CHEYENNE COUNTY HOSPITAL ASSOCIATION INC: Form 990, tax year 2024
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- Organization
- CHEYENNE COUNTY HOSPITAL ASSOCIATION INC (EIN 47-0408242)
- Tax period
- 2024-01-01 to 2024-12-31
- Filed
- 2025-11-14
- IRS object ID
- 202543189349306639
- Schema version
- 2024v5.2
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule H
- Schedule I
- Schedule J
- Schedule K
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2025-11-14T11:29:23-06:00 | ReturnTs |
| Tax Period End | 2024-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 450250958 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | EIDE BAILLY LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 18081 BURT ST STE 200 | AddressLine1Txt |
| City | OMAHA | CityNm |
| State Abbreviation | NE | StateAbbreviationCd |
| ZIP | 680224722 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2024-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 470408242 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CHEYENNE COUNTY HOSPITAL | BusinessNameLine1Txt |
| Business Name Line2 | ASSOCIATION INC | BusinessNameLine2Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | CHEY | BusinessNameControlTxt |
| Phone | 3082545825 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1000 POLE CREEK CROSSING | AddressLine1Txt |
| City | SIDNEY | CityNm |
| State Abbreviation | NE | StateAbbreviationCd |
| ZIP | 691620000 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | JASON PETIK | PersonNm |
| Person Title | CEO | PersonTitleTxt |
| Phone | 3082545825 | PhoneNum |
| Signature | 2025-11-13 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IRS Responsible Prty Info Curr | Yes (1) | IRSResponsiblePrtyInfoCurrInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | MEGAN L KOZIOL CPA | PreparerPersonNm |
| PTIN | P01544037 | PTIN |
| Phone | 4023302660 | PhoneNum |
| Preparation | 2025-11-13 | PreparationDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2024 | TaxYr |
| Build TS | 2025-03-06 01:10:19Z | BuildTS |
Form 990 IRS990
Doing Business As Name DoingBusinessAsName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SIDNEY REGIONAL MEDICAL CENTER | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | JASON PETIK | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1000 POLE CREEK CROSSING | AddressLine1Txt |
| City | SIDNEY | CityNm |
| State Abbreviation | NE | StateAbbreviationCd |
| ZIP | 691620000 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $88,587,675 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.SIDNEYRMC.COM | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1951 | FormationYr |
| Legal Domicile State | NE | LegalDomicileStateCd |
| Activity Or Mission | TO REVOLUTIONIZE HEALTHCARE SERVICES IN THE REGION. | ActivityOrMissionDesc |
| Voting Members Governing Body | 11 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 9 | VotingMembersIndependentCnt |
| Total Employee | 559 | TotalEmployeeCnt |
| Total Volunteers | 15 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $8,475,463 | PYContributionsGrantsAmt |
| CY Contributions Grants | $1,008,404 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $75,970,350 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $86,526,851 | CYProgramServiceRevenueAmt |
| PY Investment Income | $1,004,054 | PYInvestmentIncomeAmt |
| CY Investment Income | $722,210 | CYInvestmentIncomeAmt |
| PY Other Revenue | $162,002 | PYOtherRevenueAmt |
| CY Other Revenue | $231,124 | CYOtherRevenueAmt |
| PY Total Revenue | $85,611,869 | PYTotalRevenueAmt |
| CY Total Revenue | $88,488,589 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $17,200 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $49,500 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $43,466,926 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $48,067,499 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $34,775,578 | PYOtherExpensesAmt |
| CY Other Expenses | $39,019,959 | CYOtherExpensesAmt |
| PY Total Expenses | $78,259,704 | PYTotalExpensesAmt |
| CY Total Expenses | $87,136,958 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $7,352,165 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $1,351,631 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $107,255,886 | TotalAssetsBOYAmt |
| Total Assets EOY | $121,972,149 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $47,958,416 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $60,805,763 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $59,297,470 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $61,166,386 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | TO REVOLUTIONIZE HEALTHCARE SERVICES IN THE REGION. | MissionDesc |
| Significant New Program Srvc | Yes (1) | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $66,623,985 | ExpenseAmt |
| Grant | $49,500 | GrantAmt |
| Revenue | $65,705,832 | RevenueAmt |
| Desc | SIDNEY REGIONAL MEDICAL CENTER IS A NOT-FOR-PROFIT ACUTE CARE HOSPITAL WHICH PROVIDES INPATIENT, OUTPATIENT AND EMERGENCY ROOM CARE SERVICE TO PATIENTS IN AND AROUND SIDNEY, NEBRASKA AND THE REGION. IT ALSO OPERATES LONG-TERM CARE FACILITIES AND TWO PROVIDER-BASED RURAL HEALTH CLINICS IN SIDNEY, NEBRASKA. DURING THE CURRENT YEAR, SRMC ALSO BEGAN PROVIDING GROUND AMBULANCE SERVICES UPON EXIT OF THE FORMER SERVICE PROVIDER. | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $5,180,010 | ExpenseAmt |
| Revenue | $5,644,368 | RevenueAmt |
| Desc | THE EXTENDED CARE UNIT PROVIDED CARE FOR AN AVERAGE OF 48 PATIENTS DAILY DURING 2024. SRMC PROVIDED 17,661 RESIDENT DAYS OF CARE FOR IT'S RESIDENTS FROM THE CHEYENNE, DEUEL, KIMBALL AND SURROUNDING AREAS. | Desc |
Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $4,600,991 | ExpenseAmt |
| Revenue | $15,176,651 | RevenueAmt |
| Desc | IN 2024, THE HOSPITAL NURSING DEPARTMENT PROVIDED 2,048 PATIENT DAYS OF CARE, INCLUDING GENERAL INPATIENT, ICU PATIENTS AND SWING BED PATIENTS, AND DELIVERED 71 NEWBORNS FOR THE SEVEN COUNTY AREA THAT SIDNEY REGIONAL MEDICAL CENTER (SRMC) SERVES. SRMC HAD 4,436 PATIENTS SEEK CARE IN THE EMERGENCY DEPARTMENT DURING 2024 AND CARED FOR 351 OSERVATION PATIENTS WHO NEEDED CARE BUT DID NOT QUALIFY FOR INPATIENT SERVICES UNDER CMS RULES. | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expenses | $76,404,986 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (1) | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | 0 | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | Yes (1) | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | Yes (1) | TaxExemptBondsInd |
| Invest Tax Exempt Bonds | 0 | InvestTaxExemptBondsInd |
| Escrow Account | 0 | EscrowAccountInd |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuerInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | Yes (1) | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | 0 | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | Yes (1) | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 210 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 559 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | 0 | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | 0 | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 11 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 9 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | Yes (1) | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | 0 | MembersOrStockholdersInd |
