2023-11-13T16:07:19-06:00 2022-12-31 470617373 COMMONSPIRIT HEALTH 198 INVERNESS DRIVE WEST ENGLEWOOD CO 80112 990 2022-01-01 470426285 MEMORIAL COMMUNITY HOSPITAL MEMO 4024262182 810 NORTH 22ND STREET BLAIR NE 68008 TIM SCHNACK VP OPERATIONAL FINANCE & CFO 4024261295 2023-11-13 1 TIM SCHNACK XXX-XX-XXXX 0 HEATHER ADKINS P01725376 3032989100 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z JENNIFER NEWBY 810 NORTH 22ND STREET BLAIR NE 68008 48448935 0 X WWW.MCHHS.ORG X 1956 NE AS AN ENGAGED TEAM OF PHYSICIANS, MEDICAL PROFESSIONALS, AND SUPPORT STAFF WE ARE COMMITTED TO DELIVERING STATE-OF-THE-ART HEALTH CARE TAILORED TO OUR UNIQUE COMMUNITY AND SECOND TO NONE IN THE AREA. 7 5 334 8 0 0 2465869 1205943 40328732 45922708 458568 130336 791509 1187314 44044678 48446301 0 0 0 0 22058998 26138601 0 0 0 16951110 18166396 39010108 44304997 5034570 4141304 56275818 56664523 15612240 12573653 40663578 44090870 X AS A COMMUNITY HOSPITAL, MEMORIAL COMMUNITY HOSPITAL AND HEALTH SYSTEM OF BLAIR HAS STAYED COMMITTED TO KEEPING RESIDENTS OF WASHINGTON AND BURT COUNTY IN GOOD HEALTH. MEMORIAL COMMUNITY HOSPITAL HAS STRIVEN TO IMPROVE THE HEALTH STATUS OF RURAL NEBRASKA RESIDENTS THROUGH THE FOLLOWING SERVICES: 24-HOUR EMERGENCY CARE WITH HELIPORT ACCOMMODATIONS, LABOR AND DELIVERY AND CARDIOVASCULAR. CARDIOVASCULAR SERVICES INCLUDE THE FOLLOWING NON-INVASIVE DIAGNOSTICS STUDIES SUCH AS EKG, TELEMETRY MONITORING, TREADMILL STRESS TESTING, ECHO CARDIOGRAM, AND STRESS ECHO CARDIOGRAM. MEMORIAL COMMUNITY HOSPITAL AND HEALTH SYSTEM PROVIDES A VARIETY OF SPECIALTY CLINICS LOCATED IN BLAIR. ALLERGY/ASTHMA/IMMUNOLOGY, PAIN MANAGEMENT/ANESTHESIA, CARDIOLOGY, ENDOCRINOLOGY, ENT, GENERAL SURGERY, OB/GYN, NEPHROLOGY, NEUROLOGY, NEUROSURGERY, ONCOLOGY, ORTHOPEDICS, ORTHOTICS/PROSTHETICS, PLASTIC SURGERY, DERMATOLOGY, AND PODIATRY. 0 0 5272468 0 8263598 MEMORIAL COMMUNITY HOSPITAL OF BLAIR PROVIDES HEALTH CLINICS FOR THE RESIDENTS OF BLAIR AND SURROUNDING COMMUNITIES WITH HEALTH CARE PROVIDERS IN A VARIETY OF MEDICAL SPECIALTIES. THE HEALTH CLINICS REVENUE OF $8,263,598 IS THE GROSS REVENUE AFTER CONTRACTUAL ADJUSTMENTS. 1855095 0 4061930 MEMORIAL COMMUNITY HOSPITAL OF BLAIR PROVIDES THE RESIDENTS OF BLAIR AND SURROUNDING COMMUNITIES 24 HOUR EMERGENCY ROOM SERVICES. THE EMERGENCY SERVICES REVENUE OF $4,061,930 IS THE GROSS REVENUE AFTER CONTRACTUAL ADJUSTMENTS. 2149654 0 4648558 MEMORIAL COMMUNITY HOSPITAL OF BLAIR PROVIDES THE RESIDENTS OF BLAIR AND SURROUNDING COMMUNITIES WITH A VARIETY OF THERAPY SERVICES, INCLUDING PHYSICAL AND OCCUPATIONAL THERAPY, SPEECH THERAPY, SLEEP STUDIES, AND RESPIRATORY THERAPY. THE THERAPY SERVICES REVENUE OF $4,648,558 IS THE GROSS REVENUE AFTER CONTRACTUAL ADJUSTMENTS. 25631223 0 28948622 25631223 28948622 34908440 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 15 0 1 334 1 0 0 0 0 0 0 0 0 0 0 0 0 X 7 5 0 1 0 0 1 1 0 1 1 0 0 0 1 1 1 0 1 0 1 1 0 X JENNIFER NEWBY 4024262182 810 NORTH 22ND STREET BLAIR NE 68008 X SANDRA BAUMBERGER MD BOARD MEMBER/PHYSICIAN 40.00 1.00 X 277843 0 12600 SARAH CHATT TREASURER 1.00 1.00 X X 0 0 0 NEIL SMITH SECRETARY 1.00 0.00 X X 0 0 0 KYLE ACRE CHAIR 1.00 1.00 X X 0 0 0 GREGG DRABEK MD VICE CHAIR 25.00 0.00 X X 0 0 0 ROBIN CONYERS BOARD MEMBER 1.00 0.00 X 0 0 0 LORI NAHNSEN BOARD MEMBER 1.00 0.00 X 0 0 0 MANUELA BANNER-WOLF PRESIDENT & CEO 40.00 1.00 X 0 0 0 TIM SCHNACK CFO 40.00 1.00 X 0 0 0 KEVIN SISK MD PHYSICIAN 40.00 0.00 X 474562 0 11400 MAURICE BIRDWELL MD PHYSICIAN 40.00 0.00 X 366082 0 12327 AMANDA DUXBURY MD PHYSICIAN 40.00 0.00 X 337579 0 11480 MARK SHIRLEY MD PHYSICIAN 40.00 0.00 X 328680 0 0 TONY TRAN CRNA 40.00 0.00 X 304949 0 11578 2089695 0 59385 43 0 1 1 CHI HEALTH 198 INVERNESS DRIVE WEST ENGLEWOOD CO 80112 MGMT FEES/HEALTH SVCS 1320363 SIGNATURE PERFORMANCE 10330 REGENCY PARKWAY DR 335 OMAHA NE 68114 BUSINESS OFFICE SERVICES 875521 FUSION MEDICAL STAFFING LLC 11808 GRANT STREET SUITE 100 OMAHA NE 68164 STAFFING SERVICES 761751 RURAL PARTNERS IN MEDICINE 11880 AIRPORT WAY BROOMFIELD CO 80021 MEDICAL SERVICES 696010 TITAN MEDICAL GROUP LLC 2110 S 169TH PLAZA 100 OMAHA NE 68130 STAFFING SERVICES 579176 23 134652 1071291 1205943 NET PATIENT REVENUE 621110 45922708 45922708 45922708 130336 130336 114256 2634 111622 111622 111622 PHARMACY 456110 1002436 1002436 DIETARY 621110 68990 68990 OTHER MISC REVENUES 900099 4266 4266 1075692 48446301 45922708 0 1317650 21905996 18410442 3495554 440439 370158 70281 2549663 2142812 406851 1242503 994094 248409 500000 500000 10603 10603 37800 37800 6570 6570 1405556 968091 437465 177293 177293 60592 49983 10609 598744 598744 18654 5916 12738 100660 83517 17143 364503 364503 2530129 