2023-11-15T20:01:13-06:00 2022-12-31 450250958 EIDE BAILLY LLP 18081 BURT ST STE 200 OMAHA NE 680224722 990 2022-01-01 470408242 CHEYENNE COUNTY HOSPITAL ASSOCIATION INC CHEY 3082545825 1000 POLE CREEK CROSSING SIDNEY NE 691620000 JASON PETIK CEO 3082545825 2023-11-15 1 JASON PETIK 999009999 1 MEGAN L KOZIOL CPA P01544037 4023302660 2023-11-15 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z SIDNEY REGIONAL MEDICAL CENTER JASON PETIK 1000 POLE CREEK CROSSING SIDNEY NE 691620000 69163879 0 X WWW.SIDNEYRMC.COM X 1951 NE TO REVOLUTIONIZE HEALTHCARE SERVICES IN THE REGION. 12 10 494 10 0 0 6348922 132484 63840923 68202392 467466 651266 121763 140630 70779074 69126772 28700 31250 0 0 36547289 36872806 0 0 0 25635796 29468579 62211785 66372635 8567289 2754137 103262011 97113837 52722898 45716460 50539113 51397377 TO REVOLUTIONIZE HEALTHCARE SERVICES IN THE REGION. 0 0 51860944 31250 52393133 SIDNEY REGIONAL MEDICAL CENTER IS A NOT-FOR-PROFIT ACUTE CARE HOSPITAL WHICH PROVIDES INPATIENT, OUTPATIENT AND EMERGENCY ROOM CARE SERVICE TO PATIENTS IN AND AROUND SIDNEY, NEBRASKA AND THE REGION. IT ALSO OPERATES LONG-TERM CARE FACILITIES AND TWO PROVIDER-BASED RURAL HEALTH CLINICS IN SIDNEY, NEBRASKA. 6282795 5192176 THE EXTENDED CARE UNIT PROVIDED CARE FOR AN AVERAGE OF 46 PATIENTS DAILY DURING 2022. SRMC PROVIDED 16,790 RESIDENT DAYS OF CARE FOR IT'S RESIDENTS FROM THE CHEYENNE, DEUEL, KIMBALL AND SURROUNDING AREAS. 2277323 10617083 IN 2022, THE HOSPITAL NURSING DEPARTMENT PROVIDED 1,987 PATIENT DAYS OF CARE, INCLUDING GENERAL INPATIENT, ICU PATIENTS AND SWING BED PATIENTS, AND DELIVERED 79 NEWBORNS FOR THE SEVEN COUNTY AREA THAT SIDNEY REGIONAL MEDICAL CENTER (SRMC) SERVES. SRMC HAD 3,929 PATIENTS SEEK CARE IN THE EMERGENCY DEPARTMENT DURING 2022 AND CARED FOR 290 OBSERVATION PATIENTS WHO NEEDED CARE BUT DID NOT QUALIFY FOR INPATIENT SERVICES UNDER CMS RULES. 60421062 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 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0 1 159 0 1 494 1 0 0 0 0 0 0 0 0 0 0 0 0 X 12 10 0 1 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 1 1 0 X KELLY UTLEY 3082545825 1000 POLE CREEK CROSSING SIDNEY NE 69162 X REBECCA L ALLARD MD PHYSICIAN AT LARGE 40.00 0.00 X 757168 0 49008 SARA SHOLAR MD CHIEF OF STAFF 40.00 0.00 X 682296 0 35714 WILLIAM PILE CHAIRMAN 4.00 0.00 X X 0 0 0 TIM MILLER VICE CHAIRMAN 4.00 0.00 X X 0 0 0 KATHY NARJES SECRETARY 4.00 0.00 X X 0 0 0 JEFF ELLWANGER TREASURER 4.00 0.00 X X 0 0 0 STAN BELIEU MEMBER 4.00 1.00 X 0 0 0 DWIGHT SMITH MEMBER 4.00 0.00 X 0 0 0 NANCI MCCASLIN MEMBER 4.00 1.00 X 0 0 0 CLEM SCHUMACHER MEMBER 4.00 0.00 X 0 0 0 JEFF HELLER MEMBER 4.00 0.00 X 0 0 0 WILLIAM ROBINSON MEMBER 4.00 0.00 X 0 0 0 KELLY UTLEY CFO 39.00 1.00 X 242387 0 49457 JASON PETIK CEO 40.00 0.00 X 0 0 0 MATTHEW JANSEN MD DOCTOR 40.00 0.00 X 684308 0 49008 JAMES POPOVICH MD DOCTOR 40.00 0.00 X 