COMMUNITY HOSPITAL ASSOCIATION: Form 990, tax year 2023
View the entire original 990 at ProPublica ↗
- Organization
- COMMUNITY HOSPITAL ASSOCIATION (EIN 47-0533373)
- Tax period
- 2023-07-01 to 2024-06-30
- Filed
- 2025-05-15
- IRS object ID
- 202511359349308356
- Schema version
- 2023v6.0
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule H
- Schedule I
- Schedule J
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2025-05-15T12:12:52-05:00 | ReturnTs |
| Tax Period End | 2024-06-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 450250958 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | EIDE BAILLY LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 18081 BURT ST STE 200 | AddressLine1Txt |
| City | OMAHA | CityNm |
| State Abbreviation | NE | StateAbbreviationCd |
| ZIP | 680224722 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2023-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 470533373 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | COMMUNITY HOSPITAL ASSOCIATION OF MCCOOK | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | COMM | BusinessNameControlTxt |
| Phone | 3083442650 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1301 EAST H STREET PO BOX 1328 | AddressLine1Txt |
| City | MCCOOK | CityNm |
| State Abbreviation | NE | StateAbbreviationCd |
| ZIP | 69001 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | SEAN WOLFE | PersonNm |
| Person Title | CHIEF FINANCIAL OFFICER | PersonTitleTxt |
| Phone | 3083442650 | PhoneNum |
| Signature | 2025-05-15 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IRS Responsible Prty Info Curr | Yes (1) | IRSResponsiblePrtyInfoCurrInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | WENDY R COOLEY CPA | PreparerPersonNm |
| PTIN | P01523804 | PTIN |
| Phone | 4023302660 | PhoneNum |
| Preparation | 2025-05-15 | PreparationDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2023 | TaxYr |
| Build TS | 2025-03-06 01:10:19Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | SEAN WOLFE | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1301 EAST H STREET PO BOX 1328 | AddressLine1Txt |
| City | MCCOOK | CityNm |
| State Abbreviation | NE | StateAbbreviationCd |
| ZIP | 69001 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $66,266,441 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.CHMCCOOK.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1974 | FormationYr |
| Legal Domicile State | NE | LegalDomicileStateCd |
| Activity Or Mission | TO PROVIDE FOR THE HEALTHCARE NEEDS OF OUR REGION. | ActivityOrMissionDesc |
| Voting Members Governing Body | 9 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 8 | VotingMembersIndependentCnt |
| Total Employee | 378 | TotalEmployeeCnt |
| Total Volunteers | 25 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $1,924,082 | PYContributionsGrantsAmt |
| CY Contributions Grants | $667,289 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $56,537,518 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $63,188,048 | CYProgramServiceRevenueAmt |
| PY Investment Income | $887,554 | PYInvestmentIncomeAmt |
| CY Investment Income | $1,268,951 | CYInvestmentIncomeAmt |
| PY Other Revenue | $625,743 | PYOtherRevenueAmt |
| CY Other Revenue | $964,016 | CYOtherRevenueAmt |
| PY Total Revenue | $59,974,897 | PYTotalRevenueAmt |
| CY Total Revenue | $66,088,304 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $294,782 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $416,376 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $30,441,643 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $33,053,335 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $248,164 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $29,383,898 | PYOtherExpensesAmt |
| CY Other Expenses | $32,478,343 | CYOtherExpensesAmt |
| PY Total Expenses | $60,120,323 | PYTotalExpensesAmt |
| CY Total Expenses | $65,948,054 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$145,426 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $140,250 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $92,073,756 | TotalAssetsBOYAmt |
| Total Assets EOY | $91,587,690 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $33,192,371 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $32,519,348 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $58,881,385 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $59,068,342 | NetAssetsOrFundBalancesEOYAmt |
| Mission | LEADING OUR REGION TO A HEALTHIER FUTURE. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $54,921,433 | ExpenseAmt |
| Grant | $416,376 | GrantAmt |
| Revenue | $63,555,238 | RevenueAmt |
| Desc | 25-BED CRITICAL ACCESS ACUTE CARE HOSPITAL PROVIDING INPATIENT AND OUTPATIENT CARE, DIAGNOSTIC, REHABILITATION, SURGICAL, NURSERY, VISITING MEDICAL SPECIALISTS, HOME HEALTH AND HOSPICE, TWO RURAL HEALTH CLINICS, AND HEALTH AND EDUCATION PROGRAMS. | Desc |
| Total Program Service Expenses | $54,921,433 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (1) | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | Yes (1) | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | Yes (1) | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | Yes (1) | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | 0 | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | Yes (1) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | Yes (1) | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 79 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 378 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | 0 | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | 0 | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 9 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 8 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | Yes (1) | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | 0 | MembersOrStockholdersInd |
| Election Of Board Members | 0 | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | 0 | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SEAN WOLFE | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 3083448306 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1301 EAST H - PO BOX 1328 | AddressLine1Txt |
| City | MCCOOK | CityNm |
| State Abbreviation | NE | StateAbbreviationCd |
| ZIP | 69001 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (18 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| MATTHEW NIELSEN | ||||||||
| CHAIR | 1.00 | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| KURT VOSBURG | ||||||||
| VICE CHAIR | 1.00 | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| MICHAEL LORD | ||||||||
| SECRETARY | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| MATTHEW DAVIDSON | ||||||||
| TREASURER | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| KRISTIN STAGEMEYER CPA | ||||||||
| CHAIR THRU 12/24 | 1.00 | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| GARRETT RIPPEN | ||||||||
