2020-05-11T08:30:53-05:00 2019-06-30 476097913 SEIM JOHNSON LLP 18081 BURT STREET SUITE 200 OMAHA NE 680224722 990 2018-07-01 470533373 COMMUNITY HOSPITAL ASSOCIATION OF MCCOOK COMM 3083442650 1301 EAST H STREET PO BOX 1328 MCCOOK NE 69001 SEAN WOLFE CHIEF FINANCIAL OFFICER 3083442650 2020-05-08 1 WENDY R COOLEY P01523804 4023302660 163.116.133.119 2020-05-08 12:47:00 CD P 05D57004E72D560A8AB00D9FF642C8776C6EAF55 5D066E2939FE45487034BD10C4A0DC94BE27FEF9 2018 2020-11-19 02:30:22Z SEAN WOLFE 1301 EAST H STREET PO BOX 1328 MCCOOK NE 69001 51183250 0 X WWW.CHMCCOOK.ORG X 1974 NE TO EXCEL AT PROVIDING FOR THE HEALTHCARE NEEDS OF OUR REGION THROUGH QUALITY, EFFICIENT AND PATIENT-CENTERED CARE. 9 9 352 40 -3409 -3409 359453 685296 46153018 49325020 513157 549464 514243 521224 47539871 51081004 136631 140361 0 0 22554381 22943059 0 0 197546 23640874 25229968 46331886 48313388 1207985 2767616 60808299 64140482 20038228 20592280 40770071 43548202 REGIONAL HEALTHCARE EXCELLENCE 0 0 40245831 140361 49423984 25-BED CRITICAL ACCESS ACUTE CARE HOSPITAL PROVIDING INPATIENT AND OUTPATIENT CARE, DIAGNOSTIC, REHABILITATION, SURGICAL, NURSERY, VISITING MEDICAL SPECIALISTS, HOME HEALTH AND HOSPICE, TWO RURAL HEALTH CLINICS, AND HEALTH AND EDUCATION PROGRAMS. 40245831 1 1 0 1 0 0 0 0 0 1 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 86 0 1 352 1 0 0 0 0 0 0 0 0 0 0 0 0 X 9 9 0 0 0 0 1 1 0 1 1 0 0 1 1 1 1 1 1 1 1 1 1 X SEAN WOLFE 3083448306 1301 EAST H - PO BOX 1328 MCCOOK NE 69001 TODD THIESZEN CHAIR 2.00 1.00 X X 0 0 0 JULIE GILLESPIE VICE CHAIR 2.00 0.00 X X 0 0 0 LENA KOEBEL SECRETARY 2.00 0.00 X X 0 0 0 CURT SWANHORST TREASURER 2.00 0.00 X X 0 0 0 JASON BLOMSTEDT DO MEMBER THRU 12/2018 1.00 0.00 X 0 0 0 ROBERT HINZE DPM MEMBER 1.00 0.00 X 0 0 0 WARREN JONES DDS MEMBER 1.00 1.00 X 0 0 0 JANA KMOCH MEMBER 1.00 0.00 X 0 0 0 GARRETT RIPPEN MEMBER 1.00 0.00 X 0 0 0 KRISTIN STAGEMEYER CPA MEMBER 1.00 1.00 X 0 0 0 TROY BRUNTZ CEO & PRESIDENT 38.00 2.00 X 240019 0 40968 SEAN WOLFE CFO 40.00 0.00 X 146882 0 37336 EVAN GEILENKIRCHEN CRNA 40.00 0.00 X 277587 0 39334 ROSS BEAVERS CRNA 40.00 0.00 X 281961 0 21888 HEATHER FRISBIE CRNA 40.00 0.00 X 258506 0 31329 ANTHONY RODEWALD PHARMACY DIRECTOR 40.00 0.00 X 171219 0 35823 LORI BEEBY VP SUPPORT SERVICES 40.00 0.00 X 138245 0 32984 1514419 0 239662 19 0 1 0 MCCOOK CLINIC 1401 EAST H STREET MCCOOK NE 69001 ER COVERAGE 1184299 SOUTHWEST NEBRASKA PHYSICAL THERAPY 1301 E H ST MCCOOK NE 69001 PHYSICAL THERAPY SERVICES 1148820 CMBA ARCHITECTS 208 N PINE ST SUITE 301 GRAND ISLAND NE 68801 CONSTRUCTION 854287 SAMPSON CONSTRUCTION 3730 SOUTH 14TH ST LINCOLN NE 68502 CONSTRUCTION 409883 BRYAN MEDICAL CENTER 1600 S 48TH ST LINCOLN NE 68506 CARDIOLOGY ASSESSMENTS 300889 9 625024 10170 50102 685296 MEDICARE/MEDICAID PAYMENTS 621400 25971140 25971140 PATIENT SERVICE REVENUE 621400 22332061 22332061 340B PAYMENT 621400 447031 447031 OUT-SOURCE SERVICES 621400 195516 195516 379272 379272 49325020 549464 549464 224388 5750 218638 218638 218638 96496 96496 0 CAFETERIA/MEALS 900099 207031 207031 HOUSEKEEPING INCOME 900099 98964 98964 -3409 -3409 302586 51081004 49423984 -3409 975133 X 140361 140361 465205 465205 16853404 13321899 3399530 131975 1060368 841025 211011 8332 3192697 2505903 661969 24825 1371385 1046632 313815 10938 36156 36156 85862 85862 7751428 6803321 948107 180551 180551 945867 499589 444690 1588 138732 105491 33241 826183 819758 6425 69136 46148 22988 621644 283929 331154 6561 621903 618759 3144 4269710 3989313 279439 958 193332 192746 586 MEDICAL SUPPLIES 7259762 7259762 PROVISION FOR BAD DEBTS 1224138 1224138 MEMBERSHIPS & DUES 45650 1304 44346 959914 545753 401792 12369 48313388 40245831 7870011 197546 1500 1500 16149460 16173778 6379163 8111442 1677255 1746787 1086046 1230477 80328982 46493154 32366941 33835828 2578515 2857395 198821 183275 370598 0 60808299 64140482 2887331 4921439 221262 257717 16929635 14506646 0 906478 20038228 20592280 X 40770071 43548202 40770071 43548202 60808299 64140482 2767616 10515 0 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 0 0 0 0 1 3467 0 1 4043 7510 0 PART II-B, LINE 1: ITEM 1G - TROY BRUNTZ, CEO, AND PATIENT ACCOUNTS DIRECTOR, JENNI MCCONVILLE, CRCP, TRAVELED TO WASHINGTON D.C. TO ATTEND AAHAMS ADVOCACY DAYS. ITEM 1I - A PORTION OF DUES PAID TO THE AMERICAN HOSPITAL ASSOCIATION AND NEBRASKA HOSPITAL ASSOCIATION ARE USED FOR LOBBYING AND POLITICAL ACTIVITIES. MANAGEMENT IS ACTIVE IN NEBRASKA HOSPITAL ASSOCIATION'S PAC, AHA'S ADVOCACY DAY, AND OTHER INDUSTRY FUNCTIONS. 2905827 4790 306693 16500 55917 13979 3130914 2717739 17123 170965 2905827 2602861 6050 211309 15000 69985 17496 2717739 2566458 5544 59250 15224 10534 2633 2602861 2641004 45617 18369 11000 102026 25506 2566458 0.49530 0.50470 0.00000 0 1 1 71468 71468 26856116 23730065 3126051 45901738 22763089 23138649 7499660 7499660 33835828 ESTIMATED THIRD-PARTY PAYOR SETTLEMENTS 906478 906478 X PART V, LINE 4: THE ENDOWMENT FUNDS ARE HELD BY THE COMMUNITY HOSPITAL HEALTH FOUNDATION OF MCCOOK (A RELATED PARTY) AND ARE USED IN SUPPORT OF THE HOSPITAL'S PROGRAMS AND PROJECTS, INCLUDING PROPERTY AND EQUIPMENT PURCHASES, SCHOLARSHIPS, HOSPICE PROGRAMS, REHABILITATION SERVICES AND OTHERS. PART X, LINE 2: THE HOSPITAL AND FOUNDATION ARE NOT-FOR-PROFIT CORPORATIONS AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND ARE 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 TAX-EXEMPT STATUS. IN GENERAL, SUCH STANDARDS REQUIRE THE HOSPITAL AND FOUNDATION TO MEET A COMMUNITY BENEFIT STANDARD AND COMPLY WITH VARIOUS LAWS AND REGULATIONS. THE HOSPITAL AND FOUNDATION ACCOUNT FOR UNCERTAINTIES IN ACCOUNTING FOR INCOME TAX ASSETS AND LIABILITIES USING GUIDANCE INCLUDED IN FASB ASC 740, INCOME TAXES. THE HOSPITAL AND FOUNDATION RECOGNIZE THE EFFECT OF INCOME TAX POSITIONS ONLY IF THOSE POSITIONS ARE MORE LIKELY THAN NOT OF BEING SUSTAINED. AT JUNE 30, 2019 AND 2018, THE HOSPITAL AND FOUNDATION HAD NO UNCERTAIN TAX POSITIONS ACCRUED. 1 1 X 1 X 0 1 1 1 0 1 1 1140418 1140418 0.02420 2743316 2125171 618145 0.01310 3883734 2125171 1758563 0.03730 37553 37553 0.00080 86332 86332 0.00180 123885 123885 0.00260 4007619 2125171 1882448 0.03990 0 1224138 183621 22207473 22959592 -752119 X 1 1 1 1 COMMUNITY HOSPITAL ASSOCIATION OF MCCOOK 1301 EAST H STREET - PO BOX 1328 MCCOOK NE 69001 WWW.CHMCCOOK.ORG 320007 X X X X COMMUNITY HOSPITAL ASSOCIATION OF MCCOOK 1 0 0 1 X X X X X X X X X 16 1 0 0 1 X WWW.CHMCCOOK.ORG X 1 16 1 HTTPS://CHMCCOOK.ORG/ABOUT-US/COMMUNITY-HEALTH-NEEDS-ASSESSMENT 0 1 X 150.000000000000 X 1 1 X X X 1 X WWW.CHMCCOOK.ORG X WWW.CHMCCOOK.ORG X WWW.CHMCCOOK.ORG X X X X X X X 1 X 0 X X X X 1 X 0 0 COMMUNITY HOSPITAL ASSOCIATION OF MCCOOK PART V, SECTION B, LINE 5: IN ORDER TO GATHER DATA THAT WOULD ACCURATELY DEPICT THE NEEDS OF OUR REGION, WE COLLECTED INFORMATION FROM A VARIETY OF SOURCES. TO BEGIN OUR RESEARCH WE LOOKED TO AVAILABLE PRIMARY DATA SOURCES SUCH AS COUNTY CENSUSES FOR OUR SERVICE AREA, REGIONAL MARKET ANALYSIS DATA FROM TRUVEN HEALTH ANALYTICS AND STATISTICS FROM THE UNIVERSITY OF WISCONSIN'S ROBERT WOOD FOUNDATION COUNTY HEALTH RANKINGS SURVEY. WE HAVE BEEN FOLLOWING THE COUNTY HEALTH RANKINGS EFFORTS OVER THE LAST SIX YEARS TO BENCHMARK IF ANY PROGRESS HAS BEEN