676277 0 49008 KELLY CASEY MD DOCTOR 40.00 0.00 X 540311 0 49008 APRIL SMITH MD DOCTOR 40.00 0.00 X 493481 0 44417 THERESA SIMMONS CRNA 40.00 0.00 X 400042 0 49008 4476270 0 374628 58 0 1 1 RURAL PARTNERS IN MEDICINE LLC 11880 AIRPORT WAY BROOMFIELD CO 80021 PHYSICIAN SERVICES 2219909 FUSION MEDICAL STAFFING LLC PO BOX 82674 LINCOLN NE 68501 TEMPORARY STAFFING SERVICES 1564872 UNIVERSITY OF COLORADO HEALTH 7901 E LOWRY BLVD SUITE 350 DENVER CO 90230 SYSTEM SUPPORT 1488777 MEDICAL SOLUTIONS LLC 1010 N 102ND STREET SUITE 300 OMAHA NE 68114 TEMPORARY STAFFING SERVICES 960623 BYTES COMPUTER & NETWORK 1620 BROADWAY SUITE D SCOTTSBLUFF NE 69361 SYSTEM SUPPORT 714036 21 34916 95610 1958 132484 MEDICARE/MEDICAID 621110 34328366 34328366 NET PATIENT SERVICE REVENUE 621110 32579015 32579015 340B REVENUE 621110 754772 754772 SCHOOL REHAB REVENUE 621110 158903 158903 381336 381336 68202392 688373 688373 37107 -37107 -37107 -37107 CAFETERIA 722514 140630 140630 140630 69126772 68202392 0 791896 X 31250 31250 1816030 1524186 291844 108987 108987 26535823 24274474 2261349 838300 760575 77725 5788664 5337975 450689 1785002 1649528 135474 274459 274459 11673 11673 57323 57323 9097100 8352133 744967 912906 795161 117745 901449 813902 87547 1149621 1031619 118002 175773 155947 19826 186710 79878 106832 1124527 1019796 104731 4000957 3725107 275850 604333 250 604083 MEDICAL SUPPLIES 8142277 8142277 BAD DEBTS 1427280 1427280 RECRUITING FEES 527792 512353 15439 FOOD PRODUCTS 389259 389259 485140 289125 196015 66372635 60421062 5951573 0 361790 237726 41877043 36686593 9892268 10346979 462821 892692 1698330 1874761 871738 1004107 74532864 38571531 37450147 35961333 9258356 8275298 0 649707 1389518 1184641 103262011 97113837 6063295 5620981 4312837 0 7901171 7456924 29414730 28961631 5030865 3676924 52722898 45716460 X 50539113 51397377 50539113 51397377 103262011 97113837 2754137 -1895873 0 X X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 7685 7685 0 PART II-B, LINE 1: A PORTION OF THE DUES PAID TO THE AMERICAN HOSPITAL ASSOCIATION (AHA) AND THE NEBRASKA HOSPITAL ASSOCIATION (NHA) ARE USED BY THOSE ORGANIZATIONS FOR LOBBYING ACTIVITIES. 92500 1947968 2040468 49399927 22968295 26431632 20050005 14844549 5205456 3042464 758687 2283777 35961333 DEFERRED COMPENSATION PLAN LIABILITY 1184641 ESTIMATED THIRD-PARTY PAYOR SETTLEMENTS 1835002 OTHER LIABILITIES 657281 3676924 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, THE ORGANIZATION HAD NO UNCERTAIN TAX POSITIONS ACCRUED. 