COMMUNITY HOSPITAL ASSOCIATION: Form 990, tax year 2022
View the entire original 990 at ProPublica ↗
- Organization
- COMMUNITY HOSPITAL ASSOCIATION (EIN 47-0533373)
- Tax period
- 2022-07-01 to 2023-06-30
- Filed
- 2024-05-14
- IRS object ID
- 202411359349307496
- Schema version
- 2022v5.0
- 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) |
|---|---|---|
| Return | 2024-05-14T14:04:40-05:00 | ReturnTs |
| Tax Period End | 2023-06-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 450250958 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | EIDE BAILLY LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 18081 BURT ST STE 200 | AddressLine1Txt |
| City | OMAHA | CityNm |
| State Abbreviation | NE | StateAbbreviationCd |
| ZIP | 680224722 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2022-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 470533373 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | COMMUNITY HOSPITAL ASSOCIATION OF MCCOOK | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | COMM | BusinessNameControlTxt |
| Phone | 3083442650 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1301 EAST H STREET PO BOX 1328 | AddressLine1Txt |
| City | MCCOOK | CityNm |
| State Abbreviation | NE | StateAbbreviationCd |
| ZIP | 69001 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | SEAN WOLFE | PersonNm |
| Person Title | CHIEF FINANCIAL OFFICER | PersonTitleTxt |
| Phone | 3083442650 | PhoneNum |
| Signature | 2024-05-13 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | SEAN | PersonFirstNm |
| Person Last | WOLFE | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IRS Responsible Prty Info Curr | Yes (1) | IRSResponsiblePrtyInfoCurrInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | WENDY R COOLEY CPA | PreparerPersonNm |
| PTIN | P01523804 | PTIN |
| Phone | 4023302660 | PhoneNum |
| Preparation | 2024-05-13 | PreparationDt |
Additional Filer Information AdditionalFilerInformation
Trusted Customer TrustedCustomerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | 2 | TrustedCustomerCd |
| Authentication Assurance Level | AAL1 | AuthenticationAssuranceLevelCd |
| Identity Assurance Level | IAL1 | IdentityAssuranceLevelCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2022 | TaxYr |
| Build TS | 2023-04-26 12:10:37Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | SEAN WOLFE | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1301 EAST H STREET PO BOX 1328 | AddressLine1Txt |
| City | MCCOOK | CityNm |
| State Abbreviation | NE | StateAbbreviationCd |
| ZIP | 69001 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $59,977,503 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.CHMCCOOK.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1974 | FormationYr |
| Legal Domicile State | NE | LegalDomicileStateCd |
| Activity Or Mission | TO EXCEL AT PROVIDING FOR THE HEALTHCARE NEEDS OF OUR REGION THROUGH QUALITY, EFFICIENT AND PATIENT-CENTERED CARE. | ActivityOrMissionDesc |
| Voting Members Governing Body | 9 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 8 | VotingMembersIndependentCnt |
| Total Employee | 386 | TotalEmployeeCnt |
| Total Volunteers | 25 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $788,620 | PYContributionsGrantsAmt |
| CY Contributions Grants | $1,924,082 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $59,327,368 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $56,537,518 | CYProgramServiceRevenueAmt |
| PY Investment Income | $81,698 | PYInvestmentIncomeAmt |
| CY Investment Income | $887,554 | CYInvestmentIncomeAmt |
| PY Other Revenue | $657,511 | PYOtherRevenueAmt |
| CY Other Revenue | $625,743 | CYOtherRevenueAmt |
| PY Total Revenue | $60,855,197 | PYTotalRevenueAmt |
| CY Total Revenue | $59,974,897 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $173,956 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $294,782 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $28,771,903 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $30,441,643 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $402,189 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $27,881,087 | PYOtherExpensesAmt |
| CY Other Expenses | $29,383,898 | CYOtherExpensesAmt |
| PY Total Expenses | $56,826,946 | PYTotalExpensesAmt |
| CY Total Expenses | $60,120,323 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $4,028,251 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$145,426 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $97,428,013 | TotalAssetsBOYAmt |
| Total Assets EOY | $92,073,756 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $38,588,208 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $33,192,371 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $58,839,805 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $58,881,385 | NetAssetsOrFundBalancesEOYAmt |
| Mission | LEADING OUR REGION TO A HEALTHIER FUTURE. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $49,298,930 | ExpenseAmt |
| Grant | $294,782 | GrantAmt |
| Revenue | $56,675,419 | RevenueAmt |
| Desc | 25-BED 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. | Desc |
| Total Program Service Expenses | $49,298,930 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (1) | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | Yes (1) | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | Yes (1) | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | Yes (1) | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | 0 | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | Yes (1) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | Yes (1) | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 69 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 386 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | 0 | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | 0 | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 9 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 8 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | 0 | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SEAN WOLFE | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 3083448306 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1301 EAST H - PO BOX 1328 | AddressLine1Txt |
| City | MCCOOK | CityNm |
| State Abbreviation | NE | StateAbbreviationCd |
| ZIP | 69001 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (18 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Highest Compensated EmployeeHighestCompensatedEmployeeInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd |
