WEST HOLT MEMORIAL HOSPITAL: Form 990, tax year 2019
View the entire original 990 at ProPublica ↗
- Organization
- WEST HOLT MEMORIAL HOSPITAL (EIN 47-0544098)
- Tax period
- 2019-07-01 to 2020-06-30
- Filed
- 2021-05-12
- IRS object ID
- 202111329349304261
- Schema version
- 2019v5.2
- 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 L
- Schedule O
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2021-05-12T15:20:24-05:00 | ReturnTs |
| Tax Period End | 2020-06-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 476097913 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SEIM JOHNSON LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 18081 BURT STREET SUITE 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 | 2019-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 470544098 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WEST HOLT MEMORIAL HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | WEST | BusinessNameControlTxt |
| Phone | 4029252811 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 406 WEST NEELY STREET | AddressLine1Txt |
| City | ATKINSON | CityNm |
| State Abbreviation | NE | StateAbbreviationCd |
| ZIP | 68713 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | JEREMY BAUER | PersonNm |
| Person Title | CFO | PersonTitleTxt |
| Phone | 4029252811 | PhoneNum |
| Signature | 2021-05-12 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | WENDY R COOLEY | PreparerPersonNm |
| PTIN | P01523804 | PTIN |
| Phone | 4023302660 | PhoneNum |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2019 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | JEREMY BAUER | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 406 WEST NEELY STREET | AddressLine1Txt |
| City | ATKINSON | CityNm |
| State Abbreviation | NE | StateAbbreviationCd |
| ZIP | 68713 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $13,285,044 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.WESTHOLTMED.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1972 | FormationYr |
| Legal Domicile State | NE | LegalDomicileStateCd |
| Activity Or Mission | CRITICAL ACCESS HOSPITAL AND RURAL HEALTH CLINIC THAT PROVIDES MEDICAL SERVICES. | ActivityOrMissionDesc |
| Voting Members Governing Body | 9 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 7 | VotingMembersIndependentCnt |
| Total Employee | 127 | TotalEmployeeCnt |
| Total Volunteers | 10 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $175,109 | PYContributionsGrantsAmt |
| CY Contributions Grants | $1,106,098 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $12,007,640 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $11,873,186 | CYProgramServiceRevenueAmt |
| PY Investment Income | $37,095 | PYInvestmentIncomeAmt |
| CY Investment Income | $86,743 | CYInvestmentIncomeAmt |
| PY Other Revenue | $4,906 | PYOtherRevenueAmt |
| CY Other Revenue | $218,388 | CYOtherRevenueAmt |
| PY Total Revenue | $12,224,750 | PYTotalRevenueAmt |
| CY Total Revenue | $13,284,415 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | 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 | $5,499,380 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $5,755,284 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $39,001 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $6,612,407 | PYOtherExpensesAmt |
| CY Other Expenses | $6,743,073 | CYOtherExpensesAmt |
| PY Total Expenses | $12,111,787 | PYTotalExpensesAmt |
| CY Total Expenses | $12,498,357 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $112,963 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $786,058 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $10,682,608 | TotalAssetsBOYAmt |
| Total Assets EOY | $19,756,835 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $3,768,625 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $12,056,794 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $6,913,983 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $7,700,041 | NetAssetsOrFundBalancesEOYAmt |
| Mission | WEST HOLT MEDICAL SERVICES PROVIDES WELL-ROUNDED FAMILY HEALTHCARE WITH RESPECT AND UNDERSTANDING FOR THE PHYSICAL AND EMOTIONAL NEEDS OF OUR NORTH CENTRAL NEBRASKA COMMUNITIES. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $10,996,578 | ExpenseAmt |
| Revenue | $9,627,578 | RevenueAmt |
| Desc | WEST HOLT MEMORIAL HOSPITAL (WHMH) IS A 17 BED CRITICAL ACCESS HOSPITAL: SERVICES PROVIDED BY WHMH INCLUDES EMERGENCY SERVICES, LABORATORY, PHYSICAL AND OCCUPATIONAL THERAPY, RESPIRATORY THERAPY, SPEECH THERAPY, DIAGNOSTIC IMAGING TEST, CARDIOLOGY TESTS, EKG, NUCLEAR MEDICINE TESTS, IV THERAPY, SLEEP STUDIES, OP SURGERY, AND A VARIETY OF SPECIALTY CLINICS. DURING 2020, WHMH HAD 468 EMERGENCY ROOM VISITS AND PERFORMED 102 OUTPATIENT SURGERIES. THE LABORATORY PERFORMED 18,163 TESTS, DIAGNOSTIC IMAGING PERFORMED 2,454 TESTS AND PHYSICAL/OCCUPATIONAL/SPEECH THERAPY SERVICES PROVIDED 11,641 TREATMENTS. | Desc |