1 1 X 1 X 1 X 1 1 0 0 298029 0 298029 0.00450 9106673 8490734 615939 0.00930 9404702 8490734 913968 0.01380 106840 86201 20639 0.00030 13391 0 13391 0.00020 1090615 1090615 0.01640 79807 0 79807 0.00120 1290653 86201 1204452 0.01810 10695355 8576935 2118420 0.03190 75 1191 3008 0 3008 0.00000 104 523 10002 0 10002 0.00020 179 1714 13010 13010 0.00020 1 1427280 0 22917218 23162943 -245725 X 1 1 1 1 CHEYENNE COUNTY HOSPITAL ASSOCIATION 1000 POLE CREEK CROSSING SIDNEY NE 69162 WWW.SIDNEYRMC.COM 150001 X X X X CHEYENNE COUNTY HOSPITAL ASSOCIATION INC 1 0 0 1 X X X X X X X X X 20 1 1 1 1 X WWW.SIDNEYRMC.COM/501R X WWW.PPHD.ORG/PAGES/CHIP.HTML X 1 20 1 WWW.SIDNEYRMC.COM/501R 0 1 X 100.000000000000 300.000000000000 X X X X X 1 1 X X X X 1 X SIDNEYRMC.COM/501R X SIDNEYRMC.COM/501R X SIDNEYRMC.COM/501R X X X X X X 1 X 0 X X X X X 1 X 0 0 CHEYENNE COUNTY HOSPITAL ASSOCIATION INC PART V, SECTION B, LINE 5: A MAPP STEERING COMMITTEE WAS FORMED IN 2014, MADE UP OF REPRESENTATIVES FROM EACH OF THE NINE RURAL NEBRASKA HEALTH NETWORK HOSPITALS (SEE LIST OF MEMBERS IN LINE 6A). COMMITTEE MEMBERS PROVIDE GUIDANCE THROUGHOUT THE MAPP PROCESS AND ARE CHARGED WITH REVIEWING DATA AND PROGRESS ON THE CHOSEN PRIORITY AREAS, USING QUALITY IMPROVEMENT TO MODIFY IMPLEMENTATION PLANS AS NEEDED, AND SHARING RESULTS WITH STAKEHOLDERS. TWO NEW REPRESENTATIVES JOINED THE COMMITTEE IN 2017: A REPRESENTATIVE FROM THE PANHANDLE PARTNERSHIP, SERVING AS A REPRESENTATIVE OF A VARIETY OF COMMUNITY-BASED ORGANIZATIONS, AND A REPRESENTATIVE FROM THE LOCAL ECONOMIC DEVELOPMENT DISTRICT, PANHANDLE AREA DEVELOPMENT DISTRICT (PADD). EACH HOSPITAL FACILITATED AT LEAST ONE FOCUS GROUP WITH LOCAL OR AREA RESIDENTS IN THEIR SERVICE AREA. HOSPITALS WITH A GREATER THAN 50% MINORITY POPULATION MADE A CONCERTED EFFORT TO INCLUDE PEOPLE REPRESENTATIVE OF THE MINORITY POPULATION IN THE FOCUS GROUPS. GROUPS WERE INTENDED TO BE MADE UP OF 8-10 PEOPLE, ALTHOUGH THERE MAY BE SOME VARIANCE. HOSPITAL REPRESENTATIVES IDENTIFIED POTENTIAL FOCUS GROUP PARTICIPANTS AND REACHED OUT VIA PHONE CALLS, E-MAILS AND SOCIAL MEDIA TO INVITE THEM TO ATTEND A FOCUS GROUP SESSION. A TOTAL OF 16 FOCUS GROUP SESSIONS, INVOLVING APPROXIMATELY 142 NEBRASKA PANHANDLE RESIDENTS WERE COMPLETED. FOCUS GROUPS WERE LARGELY CONDUCTED IN THE SPRING OF 2020. BECAUSE OF THE COVID-19 PANDEMIC, A HANDFUL OF FOCUS GROUPS WERE COMPLETED VIA OPEN ENDED SURVEY RATHER THAN IN PERSON. CHEYENNE COUNTY HOSPITAL ASSOCIATION INC PART V, SECTION B, LINE 6A: THE FOLLOWING IS A LIST OF HOSPITALS THAT PARTICIPATED IN THE CHNA:-BOX BUTTE GENERAL HOSPITAL, ALLIANCE, NE-MORRILL COUNTY HOSPITAL, BRIDGEPORT, NE-REGIONAL WEST MEDICAL CENTER, SCOTTSBLUFF, NE-CHADRON COMMUNITY HOSPITAL, CHADRON, NE-REGIONAL WEST GARDEN COUNTY, OSHKOSH, NE-GORDON MEMORIAL HOSPITAL, GORDON, NE-KIMBALL HEALTH SERVICES, KIMBALL, NE-PERKINS COUNTY HEALTH SERVICES, GRANT, NE-SIDNEY REGIONAL MEDICAL CENTER, SIDNEY, NE CHEYENNE COUNTY HOSPITAL ASSOCIATION INC PART V, SECTION B, LINE 6B: PANHANDLE PUBLIC HEALTH DISTRICT CHEYENNE COUNTY HOSPITAL ASSOCIATION INC PART V, SECTION B, LINE 11: FROM FOCUS GROUPS, FEED BACK FROM SURVEYS, AND OTHER REGIONAL ANALYTICS, SRMC DETERMINED THE FOLLOWING POINTS WERE TO BE ADDRESSED FOR THE CHIP 2021-2023. GOALS AND STRATEGIES FOR PRIORITY AREAS ARE AS FOLLOWS:FOCUS AREA 1: BEHAVIORAL HEALTH 1. WEEKLY VISITS TO SCHOOL COUNSELORS TO IDENTIFY INDIVIDUALS WITH NEEDS AND PROACTIVELY DESIGN PLAN OF CARE. 2. MONTHLY ARTICLES, TIPS AND TECHNIQUES ABOUT MENTAL HEALTH ISSUES IN AREA MEDIA VENDORS. 