TY 2015 Form 990

(A) Name and Title	(B) Average hours per week (list any hours for related organizations below dotted line)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)	(F) Estimated amount of other compensation from the organization and related organizations
(1) DWIGHT FAULKNER CHAIR	1.0 ................. 1.0	X	X			0	0
(2) MICHAEL LEITCH VICE CHAIR	1.0 ................. 0	X	X			0	0
(3) JOHN R BROBERG SECRETARY	1.0 ................. 49.0	X	X			329,415	62,281
(4) JACOB PUGH TREASURER	1.0 ................. 0	X	X			0	0
(5) WILLIAM E DITTO TRUSTEE	1.0 ................. 0	X				0	0
(6) MARK KNACKENDOFFEL TRUSTEE	1.0 ................. 2.0	X				0	0
(7) SISTER LOIS O'MALLEY CSJ TRUSTEE	1.0 ................. 1.0	X				0	0
(8) CASEY POELL MD TRUSTEE	1.0 ................. 50.0	X				370,279	36,801
(9) DAVID A GAMBINO TRUSTEE	1.0 ................. 54.0	X				544,747	74,387
(10) SHANNAN FLACH ADMINISTRATOR	50.0 ................. 0.0		X			128,049	34,944
(11) JAMES FRASER ADMINISTRATOR FINANCE	1.0 ................. 51.0		X			181,887	18,187
(12) ROBERTA JOHNSON ASSISTANT SECRETARY	1.0 ................. 41.0		X			284,651	66,689
(13) CAROL KARP ASSISTANT TREASURER (START 10/14)/CFO	1.0 ................. 55.0		X			417,633	52,960
(14) CURTIS WOLFE CHIEF OF STAFF	50.0 ................. 0.0			X		202,178	35,534
(15) ROLAND M DAREY JR MD PHYSICIAN	50.0 ................. 0.0				X	265,585	38,668
(16) DANE DITTO MD PHYSICIAN	50.0 ................. 0.0				X	258,341	28,181
(17) KATHY A DOUGLAS NURSE PRACTICIONER	50.0 ................. 0.0				X	118,191	26,274

(A) Name and business address	(B) Description of services	(C) Compensation
DIAMOND HEALTHCARE 701 E BYRD STREET 15TH FLOOR RICHMOND,VA23219	CONSULTING	278,100
FREEMAN WHITE INC 8845 RED OAD BOULEVARD CHARLOTTE,NC28217	CONSULTING	229,984
TELEQUALITY COMMUNICATIONS 21232 GATHERING OAKS 107 SAN ANTONIO,TX78260	SERVICES	159,821
CASCADE HEALTH SERVICES 1045 SWIFT AVE NORTH KANSAS CITY,MO64116	CONTRACT LABOR	107,524

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 4

- 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.
right arrow

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

Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

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 described in section 170(b)(1)(A)(i).

A school described in section 170(b)(1)(A)(ii). (Attach Schedule E (Form 990 or 990-EZ))

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. See section 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 in lines 11a through 11d that describes the type of supporting organization and complete lines 11e, 11f, and 11g.

Type I. A supporting organization operated, supervised, or controlled by its supported organization(s), typically by giving the supported organization(s) the power to regularly appoint or elect a majority of the directors or trustees of the supporting organization. You must complete Part IV, Sections A and B.

Type II. A supporting organization supervised or controlled in connection with its supported organization(s), by having control or management of the supporting organization vested in the same persons that control or manage the supported organization(s). You must complete Part IV, Sections A and C.

Type III functionally integrated. A supporting organization operated in connection with, and functionally integrated with, its supported organization(s) (see instructions). You must complete Part IV, Sections A, D, and E.

Type III non-functionally integrated. A supporting organization operated in connection with its supported organization(s) that is not functionally integrated. The organization generally must satisfy a distribution requirement and an attentiveness requirement (see instructions). You must complete Part IV, Sections A and D, and Part V.

Check this box if the organization received a written determination from the IRS that it is a Type I, Type II, Type III functionally integrated, or Type III non-functionally integrated supporting organization.

Enter the number of supported organizations ..............

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

(i)Name of supported organization	(ii) EIN	(iv) Is the organization listed in your governing document?		(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)
(i)Name of supported organization	(ii) EIN	Yes	No	(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)


Total

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

Cat. No. 11285F

Schedule A (Form 990 or 990-EZ) 2015

Page 2

Part II

Support Schedule for Organizations Described in Sections 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) 2011	(b) 2012	(c) 2013	(d) 2014	(e) 2015	(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) 2011	(b) 2012	(c) 2013	(d) 2014	(e) 2015	(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. Do not include gain or loss from the sale of capital assets (Explain in Part VI.)..
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 section 501(c)(3) organization, check this box and stop here........................................ right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2015 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2014 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2015. 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—2014. If the organization did not check a 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—2015. 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 VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported
organization ..................................................... right arrow

10%-facts-and-circumstances test—2014. 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 VI 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) 2015

Page 3

Part III

Support Schedule for Organizations Described in Section 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) 2011	(b) 2012	(c) 2013	(d) 2014	(e) 2015	(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) 2011	(b) 2012	(c) 2013	(d) 2014	(e) 2015	(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 VI.) ..
13	Total support. (Add lines 9, 10c, 11, and 12.)..

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

Section C. Computation of Public Support Percentage

Public support percentage for 2015 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2014 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2015 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2014 Schedule A, Part III, line 17 .............

19a

331/3% support tests—2015. 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—2014. 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) 2015

Page 4

Part IV

Supporting Organizations

(Complete only if you checked a box on line 11 of Part I. If you checked 11a of Part I, complete Sections A and B. If you checked 11b of Part I, complete Sections A and C. If you checked 11c of Part I, complete Sections A, D, and E. If you checked 11d of Part I, complete Sections A and D, and complete Part V.)

Section A. All Supporting Organizations

Yes

Are all of the organization’s supported organizations listed by name in the organization’s governing documents?
If "No," describe in Part VI how the supported organizations are designated. If designated by class or purpose,
describe the designation. If historic and continuing relationship, explain.

Did the organization have any supported organization that does not have an IRS determination of status under section 509(a)(1) or (2)? If "Yes," explain in Part VI how the organization determined that the supported organization was described in section 509(a)(1) or (2).

Did the organization have a supported organization described in section 501(c)(4), (5), or (6)? If "Yes," answer (b) and (c) below.

Did the organization confirm that each supported organization qualified under section 501(c)(4), (5), or (6) and satisfied the public support tests under section 509(a)(2)? If "Yes," describe in Part VI when and how the organization made the determination.

Did the organization ensure that all support to such organizations was used exclusively for section 170(c)(2)(B) purposes? If "Yes," explain in Part VI what controls the organization put in place to ensure such use.

Was any supported organization not organized in the United States ("foreign supported organization")? If “Yes” and if you checked 11a or 11b in Part I, answer (b) and (c) below.

Did the organization have ultimate control and discretion in deciding whether to make grants to the foreign supported organization? If “Yes,” describe in Part VI how the organization had such control and discretion despite being controlled or supervised by or in connection with its supported organizations.

Did the organization support any foreign supported organization that does not have an IRS determination under sections 501(c)(3) and 509(a)(1) or (2)? If “Yes,” explain in Part VI what controls the organization used to ensure that all support to the foreign supported organization was used exclusively for section 170(c)(2)(B) purposes.

Did the organization add, substitute, or remove any supported organizations during the tax year? If “Yes,” answer (b) and (c) below (if applicable). Also, provide detail in Part VI, including (i) the names and EIN numbers of the supported organizations added, substituted, or removed; (ii) the reasons for each such action; (iii) the authority under the organization's organizing document authorizing such action; and (iv) how the action was accomplished (such as by amendment to the organizing document).

Type I or Type II only. Was any added or substituted supported organization part of a class already designated in the organization's organizing document?

Substitutions only. Was the substitution the result of an event beyond the organization's control?

Did the organization provide support (whether in the form of grants or the provision of services or facilities) to anyone other than (i) its supported organizations, (ii) individuals that are part of the charitable class benefited by one or more of its supported organizations, or (iii) other supporting organizations that also support or benefit one or more of the filing organization’s supported organizations? If “Yes,” provide detail in Part VI.

Did the organization provide a grant, loan, compensation, or other similar payment to a substantial contributor (defined in section 4958(c)(3)(C)), a family member of a substantial contributor, or a 35% controlled entity with regard to a substantial contributor? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ) .

Did the organization make a loan to a disqualified person (as defined in section 4958) not described in line 7? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ).

Was the organization controlled directly or indirectly at any time during the tax year by one or more disqualified persons as defined in section 4946 (other than foundation managers and organizations described in section 509(a)(1) or (2))? If “Yes,” provide detail in Part VI.

Did one or more disqualified persons (as defined in line 9a) hold a controlling interest in any entity in which the supporting organization had an interest? If “Yes,” provide detail in Part VI.

Did a disqualified person (as defined in line 9a) have an ownership interest in, or derive any personal benefit from, assets in which the supporting organization also had an interest? If “Yes,” provide detail in Part VI.

10a

Was the organization subject to the excess business holdings rules of section 4943 because of section 4943(f) (regarding certain Type II supporting organizations, and all Type III non-functionally integrated supporting organizations)? If “Yes,” answer line 10b below.

10a

Did the organization have any excess business holdings in the tax year? (Use Schedule C, Form 4720, to determine whether the organization had excess business holdings).

10b

Schedule A (Form 990 or 990-EZ) 2015

Page 5

Part IV

Supporting Organizations (continued)

Yes

Has the organization accepted a gift or contribution from any of the following persons?

A person who directly or indirectly controls, either alone or together with persons described in (b) and (c) below, the governing body of a supported organization?

11a

A family member of a person described in (a) above?

11b

A 35% controlled entity of a person described in (a) or (b) above? If “Yes” to a, b, or c, provide detail in Part VI.

11c

Section B. Type I Supporting Organizations

Yes

Did the directors, trustees, or membership of one or more supported organizations have the power to regularly appoint or elect at least a majority of the organization’s directors or trustees at all times during the tax year? If “No,” describe in Part VI how the supported organization(s) effectively operated, supervised, or controlled the organization’s activities. If the organization had more than one supported organization, describe how the powers to appoint and/or remove directors or trustees were allocated among the supported organizations and what conditions or restrictions, if any, applied to such powers during the tax year.

Did the organization operate for the benefit of any supported organization other than the supported organization(s) that operated, supervised, or controlled the supporting organization? If “Yes,” explain in Part VI how providing such benefit carried out the purposes of the supported organization(s) that operated, supervised or controlled the supporting organization.

Section C. Type II Supporting Organizations

Yes

Were a majority of the organization’s directors or trustees during the tax year also a majority of the directors or trustees of each of the organization’s supported organization(s)? If “No,” describe in Part VI how control or management of the supporting organization was vested in the same persons that controlled or managed the supported organization(s).

