TY 2010 Form 990

Do not include amounts reported on lines 6b, 7b, 8b, 9b, and 10b of Part VIII.	(A) Total expenses	(B) Program service expenses	(C) Management and general expenses	(D) Fundraising expenses
1	Grants and other assistance to governments and organizations in the U.S. See Part IV, line 21	0
2	Grants and other assistance to individuals in the U.S. See Part IV, line 22	0
3	Grants and other assistance to governments, organizations, and individuals outside the U.S. See Part IV, lines 15 and 16	0
4	Benefits paid to or for members	0
5	Compensation of current officers, directors, trustees, and key employees ....	162,586		162,586
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) ....	0
7	Other salaries and wages	4,032,278	3,033,624	998,654
8	Pension plan contributions (include section 401(k) and section 403(b) employer contributions) ....	176,268	129,784	46,484
9	Other employee benefits .......	375,963	278,921	97,042
10	Payroll taxes ...........	280,835	216,304	64,531
11	Fees for services (non-employees):
a	Management ......	0
b	Legal .........	0
c	Accounting ...........	80,963		80,963
d	Lobbying ...........	1,678		1,678
e	Professional fundraising. See Part IV, line 17..	0
f	Investment management fees ......	0
g	Other ..........	751,235	615,574	135,661
12	Advertising and promotion ....	0
13	Office expenses .......	0
14	Information technology ......	0
15	Royalties ..	0
16	Occupancy ...........	114,400	91,520	22,880
17	Travel ............	3,279	2,047	1,232
18	Payments of travel or entertainment expenses for any federal, state, or local public officials ......	0
19	Conferences, conventions, and meetings ....	51,485	10,166	41,319
20	Interest ...........	0
21	Payments to affiliates .......	0
22	Depreciation, depletion, and amortization .....	337,224	263,053	74,171
23	Insurance ..............	91,898	91,898
24	Other expenses. Itemize expenses not covered above. (Expenses grouped together and labeled miscellaneous may not exceed 5% of total expenses shown on line 25 below.)
a	MEDICAL AND OFFICE SUPPLIES	806,965	623,710	183,255
b	PURCHASED SERVICES	556,104	493,278	62,826
c	BAD DEBT PROVISION	543,910	543,910
d	EQUIP. RENTAL & MAINTENANCE	144,414	135,274	9,140
e	REIMBURSED SALARIES	36,783	36,783
f	All other expenses	274,989	6,684	268,305
25	Total functional expenses. Add lines 1 through 24f	8,823,257	6,572,530	2,250,727	0
26	Joint costs. Check here if following SOP 98-2 (ASC 958-720). Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation

Part X Balance Sheet
	1	Cashnon-interest-bearing ..........	279	1	279
2	Savings and temporary cash investments .......	2,591,991	2	2,213,128
3	Pledges and grants receivable, net .........		3
4	Accounts receivable, net .........	982,885	4	1,291,083
5	Receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of
	Schedule L ..........		5
6	Receivables from other disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B). Complete Part II of
	Schedule L ..........		6
7	Notes and loans receivable, net .............		7
8	Inventories for sale or use ..............	141,395	8	129,429
9	Prepaid expenses and deferred charges ............	44,585	9	267,159
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	3,000,631
b	Less: accumulated depreciation. .....	10b	1,659,315	1,374,663	10c	1,341,316
11	Investments—publicly traded securities ..........		11
12	Investments—other securities. See Part IV, line 11 ......		12
13	Investments—program-related. See Part IV, line 11 ..		13
14	Intangible assets .........		14
15	Other assets. See Part IV, line 11 ...........	1,339,968	15	1,509,572
16	Total assets. Add lines 1 through 15 (must equal line 34)...	6,475,766	16	6,751,966
	17	Accounts payable and accrued expenses .	863,464	17	771,653
18	Grants payable ..........		18
19	Deferred revenue ..........		19
20	Tax-exempt bond liabilities ..........		20
21	Escrow or custodial account liability. Complete Part IV of Schedule D..		21
22	Payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
	persons. Complete Part II of Schedule L..........		22
23	Secured mortgages and notes payable to unrelated third parties ..		23
24	Unsecured notes and loans payable to unrelated third parties ....		24
25	Other liabilities. Complete Part X of Schedule D.....	0	25	0
26	Total liabilities. Add lines 17 through 25.....	863,464	26	771,653
		Organizations that follow SFAS 117, check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets .....	5,612,302	27	5,980,313
28	Temporarily restricted net assets .....		28
29	Permanently restricted net assets .....		29
	Organizations that do not follow SFAS 117, check here and complete lines 30 through 34.
30	Capital stock or trust principal, or current funds .....		30
31	Paid-in or capital surplus, or land, building or equipment fund .....		31
32	Retained earnings, endowment, accumulated income, or other funds		32
33	Total net assets or fund balances .....	5,612,302	33	5,980,313
34	Total liabilities and net assets/fund balances .....	6,475,766	34	6,751,966

- TIN:

SCHEDULE A
(Form 990 or 990EZ)

Department of the Treasury
Internal Revenue Service

Public Charity Status and Public Support

Complete if the organization is a section 501(c)(3) organization or a section
4947(a)(1) nonexempt charitable trust.

Attach to Form 990 or Form 990-EZ. right arrow

See separate instructions.

OMB No. 1545-0047

2010

Open to Public
Inspection

Name of the organization

WAMEGO HOSPITAL ASSOCIATION INC

Employer identification number

72-1526400

Part I

Reason for Public Charity Status (All organizations must complete this part.) See instructions

The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)

A church, convention of churches, or association of churches. section 170(b)(1)(A)(i).

A school described in section 170(b)(1)(A)(ii). (Attach Schedule E.)

A hospital or a cooperative hospital service organization described in section 170(b)(1)(A)(iii).

A medical research organization operated in conjunction with a hospital described in section 170(b)(1)(A)(iii). Enter the hospital's name, city, and state:

An organization operated for the benefit of a college or university owned or operated by a governmental unit described in

section 170(b)(1)(A)(iv). (Complete Part II.)

A federal, state, or local government or governmental unit described in section 170(b)(1)(A)(v).

An organization that normally receives a substantial part of its support from a governmental unit or from the general public described in

section 170(b)(1)(A)(vi). (Complete Part II.)

A community trust described in section 170(b)(1)(A)(vi). (Complete Part II.)

An organization that normally receives: (1) more than 331/3% of its support from contributions, membership fees, and gross

receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of

its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses

acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)

An organization organized and operated exclusively to test for public safety. Seesection 509(a)(4).

An organization organized and operated exclusively for the benefit of, to perform the functions of, or to carry out the purposes of one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2). See section 509(a)(3). Check the box that describes the type of supporting organization and complete lines 11e through 11h.

Type I

Type II

Type III - Functionally integrated

Type III - Other

By checking this box, I certify that the organization is not controlled directly or indirectly by one or more disqualified persons other than foundation managers and other than one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2).

If the organization received a written determination from the IRS that it is a Type I, Type II or Type III supporting organization, check this box ..................................................

Since August 17, 2006, has the organization accepted any gift or contribution from any of the
following persons?

(i) a person who directly or indirectly controls, either alone or together with persons described in (ii)

Yes

and (iii) below, the governing body of the the supported organization? ................

11g(i)

(ii) a family member of a person described in (i) above? ......................

11g(ii)

(iii) a 35% controlled entity of a person described in (i) or (ii) above? ................

11g(iii)

Provide the following information about the supported organization(s).

(i) Name of supported organization	(ii) EIN	(iv) Is the organization in col. (i) listed in your governing document?		(v) Did you notify the organization in col. (i) of your support?		(vi) Is the organization in col. (i) organized in the U.S.?		(vii) Amount of support?
(i) Name of supported organization	(ii) EIN	Yes	No	Yes	No	Yes	No	(vii) Amount of support?


Total

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 11285F

Schedule A (Form 990 or 990-EZ) 2010

Page 2

Part II

Support Schedule for Organizations Described in IRC 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)
(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization fails to qualify under the tests listed below, please complete Part III.)

Section A. Public Support

Calendar year(or fiscal year beginning in)		(a) 2006	(b) 2007	(c) 2008	(d) 2009	(e) 2010	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") ....
2	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......
3	The value of services or facilities furnished by a governmental unit to the organization without charge..
4	Total. Add lines 1 through 3..
5	The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f)..
6	Public Support. Subtract line 5 from line 4.

Section B. Total Support

Calendar year(or fiscal year beginning in)		(a) 2006	(b) 2007	(c) 2008	(d) 2009	(e) 2010	(f) Total
7	Amounts from line 4..
8	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
9	Net income from unrelated business activities, whether or not the business is regularly carried on..
10	Other income. (Explain in Part IV.) Do not include gain or loss from the sale of capital assets..
11	Total support (Add lines 7 through 10).

Gross receipts from related activities, etc. (See instructions.) ..................

First Five Years If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here.......................................... right arrow

Section C. Computation of Public Support Percentage

Public Support Percentage for 2010 (line 6 column (f) divided by line 11 column (f)) .........

Public Support Percentage for 2009 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2010. If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization ...................... right arrow

33 1/3% support test—2009. If the organization did not check the box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization ..................... right arrow

17a

10%-facts-and-circumstances test—2010. If the organization did not check a box on line 13, 16a, or 16b and line 14
is 10% or more, and if the organization meets the "facts and circumstances" test, check this box and stop here. Explain
in Part IV how the organization meets the "facts and circumstances" test. The organization qualifies as a publicly supported
organization .................................................. right arrow

10%-facts-and-circumstances test—2009. If the organization did not check a box on line 13, 16a, 16b, or 17a and line
15 is 10% or more, and if the organization meets the "facts and circumstances" test, check this box and stop here.
Explain in Part IV how the organization meets the "facts and circumstances" test. The organization qualifies as a publicly
supported organization .............................................. right arrow

Private Foundation If the organization did not check a box on line 13, 16a, 16b, 17a or 17b, check this box and see
instructions ................................................... right arrow

Schedule A (Form 990 or 990-EZ) 2010

Page 3

Part III

Support Schedule for Organizations Described in IRC 509(a)(2)
(Complete only if you checked the box on line 9 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.)

Section A. Public Support

Calendar year(or fiscal year beginning in)		(a) 2006	(b) 2007	(c) 2008	(d) 2009	(e) 2010	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
2	Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose......
3	Gross receipts from activities that are not an unrelated trade or business under section 513..
4	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
5	The value of services or facilities furnished by a governmental unit to the organization without charge..
6	Total. Add lines 1 through 5.
7a	Amounts included on lines 1, 2, and 3 received from disqualified persons...
b	Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.
c	Add lines 7a and 7b..
8	Public Support (Subtract line 7c from line 6.)

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2006	(b) 2007	(c) 2008	(d) 2009	(e) 2010	(f) Total
9	Amounts from line 6...
10a	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
b	Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c	Add lines 10a and 10b.
11	Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.
12	Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)
13	Total support (Add lines 9, 10c, 11 and 12.).

Section C. Computation of Public Support Percentage

Public Support Percentage for 2010 (line 8 column (f) divided by line 13 column (f)) .........

Public support percentage from 2009 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2010 (line 10c column (f) divided by line 13 column (f)) ......

Investment income percentage from 2009 Schedule A, Part III, line 17 .............

