COMMUNITY MEDICAL CENTER INC: Form 990, tax year 2021
View the entire original 990 at ProPublica ↗
- Organization
- COMMUNITY MEDICAL CENTER INC (EIN 47-0421272)
- Tax period
- 2021-08-01 to 2022-07-31
- Filed
- 2023-06-07
- IRS object ID
- 202301589349300945
- Schema version
- 2021v4.0
- 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 J
- Schedule K
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2023-06-07T16:37:57-04:00 | ReturnTs |
| Tax Period End | 2022-07-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 470585450 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DOHMAN AKERLUND & EDDY LLC | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 470 | AddressLine1Txt |
| City | AURORA | CityNm |
| State Abbreviation | NE | StateAbbreviationCd |
| ZIP | 688180470 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2021-08-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 470421272 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | COMMUNITY MEDICAL CENTER INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | COMM | BusinessNameControlTxt |
| Phone | 4022456500 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3307 BARADA STREET | AddressLine1Txt |
| City | FALLS CITY | CityNm |
| State Abbreviation | NE | StateAbbreviationCd |
| ZIP | 68355 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | RYAN LARSEN | PersonNm |
| Person Title | CEO | PersonTitleTxt |
| Phone | 4022456501 | PhoneNum |
| Signature | 2023-06-07 | SignatureDt |
| Discuss With Paid Preparer | Yes (true) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | RYAN | PersonFirstNm |
| Person Last | LARSEN | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | TIMOTHY J COUFAL CPA | PreparerPersonNm |
| PTIN | P00964304 | PTIN |
| Phone | 4026946404 | PhoneNum |
| Preparation | 2023-06-07 | PreparationDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2021 | TaxYr |
| Build TS | 2023-04-26 12:10:37Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | RYAN LARSEN | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | SAME AS C ABOVE | AddressLine1Txt |
| City | FALLS CITY | CityNm |
| State Abbreviation | NE | StateAbbreviationCd |
| ZIP | 68355 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $31,528,298 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | HTTP://CMCFC.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1995 | FormationYr |
| Legal Domicile State | NE | LegalDomicileStateCd |
| Activity Or Mission | TO OFFER GENERAL HEALTHCARE SERVICES WITHIN THE SCOPE OF ITS LICENSE AND CAPABILITIES; TO RENDER HEALTHCARE TO ALL PERSONS WITHOUT RESPECT TO RACE, REGLIGIOUS BELIEFS OR FINANCIAL STANDING. | ActivityOrMissionDesc |
| Voting Members Governing Body | 10 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 9 | VotingMembersIndependentCnt |
| Total Employee | 227 | TotalEmployeeCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| PY Contributions Grants | $5,287,028 | PYContributionsGrantsAmt |
| CY Contributions Grants | $1,182,871 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $25,900,807 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $30,049,772 | CYProgramServiceRevenueAmt |
| PY Investment Income | $177,874 | PYInvestmentIncomeAmt |
| CY Investment Income | $286,087 | CYInvestmentIncomeAmt |
| CY Other Revenue | $0 | CYOtherRevenueAmt |
| PY Total Revenue | $31,365,709 | PYTotalRevenueAmt |
| CY Total Revenue | $31,518,730 | CYTotalRevenueAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $12,911,698 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $13,866,447 | CYSalariesCompEmpBnftPaidAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $13,476,647 | PYOtherExpensesAmt |
| CY Other Expenses | $15,779,440 | CYOtherExpensesAmt |
| PY Total Expenses | $26,388,345 | PYTotalExpensesAmt |
| CY Total Expenses | $29,645,887 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $4,977,364 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $1,872,843 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $48,885,584 | TotalAssetsBOYAmt |
| Total Assets EOY | $49,152,774 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $14,907,596 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $14,287,586 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $33,977,988 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $34,865,188 | NetAssetsOrFundBalancesEOYAmt |
| Mission | TO OFFER GENERAL HEALTHCARE SERVICES WITHIN THE SCOPE OF ITS LICENSE AND CAPABILITIES; TO RENDER HEALTHCARE TO ALL PERSONS WITHOUT RESPECT TO RACE, REGLIGIOUS BELIEFS OR FINANCIAL STANDING. | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $23,949,317 | ExpenseAmt |
| Revenue | $30,049,772 | RevenueAmt |
| Desc | COMMUNITY MEDICAL CENTER PROVIDES MEDICAL SERVICES TO MEET THE NEEDS OF THE PEOPLE OF RICHARDSON COUNTY AND THE SURROUNDING COMMUNITIES. COMMUNITY MEDICAL CENTER PROVIDED 1,714 INPATIENT DAYS, 365 SWING-BED DAYS, 14,134 CLINIC VISITS AND NUMEREOUS OUTPATIENT SERVICES DURING THE YEAR. COMMUNITY BENEFITS INCLUDE 1,344,415 OF SUBSIDIZED HEALTH SERVICES, 530,728 OF TRADITIONAL CHARITY CARE, 246,125 OF BAD DEBT, 8,431 OF COMMUNITY ACTIVITIES, 5,088 OF COMMUNITY SERVICES, 3,000 OF HEALTH EDUCATION, AND 500 OF CONTRIBUTIONS FOR COMMUNITY BENEFIT. | Desc |
| Total Program Service Expenses | $23,949,317 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (true) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (true) | ScheduleBRequiredInd |
| Political Campaign Acty | false | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (true) | LobbyingActivitiesInd |
| Subject To Proxy Tax | false | SubjectToProxyTaxInd |
| Donor Advised Fund | false | DonorAdvisedFundInd |
| Conservation Easements | false | ConservationEasementsInd |
| Collections Of Art | false | CollectionsOfArtInd |
