2020-07-29T14:56:53-05:00 2019-09-30 476097913 SEIM JOHNSON LLP 18081 BURT STREET SUITE 200 OMAHA NE 680224722 990 2018-10-01 470426530 JENNIE M MELHAM MEMORIAL MEDICAL CENTER INC JENN 3088724180 PO BOX 250 BROKEN BOW NE 68822 VERONICA L SCHMIDT CEO 3088724180 2020-07-21 1 WENDY R COOLEY P01523804 4023302660 209.34.201.180 2020-07-21 11:04:26 CD P 05D57004E72D560A8AB00D9FF642C8776C6EAF55 5D066E2939FE45487034BD10C4A0DC94BE27FEF9 2018 2020-11-19 02:30:22Z VERONICA L SCHMIDT PO BOX 250 BROKEN BOW NE 68822 18806102 0 X WWW.MELHAM.ORG X 1962 NE THE PRIMARY MISSION AND PURPOSE OF THE JENNIE M. MELHAM MEMORIAL MEDICAL CENTER IS TO IMPROVE THE QUALITY OF LIFE IN ITS SURROUNDING SERVICE AREA BY PROVIDING AN ENVIRONMENT WHICH PROMOTES THE BEST POSSIBLE DELIVERY OF EMERGENCY, INPATIENT, SNF/SWING BED, OUTPATIENT, AMBULATORY CARE, AND INDEPENDENT LIVING APARTMENT SERVICES. 5 5 120 25 0 0 20016 254460 16877790 17744748 534009 604704 -23248 -92110 17408567 18511802 0 0 0 0 7047035 7290452 4386 3937 43937 8613822 9193720 15665243 16488109 1743324 2023693 44586154 48357831 1626150 1781574 42960004 46576257 X JMMMC IS DEDICATED TO PROVIDING A CONTINUUM OF HIGH QUALITY, PROFESSIONAL HEALTHCARE SERVICES TO OUR RURAL SERVICE AREA THROUGH A COMPASSIONATE AND CARING STAFF. 0 0 10040134 9313407 JENNIE MELHAM MEMORIAL MEDICAL CENTER (JMMMC) OPERATES A 23-BED CRITICAL ACCESS HOSPITAL. IN ADDITION, THERE ARE 20 APARTMENTS DESIGNATED FOR THE ELDERLY. JMMMC PROVIDES OUTPATIENT SPECIALTY CLINICS AND SURGERY SERVICES. 2831198 1785354 JMMMC PROVIDES HIGH QUALITY, LOW COST ACUTE CARE TO OUR LOCAL COMMUNITY. THE ACUTE CARE DEPARTMENT EXPERIENCED 1,332 DAYS OF CARE. THIS INCLUDES SWING BED, INPATIENT AND OUTPATIENT OBSERVATION. THIS PROVIDES LOCAL ACCESS FOR OUR RESIDENTS TO OBTAIN QUALITY CARE. 1503148 1700869 JMMMC PROVIDES 24/7 EMERGENCY SERVICES TO OUR COMMUNITY. WE ENCOUNTERED 2,520 EMERGENCY ROOM VISITS. 640552 4945118 JMMMC PROVIDES RADIOLOGY SERVICES WHICH INCLUDES MOBILE MRI SERVICES, X-RAY, DIGITAL MAMMOGRAPHY, BONE DENSITOMETRY AND CT. 640552 4945118 15015032 1 1 0 1 0 0 0 0 1 1 1 0 0 0 1 1 0 1 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 0 0 0 1 28 0 1 120 1 0 0 0 0 0 0 0 0 0 0 0 0 X 5 5 0 0 0 0 1 1 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X CARLA BAZYN VPCFO 3088724180 PO BOX 250 BROKEN BOW NE 68822 DON CANTRELL CHAIRMAN 2.00 2.00 X X 0 0 0 JOHN SMITH VICE CHAIRMAN 2.00 2.00 X X 0 0 0 JOYCE RICHARDSON SECRETARY 2.00 2.00 X X 0 0 0 MIKE BORDERS TREASURER 2.00 2.00 X X 0 0 0 MIKE FLINT TREASURER THRU 1/19 2.00 2.00 X X 0 0 0 COREY STAPLES MEMBER 2.00 2.00 X 0 0 0 VERONICA L SCHMIDT PRESIDENT/CEO 2.00 2.00 X 190567 0 37601 CARLA BAZYN VP/CFO 40.00 2.00 X 122083 0 38415 REBECCA SCHAINOST PHARMACIST 40.00 0.00 X 141170 0 19669 SHELLY AMSBERRY DIRECTOR OF NURSING SERVICES 40.00 0.00 X 104600 0 38836 NICOLE LEEPER CIO 40.00 0.00 X 100487 0 16407 658907 0 150928 6 0 1 0 CENTRAL