MEMORIAL COMMUNITY HOSPITAL CORPORATION: Form 990, tax year 2021
View the entire original 990 at ProPublica ↗
- Organization
- MEMORIAL COMMUNITY HOSPITAL CORPORATION (EIN 47-0426285)
- Tax period
- 2021-01-01 to 2021-12-31
- Filed
- 2022-11-15
- IRS object ID
- 202223199349325817
- Schema version
- 2021v4.2
- 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 K
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2022-11-15T16:42:54-06:00 | ReturnTs |
| Tax Period End | 2021-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 470617373 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | COMMONSPIRIT HEALTH | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 198 INVERNESS DRIVE WEST | AddressLine1Txt |
| City | ENGLEWOOD | CityNm |
| State Abbreviation | CO | StateAbbreviationCd |
| ZIP | 80112 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2021-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 470426285 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MEMORIAL COMMUNITY HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | MEMO | BusinessNameControlTxt |
| Phone | 4024262182 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 810 NORTH 22ND STREET | AddressLine1Txt |
| City | BLAIR | CityNm |
| State Abbreviation | NE | StateAbbreviationCd |
| ZIP | 68008 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | TIM SCHNACK | PersonNm |
| Person Title | CFO | PersonTitleTxt |
| Phone | 4024262182 | PhoneNum |
| Signature | 2022-11-15 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | TIM | PersonFirstNm |
| Person Last | SCHNACK | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | XXX-XX-XXXX | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | ANGELA NOEL | PreparerPersonNm |
| PTIN | P01051055 | PTIN |
| Phone | 3032989100 | PhoneNum |
Additional Filer Information AdditionalFilerInformation
Trusted Customer TrustedCustomerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | 3 | TrustedCustomerCd |
| Authentication Assurance Level | AAL1 | AuthenticationAssuranceLevelCd |
| Identity Assurance Level | IAL1 | IdentityAssuranceLevelCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2021 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | TIM SCHNACK | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 810 NORTH 22ND STREET | AddressLine1Txt |
| City | BLAIR | CityNm |
| State Abbreviation | NE | StateAbbreviationCd |
| ZIP | 68008 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $44,045,784 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.MCHHS.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1956 | FormationYr |
| Legal Domicile State | NE | LegalDomicileStateCd |
| Activity Or Mission | 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. | ActivityOrMissionDesc |
| Voting Members Governing Body | 7 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 5 | VotingMembersIndependentCnt |
| Total Employee | 336 | TotalEmployeeCnt |
| Total Volunteers | 9 | TotalVolunteersCnt |
| Total Gross UBI | $89 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $391,675 | PYContributionsGrantsAmt |
| CY Contributions Grants | $2,465,869 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $38,626,247 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $40,328,732 | CYProgramServiceRevenueAmt |
| PY Investment Income | $352,157 | PYInvestmentIncomeAmt |
| CY Investment Income | $458,568 | CYInvestmentIncomeAmt |
| PY Other Revenue | $1,016,780 | PYOtherRevenueAmt |
| CY Other Revenue | $791,509 | CYOtherRevenueAmt |
| PY Total Revenue | $40,386,859 | PYTotalRevenueAmt |
| CY Total Revenue | $44,044,678 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $110,386 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $19,404,964 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $22,058,998 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $17,397,812 | PYOtherExpensesAmt |
| CY Other Expenses | $16,951,110 | CYOtherExpensesAmt |
| PY Total Expenses | $36,913,162 | PYTotalExpensesAmt |
| CY Total Expenses | $39,010,108 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $3,473,697 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $5,034,570 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $51,670,710 | TotalAssetsBOYAmt |
| Total Assets EOY | $56,275,818 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $18,573,707 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $15,612,240 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $33,097,003 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $40,663,578 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | 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. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $8,474,512 | ExpenseAmt |
