2013-11-14T18:00:45-06:00 2012-12-31 135565207 KPMG LLP 1212 NORTH 96TH ST SUITE 300 OMAHA NE 68102 990 2012-01-01 470426285 MEMORIAL COMMUNITY HOSPITAL MEMO 4024262182 810 North 22nd Street Blair NE 68008 TIMOTHY SCHNACK 2013-11-13 true Adam C Stark P01231721 4023481450 2012 2016-02-24 21:20:13Z TIMOTHY SCHNACK 810 North 22nd Street Blair NE 68008 35795704 false X WWW.MCHHS.ORG X 1956 NE AS AN ENGAGED TEAM OF PHYSICIANS, MEDICAL PROFESSIONALS, AND SUPPORT STAFF WE ARE COMMITTED TO DELIVERING STATE-OF-THE-ART HEALTH CARE TAILORED TO OUR UNIQUE COMMUNITY AND SECOND TO NONE IN THE AREA. 7 5 387 100 0 0 479471 541528 31546181 34865613 30907 -120475 -657265 352922 31399294 35639588 983817 814423 0 0 18709979 19564935 0 0 0 12386126 12603433 32079922 32982791 -680628 2656797 47908946 49409003 29563833 28407093 18345113 21001910 AS A COMMUNITY HOSPITAL, MEMORIAL COMMUNITY HOSPITAL AND HEALTH SYSTEM OF BLAIR HAS STAYED COMMITTED TO KEEPING RESIDENTS OF WASHINGTON AND BURT COUNTY IN GOOD HEALTH. MEMORIAL COMMUNITY HOSPITAL HAS STRIVEN TO IMPROVE THE HEALTH STATUS OF RURAL NEBRASKA RESIDENTS THROUGH THE FOLLOWING SERVICES: 24-HOUR EMERGENCY CARE WITH HELIPORT ACCOMMODATIONS, LABOR AND DELIVERY AND CARDIOVASCULAR. CARDIOVASCULAR SERVICES INCLUDE THE FOLLOWING: NON-INVASIVE DIAGNOSTICS STUDIES SUCH AS EKG, TELEMETRY MONITORING, TREADMILL STRESS TESTING, ECHO CARDIOGRAM, AND STRESS ECHO CARDIOGRAM. MEMORIAL COMMUNITY HOSPITAL AND HEALTH SYSTEM PROVIDES A VARIETY OF SPECIALTY CLINICS LOCATED IN BLAIR: ALLERGY/ASTHMA/IMMUNOLOGY, PAIN MANAGEMENT/ANESTHESIA, CARDIOLOGY, ENDOCRINOLOGY, ENT, GENERAL SURGERY, OB/GYN, NEPHROLOGY, NEUROLOGY, NEUROSURGERY, ONCOLOGY, ORTHOPEDICS, ORTHOTICS/PROSTHETICS, PLASTIC SURGERY, DERMATOLOGY, AND PODIATRY. false false 5835065 217673 9360652 COMMUNITY MEMORIAL HOSPITAL OF BLAIR PROVIDES HEALTH CLINICS FOR THE RESIDENTS OF BLAIR AND SURROUNDING COMMUNITIES WITH HEALTH CARE PROVIDERS IN A VARIETY OF MEDICAL SPECIALTIES. 2013040 98871 4251548 MEMORIAL COMMUNITY HOSPITAL OF BLAIR PROVIDES THE RESIDENTS OF BLAIR AND SURROUNDING COMMUNITIES WITH A VARIETY OF THERAPY SERVICES, INCLUDING PHYSICAL AND OCCUPATIONAL THERAPY, SPEECH THERAPY, SLEEP STUDIES, AND RESPIRATORY THERAPY. 1955414 72891 3135486 COMMUNITY MEMORIAL HOSPITAL OF BLAIR PROVIDES THE RESIDENTS OF BLAIR AND SURROUNDING COMMUNITIES 24 HOUR EMERGENCY ROOM SERVICES. 16367649 424988 18117927 THE HOSPITAL OPERATES A 21 BED ACUTE CARE HOSPITAL IN BLAIR, NE SERVING THE COMMUNITY FOR INPATIENT & OUTPATIENT SERVICES ALSO SERVES AS A COMMUNITY RESOURCE FOR HEALTH RELATED PROGRAMS, EDUCATION CLASSES, TRAINING & RECRUITMENT FOR MEDICAL PERSONNEL 16367649 424988 18117927 26171168 true true false false false false false false false true false false false true true false true false false false false false false false false true true false true true true false false false false false false false false false true false false false false false true false false false false true 22 0 true 387 true false false false false false false false false false false X 