total Total

FieldValueIRS element (for citing)
Total Community Building Expense82500TotalCommunityBuildingExpense
Net Community Building Expense82500NetCommunityBuildingExpense
Percent Of Total Expense0.00040PercentOfTotalExpense
FieldValueIRS element (for citing)
Bad Debt Expense Reported0BadDebtExpenseReported
Bad Debt Expense$3,662,516BadDebtExpenseAmount
Amount Attributable To256376AmountAttributableTo
Amount Reimbursed By Medicare67940873AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare72922403CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall-4981530MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

FieldValueIRS element (for citing)
OtherXOther
FieldValueIRS element (for citing)
Written Debt Collection Policy1WrittenDebtCollectionPolicy
Provision For Charity Care1ProvisionForCharityCare
Number Of Hospital Facilities2NumberOfHospitalFacilities

Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA (2 entries)

Facility NumberFacilityNumberAddress Line1Address/AddressLine1CityAddress/CityStateAddress/StateZIP CodeAddress/ZIPCodeLicensed HospitalLicensedHospitalGeneral Medical And SurgicalGeneralMedicalAndSurgicalEr24 HoursEr24HoursCritical Access HospitalCriticalAccessHospital
Hays Medical Center Inc
12220 CanterburyHaysKS67601XXX
Pawnee Valley Community Hospital Inc
2923 Carroll AveLarnedKS67550XXXX

Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB (2 entries)

Hospital Facility NumberHospitalFacilityNumberEligibility Criteria ExplainedEligibilityCriteriaExplainedUses FPG FreeUsesFPGFreeFPG Free PercentFPGFreePercentUses FPG DiscountedUsesFPGDiscountedFPG Discount PercentFPGDiscountPercentExplains BasisExplainsBasisIncome LevelIncomeLevelAsset LevelAssetLevelUninsured DiscountUninsuredDiscountMedicaid MedicareMedicaidMedicareExplains Application MethodExplainsApplicationMethodIncludes Publicity MeasuresIncludesPublicityMeasuresPosted On WebsitePostedOnWebsitePosted In Admission OfficePostedInAdmissionOfficeAvailable On RequestAvailableOnRequestOther PublicityOtherPublicityActions On NonpaymentActionsOnNonpaymentCollection ActivitiesCollectionActivitiesNondiscrim Emergency Care PolicyNondiscrimEmergencyCarePolicyLowest Negotiated RatesLowestNegotiatedRatesAmounts Generally BilledAmountsGenerallyBilledGross ChargesGrossCharges
Hays Medical Center Inc
111125.0000000000001400.0000000000001XXXX11XXXX101X00
Pawnee Valley Community Hospital Inc
211125.0000000000001400.0000000000001XXXX11XXXX101X00

Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC

FieldValueIRS element (for citing)
Number Of Other Facilities5NumberOfOtherFacilities

Other Facilities OtherFacilities (5 entries)

Address Line1Address/AddressLine1CityAddress/CityStateAddress/StateZIP CodeAddress/ZIPCodeFacility TypeFacilityType
Hays Family Medicine
2509 CanterburyHaysKS67601Family Medicine
Pawnee Valley Medical Associates
713 W 11th StLarnedKS67550Family Medicine
Central Kansas Urology
3520 LakinGreat BendKS67530Urology Services
HaysMed Psychiatric Associates
205 E 7th StHaysKS67601Psychiatric Services
Breast Care Center
2501 E 13th StHaysKS67601Breast Care Services

Form990 Schedule H Part VI Form990ScheduleHPartVI (13 entries)

