2021-04-21T15:49:22-05:00 2020-06-30 476097913 SEIM JOHNSON LLP 18081 BURT STREET SUITE 200 OMAHA NE 680224722 990 2019-07-01 470366569 HENDERSON HEALTH CARE SERVICES INC HEND 4027234512 1621 FRONT STREET HENDERSON NE 683710217 CHERYL BROWN CHIEF EXECUTIVE OFFICER 4027234512 2021-04-20 1 MEGAN L KOZIOL P01544037 4023302660 2019 2022-09-23 18:48:47Z CHERYL BROWN 1621 FRONT STREET HENDERSON NE 683710217 18288462 0 X WWW.HENDERSONHEALTHCARE.ORG X 1949 NE WE ARE A NONPROFIT, COMMUNITY BASED HEALTH CARE NETWORK WHOSE MISSION IS TO PROMOTE PROFESSIONAL, COMPETENT, ETHICAL AND COMPASSIONATE HEALTH CARE IN THE NAME OF CHRIST TO INDIVIDUALS, FAMILIES AND COMMUNITY. 8 8 192 30 0 0 974670 295996 13759144 15503084 216028 247073 6615 5451 14956457 16051604 0 0 0 0 8396608 8941786 0 0 0 4383416 4750653 12780024 13692439 2176433 2359165 20907651 34483244 3896281 15083914 17011370 19399330 X WE ARE A NONPROFIT, COMMUNITY BASED HEALTH CARE NETWORK WHOSE MISSION IS TO PROMOTE PROFESSIONAL, COMPETENT, ETHICAL AND COMPASSIONATE HEALTH CARE IN THE NAME OF CHRIST TO INDIVIDUALS, FAMILIES AND COMMUNITY. 0 0 8363898 8441987 ANCILLARY SERVICES - HENDERSON HEALTH CARE SERVICES IS A 13-BED COMMUNITY-BASED HEALTH CARE NETWORK LOCATED IN THE HEART OF RURAL NEBRASKA. ANCILLARY SERVICES PROVIDED INCLUDE RADIOLOGY, LABORATORY, OPERATING AND RECOVERY ROOMS, PHYSICAL, RESPIRATORY, INTRAVENOUS, OCCUPATIONAL AND SPEECH THERAPIES, CENTRAL SERVICES, EMERGENCY ROOM, SPECIALTY CLINIC, ANESTHESIOLOGY, ELECTROCARDIOLOGY, CARDIAC AND PULMONARY REHABILITATION, LABOR AND DELIVERY ROOMS AND DIABETIC EDUCATION.IN FISCAL YEAR 2020, THE HOSPITAL SERVED 2,026 RADIOLOGY PATIENTS AND 2,199 PHYSICAL THERAPY PATIENTS, HAD 510 VISITS TO THE EMERGENCY ROOM AND PERFORMED 193 OPERATIONS. HENDERSON PROVIDED 355 PATIENT DAYS OF ACUTE CARE AND 491 PATIENT DAYS OF SWING-BED CARE. 1693101 3194457 LTC NURSING - WE ARE A 40-BED LTC NON-MEDICARE CERTIFIED FACILITY, WE SERVE A MIXTURE OF PRIVATE AND MEDICAID PATIENTS AND FOR FISCAL YEAR 2020 WE HAD 98% OCCUPANCY. THE LARGEST SINGLE COST WITHIN THIS DEPARTMENT IS SALARIES AS THEY CARRY 28.6 FTES IN THIS DEPARTMENT, WHICH INCLUDES A DIRECTOR OF NURSING AND MDS COORDINATOR. THE NEXT HIGHEST COSTS ARE THE EMPLOYEE BENEFITS FOR THE STAFF, INCLUDING HEALTH INSURANCE AND RETIREMENT PLAN. WE ALSO INCUR A QUARTERLY ASSESSMENT TAX FROM NE DHHS, ASSESSED AT $3.50 PER BED PER RESIDENT DAY SO APPROXIMATELY $50,000 PER YEAR. 1626105 2197119 RURAL HEALTH CLINICS - THIS ENCOMPASSES TWO PROVIDER BASED RHCS, ONE LOCATED ADJACENT TO THE CAH AND ONE SATELLITE CLINIC IN SUTTON WHICH OFFERS EXPANDED LAB AND X-RAY. WE EMPLOY 2 MDS AND 3 PAS TO STAFF THESE CLINICS ALONG WITH NURSING AND ADMISSION STAFF. BEING LOCATED NEAR THE INTERSTATE WE ARE ABLE TO