TY 2011 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 United States. See Part IV, line 21	0
2	Grants and other assistance to individuals in the United States. See Part IV, line 22	0
3	Grants and other assistance to governments, organizations, and individuals outside the United States. 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 ....	0	0	0	0
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	4,347,479	3,424,408	923,071
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	75,330	58,004	17,326
9	Other employee benefits .......	701,034	501,998	199,036
10	Payroll taxes ...........	294,045	227,699	66,346
11	Fees for services (non-employees):
a	Management ......	245,004		245,004
b	Legal .........	0
c	Accounting ...........	117,726		117,726
d	Lobbying ...........	0
e	Professional fundraising. See Part IV, line 17..	0
f	Investment management fees ......	0
g	Other ..........	1,538,410	802,087	736,323
12	Advertising and promotion ....	48,011	1,329	46,682
13	Office expenses .......	995,139	826,182	168,957
14	Information technology ......	59,600	38,682	20,918
15	Royalties ..	0
16	Occupancy ...........	124,625	124,518	107
17	Travel ............	39,575	10,589	28,986
18	Payments of travel or entertainment expenses for any federal, state, or local public officials ......	0
19	Conferences, conventions, and meetings ....	15,006	1,942	13,064
20	Interest ...........	0
21	Payments to affiliates .......	0
22	Depreciation, depletion, and amortization .....	290,400	284,326	6,074
23	Insurance ..............	142,206	130,799	11,407
24	Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24f. If line 24f amount exceeds 10% of line 25, column (A) amount, list line 24f expenses on Schedule O.)
a	OTHER EXPENSES	70,496	10,259	60,237
b
c
d
e
f	All other expenses
25	Total functional expenses. Add lines 1 through 24f	9,104,086	6,442,822	2,661,264	0
26	Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here if following SOP 98-2 (ASC 958-720).

Part X Balance Sheet
	1	Cashnon-interest-bearing ..........	279	1	279
2	Savings and temporary cash investments .......	2,213,128	2	3,277,104
3	Pledges and grants receivable, net .........	0	3	32,868
4	Accounts receivable, net .........	1,291,083	4	1,270,529
5	Receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of
	Schedule L ..........	0	5	0
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 ..........	0	6	0
7	Notes and loans receivable, net .............	0	7	0
8	Inventories for sale or use ..............	129,429	8	140,598
9	Prepaid expenses and deferred charges ............	267,159	9	69,213
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	3,442,220
b	Less: accumulated depreciation. .....	10b	2,004,307	1,341,316	10c	1,437,913
11	Investments—publicly traded securities ..........	0	11	0
12	Investments—other securities. See Part IV, line 11 ......	0	12	0
13	Investments—program-related. See Part IV, line 11 ..	0	13	0
14	Intangible assets .........	0	14	0
15	Other assets. See Part IV, line 11 ...........	1,509,572	15	1,528,448
16	Total assets. Add lines 1 through 15 (must equal line 34)...	6,751,966	16	7,756,952
	17	Accounts payable and accrued expenses .	771,653	17	989,024
18	Grants payable ..........	0	18	0
19	Deferred revenue ..........	0	19	0
20	Tax-exempt bond liabilities ..........	0	20	0
21	Escrow or custodial account liability. Complete Part IV of Schedule D..	0	21	0
22	Payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
	persons. Complete Part II of Schedule L..........	0	22	0
23	Secured mortgages and notes payable to unrelated third parties ..	0	23	0
24	Unsecured notes and loans payable to unrelated third parties ....	0	24	0
25	Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X of Schedule D.....	0	25	0
26	Total liabilities. Add lines 17 through 25.....	771,653	26	989,024
		Organizations that follow SFAS 117, check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets .....	5,980,313	27	6,767,928
28	Temporarily restricted net assets .....	0	28	0
29	Permanently restricted net assets .....	0	29	0
	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 .....	5,980,313	33	6,767,928
34	Total liabilities and net assets/fund balances .....	6,751,966	34	7,756,952

- 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

2011

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) 2011

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) 2007	(b) 2008	(c) 2009	(d) 2010	(e) 2011	(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) 2007	(b) 2008	(c) 2009	(d) 2010	(e) 2011	(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—2011. 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—2010. 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—2011. 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—2010. 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) 2011

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) 2007	(b) 2008	(c) 2009	(d) 2010	(e) 2011	(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) 2007	(b) 2008	(c) 2009	(d) 2010	(e) 2011	(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 2011 (line 8 column (f) divided by line 13 column (f)) .........

Public support percentage from 2010 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2011 (line 10c column (f) divided by line 13 column (f)) ......

Investment income percentage from 2010 Schedule A, Part III, line 17 .............

19a

33 1/3% support tests—2011. 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—2010. 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) 2011

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) 2011

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

2011

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, line 35c (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 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 function 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) 2011

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 (and list in Part IV each affiliated group member's name, address, EIN, expenses, and share of excess lobbying expenditures).
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) 2008	(b) 2009	(c) 2010	(d) 2011	(e) Total

2a	Lobbying non-taxable amount

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

c	Total lobbying expenditures

d	Grassroots nontaxable amount

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

f	Grassroots lobbying expenditures

Schedule C (Form 990 or 990-EZ) 2011

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)).

For each “Yes” response to lines 1a through 1i below, provide in Part IV a detailed description of the lobbying activity.

(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? ..........................

Yes

1,328

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

1,328

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 carry over 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) and if either (a) BOTH Part III-A, lines 1 and 2 are answered “No” OR (b) Part III-A, line 3 is answered “Yes”.

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

Section 162(e) nondeductible 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, Part II-A; line 5; and Part ll-B, line 1.
Also, complete this part for any additional information.

Identifier	Return Reference	Explanation
LOBBYING ACTIVITIES	PART II-B, QUESTION 1I	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) 2011

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, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b
SchDMd Bullet

Attach to Form 990. SchDMd Bullet

See separate instructions.