| VICE CHAIR THRU 12/24 | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| GRANT NORGAARD | ||||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| DARREN ESCH | ||||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| JANA KMOCH | ||||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| ASHLEY VONTZ | ||||||||
| DIRECTOR | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| KAREN CRAW | ||||||||
| DIRECTOR | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| TROY BRUNTZ | ||||||||
| CEO | 39.00 | 1.00 | Yes (X) | $320,646 | $0 | $45,198 | ||
| SEAN WOLFE | ||||||||
| CFO | 40.00 | Yes (X) | $215,729 | $0 | $53,862 | |||
| RICHARD LAWTON | ||||||||
| ORTHO PHYSICAN | 40.00 | $723,133 | $0 | $60,234 | Yes (X) | |||
| JENNIFER CRAIG | ||||||||
| EMERGENCY DEPT PHYSICIAN | 40.00 | $430,544 | $0 | $48,292 | Yes (X) | |||
| EVAN GEILENKIRCHEN | ||||||||
| CRNA | 40.00 | $317,692 | $0 | $52,433 | Yes (X) | |||
| ROSS BEAVERS | ||||||||
| CRNA | 40.00 | $354,641 | $0 | $23,770 | Yes (X) | |||
| ANTHONY RODEWALD | ||||||||
| PHARMACY DIRECTOR | 40.00 | $207,766 | $0 | $53,539 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $2,570,151 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $337,328 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 42 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| RUTTS HEATING & AC | |||||
| 1001 W 1ST ST | HASTINGS | NE | 68901 | CONSTRUCTION | $1,586,514 |
| SOUTHWEST NEBRASKA PHYSICAL THERAPY | |||||
| 1301 EAST H STREET | MCCOOK | NE | 69001 | PHYSICAL THERAPY SERVICES | $1,500,864 |
| MCCOOK CLINIC | |||||
| 1401 EAST H STREET | MCCOOK | NE | 69001 | ER COVERAGE | $1,404,595 |
| PATHOLOGY SERVICES | |||||
| PO BOX 1289 | NORTH PLATTE | NE | 69103 | LAB FEES | $482,223 |
| RURALMED MANAGEMENT RESOURCES | |||||
| PO BOX 470 | HOLDREGE | NE | 68949 | MEDICAL RESOURCES | $359,434 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 16 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $437,927 | RelatedOrganizationsAmt |
| Government Grants | $229,362 | GovernmentGrantsAmt |
| Total Contributions | $667,289 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| PATIENT SERVICE REVENUE | 621400 | $62,708,466 | $62,708,466 |
| OUT-SOURCE SERVICES | 621400 | $291,779 | $291,779 |
| 340B PAYMENT | 621400 | $187,803 | $187,803 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $63,188,048 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,331,510 | TotalRevenueColumnAmt |
| Exclusion | $1,331,510 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $316,014 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $0 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $316,014 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $316,014 | TotalRevenueColumnAmt |
| Exclusion | $316,014 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $115,578 | OtherAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $178,137 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | -$62,559 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$62,559 | TotalRevenueColumnAmt |
| Exclusion | -$62,559 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | ExclusionExclusionAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|---|
| CAFETERIA/MEALS | 900099 | $280,812 | $280,812 | |
| HOUSEKEEPING INCOME | 900099 | $107,363 | $107,363 |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $259,827 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $259,827 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $648,002 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $66,088,304 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $63,555,238 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $1,865,777 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $416,376 | TotalAmt |
| Program Services | $416,376 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $648,323 | TotalAmt |
| Management And General | $648,323 | ManagementAndGeneralAmt |
Comp Disqual Persons CompDisqualPersonsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $96,542 | TotalAmt |
| Program Services | $96,542 | ProgramServicesAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $24,004,726 | TotalAmt |
| Program Services | $18,904,734 | ProgramServicesAmt |
| Management And General | $4,907,225 | ManagementAndGeneralAmt |
| Fundraising | $192,767 | FundraisingAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,373,340 | TotalAmt |
| Program Services | $1,103,074 | ProgramServicesAmt |
| Management And General | $270,266 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,119,914 | TotalAmt |
| Program Services | $4,101,326 | ProgramServicesAmt |
| Management And General | $1,018,588 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,810,490 | TotalAmt |
| Program Services | $1,422,428 | ProgramServicesAmt |
| Management And General | $370,365 | ManagementAndGeneralAmt |
| Fundraising | $17,697 | FundraisingAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $83,969 | TotalAmt |
| Management And General | $83,969 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $97,008 | TotalAmt |
| Management And General | $97,008 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $10,763,654 | TotalAmt |
| Program Services | $10,296,036 | ProgramServicesAmt |
| Management And General | $467,618 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $192,708 | TotalAmt |
| Management And General | $192,708 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,181,286 | TotalAmt |
| Program Services | $640,810 | ProgramServicesAmt |
| Management And General | $537,155 | ManagementAndGeneralAmt |
| Fundraising | $3,321 | FundraisingAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $245,941 | TotalAmt |
| Program Services | $189,942 | ProgramServicesAmt |
| Management And General | $55,999 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,119,545 | TotalAmt |
| Program Services | $1,113,911 | ProgramServicesAmt |
| Management And General | $5,634 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $58,654 | TotalAmt |
| Program Services | $35,121 | ProgramServicesAmt |
| Management And General | $23,533 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $872,965 | TotalAmt |
| Program Services | $444,112 | ProgramServicesAmt |
| Management And General | $423,588 | ManagementAndGeneralAmt |
| Fundraising | $5,265 | FundraisingAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,102,586 | TotalAmt |
| Program Services | $1,097,520 | ProgramServicesAmt |
| Management And General | $5,066 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,465,073 | TotalAmt |
| Program Services | $5,064,574 | ProgramServicesAmt |
| Management And General | $400,499 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $400,854 | TotalAmt |
| Program Services | $399,185 | ProgramServicesAmt |
