2016-05-03T15:58:10-05:00 2015-09-30 476097913 SEIM JOHNSON LLP 18081 BURT STREET SUITE 200 OMAHA NE 680224722 990 2014-10-01 470426530 JENNIE M MELHAM MEMORIAL MEDICAL CENTER INC JENN 3088724162 145 EAST MEMORIAL DRIVE BROKEN BOW NE 68822 MICHAEL J STECKLER PRESIDENT/CEO 3088724162 2016-04-26 1 BARBARA J FAJEN P00400874 4023302660 2014 2016-08-17 19:52:53Z MICHAEL J STECKLER 145 EAST MEMORIAL DRIVE BROKEN BOW NE 68822 19433384 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, NURSING HOME, DOMICILIARY, AND INDEPENDENT LIVING APARTMENT SERVICES. 5 5 204 112 0 0 51241 48025 17438221 18639708 516344 608677 119936 109431 18125742 19405841 0 0 0 0 8653457 8708659 4714 5402 5402 7944709 8571536 16602880 17285597 1522862 2120244 38122381 41681801 2492702 3275115 35629679 38406686 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 15321633 18639708 JMMMC OPERATES AT 23 BED CAH HOSPITAL ALONG WITH AN ATTACHED 50 BED NURSING HOME. IN ADDITION, THERE ARE 20 APARTMENTS DESIGNATED FOR THE ELDERLY AND A 12 BED ASSISTED LIVING CENTER. JMMMC PROVIDES ACUTE CARE, EMERGENCY CARE, LABOR AND DELIVERY SERVICES, OUTPATIENT SPECIALTY CLINICS, SURGERY SERVICES, RADIOLOGY SERVICES INCLUDING MOBILE MRI SERVICES AND INHOUSE CT SERVICES. 15321633 1 1 0 0 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 30 0 1 204 1 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 MICHAEL J STECKLER CEO 3088724160 145 MEMORIAL DRIVE BROKEN BOW NE 68822 JOHN SMITH CHAIRMAN 4.00 4.00 X X 0 0 0 DON CANTRELL VICE-CHAIRMAN 4.00 4.00 X X 0 0 0 JOYCE RICHARDSON SECRETARY 4.00 4.00 X X 0 0 0 MIKE FLINT TREASURER 4.00 4.00 X X 0 0 0 DANIEL ZACH MEMBER 4.00 4.00 X 0 0 0 MICHAEL J STECKLER PRESIDENT/CEO 40.00 4.00 X 190051 0 21888 TIMOTHY L SHUCKMAN VP/CFO 40.00 0.00 X 112590 0 18001 MELISSA POLLARD PHARMACIST 40.00 0.00 X 127795 0 10642 JEFFREY BREZINA PHARMACIST 40.00 0.00 X 101530 0 6995 531966 0 57526 4 0 1 0 SANDHILLS ANESTHESIA SERVICES LLC 79568 SUMNER ROAD BROKEN BOW NE 68822 ANESTHESIA SERVICES 518035 BRYAN MEDICAL CENTER PO BOX 82557 LINCOLN NE 68501 MOBILE PATIENT SERVICES 211465 MCMEEN PHYSICAL THERAPY PC PO BOX 435 BROKEN BOW NE 68822 PHYSICAL THERAPY SERVICES 159547 MEDIAL STAFFING NETWORK PO BOX 840292 DALLAS TX 75284 TEMPORARY STAFFING 143103 SHAWN LAWRENCE 223 SOUTH E STREET BROKEN BOW NE 68822 PHYSICIAN ER ON CALL SERVICES 113312 9 9387 9304 29334 48025 PATIENT SERVICE - MEDICARE/MEDICA 621110 9354866 9354866 PATIENT SERVICE - PRIVATE PAY 621110 9103665 9103665 WELLNESS CENTER REVENUE 624100 88046 88046 EHR INCENTIVE 621110 37700 37700 55431 55431 18639708 517237 517237 45315 23793 21522 21522 21522 95190 3750 91440 91440 91440 CAFETERIA SALES 722210 87909 87909 87909 19405841 18639708 0 718108 X 342529 342529 5922229 5346195 576034 146772 125992 20780 1810349 1532415 277934 486780 423921 62859 29153 29153 53673 53673 5402 5402 2575134 2505652 69482 664127 570519 93608 267391 267391 347957 339939 8018 5521 950 4571 46737 17167 29570 1682542 1643773 38769 96978 78435 18543 MEDICAL SUPPLIES 1844611 1844611 BAD DEBT 531947 531947 FOOD 