NEMAHA VALLEY COMMUNITY HOSPITAL: Form 990, tax year 2009

View the entire original 990 at ProPublica ↗

Organization
NEMAHA VALLEY COMMUNITY HOSPITAL (EIN 48-0764456)
Tax period
2009-07-01 to 2010-06-30
Filed
2011-01-24
IRS object ID
201100249349301005
Schema version
2009v1.7
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Timestamp2011-01-24T13:30:58-06:00Timestamp
Tax Period End Date2010-06-30TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1Wendling Noe Nelson & Johnson LLCBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1534 S Kansas Ave Suite 1500AddressLine1
CityTopekaCity
StateKSState
ZIP Code666033491ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2009-07-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN480764456EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1Nemaha Valley Community HospitalBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlNEMANameControl
Phone7853366181Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line11600 Community DriveAddressLine1
CitySenecaCity
StateKSState
ZIP Code66538ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameStan RegehrName
TitleCEOTitle
Phone7853366181Phone
Date Signed2011-01-18DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameGary D KnollName
Phone7852334226Phone
Date Prepared2011-01-18DatePrepared
FieldValueIRS element (for citing)
Tax Year2009TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonStan RegehrNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line11600 Community DriveAddressLine1
CitySenecaCity
StateKSState
ZIP Code66538ZIPCode
FieldValueIRS element (for citing)
Gross Receipts9963015GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501cXOrganization501c
Web SiteN/AWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1969YearFormation
State Legal DomicileKSStateLegalDomicile
Activity Or Mission DescriptionThe Nemaha Valley Community Hospital provides an acute care hospital to the surrounding area.ActivityOrMissionDescription
Nbr Voting Members Governing Body10NbrVotingMembersGoverningBody
Nbr Independent Voting Members9NbrIndependentVotingMembers
Total Nbr Employees143TotalNbrEmployees
Total Nbr Volunteers0TotalNbrVolunteers
Total Gross UBI1126TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year32328ContributionsGrantsPriorYear
Contributions Grants Current Year50234ContributionsGrantsCurrentYear
Program Service Revenue Prior Year9059744ProgramServiceRevenuePriorYear
Program Service Revenue CY9741488ProgramServiceRevenueCY
Investment Income Prior Year42727InvestmentIncomePriorYear
Investment Income Current Year31652InvestmentIncomeCurrentYear
Other Revenue Prior Year106981OtherRevenuePriorYear
Other Revenue Current Year99530OtherRevenueCurrentYear
Total Revenue Prior Year9241780TotalRevenuePriorYear
Total Revenue Current Year9922904TotalRevenueCurrentYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year5461270SalariesEtcPriorYear
Salaries Etc Current Year5669531SalariesEtcCurrentYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year3666252OtherExpensePriorYear
Other Expenses Current Year4043012OtherExpensesCurrentYear
Total Expenses Prior Year9127522TotalExpensesPriorYear
Total Expenses Current Year9712543TotalExpensesCurrentYear
Revenues Less Expenses Prior Year114258RevenuesLessExpensesPriorYear
Revenues Less Expenses CY210361RevenuesLessExpensesCY
Total Assets BOY14837785TotalAssetsBOY
Total Assets EOY14405762TotalAssetsEOY
Total Liabilities BOY10618139TotalLiabilitiesBOY
Total Liabilities EOY9825983TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY4219646NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY4579779NetAssetsOrFundBalancesEOY
Mission DescriptionThe Nemaha Valley Community Hospital is dedicated to providing quality health care and other related services in a compassionate manner sufficient to meet the primary health needs of its patrons within the scope of its resources and staff.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense8768159Expense
Revenue9799960Revenue
DescriptionNemaha Valley Community Hospital provides healthcare treatment to its patients.Description
Total Program Service Expense8768159TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities0LobbyingActivities
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments0TermOrPermanentEndowments
Balance Sheet Amounts Reported1BalanceSheetAmountsReported
Independent Audit Financial Stmt1IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt1ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital1Hospital
Grants To Organizations0GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds1TaxExemptBonds
Invest Tax Exempt Bonds0InvestTaxExemptBonds
Escrow Account0EscrowAccount
On Behalf Of Issuer0OnBehalfOfIssuer
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP1LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity0RelatedOrgControlledEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With109618NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees143NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income0UnrelatedBusinessIncome
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Excess Business Holdings0ExcessBusinessHoldings
Taxable Distributions0TaxableDistributions
Distribution To Donor0DistributionToDonor
Nbr Voting Governing Body Members10NbrVotingGoverningBodyMembers
Number Independent Voting Members9NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders0MembersOrStockholders
Election Of Board Members0ElectionOfBoardMembers
Decisions Subject To Approval0DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body0Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy0WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other0CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1Connie IngwersonBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number7853366181TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line11600 Community DriveAddressLine1
CitySenecaCity
StateKSState
ZIP Code66538ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (16 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationKey EmployeeKeyEmployeeHighest Compensated EmployeeHighestCompensatedEmployeeFormerFormer
Mark Heiniger
Chairman4.00XX000
Steven Kramer
Vice - Chairman4.00XX000
Joyce Schmitz
Secretary4.00XX000
Larry Kuckelman
Trustee4.00X000
Dale Olberding
Trustee4.00X000
Connie Ronnebaum
Trustee4.00X000
Judy Deters
Trustee4.00X000
Kathy Brinker
Trustee4.00X000
Dr Jody Bieker
Physician/Trustee40.00X203086021946X
Stan Regehr
CEO40.00X14851205821
Connie Ingwerson
CFO40.00X6349200
Dr James Lueger
Physician40.0021901909586X
Dr William Bartkoski
Physician40.00227666010192X
Dr Angela Stueve
Physician40.00218387020083X
Karen Hynek
ARNP40.0010601704682X
Ron Johnson
Past-Chairman4.00000X
FieldValueIRS element (for citing)
Total Reportable Comp From Org1186179TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation72310TotalOtherCompensation
Number Individuals GT100 K6NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation

