2024-08-09T12:44:48-05:00 2023-09-30 476097913 EIDE BAILLY LLP 18081 BURT ST STE 200 OMAHA NE 680224722 990 2022-10-01 470426530 JENNIE M MELHAM MEMORIAL MEDICAL CENTER INC JENN 3088724180 PO BOX 250 BROKEN BOW NE 68822 KYLE D KELLUM CEO 3088724180 2024-08-07 1 1 WENDY R COOLEY CPA P01523804 4023302660 2024-08-05 2022 2024-08-08 14:25:15Z KYLE D KELLUM PO BOX 250 BROKEN BOW NE 68822 21600217 0 X WWW.MELHAM.ORG X 1962 NE THE PRIMARY MISSION AND PURPOSE OF THE JENNIE M. MELHAM MEMORIAL MEDICAL CENTER IS TO IMPROVE THE QUALITY OF LIFE IN ITS SURROUNDING SERVICE AREA BY PROVIDING AN ENVIRONMENT WHICH PROMOTES THE BEST POSSIBLE DELIVERY OF EMERGENCY, INPATIENT, SNF/SWING BED, OUTPATIENT, AMBULATORY CARE, AND INDEPENDENT LIVING APARTMENT SERVICES. 5 5 132 20 0 0 74827 125511 18917672 20405599 692227 839433 -109839 -90817 19574887 21279726 0 0 0 0 8252227 9260684 0 0 10136 9463565 10355624 17715792 19616308 1859095 1663418 55083378 56729684 1978448 2183463 53104930 54546221 X PARTNERING WITH YOU TO INSPIRE HEALTHY LIVING THROUGH QUALITY CARE. 0 0 12548118 8513518 JENNIE MELHAM MEMORIAL MEDICAL CENTER (JMMMC) OPERATES A 23-BED CRITICAL ACCESS HOSPITAL. IN ADDITION, THERE ARE 20 APARTMENTS DESIGNATED FOR THE ELDERLY. JMMMC PROVIDES OUTPATIENT SPECIALTY CLINICS AND SURGERY SERVICES. 2394071 2404823 JMMMC PROVIDES 24/7 EMERGENCY SERVICES TO OUR COMMUNITY. WE ENCOUNTERED 2,249 EMERGENCY ROOM VISITS. 1932950 2358695 JMMMC PROVIDES HIGH QUALITY, LOW COST ACUTE CARE TO OUR LOCAL COMMUNITY. THE ACUTE CARE DEPARTMENT EXPERIENCED 1,454 DAYS OF CARE. THIS INCLUDES SWING BED, INPATIENT AND OUTPATIENT OBSERVATION. THIS PROVIDES LOCAL ACCESS FOR OUR RESIDENTS TO OBTAIN QUALITY CARE. 874549 7128563 JMMMC PROVIDES RADIOLOGY SERVICES WHICH INCLUDES MOBILE MRI SERVICES, X-RAY, DIGITAL MAMMOGRAPHY, BONE DENSITOMETRY AND CT. 874549 7128563 17749688 1 1 0 1 0 0 0 0 0 1 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 25 0 1 132 1 0 0 0 0 0 0 0 0 0 0 0 0 X 5 5 0 0 0 0 1 1 0 1 0 0 0 1 1 1 1 1 1 1 1 0 X CARLA BAZYN VPCFO 3088724180 PO BOX 250 BROKEN BOW NE 68822 JEREMY CLINGEPEEL PRESIDENT/CEO THRU 1/23 40.00 2.00 X 234813 0 45312 DARCI SHEA RN 40.00 0.00 X 190392 0 51711 CARLA BAZYN VP/CFO 40.00 2.00 X 154978 0 53235 KATHRYN DECKER CNO 40.00 0.00 X 187040 0 7872 JENNIFER SCHAAF PHARMACIST 40.00 0.00 X 157988 0 6414 MARY HARVEY DIRECTOR OUTPATIENT SERVIC 40.00 0.00 X 116697 0 21881 BEVERLY TREW NURSE 40.00 0.00 X 109024 0 22526 JOHN SMITH CHAIRMAN 2.00 2.00 X X 0 0 0 DON CANTRELL CHAIRMAN THRU 1/23 2.00 2.00 X X 0 0 0 MIKE BORDERS VICE CHAIRMAN 2.00 2.00 X X 0 0 0 JOYCE RICHARDSON SECRETARY 2.00 2.00 X X 0 0 0 COREY STAPLES TREASURER 2.00 2.00 X X 0 0 0 NORVAL L BOOKS MEMBER 2.00 2.00 X 0 0 0 STEPHANIE BOLDT INTERIM CEO 1/23 THRU 8/23 40.00 2.00 X 0 0 0 KYLE D KELLUM PRESIDENT/CEO FROM 8/23 40.00 2.00 X 0 0 0 1150932 0 208951 11 0 1 1 CENTRAL NEBRASKA MEDICAL CLINIC PO BOX 690 BROKEN BOW NE 68822 ER DOCTOR SERVICES 1108682 SANDHILLS ANESTHESIA SERVICES LLC 79568 SUMNER ROAD BROKEN BOW NE 