Section D. All Type III Supporting Organizations

Yes

Did the organization provide to each of its supported organizations, by the last day of the fifth month of the organization’s tax year, (i) a written notice describing the type and amount of support provided during the prior tax year, (ii) a copy of the Form 990 that was most recently filed as of the date of notification, and (iii) copies of the organization’s governing documents in effect on the date of notification, to the extent not previously provided?

Were any of the organization’s officers, directors, or trustees either (i) appointed or elected by the supported organization(s) or (ii) serving on the governing body of a supported organization? If "No," explain in Part VI how the organization maintained a close and continuous working relationship with the supported organization(s).

By reason of the relationship described in (2), did the organization’s supported organizations have a significant voice in the organization’s investment policies and in directing the use of the organization’s income or assets at all times during the tax year? If "Yes," describe in Part VI the role the organization’s supported organizations played in this regard.

Section E. Type III Functionally-Integrated Supporting Organizations

Check the box next to the method that the organization used to satisfy the Integral Part Test during the year (see instructions):

The organization satisfied the Activities Test. Complete line 2 below.

The organization is the parent of each of its supported organizations. Complete line 3 below.

The organization supported a governmental entity. Describe in Part VI how you supported a government entity (see instructions)

Activities Test. Answer (a) and (b) below.

Yes

Did substantially all of the organization’s activities during the tax year directly further the exempt purposes of the supported organization(s) to which the organization was responsive? If "Yes," then in Part VI identify those supported organizations and explain how these activities directly furthered their exempt purposes, how the organization was responsive to those supported organizations, and how the organization determined that these activities constituted substantially all of its activities.

Did the activities described in (a) constitute activities that, but for the organization’s involvement, one or more of the organization’s supported organization(s) would have been engaged in? If "Yes," explain in Part VI the reasons for the organization’s position that its supported organization(s) would have engaged in these activities but for the organization’s involvement.

Parent of Supported Organizations. Answer (a) and (b) below.

Did the organization have the power to regularly appoint or elect a majority of the officers, directors, or trustees of each of the supported organizations? Provide details in Part VI.

Did the organization exercise a substantial degree of direction over the policies, programs and activities of each of its supported organizations? If "Yes," describe in Part VI. the role played by the organization in this regard.

Schedule A (Form 990 or 990-EZ) 2015

Page 6

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations

Check here if the organization satisfied the Integral Part Test as a qualifying trust on Nov. 20, 1970. See instructions. All other Type III non-functionally integrated supporting organizations must complete Sections A through E.

	Section A - Adjusted Net Income		(A) Prior Year	(B) Current Year (optional)
1	Net short-term capital gain	1
2	Recoveries of prior-year distributions	2
3	Other gross income (see instructions)	3
4	Add lines 1 through 3	4
5	Depreciation and depletion	5
6	Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions)	6
7	Other expenses (see instructions)	7
8	Adjusted Net Income (subtract lines 5, 6 and 7 from line 4)	8

	Section B - Minimum Asset Amount		(A) Prior Year	(B) Current Year (optional)
1	Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year):	1
a	Average monthly value of securities	1a
b	Average monthly cash balances	1b
c	Fair market value of other non-exempt-use assets	1c
d	Total (add lines 1a, 1b, and 1c)	1d
e	Discount claimed for blockage or other factors (explain in detail in Part VI):
2	Acquisition indebtedness applicable to non-exempt use assets	2
3	Subtract line 2 from line 1d	3
4	Cash deemed held for exempt use. Enter 1-1/2% of line 3 (for greater amount, see instructions).	4
5	Net value of non-exempt-use assets (subtract line 4 from line 3)	5
6	Multiply line 5 by .035	6
7	Recoveries of prior-year distributions	7
8	Minimum Asset Amount (add line 7 to line 6)	8

	Section C - Distributable Amount		Current Year
1	Adjusted net income for prior year (from Section A, line 8, Column A)	1
2	Enter 85% of line 1	2
3	Minimum asset amount for prior year (from Section B, line 8, Column A)	3
4	Enter greater of line 2 or line 3	4
5	Income tax imposed in prior year	5
6	Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions)	6

Check here if the current year is the organization's first as a non-functionally-integrated Type III supporting organization (see instructions)

Schedule A (Form 990 or 990-EZ) 2015

Page 7

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations (continued)

Section D - Distributions		Current Year
1 Amounts paid to supported organizations to accomplish exempt purposes
2 Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity
3 Administrative expenses paid to accomplish exempt purposes of supported organizations
4 Amounts paid to acquire exempt-use assets
5 Qualified set-aside amounts (prior IRS approval required)
6 Other distributions (describe in Part VI). See instructions
7Total annual distributions. Add lines 1 through 6.
8 Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions
9 Distributable amount for 2015 from Section C, line 6
10 Line 8 amount divided by Line 9 amount

Section E - Distribution Allocations (see instructions)		(i) Excess Distributions	(ii) Underdistributions Pre-2015	(iii) Distributable Amount for 2015
1 Distributable amount for 2015 from Section C, line 6
2 Underdistributions, if any, for years prior to 2015 (reasonable cause required--see instructions)
3 Excess distributions carryover, if any, to 2015:
a
b
c
d From 2013.......
e From 2014.......
fTotal of lines 3a through e
g Applied to underdistributions of prior years
h Applied to 2015 distributable amount
i Carryover from 2010 not applied (see instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from 3f.
4Distributions for 2015 from Section D, line 7:
$
a Applied to underdistributions of prior years
b Applied to 2015 distributable amount
c Remainder. Subtract lines 4a and 4b from 4.
5 Remaining underdistributions for years prior to 2015, if any. Subtract lines 3g and 4a from line 2 (if amount greater than zero, see instructions)
6 Remaining underdistributions for 2015. Subtract lines 3h and 4b from line 1 (if amount greater than zero, see instructions)
7 Excess distributions carryover to 2016. Add lines 3j and 4c.
8 Breakdown of line 7:
a
b
c Excess from 2013.......
d From 2014.......
e From 2015.......

Schedule A (Form 990 or 990-EZ) (2015)

Schedule A (Form 990 or 990-EZ) 2015

Page 8

Part VI

Supplemental Information. Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; Part III, line 12; Part IV, Section A, lines 1, 2, 3b, 3c, 4b, 4c, 5a, 6, 9a, 9b, 9c, 11a, 11b, and 11c; Part IV, Section B, lines 1 and 2; Part IV, Section C, line 1; Part IV, Section D, lines 2 and 3; Part IV, Section E, lines 1c, 2a, 2b, 3a and 3b; Part V, line 1; Part V, Section B, line 1e; Part V Section D, lines 5, 6, and 8; and Part V, Section E, lines 2, 5, and 6. Also complete this part for any additional information. (See instructions).

Facts And Circumstances Test

Return Reference	Explanation

Schedule A (Form 990 or 990-EZ) 2015

Additional Data

Software ID:	15000238
Software Version:	2015v3.0

- 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

Information about Schedule C (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public
Inspection

If the organization answered "Yes" on 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" on 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" on Form 990, Part IV, Line 5 (Proxy Tax) (see separate instructions) or Form 990-EZ, Part V, line 35c (Proxy Tax) (see separate instructions), 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-.
1
2
3
4
5
6

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

Cat. No. 50084S

Schedule C (Form 990 or 990-EZ) 2015

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 SchCMd Bullet

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 SchCMd Bullet

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 separate instructions for lines 2a through 2f.)
Lobbying Expenditures During 4-Year Averaging Period
	Calendar year (or fiscal year beginning in)	(a) 2012	(b) 2013	(c) 2014	(d) 2015	(e) Total

2a	Lobbying nontaxable 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) 2015

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 on 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

3,369

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

3,369

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

Provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, line 5; Part II-A (affiliated group list); Part II-A, lines 1 and 2 (see instructions), and Part ll-B, line 1. Also, complete this part for any additional information.

Return Reference	Explanation
Schedule C, Part II-B, Line 1 DETAILED DESCRIPTION OF THE LOBBYING ACTIVITY	Lobbying expenses represent the portion of dues paid to national and state hospital associations that is specifically allocable to lobbying. Wamego Hospital Association, Inc. does not participate in or intervene in (including the publishing or distributing of statements) any political campaign on behalf of (or in opposition to) any candidate for public office.
Schedule C, Part II-B, Line 1 DETAILED DESCRIPTION OF THE LOBBYING ACTIVITY	Lobbying expenses represent the portion of dues paid to national and state hospital associations that is specifically allocable to lobbying. Wamego Hospital Association, Inc. does not participate in or intervene in (including the publishing or distributing of statements) any political campaign on behalf of (or in opposition to) any candidate for public office.

Schedule C (Form 990 or 990EZ) 2015

Additional Data

Software ID:	15000238
Software Version:	2015v3.0

- TIN:

SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

Complete if the organization answered "Yes," on 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.
Information about Schedule D (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

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" on Form 990, Part IV, line 6.

			(a) Donor advised funds	(b) Funds and other accounts

1	Total number at end of year ....
2	Aggregate value of contributions to (during year)
3	Aggregate value of 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" on 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, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet

Amount of expenses incurred in monitoring, inspecting, handling of violations, 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 section 170(h)(4)(B)(ii)? .............................

Yes No

In Part XIII, 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" on 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 XIII, 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)

Revenue included on 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:

Revenue included on Form 990, Part VIII, line 1 .......................... SchDMd Bullet

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

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

Cat. No. 52283D

Schedule D (Form 990) 2015

Page 2

Part III

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

Using the organization’s acquisition, 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 XIII.

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" on 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


b	If "Yes," explain the arrangement in Part XIII and complete the following table:		Amount
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, for escrow or custodial account liability?

Yes No

If "Yes," explain the arrangement in Part XIII. Check here if the explanation has been provided in Part XIII ........

Part V

Endowment Funds. Complete if the organization answered "Yes" on 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 current year end balance (line 1g, column (a)) held as:

Board designated or quasi-endowment SchDMd Bullet

Permanent endowment SchDMd Bullet

Temporarily restricted endowment SchDMd Bullet

The percentages on 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" on 3a(ii), are the related organizations listed as required on Schedule R? .........

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

Part VI

Land, Buildings, and Equipment.
Complete if the organization answered 'Yes' on Form 990, Part IV, line 11a. See Form 990, Part X, line 10.

Description of property		(a) Cost or other basis (investment)	(b)Cost or other basis (other)	(c) Accumulated depreciation	(d) Book value

1a	Land ...
b	Buildings	46,127	23,341	22,786
c	Leasehold improvements	176,529	102,409	74,120
d	Equipment ...	3,778,433	2,976,066	802,367
e	Other ...	435,100		435,100
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..				1,334,373

Schedule D (Form 990) 2015

Page 3

Part VII

InvestmentsOther Securities. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11b. 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
(3)Other
(A)
(B)
(C)
(D)
(E)
(F)
(G)
(H)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)

Part VIII

InvestmentsProgram Related. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11c. See Form 990, Part X, line 13.

