COMMUNITY HOSPITAL ASSOCIATION: Form 990, tax year 2009
View the entire original 990 at ProPublica ↗
- Organization
- COMMUNITY HOSPITAL ASSOCIATION (EIN 47-0533373)
- Tax period
- 2009-07-01 to 2010-06-30
- Filed
- 2011-02-15
- IRS object ID
- 201120469349301927
- 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
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule H
- Schedule I
- Schedule J
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2011-02-15T15:03:46-06:00 | Timestamp |
| Tax Period End Date | 2010-06-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SEIM JOHNSON SESTAK & QUIST LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 8807 INDIAN HILLS DRIVE SUITE 300 | AddressLine1 |
| City | OMAHA | City |
| State | NE | State |
| ZIP Code | 681144123 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2009-07-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 470533373 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | COMMUNITY HOSPITAL ASSOCIATION OF MCCOOK | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | COMM | NameControl |
| Phone | 3083442650 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1301 EAST H STREET PO BOX 1328 | AddressLine1 |
| City | MCCOOK | City |
| State | NE | State |
| ZIP Code | 69001 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | TROY BRUNTZ | Name |
| Title | CFO | Title |
| Phone | 3083442650 | Phone |
| Date Signed | 2011-02-11 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Julie M Gerken | Name |
| Phone | 4023302660 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2009 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | TROY BRUNTZ | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 434 SEMINOLE DRIVE | AddressLine1 |
| City | MCCOOK | City |
| State | NE | State |
| ZIP Code | 69001 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 32014752 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c | X | Organization501c |
| Web Site | www.chmccook.org | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1974 | YearFormation |
| State Legal Domicile | NE | StateLegalDomicile |
| Activity Or Mission Description | TO PROMOTE PUBLIC HEALTH | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 9 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 9 | NbrIndependentVotingMembers |
| Total Nbr Employees | 290 | TotalNbrEmployees |
| Total Nbr Volunteers | 40 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 109021 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 112505 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 28057673 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 30859461 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 133317 | InvestmentIncomePriorYear |
| Investment Income Current Year | 70023 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 886371 | OtherRevenuePriorYear |
| Other Revenue Current Year | 877596 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 29186382 | TotalRevenuePriorYear |
| Total Revenue Current Year | 31919585 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 56185 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 56080 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 12425168 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 13029667 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 14766861 | OtherExpensePriorYear |
| Other Expenses Current Year | 15686083 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 27248214 | TotalExpensesPriorYear |
| Total Expenses Current Year | 28771830 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 1938168 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 3147755 | RevenuesLessExpensesCY |
| Total Assets BOY | 25471710 | TotalAssetsBOY |
| Total Assets EOY | 34009223 | TotalAssetsEOY |
| Total Liabilities BOY | 5683846 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 11073604 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 19787864 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 22935619 | NetAssetsOrFundBalancesEOY |
| Mission Description | TO EXCEL AT PROVIDING FOR THE HEALTHCARE NEEDS OF OUR REGION THROUGH QUALITY, EFFICIENT AND PATIENT-CENTERED CARE. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 23822188 | Expense |
| Grants | 56080 | Grants |
| Revenue | 31287815 | Revenue |
| Description | CRITICAL ACCESS ACUTE CARE HOSPITAL PROVIDING INPATIENT AND OUTPATIENT CARE, DIAGNOSTIC, REHABILITATION, SURGICAL, NURSERY, VISITING MEDICAL SPECIALISTS, HOME HEALTH AND HOSPICE, TWO RURAL HEALTH CLINICS, AND HEALTH AND EDUCATION PROGRAMS. | Description |
| Total Program Service Expense | 23822188 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 1 | LobbyingActivities |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 1 | TermOrPermanentEndowments |
| Balance Sheet Amounts Reported | 1 | BalanceSheetAmountsReported |
| Independent Audit Financial Stmt | 0 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 1 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 0 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 1 | Hospital |
| Grants To Organizations | 1 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 0 | TaxExemptBonds |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 1 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 1 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 1 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 1 | RelatedEntity |
| Related Org Controlled Entity | 1 | RelatedOrgControlledEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 47 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 290 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 1 | UnrelatedBusinessIncome |