| Management And General | $1,669 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (3 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt | FundraisingFundraisingAmt |
|---|---|---|---|---|
| MEDICAL SUPPLIES | $9,585,542 | $9,585,542 | ||
| MISCELLANEOUS | $1,234,143 | $1,205,029 | $29,114 | |
| MEMBERSHIPS & DUES | $74,415 | $10,200 | $64,215 |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $65,948,054 | TotalAmt |
| Program Services | $54,921,433 | ProgramServicesAmt |
| Management And General | $10,778,457 | ManagementAndGeneralAmt |
| Fundraising | $248,164 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,600 | BOYAmt |
| EOY | $1,600 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $31,335,385 | BOYAmt |
| EOY | $29,564,598 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,835,220 | BOYAmt |
| EOY | $9,586,319 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,922,883 | BOYAmt |
| EOY | $2,165,529 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,638,840 | BOYAmt |
| EOY | $2,895,604 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $106,277,948 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $63,839,047 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $43,188,817 | BOYAmt |
| EOY | $42,438,901 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,495,268 | BOYAmt |
| EOY | $3,596,728 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $464,702 | BOYAmt |
| EOY | $660,411 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,191,041 | BOYAmt |
| EOY | $678,000 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $92,073,756 | BOYAmt |
| EOY | $91,587,690 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,336,469 | BOYAmt |
| EOY | $4,262,501 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $493,584 | BOYAmt |
| EOY | $671,128 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $28,345,753 | BOYAmt |
| EOY | $27,574,730 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $16,565 | BOYAmt |
| EOY | $10,989 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $33,192,371 | BOYAmt |
| EOY | $32,519,348 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows FASB117 | Yes (X) | OrganizationFollowsFASB117Ind |
No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $58,881,385 | BOYAmt |
| EOY | $59,068,342 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $58,881,385 | BOYAmt |
| EOY | $59,068,342 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $92,073,756 | BOYAmt |
| EOY | $91,587,690 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $140,250 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $46,707 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Info In Schedule O Part XII | Yes (X) | InfoInScheduleOPartXIIInd |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consol And Sep Basis Fincl Stmt | Yes (X) | ConsolAndSepBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | Yes (1) | FederalGrantAuditRequiredInd |
| Federal Grant Audit Performed | Yes (1) | FederalGrantAuditPerformedInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | VolunteersInd |
| Paid Staff Or Management | 0 | PaidStaffOrManagementInd |
| Media Advertisements | 0 | MediaAdvertisementsInd |
| Mailings Members | 0 | MailingsMembersInd |
| Publications Or Broadcast | 0 | PublicationsOrBroadcastInd |
| Grants Other Organizations | 0 | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | 0 | DirectContactLegislatorsInd |
| Rallies Demonstrations | 0 | RalliesDemonstrationsInd |
| Other Activities | Yes (1) | OtherActivitiesInd |
| Other Activities | $5,682 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $5,682 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | 0 | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART II-B, LINE 1: | FormAndLineReferenceDesc |
| Explanation | ITEM 1I - A PORTION OF DUES PAID TO THE AMERICAN HOSPITAL ASSOCIATION AND NEBRASKA HOSPITAL ASSOCIATION ARE USED FOR LOBBYING AND POLITICAL ACTIVITIES. MANAGEMENT IS ACTIVE IN NEBRASKA HOSPITAL ASSOCIATION'S PAC, AHA'S ADVOCACY DAY, AND OTHER INDUSTRY FUNCTIONS. | ExplanationTxt |
Schedule D IRS990ScheduleD
CY Endwmt Fund CYEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $3,660,864 | BeginningYearBalanceAmt |
| Contributions | $3,766 | ContributionsAmt |
| Investment Earnings Or Losses | $446,030 | InvestmentEarningsOrLossesAmt |
| Administrative Expenses | $165,441 | AdministrativeExpensesAmt |
| End Year Balance | $3,945,219 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $3,482,371 | BeginningYearBalanceAmt |
| Contributions | $5,110 | ContributionsAmt |
| Investment Earnings Or Losses | $214,711 | InvestmentEarningsOrLossesAmt |
| Administrative Expenses | $41,328 | AdministrativeExpensesAmt |
| End Year Balance | $3,660,864 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $3,811,948 | BeginningYearBalanceAmt |
| Contributions | $5,826 | ContributionsAmt |
| Investment Earnings Or Losses | -$260,507 | InvestmentEarningsOrLossesAmt |
| Administrative Expenses | $74,896 | AdministrativeExpensesAmt |
| End Year Balance | $3,482,371 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $3,290,398 | BeginningYearBalanceAmt |
| Contributions | $12,744 | ContributionsAmt |
| Investment Earnings Or Losses | $508,806 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $3,811,948 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $3,130,914 | BeginningYearBalanceAmt |
| Contributions | $4,680 | ContributionsAmt |
| Investment Earnings Or Losses | $180,448 | InvestmentEarningsOrLossesAmt |
| Grants Or Scholarships | $10,800 | GrantsOrScholarshipsAmt |
| Other Expenditures | $11,875 | OtherExpendituresAmt |
| Administrative Expenses | $2,969 | AdministrativeExpensesAmt |
| End Year Balance | $3,290,398 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Designated Balance EOY | 0.59310 | BoardDesignatedBalanceEOYPct |
| Prmnnt Endowment Balance EOY | 0.40690 | PrmnntEndowmentBalanceEOYPct |
| Term Endowment Balance EOY | 0.00000 | TermEndowmentBalanceEOYPct |
| Endowments Held Unrelated Org | 0 | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | Yes (1) | EndowmentsHeldRelatedOrgInd |
| Related Org List Sch R | Yes (1) | RelatedOrgListSchRInd |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $101,803 | OtherCostOrOtherBasisAmt |
| Book Value | $101,803 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $39,250,408 | OtherCostOrOtherBasisAmt |
| Depreciation | $38,709,740 | DepreciationAmt |
| Book Value | $540,668 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $58,570,863 | OtherCostOrOtherBasisAmt |
| Depreciation | $25,129,307 | DepreciationAmt |
| Book Value | $33,441,556 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $8,354,874 | OtherCostOrOtherBasisAmt |
| Book Value | $8,354,874 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $42,438,901 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | REFUNDABLE ADVANCES | Desc |
