2012-05-15T14:55:04-05:00 2011-09-30 SEIM JOHNSON LLP 18081 BURT STREET SUITE 200 OMAHA NE 680224722 990 2010-10-01 470426530 JENNIE M MELHAM MEMORIAL MED CTR INC JENN 3088724162 145 EAST MEMORIAL DRIVE BROKEN BOW NE 68822 MICHAEL J STECKLER 3088724162 2012-05-10 1 BARBARA J FAJEN 4023302660 2010 2016-02-24 21:20:13Z MICHAEL J STECKLER 145 EAST MEMORIAL DRIVE BROKEN BOW NE 68822 17605712 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 5 224 115 0 0 146744 447162 15273071 16514459 346087 469207 159799 146295 15925701 17577123 0 0 0 0 8432482 8468246 6177 5332 5332 6765063 7553317 15203722 16026895 721979 1550228 33202864 34360803 2353379 1975762 30849485 32385041 X 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. 0 1 15219662 16514459 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. 15219662 1 1 0 0 0 0 0 1 0 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 0 0 0 0 1 24 0 224 1 0 0 0 0 0 0 0 0 0 0 X 5 5 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X MICHAEL J STECKLER CEO 3088724160 PO BOX 250 BROKEN BOW NE 68822 X DANIEL ZACH 4.00 X X 0 0 0 JOHN SMITH 4.00 X X 0 0 0 RICK MAAS 4.00 X X 0 0 0 DEB GRANTZINGER 4.00 X X 0 0 0 JIM SCOTT 4.00 X X 0 0 0 JOYCE RICHARDSON 4.00 X 0 0 0 MICHAEL J STECKLER 40.00 X 166584 0 18671 TIMOTHY L SCHUCKMAN 40.00 X 99585 0 16327 MELISSA KULHANEK 40.00 X 118706 0 9787 384875 0 44785 2 0 1 0 SANDHILLS ANESTHESIA SERVICES LLC 79568 SUMNER ROAD BROKEN BOW NE 68822 ANESTHESIA CRNA SERVICES 485763 BRYAN LGH MEDICAL CENTER PO BOX 82557 LINCOLN NE 685012557 MOBILE PATIENT SERVICES 263976 MCMEEN PHYSICAL THERAPY PC PO BOX 435 BROKEN BOW NE 68822 PHYSICAL THERAPY SERVICES 185116 SHARED MEDICAL SERVICES INC PO BOX 330 COTTAGE GROVE WI 535270330 MOBILE MRI SERVICES 110475 4 447162 447162 MEDICARE/MEDICAID 621910 9225615 9225615 PATIENT SERVICE REVENU 621910 7265518 7265518 WELLNESS CENTER REVENU 621910 23326 23326 16514459 453983 453983 43952 28589 15363 15363 15363 15224 15224 15224 15224 CAFETERIA SALES 900099 96652 96652 OTHER REVENUE 900099 34280 34280 130932 17577123 16514459 0 615502 429660 128493 301167 6515210 6357032 158178 169584 153395 16189 862726 769957 92769 491066 461464 29602 2269 2269 51230 51230 5332 5332 1791017 1791017 2306027 2247205 58822 287274 287274 7083 2043 5040 27415 17061 10354 1625102 1625102 215412 144892 70520 OTHER DIRECT EXPENSES 657883 657883 BAD DEBT 542732 542732 DUES AND SUBSCRIPTIONS 26223 26223 MISCELLANEOUS 7889 7889 LICENSES 5761 5761 16026895 15219662 801901 5332 2965 2966 3915268 3163422 2315927 2488471 240016 208616 382585 376112 159613 251155 28532666 11092471 18056427 17440195 8130063 10429866 33202864 34360803 1705296 1566501 444040 61521 204043 347740 2353379 1975762 X 30849485 32385041 30849485 32385041 33202864 34360803 X 1550228 -14672 X X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1 1002 4079 4096 985 0 74192 74192 18224352 5530795 12693557 6220870 4299364 1921506 4013252 1262312 2750940 