SERVE THOSE TRAVELING THROUGH WITH HEALTHCARE NEEDS, BUT OUR GENERAL SERVICE AREA INCLUDES HENDERSON, YORK, HAMPTON, BRADSHAW, MCCOOL, SUTTON, CLAY CENTER, AND AURORA. WE AVERAGE OVER 9,100 CLINIC VISITS BETWEEN THE TWO LOCATIONS AND WE PROVIDE FAMILY PRACTICE SERVICES INCLUDING OBSTETRIC CARE, GERIATRIC CARE, AND PEDIATRIC CARE. 965036 1669521 PHARMACY/ONCOLOGY - SALARIES INCLUDE A FULL TIME PHARMACIST THAT PERFORMS MEDICATION ORDER REVIEWS FOR ALL MEDICATIONS ORDERED FOR THE HHCS CAH, THIS PHARMACIST ALSO PERFORMS THE MONTHLY INTERNAL REVIEW OF PHARMACY/MEDICATION FOR THE CAH AND LTC. SUPPLIES EXPENSE IS MOSTLY COMPOSED OF MEDICATION COSTS FOR ALL THE MEDICATIONS ADMINISTERED TO THE ER, OP, IP, SK AND OPO PATIENTS AT HHCS. MEDICATIONS ARE PURCHASED THROUGH CARDINAL. 965036 1669521 12648140 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 43 0 1 192 1 0 0 0 0 0 0 0 0 0 0 0 0 X 8 8 0 0 0 0 1 1 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X CHERYL BROWN 4027234512 1621 FRONT STREET HENDERSON NE 683710217 JAMES OHRT PHYSICIAN 113.00 X 518180 0 26851 CHRISTOPHER VANDERNECK PHYSICIAN 84.00 X 345017 0 28237 CHERYL BROWN CEO 50.00 X 178148 0 16624 JILL MYERS CFO 50.00 X 147580 0 16027 ALLISON BAUER PA-C 62.00 X 119472 0 23758 ELIZABETH BOALS-SHIVELY PHARMACIST 40.00 X 121773 0 13094 SHELLY AMACK PROFESSIONAL SERVICES OFFI 45.00 X 118934 0 3999 JUSTIN OTT CHAIRMAN 1.00 X 0 0 0 LOWELL HIEBNER VICE CHAIRMAN 1.00 X X 0 0 0 ALAN JANZEN TREASURER 1.00 X X 0 0 0 ROSELYN KORB SECRETARY 1.00 X X 0 0 0 CURTIS COGSWELL MEMBER 1.00 X 0 0 0 BRAD FRIESEN MEMBER 1.00 X 0 0 0 TERESA HAHN MEMBER 1.00 X 0 0 0 KEVIN POSTIER MEMBER 1.00 X 0 0 0 NORMAN YODER MEMBER 1.00 X 0 0 0 1549104 0 128590 8 0 1 0 SAMPSON CONSTRUCTION CO INC 3730 S 14TH STREET LINCOLN NE 68502 CONSTRUCTION 4889495 HEALTHLANDCPSI PO BOX 850309 MOBILE AL 36685 EMR SOFTWARE VENDOR 153495 CENTRAL NEBRASKA REHAB SERVICES PO BOX 5285 GRAND ISLAND NE 688025285 PHYSICAL THERAPY SERVICES 113211 3 295996 295996 ANCILLARY SERVICES 621400 7071569 7071569 LONG-TERM-CARE NURSING 621400 2675889 2675889 RURAL HEALTH CLINICS 621400 1840452 1840452 PHARMACY/ONCOLOGY 621400 1398502 1398502 340B PROGRAM REVENUE 621400 1016512 1016512 1500160 1500160 15503084 326383 326383 2156055 1493 2236010 848 -79955 645 -79310 -79310 CAFETERIA SALES 900099 5451 5451 5451 16051604 15503084 0 252524 358379 358379 6924208 6664995 259213 180212 171618 8594 1007983 948938 59045 471004 433009 37995 1856 1564 292 44185 44185 14693 14693 824439 799986 24453 23244 23244 661533 646652 14881 134590 123674 10916 270235 253809 16426 9189 7849 1340 18413 16646 1767 188755 178277 10478 1175846 1144408 31438 135718 126663 9055 MEDICAL SUPPLIES 799726 799726 FOOD 173862 173862 LICENSES AND PERMITS 90787 89269 