19a

33 1/3% support tests—2010. If the organization did not check the box on line 14, and line 15 is more than 33 1/3% and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization .......... right arrow

33 1/3% support tests—2009. If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization .... right arrow

Private Foundation If the organization did not check a box on line 14, 19a or 19b, check this box and see instructions ..... right arrow

Schedule A (Form 990 or 990-EZ) 2010

Page 4

Part IV

Supplemental Information. Supplemental Information. Complete this part to provide the explanation required by Part II, line 10; Part II, line 17a or 17b; or Part III, line 12. Also complete this part for any additional information. (See instructions).

Facts And Circumstances Test

Explanation

Schedule A (Form 990 or 990-EZ) 2010

Additional Data

Software ID:
Software Version:

- TIN:

Schedule B
(Form 990, 990-EZ,
or 990-PF)

Department of the Treasury
Internal Revenue Service

Schedule of Contributors

Attach to Form 990, 990-EZ, or 990-PF.

OMB No. 1545-0047

2010

Name of organization

WAMEGO HOSPITAL ASSOCIATION INC

Employer identification number

72-1526400

Organization type (check one):

Filers of:

Section:

Form 990 or 990-EZ

501(c)( ) (enter number) organization

4947(a)(1) nonexempt charitable trust not treated as a private foundation

527 political organization

Form 990-PF

501(c)(3) exempt private foundation

4947(a)(1) nonexempt charitable trust treated as a private foundation

501(c)(3) taxable private foundation

Check if your organization is covered by the General Rule or a Special Rule.
Note. Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.

General Rule

For an organization filing Form 990, 990-EZ, or 990-PF that received, during the year, $5,000 or more (in money or
property) from any one contributor. Complete Parts I and II.

Special Rules

For a section 501(c)(3) organization filing Form 990 or 990-EZ, that met the 33¹/3% support test of the regulations
under sections 509(a)(1) and 170(b)(1)(A)(vi), and received from any one contributor, during the year, a contribution of the
greater of (1) $5,000 or (2) 2% of the amount on (i) Form 990, Part VIII, line 1h, or (ii) Form 990-EZ, line 1. Complete Parts I and II.

For a section 501(c)(7), (8), or (10) organization filing Form 990, or 990-EZ, that received from any one contributor,
during the year, aggregate contributions of more than $1,000 for use exclusively for religious, charitable,
scientific, literary, or educational purposes, or the prevention of cruelty to children or animals. Complete Parts I, II, and
III.

For a section 501(c)(7), (8), or (10) organization filing Form 990, or 990-EZ, that received from any one contributor,
during the year, contributions for use exclusively for religious, charitable, etc., purposes, but these contributions did
not aggregate to more than $1,000. If this box is checked, enter here the total contributions that were received during
the year for an exclusively religious, charitable, etc., purpose. Do not complete any of the parts unless the General Rule
applies to this organization because it received nonexclusively religious, charitable, etc., contributions of $5,000 or more
during the year. ......................... Arrow Bullet

Caution. An Organization that is not covered by the General Rule and/or the Special Rules does not file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2 of its Form 990, or check the box in the heading of its
Form 990-EZ, or on line 2 of its Form 990-PF, to certify that it does not meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).

For Paperwork Reduction Act Notice, see the Instructions
for Form 990, 990-EZ, or 990-PF.

Cat. No. 30613XSchedule B (Form 990, 990-EZ, or 990-PF) (2010)

Name of organization WAMEGO HOSPITAL ASSOCIATION INC
Schedule B (Form 990, 990-EZ, or 990-PF) (2010) Page 1 of 1 of Part I
Part I	Contributors (see Instructions)
(a) No.	(b) Name, address, and ZIP + 4	(c) Aggregate contributions	(d) Type of contribution
RESTRICTED	RESTRICTED RESTRICTED RESTRICTED RESTRICTED, RESTRICTED RESTRICTED	$RESTRICTED	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Aggregate contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Aggregate contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Aggregate contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Aggregate contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Aggregate contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2010)

Name of organization WAMEGO HOSPITAL ASSOCIATION INC
Schedule B (Form 990, 990-EZ, or 990-PF) (2010) Page 1 of 1 of Part II
Part II	Noncash Property (see Instructions)
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
Schedule B (Form 990, 990-EZ, or 990-PF) (2010)

Schedule B (Form 990, 990-EZ, or 990-PF) (2010)

Page 1 of 1 of Part III

Name of organization
WAMEGO HOSPITAL ASSOCIATION INC

Employer identification number

72-1526400

Part III

Exclusively religious, charitable, etc., individual contributions to section 501(c)(7), (8), or (10) organizations
aggregating more than $1,000 for the year. (Complete columns (a) through (e) and the following line entry.)
For organizations completing Part III, enter the total of exclusively religious, charitable, etc.,
contributions of $1,000 or less for the year. (Enter this information once. See instructions.) Arrow Bullet

(a) No.
from
Part I

(b)
Purpose of gift

(d)
Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a) No.
from
Part I

(b)
Purpose of gift

(d)
Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a) No.
from
Part I

(b)
Purpose of gift

(d)
Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a) No.
from
Part I

(b)
Purpose of gift

(d)
Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

Schedule B (Form 990, 990-EZ, or 990-PF) (2010)

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE C
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Political Campaign and Lobbying Activities

For Organizations Exempt From Income Tax Under section 501(c) and section 527
SchCMd Bullet

Complete if the organization is described below.
SchCMd Bullet

Attach to Form 990 or Form 990-EZ. SchCMd Bullet

See separate instructions.

OMB No. 1545-0047

2010

Open to Public
Inspection

If the organization answered “Yes,” to Form 990, Part IV, Line 3, or Form 990-EZ, Part V, line 46 (Political Campaign Activities), then
Round Bullet

Section 501(c)(3) organizations: Complete Parts I-A and B. Do not complete Part I-C.
Round Bullet

Section 501(c) (other than section 501(c)(3)) organizations: Complete Parts I-A and C below. Do not complete Part I-B.
Round Bullet

Section 527 organizations: Complete Part I-A only.
If the organization answered “Yes,” to Form 990, Part IV, Line 4, or Form 990-EZ, Part VI, line 47 (Lobbying Activities), then
Round Bullet

Section 501(c)(3) organizations that have filed Form 5768 (election under section 501(h)) Complete Part II-A. Do not complete Part II-B.
Round Bullet

Section 501(c)(3) organizations that have NOT filed Form 5768 (election under section 501(h)): Complete Part II-B. Do not complete Part II-A.
If the organization answered “Yes,” to Form 990, Part IV, Line 5 (Proxy Tax) or Form 990-EZ, Part V, line 35a (Proxy Tax), then
Round Bullet

Section 501(c)(4), (5), or (6) organizations: Complete Part III.

Name of the organization

WAMEGO HOSPITAL ASSOCIATION INC

Employer identification number

72-1526400

Part I-A

Complete if the organization is exempt under section 501(c) or is a section 527 organization.

Provide a description of the organization's direct and indirect political campaign activities on behalf of or in opposition to candidates for public office in Part IV.

Political expenditures .................................... SchCMd Bullet

Volunteer hours ........................................

Part I-B

Complete if the organization is exempt under section 501(c)(3).

Enter the amount of any excise tax incurred by the organization under section 4955 ......... SchCMd Bullet

Enter the amount of any excise tax incurred by organization managers under section 4955 ...... SchCMd Bullet

If the organization incurred a section 4955 tax, did it file Form 4720 for this year? ..............

Yes No

Was a correction made? .........................................

Yes No

If "Yes," describe in Part IV.

Part I-C

Complete if the organization is exempt under section 501(c) except section 501(c)(3).

Enter the amount directly expended by the filing organization for section 527 exempt function activities SchCMd Bullet

Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt funtion activities .................................... SchCMd Bullet

Total exempt function expenditures. Add lines 1 and 2. Enter here and on Form 1120-POL, line 17b.. SchCMd Bullet

Did the filing organization file Form 1120-POL for this year? ..........................

Yes No

Enter the names, addresses and employer identification number (EIN) of all section 527 political organizations to which the filing
organization made payments. For each organization listed, enter the amount paid from the filing organization’s funds. Also enter the amount of political contributions received that were promptly and directly delivered to a separate political organization, such as a separate segregated fund or a political action committee (PAC). If additional space is needed, provide information in Part IV.

(a) Name	(b) Address	(c) EIN	(d) Amount paid from filing organization's funds. If none, enter -0-.	(e) Amount of political contributions received and promptly and directly delivered to a separate political organization. If none, enter -0-.

For Privacy Act and Paperwork Reduction Act Notice, see the instructions for Form 990.

Cat. No. 50084S

Schedule C (Form 990 or 990-EZ) 2010

Page 2

Part II-A

Complete if the organization is exempt under section 501(c)(3) and filed Form 5768 (election under section 501(h)).

A Check if the filing organization belongs to an affiliated group.
B Check if the filing organization checked box A and "limited control" provisions apply.

Limits on Lobbying Expenditures (The term "expenditures" means amounts paid or incurred.)		(b) Affiliated Group Totals
1a	Total lobbying expenditures to influence public opinion (grass roots lobbying) ......
b	Total lobbying expenditures to influence a legislative body (direct lobbying) .......
c	Total lobbying expenditures (add lines 1a and 1b) ...................
d	Other exempt purpose expenditures ........................
e	Total exempt purpose expenditures (add lines 1c and 1d) ...............
f	Lobbying nontaxable amount. Enter the amount from the following table in both columns.
	If the amount on line 1e, column (a) or (b) is:The lobbying nontaxable amount is:
	Not over $500,00020% of the amount on line 1e.
	Over $500,000 but not over $1,000,000$100,000 plus 15% of the excess over $500,000.
	Over $1,000,000 but not over $1,500,000$175,000 plus 10% of the excess over $1,000,000.
	Over $1,500,000 but not over $17,000,000$225,000 plus 5% of the excess over $1,500,000.
	Over $17,000,000$1,000,000.

g	Grassroots nontaxable amount (enter 25% of line 1f) .................
h	Subtract line 1g from line 1a. If zero or less, enter -0-. ................
i	Subtract line 1f from line 1c. If zero or less, enter -0-. ................
j	If there is an amount other than zero on either line 1h or line 1i, did the organization file Form 4720 reporting section 4911 tax for this year? ......................................	Yes No

4-Year Averaging Period Under Section 501(h) (Some organizations that made a section 501(h) election do not have to complete all of the five columns below. See the instructions for lines 2a through 2f on page 4.)
Lobbying Expenditures During 4-Year Averaging Period
	Calendar year (or fiscal year beginning in)	(a) 2007	(b) 2008	(c) 2009	(d) 2010	(e) Total

2a	Lobbying non-taxable amount

b	Lobbying ceiling amount (150% of line 2a, column(e))

c	Total lobbying expenditures

d	Grassroots non-taxable amount

e	Grassroots ceiling amount (150% of line 2d, column (e))

f	Grassroots lobbying expenditures

Schedule C (Form 990 or 990-EZ) 2010

Page 3

Part II-B

Complete if the organization is exempt under section 501(c)(3) and has NOT filed Form 5768 (election under section 501(h)).

(a)

Yes

(b)

Amount

During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:

Volunteers? .........................................

Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ....

Media advertisements? ....................................

Mailings to members, legislators, or the public? .........................

Publications, or published or broadcast statements? .......................

Grants to other organizations for lobbying purposes? .......................

Direct contact with legislators, their staffs, government officials, or a legislative body? ........

Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ......

Other activities? If "Yes," describe in Part IV ..........................

Yes

1,678

Total. lines 1c through 1i ...................................

1,678

Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....

If "Yes," enter the amount of any tax incurred under section 4912 .................

If "Yes," enter the amount of any tax incurred by organization managers under section 4912 .....

If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year? .......

Part III-A

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).