17440195 ESTIMATED THIRD-PARTY PAYOR SETTLEMENTS 347740 347740 17577123 16026895 1550228 -14672 -14672 1535556 17562451 -14672 -14672 17577123 0 17577123 16026895 0 16026895 0 16026895 PART IV, LINE 1B: JENNIE M. MELHAM MEMORIAL MEDICAL CENTER MANAGES A RESIDENT ACCOUNT TRUST FOR RESIDENTS IN THE LONGTERM CARE UNIT. DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: 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 MEDICAL CENTER'S TAX EXEMPT STATUS. IN GENERAL, SUCH STANDARDS REQUIRE THE MEDICAL CENTER 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, 2011, THE MEDICAL CENTER HAD NO UNCERTAIN TAX POSITIONS ACCRUED. 1 1 1 X 1 X 1 1 0 1 0 36041 36041 0.00230 36041 36041 0.00230 35982 35982 0.00230 237844 237844 0.01540 273826 273826 0.01770 309867 309867 0.02000 2650 2650 0.00020 2181 2181 0.00010 266 266 0.00000 17222 17222 0.00110 1600 1600 0.00010 23919 23919 0.00150 0 385340 0 6814449 6748018 66431 X 1 0 1 1 JENNIE M MELHAM MEMORIAL MEDICAL CENTER

145 MEMORIAL DRIVE BROKEN BOW NE 68822

X X X X LONGTERM CARE UNIT, ASSISTED LIVING, AND APARTMENTS NA 1 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, 2011 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, LINE 7G: THE COSTS ATTRIBUTABLE TO A PHYSICIAN CLINIC AS SUBSIDIZED HEALTH SERVICES ON PART I, LINE 7G IS $28,206. PART I, L7 COL(F): THE BAD DEBT THAT HAS BEEN SUBTRACTED FROM TOTAL EXPENSES TO DETERMINE THE DENOMINATOR IN THE PERCENTAGES FOR COLUMN (F) IS $542,732. PART II: JMMMMC'S COMMUNITY BUILDING ACTIVITIES INCLUDE FAMILY PRACTICE DOCTOR RECRUITING EXPENSES. THE RECRUITING ALLOWS THE HIRING OF PRIMARY CARE PHYSICIANS FOR THE LOCAL COMMUNITY ALLOWING ACCESS TO LOCAL HEALTHCARE SERVICES. HAVING THE AVAILABILITY OF LOCAL HEALTH CARE STRENGTHENS THE COMMUNITY AS A WHOLE, ALLOWING THE BROKEN BOW AND THE SURROUNDING AREA TO BE A VIBRANT COMMUNITY. PART III, LINE 4: THERE IS NO FOOTNOTE TO JMMMMC'S FINANCIAL STATEMENTS THAT DESCRIBES BAD DEBT. HOWEVER, THE FOLLOWING IS THE TEXT OF THE FOOTNOTE TITLED "PATIENT RECEIVABLES, NET":NET PATIENT RECEIVABLES CONSIST OF UNCOLLATERALIZED PATIENT AND THIRD PARTY OBLIGATIONS REDUCED BY A VALUATION ALLOWANCE FOR DOUBTFUL ACCOUNTS AND CONTRACTUAL ADJUSTMENTS FROM THIRD PARTY PAYORS. THE ALLOWANCES REFLECT MANAGEMENT'S ESTIMATE OF AMOUNTS THAT WILL NOT BE COLLECTED IN THE FUTURE AND ARE BASED ON REVIEWS OF PATIENT BALANCES BY PAYOR CLASSES. MANAGEMENT CONSIDERS HISTORICAL WRITE OFF AND RECOVERY INFORMATION IN DETERMINING THE ESTIMATED BAD DEBT PROVISION. THE HOSPITAL ALSO MAINTAINS A CHARITY CARE POLICY AS DESCRIBED IN NOTE 1O.THE FOLLOWING IS THE TEXT OF THE FOOTNOTE TITLED "NET PATIENT SERVICE REVENUE":THE HOSPITAL HAS AGREEMENTS WITH THIRD-PARTY PAYORS THAT PROVIDE FOR PAYMENTS TO THE HOSPITAL AT AMOUNTS DIFFERENT FROM ITS ESTABLISHED RATES. PAYMENT ARRANGEMENTS INCLUDE PROSPECTIVELY DETERMINED RATES PER DISCHARGE, REIMBURSED COSTS, DISCOUNTED CHARGES AND PER DIEM PAYMENTS. NET PATIENT SERVICE REVENUE IS REPORTED AT THE ESTIMATED NET REALIZABLE AMOUNTS FROM PATIENTS, THIRD-PARTY PAYORS, AND OTHERS FOR SERVICES RENDERED, INCLUDING ESTIMATED RETROACTIVE ADJUSTMENTS UNDER REIMBURSEMENT AGREEMENTS WITH THIRD-PARTY PAYORS. 