OMB No. 1545-0047

2011

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 can 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 education) Preservation of an historically important land area

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

Complete lines 2a through 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, and not on a historic structure listed in the National Register ....................	2d

Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during
the tax 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 (ASC 958), 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 (ASC 958), 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 (ASC 958), 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) 2011

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	Net investment earnings, gains, and 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 (line 1g) held as:

Board designated or quasi-endowment SchDMd Bullet

Permanent endowment SchDMd Bullet

Temporarily restricted endowment SchDMd Bullet

The percentages in lines 2a, 2b, and 2c should equal 100%.

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

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

Description of property		(b)Cost or other basis (other)	(c) Accumulated depreciation	(d) Book value
1a	Land .................
b	Buildings ................
c	Leasehold improvements ............	185,300	83,639	101,661
d	Equipment ................	3,256,920	1,920,668	1,336,252
e	Other .................
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).).......				1,437,913

Schedule D (Form 990) 2011

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) must 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) must 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) EST AMTS THIRD-PARTY PAYERS				818,865
(2) LIMITED USE ASSETS				709,583







Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........				1,528,448

Part X

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

1.(a) Description of Liability		(b) Book value
Federal Income Taxes		0









Total. (Column (b) must 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) 2011

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
2	Total expenses (Form 990, Part IX, column (A), line 25) .....................	2
3	Excess or (deficit) for the year. Subtract line 2 from line 1 .............	3
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 through 8 .........................	9
10	Excess or (deficit) for the year per financial statements. Combine lines 3 and 9 .........	10

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
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
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 must equal Form 990, Part I, line 12.) ......		5

Part XIII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return
1	Total expenses and losses per audited financial statements .............		1
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
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 must equal Form 990, Part I, line 18.) ......		5

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 (ASC 740)	PART X, QUESTION 2	The organization follows the FIN 48 policy of Via Christi Health, Inc. (VCH) and the policy is provided in the VCH consolidated audited financial statements. With the exception of certain subsidiaries, all of the entities in the Health System are organizations under Section 501(c)(3) of the Internal Revenue Code and are generally exempt from payment of income taxes on related income pursuant to Section 501(a) of the Internal Revenue Code. Subsidiaries which are for-profit organizations are subject to federal and state income taxes. Accounting principles generally accepted in the United States of America require the Health System's management to evaluate tax positions taken by the Health System and its subsidiaries and recognize a tax liability (or asset) if an uncertain position has been taken that more likely than not would not be sustained upon examination by the Internal Revenue Service. Management has analyzed the tax positions by the Health System and its subsidiaries, and has concluded that as of September 30, 2012 and 2011, there were no uncertain tax positions taken or expected to be taken that would require recognition of a liability (or asset) or disclosure in the financial statements. Tax assets and liabilities are recognized for the future tax consequences attributable to differences between the financial statement carrying amounts of existing assets and liabilities and their respective tax bases and operating loss and tax credit carryforwards. Income tax expense or benefit is included in other nonoperating gains and losses in the consolidated statements of operations and changes in net assets. Deferred tax assets and liabilities are measured using enacted tax rates expected to be recovered or settled. The effect on deferred tax assets and liabilities of a change in tax rates is recognized in income in the period that includes the enactment date.

Schedule D (Form 990) 2011

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

2011

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

Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a....

Yes

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

Yes

If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.

Applied uniformly to all hospital facilities Applied uniformly to most hospital facilities Generally tailored to individual hospital facilities

Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.

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

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

Yes

100% 150% 200% Other

Did the organization use FPG to determine eligibility for providing discounted care? If "Yes," indicate which of the

following was the family income limit for eligibility for discounted care: ............

Yes

200% 250% 300% 350% 400% Other

If the organization did 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 used an asset test or other threshold, regardless of income, to determine eligibility for free or discounted care.

Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? ..............

Yes

Did the organization budget amounts for free or discounted care provided under its financial assistance policy during the tax year? ............................

Yes

If "Yes," did the organization's financial assistance expenses exceed the budgeted amount?......

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

Did the organization prepare a community benefit report during the tax year?...........

Yes

If "Yes," did 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.

Financial Assistance 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 Financial Assistance at cost (from Worksheet 1) ..	59,000		59,000	0.650 %
b Medicaid (from Worksheet 3, column a) .....	363,000	-37,000	400,000	4.390 %
c Costs of other means-tested government programs (from Worksheet 3, column b) .	0	0
dTotal Financial Assistance and Means-Tested Government Programs .....	422,000	-37,000	459,000	5.040 %
Other Benefits e Community health improvement services and community benefit operations (from (Worksheet 4) ....	35,221		35,221	0.390 %
f Health professions education (from Worksheet 5) ..	1,088		1,088	0.010 %
g Subsidized health services (from Worksheet 6) ..
h Research (from Worksheet 7)
i Cash and in-kind contributions for community benefit (from Worksheet 8) ....	16,930	920	16,010	0.180 %
jTotal Other Benefits ...	53,239	920	52,319	0.580 %
kTotal. Add lines 7d and 7j. ..	475,239	-36,080	511,319	5.620 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2011

Schedule H (Form 990) 2011

Page

Part II

Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.

		(c) Total community building expense	(f) Percent of total expense
1	Physical improvements and housing
2	Economic development	880	0.010 %
3	Community support	1,085	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	1,965	0.020 %

Part III

Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense

Yes

Did 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........

326,918

Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance 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).....

5,663,915

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

5,652,326

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

11,589

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

Did the organization have a written debt collection policy during the tax year? ..........

Yes

If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI.......................

Yes

Part IV

Management Companies and Joint Ventures

(see instructions)

(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) 2011

Page

Part VFacility Information

Section A. Hospital Facilities (list in order of size 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 INC 711 GENN DRIVE WAMEGO,KS66547	X	X	X

Schedule H (Form 990) 2011

Page

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)

WAMEGO HOSPITAL ASSOCIATION INC

Name of Hospital Facility:

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 2011)
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 the community health 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 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 10
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	Participation in the development of a community-wide community benefit plan
	d	Participation in the execution of a 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 Needs Assessment
	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 and 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	Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care?		8	Yes
9	Used federal poverty guidelines (FPG) to determine eligibility for providing free care?...........		9	Yes
	If "Yes," indicate the FPG family income limit for eligibility for free care: 200.% If "No," explain in Part VI the criteria the hospital facility used.