| Amt | $10,989 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $10,989 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART V, LINE 4: | THE ENDOWMENT FUNDS ARE HELD BY THE COMMUNITY HOSPITAL HEALTH FOUNDATION OF MCCOOK (A RELATED PARTY) AND ARE USED IN SUPPORT OF THE HOSPITAL'S PROGRAMS AND PROJECTS, INCLUDING PROPERTY AND EQUIPMENT PURCHASES, SCHOLARSHIPS, HOSPICE PROGRAMS, REHABILITATION SERVICES AND OTHERS. |
| PART X, LINE 2: | THE HOSPITAL AND FOUNDATION ACCOUNT FOR UNCERTAINTIES IN ACCOUNTING FOR INCOME TAX ASSETS AND LIABILITIES USING GUIDANCE INCLUDED IN FASB ASC 740, INCOME TAXES. THE HOSPITAL AND FOUNDATION RECOGNIZE THE EFFECT OF INCOME TAX POSITIONS ONLY IF THOSE POSITIONS ARE MORE LIKELY THAN NOT OF BEING SUSTAINED. AT JUNE 30, 2024 AND 2023, THE HOSPITAL AND FOUNDATION HAD NO UNCERTAIN TAX POSITIONS ACCRUED. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
| Percent150 | Yes (X) | Percent150Ind |
| FPG Reference Discounted Care | 0 | FPGReferenceDiscountedCareInd |
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | Yes (1) | ExpensesExceedBudgetInd |
| Unable To Provide Care | 0 | UnableToProvideCareInd |
| Annual Community Bnft Report | Yes (1) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (1) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $712,914 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $712,914 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01080 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $5,282,822 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $4,183,331 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,099,491 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01670 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $5,995,736 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $4,183,331 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,812,405 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02750 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $20,570 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $20,570 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00030 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $380,757 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $380,757 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00580 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $401,327 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $401,327 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00610 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $6,397,063 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $4,183,331 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,213,732 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.03360 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $1,511,589 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $226,738 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $25,766,823 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $26,821,490 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$1,054,667 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | Yes (X) | CostToChargeRatioInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (1) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | COMMUNITY HOSPITAL ASSOCIATION OF MCCOOK | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1301 EAST H STREET - PO BOX 1328 | AddressLine1Txt |
| City | MCCOOK | CityNm |
| State Abbreviation | NE | StateAbbreviationCd |
| ZIP | 69001 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | WWW.CHMCCOOK.ORG | WebsiteAddressTxt |
| State License | 320007 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Critical Access Hospital | Yes (X) | CriticalAccessHospitalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | COMMUNITY HOSPITAL ASSOCIATION OF MCCOOK | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | 0 | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | 0 | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (1) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Prior CHNA Impact | Yes (X) | PriorCHNAImpactInd |
| CHNA Conducted | 22 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | 0 | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | 0 | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | SEE PART V, PAGE 8 | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 22 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | SEE PART V, PAGE 8 | StrategyWebsiteURLTxt |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 150.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Other Criteria | Yes (X) | OtherCriteriaInd |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | HTTPS://CHMCCOOK.ORG/FOR-PATIENTS/FINANCIAL-ASSISTANCE.HTML | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | HTTPS://CHMCCOOK.ORG/FOR-PATIENTS/FINANCIAL-ASSISTANCE.HTML | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | HTTPS://CHMCCOOK.ORG/FOR-PATIENTS/FINANCIAL-ASSISTANCE.HTML | FAPSummaryOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| Notified FAP Copy Bill Display | Yes (X) | NotifiedFAPCopyBillDisplayInd |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| FAP Translated | Yes (X) | FAPTranslatedInd |
| Other Publicity | Yes (X) | OtherPublicityInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| Provided Written Notice | Yes (X) | ProvidedWrittenNoticeInd |
| Made Effort Orally Notify | Yes (X) | MadeEffortOrallyNotifyInd |
| Processed FAP Application | Yes (X) | ProcessedFAPApplicationInd |
| Made Presumptive Elig Determ | Yes (X) | MadePresumptiveEligDetermInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Look Back Medicare Private | Yes (X) | LookBackMedicarePrivateInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| COMMUNITY HOSPITAL ASSOCIATION OF MCCOOK | PART V, SECTION B, LINE 5: COMMUNITY HOSPITAL WORKED WITH COMMUNITY HOSPITAL CONSULTING TO COLLECT DATA THAT WAS USED TO IDENTIFY THE NEEDS OF OUR REGION. ACCORDING TO THE CHNA PROCESS AND METHODOLOGY, "CHC CONSULTING CONDUCTED THE FOLLOWING RESEARCH: A DEMOGRAPHIC ANALYSIS OF THE STUDY AREA UTILIZING DEMOGRAPHIC DATA FROM THE STRATASAN AND LOCAL REPORTS, A STUDY OF THE MOST RECENT HEALTH DATA AVAILABLE, ONE-ON-ONE PHONE INTERVIEWS WITH INDIVIDUALS WHO HAVE SPECIAL KNOWLEDGE OF THE COMMUNITIES. IN ADDITION THEY ANALYZED THOSE RESULTS AND FACILITATED THE REVIEW OF COLLECTED DATA IN MARCH 2022 WITH THE CHNA TEAM." |
