ANTELOPE MEMORIAL HOSPITAL: Form 990, tax year 2023
View the entire original 990 at ProPublica ↗
- Organization
- ANTELOPE MEMORIAL HOSPITAL (EIN 47-0393176)
- Tax period
- 2023-07-01 to 2024-06-30
- Filed
- 2025-05-05
- IRS object ID
- 202541259349302374
- 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 J
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2025-05-05T14:34:15-05:00 | 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 | 470393176 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ANTELOPE MEMORIAL HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | ANTE | BusinessNameControlTxt |
| Phone | 4028874151 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 229 | AddressLine1Txt |
| City | NELIGH | CityNm |
| State Abbreviation | NE | StateAbbreviationCd |
| ZIP | 68756 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | DIANE BRUGGER | PersonNm |
| Person Title | CEO | PersonTitleTxt |
| Phone | 4028874151 | PhoneNum |
| Signature | 2025-05-05 | 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 | MEGAN L KOZIOL CPA | PreparerPersonNm |
| PTIN | P01544037 | PTIN |
| Phone | 4023302660 | PhoneNum |
| Preparation | 2025-05-05 | 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 | DIANE BRUGGER | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 229 | AddressLine1Txt |
| City | NELIGH | CityNm |
| State Abbreviation | NE | StateAbbreviationCd |
| ZIP | 68756 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $22,453,827 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.AMHNE.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1974 | FormationYr |
| Legal Domicile State | NE | LegalDomicileStateCd |
| Activity Or Mission | TO OPERATE A HOSPITAL AND AFFILIATED INSTITUTIONS IN THE COUNTY OF ANTELOPE, NEBRASKA. | ActivityOrMissionDesc |
| Voting Members Governing Body | 11 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 11 | VotingMembersIndependentCnt |
| Total Employee | 202 | TotalEmployeeCnt |
| Total Volunteers | 18 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $1,370,691 | PYContributionsGrantsAmt |
| CY Contributions Grants | $88,214 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $19,779,516 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $20,731,714 | CYProgramServiceRevenueAmt |
| PY Investment Income | $336,281 | PYInvestmentIncomeAmt |
| CY Investment Income | $479,762 | CYInvestmentIncomeAmt |
| PY Other Revenue | $58,676 | PYOtherRevenueAmt |
| CY Other Revenue | $246,212 | CYOtherRevenueAmt |
| PY Total Revenue | $21,545,164 | PYTotalRevenueAmt |
| CY Total Revenue | $21,545,902 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $4,360 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $4,076 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $11,193,715 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $12,214,996 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $8,367,692 | PYOtherExpensesAmt |
| CY Other Expenses | $8,463,803 | CYOtherExpensesAmt |
| PY Total Expenses | $19,565,767 | PYTotalExpensesAmt |
| CY Total Expenses | $20,682,875 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $1,979,397 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $863,027 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $27,084,366 | TotalAssetsBOYAmt |
| Total Assets EOY | $27,682,171 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $2,354,257 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $2,097,183 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $24,730,109 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $25,584,988 | NetAssetsOrFundBalancesEOYAmt |
| Mission | MAKING A DIFFERENCE IN PEOPLE'S LIVES THROUGH EXCELLENT PATIENT CARE. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $17,530,481 | ExpenseAmt |
| Grant | $4,076 | GrantAmt |
| Revenue | $20,920,661 | RevenueAmt |
| Desc | ANTELOPE MEMORIAL HOSPITAL IS A 17-BED CRITICAL ACCESS HOSPITAL IN NELIGH, NE. IT PROVIDES QUALITY HEALTH CARE REGARDLESS OF RACE, CREED, COLOR, NATIONAL ORIGIN, AGE, GENDER, HANDICAP OR ABILITY TO PAY. THE HOSPITAL IS A FAMILY-CENTERED, COMMUNITY-ORIENTED HOSPITAL, OFFERING COMPREHENSIVE MEDICAL SERVICES, INCLUDING A FULL-TIME EMERGENCY ROOM. | Desc |
| Total Program Service Expenses | $17,530,481 | 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 | 0 | 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 | 0 | 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 | 0 | 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 | Yes (1) | DisregardedEntityInd |
