2015-11-13T09:35:27-06:00 2014-12-31 476097913 SEIM JOHNSON LLP 18081 BURT STREET SUITE 200 OMAHA NE 680224722 990 2014-01-01 470481628 PHELPS MEMORIAL HEALTH CENTER PHEL 3089952211 1215 TIBBALS STREET HOLDREGE NE 68949 LOREN SCHRODER CHIEF FINANCIAL OFFICER 3089952211 2015-11-13 1 BARBARA J FAJEN P00400874 4023302660 2014 2016-03-07 17:11:31Z MARK HARREL 1215 TIBBALS STREET HOLDREGE NE 68949 43550417 0 X WWW.PHELPSMEMORIAL.COM X 1963 NE PHELPS MEMORIAL HEALTH CENTER IS A PROGRESSIVE FAMILY-CENTERED HEALTH CARE PROVIDER PROVIDING EXCEPTIONAL QUALITY AND COMPASSIONATE CARE FOR THE FAMILIES WE SERVE. 13 11 268 101 0 0 242743 35806 35889962 41648774 328262 912957 95854 143794 36556821 42741331 77487 29788 0 0 12341864 13796570 0 0 0 19432448 22919127 31851799 36745485 4705022 5995846 74452927 81067155 17078016 17994668 57374911 63072487 X PHELPS MEMORIAL HEALTH CENTER IS A PROGRESSIVE FAMILY-CENTERED HEALTH CARE PROVIDER PROVIDING EXCEPTIONAL QUALITY AND COMPASSIONATE CARE FOR THE FAMILIES WE SERVE. 0 0 25198831 29788 26573700 25-BED CRITICAL ACCESS HOSPITAL THAT PROVIDES INPATIENT, OUTPATIENT, SWING BED, EMERGENCY, HOME HEALTH AND AMBULANCE SERVICES IN THE LOCAL AREA. 2192095 4513496 PHARMACY - THE PHARMACY DEPARTMENT OVERSEES MEDICATION PURCHASING, STORAGE, DISPENSING, AND THE UTILIZATION THROUGHOUT PHELPS MEMORIAL HEALTH CENTER. THE PHARMACY STAFF PLAYS AN IMPORTANT ROLE IN PROVIDING DRUG INFORMATION TO HEALTH CARE PROFESSIONALS AT PHELPS MEMORIAL HEALTH CENTER. WITH THE USE OF DISPENSING TECHNOLOGIES, INCLUDING SMART INFUSION PUMPS AND BAR CODING BEDSIDE, THE PHARMACY DEPARTMENT AT PHELPS MEMORIAL HEALTH CENTER GIVES PATIENT SAFETY A TOP PRIOITY. 2173859 5193930 PHYSICIAN CLINIC - PHELPS MEMORIAL HEALTH CENTER IS DEDICATED TO PROVIDING OUR PATIENTS WITH A HIGH LEVEL OF QUALITY CARE, RIGHT HERE IN HOLDREGE, NEBRASKA. PHMC CONTRACTS WITH MANY VISITING SPECIALISTS TO PROVIDE OUR PATIENTS WITH THE SPECIALTY CARE THEY NEED WITHOUT LEAVING TOWN. VISITING PHYSICIANS AND SURGEONS PROVIDE SPECIALITIES IN THE AREAS OF CARDIOLOGY, EAR/NOSE/THROAT, GENERAL SURGERY, PAIN MANAGEMENT, NEPHROLOGY, OBSTETRICS AND GYNECOLOGY, ONCOLOGY, ORTHOPAEDICS, SPINE, PODIATRY, PSYCHIATRY, PULMONARY, UROLOGY, AND WOUND TREATMENT. 2017392 5367648 PHYSICAL THERAPY - THE THERAPY CENTER INCLUDES A LARGE GYM FOR TRAINING AND REHABILITATION, A WHIRLPOOL ROOM FOR WOUND CARE AND A SPORTS FLOOR FOR ATHLETIC TRAINING. PHYSICAL THERAPY ALLOWS INDIVIDUALS TO DEVELOP, RESTORE AND MAINTAIN MAXIMUM MOVEMENT AND FUNCTIONAL ABILITY THROUGHOUT LIFE. THIS INCLUDES PROVIDING SERVICES IN CIRCUMSTANCES WHERE MOVEMENT AND FUNCTION ARE THREATENED BY AGING, INJURY OR DISEASE. THE HYDROWORX THERAPY POOL HELPS PATIENTS RECOVER FROM SURGERY AND ARTHRITIC SYMPTOMS, AS WELL AS, ATHLETIC REHABILITATION. OCCUPATIONAL THERAPY INCORPORATES MEANINGFUL AND PURPOSEFUL OCCUPATION TO ENABLE PEOPLE WITH LIMITATIONS OR IMPAIRMENTS TO PARTICIPATE IN EVERYDAY LIFE. OCCUPATIONAL THERAPISTS WORK WITH INDIVIDUALS, FAMILIES, GROUPS AND POPULATIONS TO FACILITATE HEALTH AND WELL-BEING THROUGH ENGAGEMENT OR RE-ENGAGEMENT IN OCCUPATIONS AND EVERYDAY ACTIVITIES. OCCUPATIONAL THERAPY MAY INCLUDE RESTORING FUNCTION, ADAPTING THE PATIENT'S ENVIRONMENT, OR EVEN HELPING PATIENTS FIND EQUIPMENT TO HELP THEM PARTICIPATE MORE INDEPENDENTLY IN THEIR EVERYDAY ACTIVITIES. OCCUPATIONAL THERAPY HAS MORE ROOM TO EXPAND THEIR SERVICES AND BETTER SERVE THEIR PATIENTS. SPEECH THERAPY ADDRESSES PEOPLE'S SPEECH PRODUCTION, VOCAL PRODUCTION, SWALLOWING DIFFICULTIES AND LANGUAGE NEEDS. 