2024-05-14T14:04:40-05:00 2023-06-30 450250958 EIDE BAILLY LLP 18081 BURT ST STE 200 OMAHA NE 680224722 990 2022-07-01 470533373 COMMUNITY HOSPITAL ASSOCIATION OF MCCOOK COMM 3083442650 1301 EAST H STREET PO BOX 1328 MCCOOK NE 69001 SEAN WOLFE CHIEF FINANCIAL OFFICER 3083442650 2024-05-13 1 SEAN WOLFE 999009999 1 WENDY R COOLEY CPA P01523804 4023302660 2024-05-13 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z SEAN WOLFE 1301 EAST H STREET PO BOX 1328 MCCOOK NE 69001 59977503 0 X WWW.CHMCCOOK.ORG X 1974 NE TO EXCEL AT PROVIDING FOR THE HEALTHCARE NEEDS OF OUR REGION THROUGH QUALITY, EFFICIENT AND PATIENT-CENTERED CARE. 9 8 386 25 0 0 788620 1924082 59327368 56537518 81698 887554 657511 625743 60855197 59974897 173956 294782 0 0 28771903 30441643 0 0 402189 27881087 29383898 56826946 60120323 4028251 -145426 97428013 92073756 38588208 33192371 58839805 58881385 LEADING OUR REGION TO A HEALTHIER FUTURE. 0 0 49298930 294782 56675419 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. 49298930 1 1 0 1 0 0 0 0 0 1 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 1 1 1 0 0 1 69 0 1 386 1 0 0 0 0 0 0 0 0 0 0 0 0 X 9 8 0 0 0 0 1 1 0 1 0 0 0 1 1 1 1 1 1 1 1 0 X SEAN WOLFE 3083448306 1301 EAST H - PO BOX 1328 MCCOOK NE 69001 RICHARD LAWTON ORTHO PHYSICAN 40.00 0.00 X 721726 0 50117 ROSS BEAVERS CRNA 40.00 0.00 X 327235 0 22430 TROY BRUNTZ CEO 39.00 1.00 X 297126 0 42907 EVAN GEILENKIRCHEN CRNA 40.00 0.00 X 292297 0 43125 GABRIAL SCHEER CRNA 40.00 0.00 X 278870 0 39752 SEAN WOLFE CFO 40.00 0.00 X 194008 0 43918 ANTHONY RODEWALD PHARMACY DIRECTOR 40.00 0.00 X 201548 0 40156 KRISTIN STAGEMEYER CPA CHAIR 2.00 1.00 X X 0 0 0 GARRETT RIPPEN VICE CHAIR 2.00 0.00 X X 0 0 0 MATTHEW NIELSEN SECRETARY 2.00 0.00 X X 0 0 0 LENA KOEBEL SECRETARY THRU 12/22 2.00 0.00 X X 0 0 0 DARREN ESCH TREASURER 2.00 0.00 X X 0 0 0 JANA KMOCH DIRECTOR 1.00 0.00 X 0 0 0 KURT VOSBURG DIRECTOR 1.00 1.00 X 0 0 0 MICHAEL LORD DIRECTOR 1.00 0.00 X 0 0 0 ASHLEY VONTZ DIRECTOR 1.00 1.00 X 0 0 0 MATTHEW DAVIDSON DIRECTOR 1.00 0.00 X 0 0 0 RICK HANEY DIRECTOR THRU 12/22 1.00 1.00 X 0 0 0 2312810 0 282405 30 0 1 0 SOUTHWEST NEBRASKA PHYSICAL THERAPY 1301 EAST H STREET MCCOOK NE 69001 PHYSICAL THERAPY SERVICES 1379847 MCCOOK CLINIC 1401 EAST H STREET MCCOOK NE 69001 ER COVERAGE 1002995 BARTON ASSOCIATES INC PO BOX 417844 BOSTON MA 02241 ER LOCUM 660630 PATHOLOGY SERVICES PO BOX 1289 NORTH PLATTE NE 69103 LAB FEES 502902 MEDICAL SOLUTIONS PO BOX 850737 MINNEAPOLIS MN 55485 TRAVELING NURSES 501364 11 355477 1568605 1924082 MEDICARE/MEDICAID PAYMENTS 621400 31052149 31052149 PATIENT SERVICE REVENUE 621400 24931295 24931295 340B PAYMENT 621400 299511 299511 OUT-SOURCE SERVICES 621400 254563 254563 56537518 811075 811075 252616 0 252616 252616 252616 79085 2606 76479 76479 76479 CAFETERIA/MEALS 900099 235226 235226 HOUSEKEEPING INCOME 900099 107710 107710 30191 30191 373127 59974897 56675419 0 1375396 X 294782 294782 573075 573075 74850 74850 22956216 18114215 4668812 173189 1427046 1141559 274559 10928 3605071 2835379 715283 54409 1805385 1413425 378488 13472 63731 63731 84900 84900 9250637 8017486 1233151 202889 202889 1640531 1083528 556029 974 344144 264467 79677 1087237 1080614 6623 56899 34218 22681 717263 387118 328583 1562 1129157 1124030 5127 5442896 5044680 398216 368377 367367 1010 MEDICAL SUPPLIES 8015619 8015619 MISCELLANEOUS 902421 754766 147655 MEMBERSHIPS & DUES 77197 5593 71604 60120323 49298930 10419204 402189 1600 1600 35954981 31335385 8618946 7835220 174 2019565 1922883 2058710 2638840 103075363 59886546 45175307 43188817 3254878 3495268 343852 464702 0 1191041 97428013 92073756 4655088 4336469 378009 493584 28329222 28345753 5225889 16565 38588208 33192371 X 58839805 58881385 58839805 58881385 97428013 92073756 -145426 187006 0 X X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 5343 5343 0 PART II-B, LINE 1: 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. 