MADE WITH OUR INCREASED EFFORTS OF OUTREACH AND EDUCATION FROM OUR ORIGINAL COMMUNITY NEEDS ASSESSMENT IN 2010 AND, MOST RECENT, IN 2013. AFTER COLLECTING DATA FROM THESE SOURCES TO BEGIN THE BASIS OF OUR ASSESSMENT, WE FORMULATED A STUDY DESIGNED SPECIFICALLY TO DRAW TO THE SURFACE OUR AREA'S NEEDS ACCORDING TO ITS COMMUNITY MEMBERS, HEALTHCARE PROVIDERS AND PARTNERS. WE DECIDED THE BEST WAYS TO COLLECT THIS DATA WOULD BE THROUGH A SURVEY MADE AVAILABLE TO THE PUBLIC AND FOCUS GROUPS FOR KEY COMMUNITY PARTNERS AND THE HEALTHCARE COMMUNITY. OUR SURVEYS WERE DISTRIBUTED AND MADE READILY AVAILABLE THROUGH SEVERAL AVENUES. FIRST, IT WAS OFFERED TO 120 HIGH SCHOOL STUDENTS VISITING FROM OUR SERVICE AREA'S HIGH SCHOOLS FOR CAREER DISCOVERY DAYS. THE NEXT AVENUE WAS OFFERING THE SURVEY TO MEMBERS OF THE STERLING CONNECTION AT OUR JUNE LUNCH 'N' LEARN EDUCATIONAL SEMINAR. IT WAS ALSO ADVERTISED IN NEWSPAPERS WITHIN OUR SERVICE AREA AND HEAVILY ADVERTISED ON FACEBOOK. COMMUNITY HOSPITAL ASSOCIATION OF MCCOOK PART V, SECTION B, LINE 11: PRIORITY 1: WELLNESS EDUCATION AND SERVICES INCLUDING: PREVENTATIVE EDUCATION AND SCREENINGS, WEIGHT MANAGEMENT OPPORTUNITIES AND SUPPORT, PHYSICAL ACTIVITY EDUCATION AND SUPPORT, AND ACCESS TO AFFORDABLE FITNESS OPPORTUNITIES.DURING THIS FISCAL YEAR, IN ORDER TO MEET THE NEEDS OF THIS SPECIFICALLY IDENTIFIED NEED, WE BEGAN INCREASING OUTREACH EFFORTS FOR WELLNESS EDUCATION AND PARTICIPATION OPPORTUNITIES. THESE ACTIVITIES INCLUDED: A WELLNESS NEWSLETTER FOCUSED ON HEALTH CONCERNS AND EDUCATION FOR THE COMMUNITY BASED UPON THE FOUR AREAS OF WELLNESS IDENTIFIED IN COMMUNITY HOSPITAL'S WELLNESS FOR LIFE WELLNESS MISSION STATEMENT: PHYSICAL, EMOTIONAL, SPIRITUAL, AND INTELLECTUAL WELLNESS. THE NEWSLETTER IS DISSEMINATED THROUGH AN EMAIL LIST GATHERED FROM THE AREA CHAMBER OF COMMERCE MEMBERSHIP. THE MAILING LIST REACHES NEARLY 900 RECIPIENTS.ONGOING SUPPORT, BOTH FINANCIALLY AND WITH STAFFING AND BOARD MEMBERSHIP, COMMUNITY HOSPITAL CONTINUES TO SUPPORT THE LOCAL AREA PHYSICAL ACTIVITY SERIES, THE REPUBLICAN RIVER FITNESS SERIES. THE GROUP OFFERS EIGHT OPPORTUNITIES FOR WALKING, RUNNING, BIKING, AND OTHER ACTIVITIES. THE AVERAGE NUMBER OF PARTICIPANTS IN EACH EVENT IS NEARLY 80 INDIVIDUALS.THE ANNUAL COMMUNITY WELLNESS FAIR WAS OFFERED IN THREE LOCATIONS, MCCOOK, TRENTON, AND CURTIS, NEBRASKA. THESE FAIRS PROVIDED AN OPPORTUNITY FOR COMMUNITY MEMBERS TO RECEIVE DISCOUNTED BLOOD SCREENINGS, OFFERED AT HOSPITAL COST, AS WELL AS OTHER SCREENINGS SUCH AS DIABETES SCREENINGS, BLOOD PRESSURE SCREENING, HEARING SCREENINGS, AND MORE. ALSO INCLUDED EDUCATION FROM THE DIABETES EDUCATION PROGRAM, CANCER SUPPORT SERVICES, REHABILITATION SERVICES, EMERGENCY SERVICES, AND MORE.PRIORITY 2: ADDITIONAL VISITING MEDICAL SPECIALISTS INCLUDING: PEDIATRICS, FULL-TIME ONCOLOGIST, FULL-TIME CARDIOLOGIST, DERMATOLOGY, OBSTRETICS AND GYNECOLOGIST, FULL-TIME ORTHOPEDIC SURGEON, RHEUMATOLOGIST, PLASTIC SURGEON, AND NEUROLOGIST.DURING THIS FISCAL YEAR, IN ORDER TO MEET THE NEEDS OF THIS SPECIFICALLY IDENTIFIED NEED, WE CONTINUED TO RECRUIT AND SEEK ADDITIONAL VISITING MEDICAL SPECIALISTS. THE CURRENT OFFERING OF SPECIALISTS INCLUDES:AUDIOLOGYCARDIOLOGYCOSMETIC, RECONSTRUCTIVE & WOUND SURGERYDERMATOLOGYENTGASTROENTEROLOGYGENERAL SURGERYNEPHROLOGYNEUROLOGYNEUROSURGERYOBSTETRICS & GYNECOLOGYONCOLOGY & HEMATOLOGYOPTHALMOLOGYORTHOPEDICSPODIATRYPROSTHETICS & ORTHOTICSPULMONOLOGYRADIATION ONCOLOGYSLEEP STUDYSPINAL ORTHOPEDICSTELEHEALTH SERVICES, INCLUDING JUVENILE MENTAL HEALTHUROLOGYAN ONGOING PARTNERSHIP WITH GREAT PLAINS HEALTH IN NORTH PLATTE, NEBRASKA PROVIDES