| Form990-T Filed | 1 | Form990-TFiled |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributions |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Nbr Voting Governing Body Members | 9 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 9 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 0 | MembersOrStockholders |
| Election Of Board Members | 0 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 0 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 1 | CompensationProcessCEO |
| Compensation Process Other | 1 | CompensationProcessOther |
| Investment In Joint Venture | 1 | InvestmentInJointVenture |
| Written Policy Or Procedure | 1 | WrittenPolicyOrProcedure |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Troy Bruntz | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 3083442650 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1301 EAST H - PO BOX 1328 | AddressLine1 |
| City | MCCOOK | City |
| State | NE | State |
| ZIP Code | 69001 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (15 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|
| BRIAN ESCH | |||||||
| CHAIRMAN | 1.00 | X | X | 0 | 0 | 0 | |
| MARC HARPHAM | |||||||
| VICE CHAIRMAN | 1.00 | X | X | 0 | 0 | 0 | |
| DORIS FRIEHE | |||||||
| SECRETARY | 1.00 | X | X | 0 | 0 | 0 | |
| JAMES O'DEA | |||||||
| TREASURER | 1.00 | X | X | 0 | 0 | 0 | |
| MARTY CONROY | |||||||
| MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| RICHARD KLUG MD | |||||||
| MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| DAVE SMITH | |||||||
| MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| BRUCE BAIR | |||||||
| MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| MAX ABERCOMBIE | |||||||
| MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| JAMES ULRICH | |||||||
| CEO & PRESIDENT | 40.00 | X | 162182 | 0 | 40598 | ||
| TROY BRUNTZ | |||||||
| CFO & VP OF FINANCE | 40.00 | X | 105659 | 0 | 23244 | ||
| ANTHONY RODEWALD | |||||||
| PHARMACIST | 40.00 | 114934 | 0 | 26744 | X | ||
| TERRY GOURLEY | |||||||
| PHYSICIAN ASSISTANT | 40.00 | 101897 | 0 | 10115 | X | ||
| ELIZABETH NEAL | |||||||
| PHARMACIST | 40.00 | 108326 | 0 | 13392 | X | ||
| CHASE CRAWFORD | |||||||
| PHARMACIST | 40.00 | 107288 | 0 | 33622 | X | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 700286 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 147715 | TotalOtherCompensation |
| Number Individuals GT100 K | 6 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| MCCOOK CLINIC PC | |||||
| 1401 EAST H STREET | MCCOOK | NE | 69001 | MEDICAL PROFESSIONAL - PHYSICIANS | 969182 |
| SOUTHWEST NEBRASKA PHYSICAL THERAPY PC | |||||
| PO BOX 789 | MCCOOK | NE | 69001 | MEDICAL PROFESSIONAL - PHYSICIANS | 737283 |
| LAWRENCE FRIESTAD CRNA | |||||
| 901 WEST 7TH | MCCOOK | NE | 69001 | MEDICAL PROFESSIONAL - ANESTHESIA | 241114 |
| PATHOLOGY SERVICES | |||||
| BOX 1289 | NORTH PLATTE | NE | 69103 | MEDICAL PROFESSIONAL - PATHOLOGY | 209369 |
| CENTRAL ANESTHESIA LLC | |||||
| 72128 ROAD 401 | BARTLEY | NE | 69020 | MEDICAL PROFESSIONAL - ANESTHESIA | 160425 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 8 | NumberOfContractorsGT100K |
| Related Organizations | 97101 | RelatedOrganizations |
| Government Grants | 15404 | GovernmentGrants |
| Total Contributions | 112505 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|
| PATIENT SERVICE REVENU | 621400 | 15806753 | 15806753 |
| MEDICARE/MEDICAID PAYM | 621400 | 14565797 | 14565797 |
| RECOVERY OF ACCOUNTS | 621400 | 486911 | 486911 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 30859461 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 117748 | TotalRevenueColumn |
| Exclusion | $117,748 | ExclusionAmount |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 351913 | Real |
Less Rental Expenses LessRentalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 17938 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 333975 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 333975 | TotalRevenueColumn |
| Exclusion | $333,975 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 29504 | Other |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 77229 | Other |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | -47725 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -47725 | TotalRevenueColumn |
| Exclusion | -$47,725 | ExclusionAmount |
Other Revenue Misc OtherRevenueMisc (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | ExclusionExclusionAmount | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|---|
| CAFETERIA/MEALS | 900099 | 94954 | $94,954 | |
| HOUSEKEEPING INCOME | 900099 | 80796 | 80796 | |
| PURCHASE DISCOUNTS | 621400 | 45803 | 45803 |
Miscellaneous Revenue MiscellaneousRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 322068 | TotalRevenueColumn |
| Related Or Exempt Function Income | 301755 | RelatedOrExemptFunctionIncome |
| Exclusion | $20,313 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 543621 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 31919585 | TotalRevenueColumn |
| Related Or Exempt Function Income | 31287815 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $519,265 | ExclusionAmount |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 56080 | Total |
| Program Services | 56080 | ProgramServices |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 331683 | Total |
| Management And General | 331683 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 9834173 | Total |
| Program Services | 7950390 | ProgramServices |
| Management And General | 1883783 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 656103 | Total |
| Program Services | 516360 | ProgramServices |
| Management And General | 139743 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1373690 | Total |