Yes

Were substantially all (90% or more) dues received nondeductible by members? ................

Did the organization make only in-house lobbying expenditures of $2,000 or less? ................

Did the organization agree to carryover lobbying and political expenditures from the prior year? ..........

Part III-B

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) if BOTH Part III-A, lines 1 and 2 are answered “No” OR if Part III-A, line 3 is answered “Yes”.

Dues, assessments and similar amounts from members .....................

Section 162(e) non-deductible lobbying and political expenditures (do not include amounts of political
expenses for which the section 527(f) tax was paid).

Current year .........................................

Carryover from last year ....................................

Total ...........................................

Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .

If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political expenditure next year? ................................

Taxable amount of lobbying and political expenditures (see instructions) ..............

Part IV

Supplemental Information

Complete this part to provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, line 5; and Part ll-B, line 1i.
Also, complete this part for any additional information.

Identifier	Return Reference	Explanation
LOBBYING ACTIVITIES	SCHEDULE C, PART II-B, LINE I	A Portion of KHA dues paid are lobbying expenses. Wamego Hospital Association, INC. DOES NOT PARTICIPATE IN ACTIVITIES SUPPORTING A POLITICAL CANDIDATE.

Schedule C (Form 990 or 990EZ) 2010

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

Complete if the organization answered "Yes," to Form 990,
Part IV, line 6, 7, 8, 9, 10, 11, or 12.
SchDMd Bullet

Attach to Form 990. SchDMd Bullet

See separate instructions.

OMB No. 1545-0047

2010

Open to Public Inspection

Name of the organization

WAMEGO HOSPITAL ASSOCIATION INC

Employer identification number

72-1526400

Part I

Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" to Form 990, Part IV, line 6.

		(a) Donor advised funds	(b) Funds and other accounts
1	Total number at end of year .......
2	Aggregate contributions to (during year) ...
3	Aggregate grants from (during year) ...
4	Aggregate value at end of year .......

Did the organization inform all donors and donor advisors in writing that the assets held in donor advised
funds are the organization's property, subject to the organization's exclusive legal control? ............

Yes No

Did the organization inform all grantees, donors, and donor advisors in writing that grant funds may be
used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit. ...................................

Yes No

Part II

Conservation Easements. Complete if the organization answered "Yes" to Form 990, Part IV, line 7.

Purpose(s) of conservation easements held by the organization (check all that apply).

Preservation of land for public use (e.g., recreation or pleasure) Preservation of an historically importantly land area

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

Complete lines 2a–2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.


a	Total number of conservation easements .......................	2a
b	Total acreage restricted by conservation easements ..................	2b
c	Number of conservation easements on a certified historic structure included in (a) .....	2c
d	Number of conservation easements included in (c) acquired after 8/17/06 ........	2d

Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during
the taxable year SchDMd Bullet

Number of states where property subject to conservation easement is located SchDMd Bullet

Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and
enforcement of the conservation easements it holds? .............................

Yes No

Staff and volunteer hours devoted to monitoring, inspecting and enforcing conservation easements during the year SchDMd Bullet

Amount of expenses incurred in monitoring, inspecting, and enforcing conservation easements during the year SchDMd Bullet

Does each conservation easement reported on line 2(d) above satisfy the requirements of section
170(h)(4)(B)(i) and 170(h)(4)(B)(ii)? ....................................

Yes No

In Part XIV, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" to Form 990, Part IV, line 8.

If the organization elected, as permitted under SFAS 116, not to report in its revenue statement and balance sheet works of
art, historical treasures, or other similar assets held for public exhibition, education or research in furtherance of public service,
provide, in Part XIV, the text of the footnote to its financial statements that describes these items.

If the organization elected, as permitted under SFAS 116, to report in its revenue statement and balance sheet works of art,
historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service,
provide the following amounts relating to these items:

(i)

Revenues included in Form 990, Part VIII, line 1 ........................ SchDMd Bullet

(ii)

Assets included in Form 990, Part X .............................. SchDMd Bullet

If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under SFAS 116 relating to these items:

Revenues included in Form 990, Part VIII, line 1 .......................... SchDMd Bullet

Assets included in Form 990, Part X ............................... SchDMd Bullet

For Privacy Act and Paperwork Reduction Act Notice, see the Intructions for Form 990

Cat. No. 52283D

Schedule D (Form 990) 2010

Page 2

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)

Using the organization’s accession and other records, check any of the following that are a significant use of its collection
items (check all that apply):

Public exhibition

Loan or exchange programs

Scholarly research

Other

Preservation for future generations

Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIV.

During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?........

Yes No

Part IV

Escrow and Custodial Arrangements. Complete if the organization answered "Yes" to Form 990,
Part IV, line 9, or reported an amount on Form 990, Part X, line 21.

Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................

Yes No

If "Yes," explain the arrangement in Part XIV and complete the following table:


c	Beginning balance .................................	1c
d	Additions during the year ..............................	1d
e	Distributions during the year .............................	1e
f	Ending balance ...................................	1f

Did the organization include an amount on Form 990, Part X, line 21? .....................

Yes No

If “Yes,” explain the arrangement in Part XIV.

Part V

Endowment Funds. Complete if the organization answered "Yes" to Form 990, Part IV, line 10.

		(a)Current Year	(b)Prior Year	(c)Two Years Back	(d)Three Years Back	(e)Four Years Back
1a	Beginning of year balance ....
b	Contributions ........
c	Investment earnings or losses ...
d	Grants or scholarships .....
e	Other expenditures for facilities and programs ........
f	Administrative expenses ....
g	End of year balance ......

Provide the estimated percentage of the year end balance held as:

Board designated or quasi-endowment: SchDMd Bullet

Permanent endowment: SchDMd Bullet

Term endowment: SchDMd Bullet

Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes

(i) unrelated organizations ........................

3a(i)

(ii) related organizations ........................

3a(ii)

If "Yes" to 3a(ii), are the related organizations listed as required on Schedule R? .........

Describe in Part XIV the intended uses of the organization's endowment funds.

Part VI

InvestmentsLand, Buildings, and Equipment. See Form 990, Part X, line 10.

Description of investment		(b)Cost or other basis (other)	(c) Accumulated depreciation	(d) Book value
1a	Land .................
b	Buildings ................
c	Leasehold improvements ............	185,300	66,748	118,552
d	Equipment ................	2,732,766	1,592,567	1,140,199
e	Other .................	82,565		82,565
Total. Add lines 1a-1e. (Column (d) should equal Form 990, Part X, column (B), line 10(c).)........				1,341,316

Schedule D (Form 990) 2010

Page 3

Part VII

InvestmentsOther Securities. See Form 990, Part X, line 12.

(a) Description of security or category (including name of security)		(b)Book value	(c) Method of valuation: Cost or end-of-year market value
(1)Financial derivatives
(2)Closely-held equity interests
Other








Total. (Column (b) should equal Form 990, Part X, col.(B) line 12.)

Part VIII

InvestmentsProgram Related. See Form 990, Part X, line 13.

(a) Description of investment type		(b) Book value	(c) Method of valuation: Cost or end-of-year market value









Total. (Column (b) should equal Form 990, Part X, col.(B) line 13.)

Part IX

Other Assets. See Form 990, Part X, line 15.

(a) Description				(b) Book value
(1) LIMITED USE ASSETS				709,572
(2) EST AMTS THIRD-PARTY PAYERS				800,000
(3) OTHER RECEIVABLES				0






Total. (Column (b) should equal Form 990, Part X, col.(B) line 15.)...........				1,509,572

Part X

Other Liabilities. See Form 990, Part X, line 25.

1.(a) Description of Liability		(b) Amount
Federal Income Taxes		0
EST AMTS DUE TO 3RD PARTIES		0








Total. (Column (b) should equal Form 990, Part X, col.(B) line 25.)		0
2. Fin 48 (ASC 740) Footnote. In Part XIV, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC740).

Schedule D (Form 990) 2010

Page 4

Part XI Reconciliation of Change in Net Assets from Form 990 to Financial Statements
1	Total revenue (Form 990, Part VIII, column (A), line 12) ....................	1	9,191,268
2	Total expenses (Form 990, Part IX, column (A), line 25) .....................	2	8,823,257
3	Excess or (deficit) for the year. Subtract line 2 from line 1 .............	3	368,011
4	Net unrealized gains (losses) on investments ..........................	4
5	Donated services and use of facilities .............................	5
6	Investment expenses ...................................	6
7	Prior period adjustments ..................................	7
8	Other (Describe in Part XIV) .................................	8
9	Total adjustments (net). Add lines 4 - 8 .............................	9
10	Excess or (deficit) for the year per financial statements. Combine lines 3 and 9 .........	10	368,011

Part XII Reconciliation of Revenue per Audited Financial Statements With Revenue per Return
1	Total revenue, gains, and other support per audited financial statements .......		1	9,191,268
2	Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a	Net unrealized gains on investments ..........	2a
b	Donated services and use of facilities .........	2b
c	Recoveries of prior year grants ...........	2c
d	Other (Describe in Part XIV): ............	2d
e	Add lines 2a through 2d .....................		2e
3	Subtract line 2e from line 1.....................		3	9,191,268
4	Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b .	4a
b	Other (Describe in Part XIV): ...........	4b
c	Add lines 4a and 4b.......................		4c
5	Total Revenue. Add lines 3 and 4c. (This should equal Form 990, Part I, line 12.) ......		5	9,191,268

Part XIII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return
1	Total expenses and losses per audited financial statements .............		1	8,823,257
2	Amounts included on line 1 but not on Form 990, Part IX, line 25:
a	Donated services and use of facilities ..........	2a
b	Prior year adjustments ..............	2b
c	Other losses ................	2c
d	Other (Describe in Part XIV): ............	2d
e	Add lines 2a through 2d......................		2e
3	Subtract line 2e from line 1.....................		3	8,823,257
4	Amounts included on Form 990, Part IX, line 25, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b ..	4a
b	Other (Describe in Part XIV): ............	4b
c	Add lines 4a and 4b.......................		4c
5	Total expenses. Add lines 3 and 4c. (This should equal Form 990, Part I, line 18.) ......		5	8,823,257

Part XIV

Supplemental Information

Complete this part to provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b;
Part V, line 4; Part X; Part XI, line 8; Part XII, lines 2d and 4b; and Part XIII, lines 2d and 4b. Also complete this part to provide any additional information.

Identifier	Return Reference	Explanation
FIN 48	SCHEDULE D, PART X	THE ORGANIZATION'S AUDITED FINANCIAL STATEMENTS DO NOT CONTAIN A STATEMENT REGARDING FIN 48 POLICIES. HOWEVER, THE HOSPITAL HAS BEEN RECOGNIZED AS EXEMPT FROM INCOME TAXES UNDER SECTION 501 OF THE INTERNAL REVENUE CODE AND A SIMILAR PROVISION OF STATE LAW. HOWEVER, THE HOSPITAL IS SUBJECT TO FEDERAL INCOME TAX ON ANY UNRELATED BUSINESS TAXABLE INCOME. THE HOSPITAL IS NO LONGER SUBJECT TO FEDERAL AND STATE TAX EXAMINATIONS BY TAX AUTHORITIES FOR YEARS BEFORE 2007.

Schedule D (Form 990) 2010

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE H
(Form 990)

Department of the Treasury
Internal Revenue Service

Hospitals

Complete if the organization answered "Yes" to Form 990, Part IV, question 20.
MediumBullet

Attach to Form 990. MediumBullet

See separate instructions.