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

(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)

Part IX

Other Assets. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11d. See Form 990, Part X, line 15.

(a) Description				(b) Book value
(1) LONG TERM INVESTMENTS				6,453,531
(2) CSI RECEIVABLE				34,136
(3) DEPOSITS				37,251
(4) GRANTS DUE FROM RESTRICTED
(5) WAMEGO CITY HOSPITAL RECEIVABLE				24,790
(6) OTHER RECEIVABLES				28,606
(7) INTERCOMPANY RECEIVABLES				91,342
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........				6,669,656

Part X

Other Liabilities. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11e or 11f. See Form 990, Part X, line 25.

1.(a) Description of liability	(b) Book value
(1) Federal income taxes
MEDICARE SETTLEMENT	559,566
INTERCOMPANY PAYABLES	1,777,341
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)	2,336,907
2. Liability for uncertain tax positions. In Part XIII, 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 (ASC 740). Check here if the text of the footnote has been provided in Part XIII

Schedule D (Form 990) 2015

Page 4

Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
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 (losses) on investments ....	2a
b	Donated services and use of facilities .........	2b
c	Recoveries of prior year grants ...........	2c
d	Other (Describe in Part XIII.) ............	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 XIII.) ...........	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 XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
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 XIII.) ............	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 XIII.) ............	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 XIII

Supplemental Information

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, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information.

Return Reference

Explanation

Schedule D, Part X, Line 2 FIN 48 (ASC 740) footnote

From the consolidated audited financial statements of Ascension Health Alliance and its member organizations ("The System") which include the activity of Wamego Hospital Association, Inc.: The System accounts for uncertainty in income tax positions by applying a recognition threshold and measurement attribute for financial statement recognition and measurement of a tax position taken or expected to be taken in a tax return. The System has determined that no material unrecognized tax benefits or liabilities exist as of June 30, 2016.

Schedule D (Form 990) 2015

Additional Data

Software ID:	15000238
Software Version:	2015v3.0

- TIN:

SCHEDULE H
(Form 990)

Department of the Treasury
Internal Revenue Service

Hospitals

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

Attach to Form 990.
MediumBullet

Information about Schedule H (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public Inspection

Name of the organization

Wamego Hospital Association Inc

Employer identification number

72-1526400

Part I

Financial Assistance 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) as a factor in determining 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 as a factor in determining 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 used factors other than FPG in determining eligibility, describe in Part VI the criteria used 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, as a factor in determining 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

Financial Assistance and Means-Tested Government Programs		(a) Number of activities or programs (optional)	(b) Persons served (optional)	(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) . . .			92,206		92,206	0.81 %
b	Medicaid (from Worksheet 3, column a) . . . . .			566,225	301,347	264,878	2.33 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) . .					0	0 %
d	Total Financial Assistance and Means-Tested Government Programs . . . . .	0	0	658,431	301,347	357,084	3.14 %
Other Benefits
e	Community health improvement services and community benefit operations (from Worksheet 4).			30,416	0	30,416	0.27 %
f	Health professions education (from Worksheet 5) . . .			3,321	0	3,321	0.03 %
g	Subsidized health services (from Worksheet 6) . . . .			0	0	0	0 %
h	Research (from Worksheet 7) .			0	0	0	0 %
i	Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .			15,045	0	15,045	0.13 %
j	Total. Other Benefits . .	0	0	48,782	0	48,782	0.43 %
k	Total. Add lines 7d and 7j .	0	0	707,213	301,347	405,866	3.56 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2015

Schedule H (Form 990) 2015

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.

		(a) Number of activities or programs (optional)	(b) Persons served (optional)	(c) Total community building expense	(d) Direct offsetting revenue	(e) Net community building expense	(f) Percent of total expense
1	Physical improvements and housing					0	0 %
2	Economic development			10,998	0	10,998	0.10 %
3	Community support			679	0	679	0.01 %
4	Environmental improvements			471	0	471	0 %
5	Leadership development and training for community members					0	0 %
6	Coalition building					0	0 %
7	Community health improvement advocacy					0	0 %
8	Workforce development			1,119	0	1,119	0.01 %
9	Other					0	0 %
10	Total	0	0	13,267	0	13,267	0.12 %

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? ..........................

Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......

775,404

Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy. Explain in Part VI the methodology used by the organization to estimate this amount and the rationale, if any, for including this portion of bad debt as community benefit. ......

Provide in Part VI the text of the footnote to the organization’s financial statements that describes bad debt expense or the page number on which this footnote is contained in the attached financial statements.

Section B. Medicare

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

6,303,125

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

6,097,656

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

205,469

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(owned 10% or more by officers, directors, trustees, key employees, and physicians—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) 2015

Page

Part VFacility Information

Section A. Hospital Facilities (list in order of size from largest to smallest—see instructions) How many hospital facilities did the organization operate during the tax year?1 Name, address, primary website address, and state license number (and if a group return, the name and EIN of the subordinate hospital organization that operates the hospital facility)
1	WAMEGO HOSPITAL ASSOCIATION INC 711 GENN DRIVE WAMEGO,KS66547 HTTPS://WWW.VIACHRISTI.ORG KANSAS H-075-002	X	X	X

Schedule H (Form 990) 2015

Page 4

Part VFacility Information (continued)

Section B. Facility Policies and Practices

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

	WAMEGO HOSPITAL ASSOCIATION INC
Name of hospital facility or letter of facility reporting group

Line number of hospital facility, or line numbers of hospital facilities in a facility
reporting group (from Part V, Section A):

Yes

Community Health Needs Assessment

Was the hospital facility first licensed, registered, or similarly recognized by a state as a hospital facility in the current tax year or the immediately preceding tax year?........................

Was the hospital facility acquired or placed into service as a tax-exempt hospital in the current tax year or the immediately preceding tax year? If “Yes,” provide details of the acquisition in Section C...............

During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 12......................

Yes

If "Yes," indicate what the CHNA report describes (check all that apply):

A definition of the community served by the hospital facility

Demographics of the community

Existing health care facilities and resources within the community that are available to respond to the health needs of the community

How data was obtained

The significant health needs of the community

Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups

The process for identifying and prioritizing community health needs and services to meet the community health needs

The process for consulting with persons representing the community’s interests

Information gaps that limit the hospital facility’s ability to assess the community’s health needs

Other (describe in Section C)

Indicate the tax year the hospital facility last conducted a CHNA: 20 14

In conducting its most recent CHNA, did the hospital facility take into account input from persons who represent the broad interests of the community served by the hospital facility, including those with special knowledge of or expertise in public health? If "Yes," describe in Section C how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted .................

Yes

6 a

Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Section C..................................

Yes

Was the hospital facility’s CHNA conducted with one or more organizations other than hospital facilities?” If “Yes,” list the other organizations in Section C. ............................

Yes

Did the hospital facility make its CHNA report widely available to the public?..............

Yes

If "Yes," indicate how the CHNA report was made widely available (check all that apply):

Hospital facility’s website (list url): https://www.wamegohealthcenter.org/about-us/community-needs-assessment/

Other website (list url): http://www.pottawatomiecountycommunityneedsassessment.org/

Made a paper copy available for public inspection without charge at the hospital facility

Other (describe in Section C)

Did the hospital facility adopt an implementation strategy to meet the significant community health needs
identified through its most recently conducted CHNA? If "No," skip to line 11. ..............

Yes

Indicate the tax year the hospital facility last adopted an implementation strategy: 20 15

Is the hospital facility's most recently adopted implementation strategy posted on a website?.........

If "Yes" (list url):

If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ......

10b

Yes

Describe in Section C how the hospital facility is addressing the significant needs identified in its most recently conducted CHNA and any such needs that are not being addressed together with the reasons why such needs are not being addressed.

12a

Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)?...............................

12a

If "Yes" on line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........

12b

If "Yes" on line 12b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $

Schedule H (Form 990) 2015

Page 5

Part VFacility Information (continued)

Financial Assistance Policy (FAP)

	WAMEGO HOSPITAL ASSOCIATION INC
Name of hospital facility or letter of facility reporting group

Yes

Did the hospital facility have in place during the tax year a written financial assistance policy that:

Explained eligibility criteria for financial assistance, and whether such assistance included free or discounted care?

Yes

If “Yes,” indicate the eligibility criteria explained in the FAP:

Federal poverty guidelines (FPG), with FPG family income limit for eligibility for free care of 200.0% and FPG family income limit for eligibility for discounted care of 400.0%

Income level other than FPG (describe in Section C)

Asset level

Medical indigency

Insurance status

Underinsurance discount

Residency

Other (describe in Section C)

Explained the basis for calculating amounts charged to patients?.................

Yes

Explained the method for applying for financial assistance?...................

Yes

If “Yes,” indicate how the hospital facility’s FAP or FAP application form (including accompanying instructions) explained the method for applying for financial assistance (check all that apply):

Described the information the hospital facility may require an individual to provide as part of his or her application

Described the supporting documentation the hospital facility may require an individual to submit as part of his or
her application

Provided the contact information of hospital facility staff who can provide an individual with information about the
FAP and FAP application process

Provided the contact information of nonprofit organizations or government agencies that may be sources of
assistance with FAP applications

Other (describe in Section C)

Included measures to publicize the policy within the community served by the hospital facility?........

Yes

If "Yes," indicate how the hospital facility publicized the policy (check all that apply):

The FAP was widely available on a website (list url):

https://www.viachristi.org/patients-and-visitors/billing-and-finance/financial-assistance

The FAP application form was widely available on a website (list url):

https://www.viachristi.org/PATIENTS-AND-VISITORS/BILLING-AND-FINANCE/FINANCIAL-ASSISTANCE

A plain language summary of the FAP was widely available on a website (list url):
https://www.viachristi.org/patients-and-visitors/billing-and-finance/financial-assistance

The FAP was available upon request and without charge (in public locations in the hospital facility and by mail)

The FAP application form was available upon request and without charge (in public locations in the hospital facility
and by mail)

A plain language summary of the FAP was available upon request and without charge (in public locations in the
hospital facility and by mail)

Notice of availability of the FAP was conspicuously displayed throughout the hospital facility

Notified members of the community who are most likely to require financial assistance about availability of the FAP

Other (describe in Section C)

Billing and Collections

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 all of the actions the hospital facility or other authorized party may take upon non-payment?..................................

Yes

Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

None of these actions or other similar actions were permitted

Schedule H (Form 990) 2015

Page 6

Part VFacility Information (continued)

	WAMEGO HOSPITAL ASSOCIATION INC
Name of hospital facility or letter of facility reporting group

Yes

Did the hospital facility or other authorized party perform any of the following actions during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP?............