Name Of Contractor NameOfContractor

FieldValueIRS element (for citing)
Name PersonHarry StewartNamePerson

Address Of Contractor AddressOfContractor

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1PO Box 147AddressLine1
CitySenecaCity
StateKSState
ZIP Code66538ZIPCode
FieldValueIRS element (for citing)
Description Of ServicesCRNADescriptionOfServices
Compensation317700Compensation
FieldValueIRS element (for citing)
Number Of Contractors GT100 K1NumberOfContractorsGT100K
Government Grants31684GovernmentGrants
All Other Contributions18550AllOtherContributions
Total Contributions50234TotalContributions

Program Service Revenue ProgramServiceRevenue

FieldValueIRS element (for citing)
DescriptionPatient serviceDescription
Business Code621990BusinessCode
Total Revenue Column9741488TotalRevenueColumn
Related Or Exempt Function Income9741488RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Program Service Revenue9741488TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column44589TotalRevenueColumn
Exclusion$44,589ExclusionAmount

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real3300Real

Less Rental Expenses LessRentalExpenses

FieldValueIRS element (for citing)
Real2174Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real1126Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column1126TotalRevenueColumn
Unrelated Business Revenue1126UnrelatedBusinessRevenue

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Other25000Other

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Other37937Other

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Other-12937Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column-12937TotalRevenueColumn
Related Or Exempt Function Income-12937RelatedOrExemptFunctionIncome

Other Revenue Misc OtherRevenueMisc (2 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncomeExclusionExclusionAmount
Miscellaneous6219907140971409
Dietary Income62199026995$26,995
FieldValueIRS element (for citing)
Total Other Revenue98404TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column9922904TotalRevenueColumn
Related Or Exempt Function Income9799960RelatedOrExemptFunctionIncome
Unrelated Business Revenue1126UnrelatedBusinessRevenue
Exclusion$71,584ExclusionAmount