| COMMUNITY HOSPITAL ASSOCIATION OF MCCOOK | PART V, SECTION B, LINE 11: SIX PRIORITY AREAS WERE IDENTIFIED BY THE CHNA TEAM AND WERE DOCUMENTED ON THE CHNA IMPLEMENTATION PLAN TRACKING DOCUMENT THAT IS UPDATED EACH QUARTER. THE SIX PRIORITY AREAS ARE: PREVENTION, EDUCATION AND SERVICES TO ADDRESS HIGH MORTALITY RATES, CHRONIC DISEASES, PREVENTABLE CONDITIONS AND UNHEALTHY LIFESTYLES; FOCUS ON THE NEEDS OF THE AGING POPULATION; CONTINUED EMPHASIS ON PHYSICIAN RECRUITMENT AND RETENTION; ACCESS TO AFFORDABLE CARE AND REDUCING HEALTH DISPARITIES AMONG SPECIFIC POPULATIONS, ACCESS TO MENTAL AND BEHAVIORAL HEALTH CARE SERVICES AND PROVIDERS; AND CONTINUED FOCUS ON COVID-19 PREVENTION & RESPONSE.PRIORITY ONE: PREVENTION, EDUCATION AND SERVICES TO ADDRESS HIGH MORTALITY RATES - ACTIONS DURING THE YEAR INCLUDED HEALTHY CONNECTIONS, SOCIAL MEDIA PROMOTION FOR EVENTS, VIRTUAL WELLNESS FAIR, PROGRAMS LIKE EAT SMART GET FIT AND HEALTHY HEART INITIATIVE. COMMUNITY CONNECT WAS CREATED TO OFFER MORE WELLNESS RELATED TOPICS TO THE COMMUNITY AT LARGE TO REACH BEYOND OUR COMMUNITY PARTNERS. THE FREEDOM RUN WAS HELD IN JULY WITH OVER 100 RUNNERS PARTICIPATING. OTHER EVENTS INCLUDED HERITAGE DAYS RACE IN PARTNERSHIP WITH THE YMCA, HEALTHY KIDS DAY AT THE YMCA, AND THE WELLNESS FAIR IN CURTIS AND MCCOOK. THE HOSPITAL PROVIDED FUNDING AND PRIZES TO THE HEALTH DEPARTMENT FOR WALK TO HEALTH PROGRAM AND PARTICIPATED IN THE SENIOR FUN FAIR WITH HOME HEALTH AND THE CHHF. RADON EDUCATION WAS PROVIDED IN THE VIRTUAL WELLNESS FAIR AND INCLUDED LINKS TO GET RADON TEST OR TO GATHER MORE INFORMATION.PRIORITY TWO: FOCUS ON THE NEEDS OF THE AGING POPULATION - EVERY THURSDAY CH STAFF VOLUNTEER TIME TO DO AN HOUR SHIFT DELIVERING MEALS. LUNCH AND LEARNS WERE HELD EVERY OTHER MONTH ON HEALTH-RELATED TOPICS FOR THE ELDERLY. CH HELD FITNESS REACHING OLDER GENERATIONS CLASSES IN SIX DIFFERENT TOWNS TO ELDERLY RESIDENTS TO PROMOTE PHYSICAL ACTIVITY AMONG SENIORS. CH PROVIDED FUNDING FOR CNA CLASSES TO SUPPORT AND ENCOURAGE INTERESTED INDIVIDUALS TO PURSUE OPPORTUNITIES AS A PRACTICING CNA OR RA IN THE COMMUNITY.PRIORITY THREE: CONTINUED EMPHASIS ON PHYSICIAN RECRUITMENT AND RETENTION - DURING THE YEAR, A NEW PHYSICIAN FOR ORTHO SERVICES WAS ADDED, AND THE BRYAN CARDIOVASCULAR TRUCK WAS SCHEDULED FOR AUGUST TO OFFER SCREENINGS TO THE COMMUNITY. 40 STUDENTS ATTENDED BISON DAYS IN FEBRUARY. CAREER DISCOVERY DAYS HAD 9 SCHOOLS IN ATTENDANCE AND AROUND 100 STUDENTS REGISTERED. HEALTH CAREERS CLASS ATTENDED THROUGHOUT THE SEMESTER AND VARIOUS DEPARTMENTS PARTICIPATED. CH PARTICIPATED IN THE CONNECT THE DOTS PROGRAM WITH THE UNL EXTENSION. OTHER EVENTS INCLUDED THE UNK SCIENCE EXPLORERS CAMP FOR SEVENTH AND EIGHTH GRADE STUDENTS, SENIOR INDUSTRIAL TOUR AND MANY OTHER SHADOW OPPORTUNITIES.PRIORITY FOUR: ACCESS TO AFFORDABLE CARE AND REDUCING HEALTH DISPARITIES AMONG SPECIFIC POPULATIONS - EVENTS HELD DURING THE YEAR INCLUDED THE COMMUNITY HOSPITAL HEALTH FOUNDATION TEDDY BEAR TOSS, PRO AM, CONCERT FOR HEALTHCARE AND THE PINK OUT RODEO FOR CANCER AWARENESS HELD IN JULY. MONTHLY CAR SEAT CHECKS WERE PROVIDED AT THE FIRE STATION FOR FREE. MAGNETS WERE DISTRIBUTED TO THE COMMUNITY REGARDING TRANSPORTATION SERVICES. CH WORKED WITH THE COMMUNITIES OF EXCELLENCE PROGRAM TO PROVIDE UPDATES ON INCREASING ACCESS TO TRANSPORTATION SERVICES IN THE COMMUNITY. BOTH ENDOCRINOLOGY AND SPEECH WERE ADDED AS TELEHEALTH SERVICES DURING THE YEAR.PRIORITY FIVE: ACCESS TO MENTAL AND BEHAVIORAL HEALTH CARE SERVICES AND PROVIDERS - NEW MENTAL HEALTH PROVIDERS WERE HIRED DURING THE YEAR, AND THE BEHAVIORAL HEALTH DEPARTMENT (BH) CREATED AN UPDATED LIST OF AREA PROVIDERS AND SERVICES. BH WORKED TO CREATE SUPPORT GROUPS FOR YOUTH AND IN DECEMBER PRESENTED ON THE EFFECTS OF STRESS FROM THE HOLIDAYS. CH CONTINUES TO PROVIDE MONTHLY NEWSLETTERS AND WEBINARS FOR DIRECTORS ON MENTAL HEALTH TOPICS THROUGH THE EMPLOYEE ASSISTANCE PROGRAM.PRIORITY SIX: CONTINUED FOCUS ON COVID-19 PREVENTION & RESPONSE - THIS NEED WAS NOT SPECIFICALLY ADDRESSED DURING THE YEAR AS MANY OF THE ACTION STEPS LAID OUT IN THE IMPLEMENTATION STRATEGY HAVE BEEN PREVIOUSLY COMPLETED. |
| COMMUNITY HOSPITAL ASSOCIATION OF MCCOOK | PART V, SECTION B, LINE 13B: DISCOUNTING OR 100% WRITE-OFF TO CHARITY CARE IS ALLOWED ABOVE 150% OF THE FEDERAL POVERTY GUIDELINE BASED ON AN ANALYSIS OF INDIVIDUAL NEED AND DETERMINATION OF THE PATIENT BEING MEDICALLY INDIGENT; THIS ANALYSIS INCLUDES FACTORS SUCH AS INCOME, ACCESSIBLE ASSETS, MEDICAL AND/OR OTHER DEBTS, THE LIKELIHOOD OF ONGOING MEDICAL CARE AND THE INDIVIDUAL'S OVERALL ABILITY TO PAY.PATIENTS WHO QUALIFY FOR FINANCIAL ASSISTANCE AS MEDICALLY INDIGENT WILL BE RESPONSIBLE FOR THEIR MEDICAL BILLS UP TO A PERCENT OF THE GREATER OF THEIR HOUSEHOLD INCOME OR NET WORTH BASED ON AMOUNTS PROVIDED IN THE FINANCIAL ASSISTANCE POLICY. THERE IS NO LIMIT TO THE FPG INCOME, BUT PATIENTS OVER 501% OF FEDERAL POVERTY GUIDELINES MAY RECEIVE A DISCOUNT IF THEIR FAMILY'S MEDICAL BILLS AND RELATED DEBT ARE NO MORE THAN THE GREATER OF 20% OF HOUSEHOLD INCOME OR 10% OF NET WORTH.THE HOSPITAL MAY USE PRESUMPTIVE ELIGIBILITY AND PREVIOUS FINANCIAL ASSISTANCE DETERMINATIONS TO PROVIDE FINANCIAL ASSISTANCE IN CERTAIN CIRCUMSTANCES WHEN A PATIENT FAILS TO SUPPLY SUFFICIENT INFORMATION TO SUPPORT ELIGIBILITY. |
| COMMUNITY HOSPITAL ASSOCIATION OF MCCOOK | PART V, SECTION B, LINE 16J: THE HOSPITAL PUBLICIZED THE FINANCIAL ASSISTANCE POLICY ON BILLING INVOICES, ON POSTERS IN THE ER AND WAITING ROOMS, AT THE ADMISSIONS DESKS, INCLUDING UPON ADMISSIONS WITH SUMMARY NOTICES OF THE POLICIES. THE COMPLETE POLICY WAS AVAILABLE ON THE HOSPITAL'S WEBSITE AND UPON REQUEST. THE HOSPITAL ALSO PUBLICIZED THE POLICY THROUGH REFERRALS BY CLINICAL, SOCIAL WORKERS, AND OTHER STAFF TO THE HOSPITAL'S FINANCIAL COUNSELORS. COMMUNITY HOSPITAL ASSOCIATION OF MCCOOK DOES NOT HAVE AN LEP POPULATION OF A SINGLE PRIMARY LANGUAGE THAT REACHES 1,000 INDIVIDUALS OR 5% OF THE COMMUNITY SERVED BY THE HOSPITAL. HOWEVER, WITH SPANISH AS THE PREDOMINANT NON-ENGLISH LANGUAGE WE HAVE OPTED TO OFFER A FAP APPLICATION FORM IN THAT LANGUAGE FOR OUR PATIENTS' CONVENIENCE. |
| SCHEDULE H, PART V, SECTION B, LINE 7A AND 10A: | COMMUNITY HEALTH NEEDS ASSESSMENT AND IMPLEMENTATION STRATEGY WEBSITE:HTTPS://CHMCCOOK.ORG/ABOUT/COMMUNITY-HEALTH-NEEDS-ASSESSMENT.HTML |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 3 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (3 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| 1 - COMMUNITY HEALTHCARE & HOSPICE | ||||
| 407 WEST 5TH STREET | MCCOOK | NE | 69001 | HOME HEALTH AND HOSPICE SERVICES |
| 2 - CURTIS MEDICAL CENTER | ||||
| 302 EAST 6TH STREET | CURTIS | NE | 69025 | RURAL HEALTH CLINIC-OUTPATIENT SERVICES |
| 3 - TRENTON MEDICAL CLINIC | ||||
| 406 EAST 1ST STREET | TRENTON | NE | 69044 | RURAL HEALTH CLINIC-OUTPATIENT SERVICES |
