2013-05-10T12:15:06-05:00 2012-06-30 481026809 Wendling Noe Nelson & Johnson LLC 534 S Kansas Ave Suite 1500 Topeka KS 666033491 990 2011-07-01 480799105 McPherson Hospital Inc MCPH 6202412250 1000 Hospital Drive McPherson KS 674602326 Robert Monical 6202412250 2013-05-07 1 John R Helms P00203953 7852334226 2013-05-07 2011 2016-02-24 21:20:13Z Robert Monical 1000 Hospital Drive McPherson KS 674602326 23092077 0 X N/A X 1972 KS Provision of acute hospital care to patients regardless of ability to pay. 12 11 359 136 0 0 881268 886482 22832399 21497245 89949 150042 566136 552941 24369752 23086710 0 0 0 0 13253883 12938719 0 0 0 11466833 10280618 24720716 23219337 -350964 -132627 21117334 21172672 3413451 3412831 17703883 17759841 To meet our community's need by providing superior health care and exceptional service for each person, every time. 0 0 18878092 21642582 Provision of inpatient and outpatient hospital services. 18878092 1 1 0 0 0 0 0 0 0 1 1 0 0 1 0 1 1 0 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0 0 1 38 0 1 359 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 X 0 0 0 J David Ferrell 2.00 X 0 0 0 Bill Glazner 2.00 X X 0 0 0 Dennis C Houghton 2.00 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 0 0 0 Paul Taliaferro 2.00 X 0 0 0 Brent Wall 2.00 X X 0 0 0 Samuel Claassen 40.00 X 203505 0 28805 James Prescott MD 2.00 X 0 0 0 Rob Monical 40.00 X X 0 0 0 Shelley Overholt MD 2.00 X 0 0 0 Cindy Brown 40.00 X 18628 0 559 Teresa Gehring 40.00 X 83354 0 19489 James R Chromik 40.00 X 17996 0 540 Jill Wenger 40.00 X 86014 0 23395 Patricia Goad 40.00 X 67972 0 6702 Romida Sison-Martinez 40.00 X 42050 0 1677 Tyler G Hughes MD 40.00 X 351471 0 30607 John Worden 40.00 X 128099 0 18081 Mary Blankenship 40.00 X 114133 0 17133 Clayton Fetsch 40.00 X 272775 0 33631 1385997 0 180619 5 0 1 0 EMSC LLC 1985 Cougar Trail McPherson KS 67460 ER physician coverage 1316328 Via Christi Health Inc 8200 E Thorn Wichita KS 67226 Management fees and CEO & CFO services 1054243 National Therapeutic Assoc 11623 Arbor St Omaha NE 68144 Physical/occupational therapy 553655 Shared Medical Services PO Box 330 Cotton Grove WI 53527 Mobile MRI Services 268745 CPSI PO Box 850309 Mobile AL 366850309 Software & technical support 209000 6 701592 184890 886482 Patient Service Revenu 900099 21493776 21493776 Lab Services 621500 3469 3469 21497245 82117 82117 96946 0 96946 96946 96946 24391 48901 0 5367 24391 43534 67925 67925 Nonpatient Meals 722210 193587 193587 Auxiliary 900099 60465 60465 Fitness Center 713940 56606 56606 145337 145337 455995 23086710 21642582 0 557646 577847 224116 353731 10135534 8710621 1424913 267988 228546 39442 1140364 995463 144901 816986 684684 132302 979670 979670 84416 84416 66814 1600 65214 44151 44151 235116 143669 91447 353598 95982 257616 374032 374032 27721 22146 5575 26277 15701 10576 73200 73200 1286368 1286368 226672 74862 151810 Physician fees 2565081 2491636 73445 Medical supplies 1303440 1303440 Equipment rental & main 847834 801040 46794 Pharmacy supplies 655077 655077 1131151 695909 435242 23219337 18878092 4341245 0 880 496 7595183 4840676 3416087 3402133 537104 582942 293812 168643 28065014 19489864 8001734 8575150 2291513 497 497 1272037 1310622 21117334 21172672 1463197 2277831 475 0 1800000 1135000 4649 145130 0 3413451 3412831 X 16323905 16220594 531468 673275 848510 865972 17703883 17759841 21117334 21172672 X -132627 188585 X X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 10348 262 -81 10529 9198 1326 -176 10348 8015 1261 -78 9198 10214 -2092 -107 8015 1.00000 1 0 16312 16312 14524809 10065883 4458926 12165371 8424953 3740418 1358522 999028 359494 8575150 Other Receivables 119768 Unamortized Bond Costs 3760 Beneficial interest in net assets of McPherson Healthcare Foundation 1105869 Goodwill 39203 Estimated third-party payor settlements 42022 1310622 23086710 23219337 -132627 29316 159269 188585 55958 23086710 0 23086710 0 23086710 23219337 0 23219337 0 23219337 Description of Intended Use of Endowment Funds: Part V, Line 4: Scholarships Description of Uncertain Tax Positions Under FIN 48: Part X: Management is not aware of any uncertainties in income tax positions. 1 1 1 X 1 X 1 1 0 1 1 220340 113349 106991 0.00460 1833287 928741 904546 0.03900 2053627 1042090 1011537 0.04360 6814 6814 0.00030 4072411 2774078 1298333 0.05590 1418 1418 0.00010 4080643 2774078 1306565 0.05630 6134270 3816168 2318102 0.09990 1 723839 0 4989955 5774044 -784089 X 1 1 1 1 McPherson Hospital Inc

1000 Hospital Drive McPherson KS 67460

X X X McPherson Hospital Inc 1 1 1 200.000000000000 1 200.000000000000 1 X X X X X X 1 1 X X X X X X 1 X X X X 0 1 X 0 0 Part II: 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 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 3McPherson 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, McPherson 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, 2012. 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. McPherson Hospital, Inc. Part V, Section B, Line 19d: The Hospital utilizes the aggregate contractual adjustment percentage for Blue Cross & Blue Shield patients from the prior year to discount charges to patients eligible for financial assistance. Part VI, Line 2: McPherson 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: 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 9.4. For the year ending June 30, 2012, 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 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 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 Samuel Claassen 203505 0 0 0 0 0 10164 0 18641 0 232310 0 0 0 Tyler G Hughes MD 351471 0 0 0 0 0 12564 0 18043 0 382078 0 0 0 Clayton Fetsch 272775 0 0 0 0 0 12564 0 21067 0 306406 0 0 0 City of McPherson Kansas 486019780 582672BQ3 2003-10-28 2315000 Refunding of Series 1998 Bonds 0 0 0 2315000 1500 69725 2003 1 0 1 1 0 0 0 0 0 0 Ronald Brown Family member of Cindy Brown, Officer 47329 Employment 0 Form 990, Part VI, Section A, line 3 The Hospital entered into a management agreement with Via Christi Health, Inc. on January 1, 2011. Under the agreement, Via Christi Health, Inc. is responsible for the daily management and administration of the Hospital. 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 (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 5: Net unrealized gains on investments: 29,316. Change in beneficial interest in net assets of Foundation -3,618. Restricted investment income 2,320. Assets released for operations -33,315. Restricted contributions 266,196. Net change in assets to be used for operation of medical library -8,813. Assets released for property and equipment -63,501. Total to Form 990, Part XI, Line 5: 188,585. 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 McPherson Healthcare Foundation Inc C 4816