3. RAISE AWARENESS FOR BEHAVIORAL HEALTH AND SENIOR LIFE SOLUTIONS AT SRMC. 4. OFFER AN ANNUAL SURVEY TO ACCESS PROGRESS AND AREAS OF NEED.FOCUS AREA 2: CHRONIC CARE 1. PROMOTE CHRONIC CARE MANAGEMENT (CCM) "PROGRAM INSERTS" TO COMMUNITY VIA SOCIAL MEDIA/WEBSITE WITH E-MAIL SIGN-UP FOR FREE DOWNLOAD. 2. RESEARCH THE VIABILITY AND USAGE FOR THE LIVING WELL ONLINE PROGRAM AVAILABLE THROUGH PPHD. 3. DETERMINE THREE KEY AREAS FOR CURRENT CCM PARTICIPANTS TO TRACK IMPROVEMENTS. 4. PROMOTE DIRECT ACCESS TESTING. CHRONIC CARE MANAGEMENT IS CURRENTLY AVAILABLE FOR THOSE WHO ARE 65 AND OLDER ON MEDICARE, WITH 2 OR MORE CHRONIC ILLNESSES. REQUIRED ELIGIBILITY THROUGH THE ACO-PROGRAM REQUIRES 65+, TWO CHRONIC DISEASES AND SEEING A PROVIDER THAT WILL ENROLL THEM IF THEY QUALIFY. FOCUS AREA 3: END OF LIFE 1. CREATE ANNUAL SENIOR LIFE HEALTH FAIR PROMOTING AREA AVAILABLE RESOURCES. 2. OFFER DOULA TRAINING TO DEVELOP AN END OF LIFE VOLUNTEER SUPPORT SYSTEM. 3. DETERMINE IF PARTNERING WITH HOSPICE OF THE PLAINS AS A HOSPICE PROVIDER IS POSSIBLE.OTHER AREA NEEDS THAT ARE NOT BEING ADDRESSED AT THIS TIME ARE: 1. NOT ENOUGH HEALTH INSURANCE/NO HEALTH INSURANCE2. POVERTY3. CHILD ABUSE/NEGLECTSRMC DOES NOT HAVE THE RESOURCES TO ADDRESS THESE NEEDS AT THIS TIME. THE FOLLOWING IS A QUARTERLY RECAP OF 2022:1ST QUARTER: IN JANUARY, SRMC EXPANDED ITS SOCIAL MEDIA PRESENCE. A COMMUNITY MEETING WAS HELD JANUARY 4TH. FEBRUARY WAS HEART HEALTHY MONTH; AWARENESS WAS RAISED AND PATIENTS WERE ENCOURAGED TO SEE THEIR CARDIOLOGISTS FOR SCREENING, MONITOR BLOOD PRESSURE AND MANAGE STRESS. MANY EMPLOYEES PARTICIPATED IN NATIONAL WEAR RED DAY. MARCH WAS COLORECTAL CANCER AWARENESS MONTH; APPROXIMATELY 15 FREE SCREENING KITS WERE HANDED OUT TO COMMUNITY MEMEMBERS AND STAFF. A BLOOD DRIVE WAS HOSTED BY SRMC, DONORS INCLUDED EMPLOYEES AS WELL AS COMMUNITY MEMBERS; 38 UNITS WERE RECEIVED. THE METHODIST CHURCH ALSO HOSTED A BLOOD DRIVE; 24 UNITS WERE RECEIVED. THIS QUARTER, SRMC HOSTED A PARKINSONS SUPPORT GROUP, SUICIDE BEARVEMENT SUPPORT GROUP AND DIABETES PREVENTION EDUCATION TO NAME A FEW. TWO SRMC EMPLOYEES PARTICIPATED IN THE BIG WHEEL RACE WITH THE BIG BOY, COMING IN 2ND AND 3RD PLACE; THE MONEY THAT WAS RAISED WENT TO A LOCAL FAMILY FOR MEDICAL BILLS. DURING THIS QUARTER, RHC ADMINISTERED 264 COVID VACCINES. A LITTLE OVER 200 PATIENTS TOOK ADVANTAGE OF DIRECT ACCESS TESTING.2ND QUARTER:APRIL WAS THE SPRING EXPO, SRMC HAD BOOTH OFFERING FREE BLOOD PRESSURE SCREENINGS, BEHAVIORAL HEALTH WAS PRESENT AT THE BOOTH. MAY WAS MENTAL HEALTH AWARENESS MONTH. SENIOR LIFE SOLUTIONS CONTINUES WITH 6 PATIENTS ATTENDING 3 