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total218206Total
Management And General218206ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total4551189Total
Program Services4204346ProgramServices
Management And General346843ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total122312Total
Program Services113238ProgramServices
Management And General9074ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total502141Total
Program Services449268ProgramServices
Management And General52873ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total275683Total
Program Services243638ProgramServices
Management And General32045ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total4917Total
Management And General4917ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total15693Total
Program Services9090ProgramServices
Management And General6603ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total37209Total
Program Services36961ProgramServices
Management And General248ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total186174Total
Program Services186108ProgramServices
Management And General66ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total48512Total
Program Services33666ProgramServices
Management And General14846ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total272468Total
Program Services272468ProgramServices

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total578260Total
Program Services530378ProgramServices
Management And General47882ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total108139Total
Program Services108139ProgramServices

Other Expenses OtherExpenses (5 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
Supplies1147588111574031848
Professional fees81928673683982447
Equipment rental and ma37622631234663880
Collection fees and bad292307292307
Miscellanous88567822886279

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total67666Total
Program Services41339ProgramServices
Management And General26327ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total9712543Total
Program Services8768159ProgramServices
Management And General944384ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY130427BOY
EOY233654EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY8125899BOY
EOY3701836EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

FieldValueIRS element (for citing)
BOY237211BOY
EOY91261EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY918713BOY
EOY1199853EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY218322BOY
EOY210599EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY241846BOY
EOY229184EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis15724224LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec6995309LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY4888518BOY
EOY8728915EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY76849BOY
EOY10460EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY14837785BOY
EOY14405762EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY1762585BOY
EOY1116761EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY75554BOY
EOY44222EOY

Unsecured Notes Loans Payable UnsecuredNotesLoansPayable

FieldValueIRS element (for citing)
BOY8780000BOY
EOY8665000EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY10618139BOY
EOY9825983EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY4215543BOY
EOY4579078EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY4103BOY
EOY701EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY4219646BOY
EOY4579779EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY14837785BOY
EOY14405762EOY
FieldValueIRS element (for citing)
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee1AuditCommittee
Financial Statement ConsolidatedXFinancialStatementConsolidated
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Hospital170b1 AiiiXHospital170b1Aiii

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule D IRS990ScheduleD

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis54681OtherCostOrOtherBasis
Book Value54681BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis8731187OtherCostOrOtherBasis
Depreciation1693491Depreciation
Book Value7037696BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis6938356OtherCostOrOtherBasis
Depreciation5301818Depreciation
Book Value1636538BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings8728915TotalOfBookValueLandBuildings
Total Revenue9922904TotalRevenue
Total Expenses9712543TotalExpenses
Excess Or Deficit For Year210361ExcessOrDeficitForYear
Other$149,772OtherAmount
Total Adjustments149772TotalAdjustments
Excess Or Deficit Per FS360133ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt9925078TotRevenueEtcAuditedFinclStmt
Other Revenues2174OtherRevenues
Revenue Not Rptd F9902174RevenueNotRptdF990
Revenue Subtotal9922904RevenueSubtotal
Revenue Not Rptd On Fin Stmt0RevenueNotRptdOnFinStmt
Total Revenue Per Form9909922904TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt9714717TotExpensesEtcAuditedFinclStmt
Other Expenses Included2174OtherExpensesIncluded
Expenses Not Rptd F9902174ExpensesNotRptdF990
Expenses Subtotal9712543ExpensesSubtotal
Expenses Not Rptd On Fin Stmt0ExpensesNotRptdOnFinStmt
Total Expenses Per Form9909712543TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (4 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
Part X:Description of Uncertain Tax Positions Under FIN 48:Not applicable.
Part XI, Line 8 - Other Adjustments:Net assets released from restrictions used for operations: -31684. Temporarily restricted contributions: 123782. Restricted Investment Income: 7674. Intercomany Transfers: 50000. Temporarily restricted assets released for property and equipment: -103174. Unrestricted assets used for property and equipment: 103174.
Part XII, Line 2d - Other Adjustments:Rental expenses that offset rental income: 2174.
Part XIII, Line 2d - Other Adjustments:Rental expenses that offset rental income: 2174.