OMB No. 1545-0047

2010

Open to Public Inspection

Name of the organization

WAMEGO HOSPITAL ASSOCIATION INC

Employer identification number

72-1526400

Part I

Charity Care and Certain Other Community Benefits at Cost

Yes

Does the organization have a charity care policy? If "No," skip to question 6a...........

Yes

If "Yes," is it a written policy? .......................

Yes

If the organization has multiple hospitals, indicate which of the following best describes application of the charity care policy to the various hospitals.

Applied uniformly to all hospitals Applied uniformly to most hospitals Generally tailored to individual hospitals

Answer the following based on the charity care eligibility criteria that applies to the largest number of the organization's patients.

Does the organization use Federal Poverty Guidelines (FPG) to determine eligibility for providing free care to low

income individuals? If "Yes," indicate which of the following is the FPG family income limit for eligibility for free care:

Yes

100% 150% 200% Other 400 %

Does the organization use FPG to determine eligibility for providing discounted care to low income individuals? If

"Yes," indicate which of the following is the family income limit for eligibility for discounted care: .....

Yes

200% 250% 300% 350% 400% Other

If the organization does not use FPG to determine eligibility, describe in Part VI the income based criteria for determining eligibility for free or discounted care. Include in the description whether the organization uses an asset test or other threshold, regardless of income, to determine eligibility for free or discounted care.

Does the organization's policy provide free or discounted care to the "medically indigent"? ......

Does the organization budget amounts for free or discounted care provided under its charity care policy? ...

Yes

If "Yes," did the organization's charity care expenses exceed the budgeted amount?.........

Yes

If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discounted
care to a patient who was eligibile for free or discounted care?...............

Does the organization prepare an annual community benefit report?.............

Yes

If "Yes," does the organization make it available to the public? ..............

Yes

Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.

Charity Care and Certain Other Community Benefits at Cost

	(c) Total community benefit expense	(d) Direct offsetting revenue	(e) Net community benefit expense	(f) Percent of total expense
a Charity care at cost (from Worksheets 1 and 2) ..	51,522	0	51,522	0.620 %
b Unreimbursed Medicaid (from Worksheet 3, column a) .	386,152	36,322	349,830	4.230 %
c Unreimbursed costs—other means-tested government programs (from Worksheet 3, column b) ....	24,423	0	24,423	0.290 %
dTotal Charity Care and Means-Tested Government Programs .....	462,097	36,322	425,775	5.140 %
Other Benefits e Community health improvement services and community benefit operations (from (Worksheet 4) ....	0	0	8,010	0.100 %
f Health professions education (from Worksheet 5) ..	0	0	0	0 %
g Subsidized health services (from Worksheet 6) ..	0	0	0	0 %
h Research (from Worksheet 7)	0	0	0	0 %
i Cash and in-kind contributions to community groups (from Worksheet 8) ..	0	0	15,283	0.180 %
jTotal Other Benefits ...	0	0	23,293	0.280 %
kTotal. Add lines 7d and 7j. ..	462,097	36,322	449,068	5.420 %

For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2010

Schedule H (Form 990) 2010

Page 2

Part II

Community Building Activities Complete this table if the organization conducted any community building activities.

		(c) Total community building expense	(e) Net community building expense	(f) Percent of total expense
1	Physical improvements and housing
2	Economic development
3	Community support	892	892	0.010 %
4	Environmental improvements
5	Leadership development and training for community members
6	Coalition building
7	Community health improvement advocacy
8	Workforce development
9	Other
10	Total	892	892	0.010 %

Part III

Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense

Yes

Does the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15? ..........................

Yes

Enter the amount of the organization's bad debt expense (at cost).....

420,616

Enter the estimated amount of the organization's bad debt expense (at cost) attributable to patients eligible under the organization's charity care policy ..

Provide in Part VI the text of the footnote to the organization's financial statements that describes bad debt expense. In addition, describe the costing methodology used in determining the amounts reported on lines 2 and 3, and rationale for including a portion of bad debt amounts as community benefit.

Section B. Medicare

Enter total revenue received from Medicare (including DSH and IME).....

6,403,406

Enter Medicare allowable costs of care relating to payments on line 5.....

4,951,875

Subtract line 6 from line 5. This is the surplus or (shortfall)........

1,451,531

Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.
Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.
Check the box that describes the method used:

Cost accounting system Cost to charge ratio Other

Section C. Collection Practices

Does the organization have a written debt collection policy? ...............

Yes

If "Yes," does the organization's collection policy contain provisions on the collection practices to be followed for patients who are known to qualify for charity care or financial assistance? Describe in Part VI......

Yes

Part IV

Management Companies and Joint Ventures

(a) Name of entity	(b) Description of primary activity of entity	(c) Organization's profit % or stock ownership %	(d) Officers, directors, trustees, or key employees' profit % or stock ownership%	(e) Physicians' profit % or stock ownership %
1
2
3
4
5
6
7
8
9
10
11
12
13

Schedule H (Form 990) 2010

Page 3

Part VFacility Information

Section A. Hospital Facilities (list in order of size, measured by total revenue per facility, from largest to smallest) How many hospital facilities did the organization operate during the tax year?1 Name and address		Other (Describe)
1	WAMEGO HOSPITAL ASSOCIATION 711 GENN DRIVE WAMEGO,KS66547	X	X	X

Schedule H (Form 990) 2010

Page 4

Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)

Name of Hospital Facility:WAMEGO HOSPITAL ASSOCIATION

Line Number of Hospital Facility (from Schedule H, Part V, Section A):1

				Yes	No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2010)
1	During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. .....................		1
	If “Yes,” indicate what the Needs Assessment describes (check all that apply):
	a	A definition of the community served by the hospital facility
	b	Demographics of the community
	c	Existing health care facilities and resources within the community that are available to respond to the health needs of the community
	d	How data was obtained
	e	The health needs of the community
	f	Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
	g	The process for identifying and prioritizing community health needs and services to meet those needs
	h	The process for consulting with persons representing the community’s interests
	i	Information gaps that limit the hospital facility’s ability to assess all of the community’s health needs
	j	Other (describe in Part VI)
2	Indicate the tax year the hospital facility last conducted a Needs Assessment: 20
3	In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted.		3
4	Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................		4
5	Did the hospital facility make its Needs Assessment widely available to the public? ...........		5
	If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
	a	Hospital facility’s website
	b	Available upon request from the hospital facility
	c	Other (describe in Part VI)
6	If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
	a	Adoption of an implementation strategy to address the health needs of the hospital facility’s community
	b	Execution of the implementation strategy
	c	Development of a community benefit plan for the facility
	d	Participation in community-wide community benefit plan
	e	Inclusion of a community benefit section in operational plans
	f	Adoption of a budget for provision of services that address the needs identified in the CHNA
	g	Prioritization of health needs in the community
	h	Prioritization of services that the hospital facility will undertake to meet health needs in its community
	i	Other (describe in Part VI)
7	Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed together with the reasons why it has not addressed such needs.		7
Financial Assistance Policy
	Did the hospital facility have in place during the tax year a written financial assistance policy that:
8	Explains eligibility criteria for financial assistance, and whether such assistance includes free or discounted care?		8
9	Used federal poverty guidelines (FPG) to determine eligibility for providing free care to low incomeindividuals?..		9
	If “Yes,” indicate the FPG family income limit for eligibility for free care: %

Schedule H (Form 990) 2010

Page 5

Part VFacility Information (continued)

				Yes	No
10	Used FPG to determine eligibility for providing discounted care to low income individuals?.........		10
	If “Yes,” indicate the FPG family income limit for eligibility for discounted care: %
11	Explained the basis for calculating amounts charged to patients?.................		11
	If “Yes,” indicate the factors used in determining such amounts (check all that apply):
	a	Income level
	b	Asset level
	c	Medical indigency
	d	Insurance status
	e	Uninsured discount
	f	Medicaid/Medicare
	g	State regulation
	h	Other (describe in Part VI)
12	Explained the method for applying for financial assistance?...................		12
13	Included measures to publicize the policy within the community served by the hospital facility?.......		13
	If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
	a	The policy was posted at all times on the hospital facility’s web site
	b	The policy was attached to all billing invoices
	c	The policy was posted in the hospital facility’s emergency rooms or waiting rooms
	d	The policy was posted in the hospital facility’s admissions offices
	e	The policy was provided, in writing, to patients upon admission to the hospital facility
	f	The policy was available upon request
	g	Other (describe in Part VI)
Billing and Collections
14	Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy that explained actions the hospital facility may take upon non-payment?........		14
15	Check all of the following collection actions against a patient that were permitted under the hospital facility's policies at any time during the tax year:
	a	Reporting to credit agency
	b	Lawsuits
	c	Liens on residences
	d	Body attachments or arrests
	e	Other (describe in Part VI)
16	Did the hospital facility engage in or authorize a third party to engage in any of the following collection actions during the tax year?...................................		16
	If “Yes,” check all collection actions in which the hospital facility or a third party engaged (check all that apply):
	a	Reporting to credit agency
	b	Lawsuits
	c	Liens on residences
	d	Body attachments
	e	Other (describe in Part VI)
17	Indicate which actions the hospital facility took before initiating any of the collection actions checked in question 16 (check all that apply):
	a	Notified patients of the financial assistance policy upon admission
	b	Notified patients of the financial assistance policy prior to discharge
	c	Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
	d	Documented its determination of whether a patient who applied for financial assistance under the financial assistance policy qualified for financial assistance
	e	Other (describe in Part VI)

Schedule H (Form 990) 2010

Page 6

Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
				Yes	No
18	Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?..........		18
	If “No,” indicate the reasons why (check all that apply):
	a	The hospital facility did not provide care for any emergency medical conditions
	b	The hospital facility did not have a policy relating to emergency medical care
	c	The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
	d	Other (describe in Part VI)
Charges for Medical Care
19	Indicate how the hospital facility determined the amounts generally billed to individuals who had insurance covering emergency or other medically necessary care (check all that apply):
	a	The hospital facility used the lowest negotiated commercial insurance rate for those services at the hospital facility
	b	The hospital facility used the average of the three lowest negotiated commercial insurance rates for those services at the hospital facility
	c	The hospital facility used the Medicare rate for those services
	d	Other (describe in Part VI)
20	Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?.........		20
	If “Yes,” explain in Part VI.
21	Did the hospital facility charge any of its patients an amount equal to the gross charge for services provided to that patient?...................................		21
	If “Yes,” explain in Part VI.

Schedule H (Form 990) 2010

Page 7

Part VFacility Information (continued)

Section C. Other Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility (list in order of size, measured by total revenue per facility, from largest to smallest) How many non-hospital facilities did the organization operate during the tax year?1
Name and address		Type of Facility (Describe)
1	Wamego Family Health Care 711 Glenn Drive WAMEGO,KS66547	FAMILY PRACTICE
2
3
4
5
6
7
8
9
10

Schedule H (Form 990) 2010

Page 8

Part VI

Supplemental Information

Complete this part to provide the following information.

1	Required descriptions. Provide the description required for Part I, lines 3c, 6a, and 7; Part II; Part III, lines 4, 8, and 9b; and Part V, Section B, lines 1j, 2, 4c, 6i, 7, 11i, 13i, 17l, 18l, 19e, 21d, 25, and 26.
2	Community health needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any community health needs assessments reported in Part V, Section B.
3	Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4	Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5	Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6	Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7	State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.