| Election Of Board Members | 0 | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | 0 | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | KELLY UTLEY | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 3082545825 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1000 POLE CREEK CROSSING | AddressLine1Txt |
| City | SIDNEY | CityNm |
| State Abbreviation | NE | StateAbbreviationCd |
| ZIP | 69162 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | Yes (X) | InfoInScheduleOPartVIIInd |
Form990 Part VII Section A Form990PartVIISectionAGrp (18 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| JAMES POPOVICH MD | ||||||||
| PHYSICIAN AT LARGE | 39.00 | 1.00 | Yes (X) | $667,835 | $0 | $58,579 | ||
| APRIL SMITH MD | ||||||||
| CHIEF OF MEDICAL STAFF | 40.00 | 0.00 | Yes (X) | $606,380 | $0 | $50,829 | ||
| WILLIAM PILE | ||||||||
| CHAIRMAN | 4.00 | 0.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| TIM MILLER | ||||||||
| VICE CHAIRMAN | 4.00 | 0.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| KATHY NARJES | ||||||||
| SECRETARY | 4.00 | 0.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| JEFF ELLWANGER | ||||||||
| TREASURER | 4.00 | 0.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| STAN BELIEU | ||||||||
| MEMBER | 4.00 | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| NANCI MCCASLIN | ||||||||
| MEMBER | 4.00 | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| CLEM SCHUMACHER | ||||||||
| MEMBER | 4.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| JEFF HELLER | ||||||||
| MEMBER | 4.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| WILLIAM ROBINSON | ||||||||
| MEMBER | 4.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| KELLY UTLEY | ||||||||
| CFO | 40.00 | 0.00 | $236,322 | $0 | $36,012 | Yes (X) | ||
| JASON PETIK | ||||||||
| CEO | 40.00 | 0.00 | $413,730 | $0 | $0 | Yes (X) | ||
| KELLY CASEY MD | ||||||||
| SURGEON | 40.00 | 0.00 | $913,997 | $0 | $51,400 | Yes (X) | ||
| REBECCA L ALLARD MD | ||||||||
| PHYSICIAN | 40.00 | 0.00 | $800,348 | $0 | $54,929 | Yes (X) | ||
| SARA SHOLAR MD | ||||||||
| PHYSICIAN | 40.00 | 0.00 | $656,189 | $0 | $50,738 | Yes (X) | ||
| ARIEL SORIANO | ||||||||
| PHYSICIAN | 40.00 | 0.00 | $685,555 | $0 | $36,981 | Yes (X) | ||
| JOSHUA CALDWELL | ||||||||
| UROLOGIST | 40.00 | 0.00 | $715,163 | $0 | $23,999 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $5,695,519 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $363,467 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 80 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | Yes (1) | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| SAMPSON CONSTRUCTION CO INC | |||||
| 5825 SOUTH 14TH ST | LINCOLN | NE | 68512 | LTC CONSTRUCTION | $11,748,674 |
| RURAL PARTNERS IN MEDICINE LLC | |||||
| 11880 AIRPORT WAY | BROOMFIELD | CO | 80021 | PHYSICIAN SERVICES | $3,586,199 |
| UNIVERSITY OF COLORADO HEALTH | |||||
| 7901 E LOWRY BLVD SUITE 350 | DENVER | CO | 90230 | SYSTEM SUPPORT | $2,219,466 |
| BYTES COMPUTER & NETWORK | |||||
| 1620 BROADWAY SUITE D | SCOTTSBLUFF | NE | 69361 | SYSTEM SUPPORT | $2,191,236 |
| FUSION MEDICAL STAFFING LLC | |||||
| PO BOX 30131 | OMAHA | NE | 681031231 | TEMPORARY STAFFING SUPPORT | $1,132,540 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 47 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $304,480 | RelatedOrganizationsAmt |
| Government Grants | $703,861 | GovernmentGrantsAmt |
| All Other Contributions | $63 | AllOtherContributionsAmt |
| Total Contributions | $1,008,404 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| NET PATIENT SERVICE REVENUE | 621110 | $84,876,287 | $84,876,287 |
| 340B REVENUE | 621110 | $486,298 | $486,298 |
| SCHOOL REHAB REVENUE | 621110 | $168,476 | $168,476 |
Total Oth Program Service Rev TotalOthProgramServiceRevGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $995,790 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $995,790 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $86,526,851 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $821,296 | TotalRevenueColumnAmt |
| Exclusion | $821,296 | ExclusionAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $99,086 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | -$99,086 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$99,086 | TotalRevenueColumnAmt |
| Exclusion | -$99,086 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | CAFETERIA | Desc |
| Business | 722514 | BusinessCd |
| Total Revenue Column | $231,124 | TotalRevenueColumnAmt |
| Exclusion | $231,124 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $231,124 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $88,488,589 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $86,526,851 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $953,334 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $49,500 | TotalAmt |
| Program Services | $49,500 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,656,390 | TotalAmt |
| Program Services | $1,383,911 | ProgramServicesAmt |
| Management And General | $272,479 | ManagementAndGeneralAmt |
Comp Disqual Persons CompDisqualPersonsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $195,586 | TotalAmt |
| Program Services | $195,586 | ProgramServicesAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $34,719,458 | TotalAmt |
| Program Services | $30,736,922 | ProgramServicesAmt |
| Management And General | $3,982,536 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,002,292 | TotalAmt |
| Program Services | $899,400 | ProgramServicesAmt |
| Management And General | $102,892 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $8,189,686 | TotalAmt |
| Program Services | $6,178,371 | ProgramServicesAmt |
| Management And General | $2,011,315 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,304,087 | TotalAmt |
| Program Services | $1,689,555 | ProgramServicesAmt |
| Management And General | $614,532 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $413,730 | TotalAmt |
| Management And General | $413,730 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $99,344 | TotalAmt |
| Program Services | $102 | ProgramServicesAmt |
| Management And General | $99,242 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $66,095 | TotalAmt |
| Management And General | $66,095 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $10,946,963 | TotalAmt |
| Program Services | $10,511,576 | ProgramServicesAmt |
| Management And General | $435,387 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $281,288 | TotalAmt |
| Program Services | $262,007 | ProgramServicesAmt |
| Management And General | $19,281 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,867,591 | TotalAmt |
| Program Services | $3,300,216 | ProgramServicesAmt |
| Management And General | $567,375 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $133,610 | TotalAmt |
| Program Services | $75,109 | ProgramServicesAmt |
| Management And General | $58,501 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,074,365 | TotalAmt |
| Program Services | $957,677 | ProgramServicesAmt |
| Management And General | $116,688 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,183,068 | TotalAmt |
| Program Services | $1,168,289 | ProgramServicesAmt |
| Management And General | $14,779 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $214,516 | TotalAmt |
| Program Services | $116,023 | ProgramServicesAmt |
| Management And General | $98,493 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,253,873 | TotalAmt |
| Program Services | $1,137,096 | ProgramServicesAmt |
| Management And General | $116,777 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,723,791 | TotalAmt |