234835 234835 DUES AND SUBSCRIPTIONS 51392 14858 36534 139538 110424 29114 17285597 15321633 1958562 5402 145 145 3658978 3672623 2146124 2521985 13608 11882 446943 489760 234159 230378 35452054 17038404 15257184 18413650 15782584 16034890 582656 306488 38122381 41681801 1915423 2213417 577279 1061698 2492702 3275115 X 35629679 38406686 35629679 38406686 38122381 41681801 2120244 656763 0 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1 1066 3160 3333 893 0 33927 123 34050 32550 1250 127 33927 31550 1000 32550 30550 1000 31550 29550 1000 30550 1.00000 0 1 1 70442 70442 18725448 8497630 10227818 8383944 6431834 1952110 8272220 2108940 6163280 18413650 ESTIMATED THIRD-PARTY PAYOR SETTLEMENTS 887003 457 PENSION LIABILITIES 174695 1061698 X PART IV, LINE 1B: JENNIE M. MELHAM MEMORIAL MEDICAL CENTER MANAGES A RESIDENT ACCOUNT TRUST FOR RESIDENTS IN THE LONGTERM CARE UNIT. 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, 2015, THE MEDICAL CENTER HAD NO UNCERTAIN TAX POSITIONS ACCRUED. 1 1 1 X 1 X 1 1 1 1 1 1 47231 0 47231 0.00280 801795 642973 158822 0.00950 849026 642973 206053 0.01230 57086 0 57086 0.00340 44697 0 44697 0.00270 53340 0 53340 0.00320 155123 155123 0.00930 1004149 642973 361176 0.02160 2660 2660 0.00020 6750 6750 0.00040 622 622 0.00000 3173 3173 0.00020 2500 2500 0.00010 15705 15705 0.00090 0 531947 0 7255002 7292757 -37755 X 1 1 1 1 JENNIE M MELHAM MEMORIAL MEDICAL CENTER 145 MEMORIAL DRIVE BROKEN BOW NE 68822 WWW.MELHAM.ORG 100004 X X X X LONGTERM CARE UNIT, ASSISTED LIVING, AND APARTMENTS JENNIE M MELHAM MEMORIAL MED CTR INC 1 0 0 1 X X X X X X X X X 12 1 0 0 1 X WWW.MELHAM.ORG X 1 12 1 WWW.MELHAM.ORG 0 0 1 X 100.000000000000 200.000000000000 0 1 X X X 1 X WWW.MELHAM.ORG X WWW.MELHAM.ORG X X 1 X 0 X 1 X 0 0 JENNIE M. MELHAM MEMORIAL MED. CTR. INC. PART V, SECTION B, LINE 5: TO PREPARE FOR DEVELOPMENT OF THE CHNA, THE MEDICAL CENTER'S ADMINISTRATION COLLECTED AND ANALYZED COMMUNITY AND COUNTY POPULATION DEMOGRAPHICS, VITAL STATISTICS, ALONG WITH THE MOST RECENT 2010 MOBILIZING FOR ACTION THROUGH PLANNING AND PARTNERSHIPS (MAPP) AND THE 2011 PUBLIC HEALTH AGENCY OF NEBRASKA (PHAN) DOCUMENTS PROVIDED BY THE LOUP BASIN PUBLIC HEALTH DEPARTMENT. OTHER FEDERAL, STATE AND LOCAL DATA BASES WERE USED AS SOURCES OF INFORMATION FOR THIS REPORT. THIS IS ALL PUBLIC INFORMATION AND THIS DOCUMENTATION CAN BE FOUND IN PUBLIC SOURCES.A MEETING WAS CONVENED ON AUGUST 30, 2013, AT 9 A.M. IN THE MEDICAL CENTER'S CONFERENCE ROOM WITH MEMBERS OF THE CUSTER COUNTY HEALTHCARE COALITION. THE COALITION IS A GROUP OF AREA HEALTH CARE SERVICE PROVIDERS, REGIONAL SOCIAL SERVICE ORGANIZATIONS, REGIONAL PUBLIC HEALTH STAFF, NE DEPARTMENT OF HEALTH STAFF, AREA COMMUNITY SERVICES STAFF AND MEMBERS OF THE UNIVERSITY OF NE EXTENSION SERVICE UNIT, WHO BEGAN GETTING TOGETHER THIRTEEN YEARS AGO TO DISCUSS THE HEALTH AND SOCIAL SERVICE NEEDS OF THE COMMUNITY. THIS VOLUNTARY GROUP REVIEWED AND DISCUSSED AVAILABLE SERVICES, COMMUNITY NEEDS, CHALLENGES, OPPORTUNITIES AND WAYS TO SHARE RESOURCES FOR THE BETTERMENT OF THE