OPPORTUNITIES FOR RECRUITING ONCOLOGY PROVIDERS, AS WELL AS ORTHOPEDIC SURGEONS AND OTHER SPECIALISTS. A CONTRACT WAS PUT IN PLACE TO INCREASE THE NUMBER OF DAYS PER WEEK A VISITING ORTHOPEDIC SURGEON FROM CENTRAL NEBRASKA ORTHOPEDICS VISITS COMMUNITY HOSPITAL.PRIORITY 3: MENTAL HEALTH AND SUBSTANCE ABUSE SUPPORT, EDUCATION, OUTREACH, AND PREVENTION.DURING THIS FISCAL YEAR, ATTENTION WAS GIVEN TO THE ONGOING NEED IN THE COMMUNITY FOR INCREASED ACCESS TO MENTAL HEALTH AND SUBSTANCE ABUSE SUPPORT, EDUCATION, AND PREVENTION. THIS IS A CONCERN, NOT ONLY FOR OUR SERVICE AREA AND COMMUNITY, BUT ALSO FOR THE STATE OF NEBRASKA AS A WHOLE. THE NUMBER OF PROVIDERS AND AVAILABILITY OF INPATIENT CARE IS EXTREMELY LIMITED. COMMUNITY HOSPITAL CONTINUES TO BE A STRONG ADVOCATE FOR THIS ISSUE AT THE STATE AND NATIONAL LEVEL. THROUGH THE NEBRASKA HOSPITAL ASSOCIATION POLITICAL ACTION COMMITTEE (NHA PAC), WE DONATE DOLLARS FOR TIME TO ADVOCATE FOR ISSUES, SUCH AS THIS. OUR CEO, TROY BRUNTZ, ALSO ADVOCATES AT THE NATIONAL LEVEL AT AMERICAN HOSPITAL ASSOCIATION FUNCTIONS IN WASHINGTON D.C.A NEW TELEHEALTH PROVIDER IN MENTAL HEALTH WAS ALSO ADDED TO THE PROVIDER LIST AT THE MEDICAL SPECIALIST CENTER. THIS PROVIDER OFFERS MENTAL HEALTH SERVICES FOR OUR COMMUNITY'S YOUTH WITHOUT THE EXPENSE OF TRAVEL.THROUGHOUT THE PROCESS OF COLLECTING DATA FOR THE COMMUNITY HEALTH NEEDS ASSESSMENT, THE NEED FOR A DEDICATED EMERGENCY ROOM PROVIDER WAS IDENTIFIED. DURING KEY-INFORMANT FOCUS GROUPS, THIS ISSUE AROSE DUE TO CONCERN FOR IMPROVING AND MAINTAINING RELIABLE AND HIGH-QUALITY EMERGENCY CARE SERVICES FOR OUR SERVICE AREA. THE CONTRACTED RELATIONSHIP WITH MCCOOK CLINIC, P.C., WHICH PROVIDES OUR EMERGENCY CARE COVERAGE DURING WEEKEND HOURS, AS WELL AS THE CONTRACT WITH OUR EVENING HEALTHCARE PROVIDER, ARE BEING RE-EVALUATED. STUDIES OF SURVEYS FROM HCAHPS AND PRC HAVE ALSO PROVIDED DETAILED FEEDBACK ON SPECIFIC CONCERNS WHICH HAVE BEEN RELAYED TO PROVIDERS. EDUCATION AND INCREASE AWARENESS HAS ALSO BEEN PROVIDED. THIS ISSUE WILL CONTINUE TO BE EVALUATED OVER TIME ALONG WITH A FEASIBILITY STUDY FOR HIRING AN EMERGENCY CARE PROVIDER AT COMMUNITY HOSPITAL. COMMUNITY HOSPITAL ASSOCIATION OF MCCOOK PART V, SECTION B, LINE 16J: THE HOSPITAL PUBLICIZED THE FINANCIAL ASSISTANCE POLICY ON BILLING INVOICES, ON POSTERS IN THE ER AND WAITING ROOMS, AT THE ADMISSIONS DESKS, INCLUDING UPON ADMISSIONS WITH SUMMARY NOTICES OF THE POLICIES. THE COMPLETE POLICY WAS AVAILABLE ON THE HOSPITAL'S WEBSITE AND UPON REQUEST. THE HOSPITAL ALSO PUBLICIZED THE POLICY THROUGH REFERRALS BY CLINICAL, SOCIAL WORKERS, AND OTHER STAFF TO THE HOSPITALS FINANCIAL COUNSELORS. COMMUNITY HOSPITAL ASSOCIATION OF MCCOOK DOES NOT HAVE AN LEP POPULATION OF A SINGLE PRIMARY LANGUAGE THAT REACHES 1,000 INDIVIDUALS OR 5% OF THE COMMUNITY SERVED BY THE HOSPITAL. HOWEVER, WITH SPANISH AS THE PREDOMINANT NON-ENGLISH LANGUAGE WE HAVE OPTED TO OFFER A FAP APPLICATION FORM IN THAT LANGUAGE FOR OUR PATIENTS' CONVENIENCE. 3 1 - COMMUNITY HEALTHCARE & HOSPICE 407 WEST 5TH STREET MCCOOK NE 69001 HOME HEALTH AND HOSPICE SERVICES 2 - CURTIS MEDICAL CENTER 302 EAST 6TH STREET CURTIS NE 69025 RURAL HEALTH CLINIC-OUTPATIENT SERVICES 3 - TRENTON MEDICAL CLINIC 406 EAST 1ST STREET TRENTON NE 69044 RURAL HEALTH CLINIC-OUTPATIENT SERVICES PART I, LINE 3C: CHARITY CARE IS GRANTED TO ALL INDIVIDUALS WHOSE HOUSEHOLD INCOME IS BELOW 150% OF THE FEDERAL POVERTY GUIDELINE AT THE 100% WRITE-OFF LEVEL. DISCOUNTING OR 100% WRITE-OFF TO CHARITY CARE IS ALLOWED ABOVE 150% OF THE FEDERAL POVERTY GUIDELINE BASED ON AN ANALYSIS OF INDIVIDUAL NEED AND