| Program Services | $4,399,869 | ProgramServicesAmt |
| Management And General | $323,922 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,162,149 | TotalAmt |
| Program Services | $127,015 | ProgramServicesAmt |
| Management And General | $1,035,134 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| MEDICAL SUPPLIES | $11,529,000 | $11,529,000 | |
| RECRUITING FEES | $917,185 | $885,675 | $31,510 |
| FOOD PRODUCTS | $497,934 | $497,934 | |
| MISCELLANEOUS | $306,704 | $47,055 | $259,649 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $348,753 | TotalAmt |
| Program Services | $257,098 | ProgramServicesAmt |
| Management And General | $91,655 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $87,136,958 | TotalAmt |
| Program Services | $76,404,986 | ProgramServicesAmt |
| Management And General | $10,731,972 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $571,758 | BOYAmt |
| EOY | $13,029,617 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $28,386,443 | BOYAmt |
| EOY | $13,227,112 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $12,073,997 | BOYAmt |
| EOY | $25,058,845 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $968,288 | BOYAmt |
| EOY | $0 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,019,859 | BOYAmt |
| EOY | $2,215,907 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,048,856 | BOYAmt |
| EOY | $1,429,203 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $97,098,786 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $43,056,071 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $42,834,005 | BOYAmt |
| EOY | $54,042,715 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,617,321 | BOYAmt |
| EOY | $9,314,384 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $268,382 | EOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,090,156 | BOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,645,203 | BOYAmt |
| EOY | $3,385,984 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $107,255,886 | BOYAmt |
| EOY | $121,972,149 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,732,154 | BOYAmt |
| EOY | $8,857,214 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $75,000 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,000,596 | BOYAmt |
| EOY | $6,532,333 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $28,536,399 | BOYAmt |
| EOY | $39,861,190 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,689,267 | BOYAmt |
| EOY | $5,480,026 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $47,958,416 | BOYAmt |
| EOY | $60,805,763 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows FASB117 | Yes (X) | OrganizationFollowsFASB117Ind |
No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $59,297,470 | BOYAmt |
| EOY | $61,166,386 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $59,297,470 | BOYAmt |
| EOY | $61,166,386 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $107,255,886 | BOYAmt |
| EOY | $121,972,149 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $1,351,631 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $517,285 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Info In Schedule O Part XII | Yes (X) | InfoInScheduleOPartXIIInd |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | Yes (1) | FederalGrantAuditRequiredInd |
| Federal Grant Audit Performed | Yes (1) | FederalGrantAuditPerformedInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | VolunteersInd |
| Paid Staff Or Management | 0 | PaidStaffOrManagementInd |
| Media Advertisements | 0 | MediaAdvertisementsInd |
| Mailings Members | 0 | MailingsMembersInd |
| Publications Or Broadcast | 0 | PublicationsOrBroadcastInd |
| Grants Other Organizations | 0 | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | 0 | DirectContactLegislatorsInd |
| Rallies Demonstrations | 0 | RalliesDemonstrationsInd |
| Other Activities | Yes (1) | OtherActivitiesInd |
| Other Activities | $7,999 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $7,999 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | 0 | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART II-B, LINE 1: | FormAndLineReferenceDesc |
| Explanation | A PORTION OF THE DUES PAID TO THE AMERICAN HOSPITAL ASSOCIATION (AHA) AND THE NEBRASKA HOSPITAL ASSOCIATION (NHA) ARE USED BY THOSE ORGANIZATIONS FOR LOBBYING ACTIVITIES. | ExplanationTxt |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | $92,500 | InvestmentCostOrOtherBasisAmt |
| Other Cost Or Other Basis | $1,947,968 | OtherCostOrOtherBasisAmt |
| Book Value | $2,040,468 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $68,734,086 | OtherCostOrOtherBasisAmt |
| Depreciation | $26,351,599 | DepreciationAmt |
| Book Value | $42,382,487 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $23,208,434 | OtherCostOrOtherBasisAmt |
| Depreciation | $15,686,823 | DepreciationAmt |
| Book Value | $7,521,611 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $3,115,798 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,017,649 | DepreciationAmt |
| Book Value | $2,098,149 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $54,042,715 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (3 entries)
| DescDesc | AmtAmt |
|---|---|
| DEFERRED COMPENSATION PLAN LIABILITY | $1,575,334 |
| ESTIMATED THIRD-PARTY PAYOR SETTLEMENTS | $2,066,648 |
| OTHER LIABILITIES | $1,838,044 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $5,480,026 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART X, LINE 2: | FormAndLineReferenceDesc |
| Explanation | THE ORGANIZATION ACCOUNTS FOR UNCERTAINTIES IN ACCOUNTING FOR INCOME TAX ASSETS AND LIABILITIES USING GUIDANCE INCLUDED IN FASB ASC 740, INCOME TAXES. THE ORGANIZATION RECOGNIZES THE EFFECT OF INCOME TAX POSITIONS ONLY IF THOSE POSITIONS ARE MORE LIKELY THAN NOT OF BEING SUSTAINED. AT DECEMBER 31, 2024 AND 2023, THE ORGANIZATION HAD NO UNCERTAIN TAX POSITIONS ACCRUED. | ExplanationTxt |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
| Percent100 | Yes (X) | Percent100Ind |
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
| Percent200 D | Yes (X) | Percent200DInd |
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | 0 | ExpensesExceedBudgetInd |
| Annual Community Bnft Report | 0 | AnnualCommunityBnftReportInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $300,610 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $300,610 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00340 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $9,543,728 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $8,815,950 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $727,778 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00840 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $9,844,338 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $8,815,950 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,028,388 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01180 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $10,088,776 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $6,828,442 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $3,260,334 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.03740 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $51,494 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $51,494 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00060 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $179,516 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $179,516 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00210 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $10,319,786 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $6,828,442 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $3,491,344 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.04010 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $20,164,124 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $15,644,392 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $4,519,732 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.05190 | TotalExpensePct |