7 5 false true false false true true false true true false false false true true true false true true true false X Timothy Schnack 4024262182 810 North 22nd Street Blair NE 68008 DANIEL HUNT 10.00 0 X X 0 0 0 JOAN NEUHAUS 10.00 0 X X 0 0 0 RICHARD ROLSTON MD 10.00 0 X X 0 0 0 TERRY DUTTON 10.00 0 X X 0 0 0 ANN SCHUMACHER 10.00 0 X 0 0 0 BRAD SAWTELLE MD 40.00 0 X 248609 0 3705 DONNA MAHLENDORF 10.00 0 X 0 0 0 NICOLE KREITEL 40.00 1.00 X 109971 0 2725 SALLY HARVEY 40.00 1.00 X 0 0 0 ANDREA VERMAAS MD 40.00 0 X 369617 0 0 ANDREW REYNOLDS MD 40.00 0 X 388226 0 3705 CHAUNCEY WILKINS MD 40.00 0 X 268856 0 1305 GARRET SHAW MD 40.00 0 X 344119 0 3705 MAURICE BIRDWELL MD 40.00 0 X 273001 0 3705 2002399 0 18850 27 false true false ALEGENT CREIGHTON HEALTH 12809 WEST DODGE ROAD OMAHA NE 68154 MANAGEMENT FEES/HEALTH SERVICES 989492 QUALITY SYSTEMS INC 18111 KARMAN AVE SUITE 700 IRVINE CA 92612 COMPUTER SYSTEMS 792577 GRAHAM CONSTRUCTION COMPANY 421 GRAND AVENUE DES MOINES IA 50309 CONSTRUCTION SERVICES 399704 CASSLING 13808 F STREET OMAHA NE 68137 HEALTH SERVICES 221373 NEXTGEN 795 HORSHAM ROAD HORSHAM PA 19044 MEDICAL RECORDS 176863 6 264451 277077 541528 NET PATIENT REVENUE 621110 34865613 34865613 0 0 0 0 0 0 0 0 34865613 21416 21416 0 0 157244 157244 0 157244 157244 14225 156116 0 -141891 -141891 -141891 0 0 0 INTEREST RATE SWAP 900099 13000 13000 DIETARY 621110 78584 78584 REBATES 900099 25688 25688 78406 0 0 78406 195678 35639588 34865613 0 232447 0 814423 814423 0 0 358580 268935 89645 0 16090562 12067922 4022640 405768 304326 101442 1675697 1256773 418924 1034328 775746 258582 507993 507993 0 126530 126530 0 0 0 31496 0 31496 0 65216 65216 64480 64480 0 0 1799549 1799549 55762 41821 13941 0 90868 90868 1170134 1170134 0 2773182 2773182 189185 189185 SUPPLIES 2829834 2122376 707458 BAD DEBT 1782218 1782218 PURCHASED SERVICES 720368 540276 180092 396618 297403 99215 0 32982791 26171168 6811623 0 0 6373857 8534332 4576953 4992624 0 0 452532 414777 270265 546263 47411905 18677449 29744938 28734456 6012795 6019858 0 0 0 0 477606 166693 47908946 49409003 4168749 3780830 19782115 18775432 0 5612969 5850831 29563833 28407093 X 18345113 21001910 18345113 21001910 47908946 49409003 2656797 0 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 795389 795389 19237325 5580620 13656705 2696148 843519 1852629 24683043 12253310 12429733 0 28734456 0 INTEREST RATE SWAP 2159000 MRI CAPITAL LEASE 622235 ESTIMATED THIRD PARTY SETTLEMENTS 3069596 5850831 X FIN 48 (ASC 740) footnote Schedule D, Part X, Line 2 IN ACCORDANCE WITH FASB INTERPRETATION NO 48, ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES, INCLUDED IN FASB ASC SUBTOPIC 741- 10 - INCOME TAXES - THE HOSPITAL RECOGNIZES THE EFFECT OF INCOME TAX POSITIONS ONLY IF THOSE POSITIONS ARE MORE LIKELY THAN NOT OF BEING SUSTAINED. RECOGNIZED INCOME TAX POSITIONS ARE MEASURED AT THE LARGEST AMOUNT THAT IS GREATER THAN 50% LIKELY OF BEING REALIZED. CHANGES IN RECOGNITION OR MEASUREMENT ARE REFLECTED IN THE PERIOD IN WHICH THE CHANGE IN JUDGMENT OCCURS. IN 2012 AND 2011 