NEBRASKA MEDICAL CLINIC PO BOX 690 BROKEN BOW NE 68822 ER DOCTOR SERVICES 962103 SANDHILLS ANESTHESIA SERVICES LLC 79568 SUMNER ROAD BROKEN BOW NE 68822 ANESTHESIA SERVICES 569250 BRYAN MEDICAL CENTER PO BOX 82557 LINCOLN NE 68501 MOBILE PATIENT SERVICES 188821 PATHOLOGY SERVICES PC PO BOX 1289 NORTH PLATTE NE 69103 PATHOLOGY SERVICES 127303 NEBRASKA HEART INSTITUTE 2000 Q STREET SUITE 501 LINCOLN NE 68503 MOBILE PATIENT SERVICES 101720 5 14280 240180 254460 PATIENT SERVICE - MEDICARE/MEDICA 621110 10720949 10720949 PATIENT SERVICE - PRIVATE PAY 621110 6922803 6922803 WELLNESS CENTER REVENUE 624100 68466 68466 32530 32530 17744748 594704 594704 154216 294300 -140084 -140084 -140084 10000 0 10000 10000 10000 CAFETERIA SALES 722210 47974 47974 47974 18511802 17744748 0 512594 X 388666 388666 5315607 4919154 396453 142370 128552 13818 1060549 1027235 33314 383260 338498 44762 19204 19204 66575 66575 3937 3937 2831530 2771648 59882 2354302 2335693 18609 505215 495128 10087 343946 321523 22423 4901 1367 3534 71421 24381 47040 1581586 1550507 31079 144448 125111 19337 BAD DEBT 431612 431612 SERVICE CONTRACTS 319205 317837 1368 DUES AND SUBSCRIPTIONS 75475 37339 38136 MINOR EQUIPMENT 72398 71128 1270 371902 118319 213583 40000 16488109 15015032 1429140 43937 145 145 1866844 11096697 2381832 2346621 153804 930146 484670 447903 198776 185459 38284443 20052235 19586970 18232208 18797643 13990202 1115470 1128450 44586154 48357831 1400715 1596583 225435 184991 1626150 1781574 X 42960004 46344155 232102 42960004 46576257 44586154 48357831 2023693 1592560 0 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 2699 2699 0 PART II-B, LINE 1: JMMMC PAID DUES TO THE AMERICAN HOSPITAL ASSOCIATION AND THE NEBRASKA HOSPITAL ASSOCIATION. A PORTION OF THE DUES FOR EACH ORGANIZATION WERE USED FOR LOBBYING ACTIVITIES. 0 0 38692 1250 39942 37400 1260 32 38692 35050 2350 37400 34050 1000 35050 33927 123 34050 0.00000 1.00000 0.00000 0 1 1 70059 70059 18300323 10693215 7607108 7670812 5966905 1703907 12243249 3392115 8851134 18232208 457 PENSION LIABILITIES 184991 184991 X PART V, LINE 4: PROVIDE SUPPORT TO ENSURE CONTINUED OPERATION OF JENNIE M. MELHAM MEMORIAL MEDICAL CENTER. PART X, LINE 2: THE HOSPITAL AND FOUNDATION ARE NOT-FOR-PROFIT CORPORATIONS AS DESCRIBED IN SECTION 501(C)(3) OF THE CODE AND HAVE RECEIVED DETERMINATION LETTERS THAT THEY 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 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 MEDICAL CENTER ACCOUNTS FOR UNCERTAINTIES IN ACCOUNTING FOR INCOME TAX ASSETS AND LIABILITIES USING GUIDANCE INCLUDED IN FASB ASC 740, INCOME TAXES. THE MEDICAL CENTER RECOGNIZES THE EFFECT OF INCOME TAX POSITIONS ONLY IF THOSE POSITIONS ARE MORE LIKELY THAN NOT OF BEING SUSTAINED. AT SEPTEMBER 30, 2019 AND 2018, THE MEDICAL CENTER HAD NO UNCERTAIN TAX POSITIONS ACCRUED. 