2021-07-29T13:04:44-05:00 2020-09-30 476097913 SEIM JOHNSON LLP 18081 BURT STREET SUITE 200 OMAHA NE 680224722 990 2019-10-01 470375220 MEMORIAL HEALTH CARE SYSTEMS MEMO 4026432971 300 NORTH COLUMBIA AVENUE SEWARD NE 68434 GREG JERGER CHIEF FINANCIAL OFFICER 4026432971 2021-07-28 1 MEGAN L KOZIOL P01544037 4023302660 2019 2022-09-23 18:48:47Z GREG JERGER 300 NORTH COLUMBIA AVENUE SEWARD NE 68434 38294946 0 X WWW.MHCS.US X 1947 NE WE PROVIDE HOSPITAL ACUTE INPATIENT, SKILLED NURSING, AND OUTPATIENT SERVICES FOR THE RESIDENTS OF OUR COMMUNITY. WE PROVIDE FAMILY PRACTICE PHYSICIAN CLINIC SERVICES TO THE COMMUNITIES IN OUR SERVICE AREA. 7 7 304 32 526 0 46165 672871 35488210 35537509 1506962 1826523 239936 202449 37281273 38239352 0 0 0 0 19319974 20306180 0 0 45911 13581925 13794750 32901899 34100930 4379374 4138422 69880875 88328981 5278170 17486569 64602705 70842412 X WE ENHANCE THE QUALITY OF LIFE FOR INDIVIDUALS IN OUR COMMUNITIES BY PROVIDING EXCELLENCE IN HEALTH CARE SERVICES IN THE MOST APPROPRIATE SETTINGS. 0 0 15476458 18653016 HOSPITAL OUTPATIENT SERVICES - THE HOSPITAL PROVIDES OUTPATIENT DIAGNOSTIC, THERAPEUTIC, SURGICAL AND EMERGENCY SERVICES TO THE COMMUNITY. THERE WERE APPROXIMATELY 27,590 OUTPATIENT VISITS THIS YEAR. 6620853 6766919 FAMILY PRACTICE PHYSICIAN CLINIC SERVICES - THE ORGANIZATION PROVIDES 10 BOARD CERTIFIED FAMILY PRACTICE PHYSICIANS AND 4 PHYSICIAN ASSISTANTS THAT STAFF THE CLINICS IN SEWARD, MILFORD AND UTICA. THESE CLINICS OFFER THE MAIN SOURCE OF PRIMARY CARE FOR THE COMMUNITY. THERE WERE APPROXIMATELY 25,014 OFFICE VISITS THIS YEAR. 4980456 6002699 HOSPITAL ACUTE INPATIENT, SKILLED NURSING AND ASSISTED LIVING SERVICES - THE HOSPITAL PROVIDES THREE DIFFERENT LEVELS OF INPATIENT SERVICES TO THE COMMUNITY TO MEET THE LEVEL OF CARE NEEDS FOR EACH PATIENT, INCLUDING DELIVERY AND NURSERY SERVICES. THERE WERE APPROXIMATELY 4,968 PATIENT DAYS THIS YEAR. 2060642 4192046 FAMILY PHARMACY AND OTHER SERVICES. 2060642 4192046 29138409 1 1 0 1 0 0 0 0 0 1 1 1 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 1 1 1 0 0 1 59 0 1 304 1 0 0 0 0 0 0 0 0 0 0 0 0 X 7 7 0 0 0 0 1 1 1 1 0 0 0 1 1 1 1 1 1 1 1 0 X GREG JERGER 4026432971 300 NORTH COLUMBIA AVE SEWARD NE 68434 JAMES PLASEK MEDICAL DOCTOR 55.00 X 370870 0 58299 JACQUELINE HOBBS MEDICAL DOCTOR 55.00 X 343638 0 46886 ROGER REAMER CHIEF EXECUTIVE OFFICER 55.00 X 327850 0 57596 JOEL GABRIEL MEDICAL DOCTOR 55.00 X 301877 0 58622 JARED KETNER MEDICAL DOCTOR 55.00 X 296806 0 55877 GREG JERGER CHIEF FINANCIAL OFFICER 55.00 X 300721 0 46920 ROBERT WERGIN MEDICAL DOCTOR 