MANAGEMENT DETERMINED THAT THERE ARE NO INCOME TAX POSITIONS REQUIRING RECOGNITION IN THE CONSOLIDATED FINANCIAL STATEMENTS. true true X false false true true false true true 298 571092 571092 0.01830 0 0.00000 0 0.00000 0 298 571092 0 571092 0.01830 0 0.00000 23 216270 216270 0.00690 0 0.00000 0 0.00000 0 0.00000 0 23 216270 0 216270 0.00690 0 321 787362 0 787362 0.02520 0 0.00000 0 0.00000 0 0.00000 0 0.00000 0 0.00000 0 0.00000 0 0.00000 0 0.00000 0 0.00000 0 0 0 0 0 0.00000 true 1249732 0 13465135 13661703 -196568 X true false 1 1 MEMORIAL COMMUNITY HOSPITAL

810 NORTH 22ND STREET BLAIR NE 68008

X X X X MEMORIAL COMMUNITY HOSPITAL 1 true false false true X X X X true true X X X X true false X X X X true X false false 4 BLAIR CLINIC

812 NORTH 22ND STREET BLAIR NE 68008

PRIMARY CARE CLINIC FORT CALHOUN CLINIC

1420 CLARK STREET FORT CALHOUN NE 68023

PRIMARY CARE CLINIC COTTONWOOD CLINIC

120 SOUTH 9TH STREET TEKAMAH NE 68061

PRIMARY CARE CLINIC BURT -WASHINGTON HOME HEALTH & HOSPICE

670 SOUTH 19TH STREET BLAIR NE 68008

HOME HEALTH AND HOSPICE AGENCY Eligibility criteria for free or discounted care Schedule H, Part I, Line 3c THE AMOUNT OF FINANCIAL ASSISTANCE WRITE-OFF FOR MEMORIAL COMMUNITY HOSPITAL AND HEALTH SYSTEM IS BASED ON A FINANCIAL ASSISTANCE SLIDING FEE SCHEDULE UTILIZING A DERIVATIVE OF THE CURRENT US DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT (HUD) VERY LOW INCOME GUIDELINES, WHICH ARE UPDATED ANNUALLY. DESIGNEES OF MCH HELP PATIENTS SEEK REIMBURSEMENT FROM LOCAL, STATE, AND FEDERAL PROGRAMS AT NO CHARGE TO THE PATIENT WHEN THERE IS NO OTHER SOURCE OF PAYMENT. AFTER THESE EFFORTS/RESOURCES HAVE BEEN EXHAUSTED, PATIENTS ARE ASSISTED IN THE APPLICATION PROCESS FOR FINANCIAL ASSISTANCE. THE APPLICATION PROCESS INCLUDES COMPLETING A PERSONAL FINANCIAL APPLICATION AND PROVIDING VERIFICATION DOCUMENTS. THESE VERIFICATION DOCUMENTS MAY INCLUDE, BUT ARE NOT LIMITED TO, RECEIVING A COPY OF THE APPLICANT'S FEDERAL TAX RETURN, PAY STUB, BANK STATEMENTS, A CALL TO EMPLOYERS, OR A CREDIT REPORT, THE APPLICANT'S NET WORTH AND/OR LIQUID ASSETS, AND REASONABLE HOUSEHOLD OR BUSINESS EXPENSES. FINANCIAL ASSISTANCE MAY ALSO BE GRANTED IN CERTAIN CIRCUMSTANCES INVOLVING A CATASTROPHIC OCCURRENCE RESULTING IN MEDICAL BILLS GROSSLY EXCEEDING THE PATIENT'S ABILITY TO PAY AND IN THESE SITUATIONS, THE PATIENT'S RESPONSIBILITY WILL BE LIMITED TO 30% OF THE FAMILY'S GROSS ANNUAL INCOME. SCHEDULE H, PART I, LINE 6A SCHEDULE H, PART I, LINE 6A MEMORIAL COMMUNITY HOSPITAL PRODUCES A COMMUNITY BENEFIT REPORT THAT IS SENT TO THE NEBRASKA HOSPITAL ASSOCIATION FOR COLLECTION PURPOSES. COSTING METHODOLOGY USED TO CALCULATE FINANCIAL ASSISTANCE SCHEDULE H, PART I, LINE 7 THE COSTING METHODOLOGY USED TO CALCULATE THE AMOUNTS REPORTED IN THE TABLE WERE WORKSHEETS 1-8, EXCLUDING WORKSHEET 2, WITHIN THE SCHEDULE H INSTRUCTIONS. THE COST TO CHARGE RATIO USED IN THE CALCULATIONS WAS DERIVED FROM THE AS FILED 2012 COST REPORT. Bad Debt Expense excluded from financial assistance calculation Schedule H, Part I, Line 7, column(f) 