|---|---|---|---|---|---|---|---|---|
| RICHARD LAWTON | ||||||||
| ORTHO PHYSICAN | 40.00 | 0.00 | Yes (X) | $721,726 | $0 | $50,117 | ||
| ROSS BEAVERS | ||||||||
| CRNA | 40.00 | 0.00 | Yes (X) | $327,235 | $0 | $22,430 | ||
| TROY BRUNTZ | ||||||||
| CEO | 39.00 | 1.00 | $297,126 | $0 | $42,907 | Yes (X) | ||
| EVAN GEILENKIRCHEN | ||||||||
| CRNA | 40.00 | 0.00 | Yes (X) | $292,297 | $0 | $43,125 | ||
| GABRIAL SCHEER | ||||||||
| CRNA | 40.00 | 0.00 | Yes (X) | $278,870 | $0 | $39,752 | ||
| SEAN WOLFE | ||||||||
| CFO | 40.00 | 0.00 | $194,008 | $0 | $43,918 | Yes (X) | ||
| ANTHONY RODEWALD | ||||||||
| PHARMACY DIRECTOR | 40.00 | 0.00 | Yes (X) | $201,548 | $0 | $40,156 | ||
| KRISTIN STAGEMEYER CPA | ||||||||
| CHAIR | 2.00 | 1.00 | $0 | $0 | $0 | Yes (X) | Yes (X) | |
| GARRETT RIPPEN | ||||||||
| VICE CHAIR | 2.00 | 0.00 | $0 | $0 | $0 | Yes (X) | Yes (X) | |
| MATTHEW NIELSEN | ||||||||
| SECRETARY | 2.00 | 0.00 | $0 | $0 | $0 | Yes (X) | Yes (X) | |
| LENA KOEBEL | ||||||||
| SECRETARY THRU 12/22 | 2.00 | 0.00 | $0 | $0 | $0 | Yes (X) | Yes (X) | |
| DARREN ESCH | ||||||||
| TREASURER | 2.00 | 0.00 | $0 | $0 | $0 | Yes (X) | Yes (X) | |
| JANA KMOCH | ||||||||
| DIRECTOR | 1.00 | 0.00 | $0 | $0 | $0 | Yes (X) | ||
| KURT VOSBURG | ||||||||
| DIRECTOR | 1.00 | 1.00 | $0 | $0 | $0 | Yes (X) | ||
| MICHAEL LORD | ||||||||
| DIRECTOR | 1.00 | 0.00 | $0 | $0 | $0 | Yes (X) | ||
| ASHLEY VONTZ | ||||||||
| DIRECTOR | 1.00 | 1.00 | $0 | $0 | $0 | Yes (X) | ||
| MATTHEW DAVIDSON | ||||||||
| DIRECTOR | 1.00 | 0.00 | $0 | $0 | $0 | Yes (X) | ||
| RICK HANEY | ||||||||
| DIRECTOR THRU 12/22 | 1.00 | 1.00 | $0 | $0 | $0 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $2,312,810 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $282,405 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 30 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| SOUTHWEST NEBRASKA PHYSICAL THERAPY | |||||
| 1301 EAST H STREET | MCCOOK | NE | 69001 | PHYSICAL THERAPY SERVICES | $1,379,847 |
| MCCOOK CLINIC | |||||
| 1401 EAST H STREET | MCCOOK | NE | 69001 | ER COVERAGE | $1,002,995 |
| BARTON ASSOCIATES INC | |||||
| PO BOX 417844 | BOSTON | MA | 02241 | ER LOCUM | $660,630 |
| PATHOLOGY SERVICES | |||||
| PO BOX 1289 | NORTH PLATTE | NE | 69103 | LAB FEES | $502,902 |
| MEDICAL SOLUTIONS | |||||
| PO BOX 850737 | MINNEAPOLIS | MN | 55485 | TRAVELING NURSES | $501,364 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 11 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $355,477 | RelatedOrganizationsAmt |
| Government Grants | $1,568,605 | GovernmentGrantsAmt |
| Total Contributions | $1,924,082 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (4 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| MEDICARE/MEDICAID PAYMENTS | 621400 | $31,052,149 | $31,052,149 |
| PATIENT SERVICE REVENUE | 621400 | $24,931,295 | $24,931,295 |
| 340B PAYMENT | 621400 | $299,511 | $299,511 |
| OUT-SOURCE SERVICES | 621400 | $254,563 | $254,563 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $56,537,518 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $811,075 | TotalRevenueColumnAmt |
| Exclusion | $811,075 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $252,616 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $0 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $252,616 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $252,616 | TotalRevenueColumnAmt |
| Exclusion | $252,616 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $79,085 | OtherAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $2,606 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $76,479 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $76,479 | TotalRevenueColumnAmt |
| Exclusion | $76,479 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | ExclusionExclusionAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|---|
| CAFETERIA/MEALS | 900099 | $235,226 | $235,226 | |
| HOUSEKEEPING INCOME | 900099 | $107,710 | $107,710 |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $30,191 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $30,191 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $373,127 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $59,974,897 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $56,675,419 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $1,375,396 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $294,782 | TotalAmt |
| Program Services | $294,782 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $573,075 | TotalAmt |
| Management And General | $573,075 | ManagementAndGeneralAmt |
Comp Disqual Persons CompDisqualPersonsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $74,850 | TotalAmt |
| Program Services | $74,850 | ProgramServicesAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $22,956,216 | TotalAmt |
| Program Services | $18,114,215 | ProgramServicesAmt |
| Management And General | $4,668,812 | ManagementAndGeneralAmt |
| Fundraising | $173,189 | FundraisingAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,427,046 | TotalAmt |
| Program Services | $1,141,559 | ProgramServicesAmt |
| Management And General | $274,559 | ManagementAndGeneralAmt |
| Fundraising | $10,928 | FundraisingAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,605,071 | TotalAmt |
| Program Services | $2,835,379 | ProgramServicesAmt |
| Management And General | $715,283 | ManagementAndGeneralAmt |
| Fundraising | $54,409 | FundraisingAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,805,385 | TotalAmt |
| Program Services | $1,413,425 | ProgramServicesAmt |
| Management And General | $378,488 | ManagementAndGeneralAmt |
| Fundraising | $13,472 | FundraisingAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $63,731 | TotalAmt |
| Management And General | $63,731 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $84,900 | TotalAmt |
| Management And General | $84,900 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $9,250,637 | TotalAmt |
| Program Services | $8,017,486 | ProgramServicesAmt |
| Management And General | $1,233,151 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $202,889 | TotalAmt |
| Management And General | $202,889 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,640,531 | TotalAmt |
| Program Services | $1,083,528 | ProgramServicesAmt |
| Management And General | $556,029 | ManagementAndGeneralAmt |
| Fundraising | $974 | FundraisingAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $344,144 | TotalAmt |