| Related Entity | 0 | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 34 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 202 | 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 | 11 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 11 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | 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 | Yes (1) | 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 | 0 | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | MARTHA NELSON | PersonNm |
| Phone | 4028876282 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 229 | AddressLine1Txt |
| City | NELIGH | CityNm |
| State Abbreviation | NE | StateAbbreviationCd |
| ZIP | 68756 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (18 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|
| JOHN MLNARIK | |||||||
| PRESIDENT | 4.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| JAMES BLACKBURN | |||||||
| VICE PRESIDENT | 4.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| JAMES MEURET | |||||||
| SECRETARY/TREASURER | 4.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| JON SCHILLING | |||||||
| MEMBER | 2.00 | Yes (X) | $0 | $0 | $0 | ||
| GORDON SHRADER | |||||||
| MEMBER | 2.00 | Yes (X) | $0 | $0 | $0 | ||
| MAURY SOPER | |||||||
| MEMBER | 2.00 | Yes (X) | $0 | $0 | $0 | ||
| SAMANTHA STOLTZ | |||||||
| MEMBER | 2.00 | Yes (X) | $0 | $0 | $0 | ||
| DAVID SULLIVAN | |||||||
| MEMBER | 2.00 | Yes (X) | $0 | $0 | $0 | ||
| CHRISTOPHER TWIBELL | |||||||
| MEMBER | 2.00 | Yes (X) | $0 | $0 | $0 | ||
| DR RUSSELL VETICK | |||||||
| MEMBER | 2.00 | Yes (X) | $0 | $0 | $0 | ||
| TOM ZWINGMAN | |||||||
| MEMBER | 2.00 | Yes (X) | $0 | $0 | $0 | ||
| DIANE BRUGGER | |||||||
| ADMINISTRATOR/CEO | 40.00 | Yes (X) | $308,097 | $0 | $30,438 | ||
| MARTHA NELSON | |||||||
| CFO | 36.00 | Yes (X) | $221,699 | $0 | $26,597 | ||
| ROGER RUDLOFF MD | |||||||
| PHYSICIAN | 40.00 | $437,193 | $0 | $30,962 | Yes (X) | ||
| TROY DAWSON MD | |||||||
| PHYSICIAN | 40.00 | $391,283 | $0 | $38,370 | Yes (X) | ||
| KELLI OSBORN MD | |||||||
| PHYSICIAN | 40.00 | $282,134 | $0 | $37,440 | Yes (X) | ||
| PATRICIA GOOD APRN | |||||||
| APRN | 40.00 | $177,635 | $0 | $346 | Yes (X) | ||
| JOSHUA THOENDEL MD | |||||||
| PHYSICIAN | 40.00 | $347,705 | $0 | $37,440 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $2,165,746 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $201,593 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 13 | 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 |
|---|---|---|---|---|---|
| PSYCHIATRIC MEDICAL SERVICES | |||||
| 8 CADILLAC DRIVE SUITE 230 | BRENTWOOD | TN | 37027 | PSYCHIATRIC SERVICES | $491,148 |
| PINNACLE ANESTHESIA SERVICES | |||||
| 608 EAST 4TH STREET | NELIGH | NE | 68756 | NURSING SERVICES | $457,406 |
| OVERLAND REHAB SERVICES | |||||
| 405 JAMES STREET | VERDIGRE | NE | 68783 | PHYSICAL THERAPY SERVICES | $342,077 |
| EIDE BAILLY | |||||
| 18081 BURT STREET SUITE 200 | OMAHA | NE | 68022 | ACCOUNTING SERVICES | $145,584 |
| APPLIED CONNECTIVE TECHNOLOGIES LLC | |||||
| PO BOX 446 2508 SALEBARN RD | ALBION | NE | 68620 | IT SERVICES | $138,409 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 5 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $26,323 | GovernmentGrantsAmt |
| All Other Contributions | $61,891 | AllOtherContributionsAmt |
| Total Contributions | $88,214 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (4 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| MEDICARE/MEDICAID PAYMENTS | 621400 | $11,340,934 | $11,340,934 |
| NET PATIENT SERVICE REVENUE | 621400 | $8,880,504 | $8,880,504 |
| 340B REVENUE | 611400 | $323,501 | $323,501 |
| AMBULANCE | 621910 | $7,200 | $7,200 |
Total Oth Program Service Rev TotalOthProgramServiceRevGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $179,575 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $179,575 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $20,731,714 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $461,528 | TotalRevenueColumnAmt |
| Exclusion | $461,528 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $926,159 | SecuritiesAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $903,648 | SecuritiesAmt |
| Other | $4,277 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $22,511 | SecuritiesAmt |
| Other | -$4,277 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $18,234 | TotalRevenueColumnAmt |
| Exclusion | $18,234 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt | ExclusionExclusionAmt |
|---|---|---|---|---|
| INSURANCE PROCEEDS | 900099 | $188,947 | $188,947 | |