| Credit Counseling | false | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | Yes (true) | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (true) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | false | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | false | ReportProgramRelatedInvstInd |
| Report Other Assets | false | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (true) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (true) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | false | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (true) | ConsolidatedAuditFinclStmtInd |
| School Operating | false | SchoolOperatingInd |
| Foreign Office | false | ForeignOfficeInd |
| Foreign Activities | false | ForeignActivitiesInd |
| More Than5000 K To Org | false | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividualsInd |
| Professional Fundraising | false | ProfessionalFundraisingInd |
| Fundraising Activities | false | FundraisingActivitiesInd |
| Gaming Activities | false | GamingActivitiesInd |
| Operate Hospital | Yes (true) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (true) | AuditedFinancialStmtAttInd |
| Grants To Organizations | false | GrantsToOrganizationsInd |
| Grants To Individuals | false | GrantsToIndividualsInd |
| Schedule J Required | Yes (true) | ScheduleJRequiredInd |
| Tax Exempt Bonds | Yes (true) | TaxExemptBondsInd |
| Invest Tax Exempt Bonds | false | InvestTaxExemptBondsInd |
| Escrow Account | false | EscrowAccountInd |
| On Behalf Of Issuer | false | OnBehalfOfIssuerInd |
| Engaged In Excess Benefit Trans | false | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | false | PYExcessBenefitTransInd |
| Loan Outstanding | false | LoanOutstandingInd |
| Grant To Related Person | false | GrantToRelatedPersonInd |
| Business Rln With Org Mem | Yes (true) | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | false | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | false | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | false | DeductibleNonCashContriInd |
| Deductible Art Contribution | false | DeductibleArtContributionInd |
| Terminate Operations | false | TerminateOperationsInd |
| Partial Liquidation | false | PartialLiquidationInd |
| Disregarded Entity | false | DisregardedEntityInd |
| Related Entity | Yes (true) | RelatedEntityInd |
| Related Organization Ctrl Ent | false | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | false | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | false | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (true) | ScheduleORequiredInd |
| IRP Document | 85 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (true) | BackupWthldComplianceInd |
| Employee | 227 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (true) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | false | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | false | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | false | TaxablePartyNotificationInd |
| Nondeductible Contributions | false | NondeductibleContributionsInd |
| Indoor Tanning Services | false | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | false | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | false | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 10 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 9 | IndependentVotingMemberCnt |
| Family Or Business Rln | false | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | false | DelegationOfMgmtDutiesInd |
| Change To Org Documents | false | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | false | MembersOrStockholdersInd |
| Election Of Board Members | false | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | false | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (true) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (true) | MinutesOfCommitteesInd |
| Officer Mailing Address | false | OfficerMailingAddressInd |
| Local Chapters | false | LocalChaptersInd |
| Form990 Provided To Gvrn Body | false | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (true) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (true) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (true) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | false | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (true) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (true) | CompensationProcessCEOInd |
| Compensation Process Other | false | CompensationProcessOtherInd |
| Investment In Joint Venture | false | InvestmentInJointVentureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | RYAN LARSEN | PersonNm |
| Phone | 4022456501 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3307 BARADA STREET | AddressLine1Txt |
| City | FALLS CITY | CityNm |
| State Abbreviation | NE | StateAbbreviationCd |
| ZIP | 68355 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (17 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | OfficerOfficerInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| NICOLE MASON | ||||||||
| CHAIRPERSON | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| BONNIE KANEL | ||||||||
| VICE-CHAIR | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| TRENT SCHEITEL | ||||||||
| TREASURER | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| STEVE SEVERIN | ||||||||
| SECRETARY | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| VICKI BANGERT | ||||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| MARGARET MCINTEER | ||||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| BARB HOWARD | ||||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| GARY JORN | ||||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| JAREN PIPPITT | ||||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| RYAN LARSEN | ||||||||
| CEO | 40.00 | $229,920 | $0 | $35,658 | 2.00 | Yes (X) | ||
| RICK SICORA | ||||||||
| CFO | 40.00 | $129,185 | $0 | $14,482 | 2.00 | Yes (X) | ||
| KARI HOLDSWORTH | ||||||||