1 1 X 1 X 1 X 1 1 0 1 1 63597 0 63597 0.00400 722755 722755 786352 722755 63597 0.00400 70560 0 70560 0.00440 113520 0 113520 0.00710 184080 184080 0.01150 970432 722755 247677 0.01550 13050 0 13050 0.00080 5379 0 5379 0.00030 1509 0 1509 0.00010 8312 0 8312 0.00050 3740 0 3740 0.00020 31990 31990 0.00190 0 431612 0 9477814 9534226 -56412 X 1 1 1 1 JENNIE M MELHAM MEMORIAL MEDICAL CENTER PO BOX 250 BROKEN BOW NE 68822 WWW.MELHAM.ORG 100004 X X X X APARTMENTS JENNIE M MELHAM MEMORIAL MED CTR INC 1 0 0 1 X X X X X X X X X 18 1 0 1 1 X WWW.MELHAM.ORG X 1 15 1 WWW.MELHAM.ORG 0 1 X 100.000000000000 200.000000000000 X X X 1 1 X X X 1 X WWW.MELHAM.ORG X WWW.MELHAM.ORG X WWW.MELHAM.ORG X X X X X 1 X 0 X X X X 1 X 0 0 JENNIE M. MELHAM MEMORIAL MED. CTR. INC. PART V, SECTION B, LINE 5: IN ORDER TO UPDATE THE 2019 CHNA THE MEDICAL CENTER'S ADMINISTRATION COLLECTED AND ANALYZED THE MOST CURRENT STATE, FEDERAL AND COMMUNITY DATABASES TO UNDERSTAND THE DEMOGRAPHIC MAKEUP AND TRENDS IN THE SERVICE AREA. THIS INFORMATION WAS USED TO BETTER UNDERSTAND HOW THESE TRENDS AFFECT THE MEDICAL CENTER'S CURRENT AND FUTURE PROVISION OF HEALTHCARE TO MEET THE COMMUNITY AND COUNTY'S HEALTH NEEDS. THE MEDICAL CENTER PARTNERED WITH THE LOUP BASIN PUBLIC HEALTH DEPARTMENT (LBPHD) IN DEVELOPMENT AND ADMINISTRATION OF A 2019 COMMUNITY THEMES AND STRENGTHS ASSESSMENT SURVEY OF RESIDENTS HEALTHCARE STATUS AND NEEDS IN THE LBPHD'S NINE COUNTY SERVICE AREA.THE RESULTS OF THE SURVEY WERE SEGREGATED OUT BY CITY/COUNTY SO THAT THIS INFORMATION COULD BE BROKEN DOWN AND USED BY EACH OF THE HOSPITALS IN THE REGION FOR PLANNING PURPOSES. THE MEDICAL CENTER USED THE BROKEN BOW AND CUSTER COUNTY SURVEY RESULTS IN THE 2019 CHNA PLANNING PROCESS. JENNIE M. MELHAM MEMORIAL MED. CTR. INC. PART V, SECTION B, LINE 6B: LOUP BASIN PUBLIC HEALTH DEPARTMENT JENNIE M. MELHAM MEMORIAL MED. CTR. INC. PART V, SECTION B, LINE 11: THE ASSESSMENT SURVEY IDENTIFIED THE FOLLOWING KEY NEED AREAS; 1. ADEQUATE NUTRITION PROGRAMS AND PHYSICAL ACTIVITY2. OBESITY AND ASSOCIATED CHRONIC ILLNESS3. ACCESS TO MENTAL HEALTH SERVICESTHE MEDICAL CENTER USED THE INFORMATION FROM THE LBPHD SURVEY AND MAPP PROCESS TO ASSIST IN UPDATING PLANS FOR HEALTH SCREENING, HEALTH EDUCATION AND WELLNESS ACTIVITIES IN THE COMMUNITY. FEEDBACK ON THE CHNA AND CHIP WAS SOUGHT FROM THE PBPHD, MEDICAL CENTER BOARD OF DIRECTORS, AND LOCAL MEDICAL STAFF. ALL FEEDBACK WAS USED TO REFINE THE 2019 CHNA AND CHIP FOR THE MEDICAL CENTER'S SERVICE AREA. SOME OF THE ACTIVITIES THAT WERE DEVELOPED AND IMPLEMENTED BY THE MEDICAL CENTER AS A RESULT OF THE 2019 CHNA AND CHIP FOR OUR SERVICE AREA:THE MEDICAL CENTER IS THE SITE FOR THE LOCAL WEIGHT WATCHERS PROGRAM AND PROMOTED THIS PROGRAM AMONG MEDICAL CENTER STAFF AND THE PUBLIC.MELHAM MEDICAL CENTER HAS PARTNERED WITH AND CONTINUES TO PARTNER WITH AREA SERVICE CLUBS, THE SCHOOL DISTRICT, AND OTHER HEALTHCARE PROVIDERS TO PROVIDE WELLNESS EVENTS SUCH AS 5K FUN RUNS AND WALKS, COMMUNITY EDUCATION, AND