2023-11-10T08:33:59-06:00 2022-12-31 450250958 EIDE BAILLY LLP 18081 BURT ST STE 200 OMAHA NE 680224722 990 2022-01-01 470662290 NORTH PLATTE NEBRASKA HOSPITAL CORP NORT 3085688000 601 W LEOTA S NORTH PLATTE NE 69103 SUMMER OWEN CFO 3085688000 2023-11-09 1 SUMMER OWEN 999009999 1 MEGAN L KOZIOL CPA P01544037 4023302660 2023-11-03 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z GREAT PLAINS HEALTH IVAN MITCHELL 601 W LEOTA S NORTH PLATTE NE 69103 303998596 0 X WWW.GPHEALTH.ORG X 1971 NE PROVIDE ACUTE, PREVENTIVE AND OTHER HEALTHCARE SERVICES. 15 12 1446 105 85290 0 5089669 913043 264687777 270057515 9116230 1169578 1706252 2693993 280599928 274834129 1184299 357301 0 0 124293098 131917600 0 0 294495 115089101 126087773 240566498 258362674 40033430 16471455 507153714 483495629 133622736 127322757 373530978 356172872 TO INSPIRE HEALTH AND HEALING BY PUTTING PATIENTS FIRST -- ALWAYS. 0 0 219282798 357301 243018718 GREAT PLAINS HEALTH IS A NOT-FOR-PROFIT HEALTH SYSTEM COMMITTED TO MEETING THE HEALTHCARE NEEDS OF THE COMMUNITIES WE SERVE. OUR MEDICAL STAFF, BOARD AND LEADERSHIP BELIEVE WE OFFER SPECIALTIES THAT PROVIDE HIGH QUALITY AND LOW COST CARE TO OUR PATIENTS. SPECIALTIES THAT ARE NEW AND HAVE GROWN IN THE PAST THREE YEARS ARE ONCOLOGY, CARDIOLOGY, ORTHOPEDICS, HYPERBARIC AND WOUND CARE, AND THE DIABETIC PROGRAM TO MEET THE HEALTH CHALLENGES OF OUR COMMUNITIES. 18209032 26465086 GREAT PLAINS HEALTH OPERATES A 116-BED INPATIENT HOSPITAL. THE INPATIENT CARE PROVIDED IN THOSE UNITS ARE THE FOLLOWING: MEDICAL, SURGICAL, INTENSIVE CARE, CORONARY CARE, OBSTETRICS, LABOR & DELIVERY, NICU, AND BEHAVIOR HEALTH SERVICES. GREAT PLAINS HEALTH PATIENTS COME FROM PRIMARY AND SECONDARY MARKETS. 1956298 2494648 GREAT PLAINS HEALTH IS DEDICATED TO MEETING THE BEHAVIORAL HEALTH NEEDS OF THE COMMUNITIES WE SERVE. TO HELP MEET THOSE NEEDS, WE OPERATE A DEDICATED BEHAVIORAL HEALTH UNIT/FLOOR AT THE HOSPITAL. THE UNIT ACCEPTS A WIDE VARIETY OF BEHAVIORAL DIAGNOSIS AND ISSUES. 239448128 1 1 0 1 0 0 0 0 0 0 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 1 156 0 1 1446 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 15 12 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 0 X SUMMER OWEN CFO 3085687193 601 WEST LEOTA NORTH PLATTE NE 69103 WAYNE L WARREN MD PHYSICIAN (GPH) 40.00 X 2093939 0 51018 PUSHKAR M KANADE MD PHYSICIAN (GPH) 40.00 X 1440917 0 17665 MICHAEL SIMONSON MD PHYSICIAN (GPH) 40.00 X 1236255 0 51526 NARAYANA KODURI MD PHYSICIAN (GPH) 40.00 X 1179691 0 55326 ANIL KUMAR MD PHYSICIAN (GPH) 40.00 X 1178650 0 50326 JOVANKA VULSANOVIC MD DIRECTOR/PHYSICIAN (GPH) 40.00 X 390583 0 19217 IVAN MITCHELL CEO 39.00 X 470540 0 53076 SUMMER OWEN CFO 39.00 X 153182 0 7910 THOMAS LEGEL CFO THRU 4/22 39.00 X 77614 0 11885 JODY TOMANEK CHAIR 1.00 X X 0 0 0 LINDSAY PEDERSON VICE CHAIR 1.00 X X 0 0 0 DAN O'NEILL SECRETARY/TREASURER 1.00 X X 0 0 0 NEWTON MACK MD DIRECTOR 1.00 X 0 0 0 LADD LAKE MD CHIEF OF STAFF/DIRECTOR 1.00 X 0 0 0 JOE BOB ATKINS DIRECTOR 1.00 X 0 0 0 KRISTEN BURWICK DIRECTOR 1.00 X 0 0 0 VIKKI CARLSON DIRECTOR 1.00 X 0 0 0 MICHAEL CUNNING DIRECTOR 1.00 X 0 0 0 MATTHEW HAWKS DIRECTOR 1.00 X 0 0 0 MIKE JACOBSON DIRECTOR 1.00 X 0 0 0 PETE VOLZ DIRECTOR 1.00 X 0 0 0 ML MARTIN DIRECTOR 1.00 X 0 0 0 BENJAMIN KLUG MD VICE CHIEF OF STAFF/DIRECTOR 1.00 X 0 0 0 LANCE POLK DIRECTOR THRU 10/2022 1.00 X 0 0 0 8221371 0 317949 218 0 1 0 SAMPSON CONSTRUCTION 440 REGENCY PKWY DR 131 OMAHA NE 68114 GENERAL CONTRACTOR 14998693 HEALTH CAROUSEL LLC 3805 EDWARDS RD 700 CINCINNATI OH 45209 STAFFING SERVICES 2494578 BRYAN TELEMEDICINE 1600 S 48TH ST LINCOLN NE 68506 TELEMEDICINE SERVICES 1325512 CARDIOSOLUTION LLC SPACER 4675 CORNELL ROAD SUITE 100 CINCINNATI OH 45241 CARDIOLOGY SERVICES 1215459 MAYO CLINIC LABORATORIES 3050 SUPERIOR DR NW ROCHESTER MN 55901 LAB SERVICES 798008 58 575088 337955 913043 