2514681 15448 291654 291654 SUPPLIES 7234004 5826182 1407822 PURCHASED SERVICES 3462002 1636341 1825661 EQUIPMENT RENTAL AND MA 919904 672936 246968 DUES & SUBSCRIPTIONS 162878 79238 83640 284850 6939 277911 44304997 34908440 9396557 0 22087517 20764874 6941816 9634550 626635 667753 244945 185365 64422972 45664521 19818385 18758451 6259986 6280959 296534 372571 56275818 56664523 4321918 4577504 7728415 6576742 3561907 1419407 15612240 12573653 X 40663578 44090870 40663578 44090870 56275818 56664523 X 4141304 -707966 -6046 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 6570 6570 0 PART II-B, LINE 1: THE PORTION OF ORGANIZATION DUES THAT ARE RELATED TO LOBBYING ARE AS FOLLOWS: AMERICAN HOSPITAL ASSOCIATION - $4,632 CATHOLIC HEALTH ASSOCIATION - $1,938 886525 886525 23120276 12769445 10350831 37083395 30359291 6724104 3332776 2535785 796991 18758451 ESTIMATED THIRD-PARTY SETTLEMENTS 1270073 INTEREST RATE SWAP LIABILITY 149334 1419407 X PART X, LINE 2: IN ACCORDANCE WITH FASB INTERPRETATION NO 48, ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES, INCLUDED IN FASB ASC SUBTOPIC 740-10 - INCOME TAXES - THE HOSPITAL RECOGNIZES THE EFFECT OF INCOME TAX POSITIONS ONLY IF THOSE POSITIONS ARE MORE LIKELY THAN NOT OF BEING SUSTAINED. RECOGNIZED INCOME TAX POSITIONS ARE MEASURED AT THE LARGEST AMOUNT THIS IS GREATER THAN 50% LIKELY OF BEING REALIZED. CHANGES IN RECOGNITION OR MEASUREMENT ARE REFLECTED IN THE PERIOD IN WHICH THE CHANGE IN JUDGEMENT OCCURS. IN 2022 AND 2021, MANAGEMENT DETERMINED THAT THERE ARE NO INCOME TAX POSITIONS REQUIRING RECOGNITION IN THE CONSOLIDATED FINANCIAL STATEMENTS. 1 1 X 0 0 1 1 0 1 1 340 463433 463433 0.01050 4310124 2984172 1325952 0.02990 340 4773557 2984172 1789385 0.04040 9 159 44140 44140 0.00100 2 4 6661 6661 0.00020 18 67702 67702 0.00150 29 163 118503 118503 0.00270 29 503 4892060 2984172 1907888 0.04310 3 3281 3281 0.00010 23 730 25108 25108 0.00060 1 30 1500 1500 0.00000 1 15 3550 3550 0.00010 28 775 33439 33439 0.00080 1 783186 0 14143081 14178442 -35361 X 1 1 1 1 MEMORIAL COMMUNITY HOSPITAL 810 NORTH 22ND STREET BLAIR NE 68008 WWW.MCHHS.ORG 790001 X X X X MEMORIAL COMMUNITY HOSPITAL 1 0 0 1 X X X X X X X X X 22 1 1 1 1 X HTTPS://MCHHS.ORG/CHIP-CHNA/ X SEE PART V, PAGE 8 X 1 22 1 HTTPS://MCHHS.ORG/CHIP-CHNA/ 0 1 X X X 1 1 X X X 1 X MCHHS.ORG/WP-CONTENT/UPLOADS/2020/06/601.103-FINANCIAL-ASSISTANCE.PDF X HTTPS://MCHHS.ORG/WP-CONTENT/UPLOADS/2021/03/MCH-FINANCIAL-BROCHURE.PDF X HTTPS://MCHHS.ORG/WP-CONTENT/UPLOADS/2018/09/MCHHS_PLAIN_SPEAK.PDF X X X X 1 X 0 X X X X 1 X 0 0 MEMORIAL COMMUNITY HOSPITAL PART V, SECTION B, LINE 5: IN 2022, LEADERSHIP FROM MEMORIAL COMMUNITY HOSPITAL COLLABORATED WITH THE THREE RIVERS PUBLIC HEALTH DEPARTMENT (TRPHD) AND SCHMEECKLE RESEARCH GROUP TO CONDUCT A COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) FOR THE THREE RURAL COUNTIES SERVED BY THE TRPHD, WHICH INCLUDES WASHINGTON COUNTY, THE COUNTY IN WHICH MEMORIAL COMMUNITY HOSPITAL & HEALTH SYSTEM IS LOCATED. THE CHNA IS A FOLLOW-UP TO AND EXPANSION OF SIMILAR REPORTS CONDUCTED IN 2003, 2007, 2012, 2016 AND 2019. THE TRPHD HAS COMPLETED A CHNA AND DEVELOPED A COMMUNITY HEALTH IMPROVEMENT PLAN (CHIP) USING THE MOBILIZING FOR ACTION THROUGH PLANNING AND PARTNERSHIP (MAPP) PROCESS. MEMORIAL COMMUNITY HOSPITAL & HEALTH SYSTEM'S LEADERSHIP AND STAFF HAVE BEEN INVOLVED IN THE CHNA PLANNING PROCESS THROUGH SERVICE ON THE CHNA STEERING COMMITTEE AND PARTICIPATION IN THE MAPP PROCESS. A LARGE FOCUS GROUP COMPOSED OF DIVERSE MEMBERS OF THE COMMUNITY WAS AN IMPORTANT COMPONENT OF THE CHNA AND CHIP PLANNING PROCESS. MCH&HS LEADERS PARTICIPATED IN THE FORUM AND COMMUNITY DIALOGUE TO REVIEW THE CHNA AND IDENTIFY COMMUNITY HEALTH PRIORITIES, ASSETS AND GAPS IN WASHINGTON COUNTY. THE CHNA HAS ALSO BEEN SHARED WITH THE MEMORIAL COMMUNITY HOSPITAL & HEALTH SYSTEM BOARD OF DIRECTORS. THE MCH&HS CHNA IS LOCATED ON MCH&HS WEBSITE WWW.MCHHS.ORG AND THE FULL REPORT IS LOCATED AT WWW.THREERIVERSPUBLICHEALTH.ORG. MEMORIAL COMMUNITY HOSPITAL & HEALTH SYSTEM LEADERSHIP USED THIS CHNA DURING ITS ANNUAL STRATEGIC AND BUDGETING AND PROVIDED A MEMORIAL COMMUNITY HOSPITAL & HEALTH SYSTEM IMPLEMENTATION PLAN TO ADDRESS THE PRIORITIZED HEALTH NEEDS. MEMORIAL COMMUNITY HOSPITAL PART V, SECTION B, LINE 6A: FREMONT AREA MEDICAL CENTER & SAUNDERS COUNTY COMMUNITY HOSPITAL MEMORIAL COMMUNITY HOSPITAL PART V, SECTION B, LINE 6B: THREE RIVERS HEALTH DEPARTMENT MEMORIAL COMMUNITY HOSPITAL PART V, SECTION B, LINE 13B: THE AMOUNT OF FINANCIAL ASSISTANCE WRITE-OFF FOR MEMORIAL COMMUNITY HOSPITAL AND HEALTH SYSTEM IS BASED ON A FINANCIAL ASSISTANCE SLIDING FEE SCHEDULE UTILIZING A DERIVATIVE OF