MEMORIAL COMMUNITY HOSPITAL CORPORATION: Form 990, tax year 2010
View the entire original 990 at ProPublica ↗
- Organization
- MEMORIAL COMMUNITY HOSPITAL CORPORATION (EIN 47-0426285)
- Tax period
- 2010-01-01 to 2010-12-31
- Filed
- 2011-11-15
- IRS object ID
- 201133199349302438
- Schema version
- 2010v3.4
- 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 D
- Schedule H
- Schedule I
- Schedule J
- Schedule K
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2011-11-15T09:29:50-06:00 | Timestamp |
| Tax Period End Date | 2010-12-31 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | KPMG LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | Two Central Park Plaza Suite 1501 | AddressLine1 |
| City | Omaha | City |
| State | NE | State |
| ZIP Code | 681021626 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2010-01-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 470426285 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MEMORIAL COMMUNITY HOSPITAL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | MEMO | NameControl |
| Phone | 4024262182 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 810 NORTH 22ND STREET | AddressLine1 |
| City | BLAIR | City |
| State | NE | State |
| ZIP Code | 68008 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | NICOLE KREITEL | Name |
| Title | CFO | Title |
| Date Signed | 2011-11-14 | DateSigned |
| Authorize Third Party | true | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 4023481450 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2010 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | NICOLE KREITEL | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 810 NORTH 22ND STREET | AddressLine1 |
| City | BLAIR | City |
| State | NE | State |
| ZIP Code | 68008 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 32495962 | GrossReceipts |
| Group Return For Affiliates | false | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.MCHHS.ORG | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1956 | YearFormation |
| State Legal Domicile | NE | StateLegalDomicile |
| Activity Or Mission Description | AS AN ENGAGED TEAM OF PHYSICIANS, MEDICAL PROFESSIONALS, AND SUPPORT STAFF WE ARE COMMITTED TO DELIVERING STATE-OF-THE-ART HEALTH CARE TAILORED TO OUR UNIQUE COMMUNITY AND SECOND TO NONE IN THE AREA. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 7 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 5 | NbrIndependentVotingMembers |
| Total Nbr Employees | 385 | TotalNbrEmployees |
| Total Nbr Volunteers | 25 | TotalNbrVolunteers |
| Total Gross UBI | 2192 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 538648 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 168739 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 30510537 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 32351438 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 30845 | InvestmentIncomePriorYear |
| Investment Income Current Year | 27382 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 1207444 | OtherRevenuePriorYear |
| Other Revenue Current Year | -51597 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 32287474 | TotalRevenuePriorYear |
| Total Revenue Current Year | 32495962 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 634902 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 803838 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 17177637 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 18276124 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 11410775 | OtherExpensePriorYear |
| Other Expenses Current Year | 11884286 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 29223314 | TotalExpensesPriorYear |
| Total Expenses Current Year | 30964248 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 3064160 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 1531714 | RevenuesLessExpensesCY |
| Total Assets BOY | 44270077 | TotalAssetsBOY |
| Total Assets EOY | 45637482 | TotalAssetsEOY |
| Total Liabilities BOY | 26776050 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 26611741 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 17494027 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 19025741 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | AS A COMMUNITY HOSPITAL, MEMORIAL COMMUNITY HOSPITAL AND HEALTH SYSTEM OF BLAIR HAS STAYED COMMITTED TO KEEPING RESIDENTS OF WASHINGTON AND BURT COUNTY IN GOOD HEALTH. THROUGH THE YEARS, MEMORIAL COMMUNITY HOSPITAL HAS STRIVED TO IMPROVE THE HEALTH STATUS OF RURAL NEBRASKA RESIDENTS - CHILDREN, TEENS, ADULTS, SENIOR CITIZENS, FRIENDS AND NEIGHBORS THROUGH THE FOLLOWING SERVICES: 24-HOUR EMERGENCY CARE WITH HELIPORT ACCOMMODATIONS, LABOR AND DELIVERY AND CARDIOVASCULAR. CARDIOVASCULAR SERVICES INCLUDE THE FOLLOWING: NON-INVASIVE DIAGNOSTICS STUDIES SUCH AS EKG, TELEMETRY MONITORING, TREADMILL STRESS TESTING, ECHO CARDIOGRAM, AND STRESS ECHO CARDIOGRAM. MEMORIAL COMMUNITY HOSPITAL AND HEALTH SYSTEM PROVIDES A VARIETY OF SPECIALTY CLINICS LOCATED IN BLAIR: ALLERGY/ASTHMA/IMMUNOLOGY, PAIN MANAGEMENT/ANESTHESIA, CARDIOLOGY, ENDOCRINOLOGY, ENT, GENERAL SURGERY, OB/GYN, NEPHROLOGY, NEUROLOGY, NEUROSURGERY, ONCOLOGY, ORTHOPEDICS, ORTHOTICS/PROSTHETICS, PLASTIC SURGERY, DERMATOLOGY, PODIATRY, P | MissionDescription |
| Significant New Program Services | false | SignificantNewProgramServices |
| Significant Change | false | SignificantChange |
| Expense | 23812364 | Expense |
| Grants | 803838 | Grants |
| Revenue | 32535117 | Revenue |
| Description | THE HOSPITAL OPERATES A 21 BED ACUTE CARE HOSPITAL IN BLAIR, NE SERVING THE COMMUNITY FOR INPATIENT & OUTPATIENT SERVICES. ALSO SERVES AS A COMMUNITY RESOURCE FOR HEALTH RELATED PROGRAMS, EDUCATION CLASSES, TRAINING & RECRUITMENT FOR MEDICAL PERSONNEL. | Description |