| CCO | 40.00 | $101,118 | $0 | $20,223 | Yes (X) | |||
| DAVID BORG | ||||||||
| PHYSICIAN | 32.00 | $271,212 | $0 | $32,583 | Yes (X) | |||
| SANDRA CATLIN | ||||||||
| APRN | 40.00 | $177,705 | $0 | $26,665 | Yes (X) | |||
| ROBIN ALEXANDER | ||||||||
| CRNA | 40.00 | $191,457 | $0 | $25,049 | Yes (X) | |||
| ALYSSA FINCK | ||||||||
| PHYSICIAN | 40.00 | $264,725 | $0 | $36,581 | Yes (X) | |||
| JUSTIN WESTENGAARD | ||||||||
| PHYSICIAN | 40.00 | $392,874 | $0 | $37,946 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,758,196 | TotalReportableCompFromOrgAmt |
| Total Other Compensation | $229,187 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 12 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | false | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (true) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | false | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| NATIONAL THERAPEUTIC ASSOCATION | |||||
| 11623 ARBOR STREET | OMAHA | NE | 68144 | PT/OT SERVICES | $794,568 |
| CARDINAL HEALTH | |||||
| 21337 NETWORK PLACE | CHICAGO | IL | 60673 | PHARMACY SVCS | $593,984 |
| PRAIRIE MECHANICAL CORPORATION | |||||
| 2842 TUCKER STREET | OMAHA | NE | 68112 | HVAC UPGRADE | $469,244 |
| GRACE ANESTHESIA SERVICES LLC | |||||
| PO BOX 535 | CARROLL | IA | 51401 | ANESTHESIA SVCS | $273,661 |
| SHARED MEDICAL SERVICES | |||||
| 209 LIMESTONE PASS | COTTAGE GROVE | WI | 53527 | MRI SERVICES | $271,580 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 11 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $1,004,690 | GovernmentGrantsAmt |
| All Other Contributions | $178,181 | AllOtherContributionsAmt |
| Total Contributions | $1,182,871 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (5 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| NET PATIENT SERVICE REVENUE | 621110 | $28,731,570 | $28,731,570 |
| PHARMACY | 446110 | $1,167,334 | $1,167,334 |
| CAFETERIA | 722320 | $66,743 | $66,743 |
| MISCELLANEOUS HOSPITAL REV | 621110 | $61,130 | $61,130 |
| LIFELINE | 900099 | $22,995 | $22,995 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $30,049,772 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $284,695 | TotalRevenueColumnAmt |
| Exclusion | $284,695 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $10,960 | OtherAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $9,568 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $1,392 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,392 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $1,392 | RelatedOrExemptFuncIncomeAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $31,518,730 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $30,051,164 | RelatedOrExemptFuncIncomeAmt |
| Exclusion | $284,695 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $460,223 | TotalAmt |
| Management And General | $460,223 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $10,328,531 | TotalAmt |
| Program Services | $8,604,002 | ProgramServicesAmt |
| Management And General | $1,724,529 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $433,684 | TotalAmt |
| Program Services | $346,318 | ProgramServicesAmt |
| Management And General | $87,366 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,942,338 | TotalAmt |
| Program Services | $1,150,861 | ProgramServicesAmt |
| Management And General | $791,477 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $701,671 | TotalAmt |
| Program Services | $556,867 | ProgramServicesAmt |
| Management And General | $144,804 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $65,391 | TotalAmt |
| Management And General | $65,391 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $53,038 | TotalAmt |
| Management And General | $53,038 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,665,713 | TotalAmt |
| Program Services | $4,099,507 | ProgramServicesAmt |
| Management And General | $566,206 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $79,531 | TotalAmt |
| Program Services | $30,833 | ProgramServicesAmt |
| Management And General | $48,698 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $148,828 | TotalAmt |
| Program Services | $82,004 | ProgramServicesAmt |
| Management And General | $66,824 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $500,231 | TotalAmt |
| Program Services | $499,475 | ProgramServicesAmt |
| Management And General | $756 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $32,814 | TotalAmt |
| Program Services | $26,817 | ProgramServicesAmt |
| Management And General | $5,997 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $35,879 | TotalAmt |
| Program Services | $24,535 | ProgramServicesAmt |
| Management And General | $11,344 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $258,198 | TotalAmt |
| Program Services | $22,225 | ProgramServicesAmt |
| Management And General | $235,973 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,364,167 | TotalAmt |
| Program Services | $1,971,715 | ProgramServicesAmt |
| Management And General | $392,452 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $156,280 | TotalAmt |
| Program Services | $33,121 | ProgramServicesAmt |
| Management And General | $123,159 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| PHARMACY | $2,528,402 | $2,528,402 | |
| CENTRAL SUPPLY | $1,883,548 | $1,883,548 | |
| REPAIR AND MAINTENANCE | $1,117,269 | $639,409 | $477,860 |
| ADMIN OFFICE | $349,076 | $15,358 | $333,718 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,541,075 | TotalAmt |
| Program Services | $1,434,320 | ProgramServicesAmt |
| Management And General | $106,755 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $29,645,887 | TotalAmt |
| Program Services | $23,949,317 | ProgramServicesAmt |
| Management And General | $5,696,570 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,100,863 | BOYAmt |
