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MCPHERSON HOSPITAL INC: Form 990, tax year 2009

View the entire original 990 at ProPublica ↗

Organization
MCPHERSON HOSPITAL INC (EIN 48-0799105)
Tax period
2009-07-01 to 2010-06-30
Filed
2011-05-11
IRS object ID
201141319349301899
Schema version
2009v1.7
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)
Timestamp2011-05-11T15:06:06-05:00Timestamp
Tax Period End Date2010-06-30TaxPeriodEndDate

Preparer Firm PreparerFirm

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 Date2009-07-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN480799105EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1Memorial Hospital IncBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlMEMONameControl
Phone6202412250Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line11000 Hospital DriveAddressLine1
CityMcPhersonCity
StateKSState
ZIP Code674602326ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameJames R ChromikName
TitleCEOTitle
Phone6202412250Phone
Date Signed2011-05-10DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameGary D KnollName
Phone7852334226Phone
Date Prepared2011-05-10DatePrepared
FieldValueIRS element (for citing)
Tax Year2009TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonJames R ChromikNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line11000 Hospital DriveAddressLine1
CityMcPhersonCity
StateKSState
ZIP Code674602326ZIPCode
FieldValueIRS element (for citing)
Gross Receipts25444942GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501cXOrganization501c
Web SiteN/AWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1972YearFormation
State Legal DomicileKSStateLegalDomicile
Activity Or Mission DescriptionProvision of acute hospital care to patients regardless of ability to pay.ActivityOrMissionDescription
Nbr Voting Members Governing Body13NbrVotingMembersGoverningBody
Nbr Independent Voting Members11NbrIndependentVotingMembers
Total Nbr Employees380TotalNbrEmployees
Total Nbr Volunteers117TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year860902ContributionsGrantsPriorYear
Contributions Grants Current Year861733ContributionsGrantsCurrentYear
Program Service Revenue Prior Year24975196ProgramServiceRevenuePriorYear
Program Service Revenue CY23936245ProgramServiceRevenueCY
Investment Income Prior Year59344InvestmentIncomePriorYear
Investment Income Current Year61650InvestmentIncomeCurrentYear
Other Revenue Prior Year508238OtherRevenuePriorYear
Other Revenue Current Year579293OtherRevenueCurrentYear
Total Revenue Prior Year26403680TotalRevenuePriorYear
Total Revenue Current Year25438921TotalRevenueCurrentYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year13149246SalariesEtcPriorYear
Salaries Etc Current Year13013155SalariesEtcCurrentYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year12760110OtherExpensePriorYear
Other Expenses Current Year12263164OtherExpensesCurrentYear
Total Expenses Prior Year25909356TotalExpensesPriorYear
Total Expenses Current Year25276319TotalExpensesCurrentYear
Revenues Less Expenses Prior Year494324RevenuesLessExpensesPriorYear
Revenues Less Expenses CY162602RevenuesLessExpensesCY
Total Assets BOY21960447TotalAssetsBOY
Total Assets EOY21832703TotalAssetsEOY
Total Liabilities BOY4498300TotalLiabilitiesBOY
Total Liabilities EOY3907510TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY17462147NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY17925193NetAssetsOrFundBalancesEOY
Mission DescriptionTo meet our community's need by providing superior health care and exceptional service for each person, every time.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense22690457Expense
Revenue24025801Revenue
DescriptionProvision of inpatient and outpatient hospital services.Description
Total Program Service Expense22690457TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities0LobbyingActivities
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments1TermOrPermanentEndowments
Balance Sheet Amounts Reported1BalanceSheetAmountsReported
Independent Audit Financial Stmt1IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt0ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital1Hospital
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 Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity0RelatedOrgControlledEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With109665NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees380NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income0UnrelatedBusinessIncome
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
Nbr Voting Governing Body Members13NbrVotingGoverningBodyMembers
Number Independent Voting Members11NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs1ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders1MembersOrStockholders
Election Of Board Members1ElectionOfBoardMembers
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