| Total Program Service Expense | 23812364 | TotalProgramServiceExpense |
| Described In501 C3 | true | DescribedIn501C3 |
| Schedule B Required | true | ScheduleBRequired |
| Political Activities | false | PoliticalActivities |
| Lobbying Activities | false | LobbyingActivities |
| Donor Advised Funds | false | DonorAdvisedFunds |
| Conservation Easements | false | ConservationEasements |
| Collections Of Art | false | CollectionsOfArt |
| Credit Counseling | false | CreditCounseling |
| Term Or Permanent Endowments | false | TermOrPermanentEndowments |
| Report Land Bldg Equip | true | ReportLandBldgEquip |
| Report Invest Oth Securities | false | ReportInvestOthSecurities |
| Report Prog Rel Invest | false | ReportProgRelInvest |
| Report Other Assets | false | ReportOtherAssets |
| Report Other Liabilities | true | ReportOtherLiabilities |
| Report Fin48 Footnote | true | ReportFin48Footnote |
| Independent Audit Financial Stmt | false | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | true | ConsolidatedAuditFinancialStmt |
| School | false | School |
| Foreign Office | false | ForeignOffice |
| Foreign Activities | false | ForeignActivities |
| More Than5000 K To Organizations | false | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividuals |
| Professional Fundraising | false | ProfessionalFundraising |
| Fundraising Activities | false | FundraisingActivities |
| Gaming | false | Gaming |
| Hospital | true | Hospital |
| Financial Stmt Attached | false | FinancialStmtAttached |
| Grants To Organizations | false | GrantsToOrganizations |
| Grants To Individuals | true | GrantsToIndividuals |
| Schedule J Required | true | ScheduleJRequired |
| Tax Exempt Bonds | true | TaxExemptBonds |
| Invest Tax Exempt Bonds | false | InvestTaxExemptBonds |
| Escrow Account | false | EscrowAccount |
| On Behalf Of Issuer | false | OnBehalfOfIssuer |
| Excess Benefit Transaction | false | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | false | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | false | LoanToOfficerOrDQP |
| Grant To Related Person | false | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | false | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | false | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | true | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | false | DeductibleNonCashContributions |
| Deductible Contributions Of Art | false | DeductibleContributionsOfArt |
| Terminated | false | Terminated |
| Partial Liquidation | false | PartialLiquidation |
| Disregarded Entity | false | DisregardedEntity |
| Related Entity | true | RelatedEntity |
| Related Org Controlled Entity | false | RelatedOrgControlledEntity |
| Transaction Related Entity | false | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | false | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | false | ActivitiesConductedPartnership |
| Schedule O Required | true | ScheduleORequired |
| Number Forms Transmitted With1096 | 11 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | true | ComplianceWithBackupWitholding |
| Number Of Employees | 385 | NumberOfEmployees |
| Employment Tax Returns Filed | true | EmploymentTaxReturnsFiled |
| Unrelated Business Income | true | UnrelatedBusinessIncome |
| Form990-T Filed | true | Form990-TFiled |
| Foreign Financial Account | false | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTrans |
| Taxable Party Notification | false | TaxablePartyNotification |
| Non Deductible Contributions | false | NonDeductibleContributions |
| Quid Pro Quo Contributions | false | QuidProQuoContributions |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | false | FundsToPayPremiums |
| Premiums Paid | false | PremiumsPaid |
| Indoor Tanning Services | false | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 7 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 5 | NumberIndependentVotingMembers |
| Family Or Business Relationship | false | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | true | DelegationOfManagementDuties |
| Changes To Organizing Docs | false | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuse |
| Members Or Stockholders | true | MembersOrStockholders |
| Election Of Board Members | true | ElectionOfBoardMembers |
| Decisions Subject To Approval | false | DecisionsSubjectToApproval |
| Minutes Of Governing Body | true | MinutesOfGoverningBody |
| Minutes Of Committees | true | MinutesOfCommittees |
| Officer Mailing Address | false | OfficerMailingAddress |
| Local Chapters | false | LocalChapters |
| Form990 Provided To Governing Body | true | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | true | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | true | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | true | RegularMonitoringEnforcement |
| Whistleblower Policy | false | WhistleblowerPolicy |
| Document Retention Policy | true | DocumentRetentionPolicy |
| Compensation Process CEO | true | CompensationProcessCEO |
| Compensation Process Other | true | CompensationProcessOther |
| Investment In Joint Venture | false | InvestmentInJointVenture |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | NICOLE KREITEL | NamePerson |
| Telephone Number | 4024262182 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 810 NORTH 22ND STREET | AddressLine1 |
| City | BLAIR | City |
| State | NE | State |
| ZIP Code | 68008 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (14 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | OfficerOfficer | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|
| John Simonson MD | |||||||
| Board Member | 40.0 | X | 190251 | 0 | 12567 | ||
| TERRY DUTTON | |||||||