| CAFETERIA | 900099 | $57,265 | $57,265 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $246,212 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $21,545,902 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $20,920,661 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $537,027 | 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 | $4,076 | TotalAmt |
| Program Services | $4,076 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $586,831 | TotalAmt |
| Management And General | $586,831 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $9,241,634 | TotalAmt |
| Program Services | $8,185,291 | ProgramServicesAmt |
| Management And General | $1,056,343 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $255,578 | TotalAmt |
| Program Services | $218,576 | ProgramServicesAmt |
| Management And General | $37,002 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,492,161 | TotalAmt |
| Program Services | $1,234,837 | ProgramServicesAmt |
| Management And General | $257,324 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $638,792 | TotalAmt |
| Program Services | $554,859 | ProgramServicesAmt |
| Management And General | $83,933 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $45,583 | TotalAmt |
| Program Services | $14,142 | ProgramServicesAmt |
| Management And General | $31,441 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $91,454 | TotalAmt |
| Management And General | $91,454 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,616,530 | TotalAmt |
| Program Services | $2,371,379 | ProgramServicesAmt |
| Management And General | $245,151 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $165,560 | TotalAmt |
| Program Services | $9,147 | ProgramServicesAmt |
| Management And General | $156,413 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $715,659 | TotalAmt |
| Program Services | $606,054 | ProgramServicesAmt |
| Management And General | $109,605 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $855,224 | TotalAmt |
| Program Services | $575,106 | ProgramServicesAmt |
| Management And General | $280,118 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $256,433 | TotalAmt |
| Program Services | $245,926 | ProgramServicesAmt |
| Management And General | $10,507 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $43,215 | TotalAmt |
| Program Services | $41,498 | ProgramServicesAmt |
| Management And General | $1,717 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,504,864 | TotalAmt |
| Program Services | $1,437,954 | ProgramServicesAmt |
| Management And General | $66,910 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $331,718 | TotalAmt |
| Program Services | $316,969 | ProgramServicesAmt |
| Management And General | $14,749 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| MEDICAL SUPPLIES | $1,653,413 | $1,653,413 | |
| DUES & SUBSCRIPTIONS | $93,856 | $49,256 | $44,600 |
| MISCELLANEOUS | $75,589 | $6,319 | $69,270 |
| LICENSES | $14,705 | $5,679 | $9,026 |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $20,682,875 | TotalAmt |
| Program Services | $17,530,481 | ProgramServicesAmt |
| Management And General | $3,152,394 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $222,063 | BOYAmt |
| EOY | $623,392 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,840,970 | BOYAmt |
| EOY | $11,994,332 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,100 | BOYAmt |
| EOY | $5,100 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,120,009 | BOYAmt |
| EOY | $1,603,262 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $97,622 | BOYAmt |
| EOY | $0 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $419,058 | BOYAmt |
| EOY | $419,499 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $180,707 | BOYAmt |
| EOY | $113,569 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $31,536,567 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $18,787,478 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $13,616,687 | BOYAmt |
| EOY | $12,749,089 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $582,150 | BOYAmt |
| EOY | $173,928 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $27,084,366 | BOYAmt |
| EOY | $27,682,171 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,049,257 | BOYAmt |
| EOY | $1,863,741 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $305,000 | BOYAmt |
| EOY | $0 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $233,442 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,354,257 | BOYAmt |
| EOY | $2,097,183 | 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 | $24,703,304 | BOYAmt |
| EOY | $25,561,688 | EOYAmt |
Donor Restriction Net Assets DonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $26,805 | BOYAmt |