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Charity Care Policy1CharityCarePolicy
Written Policy1WrittenPolicy
FPG Reference Free Care1FPGReferenceFreeCare
Pcent200XPcent200
FPG Reference Discounted Care1FPGReferenceDiscountedCare
Pcent200 DXPcent200D
Free Disc Care Medically Indigent1FreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity Care1AmountsBudgetedForCharityCare
Expenses Exceeded Budget1ExpensesExceededBudget
Unable To Provide Care0UnableToProvideCare
Annual Community Benefit Report0AnnualCommunityBenefitReport

Charity Care At Cost CharityCareAtCost

FieldValueIRS element (for citing)
Total Community Benefit Expense45760TotalCommunityBenefitExpense
Net Community Benefit Expense45760NetCommunityBenefitExpense
Percent Of Total Expense0.00490PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

FieldValueIRS element (for citing)
Total Community Benefit Expense282432TotalCommunityBenefitExpense
Direct Offsetting Revenue147214DirectOffsettingRevenue
Net Community Benefit Expense135218NetCommunityBenefitExpense
Percent Of Total Expense0.01440PercentOfTotalExpense

Total Charity Care TotalCharityCare

FieldValueIRS element (for citing)
Total Community Benefit Expense328192TotalCommunityBenefitExpense
Direct Offsetting Revenue147214DirectOffsettingRevenue
Net Community Benefit Expense180978NetCommunityBenefitExpense
Percent Of Total Expense0.01930PercentOfTotalExpense

Community Health Services CommunityHealthServices

FieldValueIRS element (for citing)
Total Community Benefit Expense8346TotalCommunityBenefitExpense
Direct Offsetting Revenue6396DirectOffsettingRevenue
Net Community Benefit Expense1950NetCommunityBenefitExpense
Percent Of Total Expense0.00020PercentOfTotalExpense

Subsidized Health Services SubsidizedHealthServices

FieldValueIRS element (for citing)
Total Community Benefit Expense63570TotalCommunityBenefitExpense
Direct Offsetting Revenue14520DirectOffsettingRevenue
Net Community Benefit Expense49050NetCommunityBenefitExpense
Percent Of Total Expense0.00520PercentOfTotalExpense

Cash And In Kind Contributions CashAndInKindContributions

FieldValueIRS element (for citing)
Total Community Benefit Expense5431TotalCommunityBenefitExpense
Direct Offsetting Revenue0DirectOffsettingRevenue
Net Community Benefit Expense5431NetCommunityBenefitExpense
Percent Of Total Expense0.00060PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense77347TotalCommunityBenefitExpense
Direct Offsetting Revenue20916DirectOffsettingRevenue
Net Community Benefit Expense56431NetCommunityBenefitExpense
Percent Of Total Expense0.00600PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense405539TotalCommunityBenefitExpense
Direct Offsetting Revenue168130DirectOffsettingRevenue
Net Community Benefit Expense237409NetCommunityBenefitExpense
Percent Of Total Expense0.02530PercentOfTotalExpense
FieldValueIRS element (for citing)
Bad Debt Expense$184,446BadDebtExpenseAmount
Amount Attributable To73778AmountAttributableTo
Amount Reimbursed By Medicare5233110AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare5326936CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall-93826MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

FieldValueIRS element (for citing)
Cost To Charge RatioXCostToChargeRatio
FieldValueIRS element (for citing)
Written Debt Collection Policy1WrittenDebtCollectionPolicy
Provision For Charity Care1ProvisionForCharityCare

Form990 Schedule H Part V Form990ScheduleHPartV

Name Name

FieldValueIRS element (for citing)
Business Name Line1Nemaha Valley Community HospitalBusinessNameLine1