HEALTH FAIRS.THE MEDICAL CENTER HAS PARTNERED WITH THE BROKEN BOW POLICE DEPARTMENT TO CHARTER A CUSTER COUNTY MENTAL HEALTH TASK FORCE COMPRISED OF COUNTY SCHOOL DISTRICTS, LOCAL MENTAL HEALTH THERAPISTS, CUSTER COUNTY SHERIFF, NEBRASKA HIGHWAY PATROL, CALLAWAY DISTRICT HOSPITAL, AND CONSUMERS OF MENTAL HEALTH SERVICES. THE TASK FORCE EXISTS TO IDENTIFY MENTAL HEALTH NEEDS AND RESOURCES, REDUCE FRAGMENTATION OF SERVICES AMONG PROVIDERS, AND DEVELOP PLANS FOR COMMUNITY RESPONSE TO MENTAL HEALTH NEEDS. THE TASK FORCE RECENTLY PARTNERED WITH CUSTER AREA ROTARY AND RECEIVED A GRANT TO BRING THE WELLNESS RECOVERY ACTION PLAN (WRAP) TOOL TO THE COUNTY. LOCAL TRAINERS WILL WORK WITH LOCAL THERAPISTS, EMPLOYERS, AND SCHOOLS TO COORDINATE WRAP COMPLETION BY COMMUNITY MEMBERS TO PROACTIVELY ADDRESS WELLNESS, RECOVERY, STRESSORS, AND SUPPORT SYSTEMS. THE PLAN WILL THEN BE AVAILABLE TO LOCAL LAW ENFORCEMENT AND FIRST RESPONDERS IN A STANDARDIZED FORMAT TO ASSIST THEM IN ADDRESSING INDIVIDUALS IN CRISIS WITH THE GOAL OF AVOIDING ESCALATION OF CRISIS SITUATIONS.MELHAM MEDICAL CENTER HAS CONTRACTED WITH A PROVIDER OF ADULT INTENSIVE OUTPATIENT MENTAL HEALTH SERVICES FOR INDIVIDUALS 55 YEARS AND OLDER. THE SERVICE WILL BE PROVIDED ON THE MEDICAL CENTER CAMPUS AND BEGIN IN EARLY 2020.MELHAM MEDICAL CENTER CURRENTLY PARTNERS WITH RICHARD YOUNG BEHAVIOR HEALTH TO PROVIDE INDIVIDUAL PSYCHOLOGICAL SERVICES VIA TELEHEALTH IN THE SPECIALTY CLINIC.MELHAM MEDICAL CENTER CURRENTLY OPERATES A WELLNESS CENTER WITH COMPREHENSIVE STRENGTH AND CONDITIONING FITNESS EQUIPMENT AND A TENNIS COURT. THE MEDICAL CENTER IS CURRENTLY A CORE ORGANIZATION IN PARTNERSHIP WITH THE SCHOOL DISTRICT, MAJOR COMMUNITY EMPLOYERS, AND THE CITY OF BROKEN BOW IN AN EFFORT TO DEVELOP A COMMUNITY YMCA AND SUPPORT A YMCA PROGRAM AND WELLNESS DIRECTOR TO PROMOTE ACTIVE LIFESTYLES AND ACCESS TO WELLNESS ACTIVITIES FOR ALL AGES IN CUSTER COUNTY.ACCESS TO MENTAL HEALTH SERVICES WAS NOTED BY SURVEY PARTICIPANTS AS A NEED. THIS IS NOT AN AREA OF EXPERTISE FOR THE MEDICAL CENTER. THE MEDICAL CENTER HAS MANY OTHER FINANCIAL COMMITMENTS TO ENSURE PROVISION OF OTHER KEY MEDICAL CARE NEEDS IN THE COMMUNITY. THERE ARE EXISTING PROVIDERS IN THE COMMUNITY WHO ADDRESS MENTAL HEALTH ISSUES WITH WHOM THE MEDICAL CENTER CAN PARTNER TO AVOID DUPLICATION OF SERVICES AND UNNECESSARY COMPETITION. THERE IS LIMITED GRANT FUNDING BASED ON UTILIZATION ON WHICH THESE NON-PROFIT AGENCIES RELY.ADEQUATE NUTRITION PROGRAMS FOR RESIDENTS OF THE COMMUNITY WAS ALSO NOTED BY THE PARTICIPANTS IN THE ASSESSMENT PROCESS AS A NEED. THIS IS NOT AN AREA OF EXPERTISE FOR THE MEDICAL CENTER. THERE ARE A NUMBER OF SERVICES IN THE COMMUNITY ALREADY WORKING ON NUTRITION ISSUES IN THE COMMUNITY THAT THE MEDICAL CENTER CAN PARTNER WITH OR SUPPORT, SUCH AS THE SENIOR CENTERS AND MEALS ON WHEELS PROGRAMS. 