If "Yes," check all actions in which the hospital facility or a third party engaged:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

Indicate which efforts the hospital facility or other authorized party made before initiating any of the actions listed (whether or not checked) in line 19. (check all that apply):

Notified individuals of the financial assistance policy on admission

Notified individuals of the financial assistance policy prior to discharge

Notified individuals of the financial assistance policy in communications with the individuals regarding the individuals’ bills

Documented its determination of whether individuals were eligible for financial assistance under the hospital facility’s financial assistance policy

Other (describe in Section C)

None of these efforts were made

Policy Relating to Emergency Medical Care

Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that required 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?..................

Yes

If "No," indicate why:

The hospital facility did not provide care for any emergency medical conditions

The hospital facility’s policy was not in writing

The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Section C)

Other (describe in Section C)

Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)

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.

The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that
can be charged

The hospital facility used the average of its three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged

The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged

Other (describe in Section C)

During the tax year, did the hospital facility charge any FAP-eligible individual 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? ...............................

If "Yes," explain in Section C.

During the tax year, did the hospital facility charge any FAP-eligible individual an amount equal to the gross charge for any service provided to that individual? ...........................

If "Yes," explain in Section C.

Schedule H (Form 990) 2015

Page 7

Part V

Facility Information (continued)

Section C. Supplemental Information for Part V, Section B. Provide descriptions required for Part V, Section B, lines 2, 3j, 5, 6a, 6b, 7d, 11, 13b, 13h, 15e, 16i, 18d, 19d, 20e, 21c, 21d, 22d, 23, and 24. If applicable, provide separate descriptions for each hospital facility in a facility reporting group, designated by facility reporting group letter and hospital facility line number from Part V, Section A (“A, 1,” “A, 4,” “B, 2,” “B, 3,” etc.) and name of hospital facility.
Form and Line Reference	Explanation
Schedule H, Part V, Section B, Line 5 Facility , 1	Facility , 1 - Wamego Hospital Association, Inc.. The assessment was conducted by Wichita State University's Center for Community Support and Research (CCSR). The Riley County Seniors' Service Center provided leadership and coordination of this CHNA effort and it encompassed nearly 100 not-for-profit organizations or government agencies through survey research and/or focus group participation and feedback on initial CHNA draft. The organizations included area health care providers including health and mental health departments, unified school districts, government offices, low-income housing, senior living facilities, colleges, faith-based groups, homeless shelters and many others. Specific organizations participating included in addition to the two already name included: Caroline Peine Charitable Foundation (Manhattan Fund), Konza United Way, Via Christi Hospital - Manhattan (formerly called Mercy Regional Health Center), Riley County Council on Aging, Wamego Health Center, Riley County Health Department, 1350KMAN, Angel 95FM, Bethel AME Church, Big Brothers/Big Sisters of Riley County, Big Lakes Development Center, Boys & Girls Club of Manhattan, Catholic Charities of Northern Kansas, Center on Aging - KS State University, Child Development Center - KS State University, City of Leonardvile, City of Manhattan, City of Manhattan Parks & Recreation, City of Manhattan Social Services Advisory Board, City of Ogden, City of Randolph, City of Riley, Colorado Plaza Apartments, Community Health Ministries - Manhattan, Community Health Ministries - Wamego, Department of Sociology, Anthropology and Social Work - KS State University, Douglass Community Center, Downtown Manhattan, Inc., Family Connections of Riley County, First Presbyterian Church, First United Methodist Church, Flint Hills Area Transportation Agency, Flint Hills Breadbasket, Flint Hills Community Clinic, Flint Hills Human Rights Project, Flint Hills Volunteer Center (formerly RSVP of the Flint Hills, Inc.), Friendship Meals Program, Garden Grove Apartments, Greater Manhattan Community Foundation, Hands On Kansas State, Homecare & Hospice, Homestead Assisted Living, Housing & Credit Counseling Inc. - Manhattan, Kansas Legal Services, Konza Prairie Community Health Clinic, Konza United Way, KSNT News, League of Women Voters of Manhattan/Riley County, LGBT Resource Center - KS State University, Lion's Club, Manhattan Area Chamber of Commerce, Manhattan Area Habitat for Humanity, Manhattan Area Housing Partnership, Manhattan Area Technical College, Manhattan Arts Center, Manhattan Broadcasting, Manhattan Emergency Shelter, Inc., Manhattan Housing Authority, Manhattan Public Library, Manhattan/Riley County Preservation Alliance, Manhattan-Ogden USD 383 Head Start/Early Head Start, Meadowlark Hills Retirement Community, National Church Residences, North Central Flint Hills Area Agency on Aging, Ogden Friendship House, Pawnee Mental Health Services, Pilgrim Baptist Church, Pottawatomie County Health Department, Riley County, Riley County Community Corrections, Riley County Council on Aging, Riley County Extension, Riley County Health Department, Riley County Police Department, Saint Luke's Episcopal Church - Wamego, Salvation Army, School of Leadership Studies - KS State University, Seven Dolors Catholic Church, Shepherd's Crossing, South Manhattan Neighborhood Association, Stoneybrook Retirement Community, Sunflower CASA Project, Inc., Sunny 102.5, The Crisis Center, The KS State Collegian, The Manhattan Free Press, The Manhattan Mercury, Three Rivers, Inc., UFM Community Learning Center, USD 320 Wamego, USD 323 Rock Creek, USD 378 Riley, USD 383 Manhattan/Ogden, USD 383 Open Door, USD 384 Blue Valley, Via Christi Retirement Village, Wamego Chamber of Commerce, Wamego Smoke Signal, WIBW News and Wonder Workshop.
Schedule H, Part V, Section B, Line 6a Facility , 1	Facility , 1 - Wamego Hospital Association, Inc.. Wamego Hospital Association, Inc. conducted its CHNA with Via Christi Hospital in Manhattan. Via Christi Hospital in Manhattan is a healthcare leader in northeastern Kansas, with 150 physicians, 800 employees and 350 volunteers serving the people of Manhattan and the surrounding areas with a wide range of quality health and wellness services. Services offered in Manhattan include: Outpatient behavioral health, A full-service emergency room, Heart care and cardiac rehabilitation, Physical rehabilitation, Orthopedics, Pain management, Labor and delivery, Sleep medicine, Weight loss services (Via Christi LIGHT), and more.
Schedule H, Part V, Section B, Line 6b Facility , 1	Facility , 1 - Wamego Hospital Association, Inc.. Riley County Seniors' Service Center (RCSSC) The Riley County Seniors' Service Center provides services and activities for persons age 60 years of age and older living in Manhattan and Riley County. Services and activities provided include information and referral services. Cooperative efforts with service providers to address older adult needs, educational programs, volunteer service opportunities and recreational and social activities. KONZA UNITED WAY (KUW) SERVING CLAY, MARSHALL, POTTAWATOMIE, RILEY, WABAUNSEE AND WASHINGTON COUNTIES IN KANSAS, THE KUW FOCUSES ON THREE-SPECIFIC INITIATIVES: EDUCATION, HEALTH AND INCOME. THEIR PRIMARY GOAL IS TO ADVANCE EDUCATION, FINANCIAL STABILITY AND HEALTH FOR THOSE LIVING IN THEIR SIX COUNTY REGION WHO ARE FACING POVERTY. RILEY COUNTY COUNCIL ON AGING (RCCOA) THE PURPOSE OF RCCOA IS TO REPRESENT THE OLDER POPULATION IN RILEY COUNTY IN FUNDING REQUESTS, SUPPORTING PROPOSALS AND PROJECTS IMPORTANT TO AGING, DETERMINING AND COMMUNICATING THE NEEDS AND SERVICES FOR THE AGING WHILE ENCOURAGING AND FACILITATING ACTIVITIES THAT BENEFIT OLDER PERSONS BY COORDINATING WITH AGENCIES AND ORGANIZATIONS THAT WORK WITH OLDER PERSONS. RILEY COUNTY HEALTH DEPARTMENT (RCHD) THE RCHD HAS BEEN SERVING RILEY COUNTY FOR WELL OVER 50 YEARS. THEIR WORKFORCE INCLUDES NURSES, SOCIAL WORKERS, DIETITIANS, SUPPORT STAFF AND ADMINISTRATION. THE HEALTH DEPARTMENT OFFERS A WIDE VARIETY OF PROGRAMS AND SERVICES AND THEY VARY BY ELIGIBILITY BY COST. SOME SERVICES ARE AVAILABLE TO ANYONE WHILE SOME ARE RESTRICTED GEOGRAPHICALLY OR HAVE INCOME OR OTHER ELIGIBILITY REQUIREMENTS. SOME SERVICES ARE FREE, SOME HAVE SLIDING SCALES, SOME HAVE INSURANCE COVERAGE AND A FEW SPECIALTY SERVICES HAVE MANDATORY CHARGES. SERVICES PROVIDED INCLUDE BREAST CANCER AWARENESS, CHILD CARE LICENSING, CLINIC FORMS, COMMUNICABLE DISEASES, COMMUNITY CLINICS, COMMUNITY HEALTH PROMOTIONS AND WELLNESS, EMERGENCY PREPAREDNESS IMMUNIZATIONS AND INTERNATIONAL TRAVEL VACCINATIONS, MATERNAL AND CHILD HEALTH, RAISING RILEY, REPRODUCTIVE HEALTH SERVICE, RYAN WHITE PART B (HIV/AIDS PROGRAM), SCHOOL INSPECTIONS, SEXUALLY TRANSMITTED DISEASES (STDS), SHARPS DISPOSAL, TUBERCULOSIS (TB) CONTROL AND WOMEN INFANTS & CHILDREN (WIC) NUTRITION.
Schedule H, Part V, Section B, Line 11 Facility , 1	Facility , 1 - Wamego Hospital Association (WHA). Some of the ways WHA has contributed to Wamego and/or Pottawatomie County include: 1) Provide the support of Family Clinic physicians to Community Health Ministries' Clinic on a regular basis in seeing their patients who are not able to afford medical care but who are in need. 2) Donations of medical supplies to Community Health Ministries' Clinic when they have a need and may have limited resources to purchase their own supplies. 3) Provide free sport concussion screenings for Wamego High School athletes, many who would not be able to afford them or regularly access health care providers. Services provided that addresses the CHNA include: 1) Secondary data showed that Pottawatomie County residents are slightly less likely to consume enough fruits and vegetables than the state average; even though, the majority of survey respondents indicate that they eat healthy in general. Responses were mixed on the CHNA survey regarding whether the community has adequate access to healthy food. WHA gardeners worked together with the community to procure a grant to build their own community vegetable garden. Land was donated by the church, across from the hospital, and staff, as well as volunteers from the community, work together to grow produce and any extra produce realized is picked by WHA staff and others and donated to the local food pantry, WIC program participants, and nearby low-income housing communities. 2) Secondary data from the 2013 BRFSS showed that the percentage of Pottawatomie County residents who have experienced poor mental health is higher than the state average (12.0% for Pottawatomie, 9.7% for Kansas). The same is true for those who have experienced a depressive disorder (26.6% for County versus 18.1% for Kansas). The CHNA also found that 7.6% of respondents had been diagnosed with mental illness of some type, with depression being the most common diagnosis. The top need related to mental health were focused on affordability and access to quality services, including more providers of mental health services, affordable mental health services and insurance, high quality services and increased education and prevention regarding mental health. In order to address this need, WHA has made its licensed therapists available to work in partnership with the Community Health Ministries' Clinic through the Heritage Program. This program serves as a mental health clinic for senior adults in the City of Wamego and allows a person access to mental health care without driving to Manhattan or Topeka in order to gain access. 3) Concern was raised about the availability and affordability of child care, activities for children and youth and employment opportunities for teens. Because achieving educational goals is important to the overall economic and health status of every resident living in and around Wamego, WHA is a proud partner in the mentoring program with the school district. Every year, all students entering into the Wamego High School, are assigned a mentor who will stay with that student for their four years of high school. That adult volunteer helps the student to realize their goal of academic success, and many times steers their career aspirations, into areas the student never thought about prior to their mentoring encounter. 4) Although Pottawatomie County has a lower percentage of adults age 65 or older than is average for Kansas, concern was still voiced about their access to healthy food. WHA associates regularly assist in delivering Meals on Wheels to low income and/or home-bound elderly who are no longer able to afford or prepare healthy meals. Needs Not Being Addressed include: 1) Both secondary and survey data paint a fairly positive picture of Pottawatomie County regarding common social issues (e.g. crime, poverty, drop-out rates). Rates of poverty, youth substance abuse, and crime are lower than state averages, but secondary data show a possible issue with adult binge drinking. Survey responses note concerns about substance abuse for youth and adults, manufacturing and selling of drugs, inattentive driving and poverty. Given the resources the hospital currently has to address this need, becoming a primary player is limited except through community partnerships. WHA is willing to partner with other groups, including law enforcement, on combating these issues when adequate resources are available. 2) Education - secondary data shows that Pottawatomie County fares well regarding education except when comparing the number of Early Head Start slots and schools offering all-day/everyday Kindergarten to the state average. The primary needs as identified by respondents were recruiting and keeping good teachers, increased expectations for students and parental involvement, equality in funding among districts and more arts activities for students. Given the high ranking of the school, and the continued and growing partnership between the district and WHA, future programming was not seen to be a priority need at the present time. 3) Housing values are well above average for the state as a result over 60% of CHNA respondents agreed that there is a lack of affordable housing in the community. Housing costs are beyond the scope and financial resources of WHA. While, active in the Chamber, WHA keeps an eye on housing costs but there is relatively little WHA can do to influence the prices to become more affordable when the demand for housing continues to grow in the area. 4) Secondary data show Pottawatomie County to be relatively prosperous with higher than average median household income, median housing value and per capita sales; however, CHNA respondents indicated a lack of well-paying job opportunities. The primary needs identified by CHNA respondents are related to job availability, small business development, assistance to families for basic needs, and assistance with personal financial management. WHA reviews its own wages to ensure they are competitive for their own employees, participates on the Chamber to assist where possible on bringing in new businesses and volunteers with agencies which provide families with basic needs through Meals on Wheels, Wamego Community Garden and other projects. 5) Transportation was not identified by CHNA respondents as a major problem beyond desiring an increase of transportation options and routes (e.g. for bikes and pedestrians) and maintenance and improvements of road conditions. Transportation for medical appointments, when doctors are located outside of Wamego can be challenging for elderly drivers, So WHA works with its neighboring hospital (VCH-Manhattan) in providing access to specialists when needed.