Address Address

FieldValueIRS element (for citing)
Address Line11600 Community DriveAddressLine1
CitySenecaCity
StateKSState
ZIP Code66538ZIPCode
FieldValueIRS element (for citing)
Licensed HospitalXLicensedHospital
General Medical And SurgicalXGeneralMedicalAndSurgical
Critical Access HospitalXCriticalAccessHospital
Er24 HoursXEr24Hours

Form990 Schedule H Part VI Form990ScheduleHPartVI

FieldValueIRS element (for citing)
Bad Debt FootnotePart III, Line 4: Nemaha Valley Community Hospital provides for accounts receivable that could become uncollectible in the future by establishing an allowance to reduce the carrying value of such receivables to their estimated net realizable value. Nemaha Valley Community Hospital estimates this allowance based on the aging of its accounts receivable and its historical collection experience for each type of payor.BadDebtFootnote
Shortfall As Community BenefitPart III, Line 8: The Hospital provides service to all patients in their service area, regardless of the patient's ability to pay, and any shortfall absorbed by the Hospital is a benefit to the community.ShortfallAsCommunityBenefit
Debt Collection PolicyPart III, Line 9b: Nemaha Valley Community Hospital will make every effort to get correct financial and billing information and educate patients on charity programs and payment options.DebtCollectionPolicy
Needs AssessmentPart VI, Line 2: The Hospital receives feedback from community members regarding services currently offered and potential availability of services not offered. The Hospital also discusses the service needs of the community with the medical staff and board of trustees, who are in tune with the needs of the patients.NeedsAssessment
Patient Education AssistancePart VI, Line 3: Notification associated with patient encounter.PatientEducationAssistance
Community InformationPart VI, Line 4: The community being served consists of approximately 2,000 residents. The average household income is $41,827. 7.1% of the community residents live below federal poverty level, and 1.9% of the community residents live below 50% of the federal poverty level. Neighboring hospitals are located in Sabetha, Pawnee County, NE, and Hiawatha. They are approximately 15, 20, and 28 miles away respectively.CommunityInformation
Community Building ActivitiesPart VI, Line 5: N/ACommunityBuildingActivities
Other InformationPart VI, Line 6: The Hospital notifies the public in quarterly newsletters about services available at the hospital. The Hospital offers periodic diabetic educational programs and education programs for expectant mothers. The Hospital uses all excess funds to maintain and improve Hospital facilities and patient services.OtherInformation
Affiliated Health Care SystemPart VI, Line 7: N/AAffiliatedHealthCareSystem

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance Payment0SeverancePayment
Supplemental Nonqual Retire Plan0SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org0CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs0CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org0CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs0CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments0AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (5 entries)

Base Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
Dr Jody Bieker
192694000103920823001371602250320998290
Stan Regehr
1485120000058210001543330693190
Dr James Lueger
21901900000958600022860501135680
Dr William Bartkoski
227666000001019200023785801253600
Dr Angela Stueve
1997870001860006367013716023847001028810

Schedule K IRS990ScheduleK

Form990 Schedule K Part I Form990ScheduleKPartI

Issuer Name IssuerName

FieldValueIRS element (for citing)
Business Name Line1City of SenecaBusinessNameLine1
FieldValueIRS element (for citing)
Issuer EIN486026237IssuerEIN
CUSIP Number81712RAP4CUSIPNumber
Date Issued2008-12-01DateIssued
Issue Price8835000IssuePrice
Description Of PurposeTo refund notes payable and construction cost for an addition to HospitalDescriptionOfPurpose
Defeased0Defeased
On Behalf Of Issuer0OnBehalfOfIssuer