| Chairman | 1.0 | X | 0 | 0 | 0 | X | |
| Rod Triplett | |||||||
| VICE-CHAIRMAN | 1.0 | X | 0 | 0 | 0 | X | |
| TIM SCHNACK | |||||||
| SECRETARY | 1.0 | X | 0 | 0 | 0 | X | |
| Daniel E Hunt | |||||||
| Treasurer | 1.0 | X | 0 | 0 | 0 | X | |
| Donna Mahlendorf | |||||||
| Board MEMBER | 1.0 | X | 0 | 0 | 0 | ||
| Ann Schumacher | |||||||
| Board Member | 1.0 | X | 0 | 0 | 0 | ||
| Nicole Kreitel | |||||||
| CFO | 40.0 | 58079 | 0 | 1487 | X | ||
| SALLY HARVEY | |||||||
| CEO | 40.0 | 0 | 0 | 0 | X | ||
| Chauncey Wilkins | |||||||
| MD | 40.0 | 260566 | 0 | 6256 | X | ||
| Garret Shaw | |||||||
| MD | 40.0 | 251265 | 0 | 13141 | X | ||
| Andrea VerMaas | |||||||
| MD | 40.0 | 290547 | 0 | 6307 | X | ||
| Andrew Reynolds | |||||||
| MD | 40.0 | 361587 | 0 | 22265 | X | ||
| JAMES JORDAN | |||||||
| MD | 40.0 | 272485 | 0 | 10299 | X | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 1684780 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 72322 | TotalOtherCompensation |
| Number Individuals GT100 K | 18 | NumberIndividualsGT100K |
| Formers Listed | false | FormersListed |
| Total Comp GT150 K | true | TotalCompGT150K |
| Compensation From Other Sources | false | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (3 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| ALEGENT HEALTH | |||||
| 12809 WEST DODGE ROAD | OMAHA | NE | 68154 | MANAGEMENT FEE | 555444 |
| KPMG | |||||
| 1501 TWO CENTRAL PARK PLAZA | OMAHA | NE | 68102 | ACCOUNTING | 121930 |
| HAWKINS | |||||
| 2516 Deer Park Boulevard | OMAHA | NE | 68105 | CONSTRUCTION | 143546 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 3 | NumberOfContractorsGT100K |
| Related Organizations | 156296 | RelatedOrganizations |
| All Other Contributions | 12443 | AllOtherContributions |
| Total Contributions | 168739 | TotalContributions |
Program Service Revenue ProgramServiceRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | NET PATIENT REVENUE | Description |
| Business Code | 621110 | BusinessCode |
| Total Revenue Column | 32351438 | TotalRevenueColumn |
| Related Or Exempt Function Income | 32351438 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 32351438 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 26952 | TotalRevenueColumn |
| Exclusion | $26,952 | ExclusionAmount |
Income From Invest Bond Proceeds IncomeFromInvestBondProceeds
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Royalties Revenue RoyaltiesRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 430 | Securities |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 430 | Securities |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 430 | TotalRevenueColumn |
| Exclusion | $430 | ExclusionAmount |
Net Income From Fundraising Events NetIncomeFromFundraisingEvents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Net Income From Gaming NetIncomeFromGaming
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Net Income Or Loss NetIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Other Revenue Misc OtherRevenueMisc (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome | Unrelated Business RevenueUnrelatedBusinessRevenue | ExclusionExclusionAmount |
|---|---|---|---|---|---|
| INTEREST RATE SWAP | 900099 | -406000 | 0 | 0 | -$406,000 |
| OUTPATIENT CLINIC DOCTOR RENT | 621400 | 159679 | 159679 | 0 | $0 |
| DIETARY | 621110 | 67613 | 0 | 0 | $67,613 |
Miscellaneous Revenue MiscellaneousRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 127111 | TotalRevenueColumn |
| Related Or Exempt Function Income | 24000 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 2192 | UnrelatedBusinessRevenue |
| Exclusion | $100,919 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | -51597 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 32495962 | TotalRevenueColumn |
| Related Or Exempt Function Income | 32535117 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 2192 | UnrelatedBusinessRevenue |
| Exclusion | -$210,086 | ExclusionAmount |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Grants To Domestic Individuals GrantsToDomesticIndividuals
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 803838 | Total |
| Program Services | 803838 | ProgramServices |
Foreign Grants ForeignGrants
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Benefits To Members BenefitsToMembers
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1652532 | Total |
| Program Services | 1594453 | ProgramServices |
| Management And General | 58079 | ManagementAndGeneral |
Comp Disqual Persons CompDisqualPersons
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 13440625 | Total |
| Program Services | 9586590 | ProgramServices |
| Management And General | 3854035 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 442576 | Total |
| Program Services | 327861 | ProgramServices |
| Management And General | 114715 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1690798 | Total |
| Program Services | 1252547 | ProgramServices |
| Management And General | 438251 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1049593 | Total |
| Program Services | 720298 | ProgramServices |
| Management And General | 329295 | ManagementAndGeneral |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 56716 | Total |
| Program Services | 0 | ProgramServices |
| Management And General | 56716 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 111530 | Total |
| Program Services | 0 | ProgramServices |
| Management And General | 111530 | ManagementAndGeneral |
Fees For Services Lobbying FeesForServicesLobbying
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Prof Fundraising FeesForServicesProfFundraising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 527385 | Total |