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1Cindy L Brown VP of FinanceCFOBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number6202412250TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line11000 Hospital DriveAddressLine1
CityMcPhersonCity
StateKSState
ZIP Code674602326ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (21 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationHighest Compensated EmployeeHighestCompensatedEmployeeOfficerOfficer
Dean Elliott
Director2.00X000
J David Ferrell
Director2.00X000
Clay Fetsch MD
President Medical Staff40.00X263986028708X
Bill Glazner
Director2.00X000
Dennis C Houghton
Secretary2.00X000X
Tim R Karstetter
Director2.00X000
Dawn Loving
Director2.00X000
Marsha Silver
Chairman2.00X000X
Paul Taliaferro
Director2.00X000
Brent Wall
Vice Chairman2.00X000X
James R Chromik
CEO/President40.00X166336018570X
David Buller MD
Vice President Medical Staff2.00X000
James Prescott M D
Secretary Medical Staff2.00X000
Cindy Brown
VP of Finance/CFO40.00101895017797X
Teresa Gehring
VP of Operations40.0081221019260X
Jill Wenger
VP of Human Resources40.0084297019528X
Patricia Goad
VP of Nursing40.008544308445X
Tyler G Hughes MD
Physician40.00351471029084X
Samuel Claassen
Physician40.00159797023436X
John Worden
Pharmacy Director40.00123720015930X
Mary Blankenship
Pharmacist40.00106472015092X
FieldValueIRS element (for citing)
Total Reportable Comp From Org1524638TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation195850TotalOtherCompensation
Number Individuals GT100 K7NumberIndividualsGT100K
Formers Listed0FormersListed
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
EMSC LLC
1985 Cougar TrailMcPhersonKS67460ER physician coverage1294632
Contemporary Anesthesia Services
1436 N High DrMcPhersonKS67460Anesthesia services878288
National Therapeutic Assoc
11623 Arbor StOmahaNE68144Physical/occupational therapy501745
Shared Medical Services
PO Box 330Cotton GroveWI53527Mobile MRI Services288215
CPSI
PO Box 850309MobileAL366850309Hardware/software/technical support136337
FieldValueIRS element (for citing)
Number Of Contractors GT100 K7NumberOfContractorsGT100K
Government Grants697796GovernmentGrants
All Other Contributions163937AllOtherContributions
Total Contributions861733TotalContributions

Program Service Revenue ProgramServiceRevenue (2 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
Patient Service Revenu9000992392987123929871
Lab Services62150063746374
FieldValueIRS element (for citing)
Total Program Service Revenue23936245TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column64476TotalRevenueColumn
Exclusion$64,476ExclusionAmount

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real148362Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real148362Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column148362TotalRevenueColumn
Exclusion$148,362ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Other3195Other

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Other6021Other

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Other-2826Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column-2826TotalRevenueColumn
Exclusion-$2,826ExclusionAmount

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnExclusionExclusionAmount
Nonpatient Meals722210211848$211,848
Fitness Center71394066967$66,967
Auxiliary90009962560$62,560

Miscellaneous Revenue MiscellaneousRevenue

FieldValueIRS element (for citing)
Total Revenue Column89556TotalRevenueColumn
Related Or Exempt Function Income89556RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Other Revenue430931TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column25438921TotalRevenueColumn
Related Or Exempt Function Income24025801RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$551,387ExclusionAmount

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total907753Total
Program Services291970ProgramServices
Management And General615783ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total10097493Total
Program Services9142942ProgramServices
Management And General954551ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total276035Total
Program Services252212ProgramServices
Management And General23823ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total932277Total
Program Services867322ProgramServices
Management And General64955ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total799597Total
Program Services690980ProgramServices
Management And General108617ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total138069Total
Program Services119116ProgramServices
Management And General18953ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total39517Total
Program Services4800ProgramServices
Management And General34717ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total1223Total
Management And General1223ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total301788Total
Program Services222666ProgramServices
Management And General79122ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total276026Total
Program Services154054ProgramServices
Management And General121972ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total370597Total
Program Services370597ProgramServices

Travel Travel

FieldValueIRS element (for citing)
Total26515Total
Program Services18777ProgramServices
Management And General7738ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total138209Total
Program Services138209ProgramServices

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total1355297Total
Program Services1355297ProgramServices

Insurance Insurance

FieldValueIRS element (for citing)
Total228651Total
Program Services73056ProgramServices
Management And General155595ManagementAndGeneral

Other Expenses OtherExpenses (5 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
Physician fees34874483319437168011
Medical supplies154799615381469850
Bad debts14995781499578
Pharmacy supplies843715843715
Equipment rental & main72549570601819477

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total1283040Total
Program Services1081565ProgramServices
Management And General201475ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total25276319Total
Program Services22690457ProgramServices
Management And General2585862ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY827BOY
EOY879EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY8052113BOY
EOY7553132EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY3251075BOY
EOY3525302EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY550023BOY
EOY538080EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY275888BOY
EOY329424EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis25898852LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec17190876LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY8930276BOY
EOY8707976EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
BOY497BOY
EOY497EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY899748BOY
EOY1177413EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY21960447BOY
EOY21832703EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY1424967BOY
EOY1456855EOY

