2015-11-06T14:05:15-06:00 2014-12-31 476097913 SEIM JOHNSON LLP 18081 BURT STREET SUITE 200 OMAHA NE 680224722 990 2014-01-01 470662290 NORTH PLATTE NEBRASKA HOSPITAL CORP NORT 3086968000 601 WEST LEOTA STREET NORTH PLATTE NE 69103 KRYSTAL CLAYMORE CHIEF FINANCIAL OFFICER 3086968000 2015-11-06 1 BARBARA J FAJEN P00400874 4023302660 2014 2016-03-07 17:11:31Z GREAT PLAINS HEALTH KRYSTAL CLAYMORE 601 WEST LEOTA STREET NORTH PLATTE NE 69103 209437120 0 X WWW.GPHEALTH.ORG X 1971 NE PROVIDE ACUTE, PREVENTIVE AND OTHER HEALTHCARE SERVICES. 16 12 1017 135 72570 0 283048 1872909 154990065 170120280 2398989 11404342 648458 942692 158320560 184340223 94965 131120 0 0 74846405 80945316 0 0 0 70222348 74813561 145163718 155889997 13156842 28450226 295761550 322648810 128744384 134063677 167017166 188585133 X TO INSPIRE HEALTH AND HEALING BY PUTTING PATIENTS FIRST -- ALWAYS. 0 0 146955255 131120 170958407 GREAT PLAINS HEALTH (GPH) PROVIDES FULL SERVICE MEDICAL CARE TO THE GENERAL PUBLIC. GPH OFFERS INPATIENT AND OUTPATIENT SERVICES INCLUDING HOME SUPPORT SERVICES, OUTREACH PROGRAMS, AND FOLLOW-UP CARE TO MEET THE DIVERSE NEEDS OF THE PATIENTS GPH SERVES. GPH PROVIDES CARE TO THE UNDERINSURED AND THE UNINSURED. FURTHERMORE, GPH PROVIDES PROGRAMS, SUCH AS MEDICATION ASSISTANCE, HOME HEALTH, HOSPICE, HEALTHY START AND ATHLETIC TRAINING AND DOES NOT RECOUP THE COST OF SUCH PROGRAMS. GPH ABSORBS THE COSTS ASSOCIATED WITH PROGRAMS THAT DO NOT RECEIVE SUFFICIENT REVENUE TO COVER THE COSTS OF CARE, SO THAT GPH STILL PROVIDES COMMUNITY MEMBERS WITH THE CARE THEY NEED.GPH PROVIDES BENEFITS TO THE SURROUNDING COMMUNITIES IN THE FORM OF DONATIONS OF CASH AND SUPPLIES, SPONSORSHIP OF EVENTS, TRANSPORTATION SERVICES, ASSISTANCE IN REGISTERING FOR GOVERNMENT PROGRAMS, SCHOOL HEALTH AND STUDENT HOUSING.EDUCATING THE COMMUNITY CONCERNING THEIR HEALTH AND WELL BEING ALLOWS PATIENTS TO MANAGE THEIR OWN CARE. GPH SUBSIDIZES PROFESSIONAL DEVELOPMENT EDUCATION AND CERTIFICATION OF CLINICAL STAFF TO ENSURE GPH IS ABLE TO PROVIDE THE NEWEST TREATMENTS AND BEST CARE. 146955255 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 1 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 1 0 0 1 192 0 1 1017 1 1 1 0 0 0 0 0 0 0 0 0 X 16 12 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 1 X KRYSTAL CLAYMORE CHIEF FINANCIAL OFFICER 3086967197 601 WEST LEOTA NORTH PLATTE NE 69103 DAVID PEDERSON CHAIR 1.00 2.00 X X 0 0 0 BYRON BARKSDALE MD VICE CHAIR 1.00 2.00 X X 0 0 0 MISTY ROBERTSON SECRETARY/TREASURER 1.00 2.00 X X 0 0 0 RENEE ENGLER MD CHIEF OF STAFF/DIRECTOR 38.00 2.00 X X 427307 0 38542 KATHY BOURQUE DIRECTOR 1.00 2.00 X 0 0 0 CLARK DIFFENDAFFER MD DIRECTOR 1.00 1.00 X 0 0 0 JAY ENGEL DIRECTOR 1.00 1.00 X 0 0 0 KYLE GIFFORD DIRECTOR 1.00 2.00 X 0 0 0 DIANN KOLKMAN DIRECTOR (1/1/14 - 4/30/14) 1.00 0.00 X 0 0 0 DWIGHT LIVINGSTON DIRECTOR 1.00 1.00 X 0 0 0 NEWTON MACK MD DIRECTOR (5/1/14 - PRESENT) 1.00 1.00 X 0 0 0 MARK OETTINGER DIRECTOR 1.00 1.00 X 0 0 0 DUDLEY OLTMANS DIRECTOR 1.00 1.00 X 0 0 0 JOHN PATTERSON DIRECTOR 1.00 2.00 X 0 0 0 DARREL SMITH DIRECTOR 1.00 1.00 X 0 0 0 JAMES SMITH MD DIRECTOR 38.00 2.00 X 428982 0 38542 LINDA TUCKER DIRECTOR 1.00 1.00 X 0 0 0 GREGORY NIELSEN CEO (1/1/14 - 4/8/14) 38.00 2.00 X 479094 0 17236 MELVIN MCNEA CEO (4/8/14 - 12/31/14) 38.00 2.00 X 294384 0 28042 KRYSTAL CLAYMORE CFO 38.00 2.00 X 274361 0 37092 IRFAN A VAZIRI PHYSICIAN (GPH) 40.00 0.00 X 984584 0 37762 ARSHAD ALI PHYSICIAN (GPH) 40.00 0.00 X 879566 0 21010 SATYANARAYANA NELLURI PHYSICIAN (GPH) 40.00 0.00 X 844852 0 37662 AHMED AWAIS PHYSICIAN (GPH) 40.00 0.00 X 660963 0 23722 MICHAEL GALLENTINE PHYSICIAN (NPNPG) 40.00 0.00 X 618259 0 35492 5892352 0 315102 96 0 1 0 SNELL SERVICES INC 2345 10TH STREET GERING NE 69341 ELECTRICAL CONTRACTOR 18930770 SAMPSON CONSTRUCTION 440 REGENCY PARKWAY DRIVE OMAHA NE 68114 GENERAL CONTRACTOR 16661654 VARIAN MEDICAL SYSTMES 3100 HANSEN WAY PALO ALTO CA 94304 SOFTWARE MAINTENANCE 3146738 ERDMAN COMPANY 1 ERDMAN PLACE MADISON WI 53717 GENERAL CONTRACTOR 1669103 HDR ARCHITECTURE INC 8404 INDIAN HILLS DRIVE OMAHA