DETERMINATION OF THE PATIENT BEING MEDICALLY INDIGENT; THIS ANALYSIS INCLUDES FACTORS SUCH AS INCOME, ACCESSIBLE ASSETS, MEDICAL OR/AND OTHER DEBTS, THE LIKELIHOOD OF ONGOING MEDICAL CARE AND THE INDIVIDUAL'S OVERALL ABILITY TO PAY. PART I, LINE 6A: THE COMMUNITY BENEFIT REPORT IS PREPARED BY THE STAFF OF COMMUNITY HOSPITAL ASSOCIATION OF MCCOOK. PART I, LN 7 COL(F): THE BAD DEBT EXPENSE INCLUDED IN FORM 990, PART IX, LINE 25 BUT NOT INCLUDED IN SCHEDULE H, PART I, LINE 7, COLUMN (F) IS $1,224,138. PART II, COMMUNITY BUILDING ACTIVITIES: COMMUNITY HOSPITAL SUPPORTS VARIOUS COMMUNITY BUILDING ACTIVITIES, PRIMARILY THROUGH MONETARY SUPPORT. EXAMPLES INCLUDE SUPPORT TO THE ECONOMIC DEVELOPMENT CORPORATION, THE LOCAL COMMUNITY COLLEGE AND SOUTHWEST NEBRASKA LEADERSHIP INSTITUTE. THESE PROGRAMS DIRECTLY IMPACT THE HEALTH OF OUR COMMUNITY BY DEVELOPMENT OF EMPLOYMENT OPPORTUNITIES AND A MORE EMPLOYABLE WORKFORCE. MEMBERS OF OUR COMMUNITY WITH GOOD EMPLOYMENT HAVE ACCESS TO HEALTH INSURANCE AND ARE GENERALLY ABLE TO LIVE HEALTHIER LIVES. 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 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 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: BASED ON A COMBINATION OF PAST EXPERIENCE AND CENSUS DATA AVAILABLE, THE HOSPITAL ESTIMATES 15% OF BAD DEBT IS ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY. IN ACCORDANCE WITH ITS MISSION OBJECTIVES, THE HOSPITAL PROVIDES FINANCIAL ASSISTANCE TO PATIENTS WHO LACK FINANCIAL RESOURCES TO PAY FOR THE SERVICES THEY RECEIVE, AND THE HOSPITAL RECOGNIZES THE SPECIAL CONCERNS OF INDIVIDUALS AND HOUSEHOLDS WITH LIMITED FINANCIAL RESOURCES OR WHO ARE OTHERWISE VULNERABLE WITHIN THE COMMUNITY THE HOSPITAL SERVICES. FINANCIAL ASSISTANCE IS PROVIDED TO PATIENTS WITH DEMONSTRATED INABILITY TO PAY AS CONTRASTED WITH BAD DEBT THAT RESULTS FROM AN UNWILLINGNESS TO PAY; THUS, CHARITY CARE DOES NOT INCLUDE BAD DEBT. PART III, LINE 4: THE ORGANIZATION'S FINANCIAL STATEMENTS DO NOT CONTAIN A SPECIFIC FOOTNOTE DESCRIBING BAD DEBT. HOWEVER, PAGES 9 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 SOURCE USED TO DETERMINE THE AMOUNT REPORTED ON LINE 6 WAS THE MEDICARE COST REPORT. NO MEDICARE SHORTFALL IS TREATED AS COMMUNITY BENEFITS. PART III, LINE 9B: COMMUNITY HOSPITAL GRANTS 100% CHARITY CARE FOR PATIENTS KNOWN TO QUALIFY FOR FINANCIAL ASSISTANCE. OUR CHARITY CARE POLICY IS SET AT 150% OF THE FEDERAL POVERTY GUIDELINE BASED FAMILY SIZE. FOR PATIENTS THAT EXCEED THE INCOME THRESHOLD OF THE CHARITY CARE POLICY, OUR MEDICALLY INDIGENT FINANCIAL ASSISTANCE IS AVAILABLE FOR PATIENTS THAT HAVE INCURRED CATASTROPHIC MEDICAL COSTS OR OTHER OBLIGATIONS (PRESENTLY OR ONGOING) THAT HAVE SUBSTANTIALLY REDUCED THEIR ABILITY TO PAY. IN SUCH CASES, THE INDIVIDUAL OR GUARANTOR MAY BE DETERMINED BY THE HOSPITAL TO BE MEDICALLY INDIGENT AND MAY, AT THE HOSPITAL'S DISCRETION, BE ELIGIBLE FOR FINANCIAL ASSISTANCE IN THE FORM OF FREE OR DISCOUNTED LIABILITIES.CERTAIN CLASSES OF PATIENTS ARE DEEMED TO HAVE QUALIFIED FOR CHARITY CARE WITHOUT AN APPLICATION. ACCOUNTS THAT MAY QUALIFY FOR FINANCIAL ASSISTANCE WITHOUT A COMPLETED APPLICATION INCLUDE:1. MEDICAID SHARE OF COST PORTIONS.2. MEDICAID APPLICATIONS APPROVED FOR SUBSEQUENT CARE (NOT RETROACTIVE TO THE LIABILITY).3. PATIENTS OR GUARANTORS WHO HAVE DECLARED BANKRUPTCY.4. PATIENTS OR GUARANTORS WHO ARE DECEASED WITH NO ESTATE IN PROBATE AND FOR WHOM NO ONE ELSE (SUCH AS A SPOUSE OR LEGAL GUARDIAN) IS LEGALLY RESPONSIBLE FOR THE LIABILITY.5. PATIENTS OR GUARANTORS DETERMINED TO BE HOMELESS. PART VI, LINE 2: COMMUNITY HOSPITAL HAS COMPLETED A