2017392 5367648 31582177 1 1 0 1 0 0 0 0 0 1 1 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 1 49 0 1 268 1 0 0 0 0 0 0 0 0 0 0 X 13 11 1 1 0 0 1 1 0 1 1 0 0 1 1 1 1 1 1 1 0 0 X LOREN D SCHRODER CFO 3089952211 1215 TIBBALS STREET HOLDREGE NE 68949 KATHRYN CANADA PRESIDENT 2.00 0.00 X X 0 0 0 ROGER PETERSON VICE PRESIDENT 2.00 0.00 X X 0 0 0 STEVE KNESS TREASURER 2.00 0.00 X X 0 0 0 PHILIP HINRICHS SECRETARY 2.00 0.00 X X 0 0 0 RYAN BAUER MEMBER 2.00 0.00 X 0 0 0 GARY BERGSTEN MEMBER (THRU 4/2014) 2.00 0.00 X 0 0 0 JEFFREY BERNEY MD MEMBER 2.00 0.00 X 0 0 0 CATHY EBMEIER MEMBER 2.00 0.00 X 0 0 0 NANCY GARRELTS MEMBER 2.00 0.00 X 0 0 0 LARRY MYERS MEMBER 2.00 0.00 X 0 0 0 CHARLES REESER MEMBER 2.00 0.00 X 0 0 0 DAROLD TAGGE MEMBER 2.00 0.00 X 0 0 0 RONA VANDELL MEMBER 2.00 0.00 X 0 0 0 CHARLOTTE WIRGES MD CHIEF OF STAFF 2.00 0.00 X 0 0 0 MARK HARREL CEO 40.00 0.00 X 0 0 0 LOREN SCHRODER CFO 40.00 0.00 X 0 0 0 ROBERT M MILLER PHARMACIST 40.00 0.00 X 133060 0 17688 LEORA D SMITH CHIEF NURSING OFFICER 40.00 0.00 X 109913 0 17167 JON T MCCLYMONT PHARMACIST 40.00 0.00 X 103237 0 21695 SUSAN J HARDESSEN CQCO 40.00 0.00 X 100532 0 20530 446742 0 77080 4 0 1 1 NEW WEST ORTHOPAEDIC & SPORTS REHAB 2810 WEST 35TH STREET STE 2 KEARNEY NE 68949 THERAPY 1950936 RURAL PARTNERS IN MEDICINE LLC PO BOX 772519 STEAMBOAT SPRINGS CO 80477 SPECIALTY PHYSICIANS 1901450 QUORUM HEALTH RESOURCES 105 CONTINENTAL PLACE BRENTWOOD TN 37027 MANAGEMENT SERVICES 848855 FAMILY MEDICAL SPECIALITIES 516 WEST 14TH AVE HOLDREGE NE 68949 PHYSICIAN ON-CALL 811920 ARAMARK SERVICES 1101 MARKET STREET PHILADELPHIA PA 19107 MAINTENANCE AND LAUNDRY SERVICES 586022 13 35806 35806 NET PATIENT REVENUE 624100 20445842 20445842 MEDICARE/MEDICAID PAYM 624100 19986985 19986985 SUPPLY SALES/MISC OPER 624100 618507 618507 340B DRUG DISCOUNT PRO 624100 327756 327756 EHR INCENTIVE PAYMENT 624100 192084 192084 77600 77600 41648774 903451 903451 818592 779485 29601 39107 -29601 9506 9506 CAFETERIA 722210 143794 143794 143794 42741331 41648774 0 1056751 X 29788 29788 67128 67128 10359066 8413536 1945530 205473 167132 38341 2481730 2347792 133938 683173 555693 127480 848855 848855 115620 31939 83681 107343 18950 88393 7127290 6940090 187200 89504 32 89472 1472808 1099598 373210 758689 656383 102306 181719 134597 47122 370873 370873 5089004 4057208 1031796 139527 139527 MEDICAL SUPPLIES 5188463 5188463 BAD DEBTS 1319200 1319200 DUES AND SUBSCRIPTIONS 110232 44248 65984 36745485 31582177 5163308 0 425 425 8475998 6479952 5160353 6964527 664639 756059 243388 291626 81968374 34751456 51104574 47216918 7328245 16668310 455721 473982 1019584 2215356 74452927 81067155 4139659 2579963 12628357 15194705 310000 220000 17078016 17994668 X 57043944 62721851 104304 115083 226663 235553 57374911 63072487 74452927 81067155 5995846 -298270 0 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 2076 2076 0 PART II-B, LINE 1: DUES PAID TO NHA & AHA CONTAIN A PORTION FOR LOBBYING EXPENSES. 