Identifier	ReturnReference	Explanation
PART I, LINE 3C		WAMEGO HOSPITAL ASSOCIATION PROVIDES MEDICALLY NECESSARY CARE TO ALL PATIENTS REGARDLESS OF RACE, COLOR, CREED, ETHNIC ORIGIN, GENDER, DISABILITY, OR ECONOMIC STATUS. AT A MINIMUM, PATIENTS WITH INCOMES LESS THAN OR EQUAL TO 200% OF THE FPG WILL BE ELIGIBLE FOR 100% CHARITY CARE WRITE OFF OF CHARGES FOR SERVICES THAT HAVE BEEN PROVIDED TO THEM. PATIENTS WITH INCOMES BETWEEN 200% AND 400% OF THE FPG WILL BE CHARGED FOR SERVICES ON A SLIDING SCALE.
PART I, LINE 6A		MERCY REGIONAL HEALTH CENTER (MRHC) THE PARENT COMPANY OF WAMEGO HOSPITAL ASSOCIATION, PREPARES AND SHARES THE ANNUAL COMMUNITY BENEFIT REPORT THROUGH A PRESS RELEASE, ADVERTISEMENT IN THE LOCAL NEWSPAPER AND THE VIA CHRISTI HEALTH HOMEPAGE AT WWW.VIACHRISTI.ORG
PART I, LINE 7, COLUMN F		Per the Catholic Health Association's (CHA) A Guide for Planning and Reporting Community Benefit Guidelines, bad debt expense is removed from operating expense to arrive at the ratio of cost to charge calculation. The gross bad debt expense removed from the calculation in column (f) is $543,910.
PART I, LINE 7		The cost of providing charity care, means tested government programs, and community benefit programs is estimated using internal cost data, and is calculated in compliance with Catholic Health Association (CHA) guidelines. WHA uses a cost accounting system that addresses all patient segments (e.g. inpatient, outpatient, Medicaid, Medicare, uninsured, etc). The best available data is used to calculate the amounts reported. For certain categories this may be using a cost accounting system while for other categories, a specific cost-to-charge ratio was applied.
PART III, LINE 4		The organization's Audited Financial Statements do not include a footnote specific to the treatment of bad debt expense or uncollectible accounts. However, disclosure can be found in the Audited Financial Statements on the face of the Balance Sheet in the Patient Accounts Receivable(less allowance for uncollectible accounts) line item as well as on the Statement of Operations in the Provision for Uncollectible Accounts line item. This statement of operations reflects the charges foregone and written off as bad debt after all efforts to collect have been exhausted. A ratio of cost to charge calculation, as set forth in the CHA guidelines, is used to calculate the cost of bad debt expense. The organization had no suitable basis for estimating bad debt expense that would be attributable to patients eligible under the organization's charity care policy. For calculation of the bad debt expense at cost, see the ratio of cost to charge methodology described in Part IV, Line 1; (Part 1, Line 7) above. Wamego Hospital Association, Inc. reports bad debts in accordance with generally accepted accounting principles (GAAP). Healthcare Financial Management Statement 15 is followed to the extent that it aligns with the guidelines set forth by GAAP. Bad debt expense at cost is determined using the same cost-to-charge ratio that is used for charity care and Medicaid shortfall. Via Christi Health, Inc. follows the guidance from CHA and does not consider bad debt as a community benefit.
PART III, LINE 8		As a critical access hospital, Wamego City Hospital is reimbursed on a cost plus one percent basis through the Medicare cost report. Accordingly, all revenues and costs are included on the cost report.
PART III, LINE 9b		Wamego Hospital Association processes balances owed by patients in accordance with standard industry practice. Upon final resolution of claim processing activity with third party coverage (i.e. public benefits and private insurance), the patient responsible portion progresses through an electronic dunning schedule that includes mailing of a patient statement at 30 day increments for a minimum of four increments. Accounts unpaid are considered for turning to an independent collection agency. Patients known to qualify for financial assistance are processed as follows: the amount of assistance, typically a percent of the amount owed, is immediately written off the patient's account when approved for assistance. The remaining balance, if any, then progresses through the same collection process as noted above.
PART V		WAMEGO HOSPITAL ASSOCIATION OPERATES A FULL SERVICE HOSPITAL THAT INCLDUES LABORATORY, RADIOLOGY AND PHYSICAL/OCCUPATIONAL THERAPY DEPARTMENTS ALONG WITH CT AND MRI SERVICES. WAMEGO HOSPITAL ASSOCIATION ALSO PROVIDES 24 HOUR ON CALL EMERGENCY SERVICES. WAMEGO FAMILY HEALTHCARE CLINIC PROVIDES WELLNESS CHECKUPS, PHYSICALS AND IMMUNIZATIONS.
NEEDS ASSESSMENT		PART VI SUPPLEMENTAL INFORMATION - QUESTION 2 Wamego Hospital Association (WHA) conducts a community health assessment every three years, with the most recent one completed in September 2010. This health assessment consisted of a compilation of public health and census data, an analysis of emergency room patient diagnoses and discharges, personal interviews with over 40 different stakeholders living or working in the Wamego area. Area residents, physicians, low-income clinics, public health providers, social service agencies, community leaders and elected officials participated in this effort. Following this outreach effort, two priority areas were selected by the hospital leadership team for follow-up.
PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE		PART VI SUPPLEMENTAL INFORMATION - QUESTION 3 WHA uses a percentage of the Federal Poverty Guidelines (FPG) to determine free and discounted care. WHA personnel begin by giving the patient and family information that addresses the financial assistance policy and an application for financial assistance once a patient is identified as uninsured/underinsured. Uninsured/underinsured is based upon the patient's lack of a third party source or high balance co-pay/deductibles. Financial assistance is determined using a sliding scale based on the current Federal poverty guidelines/levels (FPL) as published in the Federal Register. All uninsured patients will receive a minimum of 15% self-pay discount from standard charges on their bill. Additional self-pay discounts are also available for individuals that qualify based on income. WHA is also a certified provider with the Medicare, Medicaid and CHAMPUS/Tricare government sponsored health care programs. FINANCIAL ASSISTANCE INFORMATION IS AVAILABLE ON THE WAMEGO HOSPITAL ASSOCIATION WEBSITE. UPON REQUEST, THE CASE MANAGEMENT DEPARTMENT WILL ASSIST PATIENTS AND FAMILIES IN COMPLETION OF NECESSARY FORMS FOR FINANCIAL ASSISTANCE IN ORDER TO OBTAIN THE APPROPRIATE MEDICARE OR MEDICAID ELIGIBILITY. THE BUSINESS OFFICE WILL MAINTAIN CONTACT WITH THE CASE MANAGEMENT DEPARTMENT, AS WELL AS PERFORM INDEPENDENT FOLLOW-UP ON THE STATUS OF APPLICATIONS IN ORDER TO VERIFY COVERAGE.
COMMUNITY INFORMATION		PART VI SUPPLEMENTAL INFORMATION - QUESTION 4 The primary service area for Wamego Hospital Association, Inc. is the city of Wamego which is geographically located on the border of Pottawatomie and Wabaunsee Counties. In 2010, the population of Wamego was estimated to be 4,680, almost evenly distributed between males and females. The median age in 2010 was 33.6, and the population of Wamego over the age of 18 equaled 2,997. 87% of the adult population in Wamego has a high school diploma or higher educational attainment. Of the persons 15 years of age or older, 70% are in the civilian labor force, while 0.5% are serving in the military. There are 1,630 households occupying 1,740 housing units, a total occupancy rate of 93.7 %. Of the 1,630 occupied housing units, 1,135 are owner-occupied while renters occupy 495. The homeowner vacancy rate is only 1.6%. 110 housing units are reported vacant (6.3%) Most of these vacancies are rental housing. The median household income in Pottawatomie County is $54,341, Geary County $43,528 and Riley County $43,801. Pottawatomie county reports 8% of its residents are below poverty level. Geary County estimates 10.5 % of its residents are below the poverty level, and Riley county estimates 19.8% of residents are below the poverty level. The Statewide poverty level is around 11.3%. The percent of nonelderly population (under age 65) who were uninsured in Kansas counties in 2006 (latest year available by county) includes 12.9 percent in Pottawatomie, 15.7 percent in Geary and 22.8 percent in Riley counties. That number has surely increased given the layoffs which have incurred as a result of the economic recession. The people most likely to be uninsured are young adults between the ages of 18 and 39. In FY 2009 the following number of persons were enrolled in Medicaid in Pottawatomie, Riley, and Geary counties respectively: 1,234; 3,008; 2,866 There are 4 hospitals available to residents living in the Pottawatomie, Riley, and Geary counties. These include Geary Community Hospital in Junction City; Irwin Army Community Hospital in Fort Riley; Mercy Regional Health Center in Manhattan; Wamego City Hospital in Wamego. There were no federally designated medically underserved areas in the Pottawatomie, Riley, or Geary counties; however, The Health Care and Mental Health Section Summary of the Flint Hills Regional Growth Plan authored in 2008 states: "Regional population growth of 32 percent over the next five to six years will strain the current health care infrastructure if communities do not add resources to address increased volumes. The current shortfall in physicians will become more acute, inpatient beds at one to two facilities will approach capacity and current wait times of one to two weeks for mental health care will lengthen."
PROMOTION OF COMMUNITY HEALTH		PART VI SUPPLEMENTAL INFORMATION - QUESTION 5 AND PART II WHA provided a wide variety of benefits to the community in FY2011 such as space for community groups to meet at no charge; a comprehensive website; educational programs about specific conditions throughout the community; informational services for the general public, as well as other professionals who may have needed special assistance; fundraising assistance to local civic campaigns and/or other organizations who support disease prevention; disease management or health promotion. Community outreach includes programs such as free clinics, health screenings, disaster readiness, health education as well as in-kind support for not-for-profit agencies in need of rent reduction space, donated lab services or other donations that are available through our staff's involvement on various boards and committees throughout our primary healthcare region. Wamego Hospital Association provided many benefits to the community in FY2011. The "Get Fit Wamego" program initiated in 2010, collaborated with other health service organizations and focused on healthy lifestyles for all involved.
AFFILIATED HEALTH CARE SYSTEM		PART VI SUPPLEMENTAL INFORMATION - QUESTION 6 This ministry is a part of the Via Christi Health (VCH) system and since its inception VCH and its affiliated organizations have been dedicated to providing accessible quality healthcare to all patients regardless of their ability to pay. VCH owns and operates 11 medical centers and outpatient facilities, two diagnostic imaging centers, one laboratory service center, a multi-specialty physician group, six durable medical equipment and home health agencies, one real estate management service and eleven senior care communities in Kansas. In addition, VCH owns and operates one senior care community in northeast Oklahoma. System wide, in FY2011 VCH provided more than $82.8 million in community benefit including traditional charity care, health services, professional education, subsidized health care, research, financial contributions and other community building activities.
STATE FILING OF COMMUNITY BENEFIT REPORT		PART VI SUPPLEMENTAL INFORMATION - QUESTION 7 Kansas does not require hospitals to file community benefit reports, but Via Christi Health, Inc. distributes Wamego Hospital Association's community benefit totals and activities annually in press releases as well as in its annual report.
PART V QUESTION 19d		The hospital charges all patients the same rates regardless of their insurance coverage. The financial assistance policy referenced in Part V applies to all services, including emergency and other medically necessary care.

Schedule H (Form 990) 2010

Additional Data

Software ID:
Software Version:

- TIN:

Schedule J
(Form 990)

Department of the Treasury
Internal Revenue Service

Compensation Information

For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet

Complete if the organization answered "Yes" to Form 990,
Part IV, question 23.
SchJMediumBullet

Attach to Form 990. SchJMediumBullet

See separate instructions.