Schedule H (Form 990) 2015

Page 8

Part VFacility Information (continued)

Section D. 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) 2015

Page 9

Part VI

Supplemental Information

Provide the following information.

1	Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II and Part III, lines 2, 3, 4, 8 and 9b.
2	Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any CHNAs 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.

Form and Line Reference	Explanation
Schedule H, Part VI, Line 7	Kansas does not require hospitals to file community benefit reports, but Via Christi Health, Inc., which includes the activity of Wamego Hospital Association, Inc., distributes their community benefit totals and activities annually in press releases as well as in our annual report.
Schedule H, Part III, Line 1 BAD DEBT IN ACCORDANCE WITH STATEMENT NO. 15	Wamego Hospital Association, Inc. (WHA) reports bad debt in accordance with generally accepted accounting principles (GAAP). Healthcare Financial Management Statement No. 15 is followed to the extent that it aligns with the guidelines set forth by GAAP.
Schedule H, Part I, Line 6a Community benefit report prepared by related organization	Via Christi Health
Schedule H, Part I, Line 7 Costing Methodology used to calculate financial assistance	The cost of providing charity care, means tested government programs, and community benefit programs is estimated using internal cost data, and is calculated in compliance with the Catholic Health Association (CHA) guidelines. The best available data was used to calculate the amounts reported in the table, a cost-to-charge ratio was calculated and applied.
Schedule H, Part II Community Building Activities	One of Wamego Health Center's employees serves on the board of directors for the Wamego Community Foundation which helps to fund various projects in the Wamego community including health profession scholarships. Through these scholarships, high school graduates from around the area are given an opportunity to pursue health care careers and upon graduation from these programs encouraged to stay in the area to promote better health for their neighbors. In addition, high school students are mentored by Wamego Health Center employees and allowed to visit the health facility and shadow health professionals on-the-job to assist them in their discernment on establishing a health care career post high school graduation. Wamego Health Center employees are also very concerned about the environment and how waste in parks, highways and sidewalks put unsuspecting visitors, residents and children at risk. Our health center staff regularly participate in an area cleanup by removing unsafe debris/waste on Highway 24 thus reducing dangers caused by hazardous materials, unsafe fluids and unsanitary conditions for all.
Schedule H, Part III, Line 2 Bad debt expense - methodology used to estimate amount	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.
Schedule H, Part III, Line 3 Bad Debt Expense Methodology	Wamego Hospital Association, Inc. has a very robust financial assistance program; therefore, no estimate is made for bad debt attributed to financial assistance eligible patients.
Schedule H, Part III, Line 4 Bad debt expense - financial statement footnote	From the audited financial statements of Ascension Health Alliance (which include the activity of Wamego Hospital Association, Inc.): The provision for doubtful accounts is based upon management's assessment of expected net collections considering historical experience, economic conditions, trends in healthcare coverage, and other collection indicators. Periodically throughout the year, management assesses the adequacy of the allowance for doubtful accounts based upon historical write-off experience by payor category, including those amounts not covered by insurance. The results of this review are then used to make any modifications to the provision for doubtful accounts to establish an appropriate allowance for doubtful accounts. After satisfaction of amounts due from insurance and reasonable efforts to collect from the patient have been exhausted, the System follows established guidelines for placing certain past-due patient balances with collection agencies, subject to the terms of certain restrictions on collection efforts as determined by the System. Accounts receivable are written off after collection efforts have been followed in accordance with the System's policies. The methodology for determining the allowance for doubtful accounts and related write-offs on uninsured patient accounts has remained consistent with the prior year. WHA's bad debt deduction was $775,404 at charges and $381,434 at cost (after the cost to charge ratio was applied to the amount of charges).
Schedule H, Part III, Line 8 Community benefit & methodology for determining medicare costs	Ascension Health and related health ministries follow the Catholic Health Association (CHA) guidelines for determining community benefit. CHA community benefit reporting guidelines suggest that Medicare shortfall is not treated as community benefit.
Schedule H, Part III, Line 9b Collection practices for patients eligible for financial assistance	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 the patient/guarantor 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 programs (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.
Schedule H, Part V, Section B, Line 16a FAP website	- WAMEGO HOSPITAL ASSOCIATION, INC.: Line 16a URL: https://www.viachristi.org/patients-and-visitors/billing-and-finance/financial-assistance;
Schedule H, Part V, Section B, Line 16b FAP Application website	- WAMEGO HOSPITAL ASSOCIATION, INC.: Line 16b URL: https://www.viachristi.org/PATIENTS-AND-VISITORS/BILLING-AND-FINANCE/FINANCIAL-ASSISTANCE;
Schedule H, Part V, Section B, Line 16c FAP plain language summary website	- WAMEGO HOSPITAL ASSOCIATION, INC.: Line 16c URL: https://www.viachristi.org/patients-and-visitors/billing-and-finance/financial-assistance;
Schedule H, Part VI, Line 2 Needs assessment	In addition to partnering with many organizations to conduct the CHNA, staff and Board members of the Wamego Hospital Association, Inc's (WHA) serve on community not-for-profit, service and faith-based boards and/or committees and are kept apprised of needs being presented. In addition, regular participation in community coalition meetings and Rotary where issues are raised are also a way that WHA stays engaged with community issues. Involvement with the schools to teach coaching staff and students the best way to prevent or recognize symptoms of injury also helps to build networks where problems can be shared and followed-up on. Keeping up with secondary data analysis conducted in behalf of Pottawatomie also helps to paint a picture on demographics so that changes can be monitored and addresses which may impact community needs.
Schedule H, Part VI, Line 3 Patient education of eligibility for assistance	Wamego Hospital Association, Inc.'s (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.
Schedule H, Part VI, Line 4 Community information	The primary Kansas County for Wamego Hospital Association, Inc. (WHA) is Pottawatomie. Pottawatomie County has a land area of 841 square miles with a 2015 estimated population of 23,298. The demographic breakout for Pottawatomie County includes: 94.0% white, 1.5% Black, 0.9% American Indian, 1.0% Asian persons, and 5.4% persons of Hispanic or Latino origin. Approximately 5.0% of Pottawatomie County residents report that a language other than English is spoken at home. When it comes to education, 95.7% completed high school and 32.2% of the adults 25 years of age or older had a bachelor's degree or higher. Median household income for Pottawatomie County residents between 2011 and 2015 was $60,216. During this same time period, the median value of owner-occupied housing units was $160,700 in Pottawatomie. Pottawatomie County reports 8.1% of its residents are below poverty level compared to the Statewide poverty level of 13.0%. Pottawatomie County has fewer residents age 65 years and older compared to the State of Kansas. Kansas reported in 2015 that 14.6% of all residents were persons 65 years of age and older. This compares to 13.4% for Pottawatomie. WHA is the only hospital in the City of Wamego and services are available to all persons regardless of their ability to pay.
Schedule H, Part VI, Line 5 Promotion of community health	Wamego Hospital Association, Inc. (WHA) enriches the area in which they operate, as well as the broader community, by increasing access to health care by providing care and support to people in need. WHA further supports this mission with a community board, open medical staff, and an emergency room available to patients regardless of ability to pay. Open Medical Staff - The medical staff of WHA is open and is composed of physicians licensed to practice medicine in the State of Kansas. WHA staff also participate in the community on boards/committees of other not-for-profit organizations. During FY2015, WHA staff served on the following area not-for-profit organizations: Wamego Housing Authority Board, Three Rivers Board, Konza United Way Board and Kansas Hospital Associations committees. In addition, WHA staff participated in projects sponsored by the Kansas Department of Transportation Highway Clean-Up Project, Wamego Community Garden, American Red Cross Blood Drive, Wamego High School Senior Interview Day, Wamego Flu Shot Clinic, etc. Community representation of the Governing body - The Board of Directors is the governing body of WHA. The majority of its members are external members comprised of persons who reside in or around Pottawatomie County and has responsibility for the charitable mission of the organization as set forth in its Articles of Incorporation and Bylaws. These directors are selected based on their expertise, experience, and other criteria established by the nominating committee of the Board of Directors. Areas of expertise and experience include areas such 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. Annually, WHA provides diagnostic and lab services for Community Health Ministries Clinic. WHA staff participate in periodic Red Cross blood drives due to our mission of caring for those who are vulnerable and in need of life-saving blood. WHA staff have assisted in fundraising activities for other not-for-profits in the community (e.g. Community Garden and Konza United Way). WHA's conference room is shared with the outside community not-for-profits so they can use more of their resources in carrying out their missions. WHA's clinicians regularly spend time at the Community Health Ministries Clinic to assist with patients who have multiple chronic diseases and who are in need of advanced medical management. WHA's counselor provides mental health services for patients accessing medical care at the Community Health Ministries Clinic on an as needed basis. WHA's staff is actively involved in delivering Meals on Wheels to homebound elderly residents living in the Pottawatomie County area. In partnership with the Wamego School District, WHA gave free concussion screenings to student athletes as well as held sports clinics for those injured. In partnership with Wamego High School, WHA staff participate in the student mentoring project, where students are matched as freshmen and the program concludes once the student graduates. WHA sponsors diabetes support groups for patients as well as their caregivers. WHA provided a series of educational presentations (e.g. mental health and clergy and presentations to seniors at the Center). In addition, when needed, clinical staff has assisted the Coroner's Office.
Schedule H, Part VI, Line 6 Affiliated health care system	WHA is an affiliate of Via Christi Health, Inc. (VCH). VCH's affiliates are multi-faceted, integrated, not-for-profit ministries including hospital and non-hospital ministries (Physician Group Practices, Hospital organizations, Research, Home Health, and Durable Medical Equipment). 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, state and national level. Ascension Health Alliance, d/b/a Ascension (Ascension), is a Missouri nonprofit corporation formed on September 13, 2011. Ascension is the sole corporate member and parent organization of Ascension Health, a Catholic national health system consisting primarily of nonprofit corporations that own and operate local healthcare facilities, or Health Ministries, located in 23 of the United States and the District of Columbia. Ascension is sponsored by Ascension Sponsor, a Public Juridic Person. The Participating Entities of Ascension Sponsor are the Daughters of Charity of St. Vincent de Paul, St. Louise Province; the Congregation of St. Joseph; the Congregation of the Sisters of St. Joseph of Carondelet; the Congregation of Alexian Brothers of the Immaculate Conception Province, Inc. - American Province; and the Sisters of the Sorrowful Mother of the Third Order of St. Francis of Assisi - US/Caribbean Province. Mission: The System directs its governance and management activities toward strong, vibrant Catholic Health Ministries united in service and healing, and dedicates its resources to spiritually centered care which sustains and improves the health of the individuals and communities it serves. In accordance with the System's mission of service to those persons living in poverty and other vulnerable persons, each Health Ministry accepts patients regardless of their ability to pay. The System uses four categories to identify the resources utilized for the care of persons living in poverty and community benefit programs: - Traditional charity care includes the cost of services provided to persons who cannot afford healthcare because of inadequate resources and/or who are uninsured or underinsured. - Unpaid cost of public programs, excluding Medicare, represents the unpaid cost of services provided to persons covered by public programs for persons living in poverty and other vulnerable persons. - Cost of other programs for persons living in poverty and other vulnerable persons includes unreimbursed costs of programs intentionally designed to serve the persons living in poverty and other vulnerable persons of the community, including substance abusers, the homeless, victims of child abuse, and persons with acquired immune deficiency syndrome. - Community benefit consists of the unreimbursed costs of community benefit programs and services for the general community, not solely for the persons living in poverty, including health promotion and education, health clinics and screenings, and medical research. Discounts are provided to all uninsured patients, including those with the means to pay. Discounts provided to those patients who did not qualify for assistance under charity care guidelines are not included in the cost of providing care of persons living in poverty and other community benefit programs. The cost of providing care to persons living in poverty and other community benefit programs is estimated by reducing charges forgone by a factor derived from the ratio of each entity's total operating expenses to the entity's billed charges for patient care. Certain costs such as graduate medical education and certain other activities are excluded from total operating expenses for purposes of this computation.