ExplanationExplanationIdentifierIdentifier
Part I, Line 7: Hays Medical Center, Inc.'s, cost accounting system was used to calculate community health improvement services, health professions education, and subsidized health services costs. A cost-to-charge ratio derived from Worksheet 2 was used to calculate financial assistance at cost and the community benefit expense attributable to serving Medicaid beneficiaries.
Part I, Line 7g: Subsidized health services community benefit expenses include $46,257,459 of expenses attributable to physician clinics that have net operating losses.
Part I, L7 Col(f): Bad debt expense of $12,937,181 is included in Part IX line 25. This amount was subtracted from total expenses when computing the denominator for the percentage calculated for line 7(f).
Part II: Hays Medical Center, Inc., helps to support the First Care Clinic in Hays, Kansas. This clinic was established to help lower income individuals receive health care at a reduced cost. Our support helps to increase the number of individuals in Hays, Kansas, who receive quality primary health care.
Part III, Line 4: Text of the footnote that describes bad debt expense:Accounts receivable are reduced by an allowance for uncollectible accounts. In evaluating the collectability of accounts receivable, the HaysMed Group analyzes its past history and identifies trends for each of its major payor sources of revenue to estimate the appropriate allowance for uncollectible accounts and provision for bad debts. Management regularly reviews data about these major payor sources of revenue in evaluating the sufficiency of the allowance for uncollectible accounts. For receivables associated with services provided to patients who have third-party coverage, the HaysMed Group analyzes contractually due amounts and provides an allowance for uncollectible accounts and a provision for bad debts, if necessary (for example, for expected uncollectible deductibles and copayments on accounts for which the third-party payor has not yet paid, or for payors who are known to be having financial difficulties that make the realization of amounts due unlikely). For receivables associated with self-pay patients (which includes both patients without insurance and patients with deductible and copayment balances due for which third-party coverage exists for part of the bill), the HaysMed Group records a significant provision for bad debts in the period of service on the basis of its past experience, which indicates that many patients are unable or unwilling to pay the portion of their bill for which they are financially responsible. The difference between the standard rates (or the discounted rates if negotiated) and the amounts actually collected after all reasonable collection efforts have been exhausted is charged off against the allowance for uncollectible accounts.Costing methodology: A cost-to-charge ratio derived from Worksheet 2 was used to calculate bad debt expense at cost.Methodology for bad debt cost for financial assistance eligible: This amount was estimated based on historical information from our collection agency on the percentage of accounts referred to collection whose guarantor was indigent.
Part III, Line 8: The Medicare cost report was the costing methodology used to determine Medicare allowable costs. Allowable costs of care reported on line 6 were determined using amounts from Worksheet D, Part V and Worksheet D-1 in the Hays Medical Center, Inc., Medicare cost report for the fiscal year ended June 30, 2012.
Part III, Line 9b: Whenever possible, the customer service representatives (CSR's) of Hays Medical Center, Inc., try to determine the estimated self-pay balance prior to the patient receiving services. FAP eligibility is first considered at this point in time. In addition, if full payment is not received or if payment is not made within 30 days, the CSR contacts the patient. If it is determined that at least a 2-year payment plan cannot be established with the patient, the CSR will screen for charity care and request that the charity care application be completed by the patient.
Part V, Section B, Line 13g: Hays Medical Center will proactively seek out applicants who may be in need of financial assistance. Hays Medical Center will post notice of this policy to all patients/guarantors through its registration, pre-registration, and financial counseling process. This policy will also be posted in prominent areas of the Hospital.Hays Medical Center, Inc.
Part V, Section B, Line 13g: Pawnee Valley Community Hospital, Inc. (PVCH) will proactively seek out applicants who may be in need of financial assistance. PVCH will post notice of this policy to all patients/guarantors through its registration, pre-registration, and financial counseling process. This policy will also be posted in prominent areas of the Hospital.Pawnee Valley Community Hospital, Inc.
Part VI, Line 3: Information regarding the Hays Medical Center, Inc., charity care program is located on the Hays Medical Center, Inc., website for patients and community members to view, and the financial assistance application is also on the website to print off and complete. In addition, if a customer service representative of Hays Medical Center, Inc. contacts a patient about a bill and in visiting with them they determine that the patient could possibly qualify for the Hospital's charity care policy, they will send the application to the patient as well.
Part VI, Line 4: Hays Medical Center, Inc. is located in Hays, Kansas, which has a population of approximately 20,000 people, as of the 2010 census. One of the State of Kansas Regents universities is also located in Hays, Kansas, so the population includes many college-aged students. The median household income of Hays, Kansas, is $44,227. Approximately 5.7% of families and 15.6% of the population were below the poverty line. Almost 6% of the Hospital's revenue is from services provided to patients eligible for Medicaid. Hays Medical Center, Inc., is the only hospital in the city of Hays. In addition, since this is a rural area and because it is the only hospital providing tertiary level care in the region, Hays Medical Center, Inc., provides certain services to the whole western half of the State of Kansas.
Part VI, Line 5: Hays Medical Center, Inc., promotes the health of the community by extending medical privileges to most qualified, local physicians. In addition, the majority of the Board of Directors live and work in the city of Hays, but they are not employed by Hays Medical Center. Inc.
Part VI, Line 6: Hays Medical Center, Inc., is not a part of an affiliated health care system.