| Program Services | $264,467 | ProgramServicesAmt |
| Management And General | $79,677 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,087,237 | TotalAmt |
| Program Services | $1,080,614 | ProgramServicesAmt |
| Management And General | $6,623 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $56,899 | TotalAmt |
| Program Services | $34,218 | ProgramServicesAmt |
| Management And General | $22,681 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $717,263 | TotalAmt |
| Program Services | $387,118 | ProgramServicesAmt |
| Management And General | $328,583 | ManagementAndGeneralAmt |
| Fundraising | $1,562 | FundraisingAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,129,157 | TotalAmt |
| Program Services | $1,124,030 | ProgramServicesAmt |
| Management And General | $5,127 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,442,896 | TotalAmt |
| Program Services | $5,044,680 | ProgramServicesAmt |
| Management And General | $398,216 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $368,377 | TotalAmt |
| Program Services | $367,367 | ProgramServicesAmt |
| Management And General | $1,010 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (3 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt | FundraisingFundraisingAmt |
|---|---|---|---|---|
| MEDICAL SUPPLIES | $8,015,619 | $8,015,619 | ||
| MISCELLANEOUS | $902,421 | $754,766 | $147,655 | |
| MEMBERSHIPS & DUES | $77,197 | $5,593 | $71,604 |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $60,120,323 | TotalAmt |
| Program Services | $49,298,930 | ProgramServicesAmt |
| Management And General | $10,419,204 | ManagementAndGeneralAmt |
| Fundraising | $402,189 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,600 | BOYAmt |
| EOY | $1,600 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $35,954,981 | BOYAmt |
| EOY | $31,335,385 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,618,946 | BOYAmt |
| EOY | $7,835,220 | EOYAmt |
Receivables From Officers Etc ReceivablesFromOfficersEtcGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $174 | BOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,019,565 | BOYAmt |
| EOY | $1,922,883 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,058,710 | BOYAmt |
| EOY | $2,638,840 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $103,075,363 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $59,886,546 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $45,175,307 | BOYAmt |
| EOY | $43,188,817 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,254,878 | BOYAmt |
| EOY | $3,495,268 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $343,852 | BOYAmt |
| EOY | $464,702 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $1,191,041 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $97,428,013 | BOYAmt |
| EOY | $92,073,756 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,655,088 | BOYAmt |
| EOY | $4,336,469 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $378,009 | BOYAmt |
| EOY | $493,584 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $28,329,222 | BOYAmt |
| EOY | $28,345,753 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,225,889 | BOYAmt |
| EOY | $16,565 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $38,588,208 | BOYAmt |
| EOY | $33,192,371 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows FASB117 | Yes (X) | OrganizationFollowsFASB117Ind |
No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $58,839,805 | BOYAmt |
| EOY | $58,881,385 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $58,839,805 | BOYAmt |
| EOY | $58,881,385 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $97,428,013 | BOYAmt |
| EOY | $92,073,756 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | -$145,426 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $187,006 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Info In Schedule O Part XII | Yes (X) | InfoInScheduleOPartXIIInd |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consol And Sep Basis Fincl Stmt | Yes (X) | ConsolAndSepBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | Yes (1) | FederalGrantAuditRequiredInd |
| Federal Grant Audit Performed | Yes (1) | FederalGrantAuditPerformedInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| 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) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | VolunteersInd |
| Paid Staff Or Management | 0 | PaidStaffOrManagementInd |
| Media Advertisements | 0 | MediaAdvertisementsInd |
| Mailings Members | 0 | MailingsMembersInd |
| Publications Or Broadcast | 0 | PublicationsOrBroadcastInd |
| Grants Other Organizations | 0 | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | 0 | DirectContactLegislatorsInd |
| Rallies Demonstrations | 0 | RalliesDemonstrationsInd |
| Other Activities | Yes (1) | OtherActivitiesInd |
| Other Activities | $5,343 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $5,343 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | 0 | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART II-B, LINE 1: | FormAndLineReferenceDesc |
| Explanation | ITEM 1I - A PORTION OF DUES PAID TO THE AMERICAN HOSPITAL ASSOCIATION AND NEBRASKA HOSPITAL ASSOCIATION ARE USED FOR LOBBYING AND POLITICAL ACTIVITIES. MANAGEMENT IS ACTIVE IN NEBRASKA HOSPITAL ASSOCIATION'S PAC, AHA'S ADVOCACY DAY, AND OTHER INDUSTRY FUNCTIONS. | ExplanationTxt |
Schedule D IRS990ScheduleD
CY Endwmt Fund CYEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $3,482,371 | BeginningYearBalanceAmt |
| Contributions | $5,110 | ContributionsAmt |
| Investment Earnings Or Losses | $214,711 | InvestmentEarningsOrLossesAmt |
| Administrative Expenses | $41,328 | AdministrativeExpensesAmt |
| End Year Balance | $3,660,864 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $3,811,948 | BeginningYearBalanceAmt |
| Contributions | $5,826 | ContributionsAmt |
| Investment Earnings Or Losses | -$260,507 | InvestmentEarningsOrLossesAmt |
| Administrative Expenses | $74,896 | AdministrativeExpensesAmt |
| End Year Balance | $3,482,371 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $3,290,398 | BeginningYearBalanceAmt |
| Contributions | $12,744 | ContributionsAmt |
| Investment Earnings Or Losses | $508,806 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $3,811,948 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $3,130,914 | BeginningYearBalanceAmt |
| Contributions | $4,680 | ContributionsAmt |
| Investment Earnings Or Losses | $180,448 | InvestmentEarningsOrLossesAmt |
| Grants Or Scholarships | $10,800 | GrantsOrScholarshipsAmt |