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.THE FOLLOWING IS THE TEXT OF THE FOOTNOTE TITLED "CHARITY CARE":THE HOSPITAL 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 HOSPITAL DOES NOT PURSUE COLLECTION OF AMOUNTS DETERMINED TO QUALIFY AS CHARITY CARE, THEY ARE NOT REPORTED IN THE STATEMENTS OF OPERATIONS.THE HOSPITAL IS DEDICATED TO PROVIDING COMPREHENSIVE HEALTHCARE SERVICES TO ALL SEGMENTS OF SOCIETY, INCLUDING THE AGED AND OTHERWISE ECONOMICALLY DISADVANTAGED. IN ADDITION, THE HOSPITAL PROVIDES A VARIETY OF COMMUNITY HEALTH SERVICES AT OR BELOW COST.THE FACILITY OVERALL COST TO CHARGE RATIO WAS APPLIED TO THE AMOUNT OF BAD DEBT LISTED IN MELHAM MEDICAL CENTER'S YEAR-END AUDITED FINANCIAL STATEMENTS. CURRENTLY JMMMMC DOES NOT HAVE A MECHANISM TO ESTIMATE THE AMOUNT OF CHARITY CARE THAT MAY EXIST IN THE BAD DEBT EXPENSE. EFFORTS ARE MADE PRIOR TO THE CLASSIFICATION OF PATIENT ACCOUNTS TO BAD DEBT STATUS TO ASCERTAIN WHETHER OR NOT INDIVIDUALS WOULD QUALIFY FOR THE CHARITY CARE PROGRAM. PART III, LINE 8: JMMMMC USED THE SEPTEMBER 30, 2011 COST REPORT TO CALCULATE THE AMOUNT REPORTED ON PART III, LINE 6. THERE IS NO SHORTFALL REPORTED ON PART III, LINE 7. 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. 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 BASED 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 52% 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 6: 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, SURGICAL TECHNICIAN 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, ETC. 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 2,600 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 7: JMMMMC IS NOT PART OF AN AFFILIATED HEALTH CARE SYSTEM. X X 0 0 0 0 0 0 0 0 0 MICHAEL J STECKLER 153605 0 12979 0 0 0 5830 0 12841 0 185255 0 0 0 CHANGES IN PROGRAM SERVICES FORM 990, PART III, LINE 3 JMMMC SOLD ITS OXYGEN CONCENTRATOR BUSINESS EFFECTIVE MAY 1, 2011. 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 DELCARING 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 COMPARITIVE 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 IT GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, OR FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC. FORM 990, PART VII: MICHAEL STECKLER, PRESIDENT AND CEO OF JENNIE M. MELHAM MEMORIAL MEDICAL CENTER INC., SPENDS ON AVERAGE 4.0 HOURS PER WEEK AS A MEMBER OF THE BOARD OF DIRECTORS OF THE MELHAM MEDICAL CENTER FOUNDATION, INC., A RELATED ORGANIZATION. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED LOSSES ON INVESTMENTS: -14,672. 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) 11B N/A 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0