| EOY | $11,336,246 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $15,041,553 | BOYAmt |
| EOY | $14,355,322 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,997,951 | BOYAmt |
| EOY | $3,742,528 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $539,888 | BOYAmt |
| EOY | $457,224 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $531,405 | BOYAmt |
| EOY | $557,834 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $45,499,349 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $27,332,042 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $19,135,350 | BOYAmt |
| EOY | $18,167,307 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,574 | BOYAmt |
| EOY | $9,238 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $530,000 | BOYAmt |
| EOY | $527,075 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $48,885,584 | BOYAmt |
| EOY | $49,152,774 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,031,298 | BOYAmt |
| EOY | $2,466,755 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,695,157 | BOYAmt |
| EOY | $6,057,505 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,154,341 | BOYAmt |
| EOY | $3,766,586 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,026,800 | BOYAmt |
| EOY | $1,996,740 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $14,907,596 | BOYAmt |
| EOY | $14,287,586 | 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 | $33,977,988 | BOYAmt |
| EOY | $34,865,188 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $33,977,988 | BOYAmt |
| EOY | $34,865,188 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $48,885,584 | BOYAmt |
| EOY | $49,152,774 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $1,872,843 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | -$985,643 | NetUnrlzdGainsLossesInvstAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | false | AccountantCompileOrReviewInd |
| FS Audited | Yes (true) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (true) | AuditCommitteeInd |
| Federal Grant Audit Required | false | FederalGrantAuditRequiredInd |
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 | false | VolunteersInd |
| Paid Staff Or Management | false | PaidStaffOrManagementInd |
| Media Advertisements | false | MediaAdvertisementsInd |
| Mailings Members | false | MailingsMembersInd |
| Publications Or Broadcast | false | PublicationsOrBroadcastInd |
| Grants Other Organizations | false | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | false | DirectContactLegislatorsInd |
| Rallies Demonstrations | false | RalliesDemonstrationsInd |
| Other Activities | Yes (true) | OtherActivitiesInd |
| Other Activities | $3,018 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $3,018 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | false | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE C, PART II-B, LINE 1 | FormAndLineReferenceDesc |
| Explanation | THE PORTION OF ORGANIZATION DUES THAT ARE RELATED TO LOBBING ARE AS FOLLOWS: NEBRASKA HOSPITAL ASSOCIATION - 1,641, AMERICAN HOSPITAL ASSOCIATION 1,377 | ExplanationTxt |
Schedule D IRS990ScheduleD
CY Endwmt Fund CYEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $4,987,235 | BeginningYearBalanceAmt |
| Contributions | $45,000 | ContributionsAmt |
| Investment Earnings Or Losses | -$178,030 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $4,854,205 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $3,672,159 | BeginningYearBalanceAmt |
| Contributions | $1,314,311 | ContributionsAmt |
| Investment Earnings Or Losses | $865 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $100 | OtherExpendituresAmt |
| End Year Balance | $4,987,235 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $4,130,577 | BeginningYearBalanceAmt |
| Contributions | $535,306 | ContributionsAmt |
| Investment Earnings Or Losses | $6,395 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $1,000,120 | OtherExpendituresAmt |
| End Year Balance | $3,672,159 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $3,569,532 | BeginningYearBalanceAmt |
| Contributions | $555,297 | ContributionsAmt |
| Investment Earnings Or Losses | $5,898 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $150 | OtherExpendituresAmt |
| End Year Balance | $4,130,577 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $3,766,040 | BeginningYearBalanceAmt |
| Contributions | $1,655,000 | ContributionsAmt |
| Investment Earnings Or Losses | $3,427 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $1,854,935 | OtherExpendituresAmt |
| End Year Balance | $3,569,532 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Designated Balance EOY | 1.00000 | BoardDesignatedBalanceEOYPct |
| Endowments Held Unrelated Org | false | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | false | EndowmentsHeldRelatedOrgInd |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,175,312 | OtherCostOrOtherBasisAmt |
| Book Value | $1,175,312 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $26,863,638 | OtherCostOrOtherBasisAmt |
| Depreciation | $14,436,168 | DepreciationAmt |
| Book Value | $12,427,470 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,847,234 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,297,827 | DepreciationAmt |
| Book Value | $549,407 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $15,575,609 | OtherCostOrOtherBasisAmt |
| Depreciation | $11,598,047 | DepreciationAmt |
| Book Value | $3,977,562 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $37,556 | OtherCostOrOtherBasisAmt |
| Book Value | $37,556 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $18,167,307 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (4 entries)
| DescDesc | AmtAmt |
|---|---|
| CONDITIONAL CONTRIBUTION | $1,050,000 |
| EST THIRD-PARTY PAYOR SETTLEMENTS | $805,000 |
| PROVIDER RELIEF FUNDS | $200,000 |