DAYS PER WEEK. KRISTEN ROSE PRESENTED ON EATING DISORDERS AT THE SPRING CONFERENCE, AS WELL AS MAKING A WEBINAR. SHE ALSO PRESENTED EDUCATION ON STRESS AT THE NEBRASKA HEALTHCARE MARKETERS CONFERENCE IN MAY. RHC IS CURRENTLY OFFERING FREE SPORTS PHYSICALS EVERY WEDNESDAY IN THE SECOND AND INTO THE THIRD QUARTER. QPR TRAINING WAS GIVEN TO PARTICIPANTS TO HELP DETECT A MENTAL HEALTH CRISIS AND HELP SAVE LIVES. WELLNESS WEDNESDAY CONTINUES WITH DIRECT ACCESS TESTING; APPROXIMATELY 270 PEOPLE UTILIZED THIS SERVICE IN THE SECOND QUARTER. 220 COVID VACCINES WERE GIVEN DURING THE SECOND QUARTER BY RHC. A BLOOD DRIVE WAS HELD IN MAY, 34 PEOPLE DONATED BLOOD. ON SITE BLOOD PRESSURE SCREENINGS CONTINUES, AT 5 DIFFERENT LOCATIONS A MONTH. DIABETES PREVENTION PROGRAM MEETS ONCE PER MONTH, WITH APPROXIMATELY 6 MEMBERS ATTENDING.3RD QUARTER:IN JULY, SRMC SUPPORTED THE LOCAL FAIR AND PROVIDED COOL TREATS TO THE KIDS. THE HCF GOLF TOURNAMENT WAS A SUCCESS IN JULY AS WELL. SRMC CURRENTLY HAS A BLOG TITLED "YOUR HEALTH MATTERS WITH GEN-ZER" THAT AIRS MONTHLY EPISODES WITH INTERESTING HEALTH INFORMATION. OUR 3 SUMMER INTERNS COMPLETED THEIR SUMMER WITH US AT THE END OF JULY. AUGUST WAS ALSO NATIONAL IMMUNIZATION MONTH, AWARENESS WAS RAISED THROUGH SOCIAL MEDIA. SEPTEMBER WAS SUICIDE AWARENESS MONTH, THE BEHAVIORAL HEALTH DEPARTMENT WORKED HARD TO RAISE AWARENESS TO RESOURCES AVAILABLE IN THIS AREA FOR THOSE IN NEED. ATTENTION WAS BROUGHT TO THE 988 LIFELINE THAT CONNECTS AT RISK INDIVIDUALS TO TRAINED CRISIS COUNSELORS. QPR TRAINING CONTINUED WITH KRISTEN ROSE. THE SUICIDE AWARENESS WALK LASTED APPROXIMATELY 2 HOURS WITH 200 ATTENDING. BEYOND HOSPITAL DOORS WAS INITIATED, A NEW PODCAST WHERE LOCAL PROVIDERS AND EXPERTS DISCUSS TOPICS OF HEALTH. SRMC HOSTED A BLOOD DRIVE IN SEPTEMBER WITH 37 DONORS. THE NATIONAL DIABETES PREVENTION PROGRAM CONTINUES TO MEET ONCE A MONTH. RHS GAVE APPROXIMATELY 234 COVID VACCINES THIS QUARTER.4TH QUARTER:IN AUGUST KRISTEN ROSE LEAD THE LOSS TEAM EDUCATION FOR 3 HOURS, SHE HAD 3 ATTENDEES. SHE ALSO TAUGHT A QPR CLASS ONLINE WITH 4 ATTENDEES. IN SEPTEMBER SRMC HOSTED A BLOOD DRIVE, WITH 28 DONORS. BEHAVIORAL HEALTH SPONSORED A SUICIDE AWARENESS WALK THAT HAD AN ESTIMATED 200 ATTENDEES. CAREER PATHWAYS CONTINUES AT THE HIGH SCHOOL WITH 17 ATTENDEES. IN OCTOBER KRISTEN ROSE TAUGHT AN EATING DISORDER CLASS WITH 10 ATTENDEES. THE OCTOBER'S PODCAST WAS ABOUT THE ASTHMA PROJECT, STAFF ALSO HAD AN OPPORTUNITY TO MEET WITH THE AMERICAN LUNG ASSOCIATION FOR CONTINUING EDUCATION. NOVEMBER'S PODCAST DISCUSSED THE IMPORTANCE OF VACCINATIONS. IN DECEMBER, SRMC CO-SPONSORED A CASA CHILI FEED FUNDRAISER. AWARENESS WAS RAISED TO RSV AND INFLUENZA SEASON IN THE FOURTH QUARTER AS WELL. DECEMBER WAS THE KICK OFF MEETING FOR THE NATIONAL DIABETES PREVENTION PROGRAM. THIS IS A YEAR-LONG PROGRAM THAT MEETS 26 TIMES AND TEACHES LIFESTYLE CHANGES TO