| EOY | $23,300 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $24,730,109 | BOYAmt |
| EOY | $25,584,988 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $27,084,366 | BOYAmt |
| EOY | $27,682,171 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $863,027 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | -$8,148 | 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) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
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 | $2,255 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $2,255 | 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 | PORTION OF THE DUES PAID TO THE NEBRASKA HOSPITAL ASSOCIATION AND THE AMERICAN HOSPITAL ASSOCIATION ARE ALLOCABLE TO LOBBYING ACTIVITIES. | ExplanationTxt |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $124,229 | OtherCostOrOtherBasisAmt |
| Book Value | $124,229 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $9,898,917 | OtherCostOrOtherBasisAmt |
| Depreciation | $5,387,455 | DepreciationAmt |
| Book Value | $4,511,462 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $17,230,824 | OtherCostOrOtherBasisAmt |
| Depreciation | $11,246,467 | DepreciationAmt |
| Book Value | $5,984,357 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $4,282,597 | OtherCostOrOtherBasisAmt |
| Depreciation | $2,153,556 | DepreciationAmt |
| Book Value | $2,129,041 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $12,749,089 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | ESTIMATED 3RD PARTY PAYER SETTLEMENT | Desc |
| Amt | $233,442 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $233,442 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART X, LINE 2: | FormAndLineReferenceDesc |
| Explanation | THE HOSPITAL ACCOUNTS FOR UNCERTAINTIES IN ACCOUNTING FOR INCOME TAX ASSETS AND LIABILITIES USING GUIDANCE INCLUDED IN FINANCIAL ACCOUNTING STANDARDS BOARD (FASB) ACCOUNTING STANDARDS CODIFICATION (ASC) 740, INCOME TAXES. THE HOSPITAL RECOGNIZES 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 HAD NO UNCERTAIN TAX POSITIONS ACCRUED. | ExplanationTxt |
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 |
Free Care Oth Percentage FreeCareOthPercentageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Free Care Other | 125.000000000000 | FreeCareOtherPct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| FPG Reference Discounted Care | 0 | FPGReferenceDiscountedCareInd |
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | 0 | ExpensesExceedBudgetInd |
| 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 | $25,982 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $25,982 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00130 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,450,472 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,259,247 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,191,225 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.05760 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,476,454 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,259,247 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,217,207 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.05890 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $26,124 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $5,581 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $20,543 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00100 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $3,210,439 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,335,890 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $874,549 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.04230 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $4,076 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $4,076 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00020 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $3,240,639 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,341,471 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $899,168 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.04350 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $5,717,093 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $3,600,718 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,116,375 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.10240 | TotalExpensePct |