Form990 Schedule K Part II Form990ScheduleKPartII

FieldValueIRS element (for citing)
Total Proceeds8746650TotalProceeds
Amount Defeased1358153AmountDefeased
Amount Unspent7388497AmountUnspent
Issuance Costs From Proceeds73122IssuanceCostsFromProceeds
Working Capital Expenditures498789WorkingCapitalExpenditures
Capital Expenditures6816586CapitalExpenditures
Year Of Subst Completion2011YearOfSubstCompletion
Current Refunding0CurrentRefunding
Advance Refunding1AdvanceRefunding
Final Allocation Made1FinalAllocationMade
Adequate Books And Recds Maintaind1AdequateBooksAndRecdsMaintaind

Form990 Schedule K Part III Form990ScheduleKPartIII

FieldValueIRS element (for citing)
Owning Bond Financed Property0OwningBondFinancedProperty
Any Lease Arrangements0AnyLeaseArrangements
Mngment Cntrct Bond Financd Prprty0MngmentCntrctBondFinancdPrprty
Any Research Agreements0AnyResearchAgreements
Bond Counsel Routinely Engaged0BondCounselRoutinelyEngaged
Post Issuance Compliance Procdrs0PostIssuanceComplianceProcdrs

Form990 Schedule K Part IV Form990ScheduleKPartIV

FieldValueIRS element (for citing)
Form8038 T Filed0Form8038TFiled
Variable Rate Issue0VariableRateIssue
Hedge Identified In Books And Recds0HedgeIdentifiedInBooksAndRecds
Gross Proceeds Invested In GIC0GrossProceedsInvestedInGIC
Gross Proceeds Invested0GrossProceedsInvested
Exception To Rebate0ExceptionToRebate

Schedule L IRS990ScheduleL

Loan Table LoanTable (2 entries)

Purpose Of LoanPurposeOfLoanLoan From OrganizationLoanFromOrganizationOriginal PrincipalOriginalPrincipalAmountBalance DueBalanceDueDefaultDefaultApproved By BoardApprovedByBoardWritten AgreementWrittenAgreement
Dr Stueve
Assist with transition from medical schoolX$16,0006222001
Dr Bieker
Assist with transition from medical schoolX$16,000445001
FieldValueIRS element (for citing)
Total Balance Due6667TotalBalanceDue

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (5 entries)

IdentifierIdentifierExplanationExplanation
Form 990, Part VI, Section B, line 11The 990 is not formally presented to the board. The document is made available upon request.
Form 990, Part VI, Section B, line 12cThe board in required to annually sign conflict of interest statement.
Form 990, Part VI, Section B, line 15aThe CEO salary and compensation is approved by the hospital's board.
Form 990, Part VI, Section C, line 19Documents are available upon request.
FORM 990 PART VII LINE 12CThe board in required to annually sign conflict of interest statement.

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII

Name Of Disregarded Entity NameOfDisregardedEntity

FieldValueIRS element (for citing)
Business Name Line1Nemaha Valley Health Care FoundationBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line11600 Community DriveAddressLine1
CitySenecaCity
StateKSState
ZIP Code66538ZIPCode
FieldValueIRS element (for citing)
EIN481097250EIN
Primary ActivitiesFundraising for the benefit of Nemaha Valley Community HospitalPrimaryActivities
Legal Domicile StateKSLegalDomicileState
Exempt Code Section501(c)(3)ExemptCodeSection
Public Charity Status509(a)PublicCharityStatus
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties0ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org0GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org1GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org0LoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs0RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs0RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs0PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs0PerformOfServicesByOtherOrgs
Sharing Of Facilities0SharingOfFacilities
Sharing Of Paid Employees0SharingOfPaidEmployees
Reimbursement Paid To Other Org0ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrg
Other Transfer To Other Org0OtherTransferToOtherOrg
Other Transfer From Other Org0OtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable

Name Of Other Organization NameOfOtherOrganization

FieldValueIRS element (for citing)
Business Name Line1Nemaha Valley Health Care FoundationBusinessNameLine1
FieldValueIRS element (for citing)
Transaction TypeCTransactionType
Amount Involved50000AmountInvolved

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