OMB No. 1545-0047

2010

Open to Public Inspection

Name of the organization

WAMEGO HOSPITAL ASSOCIATION INC

Employer identification number

72-1526400

Part I

Questions Regarding Compensation

Yes

Check the appropiate box(es) if the organization provided any of the following to or for a person listed in Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.

First-class or charter travel Housing allowance or residence for personal use

Travel for companions Payments for business use of personal residence

Tax idemnification and gross-up payments Health or social club dues or initiation fees

Discretionary spending account Personal services (e.g., maid, chauffeur, chef)

If any of the boxes in line 1a are checked, did the organization follow a written policy regarding payment or reimbursement orprovision of all the expenses described above? If "No," complete Part III to explain....

Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
officers, directors, trustees, and the CEO/Executive Director, regarding the items checked in line 1a? ....

Indicate which, if any, of the following the organization uses to establish the compensation of the
organization's CEO/Executive Director. Check all that apply.

Compensation committee Written employment contract

Independent compensation consultant Compensation survey or study

Form 990 of other organizations Approval by the board or compensation committee

During the year, did any person listed in Form 990, Part VII, Section A, line 1a with respect to the filing organization or a related organization:

Receive a severance payment or change-of-control payment? ...............

Participate in, or receive payment from, a supplemental nonqualified retirement plan? ........

Yes

Participate in, or receive payment from, an equity-based compensation arrangement? ........

If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.

Only 501(c)(3) and 501(c)(4) organizations only must complete lines 5-9.

For persons listed in form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:

The organization? ...........................

Any related organization? .........................

If "Yes," to line 5a or 5b, describe in Part III.

For persons listed in form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:

The organization? ...........................

Any related organization? .........................

If "Yes," to line 6a or 6b, describe in Part III.

For persons listed in Form 990, Part VII, Section A, line 1a, did the organization provide any non-fixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............

Were any amounts reported in Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regs. section 53.4958-4(a)(3)? If "Yes," describe
in Part III .............................

If "Yes" to line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................

For Privacy Act and Paperwork Reduction Act Notice, see the Intructions for Form 990

Cat. No. 50053T

Schedule J (Form 990) 2010

Page 2

Part II

Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use Schedule J-1 if additional space needed.

For each individual whose compensation must be reported in Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.

Note. The sum of columns (B)(i)-(iii) must equal the applicable column (D) or column (E) amounts on Form 990, Part VII, line 1a.

(A) Name		(B) Breakdown of W-2 and/or 1099-MISC compensation			(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)	(F) Compensation reported in prior Form 990 or Form 990-EZ
(A) Name		(i) Base compensation	(ii) Bonus & incentive compensation	(iii) Other reportable compensation	(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)
(1) RANDALL PETERSON	(i) (ii)	0 443,357	0 81,238	0 12,729	0 151,362	0 8,588	0 697,274	0 0
(2) ROLAND DAREY MD	(i) (ii)	0 82,510	0 185,041	0 941	0 879	0 10,191	0 279,562	0 0
(3) JOHN BROBERG	(i) (ii)	0 260,198	0 43,850	0 6,715	0 37,141	0 10,473	0 358,377	0 0

Schedule J (Form 990) 2010

Page 3

Part III

Supplemental Information

Complete this part to provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 4c, 5a, 5b, 6a, 6b, 7, and 8. Also complete this part for any additional information.

Identifier	Return Reference	Explanation
SUPPLEMENTAL NON-QUALIFED RETIREMENT PLAN PAID BY A RELATED ORGANIZATION	PART I, QUESTION 4B	Randall Peterson 132,987.12 John Broberg 21,216.00

Schedule J (Form 990) 2010

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or to provide any additional information.
MediumBullet

Attach to Form 990 or 990-EZ.

OMB No. 1545-0047

2010

Open to Public
Inspection

Name of the organization

WAMEGO HOSPITAL ASSOCIATION INC

Employer identification number

72-1526400

Identifier	Return Reference	Explanation
COMPENSATION REVIEW	PART VI, SECTION B, QUESTION 15	Wamego Hospital Association, Inc. uses the policies established by Via Christi Health, Inc. (VCH). VCH has established a common philosophy, strategy, and process for executive compensation. Through the oversight of the VCH Executive Compensation Committee, executive compensation is competitively positioned at its stated market position when compared to the compensation paid by relevant organizations (comparably-sized health systems, hospitals, and long-term care providers). VCH recognizes its responsibility to ensure that its executive compensation program is appropriate in view of its mission and tax-exempt status and that its compensation levels and expenditures are reasonable and not excessive. To ensure these ends, the VCH Executive Compensation Committee has established and approved the executive compensation philosophy for VCH and all related entities. It will also approve all changes in the compensation package for VCH executives in advance. On an annual basis, the Committee conducts a comprehensive review of total compensation for all executives. It also reviews and approves "off-cycle" compensation transactions as needed. In their review, the Committee considers the following factors: * Market data from independent compensation surveys and sources that reflect comparable positions in organizations of similar size and scope * Difficulties in recruiting and retaining executives * Skills, experience and performance history of individual executives * Critical business or strategic issues that the organization may face * Market position for total compensation The adequacy, competitiveness, and cost of the VCH total executive compensation program are reviewed on an ongoing basis and changes are made as the Committee determines appropriate. The executive compensation program will be maintained such that it will fall within the safe harbor guidelines established by the Intermediate Sanctions regulations. The Committee also employs the services of an independent compensation consultant to prepare market analysis to aid and support the Committee's actions, provide documentation of market trends for budget setting purposes, review annual compensation changes to ensure "reasonableness" and provide attestation, and provide consultation on all executive compensation issues. The Committee also relies on third-party validation of performance measures used in the determination of compensation.
FORM 990 REVIEW	PART VI, SECTION A, QUESTION 11A AND 11B	THE AUDIT COMMITTEE REVIEWS WAMEGO HOSPITAL ASSOCIATION'S FORM 990. THE AUDIT COMMITTEE REVIEWS AND APPROVES THE FORM 990 PRIOR TO THE DATE OF FILING. THE AUDIT COMMITTEE REPORTS ON THE REVIEW TO THE BOARD OF TRUSTEES AND ASSURES THAT THE BOARD HAS THE OPPORTUNITY TO REVIEW THE FINAL FORM 990 AS FILED. A COPY OF FORM 990 IS PROVIDED TO THE BOARD OF TRUSTEES VIA A SECURE EMAIL PRIOR TO FILING WITH THE IRS.
CONFLICT OF INTEREST POLICY	PART VI, SECTION B, QUESTION 12C	THE CONFLICT OF INTEREST POLICY IS MONITORED/ENFORCED AS PART OF THE SYSTEM-WIDE PROCEDURES AND IS NOT HANDLED AT THE ORGANIZATION LEVEL. THE POLICY IS MONITORED AND ENFORCED AS FOLLOWS: 1) AT TIME OF APPOINTMENT AND ANNUALLY THEREAFTER, ALL INTERESTED PERSONS, INCLUDING BOARD AND COMMITTEE MEMBERS COMPLETE A DISCLOSURE STATEMENT WHICH ADDRESSES ACTUAL OR POTENTIAL CONFLICTS OF INTEREST. 2) THE DISCLOSURE STATEMENT IS DONE ELECTRONICALLY AND THE RETURN OF THE COMPLETED STATEMENT IS A CONDITION OF CONTINUED APPOINTMENT, EMPLOYMENT OR PARTICIPATION WITH THE ORGANIZATION. 3) ALL ACTUAL OR POTENTIAL CONFLICTS ARE REVIEWED, INVESTIGATED AND RESOLVED BY THE CHIEF GOVERNANCE OFFICER AND THE CORPORATE RESPONSIBILITY OFFICER, WITH THE RESULTS SHARED WITH THE CHIEF EXECUTIVE OF THE ORGANIZATION. 4) PERIODIC REVIEWS ARE CONDUCTED BY GOVERNANCE, COMPLIANCE AND INTERNAL AUDIT TO ENSURE THE ORGANZIATION IS OPERATING CONSISTENT WITH THE POLICY AND ENFORCING THE POLICY'S TERMS.
GOVERNING DOCUMENTS	PART VI, SECTION C, QUESTION 19	WAMEGO HOSPITAL ASSOCIATION'S GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE AVAILABLE TO THE PUBLIC UPON REQUEST.
MEMBERS	PART VI, SECTION A, LINES 6-7B	WAMEGO HOSPITAL ASSOCIATION, INC. HAS MEMBERS. THE MEMBERS ARE ELECTED BY OTHER MEMBERS OF THE GOVERNING BODY. DECISIONS FOR THE GOVERNING BODY ARE MADE BY THE MEMBERS.
RELATED TAX-EXEMPT ORGANIZATIONS	SCHEDULE R, PART II	WAMEGO HOSPITAL ASSOCIATION, INC. IS INDIRECTLY CONTROLLED BY VIA CHRISTI HEALTH, INC. VIA CHRISTI HEALTH,INC. IS JOINTLY SPONSORED AND CONTROLLED BY ASCENSION HEALTH AND MARIAN HEALTH SYSTEM, WHICH IN TURN ARE SPONSORED BY THE SISTERS OF THE SORROWFUL MOTHER, FOUR PROVINCES OF THE DAUGHTERS OF CHARITY, THE CONGREGATION OF ST. JOSEPH, AND THE SISTERS OF ST. JOSEPH OF CARONDELET. DUE TO SUCH SPONSORSHIP AND CONTROL, AND IN THE INTEREST OF INCREASED CLARITY AND TRANSPARENCY, BOTH ASCENSION HEALTH AND MARIAN HEALTH SYSTEM ARE BEING LISTED AS RELATED ORGANIZATIONS ON SCHEDULE R.
EMPLOYEES	PART V, QUESTION 2A	WAMEGO HOSPITAL ASSOCIATION, INC. DID NOT FILE FORM W-3. ALL EMPLOYEES ARE PAID BY A RELATED ORGANIZATION.
COMMUNITY BENEFIT		THE COMMUNITY BENEFIT CONTRIBUTION OF WAMEGO HOSPITAL ASSOCIATION INCLUDES PROGRAMS AND ACTIVITIES THAT IMPROVE ACCESS TO HEALTH CARE AND IMPROVE HEALTH IN THE COMMUNITIES WE SERVE. IN ORDER TO PORTRAY THE FULL BREADTH OF OUR CONTRIBUTION, OUR COMMUNITY BENEFIT INFORMATION IS DESCRIBED BELOW: QUALITATIVE DESCRIPTION OF COMMUNITY BENEFIT I. MINISTRY COMMITMENT TO PROVIDING COMMUNITY BENEFIT A. MISSION AND PRIMARY EXEMPT PURPOSES As part of Via Christi Health, a Catholic health system, we share this Mission: "Inspired by the Gospel and our Catholic tradition, we serve as a healing presence with special concern for our neighbors who are vulnerable." Via Christi Health System's history extends back over 100 years and today, along with our sponsoring congregations - The Sisters of the Sorrowful Mother, Congregation of St Joseph, Sisters of St Joseph of Carondolet and the Daughters of Charity we continue to respond to community needs in Kansas and northeastern Oklahoma. The obligation to reach out to those in need and to improve community health flows directly from VCH's identity as a faith-based healing ministry. VCH continues its tradition in providing community benefit because we are committed to: Promoting and defending human dignity, Caring for persons living in poverty and other vulnerable populations, Promoting the common good, Stewarding resources responsibly B. APPROACH TO PROVIDING COMMUNITY BENEFIT Wamego Hospital Association serves people in the western Pottawatomie northern Wabaunsee, and eastern Riley county areas of Kansas. Issues and trends of significance in our community include increasing unemployment and poverty, a growing elderly population, and growing population of uninsured families. Wamego Hospital Association collaborates with other community organizations to address some of these issues and trends. C. FINANCIAL ASSISTANCE POLICIES AND PROGRAMS Wamego Hospital Association has policies and programs in place to ensure that billing and collection processes for uninsured/underinsured persons reflect our commitment to human dignity and meet the financial and local needs in the communities in which we operate. We review the financial condition of uninsured and underinsured patients and clients to determine their qualification of charity care. D. FINANCIAL SURPLUSES Financial surpluses are used to fulfill our charitable purpose. The board of directors for Wamego Hospital Association includes members of the local community. We offer free and/or discounted care to persons without adequate financial means to pay for such services. This includes the participation in Medicaid, Medicare, CHAMPUS, Tricare and/or other government-sponsored health care programs. QUANTIFIABLE DESCRIPTION OF COMMUNITY BENEFIT The financial information in this report was prepared in accordance with the Catholic Health Association's (CHA) A Guide for Planning and Reporting Community Benefit Guidelines. Per these Guidelines, we report the net expense for community benefit services, i.e., the total community benefit expense minus any associated revenue from patients, residents, payers, and other external sources. The CHA Guidelines reflect a conservative approach to reporting quantifiable community benefit. The goal of the Guidelines is to produce community benefit financial reports that reflect true costs and that describe community benefit activities that increase access to health care and improve community health for all. COMMUNITY BENEFIT 1) CHARITY CARE - AT COST $52,000 2) GOVERNMENT SPONSORED HEALTHCARE - NET EXPENSE $349,000 UNPAID COST OF PUBLIC INDIGENT CARE PROGRAMS (INCLUDES MEDICAID,SCHIP, OTHER SAFETY NET PROGRAMS; DOES NOT INCLUDE MEDICARE SHORTFALL) 3) COMMUNITY BENEFIT PROGRAMS - NET EXPENSE $48,000 TOTAL QUANTIFIABLE COMMUNITY BENEFIT - $449,000
HOURS DEVOTED FOR RELATED ORGANIZATION	FORM 990 PART VII	NAME:RANDALL PETERSON TITLE:SECRETARY HOURS:49
HOURS DEVOTED FOR RELATED ORGANIZATION	FORM 990 PART VII	NAME:JOHN BROBERG TITLE:EX-OFFICIO (non-voting) HOURS:49