Deferred Revenue DeferredRevenue

FieldValueIRS element (for citing)
BOY14738BOY
EOY9033EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY3040000BOY
EOY2430000EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY18595BOY
EOY11622EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY4498300BOY
EOY3907510EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY16517800BOY
EOY16679784EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY418329BOY
EOY439018EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY526018BOY
EOY806391EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY17462147BOY
EOY17925193EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY21960447BOY
EOY21832703EOY
FieldValueIRS element (for citing)
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee1AuditCommittee
Financial Statement SeparateXFinancialStatementSeparate
Federal Grant Audit Required0FederalGrantAuditRequired

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 Balance8015BeginningOfYearBalance
Contributions0Contributions
Investment Earnings Or Losses1261InvestmentEarningsOrLosses
Grants Or Scholarships0GrantsOrScholarships
Other Expenditures0OtherExpenditures
Administrative Expenses-78AdministrativeExpenses
End Of Year Balance9198EndOfYearBalance

Current Year Minus1 Year CurrentYearMinus1Year

FieldValueIRS element (for citing)
Beginning Of Year Balance10214BeginningOfYearBalance
Investment Earnings Or Losses-2092InvestmentEarningsOrLosses
Administrative Expenses-107AdministrativeExpenses
End Of Year Balance8015EndOfYearBalance
FieldValueIRS element (for citing)
Permanent Endowment EOY Balance1.00000PermanentEndowmentEOYBalance
Endowments Held By Unrelated Orgs1EndowmentsHeldByUnrelatedOrgs
Endowments Held By Related Orgs0EndowmentsHeldByRelatedOrgs

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis16312OtherCostOrOtherBasis
Book Value16312BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis10205530OtherCostOrOtherBasis
Depreciation6295560Depreciation
Book Value3909970BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis10076599OtherCostOrOtherBasis
Depreciation7178155Depreciation
Book Value2898444BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis5600411OtherCostOrOtherBasis
Depreciation3717161Depreciation
Book Value1883250BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings8707976TotalOfBookValueLandBuildings

Other Assets OtherAssets (5 entries)

DescriptionDescriptionBook ValueBookValue
Other Receivables7840
Unamortized Bond Costs19313
Beneficial interest in net assets of McPherson Healthcare Foundation1009526
Goodwill52455
Estimated third-party payor settlements88279
FieldValueIRS element (for citing)
Total Book Value Other Assets1177413TotalBookValueOtherAssets
Total Revenue25438921TotalRevenue
Total Expenses25276319TotalExpenses
Excess Or Deficit For Year162602ExcessOrDeficitForYear
Other$300,444OtherAmount
Total Adjustments300444TotalAdjustments
Excess Or Deficit Per FS463046ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt25438303TotRevenueEtcAuditedFinclStmt
Revenue Not Rptd F9900RevenueNotRptdF990
Revenue Subtotal25438303RevenueSubtotal
Other Revenues Not Included618OtherRevenuesNotIncluded
Revenue Not Rptd On Fin Stmt618RevenueNotRptdOnFinStmt
Total Revenue Per Form99025438921TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt25276319TotExpensesEtcAuditedFinclStmt
Expenses Not Rptd F9900ExpensesNotRptdF990
Expenses Subtotal25276319ExpensesSubtotal
Expenses Not Rptd On Fin Stmt0ExpensesNotRptdOnFinStmt
Total Expenses Per Form99025276319TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (4 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
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.

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Charity Care Policy1CharityCarePolicy
Written Policy1WrittenPolicy
FPG Reference Free Care1FPGReferenceFreeCare
Pcent100XPcent100
FPG Reference Discounted Care1FPGReferenceDiscountedCare

Discounted Other DiscountedOther

FieldValueIRS element (for citing)
OtherXOther
Discounted Other Percentage175.000000000000DiscountedOtherPercentage
FieldValueIRS element (for citing)
Free Disc Care Medically Indigent1FreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity Care1AmountsBudgetedForCharityCare
Expenses Exceeded Budget1ExpensesExceededBudget
Unable To Provide Care0UnableToProvideCare
Annual Community Benefit Report1AnnualCommunityBenefitReport
Report Publically Available1ReportPublicallyAvailable