THE CURRENT US DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT (HUD) VERY LOW INCOME GUIDELINES, WHICH ARE UPDATED ANNUALLY. FINANCIAL ASSISTANCE MAY ALSO BE GRANTED IN CERTAIN CIRCUMSTANCES INVOLVING A CATASTROPHIC OCCURRENCE RESULTING IN MEDICAL BILLS GROSSLY EXCEEDING THE PATIENT'S ABILITY TO PAY AND IN THESE SITUATIONS, THE PATIENT'S RESPONSIBILITY WILL BE LIMITED TO 30% OF THE FAMILY'S GROSS ANNUAL INCOME. SCHEDULE H, PART V, SECTION B, LINE 7B HTTPS://WWW.THREERIVERSPUBLICHEALTH.ORG/RESOURCES/DATA/COMMUNITY-HEALTH-IMPROVEMENT-PLAN-CHIP SCHEDULE H, PART V, SECTION B, LINE 11 2022 WAS THE FIRST YEAR IN THE CURRENT THREE-YEAR COMMUNITY HEALTH IMPROVEMENT PLAN FOR MEMORIAL COMMUNITY HOSPITAL AND HEALTH SYSTEM (MCH). THE 2019 CHIP IDENTIFIED THREE MAIN PRIORITY AREAS OF COMMUNITY HEALTH NEEDS. THE THREE MAIN PRIORITIES ARE ACCESS TO AFFORDABLE, ACCEPTABLE QUALITY HEALTH CARE (INCLUDING MENTAL HEALTH SERVICES), RISKY BEHAVIORS, AND PREVENTION AND SCREENING. THE FOLLOWING PARAGRAPHS WILL EXPLAIN THE GOALS AND STRATEGIES UNDER EACH PRIORITY LEVEL. IT IS IMPORTANT TO NOTE IN THE PREVIOUS YEAR, COVID-19 CHANGED, STALLED, OR ELIMINATED SOME OF THE GOALS DUE TO CHANGING PRIORITIES. WHILE THE GOALS HAD TO CHANGE TO REACT TO THE PANDEMIC, MCH REMAINED COMMITTED TO PROVIDING HEALTHCARE SERVICES AND COVID-RELATED TREATMENT, VACCINATION, AND PREVENTION. IN 2022, MCH REMAINED COMMITTED TO PROVIDING QUALITY AND ACCESSIBLE HEALTH CARE FOLLOWING THE PANDEMIC AND CONTINUED TO WORK TOWARD GOALS AND MEASURES. PRIORITY 1: ACCESS TO AFFORDABLE, ACCEPTABLE QUALITY HEALTH CARETHE FIRST PRIORITY IS ACCESS TO AFFORDABLE, ACCEPTABLE, QUALITY HEALTH CARE (INCLUDING MENTAL HEALTH SERVICES). MCH LEADERSHIP IS ACTIVELY INVOLVED IN LEGISLATIVE EFFORTS TO IMPROVE ACCESS TO AFFORDABLE CARE WITHIN THE STATE AND WITH THE FEDERAL DELEGATION THROUGH PARTNERSHIPS WITH THE NEBRASKA HOSPITAL ASSOCIATION, THE NEBRASKA RURAL HEALTH ASSOCIATION, AND THE AMERICAN HOSPITAL ASSOCIATION. FOUR GOALS WERE DETERMINED TO ADDRESS THE PRIORITY AREA OF ACCESS. GOAL 1: THE FIRST GOAL IS TO INCREASE BEHAVIORAL HEALTH OFFERINGS IN THE MCH SERVICE AREA. UNDER THIS GOAL, THE HOSPITAL:- SOLUTIONS TO ADDRESS BEHAVIORAL HEALTH WITHIN MCH*MCH COMPLETED RESEARCH AND EVALUATION OF A POSSIBLE SOLUTION FOR A PARTNERSHIP TO PROVIDE AN INTEGRATED MENTAL HEALTH PROGRAM IN THE MCH CLINICS BUT HAS SHIFTED FOCUS IN THE SHORT TERM AND IS NOW PLANNING ON A TELEHEALTH OPTION TO ADDRESS ACUTE BEHAVIORAL ISSUES IN THE EMERGENCY ROOM. IN ADDITION, AN INTEGRATED BEHAVIORAL HEALTH OFFERING CONTINUES TO BE RESEARCHED. *IMPLEMENTATION OF SENIOR LIFE SOLUTIONS (SLS), AN INTENSIVE OUTPATIENT BEHAVIORAL HEALTH AND COUNSELING PROGRAM FOR MEDICARE BENEFICIARIES. THIS PROGRAM NOW HAS A STEADY STREAM OF PATIENTS UTILIZING THE PROGRAM. SLS CONTINUES TO BE AN EXCELLENT RESOURCE FOR ADDRESSING BEHAVIORAL HEALTH ISSUES AND HAS INCREASED ITS OUTREACH EFFORTS AND BECOME A MORE RECOGNIZABLE RESOURCE IN THE COMMUNITIES IT SERVES. IN ADDITION, SLS HAS ENHANCED THE CONTENT AND RESOURCES AVAILABLE TO PATIENTS ONLINE.-COLLABORATION WITH SCHOOL SYSTEMS*COLLABORATION WITH SCHOOLS IS UTILIZED TO PREVENTATIVELY WORK WITH OUR YOUTH, LEADING A JOINT INITIATIVE WITH THE LOCAL AREA HIGH SCHOOLS TO DISTRIBUTE MENTAL HEALTH INFORMATION IS ONGOING. THE PUBLICATION BEING DISTRIBUTED HAS GONE TO A DIGITAL VERSION AND IS OFFERED ON OUR WEBSITE. -PUBLIC AWARENESS*PARTNERING WITH THE THREE RIVERS PUBLIC HEALTH DEPARTMENT FOR A PUBLIC AWARENESS CAMPAIGN SURROUNDING MENTAL HEALTH LED TO THE CREATION OF A COMMUNITY-WIDE MENTAL HEALTH FLYER WITH ALL THE AREA ORGANIZATIONS AND CONTACT INFORMATION. SOCIAL MEDIA POSTS FOR MCH ARE NOW A REGULAR MONTHLY OCCURRENCE FOCUSED ON MENTAL HEALTH. THIS AREA HAS BEEN ENHANCED BY SLS AS WELL, WHICH OFFERS MONTHLY CONTENT TO OUR SOCIAL MEDIA FOLLOWERS. GOAL 2: THE SECOND GOAL IS TO IMPROVE THE CONTINUITY OF CARE FOR RURAL HEALTH CARE PATIENTS. -POPULATION HEALTH *DURING 2022, MCH'S POPULATION HEALTH NURSE SAW AN INCREASE OF 18% IN THE NUMBER OF ANNUAL WELLNESS VISITS (INCLUDING WELCOME TO MEDICARE VISITS), AND THE CHRONIC CARE MANAGEMENT PROGRAM INCREASED 28% FROM THE PREVIOUS YEAR.