1 1 - LIBERTY SQUARE APARTMENTS PO BOX 250 BROKEN BOW NE 68822 SENIOR INDEPENDENT LIVING APARTMENT COMPLEX PART I, LINE 3C: ELIGIBILITY IS MAINLY BASED UPON FEDERAL POVERTY GUIDELINES, HOWEVER, OTHER FACTORS WILL COME INTO THE DECISION MAKING PROCESS. THESE FACTORS INCLUDE AGE, EXISTING MEDICAL DEBT, EXISTING NON-MEDICAL DEBT, ASSET OWNERSHIP, INVESTMENTS AND ANY OTHER PERTINENT INFORMATION. THE INCOME GUIDELINES ALLOW FOR ASSISTANCE, BASED UPON A SLIDING SCALE, WHERE INCOME IS FROM ANYWHERE FROM 100% TO 200% OF FEDERAL POVERTY GUIDLINES. PART I, LINE 6A: JMMMMC'S COMMUNITY BENEFIT REPORT IS NOT PREPARED BY A RELATED ORGANIZATION. PART I, LINE 7: JMMMMC USED THE SEPTEMBER 30, 2019 COST REPORT AND AUDITED FINANCIAL STATEMENTS TO CALCULATE THE AMOUNT REPORTED ON PART I, LINE 7. JMMMMC TOOK CHARITY CARE CHARGES FROM THE AUDITED FINANCIAL STATMENTS THEN REDUCED THOSE NUMBER TO A COST BASIS USING A COST-TO-CHARGE RATIO. PART I, LN 7 COL(F): THE BAD DEBT THAT HAS BEEN SUBTRACTED FROM TOTAL EXPENSES TO DETERMINE THE DENOMINATOR IN THE PERCENTAGES FOR COLUMN (F) IS $431,612. PART II, COMMUNITY BUILDING ACTIVITIES: JMMMC'S COMMUNITY BUILDING ACTIVITIES INCLUDE DISASTER TRAINING ACTIVITIES EXPENSES. JMMMC HAS WORKED WITH COMMUNITY AND REGIONAL ORGANIZATIONS TO DEVELOP DISASTER PLANS AND TRAIN BOTH OUR STAFF AND OTHER EXTERNAL ORGANIZATION'S STAFF FOR ANY POTENTIAL DISASTER RESPONSE. MEETING ROOMS, INCLUDING SOME WITH TELE VIDEO CAPABILITIES ARE AVAILABLE AND USED BY AREA ORGANIZATIONS FREE OF CHARGE. THIS SAVES THESE ORGANIZATIONS SIGNIFICANT SUMS OF MONEY, KEEPING THEIR STAFF AND VOLUNTEERS HERE LOCALLY AS OPPOSED TO COMMUTING UPWARDS OF 200 MILES OR MORE FOR CERTAIN TRAINING EVENTS. WEIGHTWATCHERS MEETS AT JMMMC TO PROVIDE THE COMMUNITY THE OPPORTUNITY TO LEARN HEALTHY EATING LIFESTYLES. PART III, LINE 2: IN EVALUATING THE COLLECTIBILITY OF ACCOUNTS RECEIVABLE, THE MEDICAL CENTER ANALYZES ITS HISTORICAL COLLECTIONS 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 MEDICAL CENTER 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 MEDICAL CENTER 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 4: THERE IS NO FOOTNOTE TO JMMMMC'S FINANCIAL STATEMENTS THAT DESCRIBES BAD DEBT. HOWEVER, PAGES 8 AND 10 OF THE ATTACHED AUDITED FINANCIAL STATEMENTS INCLUDE FOOTNOTES TITLED "PATIENT RECEIVABLES, NET", "NET PATIENT SERVICE REVENUE", AND "CHARITY CARE". PART III, LINE 8: JMMMMC USED THE SEPTEMBER 30, 2019 COST REPORT TO CALCULATE THE AMOUNT REPORTED ON PART III, LINE 6. NO MEDICARE SHORTFALL IS TREATED AS COMMUNITY BENEFITS. PART III, LINE 9B: IF A PATIENT IS IDENTIFIED THAT IS KNOWN TO QUALIFY FOR FINANCIAL ASSISTANCE, EFFORTS TO REACH OUT TO THIS INDIVIDUAL OR THE INDIVIDUAL'S FAMILY ARE MADE. THE PATIENT OR FAMILY IS REQUESTED TO COMPLETE A CHARITY CARE APPLICATION TO FORMALIZE THE PROCESS. AT THE TIME A COMPLETED APPLICATION IS RECEIVED, ALL COLLECTION EFFORTS ARE CEASED UNTIL A DETERMINATION IS MADE TO THE QUALIFICATION OF THE