Supplemental Information Detail SupplementalInformationDetail (12 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 3C: | CHARITY CARE IS GRANTED TO ALL INDIVIDUALS WHOSE HOUSEHOLD INCOME IS BELOW 150% OF THE FEDERAL POVERTY GUIDELINE AT THE 100% WRITE-OFF LEVEL. DISCOUNTING OR 100% WRITE-OFF TO CHARITY CARE IS ALLOWED ABOVE 150% OF THE FEDERAL POVERTY GUIDELINE BASED ON AN ANALYSIS OF INDIVIDUAL NEED AND DETERMINATION OF THE PATIENT BEING MEDICALLY INDIGENT; THIS ANALYSIS INCLUDES FACTORS SUCH AS INCOME, ACCESSIBLE ASSETS, MEDICAL OR/AND OTHER DEBTS, THE LIKELIHOOD OF ONGOING MEDICAL CARE AND THE INDIVIDUAL'S OVERALL ABILITY TO PAY.PATIENTS WHO QUALIFY FOR FINANCIAL ASSISTANCE AS MEDICALLY INDIGENT WILL BE RESPONSIBLE FOR THEIR MEDICAL BILLS UP TO A PERCENT OF THE GREATER OF THEIR HOUSEHOLD INCOME OR NET WORTH BASED ON AMOUNTS PROVIDED IN THE FINANCIAL ASSISTANCE POLICY. THERE IS NO LIMIT TO THE FPG INCOME, BUT PATIENTS OVER 501% OF FEDERAL POVERTY GUIDELINES MAY RECEIVE A DISCOUNT IF THEIR FAMILY'S MEDICAL BILLS AND RELATED DEBT ARE NO MORE THAN THE GREATER OF 20% OF HOUSEHOLD INCOME OR 10% OF NET WORTH.THE HOSPITAL MAY USE PRESUMPTIVE ELIGIBILITY AND PREVIOUS FINANCIAL ASSISTANCE DETERMINATIONS TO PROVIDE FINANCIAL ASSISTANCE IN CERTAIN CIRCUMSTANCES WHEN A PATIENT FAILS TO SUPPLY SUFFICIENT INFORMATION TO SUPPORT ELIGIBILITY. |
| PART I, LINE 7: | CHARITY CARE EXPENSE WAS CONVERTED TO COST ON LINE 7A BASED ON AN OVERALL COST-TO-CHARGE RATIO ADDRESSING ALL PATIENT SEGMENTS. UNREIMBURSED MEDICAID ON LINE 7B WAS CALCULATED USING THE COSTING METHODS TO PREPARE THE COST REPORTS. COMMUNITY HEALTH IMPROVEMENT SERVICES, LINE 7E, AND CASH AND IN-KIND CONTRIBUTIONS, LINE 7I, ARE REPORTED BASED ON ACTUAL EXPENSES REPORTED IN THE GENERAL LEDGER. |
| PART III, LINE 2: | THE AMOUNT ON LINE 2 REPRESENTS IMPLICIT PRICE CONCESSIONS. THE ORGANIZATION DETERMINES ITS ESTIMATE OF IMPLICIT PRICE CONCESSION BASED ON ITS HISTORICAL COLLECTION EXPERIENCE WITH THIS CLASS OF PATIENTS. FOR THE FISCAL YEAR, THE AMOUNT OF IMPLICIT PRICE CONCESSIONS REPORTED IS $1,511,589. |
| PART III, LINE 3: | BASED ON A COMBINATION OF PAST EXPERIENCE AND CENSUS DATA AVAILABLE, THE HOSPITAL ESTIMATES 15% OF THE PATIENT IMPLICIT PRICE CONCESSIONS IS ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY. IN ACCORDANCE WITH ITS MISSION OBJECTIVES, THE HOSPITAL PROVIDES FINANCIAL ASSISTANCE TO PATIENTS WHO LACK FINANCIAL RESOURCES TO PAY FOR THE SERVICES THEY RECEIVE, AND THE HOSPITAL RECOGNIZES THE SPECIAL CONCERNS OF INDIVIDUALS AND HOUSEHOLDS WITH LIMITED FINANCIAL RESOURCES OR WHO ARE OTHERWISE VULNERABLE WITHIN THE COMMUNITY THE HOSPITAL SERVICES. |
| PART III, LINE 4: | THE FOOTNOTE TO THE ORGANIZATION'S FINANCIAL STATEMENTS THAT DESCRIBES IMPLICIT PRICE CONCESSIONS IS LOCATED IN FOOTNOTE 1 ON PAGES 13 THROUGH 15 OF THE ATTACHED FINANCIAL STATEMENTS. |
| PART III, LINE 8: | THE ENTIRE MEDICARE SHORTFALL IS CONSIDERED A COMMUNITY BENEFIT. SERVICES ARE PROVIDED TO PATIENTS UNDER THE MEDICARE PROGRAM EVEN THOUGH THE HOSPITAL KNOWS THEY WILL NOT RECOVER ALL OF THE COSTS FROM PROVIDING THE SERVICES. THIS PROGRAM IS CONSIDERED SUBSIDIZED BY THE HOSPITAL AND OTHER PAYORS. PATIENTS RELY ON THESE SERVICES FOR THEIR HEALTH AND WELL-BEING AND ARE ESSENTIAL FOR THEIR ACCESS TO HEALTHCARE. TOTAL REVENUE RECEIVED FROM MEDICARE IS THE GROSS REIMBURSEMENT PLUS SETTLEMENT. BOTH TOTAL REVENUE RECEIVED FROM MEDICARE AND THE MEDICARE ALLOWABLE COSTS ARE REPORTED FROM THE MEDICARE COST REPORT. THE MEDICARE COST REPORT IS COMPLETED BASED ON THE RULES AND REGULATIONS SET FORTH BY CENTERS FOR MEDICARE AND MEDICAID SERVICES. |
| PART III, LINE 9B: | THE HOSPITAL WILL NOT TAKE ECAS AGAINST A PATIENT OR ANY OTHER INDIVIDUAL WHO HAS ACCEPTED OR IS REQUIRED TO ACCEPT FINANCIAL RESPONSIBILITY FOR A PATIENT UNLESS AND UNTIL THE HOSPITAL HAS MADE "REASONABLE EFFORTS" TO DETERMINE WHETHER THE PATIENT IS ELIGIBLE FOR FINANCIAL ASSISTANCE UNDER THIS POLICY. PATIENT FINANCIAL COUNSELING IS RESPONSIBLE TO DETERMINE WHETHER THE HOSPITAL HAS ENGAGED IN REASONABLE EFFORTS TO DETERMINE WHETHER A PATIENT IS ELIGIBLE FOR FINANCIAL ASSISTANCE.THE HOSPITAL DOES NOT TAKE ECAS AGAINST THE PATIENTS FOR AT LEAST 120 DAYS FROM THE DATE THE HOSPITAL PROVIDES THE PATIENT WITH THE FIRST POST-DISCHARGE BILL FOR CARE. A WRITTEN NOTICE IS SENT TO THE PATIENT AT LEAST 30 DAYS PRIOR TO ANY ECAS. THE NOTICE CONTAINS THE FOLLOWING INFORMATION:1. NOTIFIES THE PATIENT OF THE AVAILABILITY OF FINANCIAL ASSISTANCE,2. IDENTIFIES THE SPECIFIC ECA(S) THE HOSPITAL INTENDS TO INITIATE AGAINST THE PATIENT,3. STATES A DEADLINE AFTER WHICH ECAS MAY BE INITIATED THAT IS NO EARLIER THAN 30 DAYS AFTER THE DATE THE NOTICE IS PROVIDED TO THE PATIENT;5. PROVIDES A PLAIN LANGUAGE SUMMARY OF THE FINANCIAL ASSISTANCE POLICY WITH THE AFOREMENTIONED NOTICE; ANDMAKES A REASONABLE EFFORT TO ORALLY NOTIFY THE PATIENT ABOUT THE POTENTIAL AVAILABILITY OF FINANCIAL ASSISTANCE AT LEAST 30 DAYS PRIOR TO INITIATING ECAS AGAINST THE PATIENT DESCRIBING HOW THE INDIVIDUAL MAY OBTAIN ASSISTANCE WITH THE FINANCIAL ASSISTANCE APPLICATION PROCESS. |
| PART VI, LINE 2: | IN ADDITION TO THE CHNA, COMMUNITY HOSPITAL CONTINUES TO ASSESS THE HEALTH NEEDS OF THE COMMUNITY THROUGH A VARIETY OF WAYS, INCLUDING (BUT NOT LIMITED TO) THE FOLLOWING:1) COMMUNITY HOSPITAL IS A KEY MEMBER OF MCCOOK ON THE MOVE INITIATIVE. THIS INCLUDES FOUR KEY COMMUNITY GROUPS THAT MEET REGULARLY AND LEAD/COORDINATE ACTIVITIES WITHIN THE COMMUNITY, WHICH INCLUDE THE FAMILY, EDUCATION, HEALTH, AND ECONOMIC DEVELOPMENT PILLARS. THE HEALTH PILLAR ATTEMPTS TO BRING TOGETHER ALL THE MAJOR HEALTHCARE PROVIDERS AND PUBLIC HEALTH AGENCIES QUARTERLY TO MAINTAIN AWARENESS AND WORK WITH EACH OTHER TO ADDRESS ISSUES AS THEY EMERGE. THE HEALTH PILLAR ALSO FOCUSES ON PROJECTS THAT PROMOTE A HEALTHY LIFESTYLE. 2) COMMUNITY HOSPITAL REGULARLY SCREENS PATIENTS FOR SOCIAL DETERMINANTS OF HEALTH; INCLUDING FINANCIAL, TRANSPORTATION CONCERNS, ISSUES RELATED TO LIVING ALONE, AND OTHER SOCIAL AND FINANCIAL ISSUES THAT IMPACT THE PATIENT'S HEALTH. WE HAVE PUT VARIOUS PROCESSES IN PLACE TO HELP THESE PATIENTS ADDRESS THESE CONCERNS AND ISSUES AS THEY ARE IDENTIFIED.3) COMMUNITY HOSPITAL REGULARLY MEETS WITH OUR NURSING HOMES AND OTHER LONG TERM ASSISTED CARE FACILITIES AS WELL AS OTHER PROVIDERS IN THE REGION TO ASSURE THAT THE CONTINUUM OF CARE FOR PATIENTS ARE WELL MET AND THAT WE ARE AWARE OF AND CAN ADDRESS ANY CONCERNS AS THEY COME TO OUR ATTENTION. |
| PART VI, LINE 3: | IDENTIFICATION OF PATIENTS WITH A POTENTIAL NEED FOR FINANCIAL ASSISTANCE WILL BE ACCOMPLISHED BY BOTH AN OPEN AND PUBLICIZED APPLICATION PROCESS AND A VARIETY OF SCREENING OPPORTUNITIES INCLUDING:A. ADMISSIONS/REGISTRATION PERSONNEL BASED UPON INFORMATION RECEIVED DURING THE REGISTRATION PROCESS.B. SOCIAL SERVICES PERSONNEL BASED UPON INFORMATION DURING THE INITIAL VISIT AND DISCHARGE PLANNING.C. NURSING STAFF BASED UPON INFORMATION RECEIVED DURING DISCUSSIONS WITH FAMILY AND/OR PATIENT.D. BUSINESS OFFICE PERSONNEL BASED UPON STATUS OF ACCOUNTS AND DISCUSSIONS WITH RESPONSIBLE PARTY.E. ACCOUNTS RECEIVABLE REPORTS.HOSPITAL STAFF OR THE NOTIFIED PATIENT ADVOCATE WILL EDUCATE THE PATIENT OR GUARANTOR ABOUT THE FINANCIAL ASSISTANCE POLICY AND WILL PROVIDE THEM AN APPLICATION FOR FINANCIAL ASSISTANCE. IF NECESSARY, THE PATIENT FINANCIAL COUNSELOR OR OTHER HOSPITAL STAFF MAY ASSIST THE PATIENT IN COMPLETING THE APPLICATION; HOWEVER, THE COMPLETION OF AN APPLICATION AND PROVIDING ALL NECESSARY SUPPORTING DOCUMENTATION IS THE PATIENT'S RESPONSIBILITY. PATIENTS MAY ALSO REQUEST AN APPLICATION OR ADDITIONAL INFORMATION IN PERSON AT THE ADMISSIONS OFFICE OR BY CALLING OR WRITING THE PATIENT FINANCIAL COUNSELOR AND AN APPLICATION WILL BE MAILED.IF A PATIENT SUBMITS A COMPLETED FINANCIAL ASSISTANCE APPLICATION DURING THE APPLICATION PERIOD AND THE HOSPITAL DETERMINES THAT THE PATIENT MAY BE ELIGIBLE FOR PARTICIPATION IN MEDICAID, THE HOSPITAL WILL NOTIFY THE PATIENT IN WRITING OF SUCH POTENTIAL ELIGIBILITY AND REQUEST THAT THE PATIENT TAKE STEPS NECESSARY TO ENROLL IN SUCH PROGRAM. IN SUCH CIRCUMSTANCES THE HOSPITAL WILL DELAY THE PROCESSING OF THE PATIENT'S FINANCIAL ASSISTANCE APPLICATION UNTIL THE PATIENT'S APPLICATION FOR MEDICAID IS COMPLETED, SUBMITTED TO THE REQUISITE GOVERNMENTAL AUTHORITY, AND A DETERMINATION HAS BEEN MADE. |