1,782,218 SCHEDULE H, PART I, LINE 7G SCHEDULE H, PART I, LINE 7G MEMORIAL COMMUNITY HOSPITAL DOES NOT PROVIDE SUBSIDIZED HEALTH SERVICES. Community Building Activities Schedule H, Part II MEMORIAL COMMUNITY HOSPITAL DID NOT ENAGE IN ANY COMMUNITY BUILDING ACTIVITIES IN 2012. Bad debt expense - financial statement footnote Schedule H, Part III, Line 4 THE AUDITED FOOTNOTES FOR MEMORIAL COMMUNITY HOSPITAL AND MEDICAL CENTER DO NOT CONTAIN FOOTNOTES RELATED TO BAD DEBT EXPENSE. BAD DEBT EXPENSE IS IDENTIFIED ON THE CONSOLIDATED STATEMENT OF OPERATIONS WHICH IS CONSISTENT WITH THE REPORTING PRACTICE OF OTHER HEALTH CARE ORGANIZATIONS. BAD DEBT EXPENSE AT 100% CHARGE VALUE WAS MULTIPLIED BY THE RATIO DERIVED FROM THE SCHEDULE H WORKSHEETS IN THE SCHEDULE H INSTRUCTIONS TO ARRIVE AT AN APPROXIMATE COST VALUE. Community benefit & methodology for determining medicare costs Schedule H, Part III, Line 8 THE MEDICARE CHARGES REPORTED ON LINE 5 AND LINE 6 ARE FROM THE 2012 FILED COST REPORT WHICH USED A COST TO CHARGE RATIO. SCHEDULE H, PART III, LINE 9B SCHEDULE H, PART III, LINE 9B MEMORIAL COMMUNITY HOSPITAL'S COLLECTION POLICY DOES NOT CONTAIN PROVISIONS ON THE COLLECTION PRACTICES TO BE FOLLOWED FOR PATIENTS WHO ARE KNOWN TO QUALIFY FOR CHARITY CARE OR FINANCIAL ASSISTANCE. SCHEDULE H, PART V, SECTION B, LINE 10 SCHEDULE H, PART V, SECTION B, LINE 10 THE AMOUNT OF FINANCIAL ASSISTANCE WRITE-OFF FOR MEMORIAL COMMUNITY HOSPITAL AND HEALTH SYSTEM IS BASED ON A FINANCIAL ASSISTANCE SLIDING FEE SCHEDULE UTILIZING A DERIVATIVE OF THE CURRENT US DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT (HUD) VERY LOW INCOME GUIDELINES, WHICH ARE UPDATED ANNUALLY. DESIGNEES OF MCH HELP PATIENTS SEEK REIMBURSEMENT FROM LOCAL, STATE, AND FEDERAL PROGRAMS AT NO CHARGE TO THE PATIENT WHEN THERE IS NO OTHER SOURCE OF PAYMENT. AFTER THESE EFFORTS/RESOURCES HAVE BEEN EXHAUSTED, PATIENTS ARE ASSISTED IN THE APPLICATION PROCESS FOR FINANCIAL ASSISTANCE. THE APPLICATION PROCESS INCLUDES COMPLETING A PERSONAL FINANCIAL APPLICATION AND PROVIDING VERIFICATION DOCUMENTS. THESE VERIFICATION DOCUMENTS MAY INCLUDE, BUT ARE NOT LIMITED TO, RECEIVING A COPY OF THE APPLICANT'S FEDERAL TAX RETURN, PAY STUB, BANK STATEMENTS, A CALL TO EMPLOYERS, OR A CREDIT REPORT, THE APPLICANT'S NET WORTH AND/OR LIQUID ASSETS, AND REASONABLE HOUSEHOLD OR BUSINESS EXPENSES. FINANCIAL ASSISTANCE MAY ALSO BE GRANTED IN CERTAIN CIRCUMSTANCES INVOLVING A CATASTROPHIC OCCURRENCE RESULTING IN MEDICAL BILLS GROSSLY EXCEEDING THE PATIENT'S ABILITY TO PAY AND IN THESE SITUATIONS, THE PATIENT'S RESPONSIBILITY WILL BE LIMITED TO 30% OF THE FAMILY'S GROSS ANNUAL INCOME. SCHEDULE H, PART V, SECTION B, LINE 11 SCHEDULE H, PART V, SECTION B, LINE 11 THE AMOUNT OF FINANCIAL ASSISTANCE WRITE-OFF FOR MEMORIAL COMMUNITY HOSPITAL AND HEALTH SYSTEM IS BASED ON A FINANCIAL ASSISTANCE SLIDING FEE SCHEDULE UTILIZING A DERIVATIVE OF THE CURRENT US DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT (HUD) VERY LOW INCOME GUIDELINES, WHICH ARE UPDATED ANNUALLY. DESIGNEES OF MCH