55.00 X 312590 0 30761 MIKE HECKER CHAIRPERSON 6.00 X X 0 0 0 JOHN HUGHES VICE CHAIR 5.00 X X 0 0 0 MIKE TOMES SECRETARY/TREASURER 5.00 X X 0 0 0 TAMMY WISSING DIRECTOR 4.00 X 0 0 0 LANA DAWS DIRECTOR 4.00 X 0 0 0 STEVE KAYTON DIRECTOR 4.00 X 0 0 0 KEVIN WINGARD DIRECTOR 4.00 X 0 0 0 2254352 0 354961 25 0 1 0 SAMPSON CONSTRUCTION COMPANY INC 3730 SOUTH 14TH STREET LINCOLN NE 68502 CONSTRUCTION SERVICES 734394 ACUTE CARE INC 1606 N ANKENY BLVD SUITE 200 ANKENY IA 50023 PHYSICIAN ER SERVICES 463990 BRYAN MEDICAL CENTER 1600 S 48TH STREET LINCOLN NE 68506 DIAGNOSTIC TESTING SERVICES & ATHLETIC T 310046 MEDICAL INFORMATION TECHNOLOGY INC MEDITECH CIRCLE WESTWOOD MA 02090 SOFTWARE MAINTENANCE 151392 ALLSCRIPTS LLC 305 CHURCH AT NORTH HILL STREET RALEIGH NC 27609 SOFTWARE MAINTENANCE 137237 8 597867 75004 672871 PRIVATE INSURANCE 621400 18727562 18727562 MEDICARE 621400 14852727 14852727 SELF PAY 621400 1119775 1119775 MEDICAID 621400 837445 837445 35537509 1078306 1078306 783678 20133 21841 33753 761837 -13620 748217 748217 DAY CARE REVENUE 624100 93407 93407 MISCELLANEOUS 624100 84393 77171 526 6696 DIETARY REVENUE 623990 24649 24649 202449 38239352 35614680 526 1951275 X 733087 733087 15596910 13357701 2215019 24190 563520 480793 81754 973 2378944 2125011 250384 3549 1033719 847078 185181 1460 8696 8696 32401 32401 26502 26502 3464656 2952950 508682 3024 112758 5049 106987 722 1537908 1210802 316674 10432 13204 13204 423436 378446 44990 14774 12521 2253 2312944 2058002 254942 234512 208663 25849 MEDICAL SUPPLIES 4618957 4618957 BAD DEBTS 573705 573705 DUES & SUBSCRIPTIONS 157491 60968 95236 1287 FOOD 149250 149250 113556 98513 14769 274 34100930 29138409 4916610 45911 3123 3541 27513518 42908682 3834503 3612980 91083 63250 613751 587859 236843 234902 45658507 27472046 16551784 18186461 11113882 12304411 9295320 9662526 627068 764369 69880875 88328981 3268193 3455884 3128430 2009977 10902255 5278170 17486569 X 57520087 61741110 7082618 9101302 64602705 70842412 69880875 88328981 X 4138422 236079 1865206 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 5125 5125 0 PART II-B, LINE 1: A PORTION OF DUES PAID TO NHA, AHA AND THE CHAMBER OF COMMERCE IS DEDICATED TO LOBBYING ACTIVITIES. 