*MCH CREATED A PROCESS TO IDENTIFY AND CLOSE PATIENT CARE GAP ISSUES WITH INSURANCE COMPANIES AND PROVIDE QUALITY, CARE COORDINATION OF ALL HOSPITALIZED PATIENTS. THERE WAS A SET-BACK IN THE PREVIOUS YEAR DUE TO COVID BUT MANY INSURANCE COMPANIES HAVE BEEN CONTACTED AND CARE GAP PROCESSES IMPROVED.GOAL 3: IMPROVE AFFORDABILITY FOR PATIENTS WITHIN THE MCH SERVICE AREA. -MCH CONTINUES TO EDUCATE PATIENTS ON THE BENEFITS OF THE MDSAVE PROGRAM AND IS SEEING THE UTILIZATION WITH MDSAVE RISE. MDSAVE ALSO OFFERS AFFORDABLE PRICING ON A VARIETY OF SERVICES FOR PATIENTS. WE CONSISTENTLY EVALUATE OUR MDSAVE OFFERINGS TO IDENTIFY ADDITIONAL HEALTH SERVICES AND PROCEDURES TO BE ADDED. ADDITIONAL MARKETING MATERIALS WERE USED TO EDUCATE PATIENTS ABOUT THIS OFFERING AND OUR STAFF WAS HELPFUL IN SHARING INFORMATION ABOUT MDSAVE UPON PATIENT REGISTRATION. IN 2022 OVER $43,000 WORTH OF SERVICES WAS PURCHASED ON MDSAVE, A DECREASE IN SALES FROM 2021. THE NEED FOR MEDICATION ASSISTANCE REMAINS AND MCH HELPS BY CONNECTING PATIENTS TO THE RIGHT RESOURCES. GOAL 4: GENERATE ACCESSIBLE CARE AND APPROPRIATE CLINICAL STAFFING FOR THE CARE NEEDS OF OUR SERVICE AREA. -ACCESS TO CARE AND STAFFING*MCH CONTINUOUSLY IDENTIFIES AND ENCOURAGES CURRENT EMPLOYEES TO DEVELOP INTO OPEN LEADERSHIP POSITIONS AND HAS PROMOTED VARIOUS EMPLOYEES INTO NEW AND OFTEN ADVANCED ROLES THROUGHOUT THE YEAR. *MCH BEGAN TO UTILIZE TELEHOSPITALISTS IN CONNECTION WITH TWO APRNS WHO CARE FOR OUR IN-HOSPITAL POPULATION. THIS ALLOWS US TO INCREASE OUR PATIENT CENSUS AND CARE FOR MORE PATIENTS IN THE MCH MEDICAL/SURGICAL UNIT. *A NEW PRIMARY CARE PHYSICIAN, AND EXPANDED THE ORTHOPEDIC PROGRAM. IN ADDITION, A RHEUMATOLOGIST, DR. KATHRYN WILDY, HAS BEEN ADDED TO THE SPECIALTY CLINIC STAFF, ASSURING AN APPROPRIATE LEVEL OF PRIMARY CARE PROVIDERS AND SUB-SPECIALTY PROVIDERS FITTING THE COMMUNITY'S NEEDS. PRIORITY 2: RISKY BEHAVIORSTHE SECOND INITIATIVE IS TO ADDRESS RISKY BEHAVIORS (INCLUDING CAUSES OF OBESITY) WITHIN OUR COMMUNITYGOAL 1: THE FIRST GOAL IS REDUCTION OF VAPING RATES AMONG THE YOUTH IN OUR COMMUNITY. -MCH'S INITIATIVE WAS PARTNERING WITH AREA HIGH SCHOOLS AND LOCAL LAW ENFORCEMENT TO EDUCATE THE YOUTH ABOUT THE RISKS OF VAPING, IMPLEMENTING A PUBLIC AWARENESS CAMPAIGN TO EDUCATE DIFFERENT TARGET AUDIENCES ABOUT VAPING, ACTIVELY ADVOCATING WITH STATE AND FEDERAL LEGISLATURE AROUND VAPING LAWS, AND ASSISTING PATIENTS TO STOP NICOTINE DEPENDENCY. UNFORTUNATELY, MOST INITIATIVES WHERE ORGANIZATIONS WERE PARTNERING TOGETHER, ESPECIALLY YOUTH ORGANIZATIONS, WERE PUT ON HOLD DURING THE PANDEMIC. -MCH OFFERS AN ELECTRONIC PUBLICATION THAT ADDRESSES TOPICS AFFECTING TEENS AND OTHER HEALTH-RELATED TOPICS, WHICH HAS COVERED THE RISKS OF VAPING, AND HAD STAFF ATTEND LEGISLATIVE EVENTS TO ACTIVELY ADVOCATE WITH STATE AND FEDERAL LEGISLATIVE LAWMAKERS. MEETINGS, SPEAKING EVENTS AND PUBLIC PROGRAMS AROUND SMOKING CESSATION REMAIN IN THE PLAN FOR THE FUTURE. PARTICIPATION WITH AN AREA GROUP LED BY THE PUBLIC HEALTH DEPARTMENT CONTINUED, WHICH IS AN EXCELLENT SOURCE OF COLLABORATION AS THE ISSUES FACING YOUTH ARE DISCUSSED.GOAL 2: INCREASE AWARENESS OF DISTRACTED DRIVING. -STRATEGIES INCLUDE, PARTNERING WITH AREA SCHOOLS TO EDUCATE STUDENTS AND PARENTS TO IMPLEMENT STRATEGIES TO LOWER THE TEXTING WHILE DRIVING RATES, AND IMPLEMENTING MARKETING STRATEGIES AROUND DRIVING SAFETY. ALL ACTIVITIES WITH THE SCHOOLS AND THREE RIVERS PUBLIC HEALTH DEPARTMENT WERE PUT ON HOLD DURING THE PANDEMIC AND AS MEETINGS RETURNED TO A REGULAR BASIS, THESE ISSUES ARE BEING DISCUSSED ONCE AGAIN. SOCIAL MEDIA EDUCATION CONTINUED.GOAL 3: REDUCE THE NUMBER OF INDIVIDUALS WHO ARE OBESE BY ADDRESSING RELATED HEALTH CONDITIONS THROUGH EXERCISE AND NUTRITION. -MCH PLANNED TO ACCOMPLISH THIS GOAL BY PARTNERING WITH AREA SCHOOLS TO INTRODUCE A FUN, EASY EXERCISE ACTIVITY AND PURCHASE JUMP ROPES FOR ALL AREA SCHOOL CHILDREN, INCREASE PEDIATRIC NUTRITIONAL EDUCATION WITH YOUTH VISITS, SPONSOR AND PARTICIPATE IN AREA EVENTS FOCUSED ON HEALTH AND WELLNESS, AND FINALLY OFFER NUTRITIONAL COUNSELING TO PATIENTS AND COMMUNITY ORGANIZATIONS. MCH DID PARTNER WITH THE SCHOOLS AND MANY OTHER ORGANIZATIONS BY SPONSORING HEALTHY ACTIVITIES BUT DID NOT BUY JUMP ROPES DUE TO THE CLOSURE OF SCHOOL IN THE SPRING OF 2020. WE FOUND OPPORTUNITIES BY PARTNERING WITH THE LOCAL BLAIR FAMILY YMCA TO STRESS THE IMPORTANCE OF PHYSICAL ACTIVITY AND INVOLVEMENT TO STAY FIT AND WELL. AN EXAMPLE OF THIS IS HEALTHY KIDS DAY AND OUR SUPPORT OF YOUTH PROGRAMS AT THE YMCA. SCHEDULE H, PART V, SECTION B, LINE 11 (CONT'D) PRIORITY 3: PREVENTION AND SCREENINGTHE FINAL INITIATIVE, PREVENTION AND SCREENING, WILL FOCUS ON TWO GOALS. GOAL 1: INCREASE SCREENINGS FOR COMMON HEALTH ISSUES. -STRATEGIES OF GOAL NUMBER ONE INCLUDE INCREASING THE NUMBER OF DEPRESSION, SUICIDE, AND OTHER SCREENINGS IN CARDIO PULMONARY, THE PRIMARY CARE CLINICS, ER, MED/SURG AND PEDIATRICS, AND EDUCATING THE PUBLIC ABOUT THE IMPORTANCE OF TIMELY SCREENINGS AND WHAT AGE AND FREQUENCY RECOMMENDATIONS ARE FOR SCREENINGS. THIS IS AN ONGOING PROCESS BY VARIOUS DEPARTMENTS AND THE MARKETING DEPARTMENT. NEWSPAPER ARTICLES AND SOCIAL MEDIA POSTS HAVE BEEN USED TO GET THE WORD OUT ABOUT SCREENINGS. THE LAST STRATEGY IS TO EDUCATE PATIENTS ABOUT PROGRAMS SUCH AS THE LIVING WELL- CHRONIC DISEASE SELF-MANAGEMENT PROGRAM, EVERY WOMAN MATTERS AND THE DIABETES PREVENTION PROGRAM AND PROVIDE THEM REFERRAL TOOLS AND METHODS. CHRONIC CARE MANAGEMENT IS UNDERWAY WITH DEDICATED STAFF AND SHOWED A SIGNIFICANT INCREASE IN THE NUMBER OF PARTICIPANTS FROM THE PREVIOUS YEAR.GOAL 2: IMPLEMENT CHRONIC CARE MANAGEMENT TO IMPROVE THE HEALTH OF ALL CITIZENS IN OUR SERVICE AREA.