HELP PATIENTS SEEK REIMBURSEMENT FROM LOCAL, STATE, AND FEDERAL PROGRAMS AT NO CHARGE TO THE PATIENT WHEN THERE IS NO OTHER SOURCE OF PAYMENT. AFTER THESE EFFORTS/RESOURCES HAVE BEEN EXHAUSTED, PATIENTS ARE ASSISTED IN THE APPLICATION PROCESS FOR FINANCIAL ASSISTANCE. THE APPLICATION PROCESS INCLUDES COMPLETING A PERSONAL FINANCIAL APPLICATION AND PROVIDING VERIFICATION DOCUMENTS. THESE VERIFICATION DOCUMENTS MAY INCLUDE, BUT ARE NOT LIMITED TO, RECEIVING A COPY OF THE APPLICANT'S FEDERAL TAX RETURN, PAY STUB, BANK STATEMENTS, A CALL TO EMPLOYERS, OR A CREDIT REPORT, THE APPLICANT'S NET WORTH AND/OR LIQUID ASSETS, AND REASONABLE HOUSEHOLD OR BUSINESS EXPENSES. FINANCIAL ASSISTANCE MAY ALSO BE GRANTED IN CERTAIN CIRCUMSTANCES INVOLVING A CATASTROPHIC OCCURRENCE RESULTING IN MEDICAL BILLS GROSSLY EXCEEDING THE PATIENT'S ABILITY TO PAY AND IN THESE SITUATIONS, THE PATIENT'S RESPONSIBILITY WILL BE LIMITED TO 30% OF THE FAMILY'S GROSS ANNUAL INCOME. Means used to determine amounts billed Schedule H, Part V Section B, Line 20d (1) MEMORIAL COMMUNITY HOSPITAL - INFORMATION ON THE MEMORIAL COMMUNITY HOSPITAL FINANCIAL ASSISTANCE POLICY AND APPLICATION IS AVAILABLE AT SEVERAL ACCESS POINTS THROUGHOUT THE HOSPITAL AND IS PROVIDED ON BILLING STATEMENTS. A SELF PAY PATIENT IS CHARGED FOR SERVICES BASED ON CHARGE MASTER RATES UNLESS IT IS DETERMINED THE PATIENT IS ELIGIBLE UNDER THE FINANCIAL ASSISTANCE POLICY (FAP). IF FAP ELIGIBLE, CHARGES ARE REDUCED ACCORDING TO THE FINANCIAL ASSISTANCE POLICY GUIDELINES.; Needs assessment. Schedule H, Part VI, Line 2 MEMORIAL COMMUNITY HOSPITAL ASSESSES THE HEALTH CARE NEEDS OF THE COMMUNITIES IT SERVES THROUGH MULTIPLE CHANNELS, INCLUDING COMMUNITY HEALTH FAIRS, WELLNESS PROGRAMS, PROVIDING OCCUPATIONAL HEALTH SERVICES, LISTENING TO PATIENT AND COMMUNITY VOICES AS WELL AS WATCHING NATIONAL TRENDS. Patient education of eligibility for assistance. Schedule H, Part VI, Line 3 THERE ARE SEVERAL FINANCIAL ASSISTANCE ACCESS POINTS ASSISTANCE THROUGHOUT A PATIENT'S CARE CYCLE. BILLS CONTAIN FINANCIAL ASSISTANCE VERBIAGE, BROCHURES ARE AVAILABLE IN CLINICS AND THE HOSPITAL, AND THERE IS INFORMATION ON FINANCIAL ASSISTANCE POSTED AT REGISTRATION POINTS THROUGHOUT CLINICS AND THE HOSPITAL. INFORMATION ON THE MCH FINANCIAL ASSISTANCE POLICIES IS LOCATED AT WWW .MCHHS. ORG. DESIGNEES SUCH AS FINANCIAL COUNSELORS OF MCH HELP PATIENTS SEEK REIMBURSEMENT FROM LOCAL, STATE AND FEDERAL PROGRAMS AT NO CHARGE TO THE PATIENT, WHEN THERE IS NO OTHER SOURCE OF PAYMENT. AFTER THESE EFFORTS/RESOURCES HAVE BEEN EXHAUSTED, PATIENTS ARE ASSISTED IN THE APPLICATION PROCESS FOR FINANCIAL ASSISTANCE. Community information. Schedule H, Part VI, Line 4 MEMORIAL COMMUNITY HOSPITAL AND HEALTH SYSTEMS OF BLAIR, NE SERVES BOTH WASHINGTON AND BURT COUNTIES IN NEBRASKA. WASHINGTON COUNTY NEBRASKA HAS AN ESTIMATED POPULATION OF 20,234. CENSUS ESTIMATES SHOWTHAT WASHINGTON COUNTY'S RACIAL AND ETHNIC MAKE UP IS 97 2% WHITE 0 9% SOME OTHER RACE ALONE 0 6% TWO OR MORE RACES 1 3% HISPANIC OR LATINO. ITS MEDIAN HOUSEHOLD INCOME