NE 68114 ARCHITECTURE 808431 34 619338 17576 1235995 619338 1872909 PATIENT SERVICE REVENUE 624100 125366757 125366757 MEDICARE/MEDICAID PAYMENTS 624100 42282882 42282882 EHR INCENTIVE PAYMENTS 624100 1573559 1573559 OTHER OPERATING REVENUE 624100 618728 618728 MANAGEMENT FEES 624100 10020 10020 268334 268334 170120280 1286231 1286231 31995 0 31995 31995 31995 34836063 378945 25093607 3290 9742456 375655 10118111 10118111 NORTH PLATTE SURGICAL CENTER 621400 930087 930087 MEDICAL TRANSCRIPTION 519100 55492 55492 HOUSEKEEPING 812900 15602 15602 -90484 -91960 1476 910697 184340223 170958407 72570 11436337 X 131120 131120 2063582 933373 1130209 62931839 60440836 2491003 1757175 1677074 80101 10128141 9633190 494951 4064579 3857274 207305 495906 225194 270712 459010 459010 77781 77781 237891 237891 18907008 16528491 2378517 295441 18025 277416 4745003 4340951 404052 3390357 3316643 73714 2895025 2874609 20416 546296 449398 96898 27091 27091 10169641 10123721 45920 552790 541299 11491 MEDICAL SUPPLIES 24920189 24920189 0 BAD DEBTS 6109500 6109500 0 EDUCATION & TRAINING 416447 378951 37496 DUES & SUBSCRIPTIONS 388114 252147 135967 180071 176179 3892 155889997 146955255 8934742 0 3101 3201 62554084 134622452 18137429 20410072 32372 0 576304 977587 4196536 4401352 3419209 4219096 236521582 117151595 71748947 119369987 120296134 23141566 2744180 3025822 0 60150 12053254 12417525 295761550 322648810 16814074 21851156 108902546 108338272 3027764 3874249 128744384 134063677 X 166285037 187853004 732129 732129 167017166 188585133 295761550 322648810 X 28450226 -7658678 776419 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 10666 10666 0 PART II-B, LINE 1: THE $10,666 REPRESENTS THE PORTION OF THE DUES PAID TO THE NEBRASKA HOSPITAL ASSOCIATION AND THE AMERICAN HOSPITAL ASSOCIATION THAT ARE USED FOR LOBBYING BY THOSE ORGANIZATIONS. 213971 213971 47531932 32215079 15316853 1050956 842724 208232 103471954 81736879 21735075 84252769 2356913 81895856 119369987 ESTIMATED THIRD PARTY SETTLEMENTS 1072622 DEFERRED COMPENSATION 2801627 3874249 X PART X, LINE 2: GREAT PLAINS HEALTH (GP HEALTH) AND REGENCY RETIREMENT RESIDENCE OF NORTH PLATTE (REGENCY) ARE NOT-FOR-PROFIT CORPORATIONS AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. GREAT PLAINS MEDICAL ARTS BUILDING, INC. (GPMAI) IS A NOT-FOR-PROFIT CORPORATION AS DESCRIBED IN SECTION 501(C)(2) OF THE INTERNAL REVENUE CODE. NORTH PLATTE NEBRASKA PHYSICIANS GROUP, LLC (NPNPG) IS A LIMITED LIABILITY COMPANY WHOLLY OWNED BY GP HEALTH. GP HEALTH, REGENCY AND GPMAI HAVE RECEIVED A DETERMINATION LETTER THAT IT IS EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE INTERNAL REVENUE CODE. THE INTERNAL REVENUE SERVICE HAS ESTABLISHED STANDARDS TO BE MET TO MAINTAIN TAX-EXEMPT STATUS. IN GENERAL, SUCH STANDARDS REQUIRE GP HEALTH, REGENCY AND GPMAI TO MEET A COMMUNITY BENEFIT STANDARD AND COMPLY WITH VARIOUS LAWS AND REGULATIONS. GREAT PLAINS HOMECARE EQUIPMENT, INC. (GPHME) IS A FOR-PROFIT CORPORATION THAT RECOGNIZED FEDERAL AND STATE INCOME TAX EXPENSE OF APPROXIMATELY $68,580 AND $0 IN 2014 AND 2013, RESPECTIVELY. THE INCOME TAX EXPENSE IS INCLUDED AS AN OTHER EXPENSE OF THE CONSOLIDATED STATEMENTS OF OPERATIONS. 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, 2014, THE ORGANIZATION HAD NO UNCERTAIN TAX POSITIONS ACCRUED. WITH FEW EXCEPTIONS, THE ORGANIZATION IS NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS FOR YEARS ENDED PRIOR TO DECEMBER 31, 2011. 1 1 1 X 1 X 1 1 0 1 1 2838954 99208 2739746 0.01830 9536342 4292915 5243427 0.03500 12375296 4392123 7983173 0.05330 12555 1787239 10350 1776889 0.01190 36 419266 0 419266 0.00280 182 578417 254320 324097 0.00220 238239 4030 234209 0.00160 20000 252382 0 252382 0.00170 32773 3275543 268700 3006843 0.02020 32773 15650839 4660823 10990016 0.07350 503 0 503 0.00000 20000 68791 0 68791 0.00050 5123 0 5123 0.00000 20000 74417 74417 0.00050 0 6109500 0 42059812 53131678 -11071866 X 1 1 1 PHYSICIAN HOSPITAL CONTRACTING ORGANIZATION NEGOTIATES HEALTHCARE CONTRACTS FOR PHYSICIANS AND THE HOSPITAL 0.50000 0.00000 0.50000 