MEDICARE/MEDICAID PAYMENTS 624100 135343581 135343581 PATIENT SERVICE REVENUE 624100 133502971 133502971 OTHER OPERATING REVENUE 624100 1172163 1172163 MANAGEMENT FEES 624100 37088 37088 PATHOLOGY REVENUE 624100 1712 1712 270057515 223020 223020 93412 0 93412 93412 93412 30062285 48740 28677638 486829 1384647 -438089 946558 946558 NORTH PLATTE SURGICAL CENTER 621400 1672970 1672970 CAFETERIA REVENUE 900099 594354 594354 MID-NEBRASKA MEDICAL VENTURES 621110 316628 316628 16629 -68661 85290 2600581 274834129 271978452 85290 1857344 X 357301 357301 1184007 409800 774207 1066566 1066566 105970104 98396355 7416088 157661 3128618 2944563 179295 4760 14274004 13502788 740441 30775 6294301 5758190 525405 10706 220000 220000 340590 340590 148463 148463 523264 523264 32354414 27972454 4376553 5407 748213 295408 452225 580 3928855 3300181 587514 41160 10323454 9640376 661174 21904 5157957 4955208 199563 3186 227526 206046 21389 91 2656292 2463967 190133 2192 15750852 14797863 940397 12592 1314510 1243747 69956 807 MEDICAL SUPPLIES 50707877 50682953 24914 10 EDUCATION & TRAINING 541180 500031 40448 701 BAD DEBTS 487449 487449 DUES & SUBSCRIPTIONS 431646 247885 183081 680 225231 218997 4951 1283 258362674 239448128 18620051 294495 217353 335910 309015022 275775150 23850525 33215113 1186354 895643 8234571 8342995 4496559 4300305 313778822 181178150 123998741 132600672 4027740 6476929 2064937 1847575 30061912 19705337 507153714 483495629 24995546 25255590 89684928 85753347 18942262 16313820 133622736 127322757 X 371682443 354438360 1848535 1734512 373530978 356172872 507153714 483495629 X 16471455 -35285538 1455977 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 15914 15914 0 PART II-B, LINE 1: THE $15,914 REPRESENTS THE PORTION OF THE DUES PAID TO THE NEBRASKA HOSPITAL ASSOCIATION AND THE AMERICAN HOSPITAL ASSOCIATION THAT ARE USED FOR LOBBYING BY THOSE ORGANIZATIONS. 1995816 1995816 168876213 84745114 84131099 3218181 2383636 834545 117751286 89058124 28693162 21937326 4991276 16946050 132600672 ESTIMATED THIRD PARTY SETTLEMENTS 1621532 DEFERRED COMPENSATION 7506846 OPERATING LEASES LIABILITY 7185442 16313820 X PART X, LINE 2: THE ORGANIZATION ACCOUNTS FOR UNCERTAINTIES IN ACCOUNTING FOR INCOME TAX ASSETS AND LIABILITIES USING GUIDANCE INCLUDED IN FASB ASC 740, INCOME TAXES. THE ORGANIZATION RECOGNIZES THE EFFECT OF INCOME TAX POSITIONS ONLY IF THOSE POSITIONS ARE MORE LIKELY THAN NOT OF BEING SUSTAINED. AT DECEMBER 31, 2022 AND 2021, THE ORGANIZATION HAD NO UNCERTAIN TAX POSITIONS ACCRUED. 1 1 X 1 X 1 X 1 1 0 1 1 1689 2403668 0 2403668 0.00930 5501 38753036 24898143 13854893 0.05370 7190 41156704 24898143 16258561 0.06300 17542 1765455 26600 1738855 0.00670 94 481496 0 481496 0.00190 2100 727996 668295 59701 0.00020 586554 313180 273374 0.00110 520126 0 520126 0.00200 19736 4081627 1008075 3073552 0.01190 26926 45238331 25906218 19332113 0.07490 20000 3574 3574 0.00000 13700 20641 20641 0.00010 2000 5375 5375 0.00000 35700 29590 29590 0.00010 0 487449 0 78365723 113299234 -34933511 X 1 1 1 NORTH PLATTE SURGERY CENTER LLC PROVIDES OUTPATIENT SURGERY SERVICES 0.50000 0.00000 0.50000 2 MID-NE MEDICAL VENTURES LEASES OF PHYSICIAN'S OFFICE BUILDING 0.60000 0.00000 0.40000 1 1 GREAT PLAINS HEALTH 601 WEST LEOTA NORTH PLATTE NE 69101 WWW.GPHEALTH.ORG 510001 X X X GREAT PLAINS HEALTH 1 0 0 1 X X X X X X X X X X 22 1 0 0 1 X WWW.GPHEALTH.ORG/ABOUT-US/COMMUNITY-IMPACT X 1 22 1 WWW.GPHEALTH.ORG/ABOUT-US/COMMUNITY-IMPACT 0 1 X 150.000000000000 250.000000000000 X X X X 1 1 X X X 1 X GPHEALTH.ORG/PATIENTS-VISITORS/PRICE-ESTIMATES-BILLING-AND-FINANCIAL-ASSIST X GPHEALTH.ORG/PATIENTS-VISITORS/PRICE-ESTIMATES-BILLING-AND-FINANCIAL-ASSIST X GPHEALTH.ORG/PATIENTS-VISITORS/PRICE-ESTIMATES-BILLING-AND-FINANCIAL-ASSIST X X X X X X X 1 X 0 X X X X X 1 X 0 0 GREAT PLAINS HEALTH PART V, SECTION B, LINE 3J: THE