| PART VI, LINE 4: | COMMUNITY HOSPITAL SERVES A PRIMARY MARKET OF RED WILLOW COUNTY, WHICH IS LOCATED ON THE SOUTHERN BORDER OF NEBRASKA. IT IS 717 SQUARE MILES AND HAS APPROXIMATELY 15.0 PEOPLE PER SQUARE MILE. MCCOOK IS THE COUNTY SEAT. COMMUNITY HOSPITAL ALSO SERVES A SECONDARY MARKET INCLUDING NORTHERN KANSAS AND SOUTHWEST NEBRASKA, WHICH CONSISTS OF FURNAS, NE, HITCHCOCK, NE, DECATUR, KS, CHEYENNE, KS, FRONTIER, NE, RAWLINS, KS AND HAYES, NE. THE TOTAL ESTIMATED POPULATION FOR COMMUNITY HOSPITAL'S SERVICE AREA IS APPROXIMATELY 30,348. RED WILLOW COUNTY HAS A POPULATION OF APPROXIMATELY 10,747. THE GROUP OF COUNTIES WHICH MAKE UP THE SECONDARY MARKET FOR COMMUNITY HOSPITAL HAVE A POPULATION OF APPROXIMATELY 19,601. THE HOUSEHOLD INCOME AVERAGES FOR THESE AREAS ARE AS FOLLOWS:11.75% $0 - 15K14.5% $15K - 25K29% $25K - 50K18.5% $50K - 75K12.5% $75K - 100K13.5% $100K+ |
| PART VI, LINE 5: | COMMUNITY HOSPITAL IS THE LARGEST HOSPITAL WITHIN AN HOUR TRAVEL TIME FOR MOST OF THE COMMUNITY SERVED. THE HOSPITAL PROVIDES THE PHYSICIANS OF MCCOOK A HOSPITAL IN WHICH TO PRACTICE MEDICINE. WITHOUT THE HOSPITAL OUR PATIENTS WOULD HAVE EXTREMELY LONG DISTANCES TO TRAVEL FOR EVERYTHING FROM EMERGENCY TO ROUTINE CARE. OUR HOSPITAL IS OVERSEEN BY A NON-COMPENSATED BOARD OF INDEPENDENT COMMUNITY MEMBERS. ANY PROFITS FROM THE OPERATION OF THE HOSPITAL ARE REINVESTED BACK INTO THE FACILITIES, EQUIPMENT AND STAFF TO PROVIDE OUR COMMUNITY WITH CURRENT AND HIGH QUALITY MEDICAL SERVICES CLOSE TO HOME. |
| PART VI, LINE 7, REPORTS FILED WITH STATES | NE |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (1) | GrantRecordsMaintainedInd |
Recipient Table RecipientTable (9 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | Recipient EINRecipientEIN | IRC SectionIRCSectionDesc | Cash GrantCashGrantAmt | Non Cash AssistanceNonCashAssistanceAmt | Purpose Of GrantPurposeOfGrantTxt |
|---|---|---|---|---|---|---|---|---|
| COMMUNITY HOSPITAL HEALTH FOUNDATION | ||||||||
| 1301 E H ST | MCCOOK | NE | 69001 | 470693261 | 501(C)(3) | $82,586 | $0 | TO SUPPORT THE MISSION OF THE FOUNDATION |
| MCCOOK COLLEGE FOUNDATION | ||||||||
| 1205 EAST 1ST ST | MCCOOK | NE | 69001 | 476089800 | 501(C)(3) | $5,600 | $0 | SPONSOR OF HORMEL COMPETITION AND SPORTS SPONSORSHIP |
| UNIVERSITY OF NEBRASKA FOUNDATION | ||||||||
| 1010 LINCOLN MALL SUITE 300 | LINCOLN | NE | 68508 | 470379839 | 501(C)(3) | $30,000 | $0 | DONATION TO SUPPORT THE HEALTH SCIENCES PROGRAM (KHOP) |
| YMCA OF MCCOOK | ||||||||
| PO BOX 408 | MCCOOK | NE | 69001 | 470377999 | 501(C)(3) | $201,540 | $0 | PLEDGE ON REMODEL CAMPAIGN AND VARIOUS TEAM SPONSORSHIPS |
| NORTH PLATTE COMMUNITY COLLEGE FOUNDATION | ||||||||
| 601 WEST STATE FARM RD | NORTH PLATTE | NE | 69101 | 202459157 | 501(C)(3) | $10,450 | $0 | PLEDGE FOR HEALTH SCIENCES BUILDING AND SPORTS SPONSORSHIPS |
| MCCOOK ECONOMIC DEVELOPMENT CORP | ||||||||
| 402 NORRIS AVE SUITE 301 | MCCOOK | NE | 69001 | 470685662 | 501(C)(6) | $23,200 | $0 | SPONSORING VARIOUS COMMUNITY DEVELOPMENT PROJECTS |
| MCCOOK AREA CHAMBER OF COMMERCE | ||||||||
| 402 NORRIS AVE SUITE 316 | MCCOOK | NE | 69001 | 470233780 | 501(C)(6) | $8,000 | $0 | SPONSORSHIP |
| RED WILLOW CO FAIR BOARD | ||||||||
| PO BOX 876 | MCCOOK | NE | 69001 | GOVERNMENTAL | $30,000 | $0 | FAIR SPONSOR | |
| CITY OF MCCOOK | ||||||||
| 505 WEST C STREET | MCCOOK | NE | 69001 | GOVERNMENTAL | $20,000 | $0 | MATCHING FUNDS FOR CCCFF GRANT | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 7 | Total501c3OrgCnt |
| Total Other Org | 2 | TotalOtherOrgCnt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 2: | FormAndLineReferenceDesc |
| Explanation | GRANTS ARE MADE ONLY TO SELECTED CHARITABLE OR OTHER EXEMPT ORGANIZATIONS. COMMUNITY HOSPITAL ASSOCIATION ENTERS INTO AGREEMENTS WITH GRANTEES THAT GRANT FUNDS WILL BE RESTRICTED TO SPECIFIED EXEMPT PURPOSES. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Written Employment Contract | Yes (X) | WrittenEmploymentContractInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (7 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| RICHARD LAWTON | ||||||||||||||
| ORTHO PHYSICAN | $704,938 | $0 | $15,423 | $0 | $2,772 | $0 | $23,100 | $0 | $38,941 | $0 | $785,174 | $0 | $0 | $0 |
| JENNIFER CRAIG | ||||||||||||||
| EMERGENCY DEPT PHYSICIAN | $386,420 | $0 | $43,488 | $0 | $636 | $0 | $0 | $0 | $50,864 | $0 | $481,408 | $0 | $0 | $0 |
| ROSS BEAVERS | ||||||||||||||
| CRNA | $349,736 | $0 | $4,275 | $0 | $630 | $0 | $23,100 | $0 | $3,243 | $0 | $380,984 | $0 | $0 | $0 |
| EVAN GEILENKIRCHEN | ||||||||||||||
| CRNA | $311,611 | $0 | $4,275 | $0 | $1,806 | $0 | $22,846 | $0 | $31,936 | $0 | $372,474 | $0 | $0 | $0 |
| TROY BRUNTZ | ||||||||||||||
| CEO | $315,180 | $0 | $4,500 | $0 | $966 | $0 | $22,829 | $0 | $28,582 | $0 | $372,057 | $0 | $0 | $0 |
| SEAN WOLFE | ||||||||||||||
| CFO | $210,859 | $0 | $4,450 | $0 | $420 | $0 | $15,817 | $0 | $40,617 | $0 | $272,163 | $0 | $0 | $0 |
| ANTHONY RODEWALD | ||||||||||||||
| PHARMACY DIRECTOR | $202,658 | $0 | $4,500 | $0 | $608 | $0 | $15,284 | $0 | $40,827 | $0 | $263,877 | $0 | $0 | $0 |
Schedule L IRS990ScheduleL
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp (2 entries)
| Relationship DescriptionRelationshipDescriptionTxt | TransactionTransactionAmt | TransactionTransactionDesc | Sharing Of RevenuesSharingOfRevenuesInd |
|---|---|---|---|
| HANNAH TAYLOR | |||
| BOARD MEMBER DARREN ESCH'S DAUGHTER | $23,644 | EMPLOYEE WAGES | 0 |
| KATHERINE STAGEMEYER | |||
| BOARD MEMBER KRISTIN STAGEMEYER'S DAUGHTER-IN-LAW | $72,898 | EMPLOYEE WAGES | 0 |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (8 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 4 | COMMUNITY HOSPITAL REMOVED MEMBERSHIP FROM THE CORPORATION. IN ADDITION, THEY MADE THE SELECTION OF NEW BOARD MEMBERS A SELF PERPETUATING PROCESS INSTEAD OF AN ELECTION BY THE MEMBERSHIP. |