| Other Expenditures | $11,875 | OtherExpendituresAmt |
| Administrative Expenses | $2,969 | AdministrativeExpensesAmt |
| End Year Balance | $3,290,398 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $2,905,827 | BeginningYearBalanceAmt |
| Contributions | $4,790 | ContributionsAmt |
| Investment Earnings Or Losses | $306,693 | InvestmentEarningsOrLossesAmt |
| Grants Or Scholarships | $16,500 | GrantsOrScholarshipsAmt |
| Other Expenditures | $55,917 | OtherExpendituresAmt |
| Administrative Expenses | $13,979 | AdministrativeExpensesAmt |
| End Year Balance | $3,130,914 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Designated Balance EOY | 0.56252 | BoardDesignatedBalanceEOYPct |
| Prmnnt Endowment Balance EOY | 0.43748 | PrmnntEndowmentBalanceEOYPct |
| Term Endowment Balance EOY | 0.00000 | TermEndowmentBalanceEOYPct |
| Endowments Held Unrelated Org | 0 | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | Yes (1) | EndowmentsHeldRelatedOrgInd |
| Related Org List Sch R | Yes (1) | RelatedOrgListSchRInd |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $101,803 | OtherCostOrOtherBasisAmt |
| Book Value | $101,803 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $38,752,853 | OtherCostOrOtherBasisAmt |
| Depreciation | $35,426,530 | DepreciationAmt |
| Book Value | $3,326,323 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $58,313,279 | OtherCostOrOtherBasisAmt |
| Depreciation | $24,460,016 | DepreciationAmt |
| Book Value | $33,853,263 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $5,907,428 | OtherCostOrOtherBasisAmt |
| Book Value | $5,907,428 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $43,188,817 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | REFUNDABLE ADVANCES | Desc |
| Amt | $16,565 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $16,565 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART V, LINE 4: | 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, LINE 2: | THE HOSPITAL AND FOUNDATION ACCOUNT FOR UNCERTAINTIES IN ACCOUNTING FOR INCOME TAX ASSETS AND LIABILITIES USING GUIDANCE INCLUDED IN FASB ASC 740, INCOME TAXES. THE HOSPITAL AND FOUNDATION RECOGNIZE THE EFFECT OF INCOME TAX POSITIONS ONLY IF THOSE POSITIONS ARE MORE LIKELY THAN NOT OF BEING SUSTAINED. AT JUNE 30, 2023 AND 2022, THE HOSPITAL AND FOUNDATION HAD NO UNCERTAIN TAX POSITIONS ACCRUED. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
| Percent150 | Yes (X) | Percent150Ind |
| FPG Reference Discounted Care | 0 | FPGReferenceDiscountedCareInd |
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | Yes (1) | ExpensesExceedBudgetInd |
| Unable To Provide Care | 0 | UnableToProvideCareInd |
| Annual Community Bnft Report | Yes (1) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (1) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,279,549 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,279,549 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02130 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $4,935,570 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $3,878,722 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,056,848 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01760 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $6,215,119 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $3,878,722 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,336,397 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.03890 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $26,962 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $26,962 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00040 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $296,442 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $296,442 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00490 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $323,404 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $323,404 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00530 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $6,538,523 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $3,878,722 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,659,801 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.04420 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $2,161,477 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $324,222 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $24,643,817 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $25,787,092 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$1,143,275 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | Yes (X) | CostToChargeRatioInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (1) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | COMMUNITY HOSPITAL ASSOCIATION OF MCCOOK | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1301 EAST H STREET - PO BOX 1328 | AddressLine1Txt |
| City | MCCOOK | CityNm |
| State Abbreviation | NE | StateAbbreviationCd |
| ZIP | 69001 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | WWW.CHMCCOOK.ORG | WebsiteAddressTxt |
| State License | 320007 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Critical Access Hospital | Yes (X) | CriticalAccessHospitalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | COMMUNITY HOSPITAL ASSOCIATION OF MCCOOK | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | 0 | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | 0 | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (1) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Prior CHNA Impact | Yes (X) | PriorCHNAImpactInd |
| CHNA Conducted | 22 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | 0 | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | 0 | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | PART V, PAGE 8 | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 22 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | PART V, PAGE 8 | StrategyWebsiteURLTxt |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 150.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Other Criteria | Yes (X) | OtherCriteriaInd |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | HTTPS://CHMCCOOK.ORG/FOR-PATIENTS/FINANCIAL-ASSISTANCE.HTML | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | HTTPS://CHMCCOOK.ORG/FOR-PATIENTS/FINANCIAL-ASSISTANCE.HTML | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | HTTPS://CHMCCOOK.ORG/FOR-PATIENTS/FINANCIAL-ASSISTANCE.HTML | FAPSummaryOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| Notified FAP Copy Bill Display | Yes (X) | NotifiedFAPCopyBillDisplayInd |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| FAP Translated | Yes (X) | FAPTranslatedInd |