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2010

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service

Related Organizations and Unrelated Partnerships

Complete if the organization answered "Yes" to Form 990, Part IV, line 33, 34, 35, 36, or 37.
MediumBullet

Attach to Form 990. MediumBullet

See separate instructions.

OMB No. 1545-0047

2010

Open to Public Inspection

Name of the organization

WAMEGO HOSPITAL ASSOCIATION INC

Employer identification number

72-1526400

Part I

Identification of Disregarded Entities (Complete if the organization answered "Yes" on Form 990, Part IV, line 33.)

(a) Name, address, and EIN of disregarded entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Total income	(e) End-of-year assets	(f) Direct controlling entity

Part II

Identification of Related Tax-Exempt Organizations (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.)

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	(g) Section 512(b)(13) controlled organization
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	Yes	No
(1) Catholic Care Center Inc 6700 E 45th St N Wichita,KS67226 48-1067110	Rtrmnt Home	KS	501(C)(3)	9	na
(2) CIBOR INC 929 N St Francis Wichita,KS67214 27-0564463	Research	KS	501(C)(3)	7	na
(3) Cornerstone Assisted Living Inc 3636 N Ridge Road Wichita,KS67205 48-1241079	Rtrmnt Home	KS	501(C)(3)	9	na
(4) Gerard House Inc 3144 N Hood Wichita,KS67204 48-1049532	Shelter	KS	501(C)(3)	7	na
(5) Marian Health System Inc 1923 South Utica Avenue Tulsa,OK74104 36-3659989	Hospital Supp	DE	501(C)(3)	11	na
(6) Mercy Community Health Foundation Inc 1823 College Ave Manhattan,KS66502 48-1152279	Foundation	KS	501(C)(3)	11	na
(7) Mercy Regional Health Center Inc 1823 College Ave Manhattan,KS66502 48-1186704	Hospital	KS	501(C)(3)	3	na
(8) Mercy Regional Home Medical Services 2439 Claflin Road Manhattan,KS66502 43-2024491	Home Medical	KS	501(C)(3)	11	na
(9) Mount Carmel Foundation Inc 1102 E Centennial Dr Pittsburg,KS66762 48-0961283	Foundation	KS	501(C)(3)	11	na
(10) Salina Regional Home Medical Services 520 S Santa Fe Ave Ste 140 Salina,KS67401 43-1948057	Home Medical	KS	501(C)(3)	11	na
(11) St John's Inc 2225 Cantebury Dr Hays,KS67601 20-2828680	Rtrmnt Home	KS	501(C)(3)	9	na
(12) Via Christi Foundation Inc 723 N McLean Blvd Wichita,KS67203 48-1173588	Foundation	KS	501(C)(3)	11	na
(13) Via Christi Health Partners Inc 8200 E Thorn Dr SUITE 300 Wichita,KS67226 48-0958974	Mgmnt Co.	KS	501(C)(3)	9	na
(14) Via Christi Health Inc 8200 E Thorn Dr SUITE 300 Wichita,KS67226 48-1172107	Hospital Supp	KS	501(C)(3)	9	na
(15) Via Christi Healthcare Outreach Program 2622 W Central Suite 100 Wichita,KS67203 48-1236589	PACE Communit	KS	501(C)(3)	9	na
(16) Via Christi Home Health Wichita Inc 555 S Washington Wichita,KS67211 48-1046371	Home Health	KS	501(C)(3)	9	na
(17) Via Christi Hospital Pittsburg Inc 1102 E Centennial Dr Pittsburg,KS66762 48-0543778	Hospital	KS	501(C)(3)	3	na
(18) Via Christi Hospital Wichita St Teresa 14800 W ST TERESA Wichita,KS67235 27-1965272	Hospital	KS	501(C)(3)	3	na
(19) Via Christi Hospitals Wichita Inc 929 N St Francis Wichita,KS67214 48-1172106	Hospital	KS	501(C)(3)	3	na
(20) VC IMMEDIATE CARE MOTHER MARY ANNE INC 929 N St Francis Wichita,KS67214 20-8374099	Med. Clinic	KS	501(C)(3)	9	na
(21) Via Christi Property Services Inc 1100 N St Francis Suite 240 Wichita,KS67214 48-0948571	Property Mgmt	KS	501(C)(4)	N/A	na
(22) Via Christi Rehabilitation Hospital Inc 1151 N Rock Road Wichita,KS67206 48-1158274	Rehab.	KS	501(C)(3)	3	na
(23) Via Christi Village Georgetown Inc 1655 S Georgetown Wichita,KS67218 48-1129325	Rtrmnt Home	KS	501(C)(3)	9	na
(24) Via Christi Village Manhattan Inc 2800 Willowgrove Rd Manhattan,KS66502 48-1078862	Rtrmnt Home	KS	501(C)(3)	9	na
(25) Via Christi Village McLean Inc 777 N McLean Blvd Wichita,KS67203 48-1247723	Rtrmnt Home	KS	501(C)(3)	9	na
(26) Via Christi Village Ponca City Inc 1601 Academy Rd Ponca City,OK74604 73-1153337	Rtrmnt Home	OK	501(C)(3)	9	na
(27) Via Christi Village Pittsburg Inc 1502 E Centennial Dr Pittsburg,KS66762 74-3070971	Rtrmnt Home	KS	501(C)(3)	9	na
(28) Via Christi Villages Inc 2622 W Central Suite 100 Wichita,KS67203 48-0559086	Mgmnt Co.	KS	501(C)(3)	11	na
(29) ASCENSION HEALTH PO BOX 45998 ST LOUIS,MO63145 31-1662309	HLTH SYS GOV	MO	501(C)(3)	11	NA
(30) VIA CHRISTI INMYHOME INC 2622 W CENTRAL SUITE 100 WICHITA,KS67203 27-1889960	HLTH AGENCY	KS	501(C)(3)	9	NA
(31) VIA CHRISTI CLINIC SERVICES INC 8200 THORN DRIVE SUITE 300 WICHITA,KS67226 27-3984287	MED. CLINIC	KS	501(C)(3)	11	NA

For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50135Y

Schedule R (Form 990) 2010

Page 2

Part III

Identification of Related Organizations Taxable as a Partnership (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a partnership during the tax year.)

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Predominant income(related, unrelated, excluded from tax under sections 512-514)	(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code VUBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?		(k) Percentage ownership
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity		(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code VUBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No
(1) ST JOSEPH MRI LLC 8200 E THORN DR SUITE 300 WICHITA,KS67226 48-1007220	MEDICAL SVCS	KS	NA	N/A	0	0			0			0 %
(2) AMBULATORY SURGERY CENTER LP 8200 E THORN DR SUITE 300 WICHITA,KS67226 48-1114690	SURGERY CTR	KS	NA	N/A	0	0			0			0 %
(3) KANSAS SURGERY AND RECOVERY CTR LLC 2770 NORTH WEBB ROAD WICHITA,KS67226 48-1148580	SURGERY CTR	KS	NA	N/A	0	0			0			0 %
(4) MR IMAGING CENTER LLC 8200 E THORN DR SUITE 300 WICHITA,KS67226 48-1000538	RADIOLOGY SVC	KS	NA	N/A	0	0			0			0 %
(5) VIA CHRISTI CYBERKNIFE LLC 8200 E THORN DR SUITE 300 WICHITA,KS67226 35-4588711	RADIOLOGY SVC	KS	NA	N/A	0	0			0			0 %
(6) AMS DIAGNOSTICS LLC 8200 E THORN DR SUITE 300 WICHITA,KS67226 48-1223653	RADIOLOGY SVC	KS	NA	N/A	0	0			0			0 %
(7) PREFERRED PET IMAGING OF KS LLC 8200 E THORN DR SUITE 300 WICHITA,KS67226 48-1250123	DIAGNOSTIC IM	KS	NA	N/A	0	0			0			0 %
(8) PFI LLC 8200 E THORN DR SUITE 300 WICHITA,KS67226 72-1557076	MED CHEM MFG	KS	NA	N/A	0	0			0			0 %
(9) MERCY IMAGING LLC 1823 COLLEGE AVENUE MANHATTAN,KS66502 48-1251984	DIAGNOSTIC IM	KS	NA	N/A	0	0			0			0 %

Part IV

Identification of Related Organizations Taxable as a Corporation or Trust (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.)

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	(h) Percentage ownership
(1) AFFILIATED MEDICAL SERVICES LAB INC 2916 E CENTRAL WICHITA,KS67214 48-1239522	MEDICAL LAB	KS	VC HEALTH	C-CORP	12,321,597	7,892,802	100.000 %
(2) SUNFLOWER ASSURANCE LTD PO BOX 1085 GRAND CAYMAN,CAYMAN ISLANDSKY1-1102 CJ 98-0223159	INSURANCE CO.	CJ	NA	FOREIGN CORP	3,651,768	38,500,707	100.000 %
(3) INTEGRATED HEALTHCARE SYSTEMS INC 3311 EAST MURDOCK WICHITA,KS67208 48-0941549	CLINIC SERVICES	KS	NA	C CORP	58,758,618	41,790,046	100.000 %
(4) VCH IOWA PC TRUST 8200 THORN DRIVE SUITE 300 WICHITA,KS67226 27-6937322	BENEFICIARY TRUST	IA	NA	TRUST	0	0	100.000 %
(5) VCH IOWA PC 8200 THORN DRIVE SUITE 300 WICHITA,KS67226 27-3983977	PROF. CORP	IA	NA	CORP	0	0	100.000 %
(6) VIA CHRISTI CLINIC PA 3311 EAST MURDOCK WICHITA,KS67208 48-0993446	PROF. CORP	KS	NA	CORP	116,439,508	24,067,602	100.000 %

Schedule R (Form 990) 2010

Page 3

Part V

Transactions With Related Organizations (Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35, 35A, or 36.)