446042 16320 462362 432067 13975 446042 417219 14848 432067 401558 15661 417219 383151 18407 401558 0.49100 0.50900 0.00000 0 0 256511 256511 60058723 19442057 40616666 19974459 14875525 5098934 1678681 433874 1244807 47216918 PLEDGE PAYABLE - PHELPS COUNTY DEVELOPMENT CORP 20000 PLEDGE PAYABLE - UNIVERSITY OF NEBRASKA FOUNDATION 200000 220000 X 41123861 -298270 -298270 41422131 1319200 1319200 42741331 35426285 0 35426285 1319200 1319200 36745485 PART V, LINE 4: THE INTENDED USES FOR THE ENDOWMENT FUNDS ARE HEALTH CARE SCHOLARSHIPS, CHILD HEALTHCARE AND UNUSUAL HARDSHIP COSTS. PART X, LINE 2: THE HEALTH CENTER IS A NOT-FOR-PROFIT CORPORATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. THE HEALTH CENTER HAS 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 THE HEALTH CENTER TO MEET A COMMUNITY BENEFIT STANDARD AND COMPLY WITH VARIOUS LAWS AND REGULATIONS. THE HEALTH CENTER ACCOUNTS FOR UNCERTAINTIES IN ACCOUNTING FOR INCOME TAX ASSETS AND LIABILITIES USING GUIDANCE INCLUDED IN FASB ASC TOPIC 740, INCOME TAXES. THE HEALTH CENTER RECOGNIZES THE EFFECT OF INCOME TAX POSITIONS ONLY IF THOSE POSITIONS ARE MORE LIKELY THAN NOT OF BEING SUSTAINED. AT DECEMBER 31, 2014 AND 2013, THE HEALTH CENTER HAD NO UNCERTAIN TAX POSITIONS ACCRUED. WITH FEW EXCEPTIONS, THE HEALTH CENTER IS NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS FOR THE YEARS ENDED PRIOR TO 2011. PART XI, LINE 4B - OTHER ADJUSTMENTS: PROVISION FOR BAD DEBTS 1,319,200. PART XII, LINE 4B - OTHER ADJUSTMENTS: PROVISION FOR BAD DEBTS 1,319,200. 1 1 1 X 125.000000000000 1 X 225.000000000000 1 1 0 1 1 238448 0 238448 0.00670 1733802 1518219 215583 0.00610 1972250 1518219 454031 0.01280 23488 0 23488 0.00070 40696 0 40696 0.00110 2073575 901759 1171816 0.03310 86567 0 86567 0.00240 2224326 901759 1322567 0.03730 4196576 2419978 1776598 0.05010 4956 0 4956 0.00010 4956 4956 0.00010 0 1319200 543615 17201160 17464792 -263632 X 1 0 1 1 PHELPS MEMORIAL HEALTH CENTER 1215 TIBBALS HOLDREGE NE 68949 WWW.PHELPSMEMORIAL.COM 610003 X X X X PHELPS MEMORIAL HEALTH CENTER 1 0 0 1 X X X X X X X X X 13 1 0 0 1 X WWW.PHELPSMEMORIAL.COM X 1 13 1 WWW.PHELPSMEMORIAL.COM 0 0 1 X 125.000000000000 225.000000000000 0 1 X X 1 X X 1 0 X X X X 1 X 0 0 PHELPS MEMORIAL HEALTH CENTER PART V, SECTION B, LINE 5: IN DECEMBER 2011, THE NEBRASKA DEPARTMENT OF HEALTH AND HUMAN SERVICES ISSUED A REPORT "2011 NEBRASKA COMMUNITY THEMES AND STRENGTHS ASSESSMENT SURVEY RESULTS" FOR THE TWO RIVERS AREA, WHICH INCLUDES PHELPS COUNTY. WHEN THE ANALYSIS WAS COMPLETE, THE INFORMATION AND SUMMARY CONCLUSIONS OF THE NE DHHS REPORT WAS PRESENTED TO PMHC'S LOCAL GROUP OF EXPERTS WHO WERE ASKED IF THEY AGREE OR DISAGREE WITH THE SUMMARY CONCLUSIONS. THEY WERE FREE TO AUGMENT POTENTIAL CONCLUSIONS WITH ADDITIONAL STATEMENTS OF NEED; NEW NEEDS COULD, AND DID, EMERGE FROM THIS EXCHANGE. CONSULTATIONS WITH LOCAL EXPERTS OCCURED AGAIN VIA AN INTERNET BASED SURVEY, IN WHICH EXPERTS COMPLETED QUESTIONNAIRES IN A SERIES OF ROUNDS. PHELPS MEMORIAL HEALTH CENTER PART V, SECTION B, LINE 11: THERE WERE THREE SIGNIFICANT NEEDS IDENTIFIED IN PMHC'S COMMUNITY HEALTH NEEDS ASSESSMENT THAT WERE IDENTIFIED BUT AN IMPLEMENTATION PLAN WAS NOT DEVELOPED. THESE THREE NEEDS WERE OBESITY/OVERWEIGHT, MENTAL HEALTH, AND ALCOHOL ABUSE. THERE WERE ALSO SEVERAL OTHER IDENTIFIED NEEDS IN THE CHNA. THESE OTHER NEEDS INCLUDE THE FOLLOWING: ECONOMY, DOMESTIC VIOLENCE, ALZHEIMER'S, ACCIDENTS, STROKE, CANCER SCREENING, CORONARY HEART DISEASE, SMOKING, CHRONIC HIGH BLOOD PRESSURE, AFTER SCHOOL PROGRAMS, SEXUALLY TRANSMITTED DISEASE, CHRONIC HIGH CHOLESTEROL, CHRONIC COPD (LUNG DISEASE), CHRONIC LOW BACK PAIN, PALLIATIVE CARE AND HOSPICE, CHRONIC OSTEOPOROSIS, LIFE EXPECTANCY/PREMATURE DEATH, PATIENT COMPLIANCE, TRANSPORTATION, ORTHOPEDIC SERVICES INCLUDING SURGERY AVAILABILITY, SOCIAL NETWORKS, VACCINATIONS, PHYSICIANS.PHMC HAS A MULTIFACETED APPROACH IN MEETING THE IDENTIFIED NEEDS OF THE COMMUNITY RELATED TO MATERNAL AND INFANT HEALTH, CANCER, DIABETES, HEALTHCARE COST, QUALITY, COVERAGE AND PHYSICAL ACTIVITY. EFFORTS INCLUDE: TAKING A LEADERSHIP ROLE IN COORDINATING EDUCATIONAL AND PROGRAMMATIC INITIATIVES RELATED TO THESE AREAS, RECRUITMENT OF PHYSICIANS TO THE COMMUNITY THAT SPECIALIZE IN THE IDENTIFIED HEALTH NEEDS AND EXPANSION OF FINANCIAL ASSISTANCE EFFORTS. PART I, LINE 3C: PHELPS MEMORIAL HEALTH CENTER (PMHC) USES FEDERAL POVERTY GUIDELINES TO DETERMINE ELIGIBILITY FOR PROVIDING FREE AND DISCOUNTED CARE. PART I, LINE 6A: THE COMMUNITY BENEFIT REPORT IS PREPARED BY THE STAFF AT PMHC AND IS POSTED ON PMHC'S WEBSITE. PART I, LINE 7: THE COSTING METHODOLOGY USED TO CALCULATE THE AMOUNTS REPORTED IN THE TABLE WAS A COST-TO-CHARGE RATIO. THE RATIO WAS DERIVED FROM THE COST REPORT FOR FINANCIAL ASSISTANCE. PART I, LINE 7G: NO COSTS ASSOCIATED WITH PHYSICIAN CLINICS WERE INCLUDED AS SUBSIDIZED HEALTH SERVICES. PART I, LN 7 COL(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 $1,319,200. PART II, COMMUNITY BUILDING ACTIVITIES: ONE OF THE MAJOR COMMUNITY BUILDING ACTIVITIES THAT PMHC HELPS LEAD IS THE SAFE COMMUNITIES COALITION. PMHC EMPLOYS TWO COALITION MEMBERS, INCLUDING THE COALITION COORDINATOR WHO IS RESPONSIBLE FOR THE DAY TO DAY ORGANIZATIONAL RESPONSIBILITIES, MINUTES, AGENDAS, AND PROGRAM AND EVENT COORDINATION. SAFE COMMUNITIES COALITION IS A GROUP OF REPRESENTATIVES FROM SEVERAL COMMUNITY AGENCIES, INCLUDING PHELPS MEMORIAL HEALTH CENTER, HOLDREGE POLICE DEPARTMENT, PHELPS COUNTY SHERIFF'S DEPARTMENT, NEBRASKA STATE PATROL, YMCA OF THE PRAIRIE, SAFE CENTER, TWO RIVERS PUBLIC HEALTH DEPARTMENT, HOLDREGE, LOOMIS, AND BERTRAND SCHOOLS, AND OTHERS. PART III, LINE 2: IN EVALUATING THE COLLECTIBILITY OF ACCOUNTS RECEIVABLE, THE HEALTH CENTER 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 HEALTH 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 HEALTH 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.PAYMENT FOR SERVICES IS EXPECTED WITHIN THIRTY DAYS OF RECEIPT OF THE BILLING. ACCOUNTS CONSIDERED PAST DUE ARE SENT TO COLLECTION AGENCIES WHEN EXTERNAL COLLECTION EFFORTS HAVE BEEN UNSUCCESSFUL. ANY AMOUNTS DEEMED UNCOLLECTIBLE ARE WRITTEN OFF ON A MONTHLY BASIS. THE HEALTH CENTER DOES NOT CHARGE INTEREST ON OUTSTANDING BALANCES OWED. PART III, LINE 3: ESTIMATED BAD DEBT FOR PATIENTS ELIGIBLE FOR CHARITY CARE WAS DETERMINED BY APPLYING CHARITY CARE GUIDELINES BASED ON AVERAGE PER HOUSEHOLD INCOME FOR PHELPS COUNTY. THE HEALTH CENTER PROVIDES CARE TO PATIENTS WHO MEET CERTAIN CRITERIA UNDER ITS CHARITY CARE POLICY WITHOUT CHARGE OR AT AMOUNTS LESS THAN ITS ESTIMATED RATES. BECAUSE THE HEALTH CENTER DOES NOT PURSUE COLLECTION OF AMOUNTS DETERMINED TO QUALIFY AS CHARITY