-STRATEGIES OF THE SECOND GOAL INCLUDED HIRING AN ADDITIONAL POPULATION HEALTH NURSE AND DEVELOPING A PLAN TO PROVIDE CHRONIC CARE MANAGEMENT TO OUR COMMUNITY WHICH WAS COMPLETED. FINALLY, WE ARE PARTNERING WITH THREE RIVERS PUBLIC HEALTH DEPARTMENT TO CREATE AWARENESS AROUND THE LIVING WELL-CHRONIC DISEASE MANAGEMENT PROGRAM. THIS GOAL WAS COMPLETED INTERNALLY WITHOUT COLLABORATION WITH THE HEALTH DEPARTMENT, DUE TO THE OVERWHELMING WORKLOAD THE HEALTH DEPARTMENT FACED IN 2020 FROM THE PANDEMIC. IN ADDITION, DURING THE PANDEMIC, MCH PROVIDED MASS VACCINATION CLINICS TO ASSIST IN THE PREVENTION OF THE SPREAD OF COVID-19. THESE WERE OFFERED COMPLETELY FREE TO THE PUBLIC AND OFFERED AT VARIOUS TIMES TO MAKE THEM VERY ACCESSIBLE TO THE PUBLIC. MCH CONTINUED TO EDUCATE THE PUBLIC ON THE IMPORTANCE OF VACCINATIONS FOLLOWING THAT PERIOD AND THIS IS ONGOING.WRAPPING UP THE 2019 CHIPIN 2022, TIME AND EFFORT WERE SPENT GETTING BACK ON TRACK AND ADDRESSING THE GOALS OF THE PLAN THAT WERE HALTED DURING THE PANDEMIC. MCH WAS ABLE TO ACCOMPLISH MANY TASKS RELATING TO THE 2019 PLAN IN ITS FINAL YEAR AND IS LOOKING FORWARD TO THE ENSUING COMMUNITY HEALTH IMPROVEMENT PLAN TO BE DEVELOPED IN 2022 AND TO COMPLETE SOME OF THE OPPORTUNITIES REMAINING ON THE 2019 CHIP. 3 1 - BLAIR CLINIC 812 NORTH 22ND STREET BLAIR NE 68008 PRIMARY CARE CLINIC 2 - FORT CALHOUN CLINIC 4929 COUNTY ROAD P-43 FORT CALHOUN NE 68023 PRIMARY CARE CLINIC 3 - COTTONWOOD CLINIC 3519 HIGHWAY 32 TEKAMAH NE 68061 PRIMARY CARE CLINIC PART I, LINE 3C: THE AMOUNT OF FINANCIAL ASSISTANCE WRITE-OFF FOR MEMORIAL COMMUNITY HOSPITAL AND HEALTH SYSTEM IS BASED ON A FINANCIAL ASSISTANCE SLIDING FEE SCHEDULE UTILIZING A DERIVATIVE OF THE CURRENT US DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT (HUD) VERY LOW INCOME GUIDELINES, WHICH ARE UPDATED ANNUALLY. DESIGNEES OF MCH HELP PATIENTS SEEK REIMBURSEMENT FROM LOCAL, STATE, AND FEDERAL PROGRAMS AT NO CHARGE TO THE PATIENT WHEN THERE IS NO OTHER SOURCE OF PAYMENT. AFTER THESE EFFORTS/RESOURCES HAVE BEEN EXHAUSTED, PATIENTS ARE ASSISTED IN THE APPLICATION PROCESS FOR FINANCIAL ASSISTANCE. THE APPLICATION PROCESS INCLUDES COMPLETING A PERSONAL FINANCIAL APPLICATION AND PROVIDING VERIFICATION DOCUMENTS. THESE VERIFICATION DOCUMENTS MAY INCLUDE, BUT ARE NOT LIMITED TO, RECEIVING A COPY OF THE APPLICANT'S FEDERAL TAX RETURN, PAY STUB, BANK STATEMENTS, A CALL TO EMPLOYERS, OR A CREDIT REPORT, THE APPLICANT'S NET WORTH AND/OR LIQUID ASSETS, AND REASONABLE HOUSEHOLD OR BUSINESS EXPENSES. FINANCIAL ASSISTANCE MAY ALSO BE GRANTED IN CERTAIN CIRCUMSTANCES INVOLVING A CATASTROPHIC OCCURRENCE RESULTING IN MEDICAL BILLS GROSSLY EXCEEDING THE PATIENT'S ABILITY TO PAY AND IN THESE SITUATIONS, THE PATIENT'S RESPONSIBILITY WILL BE LIMITED TO 30% OF THE FAMILY'S GROSS ANNUAL INCOME. PART I, LINE 7: THE COSTING METHODOLOGY USED TO CALCULATE THE AMOUNTS REPORTED IN THE TABLE WERE WORKSHEETS WITHIN THE SCHEDULE H INSTRUCTIONS. THE COST TO CHARGE RATIO USED IN THE CALCULATION WAS DERIVED FROM THE FILED 2022 COST REPORT. PART I, LINE 7G: MEMORIAL COMMUNITY HOSPITAL DOES NOT PROVIDE SUBSIDIZED HEALTH SERVICES. SCHEDULE H, PART I, LINE 6A MEMORIAL COMMUNITY HOSPITAL PRODUCES A COMMUNITY BENEFIT REPORT THAT IS SENT TO THE NEBRASKA HOSPITAL ASSOCIATION FOR DATA COLLECTION PURPOSES. PART II, COMMUNITY BUILDING ACTIVITIES: MEMORIAL COMMUNITY HOSPITAL AND HEALTH SYSTEM'S (MCH) MISSION IS TO HEAL, NURTURE AND PROMOTE WELLNESS IN THE COMMUNITIES WE SERVE. 