| Program Services | 1131352 | ProgramServices |
| Management And General | 242338 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 834018 | Total |
| Program Services | 656381 | ProgramServices |
| Management And General | 177637 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 19274 | Total |
| Management And General | 19274 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 55403 | Total |
| Management And General | 55403 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 5154636 | Total |
| Program Services | 4235431 | ProgramServices |
| Management And General | 919205 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 186421 | Total |
| Management And General | 186421 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 4531263 | Total |
| Program Services | 4308326 | ProgramServices |
| Management And General | 222937 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 711431 | Total |
| Program Services | 605939 | ProgramServices |
| Management And General | 105492 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 34141 | Total |
| Program Services | 24110 | ProgramServices |
| Management And General | 10031 | ManagementAndGeneral |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 240963 | Total |
| Program Services | 112347 | ProgramServices |
| Management And General | 128616 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 137409 | Total |
| Program Services | 125931 | ProgramServices |
| Management And General | 11478 | ManagementAndGeneral |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2058498 | Total |
| Program Services | 1886541 | ProgramServices |
| Management And General | 171957 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 139328 | Total |
| Program Services | 127689 | ProgramServices |
| Management And General | 11639 | ManagementAndGeneral |
Other Expenses OtherExpenses (3 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| PROVISION FOR BAD DEBTS | 1401234 | 1401234 | |
| MISCELLANEOUS | 902598 | 570593 | 332005 |
| COLLECTION EXPENSE | 113484 | 113484 |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 28771830 | Total |
| Program Services | 23822188 | ProgramServices |
| Management And General | 4949642 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1050 | BOY |
| EOY | 1050 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5995021 | BOY |
| EOY | 6276648 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3662311 | BOY |
| EOY | 3775575 | EOY |
Receivables From Officers Etc ReceivablesFromOfficersEtc
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 73 | BOY |
| EOY | 632 | EOY |
Receivables From Disqual Persons ReceivablesFromDisqualPersons
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 69 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1111382 | BOY |
| EOY | 1093991 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 346349 | BOY |
| EOY | 431529 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 41657101 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 19972414 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 14153719 | BOY |
| EOY | 21684687 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 138344 | BOY |
| EOY | 159442 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 63461 | BOY |
| EOY | 585600 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 25471710 | BOY |
| EOY | 34009223 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2526381 | BOY |
| EOY | 4320496 | EOY |
Tax Exempt Bond Liabilities TaxExemptBondLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 143474 | BOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3013991 | BOY |
| EOY | 2697569 | EOY |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayable
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 4055539 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5683846 | BOY |
| EOY | 11073604 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 19787864 | BOY |
| EOY | 22935619 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 19787864 | BOY |
| EOY | 22935619 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 25471710 | BOY |
| EOY | 34009223 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
| Audit Committee | 1 | AuditCommittee |
| Financial Statement Consolidated | X | FinancialStatementConsolidated |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | Volunteers |
| Paid Staff Or Management | 0 | PaidStaffOrManagement |
| Media Advertisements | 0 | MediaAdvertisements |
| Mailings Members | 0 | MailingsMembers |
| Publications Or Broadcast | 0 | PublicationsOrBroadcast |
| Grants Other Organizations | 0 | GrantsOtherOrganizations |
| Direct Contact Legislators | 1 | DirectContactLegislators |
| Rallies Demonstrations | 0 | RalliesDemonstrations |
| Other Activities | 1 | OtherActivities |
| Other Activities | $3,067 | OtherActivitiesAmount |
| Total Lobbying Expenditures IIB | 3067 | TotalLobbyingExpendituresIIB |
| Not Described In501c3 | 0 | NotDescribedIn501c3 |
Form990 Schedule C Part IV Form990ScheduleCPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | Part II-B, Line 1i: | Identifier |
| Return Reference | Explanation of Other Lobbying Activities: | ReturnReference |
| Explanation | ITEM 1G - JAMES ULRICH, CEO AND PRESIDENT, TRAVELED TO WASHINGTON, D.C. TO PARTICIPATE IN "ADVOCACY DAY". MR. ULRICH MADE THIS TRIP AS A REPRESENTATIVE OF COMMUNITY HOSPITAL ASSOCIATION OF MCCOOK, AND AS A REPRESENTATIVE OF AHA AND NHA. AS AN "ADVOCACY DAY" PARTICIPANT, MR. ULRICH SPOKE WITH REPRESENTATIVES AND SENATORS REGARDING HEALTH CARE PROVIDER CONCERNS. ITEM 1I - A PORTION OF DUES PAID TO FRIENDS OF NEBRASKA NONPROFIT HOSPITALS, AMERICAN HOSPITAL ASSOCIATION AND NEBRASKA HOSPITAL ASSOCIATION IS USED BY THOSE ORGANIZATIONS TO INFLUENCE LEGISLATION. | Explanation |