| DEBT ISSUE COST | -$58,260 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $1,996,740 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| SCHEDULE D, PAGE 2, PART V, LINE 4 | THE FUNDS INCLUDE 4,053,255 DESIGNATED BY THE BOARD FOR CAPITAL IMPROVEMENTS, 70,651 DESIGNATED BY THE BOARD FOR DEFERRED COMPENSATION AND 730,299 DESIGNATED BY A LONG-TERM DEBT COVENANT ON THE AMERICAN NATIONAL BANK LOAN. |
| SCHEDULE D, PAGE 3, PART X | AS OF JULY 31, 2022 AND 2021, THERE IS NO RESERVE FOR UNCERTAIN TAX POSITIONS. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (true) | FinancialAssistancePolicyInd |
| Written Policy | Yes (true) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (true) | FPGReferenceFreeCareInd |
| Percent200 | Yes (X) | Percent200Ind |
| FPG Reference Discounted Care | Yes (true) | FPGReferenceDiscountedCareInd |
| Percent300 | Yes (X) | Percent300Ind |
| Free Care Medically Indigent | Yes (true) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (true) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | false | ExpensesExceedBudgetInd |
| Annual Community Bnft Report | Yes (true) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (true) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $530,728 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $530,728 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01790 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $530,728 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $530,728 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01790 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $5,088 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $5,088 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00020 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $3,000 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $3,000 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00010 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,344,415 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $1,344,415 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.04530 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $500 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $500 | NetCommunityBenefitExpnsAmt |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,353,003 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $1,353,003 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.04560 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,883,731 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $1,883,731 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.06350 | TotalExpensePct |
Economic Development EconomicDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $5,500 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $5,500 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00020 | TotalExpensePct |
Community Support CommunitySupportGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,931 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $2,931 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00010 | TotalExpensePct |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $8,431 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $8,431 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00030 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (true) | BadDebtExpenseReportedInd |
| Reimbursed By Medicare | $15,110,586 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $15,169,980 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$59,394 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (true) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (true) | 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 MEDICAL CENTER | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3307 BARADA STREET | AddressLine1Txt |
| City | FALLS CITY | CityNm |
| State Abbreviation | NE | StateAbbreviationCd |
| ZIP | 68355 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | WWW.CMCFC.ORG | WebsiteAddressTxt |
| State License | H000112 | 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 MEDICAL CENTER | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | false | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | false | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (true) | 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 |
| CHNA Conducted | 22 | CHNAConductedYr |
| Take Into Account Others Input | Yes (true) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | false | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | false | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (true) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | WWW.CMCFC.ORG | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Rpt Available Thru Other Method | Yes (X) | RptAvailableThruOtherMethodInd |
| Implementation Strategy Adopt | Yes (true) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 22 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (true) | StrategyPostedWebsiteInd |
| Strategy Website URL | WWW.CMCFC.ORG | StrategyWebsiteURLTxt |
| Strategy Attached | false | StrategyAttachedInd |
| Organization Incur Excise Tax | false | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (true) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 200.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 300.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Explained Basis | Yes (true) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (true) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Includes Publicity Measures | Yes (true) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | WWW.CMCFC.ORG/PATIENTS-VISITORS/ | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | WWW.CMCFC.ORG/PATIENTS-VISITORS/ | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | WWW.CMCFC.ORG/PATIENTS-VISITORS/ | 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 |
| Other Publicity | Yes (X) | OtherPublicityInd |