1937298 1288 152190 2090776 1898604 626 38068 1937298 2011573 25025 119006 257000 1898604 1813382 260 197931 2011573 1690042 1465 121875 1813382 0.00000 0.72460 0.27540 0 0 380521 380521 17272258 9393679 7878579 26037787 17258533 8779254 1967941 819834 1148107 18186461 BENEFICIAL INTEREST IN A PERPETUAL TRUST 7010526 F LONG TERM CERTIFICATES OF DEPOSIT 2652000 C 9662526 ESTIMATED THIRD-PARTY SETTLEMENTS 55514 DEFERRED COMPENSATION LIABILITY 757378 REFUNDABLE ADVANCES - CARES ACT PROVIDER RELIEF FUNDS 4043510 REFUNDABLE ADVANCES - MEDICARE ADVANCE PAYMENTS 6045853 10902255 X 39749383 236079 1865206 2101285 37648098 17549 573705 591254 38239352 33509676 0 33509676 17549 573705 591254 34100930 PART V, LINE 4: INCOME FROM THE HOSPITAL ENDOWMENT FUND WILL BE USED FOR MEMORIAL HOSPITAL TO ENHANCE AND IMPROVE THE QUALITY OF HOSPITAL SERVICES PROVIDED TO THE COMMUNITY. THIS COULD TAKE THE FORM OF KEEPING UP WITH CHANGING TECHNOLOGY, ACQUIRING THE BEST EQUIPMENT, OR IMPROVING OUR BUILDING FACILITIES. PART X, LINE 2: THE SYSTEM IS A NOT-FOR-PROFIT CORPORATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. THE SYSTEM HAS RECEIVED A DETERMINATION LETTER THAT IT IS EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE INTERNAL REVENUE CODE. THE INTERNAL REVENUE SERVICE HAS ESTABLISHED STANDARDS TO BE MET TO MAINTAIN TAX EXEMPT STATUS. IN GENERAL, SUCH STANDARDS REQUIRE THE SYSTEM TO MEET A COMMUNITY BENEFIT STANDARD AND COMPLY WITH VARIOUS LAWS AND REGULATIONS. THE SYSTEM ACCOUNTS FOR UNCERTAINTIES IN ACCOUNTING FOR INCOME TAX ASSETS AND LIABILITIES USING GUIDANCE INCLUDED IN TOPIC 740 OF THE ACCOUNTING STANDARDS CODIFICATION, INCOME TAXES. THE SYSTEM RECOGNIZES THE EFFECT OF INCOME TAX POSITIONS ONLY IF THOSE POSITIONS ARE MORE LIKELY THAN NOT OF BEING SUSTAINED. AT SEPTEMBER 30, 2020 AND 2019, THE SYSTEM HAD NO UNCERTAIN TAX POSITIONS ACCRUED. PART XI, LINE 2D - OTHER ADJUSTMENTS: CHANGE IN INTEREST IN BENEFICIAL TRUST 1,865,206. PART XI, LINE 4B - OTHER ADJUSTMENTS: PROVISION FOR BAD DEBTS 573,705. PART XII, LINE 4B - OTHER ADJUSTMENTS: PROVISION FOR BAD DEBTS 573,705. 1 1 X 1 X 175.000000000000 1 X 1 1 0 0 174533 0 174533 0.00520 1148786 834469 314317 0.00940 1323319 834469 488850 0.01460 1323319 834469 488850 0.01460 0 573705 0 13964739 14350747 -386008 X 1 1 1 1 MEMORIAL HOSPITAL 300 N COLUMBIA AVE SEWARD NE 68434 WWW.MHCS.US 720001 X X X X MEMORIAL HEALTH CARE SYSTEMS 1 0 0 1 X X X X X X X X X 18 1 0 0 1 X WWW.MHCS.US/PATIENTS-VISITORS X 1 18 1 WWW.MHCS.US/PATIENTS-VISITORS 0 1 X 175.000000000000 300.000000000000 X X X 1 1 X X X 1 X WWW.MHCS.US/FAP X WWW.MHCS.US/FAP X WWW.MHCS.US/FAP X X X X X X 1 X 0 X X X X 1 X 0 0 MEMORIAL HEALTH CARE SYSTEMS PART V, SECTION B, LINE 5: THERE WERE A TOTAL OF 20 INDIVIDUALS THAT COLLABORATED ON OUR CHNA. THESE INDIVIDUALS REPRESENTED A WIDE VARIETY OF COMMUNITY INTERESTS, INCLUDING HEALTH DEPARTMENTS, PUBLIC SCHOOLS, PHYSICIANS PRACTICES, MENTAL