Economic Development EconomicDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $400 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $400 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Workforce Development WorkforceDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $62,387 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $62,387 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00300 | TotalExpensePct |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $62,787 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $62,787 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00300 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $290,686 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $33,429 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $9,644,136 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $9,811,970 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$167,834 | 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 | ANTELOPE MEMORIAL HOSPITAL | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 102 WEST 9TH STREET | AddressLine1Txt |
| City | NELIGH | CityNm |
| State Abbreviation | NE | StateAbbreviationCd |
| ZIP | 68756 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | WWW.AMHNE.ORG | WebsiteAddressTxt |
| State License | 020001 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| 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 | ANTELOPE MEMORIAL HOSPITAL | 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 | 21 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | Yes (1) | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | Yes (1) | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | WWW.AMHNE.ORG | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 21 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | WWW.AMHNE.ORG | 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 | 125.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| 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 | WWW.AMHNE.ORG/GETPAGE.PHP?NAME=VISITORINFO&SUB=FOR%20PATIENTS | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | WWW.AMHNE.ORG/GETPAGE.PHP?NAME=VISITORINFO&SUB=FOR%20PATIENTS | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | WWW.AMHNE.ORG/GETPAGE.PHP?NAME=VISITORINFO&SUB=FOR%20PATIENTS | 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 |
| 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 |
| Prospective Medicare Medicaid | Yes (X) | ProspectiveMedicareMedicaidInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| ANTELOPE MEMORIAL HOSPITAL | PART V, SECTION B, LINE 5: ANTELOPE MEMORIAL HOSPITAL RECEIVED INPUT FROM COMMUNITY MEMBERS THROUGHOUT ANTELOPE COUNTY THROUGH THE USE OF SURVEYS POSTED ON OUR WEBSITE AND SENT THROUGH SOCIAL MEDIA. |
| ANTELOPE MEMORIAL HOSPITAL | PART V, SECTION B, LINE 6A: ANTELOPE MEMORIAL HOSPITAL, NELIGH, NE (ANTELOPE COUNTY)AVERA CREIGHTON HOSPITAL, CREIGHTON, NE (KNOX COUNTY)AVERA SAINT ANTHONY'S HOSPITAL, O'NEILL, NE (HOLT COUNTY)OSMOND GENERAL HOSPITAL, OSMOND, NE (PIERCE COUNTY)CHI PLAINVIEW HOSPITAL, PLAINVIEW, NE (PIERCE COUNTY)NIOBRARA VALLEY HOSPITAL, LYNCH, NE (BOYD COUNTY)WEST HOLT MEMORIAL HOSPITAL, ATKINSON, NE (HOLT COUNTY)BROWN COUNTY HOSPITAL, AINSWORTH, NE (BROWN COUNTY) |
| ANTELOPE MEMORIAL HOSPITAL | PART V, SECTION B, LINE 6B: NORTH CENTRAL DISTRICT HEALTH DEPARTMENT (NCDHD)THE EVERGREEN ASSISTED LIVING FACILITYGOOD SAMARITAN SOCIETY - ATKINSONREGION 4 BEHAVIORAL HEALTH SYSTEMCENTRAL NEBRASKA COMMUNITY ACTION PARTNERSHIPNORTHSTAR SERVICES BLOOMFIELDNCDHD BOARD OF HEALTHCENTRAL NEBRASKA ECONOMIC DEVELOPMENTHOLT COUNTY ECONOMIC DEVELOPMENTO'NEILL PUBLIC SCHOOL BOARD |
| ANTELOPE MEMORIAL HOSPITAL | PART V, SECTION B, LINE 11: ANTELOPE MEMORIAL HOSPITAL PLANS TO ADDRESS BOTH PRIORITY AREAS IDENTIFIED BY THE COMMUNITY WORKGROUP, WHICH SHOULD ADEQUATELY COVER THE MAJOR HEALTH PROBLEMS AND HIGH-RISK BEHAVIORS IN ITS SERVICE AREA. THE TWO FOCUS AREAS SPECIFIC TO ANTELOPE MEMORIAL HOSPITAL ARE:- HEART HEALTH- MENTAL HEALTHFOCUS AREA 1: HEART HEALTHGOAL: EFFECTIVELY PROMOTE ANTELOPE MEMORIAL HOSPITAL'S SERVICES AIMED AT PREVENTING, SCREENING AND MANAGING HEART DISEASE THROUGHOUT THE COMMUNITY SERVICE AREA. ACTION 1: COLLABORATE WITH LOCAL ENTITIES AND MEDIA OUTLETS TO EDUCATE THE PUBLIC ON HEART DISEASE RISK FACTORS AND REDUCTIONYEARLY: EVERY YEAR IN FEBRUARY WE RECOGNIZE OUR CARDIAC REHAB STAFF ON FACEBOOK AND LOCAL RADIO STATIONS AND NEWSPAPERS THAT INCLUDES EDUCATION TO THE PUBLIC ON THE REHAB PROGRAM AND SERVICES.TWICE A MONTH: AMH NURSES PROVIDE HEALTH SCREENS (BLOOD PRESSURES, HEART RATES, O2 SATS, TEMPERATURES, RESPIRATIONS, AND BLOOD GLUCOSE) AT THE NELIGH COMMUNITY CENTER. EDUCATION IS PROVIDED. TOTAL OF 69 SCREENED DURING THE CURRENT FISCAL YEAR.AMH DIABETES EDUCATION DEPARTMENT OFFERED A FREE ROAST BEEF SUPPER AT THE NELIGH COMMUNITY CENTER. AMH'S DIABETES EDUCATION DEPARTMENT EDUCATED 65 ATTENDEES ON HEALTH LIFESTYLE TIPS/DIABETES PREVENTION.ACTION 2: INCORPORATE CHOLESTEROL TESTS INTO COMMUNITY SCREENING EVENTSSEPTEMBER 20 & 22, 2023 AMH OFFERED DISCOUNTED LAB SPECIALS WITH 138 PEOPLE TESTED.OCTOBER 2023 AMH LAB ATTENDED ELKHORN RURAL PUBLIC POWER DISTRICT'S (ERPPD) HEALTH FAIR AND DREW LAB ON 50 ERPPD EMPLOYEES.DECEMBER 11, 2023 AMH REHAB SERVICES PROVIDED CHOLESTEROL, BLOOD SUGAR, AND BLOOD PRESSURE SCREENING AND EDUCATION AT NELIGH PIONEER HOMES. 