2011-03-15T17:04:35-05:00 2010-07-31 DOHMAN AKERLUND & EDDY LLC PO BOX 470 AURORA NE 688180470 990 2009-08-01 470421272 COMMUNITY MEDICAL CENTER INC COMM 4022456501 3307 BARADA STREET FALLS CITY NE 68355 SCOTT L SAWYER 4022456501 2011-03-15 true TIMOTHY J COUFAL 4026946404 2011-03-15 2009 2016-02-24 21:20:13Z RYAN LARSEN SAME AS C ABOVE FALLS CITY NE 68355 17263790 false X HTTP://CMCFC.ORG X 1995 NE TO OFFER GENERAL HEALTHCARE SERVICES WITHIN THE SCOPE OF ITS LICENSE AND CAPABILITIES; TO RENDER HEALTHCARE TO ALL PERSONS WITHOUT RESPECT TO RACE, RELIGIOUS BELIEFS OR FINANCIAL STANDING. 8 8 213 0 530551 128051 15767361 16957330 35581 -2282000 0 16333493 14803381 0 0 7745141 8547567 0 0 6843851 8357305 14588992 16904872 1744501 -2101491 28927420 33807196 14695691 21676433 14231729 12130763 TO OFFER GENERAL HEALTHCARE SERVICES WITHIN THE SCOPE OF ITS LICENSE AND CAPABILITIES; TO RENDER HEALTHCARE TO ALL PERSONS WITHOUT RESPECT TO RACE, RELIGIOUS BELIEFS OR FINANCIAL STANDING. false false 16904872 14675854 COMMUNITY MEDICAL CENTER PROVIDES MEDICAL SERVICES TO MEET THE NEEDS OF THE PEOPLE OF RICHARDSON COUNTY AND THE SURROUNDING COMMUNITIES. COMMUNITY MEDICAL CENTER PROVIDED 2,327 INPATIENT DAYS, 1,956 SWING-BED DAYS, 100 NURSERY DAYS, 11,223 CLINIC VISITS AND NUMEREOUS OUTPATIENT SERIVCES DURING THE YEAR. COMMUNITY BENEFITS INCLUDE 503,288 OF SUBSIDIZED HEALTH SERVICES, 350,879 OF TRADITIONAL CHARITY CARE, 207,066 OF BAD DEBT AND 6,000 OF HEALTH EDUCATION. 16904872 true true false false false false false false true true true false false false false false false false false false true false false true false false false false false false false false false false false false false false false false false true 40 0 true 213 true false false false false false false false false false false false 8 8 false false false false false false false true true false false false true true true false true true false false X SCOTT L SAWYER 4022456501 3307 BARADA STREET FALLS CITY NE 68355 RODGER MERZ 1.00 X 0 0 0 RENIE GERWECK 1.00 X 0 0 0 STEVE SEVERIN 1.00 X 0 0 0 DANA RATHJE 1.00 X 0 0 0 RAMONA GODEMANN 1.00 X 0 0 0 CHUCK HUNZEKER 1.00 X 0 0 0 KENT BIEKER 1.00 X 0 0 0 MARK LANNEY 1.00 X 0 0 0 RYAN LARSEN 40.00 X 146993 0 32178 SCOTT SAWYER 40.00 X 108172 0 15188 BARBARA HOWARD 40.00 X 87976 0 12246 DAVID BORG 40.00 X 337015 0 49803 SANDRA CATLIN 40.00 X 157999 0 22696 838155 132111 4 false true false SAMPSON CONSTRUCTION 730 SOUTH 14TH STREET LINCOLN NE 68502 CONSTRUCTION SE 12497690 PHYSICAL AND RESPIRATORY SERVICES 204 SOUTH 6TH STREET HIAWATHA KS 66434 PT/OT SERVICES 533018 HART FREELAND ROBERTS INC 9237 WARD PARKWAY SUITE 108 KANSAS CITY MO 64114 ARCHITECT SVCS 323385 CARDINAL HEALTH 21337 NETWORK PLACE CHICAGO IL 60673 PHARMACY SVCS 276198 CORNERSTONE ANESTHESIA 