| FAP Actions On Nonpayment | Yes (true) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | false | 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 (true) | NondisEmergencyCarePolicyInd |
| Prospective Medicare Medicaid | Yes (X) | ProspectiveMedicareMedicaidInd |
| Amounts Generally Billed | false | AmountsGenerallyBilledInd |
| Gross Charges | false | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FACILITY 1, COMMUNITY MEDICAL CENTER - PART V, LINE 3E | SIGNIFICANT HEALTH NEEDS OF THE COMMUNITY INCLUDE: 1. INCREASE ACCESS TO FITNESS AND WELLNESS OPPORTUNITIES. WHETHER IN NEW OR EXISTING FACILITIES, COMMUNITY MEMBERS NEED MORE OPPORTUNITIES TO BE ACTIVE. 2. INCREASE ACCESS TO BEHAVIORAL HEALTH RESOURCES. SUBSTANCE ABUSE IS A PERVASIVE PROBLEM. LIKEWISE, MORE SUPPORT IS NEEDED FOR THOSE SUFFERING FROM DEPRESSION, ANXIETY AND OTHER MENTAL HEALTH CONCERNS. ISOLATION FROM COVID-19 AND ONLINE LIFESTYLES IS WORSENING THESE ISSUES, ESPECIALLY AMONG YOUTH. 3. STRENGTHEN SOCIAL SUPPORT COORDINATION AND EMERGENCY SERVICES. MORE SUPPORT IS NEEDED FOR AT-RISK FAMILIES AND INDIVIDUALS. FURTHER, GREATER CONNECTEDNESS AMONG THOSE PROVIDING SOCIAL SUPPORTS WILL HELP REDUCE FATIGUE AND BURNOUT. ADDITIONAL PLANNING AND CAPACITY-BUILDING IS NECESSARY TO ADDRESS CURRENT AND POTENTIAL EMERGENCY SITUATIONS. 4. INCREASE USE OF PREVENTATIVE SERVICES AND EARLY DETECTION SCREENINGS. THESE MEASURES ARE UNDERUTILIZED. SUPPORT IS NEEDED FOR EDUCATION, HARNESSING THE INFLUENCE OF COMMUNITY ORGANIZATIONS, AND STRENGTHENING SOCIAL NETWORKS. |
| FACILITY 1, COMMUNITY MEDICAL CENTER - PART V, LINE 5 | THE PROCESS USED INVOLVED PRE-PLANNING WITH THE HEALTH DEPARTMENT; REVIEW OF AVAILABLE DATA REGARDING HEALTH STATUS INDICATORS IN THE COUNTY; USE OF INTERNAL AND EXTERNAL EXPERTS; A SURVEY OF COMMUNITY MEMBERS; A STAKEHOLDER MEETING OPEN TO ALL COMMUNITY MEMBERS AND INVOLVING REPRESENTATIVES FROM GOVERNMENT, SCHOOLS, MEDICAL STAFF, AND SOCIAL SERVICE PROVIDERS; REVIEW OF PROGRESS ON PRIORITIES ESTABLISHED IN THE PREVIOUS PLAN; PRIORITIZATION OF NEEDS IDENTIFIED; AND DEVELOPMENT OF A STRATEGIC PLAN TO RESPOND TO PRIORITIES. |
| FACILITY 1, COMMUNITY MEDICAL CENTER - PART V, LINE 7D | COPIES PROVIDED TO ALL STAKEHOLDER ORGANIZATIONS, COUNTY, CITY AND TOWNSHIP GOVERNMENT OFFICES, COMMUNITY LIBRARIES, NEWSPAPER, RADIO AND TELEVISION NEWS MEDIA. |
| FACILITY 1, COMMUNITY MEDICAL CENTER - PART V, LINE 11 | THE HOSPITAL STRATEGIES TO ADDRESS SIGNIFICATE NEEDS: A. SIX INITIATIVES TO INCREASE ASSESS TO FITNESS AND WELLNESS OPPORTUNITIES: 1. EXPLORE POTENTIAL FOR COMBINED EARLY CHILDHOOD/FITNESS/RECREATION CENTER LEAD BY PUBLIC SCHOOL AND PARTNERED WITH CITY AND ECONOMIC DEVELOPMENT. 2. ADD/EXPAND WALKING TRAIL TO HOSPITAL CAMPUS. 3. SPONSOR/ENCOURAGE REGULAR WEEKLY FITNESS ACTIVITIES (YOGA, WATER AEROBICS & COMMUNITY BASKETBALL). 4. SPONSOR TEAMS TO SUPPORT RECREATION (YOUTH SOCCER, BASEBALL, SOFTBALL & ADULT VOLLEYBALL). 5. SPONSOR EVENTS AND CHALLENGES IN PARTNERSHIP WITH CITY RECREATION TEAM (FUN RUN, FITNESS CHALLENGES & OTHER ACTIVITIES). 6. EVALUATE MEDICALLY- DIRECTED WEIGHT LOSS PROGRAMS. B. FOUR INITIATIVES TO INCREASE ACCESS TO BEHAVIORAL HEALTH RESOURCES: 1. PROVIDE SUBSIDIES & FINANCIAL SUPPORT TO INCREASE AVAILABILITY OF BEHAVIORAL HEALTH SERVICES. 2. EXPAND BEHAVIORAL HEALTH OFFERINGS IN HOSPITAL CLINICS. 3. EXPLORE ADULT FOCUSED STRUCTURED OUTPATIENT SERVICES. 4. CONTINUE TO IMPLEMENT OPIOID BEST PRACTICE RECOMMENDATIONS. C. SIX INITIATIVE TO STRENGTHEN SOCIAL SUPPORT COORDINATION AND EMERGENCY SERVICES: 1. PROVIDE SUBSIDY TO FCVAS TO SUPPORT ON-CALL AVAILABILITY, ESPECIALLY FOR TRANSFERS. 2. RECRUIT & TRAIN HOSPITAL STAFF TO DRIVER ROLE, AND ESTABLISH ROTATION. AS ABLE, EXPAND TO OTHER BUSINESSES. 3. INCREASE HOURS FOR HOSPITAL-BASED SOCIAL WORK IN HOSPITAL. 4. OFFER MEDICAL TRIAGE LINE TO SUPPORT AFTER HOURS NEEDS. 5. ENHANCE AWARENESS/COORDINATION AMOUNT SOCIAL SERVICE PROVIDERS. 6. EXPLORE FEASIBILITY OF ADDITIONAL TRANSPORTATION SERVICES, ESPECIALLY BEHAVIORAL HEALTH. D. FOUR INITIATIVES TO INCREASE USE OF PREVENTATIVE SERVICES AND EARLY DETECTION SCREENINGS: 1. INCREASE COMMUNICATION TO PATIENTS REGARDING RECOMMENDED SCREENINGS, DIABETIC PRECAUTIONS, ETC., USING WRITTEN, ELECTRONIC AND VERBAL METHODS. 2. PROVIDE EDUCATION TO COMMUNITY MEMBERS AROUND RECOMMENDED SCREENINGS. 3. INCREASE USE OF CHRONIC CARE MANAGEMENT, TRANSITIONS OF CARE MANAGEMENT AND REMOTE PATIENT MONITORING, AS APPROPRIATE. 4. PROVIDE ACCESS TO HOME RADON TESTING FOR COMMUNITY MEMBERS. |
| FACILITY 1, COMMUNITY MEDICAL CENTER - PART V, LINE 16J | AT ADMISSION OR AT LEAST PRIOR TO DISCHARGE REGISTRATION PERSONNEL REFER UNINSURED AND/OR LOW INCOME PATIENTS TO FINANCIAL COUNSELORS TO DISCUSS THE POLICY. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 2 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| FAMILY MEDICINE | ||||
| 3307 BARADA STREET | FALLS CITY | NE | 68355 | RURAL HEALTH CLINIC |
| HUMBOLDT FAMILY MEDICINE | ||||
| 1120 GRAND AVENUE | HUMBOLDT | NE | 68376 | RURAL HEALTH CLINIC |
Supplemental Information Detail SupplementalInformationDetail (8 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| SCHEDULE H, PART I, LINE 7 | THE COSTING METHODOLOGY USED TO CALCULATE THE AMOUNTS REPORTED IN THE TABLE WAS A COST TO CHARGE RATIO. |
| SCHEDULE H, PART II | COMMUNITY-BUILDING ACTIVITIES INCLUDE PROGRAMS THAT ADDRESS THE ROOT CAUSES OF HEALTH PROBLEMS, SUCH AS POVERTY, HOMELESSNESS AND ENVIRONMENTAL PROBLEMS. THE ORGANIZATION PROVIDED 5,500 TO FALLS CITY ECONMIC DEVELOPMENT AND GROWTH ENTERPRISE (EDGE) TO SUPPORT ECONOMIC DEVELOPMENT IN FALLS CITY AND RICHARDSON COUNTY. THE ORGANIZATION ALSO CONTRIBUTED 2,931 TO VARIOUS HEALTH-ORIENTED COMMUNITY ACTIVITIES AND SCHOOL PROJECTS DURING THE YEAR. |
| SCHEDULE H, PART III, LINE 8 | THE MEDICARE COST REPORT WAS USED TO DETERMINE THE AMOUNTS REPORTED ON LINE 6. |