| Grant | $0 | GrantAmt |
| Revenue | $11,354,311 | RevenueAmt |
| Desc | 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 $11,354,311 IS THE GROSS REVENUE BEFORE CONTRACTUAL ADJUSTMENTS. | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $2,681,607 | ExpenseAmt |
| Grant | $0 | GrantAmt |
| Revenue | $5,664,985 | RevenueAmt |
| Desc | MEMORIAL COMMUNITY HOSPITAL OF BLAIR PROVIDES THE RESIDENTS OF BLAIR AND SURROUNDING COMMUNITIES 24 HOUR EMERGENCY ROOM SERVICES. THE EMERGENCY SERVICES REVENUE OF $5,664,985 IS THE GROSS REVENUE BEFORE CONTRACTUAL ADJUSTMENTS. | Desc |
Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $1,586,408 | ExpenseAmt |
| Grant | $0 | GrantAmt |
| Revenue | $5,749,194 | RevenueAmt |
| Desc | 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 $5,749,194 IS THE GROSS REVENUE BEFORE CONTRACTUAL ADJUSTMENTS. | Desc |
Prog Srvc Accom Acty Other ProgSrvcAccomActyOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $17,711,711 | ExpenseAmt |
| Grant | $0 | GrantAmt |
| Revenue | $17,612,929 | RevenueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Prog Srvc Expense | $17,711,711 | TotalOtherProgSrvcExpenseAmt |
| Total Other Prog Srvc Revenue | $17,612,929 | TotalOtherProgSrvcRevenueAmt |
| Total Program Service Expenses | $30,454,238 | 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 | Yes (1) | TaxExemptBondsInd |
| Invest Tax Exempt Bonds | 0 | InvestTaxExemptBondsInd |
| Escrow Account | 0 | EscrowAccountInd |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuerInd |
| 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 | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | Yes (1) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | 0 | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 12 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 336 | 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 | 7 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 5 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | Yes (1) | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | 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 | 0 | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | 0 | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | 0 | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | Yes (1) | InvestmentInJointVentureInd |
| Written Policy Or Procedure | 0 | WrittenPolicyOrProcedureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | TIM SCHNACK | PersonNm |
| Phone | 4024262182 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 810 NORTH 22ND STREET | AddressLine1Txt |
| City | BLAIR | CityNm |
| State Abbreviation | NE | StateAbbreviationCd |
| ZIP | 68008 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | Yes (X) | InfoInScheduleOPartVIIInd |
Form990 Part VII Section A Form990PartVIISectionAGrp (16 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| SANDRA BAUMBERGER MD | ||||||||
| BOARD MEMBER/PHYSICIAN | 40.00 | 1.00 | Yes (X) | $248,146 | $0 | $37,481 | ||
| SARAH CHATT | ||||||||
| TREASURER | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| ROSE LEAVITT | ||||||||
| VICE CHAIR (TERMED 3/21/21) | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| NEIL SMITH | ||||||||
| SECRETARY | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| KYLE ACRE | ||||||||
| CHAIR | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| MARILYN RHOTEN | ||||||||
| BOARD MEMBER (TERMED 1/1/21) | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| GREGG DRABEK MD | ||||||||
| VICE CHAIR | 25.00 | 0.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| ROBIN CONYERS | ||||||||
| BOARD MEMBER | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| LORI NAHNSEN | ||||||||
| BOARD MEMBER | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| MANUELA BANNER-WOLF | ||||||||
| PRESIDENT & CEO | 40.00 | 1.00 | $0 | $0 | $0 | Yes (X) | ||
| TIM SCHNACK | ||||||||
| CFO | 40.00 | 1.00 | $0 | $0 | $0 | Yes (X) | ||
| KEVIN SISK MD | ||||||||
| PHYSICIAN | 40.00 | 0.00 | $347,605 | $0 | $23,277 | Yes (X) | ||
| CHARLES SMITH MD | ||||||||
| PHYSICIAN | 40.00 | 0.00 | $335,092 | $0 | $33,512 | Yes (X) | ||
| PAULA THIELEN-KOCHAROV MD | ||||||||
| PHYSICIAN | 40.00 | 0.00 | $327,443 | $0 | $15,443 | Yes (X) | ||
| TONY TRAN | ||||||||
| CRNA | 40.00 | 0.00 | $303,229 | $0 | $15,449 | Yes (X) | ||
| MARK SHIRLEY MD | ||||||||