68822 ANESTHESIA SERVICES 717983 BRYAN MEDICAL CENTER PO BOX 82557 LINCOLN NE 68501 MOBILE PATIENT SERVICES 169332 FIVE NINES TECHNOLOGY GROUP INC PO BOX 744821 LOS ANGELES CA 90074 IT SERVICES 142183 DOCS WHO CARE INC 800 WEST FRONTIER LANE OLATHE KS 66061 ER DOCTOR SERVICES 139945 8 113011 12500 125511 PATIENT SERVICE - MEDICARE/MEDICA 621110 13165650 13165650 PATIENT SERVICE - PRIVATE PAY 621110 7103058 7103058 WELLNESS CENTER REVENUE 624100 91153 91153 45738 45738 20405599 822708 822708 155980 320491 -164511 -164511 -164511 16725 0 16725 16725 16725 CAFETERIA SALES 722210 73694 73694 73694 21279726 20405599 0 748616 X 468517 468517 6386599 5974836 411763 183071 160679 22392 1700352 1577893 122459 522145 456893 65252 19561 19561 63205 63205 4106902 3993896 110245 2761 2561797 2497120 64677 772119 756703 15416 321432 316716 4716 7401 3839 3562 77607 22481 55126 1428546 1400490 28056 175919 155207 20712 OTHER EXPENSE 562102 256411 305691 MINOR EQUIPMENT 132752 121168 4209 7375 DUES AND SUBSCRIPTIONS 126281 55356 70925 19616308 17749688 1856484 10136 145 145 11524351 13019366 2255217 2480310 172752 196656 456646 458868 189346 321239 40501936 25351837 16339217 15150099 23354464 23132337 630671 791240 1339993 55083378 56729684 1805336 1930534 173112 252929 1978448 2183463 X 53104930 54546221 53104930 54546221 55083378 56729684 1663418 -222127 0 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 3894 3894 0 PART II-B, LINE 1: JMMMC PAID DUES TO THE AMERICAN HOSPITAL ASSOCIATION AND THE NEBRASKA HOSPITAL ASSOCIATION. A PORTION OF THE DUES FOR EACH ORGANIZATION WERE USED FOR LOBBYING ACTIVITIES. 42942 750 43692 42442 500 42942 41192 1250 42442 39942 1250 41192 38692 1250 39942 0.00000 1.00000 0.00000 0 1 1 374644 374644 17733761 12277277 5456484 9095865 7242369 1853496 13297666 5832191 7465475 15150099 457 PENSION LIABILITIES 176670 RIGHT TO USE LEASE LIABILITY 76259 252929 X PART V, LINE 4: PROVIDE SUPPORT TO ENSURE CONTINUED OPERATION OF JENNIE M. MELHAM MEMORIAL MEDICAL CENTER. PART X, LINE 2: THE MEDICAL CENTER ACCOUNTS FOR UNCERTAINTIES IN ACCOUNTING FOR INCOME TAX ASSETS AND LIABILITIES USING GUIDANCE INCLUDED IN FINANCIAL ACCOUNTING STANDARDS BOARD (FASB) ACCOUNTING STANDARDS CODIFICATION (ASC) 740, INCOME TAXES. THE MEDICAL CENTER RECOGNIZES THE EFFECT OF INCOME TAX POSITIONS ONLY IF THOSE POSITIONS ARE MORE LIKELY THAN NOT OF BEING SUSTAINED. AT SEPTEMBER 30, 2023, THE MEDICAL CENTER HAD NO UNCERTAIN TAX POSITIONS ACCRUED. 1 1 X 1 X 1 X 1 1 0 1 1 25244 0 25244 0.00130 1470999 1470999 1496243 1470999 25244 0.00130 45509 0 45509 0.00230 295598 0 295598 0.01510 341107 341107 0.01740 1837350 1470999 366351 0.01870 3992 0 3992 0.00020 6704 0 6704 0.00030 1912 0 1912 0.00010 2830 0 2830 0.00010 17293 0 17293 0.00090 32731 32731 0.00160 0 322662 0 9769515 9828752 -59237 X 1 1 1 1 JENNIE M MELHAM MEMORIAL MEDICAL CENTER PO BOX 250 BROKEN BOW NE 68822 WWW.MELHAM.ORG 100004 X X X X JENNIE M MELHAM MEMORIAL MED CTR INC 1 0 0 1 X X X X X X X X X 21 1 0 1 1 X