HEALTH, NURSING HOMES, AND VARIOUS COMMUNITY REPRESENTATIVES. THIS COMMUNITY TEAM USED A PROCESS DEVELOPED BY THE CENTERS FOR DISEASE CONTROL AND PREVENTION (CDC) AND THE NATIONAL ASSOCIATION OF CITY AND COUNTY HEALTH OFFICIALS (NACCHO). THIS PROCESS IS CALLED MOBILIZING FOR ACTION THROUGH PLANNING AND PARTNERSHIPS (MAPP) AND IT WAS USED TO PRIORITIZE PUBLIC HEALTH ISSUES AND IDENTIFY RESOURCES FOR ADDRESSING THEM. MEMORIAL HEALTH CARE SYSTEMS PART V, SECTION B, LINE 11: THERE WERE 5 HEALTH NEEDS IDENTIFIED IN THE NEEDS ASSESSMENT. MEMORIAL HEALTH CARE SYSTEMS (MHCS) DIRECTLY ADDRESSES 4 OF THESE 5 NEEDS AS FOLLOWS. 1. OBESITY - MHCS PROVIDES EFFORTS TO COMBAT CHILDHOOD OBESTITY THROUGH ITS "BLAST OFF FOR HEALTH KIDS" PROGRAM. MONTHLY COMMUNITY WELLNESS TALKS ARE HELD TO ADDRESS A HEALTHY LIFESTYLE. MHCS PROVIDES DIABETIC SUPPORT GROUPS AND NUTRITION COUNSELING. FAMILY PRACTICE PHYSICIANS WILL DISCUSS AND ENCOURAGE WEIGHT MANAGMENT AND HEALTH HABITS DURING VISITS. 2. MENTAL HEALTH - MHCS ARRANGES FOR A BEHAVIORAL HEALTH PRACTITIONER TO REGULARLY HOLD CLINICS AT THE MEMORIAL HOSPITAL SPECIALTY CLINIC. THIS PROVIDES VITAL ACCESS TO MENTAL HEALTH CARE CLOSE TO HOME. OUR FAMILY PRACTICE PHYSICIANS CAN ALSO RECOGNIZE MENTAL HEALTH COMPLICATIONS DURING VISITS AND REFER TO APPROPRIATE SOURCES FOR ADDITIONAL TREATMENT. 3. CANCER - MHCS STAFF IS TRAINED TO ADMINISTER INFUSION THERAPY AND PROVIDE CARE TO PATIENTS RECEIVING CHEMOTHERAPY AND RELATED CANCER TREATMENTS. MHCS ALSO PROVIDES CANCER SCREENING SERVICES TO THE COMMUNITY. 4. AGING ISSUES - MHCS PROVIDES PRIMARY CARE HOSPITAL INPATIENT, HOSPITAL OUTPATIENT, EMERGENCY DEPARTMENT, AND PHYSICIAN SERVICES TO THE AGING POPULATION IN ITS COMMUNITY. MHCS ARRANGES FOR VARIOUS SPECIALISTS TO PROVIDE ON-SITE VISITS TO THIS POPULATION FOR SPECIALTY CARE. MHCS PROVIDES TRAINED SOCIAL SERVICE WORKERS THAT ACT AS A VITAL RESOURCE TO THIS POPULATION.THERE WERE 5 HEALTH NEEDS IDENTIFIED IN THE NEEDS ASSESSMENT. MEMORIAL HEALTH CARE SYSTEMS (MHCS) DIRECTLY ADDRESSES 4 OF THESE BUT WAS UNABLE TO ADDRESS 1 OF THEM AS FOLLOWS. 1. ALCOHOL ABUSE - MHCS DOES NOT HAVE THE RESOURCES FOR FACILITIES AND STAFF TRAINED IN ALCOHOL ABUSE TREATMENT. MHCS NURSING AND PHYSICIANS KEEP WELL INFORMED OF ALCOHOL ABUSE RESOURCES OUTSIDE OF THE COUNTY AND MAKE REFERRALS AS NEEDED. 