GREAT PLAINS HEALTH COMMUNITY HEALTH NEEDS ASSESSMENT WAS CONDUCTED IN MAY 2022. GREAT PLAINS HEALTH EXECUTIVES, REPRESENTATIVES FROM PARTNERING AGENCIES AND THE COMMUNITY ANALYZED THE MOST UP-TO-DATE HEALTH DATA AVAILABLE, INCLUDING RELEVANT DEMOGRAPHICS AND COMMUNITY STAKEHOLDER INPUT. THE PROCESS LED TO THE IDENTIFICATION OF FIVE PRIORITY AREAS:1. RECRUIT AND RETAIN QUALITY HEALTH PROFESSIONALS.2. INCREASE ACCESS TO MENTAL AND BEHAVIORAL HEALTH CARE.3. IMPROVE ACCESS TO MEDICAL AND DENTAL CARE.4. INCREASE PREVENTION, EDUCATION TO REDUCE THE PREVALENCE OF CHRONIC DISEASES, PREVENTABLE CONDITIONS, READMISSIONS, AND HIGH MORTALITY RATES.5. INCREASE ACCESS TO SAFE AND AFFORDABLE HOUSING. GREAT PLAINS HEALTH PART V, SECTION B, LINE 5: DURING THE RESEARCH AND COLLABORATION OF CHNA DEVELOPMENT, GREAT PLAINS HEALTH CONDUCTED ONE-ON-ONE PHONE INTERVIEWS WITH INDIVIDUALS WHO REPRESENT THE BROAD INTERESTS OF THE COMMUNITY AND THOSE WITH AN EXPERTISE RELEVANT TO THE HEALTH OF THE COMMUNITY, INCLUDING STATE, LOCAL, TRIBAL OR REGIONAL GOVERNMENTAL PUBLIC HEALTH DEPARTMENT EQUIVALENT DEPARTMENT OR AGENCY; MEMBERS OF A MEDICALLY UNDERSERVED, LOW-INCOME OR MINORITY POPULATIONS IN THE COMMUNITY, OR INDIVIDUALS OR ORGANIZATIONS SERVING OR REPRESENTING THE INTERESTS OF SUCH POPULATIONS AND COMMUNITY LEADERS. DURING THESE INTERVIEWS, THE HEALTH NEEDS OF THE COMMUNITY, ACCESS ISSUES, BARRIERS AND ISSUES RELATED TO SPECIFIC POPULATIONS WERE DISCUSSED. GREAT PLAINS HEALTH PART V, SECTION B, LINE 11: GREAT PLAINS HEALTH LEADERSHIP PRIORITIZED AND DECIDED TO ADDRESS ALL OF THE PRIORITIZED NEEDS IN VARIOUS CAPACITIES THROUGH A HOSPITAL SPECIFIC IMPLEMENTATION PLAN.THE FINAL LIST OF PRIORITIZED NEEDS IS LISTED BELOW IN DESCENDING ORDER:1. RECRUIT AND RETAIN QUALITY HEALTH PROFESSIONALS.2. INCREASE ACCESS TO MENTAL AND BEHAVIORAL HEALTH CARE.3. IMPROVE ACCESS TO MEDICAL AND DENTAL CARE.4. INCREASE PREVENTION, EDUCATION TO REDUCE THE PREVALENCE OF CHRONIS DISEASES, PREVENTABLE CONDITIONS, READMISSIONS, AND HIGH MORTALITY RATES.5. INCREASE ACCESS TO SAFE AND AFFORDABLE HOUSING.GREAT PLAINS HEALTH LEADERSHIP HAS DEVELOPED AN IMPLEMENTATION PLAN TO IDENTIFY SPECIFIC ACTIVITIES AND SERVICES WHICH DIRECTLY ADDRESS THE IDENTIFIED PRIORITIES. THE OBJECTIVES WERE IDENTIFIED BY STUDYING THE PRIORITIZED HEALTH NEEDS, WITHIN THE CONTEXT OF THE HOSPITAL'S OVERALL STRATEGIC PLAN AND THE AVAILABILITY OF FINITE RESOURCES. THE PLAN INCLUDES A RATIONALE FOR EACH PRIORITY, FOLLOWED BY STRATEGIC OBJECTIVE ALIGNMENTS, SPECIFIC IMPLEMENTATION GOALS AND INITIATIVES, MEASUREMENT, RESPONSIBLE LEADERS AND ANNUAL PROGRESS/KEY RESULTS (AS APPROPRIATE). PRIORITY ONE: RECRUIT AND RETAIN QUALITY HEALTHCARE PROFESSIONALS. IMPLEMENTATION ACTIVITIES INCLUDE ACTIVELY RECRUITING HEALTHCARE PROFESSIONALS TO THE COMMUNITY, DEPLOYING RENTENTION STRATEGIES TO RETAIN PROVIDERS, ENGAGING IN COMMUNITY DEVELOPMENT, AND SEEKING TO GROW AND DEVELOP PROFESSIONALS WITH THE COMMUNITY.PRIORITY TWO: INCREASE ACCESS TO MENTAL AND BEHAVIORAL HEALTH CARE. IMPLEMENTATION ACTIVITIES INCLUDE PROVIDING POINTS OF ACCESS FOR MENTAL AND BEHAVIORAL HEALTH SERVICES IN THE COMMUNITY, UTILIZING TECHNOLOGY TO IMPROVE ACCESS TO MENTAL AND BEHAVIORAL HEALTH PARTNERSHIPS, GENERATING COMMUNITY AWARENESS AND EDUCATION ABOUT SUICIDE AND OTHER MENTAL HEALTH CONDITIONS, CREATING PARTNERSHIPS WITH LOCAL SCHOOLS AND AGENCIES TO REACH THE ADOLESCENT POPULATION, DEVELOPING MENTAL HEALTH SUPPORT SYSTEMS FOR EMPLOYEES OF GREAT PLAINS HEALTH, AND OFFERING SUPPORT SERVICES AND CLINICAL GUIDELINES DESIGNED TO ASSIST AREA PROVIDERS AND LINCOLN COUNTY RESIDENTS WITH THE DIAGNOSIS OF MENTAL OR BEHAVIORAL HEALTH. PRIORITY THREE: IMPROVE ACCESS TO MEDICAL AND DENTAL CARE. IMPLEMENTATION ACTIVITIES INCLUDE UTILIZING TECHNOLOGY TO IMPROVE ACCESS TO MEDICAL CARE, INCITING PRODUCTIVE DIALOGUE AROUND ACCESS