1518 BAD DEBTS 83342 83342 100240 67195 33045 13692439 12648140 1044299 0 2490550 13473294 1452194 1672365 278061 278246 90374 112525 21308360 8853479 12803852 12454881 3747620 6491933 45000 0 20907651 34483244 2088797 1211118 1482098 8073478 325386 5799318 3896281 15083914 X 16946620 19326175 64750 73155 17011370 19399330 20907651 34483244 2359165 28795 0 X X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 619 619 0 PART II-B, LINE 1: A PORTION OF THE DUES PAID TO THE NEBRASKA HOSPITAL ASSOCIATION (NHA) ARE USED BY THOSE ORGANIZATIONS FOR LOBBYING ACTIVITIES. 770708 770708 15014935 4820520 10194415 4996673 3919686 1076987 526044 113273 412771 12454881 DEFERRED COMPENSATION 395711 ADVANCE FEES 15500 REFUNDABLE ADVANCES 5248327 ESTIMATED THIRD-PARTY PAYOR SETTLEMENTS 139780 5799318 X 15982364 28795 28795 15953569 14693 83342 98035 16051604 13594404 0 13594404 14693 83342 98035 13692439 PART X, LINE 2: HENDERSON HEALTH CARE SERVICES, INC. (HHCS) IS A NOT-FOR-PROFIT CORPORATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND HAS RECEIVED DETERMINATION LETTERS 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 HHCS' TAX EXEMPT STATUS. IN GENERAL, SUCH STANDARDS REQUIRE HHCS TO MEET A COMMUNITY BENEFITS STANDARD AND COMPLY WITH VARIOUS LAWS AND REGULATIONS. HHCS ACCOUNTS FOR UNCERTAINTIES IN ACCOUNTING FOR INCOME TAX ASSETS AND LIABILITIES USING GUIDANCE INCLUDED IN FASB ASC 740, INCOME TAXES. HHCS 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, HHCS HAD NO UNCERTAIN TAX POSITIONS ACCRUED. PART XI, LINE 4B - OTHER ADJUSTMENTS: PROVISION FOR BAD DEBTS 83,342. PART XII, LINE 4B - OTHER ADJUSTMENTS: PROVISION FOR BAD DEBTS 83,342. 1 1 X 1 X 300.000000000000 1 X 1 1 0 0 23588 12418 11170 0.00080 572495 353057 219438 0.01610 596083 365475 230608 0.01690 4 2546 27135 22330 4805 0.00040 3 650 375 375 0.00000 7 3196 27510 22330 5180 0.00040 7 3196 623593 387805 235788 0.01730 1 83342 16668 4630598 4723194 -92596 X 1 1 1 1 HENDERSON HEALTH CARE SERVICES 1621 FRONT ST HENDERSON NE 68371 WWW.HENDERSONHEALTHCARE.ORG 820001 X X X X HENDERSON HEALTH CARE SERVICES INC 1 0 0 1 X X X X X X X X 18 1 0 1 1 X WWW.HENDERSONHEALTHCARE.ORG/ABOUT-US/COMMUNITY-NEEDS-ASSESSMENT/ X 1 18 1 WWW.HENDERSONHEALTHCARE.ORG/ABOUT-US/COMMUNITY-NEEDS-ASSESSMENT/ 0 1 X 300.000000000000 300.000000000000 X X X 1 1 X X X 1 X WWW.HENDERSONHEALTHCARE.ORG/PATIENT-INFORMATION/FINANCIAL-ASSISTANCE/ X WWW.HENDERSONHEALTHCARE.ORG/PATIENT-INFORMATION/FINANCIAL-ASSISTANCE/ X WWW.HENDERSONHEALTHCARE.ORG/PATIENT-INFORMATION/FINANCIAL-ASSISTANCE/ X X X X X X 1 X 0 X X X X 1 X 0 0 HENDERSON HEALTH CARE SERVICES INC PART V, SECTION B, LINE 5: THIS ASSESSMENT FOCUSES ON COLLECTING THE COMMUNITY'S PERSPECTIVE ON ISSUES SUCH AS HEALTH CARE, EDUCATION, CARE