INDIVIDUAL. PART VI, LINE 2: THERE IS NO FORMAL POLICY TO ASSESS THE HEALTH CARE NEEDS OF THE COMMUNITY JMMMMC SERVES OTHER THAN THE NEEDS ASSESSMENT THAT WAS CONDUCTED DURING THE 2018 TAX YEAR. PART VI, LINE 3: ALL PRIVATE PAY PATIENT ACCOUNTS ARE REVIEWED BY THE BILLING STAFF. DURING THE REVIEW PROCESS, PATIENTS THAT ARE IDENTIFIED AS POTENTIAL CANDIDATES FOR ELIGIBILTY AND ASSISTANCE ARE CONTACTED BY THE BILLING STAFF. THE BILLING STAFF ENCOURAGES THE PATIENTS TO CONTACT THE APPROPRIATE AGENCY, MAINLY THE STATE MEDICAID PROGRAM, IN ORDER FOR THEM TO ASCERTAIN THEIR ELIGIBILITY. KNOWN INDIGENT PATIENTS ARE ENCOURAGED TO COMPLETE A CHARITY CARE APPLICATION. A FINANCIAL ASSISTANCE POLICY SUMMARY IS INCLUDED WITH ALL FIRST BILLINGS. INFORMATION REGARDING THE FINANCIAL ASSISTANCE POLICY IS INCLUDED ON ALL STATEMENTS SENT OUT. PART VI, LINE 4: JENNIE M. MELHAM MEMORIAL MEDICAL CENTER SERVES THE PEOPLE OF CENTRAL NEBRASKA. LOCATED IN BROKEN BOW, THE COUNTY SEAT, THE PRIMARY SERVICE AREA ENCOMPASSES CUSTER COUNTY, BLAINE COUNTY, THOMAS COUNTY, LOUP COUNTY AND PARTS OF SHERMAN COUNTY. THE SERVICE AREA IS A VERY RURAL AREA. SOME COUNTIES OR PARTS THEREOF SERVED ARE AMONG THE SPARCEST POPULATED AREAS IN THE UNITED STATES. THE PRIMARY SERVICE AREA CONSISTS OF A POPULATION BASIS OF APPROXIMATELY 12,000. A LARGE PORTION OF THE POPULATION SERVED IS OVER AGE 65, RESULTING IN A LARGE NUMBER OF PATIENTS SEEN AT THE MEDICAL CENTER BEING COVERED BY THE MEDICARE PROGRAM. OVER 60% OF GROSS PATIENT REVENUE GENERATED AT THE MEDICAL CENTER IS MEDICARE. ADDITIONALLY, 5% OF GROSS PATIENT REVENUE IS RECEIVED FROM THE MEDICAID PROGRAM. PART VI, LINE 5: JMMMMC FURTHER PROMOTES THE HEALTH OF THE COMMUNITY BY THE FOLLOWING ACTIONS AND INITIATIVES:JMMMMC PARTICIPATES WITH AREA COMMUNITY COLLEGES BY SERVING AS A CLINICAL ROTATION SITE FOR PHYSICIAN, PHYSICIAN ASSISTANT, PHARMACY, MEDICAL TECHNOLOGY, LPN, RN, MEDICAL TRANSCRIPTIONIST, PHYSICAL THERAPIST AND RADIOLOGY TECHNOLOGY STUDENTS. SPACE AND STAFF OVERSIGHT IS PROVIDED AT NO COST TO THE COLLEGE OR THE STUDENT. JMMMMC ALSO OWNS A RESIDENTIAL HOUSE THAT IS USED TO MAKE FREE HOUSING AVAILABLE TO MANY OF THE STUDENTS WHO COME FROM OUT OF TOWN TO PARTICIPATE IN THE ABOVE STATED TRAINING PROGRAMS. JMMMMC COVERS THE COSTS RELATED TO MAINTENANCE, HEATING, COOLING, LIGHTING, LAUNDRY/LINEN, INTERNET, AND OTHER COSTS FOR THIS HOUSE.JMMMMC ASSISTS WITH LOCAL ECONOMIC DEVELOPMENT CORPORATION PROGRAMS DESIGNED TO PROMOTE INTEREST IN HEALTH CARE CAREERS. IT IS JMMMMC'S HOPE THAT BY CREATING LOCAL INTEREST IN HEALTH CARE CAREERS JMMMMC WILL INSPIRE LOCAL RESIDENTS TO SEEK OUT TRAINING AND RETURN TO THE COMMUNITY TO PURSUE A CAREER IN HEALTH CARE. JMMMMC PARTNERS WITH LOCAL HIGH SCHOOLS TO PROMOTE HEALTHCARE CAREERS TO LOCAL STUDENTS. THROUGH HOSA (HEALTH OCCUPATIONS STUDENTS OF AMERICA), A FUTURE HEALTH CARE PROFESSIONALS CHAPTER AT BROKEN BOW HIGH SCHOOL, SPEARHEADED