4 1 - SEWARD FAMILY MEDICAL CENTER 250 N COLUMBIA AVE SEWARD NE 68434 RURAL HEALTH CLINIC 2 - SEWARD FAMILY PHARMACY 250 N COLUMBIA AVE SEWARD NE 68434 PHARMACY - CONVENIENCE OF PATIENT/EMPLOYEE 3 - MILFORD FAMILY MEDICAL CENTER 119 S C ST MILFORD NE 68405 RURAL HEALTH CLINIC 4 - UTICA FAMILY MEDICAL CENTER 100 4TH ST UTICA NE 68456 RURAL HEALTH CLINIC 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: THE ORGANIZATION USED THE COST-TO-CHARGE RATIO FROM WORKSHEET 2, RATIO OF PATIENT CARE COST-TO-CHARGES, PROVIDED BY THE IRS IN THE INSTRUCTIONS OF FORM 990, SCHEDULE H. PART I, LINE 7G: THERE ARE NO COSTS REPORTED ON LINE 7G. THEREFORE, THERE WOULD BE NO COSTS ATTRIBUTABLE TO A PHYSICIAN CLINIC INCLUDED ON LINE 7G. PART I, LN 7 COL(F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 24, COLUMN (A) BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $573,705. PART II, COMMUNITY BUILDING ACTIVITIES: THERE ARE NO COMMUNITY BUILDING ACTIVITIES TO REPORT. PART III, LINE 2: IN EVALUATING THE COLLECTIBILITY OF ACCOUNTS RECEIVABLE, THE SYSTEM ANALYZES ITS PAST HISTORY 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 WHO HAVE THIRD-PARTY COVERAGE, THE SYSTEM ANALYZES CONTRACTUALLY DUE AMOUNTS AND ESTIMATES A PERCENTAGE OF THOSE ACCOUNTS THAT WILL TRANSITION TO SELF-PAY PATIENTS BASED ON HISTORICAL ANALYSIS. THE ESTIMATED PERCENTAGE OF THOSE TRANSITION ACCOUNTS ARE ADDED TO 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 SYSTEM 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: NONE OF THE ORGANIZATION'S BAD DEBT EXPENSE IS ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY. THEREFORE, THERE WOULD BE NO COSTS INCLUDED AS A COMMUNITY BENEFIT. PART III, LINE 4: THE HOSPITAL'S FINANCIAL STATMENTS DO NOT CONTAIN A SPECIFIC FOOTNOTE DESCRIBING BAD DEBT. HOWEVER, PAGES 7 AND 9 OF THE ATTACHED AUDITED FINANCIAL STATEMENTS INCLUDE FOOTNOTES TITLED "PATIENT ACCOUNTS RECEIVABLES, NET", "NET PATIENT SERVICE REVENUE AND "FINANCIAL ASSISTANCE/CHARITY CARE". PART III, LINE 8: THE ORGANIZATION USED VARIOUS WORKSHEETS FROM THE MEDICARE COST REPORT FOR THE YEAR ENDED SEPTEMBER 30, 2020 TO CALCULATE PART III, LINES 5 AND 6. MEDICARE CURRENTLY PAYS CRITICAL ACCESS HOSPITALS (CAH) 101% OF ALLOWABLE COSTS. MEDICARE PAYS THE ORGANIZATION'S RURAL HEALTH CLINICS (RHC) AT COST SUBJECT TO CERTAIN LIMITS. THERE IS GENERALLY NO MEDICARE SHORTFALL ON CAH SERVICES EXCEPT FOR SEQUESTRATION. THE SHORTFALL IS MAINLY GENERATED BY NON-RHC PHYSICIAN SERVICES THAT ARE PAID UNDER THE MEDICARE FEE SCHEDULE. MEDICARE SHORTFALLS IN PAYMENT SHOULD BE CONSIDERED A COMMUNITY BENEFIT AS IT IS PART OF THE ORGANIZATION'S MISSION TO PROVIDE THESE SERVICES EVEN IF MEDICARE REIMBURSEMENT IS BELOW COST. PART III, LINE 9B: PATIENTS THAT ARE KNOWN TO QUALIFY FOR FINANCIAL ASSISTANCE EITHER RECEIVE FREE EMERGENCY AND URGENT