Community Support CommunitySupportGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 120 | ActivitiesOrProgramsCnt |
| Persons Served | 1380 | PersonsServedCnt |
| Total Community Benefit Expns | $7,896 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $7,896 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00010 | TotalExpensePct |
Other Communtity Building Acty OtherCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 29 | ActivitiesOrProgramsCnt |
| Persons Served | 187 | PersonsServedCnt |
| Total Community Benefit Expns | $2,729 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $2,729 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 149 | ActivitiesOrProgramsCnt |
| Persons Served | 1567 | PersonsServedCnt |
| Total Community Benefit Expns | $10,625 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $10,625 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00010 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $1,650,708 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $198,085 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $30,162,882 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $32,189,152 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$2,026,270 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | Yes (X) | CostToChargeRatioInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (1) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CHEYENNE COUNTY HOSPITAL ASSOCIATION INC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1000 POLE CREEK CROSSING | AddressLine1Txt |
| City | SIDNEY | CityNm |
| State Abbreviation | NE | StateAbbreviationCd |
| ZIP | 69162 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | WWW.SIDNEYRMC.COM | WebsiteAddressTxt |
| State License | 150001 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Critical Access Hospital | Yes (X) | CriticalAccessHospitalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CHEYENNE COUNTY HOSPITAL ASSOCIATION INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | 0 | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | 0 | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (1) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Prior CHNA Impact | Yes (X) | PriorCHNAImpactInd |
| CHNA Conducted | 23 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | Yes (1) | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | Yes (1) | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | WWW.SIDNEYRMC.COM/REQUIRED-REGULATORY-POSTINGS/ | OwnWebsiteURLTxt |
| Other Website | Yes (X) | OtherWebsiteInd |
| Other Website URL | WWW.PPHD.ORG/PAGES/CHIP.HTML | OtherWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 23 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | WWW.SIDNEYRMC.COM/REQUIRED-REGULATORY-POSTINGS/ | StrategyWebsiteURLTxt |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 100.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 200.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| Residency Criteria | Yes (X) | ResidencyCriteriaInd |
| Other Criteria | Yes (X) | OtherCriteriaInd |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Provided Nonprofit Contact | Yes (X) | ProvidedNonprofitContactInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | WWW.SIDNEYRMC.COM/REQUIRED-REGULATORY-POSTINGS/ | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | WWW.SIDNEYRMC.COM/SERVICES/PATIENT-FINANCIAL-SERVICES/ | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | WWW.SIDNEYRMC.COM/REQUIRED-REGULATORY-POSTINGS/ | FAPSummaryOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| Notified FAP Copy Bill Display | Yes (X) | NotifiedFAPCopyBillDisplayInd |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| Other Publicity | Yes (X) | OtherPublicityInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| Provided Written Notice | Yes (X) | ProvidedWrittenNoticeInd |
| Made Effort Orally Notify | Yes (X) | MadeEffortOrallyNotifyInd |
| Processed FAP Application | Yes (X) | ProcessedFAPApplicationInd |
| Made Presumptive Elig Determ | Yes (X) | MadePresumptiveEligDetermInd |
| Other Actions Taken | Yes (X) | OtherActionsTakenInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Look Back Medicare Private | Yes (X) | LookBackMedicarePrivateInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (7 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| CHEYENNE COUNTY HOSPITAL ASSOCIATION INC | PART V, SECTION B, LINE 5: A MAPP STEERING COMMITTEE WAS FORMED, MADE UP OF REPRESENTATIVES FROM EACH OF THE NINE RURAL NEBRASKA HEALTH NETWORK HOSPITALS (SEE LIST OF MEMBERS IN LINE 6A). COMMITTEE MEMBERS PROVIDE GUIDANCE THROUGHOUT THE MAPP PROCESS AND ARE CHARGED WITH REVIEWING DATA AND PROGRESS ON THE CHOSEN PRIORITY AREAS, USING QUALITY IMPROVEMENT TO MODIFY IMPLEMENTATION PLANS AS NEEDED, AND SHARING RESULTS WITH STAKEHOLDERS. TWO NEW REPRESENTATIVES JOINED THE COMMITTEE: A REPRESENTATIVE FROM THE PANHANDLE PARTNERSHIP, SERVING AS A REPRESENTATIVE OF A VARIETY OF COMMUNITY-BASED ORGANIZATIONS, AND A REPRESENTATIVE FROM THE LOCAL ECONOMIC DEVELOPMENT DISTRICT, PANHANDLE AREA DEVELOPMENT DISTRICT (PADD).THE COMMUNITY HEALTH SURVEY WAS DISTRIBUTED TO PANHANDLE RESIDENTS IN OCTOBER AND NOVEMBER OF 2022 VIA PAPER AND ELECTRONIC SURVEYS. A COPY OF THE SURVEY CAN BE FOUND IN THE REGIONAL CHA. PAPER COPIES OF THE SURVEY WERE DISTRIBUTED BY HOSPITALS AND COMMUNITY-BASED ORGANIZATIONS. THE ELECTRONIC COPY WAS ADMINISTERED USING QUALTRICS AND SHARED ONLINE BY WEBSITE, SOCIAL MEDIA, AND EMAIL BY PPHD, LOCAL HOSPITALS, AND OTHER COMMUNITY ORGANIZATIONS. COUNTS AND PERCENTAGES FROM THE SURVEY RESPONSES WERE CALCULATED USING MICROSOFT EXCEL. THE INFORMATION INCLUDES RESPONSES FROM CHEYENNE COUNTY RESIDENTS AND THOSE WHO INDICATED THAT SIDNEY REGIONAL MEDICAL CENTER WAS THEIR PRIMARY HEALTHCARE FACILITY. 56 PEOPLE WERE CAPTURED IN THIS GROUP. |
| CHEYENNE COUNTY HOSPITAL ASSOCIATION INC | PART V, SECTION B, LINE 6A: THE FOLLOWING IS A LIST OF HOSPITALS THAT PARTICIPATED IN THE CHNA:-BOX BUTTE GENERAL HOSPITAL, ALLIANCE, NE-MORRILL COUNTY HOSPITAL, BRIDGEPORT, NE-REGIONAL WEST MEDICAL CENTER, SCOTTSBLUFF, NE-CHADRON COMMUNITY HOSPITAL, CHADRON, NE-REGIONAL WEST GARDEN COUNTY, OSHKOSH, NE-GORDON MEMORIAL HOSPITAL, GORDON, NE-KIMBALL HEALTH SERVICES, KIMBALL, NE-PERKINS COUNTY HEALTH SERVICES, GRANT, NE |
| CHEYENNE COUNTY HOSPITAL ASSOCIATION INC | PART V, SECTION B, LINE 6B: -RURAL NEBRASKA HEALTHCARE NETWORK-PANHANDLE PARTNERSHIP-SCOTTS BLUFF COUNTY HEALTH DEPARTMENT-NEBRASKA DEPARTMENT OF HEALTH AND HUMAN SERVICES |