2 NORTH PLATTE SURGERY CENTER LLC PROVIDES OUTPATIENT SURGERY SERVICES 0.50000 0.00000 0.50000 1 1 GREAT PLAINS HEALTH 601 WEST LEOTA NORTH PLATTE NE 69101 WWW.GPHEALTH.ORG 510001 X X X GREAT PLAINS HEALTH 1 0 0 1 X 13 1 0 0 1 X WWW.GPHEALTH.ORG 1 13 1 WWW.GPHEALTH.ORG 0 0 1 X 150.000000000000 250.000000000000 X X X 1 1 X X X 1 X X X 1 X 0 X X X 1 X X 0 0 GREAT PLAINS HEALTH PART V, SECTION B, LINE 3J: THE GREAT PLAINS HEALTH COMMUNITY HEALTH NEEDS ASSESSMENT WAS CONDUCTED FROM APRIL TO DECEMBER 2013. THE ANALYSIS INCLUDED CAREFUL REVIEW OF THE MOST CURRENT HEALTH DATA AVAILABLE, APPLICABLE DEMOGRAPHIC REVIEW AND INPUT FROM KEY COMMUNITY REPRESENTATIVES. ASSESSMENT RESULTS LED TO THE IDENTIFICATION OF FIVE PRIORITY AREAS: 1. PRIMARY CARE SERVICES AND PROVIDERS, INCLUDING NURSING STAFF. 2. PREVENTION, EDUCATION AND SERVICES TO ADDRESS HIGH MORTALITY RATES, CHRONIC CONDITIONS AND UNHEALTHY LIFESTYLES. 3. ADDITIONAL SPECIALTY CARE. 4. TEEN PREGNANCY; INCREASED EDUCATION OF THE IMPORTANCE OF PRENATAL CARE AND INCREASED AWARENESS OF AVAILABLE HEALTH CARE RESOURCES IN THE COMMUNITY. 5. AFFORDABLE PRIMARY CARE SERVICES FOR LOW-INCOME AND UNINSURED POPULATIONS. GREAT PLAINS HEALTH PART V, SECTION B, LINE 5: DURING THE RESEARCH AND COLLABORATION PHASE OF CHNA DEVELOPMENT, GREAT PLAINS HEALTH DISTRIBUTED THREE SURVEYS BETWEEN JUNE 2012 AND JULY 2012; A COMMUNITY SURVEY, AN EMPLOYEE SURVEY AND A PHYSICIAN SURVEY. THE PURPOSE OF THE SURVEY WAS TO OBTAIN INFORMATION ABOUT NEEDED HEALTHCARE SERVICES, ACCESSABILITY OF PHYSICIANS(COMMUNITY ONLY) AND HOSPITAL IMPROVEMENTS. IN ADDITION TO SURVEYS, GPRMC CONDUCTED TEN INTERVIEWS WITH PERSONS WHO REPRESENT THE BROAD INTERESTS OF THE COMMUNITY, INCLUDING THOSE WITH SPECIAL KNOWLEDGE OF OR EXPERTISE IN PUBLIC HEALTH. DURING THESE INTERVIEWS, THE HEALTH NEEDS OF THE COMMUNITY, ACCESS ISSUES, BARRIERS AND ISSUES RELATED TO SPECIFIC POPULATIONS WERE DISCUSSED. GREAT PLAINS HEALTH PART V, SECTION B, LINE 11: GREAT PLAINS' LEADERSHIP PRIORITIZED AND DECIDED TO ADDRESS ALL OF THE SIGNIFICANT NEEDS IDENTIFIED IN THE CHNA. THE FINAL LIST OF PRIORITIZED NEEDS, IN DESCENDING ORDER, IS LISTED BELOW:1.NEED FOR PRIMARY CARE SERVICES AND PROVIDERS, INCLUDING NURSING STAFF2.PREVENTION, EDUCATION AND SERVICES TO ADDRESS HIGH MORTALITY RATES, CHRONIC CONDITIONS AND UNHEALTHY LIFESTYLES3.NEED FOR ADDITIONAL LOCAL SPECIALTY CARE4.TEEN PREGNANCY: NEED FOR INCREASED EDUCATION OF THE IMPORTANCE OF PRENATAL CARE AND INCREASED AWARENESS OF AVAILABLE HEALTH CARE RESOURCES IN THE COMMUNITY5.NEED FOR AFFORDABLE PRIMARY CARE SERVICES FOR LOW-INCOME AND UNINSURED POPULATIONSTHE GREAT PLAINS LEADERSHIP TEAM DEVELOPED THE FOLLOWING IMPLEMENTATION PLAN TO IDENTIFY SPECIFIC ACTIVITIES AND SERVICES WHICH DIRECTLY ADDRESS THESE PRIORITIES. THE OBJECTIVES WERE IDENTIFIED BY STUDYING THE PRIORITIZED HEALTH NEEDS, WITHIN THE CONTEXT OF THE HEALTH SYSTEM'S OVERALL STRATEGIC PLAN, AND THE AVAILABILITY OF FINITE RESOURCES. THE PLAN INCLUDES A RATIONALE FOR EACH PRIORITY, FOLLOWED BY OBJECTIVES, SPECIFIC IMPLEMENTATION ACTIVITIES, AND THE ANTICIPATED IMPACT AND EVALUATION.PRIORITY ONE: NEED FOR PRIMARY CARE SERVICES AND PROVIDERS, INCLUDING NURSING STAFF - IMPLEMENTATION ACTIVITIES INCLUDE RECRUITING PROVIDERS, DEVELOPING NURSES AND IMPROVING PRIMARY CARE SERVICE.PRIORITY TWO: PREVENTION, EDUCATION AND SERVICES TO ADDRESS HIGH MORTALITY RATES, CHRONIC CONDITIONS AND UNHEALTHY LIFESTYLES - IMPLEMENTATION ACTIVITIES INCLUDE OFFERING COMMUNITY SCREENINGS, PROVIDING COMMUNITY HEALTH EDUCATION AND INSPIRING HEALTH THROUGH HUMAN AND FINANCIAL CAPITAL.PRIORITY THREE: NEED FOR ADDITIONAL LOCAL SPECIALTY CARE - IMPLEMENTATION ACTIVITIES INCLUDE RECRUITING SPECIALISTS TO THE REGION, EXPANDING PROGRAMS OFFERED IN THE REGION AND GROWING OUTREACH CLINICS THROUGHOUT THE REGION.PRIORITY FOUR: TEEN PREGNANCY: NEED FOR INCREASED EDUCATION OF THE IMPORTANCE OF PRENATAL CARE AND INCREASED AWARENESS OF AVAILABLE HEALTH CARE RESOURCES IN THE COMMUNITY - IMPLEMENTATION ACTIVITIES INCLUDE IMPROVING THE PROCESS AND EDUCATION TO CREATE HEALTHIER