924 PATRICIA DRIVE FALLS CITY NE 68355 CRNA SERVICES 226109 7 19263 108788 128051 NET PATIENT SERVICE REVENUE 622110 16737795 16737795 EMS CONTRACTED SERVICES 621910 68687 68687 CAFETERIA 722310 64011 64011 MISC HOSPITAL REVENUE 622110 53760 53760 LIFELINE 900099 33077 33077 16957330 11679 11679 166730 2460409 -2293679 -2293679 -2293679 14803381 14663651 11679 343141 343141 6509060 6509060 247870 247870 971830 971830 475666 475666 65071 65071 31730 31730 2087467 2087467 30732 30732 296561 296561 126981 126981 440137 440137 34841 34841 48879 48879 639051 639051 1290213 1290213 84135 84135 PHARMACY 1040892 1040892 MEDICAL SUPPLIES 702537 702537 MINOR EQUIPMENT 439636 439636 EQUIPMENT RENTAL 260171 260171 PROVISION FOR BAD DEBTS 226954 226954 511317 511317 16904872 16904872 0 0 1912855 5118584 1639799 2057340 565738 424759 2661795 2325439 194203 39654 53186 180339 417251 25199178 3172433 21272794 22026745 13247 13772 500199 485917 141000 690000 28927420 33807196 3344494 1460180 9219673 18047208 2131524 2169045 14695691 21676433 X 14231728 12130763 14231728 12130763 28927419 33807196 X false true true X true true X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false 561962 11553894 3723 11140251 979328 1.00000 false false false 1342211 1342211 17340819 652029 16688790 1597003 66058 1530945 4736584 2454346 2282238 182561 182561 22026745 CONDITIONAL CONTRIBUTION 2000000 DEFERRED COMPENSATION 156045 EST THIRD-PARTY PAYOR SETTLEMENTS 13000 2169045 14803381 16904872 -2101491 525 525 -2100966 14803906 525 525 14803381 14803381 16904872 16904872 16904872 INTENDED USES FOR ENDOWMENT FUNDS SCHEDULE D, PAGE 2, PART V, LINE 4 THE FUNDS INCLUDE 5,137 DESIGNATED BY BOARD FOR CAPITAL IMPROVEMENTS, 76,589 DESIGNATED BY BOARD FOR DEFERRED COMPENSATION, 111,240 DESIGNATED BY LONG-TERM DEBT COVENANT ON USDA LOAN AND 786,362 DESIGNATED LOAN PROCEEDS TO BE USED FOR CONSTRUCTION. true true true X true X false true true false false 350879 350879 0.02080 350879 350879 0.02080 4916 4916 0.00030 6000 6000 0.00040 525193 21905 503288 0.02980 536109 21905 514204 0.03040 886988 21905 865083 0.05120 true 176466 8823 9393960 9366217 27743 X true false COMMUNITY MEDICAL CENTER

3307 BARADA STREET FALLS CITY NE 68355

X X FAMILY MEDICINE

3307 BARADA STREET FALLS CITY NE 68355

HUMBOLDT FAMILY MEDICINE

1120 GRAND AVENUE HUMBOLDT NE 68376

FINANCIAL STATEMENT FOOTNOTE - EXPENSES INCLUDE A PROVISION FOR DOUBTFUL ACCOUNTS TO ALLOW FOR ESTIMATED UNCOLLECTIBLE ACCOUNTS. THIS PROVISION IS BASED ON PAST EXPERIENCE AND ON ANALYSIS OF CURRENT ACCOUNTS RECEIVABLE COLLECTIBILITY. ACCOUNTS ARE CONSIDERED DELINQUENT BASED ON PASSAGE OF A SPECIFIED PERIOD OF TIME AND CONSIDERATION OF PAYMENT HISTORY. ACCOUNTS DEEMED UNCOLLECTIBLE ARE CHARGED TO THE ALLOWANCE IN THE YEAR THEY ARE