| Other Publicity | Yes (X) | OtherPublicityInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| Provided Written Notice | Yes (X) | ProvidedWrittenNoticeInd |
| Made Effort Orally Notify | Yes (X) | MadeEffortOrallyNotifyInd |
| Processed FAP Application | Yes (X) | ProcessedFAPApplicationInd |
| Made Presumptive Elig Determ | Yes (X) | MadePresumptiveEligDetermInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Look Back Medicare Private | Yes (X) | LookBackMedicarePrivateInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| COMMUNITY HOSPITAL ASSOCIATION OF MCCOOK | PART V, SECTION B, LINE 5: COMMUNITY HOSPITAL WORKED WITH COMMUNITY HOSPITAL CONSULTING TO COLLECT DATA THAT WAS USED TO IDENTIFY THE NEEDS OF OUR REGION. ACCORDING TO THE CHNA PROCESS AND METHODOLOGY, "CHC CONSULTING CONDUCTED THE FOLLOWING RESEARCH: A DEMOGRAPHIC ANALYSIS OF THE STUDY AREA UTILIZING DEMOGRAPHIC DATA FROM THE STRATASAN AND LOCAL REPORTS, A STUDY OF THE MOST RECENT HEALTH DATA AVAILABLE, ONE-ON-ONE PHONE INTERVIEWS WITH INDIVIDUALS WHO HAVE SPECIAL KNOWLEDGE OF THE COMMUNITIES. IN ADDITION THEY ANALYZED THOSE RESULTS AND FACILITATED THE REVIEW OF COLLECTED DATA IN MARCH 2022 WITH THE CHNA TEAM. THE CHNA TEAM INCLUDED: TROY BRUNTZ, CEO, KAREN KLIMENT THOMPSON, VP ANCILLARY SERVICES, JON REINERS, STRATEGIC PLANNING MANAGER, AND BALEIGH ABBOTT, POPULATION HEALTH & OUTREACH COORDINATOR."RESOURCES FOR HEALTH DATA WERE COLLECTED FROM SOURCES SUCH AS: THE ROBERT WOOD JOHNSON FOUNDATION, NEBRASKA STATE DEPARTMENT OF HEALTH AND HUMAN SERVICES, SPARKMAP, UNITED STATES CENSUS BUREAU, AND THE CENTERS FOR DISEASE CONTROL AND PREVENTION.FOR THE ONE-ON-ONE INTERVIEWS, ACCORDING TO THE SAME DOCUMENT MENTIONED ABOVE: "CH PROVIDED CHC CONSULTING WITH A LIST OF PERSONS WITH SPECIAL KNOWLEDGE OF PUBLIC HEALTH IN RED WILLOW COUNTY, INCLUDING PUBLIC HEALTH REPRESENTATIVES AND OTHER INDIVIDUALS WHO FOCUS SPECIFICALLY ON UNDERREPRESENTED GROUPS. FROM THAT LIST, SIXTEEN IN-DEPTH PHONE INTERVIEWS WERE CONDUCTED USING A STRUCTURED INTERVIEW GUIDE. EXTENSIVE NOTES WERE TAKEN DURING EACH INTERVIEW AND THEN QUANTIFIED BASED ON RESPONSES, COMMUNITIES AND POPULATIONS (MINORITY, ELDERLY, UN/UNDERINSURED, ETC.) SERVED, AND PRIORITIES IDENTIFIED BY RESPONDENTS. QUALITATIVE DATA FROM THE INTERVIEWS WAS ALSO ANALYZED AND REPORTED." |
| COMMUNITY HOSPITAL ASSOCIATION OF MCCOOK | PART V, SECTION B, LINE 11: SIX PRIORITY AREAS WERE IDENTIFIED BY THE CHNA TEAM AND WERE DOCUMENTED ON THE CHNA IMPLEMENTATION PLAN TRACKING DOCUMENT THAT IS UPDATED EACH QUARTER. THE SIX PRIORITY AREAS ARE: PREVENTION; EDUCATION AND SERVICES TO ADDRESS HIGH MORTALITY RATES; CHRONIC DISEASES; PREVENTABLE CONDITIONS AND UNHEALTHY LIFESTYLES; FOCUS ON THE NEEDS OF THE AGING POPULATION; CONTINUED EMPHASIS ON PHYSICIAN RECRUITMENT AND RETENTION; ACCESS TO AFFORDABLE CARE AND REDUCING HEALTH DISPARITIES AMONG SPECIFIC POPULATIONS, ACCESS TO MENTAL AND BEHAVIORAL HEALTH CARE SERVICES AND PROVIDERS; AND CONTINUED FOCUS ON COVID-19 PREVENTION & RESPONSE. EACH PRIORITY AREA HAS ANYWHERE FROM FOUR TO 7 ACTION STEPS IDENTIFIED IN THE CHNA IMPLEMENTATION PLAN TRACKING DOCUMENT AND EACH ACTION STEP HAS AT LEAST ONE RESPONSIBLE LEADER (A CH REPRESENTATIVE WITH OWNERSHIP OF THE ACTION STEP).PRIORITY ONE: PREVENTION, EDUCATION AND SERVICES TO ADDRESS HIGH MORTALITY RATES IS THE LARGEST SECTION WITH SEVEN ACTION STEPS. EACH ACTION STEP IS EITHER IN PROGRESS OR COMPLETED: 1.A. COMMUNITY HOSPITAL WILL CONTINUE TO INCREASE EDUCATIONAL OPPORTUNITIES FOR THE PUBLIC CONCERNING WELLNESS TOPICS AND HEALTH RISK CONCERNS. ADDITIONALLY, COMMUNITY HOSPITAL WILL CONTINUE TO INCREASE AWARENESS OF AND ACCESS TO ITS EDUCATIONAL OFFERINGS. 1.B. COMMUNITY HOSPITAL WILL CONTINUE TO HOST AND/OR PARTICIPATE IN LOCAL HEALTH-RELATED EVENTS TO PROMOTE HOSPITAL SERVICES, OFFER A VARIETY OF HEALTH SCREENINGS TO THE COMMUNITY, AND/OR SUPPORT OR PARTNER WITH LOCAL ORGANIZATIONS THAT PROVIDE SERVICES TO VULNERABLE POPULATIONS.1.C. COMMUNITY HOSPITAL WILL CONTINUE TO HOST VARIOUS SUPPORT AND EDUCATIONAL GROUPS AT THE FACILITY.1.D. COMMUNITY HOSPITAL PERSONNEL WILL CONTINUE TO SERVE IN LEADERSHIP ROLES AND AS VOLUNTEERS WITH MANY AGENCIES AND COMMITTEES IN THE COMMUNITY. ADDITIONALLY, COMMUNITY HOSPITAL WILL CONTINUE TO PROVIDE STAFF REPRESENTATION AT VARIOUS CONFERENCES AND IN LOCAL CONSORTIUMS FOCUSED AROUND ITS PATIENT POPULATION'S NEEDS.1.E. COMMUNITY HOSPITAL WILL CONTINUE TO SERVE AS THE BACKBONE ORGANIZATION FOR THE COMMUNITIES OF EXCELLENCE INITIATIVE, INCLUDING WELLNESS MCCOOK, IN COLLABORATION WITH SEVERAL LOCAL PARTNER ORGANIZATIONS TO IMPROVE THE OVERALL QUALITY OF LIFE IN THE COMMUNITY.1.F. COMMUNITY HOSPITAL WILL CONTINUE TO INCENTIVIZE EMPLOYEES AND THEIR FAMILIES TO PARTICIPATE IN REGULAR PHYSICAL ACTIVITY THROUGH A DISCOUNTED MEMBERSHIP AT LOCAL GYM AND RECREATION FACILITIES, AS WELL AS WELLNESS INCENTIVES TOWARDS EMPLOYEE HEALTH INSURANCE PREMIUMS.1.G. COMMUNITY HOSPITAL WILL PROMOTE LOCAL RADON MITIGATION EFFORTS IN THE COMMUNITY.PRIORITY TWO: FOCUS ON THE NEEDS OF THE AGING POPULATION HAS SIX ACTION STEPS, ALL OF WHICH ARE IN PROGRESS:2.A. COMMUNITY HOSPITAL WILL CONTINUE TO PROVIDE HOME HEALTH, HOSPICE, AND PALLIATIVE CARE SERVICES FOR APPLICABLE RESIDENTS. FURTHERMORE, COMMUNITY HOSPITAL WILL CONTINUE TO FOCUS ON THE PATIENT'S FAMILY WELLBEING BY PROVIDING RESPITE CARE IN ORDER TO REDUCE CAREGIVER BURNOUT. 2.B. COMMUNITY HOSPITAL WILL CONTINUE TO MEET WITH LOCAL NURSING HOMES AND ASSISTED LIVING FACILITIES ON A QUARTERLY BASIS AND COMPREHENSIVELY DISCUSS ANY EMERGING ISSUES IN THE AREA AND HOW TO ADDRESS SUCH ISSUES TO IMPROVE QUALITY AND EFFICIENCY OF CARE FOR PATIENTS.2.C. COMMUNITY HOSPITAL STAFF MEMBERS REGULARLY VOLUNTEER AT THE LOCAL MEALS ON WHEELS AND SENIOR CENTER ORGANIZATIONS TO SUPPORT THE NEEDS OF ELDERLY RESIDENTS IN THE COMMUNITY.2.D. COMMUNITY HOSPITAL WILL CONTINUE TO PROVIDE FREE, MONTHLY LUNCH AND LEARN EVENTS ON HEALTH-RELATED TOPICS FOR THE ELDERLY.2.E. COMMUNITY HOSPITAL WILL CONTINUE TO OFFER FITNESS REACHING OLDER GENERATIONS (FROG) CLASSES TO ELDERLY RESIDENTS IN ORDER TO PROMOTE PHYSICAL ACTIVITY AMONG SENIORS. 