PREGNANCIES IN THE COMMUNITY FOR ANY AGE, EDUCATING YOUNG WOMEN ABOUT THE SOCIAL CONSEQUENCES OF EARLY MOTHERHOOD AND CREATING HEALTHY ALTERNATIVES FOR TEENS.PRIORITY FIVE: NEED FOR AFFORDABLE PRIMARY CARE SERVICES FOR THE LOW-INCOME AND UNINSURED POPULATIONS - IMPLEMENTATION STRATEGIES INCLUDE INCREASING ACCESS AND PROVIDING FINANCIAL SUPPORT.THERE ARE NOT ANY SIGNIFICANT NEEDS IDENTIFIED IN THE MOST RECENT CHNA THAT ARE NOT BEING ADDRESSED. GREAT PLAINS HEALTH PART V, SECTION B, LINE 13B: IF A PATIENT'S COMBINED OUTSTANDING MEDICAL BILLS, AFTER INSURANCE PAYS, EXCEEDS 7.5% OF THEIR ANNUAL GROSS INCOME, THEY WILL RECEIVE AN ADDITIONAL 25% DISCOUNT ON TOP OF THE FINANCIAL ASSISTANCE DISCOUNT WITH THE COMBINED DISCOUNT NOT TO EXCEED 100% OF THE OUTSTANDING BALANCE. OUTSTANDING MEDICAL BILLS ARE NOT RESTRICTED TO JUST GREAT PLAINS HEALTH SERVICES BUT CAN BE ANY MEDICAL SERVICES. CURRENT STATEMENTS MUST BE PROVIDED SHOWING THE OUTSTANDING BALANCES CLAIMED. GREAT PLAINS HEALTH PART V, SECTION B, LINE 16I: THE WRITTEN FINANCIAL ASSISTANCE POLICY IS ON GPH'S WEBSITE, AS WELL AS PRINTED ON THE BACK SIDE OF EACH PAGE OF THE PATIENT BILLING STATEMENT. POSTERS REGARDING AVAILABILITY OF FINANCIAL ASSISTANCE ARE POSTED AT PATIENT POINTS OF ENTRY THROUGHOUT THE HOSPITAL FACILITY. GREAT PLAINS HEALTH PART V, SECTION B, LINE 18D: OTHER PERMITTED COLLECTION ACTIONS UPON PATIENT ELIGIBILITY VERIFICATION INCLUDE SENDING BALANCE DUE STATEMENTS, ACCOUNT LETTERS AND TELEPHONE CALLS ON HIGH DOLLAR ACCOUNTS. GREAT PLAINS HEALTH PART V, SECTION B, LINE 20E: GPH WORKS WITH PATIENTS THROUGH PHONE AND IN-PERSON INTERVIEWS TO DETERMINE THE PATIENT'S FINANCIAL SITUATION AND TO DETERMINE IF THE INDIVIDUAL QUALIFIES FOR ASSISTANCE, SUCH AS MEDICAID. GREAT PLAINS HEALTH PART V, SECTION B, LINE 22D: GPH ALSO USES THE FEDERAL POVERTY GUIDELINES WHEN DETERMINING THE MAXIMUM AMOUNTS THAT CAN BE CHARGED TO FAP-ELIGIBLE INDIVIDUALS. 1 NORTH PLATTE SURGERY CENTER LLC 621 WEST FRANCIS STREET NORTH PLATTE NE 69101 OUTPATIENT SURGERIES PART I, LINE 3C: GREAT PLAINS HEALTH (GPH) MAY MAKE A DETERMINATION OF ELIGIBILTY AT ANY STAGE OF THE PROCESS, INCLUDING PAST ASSIGNMENT TO AN OUTSIDE COLLECTION AGENCY. EACH PATIENT REQUESTING FINANCIAL ASSISTANCE WILL BE ASKED TO COMPLETE A FINANCIAL QUESTIONNAIRE AND TO PROVIDE COPIES OF DOCUMENTATION INCLUDING THEIR MOST RECENT FEDERAL INCOME TAX FORM, COPIES OF RECENT PAY STUBS, BANK STATEMENTS AND OTHER APPROPRIATE INDICATORS OF INCOME. A REFERRAL FOR FINANCIAL ASSITANCE MAY BE RECOMMENDED BY THE PATIENT, FAMILY MEMBER, PHYSICIAN OR HOSPITAL DEPARTMENTS AND PROVIDED BASED ON INFORMATION FROM OTHER SOURCES. FULL FINANCIAL ASSISTANCE WILL GENERALLY BE PROVIDED WHEN GROSS HOUSEHOLD INCOME IS EQUAL TO OR LESS THAN 150% OF THE FEDERAL POVERTY GUIDELINES. A SLIDING FEE SCALE DISCOUNT WILL BE APPLIED FOR HOUSEHOLD INCOME UP TO 250% OF THE FEDERAL POVERTY GUIDELINES. THE INCOME LEVELS WILL BE UPDATED ANNUALLY BASED UPON THE MOST CURRENT FEDERAL POVERTY GUIDELINES. PART I, LINE 6A: GPH'S COMMUNITY BENEFIT REPORT IS PREPARED BY THE STAFF OF GPH. PART I, LINE 7: GPH UTILIZED AN OVERALL COST TO CHARGE RATIO (TOTAL EXPENSES - BAD DEBT) / GROSS PATIENT SERVICE REVENUE = PERCENTAGE OF COST TO CHARGE. PART I, LINE 7G: THERE ARE NO SUBSIDIZED HEALTH SERVICES REPORTED ON LINE 7G. PART I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 6,109,500. PART II, COMMUNITY BUILDING ACTIVITIES: GPH HAS MANY ACTIVITES TO PROMOTE HEALTH IN THE COMMUNITIES IT SERVES. THESE ACTIVITIES INCLUDE: RECRUITMENT OF PHYSICIANS TO MEET NEED, SPONSORING HEALTH FAIR, SPORTS CLINICS AND SUPPORT GROUPS, PHYSICIANS SERVING ON COMMUNITY BOARDS, EDUCATION PROGRAMS AND MEDICATION ASSISTANCE. THE DONATED SERVICES AND FUNDS HELP FURTHER THE MISSION AND GOALS OF COMMUNITY ORGANIZATIONS WHICH, IN TURN, HELP IMPROVE OVERALL HEALTH STATUS AND QUALITY OF LIFE OF THE COMMUNITIES SERVED. PART III, LINE 2: IN EVALUATING THE COLLECTIBILITY OF ACCOUNTS RECEIVABLE, THE ORGANIZATION ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYOR SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. WHEN