| 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 | COMMUNITY HOSPITAL'S FORM 990 & 990-T ARE PREPARED BY THE PUBLIC ACCOUNTING FIRM EIDE BAILLY. MANAGEMENT RECEIVES DRAFT COPIES OF THE COMPLETED FORMS FOR REVIEW. AFTER HOSPITAL MANAGEMENT HAS REVIEWED THE RETURNS, COMPLETE COPIES ARE DISTRIBUTED TO ALL MEMBERS OF THE BOARD OF DIRECTORS OF THE COMMUNITY HOSPITAL ASSOCIATION. |
| FORM 990, PART VI, SECTION B, LINE 12C | THE COMMUNITY HOSPITAL ASSOCIATION'S CODE OF CONDUCT REQUIRES ALL EMPLOYEES, CONTRACTORS, AND AGENTS TO REPORT ANY CONFLICTS OF INTEREST THAT ARISE. IN ADDITION, THE ASSOCIATION HAS A CONFLICT OF INTEREST POLICY APPLICABLE TO DIRECTORS, OFFICERS, MEMBERS OF COMMITTEES AND SUBCOMMITTEES WITH BOARD-DELEGATED POWERS, AND KEY EMPLOYEES THAT REQUIRES, AMONG OTHER THINGS, ALL APPLICABLE PERSONS DISCLOSE ANY RELATIONSHIPS THAT MAY CREATE A CONFLICT OF INTEREST AND ARE REQUIRED TO COMPLETE AN ANNUAL DISCLOSURE OF ALL SUCH RELATIONSHIPS. ALL SUCH RELATIONSHIPS ARE DISCLOSED TO THE ENTIRE BOARD AND SENIOR MANAGEMENT, AND ANY AND ALL CONFLICTS OR POTENTIAL CONFLICTS ARE MONITORED BY SENIOR MANAGEMENT AND THE ASSOCIATION'S COMPLIANCE FUNCTION. |
| FORM 990, PART VI, SECTION B, LINE 15 | COMMUNITY HOSPITAL'S PROCESS FOR DETERMINING THE COMPENSATION OF THE CEO IS AS FOLLOWS: THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS IS RESPONSIBLE FOR SETTING THE SALARY OF THE CEO. ANNUALLY, THE COMMITTEE CONDUCTS A REVIEW OF THE CEO'S PERFORMANCE, ABILITIES, AND OVERALL EFFECTIVENESS. THE COMMITTEE IS PRESENTED WITH SALARY AND COMPENSATION SURVEY DATA THAT IS COMPILED BY THE CEO AND THE HUMAN RESOURCE DEPARTMENT AND THE ACCURACY OF WHICH IS ATTESTED TO BY THE CFO. MULTIPLE SOURCES OF SURVEY DATA ARE USED, INCLUDING INFORMATION FROM THE NEBRASKA AND IOWA HOSPITAL ASSOCIATIONS, WHICH IS BROKEN DOWN TO SIMILARLY QUALIFIED PERSONS IN COMPARABLE POSITIONS AT SIMILARLY SIZED AND SITUATED ORGANIZATIONS. ALL SOURCE DOCUMENTATION IS GIVEN TO THE COMMITTEE AS WELL AS SUMMARIES PROVIDED FOR EASE OF REFERENCE. THE EXECUTIVE COMMITTEE CONDUCTS THE PERFORMANCE REVIEW WITH THE CEO; THEN MEETS IN PRIVATE CHAMBERS TO DISCUSS THE REVIEW AND TO DELIBERATE ANY AND ALL CHANGES TO THE EMPLOYMENT AGREEMENT, INCLUDING COMPENSATION, AND GOALS FOR THE FOLLOWING YEAR. CONTEMPORANEOUS RECORDS ARE KEPT OF ALL SURVEY AND COMPARABILITY DATA USED, AND THE RESULTS AND DECISIONS OF THE EXECUTIVE COMMITTEES MEETING ON COMPENSATION. COMPENSATION OF EMPLOYEES BELOW THE ROLE OF CEO ARE DETERMINED THROUGH THE USE OF SURVEY INFORMATION OF SIMILARLY QUALIFIED PERSONS IN COMPARABLE POSITIONS AT SIMILARLY SIZED AND SITUATED ORGANIZATIONS. THE CEO SETS THE COMPENSATION OF SENIOR MANAGEMENT BASED ON THOSE SURVEYS, TAKING IN CONSIDERATION PERFORMANCE AND EXPERIENCE OF EACH INDIVIDUAL. COMPENSATION RANGES OF EMPLOYEES BELOW SENIOR MANAGEMENT ARE SET BY HUMAN RESOURCES BASED ON MARKET WAGE RATES FOR SIMILARLY QUALIFIED PERSONS IN COMPARABLE POSITIONS AT SIMILARLY SIZED AND SITUATED ORGANIZATIONS. ALL EMPLOYEES HAVE AN ANNUAL REVIEW BY THEIR SUPERVISOR, WHICH DETERMINE WHERE IN THE SALARY RANGE AN EMPLOYEE WILL FALL. ALL SALARY RANGES, INCLUDING THOSE OF SENIOR MANAGEMENT, ARE ULTIMATELY APPROVED BY THE BOARD OF DIRECTORS DURING THE APPROVAL OF THE ANNUAL OPERATING BUDGET. |
| FORM 990, PART VI, SECTION C, LINE 19 | COMMUNITY HOSPITAL MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, FORM 990 & 990-T (CURRENT AND PAST YEARS AS REQUIRED BY LAW) AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. ANY INDIVIDUAL WHO WOULD LIKE A COPY OF ANY OF THE ABOVE MENTIONED DOCUMENTS MAY INSPECT THOSE DOCUMENTS IN PERSON AT THE HOSPITAL DURING NORMAL BUSINESS HOURS, OR REQUEST A COPY OF ANY OF THE ABOVE INFORMATION IN PERSON, BY PHONE, OR BY MAIL, AND WE WILL PROVIDE A COPY FREE OF CHARGE. |
| FORM 990, PART IX, LINE 11G | MISCELLANEOUS FEES FOR SERVICE: PROGRAM SERVICE EXPENSES 2,985,449. MANAGEMENT AND GENERAL EXPENSES 322,571. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,308,020. PHYSICIAN FEES: PROGRAM SERVICE EXPENSES 4,612,020. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,612,020. MAINTENANCE CONTRACTS: PROGRAM SERVICE EXPENSES 1,228,086. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,228,086. PT CONTRACT SERVICES: PROGRAM SERVICE EXPENSES 1,470,481. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,470,481. COLLECTION FEES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 145,047. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 145,047. |
| FORM 990, PART XII, LINE 2C | COMMUNITY HOSPITAL HAS A STANDING BOARD COMMITTEE, THE BUDGET AND FINANCE COMMITTEE, WHICH HAS THE AUTHORITY AND ASSUMES THE RESPONSIBILITY FOR THE SELECTION OF THE INDEPENDENT ACCOUNTING FIRM AND ALL RELATED OVERSIGHT, COMMUNICATION, AND REPORTING. THIS COMMITTEE APPROVES ALL ENGAGEMENT LETTERS AND RECEIVES ALL BOARD DIRECTED COMMUNICATION FROM THE INDEPENDENT ACCOUNTING FIRM. COPIES OF RECEIVED LETTERS/COMMUNICATIONS AND REPORTS ARE DISTRIBUTED TO ALL MEMBERS OF THE BOARD OF DIRECTORS IN ADDITION TO THE COMMITTEE MEMBERS. WHILE THE MEMBERS OF THE COMMITTEE HAVE CHANGED, THE PROCESS DESCRIBED HAS NOT CHANGED FROM THE PREVIOUS YEAR. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp
Disregarded Entity Name DisregardedEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | COMMUNITY HOSPITAL HEALTH FOUNDATION | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 801 WEST C STREET PO BOX 1328 | AddressLine1Txt |
| City | MCCOOK | CityNm |
| State Abbreviation | NE | StateAbbreviationCd |
| ZIP | 69001 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 470693261 | EIN |
| Primary Activities | SUPPORTING ORGANIZATION PROVIDES FUNDRAISING FOR THE HOSPITAL | PrimaryActivitiesTxt |
| Legal Domicile State | NE | LegalDomicileStateCd |
| Exempt Code Section | 501(C)(3) | ExemptCodeSectionTxt |
| Public Charity Status | LINE 12A, I | PublicCharityStatusTxt |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | COMMUNITY HOSPITAL ASSOCIATION OF MCCOOK | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Controlled Organization | Yes (1) | ControlledOrganizationInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | Yes (1) | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (1) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | Yes (1) | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (1) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (1) | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (1) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (1) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp (2 entries)
| Transaction TypeTransactionTypeTxt | InvolvedInvolvedAmt | Method Of Amount DeterminationMethodOfAmountDeterminationTxt |
|---|---|---|
| COMMUNITY HOSPITAL HEALTH FOUNDATION | ||
| C | $437,927 | CASH TRANSFERRED EQUALS FMV |
| COMMUNITY HOSPITAL HEALTH FOUNDATION | ||
| B | $82,586 | CASH TRANSFERRED EQUALS FMV |
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