CARE, THEY ARE NOT REPORTED IN THE STATEMENTS OF OPERATIONS. PART III, LINE 4: 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 HEALTH CENTER 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 HEALTH CENTER 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 HEALTH 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 HEALTH 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.PAYMENT FOR SERVICES IS EXPECTED WITHIN THIRTY DAYS OF RECEIPT OF THE BILLING. ACCOUNTS CONSIDERED PAST DUE ARE SENT TO COLLECTION AGENCIES WHEN EXTERNAL COLLECTION EFFORTS HAVE BEEN UNSUCCESSFUL. ANY AMOUNTS DEEMED UNCOLLECTIBLE ARE WRITTEN OFF ON A MONTHLY BASIS. THE HEALTH CENTER 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 PAYORS, AND OTHERS FOR SERVICES RENDERED AND INCLUDES ESTIMATED RETROACTIVE REVENUE ADJUSTMENTS DUE TO FUTURE AUDITS, REVIEWS, AND INVESTIGATIONS. RETROACTIVE ADJUSTMENTS ARE CONSIDERED IN THE RECOGNITION OF REVENUE ON AN ESTIMATED BASIS IN THE PERIOD THE RELATED SERVICES ARE RENDERED AND SUCH AMOUNTS ARE ADJUSTED IN FUTURE PERIODS AS ADJUSTMENTS BECOME KNOWN OR AS YEARS ARE NO LONGER SUBJECT TO SUCH AUDITS, REVIEWS, AND INVESTIGATIONS.CHARITY CARE:THE HEALTH CENTER 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 HEALTH CENTER DOES NOT PURSUE COLLECTION OF AMOUNTS DETERMINED TO QUALIFY AS CHARITY CARE, THEY ARE NOT REPORTED IN THE STATEMENTS OF OPERATIONS. THE HEALTH CENTER IS DEDICATED TO PROVIDING COMPREHENSIVE HEALTHCARE SERVICES TO ALL SEGMENTS OF SOCIETY, INCLUDING THE AGED AND OTHERWISE ECONOMICALLY DISADVANTAGED. IN ADDITION, THE HEALTH CENTER PROVIDES A VARIETY OF COMMUNITY HEALTH SERVICES AT OR BELOW COST. PART III, LINE 8: THE ORGANIZATION USED THE MEDICARE COST REPORT FOR FISCAL YEAR 2014 TO REPORT THE AMOUNTS OF TOTAL REVENUE RECEIVED FROM MEDICARE AND RELATED MEDICARE ALLOWABLE COSTS. THE SHORTFALL IS ATTRIBUTABLE TO COMMUNITY BENEFIT. THIS IS TO PROVIDE NECESSARY SERVICES SUCH AS HOME HEALTH AND CARDIAC REHAB THAT ARE SUBSIDIZED SERVICES BY PMHC. PART III, LINE 9B: IF A PATIENT IS UNABLE TO MAKE FULL PAYMENT OF THE PATIENT BALANCE WHEN DUE, PERIODIC, PARTIAL PAYMENTS MAY BE APPROVED IN ACCORDANCE WITH CREDIT AND COLLECTION PROCEDURES, AS AUTHORIZED BY THE CHIEF FINANCIAL OFFICER. A PATIENT FINANCIAL STATEMENT MAY BE REQUESTED TO DETERMINE APPROPRIATE PAYMENT ARRANGEMENTS.IF A PATIENT IS DETERMINED TO BE FINANCIALLY INDIGENT, THE PATIENT FINANCIAL SERVICES DEPARTMENT WILL ASSIST THE PATIENT IN APPLYING FOR OTHER FINANCIAL ASSISTANCE. IF NO SOURCE OF FINANCIAL ASSISTANCE IS AVAILABLE, THE HOSPITAL WILL REVIEW THE ACCOUNT FOR CHARITY CARE ALLOWANCE. ALL CHARITY CARE ALLOWANCE MUST BE APPROVED BY THE CHIEF FINANCIAL OFFICER AND PATIENT FINANCIAL SEVICES LEADER.IF PAYMENT ARRANGEMENTS HAVE NOT BEEN MADE AFTER 120 DAYS THE FIRST NOTICE IS RECEIVED, THE PATIENT IS SENT A LETTER STATING THAT THE ACCOUNT IS BEING FORWARDED TO A COLLECTION AGENCY. PART VI, LINE 2: PHELPS MEMORIAL HEALTH CENTER MANAGEMENT, BOARD OF DIRECTORS AND MEDICAL STAFF MEET EVERY 3 TO 5 YEARS FOR A MAJOR STRATEGIC PLANNING AGENDA THAT INCLUDES ASSESSMENT OF THE HEALTH CARE NEEDS OF THE COMMUNITY. OUTSIDE RESOURCES ARE UTILIZED TO IDENTIFY THE CURRENT PATIENT DEMOGRAPHIC TRENDS, HEALTH CARE CONCERNS IN OUR COUNTY AND STATE, PHYSICIAN NEED, ETC. EVERY