3482371 5110 214711 41328 3660864 3811948 5826 -260507 74896 3482371 3290398 12744 508806 3811948 3130914 4680 180448 10800 11875 2969 3290398 2905827 4790 306693 16500 55917 13979 3130914 0.56252 0.43748 0.00000 0 1 1 101803 101803 38752853 35426530 3326323 58313279 24460016 33853263 5907428 5907428 43188817 REFUNDABLE ADVANCES 16565 16565 X 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. 1 1 X 1 X 0 1 1 1 0 1 1 1279549 0 1279549 0.02130 4935570 3878722 1056848 0.01760 6215119 3878722 2336397 0.03890 26962 0 26962 0.00040 296442 0 296442 0.00490 323404 323404 0.00530 6538523 3878722 2659801 0.04420 1 2161477 324222 24643817 25787092 -1143275 X 1 1 1 1 COMMUNITY HOSPITAL ASSOCIATION OF MCCOOK 1301 EAST H STREET - PO BOX 1328 MCCOOK NE 69001 WWW.CHMCCOOK.ORG 320007 X X X X COMMUNITY HOSPITAL ASSOCIATION OF MCCOOK 1 0 0 1 X X X X X X X X X 22 1 0 0 1 X PART V, PAGE 8 X 1 22 1 PART V, PAGE 8 0 1 X 150.000000000000 X X 1 1 X X X 1 X HTTPS://CHMCCOOK.ORG/FOR-PATIENTS/FINANCIAL-ASSISTANCE.HTML X HTTPS://CHMCCOOK.ORG/FOR-PATIENTS/FINANCIAL-ASSISTANCE.HTML X HTTPS://CHMCCOOK.ORG/FOR-PATIENTS/FINANCIAL-ASSISTANCE.HTML X X X X X X X 1 X 0 X X X X 1 X 0 0 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 3 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 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 1 COMMUNITY HOSPITAL HEALTH FOUNDATION 1301 E H ST MCCOOK NE 69001 470693261 501(C)(3) 78809 0 TO SUPPORT THE MISSION OF THE FOUNDATION MCCOOK COLLEGE FOUNDATION 1205 EAST 1ST ST MCCOOK NE 69001 476089800 501(C)(3) 55900 0 PLEDGE FOR HEALTH SCIENCES CENTER AND SCHOLARSHIPS UNIVERSITY OF NEBRASKA FOUNDATION 1010 LINCOLN MALL SUITE 300 LINCOLN NE 68508 470379839 501(C)(3) 7500 0 DONATION TO SUPPORT THE HEALTH SCIENCES PROGRAM (KHOP) MCCOOK CHRISTIAN CHURCH 507 W B ST MCCOOK NE 69001 053812790 501(C)(3) 12500 0 PATIENT ASSISTANCE FUND AND SPONSORSHIP OF THE FREEDOM FESTIVAL YMCA OF MCCOOK PO BOX 408 MCCOOK NE 69001 470377999 501(C)(3) 105000 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) 10000 0 PLEDGE FOR HEALTH SCIENCES CENTER 6 0 PART I, LINE 2: 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. X X X X 0 0 0 0 0 0 0 0 0 RICHARD LAWTON ORTHO PHYSICAN 719795 0 0 0 1931 0 21350 0 28767 0 771843 0 0 0 ROSS BEAVERS CRNA 319875 0 6570 0 790 0 21350 0 1080 0 349665 0 0 0 TROY BRUNTZ CEO 289611 0 6148 0 1367 0 21202 0 21705 0 340033 0 0 0 EVAN GEILENKIRCHEN CRNA 284371 0 5960 0 1966 0 21020 0 22105 0 335422 0 0 0 GABRIAL SCHEER CRNA 272563 0 5557 0 750 0 19996 0 19756 0 318622 0 0 0 SEAN WOLFE CFO 189535 0 3822 0 651 0 14202 0 29716 0 237926 0 0 0 ANTHONY RODEWALD PHARMACY DIRECTOR 197554 0 3454 0 540 0 14651 0 25505 0 241704 0 0 0 HANNAH TAYLOR BOARD MEMBER DARREN ESCH'S DAUGHTER 90926 WAGES 0 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. COMMUNITY HOSPITAL HEALTH FOUNDATION 801 WEST C STREET PO BOX 1328 MCCOOK NE 69001 470693261 SUPPORTING ORGANIZATION PROVIDES FUNDRAISING FOR THE HOSPITAL NE 501(C)(3) LINE 12A, I COMMUNITY HOSPITAL ASSOCIATION OF MCCOOK 1 0 1 1 0 0 0 0 0 0 0 1 0 1 1 1 1 1 0 0 COMMUNITY HOSPITAL HEALTH FOUNDATION C 355477 CASH TRANSFERRED EQUALS FMV COMMUNITY HOSPITAL HEALTH FOUNDATION B 78809 CASH TRANSFERRED EQUALS FMV