| CHEYENNE COUNTY HOSPITAL ASSOCIATION INC | PART V, SECTION B, LINE 11: DURING THE LATEST CHNA PROCESS, THE FOLLOWING NEEDS WERE IDENTIFIED:1. MENTAL/BEHAVIORAL HEALTH2. CHILDCARE3. COMMUNITY EDUCATIONOTHER AREA NEEDS THAT ARE NOT BEING ADDRESSED AT THIS TIME DUE TO SRMC NOT HAVING THE RESOURCES TO ADDRESS THESE NEEDS AT THIS TIME:1. NOT ENOUGH OR NO HEALTH INSURANCE2. SUBSTANCE ABUSE3. AFFORDABLE HOUSINGTAKING THE SIGNIFICANT NEEDS IDENTIFIED INTO ACCOUNT, THE FOLLOWING GOALS HAVE BEEN SET TO ADDRESS EACH NEED:FOCUS AREA 1: BEHAVIORAL HEALTH : IMPROVE ACCESS TO MENTAL HEALTH CARE1. GROW SRMC TELEPSYCH PROGRAM. PARTNER WITH BRYAN HEALTH AND BOYS TOWN TO PROVIDE TELEPSYCH SERVICE FOR COMMUNITY MEMBERS. COLLABORATE WITH REGIONAL HOSPITALS TO GROW TELEPSYCH CAPACITY. MEET WITH SCHOOL MENTAL HEALTH TEAMS TO SHARE RESOURCES.2. GROW SRMC RELATIONSHIPS WITH COMMUNITY SCHOOLS. KRISTEN ROSE GOES TO SCHOOLS IN THE IMMEDIATE AND SURROUNDING AREAS TO PROVIDE COMET TRAINING. QPR TRAINING CONTINUES WITH KRISTEN. THE BEHAVIORAL HEALTH DEPARTMENT HAS RAISED AWARENESS BY ENCOURAGING THE USE OF "MY COMPANION" APP; AN APP THAT GIVES TEENS AN OUTLET TO EXPRESS AND TRACK THEIR EMOTIONS AND CONNECT TO EMERGENCY HOTLINES IF NEEDED. AS WELL AS 988 LIFE LINE CRISIS CENTER. EATING DISORDER EDUCATION AND AWARENESS REMAINS A TOPIC THAT KRISTIN EDUCATES ON AT BHECN BEHAVIORAL HEALTH CONFERENCES. FOCUS AREA 2: IMPROVE QUALITY CHILD CARE1. CREATE DIAPER AND FORMULA PANTRIES. 2. PARTICIPATE IN COMMUNITY CHILD WORKING GROUPS TO GATHER RESOURCES TO SUPPORT THE DEVELOPMENT OF PROGRAMS. SRMC WOULD ASSIST IN DETERMINING A DONATION SITE. SRMC WOULD SUPPORT LOCAL DAYCARES. PROVIDE CPR TRAINING TO DAYCARE PROVIDERS. JEANNE OGDEN AND BROOKE STEFFENS PROVIDE SAFE SITTER CLASSES, SAFE AT HOME AND A SIMILAR PROGRAM FOR GRANDPARENTS WHO CARE FOR CHILDREN. FUTURE PLANS WILL BE DETERMINED TO PARTNER WITH KIDS KORNER FOR POTENTIAL DIAPER/FORMULA PANTRY. FOCUS AREA 3: IMPROVE COMMUNITY EDUCATION ABOUT HEALTH AND RESOURCES1. DEVELOP RELATIONSHIPS WITH COMMUNITY ORGANIZATIONS WITH THE COMMUNITY NAVIGATOR.2. BUILD THE HOSPITAL'S POSITION OF BEING A GOOD SOURCE OF HEALTH INFORMATION FOR THE COMMUNITY. THE COMMUNITY NAVIGATOR WILL ATTEND COMMUNITY MEETINGS WITH OTHER ORGANIZATIONS AND SHARE RESOURCES, PROMOTE HEALTH AWARENESS MONTHS AND SHARE NUTRITIONAL INFORMATION. MALARIE GABEL IS REACHING OUT TO AREA BUSINESSES TO OFFER PRE EMPLOYMENT EXAM OPPORTUNITIES THROUGH COMMUNITY HEALTH. A NEW RELATIONSHIP HAS BEEN ESTABLISHED WITH CLEAN HARBORS IN KIMBALL.DURING THE YEAR, THE FOLLOWING ACTIONS WERE TAKEN TO ACHIEVE THE GOALS SET ABOVE: QUARTER 1SRMC WAS RECOGNIZED AS A HOSPITAL BREASTFEEDING CHAMPION. THE NATIONAL DIABETES PREVENTION PROGRAM (NDPP) STARTED OVER IN JANUARY. THEY MET ONCE A WEEK WITH 5-10 ATTENDEES EVERY WEEK. SRMC PROMOTED HEART HEALTH MONTH IN FEBRUARY. THE NEBRASKA BEEF COUNCIL PRESENTED TO THE NDPP, CARDIAC REHAB AND PT/OT PATIENTS ON HOW TO CHOOSE THE HEALTHIEST CUTS OF MEAT AND HOW TO PREPARE IT. THE REHAB DEPT WENT TO DIFFERENT SCHOOLS IN THE AREA AND DID ATHLETIC ASSESSMENTS ON 10 DIFFERENT OCCASIONS. RWMC BLOOD CENTER COLLECTED A TOTAL OF 44 UNITS AT THE BLOOD DRIVE. THE SAFE SITTER CLASS WAS OFFERED IN MARCH AND HAD 5 PARTICIPANTS. MARCH WAS COLORECTAL CANCER AWARENESS MONTH. THE MARKETING DEPT. ADVERTISED THE FREE TEST KITS THAT ARE AVAILABLE FOR ELIGIBLE PATIENTS THAT CAN BE PICKED UP AT THE LAB DEPT. THE REHAB DEPT. PUT ON A PARKINSON'S SUPPORT GROUP IN JANUARY. 300 PATIENTS UTILIZED DIRECT ACCESS TESTING. MONTHLY BLOOD PRESSURE CHECKS WERE DONE AT OUR 5 REGULARLY SCHEDULED SITES WITH A TOTAL OF 98 BLOOD PRESSURES TAKEN. MET WITH COMMUNITY OUTREACH COORDINATOR TO SEE ABOUT SCHEDULING ADDITIONAL SITES. KRISTEN ROSE DID BEHAVIORAL HEALTH EDUCATION WITH 40 KIDS AT THE SIDNEY MIDDLE SCHOOL. THE MRI MACHINE UPDATE WAS COMPLETED IN MARCH. KRISTEN PRESENTED ON NATURE AND MENTAL WELLBEING TO 47 PARTICIPANTS. WE HAVE PROVIDED SERVICES TO 8 NEW EMPLOYEES FROM CLEAN HARBORS IN QUARTER 1.QUARTER 2IN APRIL, THE NATIONAL DIABETES PREVENTION PROGRAM DROPPED TO EVERY OTHER WEEK AND CONSISTENTLY HAD 6 PARTICIPANTS. SRMC HAD A BOOTH AT THE SPRING EXPO. VARIOUS DEPARTMENTS TOOK SHIFTS AT THE BOOTH TO OFFER A VARIETY OF INFORMATION AND RESOURCES. LIFE ASSIST DEVICES WERE INSTALLED FOR 9 INDIVIDUALS IN QUARTER 2. SRMC PARTNERED WITH YOMINGO, AN ONLINE PARENTHOOD EDUCATION PROGRAM. SRMC HELPED CELEBRATE NEBRASKA PUBLIC TRANSIT WEEK BY SPONSORING A FREE RIDE FRIDAY ON APRIL 26TH FOR OUR COMMUNITY MEMBERS. A SAFE AT HOME AND SAFE SITTER CLASSES WERE OFFERED BY JEANNE OGDEN AND BROOKE STEFFENS. SUN SAFETY INFORMATION WAS SHARED ON SOCIAL MEDIA. SUNSCREEN WAS PROVIDED TO STAFF MEMBERS. IN JUNE, A FREE MONTHLY BLOOD PRESSURE CLINIC WAS STARTED AT SRMC IN THE COFFEE CURE GIVING US 6 BLOOD PRESSURE CLINIC SITES. A TOTAL OF 179 BLOOD PRESSURES WERE TAKEN IN QUARTER 2. WE HAVE PROVIDED SERVICES TO 5 NEW EMPLOYEES FROM CLEAN HARBORS. RWMC BLOOD CENTER COLLECTED A TOTAL OF 33 UNITS AT THE 2ND BLOOD DRIVE FOR THE YEAR. JEANNE DID A CPR CLASS IN PEETZ FOR KIDS AND COACHES. THERE WERE 16 PARTICIPANTS. THE LAB DEPARTMENT HAD 315 DIRECT ACCESS PATIENTS IN QUARTER 2. KRISTEN HAS 6 ENROLLED IN SENIOR SOCIAL. SHE PROVIDED MENTAL HEALTH EDUCATION TO 5 PEOPLE AT THE BHECN PANHANDLE. QUARTER 3 IN JULY, THE NATIONAL DIABETES PREVENTION PROGRAM DROPPED TO ONCE A MONTH AND CONTINUES TO HAVE 4-8 PARTICIPANTS. KRISTEN PROVIDED STRESS MANAGEMENT EDUCATION TO WOMEN IN AG IN SIDNEY WHERE 50 INDIVIDUALS WERE PRESENT AND DID PTSD EDUCATION FOR PLAINSWEST CASA WITH 8 PARTICIPANTS. IN JULY, WE ADDED A 7TH BLOOD PRESSURE CLINIC SITE IN DALTON. A TOTAL OF 261 BLOOD PRESSURES WERE TAKEN IN QUARTER 3. LIFE ASSIST DEVICES WERE INSTALLED FOR 10 INDIVIDUALS IN QUARTER 3. WE HAVE PROVIDED SERVICES TO 13 NEW CLEAN HARBORS EMPLOYEES. RWMC BLOOD CENTER COLLECTED A TOTAL OF 29 UNITS AT THE 3RD BLOOD DRIVE FOR THE YEAR. THE LAB DEPARTMENT HAD 288 DIRECT ACCESS PATIENTS IN THE 3RD QUARTER. KRISTEN PUT ON TWO COMET COMMUNITY TRAININGS AT THE WESTERN NEBRASKA SCHOOL MENTAL HEALTH CONFERENCE. SHE HAD A TOTAL OF 14 PARTICIPANTS. PT ATTENDED 11 SPORTING EVENTS. KRISTEN TRAVELED TO DOANE TO DO MH EDUCATION WITH 14 INDIVIDUALS. THE REHAB DEPT. HELD 2 PARKINSONS SUPPORT GROUP SESSIONS.QUARTER 4 JAMIE PUT ON A SCRUB CAMP IN OCTOBER. COMMUNITY HEALTH ORGANIZED AN EMERGENCY SHORTAGE BLOOD DRIVE IN OCTOBER. MALARIE PARTNERED WITH PRICE CREAM TO GIVE A PINT OF ICE CREAM FOR EVERY DONOR WHO GIVES A PINT OF BLOOD. IN ADDITION TO THE REGULARLY SCHEDULED BLOOD DRIVE IN DECEMBER, THE BLOOD CENTER COLLECTED A TOTAL OF 97 UNITS FOR THE 4TH QUARTER. THE NATIONAL DIABETES PREVENTION PROGRAM CONTINUED TO MEET MONTHLY . THE PROGRAM ENDED ON DECEMBER 4TH WITH 5 PARTICIPANTS SUCCESSFULLY COMPLETING THE PROGRAM. A TOTAL OF 254 ONSITE BLOOD PRESSURES WERE TAKEN IN QUARTER 4. LIFE ASSIST DEVICES WERE INSTALLED FOR 6 INDIVIDUALS. WE PROVIDED SERVICES TO 6 NEW EMPLOYEES FOR CLEAN HARBORS. THE LAB DEPARTMENT HAD 288 DIRECT ACCESS PATIENTS IN THE 4TH QUARTER. KRISTEN HELD A MATERNAL MH EDUCATION CLASS FOR SIDNEY/MIERA MOON COLLECTIVE WITH 6 PARTICIPANTS. PT ATTENDED 3 SPORTING EVENTS. COMMUNITY HEALTH ORGANIZED A DIAPER DRIVE IN DECEMBER AND HAD 30 FAMILIES RECEIVE DIAPERS, WIPES, AND/OR FORMULA. |
| CHEYENNE COUNTY HOSPITAL ASSOCIATION INC | PART V, SECTION B, LINE 13H: PATIENTS MAY BE CONSIDERED FOR CHARITY CARE FOR MEDICALLY NECESSARY SERVICES. WHEN IN QUESTION, MEDICALLY NECESSARY SERVICES SHALL BE DETERMINED BY THE EXAMINING PHYSICIAN. PATIENTS MUST BE RESIDENTS OF CHEYENNE OR DEUEL COUNTY AND/OR A 20 MILE RADIUS OF SIDNEY REGIONAL MEDICAL CENTER. THIS MAY BE WAIVED FOR PATIENTS ADMITTED VIA THE EMERGENCY DEPARTMENT OR AT THE DISCRETION OF ADMINISTRATION.SPECIFICALLY IDENTIFIED CASES MAY BE PRESUMED ELIGIBLE FOR CHARITABLE ASSISTANCE AND CLASSIFIED WITHOUT A COMPLETED APPLICATION OR ASSESSMENT. EXAMPLES OF THESE CASES ARE: PATIENT IS DECEASED WITH NO KNOWN ESTATE OR SPOUSE; PATIENTS WITH CURRENT ELIGIBILITY UNDER COUNTY OR STATE MEDICAL INDIGENT SERVICES ADMINISTERED BY COUNTY OR STATE FACILITIES; PATIENT IS HOMELESS OR HAS BEEN IDENTIFIED AS BEING WITHOUT RESOURCES BASED ON PREVIOUS ACCOUNT ACTION AND CONTACT WITH THE SRMC STAFF. |