| Total Program Service Expenses | $10,996,578 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (1) | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | Yes (1) | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (1) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | 0 | 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 | Yes (1) | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | 0 | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | 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 | 15 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 127 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | 0 | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | 0 | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 9 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 7 | 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 | 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 | 0 | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | 0 | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | JEREMY BAUER | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 4029252811 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 406 WEST NEELY STREET | AddressLine1Txt |
| City | ATKINSON | CityNm |
| State Abbreviation | NE | StateAbbreviationCd |
| ZIP | 68713 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (17 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Highest Compensated EmployeeHighestCompensatedEmployeeInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd |
|---|---|---|---|---|---|---|---|
| JEFFREY HAGEN | |||||||
| PHARMACIST | 40.00 | Yes (X) | $124,583 | $0 | $31,572 | ||
| NICK KONRAD | |||||||
| PHYSICAL THERAPIST | 40.00 | Yes (X) | $112,758 | $0 | $39,700 | ||
| AMY KINKENNON | |||||||
| PHARMACIST | 40.00 | Yes (X) | $144,644 | $0 | $6,346 | ||
| APRIL DEXTER | |||||||
| NURSE PRACTITIONER | 32.00 | Yes (X) | $122,760 | $0 | $8,308 | ||
| LORRETTA DANIELS | |||||||
| PHYSICIAN ASSISTANT | 29.00 | Yes (X) | $120,819 | $0 | $427 | ||
| JEREMY BAUER | |||||||
| CFO | 40.00 | $75,310 | $0 | $32,189 | Yes (X) | ||
| ASHLEY RIVERA | |||||||
| CEO | 40.00 | $66,579 | $0 | $9,673 | Yes (X) | ||
| TRENT SCHAAF | |||||||
| PRESIDENT | 2.00 | $0 | $0 | $0 | Yes (X) | Yes (X) | |
| BRYAN RENTSCHLER | |||||||
| FIRST VICE PRESIDENT | 1.00 | $0 | $0 | $0 | Yes (X) | Yes (X) | |
| JOHN KRAMER | |||||||
| SECOND VICE PRESIDENT | 1.00 | $0 | $0 | $0 | Yes (X) | Yes (X) | |
| JACK WOLF | |||||||
| SECRETARY THRU 11/19 | 1.00 | $0 | $0 | $0 | Yes (X) | Yes (X) | |
| JARROD HAMIK | |||||||
| SECRETARY | 1.00 | $0 | $0 | $0 | Yes (X) | Yes (X) | |
| BRENDAN BORER | |||||||
| TREASURER | 1.00 | $0 | $0 | $0 | Yes (X) | Yes (X) | |
| LORI OLSON | |||||||
| MEMBER | 1.00 | $0 | $0 | $0 | Yes (X) | ||
| BRETT LIESWALD | |||||||
| MEMBER | 1.00 | $0 | $0 | $0 | Yes (X) | ||
| SUSAN MYERS | |||||||
| MEMBER | 1.00 | $0 | $0 | $0 | Yes (X) | ||
| MARSHA THURLOW | |||||||
| MEMBER | 1.00 | $0 | $0 | $0 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $767,453 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $128,215 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 6 | 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 |
|---|---|---|---|---|---|
| RADEC CONSTRUCTION COMPANY | |||||
| 308 N BROADWAY AVE | HARTINGTON | NE | 68739 | CONSTRUCTION SERVICES | $1,263,082 |
| GREATER SANDHILLS FAMILY HEALTHCARE | |||||
| PO BOX 70 | STUART | NE | 68780 | PROVIDER ER COVERAGE | $324,406 |
| FOCUSONE SOLUTIONS | |||||
| 13609 CALIFORNIA ST | OMAHA | NE | 68154 | AGENCY NURSING SERVICES | $277,866 |
| FAITH REGIONAL HEALTH SERVICES | |||||
| 1500 KOENIGSTEIN AVE | NORFOLK | NE | 68701 | IT SUPPORT/CNO CONTRACT | $189,158 |
| BE SMITH LLC | |||||
| PO BOX 74007636 | CHICAGO | IL | 60674 | RECRUITMENT SERVICES | $109,704 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 5 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $1,017,227 | GovernmentGrantsAmt |
| All Other Contributions | $88,871 | AllOtherContributionsAmt |
| Total Contributions | $1,106,098 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (4 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| MEDICARE/MEDICAID PAYMENTS | 621110 | $6,101,862 | $6,101,862 |
| PATIENT SERVICE REVENUE | 621110 | $2,691,693 | $2,691,693 |
| RETAIL PHARMACY REVENUE | 621110 | $2,458,625 | $2,458,625 |
| 340B PROGRAM REVENUE | 621110 | $605,277 | $605,277 |
Total Oth Program Service Rev TotalOthProgramServiceRevGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $15,729 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $15,729 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $11,873,186 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $86,743 | TotalRevenueColumnAmt |
| Exclusion | $86,743 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $6,000 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $629 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $5,371 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $5,371 | TotalRevenueColumnAmt |
| Exclusion | $5,371 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| INSURANCE PROCEEDS | 900099 | $190,999 | $190,999 |
| NET BAD DEBT RECOVERIES | 900099 | $22,018 | $22,018 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $213,017 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $13,284,415 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $12,086,203 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $92,114 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $183,751 | TotalAmt |