2.F. THROUGH THE CNA INITIATIVE, COMMUNITY HOSPITAL PARTNERS WITH NURSING HOMES, SCHOOLS AND OTHERS IN THE REGION TO SUPPORT AND ENCOURAGE INTERESTED INDIVIDUALS TO PURSUE OPPORTUNITIES AS A PRACTICING CNA OR RN IN THE COMMUNITY.PRIORITY THREE: CONTINUED EMPHASIS ON PHYSICIAN RECRUITMENT AND RETENTION HAS FOUR ACTION STEPS, ALL CURRENTLY IN PROGRESS:3.A. COMMUNITY HOSPITAL OFFERS SEVERAL MEDICAL CLINICS OFFERING A VARIETY OF SPECIALTY CARE SERVICES. THE COMMUNITIES OF TRENTON AND CURTIS ARE SERVED BY LOCAL RURAL CLINICS PROVIDED BY COMMUNITY HOSPITAL. ADDITIONALLY, COMMUNITY HOSPITAL WILL ASSESS INFORMATION FROM THE SEMI-ANNUAL MARKET ASSESSMENT AND WILL CONTINUE TO TRACK RECRUITING EFFORTS OF NEW SPECIALISTS THROUGH SERVICE SEED. AS OPPORTUNITIES FOR ADDITIONAL SERVICES ARE EVALUATED, COMMUNITY HOSPITAL WILL ALSO FOCUS ON APPROPRIATE STAFFING FOR THE ADDITION OF SUCH SERVICES.3.B. COMMUNITY HOSPITAL WILL CONTINUE TO OFFER VARIOUS MOBILE SERVICES ON A REGULAR BASIS, SUCH AS PET/CT, CARDIOVASCULAR SCREENINGS, AND NUCLEAR STUDIES.3.C. COMMUNITY HOSPITAL MAINTAINS AN UPDATED CALENDAR OF VISITING SPECIALISTS ON ITS WEBSITE FOR RESIDENTS TO ACCESS AND UTILIZE IN PLANNING HEALTH CARE APPOINTMENTS. ADDITIONALLY, COMMUNITY HOSPITAL WILL CONTINUE TO IMPLEMENT ROTATING FACEBOOK ADVERTISEMENTS FEATURING VISITING SPECIALISTS.3.D. COMMUNITY HOSPITAL WILL CONTINUE TO SERVE AS A TEACHING FACILITY AND ALLOW FOR STUDENTS PURSUING HEALTH-RELATED CAREERS TO ROTATE THROUGH THE FACILITY FOR A VARIETY OF PROGRAMS, INCLUDING, BUT NOT LIMITED TO, THERAPY, PHARMACY, NURSING, AND PUBLIC HEALTH.PRIORITY FOUR: ACCESS TO AFFORDABLE CARE AND REDUCING HEALTH DISPARITIES AMONG SPECIFIC POPULATIONS HAS SIX ACTION STEPS, EITHER COMPLETED OR IN PROGRESS WITH THE EXCEPTION OF 4.A. ON HOLD DUE TO EMS STAFFING LIMITATIONS: 4.A. THE HOSPITAL WILL CONTINUE TO PARTICIPATE IN THE MCCOOK PARAMEDICINE PROGRAM IN PARTNERSHIP WITH THE LOCAL FIRE DEPARTMENT AND PRIMARY CARE CLINIC TO VISIT THE HOMES OF SELECT PATIENTS IDENTIFIED THROUGH A SCREENING PROCESS AND PRACTITIONER REFERRAL. 4.B. COMMUNITY HOSPITAL WILL CONTINUE TO HOST AND PARTICIPATE IN DONATION DRIVES AND FUNDRAISING EVENTS TO BENEFIT UNDERSERVED ORGANIZATIONS IN THE COMMUNITY, AS WELL AS EDUCATIONAL EVENTS.4.C. COMMUNITY HOSPITAL WILL CONTINUE TO PROVIDE A LANGUAGE LINE TO OFFER TRANSLATION SERVICES FOR NON-ENGLISH SPEAKING PATIENTS AND FAMILIES AS NEEDED. 4.D. COMMUNITY HOSPITAL PROVIDES FINANCIAL COUNSELING SERVICES FOR PATIENTS REQUIRING ASSISTANCE.4.E. IN CONJUNCTION WITH THE COMMUNITIES OF EXCELLENCE PROGRAM, COMMUNITY HOSPITAL WILL EXPLORE INCREASING ACCESS TO TRANSPORTATION SERVICES IN THE COMMUNITY.4.F. COMMUNITY HOSPITAL WILL CONTINUE TO INCREASE ACCESS TO CARE THROUGH THE PROVISION OF TELEHEALTH SERVICES TO APPLICABLE PATIENTS AND EXPLORE EXPANSION OF TELEHEALTH SERVICES AS OPPORTUNITIES ARISE.PRIORITY FIVE: ACCESS TO MENTAL AND BEHAVIORAL HEALTH CARE SERVICES AND PROVIDERS HAS FOUR ACTION STEPS, ALL OF WHICH ARE CURRENTLY IN PROGRESS: 5.A. COMMUNITY HOSPITAL WILL CONTINUE TO GROW AND EXPAND MENTAL HEALTH SERVICES PROVIDED TO THE COMMUNITY.5.B. COMMUNITY HOSPITAL WILL CONTINUE TO SHARE AN ANNUALLY-UPDATED LIST OF AREA AND TELEHEALTH PROVIDERS FOR MENTAL HEALTH SUPPORT AND COUNSELING SERVICES.5.C. COMMUNITY HOSPITAL WILL CONTINUE TO ADVOCATE AND EXPLORE OPPORTUNITIES TO SUPPORT OTHER OUTLETS IN THE COMMUNITY AND CONNECT PATIENTS WITH MENTAL AND BEHAVIORAL HEALTH RESOURCES AS OPPORTUNITIES ARISE.5.D. COMMUNITY HOSPITAL WILL CONTINUE TO OFFER MENTAL HEALTH SUPPORT TO ITS EMPLOYEES THROUGH THE EMPLOYEE ASSISTANCE PROGRAM (EAP). PRIORITY SIX: CONTINUED FOCUS ON COVID-19 PREVENTION & RESPONSE HAS FIVE ACTION STEPS, ALL OF WHICH ARE IN PROGRESS OR COMPLETED: 6.A. COMMUNITY HOSPITAL WILL CONTINUE TO PROVIDE EDUCATION ON COVID-19 AND PREVENTION MATERIALS AS OPPORTUNITIES ARISE.6.B. COMMUNITY HOSPITAL CONTINUES FOLLOWING CDC GUIDELINES AND CMS MANDATES TO CONTROL THE SPREAD AND REDUCE RISK OF COVID-19 INFECTION WHEN DISCHARGING PATIENTS TO A LOWER LEVEL OF CARE AND THEIR HOME ENVIRONMENT.6.C. COMMUNITY HOSPITAL WILL CONTINUE TO DONATE PPE (EX. MASKS, FACE SHIELDS, SURGICAL GOWNS, ETC.) TO LOCAL ORGANIZATIONS TO HELP CONTROL THE SPREAD AND REDUCE RISK OF COVID-19 INFECTION AS OPPORTUNITIES ARISE.6.D. COMMUNITY HOSPITAL CONTINUES TO REPORT COVID-19 TEST AND PATIENT ADMISSIONS DATA TO THE STATE AND CENTERS FOR DISEASE CONTROL (CDC) IN AN ONGOING EFFORT TO SHARE TIMELY INFORMATION AND RESEARCH REGARDING THE PANDEMIC. VACCINATION RATES AT THE HOSPITAL ARE ALSO PROVIDED.6.E. COMMUNITY HOSPITAL WILL PROVIDE SUPPORT STAFF AND SERVICES TO LOCAL ORGANIZATIONS AS APPROPRIATE TO HELP REDUCE THE IMPACT OF COVID-19.ALL IDENTIFIED COMMUNITY HEALTH NEEDS ARE INCLUDED AND ADDRESSED IN THE SIX PRIORITY AREAS INCLUDED IN CHNA AND RELATED ACTION PLANS. ACCORDINGLY, THERE CURRENTLY ARE NOT ANY IDENTIFIED NEEDS THAT ARE NOT BEING ADDRESSED AS PART OF THE PLAN. |
| COMMUNITY HOSPITAL ASSOCIATION OF MCCOOK | PART V, SECTION B, LINE 13B: DISCOUNTING OR 100% WRITE-OFF TO CHARITY CARE IS ALLOWED ABOVE 150% 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 AND/OR OTHER DEBTS, THE LIKELIHOOD OF ONGOING MEDICAL CARE AND THE INDIVIDUAL'S OVERALL ABILITY TO PAY. |
| COMMUNITY HOSPITAL ASSOCIATION OF MCCOOK | PART V, SECTION B, LINE 16J: THE HOSPITAL PUBLICIZED THE FINANCIAL ASSISTANCE POLICY ON BILLING INVOICES, ON POSTERS IN THE ER AND WAITING ROOMS, AT THE ADMISSIONS DESKS, INCLUDING UPON ADMISSIONS WITH SUMMARY NOTICES OF THE POLICIES. THE COMPLETE POLICY WAS AVAILABLE ON THE HOSPITAL'S WEBSITE AND UPON REQUEST. THE HOSPITAL ALSO PUBLICIZED THE POLICY THROUGH REFERRALS BY CLINICAL, SOCIAL WORKERS, AND OTHER STAFF TO THE HOSPITALS FINANCIAL COUNSELORS. COMMUNITY HOSPITAL ASSOCIATION OF MCCOOK DOES NOT HAVE AN LEP POPULATION OF A SINGLE PRIMARY LANGUAGE THAT REACHES 1,000 INDIVIDUALS OR 5% OF THE COMMUNITY SERVED BY THE HOSPITAL. HOWEVER, WITH SPANISH AS THE PREDOMINANT NON-ENGLISH LANGUAGE WE HAVE OPTED TO OFFER A FAP APPLICATION FORM IN THAT LANGUAGE FOR OUR PATIENTS' CONVENIENCE. |
| SCHEDULE H, PART V, SECTION B, LINE 7A AND 10A: | COMMUNITY HEALTH NEEDS ASSESSMENT AND IMPLEMENTATIONSTRATEGY WEBSITE:HTTPS://CHMCCOOK.ORG/ABOUT/COMMUNITY-HEALTH-NEEDS-ASSESSMENT.HTML |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 3 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (3 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| 1 - COMMUNITY HEALTHCARE & HOSPICE | ||||
| 407 WEST 5TH STREET | MCCOOK | NE | 69001 | HOME HEALTH AND HOSPICE SERVICES |
| 2 - CURTIS MEDICAL CENTER | ||||
| 302 EAST 6TH STREET | CURTIS | NE | 69025 | RURAL HEALTH CLINIC-OUTPATIENT SERVICES |
| 3 - TRENTON MEDICAL CLINIC | ||||
| 406 EAST 1ST STREET | TRENTON | NE | 69044 | RURAL HEALTH CLINIC-OUTPATIENT SERVICES |