EVALUATING RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE ORGANIZATION ANALYZES CONTRACTUALLY DUE AMOUNTS AND ESTIMATES A PERCENTAGE OF THOSE ACCOUNTS THAT WILL TRANSITION TO SELF-PAY PATIENTS BASED ON HISTORICAL ANALYSIS. THE ESTIMATED PERCENTAGE OF THOSE TRANSITION ACCOUNTS ARE ADDED TO RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL). THE ORGANIZATION 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.IN 2013, THE ORGANIZATION ADOPTED A NEW POLICY RELATIVE TO SELF-PAY DISCOUNTS, WHEREBY CHARGES AND SUBSEQUENT BILLINGS WERE REDUCED TO APPROXIMATE REIMBURSEMENT LEVELS RECEIVED FROM GOVERNMENTAL THIRD-PARTY PAYORS.PAYMENT FOR SERVICES IS EXPECTED WITHIN THIRTY DAYS OF RECEIPT OF THE BILLING. ACCOUNTS CONSIDERED PAST DUE ARE SENT TO COLLECTION AGENCIES WHEN INTERNAL COLLECTION EFFORTS HAVE BEEN UNSUCCESSFUL. ANY AMOUNTS DEEMED UNCOLLECTIBLE ARE WRITTEN OFF ON A MONTHLY BASIS. THE ORGANIZATION DOES NOT CHARGE INTEREST ON OUTSTANDING BALANCES OWED. PART III, LINE 3: THE ORGANIZATION PROVIDES CHARITY CARE TO PATIENTS WHO ARE FINANCIALLY UNABLE TO PAY FOR THE HEALTHCARE SERVICES THEY RECEIVE. PATIENTS WHO QUALIFY FOR CHARITY CARE ARE GIVEN A PERCENTAGE DISCOUNT FROM ESTABLISHED CHARGES BASED ON A SLIDING SCALE USING POVERTY GUIDELINES. IT IS THE POLICY OF THE ORGANIZATION NOT TO PURSUE COLLECTION OF AMOUNTS DETERMINED TO QUALIFY AS CHARITY CARE. ACCORDINGLY, THE ORGANIZATION DOES NOT REPORT THESE AMOUNTS IN NET OPERATING REVENUE OR IN THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. THE ORGANIZATION DETERMINES THE COSTS ASSOCIATED WITH PROVIDING CHARITY CARE BY AGGREGATING THE DIRECT AND INDIRECT COSTS, INCLUDING SALARIES, BENEFITS, SUPPLIES, AND OTHER OPERATING EXPENSES, BASED ON THE OVERALL COST TO CHARGE RATIO FOR GP HEALTH AND NPNPG. PART III, LINE 4: THE COSTING METHODOLOGY USED IN DETERMINING THE BAD DEBT EXPENSES INCLUDES CALCULATING ON A MONTHLY BASIS THE TOTAL ESTIMATED AMOUNTS BASED ON HISTORICAL WRITE OFFS.THE ORGANIZATION'S FINANCIAL STATEMENTS DO NOT CONTAIN A SPECIFIC FOOTNOTE DESCRIBING BAD DEBT. HOWEVER, THE FOLLOWING IS THE TEXT OF THE FOOTNOTES TITLED "PATIENT ACCOUNTS RECEIVABLE, NET," "NET PATIENT SERVICE REVENUE," AND "CHARITY CARE":PATIENT ACCOUNTS RECEIVABLE, NET:THE ORGANIZATION REPORTS PATIENT ACCOUNTS RECEIVABLE FOR SERVICES RENDERED AT NET REALIZABLE AMOUNTS FROM THIRD-PARTY PAYORS, PATIENTS AND OTHERS. ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS. IN EVALUATING THE COLLECTIBILITY OF ACCOUNTS RECEIVABLE, THE ORGANIZATION ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYOR SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE ORGANIZATION ANALYZES CONTRACTUALLY DUE AMOUNTS AND ESTIMATES A PERCENTAGE OF THOSE ACCOUNTS THAT WILL TRANSITION TO SELF-PAY PATIENTS BASED ON HISTORICAL ANALYSIS. THE ESTIMATED PERCENTAGE OF THOSE TRANSITION ACCOUNTS ARE ADDED TO RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL). THE ORGANIZATION 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.IN 2013, THE ORGANIZATION ADOPTED A NEW POLICY RELATIVE TO SELF-PAY DISCOUNTS, WHEREBY CHARGES AND SUBSEQUENT BILLINGS WERE REDUCED TO APPROXIMATE REIMBURSEMENT LEVELS RECEIVED FROM GOVERNMENTAL THIRD-PARTY PAYORS.PAYMENT FOR SERVICES IS EXPECTED WITHIN THIRTY DAYS OF RECEIPT OF THE BILLING. ACCOUNTS CONSIDERED PAST DUE ARE SENT TO COLLECTION AGENCIES WHEN INTERNAL COLLECTION EFFORTS HAVE BEEN UNSUCCESSFUL. ANY AMOUNTS DEEMED UNCOLLECTIBLE ARE WRITTEN OFF ON A MONTHLY BASIS. THE ORGANIZATION DOES NOT CHARGE INTEREST ON OUTSTANDING BALANCES OWED.NET PATIENT SERVICE REVENUE:NET PATIENT SERVICE REVENUE IS REPORTED AT THE ESTIMATED NET REALIZABLE AMOUNTS FROM PATIENTS, THIRD-PARTY PAYERS, AND OTHERS FOR SERVICES RENDERED, INCLUDING ESTIMATED RETROACTIVE ADJUSTMENTS UNDER REIMBURSEMENT AGREEMENTS WITH THIRD-PARTY PAYERS. RETROACTIVE ADJUSTMENTS ARE ACCRUED ON AN ESTIMATED BASIS IN THE PERIOD THE RELATED SERVICES ARE RENDERED AND ADJUSTED IN FUTURE PERIODS AS FINAL SETTLEMENTS ARE DETERMINED.CHARITY CARE:THE ORGANIZATION PROVIDES CARE TO PATIENTS