Charity Care At Cost CharityCareAtCost

FieldValueIRS element (for citing)
Total Community Benefit Expense221640TotalCommunityBenefitExpense
Direct Offsetting Revenue75339DirectOffsettingRevenue
Net Community Benefit Expense146301NetCommunityBenefitExpense
Percent Of Total Expense0.00620PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

FieldValueIRS element (for citing)
Total Community Benefit Expense2065794TotalCommunityBenefitExpense
Direct Offsetting Revenue1107598DirectOffsettingRevenue
Net Community Benefit Expense958196NetCommunityBenefitExpense
Percent Of Total Expense0.04030PercentOfTotalExpense

Total Charity Care TotalCharityCare

FieldValueIRS element (for citing)
Total Community Benefit Expense2287434TotalCommunityBenefitExpense
Direct Offsetting Revenue1182937DirectOffsettingRevenue
Net Community Benefit Expense1104497NetCommunityBenefitExpense
Percent Of Total Expense0.04650PercentOfTotalExpense

Community Health Services CommunityHealthServices

FieldValueIRS element (for citing)
Total Community Benefit Expense9049TotalCommunityBenefitExpense
Net Community Benefit Expense9049NetCommunityBenefitExpense
Percent Of Total Expense0.00040PercentOfTotalExpense

Subsidized Health Services SubsidizedHealthServices

FieldValueIRS element (for citing)
Total Community Benefit Expense3163187TotalCommunityBenefitExpense
Direct Offsetting Revenue2692933DirectOffsettingRevenue
Net Community Benefit Expense470254NetCommunityBenefitExpense
Percent Of Total Expense0.01980PercentOfTotalExpense

Cash And In Kind Contributions CashAndInKindContributions

FieldValueIRS element (for citing)
Total Community Benefit Expense4016TotalCommunityBenefitExpense
Net Community Benefit Expense4016NetCommunityBenefitExpense
Percent Of Total Expense0.00020PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense3176252TotalCommunityBenefitExpense
Direct Offsetting Revenue2692933DirectOffsettingRevenue
Net Community Benefit Expense483319NetCommunityBenefitExpense
Percent Of Total Expense0.02040PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense5463686TotalCommunityBenefitExpense
Direct Offsetting Revenue3875870DirectOffsettingRevenue
Net Community Benefit Expense1587816NetCommunityBenefitExpense
Percent Of Total Expense0.06690PercentOfTotalExpense

Community Support CommunitySupport

FieldValueIRS element (for citing)
Total Community Building Expense370TotalCommunityBuildingExpense
Net Community Building Expense370NetCommunityBuildingExpense
Percent Of Total Expense0.00000PercentOfTotalExpense

Total Total

FieldValueIRS element (for citing)
Total Community Building Expense370TotalCommunityBuildingExpense
Net Community Building Expense370NetCommunityBuildingExpense
FieldValueIRS element (for citing)
Bad Debt Expense Reported1BadDebtExpenseReported
Bad Debt Expense$783,230BadDebtExpenseAmount
Amount Attributable To0AmountAttributableTo
Amount Reimbursed By Medicare4789927AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare6355237CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall-1565310MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

FieldValueIRS element (for citing)
OtherXOther
FieldValueIRS element (for citing)
Written Debt Collection Policy1WrittenDebtCollectionPolicy
Provision For Charity Care1ProvisionForCharityCare

Form990 Schedule H Part V Form990ScheduleHPartV

Name Name

FieldValueIRS element (for citing)
Business Name Line1Memorial Hospital IncBusinessNameLine1

Address Address

FieldValueIRS element (for citing)
Address Line11000 Hospital DriveAddressLine1
CityMcPhersonCity
StateKSState
ZIP Code67460ZIPCode
FieldValueIRS element (for citing)
Licensed HospitalXLicensedHospital
General Medical And SurgicalXGeneralMedicalAndSurgical
Er24 HoursXEr24Hours

Form990 Schedule H Part VI Form990ScheduleHPartVI

FieldValueIRS element (for citing)
Bad Debt FootnotePart 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.BadDebtFootnote
Shortfall As Community BenefitPart 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.ShortfallAsCommunityBenefit
Debt Collection PolicyPart 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.DebtCollectionPolicy
Needs AssessmentPart VI, Line 2: Memorial Hospital, Inc. does not have a formal community needs assessment process at this time.NeedsAssessment
Patient Education AssistancePart 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.PatientEducationAssistance
Community InformationPart 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.CommunityInformation
Community Building ActivitiesPart 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.CommunityBuildingActivities
Other InformationPart 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.OtherInformation