TO LOW-INCOME DENTAL CARE IN LINCOLN COUNTY, ENGAGING IN PROGRAMS THAT SERVE THOSE UNABLE TO PAY FOR HEALTHCARE SERVICES, ENHANCING PHYSICAL STRUCTURE OF TREATMENT AREAS TO CREATE GREATER ACCESS TO CARE, AND EXPANDING LOCAL HEALTHCARE SERVICES SO THAT PATIENTS CAN STAY AS CLOSE TO HOME AS POSSIBLE FOR MEDICAL CARE.PRIORITY FOUR: INCREASE PREVENTION EDUCATION TO REDUCE THE PREVALENCE OF CHRONIC DISEASES, PREVENTABLE CONDITIONS, READMISSIONS AND HIGH MORTALITY RATES. IMPLEMENTATION ACTIVITIES INCLUDE OFFERING COMMUNITY EVENTS DESIGNED TO IMPROVE HEALTH AND WELLNESS, PARTNERING WITH LOCAL ORGANIZATIONS WHO WORK TO IMPROVE WELLNESS IN THE COMMUNITY, ENHANCING THE GPFIT! INITIATIVE TO IMPROVE COMMUNITY WELLNESS, PROVIDING COMMUNITY EDUCATION DESIGNED TO IMPROVE THE HEALTH OF THE COMMUNITY, PROVIDING COMMUNITY RESOURCES TO IMPROVE HEALTH AND WELLNESS, PROMOTING PREVENTION EDUCATION AND MESSAGING THROUGHOUT THE COMMUNITY, AND CREATING WRAP-AROUND SERVICES DESIGNED TO ENHANCE THE SUCCESS OF PATIENTS WITH CHRONIC DISEASE.PRIORITY FIVE: INCREASE ACCESS TO SAFE AND AFFORDABLE HOUSING. IMPLEMENTATION ACTIVITIES INCLUDE INCREASING ACCESS TO SAFE AND AFFORDABLE HOUSING OPTIONS IN THE COMMUNITY BY PARTICIPATING IN THE HOUSING TASK FORCE, ASSISTING WITH HOUSING DOWN PAYMENTS FOR HEALTHCARE WORKERS EMPLOYED AT GPH, WORKING WITH LOCAL HOTELS TO OFFER PATIENTS RECEIVING CARE AND THEIR FAMILIES DISCOUNTED RATES AND CONTINUING TO BE ACTIVELY ENGAGED IN INITIATIVES TO GROW HOUSING.THERE ARE NOT ANY SIGNIFICANT NEEDS IDENTIFIED IN THE MOST RECENT CHNA THAT ARE NOT BEING ADDRESSED. GREAT PLAINS HEALTH PART V, SECTION B, LINE 13B: IF A PATIENT'S COMBINED OUTSTANDING MEDICAL BILLS, AFTER INSURANCE PAYS, EXCEEDS 7.5% OF THEIR ANNUAL GROSS INCOME, THEY WILL RECEIVE AN ADDITIONAL 25% DISCOUNT ON TOP OF THE FINANCIAL ASSISTANCE DISCOUNT WITH THE COMBINED DISCOUNT NOT TO EXCEED 100% OF THE OUTSTANDING BALANCE. OUTSTANDING MEDICAL BILLS ARE NOT RESTRICTED TO JUST GREAT PLAINS HEALTH SERVICES BUT CAN BE ANY MEDICAL SERVICES. CURRENT STATEMENTS MUST BE PROVIDED SHOWING THE OUTSTANDING BALANCES CLAIMED. GREAT PLAINS HEALTH PART V, SECTION B, LINE 16J: THE WRITTEN FINANCIAL ASSISTANCE POLICY IS ON GPH'S WEBSITE, AS WELL AS PRINTED ON THE BACK SIDE OF EACH PAGE OF THE PATIENT BILLING STATEMENT. POSTERS REGARDING AVAILABILITY OF FINANCIAL ASSISTANCE ARE POSTED AT PATIENT POINTS OF ENTRY THROUGHOUT THE HOSPITAL FACILITY. GREAT PLAINS HEALTH PART V, SECTION B, LINE 20E: GPH WORKS WITH PATIENTS THROUGH PHONE AND IN-PERSON INTERVIEWS TO DETERMINE THE PATIENT'S FINANCIAL SITUATION AND TO DETERMINE IF THE INDIVIDUAL QUALIFIES FOR ASSISTANCE, SUCH AS MEDICAID. 1 1 - NORTH PLATTE SURGERY CENTER LLC 621 WEST FRANCIS STREET NORTH PLATTE NE 69101 OUTPATIENT SURGERIES PART I, LINE 3C: GREAT PLAINS HEALTH (GPH) MAY MAKE A DETERMINATION OF ELIGIBILTY AT ANY STAGE OF THE PROCESS, INCLUDING PAST ASSIGNMENT TO AN OUTSIDE COLLECTION AGENCY. EACH PATIENT REQUESTING FINANCIAL ASSISTANCE WILL BE ASKED TO COMPLETE A FINANCIAL QUESTIONNAIRE AND TO PROVIDE COPIES OF DOCUMENTATION INCLUDING THEIR MOST RECENT FEDERAL INCOME TAX FORM, COPIES OF RECENT PAY STUBS, BANK STATEMENTS AND OTHER APPROPRIATE INDICATORS OF INCOME. A REFERRAL FOR FINANCIAL ASSITANCE MAY BE RECOMMENDED BY THE PATIENT, FAMILY MEMBER, PHYSICIAN OR HOSPITAL DEPARTMENTS AND PROVIDED BASED ON INFORMATION FROM OTHER SOURCES. FULL FINANCIAL ASSISTANCE WILL GENERALLY BE PROVIDED WHEN GROSS HOUSEHOLD INCOME IS EQUAL TO OR LESS THAN 150% OF THE FEDERAL POVERTY GUIDELINES. A SLIDING FEE SCALE DISCOUNT WILL BE APPLIED FOR HOUSEHOLD INCOME UP TO 250% OF THE FEDERAL POVERTY GUIDELINES. THE INCOME LEVELS WILL BE UPDATED ANNUALLY BASED UPON THE MOST CURRENT FEDERAL POVERTY GUIDELINES. PART I, LINE 6A: GPH'S COMMUNITY BENEFIT REPORT IS PREPARED BY THE STAFF OF GPH. PART I, LINE 7: GPH UTILIZED