Schedule H (Form 990) 2015

Additional Data

Software ID:	15000238
Software Version:	2015v3.0

- TIN:

Schedule I
(Form 990)

Department of the Treasury
Internal Revenue Service

Grants and Other Assistance to Organizations,
Governments and Individuals in the United States

Complete if the organization answered "Yes," on Form 990, Part IV, line 21 or 22.
lBullet

Attach to Form 990.
lBullet

Information about Schedule I (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public
Inspection

Name of the organization
Wamego Hospital Association Inc

Employer identification number
72-1526400

Part I

General Information on Grants and Assistance

Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ........................

Yes No

Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.

Part II

Grants and Other Assistance to Domestic Organizations and Domestic Governments. Complete if the organization answered "Yes" on Form 990, Part IV, line 21, for any recipient

that received more than $5,000. Part II can be duplicated if additional space is needed.

(a) Name and address of organization or government	(b) EIN	(c) IRC section if applicable	(d) Amount of cash grant	(e) Amount of non-cash assistance	(f) Method of valuation (book, FMV, appraisal, other)	(g) Description of non-cash assistance	(h) Purpose of grant or assistance

(1) Pottawatomie County Economic Development
1004 Lincoln
P O Box 288
Wamego,KS66547

48-1059912

501(C)(3)

10,000

Advance Pottawatomie County

Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Bullet Image

Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image

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

Cat. No. 50055P

Schedule I (Form 990) 2015

Page 2

Part III

Grants and Other Assistance to Domestic Individuals. Complete if the organization answered "Yes" on Form 990, Part IV, line 22.
Part III can be duplicated if additional space is needed.

(a) Type of grant or assistance	(b) Number of recipients	(c) Amount of cash grant	(d) Amount of non-cash assistance	(e) Method of valuation (book, FMV, appraisal, other)	(f) Description of non-cash assistance

(1)
(2)
(3)
(4)
(5)
(6)
(7)

Part IV

Supplemental Information. Provide the information required in Part I, line 2, Part III, column (b), and any other additional information.

Return Reference	Explanation
Schedule I, Part I, Line 2 Procedures for monitoring use of grant funds.	ORGANIZATIONS REQUESTING DONATIONS ARE ASKED TO SUBMIT A REQUEST IN WRITING WHICH IDENTIFIES THE NEED THE DONATION WILL BE ADDRESSING, ALONG WITH GOALS AND OBJECTIVES. REQUESTS ARE REVIEWED BY ADMINISTRATION AT A WEEKLY MEETING.

Schedule I (Form 990) 2015

Additional Data

Software ID:	15000238
Software Version:	2015v3.0

- 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" on Form 990, Part IV, line 23.
SchJMediumBullet

Attach to Form 990.
SchJMediumBullet

Information about Schedule J (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

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 on 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 of 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
directors, trustees, officers, including the CEO/Executive Director, regarding the items checked in line 1a? ..

Indicate which, if any, of the following the filing organization used 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 on 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), 501(c)(4), and 501(c)(29) organizations must complete lines 5-9.

For persons listed on 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," on line 5a or 5b, describe in Part III.

For persons listed on 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," on line 6a or 6b, describe in Part III.

For persons listed on 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 on 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" on line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................

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

Cat. No. 50053T

Schedule J (Form 990) 2015

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 on 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 (E) amounts for that individual.

(A) Name and Title		(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 in column(B) reported as deferred on prior Form 990
(A) Name and Title		(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)
1JOHN R BROBERG SECRETARY	(i) (ii)	0 ------------- 288,916	0 ------------- 36,151	0 ------------- 4,348	0 ------------- 51,381	0 ------------- 10,900	0 ------------- 391,696	0 ------------- 0
2CASEY POELL MD TRUSTEE	(i) (ii)	0 ------------- 319,156	0 ------------- 50,702	0 ------------- 421	0 ------------- 22,525	0 ------------- 14,276	0 ------------- 407,080	0 ------------- 0
3DAVID A GAMBINO TRUSTEE	(i) (ii)	0 ------------- 444,439	0 ------------- 92,278	0 ------------- 8,029	0 ------------- 49,950	0 ------------- 24,437	0 ------------- 619,133	0 ------------- 0
4JEFF SEIRER ASSISTANT TREASURER (END 9/14)	(i) (ii)	0 ------------- 269,148	0 ------------- 49,628	0 ------------- 2,716	0 ------------- 50,408	0 ------------- 20,767	0 ------------- 392,667	0 ------------- 0
5SHANNAN FLACH ADMINISTRATOR	(i) (ii)	0 ------------- 115,581	0 ------------- 12,060	0 ------------- 409	0 ------------- 15,186	0 ------------- 19,758	0 ------------- 162,994	0 ------------- 0
6JAMES FRASER ADMINISTRATOR FINANCE	(i) (ii)	0 ------------- 163,080	0 ------------- 16,429	0 ------------- 2,378	0 ------------- 4,165	0 ------------- 14,022	0 ------------- 200,074	0 ------------- 0
7ROBERTA JOHNSON ASSISTANT SECRETARY	(i) (ii)	0 ------------- 244,281	0 ------------- 33,055	0 ------------- 7,315	0 ------------- 58,855	0 ------------- 7,834	0 ------------- 351,340	0 ------------- 0
8CAROL KARP ASSISTANT TREASURER (START 10/14)/CFO	(i) (ii)	0 ------------- 352,689	0 ------------- 61,150	0 ------------- 3,794	0 ------------- 31,950	0 ------------- 21,010	0 ------------- 470,593	0 ------------- 0
9CURTIS WOLFE CHIEF OF STAFF	(i) (ii)	0 ------------- 201,548	0 ------------- 0	0 ------------- 630	0 ------------- 15,486	0 ------------- 20,048	0 ------------- 237,712	0 ------------- 0
10ROLAND M DAREY JR MD PHYSICIAN	(i) (ii)	0 ------------- 264,558	0 ------------- 0	0 ------------- 1,027	0 ------------- 17,225	0 ------------- 21,443	0 ------------- 304,253	0 ------------- 0
11DANE DITTO MD PHYSICIAN	(i) (ii)	0 ------------- 244,623	0 ------------- 12,611	0 ------------- 1,107	0 ------------- 8,910	0 ------------- 19,271	0 ------------- 286,522	0 ------------- 0
12TIMOTHY MINGES MD PHYSICIAN	(i) (ii)	0 ------------- 215,493	0 ------------- 160	0 ------------- 2,891	0 ------------- 15,820	0 ------------- 14,722	0 ------------- 249,086	0 ------------- 0

Schedule J (Form 990) 2015

Page 3

Part III

Supplemental Information

Provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4a, 4b, 4c, 5a, 5b, 6a, 6b, 7, and 8, and for Part II. Also complete this part for any additional information.