WHO MEET CERTAIN CRITERIA UNDER ITS CHARITY CARE POLICY WITHOUT CHARGE OR AT AMOUNTS LESS THAN ITS ESTABLISHED RATES. BECAUSE THE ORGANIZATION DOES NOT PURSUE COLLECTION OF AMOUNTS DETERMINED TO QUALIFY AS CHARITY CARE, THEY ARE NOT REPORTED AS REVENUE.THE ORGANIZATION IS DEDICATED TO PROVIDING COMPREHENSIVE HEALTH CARE SERVICES TO ALL SEGMENTS OF SOCIETY, INCLUDING THE AGED AND OTHERWISE ECONOMICALLY DISADVANTAGED. IN ADDITION, THE ORGANIZATION PROVIDES A VARIETY OF COMMUNITY HEALTH SERVICES AT OR BELOW COST. PART III, LINE 8: THE MEDICARE SHORTFALL IS BASED ON THE INFORMATION FROM THE COST REPORT. THESE COSTS ARE MEDICARE REIMBURSABLE COSTS, NOT ALL COSTS. THESE MEDICARE REIMBURSABLE COSTS SHOULD BE TREATED AS A COMMUNITY BENEFIT TO THE EXTENT THAT MEDICARE REVENUES DO NOT COVER THE COSTS. WE DO NOT USE ANY NEGOTIATION TOOL WITH MEDICARE FOR OUR RATES; THE RATES THAT WE ARE PAID ARE MANDATED. HENCE, THIS DOES NOT GIVE US THE ABILITY AS A PROVIDER TO RECEIVE SUFFICIENT REVENUES TO COVER THE MEDICARE COSTS. AS A FACILITY WE ARE WORKING TOWARD COSTS SAVINGS. PART III, LINE 9B: IF THE COLLECTION AGENCY LEARNS INFORMATION THAT INDICATES THAT THE PATIENT MAY BE ELIGIBLE FOR FINANCIAL ASSISTANCE UNDER THE GPH CHARITY CARE POLICY, THEN THE COLLECTION AGENCY SHALL PROMPTLY NOTIFY THE PATIENT FINANCIAL SERVICES DIRECTOR AND CEASE ANY FURTHER COLLECTION ACTIVITY UNTIL GPH DETERMINES THE PATIENT ELIGIBILITY. PART VI, LINE 2: GPH USES STRATEGIC PLANNING PROCESSES, MARKET STUDIES, OPEN FORUMS WITH PHYSICIANS, COMMUNITY FOCUS GROUPS, CUSTOMER SERVICE SURVEYS AND COMMUNITY SURVEYS TO ASSESS THE HEALTH CARE NEEDS OF THE COMMUNITIES GPH SERVES. PATIENT CARE AND SUPPORT SERVICES PROVIDED BY GPH ARE BASED ON GPH'S MISSION, VISION, VALUES AND STANDARDS OF BEHAVIOR. PATIENT CARE AND ANCILLARY SERVICES ARE ORGANIZED IN RESPONSE TO PATIENT NEEDS AS IDENTIFIED THROUGH THE STRATEGIC PLANNING PROCESS. THE GPH STRATEGIC PLAN FOCUSES ON ACHIEVING A CONTINUUM OF CARE TO MEET THE NEEDS OF THE COMMUNITY SERVED. THE STRATEGIC PLANNING PROCESS IS COMPLETED APPROXIMATELY EVERY THREE TO FIVE YEARS. PART VI, LINE 3: FOR PATIENTS THAT GPH DETERMINES ARE FINANCIALLY INDIGENT, THE PATIENT/GUARANTOR WILL BE NOTIFIED AND ASSISTED BY THE GPH PATIENT FINANCIAL SERVICES IN APPLYING FOR FINANCIAL ASSISTANCE. IF NO SOURCE OF FINANCIAL ASSISTANCE IS AVAILABLE, THE ACCOUNT WILL BE REVIEWED FOR A CHARITY ALLOWANCE ACCORDING TO THE HOSPITAL'S CHARITY POLICY (ADMINISTRATIVE POLICY 8210-0008). CASE MANAGERS ARE AVAILABLE AT GPH TO ASSIST PATIENTS AND THEIR FAMILIES WITH THE FINANCIAL AND SOCIAL STRESS THAT ACCOMPANY ILLNESS AND HOSPITALIZATION. CASE MANAGERS HAVE A WORKING KNOWLEDGE OF SOCIAL WORK THEORIES AND ARE ABLE TO ASSIST PATIENTS WITH CONTACTING COMMUNITY AGENCIES THAT CAN ASSIST THEM IN RECOVERY AND FINANCIAL NEEDS. AN OUTSIDE AGENCY IS USED TO PROVIDE ASSISTANCE TO PATIENTS IN DETERMINING THEIR ELIGIBILITY FOR MEDICAID. ONE-ON-ONE FINANCIAL COUNSELING IS AVAILABLE TO EVERY PATIENT, UPON REQUEST. PART VI, LINE 4: GREAT PLAINS HEALTH IS THE ONLY HOSPITAL IN LINCOLN COUNTY AND IS A REGIONAL REFERRAL HOSPITAL FOR NINETEEN OTHER COUNTIES IN NEBRASKA. GPH SERVES A MARKET OF OVER 123,026 RESIDENTS. OVER NINETY-THREE PERCENT OF GPH'S INPATIENT ADMISSIONS COME FROM WITHIN THIS MARKET. SEVENTY-TWO PERCENT OF THE PATIENTS COME FROM LINCOLN COUNTY. THE PRIMARY SERVICE AREA IS DEFINED AS LINCOLN COUNTY. THE SECONDARY SERVICE AREA INCLUDES THE FOLLOWING NINETEEN COUNTIES: ARTHUR, FRONTIER, HOOKER, PERKINS, CHASE, GRANT, GOSPER, KEITH, RED WILLOW, FURNAS, DUNDY, CHERRY, CUSTER, HAYES, LOGAN, THOMAS, DAWSON, HITCHCOCK, AND MCPHERSON. THE TOTAL POPULATION OF THE SECONDARY SERVICE AREA IS ABOUT 86,000.THE POPULATION IN THE SERVICE AREA IS EXPECTED TO CONTINUE THE SHIFT TOWARDS AN AGING POPULATION THAT WOULD INCREASE SERVICE UTILIZATION. HOSPITALS IN THE SECONDARY SERVICE AREA ARE: CHASE COUNTY COMMUNITY HOSPITAL (CHASE COUNTY), CHERRY COUNTY HOSPITAL (CHERRY COUNTY), CALLAWAY DISTRICT HOSPITAL (CUSTER COUNTY), JENNIE M. MELHAM MEMORIAL HOSPITAL (CUSTER COUNTY), COZAD