5 PEOPLE ATTENDED.APRIL 24 & 26, 2024 AMH OFFERED DISCOUNTED LAB SPECIALS WITH 164 PEOPLE TESTED. ACTION 3: ENSURE STAFF IS TRAINED ON THE MOST UP-TO-DATE STANDARDS FOR BLOOD PRESSURE MEASUREMENT.JANUARY 24, 2024 AMH STAFF TOOK THE MEASURE ACCURATELY, THE FIRST STEP IN HYPERTENSION CONTROL COURSE FROM BRYAN HEALTH. ACTION 4: COLLABORATE WITH LOCAL ENTITIES AND MEDIA OUTLETS TO EDUCATE THE PUBLIC ON SERVICES COVERED BY INSURANCE BENEFITS. OCTOBER 15 DECEMBER 7, 2023 DANIELLE VAN BUREN COUNSELED 37 PEOPLE ON MEDICARE ENROLLMENT. MARCH 5-6, 2024 ANTELOPE COUNTY AG & HOME EXPO DR. THOENDEL DID A PRESENTATION ON "NAVIGATING CANCER SCREENING: WHAT YOU NEED TO KNOW" (8 ATTENDED). TAMI KESTER, CHRISTINE COUNTS, AND AMY WRIGHT OFFERED BLOOD PRESSURE CHECKS (47 CHECKED).ACTION 5: OFFER BASIC LIFE SUPPORT (BLS) TO AMH STAFF AND LIFE-SAVING CLASSES TO THE PUBLIC. JUNE 19, 2024 AMH OFFERED A FREE LIFE-SAVING CLASS TO THE PUBLIC; HOWEVER, NO RESPONSE (ADVERTISED ON FACEBOOK). FOCUS AREA 2: MENTAL HEALTHGOAL 1: INCREASE THE NUMBER OF COUNSELING SERVICES AT ANTELOPE MEMORIAL HOSPITAL BY 1%ACTION 1: ADD AN ONSITE LICENSED MENTAL HEALTH PRACTITIONER FOR PATIENTS OF ALL AGES UNABLE TO MEET DUE TO CHANGES IN PROGRAM DIRECTORS. AMH CONTINUES TO ADVERTISE OUR CURRENT MENTAL HEALTH SERVICES VIA FACEBOOK AND LOCAL NEWSPAPERS. GOAL 2: EFFECTIVELY RAISE MENTAL HEALTH AWARENESS TO YOUTH, ADULTS AND SENIORS AND EDUCATE THEM ON AVAILABLE MENTAL HEALTH SERVICESACTION 1: INCREASE ANTELOPE MEMORIAL HOSPITAL'S STAFF PARTICIPATION IN THE ANTELOPE COUNTY DOES CARE (ACDC) COALITION. AMH HOSTED AND STAFF ATTENDED 6 MEETINGS OF THE ACDC.ACTION 2: COLLABORATE WITH LOCAL ENTITIES AND MEDIA OUTLETS TO EDUCATE THE PUBLIC ON MENTAL HEALTH RISK FACTORS AND AVAILABLE SERVICES. NOVEMBER 17, 2023 2 AMH STAFF MEMBERS ATTENDED DOUG WIDOW'S EQUINE-ASSISTED THERAPY PRESENTATION. INFORMATION WAS SHARED WITH NELIGH'S CHIEF OF POLICE AND ANTELOPE COUNTY SHERIFF.WEEKLY/MONTHLY MENTAL HEALTH SERVICES OFFERED AT AMH ARE ADVERTISED IN OUR LOCAL NEWSPAPERS AND ON FACEBOOK.MAY 2024 - MENTAL HEALTH AWARENESS MONTH - SENIOR LIFE SOLUTIONS HAD PROMOTIONAL/INFORMATIONAL TABLES SET UP AT THE NELIGH AND ELGIN SENIOR CENTERS AND HOSPITAL. AMH SENIOR LIFE SOLUTIONS STAFF PROVIDE BINGO AT THE NELIGH COMMUNITY CENTER. EDUCATION IS PROVIDED. JUNE 26, 2024 FACEBOOK POST EDUCATING PUBLIC ON THE THREE-DIGIT NATIONAL LIFELINE NUMBER TO CALL FOR SUICIDE PREVENTION AND MENTAL HEALTH CRISIS (988).THERE WERE NO SIGNIFICANT NEEDS IDENTIFIED THAT ARE NOT CURRENTLY BEING ADDRESSED. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 5 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (5 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| 1 - AMH FAMILY PRACTICE | ||||
| 109 WEST 11TH STREET PO BOX 109 | NELIGH | NE | 68756 | FAMILY PRACTICE MEDICAL CLINIC |
| 2 - AMH TILDEN CLINIC | ||||
| 200 S ANTELOPE STREET | TILDEN | NE | 68781 | FAMILY PRACTICE MEDICAL CLINIC |
| 3 - AMH CLEARWATER CLINIC | ||||
| 308 NEVADA STREET | CLEARWATER | NE | 68726 | FAMILY PRACTICE MEDICAL CLINIC |
| 4 - AMH ELGIN CLINIC | ||||
| 101 WEST CEDAR STREET | ELGIN | NE | 68636 | FAMILY PRACTICE MEDICAL CLINIC |
| 5 - ORCHARD MEDICAL CLINIC | ||||
| 103 WASHINGTON STREET | ORCHARD | NE | 68764 | FAMILY PRACTICE MEDICAL CLINIC |
Supplemental Information Detail SupplementalInformationDetail (14 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 3C: | IN ADDITION TO FEDERAL POVERTY GUIDELINES, THE HOSPITAL ALSO USES ASSET LEVEL, INSURANCE STATUS AND UNDERINSURANCE STATUS TO DETERMINE ELIGIBILITY FOR FREE CARE. DISCOUNTED CARE IS NOT OFFERED, AS FINANCIAL ASSISTANCE IS BASED UPON AN ALL OR NOTHING POLICY. IF THE PATIENT QUALIFIES FOR FINANCIAL ASSISTANCE, THEY WILL RECEIVE A 100% DISCOUNT. |
| 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 CONTRIBUTIONS, LINE 7I, ARE REPORTED BASED ON ACTUAL EXPENSES REPORTED IN THE GENERAL LEDGER. THE COST FOR SUBSIDIZED HEALTH SERVICES REPORTED ON LINE 7G WAS CALCULATED USING THE RATIO OF PATIENT COST TO CHARGES ON WORKSHEET 2. |
| PART I, LINE 7G: | SUBSIDIZED HEALTH SERVICES INCLUDE THREE PHYSICIAN CLINICS IN NEIGHBORING COMMUNITIES, AS WELL AS PHYSICAL THERAPY SERVICES, PATIENT TRANSPORT AND CARDIAC REHAB. |