Return Reference

Explanation

Schedule J, Part I, Line 3

The organization does not compensate the top management official for their role as President of the organization. However, if a President was employed, this person's salary would be set using the following policies established by Via Christi Health, Inc., a related organization: - Compensation Committee - Independent Compensation Consultant - Compensation Survey or Study - Approval by the Board or Compensation Committee

Schedule J, Part I, Line 4b Supplemental nonqualified retirement plan

Eligible executives participate in a program that provides for supplemental retirement benefits. The payment of benefits under the program, if any, is entirely dependent upon the facts and circumstances under which the executive terminates employment with the organization. Benefits under the program are funded annually based on participation and are not vested until the 5 year service requirement is reached. Due to the substantial risk of forfeiture provision, there is no guarantee that these executives will ever receive any benefit under the program. The amount funded annually under the program to the executives is reported as compensation on Form 990 Schedule J, Part II, Column B in the year funded. The amount ultimately paid under the program to executives is reported on Form 990 Schedule J, Part II, Column F. There were no distributions from a supplemental nonqualified retirement plan during the year. Keysop plan-frozen: Eligible executives participated in a frozen supplemental option benefit program that provides for supplemental retirement benefits that was limited to Via Christi Hospital St. Francis, Preferred Medical Associates Physicians, Mount Carmel Regional Medical Center and Via Christi Health system executives. The payment of benefits under the program, if any, was linked to the exercise date for the options or to earned dividends on the options. Executives were vested in full when the options were granted. The amount ultimately paid under the program to executives receiving net option value is reported on Form 990 Schedule J, Part II, Column F. The following individual received a distribution from the Keysop plan in the amount listed below: Roberta Johnson - 16271

Schedule J (Form 990) 2015

Additional Data

Software ID:	15000238
Software Version:	2015v3.0

- 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 990-EZ or to provide any additional information.
MediumBullet

Attach to Form 990 or 990-EZ.
MediumBullet

Information about Schedule O (Form 990 or 990-EZ) and its instructions is at
www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public
Inspection

Name of the organization

Wamego Hospital Association Inc

Employer identification number

72-1526400

Return Reference	Explanation
Form 990, Part VI, Line 6 Classes of members or stockholders	Wamego Hospital Association, Inc. has two corporate members, Via Christi Hospital Manhattan, Inc. and City of Wamego.
Form 990, Part VI, Line 7a Members or stockholders electing members of governing body	Wamego Hospital Association, Inc. has two corporate members, Via Christi Hospital Manhattan, Inc. and City of Wamego, who have the ability to elect members to the governing body of Wamego Hospital Association, Inc.
Form 990, Part VI, Line 7b Decisions requiring approval by members or stockholders	All decisions that have a material impact to Wamego Hospital Association, Inc. financial information or corporation as a whole are subject to approval by its two corporate members, Via Christi Hospital Manhattan, Inc. and Wamego City Hospital.
Form 990, Part VI, Line 11b Review of form 990 by governing body	The finance committee reviews Wamego Hospital Association, Inc.'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.
Form 990, Part VI, Line 12c Conflict of interest policy	The conflict of interest policy is monitored/enforced as part of the system-wide procedures and is not handled at the organizational 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; and 4 - Periodic reviews are conducted by governance, compliance, and internal audit to ensure the organization is operating consistent with the policy and enforcing the policy's terms.
Form 990, Part VI, Line 19 Required documents available to the public	Wamego Hospital Association, Inc.'s governing documents and conflict of interest policy are available to the public upon request.
Form 990, Part IX, Line 11g Other Fees	CONTRACT LABOR - Total Expense: 284672, Program Service Expense: 281454, Management and General Expenses: 3218, Fundraising Expenses: ; PURCHASED SERVICES - Total Expense: 834372, Program Service Expense: 766670, Management and General Expenses: 67702, Fundraising Expenses: ; PROFESSIONAL FEES - Total Expense: 572624, Program Service Expense: 432868, Management and General Expenses: 139756, Fundraising Expenses: ; - Total Expense: , Program Service Expense: , Management and General Expenses: , Fundraising Expenses: ; - Total Expense: , Program Service Expense: , Management and General Expenses: , Fundraising Expenses: ; - Total Expense: , Program Service Expense: , Management and General Expenses: , Fundraising Expenses: ; - Total Expense: , Program Service Expense: , Management and General Expenses: , Fundraising Expenses: ; - Total Expense: , Program Service Expense: , Management and General Expenses: , Fundraising Expenses: ; - Total Expense: , Program Service Expense: , Management and General Expenses: , Fundraising Expenses: ; - Total Expense: , Program Service Expense: , Management and General Expenses: , Fundraising Expenses: ;
Form 990, Part XII, Line 2c oversight of audit or selection of independent accountant	The activity of Wamego Hospital Association, Inc. is reported in the consolidated financial statements of Ascension Health Alliance. No individual audit of Wamego Hospital Association, Inc. is completed. Ascension Health Alliance's audit committee assumes responsibility for oversight of the audit of the financial statements. The audited financial statements are of Ascension Health Alliance and Affiliates, which include the activity of Wamego Hospital Association, Inc.
Form 990, Part IV, Line 20B Explanation of Financial Statements	The activity of Wamego Hospital Association, Inc. ("Wamego") is reported in the consolidated financial statements of Ascension Health Alliance. No individual audit of Wamego is completed. Therefore, the attached audited financial statements are of Ascension Health Alliance and Affiliates, which include the activity of Wamego.
Form 990, Part VI, Line 15 Process for Determining Compensation	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; and - 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 consultation on all executive compensation issues. The Committee also relies on third-party validation of performance measures used in the determination of compensation.

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

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2015

Additional Data

Software ID:	15000238
Software Version:	2015v3.0

- TIN:

SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service

Related Organizations and Unrelated Partnerships

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

Attach to Form 990.
MediumBullet

Information about Schedule R (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

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 (if applicable) 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 entity?
(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 ALLIANCE PO BOX 45998 ST LOUIS,MO63145 45-3358926	NATIONAL HEALTH SYSTEM	MO	501(c)(3	Type I	NA		No
(2)ASCENSION HEALTH PO BOX 45998 ST LOUIS,MO63145 31-1662309	NATIONAL HEALTH SYSTEM	MO	501(c)(3	Type I	ASCENSION HEALTH ALLIANCE		No
(3)VIA CHRISTI HEALTH INC 8200 E THORN DRIVE SUITE 300 WICHITA,KS67226 48-1172107	HEALTH SYSTEM PARENT	KS	501(c)(3	Type III-FI	ASCENSION HEALTH ALLIANCE		No
(4)VIA CHRISTI HOSPITAL PITTSBURG INC 1 MT CARMEL WAY PITTSBURG,KS66762 48-0543778	HOSPITAL	KS	501(c)(3	3	VIA CHRISTI HEALTH INC		No
(5)VIA CHRISTI HOSPITAL WICHITA ST TERESA INC 14800 W ST TERESA WICHITA,KS67235 27-1965272	HOSPITAL	KS	501(c)(3	3	VIA CHRISTI HEALTH INC		No
(6)VIA CHRISTI HOSPITALS WICHITA INC 929 N SAINT FRANCIS WICHITA,KS67214 48-1172106	HOSPITAL	KS	501(c)(3	3	VIA CHRISTI HEALTH INC		No
(7)GERARD HOUSE INC 3144 N HOOD WICHITA,KS67204 48-1049532	HOSPITAL SUPPORT	KS	501(c)(3	9	VIA CHRISTI HOSPITALS WICHITA INC		No
(8)VIA CHRISTI REHABILITATION HOSPITAL INC 1151 N ROCK ROAD WICHITA,KS67206 48-1158274	REHABILITATION HOSPITAL	KS	501(c)(3	3	VIA CHRISTI HOSPITALS WICHITA INC		No
(9)VIA CHRISTI PROPERTY SERVICES INC 8200 E THORN DRIVE SUITE 300 WICHITA,KS67226 48-0948571	PROPERTY MANAGEMENT	KS	501(c)(4		VIA CHRISTI HOSPITALS WICHITA INC		No
(10)VIA CHRISTI HEALTH PARTNERS INC 8200 E THORN DRIVE SUITE 300 WICHITA,KS67226 48-0958974	MANAGEMENT COMPANY	KS	501(c)(3	9	VIA CHRISTI HEALTH INC		No
(11)Via Christi Hospital Manhattan Inc 1823 COLLEGE AVENUE MANHATTAN,KS66502 48-1186704	HOSPITAL	KS	501(c)(3	3	VIA CHRISTI HEALTH INC		No
(12)SALINA REGIONAL HOME MEDICAL SERVICES LLC 520 SOUTH SANTA FE AVE SALINA,KS67401 43-1948057	MEDICAL EQUIPMENT	KS	501(c)(3	9	SALINA REGIONAL HEALTH CENTER INC		No

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

Cat. No. 50135Y

Schedule R (Form 990) 2015

Page 2

Part III

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

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Predominant income(related, unrelated, excluded from tax under sections 512-514)	(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?		(k) Percentage ownership
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity		(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No
(1) AMBULATORY SURGERY CENTER LP 818 N Emporia Ste 108 WICHITA,KS67214 48-1114690	SURGERY CENTER	KS	NA	N/A								0 %
(2) KANSAS SURGERY AND RECOVERY CENTER LLC 2770 North Webb Road WICHITA,KS67226 48-1148580	SURGERY CENTER	KS	NA	N/A								0 %
(3) VIA CHRISTI IMAGING LLC (fka MERCY IMAGING LLC) 1823 College Avenue MANHATTAN,KS66502 48-1251984	RADIOLOGY SERVICES	KS	NA	N/A								0 %

Part IV

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

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	(i) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	Yes	No
(1) VIA CHRISTI CLINIC SERVICES INC 8200 E THORN DRIVE SUITE 300 WICHITA,KS67226 27-3984287	CLINIC SERVICES	KS	NA	C Corporation				No
(2) AFFILIATED MEDICAL SERVICES LABORATORY INC 2916 E CENTRAL WICHITA,KS67214 48-1239522	MEDICAL LABORATORY	KS	NA	C Corporation				No
(3) INTEGRATED HEALTHCARE SYSTEMS INC 3311 EAST MURDOCK WICHITA,KS67208 48-0941549	CLINIC SERVICES	KS	NA	C Corporation				No
(4) VCH IOWA PC TRUST 8200 E THORN DRIVE SUITE 300 WICHITA,KS67226 27-6937322	BENEFICIARY TRUST	IA	NA	Trust				No
(5) VCH IOWA PC 8200 E THORN DRIVE SUITE 300 WICHITA,KS67226 27-3983977	PROFESSIONAL ASSOCIATION	IA	NA	C Corporation				No
(6) VIA CHRISTI CLINIC PA 3311 EAST MURDOCK WICHITA,KS67208 48-0993446	PROFESSIONAL ASSOCIATION	KS	NA	C Corporation				No
(7) VIA CHRISTI HEALTH ALLIANCE IN ACCOUNTABLE CARE INC 8200 E Thorn Drive Suite 300 Wichita,KS67226 46-2872857	ACO	KS	NA	C Corporation				No

Schedule R (Form 990) 2015

Page 3

Part V

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

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

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, or (iv) rent from a controlled entity .....................