FOR OLDER ADULTS, JOBS, SUPPORT NETWORKS, HEALTH PROBLEMS, AND RISKY BEHAVIORS. A SURVEY WAS DESIGNED BY UTILIZING A SAMPLE SURVEY PROVIDED BY NACCHO. AN UPDATED SURVEY WAS DESIGNED AND DISTRIBUTED IN 2018. THE SURVEY WAS DISTRIBUTED THROUGHOUT THE DISTRICT FROM MAY TO JULY 31, 2018 TO COMMUNITY MEETINGS SUCH AS ROTARY, KIWANIS, OR SERTOMA CLUBS. THEY WERE TAKEN TO AREA CHURCHES, SCHOOL EVENTS, COUNTY FAIRS, ETC. THE SURVEY WAS ALSO AVAILABLE ONLINE AT SURVEY MONKEY. RESPONSES WERE RECEIVED FROM 254 INDIVIDUALS. HENDERSON HEALTH CARE SERVICES INC PART V, SECTION B, LINE 6B: FOUR CORNERS HEALTH DEPARTMENT HENDERSON HEALTH CARE SERVICES INC PART V, SECTION B, LINE 11: HENDERSON HEALTH CARE SERVICES, INC. CONTINUES TO PUT FORTH RESOURCES TO ADDRESS THE IDENTIFIED NEEDS AS FOLLOWS:1) OBESITY/NUTRITION/PHYSICAL ACTIVITY: HHCS PROMOTES HEALTHY LIFESTYLES BY PARTNERING WITH FOUR CORNERS HEALTH DEPARTMENT, SPONSORING AN ANNUAL COMMUNITY WEIGHT LOSS CHALLENGE, OFFERING AN ANNUAL HEALTH FAIR TO EMPLOYEES AND THE GENERAL PUBLIC, OFFERING WELLNESS CENTER ACCESS TO EMPLOYEES AND THE PUBLIC, AND PROVIDING NUTRITIONAL COUNSELING AND DIABETIC EDUCATION TO PATIENTS. 2) CANCER: HHCS CONTINUES TO PROMOTE CANCER AWARENESS BY PARTNERING WITH FOUR CORNERS HEALTH DEPARTMENT, RELEASING MESSAGES TO THE PUBLIC ENCOURAGING SCREENING AND EARLY DETECTION IN THE LOCAL NEWSPAPER, WEBSITE OR QUARTERLY NEWSLETTER, AND HOST COMMUNITY HEALTH EVENTS.3) MENTAL HEALTH: HHCS PROMOTES MENTAL HEALTH BY MAKING APPROPRIATE MENTAL HEALTH REFERRALS WHEN DEEMED NECESSARY AND DEVELOPING A CLEAR AND CONSISTENT MESSAGE TO THE GENERAL PUBLIC AND PATIENTS OF HHCS. THIS INCLUDES SPONSORING A SPEAKER AT THE HEARTLAND COMMUNITY SCHOOL AND SUTTON PUBLIC SCHOOL FOCUSING ON SUICIDE PREVENTION/MENTAL HEALTH AMONGST TEENAGERS, CYBER BULLYING AND RISKY BEHAVIORS, AND CONTRACTING FOR EMERGENCY SERVICES WHERE MENTAL HEALTH COORDINATION CAN BE INITIATED.4) ALCOHOL/DRUG ABUSE: HHCS PROVIDES SUPPORT FOR ALCOHOL/DRUG ABUSE BY COLLABORATING WITH THE LOCAL PUBLIC HEALTH SYSTEM TO EDUCATE AND BE A RESOURCE FOR MEMBERS OF THE COMMUNITY. 5) HEART DISEASE AND STROKE: HHCS PROVIDES SUPPORT FOR HEART DISEASE AND STROKES BY PROVIDING SPECIALTY CLINICS THAT SPECIALIZE IN CARDIOLOGY AND CARDIOVASCULAR SERVICES. THEY ALSO PROMOTE THESE SERVICES THROUGH PUBLIC EDUCATION AND VIA A FACILITY NEWSLETTER.OF THE NEEDS IDENTIFIED, THERE WERE NO SIGNIFICANT NEEDS THAT ARE NOT BEING ADDRESSED. 