| Management And General | $183,751 | ManagementAndGeneralAmt |
Comp Disqual Persons CompDisqualPersonsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $161,734 | TotalAmt |
| Program Services | $161,734 | ProgramServicesAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,659,606 | TotalAmt |
| Program Services | $4,067,554 | ProgramServicesAmt |
| Management And General | $562,227 | ManagementAndGeneralAmt |
| Fundraising | $29,825 | FundraisingAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $91,916 | TotalAmt |
| Program Services | $81,194 | ProgramServicesAmt |
| Management And General | $9,848 | ManagementAndGeneralAmt |
| Fundraising | $874 | FundraisingAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $316,624 | TotalAmt |
| Program Services | $255,336 | ProgramServicesAmt |
| Management And General | $57,158 | ManagementAndGeneralAmt |
| Fundraising | $4,130 | FundraisingAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $341,653 | TotalAmt |
| Program Services | $289,675 | ProgramServicesAmt |
| Management And General | $49,943 | ManagementAndGeneralAmt |
| Fundraising | $2,035 | FundraisingAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $30,284 | TotalAmt |
| Management And General | $30,284 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $17,379 | TotalAmt |
| Management And General | $17,379 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $42,140 | TotalAmt |
| Management And General | $42,140 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,527,395 | TotalAmt |
| Program Services | $1,408,275 | ProgramServicesAmt |
| Management And General | $119,120 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $29,388 | TotalAmt |
| Management And General | $29,388 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $279,999 | TotalAmt |
| Program Services | $188,602 | ProgramServicesAmt |
| Management And General | $91,275 | ManagementAndGeneralAmt |
| Fundraising | $122 | FundraisingAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $191,224 | TotalAmt |
| Program Services | $159,774 | ProgramServicesAmt |
| Management And General | $30,157 | ManagementAndGeneralAmt |
| Fundraising | $1,293 | FundraisingAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $144,236 | TotalAmt |
| Program Services | $136,461 | ProgramServicesAmt |
| Management And General | $7,775 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $18,998 | TotalAmt |
| Program Services | $15,718 | ProgramServicesAmt |
| Management And General | $3,279 | ManagementAndGeneralAmt |
| Fundraising | $1 | FundraisingAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $113,688 | TotalAmt |
| Program Services | $105,218 | ProgramServicesAmt |
| Management And General | $8,470 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $693,962 | TotalAmt |
| Program Services | $642,260 | ProgramServicesAmt |
| Management And General | $51,702 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $83,459 | TotalAmt |
| Program Services | $7,920 | ProgramServicesAmt |
| Management And General | $75,539 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt | FundraisingFundraisingAmt |
|---|---|---|---|---|
| MEDICAL SUPPLIES | $2,850,781 | $2,850,781 | ||
| MISCELLANEOUS | $652,275 | $560,828 | $90,726 | $721 |
| LICENSES & FEES | $48,687 | $46,070 | $2,617 | |
| FOOD | $19,178 | $19,178 |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $12,498,357 | TotalAmt |
| Program Services | $10,996,578 | ProgramServicesAmt |
| Management And General | $1,462,778 | ManagementAndGeneralAmt |
| Fundraising | $39,001 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $460 | BOYAmt |
| EOY | $460 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,364,684 | BOYAmt |
| EOY | $11,091,735 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,712,419 | BOYAmt |
| EOY | $1,538,706 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $486,634 | BOYAmt |
| EOY | $587,404 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $88,377 | BOYAmt |
| EOY | $50,893 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $15,131,639 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $9,174,451 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,804,585 | BOYAmt |
| EOY | $5,957,188 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $225,449 | BOYAmt |
| EOY | $225,449 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $305,000 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,682,608 | BOYAmt |
| EOY | $19,756,835 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $720,083 | BOYAmt |
| EOY | $1,083,998 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,971,574 | BOYAmt |
| EOY | $5,647,196 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $76,968 | BOYAmt |
| EOY | $5,325,600 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,768,625 | BOYAmt |
| EOY | $12,056,794 | 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 | $6,409,117 | BOYAmt |
| EOY | $7,361,271 | EOYAmt |
Donor Restriction Net Assets DonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $504,866 | BOYAmt |
| EOY | $338,770 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,913,983 | BOYAmt |