2022 PRESENTED ANOTHER YEAR OF OPPORTUNITIES FOR MCH AS THINGS BEGAN TO RETURN TO MORE NORMAL PRACTICES FOLLOWING THE PANDEMIC. IN 2022, MCH DEMONSTRATED GREAT RESILIENCE FOLLOWING A PERIOD OF TIME WHERE THE HEALTHCARE ENVIRONMENT WAS SIGNIFICANTLY IMPACTED. MCH RETURNED TO MORE REGULAR ACTIVITY IN TERMS OF SUPPORTING COMMUNITY ORGANIZATION AND ALSO EVENTS THAT WERE HELD INTERNALLY. MCH BEGAN TO SEE MORE SHADOWING OPPORTUNITIES AND WELCOMED STUDENTS, BOTH HIGH SCHOOL AND COLLEGE, INTO OUR FACILITY AND PRESENT THEM WITH OPPORTUNITIES TO LEARN ABOUT MCH AND VARIOUS CAREER OPPORTUNITIES THAT WE OFFER. OUR PFAC GROUP RE-ENGAGED AND COMMUNITY EDUCATION THROUGH LUNCH AND LEARNS CONTINUED TO WELCOME MANY GUESTS ON A MONTHLY BASIS WHO LEARNED ABOUT VARIOUS HEALTH-RELATED TOPICS. MCH WAS ABLE TO SUPPORT PROGRAMS AND EVENTS SUCH AS THE BIKE RODEO, PARADES, CHAMBER AFTER HOURS AND COFFEES, STOP THE BLEED COURSES, CPR CLASSES, AND DIFFERENT CLASSES FOR SENIORS SUCH AS THE SENIOR EXERCISE CLASSES. WE ALSO HOSTED TWO BABY EXPOS IN SUPPORT OF THE MCH LABOR & DELIVERY DEPARTMENT AND HELD A CHRISTMAS CELEBRATION FOR THE COMMUNITY. BLOOD DRIVES WERE ALSO HELD IN PARTNERSHIP WITH THE AMERICAN RED CROSS. MCH LEADERSHIP SERVED ON THE WASHINGTON COUNTY CHAMBER BOARD AND THE GATEWAY DEVELOPMENT BOARD IN SUPPORT OF ECONOMIC DEVELOPMENT AND COMMUNITY BUILDING EFFORTS. MCH WAS PLEASED TO ENGAGE IN VARIOUS ACTIVITIES AS WE ARE DEDICATED TO THE COMMUNITY AS PART OF OUR MISSION. PART III, LINE 2: COSTING METHODOLOGY FOR AMOUNTS REPORTED ON LINE 2 IS DETERMINED USING THE ORGANIZATION'S COST/CHARGE RATIO OF 62.90%. WHEN DISCOUNTS ARE EXTENDED TO SELF-PAY PATIENTS, THESE PATIENT ACCOUNT DISCOUNTS ARE RECORDED AS A REDUCTION IN REVENUE, NOT AS BAD DEBT EXPENSE. PART III, LINE 3: COMMUNITY MEMORIAL HOSPITAL DOES NOT BELIEVE THAT ANY PORTION OF BAD DEBT EXPENSE COULD REASONABLY BE ATTRIBUTED TO PATIENTS WHO QUALIFY FOR FINANCIAL ASSISTANCE SINCE AMOUNTS DUE FROM THOSE INDIVIDUALS' ACCOUNTS WILL BE RECLASSIFIED FROM BAD DEBT EXPENSE TO CHARITY CARE WITHIN 30 DAYS FOLLOWING THE DATE THAT THE PATIENT IS DETERMINED TO QUALIFY FOR CHARITY CARE. PART III, LINE 4: THE AUDITED FOOTNOTES FOR MEMORIAL COMMUNITY HOSPITAL AND MEDICAL CENTER DO NOT CONTAIN FOOTNOTES RELATED TO BAD DEBT EXPENSE. BAD DEBT EXPENSE IS IDENTIFIED ON THE CONSOLIDATED STATEMENT OF OPERATION WHICH IS CONSISTENT WITH THE REPORTING PRACTICE OF OTHER HEALTH CARE ORGANIZATIONS. BAD DEBT EXPENSE AT 100% CHARGE VALUE WAS MULTIPLIED BY THE RATIO DERIVED FROM THE SCHEDULE H WORKSHEETS IN THE SCHEDULE H INSTRUCTIONS TO ARRIVE AT AN APPROXIMATE COST VALUE. PART III, LINE 8: MEMORIAL COMMUNITY HOSPITAL EXCLUDED MEDICARE SHORTFALLS FROM THE OVERALL COMMUNITY BENEFIT REPORT.THE MEDICARE CHARGES REPORTED ON LINE 5 AND LINE 6 ARE FROM THE 2022 FILED COST REPORT WHICH USED A COST TO CHARGE RATIO. PART III, LINE 9B: ALL ACCOUNTS MUST HAVE GONE THROUGH A MINIMUM OF THREE STATEMENT CYCLES ENSURING THE GUARANTOR HAS HAD TIME TO REVIEW AND PAY ON THE ACCOUNTS OWED ON. NO ACCOUNT WILL BE PREPARED FOR COLLECTIONS BEFORE IT HAS REACHED 121 DAYS FROM THE DATE OF POST DISCHARGE BILLING. ALL ACCOUNTS MUST HAVE ONE DOCUMENTED, ATTEMPTED PHONE CALL TO THE GUARANTOR. PATIENTS WILL BE GIVEN THE OPPORTUNITY TO APPLY FOR MCHHS' FINANCIAL ASSISTANCE PROGRAM IN THE EVENT THAT THEY ARE UNABLE TO MEET THEIR FINANCIAL OBLIGATIONS. THE FINANCIAL CLASS ON THE EFFECTED EPISODES WILL BE CHANGED TO "FA AND A FINAL ATTEMPT LETTER WHICH INCLUDES INFORMATION REGARDING THE MCH FINANCIAL ASSISTANCE PROGRAM AND IT'S AVAILABILITY TO QUALIFIED APPLICANTS WILL BE SENT INDICATING THAT A PAYMENT OR RESPONSE IS NECESSARY OR ELSE THE ACCOUNT WOULD BE SENT TO AN OUTSIDE AGENCY FOR COLLECTION ATTEMPTS. IF A PATIENT CONTACTS MCHHS TO INQUIRE ABOUT FINANCIAL ASSISTANCE AND THE ACCOUNT IS LESS THAN 240 DAYS, THEN ALL COLLECTION EFFORTS WILL BE CEASED AND THE PATIENT WILL BE GIVEN 2 WEEKS TO COMPLETE AND RETURN THE REQUIRED APPLICATION AND DOCUMENTS. SHOULD THE PATIENT NOT QUALIFY AND/OR NOT RETURN THE REQUIRED APPLICATION, THEN COLLECTION EFFORTS SHALL RESUME. SHOULD PATIENTS COMPLETE AND RETURN THE REQUIRED APPLICATION AND DOCUMENTS AT ANY TIME PRIOR TO 241 DAYS, THEN COLLECTION EFFORTS WILL CEASE UNTIL THE APPLICATION IS REVIEWED.MEMORIAL COMMUNITY HOSPITAL'S COLLECTION POLICY DOES CONTAIN PROVISIONS OF THE COLLECTION PRACTICES TO BE FOLLOWED FOR PATIENTS WHO ARE KNOWN TO QUALIFY FOR CHARITY CARE OR FINANCIAL ASSISTANCE. PART VI, LINE 2: MEMORIAL COMMUNITY HOSPITAL ASSESSES THE HEALTH CARE NEEDS OF THE COMMUNITIES IT SERVES THROUGH MULTIPLE CHANNELS INCLUDING COMMUNITY HEALTH FAIRS, WELLNESS PROGRAMS, PROVIDING OCCUPATIONAL HEALTH SERVICES, LISTENING TO PATIENT AND COMMUNITY VOICES AS WELL AS WATCHING NATIONAL TRENDS. PART VI, LINE 3: THERE ARE SEVERAL FINANCIAL ASSISTANCE ACCESS POINTS THROUGHOUT A PATIENT'S CARE CYCLE. BILLS CONTAIN FINANCIAL ASSISTANCE VERBIAGE, BROCHURES ARE AVAILABLE IN CLINICS AND THE HOSPITAL, AND THERE IS INFORMATION ON FINANCIAL ASSISTANCE POSTED AT REGISTRATION POINTS THROUGHOUT CLINICS AND THE HOSPITAL. INFORMATION ON THE MCH FINANCIAL ASSISTANCE POLICIES IS LOCATED AT WWW.MCHHS.ORG. DESIGNEES SUCH AS FINANCIAL COUNSELORS OF MCH HELP PATIENTS SEEK REIMBURSEMENT FROM LOCAL, STATE AND FEDERAL PROGRAMS AT NO