5 1 - HENDERSON FAMILY CARE 1621 FRONT STREET HENDERSON NE 68371 RURAL HEALTH CLINIC 2 - SUTTON FAMILY PRACTICE 1106 N SAUNDERS SUITE 2 SUTTON NE 68979 RURAL HEALTH CLINIC 3 - CARE CENTER 1621 FRONT STREET HENDERSON NE 68371 LONG-TERM CARE 4 - ROSEWOOD COURT 1621 FRONT STREET HENDERSON NE 68371 ASSISTED LIVING 5 - PRAIRIE GARDEN ESTATES 1621 FRONT STREET HENDERSON NE 68371 INDEPENDENT LIVING PART I, LINE 3C: NOT APPLICABLE PART I, LINE 6A: THE ORGANIZATION DID NOT PREPARE A COMMUNITY BENEFIT REPORT DURING THE YEAR. PART I, LINE 7: HENDERSON HEALTH CARE SERVICES, INC. USED THE WORKSHEETS PROVIDED IN THE IRS INSTRUCTIONS FOR SCHEDULE H IN ADDITION TO THE INTERNAL COST ACCOUNTING SYSTEM. PART I, LN 7 COL(F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $83,342. PART II, COMMUNITY BUILDING ACTIVITIES: HHCS IS THE LARGEST EMPLOYER IN THE COMMUNITY WITH APPROXIMATELY 160 EMPLOYEES FROM THE SURROUNDING COMMUNITIES. THE DIRECTOR OF NURSING STAFF AND HUMAN RESOURCES REGULARLY ATTENDS JOB FAIRS PROMOTING HEALTH CARE POSITIONS. HHCS ALSO HOSTS THE HENDERSON HEARTLAND SCHOOL JUNIOR HIGH FOR A CAREER DAY IN WHICH THEY COME FOR A TOUR OF THE FACILITY TO LEARN ABOUT THE VAST ARRAY OF JOBS OFFERED WITHIN THE HEALTHCARE INDUSTRY. A NEW PHYSICIAN ASSISTANT HAS BEEN RECRUITED TO THE FACILITY RECENTLY. THE HOSPITAL OFFERS AN ANNUAL HEALTH FAIR LAB PROGRAM THAT PROVIDES REDUCED COST TESTS FOR THE PUBLIC, HHCS ALSO PROMOTES HEALTHCARE AT THE SUTTON AND HENDERSON ANNUAL HOME SHOWS AND ALSO HOLDS AN ANNUAL WELLNESS CHALLENGE FOR THE PUBLIC TO PROMOTE FITNESS. DURING THE MONTHS OF JANUARY THROUGH MAY, HHCS HOSTS TRAIN YOUR BRAIN FOR WEIGHT LOSS CLASSES FEATURING BIGGEST LOSER CONTESTANT, MARTY WOLFF. PART III, LINE 2: IN EVALUATING THE COLLECTIBILITY OF ACCOUNTS RECEIVABLE, HHCS ANALYZES ITS HISTORICAL COLLECTIONS AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYOR SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS AND RESIDENTS WHO HAVE THIRD-PARTY COVERAGE, HHCS 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 AND RESIDENTS (WHICH INCLUDES BOTH PATIENTS AND RESIDENTS WITHOUT INSURANCE, AND PATIENTS AND RESIDENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), HHCS RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS AND RESIDENTS 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: THE ORGANIZATION REVIEWED THEIR BAD DEBTS WRITTEN OFF DURING THE YEAR AS WELL AS PAST EXPERIENCE WITH PATIENTS SERVED AND DETERMINED APPROXIMATELY 20% OF BAD DEBT ACCOUNTS WRITTEN OFF WOULD HAVE QUALIFIED FOR CHARITY CARE IF THE INDIVIDUALS WOULD HAVE COMPLETED THE APPLICATION PROCESS. PART III, LINE 4: THE HOSPITAL'S FINANCIAL STATMENTS 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 AND RESIDENT RECEIVABLES, NET", "NET PATIENT AND RESIDENT SERVICE REVENUE AND "FINANCIAL ASSISTANCE/CHARITY CARE". PART III, LINE 8: THE INFORMATION IS FROM THE MEDICARE COST REPORT WHICH IS BASED ON ROUTINE COST PER DAY AND COST TO CHARGE RATIOS. A SHORTFALL REPRESENTS ACTUAL UNREIMBURSED COSTS INCURRED BY THE HOSPITAL IN PROVIDING SERVICES TO INDIVIDUALS