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

Yes

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

Yes

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

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

f Dividends from related organization(s) ............................

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

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

Yes

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

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

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

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

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

Yes

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

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

Yes

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

Yes

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

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

Yes

s 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 related organization	(b) Transaction type (a-s)	(c) Amount involved	(d) Method of determining amount involved

Schedule R (Form 990) 2015

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 V-UBI 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 V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No

Schedule R (Form 990) 2015

Page 5

Part VII

Supplemental Information

Provide additional information for responses to questions on Schedule R (see instructions).

Return Reference	Explanation

Schedule R (Form 990) 2015

Additional Data

Software ID:	15000238
Software Version:	2015v3.0

1	Briefly describe the organization’s mission or most significant activities: Serves 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	8
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	5
5	Total number of individuals employed in calendar year 2015 (Part V, line 2a) ......	5	0
6	Total number of volunteers (estimate if necessary) .............	6	3
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	0

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	75,000	8,580
9	Program service revenue (Part VIII, line 2g) .........	12,047,485	11,579,131
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	107,476	45,268
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	31,593	28,560
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	12,261,554	11,661,539
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...		12,612
14	Benefits paid to or for members (Part IX, column (A), line 4).....		0
15	Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10)		0
16a	Professional fundraising fees (Part IX, column (A), line 11e) .....		0
b	Total fundraising expenses (Part IX, column (D), line 25) 0
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	11,176,852	11,372,937
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	11,176,852	11,385,549
19	Revenue less expenses. Subtract line 18 from line 12.......	1,084,702	275,990
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	9,816,480	11,002,681
21	Total liabilities (Part X, line 26).............	2,027,346	3,055,614
22	Net assets or fund balances. Subtract line 21 from line 20.....	7,789,134	7,947,067

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 8,425,991 including grants of $ 12,612 ) (Revenue $ 11,581,253 )
	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, OTOLARYNGOLOGY, OPHTHAMOLOGY, UROLOGY, AND DIABETES. AS A FULL SERVICE HOSPITAL CENTRALLY LOCATED TO SUPPORT POTTAWATOMIE, WABAUNSEE AND SURROUNDING COUNTIES, WAMEGO HOSPITAL ASSOCIATION, INC. (WHA) OFFERS A COMBINATION OF TECHNOLOGY AND CARING TO PROVIDE ALL THE SPECIALTIES AND SERVICES NEEDED TO SUPPORT THE COMMUNITY'S HEALTH CARE NEEDS, FROM OUTPATIENT THERAPIES AND PREVENTATIVE CARE TO LONG-TERM INPATIENT CARE AND EMERGENCY SERVICES. AS A PART OF VIA CHRISTI HEALTH, INC., A CATHOLIC HEALTH SYSTEM, WE SHARE THIS MISSION: "INSPIRED BY THE GOSPEL AND OUR CATHOLIC TRADITION, WE SERVE AS A HEALING PRESENCE WITH SPECIAL CONCERN FOR OUR NEIGHBORS WHO ARE VULNERABLE". VIA CHRISTI HEALTH SYSTEM'S HISTORY EXTENDS BACK OVER 100 YEARS AND TODAY, ALONG WITH OUR SPONSORING ORGANIZATION, ASCENSION HEALTH, WE CONTINUE TO RESPOND TO COMMUNITY NEEDS IN KANSAS AND NORTHEASTERN OKLAHOMA.

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 expenses8,425,991

(A) Name and Title	(B) Average hours per week (list any hours for related organizations below dotted line)			(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
(18) TIMOTHY MINGES MD PHYSICIAN	50.0 .......................0.0	X		0	218,544	30,542
(19) JEFF SEIRER ASSISTANT TREASURER (END 9/14)	0.0 .......................49.0		X	0	321,492	71,175

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	0	3,640,992	576,623

1a	Federated campaigns..		1a
b	Membership dues..		1b
c	Fundraising events..		1c
d	Related organizations		1d
e	Government grants (contributions)		1e	8,580

f	All other contributions, gifts, grants, and similar amounts not included above		1f

g	Noncash contributions included in lines 1a-1f:$
h Total.Add lines 1a-1f.......		8,580

			Business Code
2a	NET PATIENT SERVICE REVENUE	621990	11,523,282	11,523,282
b	MEANINGFUL USE REVENUE	621990	55,849	55,849
c
d
e
f	All other program service revenue.			0	0	0	0
g Total.Add lines 2a–2f.....			11,579,131

3 Investment income (including dividends, interest, and othersimilar amounts) ..........			45,268			45,268
4 Income from investment of tax-exempt bond proceeds
5 Royalties...........
		(ii) Personal	(i) Real
6a	Gross rents		6,113
b	Less: rental expenses
c	Rental income or (loss)	0	6,113
d	Net rental income or (loss)......			6,113			6,113
		(ii) Other	(i) Securities
7a	Gross amount from sales of assets other than inventory
b	Less: cost or other basis and sales expenses
c	Gain or (loss)	0	0
d	Net gain or (loss).....
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..
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..
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..
Business Code			Miscellaneous Revenue
11a	EMPLOYEE MEALS & VENDING INCOME		722514	20,055			20,055
b	MEDICAL RECORD FEES INCOME		621990	2,122	2,122
c	Unclaimed Property		900099	270			270
d	All other revenue ....			0	0	0	0
e	Total. Add lines 11a–11d ......			22,447
12	Total revenue. See Instructions......			11,661,539	11,581,253	0	71,706

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21	12,612	12,612
2	Grants and other assistance to individuals in the United States. See Part IV, line 22
3	Grants and other assistance to governments, organizations, and individuals outside the United States. See Part IV, lines 15 and 16
4	Benefits paid to or for members
5	Compensation of current officers, directors, trustees, and key employees ....
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) ....
7	Other salaries and wages
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....
9	Other employee benefits .......
10	Payroll taxes ...........
11	Fees for services (non-employees):
a	Management ......
b	Legal .........
c	Accounting ...........
d	Lobbying ...........
e	Professional fundraising services. See Part IV, line 17
f	Investment management fees ......
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O)	1,691,668	1,480,992	210,676	0
12	Advertising and promotion ....	22,139	401	21,738
13	Office expenses .......	961,115	854,158	106,957
14	Information technology ......	33,978	19,285	14,693
15	Royalties ..
16	Occupancy ...........	227,129	226,311	818
17	Travel ............	28,467	22,271	6,196
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .
19	Conferences, conventions, and meetings ....	26,643	7,794	18,849
20	Interest ...........
21	Payments to affiliates .......
22	Depreciation, depletion, and amortization ..	248,040	256,784	-8,744
23	Insurance ...	89,888	24,015	65,873
24	Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a	Purchased Services- Affiliate	6,511,244	5,130,403	1,380,841
b	MANAGEMENT FEES	1,028,479		1,028,479
c	payroll taxes	379,082	325,799	53,283
d	i/c lab services	53,330	53,330
e	All other expenses	71,735	11,836	59,899	0
25	Total functional expenses. Add lines 1 through 24e	11,385,549	8,425,991	2,959,558	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).

1	Cash–non-interest-bearing ........			2,651,121	1	1,613,537
2	Savings and temporary cash investments .........			871,046	2	0
3	Pledges and grants receivable, net ......				3
4	Accounts receivable, net .............			1,402,269	4	1,318,236
5	Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of Schedule L
					5	0
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), persons described in section 4958(c)(3)(B), and contributing employers and sponsoring organizations of section 501(c)(9) voluntary employees' beneficiary organizations (see instructions) Complete Part II of Schedule L
					6	0
7	Notes and loans receivable, net ....				7
8	Inventories for sale or use ........			27,969	8	28,700
9	Prepaid expenses and deferred charges ......			0	9	749
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	4,436,189
b	Less: accumulated depreciation	10b	3,101,816	1,306,540	10c	1,334,373
11	Investments—publicly traded securities .				11
12	Investments—other securities. See Part IV, line 11 .....			0	12
13	Investments—program-related. See Part IV, line 11 ..			0	13
14	Intangible assets ...............			62,450	14	37,430
15	Other assets. See Part IV, line 11 ...........			3,495,085	15	6,669,656
16	Total assets. Add lines 1 through 15 (must equal line 34)...			9,816,480	16	11,002,681

17	Accounts payable and accrued expenses .....	1,316,825	17	718,707
18	Grants payable ...		18
19	Deferred revenue .........		19
20	Tax-exempt bond liabilities .........		20
21	Escrow or custodial account liability. Complete Part IV of Schedule D		21
22	Loans and other payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
	persons. Complete Part II of Schedule L..		22
23	Secured mortgages and notes payable to unrelated third parties ..		23
24	Unsecured notes and loans payable to unrelated third parties ..		24
25	Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X of Schedule D	710,521	25	2,336,907
26	Total liabilities. Add lines 17 through 25..	2,027,346	26	3,055,614

	Organizations that follow SFAS 117 (ASC 958), check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets	7,789,134	27	7,947,067
28	Temporarily restricted net assets ...........		28
29	Permanently restricted net assets		29
	Organizations that do not follow SFAS 117 (ASC 958), 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 ...........	7,789,134	33	7,947,067
34	Total liabilities and net assets/fund balances ........	9,816,480	34	11,002,681