Note. Complete line 1 if any entity is listed in Parts II, III or IV.

Yes

1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?

a Receipt of (i) interest (ii) annuities (iii) royalties (iv) rent from a controlled entity . . . . . . . . . . . . . . . . . . . . . . .

b Gift, grant, or capital contribution to other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

c Gift, grant, or capital contribution from other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

d Loans or loan guarantees to or for other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

e Loans or loan guarantees by other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

f Sale of assets to other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

g Purchase of assets from other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

h Exchange of assets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

i Lease of facilities, equipment, or other assets to other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . .

j Lease of facilities, equipment, or other assets from other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . .

k Performance of services or membership or fundraising solicitations for other organization(s) . . . . . . . . . . . . . . . . . . . . . .

l Performance of services or membership or fundraising solicitations by other organization(s) . . . . . . . . . . . . . . . . . . . . . .

m Sharing of facilities, equipment, mailing lists, or other assets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

n Sharing of paid employees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

o Reimbursement paid to other organization for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

p Reimbursement paid by other organization for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

q Other transfer of cash or property to other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

r Other transfer of cash or property from other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.

(a) Name of other organization	(b) Transaction type(a-r)	(c) Amount involved	(d) Method of determining amount involved
(1)
(2)
(3)
(4)
(5)
(6)

Schedule R (Form 990) 2010

Page 4

Part VI

Unrelated Organizations Taxable as a Partnership (Complete if the organization answered "Yes" on Form 990, Part IV, line 37.)

Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.

(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Are all partners section 501(c)(3) organizations?		(e) Share of end-of-year assets	(f) Disproprtionate allocations?		(g) Code VUBI amount in box 20 of Schedule K-1 (Form 1065)	(h) General or managing partner?
(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	Yes	No	(e) Share of end-of-year assets	Yes	No	(g) Code VUBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No

Schedule R (Form 990) 2010

Page 5

Part VII

Supplemental Information

Complete this part to provide additional information for responses to questions on Schedule R (see instructions).

Identifier	Return Reference	Explanation

Additional Data

Software ID:
Software Version:

1	Briefly describe the organization’s mission or most significant activities: A full service hospital providing health care services to support Pottawatomie, Wabaunsee and surrounding counties.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ....	3	9
4	Number of independent voting members of the governing body (Part VI, line 1b) ....	4	7
5	Total number of individuals employed in calendar year 2010 (Part V, line 2a) ...	5	0
6	Total number of volunteers (estimate if necessary) ....	6	15
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ..	7a	0
b	Net unrelated business taxable income from Form 990-T, line 34 ..	7b

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	9,474	75,245
9	Program service revenue (Part VIII, line 2g) .........	8,540,922	9,107,536
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	11,941	-11,484
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	33,056	19,971
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)...................	8,595,393	9,191,268
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	0	0
14	Benefits paid to or for members (Part IX, column (A), line 4) ....	0	0
15	Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10)	4,353,211	5,027,930
16a	Professional fundraising fees (Part IX, column (A), line 11e)....	0	0
b	Total fundraising expenses (Part IX, column (D), line 25) 0
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24f)....	3,358,938	3,795,327
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	7,712,149	8,823,257
19	Revenue less expenses. Subtract line 18 from line 12......	883,244	368,011
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16)............	6,475,766	6,751,966
21	Total liabilities (Part X, line 26)............	863,464	771,653
22	Net assets or fund balances. Subtract line 21 from line 20 .....	5,612,302	5,980,313

Sign Here

	Signature of officer	Date

	Type or print name and title.

Paid Preparer's Use Only	Preparer's signature	Date	Check if self- employed	Preparer’s taxpayer identification number (see instructions)
	Firm’s name (or yours if self-employed), address, and ZIP + 4			EIN
				Phone no.


4a	(Code: ) (Expenses $ 6,572,530 including grants of $ ) (Revenue $ 9,109,733 )
	Providing health care services and charity care. The hospital provides care without charge or at amounts less than its established rates to patients meeting certain criteria under its charity care policy. The Hospital provides the following services to the residents of Wamego and surrounding communities: Inpatient, Hospitalization, Emergency Room, Swing Bed, Outpatient IV Therapies, Diabetes Education, Specialty clinics, Laboratory, Imaging Services, Heritage Programs for Senior Adults, and Dietary Consultation. The Specialty Clinics include the following: Podiatry, Surgery, Orthopedics, Gastroenterology, Otallaryngology, Opthamology, Urology, and Diabetes.

4b	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )












4c	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )












4d	Other program services. (Describe in Schedule O.)
	(Expenses $ including grants of $ ) (Revenue $ )
4e	Total program service expenses$ 6,572,530

(A) Name and Title	(B) Average hours per week (describe hours for related organizations in Schedule O)	(C) Position (check all that apply)			(D) Reportable compensation from the organization (W- 2/1099-MISC)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)	(F) Estimated amount of other compensation from the organization and related organizations
(A) Name and Title
(1) LANCE WHITE CHAIRMAN	1.0	X	X		0	0	0
(2) BILL DITTO DDS TREASURER	1.0	X	X		0	0	0
(3) JAKE PUGH TRUSTEE	1.0	X			0	0	0
(4) RANDALL PETERSON SECRETARY	1.0	X	X		0	537,324	159,950
(5) JOHN BROBERG EX-OFFICIO (non-voting)	1.0	X			0	310,763	47,614
(6) MARK KNACKENDOFFEL VICE CHAIRMAN	1.0	X	X		0	0	0
(7) MICHAEL LEITCH TRUSTEE	1.0	X			0	0	0
(8) DOUG HARPER MD TRUSTEE	1.0	X			0	0	0
(9) MERL PAGE TRUSTEE (non-voting)	1.0	X			0	0	0
(10) SISTER LOIS ANN O'MALLEY TRUSTEE	1.0	X			0	0	0
(11) SHANNON FLACH EX-OFFICIO	50.0	X			0	115,147	22,616
(12) ROLAND DAREY MD PHYSICIAN	50.0			X	0	268,492	11,070
(13) KATHY DOUGLAS NURSE PRACTIONER	50.0			X	0	109,225	8,667

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)............	0	1,340,951	249,917

(A) Name and business address	(B) Description of services	(C) Compensation
DIAMOND HEALTHCARE PO BOX 85050 RICHMOND,VA23285	GEROPSYCH SERVICES	270,000
FLINT HILLS ANESTHESIA 1380 J AVENUE COUNCIL GROVE,KS66846	CRNA SERVICES	130,230



2 Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 in compensation from the organization 2

				(A) Total revenue	(B) Related or exempt function revenue	(C) Unrelated business revenue	(D) Revenue excluded from tax under sections 512, 513, or 514
1a	Federated campaigns..1a
b	Membership dues....1b
c	Fundraising events....1c
d	Related organizations...1d
e	Government grants (contributions)1e		42,816

f	All other contributions, gifts, grants, and similar amounts not included above1f		32,429
g	Noncash contributions included in lines 1a-1f:$
h	Total. Add lines 1a-1f.......			75,245
			Business Code
2a	NET PATIENT SERVICE REVENUE		621,610	9,107,536	9,107,536
b
c
d
e
f	All other program service revenue .
g	Total. Add lines 2a–2f........			9,107,536
3	Investment income (including dividends, interest
	and other similar amounts).....			7,714			7,714
4	Income from investment of tax-exempt bond proceeds..			0
5	Royalties............			0
		(i) Real	(ii) Personal
6a	Gross Rents	5,020
b	Less: rental expenses
c	Rental income or (loss)	5,020
d	Net rental income or (loss).......			5,020			5,020
		(i) Securities	(ii) Other
7a	Gross amount from sales of assets other than inventory		9,713
b	Less: cost or other basis and sales expenses		28,911
c	Gain or (loss)		-19,198
d	Net gain or (loss)..........			-19,198			-19,198
8a	Gross income from fundraising events (not including $ of contributions reported on line 1c). See Part IV, line 18 ...
	a
b	Less: direct expenses ...b
c	Net income or (loss) from fundraising events..			0
9a	Gross income from gaming activities. See Part IV, line 19 ...
	a
b	Less: direct expenses ...b
c	Net income or (loss) from gaming activities...			0
10a	Gross sales of inventory, less returns and allowances .
	a
b	Less: cost of goods sold ..b
c	Net income or (loss) from sales of inventory..			0
Miscellaneous Revenue			Business Code
11a	EMPLOYEE MEALS		721,000	12,248			12,248
b	ROI PROCESSING FEES		541,610	1,867	1,867
c	VENDING MACHINES		722,210	506			506
d	All other revenue ....			330	330
e	Total. Add lines 11a–11d ......			14,951
12	Total revenue. See Instructions....			9,191,268	9,109,733		6,290


				(A) Beginning of year		(B) End of year
1	Cashnon-interest-bearing ..........			279	1	279
2	Savings and temporary cash investments .......			2,591,991	2	2,213,128
3	Pledges and grants receivable, net .........				3
4	Accounts receivable, net .........			982,885	4	1,291,083
5	Receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of
	Schedule L ..........				5
6	Receivables from other disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B). Complete Part II of
	Schedule L ..........				6
7	Notes and loans receivable, net .............				7
8	Inventories for sale or use ..............			141,395	8	129,429
9	Prepaid expenses and deferred charges ............			44,585	9	267,159
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	3,000,631
b	Less: accumulated depreciation. .....	10b	1,659,315	1,374,663	10c	1,341,316
11	Investments—publicly traded securities ..........				11
12	Investments—other securities. See Part IV, line 11 ......				12
13	Investments—program-related. See Part IV, line 11 ..				13
14	Intangible assets .........				14
15	Other assets. See Part IV, line 11 ...........			1,339,968	15	1,509,572
16	Total assets. Add lines 1 through 15 (must equal line 34)...			6,475,766	16	6,751,966
17	Accounts payable and accrued expenses .			863,464	17	771,653
18	Grants payable ..........				18
19	Deferred revenue ..........				19
20	Tax-exempt bond liabilities ..........				20
21	Escrow or custodial account liability. Complete Part IV of Schedule D..				21
22	Payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
	persons. Complete Part II of Schedule L..........				22
23	Secured mortgages and notes payable to unrelated third parties ..				23
24	Unsecured notes and loans payable to unrelated third parties ....				24
25	Other liabilities. Complete Part X of Schedule D.....			0	25	0
26	Total liabilities. Add lines 17 through 25.....			863,464	26	771,653
	Organizations that follow SFAS 117, check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets .....			5,612,302	27	5,980,313
28	Temporarily restricted net assets .....				28
29	Permanently restricted net assets .....				29
	Organizations that do not follow SFAS 117, check here and complete lines 30 through 34.
30	Capital stock or trust principal, or current funds .....				30
31	Paid-in or capital surplus, or land, building or equipment fund .....				31
32	Retained earnings, endowment, accumulated income, or other funds				32
33	Total net assets or fund balances .....			5,612,302	33	5,980,313
34	Total liabilities and net assets/fund balances .....			6,475,766	34	6,751,966