| EOY | $7,700,041 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,682,608 | BOYAmt |
| EOY | $19,756,835 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $786,058 | ReconcilationRevenueExpnssAmt |
| 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) |
|---|---|---|
| Separate Basis Fincl Stmt | Yes (X) | SeparateBasisFinclStmtInd |
| 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 | $475 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $475 | 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 | WEST HOLT MEMORIAL HOSPITAL PAYS ASSOCATION DUES TO THE NEBRASKA HOSPITAL ASSOCIATION (NHA), OF WHICH A PORTION IS USED BY THE ASSOCIATION FOR LOBBYING PURPOSES. | ExplanationTxt |
Schedule D IRS990ScheduleD
CY Endwmt Fund CYEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $338,770 | BeginningYearBalanceAmt |
| End Year Balance | $338,770 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $338,770 | BeginningYearBalanceAmt |
| End Year Balance | $338,770 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $113,321 | BeginningYearBalanceAmt |
| Contributions | $225,449 | ContributionsAmt |
| End Year Balance | $338,770 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $113,321 | BeginningYearBalanceAmt |
| End Year Balance | $113,321 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $113,321 | BeginningYearBalanceAmt |
| End Year Balance | $113,321 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Designated Balance EOY | 0.00000 | BoardDesignatedBalanceEOYPct |
| Prmnnt Endowment Balance EOY | 0.00000 | PrmnntEndowmentBalanceEOYPct |
| Term Endowment Balance EOY | 1.00000 | TermEndowmentBalanceEOYPct |
| Endowments Held Unrelated Org | 0 | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | 0 | EndowmentsHeldRelatedOrgInd |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $39,958 | OtherCostOrOtherBasisAmt |
| Book Value | $39,958 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $6,422,626 | OtherCostOrOtherBasisAmt |
| Depreciation | $3,663,480 | DepreciationAmt |
| Book Value | $2,759,146 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $6,691,313 | OtherCostOrOtherBasisAmt |
| Depreciation | $5,417,545 | DepreciationAmt |
| Book Value | $1,273,768 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,977,742 | OtherCostOrOtherBasisAmt |
| Depreciation | $93,426 | DepreciationAmt |
| Book Value | $1,884,316 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $5,957,188 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)
| DescDesc | AmtAmt |
|---|---|
| CONTRACT LIABILITY - MEDICARE ADVANCE PAYMENTS | $2,659,167 |
| CARES ACT FUNDS | $2,666,433 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $5,325,600 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $13,285,044 | TotalRevEtcAuditedFinclStmtAmt |
| Other Revenue | $629 | OtherRevenueAmt |
| Revenue Not Reported | $629 | RevenueNotReportedAmt |
| Revenue Subtotal | $13,284,415 | RevenueSubtotalAmt |
| Revenue Not Reported Fincl Stmt | $0 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $13,284,415 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $12,498,986 | TotExpnsEtcAuditedFinclStmtAmt |
| Other Expenses Included | $629 | OtherExpensesIncludedAmt |
| Expenses Not Reported | $629 | ExpensesNotReportedAmt |
| Expenses Subtotal | $12,498,357 | ExpensesSubtotalAmt |
| Expenses Not Rpt Fincl Stmt | $0 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $12,498,357 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART V, LINE 4: | THESE FUNDS HAVE BEEN RESTRICTED BY A DONOR FOR SPECIFIC PURPOSES. THE PRINCIPAL CANNOT BE EXPENDED UNTIL 2047. |
| PART X, LINE 2: | THE HOSPITAL IS A NOT-FOR-PROFIT CORPORATION AS DESCRIBED IN SECTION 501(C)(3) OF THE CODE AND HAS RECEIVED A DETERMINATION LETTER THAT IT IS EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. THE INTERNAL REVENUE SERVICE HAS ESTABLISHED STANDARDS TO BE MET TO MAINTAIN THE HOSPITAL'S TAX EXEMPT STATUS. IN GENERAL, SUCH STANDARDS REQUIRE THE HOSPITAL TO MEET A COMMUNITY BENEFITS STANDARD AND COMPLY WITH VARIOUS LAWS AND REGULATIONS. THE HOSPITAL ACCOUNTS FOR UNCERTAINTIES IN ACCOUNTING FOR INCOME TAX ASSETS AND LIABILITIES USING GUIDANCE INCLUDED IN FASB 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, 2020 AND 2019, THE HOSPITAL HAD NO UNCERTAIN TAX POSITIONS ACCRUED. |
| PART XI, LINE 2D - OTHER ADJUSTMENTS: | RENTAL EXPENSES 629. |
| PART XII, LINE 2D - OTHER ADJUSTMENTS: | RENTAL EXPENSES 629. |
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 | 110.000000000000 | FreeCareOtherPct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
Discounted Care Oth Percentage DiscountedCareOthPercentageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Discounted Care Other | 190.000000000000 | DiscountedCareOtherPct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| 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 | $50,674 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $50,674 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00410 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $443,654 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $185,432 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $258,222 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02070 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $494,328 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $185,432 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $308,896 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02480 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 1349 | PersonsServedCnt |