Supplemental Information Detail SupplementalInformationDetail (14 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 3C: | CHARITY CARE IS GRANTED TO ALL INDIVIDUALS WHOSE HOUSEHOLD INCOME IS BELOW 150% OF THE FEDERAL POVERTY GUIDELINE AT THE 100% WRITE-OFF LEVEL. DISCOUNTING OR 100% WRITE-OFF TO CHARITY CARE IS ALLOWED ABOVE 150% 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. |
| PART I, LINE 6A: | THE COMMUNITY BENEFIT REPORT IS PREPARED BY THE STAFF OF COMMUNITY HOSPITAL ASSOCIATION OF MCCOOK. |
| PART II, COMMUNITY BUILDING ACTIVITIES: | COMMUNITY HOSPITAL SUPPORTS VARIOUS COMMUNITY BUILDING ACTIVITIES, PRIMARILY THROUGH MONETARY SUPPORT. EXAMPLES INCLUDE SUPPORT TO THE ECONOMIC DEVELOPMENT CORPORATION, THE LOCAL COMMUNITY COLLEGE AND SOUTHWEST NEBRASKA LEADERSHIP INSTITUTE. 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. |
| PART III, LINE 2: | THE ORGANIZATION DETERMINES ITS ESTIMATE OF IMPLICIT PRICE CONCESSIONS BASED ON HISTORICAL COLLECTION EXPERIENCE WITH VARIOUS CLASSES OF PATIENTS. |
| PART III, LINE 3: | BASED ON A COMBINATION OF PAST EXPERIENCE AND CENSUS DATA AVAILABLE, THE HOSPITAL ESTIMATES 15% OF THE PATIENT IMPLICIT PRICE CONCESSIONS IS ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY. IN ACCORDANCE WITH ITS MISSION OBJECTIVES, THE HOSPITAL PROVIDES FINANCIAL ASSISTANCE TO PATIENTS WHO LACK FINANCIAL RESOURCES TO PAY FOR THE SERVICES THEY RECEIVE, AND THE HOSPITAL RECOGNIZES THE SPECIAL CONCERNS OF INDIVIDUALS AND HOUSEHOLDS WITH LIMITED FINANCIAL RESOURCES OR WHO ARE OTHERWISE VULNERABLE WITHIN THE COMMUNITY THE HOSPITAL SERVICES. |
| PART III, LINE 4: | PAGES 10, 14, AND 15 OF THE ATTACHED AUDITED FINANCIAL STATEMENTS INCLUDE FOOTNOTES TITLED "PATIENT RECEIVABLES," "PATIENT SERVICE REVENUE, AND "PATIENT FINANCIAL ASSISTANCE" THAT PROVIDE DESCRIPTIONS OF IMPLICIT PRICE CONCESSIONS. |
| PART III, LINE 8: | THE SOURCE USED TO DETERMINE THE AMOUNT REPORTED ON LINE 6 WAS THE MEDICARE COST REPORT. NO MEDICARE SHORTFALL IS TREATED AS COMMUNITY BENEFITS. |
| PART III, LINE 9B: | COMMUNITY HOSPITAL GRANTS 100% CHARITY CARE FOR PATIENTS KNOWN TO QUALIFY FOR FINANCIAL ASSISTANCE. OUR CHARITY CARE POLICY IS SET AT 150% OF THE FEDERAL POVERTY GUIDELINE BASED FAMILY SIZE. FOR PATIENTS THAT EXCEED THE INCOME THRESHOLD OF THE CHARITY CARE POLICY, OUR MEDICALLY INDIGENT FINANCIAL ASSISTANCE IS AVAILABLE FOR PATIENTS THAT HAVE INCURRED CATASTROPHIC MEDICAL COSTS OR OTHER OBLIGATIONS (PRESENTLY OR ONGOING) THAT HAVE SUBSTANTIALLY REDUCED THEIR ABILITY TO PAY. IN SUCH CASES, THE INDIVIDUAL OR GUARANTOR MAY BE DETERMINED BY THE HOSPITAL TO BE MEDICALLY INDIGENT AND MAY, AT THE HOSPITAL'S DISCRETION, BE ELIGIBLE FOR FINANCIAL ASSISTANCE IN THE FORM OF FREE OR DISCOUNTED LIABILITIES.CERTAIN CLASSES OF PATIENTS ARE DEEMED TO HAVE QUALIFIED FOR CHARITY CARE WITHOUT AN APPLICATION. ACCOUNTS THAT MAY QUALIFY FOR FINANCIAL ASSISTANCE WITHOUT A COMPLETED APPLICATION INCLUDE:1. MEDICAID SHARE OF COST PORTIONS.2. MEDICAID APPLICATIONS APPROVED FOR SUBSEQUENT CARE (NOT RETROACTIVE TO THE LIABILITY).3. PATIENTS OR GUARANTORS WHO HAVE DECLARED BANKRUPTCY.4. PATIENTS OR GUARANTORS WHO ARE DECEASED WITH NO ESTATE IN PROBATE AND FOR WHOM NO ONE ELSE (SUCH AS A SPOUSE OR LEGAL GUARDIAN) IS LEGALLY RESPONSIBLE FOR THE LIABILITY.5. PATIENTS OR GUARANTORS DETERMINED TO BE HOMELESS. |
| PART VI, LINE 2: | COMMUNITY HOSPITAL HAS COMPLETED A COMMUNITY HEALTH NEEDS ASSESSMENT. ACTION PLANS ARE IN PLACE TO ADDRESS THE IDENTIFIED NEEDS IN THE REPORT. |
| PART VI, LINE 3: | IDENTIFICATION OF PATIENTS WITH A POTENTIAL NEED FOR FINANCIAL ASSISTANCE WILL BE ACCOMPLISHED BY BOTH AN OPEN AND PUBLICIZED APPLICATION PROCESS AND A VARIETY OF SCREENING OPPORTUNITIES INCLUDING:A. ADMISSIONS/REGISTRATION PERSONNEL BASED UPON INFORMATION RECEIVED DURING THE REGISTRATION PROCESS.B. SOCIAL SERVICES PERSONNEL BASED UPON INFORMATION DURING THE INITIAL VISIT AND DISCHARGE PLANNING.C. NURSING STAFF BASED UPON INFORMATION RECEIVED DURING DISCUSSIONS WITH FAMILY AND/OR PATIENT.D. BUSINESS OFFICE PERSONNEL BASED UPON STATUS OF ACCOUNTS AND DISCUSSIONS WITH RESPONSIBLE PARTY.E. ACCOUNTS RECEIVABLE REPORTS.HOSPITAL STAFF OR THE NOTIFIED PATIENT ADVOCATE WILL EDUCATE THE PATIENT OR GUARANTOR ABOUT THE FINANCIAL ASSISTANCE POLICY AND WILL PROVIDE THEM AN APPLICATION FOR FINANCIAL ASSISTANCE. IF NECESSARY, THE PATIENT FINANCIAL COUNSELOR OR OTHER HOSPITAL STAFF MAY ASSIST THE PATIENT IN COMPLETING THE APPLICATION; HOWEVER, THE COMPLETION OF AN APPLICATION AND PROVIDING ALL NECESSARY SUPPORTING DOCUMENTATION IS THE PATIENT'S RESPONSIBILITY. PATIENTS MAY ALSO REQUEST AN APPLICATION OR ADDITIONAL INFORMATION IN PERSON AT THE ADMISSIONS OFFICE OR BY CALLING OR WRITING THE PATIENT FINANCIAL COUNSELOR AND AN APPLICATION WILL BE MAILED. |
| PART VI, LINE 4: | COMMUNITY HOSPITAL SERVES A PRIMARY MARKET OF RED WILLOW COUNTY, WHICH IS LOCATED ON THE SOUTHERN BORDER OF NEBRASKA. IT IS 717 SQUARE MILES AND HAS APPROXIMATELY 15.0 PEOPLE PER SQUARE MILE. MCCOOK IS THE COUNTY SEAT. COMMUNITY HOSPITAL ALSO SERVES A SECONDARY MARKET INCLUDING NORTHERN KANSAS AND SOUTHWEST NEBRASKA, WHICH CONSISTS OF FURNAS, NE, HITCHCOCK, NE, DECATUR, KS, CHEYENNE, KS, FRONTIER, NE, RAWLINS, KS AND HAYES, NE. THE TOTAL ESTIMATED POPULATION FOR COMMUNITY HOSPITAL'S SERVICE AREA IS APPROXIMATELY 30,348. RED WILLOW COUNTY HAS A POPULATION OF APPROXIMATELY 10,747. THE GROUP OF COUNTIES WHICH MAKE UP THE SECONDARY MARKET FOR COMMUNITY HOSPITAL HAVE A POPULATION OF APPROXIMATELY 19,601. THE HOUSEHOLD INCOME AVERAGES FOR THESE AREAS ARE AS FOLLOWS:11.75% $0 - 15K14.5% $15K - 25K29% $25K - 50K18.5% $50K - 75K12.5% $75K - 100K13.5% $100K+ |
| PART VI, LINE 5: | 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 IN WHICH 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. |
| PART VI, LINE 6: | N/A |
| PART VI, LINE 7, REPORTS FILED WITH STATES | NE |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (1) | GrantRecordsMaintainedInd |
Recipient Table RecipientTable (6 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | Recipient EINRecipientEIN | IRC SectionIRCSectionDesc | Cash GrantCashGrantAmt | Non Cash AssistanceNonCashAssistanceAmt | Purpose Of GrantPurposeOfGrantTxt |
|---|---|---|---|---|---|---|---|---|
| COMMUNITY HOSPITAL HEALTH FOUNDATION | ||||||||
| 1301 E H ST | MCCOOK | NE | 69001 | 470693261 | 501(C)(3) | $78,809 | $0 | TO SUPPORT THE MISSION OF THE FOUNDATION |
| MCCOOK COLLEGE FOUNDATION | ||||||||
| 1205 EAST 1ST ST | MCCOOK | NE | 69001 | 476089800 | 501(C)(3) | $55,900 | $0 | PLEDGE FOR HEALTH SCIENCES CENTER AND SCHOLARSHIPS |