| PART II, COMMUNITY BUILDING ACTIVITIES: | COMMUNITY BUILDING ACTIVITIES DURING THE YEAR INCLUDED THE FOLLOWING:- MEMBERSHIP DUES AND ATTENDANCE AT MONTHLY CHAMBER OF COMMERCE MEETINGS TO PROMOTE LOCAL BUSINESS AND WORKING FOR THE BETTERMENT OF THE COMMUNITY AS A WHOLE.- DEVELOPING THE WORKFORCE BY PROVIDING SCHOLARSHIPS TO INCREASE MEDICAL EDUCATION IN THE COMMUNITY, AS WELL AS OTHER PAYMENTS FOR ENSURING THE CONTINUOUS RECRUITMENT OF PHYSICIANS AND OTHER HEALTH PROFESSIONALS TO THE AREA. |
| PART III, LINE 2: | THE HOSPITAL DETERMINES ITS ESTIMATE OF IMPLICIT PRICE CONCESSIONS BASED ON HISTORICAL COLLECTION EXPERIENCE WITH VARIOUS CLASSES OF PATIENTS. |
| PART III, LINE 3: | THE ESTIMATED AMOUNT OF THE ORGANIZATION'S IMPLICIT PRICE CONCESSIONS ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S CHARITY CARE POLICY IS CALCULATED BASED ON AN APPROXIMATE 11.5% OF INDIVIDUALS LIVING BELOW THE POVERTY LEVEL IN THE SERVICE AREA. |
| PART III, LINE 4: | THE FOOTNOTE TO THE ORGANIZATION'S FINANCIAL STATEMENTS THAT DESCRIBES IMPLICIT PRICE CONCESSIONS IS LOCATED IN FOOTNOTE 1 ON PAGES 14 AND 15 OF THE ATTACHED FINANCIAL STATEMENTS. |
| PART III, LINE 8: | THE MEDICARE SHORTFALL IS BASED ON THE INFORMATION FROM THE COST REPORT. THESE COSTS ARE MEDICARE REIMBURSABLE COSTS, NOT ALL COSTS. THESE MEDICARE REIMBURSABLE COSTS SHOULD BE TREATED AS A COMMUNITY BENEFIT TO THE EXTENT THAT MEDICARE REVENUES DO NOT COVER THE COSTS, THEREFORE THE ENTIRE SHORTFALL SHOULD BE TREATED AS A COMMUNITY BENEFIT. WE DO NOT USE ANY NEGOTIATION TOOL WITH MEDICARE FOR OUR RATES; THE RATES THAT WE ARE PAID ARE MANDATED. HENCE, THIS DOES NOT GIVE US THE ABILITY AS A PROVIDER TO RECEIVE SUFFICIENT REVENUES TO COVER THE MEDICARE COSTS. AS A FACILITY WE ARE WORKING TOWARD COSTS SAVINGS. |
| PART III, LINE 9B: | IF A PERSON APPLIES FOR FINANCIAL ASSISTANCE IN ACCORDANCE WITH THE FINANCIAL ASSISTANCE POLICY ALL COLLECTION EFFORTS WILL STOP UNTIL THE DETERMINATION OF ELIGIBILITY FOR FINANCIAL ASSISTANCE IS MADE. IF THE PERSON QUALIFIES FOR FINANCIAL ASSISTANCE, THE HOSPITAL WILL TAKE STEPS TO REVERSE COLLECTIONS ACTION, REPORTS, AND OTHER ACTIONS THAT HAVE BEEN TAKEN TO OBTAIN PAYMENT. |
| PART VI, LINE 2: | ANTELOPE MEMORIAL HOSPITAL PERFORMED THE FOLLOWING PROCEDURES TO ASSESS THE HEALTH NEEDS OF THE COMMUNITY IT SERVES: - COMMUNITY FOCUS GROUP MEETINGS - CONFERENCE CALLS WITH DHHS PERSONNEL FOR INPUT, GUIDANCE, AND FEEDBACK - STRATEGIC PLANNING SESSIONS |
| PART VI, LINE 3: | PATIENTS MAY OBTAIN A COPY OF THE FINANCIAL ASSISTANCE POLICY, A PLAIN LANGUAGE SUMMARY OF THE POLICY, AND A FINANCIAL ASSISTANCE APPLICATION FREE OF CHARGE (I) BY MAIL BY CALLING 402-887-6286, (II) BY E-MAIL (UPON PATIENT ELECTION) BY E-MAILING PATIENTFINANCIALCOUNSELOR@AMHNE.ORG, (III) BY DOWNLOAD FROM WWW.AMHNE.ORG/PAGES/FINANCIALASSISTANCE/INDEX.HTML, OR (IV) IN PERSON AT (A) THE EMERGENCY ROOM, (B) ANY ADMISSION AREAS, OR ( C) THE OFFICE OF THE PATIENT FINANCIAL COUNSELOR LOCATED NEAR THE HOSPITAL BUSINESS OFFICE. ANTELOPE MEMORIAL HOSPITAL ALSO INCLUDES ITS PAYMENT POLICY WITH ALL STATEMENTS SENT TO PATIENTS. 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: | ANTELOPE MEMORIAL HOSPITAL IS THE ONLY ACUTE CARE FACILITY SERVING THE ANTELOPE COUNTY AREA DUE TO THE CLOSURE OF TILDEN COMMUNITY HOSPITAL. ANTELOPE MEMORIAL HOSPITAL ALSO PROVIDES SERVICE TO THE FOLLOWING FIVE NEBRASKA COUNTIES: BOONE, HOLT, KNOX, MADISON AND PIERCE. THE NORTH CENTRAL DISTRICT HEALTH DEPARTMENT PROJECTS THE TOTAL SERVICE POPULATION TO BE AROUND 45,000 RESIDENTS, OF WHICH 11.5% ARE BELOW THE POVERTY LEVEL. THE POPULATION IS DECREASING, AND OVER 50% OF RESIDENTS ARE OVER THE AGE OF 45. |
| PART VI, LINE 5: | ANTELOPE MEMORIAL HOSPITAL PROMOTES THE HEALTH OF ITS COMMUNITY BY PROVIDING A COMMUNITY-BASED WELLNESS PROGRAM THAT ENCOURAGES INDIVIDUALS TO LIVE A HEALTHIER LIFESTYLE. AMH OFFERS A VARIETY OF EQUIPMENT AND GUIDANCE TO ASSIST COMMUNITY MEMBERS IN REACHING THEIR INDIVIDUAL WELLNESS GOALS, SUCH AS PREVENTING DISEASES AND CREATING A HEALTHIER COMMUNITY. AMH OFFERS ITS COMMUNITY DIABETES EDUCATION CLASSES, SMOKING CESSATION EDUCATION, AND OUTPATIENT GROUP THERAPY PROGRAMS DESIGNED FOR THOSE STRUGGLING WITH SYMPTOMS OF DEPRESSION AND ANXIETY.AMH ALSO COLLABORATES WITH NORTH CENTRAL DISTRICT HEALTH DEPARTMENT AND OTHER COMMUNITY PARTNERS TO FOCUS ON SUBSTANCE ABUSE PREVENTION, MOST RECENTLY PROVIDING DRUG RECOGNITION AND AWARENESS TRAINING. |