CARE IN THE HOSPITAL IF THEY ARE AT OR BELOW 175% OF POVERTY, OR A SLIDING DISCOUNT IF THEY ARE AT OR BELOW 300% OF POVERTY. SHOULD THESE PATIENTS OWE A PORTION OF THEIR BILL, THE ORGANIZATION FOLLOWS THE SAME COLLECTION POLICY AS IT DOES FOR PATIENTS WHO DO NOT QUALIFY FOR FINANCIAL ASSISTANCE. THE PROCESS IS: 1) STATEMENTS ARE SENT MONTHLY; 2) PHONE CONTACT IS MADE AFTER 30-35 DAYS IF NO PAYMENT FROM FIRST STATEMENT; 3) IF THE PATIENT CANNOT PAY FULL BALANCE, MONTHLY PAYMENT ARRANGEMENTS ARE OFFERED; 4) AFTER 120 DAYS FROM FIRST STATEMENT THE ACCOUNT MAY BE SENT TO A COLLECTION AGENCY. PART VI, LINE 2: THE ORGANIZATION IS GOVERNED BY A VOLUNTEER BOARD OF DIRECTORS WHICH HAS 7 MEMBERS FROM THE COMMUNITY. THE BOARD OF DIRECTORS ASSISTS HOSPITAL ADMINISTRATION IN IDENTIFYING SERVICES NEEDED BY THE COMMUNITIES SERVED. PART VI, LINE 3: THE BUSINESS OFFICE IS EDUCATED ON HOW TO INFORM PATIENTS ABOUT THE PROCESS OF APPLYING FOR MEDICAID COVERAGE. OUR FINANCIAL ASSISTANCE POLICY, FAP SUMMARY AND FINANCIAL ASSISTANCE APPLICATION ARE ALL LISTED ON THE ORGANIZATION'S WEB-SITE. A COPY OF THE FAP SUMMARY IS INCLUDED WITH THE FINANCIAL AGREEMENT EACH PATIENT SIGNS UPON ADMISSION TO THE HOSPITAL. A NOTICE OF THE AVAILABILITY OF FINANCIAL ASSISTANCE IS ALSO INCLUDED ON ALL BILLING STATEMENTS SENT TO PATIENTS. PART VI, LINE 4: THE ORGANIZATION'S PRIMARY SERVICE AREA IS SEWARD COUNTY, NEBRASKA, WHICH HAS A POPULATION OF AROUND 17,000. IT MAINLY PROVIDES PRIMARY CARE SERVICES WITH SOME SPECIALTY CARE OFFERED BY VISITING SPECIALISTS THAT PRACTICE HERE MAINLY OUT OF LINCOLN, NEBRASKA. PART VI, LINE 5: THE ORGANIZATION OFFERS EXTENSIVE HEALTHCARE AND WELLNESS EDUCATION TO THE COMMUNITY ON AN ON-GOING BASIS. THE COSTS FOR THESE SERVICES ARE NOT SEPARATELY IDENTIFIED AS "COMMUNITY BENEFIT" EXPENSES ELSEWHERE IN THIS RETURN. IT IS LIKELY THESE COSTS EXCEED $100,000 PER YEAR, AND THERE IS NO OFFSETTING REVENUE. THE HOSPITAL MAINTAINS AN OPEN MEDICAL STAFF AND HAS A GOVERNING BOARD OF DIRECTORS WHICH ARE ALL MEMBERS OF THE COMMUNITY SERVED. ALL SURPLUS FUNDS ARE USED TO FURTHER THE MISSION OF PROVIDING EXCELLENT HEALTHCARE SERVICES TO THE MEMBERS OF THE COMMUNITIES SERVED. PART VI, LINE 6: THE ORGANIZATION IS NOT PART OF AN AFFILIATED HEALTH CARE SYSTEM. X 1 1 X X X 0 0 0 1 0 0 0 0 0 JAMES PLASEK MEDICAL DOCTOR 206135 0 164645 0 90 0 11200 0 47099 0 429169 0 0 0 JACQUELINE HOBBS MEDICAL DOCTOR 206135 0 137449 0 54 0 11200 0 35686 0 390524 0 0 0 ROGER REAMER CHIEF EXECUTIVE OFFICER 285905 0 41945 0 0 0 11200 0 46396 0 385446 0 0 0 JOEL GABRIEL MEDICAL DOCTOR 