WWW.MELHAM.ORG/DOWNLOADS X 1 21 1 WWW.MELHAM.ORG/DOWNLOADS 0 1 X 100.000000000000 200.000000000000 X X X 1 1 X X X 1 X WWW.MELHAM.ORG/FINANCIAL-ASSISTANCE-PROGRAM X WWW.MELHAM.ORG/FINANCIAL-ASSISTANCE-PROGRAM X WWW.MELHAM.ORG/FINANCIAL-ASSISTANCE-PROGRAM X X X X X 1 X 0 X X X X 1 X 0 0 JENNIE M. MELHAM MEMORIAL MED. CTR. INC. PART V, SECTION B, LINE 5: IN ORDER TO UPDATE THE FISCAL YEAR 2022 CHNA THE MEDICAL CENTER'S ADMINISTRATION ALONG WITH VVV CONSULTANTS, LLC COLLECTED AND ANALYZED THE MOST CURRENT STATE, FEDERAL AND COMMUNITY DATABASES TO UNDERSTAND THE DEMOGRAPHIC MAKEUP AND TRENDS IN THE SERVICE AREA. THIS INFORMATION WAS USED TO BETTER UNDERSTAND HOW THESE TRENDS AFFECT THE MEDICAL CENTER'S CURRENT AND FUTURE PROVISION OF HEALTHCARE TO MEET THE COMMUNITY AND COUNTY'S HEALTH NEEDS. THE MEDICAL CENTER PARTNERED WITH VVV CONSULTANTS, LLC AND THE LOUP BASIN PUBLIC HEALTH DEPARTMENT (LBPHD) IN DEVELOPMENT AND ADMINISTRATION OF A 2022 COMMUNITY THEMES AND STRENGTHS ASSESSMENT SURVEY OF RESIDENTS HEALTHCARE STATUS AND NEEDS IN THE LBPHD'S NINE COUNTY SERVICE AREA.THE RESULTS OF THE SURVEY WERE SEGREGATED OUT BY CITY/COUNTY SO THAT THIS INFORMATION COULD BE BROKEN DOWN AND USED BY EACH OF THE HOSPITALS IN THE REGION FOR PLANNING PURPOSES. THE MEDICAL CENTER USED THE BROKEN BOW AND CUSTER COUNTY SURVEY RESULTS IN THE 2022 CHNA PLANNING PROCESS. JENNIE M. MELHAM MEMORIAL MED. CTR. INC. PART V, SECTION B, LINE 6B: LOUP BASIN PUBLIC HEALTH DEPARTMENT JENNIE M. MELHAM MEMORIAL MED. CTR. INC. PART V, SECTION B, LINE 11: THE ASSESSMENT SURVEY IDENTIFIED THE FOLLOWING KEY NEED AREAS: 1. ACCESS TO MENTAL HEALTH SERVICES2. HOUSING AVAILABILITY3. ACCESS TO PRIMARY CARETHE MEDICAL CENTER USED THE INFORMATION FROM THE COMMUNITY INSIGHT VIA AN ONLINE PERCEPTION SURVEY AND MAPP PROCESS TO ASSIST IN UPDATING PLANS FOR HEALTH SCREENING, HEALTH EDUCATION AND WELLNESS ACTIVITIES IN THE COMMUNITY. FEEDBACK ON THE CHNA AND CHIP WAS SOUGHT FROM THE LBPHD, MEDICAL CENTER BOARD OF DIRECTORS, AND LOCAL MEDICAL STAFF. ALL FEEDBACK WAS USED TO REFINE THE 2022 CHNA AND CHIP FOR THE MEDICAL CENTER'S SERVICE AREA. SOME OF THE ACTIVITIES THAT WERE DEVELOPED AND IMPLEMENTED BY THE MEDICAL CENTER AS A RESULT OF THE 2022 CHNA AND CHIP FOR OUR SERVICE AREA:ACCESS TO MENTAL HEALTH SERVICES WAS NOTED BY SURVEY PARTICIPANTS AS A NEED. THE MEDICAL CENTER HAS MANY OTHER FINANCIAL COMMITMENTS TO ENSURE PROVISION OF OTHER KEY MEDICAL CARE NEEDS IN THE COMMUNITY. THERE ARE EXISTING PROVIDERS IN THE COMMUNITY WHO ADDRESS MENTAL HEALTH ISSUES FOR ALL AGES WITH WHOM THE MEDICAL CENTER CAN PARTNER TO AVOID DUPLICATION OF SERVICES AND UNNECESSARY COMPETITION. THERE IS LIMITED GRANT FUNDING BASED ON UTILIZATION ON WHICH THESE NON-PROFIT AGENCIES RELY.THE MEDICAL CENTER COLLABORATED WITH THE SANDHILLS COMMUNITY INITIATIVE TO IDENTIFY AND PUBLISH AVAILABLE COMMUNITY CRISIS RESOURCES INCLUDING THE PROMOTION OF THE STATE 988 24-HOUR CRISIS HOTLINE.THE MEDICAL CENTER CONTINUES TO EDUCATE EMERGENCY DEPARTMENT STAFF REGARDING