COMMUNITY HOSPITAL (DAWSON COUNTY), GOTHENBURG MEMORIAL HOSPITAL (DAWSON COUNTY), TRI COUNTY HOSPITAL (DAWSON COUNTY), DUNDY COUNTY HOSPITAL (DUNDY COUNTY), TRI VALLEY HEALTH SYSTEM (FURNAS COUNTY), OGALLALA COMMUNITY HOSPITAL (KEITH COUNTY), PERKINS COUNTY HEALTH SERVICES (PERKINS COUNTY), AND COMMUNITY HOSPITAL (RED WILLOW COUNTY).MARKET OVERVIEWPRIMARY SERVICE AREA- CONSISTS OF LINCOLN COUNTY- ACCOUNTS FOR NEARLY 74.1% GPH'S INPATIENT CASES- THE 2014 POPULATION IS 35,815 SECONDARY SERVICE AREA- CONSISTS OF NINETEEN COUNTIES EXTENDING NORTH TO SOUTH DAKOTA, SOUTH TO KANSAS AND WEST TO COLORADO - ACCOUNTS FOR 25.9% OF GPH'S INPATIENT CASES - POPULATION 86,462 IN 2012 - LARGEST EMPLOYER IS UNION PACIFIC WITH 2,300 EMPLOYEES AT THE END OF 2013 PART VI, LINE 5: GPH HAS MANY ACTIVITES TO PROMOTE HEALTH IN THE COMMUNITIES IT SERVES. THESE ACTIVITIES INCLUDE: RECRUITMENT OF PHYSICIANS TO MEET NEED, SPONSORING HEALTH FAIR, SPORTS CLINICS AND SUPPORT GROUPS, PHYSICIANS SERVING ON COMMUNITY BOARDS, EDUCATION PROGRAMS AND MEDICATION ASSISTANCE. THE DONATED SERVICES AND FUNDS HELP FURTHER THE MISSION AND GOALS OF COMMUNITY ORGANIZATIONS WHICH, IN TURN, HELP IMPROVE OVERALL HEALTH STATUS AND QUALITY OF LIFE OF THE COMMUNITIES SERVED. PART VI, LINE 6: GREAT PLAINS HEALTH ASSISTS IN IDENTIFYING AND RECRUITING TOP PHYSICIANS IN NEEDED SPECIALTIES. GPH PROVIDES EDUCATION TO THE COMMUNITY ON VARIOUS HEALTH PROGRAMS FOR EMPLOYEES, EMPLOYERS AND THE COMMUNITY GPH SERVES. MANY MEMBERS OF THE STAFF HOLD SPEAKING ENGAGEMENTS TO PROVIDE MEDICAL INFORMATION TO THE COMMUNITY. THE MEDICATION ASSISTANCE PROGRAM ASSISTS PATIENTS TO FIND OTHER MEANS TO AFFORD THEIR PRESCRIPTIONS.THE HEALTH CENTER OPERATES ACUTE AND PSYCHIATRIC CARE BEDS, A HOME HEALTH AGENCY, AND PROVIDES VARIOUS OUTPATIENT AND EMERGENCY MEDICAL TREATMENT SERVICES. THE AFFILIATES LEASE AND SELL HOME MEDICAL EQUIPMENT TO THE PUBLIC, RENT OFFICE SPACE TO PHYSICIAN PRACTICES, RENT INDEPENDENT LIVING APARTMENTS TO THE ELDERLY AND PROVIDE PHYSICIAN PROFESSIONAL MEDICAL SERVICES AND OTHER PROGRAMS TO PATIENTS. PART VI, LINE 7: GPH DOES NOT FILE A COMMUNITY BENEFIT REPORT WITH ANY STATE. 1 NEBRASKALAND DAYS INC PO BOX 706 NORTH PLATTE NE 69103 470521025 501(C)(4) 36000 SPONSOR OF 2014 EVENTS PLATTE RIVER FITNESS SERIES 1300 MCDONALD ROAD NORTH PLATTE NE 69101 476006297 GOVERNMENTAL 10000 SPONSOR OF 2014 EVENTS COMMUNITY HOSPITAL HEALTH FOUNDATION PO BOX 1328 MCCOOK NE 69001 470693261 501(C)(3) 5000 SUPPORT OF 2014 EVENTS CREATIVITY UNLIMITED ARTS COUNCIL PO BOX 266 NORTH PLATTE NE 69103 202209105 501(C)(3) 10000 FOR RENOVATION TO THE PRAIRIE ARTS CENTER NORTH PLATTE AMERICAN LEGION PO BOX 664 NORTH PLATTE NE 69101 470260081 501(C)(19) 8000 SUPPORT OF THE LEGION BASEBALL PROGRAM HALL OF FAME NORTH PLATTE COMMUNITY PLAYHOUSE INC PO BOX 825 NORTH PLATTE NE 69103 476032789 501(C)(3) 7500 SUPPORT OF THE TOWN HALL LECTURE SERIES NORTH PLATTE HIGH SCHOOL 1220 WEST 2ND ST NORTH PLATTE NE 69101 476004045 501(C)(3) 6713 FOR THE PURCHASE OF WALL PADS 5 2 PART I, LINE 2: GREAT PLAINS HEALTH PROVIDES SPONSORSHIP DOLLARS TO CHARITABLE EVENTS IN THE LOCAL AREA. THE ORGANIZATION GIVES TO CHARITABLE ORGANIZATIONS IN THE AREA WHICH BENEFIT THE LOCAL COMMUNITY. X X X X 0 0 0 0 0 0 0 0 0 RENEE ENGLER MD CHIEF OF STAFF/DIRECTOR 343457 0 55763 0 28087 0 10400 0 28142 0 465849 0 0 0 JAMES SMITH MD DIRECTOR 381795 0 46773 0 414 0 10400 0 28142 0 467524 0 0 0 GREGORY NIELSEN CEO (1/1/14 - 4/8/14) 139087 0 46125 0 293882 0 7522 0 9714 0 496330 0 0 0 MELVIN MCNEA CEO (4/8/14 - 12/31/14) 253249 0 41135 0 0 0 0 0 28042 0 322426 0 0 0 KRYSTAL CLAYMORE CFO 237931 0 36250 0 180 0 10400 0 26692 0 311453 0 0 0 IRFAN A VAZIRI PHYSICIAN (GPH) 888338 0 95976 0 270 0 10400 0 27362 0 1022346 0 0 0 ARSHAD ALI PHYSICIAN (GPH) 826811 0 38890 0 13865 0 10400 0 10610 0 900576 0 0 0 SATYANARAYANA NELLURI PHYSICIAN (GPH) 794119 0 34865 0 15868 0 10400 0 27262 0 882514 0 0 0 AHMED AWAIS PHYSICIAN (GPH) 399130 0 256476 0 5357 0 10400 0 13322 0 684685 0 0 0 MICHAEL GALLENTINE PHYSICIAN (NPNPG) 503149 0 114930 0 180 0 10400 