| FORM 990, PART VI, LINE 7: | NEBRASKA DOES NOT REQUIRE THE FILING OF A COMMUNITY BENEFIT REPORT WITH THE STATE, HOWEVER A COMMUNITY BENEFIT REPORT IS FILED ANNUALLY WITH THE NEBRASKA HOSPITAL ASSOCIATION. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Independent Consultant | Yes (X) | IndependentConsultantInd |
| 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| ROGER RUDLOFF MD | ||||||||||||||
| PHYSICIAN | $437,193 | $0 | $0 | $0 | $0 | $0 | $14,994 | $0 | $15,968 | $0 | $468,155 | $0 | $0 | $0 |
| TROY DAWSON MD | ||||||||||||||
| PHYSICIAN | $391,283 | $0 | $0 | $0 | $0 | $0 | $14,994 | $0 | $23,376 | $0 | $429,653 | $0 | $0 | $0 |
| JOSHUA THOENDEL MD | ||||||||||||||
| PHYSICIAN | $347,705 | $0 | $0 | $0 | $0 | $0 | $14,994 | $0 | $22,446 | $0 | $385,145 | $0 | $0 | $0 |
| DIANE BRUGGER | ||||||||||||||
| ADMINISTRATOR/CEO | $308,097 | $0 | $0 | $0 | $0 | $0 | $12,145 | $0 | $18,293 | $0 | $338,535 | $0 | $0 | $0 |
| KELLI OSBORN MD | ||||||||||||||
| PHYSICIAN | $282,134 | $0 | $0 | $0 | $0 | $0 | $14,994 | $0 | $22,446 | $0 | $319,574 | $0 | $0 | $0 |
| MARTHA NELSON | ||||||||||||||
| CFO | $221,699 | $0 | $0 | $0 | $0 | $0 | $6,850 | $0 | $19,747 | $0 | $248,296 | $0 | $0 | $0 |
| PATRICIA GOOD APRN | ||||||||||||||
| APRN | $177,635 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $346 | $0 | $177,981 | $0 | $0 | $0 |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (7 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 1A | THE EXECUTIVE COMMITTEE, COMPRISED OF THE PRESIDENT, VICE PRESIDENT, SECRETARY AND TREASURER, SHALL HAVE THE POWER TO TRANSACT ALL REGULAR BUSINESS OF THE HOSPITAL. |
| FORM 990, PART VI, SECTION B, LINE 11B | THE FORM 990 IS PREPARED BY A CERTIFIED PUBLIC ACCOUNTANT AND DELIVERED TO THE CHIEF FINANCIAL OFFICER. THE CFO AND CEO REVIEW THE FORM 990 AND THE ADMINISTRATOR PRESENTS IT AT A MONTHLY BOARD MEETING, PRIOR TO FILING. |
| FORM 990, PART VI, SECTION B, LINE 12C | ALL OFFICERS, DIRECTORS, COMMITTEE MEMBERS AND KEY EMPLOYEES SHALL REVIEW THE CONFLICT OF INTEREST POLICY AND COMPLETE A CONFLICT OF INTEREST QUESTIONNAIRE AND CERTIFICATION UPON INITIAL AFFILIATION WITH THE CORPORATION AND ON AN ANNUAL BASIS THEREAFTER. ANY POTENTIAL CONFLICTS SHOULD BE DICLOSED TO THE BOARD OF DIRECTORS AND MADE A MATTER OF RECORD WHENEVER IT ARISES, OR WHENEVER IT INVOLVES A MATTER OF BOARD ACTION. ANY PERSON HAVING A CONFLICT OF INTEREST OR POSSIBLE CONFLICT IN ANY MATTER SHOULD NOT VOTE OR USE HIS OR HER INFLUENCE ON THE MATTER. |
| FORM 990, PART VI, SECTION B, LINE 15A | SALARY COMPARISON DATA FROM THE NEBRASKA HOSPITAL ASSOCIATION IS USED TO COMPARE ADMINISTRATOR SALARY WITH THAT OF OTHER NEBRASKA CRITICAL ACCESS HOSPITALS. THE CHIEF EXECUTIVE OFFICER AND CHIEF FINANCIAL OFFICER SALARIES ARE DETERMINED USING THE NEBRASKA HOSPITAL ASSOCIATION SALARY SURVEYS AND ARE THEN SET BY THE BOARD OF DIRECTORS. THE BOARD MINUTES DOCUMENT THE DELIBERATIONS AND SALARY DECISIONS. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION DOES NOT MAKE THESE DOCUMENTS AVAILABLE TO THE PUBLIC. |
| FORM 990, PART IX, LINE 11G | OTHER FEES FOR SERVICE: PROGRAM SERVICE EXPENSES 1,458,289. MANAGEMENT AND GENERAL EXPENSES 203,956. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,662,245. THERAPIST FEES: PROGRAM SERVICE EXPENSES 786,508. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 786,508. MRI FEES: PROGRAM SERVICE EXPENSES 61,225. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 61,225. NUCLEAR IMAGING FEES: PROGRAM SERVICE EXPENSES 65,357. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 65,357. COLLECTION FEES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 41,195. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 41,195. |
| FORM 990, PART XII, LINE 2C: | THE FULL BOARD OF DIRECTORS OVERSEES SELECTION OF AN INDEPENDENT ACCOUNTANT AND THE AUDIT OF THE ANTELOPE MEMORIAL HOSPITAL'S FINANCIAL STATEMENTS. THIS PROCESS HAS NOT CHANGED FROM PRIOR YEARS. |
Schedule R IRS990ScheduleR
Id Disregarded Entities IdDisregardedEntitiesGrp
Disregarded Entity Name DisregardedEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | HILLTOP COMMUNITY PHARMACY LLC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 108 W 11TH ST | AddressLine1Txt |
| City | NELIGH | CityNm |
| State Abbreviation | NE | StateAbbreviationCd |
| ZIP | 68756 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 992418371 | EIN |
| Primary Activities | PHARMACY | PrimaryActivitiesTxt |
| Legal Domicile State | NE | LegalDomicileStateCd |
| Total Income | $0 | TotalIncomeAmt |
| End Of Year Assets | $186,128 | EndOfYearAssetsAmt |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ANTELOPE MEMORIAL HOSPITAL | BusinessNameLine1Txt |
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