| PHYSICIAN | 40.00 | 0.00 | $302,467 | $0 | $0 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,863,982 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $125,162 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 30 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | Yes (1) | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| CHI HEALTH | |||||
| 198 INVERNESS DRIVE WEST | ENGLEWOOD | CO | 80112 | MGMT FEES/HEALTH SVCS | $1,546,044 |
| MMC MECHANICAL CONTRACTORS INC | |||||
| 9751 S 142ND STREET | OMAHA | NE | 68138 | MECHANICAL SERVICES | $1,114,953 |
| RURAL PARTNERS IN MEDICINE | |||||
| 11880 AIRPORT WAY | BROOMFIELD | CO | 80021 | MEDICAL SERVICES | $935,938 |
| SIGNATURE PERFORMANCE | |||||
| 10330 REGENCY PARKWAY DR 335 | OMAHA | NE | 68114 | BUSINESS OFFICE SERVICES | $769,750 |
| FUSION MEDICAL STAFFING LLC | |||||
| 11808 GRANT STREET SUITE 100 | OMAHA | NE | 68164 | STAFFING SERVICES | $601,975 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 22 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $104,573 | RelatedOrganizationsAmt |
| Government Grants | $2,097,091 | GovernmentGrantsAmt |
| All Other Contributions | $264,205 | AllOtherContributionsAmt |
| Total Contributions | $2,465,869 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | NET PATIENT REVENUE | Desc |
| Business | 621110 | BusinessCd |
| Total Revenue Column | $40,328,732 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $40,328,732 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $40,328,732 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $458,568 | TotalRevenueColumnAmt |
| Unrelated Business Revenue | $89 | UnrelatedBusinessRevenueAmt |
| Exclusion | $458,479 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $117,745 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $1,106 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $116,639 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $116,639 | TotalRevenueColumnAmt |
| Exclusion | $116,639 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | ExclusionExclusionAmt |
|---|---|---|---|
| PHARMACY | 446110 | $524,987 | $524,987 |
| DIETARY | 621110 | $66,486 | $66,486 |
| REBATES | 900099 | $30,710 | $30,710 |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $52,687 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $52,687 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $674,870 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $44,044,678 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $40,381,419 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $89 | UnrelatedBusinessRevenueAmt |
| Exclusion | $1,197,301 | ExclusionAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $18,357,439 | TotalAmt |
| Program Services | $15,219,950 | ProgramServicesAmt |
| Management And General | $3,137,489 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $408,950 | TotalAmt |
| Program Services | $339,056 | ProgramServicesAmt |
| Management And General | $69,894 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,198,575 | TotalAmt |
| Program Services | $1,822,814 | ProgramServicesAmt |
| Management And General | $375,761 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,094,034 | TotalAmt |
| Program Services | $870,531 | ProgramServicesAmt |
| Management And General | $223,503 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $502,682 | TotalAmt |
| Management And General | $502,682 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $32,813 | TotalAmt |
| Management And General | $32,813 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $24,850 | TotalAmt |
| Management And General | $24,850 | ManagementAndGeneralAmt |
Fees For Services Lobbying FeesForServicesLobbyingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,928 | TotalAmt |
| Program Services | $5,928 | ProgramServicesAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,568,870 | TotalAmt |
| Program Services | $1,150,822 | ProgramServicesAmt |
| Management And General | $418,048 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $157,688 | TotalAmt |
| Program Services | $157,688 | ProgramServicesAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $48,953 | TotalAmt |
| Program Services | $40,692 | ProgramServicesAmt |
| Management And General | $8,261 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $495,357 | TotalAmt |
| Program Services | $495,357 | ProgramServicesAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $11,368 | TotalAmt |
| Program Services | $4,926 | ProgramServicesAmt |
| Management And General | $6,442 | ManagementAndGeneralAmt |