IS $59,181 COMPARED TO $47,470 FOR THE STATE OF NEBRASKA. APPROXIMATELY 15% OF THE STUDENTS IN WASHINGTON COUNTY RECEIVE FREE OR REDUCED LUNCH. BURT COUNTY HAS AN ESTIMATED POPULATION OF 6,858. CENSUS ESTIMATES SHOWTHAT BURT COUNTY'S RACIAL AND ETHNIC MAKE UP IS 95 9% WHITE 1 1% SOME OTHER RACE ALONE 1 2% TWO OR MORE RACES 1 8% HISPANIC OR LATINO. ITS MEDIAN HOUSEHOLD INCOME IS $42,242 COMPARED TO $47,470 FOR THE STATE OF NEBRASKA. APPROXIMATELY ONE THIRD OFTHE STUDENTS IN EACH OF THE SCHOOL DISTRICTS RECEIVE FREE OR REDUCED LUNCH. Promotion of community health Schedule H, Part VI, Line 5 MCH&HS PROMOTES THE HEALTH OF ITS COMMUNITY THROUGH FINANCIAL AND IN-KIND DONATIONS. Affiliated health care system Schedule H, Part VI, Line 6 BOARD OF DIRECTORS - THE BOARD OF DIRECTORS MANAGE THE AFFAIRS OF MEMORIAL COMMUNITY HOSPITAL IN BLAIR, NE THERE ARE SEVEN DIRECTORS WHO SERVE ON THE BOARD 3 MEMBERS FROM THE COMMUNITY, 3 MEMBERS FROM ALEGENT HEALTH AND 1 MEMBER FROM THE MCH&HS MEDICAL STAFF THE BOARD OF DIRECTORS IS COMPROMISED OF INDIVIDUALS WHO ARE LEADERS IN THE FIELDS OF BUSINESS, HEALTHCARE, ACCOUNTING AND MEDICINE AND UNDERSTAND THEIR ROLE IN PROVIDING STRONG CORPORATE GOVERNANCE EMERGENCY DEPARTMENT - MEMORIAL COMMUNITY HEALTH HAS A FULL-TIME EMERGENCY DEPARTMENT THAT IS OPEN TO THE PUBLIC AND PROVIDES MEDICAL SCREENING EXAMINATIONS AND STABILIZING TREATMENT WITHIN THE CAPABILITIES AND CAPACITIES OF THE HOSPITAL REGARDLESS OF BUT NOT LIMITED TO THE PATIENT'S RACE, COLOR, SEX, AGE AND/OR ABILITY TO PAY MCH&HS IS IN COMPLIANCE WITH THE FEDERAL EMTALA GUIDELINES MEDICAL STAFF- MCHHS MAINTAINS AN OPEN MEDICAL STAFF ALL QUALIFIED MDS, DOS, OTHER HEALTHCARE PRACTITIONERS, AND MID-LEVEL PRACTITIONERS ARE ELIGIBLE TO APPLY FOR PRIVILEGES AT THE HOSPITAL MCH&HS POLICY ON PHYSICIAN CREDENTIALING IS THAT NO INDIVIDUAL IS TO BE DENIED MEDICAL STAFF APPOINTMENT BASED ON SEX, RACE, CREED, COLOR OR NATIONAL ORIGIN THE STANDARDS A PHYSICIAN MUST MEET FOR APPOINTMENT RELATE TO (1) EDUCATIONAL QUALIFICATIONS AND LICENSING, (2) PROFESSIONAL COMPETENCE, (3) CHARACTER, (4) ETHICAL STANDING, AND (5) ABILITY TO RELATE TO AND WORK WITH OTHERS APPLICATIONS ARE REVIEWED AT SEVERAL LEVELS WITHIN THE ORGANIZATION PHYSICIANS WHO HAVE BEEN GRANTED STAFF PRIVILEGES AUTOMATICALLY BECOME MEMBERS OF THE MEDICAL STAFF AT THE HOSPITAL FOR WHICH PRIVILEGES HAVE BEEN GRANTED true CHARITY CARE 298 0 814423 BOOK MEDICAL CARE Procedures for monitoring use of grant funds Schedule I, Part I, Line 2 MEMORIAL COMMUNITY HOSPITAL DOES NOT GIVE OUT GRANTS. INSTEAD, IT PROVIDES FINANCIAL ASSISTANCE TO THOSE PATIENTS IN NEED THAT QUALIFY UNDER THE HOSPITAL'S CHARITY CARE POLICY. X X X false false false false false false false false false ANDREA VERMAAS MD 165472 0 204145 0 0 0 0 0 0 0 369617 0 0 0 ANDREW REYNOLDS MD 322441 0 65262 0 523 0 0 0 3705 0 391931 0 0 0 BRAD SAWTELLE MD 142132 0 104894 0 1583 0 0 0 3705 0 252314 0 0 0 CHAUNCEY WILKINS MD 131855 0 137001 0 0 0 0 0 1305 0 270161 0 0 0 GARRET SHAW MD 283477 0 59684 0 958 0 0 0 3705 0 347824 0 0 0 MAURICE