| CHEYENNE COUNTY HOSPITAL ASSOCIATION INC | PART V, SECTION B, LINE 16J: THE POLICY IS REFERENCED IN BILLING LETTERS AND IS ORALLY COMMUNICATED DURING REGISTRATION OR ADMISSIONS AND THROUGH THE PATIENT FINANCIAL SERVICES FOLLOW UP PROCESSES, INCLUDING PATIENT ADVOCACY CONVERSATIONS. THE POLICY IS AVAILABLE IN ADMISSIONS AND WAITING AREAS AT THE HOSPITAL. SIGNAGE IS POSTED IN WAITING AREAS REFERRING PATIENTS TO THE WEBSITE TO VIEW THE POLICY. ADDITIONALLY, THE PLAIN LANGUAGE SUMMARY IS INCLUDED IN ALL DISCHARGE PACKETS WITH REFERENCE TO THE WEBSITE OR FINANCIAL SERVICES TO OBTAIN THE ENTIRE POLICY. |
| CHEYENNE COUNTY HOSPITAL ASSOCIATION INC | PART V, SECTION B, LINE 20E: SRMC ATTEMPTS OTHER NON-EXTRAORDINARY COLLECTION EFFORTS SUCH AS: SUBSEQUENT MONTHLY BILLINGS, COLLECTION LETTERS AND/OR TELEPHONE CALLS CONSTITUTING A GENUINE EFFORT TO HELP OUR PATIENTS TO ARRANGE FOR PAYMENT IF THEY CAN AFFORD IT. DOCUMENTATION OF THESE EFFORTS WILL BE MADE BY NOTATING PATIENT ACCOUNTS AND DOCUMENTING STATEMENTS AND REPORTS OF TELEPHONE CALLS AND PERSONAL CONTACTS. FOR ELECTIVE PROCEDURES, PATIENTS ARE ASKED TO MEET WITH A FINANCIAL COUNSELOR BEFORE THE PROCEDURE TO SET UP PAYMENT ARRANGEMENTS. SRMC DOES OFFER LOANS TO PATIENTS WITH NO COLLATERAL FROM THE PATIENTS. SRMC ALSO SECURES FINANCING FOR THE PATIENTS IF THEY DO NOT QUALIFY FOR CHARITY CARE. SRMC DOES NOT REQUIRE PATIENTS WHO QUALIFY FOR CHARITY CARE UNDER THE FINANCIAL ASSISTANCE POLICY TO OBTAIN A LOAN TO PAY THE ACCOUNT. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 4 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (4 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| 1 - SIDNEY REG'L MEDICAL CTR EXTENDED CARE | ||||
| 1855 GREENWOOD ROAD | SIDNEY | NE | 69162 | LONG TERM CARE FACILITY |
| 2 - SLOAN ESTATES ASSISTED LIVING | ||||
| 2550 CRAIG AVENUE | SIDNEY | NE | 69162 | ASSISTED LIVING |
| 3 - SIDNEY REG'L MEDICAL CTR WALK IN CLINIC | ||||
| 610 GLOVER ROAD SUITE 4 | SIDNEY | NE | 69162 | WALK IN CLINIC |
| 4 - SIDNEY REGIONAL MEDICAL CENTER EMS | ||||
| 1000 POLE CREEK CROSSING | SIDNEY | NE | 69162 | EMS AMBULANCE SERVICES |
Supplemental Information Detail SupplementalInformationDetail (12 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 3C: | IN ADDITION TO FEDERAL POVERTY GUIDELINES, THE HOSPITAL USES ASSET LEVEL, MEDICAL INDIGENCY, UNDERINSURANCE STATUS AND RESIDENCY TO DETERMINE ELIGIBILITY FOR FREE OR DISCOUNTED CARE. SPECIFICALLY IDENTIFIED CASES MAY BE PRESUMED ELIGIBLE FOR CHARITABLE ASSISTANCE AND CLASSIFIED WITHOUT A COMPLETED APPLICATION OR ASSESSMENT. EXAMPLES OF THESE CASES ARE: PATIENT IS DECEASED WITH NO KNOWN ESTATE OR SPOUSE, PATIENTS WITH CURRENT ELIGIBILITY UNDER COUNTY OR STATE MEDICAL INDIGENT SERVICES ADMINISTERED BY COUNTY OR STATE FACILITIES, PATIENT IS HOMELESS OR HAS BEEN IDENTIFIED AS BEING WITHOUT RESOURCES BASED ON PREVIOUS ACCOUNT ACTION AND CONTACT WITH STAFF. |
| PART I, LINE 7: | CHARITY CARE EXPENSE WAS CONVERTED TO COST ON LINE 7A BASED ON AN OVERALL COST-TO-CHARGE RATIO ADDRESSING ALL PATIENT SEGMENTS. UNREIMBURSED MEDICAID ON LINE 7B WAS CALCULATED USING THE COSTING METHODS TO PREPARE THE COST REPORTS. COMMUNITY HEALTH IMPROVEMENT SERVICES, LINE 7E, HEALTH PROFESSIONS EDUCATION, LINE 7F, AND CONTRIBUTIONS FOR COMMUNITY BENEFIT, LINE 7I, ARE REPORTED BASED ON ACTUAL EXPENSES REPORTED IN THE GENERAL LEDGER. |
| PART II, COMMUNITY BUILDING ACTIVITIES: | COMMUNITY BUILDING ACTIVITIES INCLUDE THERAPISTS AVAILABLE AT SPORTING EVENTS AND COMMUNITY CENTERS, AS WELL AS WELLNESS CAMPAIGNS IN COOPERATION WITH THE COMMUNITY CENTER. OTHER ACTIVITIES INCLUDE BLOOD DRAWS, BLOOD PRESSURE SCREENINGS, DIABETES PREVENTION PROGRAMS AND MULTIPLE SMALLER COMMUNITY EDUCATION PROGRAMS THROUGH RADIO INTERVIEWS WITH HEALTH PROFESSIONALS. |
| PART III, LINE 2: | THE AMOUNT ON LINE 2 REPRESENTS IMPLICIT PRICE CONCESSIONS. THE ORGANIZATION DETERMINES ITS ESTIMATE OF IMPLICIT PRICE CONCESSIONS BASED ON HISTORICAL COLLECTION EXPERIENCE WITH VARIOUS CLASSES OF PATIENTS AND RESIDENTS. |
| PART III, LINE 3: | THE ESTIMATED AMOUNT OF THE ORGANIZATION'S IMPLICIT PRICE CONCESSIONS ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S CHARITY CARE POLICY IS CALCULATED BASED ON AN APPROXIMATE 12% OF INDIVIDUALS LIVING BELOW THE POVERTY LEVEL IN THE SERVICE AREA. |
| PART III, LINE 4: | THE FOOTNOTE TO THE ORGANIZATION'S FINANCIAL STATEMENTS THAT DESCRIBES IMPLICIT PRICE CONCESSIONS IS LOCATED IN FOOTNOTE 1 ON PAGES 13 AND 14 OF THE ATTACHED FINANCIAL STATEMENTS. |
| PART III, LINE 8: | THE ENTIRE MEDICARE SHORTFALL IS CONSIDERED A COMMUNITY BENEFIT. SERVICES ARE PROVIDED TO PATIENTS UNDER THE MEDICARE PROGRAM EVEN THOUGH THE HOSPITAL KNOWS THEY WILL NOT RECOVER ALL OF THE COSTS FROM PROVIDING THE SERVICES. THIS PROGRAM IS CONSIDERED SUBSIDIZED BY THE HOSPITAL AND OTHER PAYORS. PATIENTS RELY ON THESE SERVICES FOR THEIR HEALTH AND WELL-BEING AND ARE ESSENTIAL FOR THEIR ACCESS TO HEALTHCARE. TOTAL REVENUE RECEIVED FROM MEDICARE IS THE GROSS REIMBURSEMENT PLUS SETTLEMENT. BOTH TOTAL REVENUE RECEIVED FROM MEDICARE AND THE MEDICARE ALLOWABLE COSTS ARE REPORTED FROM THE MEDICARE COST REPORT. THE MEDICARE COST REPORT IS COMPLETED BASED ON THE RULES AND REGULATIONS SET FORTH BY CENTERS FOR MEDICARE AND MEDICAID SERVICES. |
| PART III, LINE 9B: | COLLECTION EFFORTS SHALL BE SUSPENDED ONCE A FAP APPLICATION HAS BEEN SUBMITTED AND WILL REMAIN SO UNTIL ELIGIBILITY IS DETERMINED. AN ADDITIONAL 30 DAYS SHALL BE GIVEN IF AN APPLICATION IS INCOMPLETE OR MISSING REQUESTED DOCUMENTATION, IN ORDER TO PROVIDE TIME TO RECTIFY MISSING INFORMATION OR UNTIL ELIGIBILITY CAN BE DETERMINED. PATIENTS HAVE 240 DAYS FROM THE DATE OF THE FIRST POST-DISCHARGE BILLING STATEMENT TO APPLY FOR FAP. IF THEY QUALIFY, THEY CAN'T BE CHARGED MORE THAN AMOUNTS GENERAL BILLED CALCULATION. FOR FAP ELIGIBLE PATIENTS, THIS INCLUDES ACCOUNTS THAT HAVE PREVIOUSLY BEEN SENT TO COLLECTION.SRMC DOES NOT ENGAGE IN EXTRAORDINARY COLLECTION ACTIONS AGAINST AN INDIVIDUAL TO OBTAIN PAYMENT FOR CARE BEFORE MAKING REASONABLE EFFORTS TO DETERMINE WHETHER THE INDIVIDUAL IS ELIGIBLE FOR FINANCIAL ASSISTANCE UNDER THIS POLICY. REASONABLE EFFORTS BY SRMC INCLUDE WRITTEN NOTIFICATION AT ADMISSIONS ND/OR PRIOR TO COLLECTION EFFORTS WHERE PATIENTS ARE ADVISED OF FINANCIAL ASSISTANCE OPTIONS. IN ADDITION, WRITTEN AND/OR VERBAL COMMUNICATION DURING FINANCIAL ADVISEMENT AND PRE-COLLECTION PROCESS SHALL INCLUDE FINANCIAL ASSISTANCE AS A PAYMENT OPTION, FINANCIAL ASSISTANCE INFOMRAITON IS ALSO INCLUDED IN WRITTEN NOTIFICATION ON BILLING STATEMENTS AND PRE-COLLECTION NOTICES. WHEN A PATIENT IS IDENTIFIED ON A PRE-COLLECTION REPORT, REASONABLE ATTEMPTS SHALL BE MADE TO CONTACT THE PATIENT TO ADVISE THEM OF FINANCIAL ASSISTANCE BEFORE THE ACCOUNT IS TURNED IN FOR COLLECTION. |
| PART VI, LINE 2: | COMMUNITY NEEDS ARE DETERMINED USING PUBLIC OPINION, PATIENT SATISFACTION RECOMMENDATIONS, BOARD AND LEADERSHIP EXPERIENCE, COMMUNICATIONS WITH COMMUNITY MEMBERS, AND PHYSICIAN INPUT. FUTURE MEASUREMENTS OF HEALTH DATA MINED FROM CLAIMS SUBMISSIONS WILL BE USED TO FURTHER ANALYZE THE NEEDS OF THE COMMUNITY. |