| Management And General | 527385 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 76006 | Total |
| Program Services | 76006 | ProgramServices |
| Management And General | 0 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Royalties Royalties
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 480187 | Total |
| Program Services | 480187 | ProgramServices |
| Management And General | 0 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 78506 | Total |
| Program Services | 70105 | ProgramServices |
| Management And General | 8401 | ManagementAndGeneral |
Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 118327 | Total |
| Program Services | 115749 | ProgramServices |
| Management And General | 2578 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1286072 | Total |
| Program Services | 1286072 | ProgramServices |
| Management And General | 0 | ManagementAndGeneral |
Payments To Affiliates PaymentsToAffiliates
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2618424 | Total |
| Program Services | 2602976 | ProgramServices |
| Management And General | 15448 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 228848 | Total |
| Program Services | 57673 | ProgramServices |
| Management And General | 171175 | ManagementAndGeneral |
Other Expenses OtherExpenses (5 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| SUPPLIES | 3356843 | 2712969 | 643874 |
| BAD DEBT | 899264 | 899264 | 0 |
| PURCHASED SERVICES | 857880 | 413664 | 444216 |
| EQUIPMENT RENTAL & MAINTENANCE | 792060 | 591143 | 200917 |
| DUES AND SUBSCRIPTIONS | 92055 | 69016 | 23039 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 304183 | Total |
| Program Services | 151953 | ProgramServices |
| Management And General | 152230 | ManagementAndGeneral |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 30964248 | Total |
| Program Services | 23812364 | ProgramServices |
| Management And General | 7151884 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5270970 | BOY |
| EOY | 5127268 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3985777 | BOY |
| EOY | 4581378 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 199256 | BOY |
| EOY | 264435 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 185493 | BOY |
| EOY | 341168 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 43777786 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 13752737 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 31737834 | BOY |
| EOY | 30025049 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 677574 | BOY |
| EOY | 4000672 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2213173 | BOY |
| EOY | 1297512 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 44270077 | BOY |
| EOY | 45637482 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3381028 | BOY |
| EOY | 3552192 | EOY |
Tax Exempt Bond Liabilities TaxExemptBondLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 21200000 | BOY |
| EOY | 20736599 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2195022 | BOY |
| EOY | 2322950 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 26776050 | BOY |
| EOY | 26611741 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 17494027 | BOY |
| EOY | 19025741 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 17494027 | BOY |
| EOY | 19025741 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 44270077 | BOY |
| EOY | 45637482 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expenses | 1531714 | ReconcilationRevenueExpenses |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | false | AccountantCompileOrReview |
| FS Audited | true | FSAudited |
| Audit Committee | true | AuditCommittee |
| Financial Statement Consolidated | X | FinancialStatementConsolidated |
| Federal Grant Audit Required | false | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
| Contrib By Controlling Individual | false | ContribByControllingIndividual |
| Contribution By Related Party | false | ContributionByRelatedParty |
| Contrib By35 Controlled Entity | false | ContribBy35ControlledEntity |
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 D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Art Public Exhibition Amts | ArtPublicExhibitionAmts | |
| Held Works Of Art Amts | HeldWorksOfArtAmts |
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 663787 | OtherCostOrOtherBasis |
| Book Value | 663787 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 18605046 | OtherCostOrOtherBasis |
| Depreciation | 4215387 | Depreciation |
| Book Value | 14389659 | BookValue |
Leasehold Improvements LeaseholdImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 2525095 | OtherCostOrOtherBasis |
| Depreciation | 482548 | Depreciation |
| Book Value | 2042547 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 21983858 | OtherCostOrOtherBasis |
| Depreciation | 9054802 | Depreciation |
| Book Value | 12929056 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 0 | OtherCostOrOtherBasis |
| Book Value | 0 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 30025049 | TotalOfBookValueLandBuildings |
| Federal Income Tax Liability | 0 | FederalIncomeTaxLiability |
Other Liabilities OtherLiabilities (3 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| INTEREST RATE SWAP LIABILITY | $1,183,000 |
| ACCRUED PROFESSIONAL LIABILITY | $129,000 |
| MRI CAPITAL LEASE | $1,010,950 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 2322950 | TotalOfAmounts |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | FIN 48 FOOTNOTE | Identifier |
| Return Reference | SCHEDULE D, PART X, Line 2 | ReturnReference |