MENTAL HEALTH DELIVERY ISSUES AND HOW TO ADDRESS THEM. THE MEDICAL CENTER ALSO PROVIDES CONTINUING EDUCATION COURSES AND LUNCH AND LEARN PRESENTATIONS TO KEEP EVERYONE CURRENT IN TERMS OF TREATING MENTAL HEALTH ISSUES. THE MEDICAL CENTER HAS PARTNERED WITH THE BROKEN BOW POLICE DEPARTMENT TO CHARTER A CUSTER COUNTY MENTAL HEALTH TASK FORCE COMPRISED OF COUNTY SCHOOL DISTRICTS, LOCAL MENTAL HEALTH THERAPISTS, CUSTER COUNTY SHERIFF, NEBRASKA HIGHWAY PATROL, CALLAWAY DISTRICT HOSPITAL, AND CONSUMERS OF MENTAL HEALTH SERVICES. THE TASK FORCE EXISTS TO IDENTIFY MENTAL HEALTH NEEDS AND RESOURCES, REDUCE FRAGMENTATION OF SERVICES AMONG PROVIDERS, AND DEVELOP PLANS FOR COMMUNITY RESPONSE TO MENTAL HEALTH NEEDS. THE TASK FORCE RECENTLY PARTNERED WITH CUSTER AREA ROTARY AND RECEIVED A GRANT TO BRING THE WELLNESS RECOVERY ACTION PLAN (WRAP) TOOL TO THE COUNTY. LOCAL TRAINERS WILL WORK WITH LOCAL THERAPISTS, EMPLOYERS, AND SCHOOLS TO COORDINATE WRAP COMPLETION BY COMMUNITY MEMBERS TO PROACTIVELY ADDRESS WELLNESS, RECOVERY, STRESSORS, AND SUPPORT SYSTEMS. THE PLAN WILL THEN BE AVAILABLE TO LOCAL LAW ENFORCEMENT AND FIRST RESPONDERS IN A STANDARDIZED FORMAT TO ASSIST THEM IN ADDRESSING INDIVIDUALS IN CRISIS WITH THE GOAL OF AVOIDING ESCALATION OF CRISIS SITUATIONS.THE MEDICAL CENTER CURRENTLY PARTNERS WITH RICHARD YOUNG BEHAVIOR HEALTH TO PROVIDE INDIVIDUAL PSYCHOLOGICAL SERVICES VIA TELEHEALTH IN THE SPECIALTY CLINIC.THE MEDICAL CENTER HAS BEEN AN ACTIVE PART OF THE CUSTER ECONOMIC DEVELOPMENT CORPORATION (CEDC). THE CEDC HAS BEEN DEVELOPING THE COUNTYWIDE HOUSING DEVELOPMENT PLAN THAT WILL ADDRESS AFFORDABLE/SAFE HOUSING FOR RESIDENTS. THE CEDC IS ALSO WORKING TO SEEK ADDITIONAL GRANT MONEY TO ALLOW FOR LOCAL CONTRACTORS TO BID HOUSING DEVELOPMENT PROJECTS.THE MEDICAL CENTER IS EVALUATING DIFFERENT AVENUES THAT MAY HELP WITH THE NEED OF ACCESS TO PRIMARY CARE. THE IDEAS RANGE FROM CONDUCTING A FORMAL PHYSICIAN MANPOWER ASSESSMENT TO DOCUMENT THE NUMBER OF PCP AND STAFF NEEDED TO THE FEASIBILITY OF EXPANDING THE CLINIC'S AFTER-HOUR CARE PROGRAM TO ALLOW FORM MORE WALK-INS.THERE WERE NO SIGNIFICANT NEEDS IDENTIFIED THAT ARE NOT BEING ADDRESSED.DURING THE FISCAL YEAR ENDING 9/30/23, THE MEDICAL CENTER STARTED EXPLORING TELEHEALTH OPTIONS FOR CHILD PSYCHIATRY. THIS HAS LED TO IDENTIFYING A PHYSICIAN AND DISCUSSING CONTRACTING TERMS TO PROVIDE SAID SERVICE.THE MEDICAL CENTER HAS HAD MULTIPLE DISCUSSIONS RELATED TO THE EXPANSION OF PRIMARY CARE. IT WAS DECIDED TO PLACE THOSE DISCUSSIONS INTO THE CURRENT 3-YEAR STRATEGIC PLAN. OPTIONS INCLUDE A FREESTANDING URGENT CARE, AND POTENTIAL WALK-IN CLINIC(S) OUTSIDE OF BROKEN BOW. ADDITIONALLY, COLLABORATIVE DISCUSSIONS WITH THE INDEPENDENT PRIMARY CARE OFFICE IN BROKEN BOW HAVE OCCURRED RELATIVE TO PROVIDER SUCCESSION PLANNING. 