| PART VI, LINE 3: | THE FINANCIAL ASSISTANCE POLICY IS REFERENCED IN BILLING LETTERS AND IS ORALLY COMMUNICATED DURING REGISTRATION OR ADMISSIONS AND THROUGH THE PATIENT FINANCIAL SERVICES FOLLOW UP PROCESSES, INCLUDING PATIENT ADVOCACY CONVERSATIONS. THE POLICY IS AVAILABLE IN ADMISSIONS AND WAITING AREAS AT THE HOSPITAL. SIGNAGE IS POSTED IN WAITING AREAS REFERRING PATIENTS TO THE WEBSITE TO REVIEW THE POLICY. ADDITIONALLY, A PLAIN LANGUAGE SUMMARY IS INCLUDED IN ALL DISCHARGE PACKETS WITH REFERENCE TO THE WEBSITE OR FINANCIAL SERVICES TO OBTAIN THE ENTIRE POLICY. AT THE POINT OF REGISTRATION, A PATIENT'S INSURED STATUS IS DETERMINED. PATIENTS WHO ARE UNDERINSURED OR UNINSURED RECEIVE COUNSELING THROUGH THE HOSPITAL'S PATIENT ADVOCATE AND/OR A MEMBER OF THE FINANCIAL SERVICES OR REGISTRATION STAFF SERVING AS A FINANCIAL COUNSELOR. INFORMATION IS CONVEYED TO THE PATIENT OR THE GUARANTOR REGARDING MEDICAID AND MEDICARE, AS WELL AS CHARITY CARE PROVIDED BY THE HOSPITAL. ADDITIONAL COUNSELING IS PROVIDED AFTER DISMISSAL WHEN THE PROACTIVE APPROACH IS UNSUCCESSFUL. SOCIAL SERVICES PERSONNEL AND PATIENT FINANCIAL COUNSELORS MEET WITH PATIENTS INDIVIDUALLY WHEN NEEDED REGARDING THEIR COVERAGE IN AN ATTEMPT TO DETERMINE ELIGIBILITY FOR FINANCIAL ASSISTANCE AND OTHER MEANS FOR THE INDIVIDUALS. |
| PART VI, LINE 4: | MOST OF THE AREA THAT THE HOSPITAL SERVES IS LOCATED IN CHEYENNE COUNTY WHICH HAS A POPULATION OF 9,541 PEOPLE AND IS MOSTLY A RURAL AREA. THE CITIES OF SIDNEY, LODGEPOLE, POTTER, DALTON, GURLEY AND SUNOL ARE LOCATED WITHIN THE COUNTY AND ARE GENERALLY WITHIN APPROXIMATELY 30 MILES FROM THE HOSPITAL. ACCORDING TO THE US CENSUS BUREAU, THE 2023 DEMOGRAPHIC IS APPROXIMATELY 94.4% CAUCASIAN. THE MEDIAN HOUSEHOLD INCOME IN CHEYENNE COUNTY IS $54,038 WITH A POVERTY RATE OF 12.0%. THE PERCENTAGE OF PEOPLE UNDER AGE 65 WHO ARE UNINSURED IS 7.6%. SIDNEY REGIONAL MEDICAL IS THE ONLY HOSPITAL SERVING THIS AREA. |
| PART VI, LINE 5: | THE MAJORITY OF THE ORGANIZATION'S GOVERNING BODY IS COMPRISED OF PERSONS WHO RESIDE IN THE ORGANIZATION'S PRIMARY SERVICE AREA. THE ORGANIZATION EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN ITS COMMUNITY. IN ADDITION TO THE ACTIVITIES ADDRESSED IN THE CHNA REPORT, THE HOSPITAL SUPPORTED THE COMMUNITY THROUGH ACTIVITIES SUCH AS THERAPISTS AVAILABLE AT SPORTING EVENTS AND THE COMMUNITY CENTER AND WELLNESS CAMPAIGNS IN COOPERATION WITH THE COMMUNITY CENTER. OTHER ACTIVITIES INCLUDE COMMUNITY BLOOD DRAWS, BLOOD PRESSURE SCREENINGS, DIABETES PREVENTION PROGRAMS AND MULTIPLE SMALLER COMMUNITY EDUCATION PROGRAMS THROUGH RADIO INTERVIEWS WITH HEALTH PROFESSIONALS. |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (1) | GrantRecordsMaintainedInd |
Recipient Table RecipientTable (3 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | Recipient EINRecipientEIN | Cash GrantCashGrantAmt | Non Cash AssistanceNonCashAssistanceAmt | Purpose Of GrantPurposeOfGrantTxt | IRC SectionIRCSectionDesc |
|---|---|---|---|---|---|---|---|---|
| DICKEY AND ASSOCIATES AUCTIONEERS | ||||||||
| 1616 BIRCH STREET | SIDNEY | NE | 69162 | 822544780 | $8,500 | $0 | YOUTH LIVESTOCK SPONSORSHIP | |
| THE CATTLEMAN'S BALL | ||||||||
| 4834 ROAD T | DAVENPORT | NE | 68335 | 911812186 | $21,000 | $0 | ANNUAL DONATION | 501(C)(3) |
| SIDNEY HIGH SCHOOLS | ||||||||
| 1101 21ST AVE | SIDNEY | NE | 69162 | 476001927 | $10,000 | $0 | SIDNEY HS PARTNERSHIP AGREEMENT | GOVERNMENTAL ENTITY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 2 | Total501c3OrgCnt |
| Total Other Org | 1 | TotalOtherOrgCnt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 2: | FormAndLineReferenceDesc |
| Explanation | THE BOARD OF DIRECTORS MUST APPROVE, BY A MAJORITY VOTE OF THE QUORUM IN ATTENDANCE, THE DONATION TO THE ORGANIZATION OR GOVERNMENTAL ENTITY. DURING THE FOLLOWING 12 TO 24 MONTHS AFTER THE DONATION IS DISTRIBUTED, CONTINUED MONITORING OF THE PROJECT OR DONATION RESTRICTIONS, IF APPLICABLE, SHALL BE REPORTED TO THE BOARD OF DIRECTORS. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| First Class Or Charter Travel | Yes (X) | FirstClassOrCharterTravelInd |
| Housing Allowance Or Residence | Yes (X) | HousingAllowanceOrResidenceInd |
| Written Policy Ref T And E Expnss | Yes (1) | WrittenPolicyRefTAndEExpnssInd |
| Substantiation Required | Yes (1) | SubstantiationRequiredInd |
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (9 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| KELLY CASEY MD | ||||||||||||||
| SURGEON | $629,966 | $0 | $284,031 | $0 | $0 | $0 | $14,453 | $0 | $37,097 | $0 | $965,547 | $0 | $0 | $0 |
| REBECCA L ALLARD MD | ||||||||||||||
| PHYSICIAN | $800,348 | $0 | $0 | $0 | $0 | $0 | $15,250 | $0 | $39,823 | $0 | $855,421 | $0 | $0 | $0 |
| JOSHUA CALDWELL | ||||||||||||||
| UROLOGIST | $539,407 | $0 | $175,756 | $0 | $0 | $0 | $15,250 | $0 | $8,876 | $0 | $739,289 | $0 | $0 | $0 |
| JAMES POPOVICH MD | ||||||||||||||
| PHYSICIAN AT LARGE | $637,835 | $0 | $30,000 | $0 | $0 | $0 | $23,000 | $0 | $35,723 | $0 | $726,558 | $0 | $0 | $0 |
| ARIEL SORIANO | ||||||||||||||
| PHYSICIAN | $640,555 | $0 | $45,000 | $0 | $0 | $0 | $19,483 | $0 | $17,642 | $0 | $722,680 | $0 | $0 | $0 |
| SARA SHOLAR MD | ||||||||||||||
| PHYSICIAN | $626,189 | $0 | $30,000 | $0 | $0 | $0 | $15,250 | $0 | $35,632 | $0 | $707,071 | $0 | $0 | $0 |
| APRIL SMITH MD | ||||||||||||||
| CHIEF OF MEDICAL STAFF | $556,380 | $0 | $50,000 | $0 | $0 | $0 | $15,250 | $0 | $35,723 | $0 | $657,353 | $0 | $0 | $0 |
| JASON PETIK | ||||||||||||||
| CEO | $413,730 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $413,730 | $0 | $0 | $0 |
| KELLY UTLEY | ||||||||||||||
| CFO | $235,530 | $0 | $0 | $0 | $792 | $0 | $12,278 | $0 | $23,878 | $0 | $272,478 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 1A | CHARTER AIRFAIRE, WHICH WAS ONLY FOR BUSINESS TRAVEL AND REIMBURSED UNDER AN ACCOUNTABLE PLAN, AND PAID HOUSING, PROVIDED BY THE HOSPITAL AND REQUIRED AS A CONDITION OF EMPLOYMENT FOR THE EMPLOYER'S CONVENIENCE, WAS PROVIDED FOR AERIEL SORIANO, PHYSICIAN, AND WAS NOT INCLUDED IN TAXABLE INCOME. |
| SCHEDULE J, PART III: | JASON PETIK, CEO, RECEIVES COMPENSATION FROM POUDRE VALLEY MEDICAL GROUP, AN UNRELATED ENTITY. POUDRE VALLEY MEDICAL GROUP PROVIDES MANAGEMENT SERVICES TO ITS CLIENTS, INCLUDING THE SIDNEY REGIONAL MEDICAL CENTER. THE SIDNEY REGIONAL MEDICAL CENTER'S BOARD OF DIRECTORS SETS THE COMPENSATION FOR MR. PETIK. MR. PETIK RECEIVED TOTAL COMPENSATION OF $413,730. MR. PETIK'S COMPENSATION IS REFLECTED IN PART IX, LINE 11A. |
Schedule K IRS990ScheduleK
Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
Issuer Name IssuerName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | THE COUNTY OF DEUEL NEBRASKA | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Issuer EIN | 476006452 | BondIssuerEIN |
| CUSIP | 251476AA5 | CUSIPNum |
| Bond Issued | 2014-10-16 | BondIssuedDt |
| Issue Price | $10,000,000 | IssuePriceAmt |
| Purpose | CONSTRUCT HOSPITAL | PurposeDesc |
| Defeased | 0 | DefeasedInd |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuerInd |
| Pool Financing | 0 | PoolFinancingInd |
Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Retired | $3,467,667 | RetiredAmt |
| Total Proceeds | $10,000,000 | TotalProceedsAmt |
| Capital Expenditures | $10,000,000 | CapitalExpendituresAmt |
| Substantial Completion | 2015 | SubstantialCompletionYr |
| Refunding Tax Exempt Bonds | 0 | RefundingTaxExemptBondsInd |
| Refunding Taxable Bonds | 0 | RefundingTaxableBondsInd |
| Final Allocation Made | Yes (1) | FinalAllocationMadeInd |
| Adequate Books And Rec Maint | Yes (1) | AdequateBooksAndRecMaintInd |
Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Owning Bond Financed Property | 0 | OwningBondFinancedPropertyInd |