ELIGIBLE FOR MEDICARE. THIS IS A BENEFIT TO THE COMMUNITY AS IT IS PROVIDED BELOW COST. PART III, LINE 9B: HHCS RESERVES THE RIGHT TO PROVIDE FINANCIAL ASSISTANCE EVEN THOUGH AN APPLICATION HAS NOT BEEN SUBMITTED FOR THE APPLICABLE CARE. HHCS MAY UTILIZE PREVIOUS FAP APPLICATIONS TO DETERMINE THE ASSISTANCE PROVIDED TO THE PATIENT. IF THE PATIENT IS PROVIDED LESS THAN THE MAXIMUM POSSIBLE LEVEL OF FINANCIAL ASSISTANCE, HHCS WILL: - NOTIFY THE PATIENT REGARDING THE BASIS FOR THE PRESUMPTIVE FINANCIAL ASSISTANCE; - NOTIFY THE PATIENT AS TO HOW TO APPLY FOR POTENTIALLY MORE FINANCIAL ASSISTANCE; - GIVE THE PATIENT A REASONABLE AMOUNT OF TIME TO APPLY FOR MORE GENEROUS ASSISTANCE BEFORE INITIATING COLLECTION ACTIONS; AND - IF THE INDIVIDUAL SUBMITS A COMPLETED APPLICATION SEEKING ADDITIONAL FINANCIAL ASSISTANCE DURING THE LATER OF THE APPLICATION PERIOD OR THE RESPONSE TIME SET FORTH IN THE NOTICE, PROCESS THE APPLICATION IN ACCORDANCE WITH THE POLICY. PART VI, LINE 2: MEDICAL STAFF MEETINGS (INCLUDES ADMINISTRATION, DONS, ALL EMPLOYED PROVIDERS, PHARMACISTS) AND PROVIDER MEETINGS (INCLUDES ONLY EMPLOYED PROVIDERS, CEO AND DON) ARE HELD MONTHLY DURING WHICH OUR MEDICAL STAFF HAVE AN OPPORTUNITY TO SHARE WHAT THEY ARE SEEING FOR RECURRING CASES OF DISEASE MANAGEMENT IN THEIR PATIENTS. IF A TREND IS IDENTIFIED THRU THAT DISCUSSION THEN WE TRY TO DEVELOP AN OUTREACH TO THE COMMUNITY. FOR EXAMPLE, PATIENT EDUCATION IN THE NEWSLETTER OR PAMPHLETS IN THE CLINIC EXAM ROOMS, IT BECOMES A FOCUS POINT FOR ALL PROVIDERS WHEN SEEING THEIR PATIENTS. WE MAY ALSO TURN TO COMMUNITY OUTREACH EDUCATION SESSIONS WHERE OUR STAFF HOLD "TOWN HALL" MEETINGS TO EDUCATE THOSE INTERESTED IN ATTENDING. WE ALSO HOLD ANNUAL HEALTH FAIR LABS IN FEBRUARY AND WE COLLECTIVELY LOOK AT RESULTS TO DETERMINE ANY TRENDS IN HEALTH MANAGEMENT THAT NEED TO BE A FOCUS FOR OUR PROVIDERS FOR THE NEXT YEAR. THIS CAN HELP US IDENTIFY ADDITIONAL LAB OR RADIOLOGY TESTS THAT WE NEED TO OFFER IN OUR FACILITY. IT CAN ALSO TELL US IF WE NEED TO FOCUS ON A SPECIALTY CLINIC THAT MAY NEED TO BE RECRUITED TO PROVIDE THE SERVICE IN-HOUSE. FOR EXAMPLE, WE ARE CURRENTLY SEEING A LOT OF ALLERGY INJECTIONS, SO WE WOULD HOPE TO RECRUIT AN ALLERGIST TO COME PROVIDE A SPECIALTY CLINIC MONTHLY IN OUR FACILITY. LASTLY, WE HAVE PURCHASED KPI NINJA SOFTWARE THAT WILL ALLOW US TO DATA MINE OUR CLAIMS AND DIAGNOSIS SO WE CAN ANALYZE TO SEE WHAT TYPES OF HEALTH MANAGEMENT ARE PREVALENT IN OUR COMMUNITIES. PART VI, LINE 3: IT IS NOTED THAT HENDERSON HEALTH CARE OFFERS CHARITY CARE IN THE ADMISSION FORMS THAT ALL PATIENTS SIGN WHEN THEY COME TO THE CLINIC AND HOSPITAL AND THE FAP IS POSTED IN THE HOSPITAL WAITING ROOMS. ALSO, IN COLLECTION LETTERS, PATIENTS ARE ENCOURAGED TO CONTACT THE