Pymt Travel Entrtnmnt Pub Ofcl PymtTravelEntrtnmntPubOfclGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $110,719 | TotalAmt |
| Program Services | $94,067 | ProgramServicesAmt |
| Management And General | $16,652 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $414,303 | TotalAmt |
| Program Services | $414,303 | ProgramServicesAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,468,507 | TotalAmt |
| Program Services | $2,453,059 | ProgramServicesAmt |
| Management And General | $15,448 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $238,989 | TotalAmt |
| Management And General | $238,989 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| SUPPLIES | $5,915,040 | $4,918,773 | $996,267 |
| PURCHASED SERVICES | $3,642,996 | $1,769,840 | $1,873,156 |
| EQUIPMENT RENTAL AND MA | $854,351 | $624,968 | $229,383 |
| DUES & SUBSCRIPTIONS | $136,496 | $60,922 | $75,574 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $321,200 | TotalAmt |
| Program Services | $10,542 | ProgramServicesAmt |
| Management And General | $310,658 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $39,010,108 | TotalAmt |
| Program Services | $30,454,238 | ProgramServicesAmt |
| Management And General | $8,555,870 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $20,257,312 | BOYAmt |
| EOY | $22,087,517 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,956,078 | BOYAmt |
| EOY | $6,941,816 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $459,065 | BOYAmt |
| EOY | $626,635 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $315,124 | BOYAmt |
| EOY | $244,945 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $62,968,225 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $43,149,840 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $19,089,388 | BOYAmt |
| EOY | $19,818,385 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,241,630 | BOYAmt |
| EOY | $6,259,986 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $352,113 | BOYAmt |
| EOY | $296,534 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $51,670,710 | BOYAmt |
| EOY | $56,275,818 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,012,500 | BOYAmt |
| EOY | $4,321,918 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,830,465 | BOYAmt |
| EOY | $7,728,415 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,730,742 | BOYAmt |
| EOY | $3,561,907 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $18,573,707 | BOYAmt |
| EOY | $15,612,240 | 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 | $33,097,003 | BOYAmt |
| EOY | $40,663,578 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $33,097,003 | BOYAmt |
| EOY | $40,663,578 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $51,670,710 | BOYAmt |
| EOY | $56,275,818 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $5,034,570 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $389,130 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | $2,142,875 | OtherChangesInNetAssetsAmt |
| 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 | $5,928 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $5,928 | 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 | THE PORTION OF ORGANIZATION DUES THAT ARE RELATED TO LOBBYING ARE AS FOLLOWS: AMERICAN HOSPITAL ASSOCIATION - $4,164 CATHOLIC HEALTH ASSOCIATION - $1,764 | ExplanationTxt |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $886,525 | OtherCostOrOtherBasisAmt |
| Book Value | $886,525 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $22,904,269 | OtherCostOrOtherBasisAmt |
| Depreciation | $12,083,710 | DepreciationAmt |
| Book Value | $10,820,559 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $35,891,464 | OtherCostOrOtherBasisAmt |
| Depreciation | $28,683,898 | DepreciationAmt |
| Book Value | $7,207,566 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $3,285,967 | OtherCostOrOtherBasisAmt |
| Depreciation | $2,382,232 | DepreciationAmt |
| Book Value | $903,735 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $19,818,385 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (3 entries)
| DescDesc | AmtAmt |
|---|---|
| ESTIMATED THIRD-PARTY SETTLEMENTS | $1,736,352 |
| INTEREST RATE SWAP LIABILITY | $767,100 |
| ADVANCED GRANTS - COVID-19 FUNDS | $1,058,455 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $3,561,907 | 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 | 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 2021 AND 2020, MANAGEMENT DETERMINED THAT THERE ARE NO INCOME TAX POSITIONS REQUIRING RECOGNITION IN THE CONSOLIDATED FINANCIAL STATEMENTS. | 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 | 0 | FPGReferenceFreeCareInd |