AN OVERALL COST TO CHARGE RATIO (TOTAL EXPENSES - BAD DEBT) / GROSS PATIENT SERVICE REVENUE = PERCENTAGE OF COST TO CHARGE. PART I, LINE 7G: SUBSIDIZED HEALTH SERVICES REPORTED ON LINE 7G INCLUDE TRAINING FOR EMS, OUTREACH, LIFE SUPPORT OUTSIDE, AND ER, TRAUMA, AND LIFE SUPPORT FOR HOSPITAL EDUCATION. PART I, LN 7 COL(F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $487,449. PART II, COMMUNITY BUILDING ACTIVITIES: GPH HAS MANY ACTIVITES TO PROMOTE HEALTH IN THE COMMUNITIES IT SERVES. THESE ACTIVITIES INCLUDE: RECRUITMENT OF PHYSICIANS TO MEET NEED, SPONSORING HEALTH FAIR, SPORTS CLINICS AND SUPPORT GROUPS, PHYSICIANS SERVING ON COMMUNITY BOARDS, EDUCATION PROGRAMS AND MEDICATION ASSISTANCE. THE DONATED SERVICES AND FUNDS HELP FURTHER THE MISSION AND GOALS OF COMMUNITY ORGANIZATIONS WHICH, IN TURN, HELP IMPROVE OVERALL HEALTH STATUS AND QUALITY OF LIFE OF THE COMMUNITIES SERVED. PART III, LINE 2: THE ORGANIZATION DETERMINES THE TRANSACTION PRICE BASED ON STANDARD CHARGES FOR GOODS AND SERVICES PROVIDED, REDUCED BY CONTRACTUAL ADJUSTMENTS PROVIDED TO THIRD-PARTY PAYORS, DISCOUNTS PROVIDED TO UNINSURED PATIENTS IN ACCORDANCE WITH THE ORGANIZATION'S POLICY, AND OR IMPLICIT PRICE CONCESSIONS PROVIDED TO UNINSURED PATIENTS. THE ORGANIZATION DETERMINES ITS ESTIMATES OF CONTRACTUAL ADJUSTMENTS AND DISCOUNTS BASED ON CONTRACTUAL AGREEMENTS, ITS DISCOUNT POLICIES AND HISTORICAL EXPERIENCE. THE ORGANIZATION DETERMINES ITS ESTIMATE OF IMPLICIT PRICE CONCESSIONS BASED ON HISTORICAL COLLECTION EXPERIENCE WITH VARIOUS CLASSES OF PATIENTS. PART III, LINE 3: IN ACCORDANCE WITH ITS MISSION OBJECTIVES, THE ORGANIZATION PROVIDES FREE CARE TO PATIENTS WHO LACK FINANCIAL RESOURCES TO PAY FOR THE SERVICES THEY RECEIVE. IT IS THE POLICY OF THE ORGANIZATION NOT TO PURSUE COLLECTION OF AMOUNTS DETERMINED TO BE PATIENT FINANCIAL ASSISTANCE. ACCORDINGLY, THE ORGANIZATION DOES NOT REPORT THESE AMOUNTS IN PATIENT SERVICE REVENUE. THE ESTIMATED COST INCURRED BY THE ORGANIZATION TO PROVIDE THESE SERVICES TO PATIENTS WHO ARE UNABLE TO PAY WAS APPROXIMATELY $2,687,000 FOR THE YEAR ENDED DECEMBER 31, 2022. THE ESTIMATED COST OF THESE SERVICES WAS DETERMINED USING A RATIO OF COSTS TO STANDARD CHARGES AND APPLYING THAT RATIO TO THE STANDARD CHARGES ASSOCIATED WITH PROVIDING CHARITY CARE FOR THE PERIOD. STANDARD CHARGES ASSOCIATED WITH PROVIDING CARE TO CHARITY PATIENTS INCLUDES ONLY THE RELATED CHARGES FOR THOSE PATIENTS WHO ARE FINANCIALLY UNABLE TO PAY AND QUALIFY UNDER THE ORGANIZATION'S PATIENT FINANCIAL ASSISTANCE/CHARITY CARE POLICY AND THAT DO NOT OTHERWISE QUALIFY FOR REIMBURSEMENT FROM A GOVERNMENTAL PROGRAM. PART III, LINE 4: THE COSTING METHODOLOGY USED IN DETERMINING THE BAD DEBT EXPENSES INCLUDES CALCULATING ON A MONTHLY BASIS THE TOTAL ESTIMATED AMOUNTS BASED ON HISTORICAL WRITE OFFS.THE ORGANIZATION'S FINANCIAL STATEMENTS DO NOT CONTAIN A SPECIFIC FOOTNOTE DESCRIBING BAD DEBT. FOOTNOTES TITLED "PATIENT RECEIVABLES," "PATIENT SERVICE REVENUE, AND "FINANCIAL ASSISTANCE/CHARITY CARE" CAN BE FOUND ON PAGES 9, 11, 12, AND 13 OF THE ATTACHED AUDITED FINANCIAL STATEMENTS. PART III, LINE 8: THE MEDICARE SHORTFALL IS BASED ON THE INFORMATION FROM THE COST REPORT. THESE COSTS ARE MEDICARE REIMBURSABLE COSTS, NOT ALL COSTS. THESE MEDICARE REIMBURSABLE COSTS SHOULD BE TREATED AS A COMMUNITY BENEFIT TO THE EXTENT THAT MEDICARE REVENUES DO NOT COVER THE COSTS. WE DO NOT USE ANY NEGOTIATION TOOL WITH MEDICARE FOR OUR RATES; THE RATES THAT WE ARE PAID ARE MANDATED. HENCE, THIS DOES NOT GIVE US THE ABILITY AS A PROVIDER TO RECEIVE SUFFICIENT REVENUES TO COVER THE MEDICARE COSTS. AS A FACILITY WE ARE WORKING TOWARD COSTS SAVINGS. PART III, LINE 9B: IF THE COLLECTION AGENCY LEARNS INFORMATION THAT INDICATES THAT THE PATIENT MAY BE ELIGIBLE FOR FINANCIAL ASSISTANCE UNDER THE GPH CHARITY CARE POLICY, THEN THE COLLECTION