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Idemnification Gross Up PaymentsXIdemnificationGrossUpPayments
Club Dues Or FeesXClubDuesOrFees
Written Policy Re T And E Expenses1WrittenPolicyReTAndEExpenses
Substantiation Required1SubstantiationRequired
Compensation CommitteeXCompensationCommittee
Independent ConsultantXIndependentConsultant
Written Employment ContractXWrittenEmploymentContract
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance Payment0SeverancePayment
Supplemental Nonqual Retire Plan1SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org0CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs0CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org1CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs0CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments0AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (15 entries)

Base Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
Darrell Werth MD
59850005521807770134750195980687568000
Ross Buckles DO
20000001420550120000134750247310392261000
Dr Kurt Rider
22700000016601085750279630280139000
John Jeter MD
4087090445430147690979630249630590947000
John Lloyd
3220000133068060000134750210980495641000
William Overbey
2162820191190118700492350277310324237000
Bryce Young
219371019388046330497390277310320862000
Dale Montgomery
140100093570124320320010272090221099000
D Bruce Whittington
142159094920132530324830272090224596000
Christine Fisher
60000003169190430134750249630955400000
Alex De Carvalho
50000004805910350001347501541601012982000
Jeffery Curtis
59700001621680770134750279630800683000
Vivek Sharma
5000000271315030000134750180980805888000
Robert Bassett
4970000298973014811013475021880826447000
Kenneth Lindsey
7012501756403781003705000129204000

Form990 Schedule J Part III Form990ScheduleJPartIII (3 entries)

Return ReferenceReturnReferenceExplanationExplanation
Part I, Line 1aBenefits identified include tax indemnification on health claims and health club dues. Both benefits are available to the CEO and are included in taxable income.
Part I, Line 4bJohn Jeter, M.D. - $67,988 William Overbey - $35,760 Bryce Young - $36,264 Dale Montgomery - $22,869 D. Bruce Whittington $23,198
Part I, Line 6A portion of incentive compensation for officers and key employees is determined by net earnings exceeding budget for the fiscal year.

Schedule K IRS990ScheduleK

Form990 Schedule K Part I Form990ScheduleKPartI (3 entries)

Issuer EINIssuerEINCUSIP NumberCUSIPNumberDate IssuedDateIssuedIssue PriceIssuePriceDescription Of PurposeDescriptionOfPurposeDefeasedDefeasedOn Behalf Of IssuerOnBehalfOfIssuerPool FinancingPoolFinancing
Kansas Development Finance Authority
48106658948543BGR32003-11-1216000878Construction000
Kansas Development Finance Authority
48106658948543BJD12005-11-2223635944Construction000
Kansas Development Finance Authority
48106658948543BLY22010-11-0246930167Refinancing of previous bond and equipment000

Form990 Schedule K Part II Form990ScheduleKPartII (3 entries)

Total ProceedsTotalProceedsAmount In Reserve FundAmountInReserveFundIssuance Costs From ProceedsIssuanceCostsFromProceedsCapital ExpendituresCapitalExpendituresYear Of Subst CompletionYearOfSubstCompletionCurrent RefundingCurrentRefundingAdvance RefundingAdvanceRefundingFinal Allocation MadeFinalAllocationMadeAdequate Books And Recds MaintaindAdequateBooksAndRecdsMaintaindAmount RetiredAmountRetired
1666572812000247264891593921520050011
2363594420371253160002331994420060111
46930167667574299625932012101116300000

Form990 Schedule K Part III Form990ScheduleKPartIII (3 entries)

Owning Bond Financed PropertyOwningBondFinancedPropertyAny Lease ArrangementsAnyLeaseArrangementsMngment Cntrct Bond Financd PrprtyMngmentCntrctBondFinancdPrprtyAny Research AgreementsAnyResearchAgreementsPost Issuance Compliance ProcdrsPostIssuanceComplianceProcdrs
00001
00001
00001

Form990 Schedule K Part IV Form990ScheduleKPartIV (3 entries)