| 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) |
|---|---|---|
| Persons Served | 362 | PersonsServedCnt |
| Total Community Benefit Expns | $642,890 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $642,890 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01650 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $3,160,880 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,421,978 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $738,902 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01890 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 362 | PersonsServedCnt |
| Total Community Benefit Expns | $3,803,770 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,421,978 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,381,792 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.03540 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 12 | ActivitiesOrProgramsCnt |
| Persons Served | 438 | PersonsServedCnt |
| Total Community Benefit Expns | $64,065 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $64,065 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00160 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 7 | ActivitiesOrProgramsCnt |
| Persons Served | 15 | PersonsServedCnt |
| Total Community Benefit Expns | $27,530 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $27,530 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00070 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 38 | ActivitiesOrProgramsCnt |
| Total Community Benefit Expns | $52,014 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $52,014 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00130 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 57 | ActivitiesOrProgramsCnt |
| Persons Served | 453 | PersonsServedCnt |
| Total Community Benefit Expns | $143,609 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $143,609 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00360 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 57 | ActivitiesOrProgramsCnt |
| Persons Served | 815 | PersonsServedCnt |
| Total Community Benefit Expns | $3,947,379 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,421,978 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,525,401 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.03900 | TotalExpensePct |
Community Support CommunitySupportGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 9 | ActivitiesOrProgramsCnt |
| Persons Served | 450 | PersonsServedCnt |
| Total Community Benefit Expns | $7,288 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $7,288 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00020 | TotalExpensePct |
Leadership Development LeadershipDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 1 | ActivitiesOrProgramsCnt |
| Persons Served | 30 | PersonsServedCnt |
| Total Community Benefit Expns | $150 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $150 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Workforce Development WorkforceDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 1 | ActivitiesOrProgramsCnt |
| Persons Served | 1 | PersonsServedCnt |
| Total Community Benefit Expns | $8,407 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $8,407 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00020 | TotalExpensePct |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 11 | ActivitiesOrProgramsCnt |
| Persons Served | 481 | PersonsServedCnt |
| Total Community Benefit Expns | $15,845 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $15,845 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00040 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $568,909 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $0 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $12,206,915 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $12,093,476 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | $113,439 | 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 | MEMORIAL COMMUNITY HOSPITAL | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 810 NORTH 22ND STREET | AddressLine1Txt |
| City | BLAIR | CityNm |
| State Abbreviation | NE | StateAbbreviationCd |
| ZIP | 68008 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | WWW.MCHHS.ORG | WebsiteAddressTxt |
| State License | 790001 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Critical Access Hospital | Yes (X) | CriticalAccessHospitalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MEMORIAL COMMUNITY 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 | 19 | 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 | HTTPS://MCHHS.ORG/CHIP-CHNA/ | OwnWebsiteURLTxt |