COMMUNITY HEALTH NEEDS ASSESSMENT. ACTION PLANS ARE IN PLACE TO ADDRESS SEVERAL OF THE IDENTIFIED NEEDS IN THE REPORT. PART VI, LINE 3: IDENTIFICATION OF PATIENTS WITH A POTENTIAL NEED FOR FINANCIAL ASSISTANCE WILL BE ACCOMPLISHED BY BOTH AN OPEN AND PUBLICIZED APPLICATION PROCESS AND A VARIETY OF SCREENING OPPORTUNITIES INCLUDING:A. ADMISSIONS/REGISTRATION PERSONNEL BASED UPON INFORMATION RECEIVED DURING THE REGISTRATION PROCESS.B. SOCIAL SERVICES PERSONNEL BASED UPON INFORMATION DURING THE INITIAL VISIT AND DISCHARGE PLANNING.C. NURSING STAFF BASED UPON INFORMATION RECEIVED DURING DISCUSSIONS WITH FAMILY AND/OR PATIENT.D. BUSINESS OFFICE PERSONNEL BASED UPON STATUS OF ACCOUNTS AND DISCUSSIONS WITH RESPONSIBLE PARTY.E. ACCOUNTS RECEIVABLE REPORTS.HOSPITAL STAFF OR THE NOTIFIED PATIENT ADVOCATE WILL EDUCATE THE PATIENT OR GUARANTOR ABOUT THE FINANCIAL ASSISTANCE POLICY AND WILL PROVIDE THEM AN APPLICATION FOR FINANCIAL ASSISTANCE. IF NECESSARY, THE PATIENT FINANCIAL COUNSELOR OR OTHER HOSPITAL STAFF MAY ASSIST THE PATIENT IN COMPLETING THE APPLICATION; HOWEVER, THE COMPLETION OF AN APPLICATION AND PROVIDING ALL NECESSARY SUPPORTING DOCUMENTATION IS THE PATIENT'S RESPONSIBILITY. PATIENTS MAY ALSO REQUEST AN APPLICATION OR ADDITIONAL INFORMATION IN PERSON AT THE ADMISSIONS OFFICE OR BY CALLING OR WRITING THE PATIENT FINANCIAL COUNSELOR AND AN APPLICATION WILL BE MAILED. PART VI, LINE 4: COMMUNITY HOSPITAL SERVES A PRIMARY MARKET OF RED WILLOW COUNTY, WHICH IS LOCATED ON THE SOUTHERN BORDER OF NEBRASKA. IT IS 717 SQUARE MILES AND HAS APPROXIMATELY 15.0 PEOPLE PER SQUARE MILE. MCCOOK IS THE COUNTY SEAT. COMMUNITY HOSPITAL ALSO SERVES A SECONDARY MARKET INCLUDING NORTHERN KANSAS AND SOUTHWEST NEBRASKA, WHICH CONSISTS OF FURNAS, NE, HITCHCOCK, NE, DECATUR, KS, CHEYENNE, KS, FRONTIER, NE, RAWLINS, KS AND HAYES, NE. THE TOTAL ESTIMATED POPULATION FOR COMMUNITY HOSPITAL'S SERVICE AREA IS APPROXIMATELY 30,348. RED WILLOW COUNTY HAS A POPULATION OF APPROXIMATELY 10,747. THE GROUP OF COUNTIES WHICH MAKE UP THE SECONDARY MARKET FOR COMMUNITY HOSPITAL HAVE A POPULATION OF APPROXIMATELY 19,601. THE HOUSEHOLD INCOME AVERAGES FOR THESE AREAS ARE AS FOLLOWS:11.75% $0 - 15K14.5% $15K - 25K29% $25K - 50K18.5% $50K - 75K12.5% $75K - 100K13.5% $100K+ PART VI, LINE 5: COMMUNITY HOSPITAL IS THE LARGEST HOSPITAL WITHIN AN HOUR TRAVEL TIME FOR MOST OF THE COMMUNITY SERVED. THE HOSPITAL PROVIDES THE PHYSICIANS OF MCCOOK A HOSPITAL IN WHICH TO PRACTICE MEDICINE. WITHOUT THE HOSPITAL OUR PATIENTS WOULD HAVE EXTREMELY LONG DISTANCES TO TRAVEL FOR EVERYTHING FROM EMERGENCY TO ROUTINE CARE. OUR HOSPITAL IS OVERSEEN BY A NON-COMPENSATED BOARD OF INDEPENDENT COMMUNITY MEMBERS. ANY PROFITS FROM THE OPERATION OF THE HOSPITAL ARE REINVESTED BACK INTO THE FACILITIES, EQUIPMENT AND STAFF TO PROVIDE OUR COMMUNITY WITH CURRENT AND HIGH QUALITY MEDICAL SERVICES CLOSE TO HOME. PART VI, LINE 6: N/A PART VI, LINE 7, REPORTS FILED WITH STATES NE 1 RED WILLOW CO FAIR BOARD PO BOX 876 MCCOOK NE 69001 476006500 GOVERNMENT 15000 FAIR SPONSOR. COMMUNITY HOSPITAL HEALTH FOUNDATION 1301 E H ST MCCOOK NE 69001 470693261 501(C)(3) 65104 TO SUPPORT THE MISSION OF THE FOUNDATION. CITY OF CURTIS 201 GARLICK AVE CURTIS NE 69025 476006157 GOVERNMENT 5000 CITY PARK DONATION. CATTLEMEN'S BALL OF NEBRASKA INC 4834 ROAD T DAVENPORT NE 68335 911812186 501(C)(3) 5000 SPONSOR. CHADRON STATE FOUNDATION 1000 MAIN CHADRON NE 69337 237352673 501(C)(3) 5000 PROGRAM SUPPORT. MCCOOK COLLEGE FOUNDATION 1205 EAST 1ST ST MCCOOK NE 69001 476089800 501(C)(3) 5000 BANNER SPONSOR. ROCK MOUNTAIN PERFORMANCE EXCELLENCE PO BOX 17545 DENVER CO 80217 841543649 501(C)(3) 5000 PROGRAM SUPPORT. MAKE A WISH NEBRASKA 412 EAST 25TH ST STE 5 KEARNEY NE 68847 470671096 501(C)(3) 5000 SUPPORT THE MAKE-A-WISH PROGRAM IN NEBRASKA. 