COMMUNITY'S HEALTH.THE COALITION MEMBERSHIP ASSISTED IN DEVELOPMENT OF THE HOSPITAL'S COMMUNITY HEALTH NEEDS ASSESSMENT. THE GROUP REVIEWED AND DISCUSSED THE MEDICAL CENTER'S NEED FOR A CHNA, THEY DISCUSSED THE CHNA DEVELOPMENT PROCESS AND HOW THE MEDICAL CENTER'S CHNA COULD POTENTIALLY AFFECT THE COMMUNITY'S HEALTH.IMPORTANT INFORMATION, IDEAS AND OPINIONS WERE GATHERED FROM THE MEMBERS TO BE USED IN THE CHNA DEVELOPMENT PROCESS. THE COALITION MEMBERS' INSIGHTS INTO THE PUBLIC HEALTH NEEDS OF THE COMMUNITY WERE VERY DETAILED AND USEFUL. THE COALITION MEMBERS REVIEWED AND DISCUSSED A LIST OF POSSIBLE HEALTH ISSUES AND HEALTH NEEDS IN THE COMMUNITY. THE GROUP WAS THEN ASKED TO ADD TO THE LIST BY IDENTIFYING ANY ADDITIONAL ISSUES OR NEEDS THAT THEY FELT SHOULD BE ADDED TO THE LIST OF COMMUNITY HEALTH NEEDS FOR THE PURPOSES OF THIS ASSESSMENT. ONCE THE GROUP FELT THE LIST WAS COMPLETE, THE COALITION MEMBERS WERE THEN ASKED TO GO THROUGH A GROUP PROCESS OF IDENTIFYING THE TOP FOUR HEALTH NEEDS IN THE COMMUNITY THAT IS SERVED BY THE MEDICAL CENTER. THROUGH A PROCESS OF OPEN DISCUSSION THESE ITEMS WERE THEN PRIORITIZED BY THE MEMBERS PRESENT. THE RESULT OF THIS IDENTIFICATION AND PRIORITIZATION PROCESS WAS THE BASIS OF THE HOSPITAL'S CHNA. JENNIE M. MELHAM MEMORIAL MED. CTR. INC. PART V, SECTION B, LINE 11: THE MEDICAL CENTER WAS NOT ABLE TO COMPLETELY ADDRESS ALL THE HEALTH NEEDS IDENTIFIED IN THE CHNA. THE MEDICAL CENTER HAS ADDRESSED HEALTH NEEDS RELATED TO IMPROVED ACCESS TO COMMUNITY HEALTH SCREENING AND EDUCATION, OBESITY/PHYSICIAN ACTIVITY/EXERCISE AND WEIGHT LOSS. THE MEDICAL CENTER HAS ASSISTED IN ADDRESSING SOME OF THE ACCESS TO MENTAL HEALTH SERVICES THROUGH THE USE OF TELE VIDEO SERVICES TO PROVIDE LOCAL ACCESS TO OUT OF TOWN MENTAL HEALTH PRACTITIONERS. THE MEDICAL CENTER HAS ALSO ASSISTED IN SOME FUNDRAISING ACTIVITIES FOR LOCAL MENTAL HEALTH PROGRAMS. LACK OF HUMAN RESOURCES AND OTHER EDUCATIONAL RESOURCES HAS LIMITED THE SUCCESS IN MEETING SOME OF THE GOALS SET IN THE ORIGINAL CHNA. WE ARE TRYING TO ADDRESS THESE ISSUES AND FEEL THAT WE ARE DEVELOPING SOME SOLUTIONS THAT WILL ALLOW US TO HAVE GREATER SUCCESS IN THE NEXT YEAR IN ADDRESSING THESE LOCAL HEALTH NEEDS. JENNIE M. MELHAM MEMORIAL MED. CTR. INC. PART V, SECTION B, LINE 22D: JMMMC CHARGES THE SAME AMOUNT FOR ALL PATIENTS. PATIENTS FAP-ELIGIBLE HAVE ACCOUNTS ADJUSTED AS A PERCENT OF CHARGES UP TO 100% OF CHARGES BASED UPON A SLIDING SCALE OF ASSISTANCE. THE FAP AND THE SLIDING SCALE OF ASSISTANCE IS BASED ON FEDERAL POVERTY GUIDELINES. PART V, SECTION B, LINE 16 FINANCIAL ASSISTANCE POLICY WEBSITE AVAILABILITY JENNIE M. MELHAM MEMORIAL MED. CTR. INC. PART V, SECTION B, LINE 16A WEBSITE: WWW.MELHAM.ORG JENNIE M. MELHAM MEMORIAL MED. CTR. INC. PART V, SECTION B, LINE 16B WEBSITE: WWW.MELHAM.ORG 3 HERITAGE HALL 145 MEMORIAL DRIVE BROKEN BOW NE 68822 50-BED LONG TERM CARE CENTER INDEPENDENCE HALL 145 MEMORIAL DRIVE BROKEN BOW NE 68822 12-BED ASSISTED LIVING CENTER LIBERTY SQUARE APARTMENTS 145 MEMORIAL DRIVE BROKEN BOW NE 68822 SENIOR INDEPENDENT LIVING APARTMENT COMPLEX PART I, LINE 3C: PATIENTS MAY COMPLETE AN APPLICATION FOR CHARITY CARE ASSISTANCE. THE APPLICATION IS REVIEWED, VERIFIED, THEN PRESENTED TO THE BOARD OF DIRECTORS FOR A DECISION. 