| Other Website | Yes (X) | OtherWebsiteInd |
| Other Website URL | HTTPS://WWW.THREERIVERSPUBLICHEALTH.ORG/ABOUT-US/CHA-AND-CHIP | OtherWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 19 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | HTTPS://MCHHS.ORG/CHIP-CHNA/ | StrategyWebsiteURLTxt |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| Income Level Criteria | Yes (X) | IncomeLevelCriteriaInd |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| 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 | MCHHS.ORG/WP-CONTENT/UPLOADS/2020/06/601.103-FINANCIAL-ASSISTANCE.PDF | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | HTTPS://MCHHS.ORG/WP-CONTENT/UPLOADS/2021/03/MCH-FINANCIAL-BROCHURE.PDF | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | HTTPS://MCHHS.ORG/WP-CONTENT/UPLOADS/2018/09/MCHHS_PLAIN_SPEAK.PDF | 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 |
| 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 (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| MEMORIAL COMMUNITY HOSPITAL | PART V, SECTION B, LINE 5: IN 2019, 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, AND 2016. 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 11: 2021 WAS THE THIRD YEAR IN THE CURRENT, THREE-YEAR COMMUNITY HEALTH IMPROVEMENT PLAN FOR MEMORIAL COMMUNITY HOSPITAL AND HEALTH SYSTEM (MCH). THE 2019 CHIP IDENTIFIED THREE MAIN PRIORITIES. FIRST, ACCESS TO AFFORDABLE, ACCEPTABLE, QUALITY HEALTH CARE (INCLUSIVE OF MENTAL HEALTH SERVICES), SECOND, RISKY BEHAVIORS, AND THIRD, PREVENTION AND SCREENING. THE FOLLOWING PARAGRAPHS WILL EXPLAIN THE GOALS AND STRATEGIES UNDER EACH PRIORITY LEVEL. IT IS IMPORTANT TO NOTE, 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. THIS WAS A TALL ORDER BUT MCH REMAINED COMMITTED TO PROVIDING QUALITY AND ACCESSIBLE HEALTH CARE AMIDST A PANDEMIC.*ACCESS TO AFFORDABLE, ACCEPTABLE, QUALITY HEALTH CARE- THE FIRST PRIORITY IS ACCESS TO AFFORDABLE, ACCEPTABLE, QUALITY HEALTH CARE (INCLUSIVE OF MENTAL HEALTH SERVICES). FOUR GOALS WERE DETERMINED TO MEET THIS NEED. FIRST, INCREASING BEHAVIORAL HEALTH OFFERINGS IN THE MCH SERVICE AREA. UNDER THIS GOAL, THE HOSPITAL IMPLEMENTED SENIOR LIFE SOLUTIONS AND NOW HAS A STEADY STREAM OF PATIENTS UTILIZING THE PROGRAM. SECOND, MCH RESEARCHED AND EVALUATED A POSSIBLE SOLUTION FOR AN INTEGRATED MENTAL HEALTH PROGRAM IN THE MCH CLINICS BUT HAS EXTENDED THE GOAL AND ARE INSTEAD RESEARCHING A TELEHEALTH OPTION. THE THIRD PART, LEADING A JOINT INITIATIVE WITH THE LOCAL AREA HIGH SCHOOLS TO DISTRIBUTE MENTAL HEALTH INFORMATION, IS ONGOING. FINALLY, 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. - THE SECOND GOAL IS TO IMPROVE THE CONTINUITY OF CARE FOR RURAL HEALTH CARE PATIENTS. 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 DUE TO COVID BUT MANY INSURANCE COMPANIES HAVE BEEN CONTACTED AND CARE GAP PROCESSES IMPROVED.- THE THIRD GOAL IS TO 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. IN 2021 OVER $71,000 WORTH OF SERVICES WAS PURCHASED ON MDSAVE. THE NEED FOR MEDICATION ASSISTANCE REMAINS AND MCH HELPS BY CONNECTING PATIENTS TO THE RIGHT RESOURCES. - FINALLY, THE LAST GOAL, IS TO GENERATE ACCESSIBLE CARE AND APPROPRIATE CLINICAL STAFFING FOR THE CARE NEEDS OF OUR SERVICE AREA. MCH IS ALWAYS IDENTIFYING CURRENT EMPLOYEES TO DEVELOP INTO OPEN POSITIONS AND HAS PROMOTED VARIOUS EMPLOYEES INTO NEW ROLES THROUGHOUT THE YEAR. MCH ALSO ADDED TELEHOSPITALISTS, A NEW PRIMARY CARE PHYSICIAN, AND TWO ORTHOPEDIC SURGEONS SPECIALIZING IN THE FOOT AND ANKLE AND SHOULDER, ASSURING APPROPRIATE LEVEL OF PRIMARY CARE PROVIDERS AND SUB-SPECIALTY PROVIDERS FOR THE NEEDS OF THE COMMUNITY. *RISKY BEHAVIORS- THE SECOND INITIATIVE IS RISKY BEHAVIORS (INCLUDING CAUSES OF OBESITY). THE FIRST GOAL IS REDUCING 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, WERE PUT ON HOLD. MCH DISTRIBUTES A HEALTHCARE MAGAZINE FOCUSED ON TEENS, WHICH ALSO COVERS THE RISK 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 WERE CANCELLED BUT WILL REMAIN IN THE PLAN FOR THE FUTURE.- THE SECOND GOAL IS TO 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 HOWEVER SOCIAL MEDIA EDUCATION IS ONGOING.- THE THIRD GOAL WAS TO 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. OUR PEDIATRICIAN CONTINUED HER NUTRITIONAL EDUCATION WITH ALL FAMILIES. *PREVENTION AND SCREENING- THE FINAL INITIATIVE, PREVENTION AND SCREENING, WILL FOCUS ON TWO GOALS. ONE, INCREASE SCREENINGS FOR COMMON HEALTH ISSUES AND TWO, IMPLEMENTING CHRONIC CARE MANAGEMENT TO IMPROVE THE HEALTH OF ALL CITIZENS IN OUR SERVICE AREA.