| Total Community Benefit Expns | $181,905 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $20,595 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $161,310 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01290 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 2 | PersonsServedCnt |
| Total Community Benefit Expns | $1,000 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,000 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00010 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 1351 | PersonsServedCnt |
| Total Community Benefit Expns | $182,905 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $20,595 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $162,310 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01300 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 1351 | PersonsServedCnt |
| Total Community Benefit Expns | $677,233 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $206,027 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $471,206 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.03780 | TotalExpensePct |
Leadership Development LeadershipDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 1 | ActivitiesOrProgramsCnt |
| Persons Served | 110 | PersonsServedCnt |
| Total Community Benefit Expns | $4,399 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $529 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $3,870 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00030 | TotalExpensePct |
Health Improvement Advocacy HealthImprovementAdvocacyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 8 | ActivitiesOrProgramsCnt |
| Persons Served | 1349 | PersonsServedCnt |
| Total Community Benefit Expns | $5,072 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $5,072 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00040 | TotalExpensePct |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 9 | ActivitiesOrProgramsCnt |
| Persons Served | 1459 | PersonsServedCnt |
| Total Community Benefit Expns | $9,471 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $529 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $8,942 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00070 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $0 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $0 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $5,555,544 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $5,651,981 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$96,437 | 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 | WEST HOLT MEMORIAL HOSPITAL | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 406 W NEELY | AddressLine1Txt |
| City | ATKINSON | CityNm |
| State Abbreviation | NE | StateAbbreviationCd |
| ZIP | 68713 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | WWW.WESTHOLTMED.ORG | WebsiteAddressTxt |
| State License | 410001 | 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 | WEST HOLT 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 | 18 | 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://WWW.WESTHOLTMED.ORG/ | OwnWebsiteURLTxt |
| Other Website | Yes (X) | OtherWebsiteInd |
| Other Website URL | HTTP://WWW.NCDHD.ORG/ | OtherWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 18 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | HTTPS://WWW.WESTHOLTMED.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 | 110.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 190.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| 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 |
| Provided Nonprofit Contact | Yes (X) | ProvidedNonprofitContactInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | WWW.WESTHOLTMED.ORG | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | WWW.WESTHOLTMED.ORG | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | WWW.WESTHOLTMED.ORG | 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 Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| Provided Written Notice | Yes (X) | ProvidedWrittenNoticeInd |
| Made Effort Orally Notify | Yes (X) | MadeEffortOrallyNotifyInd |
| Processed FAP Application | Yes (X) | ProcessedFAPApplicationInd |