| Explanation | In accordance with fasb interpretation no. 48, accounting for uncertainty in income taxes, included in fasb asc subtopic 741-10 - Income taxes - Overall, the hospital recognizes the effect of income tax positions only if those positions are more likely than not of being sustained. Recognized income tax positions are measured at the largest amount that is greater than 50% likely of being realized. Changes in recognition or measurement are reflected in the period in which the change in judgment occurs. In 2010 and 2009, management determined that there are no income tax positions requiring recognition in the consolidated financial statements. | Explanation |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | true | CharityCarePolicy |
| Written Policy | true | WrittenPolicy |
| Policy Applied To All Hospitals | X | PolicyAppliedToAllHospitals |
| FPG Reference Free Care | false | FPGReferenceFreeCare |
| FPG Reference Discounted Care | false | FPGReferenceDiscountedCare |
| Free Disc Care Medically Indigent | true | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | true | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | false | ExpensesExceededBudget |
| Annual Community Benefit Report | true | AnnualCommunityBenefitReport |
| Report Publically Available | false | ReportPublicallyAvailable |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 306 | PersonsServed |
| Total Community Benefit Expense | 590211 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 590211 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01960 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 306 | PersonsServed |
| Total Community Benefit Expense | 590211 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 590211 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01960 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 16078 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 16078 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00050 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 16078 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 16078 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00050 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 306 | PersonsServed |
| Total Community Benefit Expense | 606289 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 606289 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.02010 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | true | BadDebtExpenseReported |
| Bad Debt Expense | $667,793 | BadDebtExpenseAmount |
| Amount Attributable To | 0 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 11938996 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 11856616 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | 82380 | 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 | true | WrittenDebtCollectionPolicy |
| Provision For Charity Care | false | ProvisionForCharityCare |
| Number Of Hospital Facilities | 1 | NumberOfHospitalFacilities |
Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility Number | 1 | FacilityNumber |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MEMORIAL COMMUNITY HOSPITAL | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 810 NORTH 22ND STREET | AddressLine1 |
| City | BLAIR | City |
| State | NE | State |
| ZIP Code | 68008 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | X | LicensedHospital |
| General Medical And Surgical | X | GeneralMedicalAndSurgical |
| Critical Access Hospital | X | CriticalAccessHospital |
| Er24 Hours | X | Er24Hours |
Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MEMORIAL COMMUNITY HOSPITAL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
| Eligibility Criteria Explained | true | EligibilityCriteriaExplained |
| Uses FPG Free | false | UsesFPGFree |
| Uses FPG Discounted | false | UsesFPGDiscounted |
| Explains Basis | true | ExplainsBasis |
| Income Level | X | IncomeLevel |
| Asset Level | X | AssetLevel |
| Medical Indigency | X | MedicalIndigency |
| Explains Application Method | true | ExplainsApplicationMethod |
| Includes Publicity Measures | true | IncludesPublicityMeasures |
| Posted On Website | X | PostedOnWebsite |
| Posted In Emergency Room | X | PostedInEmergencyRoom |
| Posted In Admission Office | X | PostedInAdmissionOffice |
| Available On Request | X | AvailableOnRequest |
| Actions On Nonpayment | true | ActionsOnNonpayment |
| Permit Report To Credit Agency | X | PermitReportToCreditAgency |
| Permit Lawsuit | X | PermitLawsuit |
| Collection Activities | true | CollectionActivities |
| Report To Credit Agency | X | ReportToCreditAgency |
| Lawsuit | X | Lawsuit |
| Notify Upon Admission | X | NotifyUponAdmission |
| Notify Before Discharge | X | NotifyBeforeDischarge |
| Notified All Patients | X | NotifiedAllPatients |
| Documented Determination | X | DocumentedDetermination |
| Nondiscrim Emergency Care Policy | true | NondiscrimEmergencyCarePolicy |
| Used Other Method | X | UsedOtherMethod |
| Amounts Generally Billed | false | AmountsGenerallyBilled |
| Gross Charges | true | GrossCharges |
Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Other Facilities | 4 | NumberOfOtherFacilities |
Other Facilities OtherFacilities (4 entries)
| Address Line1Address/AddressLine1 | CityAddress/City | StateAddress/State | ZIP CodeAddress/ZIPCode | Facility TypeFacilityType |
|---|---|---|---|---|
| BLAIR CLINIC | ||||
| 812 NORTH 22ND STREET | BLAIR | NE | 68008 | PRIMARY CARE CLINIC |
| FORT CALHOUN CLINIC | ||||
| 1420 CLARK STREET | FORT CALHOUN | NE | 68023 | PRIMARY CARE CLINIC |
| COTTONWOOD CLINIC | ||||
| 120 SOUTH 9TH STREET | TEKAMAH | NE | 68061 | PRIMARY CARE CLINIC |
| BURT-WASHINGTON HOME HEALTH & HOSPICE | ||||
| 670 SOUTH 19TH STREET | BLAIR | NE | 68008 | HOME HEALTH AND HOSPICE AGENCY |
Form990 Schedule H Part VI Form990ScheduleHPartVI (15 entries)
| IdentifierIdentifier | ExplanationExplanation | Return ReferenceReturnReference |