Schedule H (Form 990) 2011

Page

Part VFacility Information (continued)

				Yes	No
10	Used FPG to determine eligibility for providing discounted care?.................		10	Yes
	If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 400.% If "No," explain in Part VI the criteria the hospital facility used.
11	Explained the basis for calculating amounts charged to patients?.................		11	Yes
	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	Yes
13	Included measures to publicize the policy within the community served by the hospital facility?.......		13	Yes
	If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
	a	The policy was posted 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 (FAP) that explained actions the hospital facility may take upon non-payment?.......		14		No
15	Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
	a	Reporting to credit agency
	b	Lawsuits
	c	Liens on residences
	d	Body attachments
	e	Other similar actions (describe in Part VI)
16	Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?..........		16		No
	If “Yes,” check all actions in which the hospital facility or a third party engaged:
	a	Reporting to credit agency
	b	Lawsuits
	c	Liens on residences
	d	Body attachments
	e	Other similar actions (describe in Part VI)
17	Indicate which efforts the hospital facility made before initiating any of the actions checked in line 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 patients were eligible for financial assistance under the hospital facility’s financial assistance policy
	e	Other (describe in Part VI)

Schedule H (Form 990) 2011

Page

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	Yes
	If “No,” indicate why:
	a	The hospital facility did not provide care for any emergency medical conditions
	b	The hospital facility’s policy was not in writing
	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)
Individuals Eligible for Financial Assistance
19	Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
	a	The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
	b	The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
	c	The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
	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		No
	If “Yes,” explain in Part VI.
21	Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?...............................		21		No
	If “Yes,” explain in Part VI.

Schedule H (Form 990) 2011

Page

Part VFacility Information (continued)

Section C. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility (list in order of size, from largest to smallest) How many non-hospital health care facilities did the organization operate during the tax year?1
Name and address		Type of Facility (describe)
1	WAMEGO FAMILY HEALTH CARE 711 GENN DRIVE WAMEGO,KS66547	FAMILY PRACTICE
2
3
4
5
6
7
8
9
10

Schedule H (Form 990) 2011

Page

Part VI

Supplemental Information

Complete this part to provide the following information.