| Made Presumptive Elig Determ | Yes (X) | MadePresumptiveEligDetermInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Look Back Medicare Private | Yes (X) | LookBackMedicarePrivateInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| WEST HOLT MEMORIAL HOSPITAL | PART V, SECTION B, LINE 5: WEST HOLT MEMORIAL HOSPITAL (WHMH) COLLABORATED WITH NCDHD (NORTH CENTRAL DISTRICT HEALTH DEPARTMENT) AGAIN, ALONG WITH OTHER HOSPITALS IN OUR HEALTH DISTRICT TO COMPLETE THE CHNA. DATA WAS GATHERED THROUGH THE PROCESS OF MOBILIZING FOR ACTION THROUGH PLANNING AND PARTNERSHIPS (MAPP), BEHAVIORAL HEALTH, AND CENSUS DATA. NCDHD CONTRACTED WITH JUAN PAULO RAMIREZ, PH.D. DR. RAMIREZ IS THE OWNER OF GIS AND HUMAN DIMENSIONS, LLC, AND IS AN INDEPENDENT CONTRACTOR. DR. RAMIREZ HAS PREVIOUSLY WORKED FOR THE NEBRASKA DEPARTMENT OF HEALTH AND HUMAN SERVICES COMPILING DIFFERENT DATA SETS FOR THE DIVISION OF PUBLIC HEALTH. BEGINNING IN JULY OF 2018, WHMH WAS A PART OF THE CORE GROUP WHO BEGAN WORKING WITH NCDHD PREPARING FOR THE NEXT ROUND OF CHNA ACTIVITIES. THERE WERE BRAINSTORMING SESSIONS INVOLVING NCDHD STAFF MEMBERS AND NCCCP (NORTH CENTRAL COMMUNITY CARE PARTNERSHIP) MEMBERS, IN ADDITION TO KEY PERSONNEL FROM HOSPITALS WITHIN OUR HEALTH DISTRICT. WE FIRST WORKED TO INCREASE PARTICIPATION FROM THE PUBLIC HEALTH SECTOR BY SENDING EMAILS AND MAKING DIRECT PHONE CALLS. THE ESSENTIAL BUILDING BLOCKS OF MAPP ARE FOUR ASSESSMENTS WHICH PROVIDE CRITICAL INSIGHTS INTO THE HEALTH CHALLENGES AND OPPORTUNITIES CONFRONTING THE COMMUNITY. THESE FOUR ASSESSMENTS AND THE ISSUES THEY ADDRESS ARE DESCRIBED BELOW.THE COMMUNITY THEMES AND STRENGTHS ASSESSMENT IS THE FIRST OF THE FOUR ASSESSMENTS. THIS IS A SUBJECTIVE LOOK AT HOW THE COMMUNITY VIEWS ITS HEALTH TO CAPTURE THE PERCEIVED NEEDS IN THE COMMUNITIES WE SERVE. THIS STEP INCLUDED SURVEYS SUCH AS THE SPECIAL POPULATION NEEDS ASSESSMENT AND THE 2018 COMMUNITY HEALTH ASSESSMENT. ADDITIONAL THEMES AND STRENGTHS WERE IDENTIFIED AT THE DATA PRESENTATION MEETING IN MARCH.THE SECOND ASSESSMENT IS THE FORCES OF CHANGE. THIS FOCUSES ON IDENTIFYING FORCES SUCH AS SOCIAL, ETHICAL, LEGISLATIVE, TECHNOLOGICAL, ENVIRONMENTAL, LEGAL ISSUES AND OTHER IMPENDING CHANGES WHICH AFFECT THE CONTEXT IN WHICH THE COMMUNITY AND ITS PUBLIC HEALTH SYSTEM OPERATE. THERE WERE FOCUS GROUP MEETINGS HOSTED THROUGHOUT THE DISTRICT.THE THIRD ASSESSMENT IS THE COMMUNITY HEALTH STATUS ASSESSMENT, WHICH IDENTIFIES COMMUNITY HEALTH AND QUALITY OF LIFE ISSUES. THIS CONTAINS A COMPREHENSIVE DATA COLLECTION PROCESS THAT INCLUDES PUBLIC HEALTH DATA COLLECTED BY NEBRASKA DHHS, AS WELL AS DATA FROM BEHAVIORAL RISK FACTOR SURVEILLANCE SYSTEM (BRFSS), YOUTH RISK BEHAVIOR SURVEY (YRBS) AND NEBRASKA RISK AND PROTECTIVE FACTOR STUDENT SURVEY (NRPFSS), AS WELL AS OTHER DATA SOURCES. THE COMMUNITY HEALTH STATUS ASSESSMENT PROVIDES MOST OF THE DATA IN THE REPORT.THE FINAL ASSESSMENT PIECE OF THE MAPP PROCESS IS THE LOCAL AND PUBLIC HEALTH SYSTEM ASSESSMENT. THIS FOCUSES ON ALL OF THE ORGANIZATIONS AND ENTITIES WHICH CONTRIBUTE TO PUBLIC HEALTH. THE LOCAL PUBLIC HEALTH SYSTEM ASSESSMENT (LPHSA) ANSWERS QUESTIONS SUCH AS: "WHAT ARE THE COMPONENTS, ACTIVITIES, COMPETENCIES, AND CAPACITIES OF OUR LOCAL PUBLIC HEALTH SYSTEM? AND "HOW ARE THE ESSENTIAL SERVICES BEING PROVIDED TO OUR COMMUNITIES?" THE TEN ESSENTIAL PUBLIC HEALTH SERVICES WERE REVIEWED AND DISCUSSED.TIMELINE:JULY-SEPTEMBER 2018 - ORGANIZE, COORDINATE PARTICIPANTS AND PREPARE FOR PROCESSOCTOBER 2018-FEBRUARY 2019 - COMMUNITY HEALTH NEEDS ASSESSMENT DATA COLLECTIONFEBRUARY-MARCH 2019 - COMMUNITY THEMES & STRENGTHS, FORCES OF CHANGE, & LOCAL PUBLIC HEALTH SYSTEM ASSESSMENTSMARCH 2019 - COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) DATA PRESENTATIONAPRIL-MAY 2019 - CHNA REPORT COMPLETED, ADOPTED BY HOSPITAL GROUP AND COMMUNITY PARTNERS, PRIORITY AREAS SELECTED BY PARTNERSHIP MEMBERS, GOALS AND STRATEGIES DEVELOPED FOR COMMUNITY HEALTH IMPROVEMENT PLAN. |
| WEST HOLT MEMORIAL HOSPITAL | PART V, SECTION B, LINE 6A: THE FOLLOWING HOSPITALS PARTICIPATED IN THE FACILITIES CHNA:ANTELOPE MEMORIAL HOSPITAL, NELIGH, NE (ANTELOPE COUNTY)AVERA CREIGHTON HOSPITAL, CREIGHTON, NE (KNOX COUNTY)AVERA ST. ANTHONY'S HOSPITAL O'NEILL, NE (HOLT COUNTY)BROWN COUNTY HOSPITAL, AINSWORTH, NE (BROWN COUNTY)CHERRY COUNTY HOSPITAL, VALENTINE, NE (CHERRY COUNTY)NIOBRARA VALLEY HOSPITAL, LYNCH, NE (BOYD COUNTY)OSMOND GENERAL HOSPITAL, OSMOND, NE (PIERCE COUNTY)PLAINVIEW COMMUNITY HOSPITAL, PLAINVIEW, NE (PIERCE COUNTY)ROCK COUNTY HOSPITAL, BASSETT, NE (ROCK COUNTY) |
| WEST HOLT MEMORIAL HOSPITAL | PART V, SECTION B, LINE 6B: AREA SUBSTANCE ABUSE AND PREVENTION COALITIONCENTRAL NEBRASKA ECONOMIC DEVELOPMENTCENTRAL NEBRASKA COMMUNITY ACTION PARTNERSHIP NORTH CENTRAL COMMUNITY CARE PARTNERSHIPNORTH CENTRAL DISTRICT HEALTH DEPARTMENT BOARD OF HEALTHO'NEILL CHAMBER OF COMMERCEO'NEILL PUBLIC SCHOOLSCOUNSELING AND ENRICHMENT CENTERBUILDING BLOCKS FOSTER CARE AGENCYUNIVERSITY OF NEBRASKA EXTENSION OFFICE, BROWN-ROCK-KEYA PAHA COUNTYEWING PUBLIC SCHOOLSLYNCH PUBLIC SCHOOLSVALENTINE PUBLIC SCHOOLSO'NEILL LIONS CLUBO'NEILL ROTARY CLUBWEST HOLT HEALTH MINISTRIESHOLT COUNTY ECONOMIC DEVELOPMENTANTELOPE COUNTY ECONOMIC DEVELOPMENTPIERCE COUNTY ECONOMIC DEVELOPMENTBRIGHT HORIZONSWE CARE, INC. |
| WEST HOLT MEMORIAL HOSPITAL | PART V, SECTION B, LINE 11: WEST HOLT MEMORIAL HOSPITAL IS ADDRESSING THE SIGNIFICANT NEEDS IDENTIFIED IN ITS MOST RECENTLY CONDUCTED CHNA OF CHRONIC DISEASE DETECTION AND MANAGEMENT AND MENTAL WELLNESS THROUGH PROMOTION OF HEALTH MAINTENANCE WITH HEALTH SCREENINGS AND ADDITIONAL DETECTION CARE MANAGEMENT (BLOOD PRESSURE CHECKS, DEXA SCANS, REDUCED PRICE LABS, AND AN ANNUAL HEALTH FAIR THAT IS FREE TO THE COMMUNITY). WE ALSO ATTEND AN ANNUAL WOMEN'S HEALTH CONFERENCE AND ASSIST WITH THE LOCAL FOOD PANTRY. PHQ9 QUESTIONNAIRE'S ARE OFFERED TO HELP IDENTIFY MENTAL WELL BEING IN PATIENTS THAT MIGHT BE AT RISK. WEST HOLT MEMORIAL HOSPITAL IS ADDRESSING ALL SIGNIFICANT NEEDS IDENTIFIED IN THE MOST RECENTLY CONDUCTED CHNA. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | 1 - WEST HOLT CLINIC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 405 WEST PEARL STREET | AddressLine1Txt |