|---|---|---|
| Part I, line 3c | The amount of financial assistance write-off for Memorial Community Hospital and Health System is based on a financial assistance sliding fee schedule utilizing a derivative of the current US Department of Housing and Urban Development (HUD) very low income guidelines, which are updated annually. Designees of MCH help patients seek reimbursement from local, state, and federal programs at no charge to the patient when there is no other source of payment. After these efforts/resources have been exhausted, patients are assisted in the application process for financial assistance. The application process includes completing a personal financial application and providing verification documents. These verification documents may include, but are not limited to, receiving a copy of the applicant's federal tax return, pay stub, bank statements, a call to employers, or a credit report; the applicant's net worth and/or liquid assets; and reasonable household or business expenses. Financial assistance may also be granted in certain circumstances involving a catastrophic occurrence resulting in medical bills grossly exceeding the patient's ability to pay and in these situations, the patient's responsibility will be limited to 30% of the family's gross annual income. | |
| Part I, line 6a | Memorial Community Hospital produces a Community Benefit Report that is sent to the Nebraska Hospital Association for data collection purposes. | |
| Part I, line 7g | Memorial Community Hospital does not provide subsidized health services. | |
| Part I, line 7, column (f) | BAD DEBT OF $899,264 INCLUDED IN FUNCTIONAL EXPENSE TOTAL PART IX LINE 25 IS NOT INCLUDED IN THE TOTAL OPERATING EXPENSE $30,964,248 USED TO CALCULATE THE TABLE 7 PERCENTAGES. | |
| Part I, line 7 | The costing methodology used to calculate the amounts reported in the table were worksheets 1-8, excluding worksheet 2, with the Schedule H instructions. The cost to charge ratio used in the calculations was derived from the as filed 2010 cost report. | |
| Part III, line 4 | THE AUDITED FOOTNOTES FOR MEMORIAL COMMUNITY HOSPITAL AND MEDICAL CENTER DO NOT CONTAIN FOOTNOTES RELATED TO BAD DEBT EXPENSE. BAD DEBT EXPENSE IS IDENTIFIED ON THE CONSOLIDATED STATEMENT OF OPERATIONS WHICH IS CONSISTENT WITH THE REPORTING PRACTICE OF OTHER HEALTH CARE ORGANIZATIONS. BAD DEBT EXPENSE AT 100% CHARGE VALUE WAS MULTIPLIED BY THE RATIO DERIVED FROM THE SCHEDULE H WORKSHEETS IN THE SCHEDULE H INSTRUCTIONS TO ARRIVE AT AN APPROXIMATE COST VALUE. | |
| Part III, line 8 | The Medicare charges reported on Line 5 and Line 6 are from the 2010 filed cost report which used a cost to charge ratio. | |
| Part III, line 9b | MEMORIAL COMMUNITY HOSPITAL'S collection policy does not contain provisions on the collection practices to be followed for patients who are known to qualify for charity care or financial assistance. | |
| Needs assessment | MEMORIAL COMMUNITY HOSPITAL assesses the health care needs of the communities it serves through multiple channels including community health fairs, wellness programs, providing occupational health services, listening to patient and community voices as well as watching national trends. | |
| Patient education of eligibility for assistance | There are several financial assistance access points throughout a patient's care cycle. Bills contain financial assistance verbiage; brochures are available in clinics and the hospital, and there is information on financial assistance posted at registration points throughout clinics and the hospital. Information on the MCH financial assistance policies is located at WWW.MCHHS.ORG. Designees such as financial counselors of MCH help patients seek reimbursement from local, state and federal programs at no charge to the patient, when there is no other source of payment. After these efforts/resources have been exhausted, patients are assisted in the application process for financial assistance. | |
| Community information | MEMORIAL COMMUNITY HOSPITAL AND HEALTH SYSTEMS OF BLAIR, NE SERVES BOTH WASHINGTON AND BURT COUNTIES IN NEBRASKA. WASHINGTON COUNTY NEBRASKA HAS AN ESTIMATED POPULATION OF 20,234. CENSUS ESTIMATES SHOW THAT WASHINGTON COUNTY'S RACIAL AND ETHNIC MAKE UP IS 97.2% WHITE 0.9% SOME OTHER RACE ALONE 0.6% TWO OR MORE RACES 1.3% HISPANIC OR LATINO. ITS MEDIAN HOUSEHOLD INCOME IS $59,181 COMPARED TO $47,470 FOR THE STATE OF NEBRASKA. APPROXIMATELY 15% OF THE STUDENTS IN WASHINGTON COUNTY RECEIVE FREE OR REDUCED LUNCH. BURT COUNTY HAS AN ESTIMATED POPULATION OF 6,858. CENSUS ESTIMATES SHOW THAT BURT COUNTY'S RACIAL AND ETHNIC MAKE UP IS 95.9% WHITE 1.1% SOME OTHER RACE ALONE 1.2% TWO OR MORE RACES 1.8% HISPANIC OR LATINO. ITS MEDIAN HOUSEHOLD INCOME IS $42,242 COMPARED TO $47,470 FOR THE STATE OF NEBRASKA. APPROXIMATELY ONE THIRD OF THE STUDENTS IN EACH OF THE SCHOOL DISTRICTS RECEIVE FREE OR REDUCED LUNCH. | |
| PART II | MEMORIAL COMMUNITY HOSPITAL DID NOT ENAGE IN ANY COMMUNITY BUILDING ACTIVITIES IN 2010. | Community building activities |
| Promotion of community health | MCH&HS promotes the health of its community through financial and in-kind donations. | |