AGENCY SHALL PROMPTLY NOTIFY THE PATIENT FINANCIAL SERVICES DIRECTOR AND CEASE ANY FURTHER COLLECTION ACTIVITY UNTIL GPH DETERMINES THE PATIENT ELIGIBILITY. PART VI, LINE 2: GPH USES STRATEGIC PLANNING PROCESSES, MARKET STUDIES, OPEN FORUMS WITH PHYSICIANS, COMMUNITY FOCUS GROUPS, CUSTOMER SERVICE SURVEYS AND COMMUNITY SURVEYS TO ASSESS THE HEALTH CARE NEEDS OF THE COMMUNITIES GPH SERVES. PATIENT CARE AND SUPPORT SERVICES PROVIDED BY GPH ARE BASED ON GPH'S MISSION, VISION, VALUES AND STANDARDS OF BEHAVIOR. PATIENT CARE AND ANCILLARY SERVICES ARE ORGANIZED IN RESPONSE TO PATIENT NEEDS AS IDENTIFIED THROUGH THE STRATEGIC PLANNING PROCESS. THE GPH STRATEGIC PLAN FOCUSES ON ACHIEVING A CONTINUUM OF CARE TO MEET THE NEEDS OF THE COMMUNITY SERVED. THE STRATEGIC PLANNING PROCESS IS COMPLETED APPROXIMATELY EVERY THREE TO FIVE YEARS. PART VI, LINE 3: FOR PATIENTS THAT GPH DETERMINES ARE FINANCIALLY INDIGENT, THE PATIENT/GUARANTOR WILL BE NOTIFIED AND ASSISTED BY THE GPH PATIENT FINANCIAL SERVICES IN APPLYING FOR FINANCIAL ASSISTANCE. IF NO SOURCE OF FINANCIAL ASSISTANCE IS AVAILABLE, THE ACCOUNT WILL BE REVIEWED FOR A CHARITY ALLOWANCE ACCORDING TO THE HOSPITAL'S CHARITY POLICY (ADMINISTRATIVE POLICY 8210-0008). CASE MANAGERS ARE AVAILABLE AT GPH TO ASSIST PATIENTS AND THEIR FAMILIES WITH THE FINANCIAL AND SOCIAL STRESS THAT ACCOMPANY ILLNESS AND HOSPITALIZATION. CASE MANAGERS HAVE A WORKING KNOWLEDGE OF SOCIAL WORK THEORIES AND ARE ABLE TO ASSIST PATIENTS WITH CONTACTING COMMUNITY AGENCIES THAT CAN ASSIST THEM IN RECOVERY AND FINANCIAL NEEDS. AN OUTSIDE AGENCY IS USED TO PROVIDE ASSISTANCE TO PATIENTS IN DETERMINING THEIR ELIGIBILITY FOR MEDICAID. ONE-ON-ONE FINANCIAL COUNSELING IS AVAILABLE TO EVERY PATIENT, UPON REQUEST. PART VI, LINE 4: GREAT PLAINS HEALTH IS THE ONLY HOSPITAL IN LINCOLN COUNTY AND IS A REGIONAL REFERRAL HOSPITAL FOR NINETEEN OTHER COUNTIES IN NEBRASKA. GPH SERVES A MARKET OF OVER 134,000 RESIDENTS. OVER NINETY-THREE PERCENT OF GPH'S INPATIENT ADMISSIONS COME FROM WITHIN THIS MARKET. SEVENTY-TWO PERCENT OF THE PATIENTS COME FROM LINCOLN COUNTY. THE PRIMARY SERVICE AREA IS DEFINED AS LINCOLN COUNTY. THE SECONDARY SERVICE AREA INCLUDES THE FOLLOWING NINETEEN COUNTIES: ARTHUR, FRONTIER, HOOKER, PERKINS, CHASE, GRANT, GOSPER, KEITH, RED WILLOW, FURNAS, DUNDY, CHERRY, CUSTER, HAYES, LOGAN, THOMAS, DAWSON, HITCHCOCK, AND MCPHERSON. THE TOTAL POPULATION OF THE SECONDARY SERVICE AREA IS ABOUT 99,000.THE POPULATION IN THE SERVICE AREA IS EXPECTED TO CONTINUE THE SHIFT TOWARDS AN AGING POPULATION THAT WOULD INCREASE SERVICE UTILIZATION. HOSPITALS IN THE SECONDARY SERVICE AREA ARE: CHASE COUNTY COMMUNITY HOSPITAL (CHASE COUNTY), CHERRY COUNTY HOSPITAL (CHERRY COUNTY), CALLAWAY DISTRICT HOSPITAL (CUSTER COUNTY), JENNIE M. MELHAM MEMORIAL HOSPITAL (CUSTER COUNTY), COZAD COMMUNITY HOSPITAL (DAWSON COUNTY), GOTHENBURG MEMORIAL HOSPITAL (DAWSON COUNTY), TRI COUNTY HOSPITAL (DAWSON COUNTY), DUNDY COUNTY HOSPITAL (DUNDY COUNTY), TRI VALLEY HEALTH SYSTEM (FURNAS COUNTY), OGALLALA COMMUNITY HOSPITAL (KEITH COUNTY), PERKINS COUNTY HEALTH SERVICES (PERKINS COUNTY), AND COMMUNITY HOSPITAL (RED WILLOW COUNTY).MARKET OVERVIEWPRIMARY SERVICE AREA- CONSISTS OF LINCOLN COUNTY- ACCOUNTS FOR NEARLY 64.8% GPH'S INPATIENT CASES- THE 2019 POPULATION WAS 36,338SECONDARY SERVICE AREA- CONSISTS OF NINETEEN COUNTIES EXTENDING NORTH TO SOUTH DAKOTA, SOUTH TO KANSAS AND WEST TO COLORADO - ACCOUNTS FOR 29.0% OF GPH'S INPATIENT CASES - POPULATION 101,938 IN 2019 - LARGEST EMPLOYER IS UNION PACIFIC PART VI, LINE 5: GPH HAS MANY ACTIVITES TO PROMOTE HEALTH IN THE COMMUNITIES IT SERVES. THESE ACTIVITIES INCLUDE: RECRUITMENT OF PHYSICIANS TO MEET NEED, SPONSORING HEALTH FAIR, SPORTS CLINICS AND SUPPORT GROUPS, PHYSICIANS SERVING ON COMMUNITY BOARDS, EDUCATION PROGRAMS AND MEDICATION ASSISTANCE. THE DONATED SERVICES