BIRDWELL MD 273001 0 0 0 0 0 0 0 3705 0 276706 0 0 0 A HOSPITAL AUTH #1 OF WASHINGTON CO NE 521441599 000000000 2007-06-19 9250000 CONSTRUCTION OF FACILITY false false false B HOSPITAL AUTHO #1 OF WASHINGTON CO NE 521441599 000000000 2008-05-22 8000000 CONSTRUCTION OF FACILITY false false false C HOSPITAL AUTH #1 OF WASHINGTON CO NE 521441599 000000000 2009-02-12 3950000 CONSTRUCTION OF FACILITY false false false A 766953 0 9493722 0 0 0 173747 0 0 9319975 0 0 2008 false false true true B 638561 0 8059333 0 0 0 65000 0 0 7994333 0 0 2008 false false true true C 1021514 0 3953609 0 0 0 11450 0 0 3942159 0 0 2009 false false true true A false false false false false false 0.0000 0.0000 0.0000 false false 0.000000 false false B false false false false false false 0.0000 0.0000 0.0000 false false 0.000000 false false C false false false false false false 0.0000 0.0000 0.0000 false false 0.000000 false false A false false true true false false 0 false false false 0 false false false B false false true true true true FNB OF OMAHA 20.1 true false false 0.0 false false false C false false true true true false 0 false false false 0 false false false A false B false C false SCHEDULE K, PART II, LINE 3 SCHEDULE K, PART II, LINE 3 PART II, LINE 3 - THE TOTAL PROCEEDS DO NOT AGREE TO THE ISSUE PRICE IN PART I, COLUMN (E) DUE TO INVESTMENT EARNINGS. ISSUER NAME: Hospital Auth #1 of Washington Co NE: No Rebate Due. Schedule K, Part IV, Line 2c THE CALCULATION FOR COMPUTING NO REBATE DUE WAS PERFORMED ON 5/31/2010. ISSUER NAME: Hospital Autho #1 of Washington Co NE: No Rebate Due. Schedule K, Part IV, Line 2c THE CALCULATION FOR COMPUTING NO REBATE DUE WAS PERFORMED ON 4/30/2010. ISSUER NAME: Hospital Auth #1 of Washington Co NE: No Rebate Due. Schedule K, Part IV, Line 2c THE CALCULATION FOR COMPUTING NO REBATE DUE WAS PERFORMED ON 8/12/2009. TERRY DUTTON CHAIRMAN WASHINGTON CO BANK PRESIDENT 1133414 INTEREST EXPENSE false Delegation of management duties Form 990, Part VI, Section A, Line 3 THE CEO OF MEMORIAL COMMUNITY HOSPITAL CORPORATION (HOSPITAL ) IS PROVIDED BY ONE OF ITS MEMBERS, ALEGENT CREIGHTON HEALTH. THE CEO IS AN EMPLOYEE OF ALEGENT CREIGHTON HEALTH, AND THE HOSPITAL REIMBURSES THE MEMBER FOR THE CEO'S COMPENSATION AND BENEFITS. THE HOSPITAL PAYS ALEGENT CREIGHTON HEALTH A MANAGEMENT FEE EQUAL TO THE DIRECT COST OF THE CEO'S COMPENSATION AND BENEFITS PLUS 55% OF EARNINGS BEFORE INTEREST, DEPRECIATION, AND AMORTIZATION. Classes of members or stockholders Form 990, Part VI, Section A, Line 6 MEMORIAL COMMUNITY HOSPITAL CORPORATION ( HOSPITAL ) HAS TWO MEMBERS - MEMORIAL COMMUNITY HEALTH SYSTEM, INC (MCHS ) AND ALEGENT HEALTH - IMMANUEL MEDICAL CENTER (IMMANUEL). THE HOSPITAL HAS A SEVEN MEMBER BOARD OF DIRECTORS. MCHS APPOINTS THREE OF THESE BOARD MEMBERS, IMMANUEL APPOINTS THREE , AND THE MEDICAL STAFF APPOINTS ONE MEMBER, WHO IS ALWAYS THE MEDICAL STAFF PRESIDENT. ALL OFFICIAL ACTIONS OF THE BOARD REQUIRE AN AFFIRMATIVE VOTE OF TWO-THIRDS OF THE ENTIRE BOARD OF DIRECTORS. A SIMPLE MAJORITY OF THE BOARD OF