| Other information required | Board of Directors - The Board of Directors manage the affairs of Memorial Community Hospital in Blair, NE. There are seven directors who serve on the Board: 3 members from the community, 3 members from Alegent Health and 1 member from the MCH&HS Medical Staff. The Board of Directors is compromised of individuals who are leaders in the fields of business, healthcare, accounting and medicine and understand their role in providing strong corporate governance. Emergency Department - Memorial Community Health has a full-time emergency department that is open to the public and provides medical screening examinations and stabilizing treatment within the capabilities and capacities of the hospital regardless of but not limited to the patient's race, color, sex, age and/or ability to pay. MCH&HS is in compliance with the Federal EMTALA guidelines. Medical Staff - MCHHS maintains an open medical staff. All qualified MDs, Dos, Other healthcare practitioners, and Mid-level practitioners are eligible to apply for privileges at the Hospital. MCH&HS policy on physician credentialing is that no individual is to be denied medical staff appointment based on sex, race, creed, color or national origin. The standards a physician must meet for appointment relate to (1) educational qualifications and licensing; (2) professional competence, (3) character, (4) ethical standing, and (5) ability to relate to and work with others. Applications are reviewed at several levels within the organization. Physicians who have been granted staff privileges automatically become members of the medical staff at the hospital for which privileges have been granted. | |
| Affiliated health care system | SEE BOARD OF DIRECTORS NARRATIVE ABOVE PART VI, LINE 7: STATES WHERE ORGANIZATION FILES COMMUNITY BENEFITS REPORT: NONE |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Records Maintained | false | RecordsMaintained |
Form990 Schedule I Part III Form990ScheduleIPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Type Of Grant | CHARITY CARE | TypeOfGrant |
| Number Of Recipients | 306 | NumberOfRecipients |
| Amount Of Cash Grant | 0 | AmountOfCashGrant |
| Amount Of Non Cash Assistance | 803838 | AmountOfNonCashAssistance |
| Method Of Valuation | BOOK | MethodOfValuation |
| Description Of Non Cash Assistance | MEDICAL CARE | DescriptionOfNonCashAssistance |
Form990 Schedule I Part IV Form990ScheduleIPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | MONITORING OF GRANT FUNDS | Identifier |
| Return Reference | SCHEDULE I, PART I, LINE 2 | ReturnReference |
| Explanation | Grant funds are requested and the use of such funds are monitored through our Critical Access Network of hospitals using standardized forms for both grant proposals, as well as reports on how grant funds were used. A representative of the Critical Access Network reviews all documentation to ensure consistency of information among the network hospitals, as well as compliance with reporting requirements to granting agencies. | Explanation |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | X | CompensationCommittee |
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | false | SeverancePayment |
| Supplemental Nonqual Retire Plan | false | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | false | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | false | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | false | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | false | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | false | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | false | AnyNonFixedPayments |
| Initial Contract Exception | false | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (6 entries)
| Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| John Simonson MD | |||||||||||||
| 110715 | 0 | 62933 | 0 | 16603 | 0 | 5380 | 0 | 7187 | 0 | 202818 | 0 | 0 | 0 |
| Chauncey Wilkins | |||||||||||||
| 120874 | 0 | 125500 | 0 | 14192 | 0 | 5434 | 0 | 822 | 0 | 266822 | 0 | 0 | 0 |
| Garret Shaw | |||||||||||||
| 190657 | 0 | 19412 | 0 | 41196 | 0 | 6000 | 0 | 7141 | 0 | 264406 | 0 | 0 | 0 |
| Andrea VerMaas | |||||||||||||
| 145867 | 0 | 121232 | 0 | 23448 | 0 | 6307 | 0 | 0 | 0 | 296854 | 0 | 0 | 0 |
| Andrew Reynolds | |||||||||||||
| 281605 | 0 | 61521 | 0 | 18461 | 0 | 11077 | 0 | 11188 | 0 | 383852 | 0 | 0 | 0 |
| JAMES JORDAN | |||||||||||||
| 210940 | 0 | 38333 | 0 | 23212 | 0 | 6306 | 0 | 4907 | 0 | 283698 | 0 | 0 | 0 |
Schedule K IRS990ScheduleK
Form990 Schedule K Part I Form990ScheduleKPartI (3 entries)
| Issuer EINIssuerEIN | CUSIP NumberCUSIPNumber | Date IssuedDateIssued | Issue PriceIssuePrice | Description Of PurposeDescriptionOfPurpose | DefeasedDefeased | On Behalf Of IssuerOnBehalfOfIssuer | Pool FinancingPoolFinancing |
|---|---|---|---|---|---|---|---|
| Hospital Auth #1 of Washington Cnty NE | |||||||
| 521441599 | 000000000 | 2007-06-19 | 9250000 | CONSTRUCTION OF FACILITY | false | false | false |
| Hospital Auth #1 of Washington Cnty NE | |||||||
| 521441599 | 000000000 | 2008-05-22 | 8000000 | CONSTRUCTION OF FACILITY | false | false | false |
| Hospital Auth #1 of Washington Cnty NE | |||||||
| 521441599 | 000000000 | 2009-02-12 | 3950000 | CONSTRUCTION OF FACILITY | false | false | false |
Form990 Schedule K Part II Form990ScheduleKPartII (3 entries)
| Amount RetiredAmountRetired | Total ProceedsTotalProceeds | Issuance Costs From ProceedsIssuanceCostsFromProceeds | Capital ExpendituresCapitalExpenditures | Year Of Subst CompletionYearOfSubstCompletion | Current RefundingCurrentRefunding | Advance RefundingAdvanceRefunding | Final Allocation MadeFinalAllocationMade | Adequate Books And Recds MaintaindAdequateBooksAndRecdsMaintaind |
|---|---|---|---|---|---|---|---|---|
| 79548 | 9493722 | 173747 | 9319975 | 2008 | false | false | true | true |
| 119662 | 8059334 | 65000 | 7994334 | 2008 | false | false | true | true |
| 265012 | 3953609 | 11450 | 3942159 | 2009 | false | false | true | true |
Form990 Schedule K Part IV Form990ScheduleKPartIV (3 entries)
| Form8038 T FiledForm8038TFiled | Variable Rate IssueVariableRateIssue | Hedge Identified In Books And RecdsHedgeIdentifiedInBooksAndRecds | Gross Proceeds Invested In GICGrossProceedsInvestedInGIC | Gross Proceeds InvestedGrossProceedsInvested | Exception To RebateExceptionToRebate | Term Of HedgeTermOfHedge | Superintegrated HedgeSuperintegratedHedge | Hedge TerminatedHedgeTerminated |