Schedule D IRS990ScheduleD
Current Year CurrentYear
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 1545264 | BeginningOfYearBalance |
| Contributions | 441506 | Contributions |
| Investment Earnings Or Losses | 165360 | InvestmentEarningsOrLosses |
| Other Expenditures | 45171 | OtherExpenditures |
| Administrative Expenses | 11858 | AdministrativeExpenses |
| End Of Year Balance | 2095101 | EndOfYearBalance |
Current Year Minus1 Year CurrentYearMinus1Year
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 1852460 | BeginningOfYearBalance |
| Contributions | 42818 | Contributions |
| Investment Earnings Or Losses | -288173 | InvestmentEarningsOrLosses |
| Other Expenditures | 47008 | OtherExpenditures |
| Administrative Expenses | 14833 | AdministrativeExpenses |
| End Of Year Balance | 1545264 | EndOfYearBalance |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Designated EOY Balance | 0.28310 | BoardDesignatedEOYBalance |
| Permanent Endowment EOY Balance | 0.71690 | PermanentEndowmentEOYBalance |
| Endowments Held By Unrelated Orgs | 0 | EndowmentsHeldByUnrelatedOrgs |
| Endowments Held By Related Orgs | 1 | EndowmentsHeldByRelatedOrgs |
| Are Related Orgs Listed Schedule R | 1 | AreRelatedOrgsListedScheduleR |
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 133878 | OtherCostOrOtherBasis |
| Book Value | 133878 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 12895630 | OtherCostOrOtherBasis |
| Depreciation | 9964625 | Depreciation |
| Book Value | 2931005 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 18561881 | OtherCostOrOtherBasis |
| Depreciation | 9604611 | Depreciation |
| Book Value | 8957270 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 10065712 | OtherCostOrOtherBasis |
| Depreciation | 403178 | Depreciation |
| Book Value | 9662534 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 21684687 | TotalOfBookValueLandBuildings |
| Total Revenue | 31919585 | TotalRevenue |
| Total Expenses | 28771830 | TotalExpenses |
| Excess Or Deficit For Year | 3147755 | ExcessOrDeficitForYear |
| Total Adjustments | 0 | TotalAdjustments |
| Excess Or Deficit Per FS | 3147755 | ExcessOrDeficitPerFS |
| Tot Revenue Etc Audited Fincl Stmt | 31937523 | TotRevenueEtcAuditedFinclStmt |
| Other Revenues | 17938 | OtherRevenues |
| Revenue Not Rptd F990 | 17938 | RevenueNotRptdF990 |
| Revenue Subtotal | 31919585 | RevenueSubtotal |
| Revenue Not Rptd On Fin Stmt | 0 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 31919585 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 28789768 | TotExpensesEtcAuditedFinclStmt |
| Other Expenses Included | 17938 | OtherExpensesIncluded |
| Expenses Not Rptd F990 | 17938 | ExpensesNotRptdF990 |
| Expenses Subtotal | 28771830 | ExpensesSubtotal |
| Expenses Not Rptd On Fin Stmt | 0 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 28771830 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV (4 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| Part V, Line 4: | Description of Intended Use of Endowment Funds: | THE ENDOWMENT FUNDS ARE HELD BY THE COMMUNITY HOSPITAL HEALTH FOUNDATION OF MCCOOK (A RELATED PARTY) AND ARE USED IN SUPPORT OF THE HOSPITAL'S PROGRAMS AND PROJECTS, INCLUDING PROPERTY AND EQUIPMENT PURCHASES, SCHOLARSHIPS, HOSPICE PROGRAMS, REHABILITATION SERVICES AND OTHERS. |
| Part X: | Description of Uncertain Tax Positions Under FIN 48: | The Hospital and Foundation are not-for-profit corporations as described in Section 501(c)(3) of the Internal Revenue Code and 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 tax-exempt status. In general, such standards require the Hospital and Foundation to meet a community benefit standard and comply with various laws and regulations. Red Willow is a for-profit corporation. Red Willow had $14,398 and $9,188 of taxable income; incurred and paid $2,160 and $1,378 of federal income tax; and incurred and paid $803 and $513 of state income tax for the fiscal years ending December 31, 2009 and 2008, respectively. As of June 30, 2010, Red Willow had no tax liability. The Hospital, Foundation and Red Willow account for uncertainties in accounting for income tax assets and liabilities using guidance included in FASB ASC 740, Income Taxes. The Hospital, Foundation and Red Willow recognize the effect of income tax positions only if those positions are more likely than not of being sustained. At June 30, 2010 and 2009, the Hospital, Foundation and Red Willow had no uncertain tax positions accrued. |
| Part XII, Line 2d - Other Adjustments: | RENTAL EXPENSES INCLUDED ON FORM 990, PART VIII, LINE 6B:: 17938. | |
| Part XIII, Line 2d - Other Adjustments: | RENTAL EXPENSES INCLUDED ON FORM 990, PART VIII, LINE 6B:: 17938. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | 1 | CharityCarePolicy |
| Written Policy | 1 | WrittenPolicy |
| FPG Reference Free Care | 1 | FPGReferenceFreeCare |
Other Percentage OtherPercentage
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | X | Other |
| Free Other Percentage | 125.000000000000 | FreeOtherPercentage |
| Field | Value | IRS element (for citing) |
|---|---|---|
| FPG Reference Discounted Care | 0 | FPGReferenceDiscountedCare |
| Free Disc Care Medically Indigent | 1 | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | 1 | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | 0 | ExpensesExceededBudget |
| Annual Community Benefit Report | 1 | AnnualCommunityBenefitReport |