1	Required descriptions. Provide the descriptions 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, 3, 4, 5c, 6i, 7, 9, 10, 11h, 13g, 15e, 16e, 17e, 18d, 19d, 20, and 21.
2	Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any 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
Annual Community Benefit Report	Part I, Question 6b	A community benefit update that includes Wamego Hospital Association Inc. data is printed in the Via Christi Health's annual report which is released in various formats to the public and available from the Via Christi Health's website at www.viachristi.org/about-us or upon request. In addition, Wamego makes public presentations when invited on the findings of the latest health needs assessment. Wamego and Mercy Regional Health Center's (MRHC) community benefit summary is prepared and printed in "Up Close," a magazine printed with 2,400 copies distributed to surrounding communities of Clay Center, Manhattan and Wamego. "Up Close" is also available on MRHC's website at www.mercyregional.org.
Community Benefit Programs	Part I, Question 7	For examples of some of the community benefit programs provided by Wamego Hospital Association Inc. and Mercy Regional Health Center, a combined report is included with the Schedule O footnote for Part III Statement of Program Services.
Audit Footnote on Bad Debt Expense	Part III, Section A, Question 4	The provision for bad debt expense is based upon management's assessment of expected net collections considering economic conditions, historical experience, trends in health care coverage, and other collection indicators. Periodically throughout the year, management assesses the adequacy of the allowance for uncollectible accounts based upon historical write-off experience by payer category, including those amounts not covered by insurance. The results of this review are then used to make any modifications to the provision for bad debt expense to establish an appropriate allowance for uncollectible accounts. After satisfaction of amounts due from insurance and reasonable efforts to collect from the patient have been exhausted, Wamego Hospital Association Inc. (WHA) follows established guidelines for placing certain past-due patient balances with collection agencies, subject to terms of certain restrictions on collection efforts as determined by the WHA. Accounts receivable are written off after collections efforts have been followed in accordance with the WHA's policies. WHA 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. WHA follows the guidance from CHA and does not consider bad debt as a community benefit.
Medicare Shortfall	Part III, Section B, Question 8	Wamego Hospital Association Inc. follows the CHA guidelines regarding Medicare and does not include it as community benefit.
Debt Collection Policy	Part III, Section C, Question 9b	It is the policy of Wamego Hospital Association Inc. (WHA) to promote socially just practices for billing and collections for all patients receiving care. The policy is intended to further the WHA mission by requiring ethical conduct in billing and collecting self-pay balances from patient/guarantor's regardless of ability to pay. The policy ensures that prior to turning an account to a Third Party Collection Agent (Agent) for collection activity, WHA will perform a reasonable review of each account to verify that the patient/guarantor is not potentially eligible for any government assistance program (e.g., Medicaid, Medicare, etc.) and would likely not qualify for charity care. WHA will direct its staff and Agents to periodically assess each patient/guarantor's ability to pay or to determine eligibility for charity care. The review and assessment should include but may not be limited to the following: a. Ensure the patient/guarantor has been notified of WHA's financial assistance policy; b. Ensure the patient/guarantor was offered a financial assistance application; c. Ensure documentation of any known extraordinary financial circumstances of the patient/guarantor or if they are medically indigent.
PART V		WAMEGO HOSPITAL ASSOCIATION INC. OPERATES A FULL SERVICE HOSPITAL THAT INCLUDES 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, Question 2	Ministry representatives are involved with numerous coalitions that periodically assess community needs (e.g. Flint Hills Community Clinic, Kansas Health Care Collaborative, United Way of Riley County, Shepherds' Crossing and others) and in FY2011 conducted their own health assessment. Secondary data, other community assessments and one-on-one interviews with community leaders, social service providers, health care providers and government representatives are used to conduct the assessments.
PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE	Part VI, Question 3	Wamego Hospital Association Inc. (WHA) financial assistance staff is trained on how to qualify patients for Medicaid, SCHIP, and other such income-based programs. During the patient's registration, admissions, and discharge processes, WHA attempts to identify patients who may be eligible for charity or discounted care through the charity care policy. In addition, WHA uses a percentage of the Federal Poverty Guidelines (FPG) to determine free and discounted care.
COMMUNITY INFORMATION	Part VI, Question 4	The primary counties for Manhattan ministries include Riley, Geary and Pottawatomie. Riley County has a land area of 610 square miles with a 2011 estimated population of 72,997. Pottawatomie County has a land area of 841 square miles with a 2011 estimated population of 21,920. Geary County has a land area of 385 square miles with a 2011 estimated population of 35,323. Riley County's population demographic includes: 85.0% white, 6.6% Black, 0.7% American Indian, 4.2% Asian and 7.0% persons of Hispanic or Latino origin. The diversity of the population in Riley County is greater than for Pottawatomie County. Racial breakout for Pottawatomie County includes: 94.6% white, 1.3% Black, 0.9% American Indian, 0.8% Asian persons, and 4.7% persons of Hispanic or Latino origin. The demographic distribution for Geary County includes: 70.2% white, 18.4% Black, 1.2% American Indian, 3.4% Asian and 13.1% Hispanic or Latino origin. Geary County has the highest diversity rates primarily due to Fort Riley, an Army base and Home of the 1st Infantry Division. Almost 8.5% of the Riley County residents, 4.5% of the Pottawatomie County residents and 13.0% of the Geary County residents report that a language other than English is spoken at home. When it comes to education, 95.3% of Riley County residents completed high school and 45.6% had a bachelor's degree or higher. This compares to 93.2% and 29.7% for Pottawatomie County and 91.3% and 19.9% for Geary County. Median household income for Riley County residents between 2007 and 2011 was $41,427 compared to $54,309 for Pottawatomie County and $45,649 for Geary County. During this same time period, the median value of owner-occupied housing units in Riley County was $164,500 compared to $148,200 in Pottawatomie and $122,000 for Geary County residents. Riley County reports 23.6% of its residents are below poverty level compared to 6.8% for Pottawatomie and 12.5% for Geary County. The Statewide poverty level is around 12.6%. Riley County has far fewer residents age 65 years and older compared to the State of Kansas and the other two counties. Kansas reported in 2011 that 13.3% of all residents were persons 65 years of age and older. This compares to 7.3% for Riley, 12.2% for Pottawatomie and 7.5% for Geary Counties. The City of Manhattan is home to Kansas State University which has a student enrollment of 23,810 for Spring 2013 semester. Mercy Regional Health Center (MRHC) is the only hospital in the City of Manhattan and is the largest full-service medical center in the area that is available to all persons regardless of their ability to pay. Wamego Hospital Association Inc. is the only hospital in the City of Wamego but is approximately 12 miles from MRHC should emergencies call for a full-service medical center.