BY JMMMMC, THE MEDICAL CENTER PROVIDES SPEAKERS, MENTORSHIP, AND JOB SHADOW EXPERIENCES TO STUDENTS.NOT ALL PATIENTS HAVE AN ABILITY TO PAY AT TIME OF SERVICE. JMMMMC HAS DEVELOPED GUIDELINES THAT DO NOT REQUIRE PAYMENT IN FULL AT TIME OF SERVICE FOR EMERGENT, URGENT OR ELECTIVE SERVICES AND ALLOWS FOR EXTENDED PERIODS OF TIME FOR PAYMENT OF THE DEBT AND NO INTEREST CHARGES ARE INCURRED. EVERY EFFORT IS MADE BY JMMMMC TO KEEP HEALTHCARE AFFORDABLE FOR AREA PATIENTS.MEDICAL CENTER MEETING ROOMS ARE PROVIDED FREE OF CHARGE TO OUTSIDE COMMUNITY SERVICE ORGANIZATIONS WHO ARE PROMOTING HEALTHY LIFESTYLES AND WELLNESS PROMOTION.FREE BROADBAND ACCESS AND COMPUTER RESOURCES ARE PROVIDED FREE OF CHARGE TO LOCAL EMT VOLUNTEERS ALLOWING THEM TO BE MORE EFFICIENT IN THEIR DUTIES. THIS ALLOWS FOR BETTER PARTICIPATION IN THE EMT PROGRAM, THUS EXTENDING EMERGENCY TRANSFER SERVICES TO LOCAL RESIDENTS AND VISITORS. TELEVIDEO EQUIPMENT IS PROVIDED FREE OF CHARGE TO AREA EMT VOLUNTEERS. THIS ALLOWS FOR QUARTERLY TRAINING TO BE PROVIDED LOCALLY THAT IS REQUIRED TO MEET THEIR CONTINUING EDUCATION REQUIREMENTS AND MAINTAIN THEIR CERTIFICATION. THE AVAILABILITY OF THIS SERVICE FOR THE EMTS RESULTS IN SIGNIFICANT SAVINGS IN TERMS OF TRAVEL COSTS AND TRAVEL TIME, HELPING BOOST MORALE AND ENCOURAGING PARTICIPATION OF THIS EXTREMELY IMPORTANT SERVICE. IN THIS RURAL COMMUNITY, THERE IS NO OTHER EMERGENCY AMBULANCE SERVICE OTHER THAN THE LOCAL VOLUNTEERS. LOCAL LAW ENFORCEMENT, THE COUNTY ATTORNEY AND HEALTH DEPARTMENTS ALSO MAKE USE OF THE TELEVIDEO EQUIPMENT TO PROMOTE HEALTH AND SAFETY IN THE COMMUNITY. JMMMMC PROVIDES SPACE FREE OF CHARGE TO THE CUSTER COUNTY COMMUNICATIONS DEPARTMENT. THIS COMMUNICATION CENTER HANDLES ALL RADIO COMMUNICATION BETWEEN THE LAW ENFORCEMENT AGENCIES, FIRE DEPARTMENTS AND EMERGENCY RESPONDERS FOR CUSTER COUNTY. THIS SPACE HOUSES EQUIPMENT THAT SERVES AS A BACKUP TO THEIR PRIMARY COMMUNICATION EQUIPMENT. IN SITUATIONS WHERE THE PRIMARY EQUIPMENT FAILS, THIS ALLOWS THE CUSTER COUNTY COMMUNICATIONS DEPARTMENT TO HAVE EMERGENCY BACKUP EQUIPMENT TO CONTINUE TO PROVIDE THE CRITICAL COMMUNICATION NEEDS OF CUSTER COUNTY.JMMMMC'S EMERGENCY ROOM SERVICES ARE PROVIDED 24 HOURS PER DAY, 7 DAYS PER WEEK. THIS DEPARTMENT OPERATES AT A SIGNIFICANT LOSS BUT ENSURES THAT PATIENTS HAVE ACCESS TO EMERGENCY HEALTHCARE AT ALL TIMES. THE ER IS CERTIFIED AS A LEVEL IV TRAUMA CENTER AND THE SERVICE AREA EXTENDS APPROXIMATELY 100 MILES EAST TO WEST ALONG THE HIGHWAY 2 CORRIDOR. THIS IS THE MAIN HIGHWAY HORIZONTALLY BISECTING NEBRASKA AND IS USED BY MANY TRAVELERS AND VACATIONERS, GIVING THEM ACCESS TO EMERGENCY AND TRAUMA CARE. JMMMMC'S EMERGENCY ROOM PROVIDES AROUND 2,500 EMERGENCY ROOM VISITS PER YEAR. THE MEDICAL CENTER PAYS LOCAL PHYSICIANS TO BE AVAILABLE TO PROVIDE EMERGENCY ROOM SERVICES 24 HOURS PER DAY, 365 DAYS PER YEAR. PART VI, LINE 6: JMMMMC IS NOT PART OF AN AFFILIATED