| Report Publically Available | 1 | ReportPublicallyAvailable |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 393824 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 393824 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01440 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 1969828 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 1968413 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1415 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00010 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 2363652 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 1968413 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 395239 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01450 | PercentOfTotalExpense |
Cash And In Kind Contributions CashAndInKindContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 54435 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 54435 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00200 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 54435 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 54435 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00200 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 2418087 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 1968413 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 449674 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01650 | PercentOfTotalExpense |
Health Improvement Advocacy HealthImprovementAdvocacy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 102468 | TotalCommunityBuildingExpense |
| Direct Offsetting Revenue | 19145 | DirectOffsettingRevenue |
| Net Community Building Expense | 83323 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00300 | PercentOfTotalExpense |
Workforce Development WorkforceDevelopment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 5496 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 5496 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00020 | PercentOfTotalExpense |
Total Total
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 107964 | TotalCommunityBuildingExpense |
| Direct Offsetting Revenue | 19145 | DirectOffsettingRevenue |
| Net Community Building Expense | 88819 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00320 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 0 | BadDebtExpenseReported |
| Bad Debt Expense | $844,482 | BadDebtExpenseAmount |
| Amount Attributable To | 126600 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 12226135 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 12208854 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | 17281 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | X | CostToChargeRatio |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | 1 | WrittenDebtCollectionPolicy |
| Provision For Charity Care | 1 | ProvisionForCharityCare |
Form990 Schedule H Part V Form990ScheduleHPartV (6 entries)
| Address Line1Address/AddressLine1 | CityAddress/City | StateAddress/State | ZIP CodeAddress/ZIPCode | Licensed HospitalLicensedHospital | General Medical And SurgicalGeneralMedicalAndSurgical | Critical Access HospitalCriticalAccessHospital | Er24 HoursEr24Hours | OtherOther |
|---|---|---|---|---|---|---|---|---|
| COMMUNITY HOSPITAL ASSN OF MCCOOK | ||||||||
| 1301 EAST H STREET - PO BOX 1328 | MCCOOK | NE | 69001 | X | X | X | X | |
| COMMUNITY HEALTHCARE & HOSPICE | ||||||||
| 407 WEST 5TH STREET | MCCOOK | NE | 69001 | HOME HEALTH AND HOSPICE SERVICES | ||||
| COMMUNITY HOSPITAL SLEEP LAB | ||||||||
| 801 WEST C STREET SUITE 3B | MCCOOK | NE | 69001 | OUTPATIENT SLEEP SERVICES | ||||
| CURTIS MEDICAL CENTER | ||||||||
| 302 EAST 6TH STREET | CURTIS | NE | 69025 | RURAL HEALTH CLINIC-OUTPATIENT SERVICES | ||||
| TRENTON MEDICAL CLINIC | ||||||||
| 406 EAST 1ST STREET | TRENTON | NE | 69044 | RURAL HEALTH CLINIC-OUTPATIENT SERVICES | ||||
| COMMUNITY HOSPITAL - OUTPATIENT SERVICES | ||||||||
| 104 NORTH 3RD STREET | INDIANOLA | NE | 69034 | OUTPATIENT SERVICES | ||||
Form990 Schedule H Part VI Form990ScheduleHPartVI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Income Based Criteria | Part I, Line 3c: Charity Care is granted to all individuals whose household income is below 125% of the federal poverty guideline at the 100% write-off level. Discounting or 100% write-off to charity care is allowed above 125% of the federal poverty guideline based on an analysis of individual need and determination of the patient being medically indigent; this analysis includes factors such as income, accessible assets, medical or/and other debts, the likelihood of ongoing medical care and the individual's overall ability to pay. | IncomeBasedCriteria |
| Costing Method Used | Part I, Line 7: The organization uses a cost-to-charge ratio methodology derived from worksheet #2 of the form 990 instructiions. | CostingMethodUsed |
| Percent Of Total Expense Expln | Part I, Line 7f: the bad debt expense included in form 990, part ix, line 25 but not included in Schedule h, part i, line 7, column (f) is $1,401,234. | PercentOfTotalExpenseExpln |