DEEMED UNCOLLECTIBLE. AS A RESULT, THERE IS AT LEAST A REASONABLE POSSIBILITY THAT RECORDED ESTIMATES WILL CHANGE BY A MATERIAL AMOUNT IN THE NEAR TERM. THE ALLOWANCE FOR DOUBTFUL ACCOUNTS WAS 465,000 AND 459,000 AT JULY 31, 2010 AND 2009, RESPECTIVELY. COSTING METHODOLOGY FOR LINE 2 - OVERALL COST TO CHARGE RATIO WAS USED TO DETERMINE AMOUNTS REPORTED ON SCHEDULE H, PART III, LINE 2. BAD DEBT EXPENSE REPORTED ON FORM 990, PART IX, LINE 25 WAS 226,954. COSTING METHODOLOGY FOR LINE 3 - AFTER REVIEW OF BAD DEBTS WRITTEN OFF IT WAS DETERIMINED APPROXIMATELY 5% OF BAD DEBT ACCOUNTS WRITTEN OFF WOULD HAVE QUALIFIED FOR CHARITY CARE IF THE INDIVIDUALS WOULD HAVE COMPLETED THE APPLICATION PROCESS. RATIONALE FOR INCLUDING BAD DEBT AMOUNTS AS COMMUNITY BENEFIT - BY LAW, THE ORGANZIATION CAN NOT REFUSE CERTAIN SERVICES TO PATIENTS THUS BAD DEBT SHOULD BE INCLUDED AS COMMUNITY BENEFIT. THE MEDICARE COST REPORT WAS USED TO DETERMINE THE AMOUNTS REPORTED ON LINE 6. THE ORGANIZATION ASSESSES THE NEEDS OF THE COMMUNITIES IT SERVICES BY MONITORING THE UTILIZATION OF SERVICES OFFERED AND EVALUATING NEW SERVICES WHICH COULD BE OFFERED TO IMPROVE THE HEALTH AND WELFARE OF THE CITIZENS IN THE COMMUNITIES IT SERVES. STARTING IN 2012 THE ORGANIZATION WILL CONDUCT A COMMUNITY NEEDS ASSESSMENT EVERY 3 YEARS AND EXECUTE AGAINST IT. THE ORGANIZATION INFORMS AND EDUCATES PATIENTS AND PERSONS WHO MAY BE BILLED FOR PATIENT CARE ABOUT THEIR ELIGIBILITY FOR ASSISTANCE BY POSTING THEIR CHARITY CARE POLICIES AND OTHER FEDERAL, STATE, AND LOCAL GOVERNMENT PROGRAMS OR UNDER THE ORGANIZATION'S HELPFUL OPTIONS FOR PATIENT EXPENSES (HOPE) PROGRAM OR CHARITY CARE POLICY BY POSTING GUIDELINES IN ADMITTING AREAS, HAVING THE INFORMATION AVAILABLE ON THEIR WEBSITE, PUBLICATIONS IN NEWSPAPERS ADS AND THROUGHT DISCUSSIONS WITH INDIVIDUALS SEEKING INFORMATION. RICHARDSON COUNTY, NEBRASKA IS PRIMARILY RURAL AND INCLUDES THE CITIES OF BARADA, DAWSON, FALLS CITY, HUMBOLDT, PRESTON, RULO, SALEM SHUBERT, STELLA AND VERDON. IT IS LOCATED IN THE SOUTHEAST CORNER OF NEBRASKA. POPULATION ESTIMATE FOR 2009 IS 8,125. PERSONS 65 YEARS OLD AND OVER 21.7%. PERSONS UNDER 18 YEAS OND 21.9%. WHITE PERSONS 94.6%, BLACK PERSONS .3%, AMERICAN INDIAN AND ALASKA NATIVE PERSONS 3.0%, ASIAN PERSONS .3%, AND PERSONS REPORTING TWO OR MORE RACES 1.8%. NUMBER OF HOUSEHOLDS (2000) 3,993, PERSONS PER HOUSEHOLD (2000) 2.34, MEDIAN HOUSEHOLD INCOME (2008) 37,937, PER CAPITA MONEY INCOME (1999) 16,460 AND PERCENT OF PERSONS BELOW POVERTY LEVEL (2008) 10.9%. ALTHOUGH, NO COMMUNITY BUILDING ACTIVITIES WERE REPORTED IN PART II THE ORGANIZATION WORKS CLOSELY WITH OTHERS IN THE COMMUNITY TO IMPROVE THE HEALTH AND WELFARE OF COMMUNITY MEMBERS. THE ORGANIZATION HAS RECENTLY MOVED INTO A NEW HOSPITAL FACILITY TO PROVIDE THE