8 0 PART I, LINE 2: GRANTS ARE MADE ONLY TO SELECTED CHARITABLE OR OTHER EXEMPT ORGANIZATIONS. COMMUNITY HOSPITAL ASSOCIATION ENTERS INTO AGREEMENTS WITH GRANTEES THAT GRANT FUNDS WILL BE RESTRICTED TO SPECIFIED EXEMPT PURPOSES. X X X X 0 0 0 0 0 0 0 0 0 TROY BRUNTZ CEO & PRESIDENT 239209 0 0 0 810 0 17159 0 23809 0 280987 0 0 0 SEAN WOLFE CFO 146477 0 0 0 405 0 10871 0 26465 0 184218 0 0 0 EVAN GEILENKIRCHEN CRNA 276310 0 0 0 1277 0 19250 0 20084 0 316921 0 0 0 ROSS BEAVERS CRNA 281481 0 0 0 480 0 19888 0 2000 0 303849 0 0 0 HEATHER FRISBIE CRNA 257832 0 0 0 674 0 8719 0 22610 0 289835 0 0 0 ANTHONY RODEWALD PHARMACY DIRECTOR 170699 0 0 0 520 0 12374 0 23449 0 207042 0 0 0 LORI BEEBY VP SUPPORT SERVICES 137633 0 0 0 612 0 10087 0 22897 0 171229 0 0 0 FORM 990, PART VI, SECTION A, LINE 6 THE MEMBERS CONSIST OF ALL PERSONS WHO CONTRIBUTE TO THE BUILDING AND IMPROVEMENT FUND OF THE CORPORATION, AT ANY TIME DURING THE EXISTENCE OF THE CORPORATION, NOT LESS THAN THE SUM OF $100. FORM 990, PART VI, SECTION A, LINE 7A THE MEMBERS ELECT THE BOARD OF DIRECTORS AT THE ANNUAL MEETING EACH YEAR. FORM 990, PART VI, SECTION B, LINE 11B COMMUNITY HOSPITAL'S FORM 990, 990-T AND NEBRASKA INCOME TAX FORMS ARE PREPARED BY THE PUBLIC ACCOUNTING FIRM SEIM JOHNSON. MANAGEMENT RECEIVES DRAFT COPIES OF THE COMPLETED FORMS FOR REVIEW. AFTER HOSPITAL MANAGEMENT HAS REVIEWED THE RETURNS, COMPLETE COPIES ARE DISTRIBUTED TO ALL MEMBERS OF THE BOARD OF DIRECTORS OF THE COMMUNITY HOSPITAL ASSOCIATION AND THE RETURNS ARE APPROVED FOR FILING BY THE BUDGET & FINANCE COMMITTEE OF THE BOARD (A STANDING COMMITTEE WITH RESPONSIBILITY TO OVERSEE FINANCIAL, AUDIT, TAXATION AND BUDGET MATTERS OF THE HOSPITAL). BOARD COMMITTEE APPROVAL IS REQUIRED PRIOR TO SIGNATURE AND SUBMISSION OF THE RETURNS TO THE IRS AND STATE TAXING AUTHORITIES. FORM 990, PART VI, SECTION B, LINE 12C THE COMMUNITY HOSPITAL ASSOCIATION'S CODE OF CONDUCT REQUIRES ALL EMPLOYEES, CONTRACTORS, AND AGENTS TO REPORT ANY CONFLICTS OF INTEREST THAT ARISE. IN ADDITION, THE ASSOCIATION HAS A CONFLICT OF INTEREST POLICY APPLICABLE TO DIRECTORS, OFFICERS, MEMBERS OF COMMITTEES AND SUBCOMMITTEES WITH BOARD-DELEGATED POWERS, AND KEY EMPLOYEES THAT REQUIRES, AMONG OTHER THINGS, ALL APPLICABLE PERSONS DISCLOSE ANY RELATIONSHIPS THAT MAY CREATE A CONFLICT OF INTEREST AND ARE REQUIRED TO COMPLETE AN ANNUAL DISCLOSURE OF ALL SUCH RELATIONSHIPS. ALL SUCH RELATIONSHIPS ARE DISCLOSED TO THE ENTIRE BOARD AND SENIOR MANAGEMENT, AND ANY AND ALL CONFLICTS OR POTENTIAL CONFLICTS ARE MONITORED BY SENIOR MANAGEMENT AND THE ASSOCIATION'S COMPLIANCE FUNCTION. FORM 990, PART VI, SECTION B, LINE 15 COMMUNITY HOSPITAL'S PROCESS FOR DETERMINING THE COMPENSATION OF THE CEO IS AS FOLLOWS: THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS IS RESPONSIBLE FOR SETTING THE SALARY OF THE CEO. ANNUALLY, THE COMMITTEE CONDUCTS A REVIEW OF THE CEO'S PERFORMANCE, ABILITIES, AND OVERALL EFFECTIVENESS. THE COMMITTEE IS PRESENTED WITH SALARY AND COMPENSATION SURVEY DATA THAT IS COMPILED BY THE CEO AND THE HUMAN RESOURCE DEPARTMENT AND THE ACCURACY OF WHICH IS ATTESTED TO BY THE CFO. MULTIPLE SOURCES OF SURVEY DATA ARE USED, INCLUDING INFORMATION FROM THE NEBRASKA AND IOWA HOSPITAL ASSOCIATIONS, WHICH IS BROKEN DOWN TO SIMILARLY QUALIFIED PERSONS IN COMPARABLE POSITIONS AT SIMILARLY SIZED AND SITUATED ORGANIZATIONS. ALL SOURCE DOCUMENTATION IS GIVEN TO THE COMMITTEE AS WELL AS