HELP PREVENT DIABETES. IT OFFICIALLY STARTS AFTER THE FIRST OF THE YEAR. THIS FALL THE NURSING SCHOLARSHIP PROGRAM WAS ADVERTISED ON SOCIAL MEDIA, AS WELL AS THE RADIO COVERAGE. SRMC CO-SPONSORED HOLIDAY AT HICKORY SQUARE. APPROXIMATELY 139 PATIENT'S UTILIZED DIRECT ACCESS TESTING. RHC GAVE APPROXIMATELY 350 COVID VACCINES. CHEYENNE COUNTY HOSPITAL ASSOCIATION INC PART V, SECTION B, LINE 13B: PATIENTS MAY BE CONSIDERED FOR CHARITY CARE FOR MEDICALLY NECESSARY SERVICES. WHEN IN QUESTION, MEDICALLY NECESSARY SERVICES SHALL BE DETERMINED BY THE EXAMINING PHYSICIAN. PATIENTS MUST BE RESIDENTS OF CHEYENNE OR DEUEL COUNTY AND/OR A 20 MILE RADIUS OF SIDNEY REGIONAL MEDICAL CENTER. THIS MAY BE WAIVED FOR PATIENTS ADMITTED VIA THE EMERGENCY DEPARTMENT OR AT THE DISCRETION OF ADMINISTRATION.SPECIFICALLY IDENTIFIED CASES MAY BE PRESUMED ELIGIBLE FOR CHARITABLE ASSISTANCE AND CLASSIFIED WITHOUT A COMPLETED APPLICATION OR ASSESSMENT. EXAMPLES OF THESE CASES ARE: PATIENT IS DECEASED WITH NO KNOWN ESTATE OR SPOUSE; PATIENTS WITH CURRENT ELIGIBILITY UNDER COUNTY OR STATE MEDICAL INDIGENT SERVICES ADMINISTERED BY COUNTY OR STATE FACILITIES; PATIENT IS HOMELESS OR HAS BEEN IDENTIFIED AS BEING WITHOUT RESOURCES BASED ON PREVIOUS ACCOUNT ACTION AND CONTACT WITH THE SRMC STAFF.PERCENT OF CHARITY WILL BE BASED ON HOUSEHOLD INCOME AND SIZE, REAL ESTATE, PERSONAL PROPERTY AND INVESTMENT EQUITY, WITH CREDIT TO BE GIVEN FOR ALREADY EXISTING MEDICAL LOANS, IN COMPARISON TO THE CURRENT YEAR FEDERAL POVERTY GUIDELINES. THE HHS POVERTY GUIDELINES ARE PUBLISHED EACH YEAR IN THE FEDERAL REGISTER. FREE CARE WILL BE GIVEN TO HOUSEHOLDS THAT ARE AT 100% OF THE POVERTY LEVEL. DISCOUNTED CARE WILL BE GIVEN AT UP TO 300% OF THE POVERTY LEVEL. CHEYENNE COUNTY HOSPITAL ASSOCIATION INC PART V, SECTION B, LINE 16J: THE POLICY IS REFERENCED IN BILLING LETTERS AND IS ORALLY COMMUNICATED DURING REGISTRATION OR ADMISSIONS AND THROUGH THE PATIENT FINANCIAL SERVICES FOLLOW UP PROCESSES, INCLUDING PATIENT ADVOCACY CONVERSATIONS. THE POLICY IS AVAILABLE IN ADMISSIONS AND WAITING AREAS AT THE HOSPITAL. SIGNAGE IS POSTED IN WAITING AREAS REFERRING PATIENTS TO THE WEBSITE TO VIEW THE POLICY. ADDITIONALLY, PLAIN LANGUAGE SUMMARY IS INCLUDED IN ALL DISCHARGE PACKETS WITH REFERENCE TO THE WEBSITE OR FINANCIAL SERVICES TO OBTAIN THE ENTIRE POLICY. CHEYENNE COUNTY HOSPITAL ASSOCIATION INC PART V, SECTION B, LINE 20E: SRMC ATTEMPTS OTHER NON-EXTRAORDINARY COLLECTION EFFORTS SUCH AS: SUBSEQUENT MONTHLY BILLINGS, COLLECTION LETTERS AND/OR TELEPHONE CALLS CONSTITUTING A GENUINE EFFORT TO HELP OUR PATIENTS TO ARRANGE FOR PAYMENT IF THEY CAN AFFORD IT. DOCUMENTATION OF THESE EFFORTS WILL BE MADE BY NOTATING PATIENT ACCOUNTS AND DOCUMENTING STATEMENTS AND REPORTS OF TELEPHONE CALLS AND PERSONAL CONTACTS. FOR ELECTIVE PROCEDURES, PATIENTS ARE ASKED TO MEET WITH A FINANCIAL COUNSELOR BEFORE THE PROCEDURE TO SET UP PAYMENT ARRANGEMENTS. SRMC DOES OFFER LOANS TO PATIENTS WITH NO COLLATERAL FROM THE PATIENTS. SRMC ALSO SECURES FINANCING FOR THE PATIENTS IF THEY DO NOT QUALIFY FOR CHARITY CARE. SRMC DOES NOT REQUIRE PATIENTS WHO QUALIFY FOR CHARITY CARE UNDER THE FINANCIAL ASSISTANCE POLICY TO OBTAIN A LOAN TO PAY THE ACCOUNT. 