DIRECTORS CONSTITUTES A QUORUM FOR THE TRANSACTION OF BUSINESS. Members or stockholders electing members of governing body Form 990, Part VI, Section A, Line 7a MEMORIAL COMMUNITY HOSPITAL CORPORATION ( HOSPITAL ) HAS TWO MEMBERS - MEMORIAL COMMUNITY HEALTH SYSTEM, INC (MCHS ) AND ALEGENT HEALTH - IMMANUEL MEDICAL CENTER (IMMANUEL). THE HOSPITAL HAS A SEVEN MEMBER BOARD OF DIRECTORS. MCHS APPOINTS THREE OF THESE BOARD MEMBERS, IMMANUEL APPOINTS THREE , AND THE MEDICAL STAFF APPOINTS ONE MEMBER, WHO IS ALWAYS THE MEDICAL STAFF PRESIDENT. ALL OFFICIAL ACTIONS OF THE BOARD REQUIRE AN AFFIRMATIVE VOTE OF TWO-THIRDS OF THE ENTIRE BOARD OF DIRECTORS. A SIMPLE MAJORITY OF THE BOARD OF DIRECTORS CONSTITUTES A QUORUM FOR THE TRANSACTION OF BUSINESS. Review of form 990 by governing body Form 990, Part VI, Section B, Line 11b NO REVIEW WAS OR WILL BE CONDUCTED. Conflict of interest policy Form 990, Part VI, Section B, Line 12c ANNUALLY, EACH BOARD MEMBER SIGNS A CONFLICT OF INTEREST STATEMENT AND IS GIVEN A COPY OF THE CONFLICT OF INTEREST POLICY. THE CHAIRMAN OF THE BOARD REVIEWS THESE STATEMENTS AND ENSURES THAT BOARD MEMBERS EXCUSE THEMSELVES FROM DISCUSSIONS AT BOARD MEETINGS ON TOPICS WHERE THEY HAVE A CONFLICT OF INTEREST. Process used to establish compensation of top management official Form 990, Part VI, Section B, Line 15a THE OFFICERS OF THE BOARD ARE NOT COMPENSATED FOR THEIR DUTIES THEY ARE VOLUNTEERS THE OFFICERS OF THE CORPORATION (THE EXECUTIVES) ARE COMPENSATED BASED ON RECOMMENDATIONS OF THE COMPENSATION COMMITTEE OF THE BOARD. THE COMPENSATION COMMITTEE LOOKS AT COMPARATIVE HOSPITAL AND INDUSTRY SALARY INFORMATION IN SETTING BASE SALARIES, AND REVIEWS AND APPROVES THE INDIVIDUAL GOALS PROPOSED BY THE EXECUTIVE TEAM FOR INCENTIVE COMPENSATION. Process used to establish compensation of other officers/key employees Form 990, Part VI, Section B, Line 15b THE OFFICERS OF THE BOARD ARE NOT COMPENSATED FOR THEIR DUTIES THEY ARE VOLUNTEERS THE OFFICERS OF THE CORPORATION (THE EXECUTIVES) ARE COMPENSATED BASED ON RECOMMENDATIONS OF THE COMPENSATION COMMITTEE OF THE BOARD. THE COMPENSATION COMMITTEE LOOKS AT COMPARATIVE HOSPITAL AND INDUSTRY SALARY INFORMATION IN SETTING BASE SALARIES, AND REVIEWS AND APPROVES THE INDIVIDUAL GOALS PROPOSED BY THE EXECUTIVE TEAM FOR INCENTIVE COMPENSATION. Governing documents, conflict of interest policy and financial statements available to the public Form 990, Part VI, Section C, Line 19 MEMORIAL COMMUNITY HOSPITAL'S AUDIT REPORT IS MADE AVAILABLE TO THE PUBLIC. THE CONFLICT OF INTEREST POLICY AND GOVERNING DOCUMENTS ARE NOT AVAILABLE TO THE PUBLIC. MEMORIAL COMMUNITY HOSPITAL FOUNDATION 810 N 22ND STREET BLAIR NE 68008 SUPPORT NE 501(C)(3) 11 - Type III - FI MCHS false MEMORIAL COMMUNITY HEALTH SYSTEM 810 NORTH 22ND STREET BLAIR NE 68008 HEALTH SYSTEM NE 501(C)(3) 7 NA false MCH AUXILIARY THRIFT SHOP 810 NORTH 22ND STREET BLAIR NE 68008 AUXILIARY NE 501(C)(3) 7 MCHS false false false true false false false false false false false false false true false true false true false false