BEST POSSIBLE CARE TO PATIENTS IT SERVES. ALSO, AS THE LARGEST EMPLOYER IN FALLS CITY, THE NEW FACILITY PROVIDES A BETTER WORK ENVIRONMENT FOR THE ORGANIZATIONS WORKFORCE. THE ORGANIZATION BOARD OF DIRECTORS IS COMPRISED OF PERSONS WHO RESIDE IN THE ORGANIZATION'S PRIMARY SERVICE AREA WHO ARE NEITHER EMPLOYEES NOR CONTACTORS OF THE ORGANIZATION, NOR FAMILY MEMBERS THEREOF. THE ORGANIZATION EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN ITS COMMUNITY. IN ADDITION, THE ORGANIZATION CONTINUALLY APPLIES SURPLUS FUNDS TOWARD THE IMPROVEMENT OF PATIENT CARE, SUCH AS NEW FACILITIES AND THE PURCHASE OF NEW/UPDATED MEDICAL EQUIPMENT. X true true X X X false false false true false false false false false RYAN LARSEN 126993 20000 17435 14743 179171 DAVID BORG 150763 152677 33575 35060 14743 386818 SANDRA CATLIN 58172 82262 17565 7953 14743 180695 FRINGE OR EXPENSE EXPLANATION SCHEDULE J, PAGE 1, PART I, LINE 1A RYAN LARSON, CEO- LIONS CLUB DUES 70.00 COMPENSATION CONTINGENT UPON REVENUES OF ORGANIZATION SCHEDULE J, PAGE 1, PART I, LINE 5A PROVIDER PRODUCTIVITY BONUSES ARE CALCULATED BASED ON RURAL HEALTH CLINIC REVENUE. DAVID BORG 152,677 SANDY CATLIN 82,262 ORGANIZATION'S PROCESS USED TO REVIEW FORM 990 FORM 990, PAGE 6, PART VI, LINE 11 FORM 990 IS REVIEWED BY THE CFO AND IS PRESENTED TO THE FIANCE COMMITTEE OF THE BOARD OF DIRECTORS FOR APPROVAL PRIOR TO FILING THE RETURN. ENFORCEMENT OF CONFLICTS POLICY FORM 990, PAGE 6, PART VI, LINE 12C MANAGEMENT CONTINUALLY REVIEWS OFFICERS, DIRECTORS, TRUSTEES AND KEY EMPLOYEES ANNUAL DISCLOSURES AND RELATIONSHIPS WITH COMMUNITY MEDICAL CENTER TO IDENTIFY POSSIBLE CONFLICT OF INTEREST. ONCE A CONFLICT OF INTEREST IS IDENTIFIED, THE CONFLICT WOULD BE DOCUMENTED AND MONITORED TO ENSURE APPROPRIATE ACTION BASED ON THE SITUATION. COMPENSATION PROCESS FOR TOP OFFICIAL FORM 990, PAGE 6, PART VI, LINE 15A COMPENSATION FOR THE CEO IS DETERMINED BY THE BOARD OF DIRECTORS. THE BOARD OF DIRECTORS UTILIZE INDEPENDENT PARTIES OR STUDIES OCCASIONALLY. GOVERNING DOCUMENTS DISCLOSURE EXPLANATION FORM 990, PAGE 6, PART VI, LINE 19 GOVERNING DOCUMENTS, CONFLICTS OF INTEREST STATEMENTS AND FINANCIAL STATEMENTS ARE NOT MADE AVAILABLE TO THE PUBLIC WITHOUT APPROVAL BY THE BOARD OF DIRECTORS. ADDITIONAL INFORMATION SCHEDULE O FORM 990, PART VI, LINE 10 - ORGANIZATION'S PROCESS USED TO REVIEW FORM 990 - THE FORM 990 AND SUPPORTING SCHEDULES WERE MADE AVAILABLE TO THE FINANCE COMMITTEE AND CFO PRIOR TO FILING. UPON REVIEW, THE FINANCE COMMITTEE AND CFO APPROVED THE FILING OF THE FORM 990 AND SUPPORTING SCHEDULES. FORM 990, PART VI, LINE 19 - AVAILIBILITY OF GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS - THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE NOT MADE AVAILABLE TO THE PUBLIC WITHOUT BOARD APPROVAL.