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Written Employment ContractXWrittenEmploymentContract
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance Payment0SeverancePayment
Supplemental Nonqual Retire Plan0SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org0CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs0CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org0CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs0CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments0AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (4 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
Clay Fetsch MD
2639860000012188016520029269401343510
James R Chromik
16633600000489501367501849060812450
Tyler G Hughes MD
3514710000012564016520038055501757360
Samuel Claassen
15979700000691601652001832330799560

Schedule K IRS990ScheduleK

Form990 Schedule K Part I Form990ScheduleKPartI

Issuer Name IssuerName

FieldValueIRS element (for citing)
Business Name Line1City of McPherson KansasBusinessNameLine1
FieldValueIRS element (for citing)
Issuer EIN486019780IssuerEIN
CUSIP Number582672BQ3CUSIPNumber
Date Issued2003-10-28DateIssued
Issue Price2315000IssuePrice
Description Of PurposeRefunding of Series 1998 BondsDescriptionOfPurpose
Defeased0Defeased
On Behalf Of Issuer0OnBehalfOfIssuer

Form990 Schedule K Part II Form990ScheduleKPartII

FieldValueIRS element (for citing)
Total Proceeds2315000TotalProceeds
Amount In Reserve Fund150000AmountInReserveFund
Issuance Costs From Proceeds69725IssuanceCostsFromProceeds
Year Of Subst Completion2003YearOfSubstCompletion
Current Refunding1CurrentRefunding
Advance Refunding0AdvanceRefunding
Final Allocation Made1FinalAllocationMade
Adequate Books And Recds Maintaind1AdequateBooksAndRecdsMaintaind

Form990 Schedule K Part IV Form990ScheduleKPartIV

FieldValueIRS element (for citing)
Form8038 T Filed0Form8038TFiled
Variable Rate Issue0VariableRateIssue
Hedge Identified In Books And Recds0HedgeIdentifiedInBooksAndRecds
Gross Proceeds Invested In GIC0GrossProceedsInvestedInGIC
Gross Proceeds Invested0GrossProceedsInvested
Exception To Rebate0ExceptionToRebate

Schedule L IRS990ScheduleL

Form990 Schedule L Part IV Form990ScheduleLPartIV (2 entries)

RelationshipRelationshipDescription Of TransactionDescriptionOfTransactionSharing Of RevenuesSharingOfRevenues
Cindy Brown-VP of FinanceCFO
Spousal RelationshipEmployee0
Ronald Brown RN BSN-Staff Nurse
Spousal RelationshipEmployee0

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (9 entries)

IdentifierIdentifierExplanationExplanationReturn ReferenceReturnReference
Form 990, Part VI, Section A, line 4The organization's bylaws were updated in the fiscal year ending June 30, 2010.
Form 990, Part VI, Section A, line 6Organization's sole member is MACCO Healthcare, Inc.
Form 990, Part VI, Section A, line 7aMACCO Healthcare, Inc. approves members of the governing body of the organization (Memorial Hospital, Inc.).
Form 990, Part VI, Section B, line 11A 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 12cThe 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 15Organization 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 19The 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:The Finance Committee reviews the audit prior to submitting to the Board.Review of financial statements
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.

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (2 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatus
MACCO Healthcare Inc
1000 Hospital DriveMcPhersonKS67460481059194Sole Member of Memorial Hopsital, Inc. and McPherson Healthcare FDN, Inc.KS501(c)(3)170(b)(1) (A)(vi)
McPherson Healthcare Foundation Inc
1016 N MainMcPhersonKS67460481043952Raise Funds to support the operation of Memorial Hopsital, Inc.KS501(c)(3)170(b)(1) (A)(vi)
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 Org0LoansOrGuaranteesToOtherOrg
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 Orgs0RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs0PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs0PerformOfServicesByOtherOrgs
Sharing Of Facilities0SharingOfFacilities
Sharing Of Paid Employees0SharingOfPaidEmployees
Reimbursement Paid To Other Org1ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrg
Other Transfer To Other Org0OtherTransferToOtherOrg
Other Transfer From Other Org0OtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable (2 entries)

Transaction TypeTransactionTypeAmount InvolvedAmountInvolved
McPherson Healthcare Foundation Inc
C48717
McPherson Healthcare Foundation Inc
O18580