| Bad Debt Footnote | Part III, Line 4: Community Hospital's bad debt expense is recorded at gross revenue value on the Hospital's books based on actual bad debt incurred during the fiscal year and an estimate amount of accounts receivable at year end that, based on historical trends, are projected to be uncollectible from patients and/or third party Payors. Bad debt expense does not include any amounts attributable to patients that are known by the Hospital to qualify for the charity care program, nor does it include any amounts written off due to contractual relationships with third party Payors. The Cost of bad debt on line 2 was calculated using the overall cost-to-charge ratio from worksheet #2 in the Form 990 instructions. Line 3 was estimated using both quantitative and qualitative sources. The quantitative source was an analytical analysis of the amount of charity care given by Community Hospital compared to the local demographics for poverty based on US Census data. One of the assumptions made was that most individuals that would have qualified for charity care but would not apply ended up as bad debt write-offs of the Hospital. This analysis showed that approximately 5% of the bad debt expense was likely to have come from individuals that would have qualified for charity care had they applied. The qualitative source we employed was to ask our staff that routinely handle charity care applications and bad debt determinations, what percentage, in their professional opinion, of bad debt was from individuals that would have likely qualified for the charity care program had the patient applied for assistance. The estimate we received was 15%-20% of accounts turned over as bad debt, in their opinion, likely would have qualified for charity assistance had the patient been cooperative in the process and applied for charity care. After analysis of these factors, the Hospital is recording 15% of its bad debt costs on Line 3. | BadDebtFootnote |
| Shortfall As Community Benefit | Part III, Line 8: THE SOURCE USED TO DETERMINE THE AMOUNT REPORTED ON LINE 6 WAS THE MEDICARE COST REPORT. | ShortfallAsCommunityBenefit |
| Debt Collection Policy | Part III, Line 9b: Community Hospital will adhere to hospital policies regarding Charity Care and grant a 100% Charity Care write-off for all patients known to qualify for Charity Care. | DebtCollectionPolicy |
| Needs Assessment | Part VI, Line 2: Community Hospital conducts a community health needs assessment (CHNA) and has an implementation strategy to meet the community health needs identified through such assessment. The CHNA uses input from persons who represented the broad interests of the community served by Community Hospital, including community members, physicians, nurses, clinicians and leaders from other organizations dedicated to public health and welfare. | NeedsAssessment |
| Patient Education Assistance | Part VI, Line 3: Community Hospital works with patients identified as possibly qualifying for federal or state programs (i.e. Medicaid or Medicare) in applying for those programs. Community Hospital uses multiple communication channels and opportunities to communicate our charity policy to our patients, both at the time of service and in the collection process. Our patients are provided information by signs posted in the facility, through literature available in the community and at the facility, at the time of registration and on each billing that is mailed. | PatientEducationAssistance |
| Community Information | Part VI, Line 4: Community Hospital serves a rural population of approximately 29,700 people living in an area of 717 square miles. Approximately 19% of the population is elderly (over 65). Over one half of the households have annual incomes of $40,000 or less and 81% have annual incomes of $60,000 or less; the median household income is $33,000. The number of families living below the federal poverty level is higher than the nebraska state average. | CommunityInformation |
| Community Building Activities | Part VI, Line 5: Community Hospital supports various community building activities, primarily through monetary support. Examples include support to: the Economic Development Corporation, the local Community College and Invest Nebraska. These programs directly impact the health of our community by development of employment opportunities and a more employable workforce. Members of our community with good employment have access to health insurance and are generally able to live healthier lives. | CommunityBuildingActivities |
| Other Information | Part VI, Line 6: Community Hospital is the largest hospital within an hour travel time for most of the community served. The Hospital provides the physicians of McCook a Hospital to practice medicine. without the Hospital our patients would have extremely long distances to travel for everything from emergency to routine care. Our Hospital is overseen by a non-compensated board of independent community members. Any profits from the operation of the hospital are reinvested back into the facilities, equipment and staff to provide our community with current and high quality medical services close to home. | OtherInformation |
| Affiliated Health Care System | Part VI, Line 7: N/A | AffiliatedHealthCareSystem |
| Reports Filed With States | NE | ReportsFiledWithStates |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Records Maintained | 1 | RecordsMaintained |
Recipient Table RecipientTable (3 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EIN Of RecipientEINOfRecipient | IRC SectionIRCSection | Amount Of Cash GrantAmountOfCashGrant | Purpose Of GrantPurposeOfGrant | Address Line2AddressUS/AddressLine2 |
|---|---|---|---|---|---|---|---|---|
| INVEST NEBRASKA CORPORATION | ||||||||
| 4701 INNOVATION DR | LINCOLN | NE | 68521 | 460469145 | 501(c)(3) | 6667 | TO SUPPORT ECONOMIC DEVELOPMENT IN OUR COMMUNITY. | |
| MCCOOK COLLEGE FOUNDATION | ||||||||
| PO BOX 195 | MCCOOK | NE | 69001 | 476089800 | 501(c)(3) | 20000 | SUPPORT FOR THE CONSTRUCTION OF THE MCC EVENT CENTER WHICH PROMOTES HEALTH AND WELLNESS CURRICULUM AND ACTIVITIES IN THE MCCOOK COMMUNITY. | |
| MCCOOK ECONOMIC DEVELOPMENT CORPORATION | ||||||||
| 301 NORRIS AVE SUITE 200 - PO BOX | MCCOOK | NE | 69001 | 470685662 | 501(c)(4) | 14000 | TO RECRUIT, STRENGTHEN AND EXPAND THE BUSINESSES THAT ARE THE FOUNDATION TO OUR LOCAL ECONOMY. | 626 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Nbr Of501 C3 And Govt Grants | 2 | TotalNbrOf501C3AndGovtGrants |