|---|---|---|---|---|---|---|---|---|
| (no name) | ||||||||
| false | false | false | false | false | true | |||
| SEE PART V | ||||||||
| false | true | true | false | false | true | 20.1 | true | false |
| (no name) | ||||||||
| false | true | false | false | false | true | |||
Form990 Schedule K Part V Form990ScheduleKPartV (2 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| SCHEDULE K | PART IV, COLUMN B, LINE 3(B) | FIRST NATIONAL BANK OF OMAHA |
| SCHEDULE K | PART II, LINE 3 | The total proceeds do not agree to the issue price in Part I, Column (e) due to investment earnings. |
Schedule L IRS990ScheduleL
Form990 Schedule L Part IV Form990ScheduleLPartIV
Name Of Interested Person NameOfInterestedPerson
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | TERRY DUTTON CHAIRMAN | NamePerson |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Relationship | WASH CO. BANK PRESIDENT | Relationship |
| Amount Of Transaction | 1230723 | AmountOfTransaction |
| Description Of Transaction | INTEREST EXPENSE | DescriptionOfTransaction |
| Sharing Of Revenues | false | SharingOfRevenues |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (6 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| DISCLOSURE TO THE PUBLIC | 990, PART VI, SECTION C, LINE 19 | MEMORIAL COMMUNITY HOSPITAL'S AUDIT REPORT IS MADE AVAILABLE TO THE PUBLIC. THE CONFLICT OF INTEREST POLICY AND GOVERNING DOCUMENTS ARE NOT AVAILABLE TO THE PUBLIC. |
| CONFLICT OF INTEREST POLICY | 990, PART VI, SECTION B, LINE 12C | Each board member annually signs a conflict of interest statement and is given a copy of the conflict of interest policy. The chairman of the board reviews these statements and ensures that board members excuse themselves from discussions at board meetings on topics where they have a conflict of interest. |
| COMPENSATION | 990, PART VI, SECTION B, LINE 15A & 15B | The officers of the board are not compensated for their duties. They are volunteers. The officers of the corporation (the executives) are compensated based on recommendations of the compensation committee of the board. The compensation committee looks at comparative hospital and industry salary information in setting base salaries, and reviews and approves the individual goals proposed by the executive team for incentive compensation. |
| MEMBER RIGHTS | 990, PART VI, SECTION A, LINE 6 and 7a | Memorial Community Hospital Corporation ("Hospital") has two members - Memorial Community Health System, Inc. ("MCHS") and Alegent Health - Immanuel Medical Center ("Immanuel"). The Hospital has a seven member board of directors. MCHS appoints three of these board members, Immanuel appoints three, and the medical staff appoints one member which is always the medical staff president. All official actions of the board require an affirmative vote of two-thirds of the entire Board of Directors. A simple majority of the Board of Directors constitutes a quorum for the transaction of business. |
| BOARD APPROVAL OF 990 | PART VI, SECTION B, LINE 11B | THE BOARD MEMBERS RECEIVED A COPY OF THE FINAL 990 VIA EMAIL PRIOR TO FILING. |
| DELEGATION OF MANAGEMENT DUTIES | 990, PART VI, SECTION A, LINE 3 | The ceo of memorial community hospital corporation (hospital) is provided by one of its members (Alegent health). The ceo is an employee of Alegent health, and the hospital reimburses the member for the ceo's compensation and benefits. The Hospital pays Alegent health a management fee equal to the direct cost of the ceo's compensation and benefits plus 5.5% of earnings before interest, depreciation, and amortization for Alegent Health's support. |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII (3 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Public Charity StatusPublicCharityStatus | Business Name Line1DirectControllingEntityName/BusinessNameLine1 |
|---|---|---|---|---|---|---|---|---|---|
| MEMORIAL COMMUNITY HOSPITAL FOUNDATION | |||||||||
| 810 N 22ND STREET | BLAIR | NE | 68008 | 113660156 | SUPPORT | NE | 501(c)(3) | Line 11(C) | MCHS |
| MEMORIAL COMMUNITY HEALTH SYSTEM | |||||||||
| 810 NORTH 22ND STREET | BLAIR | NE | 68008 | 470718840 | HEALTH SYS. | NE | 501(c)(3) | LINE 7 | NA |
| MCH AUXILIARY THRIFT SHOP | |||||||||
| 810 NORTH 22ND STREET | BLAIR | NE | 68008 | 470748162 | AUXILIARY | NE | 501(C)(3) | LINE 7 | MCHS |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | false | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | false | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | true | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | false | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | false | LoansOrGuaranteesFromOtherOrg |
| Sale Of Assets To Other Org | false | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | false | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | false | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | false | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | false | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | false | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | true | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | false | SharingOfFacilities |
| Sharing Of Paid Employees | true | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | false | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | true | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | false | OtherTransferToOtherOrg |
| Other Transfer From Other Org | false | OtherTransferFromOtherOrg |
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