0 25092 0 653751 0 0 0 A HOSPITAL AUTHORITY NO 1 OF LINCOLN COUNTY NEBRASKA 971837633 533282BQ1 2012-11-15 109560864 CONSTRUCT/UPDATE FACILITIES AND REFUND PRIOR REVENUE BONDS 0 0 0 A 109870351 1189899 67384272 9390952 31905229 1 1 0 1 A 0 0 1 1 0 0 0 1 A 0 1 1 0 0 0 0 0 1 A 1 PART II, LINE 3: THE TOTAL PROCEEDS DO NOT AGREE TO THE ISSUE PRICE IN PART I, COLUMN (E) DUE TO INVESTMENT EARNINGS. DAVID PEDERSEN MR. PEDERSEN, A DIRECTOR, IS 49% OWNER OF PERIPETY, LLC D/B/A PRO PRINTING 120626 PRINTING SERVICES 0 BYRON L BARKSDALE MR. BARKSDALE, A DIRECTOR, IS PART OWNER OF PATHOLOGY SERVICES, PC 379201 PATHOLOGY SERVICES 0 X 1 619338 NET BOOK VALUE 0 1 0 FORM 990, PART VI, SECTION B, LINE 11 COPIES OF THE FORM 990 ARE DISTRIBUTED TO THE AUDIT COMMITTEE OF THE BOARD FOR REVIEW. THIS IS DONE VIA THE BOARD PORTAL WHICH IS AVAILABLE TO ALL BOARD MEMBERS. FOLLOW UP IS DISCUSSED AT THE NEXT MEETING FOLLOWING THE FILING OF THE FORM 990. FORM 990, PART VI, SECTION B, LINE 12C GPH PROVIDES A CONFLICT OF INTEREST QUESTIONNAIRE TO EACH OFFICER AND DIRECTOR. THE CONFLICT OF INTEREST QUESTIONNAIRE IS COMPLETED AND RETURNED ANNUALLY. ANY QUESTIONABLE SITUATION IS DISCLOSED ON THE QUESTIONNAIRE. FURTHERMORE, ANY POTENTIAL CONFLICTS ARISING DURING THE YEAR ARE TO BE REPORTED TO ADMINISTRATION. THE CONFLICTS REVIEW COMMITTEE REVIEWS ANY TRANSACTIONS THAT MAY BE CONSIDERED TO HAVE A CONFLICT OF INTEREST. FORM 990, PART VI, SECTION B, LINE 15 THE GREAT PLAINS HEALTH BOARD OF DIRECTORS STRIVES TO COMPENSATE OFFICERS AND KEY EMPLOYEES AT LEVELS THAT ARE COMPETITIVE IN THE MARKETPLACE, COST EFFECTIVE AND, AS MUCH AS POSSIBLE, INTERNALLY EQUITABLE. THE EXECUTIVE COMMITTEE FOR THE BOARD OF DIRECTORS MEETS NO LESS THAN ANNUALLY TO REVIEW COMPENSATION PACKAGES FOR GPH'S PRESIDENT, OFFICERS, AND KEY EMPLOYEES. COMPENSATION DATA IS GATHERED BY AN INDEPENDENT EXECUTIVE COMPENSATION CONSULTANT BY SURVEYING COMPARABLE POSITIONS AT PEER INSTITUTIONS, ENSURING THAT COMPENSATION PACKAGES ARE MEETING FAIR MARKET VALUE. A COMPLETE ANALYSIS OF DATA IS REQUESTED FROM THE CONSULTANT AT LEAST EVERY FOUR YEARS. THE INDEPENDENT EXECUTIVE COMPENSATION CONSULTANT IS ULTIMATELY ACCOUNTABLE TO THE EXECUTIVE COMMITTEE AND THE BOARD. THE EXECUTIVE COMMITTEE ANNUALLY RECOMMENDS TO THE BOARD THE SELECTION/RETENTION OF THE INDEPENDENT EXECUTIVE COMPENSATION CONSULTANT; REVIEWS COMPENSATION RECOMMENDATIONS; AND DETERMINES THOSE OFFICERS AND KEY EMPLOYEES FOR WHOM WRITTEN EMPLOYMENT CONTRACTS WILL BE REQUIRED. THE BOARD OF DIRECTORS HAS THE AUTHORITY TO ANNUALLY AUTHORIZE MANAGEMENT TO PROCEED WITH IMPLEMENTATION OF PROPOSED COMPENSATION OF OFFICERS AND KEY EMPLOYEES. FORM 990, PART VI, SECTION C, LINE 19 GREAT PLAINS HEALTH DOES NOT MAKE ITS CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC. UPON WRITTEN REQUEST TO THE CHIEF FINANCIAL OFFICER, GOVERNING DOCUMENTS WILL BE MADE AVAILABLE TO THE PUBLIC FOR REVIEW AT THE HOSPITAL'S ADMINSTRATIVE OFFICE. FORM 990, PART IX, LINE 11G OTHER FEES: PROGRAM SERVICE EXPENSES 1,014,600. MANAGEMENT AND GENERAL EXPENSES 339,508. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,354,108. PHYSICIAN FEES: PROGRAM SERVICE EXPENSES 4,568,605. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,568,605. SERVICE CONTRACTS: PROGRAM SERVICE EXPENSES 6,567,508. MANAGEMENT AND GENERAL EXPENSES 1,163,500. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 7,731,008. CONTRACT LABOR: PROGRAM SERVICE EXPENSES 3,685,443. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,685,443. PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 692,335. MANAGEMENT AND GENERAL EXPENSES 875,509. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,567,844. FORM 990, PART XI, LINE 9: CHANGE IN INTEREST IN GREAT PLAINS HEALTH CARE FOUNDATION 776,419. FORM 990, PART XII, LINE 2C: THE BOARD OF DIRECTORS OF GREAT PLAINS HEALTH ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF ITS FINANCIAL STATEMENTS AND SELECTION OF AN INDEPENDENT ACCOUNTANT. THIS PROCESS HAS NOT CHANGED FROM PRIOR YEARS. 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