| Total Nbr Of Other Organizations | 1 | TotalNbrOfOtherOrganizations |
Form990 Schedule I Part IV Form990ScheduleIPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | Procedure for Monitoring Grants in the U.S.: | Identifier |
| Return Reference | Part I, Line 2: | ReturnReference |
| Explanation | Schedule I, Part I, Line 2: GRANTS ARE MADE ONLY TO SELECTED CHARITABLE OR OTHER EXEMPT ORGANIATIONS. COMMUNITY HOSPITAL ASSOCIATION ENTERS INTO AGREEMENTS WITH GRANTEES THAT GRANT FUNDS WILL BE RESTRICTED TO SPECIFIED EXEMPT PURPOSES. | Explanation |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | X | CompensationCommittee |
| Written Employment Contract | X | WrittenEmploymentContract |
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | 0 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 0 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 0 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 0 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 0 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 0 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | JAMES ULRICH | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Base Compensation Filing Org | 162182 | BaseCompensationFilingOrg |
| Comp Based On Related Orgs | 0 | CompBasedOnRelatedOrgs |
| Bonus Filing Org | 0 | BonusFilingOrg |
| Bonus Related Orgs | 0 | BonusRelatedOrgs |
| Other Compensation Filing Org | 0 | OtherCompensationFilingOrg |
| Other Compensation Related Orgs | 0 | OtherCompensationRelatedOrgs |
| Deferred Comp Filing Org | 11536 | DeferredCompFilingOrg |
| Deferred Comp Related Orgs | 0 | DeferredCompRelatedOrgs |
| Nontaxable Benefits Filing Org | 29062 | NontaxableBenefitsFilingOrg |
| Nontaxable Benefits Related Orgs | 0 | NontaxableBenefitsRelatedOrgs |
| Total Compensation Filing Org | 202780 | TotalCompensationFilingOrg |
| Total Compensation Related Orgs | 0 | TotalCompensationRelatedOrgs |
| Comp Report Prior990 Filing Org | 0 | CompReportPrior990FilingOrg |
| Comp Report Prior990 Related Orgs | 0 | CompReportPrior990RelatedOrgs |
Schedule L IRS990ScheduleL
Loan Table LoanTable (2 entries)
| Purpose Of LoanPurposeOfLoan | Loan From OrganizationLoanFromOrganization | Original PrincipalOriginalPrincipalAmount | Balance DueBalanceDue | DefaultDefault | Approved By BoardApprovedByBoard | Written AgreementWrittenAgreement |
|---|---|---|---|---|---|---|
| TROY BRUNTZ CFO | ||||||
| EMPLOYEE COMPUTER PURCHASE | X | $1,087 | 632 | 0 | 0 | 1 |
| SUZANNE ABERCROMBIE | ||||||
| EMPLOYEE COMPUTER PURCHASE | X | $717 | 69 | 0 | 0 | 1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Balance Due | 701 | TotalBalanceDue |
Form990 Schedule L Part IV Form990ScheduleLPartIV (3 entries)
| RelationshipRelationship | Amount Of TransactionAmountOfTransaction | Description Of TransactionDescriptionOfTransaction | Sharing Of RevenuesSharingOfRevenues |
|---|---|---|---|
| MARTY CONROY JOYCE CONROY | |||
| MR. CONROY: BOARD OF DIRECTORS - MEMBER, JOYCE CONROY: SPOUSE | 19635 | MRS. CONROY IS EMPLOYED BY THE HOSPITAL. | 0 |
| MAX ABERCROMBIE SUZANNE ABERCROMB | |||
| MAX ABERCROMBIE: BOARD OF DIRECTORS - MEMBER, SUZANNE ABERCROMBIE: SPOUSE | 17432 | MRS. ABERCROMBIE IS EMPLOYED BY THE HOSPITAL. | 0 |
| MCCOOK CLINIC PC | |||
| RICHARD KLUG,MD: BOARD OF DIRECTORS-MEMBER, and PARTNER IN MCCOOK CLINIC,PC | 1265852 | THE HOSPITAL PAID THE CLINIC $963,600 AND $32,244 FOR EMERGENCY ROOM COVERAGE AND RURAL HEALTH CLINIC COVERAGE, RESPECTIVELY. THE CLINIC PAID THE HOSPITAL $215,421 FOR RENT OF THE BUILDING AND $54,587 FOR ENVIRONMENTAL SERVICES IN THE BUILDING. | 0 |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (5 entries)
| IdentifierIdentifier | ExplanationExplanation |
|---|---|
| Form 990, Part VI, Section B, line 11 | Community Hospital's Form 990, 990-T and Nebraska form 1120N are compiled by the PUBLIC ACCOUNTING firm Seim Johnson. Management receives draft copies of the completed forms for review. After Hospital management has reviewed the returns, members of the Board of Directors of the Community Hospital Association REVIEW THE RETURNS. FINALLY, THE RETURNS ARe approved for filing by the Budget & Finance Committee of the Board (a standing committee with responsibility to oversee financial, audit, taxation and budget matters of the Hospital). Board Committee approval is required prior to signature and submission of the returns to the IRS and STATE TAXING AUTHORITIES. |
| Form 990, Part VI, Section B, line 12c | The Community Hospital Association's Code of Conduct requires all employees, contractors, and agents to report any conflicts of interest that arise. In addition, the Association has a conflict of interest policy that is applicable to directors, officers, members of committees and subcommittees with board-delegated powers, and key employees that requires, among other things, all applicable persons disclose any relationships that may create a conflict of interest and are required to complete an annual disclosure of all such relationships. All such relationships are disclosed to the entire board and senior management, and any and all conflicts or potential conflicts are monitored by senior management and the Association's compliance function. |