AND FUNDS HELP FURTHER THE MISSION AND GOALS OF COMMUNITY ORGANIZATIONS WHICH, IN TURN, HELP IMPROVE OVERALL HEALTH STATUS AND QUALITY OF LIFE OF THE COMMUNITIES SERVED. PART VI, LINE 6: GREAT PLAINS HEALTH IS NOT PART OF AN AFFILIATED HEALTHCARE SYSTEM, BUT ASSISTS IN IDENTIFYING AND RECRUITING TOP PHYSICIANS IN NEEDED SPECIALTIES. GPH PROVIDES EDUCATION TO THE COMMUNITY ON VARIOUS HEALTH PROGRAMS FOR EMPLOYEES, EMPLOYERS AND THE COMMUNITY GPH SERVES. MANY MEMBERS OF THE STAFF HOLD SPEAKING ENGAGEMENTS TO PROVIDE MEDICAL INFORMATION TO THE COMMUNITY. THE MEDICATION ASSISTANCE PROGRAM ASSISTS PATIENTS TO FIND OTHER MEANS TO AFFORD THEIR PRESCRIPTIONS.THE HEALTH CENTER OPERATES ACUTE AND PSYCHIATRIC CARE BEDS, A HOME HEALTH AGENCY, AND PROVIDES VARIOUS OUTPATIENT AND EMERGENCY MEDICAL TREATMENT SERVICES. THE AFFILIATES LEASE AND SELL HOME MEDICAL EQUIPMENT TO THE PUBLIC, RENT OFFICE SPACE TO PHYSICIAN PRACTICES AND PROVIDE PHYSICIAN PROFESSIONAL MEDICAL SERVICES AND OTHER PROGRAMS TO PATIENTS. PART VI, LINE 7: GPH DOES NOT FILE A COMMUNITY BENEFIT REPORT WITH ANY STATE. 1 NEBRASKALAND DAYS INC PO BOX 706 NORTH PLATTE NE 69103 470521025 501(C)(4) 20300 0 SPONSOR OF EVENTS PLATTE RIVER FITNESS SERIES 1300 MCDONALD ROAD NORTH PLATTE NE 69101 476006297 GOVERNMENTAL 35000 0 SPONSOR OF EVENTS CREATIVITY UNLIMITED ARTS COUNCIL PO BOX 266 NORTH PLATTE NE 69103 202209105 501(C)(3) 10000 0 FOR RENOVATION TO THE PRAIRIE ARTS CENTER NORTH PLATTE CHAMBER OF COMMERCE 502 S DEWY NORTH PLATTE NE 69101 237355570 GOVERNMENTAL 113970 0 SHOT IN THE ARM HOUSING INCENTIVE PROGRAM PHASE 3 NORTH PLATTE PUBLIC SCHOOLS 301 WEST F PO BOX 1557 NORTH PLATTE NE 69101 476004045 GOVERNMENTAL 121852 0 PURCHASE OF EDUCATIONAL SOFTWARE 3 2 PART I, LINE 2: GREAT PLAINS HEALTH PROVIDES SPONSORSHIP DOLLARS TO CHARITABLE EVENTS IN THE LOCAL AREA. THE ORGANIZATION GIVES TO CHARITABLE ORGANIZATIONS IN THE AREA WHICH BENEFIT THE LOCAL COMMUNITY. X X X X 0 0 0 0 0 0 0 1 0 WAYNE L WARREN MD PHYSICIAN (GPH) 2066413 0 3752 0 23774 0 12200 0 38818 0 2144957 0 0 0 PUSHKAR M KANADE MD PHYSICIAN (GPH) 1379626 0 58498 0 2793 0 12200 0 5465 0 1458582 0 0 0 MICHAEL SIMONSON MD PHYSICIAN (GPH) 1161287 0 71368 0 3600 0 12200 0 39326 0 1287781 0 0 0 NARAYANA KODURI MD PHYSICIAN (GPH) 1093703 0 85688 0 300 0 12200 0 43126 0 1235017 0 0 0 ANIL KUMAR MD PHYSICIAN (GPH) 1123548 0 54652 0 450 0 12200 0 38126 0 1228976 0 0 0 JOVANKA VULSANOVIC MD DIRECTOR/PHYSICIAN (GPH) 319776 0 69113 0 1694 0 12200 0 7017 0 409800 0 0 0 IVAN MITCHELL CEO 421107 0 30100 0 19333 0 12200 0 40876 0 523616 0 0 0 SUMMER OWEN CFO 142921 0 100 0 10161 0 6151 0 1759 0 161092 0 0 0 PART I, LINE 7 PHYSICIANS ARE ELIGIBLE FOR NON-FIXED QUALITY COMPENSATION BONUSES. QUALITY INDICATORS FOR QUALITY COMPENSATION SHALL BE OBJECTIVE, IDENTIFIABLE STANDARDS THAT ARE ESTABLISHED BY GPH, THE PHYSICIAN AND EXECUTIVE DIRECTOR IN WRITING ON AN ANNUAL BASIS PRIOR TO THE BEGINNING OF A NEW CONTRACT YEAR. SAID QUALITY METRICS SHALL NOT RELATE IN ANY MANNER TO THE VOLUME OR VALUE OF REFERRALS OR OTHER BUSINESS GENERATED BY PHYSICIAN FOR HOSPITAL OR AFFILIATES THEREOF OR BASED UPON REDUCING OR REFUSING CARE PROVIDED TO BENEFICIARIES OF FEDERAL PROGRAMS. THE FOLLOWING PHYSICIANS RECEIVED BONUSES DURING THE YEAR: MICHAEL SIMONSON, MD WAYNE WARREN, MD PUSHKAR KANADE, MD ANIL KUMAR, MD NARAYANA KODURI, MD JOVANKA VULSANOVIC, MD MICHELLE L MCNEA SPOUSE OF MELVIN MCNEA, OFFICER. 