- STRATEGIES OF GOAL NUMBER ONE INCLUDE INCREASING THE NUMBER OF DEPRESSION, SUICIDE, AND OTHER SCREENINGS IN CARDIO PULMONARY, THE 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 WERE PRIMARILY USED TO ACCOMPLISH THIS. 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. - 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. AND FINALLY, PARTNERING WITH THREE RIVERS PUBLIC HEALTH DEPARTMENT TO CREATE AWARENESS AROUND THE LIVING WELL-CHRONIC DISEASE MANAGEMENT PROGRAM. THIS GOAL WAS COMPLETED ON AN INTERNAL LEVEL DUE TO THE OVERWHELMING WORK LOAD THE HEALTH DEPARTMENT FACED IN 2020 FROM THE PANDEMIC. IN ADDITION, MCH PROVIDED MASS VACCINATION CLINICS IN ORDER TO ASSIST IN THE PREVENTION OF THE SPREAD OF COVID. THESE WERE OFFERED COMPLETELY FREE TO THE PUBLIC AND OFFERED AT VARIOUS TIMES TO MAKE THEM VERY ACCESSIBLE TO THE PUBLIC. *WRAPPING UP THE 2019 CHIP WE ANTICIPATE NEXT YEAR AND THE ENSUING COMMUNITY HEALTH IMPROVEMENT PLAN TO COMPLETE SOME OF THE OPPORTUNITIES REMAINING ON THE 2019 CHIP. IN 2021, THE PANDEMIC TOOK TIME, EFFORT, AND FUNDING AWAY FROM MANY OF THE GOALS AND INITIATIVES THAT WERE SLATED TO START. IN ADDITION, MANY ORGANIZATIONS MCH WAS PARTNERING WITH HAD THEIR PRIORITIES CHANGE AS WELL. |
| 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. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 3 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (3 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| 1 - 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 |
Supplemental Information Detail SupplementalInformationDetail (15 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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 2021 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. 2021 PRESENTED ANOTHER YEAR OF CHALLENGES AND OPPORTUNITIES FOR MCH. LEARNING HOW TO OPERATE AND LIVE WITH A PANDEMIC WAS NEW TO EVERYONE BUT WITH COVID VACCINES, NEW MEDICATIONS, AND FURTHER UNDERSTANDING OF THE DISEASE, MCH WAS ABLE TO FLEX TO THE CURRENT SITUATION AND ADAPT THROUGHOUT THE YEAR. DURING TIMES OF MODERATE TO HIGH SPREAD, MCH'S DECISION WAS TO NOT ACTIVELY DO COMMUNITY OUTREACH IN PERSON. MCH CONTINUED TO SUPPORT LOCAL ORGANIZATIONS THROUGH SPONSORSHIPS AND PARTICIPATED IN OUTDOOR EVENTS WHEN APPROPRIATE. EVENTUALLY, MCH WAS ABLE TO CONTINUE STUDENT SHADOWING OPPORTUNITIES FOR MEDICAL STUDENTS, OFFER LUNCH AND LEARNS TO THE COMMUNITY WHEN THE COVID NUMBERS WANED, HOST TAI CHI AND SENIOR EXERCISE CLASSES, TEACH STOP-THE-BLEED CLASSES, AND PARTICIPATE IN COMMUNITY BLOOD DRIVES AT OUR FACILITY. HOWEVER, THE LARGEST COMMUNITY OUTREACH ACTIVITIES OF THE YEAR BY FAR WAS OUR PARTICIPATION IN TEST NEBRASKA AND COVID VACCINE CLINICS FOR OUR COMMUNITY. HUNDREDS OF HOURS OF STAFF TIME WERE DEDICATED TO ORGANIZING, SCHEDULING, AND GIVING VACCINES. MCH GAVE OVER 10,000 COVID VACCINES. |
| PART III, LINE 2: | COSTING METHODOLOGY FOR AMOUNTS REPORTED ON LINE 2 IS DETERMINED USING THE ORGANIZATION'S COST/CHARGE RATIO OF 61.60%. 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: | THE MEDICARE CHARGES REPORTED ON LINE 5 AND LINE 6 ARE FROM THE 2021 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 20,667 AND APPROXIMATELY 61.2% OF THE POPULATION IN WASHINGTON COUNTY IS CONSIDERED RURAL. CENSUS ESTIMATES SHOW THAT WASHINGTON COUNTY'S RACIAL AND ETHNIC MAKEUP IS 5.3% OF THE POPULATION AND ITS MEDIAN AGE IS 41.2 AS COMPARED TO THE STATE AT 36.3. THE MEDIAN HOUSEHOLD INCOME IS $66,485 COMPARED TO $56,675 FOR THE STATE OF NEBRASKA. 23.1% OF SCHOOL AGE CHILDREN WERE ELIGIBLE FOR FREE OR REDUCED LUNCH IN WASHINGTON COUNTY DURING THE 2018-2019 SCHOOL YEAR. BURT COUNTY HAS A POPULATION OF 6,459 AND IT'S ETHNIC AND RACIAL MAKEUP IS 5.3% OF THE POPULATION. THE MEDIAN HOUSEHOLD INCOME IS $51,482 AND APPROXIMATELY 36% OF CHILDREN IN BURT COUNTY ARE ON FREE AND 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 |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | Yes (1) | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | Yes (1) | 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 (6 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| KEVIN SISK MD | ||||||||||||||
| PHYSICIAN | $231,884 | $0 | $115,721 | $0 | $0 | $0 | $12,151 | $0 | $11,126 | $0 | $370,882 | $0 | $0 | $0 |
| CHARLES SMITH MD | ||||||||||||||
| PHYSICIAN | $321,842 | $0 | $13,250 | $0 | $0 | $0 | $24,702 | $0 | $8,810 | $0 | $368,604 | $0 | $0 | $0 |
| PAULA THIELEN-KOCHAROV MD | ||||||||||||||
| PHYSICIAN | $238,918 | $0 | $88,525 | $0 | $0 | $0 | $15,204 | $0 | $239 | $0 | $342,886 | $0 | $0 | $0 |