| Form 990, Part VI, Section B, line 15 | Community Hospitals process for determining the compensation of the CEO is as follows: The Executive Committee of the Board of Directors is responsible for setting the salary of the CEO. Annually, the Committee conducts a review of the CEO's performance, abilities, and overall effectiveness. The Committee is presented with salary and compensation survey data that is compiled by the CEO and the human resource department and the accuracy of which is attested to by the CFO. Multiple sources of survey data are used, including information from the Nebraska and Iowa Hospital Associations, which is broken down to similarly qualified persons in comparable positions at similarly sized and situated organizations. All source documentation is given to the Committee as well as summaries provided for ease of reference. The Executive Committee conducts the performance review with the CEO; then meetS in private chambers to discuss the review and to deliberate any and all changes to the employment agreement, including compensation, and goals for the following year. Contemporaneous records are kept of all survey and comparability data used, and the results and decisions of the Executive Committees meeting on compensation. Compensation of Employees below the role of CEO are determined through the use of survey information of similarly qualified persons in comparable positions at similarly sized and situated organizations. The CEO sets the compensation of senior management based on those surveys, taking in consideration performance and experience of each individual. Compensation ranges of employees below senior management are set by human resources based on market wage rates for similarly qualified persons in comparable positions at similarly sized and situated organizations. All employees have an annual review by their supervisor, which determine where in the salary range an employee will fall. All salary ranges, including those of senior management, are ultimately approved by the Board of Directors during the approval of the annual operating budget. |
| Form 990, Part VI, Section C, line 19 | Community Hospital makes its governing documents, conflict of interest policy, Form 990 & 990-T (current and past years as required by law) and financial statements available to the public upon request. Any individual who would like a copy of any of the above mentioned documents can inspect those documents in person at the Hospital during normal business hours, or request a copy of any of the above information in person, by phone, or by mail, and we will provide a copy free of charge. |
| FORM 990, PART XI, LINE 2C | Community Hospital has a standing Board Committee, the Budget and Finance Committee, which has the authority and assumes the responsibility for the selection of the independent accounting firm and all related oversight, communication, and reporting. This committee approves all engagement letters and receives all board directed communication from the independent accounting firm. Copies of received letters/communications and reports are distributed to all members of the Board of Directors in addition to the committee members. While the members of the committee have changed, the process described has not changed from the previous year. |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII
Name Of Disregarded Entity NameOfDisregardedEntity
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | COMMUNITY HOSPITAL HEALTH FOUNDATION | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 801 WEST C STREET PO BOX 1328 | AddressLine1 |
| City | MCCOOK | City |
| State | NE | State |
| ZIP Code | 69001 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 470693261 | EIN |
| Primary Activities | SUPPORTING ORGANIZATION PROVIDES FUNDRAISING FOR THE HOSPITAL | PrimaryActivities |
| Legal Domicile State | NE | LegalDomicileState |
| Exempt Code Section | 501(C)(3) | ExemptCodeSection |
| Public Charity Status | 11C, TYPE III-FI | PublicCharityStatus |
| Direct Controlling Entity NA | N/A | DirectControllingEntityNA |
Form990 Schedule R Part IV Form990ScheduleRPartIV
Name Of Related Org NameOfRelatedOrg
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RED WILLOW HOLDING COMPANY | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1301 EASH H STREET | AddressLine1 |
| City | MCCOOK | City |
| State | NE | State |
| ZIP Code | 69001 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 470628195 | EIN |
| Primary Activity | RENTAL REAL ESTATE - CLINIC BUILDING | PrimaryActivity |
| Legal Domicile State | NE | LegalDomicileState |
| Direct Controlling Entity NA | N/A | DirectControllingEntityNA |
| Type Of Entity | C | TypeOfEntity |
| Share Of Total Income | 50779 | ShareOfTotalIncome |
| Share Of EOY Assets | 112481 | ShareOfEOYAssets |
| Percentage Ownership | 1.00000 | PercentageOwnership |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 0 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 1 | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | 1 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 0 | LoansOrGuaranteesFromOtherOrg |
| Sale Of Assets To Other Org | 0 | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | 0 | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | 0 | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | 0 | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | 1 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 0 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 1 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 1 | SharingOfFacilities |
| Sharing Of Paid Employees | 0 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 1 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 1 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 0 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 0 | OtherTransferFromOtherOrg |
Transactions Related Orgs Table TransactionsRelatedOrgsTable (2 entries)
| Transaction TypeTransactionType | Amount InvolvedAmountInvolved |
|---|---|
| RED WILLOW MEDICAL HOLDING | |
| J | 50261 |
| COMMUNITY HOSPITAL HEALTH FOUNDATION | |
| C | 97101 |
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