1 1 - LIBERTY SQUARE APARTMENTS PO BOX 250 BROKEN BOW NE 68822 SENIOR INDEPENDENT LIVING APARTMENT COMPLEX PART I, LINE 3C: ELIGIBILITY IS MAINLY BASED UPON FEDERAL POVERTY GUIDELINES, HOWEVER, OTHER FACTORS WILL COME INTO THE DECISION MAKING PROCESS. THESE FACTORS INCLUDE AGE, EXISTING MEDICAL DEBT, EXISTING NON-MEDICAL DEBT, ASSET OWNERSHIP, INVESTMENTS AND ANY OTHER PERTINENT INFORMATION. THE INCOME GUIDELINES ALLOW FOR ASSISTANCE, BASED UPON A SLIDING SCALE, WHERE INCOME IS FROM ANYWHERE FROM 100% TO 200% OF FEDERAL POVERTY GUIDLINES. PART I, LINE 6A: JMMMC'S COMMUNITY BENEFIT REPORT IS NOT PREPARED BY A RELATED ORGANIZATION. PART I, LINE 7: JMMMC USED THE SEPTEMBER 30, 2023 COST REPORT AND AUDITED FINANCIAL STATEMENTS TO CALCULATE THE AMOUNT REPORTED ON PART I, LINE 7. JMMMC TOOK CHARGES FROM THE COST REPORT AND TEH AUDITED FINANCIAL STATMENTS THEN REDUCED THOSE NUMBER TO A COST BASIS USING A COST-TO-CHARGE RATIO. PART II, COMMUNITY BUILDING ACTIVITIES: JMMMC'S COMMUNITY BUILDING ACTIVITIES INCLUDE DISASTER TRAINING ACTIVITIES EXPENSES. JMMMC HAS WORKED WITH COMMUNITY AND REGIONAL ORGANIZATIONS TO DEVELOP DISASTER PLANS AND TRAIN BOTH OUR STAFF AND OTHER EXTERNAL ORGANIZATION'S STAFF FOR ANY POTENTIAL DISASTER RESPONSE. MEETING ROOMS, INCLUDING SOME WITH TELE VIDEO CAPABILITIES ARE AVAILABLE AND USED BY AREA ORGANIZATIONS FREE OF CHARGE. THIS SAVES THESE ORGANIZATIONS SIGNIFICANT SUMS OF MONEY, KEEPING THEIR STAFF AND VOLUNTEERS HERE LOCALLY AS OPPOSED TO COMMUTING UPWARDS OF 200 MILES OR MORE FOR CERTAIN TRAINING EVENTS. WEIGHTWATCHERS MEETS AT JMMMC TO PROVIDE THE COMMUNITY THE OPPORTUNITY TO LEARN HEALTHY EATING LIFESTYLES. PART III, LINE 2: THE MEDICAL CENTER DETERMINES ITS ESTIMATE OF IMPLICIT PRICE CONCESSIONS BASED ON HISTORICAL COLLECTION EXPERIENCE WITH VARIOUS CLASSES OF PATIENTS. THE AMOUNT ON LINE 2 REPRESENTS IMPLICIT PRICE CONCESSIONS. PART III, LINE 4: PAGES 9, 11 AND 13 OF THE ATTACHED AUDITED FINANCIAL STATEMENTS INCLUDE FOOTNOTES TITLED "PATIENT RECEIVABLES", "PATIENT SERVICE REVENUE", AND "PATIENT FINANCIAL ASSISTANCE" THAT PROVIDE DESCRIPTIONS OF IMPLICIT PRICE CONCESSIONS. PART III, LINE 8: JMMMC USED THE SEPTEMBER 30, 2023 COST REPORT TO CALCULATE THE AMOUNT REPORTED ON PART III, LINE 6. ALL MEDICARE SHORTFALL IS TREATED AS COMMUNITY BENEFITS AS PROVIDING SERVICES TO MEDICARE IS REQUIRED AND THE ELDERLY IS A CHARITABLE CLASS. PART III, LINE 9B: IF A PATIENT IS IDENTIFIED THAT IS KNOWN TO QUALIFY FOR FINANCIAL ASSISTANCE, EFFORTS TO REACH OUT TO THIS INDIVIDUAL OR THE INDIVIDUAL'S FAMILY ARE MADE. THE PATIENT OR FAMILY IS REQUESTED TO COMPLETE A CHARITY CARE APPLICATION TO FORMALIZE THE PROCESS. AT THE TIME A COMPLETED APPLICATION IS RECEIVED, ALL COLLECTION EFFORTS ARE CEASED UNTIL A DETERMINATION IS MADE TO THE QUALIFICATION OF THE INDIVIDUAL. PART VI, LINE 2: THERE IS NO FORMAL POLICY TO ASSESS THE HEALTH CARE NEEDS OF THE COMMUNITY JMMMC SERVES OTHER THAN THE NEEDS ASSESSMENT THAT WAS CONDUCTED DURING THE 2021 TAX YEAR. PART VI, LINE 3: ALL PRIVATE PAY PATIENT ACCOUNTS ARE REVIEWED BY THE BILLING STAFF. DURING THE REVIEW PROCESS, PATIENTS THAT ARE IDENTIFIED AS POTENTIAL CANDIDATES FOR ELIGIBILTY AND ASSISTANCE ARE CONTACTED BY THE BILLING