PROMOTION OF COMMUNITY HEALTH	Part VI, Question 5	Wamego Hospital Association Inc. (WHA) enriches the community in which it operate as well as the broader community, improving medicine through educating physicians and other healthcare providers, and providing care and support to people in need. Wamego further supports this mission with a community board, open medical staff and an emergency room available to patients regardless of ability to pay. Community representation on the Governing Body - The Board of Trustees is the governing body of WHA. The majority of its members are external members comprised of persons who reside in or around the city of Wamego and they have overall responsibility for the charitable mission of the organization as set forth in its Articles of Incorporation and By Laws. These trustees are selected based on their expertise, experience and other criteria established by the nominating committee of the Board of Trustees. Areas of expertise and experience include such areas as healthcare, finance, education, and local government. The Board actively debates and sets policy and strategic direction for the ministry but does not get involved in issues related to daily operations. The Board takes a balanced approach when addressing community and business/financial concerns. The Board is also the primary group for determining the use of surplus funds generated by the organization which are reinvested in the ministry in order to allow the ministry to sustain its mission and prepare for the future. Open Medical Staff - The medical staff of WHA is an open medical staff and is composed of physicians, dentists and podiatrists licensed to practice medicine in the State of Kansas. Wamego staff also participates in the community on boards of other not-for-profit organizations, government entities, foundations, area colleges and university committees, state-wide coalitions, etc. Emergency Medical Services - WHA's EMS provides standby care for various community activities to ensure quick response of medical care should accidents occur during an event. In FY2012, Wamego provided assistance for the Riley County Rodeo; Thunder Over Manhattan; July 4th Celebrations; Juneteenth Celebrations; Alert Road Race; Job Corp Safethy Day; 4-H Discover Days; St Patrick's Day Road Race, Aggieville New Years Eve Celebration; KState Football; and Spooktacular. One Community Campaign - WHA's staff annually volunteer to coordinate the internal campaign which benefits United Way of Riley County. WHA staff serve as department ambassadors assisting with presentations, pledge card distribution and collection, hosting team meetings and learning about the various programs funded through the local United Way. Security Transport is a support service provided by WHA when patients are brought to the hospital emergency department but are in need of psychiatric placement but are unable to pay for transportation to get access to the facilities which are located outside of the Manhattan area. Most of these patients are transferred to Larned, Osawatomie, Kansas University Medical Center in Kansas City or other locations and the transportation costs would be exorbitant for those who are not covered by insurance or for families who may not have the resources to provide the needed transportation to other facilities. Over all, Mercy Regional Health Center and WHA combined community benefit programs (not counting unpaid reimbursement of Medicare or bad debt) accounted for $5.6 million to the geographical area of Manhattan and Wamego, Kansas for FY2012.
AFFILIATED HEALTH CARE SYSTEM	Part VI, Question 6	Wamego Hospital Association Inc. is an affiliate of Via Christi Health, Inc (VCH). VCH's affiliates are large multi-faceted, integrated, not-for-profit ministries including Hospital and Non-Hospital ministries (Physician Group Practices, Hospital organizations, Research, Home Health, Durable Medical Equipment, and Senior Facilities). These ministries work together to care for patients, joined by common systems and a philosophy of serving as a healing presence with special concern for our neighbors especially those who are vulnerable. This community benefit happens through its focus on patient care, education, and research. The organizations work together to serve their communities at the local, regional and state level.
STATE FILING OF COMMUNITY BENEFIT REPORT	Part VI, Question 7	Not Applicable - Kansas does not require hospitals to file community benefit reports but Via Christi Health, Inc. (other ministry's name) distributes our community benefit totals and activities annually in press releases as well as in our annual report.
PART I, QUESTION 3C		The Federal poverty guideline was used.
Community Building Activities	Part II	Community building activities are essential roles for health care organizations in that they address many of the underlying determinants of health. Research has consistently shown that when the socioeconomic factors influencing health are explored, health care actually plays a smaller role proportionately. A report in the Journal of American Medical Association and the Center for Disease Control suggests that the determinants impacting health are as follows: lifestyle and behaviors, 50%; environment, 20%; genetics and human biology, 20%; and health care, 10%. Community building activities help to address the other determinants outside of the role traditionally played by health care organizations. The hospital provides timely and specific resources to help community organizations through donations to fulfill their missions of improving the well-being of the community and contributing to its overall health status in ways that may differ from direct clinical services provided by the hospital. These activities are almost exclusively done in partnership with other community organizations which are better suited to address identified community needs. Listed below are just a few of the Community Building activities reported by our hospital during FY2012. This is not a complete listing but a sampling of how the hospital participates in the health of the community through its Community Building activities. Wamego Hospital Association (WHA) High School Mentoring Program - WHA staff are matched for four years with high school freshmen. The goal is to improve upon the Wamego High School graduation rates by matching community volunteers with incoming freshmen who will stay connected during their high school career with the same volunteer. By participating in this unique mentoring program, WHA employees are contributing to the success of WHA students and as a result, are improving the quality of life for all Wamego residents. Chamber of Commerce - WHA staff assists the Wamego Chamber through recruitment of volunteers to help support and execute events that is hosted for the community. Through the efforts of WHA, volunteers are recruited to help with Chamber fundraising and economic development activities as well as assist with various partnership projects that are held with other local not-for-profit organizations. This volunteer recruitment improves the health of the community because some of the new economic development activities include recruiting healthcare specialists to spend some time in the area to provide care for the rural residents.
Estimating Bad Debt Expense	Part III, Section A, Question 3	The organization has no suitable basis for estimating bad debt expense that would be attributable to patients eligible under the organization's charity care policy.
Financial Assistance Policy	Part V, Section B, Question 13g	The full policy is not posted in each of these areas; however, reference to the policy is posted and the policy is immediately available to anyone who requests it.