| City | ATKINSON | CityNm |
| State Abbreviation | NE | StateAbbreviationCd |
| ZIP | 68713 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | RURAL HEALTH CLINIC | FacilityTxt |
Supplemental Information Detail SupplementalInformationDetail (15 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 3C: | THE HOSPITAL HAS A POLICY AND USES THE FEDERAL POVERTY GUIDELINES TO DETERMINE ELIGIBILITY. THOSE REQUESTING CHARITY CARE MUST FILL OUT AN APPLICATION. |
| PART I, LINE 6A: | THE HOSPITAL PREPARES ITS OWN COMMUNITY BENEFIT REPORT WHICH IS INCLUDED IN THE NEBRASKA HOSPITAL ASSOCIATION ANNUAL COMMUNITY BENEFIT REPORT. |
| PART I, LINE 7G: | THERE ARE NO SUBSIDIZED HEALTH SERVICES AT THIS TIME. |
| PART I, LN 7 COL(F): | DURING THE YEAR ENDED JUNE 30, 2020, THE BAD DEBT RECOVERIES EXCEEDED THE BAD DEBT EXPENSE. THERE IS NO BAD DEBT EXPENSE INCLUDED ON FORM 990, PART XI, LINE 25. |
| PART II, COMMUNITY BUILDING ACTIVITIES: | WEST HOLT MEMORIAL HOSPITAL PROVIDES LAB SCREENING ONCE A YEAR AT A GREATLY REDUCED RATE. THE RESULTS ARE SENT TO THE INDIVIDUALS AT WHICH TIME THEY CAN TAKE TO THEIR PRIMARY PROVIDER AND HAVE THEM REVIEWED. THE HOSPITAL ALSO OFFERS FREE COLORECTAL CANCER SCREENING ONCE A YEAR. WEST HOLT ALSO ARRANGED AN ACTIVE SHOOTER TRAINING WITH CHAD SHEEHAN OF SHEEHAN STRATEGIC SOLUTIONS. THIS LIFE-SAVING TRAINING WAS FREE TO LOCAL BUSINESSES, TEACHERS, EMERGENCY RESPONDERS, AND HEALTHCARE WORKERS. IT FOCUSED ON EDUCATING AND PREPARING ATTENDEES TO SURVIVE WORKPLACE OR SCHOOL VIOLENCE, AND TODAY'S ACTIVE SHOOTER. |
| PART III, LINE 2: | IN EVALUATING THE COLLECTIBILITY OF ACCOUNTS RECEIVABLE, THE HOSPITAL ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYER SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYER SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE HOSPITAL ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR BAD DEBTS FOR THOSE ACCOUNTS OVER A CERTAIN AGE BASED ON DISCHARGE THAT MAKE THE REALIZATION OF AMOUNTS DUE UNLIKELY. FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), THE HOSPITAL RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES IF NEGOTIATED) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. |
| PART III, LINE 3: | DURING THE YEAR ENDED JUNE 30, 2020, THE BAD DEBT RECOVERIES EXCEEDED THE BAD DEBT EXPENSE AND THUS NO PORTION IS ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY. |
| PART III, LINE 4: | THE HOSPITAL'S FINANCIAL STATEMENTS DO NOT CONTAIN A SPECIFIC FOOTNOTE DESCRIBING BAD DEBT. HOWEVER, PAGES 8, 10 AND 11 OF THE ATTACHED AUDITED FINANCIAL STATEMENTS INCLUDE FOOTNOTES TITLED "PATIENT RECEIVABLES, NET," "NET PATIENT SERVICE REVENUE, AND "CHARITY CARE". |
| PART III, LINE 8: | THE COMMUNITY DOES BENEFIT BECAUSE THE HOSPITAL APPLIES OTHER REVENUES TO COVER THE COSTS OF CARING FOR MEDICARE PATIENTS.THE COSTING METHODOLOGY USED FOR PART III, SECTION B, LINE 6 IS THE COSTS TAKEN DIRECTLY FROM THE MEDICARE COST REPORT WHICH ARE ASSOCIATED WITH THE TOTAL REVENUE REPORTED IN LINE 5. NO MEDICARE SHORTFALL IS TREATED AS COMMUNITY BENEFITS. |
| PART III, LINE 9B: | FOR PATIENTS WITH EXCEPTIONALLY LARGE MEDICAL BILLS OR WHOSE PERSONAL CIRCUMSTANCES ARE SUCH THAT THE PAYMENT OPTIONS ARE NEITHER REALISTIC NOR AFFORDABLE, THE FINANCIAL ADVISOR SHALL ATTEMPT TO DETERMINE THE PATIENT'S ABILITIES TO PAY WHILE VISITING WITH THE PATIENT. THE FINANCIAL ADVISOR, CFO OR CEO WILL HAVE THE FULL AUTHORITY TO MAKE AND APPROVE PAYMENT ARRANGEMENTS. |
| PART VI, LINE 2: | THE ORGANIZATION ASSESSES THE HEALTH CARE NEEDS OF THE COMMUNITY IT SERVES THROUGH ROUTINE COLLECTION OF INFORMATION ABOUT IMPORTANT ASPECTS OF PATIENT CARE PROVIDED IN THE HOSPITAL AND ABOUT THE CLINICAL PERFORMANCE OF ALL INDIVIDUALS WITH CLINICAL PRIVILEGES. THIS INFORMATION IS COLLECTED THROUGH ACTIVITIES OF THE MEDICAL STAFF COMMITTEES, THE OVERALL QUALITY ASSURANCE PROGRAM, AND THROUGH THE MEDICAL STAFF MONITORING ACTIVITIES. THROUGH THIS COLLECTION OF INFORMATION, PERIODIC ASSESSMENTS ARE CONDUCTED TO IDENTIFY OPPORTUNITIES TO IMPROVE PATIENT CARE AND THE PROBLEMS THAT NEED RESOLUTIONS. |
| PART VI, LINE 3: | ALL NEW PATIENTS ARE GIVEN A "NEW PATIENT PACKET" THAT CONTAINS WEST HOLT MEDICAL SERVICES BILLING AND COLLECTION POLICY WHICH OUTLINES PATIENT ELIGIBILITY FOR FINANCIAL ASSISTANCE. THERE IS ALSO A FINANCIAL ASSISTANCE SECTION ON WESTHOLTMED.ORG UNDER PATIENT RESOURCES THAT INCLUDES OUR COMPREHENSIVE CHARITY CARE POLICY AND FINANCIAL ASSISTANCE POLICY (ALSO A PLAIN LANGUAGE SUMMARY VERSION). THESE RESOURCES ARE ALSO MADE AVAILABLE FOR ALL PATIENTS IN THE REGISTRATION AREAS OF THE FACILITY. PATIENTS ARE ENCOURAGED TO SPEAK WITH OUR FINANCIAL COUNSELOR AND SOCIAL SERVICES WORKER TO FURTHER EDUCATE THEMSELVES ON ALL AVENUES FOR FINANCIAL ASSISTANCE. |