CHARGE TO THE PATIENT, WHEN THERE IS NO OTHER SOURCE OF PAYMENT. AFTER THESE EFFORTS/RESOURCES HAVE BEEN EXHAUSTED, PATIENTS ARE ASSISTED IN THE APPLICATION PROCESS FOR FINANCIAL ASSISTANCE. PART VI, LINE 4: MEMORIAL COMMUNITY HOSPITAL AND HEALTH SYSTEM OF BLAIR, NEBRASKA SERVES BOTH WASHINGTON AND BURT COUNTIES IN NEBRASKA. WASHINGTON COUNTY NEBRASKA HAS AN ESTIMATED POPULATION OF 21,167 AND APPROXIMATELY 61% OF THE POPULATION IN WASHINGTON COUNTY IS CONSIDERED RURAL. CENSUS ESTIMATES SHOW THAT WASHINGTON COUNTY'S RACIAL AND ETHNIC MAKEUP IS 4.4% OF THE POPULATION AND ITS MEDIAN AGE IS 41.5 AS COMPARED TO THE STATE AT 36.6. THE MEDIAN HOUSEHOLD INCOME IS $83,491 COMPARED TO $73,360 FOR THE STATE OF NEBRASKA. IN WASHINGTON COUNTY, 25.6% OF SCHOOL AGE CHILDREN IN BLAIR, 14.1% IN FORT CALHOUN, AND 21.9 % IN ARLINGTON WERE ELIGIBLE FOR FREE OR REDUCED LUNCH BASED ON DATA FROM JUNE 2023, COMPARED TO 45.2% IN THE STATE. BURT COUNTY HAS A POPULATION OF 6,727 AND IT'S ETHNIC AND RACIAL MAKEUP IS 7% OF THE POPULATION. THE MEDIAN HOUSEHOLD INCOME IS $55,769. IN BURT COUNTY, 33.6% OF TEKAMAH SCHOOL AGE CHILDREN, 9.6 % IN OAKLAND/CRAIG AND 51.5% IN LYONS/DECATUR RECEIVED FREE OR REDUCED LUNCH AT SCHOOL. PART VI, LINE 5: MCH&HS PROMOTES THE HEALTH OF ITS COMMUNITY THROUGH FINANCIAL AND IN-KIND DONATIONS. BOARD OF DIRECTORS - THE BOARD OF DIRECTORS MANAGE THE AFFAIRS OF MEMORIAL COMMUNITY HOSPITAL IN BLAIR, NEBRASKA. THERE ARE SEVEN DIRECTORS WHO SERVE ON THE BOARD: THREE MEMBERS FROM THE COMMUNITY, THREE MEMBERS FROM CHI HEALTH AND ONE MEMBER FROM THE MCH&HS MEDICAL STAFF. THE BOARD OF DIRECTORS IS COMPROMISED OF INDIVIDUALS WHO ARE LEADERS IN THE FIELDS OF BUSINESS, HEALTHCARE, ACCOUNTING AND MEDICINE AND WHO UNDERSTAND THEIR ROLE IN PROVIDING STRONG CORPORATE GOVERNANCE. EMERGENCY DEPARTMENT - MEMORIAL COMMUNITY HEALTH HAS A FULL-TIME EMERGENCY DEPARTMENT THAT IS OPEN TO THE PUBLIC AND PROVIDES MEDICAL SCREENING, EXAMINATION, AND STABILIZING TREATMENT WITHIN THE CAPABILITIES AND CAPACITIES OF THE HOSPITAL REGARDLESS OF BUT NOT LIMITED TO THE PATIENT'S RACE, COLOR, SEX, AGE AND/OR ABILITY TO PAY. MCH&HS IS IN COMPLIANCE WITH THE FEDERAL EMTALA GUIDELINES. MEDICAL STAFF - MCH&HS MAINTAIN AN OPEN MEDICAL STAFF. ALL QUALIFIED MDS, DSO, OTHER HEALTHCARE PRACTITIONERS, AND MID-LEVEL PRACTITIONERS ARE ELIGIBLE TO APPLY FOR PRIVILEGES AT THE HOSPITAL. MCH&HS POLICY ON PHYSICIAN CREDENTIALING IS THAT NO INDIVIDUAL IS TO BE DENIED MEDICAL STAFF APPOINTMENT BASED ON SEX, RACE, CREED, COLOR OR NATIONAL ORIGIN. THE STANDARDS A PHYSICIAN MUST MEET FOR APPOINTMENT RELATE TO (1) EDUCATIONAL QUALIFICATION AND LICENSING, (2) PROFESSIONAL COMPETENCE, (3) CHARACTER, (4) ETHICAL STANDING, AND (5) ABILITY TO RELATE TO AND WORK WITH OTHERS. APPLICATIONS ARE REVIEWED AT SEVERAL LEVELS WITHIN THE ORGANIZATION. PHYSICIANS WHO HAVE BEEN GRANTED STAFF PRIVILEGES AUTOMATICALLY BECOME A MEMBER OF THE MEDICAL STAFF AT THE HOSPITAL FOR WHICH PRIVILEGES HAVE BEEN GRANTED. SCHEDULE H, PART VI, LINE 7 STATE FILING OF COMMUNITY BENEFIT REPORT: NE 0 0 0 1 1 0 0 0 0 KEVIN SISK MD PHYSICIAN 250984 0 223578 0 0 0 0 0 11400 0 485962 0 0 0 MAURICE BIRDWELL MD PHYSICIAN 354915 0 11167 0 0 0 0 0 12327 0 378409 0 0 0 AMANDA DUXBURY MD PHYSICIAN 248690 0 88889 0 0 0 0 0 11480 0 349059 0 0 0 MARK SHIRLEY MD PHYSICIAN 320013 0 8667 0 0 0 0 0 0 0 328680 0 0 0 TONY TRAN CRNA 296282 0 8667 0 0 0 0 0 11578 0 316527 0 0 0 SANDRA BAUMBERGER MD BOARD MEMBER/PHYSICIAN 219614 0 58229 0 0 0 0 0 12600 0 290443 0 0 0 PART I, LINE 3 DURING THE CALENDAR YEAR 2022, COMPENSATION FOR THE CEO WAS ESTABLISHED AND PAID BY CHI HEALTH, AN UNRELATED ORGANIZATION. CHI HEALTH USED THE FOLLOWING METHODS TO ESTABLISH THE COMPENSATION: (1) COMPENSATION SURVEYS OR STUDIES (2) INDEPENDENT COMPENSATION CONSULTANT AND (3) APPROVAL BY THE BOARD COMPENSATION COMMITTEE. PART I, LINE 5 ON A QUARTERLY BASIS, PHYSICIANS ARE ELIGIBLE FOR A BONUS IF THEIR OWN PERSONAL GROSS REVENUE PRODUCTION (WITH CERTAIN LIMITS ON WHAT IS INCLUDED) EXCEED A THRESHOLD. THEY THEN GET X% OF THE AMOUNT OVER THAT GROSS REVENUE THRESHOLD. THEY ARE ALSO ELIGIBLE FOR A KEY PERFORMANCE INDICATOR (KPI) ANNUAL BONUS ONLY IF THE COMBINED EBIDA (MCH AND ITS RELATED ORGANIZATION) TARGET IS ACHIEVED. THE KPI ANNUAL BONUSES ARE NOT BASED ON THE PHYSICIANS' SALARIES BUT BASED ON HOW THEY PERFORM ON THE 5 METRICS OF THE KPI PLAN. MCH PHYSICIANS ARE ELIGIBLE FOR A KEY PERFORMANCE INDICATOR (KPI) ANNUAL BONUS ONLY IF THE COMBINED EBIDA (MCH AND ITS RELATED ORGANIZATION) TARGET IS ACHIEVED. THE KPI ANNUAL BONUSES ARE NOT BASED ON THE PHYSICIANS' SALARIES BUT BASED ON HOW THEY PERFORM ON THE 5 METRICS OF THE