Schedule H (Form 990) 2011

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

2011

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 or provision 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. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.

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 Regulations 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) 2011

Page 2

Part II

Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use duplicate copies if additional space is 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) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and column (E) for that individual.

(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 as deferred in prior Form 990
(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)	(F) Compensation reported as deferred in prior Form 990
(1) Casey Poell	(i) (ii)	0 252,377	0 18,500	0 1,259	0 3,724	0 7,998	0 283,858	0 0
(2) David Gambino	(i) (ii)	0 414,410	0 95,511	0 11,674	0 62,769	0 8,927	0 593,291	0 0
(3) John Broberg	(i) (ii)	0 265,055	0 72,373	0 7,111	0 40,794	0 11,137	0 396,470	0 0
(4) Randall Peterson	(i) (ii)	0 502,186	0 124,597	0 14,037	0 125,809	0 9,461	0 776,090	0 0
(5) Roland M Darey Jr	(i) (ii)	0 74,906	0 187,509	0 1,261	0 0	0 11,670	0 275,346	0 0

Schedule J (Form 990) 2011

Page 3

Part III

Supplemental Information

Complete this part to provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 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	JOHN BROBERG 21,695 DAVID GAMBINO 44,394 RANDALL PETERSON 105,227

Schedule J (Form 990) 2011

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

2011

Open to Public
Inspection

Name of the organization

Wamego Hospital Association Inc

Employer identification number

72-1526400

Identifier	Return Reference	Explanation
Members or Stockholders	Part VI, Section A, Questions 6, 7a and 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.
Form 990 Review Process	Part VI, Section B, Question 11b	THE FINANCE COMMITTEE REVIEWS WAMEGO HOSPITAL ASSOCIATION'S FORM 990. THE FINANCE COMMITTEE REVIEWS AND APPROVES THE FORM 990 PRIOR TO THE DATE OF FILING. THE FINANCE 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 Monitoring & Enforcement	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.
Process for Determining Compensation	Part VI, Section B, Questions 15a and 15b	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.
How Documents are Made Available to the Public	Part VI, Section C, Question 19	WAMEGO HOSPITAL ASSOCIATION'S GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE AVAILABLE TO THE PUBLIC UPON REQUEST.
EMPLOYEES	PART V, QUESTION 2A	WAMEGO HOSPITAL ASSOCIATION INC. DID NOT FILE FORM W-3. ALL EMPLOYEES ARE PAID BY A RELATED ORGANIZATION.
RECONCILIATION OF NET ASSETS	PART XI, QUESTION 5	UNREALIZED GAIN 29,883
Statement of Program Service Accomplishments	Part III	Wamego Hospital Association (WHA) is a member of Via Christi Health (VCH). As a Catholic health system, VCH has its origins in faith-based responses to health needs of our communities, with a particular concern for those living in poverty and who are vulnerable. In addition to typical inpatient and outpatient services, VCH operates primary care clinics, a low income neighborhood outreach clinic, specialty hospitals and centers, home medical services, therapy centers and long-term care villages. 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 According to the VCH' mission statement, "As a part of Via Christi Health, 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." 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. The following are WHA definitions for quantifiable community benefits reports below. Charity Care - Free or discounted health services provided to persons who cannot afford to pay and who meet VCH's criteria for financial assistance. Charity care is reported in terms of costs, not charges. Charity care does not include bad debt. Gov't Sponsored Means-Tested Health Care - Includes unpaid costs of public programs for low-income persons - the shortfall created when VCH receives payments that are less than the cost of caring for public program beneficiaries. This payment shortfall is not the same as a contractual allowance, which is the full difference between charges and government payments. Health Professions Education - Helping to prepare future health care professionals is a distinguishing characteristic of not-for-profit health care and constitutes a significant community benefit. This category includes programs and financial assistance for physicians and medical students, nurses and nursing students, interns and other health professionals. For fiscal year ended September 30, 2012: Community Benefit (WHA Inc.): 1. Charity care - at cost $0.06 million 2. Government sponsored health care - net expense $0.40 million 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 $0.06 million 4. Total Quantifiable Community Benefit $0.52 million Listed below are just a few of the community benefit programs offered by Wamego Hospital Association (WHA) during FY 2012. This is not a complete listing but a sampling of how the hospital gives back to the community while meeting current needs. WHA enriches the community in which it operate as well as the broader community, improving medicine through educating physicians and other healthcare providers, and providing care and support to people in need. Wamego further supports this mission with a community board, open medical staff and an emergency room available to patients regardless of ability to pay. Community representation on the Governing Body - The Board of Trustees is the governing body of WHA. The majority of its members are external members comprised of persons who reside in or around the city of Wamego and they have overall responsibility for the charitable mission of the organization as set forth in its Articles of Incorporation and By Laws. These trustees are selected based on their expertise, experience and other criteria established by the nominating committee of the Board of Trustees. Areas of expertise and experience include such areas as healthcare, finance, education, and local government. The Board actively debates and sets policy and strategic direction for the ministry but does not get involved in issues related to daily operations. The Board takes a balanced approach when addressing community and business/financial concerns. The Board is also the primary group for determining the use of surplus funds generated by the organization which are reinvested in the ministry in order to allow the ministry to sustain its mission and prepare for the future. Open Medical Staff - The medical staff of WHA is an open medical staff and is composed of physicians, dentists and podiatrists licensed to practice medicine in the State of Kansas. Wamego staff also participates in the community on boards of other not-for-profit organizations, government entities, foundations, area colleges and university committees, state-wide coalitions, etc. Emergency Medical Services - WHA's EMS provides standby care for various community activities to ensure quick response of medical care should accidents occur during an event. In FY2012, Wamego provided assistance for the Riley County Rodeo; Thunder Over Manhattan; July 4th Celebrations; Juneteenth Celebrations; Alert Road Race; Job Corp Safety Day; 4-H Discover Days; St Patrick's Day Road Race, Aggieville New Year's Eve Celebration; K-State Football; and Spooktacular. One Community Campaign - WHA's staff annually volunteer to coordinate the internal campaign which benefits United Way of Riley County. Staff at WHA serve as department ambassadors assisting with presentations, pledge card distribution and collection, hosting team meetings and learning about the various programs funded through the local United Way. Security Transport is a support service provided by WHA when patients are brought to the hospital emergency department but are in need of psychiatric placement but are unable to pay for transportation to get access to the facilities which are located outside of the Manhattan area. Most of these patients are transferred to Larned, Osawatomie, Kansas University Medical Center in Kansas City or other locations and the transportation costs would be exorbitant for those who are not covered by insurance or for families who may not have the resources to provide the needed transportation to other facilities. High School Mentoring Program - WHA staff are matched for four years with high school freshmen. The goal is to improve upon the Wamego High School graduation rates by matching community volunteers with incoming freshmen who will stay connected during their high school career with the same volunteer. By participating in this unique mentoring program, WHA employees are contributing to the success of WHA students and as a result, are improving the quality of life for all Wamego residents. Chamber of Commerce - WHA staff assists the Wamego Chamber through recruitment of volunteers to help support and execute events that is hosted for the community. Through the efforts of WHA, volunteers are recruited to help with Chamber fundraising and economic development activities as well as assist with various partnership projects that are held with other local not-for-profit organizations. This volunteer recruitment improves the health of the community because some of the new economic development activities include recruiting healthcare specialists to spend some time in the area to provide care for the rural residents.
HOURS DEVOTED FOR RELATED ORGANIZATION	FORM 990 PART VII	NAME:Casey Poell TITLE:Trustee HOURS:49
HOURS DEVOTED FOR RELATED ORGANIZATION	FORM 990 PART VII	NAME:David Gambino TITLE:Secretary HOURS:49
HOURS DEVOTED FOR RELATED ORGANIZATION	FORM 990 PART VII	NAME:John Broberg TITLE:Trustee HOURS:49
HOURS DEVOTED FOR RELATED ORGANIZATION	FORM 990 PART VII	NAME:Randall Peterson TITLE:Trustee - Termed 04/20/2012 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) 2011