STAFF. THE BILLING STAFF ENCOURAGES THE PATIENTS TO CONTACT THE APPROPRIATE AGENCY, MAINLY THE STATE MEDICAID PROGRAM, IN ORDER FOR THEM TO ASCERTAIN THEIR ELIGIBILITY. KNOWN INDIGENT PATIENTS ARE ENCOURAGED TO COMPLETE A CHARITY CARE APPLICATION. A FINANCIAL ASSISTANCE POLICY SUMMARY IS INCLUDED WITH ALL FIRST BILLINGS. INFORMATION REGARDING THE FINANCIAL ASSISTANCE POLICY IS INCLUDED ON ALL STATEMENTS SENT OUT. PART VI, LINE 4: JENNIE M. MELHAM MEMORIAL MEDICAL CENTER SERVES THE PEOPLE OF CENTRAL NEBRASKA. LOCATED IN BROKEN BOW, THE COUNTY SEAT, THE PRIMARY SERVICE AREA ENCOMPASSES CUSTER COUNTY, BLAINE COUNTY, THOMAS COUNTY, LOUP COUNTY AND PARTS OF SHERMAN COUNTY. THE SERVICE AREA IS A VERY RURAL AREA. SOME COUNTIES OR PARTS THEREOF SERVED ARE AMONG THE SPARCEST POPULATED AREAS IN THE UNITED STATES. THE PRIMARY SERVICE AREA CONSISTS OF A POPULATION BASIS OF APPROXIMATELY 12,000. A LARGE PORTION OF THE POPULATION SERVED IS OVER AGE 65, RESULTING IN A LARGE NUMBER OF PATIENTS SEEN AT THE MEDICAL CENTER BEING COVERED BY THE MEDICARE PROGRAM. OVER 50% OF GROSS PATIENT REVENUE GENERATED AT THE MEDICAL CENTER IS MEDICARE. THE MEDICARE ADVANTAGE GROSS PATIENT REVENUE IS 7%. ADDITIONALLY, 8% OF GROSS PATIENT REVENUE IS RECEIVED FROM THE MEDICAID PROGRAM. PART VI, LINE 5: JMMMC FURTHER PROMOTES THE HEALTH OF THE COMMUNITY BY THE FOLLOWING ACTIONS AND INITIATIVES:JMMMC PARTICIPATES WITH AREA COMMUNITY COLLEGES BY SERVING AS A CLINICAL ROTATION SITE FOR PHYSICIAN, PHYSICIAN ASSISTANT, PHARMACY, MEDICAL TECHNOLOGY, LPN, RN, MEDICAL TRANSCRIPTIONIST, PHYSICAL THERAPIST AND RADIOLOGY TECHNOLOGY STUDENTS. SPACE AND STAFF OVERSIGHT IS PROVIDED AT NO COST TO THE COLLEGE OR THE STUDENT. JMMMC ALSO OWNS A RESIDENTIAL HOUSE THAT IS USED TO MAKE FREE HOUSING AVAILABLE TO MANY OF THE STUDENTS WHO COME FROM OUT OF TOWN TO PARTICIPATE IN THE ABOVE STATED TRAINING PROGRAMS. JMMMC COVERS THE COSTS RELATED TO MAINTENANCE, HEATING, COOLING, LIGHTING, LAUNDRY/LINEN, INTERNET, AND OTHER COSTS FOR THIS HOUSE.JMMMC ASSISTS WITH LOCAL ECONOMIC DEVELOPMENT CORPORATION PROGRAMS DESIGNED TO PROMOTE INTEREST IN HEALTH CARE CAREERS. IT IS JMMMC'S HOPE THAT BY CREATING LOCAL INTEREST IN HEALTH CARE CAREERS JMMMC WILL INSPIRE LOCAL RESIDENTS TO SEEK OUT TRAINING AND RETURN TO THE COMMUNITY TO PURSUE A CAREER IN HEALTH CARE. JMMMC PARTNERS WITH LOCAL HIGH SCHOOLS TO PROMOTE HEALTHCARE CAREERS TO LOCAL STUDENTS. THROUGH HOSA (HEALTH OCCUPATIONS STUDENTS OF AMERICA), A FUTURE HEALTH CARE PROFESSIONALS CHAPTER AT BROKEN BOW HIGH SCHOOL, SPEARHEADED BY JMMMC, THE MEDICAL CENTER PROVIDES SPEAKERS, MENTORSHIP, AND JOB SHADOW EXPERIENCES TO STUDENTS. THE MEDICAL CENTER PARTNERS WITH THE LOCAL HIGH SCHOOL AND COMMUNITY COLLEGE TO PROVIDE CERTIFIED NURSING ASSISTANT CLASSES TO HIGH SCHOOL STUDENTS.NOT ALL PATIENTS HAVE AN ABILITY TO PAY AT TIME OF SERVICE. JMMMC HAS DEVELOPED GUIDELINES THAT DO NOT REQUIRE PAYMENT IN FULL AT TIME OF SERVICE FOR EMERGENT, URGENT OR ELECTIVE SERVICES AND ALLOWS FOR EXTENDED