HOSPITAL IF THEY ARE INTERESTED IN APPLYING FOR CHARITY CARE. LASTLY, CHARITY CARE IS VERBALLY EXPLAINED TO PATIENTS IF THEY CALL STATING THEY CAN'T PAY FOR THEIR MEDICAL BILL. HHCS ALSO PUBLISHES A NOTICE ANNUALLY IN A NEWSLETTER THAT WE OFFER CHARITY CARE, AND WE PROVIDE OUR POLICY AND APPLICATIONS TO THE CLAY COUNTY AND YORK COUNTY HEALTH DEPARTMENT IN AN EFFORT TO REACH THOSE IN NEED. PART VI, LINE 4: HENDERSON HEALTH CARE SERVICES IS LOCATED IN HENDERSON, NEBRASKA PROVIDING HEALTH CARE SERVICES TO RURAL COMMUNITIES THAT PRIMARILY INCLUDE YORK COUNTY (13,665), CLAY COUNTY (6,624), AND HAMILTON COUNTY (9,132) RESPECTIVELY; APPROXIMATELY 30,000 IN TOTAL. HENDERSON HEALTH CARE PROVIDES HEALTH CARE SERVICES TO INFANTS, CHILDREN, ADOLESCENTS, ADULT MEN AND WOMEN, AND THE AGED. THERE IS AN AVERAGE OF 16.67 PERSONS PER SQUARE MILE IN THE SERVICE AREA COMPARED TO ABOUT 80 PER SQUARE MILE ACROSS THE UNITED STATES. THE RESIDENTS OF THESE COUNTIES ARE 97.44% WHITE WITH 17.64% OVER THE AGE OF 65 YEARS AND 5.94% BELOW POVERTY LEVEL. PART VI, LINE 5: HHCS OFFERS A FULL ARRAY OF HEALTH CARE SERVICES FROM BIRTH TO DEATH BY PROVIDING OBSTETRIC CARE ALL THE WAY TO LONG TERM CARE NEEDS AND RESPITE NEEDS. THE HOSPITAL BRINGS SPECIALISTS OF MANY AREAS TO THE LOCAL COMMUNITY BY PROVIDING SPECIALTY CLINICS WITHIN THE COMMUNITY. THE HOSPITAL ALSO OFFERS A BABY BOOT CAMP FOR EXPECTING MOTHERS TO PROMOTE POSITIVE PRENATAL HEALTH AND EDUCATION FOR MOTHERS ABOUT PROPER BABY SAFETY AND IMMUNIZATIONS. PHYSICIANS DO SPEAKING ENGAGEMENTS AT THE SUTTON AND HENDERSON SCHOOLS ON VARIOUS HEALTH TOPICS RELATED TO THEIR AGE GROUP. HHCS HOSTS MEDICAL STUDENTS FOR ROTATION AND STRIVES TO EDUCATE THESE STUDENTS AND RESIDENTS. A QUARTERLY NEWSLETTER IS ISSUED THAT SPOTLIGHTS OUR NEW SERVICES BUT ALSO OFFERS A QUESTION AND ANSWER SESSION FOR HOT TOPICS WITH THE PROVIDERS. HHCS RECENTLY HIRED A PHARMACIST AND PLANS TO INITIATE PUBLIC EDUCATION ON MEDICATIONS IN THE NEAR FUTURE. HHCS OFFERS 24 HOUR ER CARE AND WORKS WITH AVERA EMERGENCY PROGRAM TO PROVIDE THE BEST TRAUMA AND CRITICAL CARE TO ER PATIENTS. THE HOSPITAL ALSO OFFERS A DIABETES PREVENTION CLASS FREE TO THE PUBLIC WHICH MEETS WEEKLY TO PROVIDE EDUCATION AND SUPPORT FOR ATTENDEES. PART VI, LINE 6: HENDERSON HEALTH CARE SERVICES, INC. IS NOT A PART OF AN AFFILIATED HEALTH CARE SYSTEM. X X 0 0 0 0 0 0 0 1 0 JAMES OHRT PHYSICIAN 483400 0 34780 0 0 0 10851 0 16000 0 545031 0 0 0 CHRISTOPHER VANDERNECK PHYSICIAN 345017 0 0 0 0 0 11200 0 17037 0 373254 0 0 0 CHERYL BROWN CEO 172532 0 5616 0 0 0 4921 0 11703 0 194772 0 0 0 JILL MYERS CFO 144399 0 3181 0 0 0 5672 0 10355 0 163607 0 0 0 PART I, LINE 7 PHYSICIAN BONUSES ARE DEPENDENT UPON THE INDIVIDUAL PHYSICIAN'S CHARGED FEES (ADJUSTED FOR CONTRACTUAL AGREEMENTS AND PHYSICIAN'S PERSONAL PROFESSIONAL SERVICES) AND ARE PAID OUT AS A PERCENTAGE OF REVENUE ABOVE A THRESHOLD, WHICH VARIES WITH PHYSICIAN'S PRODUCTIVITY. JAMES OHRT RECEIVED A PRODUCTIVITY BONUS DURING THE YEAR. FORM 990, PART VI, SECTION A, LINE 6 EVERY PERSON, SOCIETY, BUSINESS OR CONGREGATION WHO HAS DONATED ONE HUNDRED DOLLARS OR MORE FOR THE BENEFIT OF HENDERSON HEALTH CARE SERVICES, INC.