YEAR MANAGEMENT, BOARD OF DIRECTORS AND MEDICAL STAFF MEET TO DISCUSS AND ASSESS THE ONGOING HEALTH CARE NEEDS OF THE COMMUNITY AND DEVELOP AN ANNUAL BUSINESS PLAN TO ADDRESS THESE NEEDS IN THE UPCOMING YEAR. PART VI, LINE 3: PHELPS MEMORIAL HEALTH CENTER SOCIAL SERVICES DEPARTMENT MONITORS PATIENTS WITHIN THE HOSPITAL AND INDENTIFIES POSSIBLE PATIENTS THAT COULD QUALIFY FOR ASSISTANCE UNDER FEDERAL, STATE OR LOCAL GOVERNMENT. A REPRESENTATIVE OF SOCIAL SERVICES THEN MEETS WITH THE PATIENT TO ASSIST IN REGISTERING FOR SUCH ASSISTANCE. EVERY PATIENT REGISTERING AT PHELPS MEMORIAL HEALTH CENTER IS GIVEN A BILLING PAMPHLET THAT EXPLAINS THE FINANCIAL ASSISTANCE PROGRAM. ATTACHED TO EVERY STATEMENT THERE IS A PAYMENT OPTIONS LETTER THAT ALLOWS PATIENTS TO INQUIRE ABOUT THE FINANCIAL ASSISTANCE PROGRAM. EVERY PATIENT WITH A SELF PAY BALANCE IS SENT A LETTER INFORMING THEM PHELPS MEMORIAL HEALTH CENTER HAS A FINANCIAL ASSISTANCE PROGRAM THAT THEY MAY APPLY FOR. PART VI, LINE 4: PHELPS COUNTY NEBRASKA IS LOCATED ON THE HIGH PLAINS IN RURAL NEBRASKSA. THE PRIMARY INDUSTRY IS AGRICULTURE INCLUDING CROPS AND LIVESTOCK. ADDITIONAL INDUSTRY INCLUDES MANUFACTURING. PMHC'S PRIMARY SERVICE AREA IS THE COUNTY OF PHELPS AND PORTIONS OF SURROUNDING COUNTIES WITH A TOTAL SERVICE POPULATION OF APPROXIMATELY 20,000. PART VI, LINE 5: PHELPS MEMORIAL HEALTH CENTER IS THE LEADING ENTITY FOR HEALTH PROMOTION IN THE COMMUNITY IN PARTNERSHIP WITH LOCAL PHYSICIANS, OTHER HEALTH CARE PROFESSIONALS AND THE LOCAL PUBLIC HEALTH DEPARTMENT. THE HOSPITAL IS GOVERNED BY A VOLUNTEER GROUP OF LOCAL CITIZENS REPRESENTING ALL ASPECTS OF THE COMMUNITY. THE MEDICAL STAFF IS OPEN TO ALL PHYSICIANS AND MEDICAL STAFF PROFESSIONALS THAT MEET CREDENTIALING CRITERIA. PHELPS MEMORIAL HEALTH CENTER MAINTAINS A PERMANENT SUB-COMMITTEE OF THE BOARD THAT SUPPORTS AND PROMOTES COMMUNITY HEALTH PROJECTS THROUGH GRANT FUNDING AND OTHER ASSISTANCE. IN ADDITION, THE HOSPITAL PROVIDES MULTIPLE HEALTH RELATED ANNUAL EVENTS TO THE PUBLIC AT NO CHARGE THAT ADDRESS HEALTH CARE NEEDS AND RISKS OF THE COMMUNITY. PART VI, LINE 6: PMHC IS NOT PART OF AN AFFILIATED HEALTH CARE SYSTEM. 1 HOLDREGE RURAL FIRE PROTECTION DISTRICT NO 6 PO BOX 199 HOLDREGE NE 68949 476088076 GOV ENTITY 6000 0 FOR THE PURCHASE OF A FIRE EXTINGUISHER TRAINING SYSTEM BERTRAND FIRE RESCUE 516 MINOR AVE BERTRAND NE 68927 476006103 GOV ENTITY 7500 0 FOR THE PURCHASE OF A JAWS OF LIFE VILLAGE OF LOOMIS 506 PALMER LOOMIS NE 68958 476006261 GOV ENTITY 5000 0 FOR THE PURCHASE OF A SPLASH PAD HOLDREGE POLICE DEPARTMENT 813 5TH AVE HOLDREGE NE 68949 476006232 GOV ENTITY 11288 0 FOR THE PURCHASE AED'S FOR POLICE CARS 4 0 PART I, LINE 2: ALL GRANTS ARE MADE TO LOCAL ORGANIZATIONS IN PHELPS COUNTY AND SURROUNDING COUNTIES. THERE IS CRITERIA IN PLACE TO ENSURE GRANTS ARE AWARDED TO ORGANIZATIONS MEETING FOUNDATION GUIDELINES. X 0 1 X X 0 0 0 0 0 0 0 0 0 ROBERT M MILLER PHARMACIST 132336 0 0 0 724 0 4116 0 13572 0 150748 0 0 0 PART I, LINE 1A PHELPS MEMORIAL HEALTH CENTER PROVIDES A MEMBERSHIP TO A COUNTRY CLUB FOR THE CEO OF THE ORGANIZATION. THE MEMBERSHIP ALLOWS THE CEO AND OTHER MEMBERS OF THE STAFF TO TAKE EMPLOYEES, CLIENTS AND VENDORS OUT TO THE COUNTRY CLUB AND IS LIMITED TO BUSINESS USE. FURTHERMORE, THE ORGANIZATION UTILIZES THE COUNTRY CLUB'S