| SCHEDULE H, PART III, LINE 9B | BILLING AND COLLECTION POLICY PART III. I.COMPLETED APPLICATION - IF A COMPLETE APPLICATION FOR FINANCIAL ASSISTANCE UNDER THE FAP IS SUBMITTED BY A RESPONSIBLE INDIVIDUAL(S), AT ANY TIME PRIOR TO THE APPLICATION DEADLINE, CMC WILL SUSPEND ECA'S WHILE SUCH FINANCIAL ASSISTANCE APPLICATION IS PENDING. THIS WILL INCLUDE ANY CURRENT ACCOUNTS AND BAD DEBT ACCOUNTS GOING BACK 240 DAYS FROM THE DATE OF THE FIRST STATEMENT ON THE ACCOUNT. 1.IF PATIENT ACCOUNTS DETERMINES DEFINITIVELY THAT THE RESPONSIBLE INDIVIDUAL(S) IS INELIGIBLE FOR ANY FINANCIAL ASSISTANCE UNDER THE FAP, CMC WILL INFORM THE RESPONSIBLE INDIVIDUAL(S) IN WRITING THE DENIAL, INCLUDING REASON(S) FOR THE DENIAL. 2.IF A PATIENT IS ELIGIBLE FOR FINANCIAL ASSISTANCE OTHER THAN FREE CARE, CMC WILL: A. PROVIDE THE PATIENT WITH A REVISED BILL SETTING FORTH: (I) THE AMOUNT THE PATIENT OWES FOR CARE PROVIDED AFTER FINANCIAL ASSISTANCE, (II) HOW THE REVISED AMOUNT WAS DETERMINED; AND (III) EITHER THE AGB FOR THE CARE PROVIDED OR INSTRUCTIONS ON HOW THE PATIENT CAN OBTAIN INFORMATION REGARDING THE AGB FOR THE CARE PROVIDED; B. PROVIDE THE PATIENT WITH A REFUND FOR ANY AMOUNT THE PATIENT HAS PAID IN EXCESS OF THE AMOUNT OWED TO CMC (UNLESS SUCH AMOUNT IS LESS THAN 5); AND C. TAKE REASONABLE MEASURES TO REVERSE ANY ECAS TAKEN AGAINST THE PATIENT. |
| SCHEDULE H, PART VI, LINE 2 | THE ORGANIZATION USES ITS CHNA TO ASSESS THE NEEDS OF THE COMMUNITY IT SERVICES. |
| SCHEDULE H, PART VI, LINE 3 | THE ORGANIZATION INFORMS AND EDUCATES PATIENTS AND PERSONS WHO MAY BE BILLED FOR PATIENT CARE ABOUT THEIR ELIGIBILITY FOR ASSISTANCE UNDER THE ORGANIZATION'S HELPFUL OPTIONS FOR PATIENT EXPENSES (HOPE) PROGRAM OR FINANCIAL ASSISTANCE POLICY BY HAVING THE INFORMATION AVAILABLE ON THEIR WEBSITE, PROVIDING THE INFORMATION TO ALL WHO INQUIRE ABOUT OBTAINING FINANCIAL ASSISTANCE, AND BY REFERRING THOSE KNOWN TO BE UNINSURED AND/OR TO HAVE LOW INCOME TO FINANCIAL COUNSELORS WHO WILL DISCUSS THE POLICY. |
| SCHEDULE H, PART VI, LINE 4 | RICHARDSON COUNTY, NEBRASKA IS PRIMARILY RURAL AND INCLUDES THE CITIES OF BARADA, DAWSON, FALLS CITY, HUMBOLDT, PRESTON, RULO, SALEM SHUBERT, STELLA, AND VERDON. IT IS LOCATED IN THE SOUTHEAST CORNER OF NEBRASKA. POPULATION ACCORDING TO THE 2020 CENSUS IS 7,871, DECLINING 5.9% FROM 2010. PERSONS 65 YEARS AND OLDER IS 24.9% WHILE PERSONS 18 AND YOUNGER IS 21.4%. ETHNIC BACKGROUDS BY PERCENT INCLUDE WHITE - 93.0%, AMERICAN INDIAN AND ALASKA NATIVE PERSONS - 3.3%, WITH ALL OTHERS REPORTING LESS THAN 4% COMBINED. THERE ARE 3,706 HOUSEHOLDS WITH AN AVERAGE OF 2.10 PERSONS PER HOUSEHOLD. MEDIAN HOUSEHOLD INCOME IS 44,524 WITH 9.5% OF PERSONS BELOW THE POVERTY LEVEL. THERE ARE 551.84 TOTAL SQUARE MILES AND 14.2 PERSON PER SQUARE MILE. |
| SCHEDULE H, PART VI, LINE 5 | THE ORGANIZATION'S BOARD OF DIRECTORS IS COMPRISED OF PERSONS WHO RESIDE IN THE ORGANIZATION'S PRIMARY SERVICE AREA WHO ARE NEITHER EMPLOYEES NOR CONTRACTORS OF THE ORGANIZATION, NOR FAMILY MEMBERS THEREOF. THE ORGANIZATION EXTENDS MEDICAL STAFF PRIVALEDGES TO ALL QUALIFIED PHYSICIANS IN ITS COMMUNITY. IN ADDITION, THE ORGANIZATION CONTINUALLY APPLIES SURPLUS FUNDS TOWARD THE IMPROVEMENT OF PATIENT CARE, SUCH AS NEW FACILITIES AND THE PURCHASE OF NEW/UPDATED MEDICAL EQUIPMENT. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Employment Contract | Yes (X) | WrittenEmploymentContractInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | false | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | false | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | false | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | Yes (true) | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | false | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | false | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | false | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | false | AnyNonFixedPaymentsInd |
| Initial Contract Exception | false | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (6 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt |
|---|---|---|---|---|---|---|
| RYAN LARSEN | ||||||
| CEO | $205,943 | $23,000 | $977 | $11,990 | $23,668 | $265,578 |
| DAVID BORG | ||||||
| PHYSICIAN | $241,103 | $30,109 | $14,311 | $18,272 | $303,795 | |
| SANDRA CATLIN | ||||||
| APRN | $50,740 | $126,605 | $360 | $9,581 | $17,084 | $204,370 |
| ROBIN ALEXANDER | ||||||
| CRNA | $178,743 | $12,714 | $10,571 | $14,478 | $216,506 | |
| ALYSSA FINCK | ||||||
| PHYSICIAN | $227,739 | $25,957 | $11,029 | $13,435 | $23,146 | $301,306 |
| JUSTIN WESTENGAARD | ||||||
| PHYSICIAN | $280,768 | $112,106 | $14,800 | $23,146 | $430,820 | |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE J, PAGE 1, PART I, LINE 5A | FormAndLineReferenceDesc |
| Explanation | PROVIDER PRODUCTIVITY BONUSES ARE CALCULATED BASED ON RHC REVENUE PRODUCED. BONUSES BASED ON REVENUES: SANDRA CATLIN 126,605 DAVID BORG 30,109 JUSTIN WESTENGAARD 92,106 ALYSSA FINCK 5,957 ROBIN ALEXANDER 12,714 | ExplanationTxt |
Schedule K IRS990ScheduleK
Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
Issuer Name IssuerName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CITY OF FALLS CITY NEBRASKA | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Issuer EIN | 476006187 | BondIssuerEIN |
| Bond Issued | 2015-12-23 | BondIssuedDt |
| Issue Price | $9,945,000 | IssuePriceAmt |
| Purpose | REFUND 2009 NEW HOSPITAL DEBT | PurposeDesc |
| Defeased | false | DefeasedInd |
| On Behalf Of Issuer | false | OnBehalfOfIssuerInd |
| Pool Financing | false | PoolFinancingInd |
Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Retired | $3,887,495 | RetiredAmt |
| Total Proceeds | $9,945,000 | TotalProceedsAmt |
| In Reserve Fund | $400,000 | InReserveFundAmt |
| Other Spent Proceeds | $9,945,000 | OtherSpentProceedsAmt |
| Substantial Completion | 2015 | SubstantialCompletionYr |