Form8038 T FiledForm8038TFiledVariable Rate IssueVariableRateIssueHedge Identified In Books And RecdsHedgeIdentifiedInBooksAndRecdsGross Proceeds Invested In GICGrossProceedsInvestedInGICGross Proceeds InvestedGrossProceedsInvestedException To RebateExceptionToRebate
000000
000000
000000
FieldValueIRS element (for citing)
Fed Tax Requirements ComplianceXFedTaxRequirementsCompliance

Schedule L IRS990ScheduleL

Form990 Schedule L Part IV Form990ScheduleLPartIV (7 entries)

RelationshipRelationshipAmount Of TransactionAmountOfTransactionDescription Of TransactionDescriptionOfTransactionSharing Of RevenuesSharingOfRevenues
Blue Cross and Blue Shield of Kansas
Entity of which Gary Shorman, current director, is a director65500000Payment for health care services provided to benenficiaries of Blue Cross and Blue Shield's insurance plans. These payments represent approximately 2.75% of Blue Cross and Blue Shield of Kansas' annual disbursements.0
Eagle Communications
Entity of which Gary Shorman, current director, is an officer144796Payments for cable/internet0
Jeter Law Firm
Partnership more than 5% owned by family member of John Jeter, CEO5841Payments for legal services0
Lynette Pfannenstiel
Family member of D.G. Bickle, current director95976Employment arrangement0
Heather Harris
Family member of Ross Buckles, D.O., current director171136Employment arrangement0
Arlene Werth
Family member of Darrell Werth, MD, current director66271Employment arrangement0
Barbara Werth
Family member of Darrell Werth, MD, current director21852Employment arrangement0

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (7 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
Form 990, Part VI, Section A, line 4The bylaws for the organization were amended as of January 30, 2012.
Form 990, Part VI, Section B, line 11Form 990 was reviewed with the officers and Board Finance committee.
Form 990, Part VI, Section B, line 12cOfficers, directors, and key employees, along with all associates, are required to complete a conflict of interest statement annually. The statements are used to monitor and enforce compliance with the policy.
Form 990, Part VI, Section B, line 15The CEO's, officers', and key employees' salaries are reviewed annually by an independent consulting group and the Compensation Committee, which is made up of members of the Board.
Form 990, Part VI, Section C, line 19These documents are not made available to the public. Financial statements are released to bond holders on a quarterly basis.
Form 990, Part XI, line 5:Net unrealized losses on investments: -4,059,769. Change in beneficial interest in net assets of Hadley Foundation -556,940. Total to Form 990, Part XI, Line 5: -4,616,709.Changes in Net Assets or Fund Balances:
Form 990. Part XII, Line 2cHays Medical Center, Inc., has an audit committee that is responsible for the oversight of the financial statement audit and the selection process of an independent accountant.Financial Statements and Reporting

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (3 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Controlled OrgControlledOrg
Hays Medical Center Foundation
2220 CanterburyHaysKS67601481179684Provide grants and allocations to Hays Medical Center, Inc.KS501(c)(3)Line 11a, IHays Medical Center Inc1
HaysMed Partners Inc
2220 CanterburyHaysKS67601270877152Owns management contract for Pawnee Valley Community HospitalKS501(c)(3)Line 3Hays Medical Center Inc1
Pawnee Valley Community Hospital Inc
2220 CanterburyHaysKS67601481253246Hospital operated by Hays Medical CenterKS501(c)(3)Line 3HaysMed Partners Inc1
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties0ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org0GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org1GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org1LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org0LoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs0RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs1RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs1PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs0PerformOfServicesByOtherOrgs
Sharing Of Facilities0SharingOfFacilities
Sharing Of Paid Employees1SharingOfPaidEmployees
Reimbursement Paid To Other Org0ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org1ReimbursementPaidByOtherOrg
Other Transfer To Other Org0OtherTransferToOtherOrg
Other Transfer From Other Org1OtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable (7 entries)

Transaction TypeTransactionTypeAmount InvolvedAmountInvolvedMethod Of Amt DeterminationMethodOfAmtDetermination
Hays Medical Center Foundation
C24140Cash received
Hays Medical Center Foundation
P215162Actual cost
Pawnee Valley Community Hospital Inc
D141190Cash advanced
Pawnee Valley Community Hospital Inc
K508347Actual cost
Pawnee Valley Community Hospital Inc
N462169Actual cost
Pawnee Valley Community Hospital Inc
J67067Cash paid
Pawnee Valley Community Hospital Inc
R1429000Reimbursement received