FACILITY FOR MEETINGS AND OTHER EVENTS. FORM 990, SCHEDULE J, PART II: MARK HARREL AND LOREN SCHRODER RECEIVE COMPENSATION FROM QUORUM HEALTH RESOURCES, AN UNRELATED ENTITY, WHICH PROVIDES MANAGEMENT SERVICES TO ITS CLIENTS. THE PHELPS MEMORIAL HEALTH CENTER BOARD OF DIRECTORS SETS THE SALARY AND BENEFITS FOR MR. HARREL AND MR. SCHRODER. QUORUM HEALTH RESOURCES CHARGES PHELPS MEMORIAL HEALTH CENTER FOR THE SERVICES MR. HARREL AND MR. SCHRODER PROVIDE TO THE ORGANIZATION. MR. HARREL RECEIVED BASE COMPENSATION OF $197,032, A BONUS OF $20,000 AND BENEFITS TOTALING $50,852 FOR 2014. MR. SCHRODER RECEIVED BASE COMPENSATION OF $150,307 AND BENEFITS TOTALING $38,559 FOR 2014. FAMILY MEDICAL SPECIALTIES CHARLOTTE WIRGES & JEFFREY BERNEY, BOARD MEMBERS, OWN 16.67% EACH 811920 PHELPS MEMORIAL HEALTH CENTER PAID FAMILY MEDICAL SPECIALTIES FOR EMERGENCY ROOM, CARDIAC REHABILITIATION, AND RESPIRATORY REHABILITATION COVERAGE 0 FAMILY MEDICAL SPECIALTIES CHARLOTTE WIRGES & JEFFREY BERNEY, BOARD MEMBERS, OWN 16.67% EACH 348289 PHELPS MEMORIAL HEALTH CENTER RECEIVED RENT FROM FAMILY MEDICAL SPECIALTIES 0 JANELL HUSTON EMPLOYEE OF ORGANIZATION & SISTER OF SHERYL MCCLYMONT, FORMER BOARD MEMBER 67128 EMPLOYEES W-2 WAGES 0 FAMILY MEDICAL SPECIALTIES SCOTT EHRESMAN, FORMER BOARD MEMBER, OWNS 16.67% 811920 PHELPS MEMORIAL HEALTH CENTER PAID FAMILY MEDICAL SPECIALTIES FOR EMERGENCY ROOM, CARDIAC REHABILITIATION, AND RESPIRATORY REHABILITATION COVERAGE 0 FAMILY MEDICAL SPECIALTIES SCOTT EHRESMAN, FORMER BOARD MEMBER, OWNS 16.67% 348289 PHELPS MEMORIAL HEALTH CENTER RECEIVED RENT FROM FAMILY MEDICAL SPECIALTIES 0 FORM 990, PART VI, SECTION A, LINE 2 CHARLOTTE WIRGES, MD AND JEFFERY BERNEY, MD BOTH MEMBERS OF THE BOARD, HAVE A BUSINESS RELATIONSHIP. FORM 990, PART VI, SECTION A, LINE 3 QUORUM HEALTH RESOURCES, LLC ("QHR") AND PHELPS MEMORIAL HEALTH CENTER ("PMHC") HAVE AN AGREEMENT IN PLACE FOR ADMINISTRATIVE SERVICES. QHR PROVIDES THE HOSPITAL THE SERVICES OF INDIVIDUALS TO SERVE AS THE CEO & CFO AT PMHC. THE CEO & CFO SHALL OVERSEE THE EXECUTION AND PERFORMANCE OF THE ADMINISTRATIVE FUNCTIONS OF PMHC AND COMMUNICATE THE BUSINESS AND OPERATIONAL ACTIVITY OF PMHC WITH THE BOARD OR BOARD REPRESENTATIVE ROUTINELY. THE CFO REPORTS TO THE CEO, AND THE CEO IS ACCOUNTABLE AND REPORTS DIRECTLY TO THE BOARD. FORM 990, PART VI, SECTION A, LINE 6 EVERY DONOR OF A GIFT OF $100 OR MORE TO PHELPS COUNTY MEMORIAL HOSPITAL ASSOCIATION SHALL BE A MEMBER OF PHELPS MEMORIAL HEALTH CENTER. FORM 990, PART VI, SECTION A, LINE 7A EACH MEMBER OF PHELPS MEMORIAL HEALTH CENTER HAS ONE VOTE IN THE ELECTION OF DIRECTORS. FORM 990, PART VI, SECTION B, LINE 11 A COPY OF THE FORM 990 WILL BE DISTRIBUTED TO THE BOARD OF DIRECTORS A WEEK BEFORE THE BOARD MEETING. DURING THE BOARD OF DIRECTORS MEETING THE FORM 990 WILL BE THOROUGHLY REVIEWED AND DISCUSSED IN ORDER TO ADDRESS ANY QUESTIONS PRIOR TO ITS SUBMISSION TO IRS. FORM 990, PART VI, SECTION B, LINE 12C PMHC BOARD OF TRUSTEES DISCLOSE CONFLICTS OF INTEREST ON AN ANNUAL BASIS BY SIGNING A CONFLICT OF INTEREST STATEMENT. ALL MEMBERS OF THE BOARD OF DIRECTORS, THE TOP MANAGEMENT OFFICIAL (CEO) AND THE TOP FINANCIAL OFFICIAL (CFO) ARE REQUIRED TO DISCLOSE, ON AN ANNUAL BASIS, ALL INTERESTS THAT COULD GIVE RISE TO A CONFLICT OF INTEREST. THESE DISCLOSURES