PERIODS OF TIME FOR PAYMENT OF THE DEBT AND NO INTEREST CHARGES ARE INCURRED. EVERY EFFORT IS MADE BY JMMMC TO KEEP HEALTHCARE AFFORDABLE FOR AREA PATIENTS.MEDICAL CENTER MEETING ROOMS ARE PROVIDED FREE OF CHARGE TO OUTSIDE COMMUNITY SERVICE ORGANIZATIONS WHO ARE PROMOTING HEALTHY LIFESTYLES AND WELLNESS PROMOTION.FREE BROADBAND ACCESS AND COMPUTER RESOURCES ARE PROVIDED FREE OF CHARGE TO LOCAL EMT VOLUNTEERS ALLOWING THEM TO BE MORE EFFICIENT IN THEIR DUTIES. THIS ALLOWS FOR BETTER PARTICIPATION IN THE EMT PROGRAM, THUS EXTENDING EMERGENCY TRANSFER SERVICES TO LOCAL RESIDENTS AND VISITORS. TELEVIDEO EQUIPMENT IS PROVIDED FREE OF CHARGE TO AREA EMT VOLUNTEERS. THIS ALLOWS FOR QUARTERLY TRAINING TO BE PROVIDED LOCALLY THAT IS REQUIRED TO MEET THEIR CONTINUING EDUCATION REQUIREMENTS AND MAINTAIN THEIR CERTIFICATION. THE AVAILABILITY OF THIS SERVICE FOR THE EMTS RESULTS IN SIGNIFICANT SAVINGS IN TERMS OF TRAVEL COSTS AND TRAVEL TIME, HELPING BOOST MORALE AND ENCOURAGING PARTICIPATION OF THIS EXTREMELY IMPORTANT SERVICE. IN THIS RURAL COMMUNITY, THERE IS NO OTHER EMERGENCY AMBULANCE SERVICE OTHER THAN THE LOCAL VOLUNTEERS. LOCAL LAW ENFORCEMENT, THE COUNTY ATTORNEY AND HEALTH DEPARTMENTS ALSO MAKE USE OF THE TELEVIDEO EQUIPMENT TO PROMOTE HEALTH AND SAFETY IN THE COMMUNITY. JMMMC PROVIDES SPACE FREE OF CHARGE TO THE CUSTER COUNTY COMMUNICATIONS DEPARTMENT. THIS COMMUNICATION CENTER HANDLES ALL RADIO COMMUNICATION BETWEEN THE LAW ENFORCEMENT AGENCIES, FIRE DEPARTMENTS AND EMERGENCY RESPONDERS FOR CUSTER COUNTY. THIS SPACE HOUSES EQUIPMENT THAT SERVES AS A BACKUP TO THEIR PRIMARY COMMUNICATION EQUIPMENT. IN SITUATIONS WHERE THE PRIMARY EQUIPMENT FAILS, THIS ALLOWS THE CUSTER COUNTY COMMUNICATIONS DEPARTMENT TO HAVE EMERGENCY BACKUP EQUIPMENT TO CONTINUE TO PROVIDE THE CRITICAL COMMUNICATION NEEDS OF CUSTER COUNTY.JMMMC'S EMERGENCY ROOM SERVICES ARE PROVIDED 24 HOURS PER DAY, 7 DAYS PER WEEK. THIS DEPARTMENT OPERATES AT A SIGNIFICANT LOSS BUT ENSURES THAT PATIENTS HAVE ACCESS TO EMERGENCY HEALTHCARE AT ALL TIMES. THE ER IS CERTIFIED AS A LEVEL IV TRAUMA CENTER AND THE SERVICE AREA EXTENDS APPROXIMATELY 100 MILES EAST TO WEST ALONG THE HIGHWAY 2 CORRIDOR. THIS IS THE MAIN HIGHWAY HORIZONTALLY BISECTING NEBRASKA AND IS USED BY MANY TRAVELERS AND VACATIONERS, GIVING THEM ACCESS TO EMERGENCY AND TRAUMA CARE. JMMMC'S EMERGENCY ROOM PROVIDES AROUND 2,500 EMERGENCY ROOM VISITS PER YEAR. THE MEDICAL CENTER PAYS LOCAL PHYSICIANS TO BE AVAILABLE TO PROVIDE EMERGENCY ROOM SERVICES 24 HOURS PER DAY, 365 DAYS PER YEAR. PART VI, LINE 6: JMMMC IS NOT PART OF AN AFFILIATED HEALTH CARE SYSTEM. X X 0 0 0 0 0 0 0 0 0 JEREMY CLINGEPEEL PRESIDENT/CEO THRU 1/23 214813 0 20000 0 0 0 0 0 45312 0 280125 0 0 0 DARCI SHEA RN 190392 0 0 0 0 0 7187 0 44524 0 242103 0 0 0 CARLA BAZYN VP/CFO 154978 0 0 0 0 0 6026 0 47209 0 208213 0 0 0 KATHRYN DECKER CNO 187040 0 0 0 0 0 5842 0 2030 0 194912 0 0 0 JENNIFER SCHAAF PHARMACIST 152988 0 5000 0 0 0 5128 0 1286 0 164402 0 0 0 PART I, LINE 3 STEPHANIE BOLDT