206135 0 95688 0 54 0 11200 0 47422 0 360499 0 0 0 JARED KETNER MEDICAL DOCTOR 206135 0 90533 0 138 0 11200 0 44677 0 352683 0 0 0 GREG JERGER CHIEF FINANCIAL OFFICER 260840 0 39881 0 0 0 11200 0 35720 0 347641 0 0 0 ROBERT WERGIN MEDICAL DOCTOR 206135 0 105693 0 762 0 11200 0 19561 0 343351 0 0 0 PART I, LINE 1A THE ORGANIZATION PROVIDES A SECTION 162 BONUS PLAN IN WHICH THE CHIEF EXECUTIVE OFFICER AND CHIEF FINANCIAL OFFICER RECEIVE TAXABLE COMPENSATION ON AN ANNUAL BASIS TO PURCHASE LIFE INSURANCE, DISABILITY INSURANCE, AND/OR OTHER INSURANCE BENEFITS. THE BONUS PLAN AND AMOUNT WERE ESTABLISHED BY THE BOARD OF DIRECTORS AND ARE GROSSED-UP PER THE PLAN DESIGN IN ORDER TO PROVIDE A FIXED AMOUNT AFTER TAXES THAT IS AVAILABLE FOR INSURANCE PREMIUMS. THE FULL TAXABLE AMOUNT IS INCLUDED IN BOX 5 OF THE W-2 AND HAS BEEN INCLUDED IN PART II OF THIS SCHEDULE J UNDER COLUMN B(II). PART I, LINE 5 PHYSICIANS RECEIVE BONUSES BASED ON THEIR INDIVIDUAL PROFESSIONAL CHARGES. FORM 990, PART VI, SECTION A, LINE 6 MEMORIAL HEALTH CARE SYSTEMS IS A CORPORATION THAT HAS MEMBERS. ANYONE DONATING $100 TO MEMORIAL HEALTH CARE SYSTEMS CAN FILL OUT AN APPLICATION AND BECOME A MEMBER. MEMORIAL HEALTH CARE SYSTEMS CURRENTLY HAS ABOUT 692 CORPORATE MEMBERS. FORM 990, PART VI, SECTION A, LINE 7A THE MEMBERS OF MEMORIAL HEALTH CARE SYSTEMS (AS DESCRIBED ON FORM 990, PART VI, SECTION A, LINE 6) ELECT THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION A, LINE 7B THE MEMBERS OF MEMORIAL HEALTH CARE SYSTEMS (AS DESCRIBED ON FORM 990, PART VI, SECTION A, LINE 6) APPROVE ANY CHANGES IN THE ARTICLES OF INCORPORATION AND ANY CHANGES TO THE BYLAWS THAT EFFECT THE ELECTION OF THE BOARD OF DIRECTORS (VOTING RIGHTS). THE MEMBERS WOULD ALSO APPROVE ANY SIGNIFICANT DECISIONS, SUCH AS THE SALE OR MERGER OF THE CORPORATION OR A SALE OF ALL OF THE ASSETS OF THE CORPORATION. FORM 990, PART VI, SECTION A, LINE 8B THERE ARE NO COMMITTEES WITH THE AUTHORITY TO ACT ON BEHALF OF THE BOARD. ANY COMMITTEE WHICH REPORTS TO THE BOARD HAS ITS REPORT DOCUMENTED IN THE MINUTES OF THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION B, LINE 11B THE CHIEF FINANCIAL OFFICER IS RESPONSIBLE FOR THE TIMELY FILING OF THE FORM 990. THE ACTUAL FORM 990 IS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM. ALL INFORMATION IS PROVIDED BY THE ORGANIZATION TO THE ACCOUNTING FIRM WHO THEN PREPARES THE FORM 990 FOR SUBMITTAL TO THE IRS. PRIOR TO SUBMISSION TO THE IRS, A FULL COPY OF THE FORM 990 IS MADE AVAILABLE TO ALL BOARD MEMBERS. THE FORM 990 IS REVIEWED BY THE FINANCE COMMITTEE AT A