KPI PLAN. A HOSPITAL AUTH #1 OF WASHINGTON CNTY NE 521441599 2007-06-19 9250000 CONSTRUCTION OF FACILITY 0 0 0 B HOSPITAL AUTH #1 OF WASHINGTON CNTY NE 521441599 2008-05-22 8000000 CONSTRUCTION OF FACILITY 0 0 0 A 6083268 9493722 173747 9319975 0 0 1 1 B 4589989 8059333 65000 7994333 0 0 1 1 A 0 0 0 0 0 0 0 B 0 0 0 0 0 0 0 A 0 0 1 1 0 0 0 0 0 B 0 0 1 1 1 1 FNB OF OMAHA 201.000000000000 1 0 0 0 0 A 0 B 0 SCHEDULE K, PART I NOTE REGARDING THE REBATE COMPUTATION SINCE THE BOND PROCEEDS HAVE BEEN SPENT, A SPENDING EXCEPTION WAS MET, AND THE DEBT SERVICE FUND WAS OPERATED ON A BONA FIDE BASIS, NO FURTHER REBATE CALCULATIONS ARE NECESSARY. SCHEDULE K, PART I, COLUMN (A) BOND RENEWAL IN 2017, MEMORIAL COMMUNITY HOSPITAL AMENDED ITS 2007 BOND SERIES WITH A NEW INTEREST RATE OF 3.01%. FORM 990, PART VI, SECTION A, LINE 3 THE CEO AND CFO OF MEMORIAL COMMUNITY HOSPITAL CORPORATION (HOSPITAL) ARE PROVIDED BY CHI HEALTH. THE CEO & CFO ARE EMPLOYEES OF CHI HEALTH, AND THE HOSPITAL REIMBURSES CHI HEALTH FOR THEIR COMPENSATION AND BENEFITS. THE HOSPITAL PAYS CHI HEALTH A MANAGEMENT FEE EQUAL TO THE DIRECT COST OF THEIR COMPENSATION AND BENEFITS PLUS 10% OF EARNINGS BEFORE INTEREST, DEPRECIATION, AND AMORTIZATION. FORM 990, PART VI, SECTION A, LINE 6 CORPORATE MEMBERS MEMORIAL COMMUNITY HOSPITAL CORPORATION (HOSPITAL) HAS TWO MEMBERS - MEMORIAL COMMUNITY HEALTH SYSTEM, INC (MCHS) AND ALEGENT HEALTH - IMMANUEL MEDICAL CENTER (IMMANUEL). FORM 990, PART VI, SECTION A, LINE 7A BOARD MEMBERS THE HOSPITAL HAS A SEVEN MEMBER BOARD OF DIRECTORS. MCHS APPOINTS THREE OF THESE BOARD MEMBERS, IMMANUEL APPOINTS THREE, AND THE MEDICAL STAFF APPOINTS ONE MEMBER, WHO IS ALWAYS THE MEDICAL STAFF PRESIDENT. ALL OFFICIAL ACTIONS OF THE BOARD REQUIRE AN AFFIRMATIVE VOTE OF TWO-THIRDS OF THE ENTIRE BOARD OF DIRECTORS. A SIMPLE MAJORITY OF THE BOARD OF DIRECTORS CONSTITUTES A QUORUM FROM THE TRANSACTION OF BUSINESS. FORM 990, PART VI, SECTION B, LINE 11B NO REVIEW WAS OR WILL BE CONDUCTED. FORM 990, PART VI, SECTION B, LINE 12C ANNUALLY, EACH BOARD MEMBER SIGNS A CONFLICT OF INTEREST STATEMENT AND IS GIVEN A COPY OF THE CONFLICT OF INTEREST POLICY. THE CHAIRMAN OF THE BOARD REVIEWS THESE STATEMENTS AND ENSURES THAT BOARD MEMBERS EXCUSE THEMSELVES FROM DISCUSSIONS AT BOARD MEETINGS ON TOPICS WHERE THEY HAVE A CONFLICT OF INTEREST. FORM 990, PART VI, SECTION B, LINE 15B EXECUTIVE COMPENSATION THE OFFICERS OF THE BOARD ARE NOT COMPENSATED FOR THEIR DUTIES, THEY ARE VOLUNTEERS. THE OFFICERS OF THE CORPORATION (THE EXECUTIVES) ARE COMPENSATED BASED ON RECOMMENDATION OF THE COMPENSATION COMMITTEE OF THE BOARD. THE COMPENSATION COMMITTEE LOOKS AT COMPARATIVE HOSPITAL AND INDUSTRY SALARY INFORMATION IN SETTING BASE SALARIES AND REVIEWS AND APPROVES THE INDIVIDUAL GOALS PROPOSED BY THE EXECUTIVE TEAM FOR INCENTIVE COMPENSATION. FORM 990, PART VI, SECTION C, LINE 19 MEMORIAL COMMUNITY HOSPITAL'S AUDIT REPORT IS MADE AVAILABLE TO THE PUBLIC. THE CONFLICT OF INTEREST POLICY AND GOVERNING DOCUMENTS ARE NOT AVAILABLE TO THE PUBLIC. FORM 990, PART VI, SECTION B, LINE 16B JOINT VENTURE POLICY MEMORIAL COMMUNITY HOSPITAL HAS NOT FORMALLY ADOPTED A WRITTEN POLICY OR WRITTEN PROCEDURE REGARDING JOINT VENTURES. HOWEVER, MCH EVALUATES THE JOINT VENTURE BEFORE ENTERING INTO AN AGREEMENT, TO ENSURE THEY DO NOT ENTER INTO ANY JOINT VENTURE THAT WOULD JEOPARDIZE THE HOSPITALS' EXEMPT PURPOSE. FORM 990, PART VII, SECTION A, LINE 1A TIM SCHNACK & MANUELA WOLF'S COMPENSATION TIM SCHNACK & MANUELA WOLF ARE THE CFO AND CEO OF MEMORIAL COMMUNITY HOSPITAL, RESPECTFULLY, AND ARE PAID BY CHI HEALTH. MEMORIAL COMMUNITY HOSPITAL PAID CHI HEALTH FOR THEIR SERVICES PROVIDED. THEREFORE, TIM SCHNACK & MANUELA WOLF SHOW $0 REPORTABLE COMPENSATION FROM THE FILING ORGANIZATION AND FROM ANY RELATED ORGANIZATION AS THEY WERE DIRECTLY PAID BY CHI HEALTH. FORM 990, PART VII, SECTION A, LINE 5 DR. DRABEK PROVIDES MEDICAL DIRECTOR AND SURGICAL SERVICES TO MEMORIAL COMMUNITY HOSPITAL (MCH). DR. DRABEK IS AN EMPLOYEE OF ALEGENT CREIGHTON CLINIC WHO LEASES DR. DRABEK TO MCH ON A PART TIME BASIS. MCH PAYS ALEGENT CREIGHTON CLINIC FOR DR. DRABEK'S SERVICES. FORM 990, PART XI, LINE 9: OTHER CHANGES IN NET ASSETS -6,046. MEMORIAL COMMUNITY HOSPITAL FOUNDATION 810 N 22ND STREET BLAIR NE 68008 113660156 SUPPORT NE 501(C)(3) LINE 7 N/A 0 MEMORIAL COMMUNITY HEALTH SYSTEM 810 N 22ND STREET BLAIR NE 68008 470718840 HEALTH SYSTEM NE 501(C)(3) LINE 7 N/A 0 MCH AUXILIARY THRIFT SHOP 810 N 22ND STREET BLAIR NE 68008 470748162 AUXILIARY NE 501(C)(3) LINE 7 N/A 1 0 0 1 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 MEMORIAL COMMUNITY HOSPITAL FOUNDATION CORPORATION C 80934 COST