| PART VI, LINE 4: | WEST HOLT MEMORIAL HOSPITAL IS IN THE NORTH CENTRAL DISTRICT HEALTH DEPARTMENT AREA WHICH CONSISTS OF 9 COUNTIES IN NORTH CENTRAL NEBRASKA. RESIDENTS BETWEEN THE AGE OF 18-65 ACCOUNT FOR 58.50%, OVER THE AGE OF 65 ACCOUNT FOR 22.3%, AND 19.2% OF THE POPULATION IS UNDER THE AGE OF 18. THE POPULATION DENSITY IN THE AREA IS 4.2 PEOPLE PER SQUARE MILE AS COMPARED TO THE NEBRASKA RATE OF 24.5 PEOPLE PER SQUARE MILE. THE PERCENT OF THE POPULATION WITH INCOMES BELOW 100% OF THE FEDERAL POVERTY LEVEL IS 10.3%, WHILE THE STATE PERCENTAGE IS 12.0%. THE AREA FACES AN ACUTE SHORTAGE OF PHYSICIANS IN NEARLY EVERY SPECIALTY AREA. GIVEN THE VASTNESS OF THE REGION AND SPARSE POPULATION DENSITY, IT IS NOT UNCOMMON FOR RESIDENTS TO LIVE MANY MILES FROM THE NEAREST HEALTH CARE PROVIDER. |
| PART VI, LINE 5: | THE HOSPITAL HAS THE AUTHORITY FOR A 40 MEMBER COMMUNITY BOARD WITH 17 MEMBERS CURRENTLY SERVING. FROM THIS GROUP, 9 MEMBERS SERVE AS THE HOSPITAL BOARD. ONE THIRD OF THE MEMBERS ARE ELECTED EVERY YEAR AT THE ANNUAL MEETING. THIS MEETING IS HELD THE FOURTH MONDAY OF OCTOBER AND IS OPEN TO THE COMMUNITY. THOSE ATTENDING ARE INVITED TO ASK QUESTIONS AND VOICE ANY CONCERNS THEY MAY HAVE. THE HOSPITAL HOSTS A HEALTH FAIR EVERY YEAR. LAB TESTS ARE OFFERED AT A REDUCED RATE AND OUTSIDE VENDORS OFFER INFORMATION FOR THE PARTICIPANTS. THE HOSPITAL OFFERS REDUCED PRICED LAB TESTS AND FREE COLORECTAL CANCER TESTS. |
| PART VI, LINE 6: | THE HOSPITAL IS NOT PART OF AN AFFILIATED HEALTH CARE SYSTEM. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Employment Contract | Yes (X) | WrittenEmploymentContractInd |
| 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 (3 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| JEFFREY HAGEN | ||||||||||||||
| PHARMACIST | $124,583 | $0 | $0 | $0 | $0 | $0 | $4,222 | $0 | $27,350 | $0 | $156,155 | $0 | $0 | $0 |
| NICK KONRAD | ||||||||||||||
| PHYSICAL THERAPIST | $112,758 | $0 | $0 | $0 | $0 | $0 | $3,952 | $0 | $35,748 | $0 | $152,458 | $0 | $0 | $0 |
| AMY KINKENNON | ||||||||||||||
| PHARMACIST | $144,644 | $0 | $0 | $0 | $0 | $0 | $4,386 | $0 | $1,960 | $0 | $150,990 | $0 | $0 | $0 |
Schedule L IRS990ScheduleL
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp (2 entries)
| Relationship DescriptionRelationshipDescriptionTxt | TransactionTransactionAmt | TransactionTransactionDesc | Sharing Of RevenuesSharingOfRevenuesInd |
|---|---|---|---|
| KRISTI TIELKE | |||
| EMPLOYEE OF HOSPITAL AND SISTER OF LORI OLSON, BOARD MEMBER | $52,291 | EMPLOYEE W-2 WAGES | 0 |
| AMY RENTSCHLER | |||
| EMPLOYEE OF HOSPITAL AND SPOUSE OF BRYAN RENTSCHLER, BOARD VICE PRESIDENT | $109,443 | EMPLOYEE W-2 WAGES | 0 |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (9 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 6 | WEST HOLT MEMORIAL HOSPITAL SHALL HAVE ONE CLASS OF MEMBERS, CONSISTING OF FORTY INDIVIDUALS, OR FEWER IF THERE ARE LESS THAN 40 QUALIFIED INDIVIDUALS WILLING TO SERVE. MEMBERS MUST BE CITIZENS OF THE UNITED STATES, RESIDENTS OF HOLT COUNTY, NEBRASKA OR AN ADJOINING COUNTY, AND HAVE ATTAINED THE AGE OF MAJORITY. |
| FORM 990, PART VI, SECTION A, LINE 7A | THE MEMBERS OF WEST HOLT MEMORIAL HOSPITAL HAVE THE POWER TO ELECT AND REMOVE INDIVIDUALS TO MEMBERSHIP, ELECT THE DIRECTORS OF THE BOARD OF DIRECTORS, AND MAKE RECOMMENDATIONS TO THE BOARD ON OTHER MATTERS. EACH MEMBER SHALL HAVE ONE VOTE ON EACH MATTER SUBMITTED TO A VOTE OF THE MEMBERS. |
| FORM 990, PART VI, SECTION A, LINE 8B | THERE ARE NO COMMITTEES WITH AUTHORITY TO ACT ON BEHALF OF THE BOARD OF DIRECTORS. EACH COMMITTEE NEEDS APPROVAL FROM THE BOARD OF DIRECTORS. |
| FORM 990, PART VI, SECTION B, LINE 11B | THE CEO AND CFO WILL REVIEW THE FORM 990 PRIOR TO SUBMISSION TO THE IRS. THE BOARD OF DIRECTORS WILL BE PROVIDED THE FORM 990 PRIOR TO FILING. |
| FORM 990, PART VI, SECTION B, LINE 12C | FOLLOWING THE ELECTION OF THE BOARD OF DIRECTORS, EACH MEMBER IS REQUIRED TO SIGN THE CONFLICT OF INTEREST POLICY AND REFRAIN FROM THOSE SITUATIONS THAT MAY CAUSE NON-COMPLIANCE. |
| FORM 990, PART VI, SECTION B, LINE 15A | COMPDATA CONSULTING AND THE NEBRASKA HOSPITAL ASSOCIATION ARE CONTACTED WITH SALARY RANGES FOR THESE POSITIONS. THE CEO'S SALARY IS SET BY THE BOARD OF DIRECTORS. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE PUBLIC IS WELCOME TO COME TO THE FACILITY TO VIEW THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY OR FINANCIAL STATEMENTS AT ANYTIME. |
| FORM 990, PART IX, LINE 11G | MACHINE SERVICE FEES: PROGRAM SERVICE EXPENSES 329,263. MANAGEMENT AND GENERAL EXPENSES 76,719. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 405,982. PHYSICIAN FEES: PROGRAM SERVICE EXPENSES 582,559. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 582,559. CONSULTING FEES: PROGRAM SERVICE EXPENSES 129,992. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 129,992. OTHER FEES FOR SERVICE: PROGRAM SERVICE EXPENSES 366,461. MANAGEMENT AND GENERAL EXPENSES 42,401. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 408,862. |
| FORM 990, PART XI, LINE 2C: | THE BOARD OF DIRECTORS ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF ITS FINANCIAL STATEMENTS AND SELECTION OF AN INDEPENDENT ACCOUNTANT. THIS PROCESS HAS NOT CHANGED SINCE THE PRIOR YEAR. |
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