75512 EMPLOYMENT WITH HOSPITAL 0 KRISTIN LAKE SPOUSE OF DR. LADD LAKE, DIRECTOR 124562 EMPLOYMENT WITH HOSPITAL 0 JOSEPH RUYBAL SON-IN-LAW OF PETE VOLZ, DIRECTOR 138187 EMPLOYMENT WITH HOSPITAL 0 EDUARDO A F FREITAS SPOUSE OF JOVANKA VUKSANOVIC, DIRECTOR 728305 EMPLOYMENT WITH HOSPITAL 0 FORM 990, PART VI, SECTION A, LINE 1A THE EXECUTIVE COMMITTEE, CONSISTING OF THE OFFICERS OF THE BOARD OF DIRECTORS, HAS THE AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY. FORM 990, PART VI, SECTION A, LINE 6 THE CORPORATION HAS TWO CLASSES OF MEMBERS, CHARTER MEMBERS AND PATRON MEMBERS. CHARTER MEMBERS CONTRIBUTED TO THE ORIGINAL FUND DRIVE. THOSE INDIVIDUAL WHO CONTRIBUTE $500 TO EITHER GPH OR THE FOUNDATION AND DID NOT CONTRIBUTE DURING THE ORIGINAL FUND DRIVE SHALL BE DESIGNATED AS PATRON MEMBERS. FORM 990, PART VI, SECTION A, LINE 7A MEMBERS ARE ENTITLED TO ONE VOTE IN ELECTIONS OF BOARD MEMBERS. FORM 990, PART VI, SECTION A, LINE 7B MEMBERS HAVE THE POWER TO APPROVE AMENDMENTS TO THE ARTICLES OF INCORPORATION OR BYLAWS, A MERGER, A CONSOLIDATION, DISSOLUTION, OR SALE OF ALL OR SUBSTANTIALLY ALL THE ASSETS. FORM 990, PART VI, SECTION B, LINE 11B COPIES OF THE FORM 990 ARE AVAILABLE TO THE BOARD ON A PORTAL. THE BOARD IS NOTIFIED WHEN IT IS AVAILABLE FOR VIEWING. FORM 990, PART VI, SECTION B, LINE 12C GPH PROVIDES A CONFLICT OF INTEREST QUESTIONNAIRE TO EACH OFFICER AND DIRECTOR. THE CONFLICT OF INTEREST QUESTIONNAIRE IS COMPLETED AND RETURNED ANNUALLY. ANY QUESTIONABLE SITUATION IS DISCLOSED ON THE QUESTIONNAIRE. FURTHERMORE, ANY POTENTIAL CONFLICTS ARISING DURING THE YEAR ARE TO BE REPORTED TO ADMINISTRATION. THE CONFLICTS REVIEW COMMITTEE REVIEWS ANY TRANSACTIONS THAT MAY BE CONSIDERED TO HAVE A CONFLICT OF INTEREST. FORM 990, PART VI, SECTION B, LINE 15 THE GREAT PLAINS HEALTH BOARD OF DIRECTORS STRIVES TO COMPENSATE OFFICERS AT LEVELS THAT ARE COMPETITIVE IN THE MARKETPLACE, COST EFFECTIVE AND, AS MUCH AS POSSIBLE, INTERNALLY EQUITABLE. THE EXECUTIVE COMMITTEE FOR THE BOARD OF DIRECTORS MEETS NO LESS THAN ANNUALLY TO REVIEW COMPENSATION PACKAGES FOR GPH'S PRESIDENT AND OFFICERS. COMPENSATION DATA IS GATHERED BY AN INDEPENDENT EXECUTIVE COMPENSATION CONSULTANT BY SURVEYING COMPARABLE POSITIONS AT PEER INSTITUTIONS, ENSURING THAT COMPENSATION PACKAGES ARE MEETING FAIR MARKET VALUE. A COMPLETE ANALYSIS OF DATA IS REQUESTED FROM THE CONSULTANT AT LEAST EVERY FOUR YEARS. THE INDEPENDENT EXECUTIVE COMPENSATION CONSULTANT IS ULTIMATELY ACCOUNTABLE TO THE EXECUTIVE COMMITTEE AND THE BOARD. THE EXECUTIVE COMMITTEE ANNUALLY RECOMMENDS TO THE BOARD THE SELECTION/RETENTION OF THE INDEPENDENT EXECUTIVE COMPENSATION CONSULTANT; REVIEWS COMPENSATION RECOMMENDATIONS; AND DETERMINES THOSE OFFICERS FOR WHOM WRITTEN EMPLOYMENT CONTRACTS WILL BE REQUIRED. THE BOARD OF DIRECTORS HAS THE AUTHORITY TO ANNUALLY AUTHORIZE MANAGEMENT TO PROCEED WITH IMPLEMENTATION OF PROPOSED COMPENSATION OF OFFICERS. FORM 990, PART VI, SECTION C, LINE 19 GREAT PLAINS HEALTH DOES NOT MAKE ITS CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC. UPON WRITTEN REQUEST TO THE CFO, GOVERNING DOCUMENTS WILL BE MADE AVAILABLE TO THE PUBLIC FOR REVIEW AT THE HOSPITAL'S ADMINSTRATIVE OFFICE. FORM 990, PART IX, LINE 11G PHYSICIAN FEES: PROGRAM SERVICE EXPENSES 9,096,406. MANAGEMENT AND GENERAL EXPENSES 15,700. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 9,112,106. SERVICE CONTRACTS: PROGRAM SERVICE EXPENSES 4,423,973. MANAGEMENT AND GENERAL EXPENSES 1,300,958. FUNDRAISING EXPENSES 3,130. TOTAL EXPENSES 5,728,061. CONTRACT LABOR: PROGRAM SERVICE EXPENSES 14,156,169. MANAGEMENT AND GENERAL EXPENSES 113,815. FUNDRAISING EXPENSES 98. TOTAL EXPENSES 14,270,082. PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 295,906. MANAGEMENT AND GENERAL EXPENSES 2,946,080. FUNDRAISING EXPENSES 2,179. TOTAL EXPENSES 3,244,165. FORM 990, PART XI, LINE 9: CHANGE IN INTEREST IN GREAT PLAINS HEALTH CARE FOUNDATION -114,023. EQUITY TRANSFER TO NPNHA, LLC 1,570,000. FORM 990, PART XII, LINE 2C: THE BOARD OF DIRECTORS OF GREAT PLAINS HEALTH ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF ITS FINANCIAL STATEMENTS AND SELECTION OF AN INDEPENDENT ACCOUNTANT. THIS PROCESS HAS NOT CHANGED FROM PRIOR YEARS. 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