| TONY TRAN | ||||||||||||||
| CRNA | $293,729 | $0 | $9,500 | $0 | $0 | $0 | $4,638 | $0 | $10,811 | $0 | $318,678 | $0 | $0 | $0 |
| MARK SHIRLEY MD | ||||||||||||||
| PHYSICIAN | $296,717 | $0 | $5,750 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $302,467 | $0 | $0 | $0 |
| SANDRA BAUMBERGER MD | ||||||||||||||
| BOARD MEMBER/PHYSICIAN | $205,446 | $0 | $42,700 | $0 | $0 | $0 | $26,000 | $0 | $11,481 | $0 | $285,627 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 3 | DURING THE CALENDAR YEAR 2021, 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. |
Schedule K IRS990ScheduleK
Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp (2 entries)
| Bond ReferenceBondReferenceCd | Bond Issuer EINBondIssuerEIN | Bond IssuedBondIssuedDt | Issue PriceIssuePriceAmt | PurposePurposeDesc | DefeasedDefeasedInd | On Behalf Of IssuerOnBehalfOfIssuerInd | Pool FinancingPoolFinancingInd |
|---|---|---|---|---|---|---|---|
| HOSPITAL AUTH #1 OF WASHINGTON CNTY NE | |||||||
| A | 521441599 | 2007-06-19 | $9,250,000 | CONSTRUCTION OF FACILITY | 0 | 0 | 0 |
| HOSPITAL AUTH #1 OF WASHINGTON CNTY NE | |||||||
| B | 521441599 | 2008-05-22 | $8,000,000 | CONSTRUCTION OF FACILITY | 0 | 0 | 0 |
Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp (2 entries)
| Bond ReferenceBondReferenceCd | RetiredRetiredAmt | Total ProceedsTotalProceedsAmt | Issuance Costs From ProceedsIssuanceCostsFromProceedsAmt | Working Capital ExpendituresWorkingCapitalExpendituresAmt | Refunding Tax Exempt BondsRefundingTaxExemptBondsInd | Refunding Taxable BondsRefundingTaxableBondsInd | Final Allocation MadeFinalAllocationMadeInd | Adequate Books And Rec MaintAdequateBooksAndRecMaintInd |
|---|---|---|---|---|---|---|---|---|
| A | $5,436,536 | $9,493,722 | $173,747 | $9,319,975 | 0 | 0 | Yes (1) | Yes (1) |
| B | $4,085,048 | $8,059,333 | $65,000 | $7,994,333 | 0 | 0 | Yes (1) | Yes (1) |
Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp (2 entries)
| Bond ReferenceBondReferenceCd | Owning Bond Financed PropertyOwningBondFinancedPropertyInd | Any Lease ArrangementsAnyLeaseArrangementsInd | Mgmt Contract Bond Fincd PropMgmtContractBondFincdPropInd | Any Research AgreementsAnyResearchAgreementsInd | Bond Iss Meet Prvt Sec Pymt TestBondIssMeetPrvtSecPymtTestInd | Change In Use Bond Financed PropChangeInUseBondFinancedPropInd | Procs Nonqualified Bond RemdtdProcsNonqualifiedBondRemdtdInd |
|---|---|---|---|---|---|---|---|
| A | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| B | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp (2 entries)
| Bond ReferenceBondReferenceCd | Form8038 T FiledForm8038TFiledInd | Rebate Not Due YetRebateNotDueYetInd | Exception To RebateExceptionToRebateInd | No Rebate DueNoRebateDueInd | Variable Rate IssueVariableRateIssueInd | Hedge Identified In Bks And RecHedgeIdentifiedInBksAndRecInd | Gross Proceeds Invested In GICGrossProceedsInvestedInGICInd | Gross Proceeds InvestedGrossProceedsInvestedInd | Written Proc To Monitor ReqsWrittenProcToMonitorReqsInd | Term Of HedgeTermOfHedgePct | Superintegrated HedgeSuperintegratedHedgeInd | Hedge TerminatedHedgeTerminatedInd |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| (no name) | ||||||||||||
| A | 0 | 0 | Yes (1) | Yes (1) | 0 | 0 | 0 | 0 | 0 | |||
| FNB OF OMAHA | ||||||||||||
| B | 0 | 0 | Yes (1) | Yes (1) | Yes (1) | Yes (1) | 0 | 0 | 0 | 201.000000000000 | Yes (1) | 0 |
Procedures Corrective Action ProceduresCorrectiveActionGrp (2 entries)
| Bond ReferenceBondReferenceCd | Procedures Corrective ActionProceduresCorrectiveActionInd |
|---|---|
| A | 0 |
| B | 0 |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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%. |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (11 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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 | BOARD 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: | CARES ACT GRANTS REVENUE RECOGNITION RECONCILIATION 2,142,875. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (3 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Direct Controlling NADirectControllingNACd | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|---|
| 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 | Yes (1) |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (1) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (1) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | 0 | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
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