| Refunding Tax Exempt Bonds | Yes (true) | RefundingTaxExemptBondsInd |
| Refunding Taxable Bonds | false | RefundingTaxableBondsInd |
| Final Allocation Made | Yes (true) | FinalAllocationMadeInd |
| Adequate Books And Rec Maint | Yes (true) | AdequateBooksAndRecMaintInd |
Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Owning Bond Financed Property | false | OwningBondFinancedPropertyInd |
| Any Lease Arrangements | false | AnyLeaseArrangementsInd |
| Mgmt Contract Bond Fincd Prop | Yes (true) | MgmtContractBondFincdPropInd |
| Engage Bond Counsel Contracts | false | EngageBondCounselContractsInd |
| Any Research Agreements | false | AnyResearchAgreementsInd |
| Bond Iss Meet Prvt Sec Pymt Test | false | BondIssMeetPrvtSecPymtTestInd |
| Change In Use Bond Financed Prop | false | ChangeInUseBondFinancedPropInd |
| Procs Nonqualified Bond Remdtd | Yes (true) | ProcsNonqualifiedBondRemdtdInd |
Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Form8038 T Filed | false | Form8038TFiledInd |
| Rebate Not Due Yet | Yes (true) | RebateNotDueYetInd |
| Exception To Rebate | Yes (true) | ExceptionToRebateInd |
| No Rebate Due | false | NoRebateDueInd |
| Variable Rate Issue | Yes (true) | VariableRateIssueInd |
| Hedge Identified In Bks And Rec | false | HedgeIdentifiedInBksAndRecInd |
| Gross Proceeds Invested In GIC | false | GrossProceedsInvestedInGICInd |
| Gross Proceeds Invested | false | GrossProceedsInvestedInd |
| Written Proc To Monitor Reqs | Yes (true) | WrittenProcToMonitorReqsInd |
Procedures Corrective Action ProceduresCorrectiveActionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Procedures Corrective Action | Yes (true) | ProceduresCorrectiveActionInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PURPOSE OF ISSUE DESCRIPTION | FormAndLineReferenceDesc |
| Explanation | CITY OF FALLS CITY, NEBRASKA REFUND 2009 NEW HOSPITAL DEBT | ExplanationTxt |
Schedule L IRS990ScheduleL
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp
Name Of Interested NameOfInterested
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | ALLAN TRAMP | PersonNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Relationship Description | BOARD MEMBER | RelationshipDescriptionTxt |
| Transaction | $55,350 | TransactionAmt |
| Transaction | SUPERVISOR/PHYSICIAN | TransactionDesc |
| Sharing Of Revenues | false | SharingOfRevenuesInd |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PAGE 6, PART VI, LINE 11B | THE FORM 990 IS REVIEWED BY THE CFO AND IS PRESENTED TO THE FINANCE COMMITTEE OF THE BOARD OF DIRECTORS FOR APPROVAL PRIOR TO FILING THE RETURN. |
| FORM 990, PAGE 6, PART VI, LINE 12C | MANAGEMENT CONTINUALLY REVIEWS OFFICERS, DIRECTORS, TRUSTEES AND KEY EMPLOYEES ANNUAL DISCLOSURES AND RELATIONSHIPS WITH COMMUNITY MEDICAL CENTER TO IDENTIFY POSSIBLE CONFLICTS OF INTEREST. ONCE A CONFLICT OF INTEREST IS IDENTIFIED, THE CONFLICT WOULD BE DOCUMENTED AND MONITORED TO ENSURE APPROPRIATE ACTION IS TAKEN BASED ON THE SITUATION. |
| FORM 990, PAGE 6, PART VI, LINE 15A | COMPENSATION FOR THE CEO IS DETERMINED BY THE BOARD OF DIRECTORS. THE BOARD OF DIRECTORS UTILIZE INDEPENDENT PARTIES OR STUDIES OCCASIONALLY. |
| FORM 990, PAGE 6, PART VI, LINE 19 | GOVERNING DOCUMENTS, CONFLICTS OF INTEREST STATEMENTS, AND FINANCIAL STATEMENTS ARE NOT MADE AVAILABLE TO THE PUBLIC WITHOUT APPROVAL BY THE BOARD OF DIRECTORS. |
| FORM 990, PART IX, LINE 11G | CONSULTING FEES 36,000 37,570 0 COLLECTION FEES 0 8,455 0 BILLING FEES 7,930 44,078 0 COMPUTER MAINTENANCE 178 31,012 0 SERVICE AND LICENSE FEES 0 14,786 0 BANK/CREDIT CARD FEES 0 64,256 0 CONTRACT LABOR 378,745 115,632 0 PURCHASED SERVICE 1,275,062 250,417 0 CONTRACT SERVICE 2,389,677 0 0 DIETARY CONTRACT SERVICE 11,915 0 0 TOTAL 4,099,507 566,206 0 |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp
Disregarded Entity Name DisregardedEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | COMMUNITY MEDICAL CENTER FOUNDATION | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3307 BARADA STREET | AddressLine1Txt |
| City | FALLS CITY | CityNm |
| State Abbreviation | NE | StateAbbreviationCd |
| ZIP | 68355 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 463491851 | EIN |
| Primary Activities | SUPPORT | PrimaryActivitiesTxt |
| Legal Domicile State | NE | LegalDomicileStateCd |
| Exempt Code Section | 501C3 | ExemptCodeSectionTxt |
| Public Charity Status | 12A | PublicCharityStatusTxt |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CMC | BusinessNameLine1Txt |
| Business Name Line2 | COMMUNITY MEDICAL CENTER INC | BusinessNameLine2Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Controlled Organization | false | ControlledOrganizationInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | false | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | false | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | false | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | false | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | false | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | false | DivRelatedOrganizationInd |
| Asset Sale To Other Org | false | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | false | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | false | AssetExchangeInd |
| Rental Of Facilities To Oth Org | false | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | false | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | false | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | false | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | false | SharingOfFacilitiesInd |
| Paid Employees Sharing | false | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | false | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | false | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | false | TransferToOtherOrgInd |
| Transfer From Other Org | false | TransferFromOtherOrgInd |