ARE REVIEWED BY THE BOARD OF DIRECTORS, THE CEO AND THE ORGANIZATION'S COMPLIANCE OFFICER. ACTUAL CONFLICTS ARE ALSO REVIEWED BY THE ENTIRE BOARD OF DIRECTORS. UPON A DIRECTOR'S DISCLOSURE OF A CONFLICT OF INTEREST, THAT DIRECTOR WITHDRAWS FROM BOARD CONSIDERATION AND DISCUSSION, DOES NOT PARTICIPATE IN THE VOTING OR DECISION-MAKING AND, AT THE REQUEST OF THE PRESIDENT, IS EXCUSED FROM THE BOARD MEETING DURING DISCUSSION AND VOTING. ALL EMPLOYEES, INCLUDING SENIOR LEADERSHIP AND DEPARTMENT LEADERS ALSO DISCLOSE AND SIGN A CONFLICT OF INTEREST STATEMENT DURING THEIR ANNUAL REVIEWS. FORM 990, PART VI, SECTION B, LINE 15A QUORUM HEALTH RESOURCES, LLC ("QHR") PROVIDES ADMINISTRATIVE SERVICES TO PHELPS MEMORIAL HEALTH CENTER ("PMHC"). THIS INCLUDES PROVIDING THE HOSPITAL WITH A CHIEF EXECUTIVE OFFICER AND CHIEF FINANCIAL OFFICER. THE BOARD OF DIRECTORS CONDUCTS AN ANNUAL EVALUATION FOR THE CEO AND CFO. A NATIONAL COMPARATIVE BENCHMARK FROM QHR IS PRESENTED TO THE BOARD OF DIRECTORS. THIS COMPARATIVE DATA IS BASED ON SIMILAR HOSPITAL SIZE AND SIMILAR ANNUAL NET REVENUE. THIS DATA IS UTILIZED BY THE BOARD OF DIRECTORS IN ADDITION TO THE ANNUAL PERFORMANCE OF THE CEO AND CFO TO DETERMINE COMPENSATION. MARKET ADJUSTMENTS ARE DETERMINED ANNUALLY BY THE HR LEADER, CEO AND CFO WITH APPROPRIATE DEPARTMENT LEADERS. PAY INCREASES SHALL BE DETERMINED BY THE PERFORMANCE APPRAISAL OVERALL SCORE. ANNUAL PAY INCREASES ARE EFFECTIVE ON THE SECOND PAY PERIOD IN AUGUST EACH YEAR PROVIDED AN ANNUAL PERFORMANCE APPRAISAL HAS BEEN COMPLETED ELECTRONICALLY. THE HUMAN RESOURCE LEADER AND CEO SHALL BE RESPONSIBLE FOR COMPLETION OF AN ANNUAL COMPETENCY REPORT TO BE SUBMITTED TO THE BOARD OF DIRECTORS. THIS REPORT SHALL INCLUDE COMPETENCY OF ALL HOSPITAL EMPLOYEES. FORM 990, PART VI, SECTION C, LINE 19 PMHC DOES NOT MAKE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY OR FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC. FORM 990, PART IX, LINE 11G PHYSICIAN FEES: PROGRAM SERVICE EXPENSES 2,762,972. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,762,972. OUTSIDE PHYSICAL AND OCCUPATIONAL THERAPY FEES: PROGRAM SERVICE EXPENSES 1,955,676. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,955,676. ANESTEHESIOLOGY FEES: PROGRAM SERVICE EXPENSES 550,300. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 550,300. X-RAY SERVICES: PROGRAM SERVICE EXPENSES 294,466. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 294,466. OTHER FEES FOR SERVICE: PROGRAM SERVICE EXPENSES 1,376,676. MANAGEMENT AND GENERAL EXPENSES 187,200. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,563,876. FORM 990, PART XII, LINE 2C: PHELPS MEMORIAL HEALTH CENTER HAS A BOARD OF DIRECTORS THAT IS ORGANIZED INTO SIX STANDING COMMITTEES: EXECUTIVE COMMITTEE; FINANCE COMMITTEE; QUALITY & COMMUNITY HEALTH COMMITTEE; GOVERNANCE COMMITTEE; SPECIALTY RECRUITMENT COMMITTEE; AND FOUNDATION COMMITTEE. IT IS THE FINANCE COMMITTEE'S DUTY TO PROVIDE INPUT INTO THE ANNUAL BUDGET PREPARATION, THE THREE YEAR CAPITAL AND LAND USE PROJECTIONS, MONITOR INVESTMENT FUNDS, PROVIDE FOR AN ANNUAL OUTSIDE AUDIT AND IN GENERAL SEE TO THE OVERALL FINANCIAL WELL BEING OF THE FACILITY. THE OVERSIGHT PROCESS OF THE AUDIT AND THE SELECTION PROCESS OF AN INDEPENDENT ACCOUNTANT HAS NOT CHANGED FROM THE PRIOR YEAR.