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, 2015 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 $531,947. 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. 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 9-11 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, 2015 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 IN 2012. 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. 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 51% OF GROSS PATIENT REVENUE GENERATED AT THE MEDICAL CENTER IS MEDICARE. ADDITIONALLY, 11% 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 THAT ARE 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 THEN RETURN TO THE COMMUNITY TO PURSUE A CAREER IN HEALTH CARE. JMMMMC ALSO PARTNERS WITH LOCAL HIGH SCHOOLS TO PROMOTE HEALTHCARE CAREERS TO LOCAL STUDENTS. A LOCAL "HOME GROWN" WORKFORCE IS ESSENTIAL TO THE OPERATIONS OF JMMMMC AND THUS THE DELIVERY OF HEALTHCARE IN THE AREA. JMMMMC PROVIDES SPEAKERS TO LOCAL SCHOOLS ABOUT HEALTHCARE CAREERS AND PROVIDES TOURS, AS REQUESTED. IN THIS WAY, THE MEDICAL CENTER PROMOTES HEALTH CARE TO A FUTURE WORKFORCE TO CONTINUE LOCAL HEALTHCARE OPERATIONS.NOT ALL PATIENTS HAVE AN ABILITY TO PAY AT TIME OF SERVICE. THEREFORE, JMMMMC HAS DEVELOPED FAIRLY LIBERAL CREDIT GUIDELINES. THESE GUIDELINES 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 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 I 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 2,400 EMERGENCY ROOM VISITS PER YEAR. THE MEDICAL CENTER PAYS LOCAL PHYSICIANS TO CARRY A PAGER AND BE AVAILABLE TO PROVIDE EMERGENCY ROOMS 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 MICHAEL J STECKLER PRESIDENT/CEO 174448 0 15603 0 0 0 7011 0 14877 0 211939 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 11 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 409,378. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 409,378. PHYSICAL THERAPY: PROGRAM SERVICE EXPENSES 166,207. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 166,207. LAB TEST FEES: PROGRAM SERVICE EXPENSES 105,924. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 105,924. LONG TERM CARE FEES: PROGRAM SERVICE EXPENSES 216,964. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 216,964. OTHER FEES FOR SERVICE: PROGRAM SERVICE EXPENSES 965,356. MANAGEMENT AND GENERAL EXPENSES 69,482. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,034,838. PHYSICIAN ER CALL PAYMENTS: PROGRAM SERVICE EXPENSES 641,823. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 641,823. FORM 990, PART XI, 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 145 MEMORIAL DRIVE BROKEN BOW NE 68822 470795995 SUPPORTING THE OPERATIONS OF A CRITICAL ACCESS HOSPITAL NE 501(C)(3) LINE 11B, II JENNIE M MELHAM MEMORIAL MEDICAL CENTER INC 1 0 0 1 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0