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

2011

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) Ascension Health PO Box 45998 St Louis,MO63145 31-1662309	Hlth Sys Gov	MO	501(c)(3)	11-I	NA		No
(2) Catholic Care Center Inc 6700 E 45th St N Wichita,KS67226 48-1067110	Rtrmnt Home	KS	501(c)(3)	9	NA		No
(3) Cornerstone Assisted Living Inc 2622 W Central Suite 100 Wichita,KS67203 48-1241079	Rtrmnt Home	KS	501(c)(3)	9	NA		No
(4) Gerard House Inc 3144 N Hood Wichita,KS67204 48-1049532	Shelter	KS	501(c)(3)	7	NA		No
(5) Marian Health System Inc 1923 South Utica Avenue Tulsa,OK74104 36-3659989	Hospital Supp	DE	501(c)(3)	11-I	NA		No
(6) Mercy Community Health Foundation Inc 1823 College Avenue Manhattan,KS66502 48-1152279	Foundation	KS	501(c)(3)	9	NA		No
(7) Mercy Regional Health Center Inc 1823 College Avenue Manhattan,KS66502 48-1186704	Hospital	KS	501(c)(3)	3	NA		No
(8) Mercy Regional Home Medical Services LLC 2439 Claflin Road Manhattan,KS66502 43-2024491	Home Medical	KS	501(c)(3)	11-III FI	NA		No
(9) Mount Carmel Foundation Inc 1102 E Centennial Drive Pittsburg,KS66762 48-0961283	Foundation	KS	501(c)(3)	11-I	NA		No
(10) Salina Regional Home Medical Services 520 S Santa Fe Ave Suite 140 Salina,KS67401 43-1948057	Home Medical	KS	501(c)(3)	11-III O	NA		No
(11) St Johns Inc 2225 Cantebury Drive Hayes,KS67601 20-2828680	Rtrmnt Home	KS	501(c)(3)	9	NA		No
(12) Via Christi Clinic Services 8200 E Thorn Drive Suite 300 Wichita,KS67226 27-3984287	Med Clinic	KS	501(c)(3)	11-I	NA		No
(13) Via Christi Foundation Inc 723 N McLean Blvd Wichita,KS67203 48-1173588	Foundation	KS	501(c)(3)	11-III FI	NA		No
(14) Via Christi Health Partners Inc 8200 E Thorn Drive Suite 300 Wichita,KS67226 48-0958974	Mgmt Co	KS	501(c)(3)	9	NA		No
(15) Via Christi Health Inc 8200 E Thorn Drive Suite 300 Wichita,KS67226 48-1172107	Hospital Supp	KS	501(c)(3)	9	NA		No
(16) Via Christi Healthcare Outreach Program 2622 W Central Suite 100 Wichita,KS67203 48-1236589	Pace Communit	KS	501(c)(3)	9	NA		No
(17) Via Christi Home Health Wichita Inc 555 S Washington Wichita,KS67211 48-1046371	Home Health	KS	501(c)(3)	9	NA		No
(18) Via Christi Hospital Pittsburg Inc 1102 E Centennial Drive Pittsburg,KS66762 48-0543778	Hospital	KS	501(c)(3)	3	NA		No
(19) Via Christi Hospital Wichita St Teresa 14800 W St Teresa Wichita,KS67235 27-1965272	Hospital	KS	501(c)(3)	3	NA		No
(20) Via Christi Hospitals Wichita Inc 929 N St Francis Wichita,KS67214 48-1172106	Hospital	KS	501(c)(3)	3	NA		No
(21) VC Immediate Care Mother Mary Anne Inc 929 N St Francis Wichita,KS67214 20-8374099	Med Clinic	KS	501(c)(3)	9	NA		No
(22) Via Christi InMyHome Inc 2622 W Central Suite 100 Wichita,KS67203 27-1889960	Hlth Agency	KS	501(c)(3)	9	NA		No
(23) Via Christi Property Services Inc 1100 N St Francis Suite 240 Wichita,KS67214 48-0948571	Property Mgmt	KS	501(c)(4)		NA		No
(24) Via Christi Rehabilitation Hospital Inc 1151 N Rock Road Wichita,KS67206 48-1158274	Rehab	KS	501(c)(3)	3	NA		No
(25) Via Christi Village Georgetown Inc 1655 S Georgetown Wichita,KS67218 48-1129325	Rtrmnt Home	KS	501(c)(3)	9	NA		No
(26) Via Christi Village Manhattan Inc 2800 Willowgrove Rd Manhattan,KS66502 48-1078862	Rtrmnt Home	KS	501(c)(3)	9	NA		No
(27) Via Christi Village McLean Inc 777 N McLean Blvd Wichita,KS67203 48-1247723	Rtrmnt Home	KS	501(c)(3)	9	NA		No
(28) Via Christi Village Ponca City Inc 1601 Academy Road Ponca City,OK74604 73-1153337	Rtrmnt Home	OK	501(c)(3)	9	NA		No
(29) Via Christi Village Pittsburg Inc 1502 E Centennial Dr Pittsburg,KS66762 74-3070971	Rtrmnt Home	KS	501(c)(3)	9	NA		No
(30) Via Christi Villages Inc 2622 W Central Suite 100 Wichita,KS67206 48-0559086	Mgmt Co	KS	501(c)(3)	11-III FI	NA		No

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

Cat. No. 50135Y

Schedule R (Form 990) 2011

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	(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?
(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) Ambulatory Surgery Center LP 8200 E Thorn Drive Suite 300 Wichita,KS67226 48-1007220	Surgery Ctr	KS	NA	0	0		No	0		No
(2) AMS Diagnostics LLC 8200 E Thorn Drive Suite 300 Wichita,KS67226 48-1223653	Radiology Svc	KS	NA	0	0		No	0		No
(3) Kansas Surgery and Recovery Ctr 8200 E Thorn Drive Suite 300 Wichita,KS67226 48-1148580	Surgery Ctr	KS	NA	0	0		No	0		No
(4) Mercy Imaging LLC 8200 E Thorn Drive Suite 300 Wichita,KS67226 48-1251984	Diagnostic Im	KS	NA	0	0		No	0		No
(5) MR Imaging Center LLC 8200 E Thorn Drive Suite 300 Wichita,KS67226 48-1000538	Radiology Svc	KS	NA	0	0		No	0		No
(6) PFI LLC 8200 E Thorn Drive Suite 300 Wichita,KS67226 72-1557076	Med Chem Mfg	KS	NA	0	0		No	0		No
(7) Preferred PET Imaging of KS LLC 8200 E Thorn Drive Suite 300 Wichita,KS67226 48-1250123	Diagnostic Im	KS	NA	0	0		No	0		No
(8) St Joseph MRI LLC 8200 E Thorn Drive Suite 300 Wichita,KS67226 48-1007220	Medical Svcs	KS	NA	0	0		No	0		No
(9) Via Christi Cyberknife LLC 8200 E Thorn Drive Suite 300 Wichita,KS67226 35-4588711	Radiology Svc	KS	NA	0	0		No	0		No

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)	(h) Percentage ownership
(1) Affiliated Medical Services Lab Inc 2916 E Central Wichita,KS67214 48-1239522	Medical Lab	KS	VC Health	C Corp	100.000 %
(2) Integrated Healthcare Systems Inc 3311 East Murdock Wichita,KS67208 48-0941549	Clinic Svcs	KS	NA	C Corp	100.000 %
(3) Sunflower Assurance LTD PO Box 1085 Grand Cayman KY1-1102 CJ 98-0223159	Insurance Co	CJ	NA	C Corp	100.000 %
(4) Via Christi Clinic PA 3311 East Murdock Wichita,KS67208 48-0993446	Prof Assoc	KS	NA	C Corp	100.000 %
(5) VCH Iowa PC 8200 E Thorn Drive Suite 300 Wichita,KS67226 27-3983977	Holding Co	IA	NA	Trust	100.000 %
(6) VCH Iowa PC Trust 8200 E Thorn Drive Suite 300 Wichita,KS67226 27-6937322	Ben Trust	IA	NA	Trust	100.000 %

Schedule R (Form 990) 2011

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 related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

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

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

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

h Exchange of assets with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

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

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

m Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) . . . . . . . . . . . . . . . . . . . . .

n Sharing of paid employees with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

o Reimbursement paid to related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

p Reimbursement paid by related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

r Other transfer of cash or property from related 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) 2011

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)	(e) Are all partners section 501(c)(3) organizations?		(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?
(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	Yes	No	(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

Schedule R (Form 990) 2011

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
Related Tax Exempt Organizations	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.