| UNIVERSITY OF NEBRASKA FOUNDATION | ||||||||
| 1010 LINCOLN MALL SUITE 300 | LINCOLN | NE | 68508 | 470379839 | 501(C)(3) | $7,500 | $0 | DONATION TO SUPPORT THE HEALTH SCIENCES PROGRAM (KHOP) |
| MCCOOK CHRISTIAN CHURCH | ||||||||
| 507 W B ST | MCCOOK | NE | 69001 | 053812790 | 501(C)(3) | $12,500 | $0 | PATIENT ASSISTANCE FUND AND SPONSORSHIP OF THE FREEDOM FESTIVAL |
| YMCA OF MCCOOK | ||||||||
| PO BOX 408 | MCCOOK | NE | 69001 | 470377999 | 501(C)(3) | $105,000 | $0 | PLEDGE ON REMODEL CAMPAIGN AND NEW BASKETBALL HOOPS |
| NORTH PLATTE COMMUNITY COLLEGE FOUNDATION | ||||||||
| 601 WEST STATE FARM RD | NORTH PLATTE | NE | 69101 | 202459157 | 501(C)(3) | $10,000 | $0 | PLEDGE FOR HEALTH SCIENCES CENTER |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 6 | Total501c3OrgCnt |
| Total Other Org | 0 | TotalOtherOrgCnt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 2: | FormAndLineReferenceDesc |
| Explanation | GRANTS ARE MADE ONLY TO SELECTED CHARITABLE OR OTHER EXEMPT ORGANIZATIONS. COMMUNITY HOSPITAL ASSOCIATION ENTERS INTO AGREEMENTS WITH GRANTEES THAT GRANT FUNDS WILL BE RESTRICTED TO SPECIFIED EXEMPT PURPOSES. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Written Employment Contract | Yes (X) | WrittenEmploymentContractInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (7 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| RICHARD LAWTON | ||||||||||||||
| ORTHO PHYSICAN | $719,795 | $0 | $0 | $0 | $1,931 | $0 | $21,350 | $0 | $28,767 | $0 | $771,843 | $0 | $0 | $0 |
| ROSS BEAVERS | ||||||||||||||
| CRNA | $319,875 | $0 | $6,570 | $0 | $790 | $0 | $21,350 | $0 | $1,080 | $0 | $349,665 | $0 | $0 | $0 |
| TROY BRUNTZ | ||||||||||||||
| CEO | $289,611 | $0 | $6,148 | $0 | $1,367 | $0 | $21,202 | $0 | $21,705 | $0 | $340,033 | $0 | $0 | $0 |
| EVAN GEILENKIRCHEN | ||||||||||||||
| CRNA | $284,371 | $0 | $5,960 | $0 | $1,966 | $0 | $21,020 | $0 | $22,105 | $0 | $335,422 | $0 | $0 | $0 |
| GABRIAL SCHEER | ||||||||||||||
| CRNA | $272,563 | $0 | $5,557 | $0 | $750 | $0 | $19,996 | $0 | $19,756 | $0 | $318,622 | $0 | $0 | $0 |
| SEAN WOLFE | ||||||||||||||
| CFO | $189,535 | $0 | $3,822 | $0 | $651 | $0 | $14,202 | $0 | $29,716 | $0 | $237,926 | $0 | $0 | $0 |
| ANTHONY RODEWALD | ||||||||||||||
| PHARMACY DIRECTOR | $197,554 | $0 | $3,454 | $0 | $540 | $0 | $14,651 | $0 | $25,505 | $0 | $241,704 | $0 | $0 | $0 |
Schedule L IRS990ScheduleL
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp
Name Of Interested NameOfInterested
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | HANNAH TAYLOR | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Relationship Description | BOARD MEMBER DARREN ESCH'S DAUGHTER | RelationshipDescriptionTxt |
| Transaction | $90,926 | TransactionAmt |
| Transaction | WAGES | TransactionDesc |
| Sharing Of Revenues | 0 | SharingOfRevenuesInd |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (9 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 6 | THE MEMBERS CONSIST OF ALL PERSONS WHO CONTRIBUTE TO THE BUILDING AND IMPROVEMENT FUND OF THE CORPORATION, AT ANY TIME DURING THE EXISTENCE OF THE CORPORATION, NOT LESS THAN THE SUM OF $100. |
| FORM 990, PART VI, SECTION A, LINE 7A | THE MEMBERS ELECT THE BOARD OF DIRECTORS AT THE ANNUAL MEETING EACH YEAR. |
| FORM 990, PART VI, SECTION A, LINE 8B | THERE IS NO COMMITTEE WITH AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY. |
| FORM 990, PART VI, SECTION B, LINE 11B | COMMUNITY HOSPITAL'S FORM 990 & 990-T ARE PREPARED BY THE PUBLIC ACCOUNTING FIRM EIDE BAILLY. MANAGEMENT RECEIVES DRAFT COPIES OF THE COMPLETED FORMS FOR REVIEW. AFTER HOSPITAL MANAGEMENT HAS REVIEWED THE RETURNS, COMPLETE COPIES ARE DISTRIBUTED TO ALL MEMBERS OF THE BOARD OF DIRECTORS OF THE COMMUNITY HOSPITAL ASSOCIATION. |
| 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 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 HOSPITAL'S 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 MAY 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 IX, LINE 11G | MISCELLANEOUS FEES FOR SERVICE: PROGRAM SERVICE EXPENSES 2,340,199. MANAGEMENT AND GENERAL EXPENSES 1,101,863. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,442,062. PHYSICIAN FEES: PROGRAM SERVICE EXPENSES 3,463,848. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,463,848. MAINTENANCE CONTRACTS: PROGRAM SERVICE EXPENSES 948,272. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 948,272. PT CONTRACT SERVICES: PROGRAM SERVICE EXPENSES 1,265,167. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,265,167. COLLECTION FEES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 131,288. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 131,288. |
| FORM 990, PART XII, 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
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp
Disregarded Entity Name DisregardedEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | COMMUNITY HOSPITAL HEALTH FOUNDATION | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 801 WEST C STREET PO BOX 1328 | AddressLine1Txt |
| City | MCCOOK | CityNm |
| State Abbreviation | NE | StateAbbreviationCd |
| ZIP | 69001 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 470693261 | EIN |
| Primary Activities | SUPPORTING ORGANIZATION PROVIDES FUNDRAISING FOR THE HOSPITAL | PrimaryActivitiesTxt |
| Legal Domicile State | NE | LegalDomicileStateCd |
| Exempt Code Section | 501(C)(3) | ExemptCodeSectionTxt |
| Public Charity Status | LINE 12A, I | PublicCharityStatusTxt |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | COMMUNITY HOSPITAL ASSOCIATION OF MCCOOK | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Controlled Organization | Yes (1) | ControlledOrganizationInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | Yes (1) | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (1) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | Yes (1) | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (1) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (1) | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (1) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (1) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp (2 entries)
| Transaction TypeTransactionTypeTxt | InvolvedInvolvedAmt | Method Of Amount DeterminationMethodOfAmountDeterminationTxt |
|---|---|---|
| COMMUNITY HOSPITAL HEALTH FOUNDATION | ||
| C | $355,477 | CASH TRANSFERRED EQUALS FMV |
| COMMUNITY HOSPITAL HEALTH FOUNDATION | ||
| B | $78,809 | CASH TRANSFERRED EQUALS FMV |