HEALTH CARE SYSTEM. X X 0 0 0 0 0 0 0 0 0 VERONICA L SCHMIDT PRESIDENT/CEO 162292 0 28275 0 0 0 0 0 37601 0 228168 0 0 0 CARLA BAZYN VP/CFO 122083 0 0 0 0 0 4701 0 33714 0 160498 0 0 0 REBECCA SCHAINOST PHARMACIST 141170 0 0 0 0 0 4536 0 15133 0 160839 0 0 0 FORM 990, PART VI, SECTION A, LINE 6 THE MEMBERS CONSIST OF ALL PERSONS WHO CONTRIBUTE TO THE CORPORATION THE SUM OF NOT LESS THAN $25 AT ANY TIME DURING THE EXISTENCE OF THE CORPORATION. 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 THE FORM 990 WILL BE PRESENTED TO THE BOARD OF DIRECTORS AT A REGULARLY SCHEDULED BOARD MEETING PRIOR TO FILING THE FORM 990. DIRECTORS WILL BE ALLOWED TO REVIEW THE FORM AT THE MEETING. IF ADDITIONAL TIME IS NEEDED ON THEIR PART FOR REVIEW, NECESSARY TIME WILL BE ALLOTTED TO THEM TO REVIEW THE DOCUMENT PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C THE CONFLICT OF INTEREST POLICY IS PRESENTED ANNUALLY TO THE BOARD OF DIRECTORS. THIS FORM IS REVIEWED AND DISCUSSED WITH THEM. THE BOARD MEMBERS ARE REQUIRED TO SIGN A CONFLICT OF INTEREST DISCLOSURE FORM. THE CHAIRMAN CAN POINT OUT ANY KNOWN CONFLICTS OF INTEREST. INDIVIDUAL BOARD MEMBERS ARE ALSO RESPONSIBLE FOR DECLARING CONFLICTS AND UPON A CONFLICT, THEY ARE EXCLUDED FROM THE VOTE BUT NOT FROM THE DISCUSSION. FORM 990, PART VI, SECTION B, LINE 15 THE BOARD OF DIRECTORS IS PRESENTED WITH COMPARATIVE INFORMATION FROM WAGE STUDIES PERFORMED BY THE NEBRASKA HOSPITAL ASSOCIATION. NHA GATHERS THE WAGE INFORMATION ANNUALY FROM MOST, IF NOT ALL, OF THE HOSPITALS IN THE STATE. THE DATA CAN BE ANALYZED IN A VARIETY OF FORMATS, ALLOWING FOR EXCELLENT WAGE COMPARISON. THE BOARD SETS THE CEO SALARY BASED UPON THIS INFORMATION. FORM 990, PART VI, SECTION C, LINE 19 JENNIE M. MELHAM MEMORIAL MEDICAL CENTER DOES NOT MAKE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, OR FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC. FORM 990, PART IX, LINE 11G PATIENT TEST FEES: PROGRAM SERVICE EXPENSES 335,328. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 335,328. PHYSICAL/OCCUPATIONAL THERAPY: PROGRAM SERVICE EXPENSES 78,583. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 78,583. LAB TEST FEES: PROGRAM SERVICE EXPENSES 139,953. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 139,953. OTHER FEES FOR SERVICE: PROGRAM SERVICE EXPENSES 926,335. MANAGEMENT AND GENERAL EXPENSES 59,882. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 986,217. PHYSICIAN ER CALL PAYMENTS: PROGRAM SERVICE EXPENSES 1,291,449. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,291,449. FORM 990, PART XII, 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 FROM THE PRIOR YEAR. THE MELHAM MEDICAL CENTER FOUNDATION INC PO BOX 250 BROKEN BOW NE 68822 470795995 SUPPORTING THE OPERATIONS OF A CRITICAL ACCESS HOSPITAL NE 501(C)(3) LINE 12B, II JENNIE M MELHAM MEMORIAL MEDICAL CENTER INC 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0