SUMMARIES PROVIDED FOR EASE OF REFERENCE. THE EXECUTIVE COMMITTEE CONDUCTS THE PERFORMANCE REVIEW WITH THE CEO; THEN MEETS IN PRIVATE CHAMBERS TO DISCUSS THE REVIEW AND TO DELIBERATE ANY AND ALL CHANGES TO THE EMPLOYMENT AGREEMENT, INCLUDING COMPENSATION, AND GOALS FOR THE FOLLOWING YEAR. CONTEMPORANEOUS RECORDS ARE KEPT OF ALL SURVEY AND COMPARABILITY DATA USED, AND THE RESULTS AND DECISIONS OF THE EXECUTIVE COMMITTEES MEETING ON COMPENSATION. COMPENSATION OF EMPLOYEES BELOW THE ROLE OF CEO ARE DETERMINED THROUGH THE USE OF SURVEY INFORMATION OF SIMILARLY QUALIFIED PERSONS IN COMPARABLE POSITIONS AT SIMILARLY SIZED AND SITUATED ORGANIZATIONS. THE CEO SETS THE COMPENSATION OF SENIOR MANAGEMENT BASED ON THOSE SURVEYS, TAKING IN CONSIDERATION PERFORMANCE AND EXPERIENCE OF EACH INDIVIDUAL. COMPENSATION RANGES OF EMPLOYEES BELOW SENIOR MANAGEMENT ARE SET BY HUMAN RESOURCES BASED ON MARKET WAGE RATES FOR SIMILARLY QUALIFIED PERSONS IN COMPARABLE POSITIONS AT SIMILARLY SIZED AND SITUATED ORGANIZATIONS. ALL EMPLOYEES HAVE AN ANNUAL REVIEW BY THEIR SUPERVISOR, WHICH DETERMINE WHERE IN THE SALARY RANGE AN EMPLOYEE WILL FALL. ALL SALARY RANGES, INCLUDING THOSE OF SENIOR MANAGEMENT, ARE ULTIMATELY APPROVED BY THE BOARD OF DIRECTORS DURING THE APPROVAL OF THE ANNUAL OPERATING BUDGET. FORM 990, PART VI, SECTION C, LINE 19 COMMUNITY HOSPITAL MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, FORM 990 & 990-T (CURRENT AND PAST YEARS AS REQUIRED BY LAW) AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. ANY INDIVIDUAL WHO WOULD LIKE A COPY OF ANY OF THE ABOVE MENTIONED DOCUMENTS MAY INSPECT THOSE DOCUMENTS IN PERSON AT THE HOSPITAL DURING NORMAL BUSINESS HOURS, OR REQUEST A COPY OF ANY OF THE ABOVE INFORMATION IN PERSON, BY PHONE, OR BY MAIL, AND WE WILL PROVIDE A COPY FREE OF CHARGE. FORM 990, PART IX, LINE 11G MISCELLANEOUS FEES FOR SERVICE: PROGRAM SERVICE EXPENSES 2,644,923. MANAGEMENT AND GENERAL EXPENSES 840,278. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,485,201. PHYSICIAN FEES: PROGRAM SERVICE EXPENSES 2,363,924. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,363,924. MAINTENANCE CONTRACTS: PROGRAM SERVICE EXPENSES 741,056. MANAGEMENT AND GENERAL EXPENSES 3,088. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 744,144. PT CONTRACT SERVICES: PROGRAM SERVICE EXPENSES 1,053,418. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,053,418. COLLECTION FEES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 104,741. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 104,741. FORM 990, PART XII, LINE 2C COMMUNITY HOSPITAL HAS A STANDING BOARD COMMITTEE, THE BUDGET AND FINANCE COMMITTEE, WHICH HAS THE AUTHORITY AND ASSUMES THE RESPONSIBILITY FOR THE SELECTION OF THE INDEPENDENT ACCOUNTING FIRM AND ALL RELATED OVERSIGHT, COMMUNICATION, AND REPORTING. THIS COMMITTEE APPROVES ALL ENGAGEMENT LETTERS AND RECEIVES ALL BOARD DIRECTED COMMUNICATION FROM THE INDEPENDENT ACCOUNTING FIRM. COPIES OF RECEIVED LETTERS/COMMUNICATIONS AND REPORTS ARE DISTRIBUTED TO ALL MEMBERS OF THE BOARD OF DIRECTORS IN ADDITION TO THE COMMITTEE MEMBERS. WHILE THE MEMBERS OF THE COMMITTEE HAVE CHANGED, THE PROCESS DESCRIBED HAS NOT CHANGED FROM THE PREVIOUS YEAR. COMMUNITY HOSPITAL HEALTH FOUNDATION 801 WEST C STREET PO BOX 1328 MCCOOK NE 69001 470693261 SUPPORTING ORGANIZATION PROVIDES FUNDRAISING FOR THE HOSPITAL NE 501(C)(3) LINE 12A, I COMMUNITY HOSPITAL ASSOCIATION OF MCCOOK 1 0 1 1 0 0 0 0 0 0 0 1 0 1 1 1 1 1 0 0 COMMUNITY HOSPITAL HEALTH FOUNDATION C 625024 CASH TRANSFERRED EQUALS FMV COMMUNITY HOSPITAL HEALTH FOUNDATION B 65104 CASH TRANSFERRED EQUALS FMV