WAS PAID BY AN UNRELATED ORGANIZATION, BRYAN HEALTH, FOR HER POSITION AS INTERIM CEO. BRYAN HEALTH USES APPROVAL BY THE BOARD IN DETERMINING HER COMPENSATION. FORM 990, PART VI, SECTION A, LINE 6 THE MEMBERS CONSIST OF ALL PERSONS WHO CONTRIBUTE TO THE CORPORATION THE SUM OF NOT LESS THAN $25 AT ANY TIME DURING THE EXISTENCE OF THE CORPORATION. FORM 990, PART VI, SECTION A, LINE 7A THE MEMBERS ELECT THE BOARD OF DIRECTORS AT THE ANNUAL MEETING EACH YEAR. FORM 990, PART VI, SECTION A, LINE 8B THERE IS NO COMMITTEE WITH AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 WILL BE PRESENTED TO THE BOARD OF DIRECTORS ELECTRONICALLY PRIOR TO FILING THE FORM 990. FORM 990, PART VI, SECTION B, LINE 12C THE CONFLICT OF INTEREST POLICY IS PRESENTED ANNUALLY TO THE BOARD OF DIRECTORS. THIS FORM IS REVIEWED AND DISCUSSED WITH THEM. THE BOARD MEMBERS ARE REQUIRED TO SIGN A CONFLICT OF INTEREST DISCLOSURE FORM. THE CHAIRMAN CAN POINT OUT ANY KNOWN CONFLICTS OF INTEREST. INDIVIDUAL BOARD MEMBERS ARE ALSO RESPONSIBLE FOR DECLARING CONFLICTS AND UPON A CONFLICT, THEY ARE EXCLUDED FROM THE VOTE BUT NOT FROM THE DISCUSSION. FORM 990, PART VI, SECTION B, LINE 15 THE BOARD OF DIRECTORS IS PRESENTED WITH COMPARATIVE INFORMATION FROM WAGE STUDIES PERFORMED BY THE NEBRASKA HOSPITAL ASSOCIATION. NHA GATHERS THE WAGE INFORMATION ANNUALY FROM MOST, IF NOT ALL, OF THE HOSPITALS IN THE STATE. THE DATA CAN BE ANALYZED IN A VARIETY OF FORMATS, ALLOWING FOR EXCELLENT WAGE COMPARISON. THE BOARD SETS THE CEO SALARY BASED UPON THIS INFORMATION. FORM 990, PART VI, SECTION C, LINE 19 JENNIE M. MELHAM MEMORIAL MEDICAL CENTER DOES NOT MAKE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, OR FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC. FORM 990, PART IX, LINE 11G PATIENT TEST FEES: PROGRAM SERVICE EXPENSES 342,541. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 342,541. PHYSICAL/OCCUPATIONAL THERAPY: PROGRAM SERVICE EXPENSES 99,387. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 99,387. LAB TEST FEES: PROGRAM SERVICE EXPENSES 130,001. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 130,001. OTHER FEES FOR SERVICE: PROGRAM SERVICE EXPENSES 1,526,414. MANAGEMENT AND GENERAL EXPENSES 110,245. FUNDRAISING EXPENSES 2,761. TOTAL EXPENSES 1,639,420. PHYSICIAN ER CALL PAYMENTS: PROGRAM SERVICE EXPENSES 1,473,704. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,473,704. SERVICE CONTRACTS: PROGRAM SERVICE EXPENSES 421,849. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 421,849. FORM 990, PART XII, LINE 2C: THE BOARD OF DIRECTORS ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF ITS FINANCIAL STATEMENTS AND SELECTION OF AN INDEPENDENT ACCOUNTANT. THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. THE MELHAM MEDICAL CENTER FOUNDATION INC PO BOX 250 BROKEN BOW NE 68822 470795995 SUPPORTING THE OPERATIONS OF A CRITICAL ACCESS HOSPITAL NE 501(C)(3) LINE 12B, II JENNIE M MELHAM MEMORIAL MEDICAL CENTER INC 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0