(HHCS) DURING THEIR LIFETIME SHALL BE A MEMBER OF HHCS. NO PERSON, SOCIETY, BUSINESS OR CONGREGATION SHALL BE ENTITLED TO MORE THAN ONE VOTE REGARDLESS OF THE CONTRIBUTIONS IN EXCESS OF ONE HUNDRED DOLLARS, AND A PERSON MUST BE OF LEGAL AGE TO EXERCISE VOTING PRIVILEGES. ACCEPTANCE OF ANY DONATION OF $100.00 OR MORE CONSTITUTES APPROVAL OF A LIFETIME MEMBERSHIP. THE MEMBERSHIP IS NOT TRANSFERABLE OR ASSIGNABLE. FORM 990, PART VI, SECTION A, LINE 7A THE BOARD OF DIRECTORS ARE ELECTED BY THE MEMBERSHIP AT THE ANNUAL MEMBERSHIP MEETING. FORM 990, PART VI, SECTION B, LINE 11B FORM 990 IS PREPARED BY AN OUTSIDE ACCOUNTING FIRM AND REVIEWED BY MANAGEMENT. A FINAL COPY OF THE FORM 990 IS PROVIDED TO THE BOARD OF DIRECTORS PRIOR TO FILING WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C EACH DIRECTOR, OFFICER AND MEMBER OF A COMMITTEE WITH BOARD-DELEGATED POWERS SHALL ANNUALLY SIGN A STATEMENT THAT AFFIRMS THAT SUCH PERSON: 1) HAS RECEIVED A COPY OF THE CONFLICT OF INTEREST POLICY, 2) HAS READ AND UNDERSTANDS THE POLICY, 3) HAS AGREED TO COMPLY WITH THE POLICY, AND 4) UNDERSTANDS THAT THE CORPORATION IS A TAX EXEMPT CHARITABLE ORGANIZATION AND THAT IN ORDER TO MAINTAIN ITS FEDERAL TAX EXEMPTION IT MUST ENGAGE PRIMARILY IN ACTIVITIES THAT ACCOMPLISH ONE OR MORE OF ITS TAX-EXEMPT PURPOSES. AFTER DISCLOSURE OF THE FINANCIAL INTEREST AND ALL MATERIAL FACTS, AND AFTER ANY DISCUSSION WITH THE INTERESTED PERSON, HE/SHE SHALL LEAVE THE BOARD OR COMMITTEE MEETING WHILE THE DETERMINATION OF A CONFLICT OF INTEREST IS DISCUSSED AND VOTED UPON. ANY PERSON WITH A POSSIBLE CONFLICT OF INTEREST IN ANY MATTER SHOULD NOT VOTE OR USE HIS/HER PERSONAL INFLUENCE ON THE MATTER. FORM 990, PART VI, SECTION B, LINE 15 COMPENSATION IS DETERMINED BY A FACILITY EVALUATION TOOL COMPLETED BY THE BOARD PRESIDENT AND REVIEWED WITH AND APPROVED BY THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS AND THE CONFLICT OF INTEREST POLICY ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST. THE FINANCIAL STATEMENTS ARE DISTRIBUTED AT THE ANNUAL MEETING TO THOSE IN ATTENDANCE AND ARE ALSO AVAILABLE UPON REQUEST. FORM 990, PART XI, LINE 2C: THE BOARD OF DIRECTORS ASSUMES THE RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF HHCS'S FINANCIAL STATEMENTS AND SELECTION OF AN INDEPENDENT ACCOUNTANT. THIS PROCESS HAS NOT CHANGED SINCE THE PRIOR YEAR.