REGULAR FINANCE COMMITTEE MEETING. THIS REVIEW MAY TAKE PLACE AFTER THE FORM 990 HAS BEEN FILED WITH THE IRS IN ORDER TO MEET THE FILING DEADLINE. THE FINANCE COMMITTEE REVIEW IS DOCUMENTED IN THE FINANCE COMMITTEE MINUTES WHICH ARE THEN APPROVED BY THE FULL BOARD AT THE NEXT REGULAR BOARD MEETING. FORM 990, PART VI, SECTION B, LINE 12C EACH MEMBER OF THE BOARD OF DIRECTORS AND ALL SENIOR MANAGEMENT OFFICIALS OF THE ORGANIZATION FILE AN ANNUAL CONFLICT OF INTEREST FORM IN WHICH THEY ARE REQUIRED TO LIST ALL CONFLICTS OF INTEREST. ADMINISTRATION REVIEWS THE ANNUAL CONFLICT OF INTEREST STATEMENTS AND ALL CONFLICTS ARE REPORTED TO THE BOARD CHAIRPERSON. FORM 990, PART VI, SECTION B, LINE 15 THE BOARD OF DIRECTORS PERFORMS AN ANALYSIS OF THE FAIR MARKET VALUE OF COMPENSATION FOR BOTH THE CHIEF EXECUTIVE OFFICER AND CHIEF FINANCIAL OFFICER. LONGEVITY, QUALITY OF THE HEALTHCARE SERVICES PROVIDED, COMMUNITY PERCEPTION, AND FINANCIAL PERFORMANCE ARE ALL FACTORED INTO THE ANALYSIS. THE BOARD OF DIRECTORS THEN APPROVES THE COMPENSATION PACKAGES. THE LAST FULL REVIEW AND ANALYSIS WAS DONE IN AUGUST 2018 AND ANNUAL COMPENSATION WAS SET UNDER THE CEO CONTRACT FOR A 5 YEAR PERIOD OF 2019 THROUGH 2023. THE CFO COMPENSATION WAS REVIEWED BY THE BOARD OF DIRECTORS AT THE SAME TIME AND THE CEO WAS DELEGATED THE AUTHORITY TO ADJUST AND MONITOR CFO COMPENSATION WITHIN THE PARAMETERS SET BY THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION DOES NOT MAKE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, OR ITS FINANCIAL STATEMENTS AVAILABLE TO THE GENERAL PUBLIC. HOWEVER, THE CORPORATE MEMBERSHIP OF THE ORGANIZATION CONSISTS OF 692 MEMBERS OF THE COMMUNITY SERVED. THE CORPORATE MEMBERSHIP APPROVES THE ARTICLES OF INCORPORATION. FORM 990, PART IX, LINE 11G OTHER PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 2,233,456. MANAGEMENT AND GENERAL EXPENSES 508,682. FUNDRAISING EXPENSES 3,024. TOTAL EXPENSES 2,745,162. EMERGENCY ROOM PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 719,494. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 719,494. FORM 990, PART XI, LINE 9: CHANGE IN INTEREST IN BENEFICIAL TRUST 1,865,206. FORM 990, PART XI, LINE 2C: THE FINANCE COMMITTEE OF THE BOARD OF DIRECTORS ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF ITS FINANCIAL STATEMENTS AND SELECTION OF THE INDEPENDENT ACCOUNTANT. THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. CHARITABLE TRUST TRUST NE MEMORIAL HEALTH CARE SYSTEMS 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 CHARITABLE TRUST S 466466 CASH TRANSFERRED EQUALS FMV