3 1 - SIDNEY REG'L MEDICAL CTR EXTENDED CARE 549 KELLER DRIVE SIDNEY NE 69162 LONG TERM CARE FACILITY 2 - SLOAN ESTATES ASSISTED LIVING 2550 CRAIG AVENUE SIDNEY NE 69162 ASSISTED LIVING 3 - SIDNEY REG'L MEDICAL CTR WALK IN CLINIC 610 GROVER ROAD SUITE 4 SIDNEY NE 69162 WALK IN CLINIC PART I, LINE 3C: THE CALCULATION FOR ELIGIBILITY IS BASED ON ALL INCOME PER HOUSEHOLD WITH EXCEPTIONS MADE FOR WAGE EARNERS WHO ARE STUDENTS. OTHER MEDICAL PAYMENTS ALREADY BEING MADE ARE CONSIDERED IN THE CALCUATION. INCOME IS COMPARED TO THE NATIONAL POVERTY GUIDELINES AND A DETERMINATION OF REDUCTION IS MADE BASED ON THE ADJUSTED INCOME LEVEL. THE WRITE OFF AMOUNT MAY BE REDUCED FOR EQUITY IN ASSETS, IF ANY, ABOVE EXEMPTION THRESHOLDS FOR HOMES AND VEHICLES. THERE IS NO EXEMPTION FOR INVESTMENTS OR OTHER ASSETS HELD. PART I, LINE 6A: THE COMMUNITY BENEFIT REPORT WAS NOT PREPARED IN THE CURRENT YEAR. PART I, LINE 7: THE COST TO CHARGE RATIO IS DETERMINED AS FOLLOWS: (TOTAL EXPENSES - BAD DEBT)/GROSS PATIENT SERVICE REVENUE = PERCENTAGE OF COST TO CHARGE. PART I, LINE 7G: THERE ARE NO COSTS ASSOCIATED WITH PHYSICIAN CLINICS INCLUDED AS SUBSIDIZED HEALTH SERVICES. PART I, LN 7 COL(F): BAD DEBT EXPENSE OF $1,427,280 HAS BEEN EXCLUDED FROM THE DENOMINATOR IN THE CALCULATION OF THE PERCENTAGES IN LINE 7, COLUMN F. PART II, COMMUNITY BUILDING ACTIVITIES: COMMUNITY SUPPORT INCLUDES ACTIVITIES SUCH AS THERAPISTS AVAILABLE AT GAMES AND AT THE COMMUNITY CENTER AND WELLNESS CAMPAIGNS IN COOPERATION WITH THE COMMUNITY CENTER. OTHER ACTIVITIES INCLUDE COMMUNITY BLOOD DRAWS, HEALTH FAIR, BLOOD PRESSURE SCREENINGS, DIABETES PREVENTION PROGRAMS, AND MULTIPLE SMALLER COMMUNITY EDUCATION PROGRAMS THROUGH RADIO INTERVIEWS WITH HEALTH PROFESSIONALS. PART III, LINE 2: BAD DEBTS RESULT WHEN A PATIENT WHO HAS BEEN DETERMINED TO HAVE THE FINANCIAL CAPACITY TO PAY FOR HEALTHCARE SERVICES IS UNWILLING TO SETTLE THE CLAIM. DUE TO A COMPLIANCE WITH FASB TOPIC 606 CONCERNING REVENUE RECOGNITION, BAD DEBT EXPENSE HAS BEEN GREATLY REDUCED AS THE RECOGNITION OF BAD DEBT IS AN EXPENSE ASSOCIATED WITH SPECIFIC ACCOUNTS RATHER THAN AN ALLOWANCE FOR DOUBTFUL ACCOUNTS WHICH ARE UNSPECIFIC AND CLASSIFIED AS AN IMPLICIT PRICE CONCESSION REDUCING REVENUE ON THE OPERATING STATEMENT. PART III, LINE 3: CONSISTENT WITH THE ORGANIZATION'S MISSION, CARE IS PROVIDED TO PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. THEREFORE, THE ORGANIZATION HAS PROVIDED IMPLICIT PRICE CONCESSIONS TO UNINSURED PATIENTS AND PATIENTS WITH UNINSURED BALANCES (COPAYS AND DEDUCTIBLES). THE IMPLICIT