| Any Lease Arrangements | 0 | AnyLeaseArrangementsInd |
| Mgmt Contract Bond Fincd Prop | 0 | MgmtContractBondFincdPropInd |
| Any Research Agreements | 0 | AnyResearchAgreementsInd |
| Private Bus Use By Others | 0.00000 | PrivateBusUseByOthersPct |
| Private Bus Concerning UBI | 0.00000 | PrivateBusConcerningUBIPct |
| Total Private Business Use | 0.00000 | TotalPrivateBusinessUsePct |
| Bond Iss Meet Prvt Sec Pymt Test | 0 | BondIssMeetPrvtSecPymtTestInd |
| Change In Use Bond Financed Prop | 0 | ChangeInUseBondFinancedPropInd |
| Procs Nonqualified Bond Remdtd | Yes (1) | ProcsNonqualifiedBondRemdtdInd |
Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Form8038 T Filed | 0 | Form8038TFiledInd |
| Rebate Not Due Yet | 0 | RebateNotDueYetInd |
| Exception To Rebate | Yes (1) | ExceptionToRebateInd |
| No Rebate Due | 0 | NoRebateDueInd |
| Variable Rate Issue | Yes (1) | VariableRateIssueInd |
| Hedge Identified In Bks And Rec | 0 | HedgeIdentifiedInBksAndRecInd |
| Gross Proceeds Invested In GIC | 0 | GrossProceedsInvestedInGICInd |
| Gross Proceeds Invested | 0 | GrossProceedsInvestedInd |
| Written Proc To Monitor Reqs | Yes (1) | WrittenProcToMonitorReqsInd |
Procedures Corrective Action ProceduresCorrectiveActionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Procedures Corrective Action | Yes (1) | ProceduresCorrectiveActionInd |
Schedule L IRS990ScheduleL
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp (2 entries)
| Relationship DescriptionRelationshipDescriptionTxt | TransactionTransactionAmt | TransactionTransactionDesc | Sharing Of RevenuesSharingOfRevenuesInd |
|---|---|---|---|
| SUSAN PETIK | |||
| EMPLOYEE OF ORGANIZATION AND SPOUSE OF JASON PETIK, CEO | $147,285 | EMPLOYEE COMPENSATION | 0 |
| KEVIN UTLEY | |||
| EMPLOYEE OF ORGANIZATION AND SPOUSE OF KELLY UTLEY, CFO | $48,302 | EMPLOYEE COMPENSATION | 0 |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (10 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART III, LINE 2 | DURING THE YEAR, THE HOSPITAL BEGAN PROVIDING GROUND AMBULANCE SERVICES UPON EXIT OF THE FORMER SERVICE PROVIDER. |
| FORM 990, PART VI, SECTION A, LINE 1A | THE EXECUTIVE COMMITTEE IS MADE UP OF 4 MEMBERS OF THE BOARD. THE EXECUTIVE COMMITTEE HAS THE SAME AUTHORITY TO ACT AS THE FULL BOARD. |
| FORM 990, PART VI, SECTION A, LINE 3 | POUDRE VALLEY MEDICAL GROUP CURRENTLY EMPLOYS THE CHIEF EXECUTIVE OFFICER FOR SIDNEY REGIONAL MEDICAL CENTER. |
| FORM 990, PART VI, SECTION B, LINE 11B | THE ORGANIZATION'S ACCOUNTING DEPARTMENT PROVIDES DOCUMENTATION TO THE INDEPENDENT ACCOUNTING FIRM FOR THE PREPARATION OF THE FORM 990. COMMUNICATIONS BETWEEN THE ACCOUNTING FIRM AND THE ACCOUNTING DEPARTMENT FINALIZE THE PREPARATION OF THE FORM 990. THE CEO AND CFO THEN REVIEW THE FORM 990 AND E-MAIL THE PUBLIC DISCLOSURE COPY TO ALL MEMBERS OF THE BOARD OF DIRECTORS FOR THEIR REVIEW. ONCE THE 990 RETURN HAS BEEN APPROVED BY ALL PARTIES IT IS SUBMITTED TO THE IRS ON OR BEFORE THE REGULAR OR EXTENDED DUE DATE. |
| FORM 990, PART VI, SECTION B, LINE 12C | EACH YEAR ALL BOARD MEMBERS ARE REQUIRED TO DISCLOSE ANY CONFLICTS OF INTEREST. ANY DUALITY OF INTEREST OR POTENTIAL CONFLICT OF INTEREST ON THE PART OF ANY OFFICER, DIRECTOR, COMMITTEE MEMBER, OR ANY KEY EMPLOYEE IS DISCLOSED TO THE BOARD OF DIRECTORS AND MADE A MATTER OF RECORD WHENEVER IT ARISES. WHENEVER IT INVOLVES A MATTER OF BOARD ACTION, ANY OFFICER, DIRECTOR, COMMITTEE MEMBER, OR KEY EMPLOYEE HAVING A DUALITY OF INTEREST OR A POSSIBLE CONFLICT OF INTEREST IN ANY MATTER DOES NOT VOTE OR ABSTAINS FROM THE VOTE, IF PRESENT IN THE ROOM. OFTEN THE BOARD MEMBER IS ASKED TO LEAVE THE MEETING DURING DISCUSSION PERIODS AND FOR THE VOTE ON ISSUES FOR WHICH CONFLICT EXISTS. THESE INDIVIDUALS DO NOT USE THEIR PERSONAL INFLUENCE ON THE MATTERS. |
| FORM 990, PART VI, SECTION B, LINE 15 | POUDRE VALLEY MEDICAL GROUP PROVIDES ADMINISTRATIVE SERVICES TO SIDNEY REGIONAL MEDICAL CENTER (SRMC). THIS INCLUDES PROVIDING THE HOSPITAL'S CHIEF EXECUTIVE OFFICER. SRMC'S METHOD TO DETERMINE EXECUTIVE SALARY RANGES IS TO ANNUALLY PULL SALARY RANGES FROM NO LESS THAN TWO SURVEY SOURCES (THREE WHEN POSSIBLE) TO DETERMINE THE AVERAGE SALARY RANGE FOR EACH EXECUTIVE POSITION BY GEOGRAPHICAL REGION. THESE ARE REVIEWED AND PRESENTED TO THE HUMAN RESOURCE COMMITTEE OF THE BOARD OF DIRECTORS FOR REVIEW AND APPROVAL/RECOMMENDATIONS. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE MADE AVAILABLE UPON REQUEST. ALSO, THE FINANCIAL STATEMENTS ARE SENT ANNUALLY TO COMMUNITY LEADERS. |
| FORM 990, PART VII, SECTION A, LINE 5: | JASON PETIK RECEIVES COMPENSATION FROM AN UNRELATED ORGANIZATION, POUDRE VALLEY MEDICAL GROUP, WHICH PROVIDES MANAGEMENT SERVICES TO SIDNEY REGIONAL MEDICAL CENTER. |
| FORM 990, PART IX, LINE 11G | PROFESSIONAL FEES - OTHER: PROGRAM SERVICE EXPENSES 8,281,909. MANAGEMENT AND GENERAL EXPENSES 435,387. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 8,717,296. CONTRACT SERVICES - SURGERY PROFESSIONALS: PROGRAM SERVICE EXPENSES 1,702,160. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,702,160. CONTRACT SERVICES - ANESTHESIA PROFESSIONALS: PROGRAM SERVICE EXPENSES 527,507. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 527,507. |
| FORM 990, PART XI, LINE 2C: | THE BOARD OF DIRECTORS ASSUMES THE RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF SRMC'S FINANCIAL STATEMENTS AND SELECTION OF AN INDEPENDENT ACCOUNTANT. THIS PROCESS HAS NOT CHANGED SINCE THE PRIOR YEAR. |
Schedule R IRS990ScheduleR
Id Disregarded Entities IdDisregardedEntitiesGrp (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Total IncomeTotalIncomeAmt | End Of Year AssetsEndOfYearAssetsAmt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt |
|---|---|---|---|---|---|---|---|---|---|
| SIDNEY REGIONAL MEDICAL CENTER LONG TERM CARE LLC | |||||||||
| 1000 POLE CREEK CROSSING | SIDNEY | NE | 69162 | 883636613 | LONG-TERM CARE & ASSISTED LIVING | NE | $6,091,185 | $3,120,780 | CHEYENNE COUNTY HOSPITAL ASSOCIATION INC |
| SIDNEY REGIONAL MEDICAL CENTER EMS LLC | |||||||||
| 1000 POLE CREEK CROSSING | SIDNEY | NE | 69162 | 993681050 | EMERGENCY MEDICAL SERVICES | NE | $325,269 | $277,718 | CHEYENNE COUNTY HOSPITAL ASSOCIATION INC |
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp
Disregarded Entity Name DisregardedEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CHEYENNE COUNTY HOSPITAL AND HEALTH CENTER FOUNDATION | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1000 POLE CREEK CROSSING | AddressLine1Txt |
| City | SIDNEY | CityNm |
| State Abbreviation | NE | StateAbbreviationCd |
| ZIP | 69162 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 470686476 | EIN |
| Primary Activities | SUPPORT SIDNEY REGIONAL MEDICAL CENTER | PrimaryActivitiesTxt |
| Legal Domicile State | NE | LegalDomicileStateCd |
| Exempt Code Section | 501(C)(3) | ExemptCodeSectionTxt |
| Public Charity Status | LINE 12C, III-FI | PublicCharityStatusTxt |
| Direct Controlling NA | N/A | DirectControllingNACd |
| Controlled Organization | 0 | ControlledOrganizationInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | Yes (1) | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (1) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (1) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (1) | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (1) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (1) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
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