Additional Data

Software ID:
Software Version:

1	Briefly describe the organization’s mission or most significant activities: AS A PART OF VIA CHRISTI HEALTH, 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.
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	6
5	Total number of individuals employed in calendar year 2011 (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) .........	75,245	6,308
9	Program service revenue (Part VIII, line 2g) .........	9,107,536	9,795,029
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	-11,484	29,702
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	19,971	30,779
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)...................	9,191,268	9,861,818
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)	5,027,930	5,417,888
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)....	3,795,327	3,686,198
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	8,823,257	9,104,086
19	Revenue less expenses. Subtract line 18 from line 12.......	368,011	757,732
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	6,751,966	7,756,952
21	Total liabilities (Part X, line 26).............	771,653	989,024
22	Net assets or fund balances. Subtract line 21 from line 20.....	5,980,313	6,767,928

Sign Here

	Signature of officer	Date

	Type or print name and title.


4a	(Code: ) (Expenses $ 6,442,822 including grants of $ ) (Revenue $ 9,797,029 )
	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$ 6,442,822

(A) Name and Title	(B) Average hours per week (describe hours for related organizations in Schedule O)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)			(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) Casey Poell Trustee	1.0	X			0	272,136	11,722
(2) David Gambino Secretary	1.0	X	X		0	521,595	71,696
(3) Jacob Pugh Trustee	1.0	X			0	0	0
(4) John Hupe Trustee	1.0	X			0	0	0
(5) John Broberg Trustee	1.0	X			0	344,539	51,931
(6) Lois O'Malley Trustee	1.0	X			0	0	0
(7) Mark Knackendoffel Chair	1.0	X	X		0	0	0
(8) Michael Leitch Trustee	1.0	X			0	0	0
(9) William Ditto Treasurer	1.0	X	X		0	0	0
(10) Randall Peterson Trustee - Termed 04/20/2012	1.0	X			0	640,820	135,270
(11) Kathy Douglas Nurse Practitioner	50.0			X	0	107,260	9,218
(12) Roland M Darey Jr Physician	50.0			X	0	263,676	11,670

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)............	0	2,150,026	291,507

(A) Name and business address	(B) Description of services	(C) Compensation
Diamond Healthcare 701 E Byrd Street 15th Floor RICHMOND,VA23219	Consulting	272,000




2 Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization 1

				(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

f	All other contributions, gifts, grants, and similar amounts not included above1f		6,308
g	Noncash contributions included in lines 1a-1f:$
h	Total. Add lines 1a-1f.......			6,308
			Business Code
2a	NET PATIENT SERVICE REVENUE		621,610	9,213,662	9,213,662
b	MEANINGFUL USE REVENUE		621,610	581,367	581,367
c
d
e
f	All other program service revenue .
g	Total. Add lines 2a–2f........			9,795,029
3	Investment income (including dividends, interest
	and other similar amounts).....			17,093			17,093
4	Income from investment of tax-exempt bond proceeds..			0
5	Royalties............			0
		(i) Real	(ii) Personal
6a	Gross rents	10,637
b	Less: rental expenses
c	Rental income or (loss)	10,637
d	Net rental income or (loss).......			10,637			10,637
		(i) Securities	(ii) Other
7a	Gross amount from sales of assets other than inventory	12,609
b	Less: cost or other basis and sales expenses	0
c	Gain or (loss)	12,609
d	Net gain or (loss)..........			12,609			12,609
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	17,486			17,486
b	ROI PROCESSING FEES		541,610	1,868	1,868
c	VENDING MACHINES		722,210	656			656
d	All other revenue ....			132	132
e	Total. Add lines 11a–11d ......			20,142
12	Total revenue. See Instructions....			9,861,818	9,797,029		58,481


				(A) Beginning of year		(B) End of year
1	Cashnon-interest-bearing ..........			279	1	279
2	Savings and temporary cash investments .......			2,213,128	2	3,277,104
3	Pledges and grants receivable, net .........			0	3	32,868
4	Accounts receivable, net .........			1,291,083	4	1,270,529
5	Receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of
	Schedule L ..........			0	5	0
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 ..........			0	6	0
7	Notes and loans receivable, net .............			0	7	0
8	Inventories for sale or use ..............			129,429	8	140,598
9	Prepaid expenses and deferred charges ............			267,159	9	69,213
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	3,442,220
b	Less: accumulated depreciation. .....	10b	2,004,307	1,341,316	10c	1,437,913
11	Investments—publicly traded securities ..........			0	11	0
12	Investments—other securities. See Part IV, line 11 ......			0	12	0
13	Investments—program-related. See Part IV, line 11 ..			0	13	0
14	Intangible assets .........			0	14	0
15	Other assets. See Part IV, line 11 ...........			1,509,572	15	1,528,448
16	Total assets. Add lines 1 through 15 (must equal line 34)...			6,751,966	16	7,756,952
17	Accounts payable and accrued expenses .			771,653	17	989,024
18	Grants payable ..........			0	18	0
19	Deferred revenue ..........			0	19	0
20	Tax-exempt bond liabilities ..........			0	20	0
21	Escrow or custodial account liability. Complete Part IV of Schedule D..			0	21	0
22	Payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
	persons. Complete Part II of Schedule L..........			0	22	0
23	Secured mortgages and notes payable to unrelated third parties ..			0	23	0
24	Unsecured notes and loans payable to unrelated third parties ....			0	24	0
25	Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X of Schedule D.....			0	25	0
26	Total liabilities. Add lines 17 through 25.....			771,653	26	989,024
	Organizations that follow SFAS 117, check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets .....			5,980,313	27	6,767,928
28	Temporarily restricted net assets .....			0	28	0
29	Permanently restricted net assets .....			0	29	0
	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 .....			5,980,313	33	6,767,928
34	Total liabilities and net assets/fund balances .....			6,751,966	34	7,756,952