PRICE CONCESSIONS INCLUDED IN ESTIMATING TRANSACTION PRICE REPRESENT THE DIFFERENCE BETWEEN AMOUNTS BILLED TO PATIENTS AND THE AMOUNTS THE ORGANIZATION EXPECTS TO COLLECT BASED ON COLLECTION HISTORY WITH THOSE PATIENTS. PART III, LINE 4: THE HOSPITAL'S FINANCIAL STATMENTS DO NOT CONTAIN A SPECIFIC FOOTNOTE DESCRIBING BAD DEBT. HOWEVER, PAGES 8, 10, 11, AND 12 OF THE ATTACHED AUDITED FINANCIAL STATEMENTS INCLUDE FOOTNOTES TITLED "PATIENT RECEIVABLES", "PATIENT SERVICE REVENUE AND "PATIENT FINANCIAL ASSISTANCE". PART III, LINE 8: THE ORGANIZATION USED THE MEDICARE COST REPORT FOR FISCAL YEAR 2022 TO REPORT THE AMOUNTS OF TOTAL REVENUE RECEIVED FROM MEDICARE AND RELATED MEDICARE ALLOWABLE COSTS. MEDICARE PAYS THE HOSPITAL'S RURAL HEALTH CLINICS (RHC) AT COST SUBJECT TO CERTAIN LIMITS. THE MEDICARE SHORTFALL IN PAYMENTS SHOULD BE CONSIDERED A COMMUNITY BENEFIT AS IT IS PART OF THE HOSPITAL'S MISSION TO PROVIDE THESE SERVICES EVEN IF MEDICARE REIMBURSEMENT IS BELOW COST. PART III, LINE 9B: THE CHARITY CARE POLICY ALLOWS FOR PROACTIVE WRITE OFF TO ALLOWANCE FOR CHARITY CARE OF ANY BALANCE OWED BY A PATIENT KNOWN TO QUALIFY FOR CHARITY CARE UNDER THE FINANCIAL ASSISTANCE POLICY. COLLECTION PROCEDURES DO NOT ENSUE ON ANY ACCOUNTS ELIGIBLE FOR FINANCIAL ASSISTANCE. PART VI, LINE 2: NEEDS ASSESSMENTS ARE DETERMINED THROUGH SCIENTIFIC, AS WELL AS UNSCIENTIFIC METHODS. EVERY 3 YEARS A MARKET ASSESSMENT IS COMPLETED USING CLAIMS DATA WHICH REVEALS THE NEEDS OF COMMUNITY MEMBERS BEING MET ELSEWHERE DUE TO EITHER UNAVAILABILITY OF SERVICE OR PATIENT CHOICE. THIS ASSESSMENT INCLUDES THE DEMOGRAPHICS OF THE AREA WHICH SHOW AN AGING AND MODERATE INCOME POPULATION. THESE FACTS ARE THEN USED TO DETERMINE THE NEEDS OF THE COMMUNITY AS WELL AS THE FUTURE NEEDS BASED ON HISTORICAL DATA. ADDITIONALLY, COMMUNITY NEEDS ARE DETERMINED USING PUBLIC OPINION, PATIENT SATISFACTION RECOMMENDATIONS, BOARD AND LEADERSHIP EXPERIENCE, COMMUNICATIONS WITH COMMUNITY MEMBERS, AND PHYSICIAN INPUT. FUTURE MEASUREMENTS OF HEALTH DATA MINED FROM CLAIMS SUBMISSIONS WILL BE USED TO FURTHER ANALYZE THE NEEDS OF THE COMMUNITY. PART VI, LINE 3: AT THE POINT OF REGISTRATION, A PATIENT'S INSURED STATUS IS DETERMINED. PATIENTS WHO ARE UNDERINSURED OR UNINSURED RECEIVE COUNSELING THROUGH THE HOSPITAL'S PATIENT ADVOCATE AND/OR A MEMBER OF THE FINANCIAL SERVICES OR REGISTRATION STAFF SERVING AS A FINANCIAL COUNSELOR. INFORMATION IS CONVEYED TO THE PATIENT OR THE GUARANTOR REGARDING MEDICAID AND MEDICARE, AS WELL AS CHARITY CARE PROVIDED BY THE HOSPITAL. ADDITIONAL COUNSELING IS PROVIDED AFTER DISMISSAL WHEN THE PROACTIVE APPROACH WAS UNSUCCESSFUL. ADDITIONALLY, SOCIAL SERVICES PERSONNEL AND PATIENT FINANCIAL COUNSELORS MEET WITH PATIENTS INDIVIDUALLY WHEN NEEDED REGARDING THEIR COVERAGE IN AN ATTEMPT TO DETERMINE ELIGIBILITY FOR FINANCIAL ASSISTANCE AND OTHER MEANS FOR THE INDIVIDUALS. PART VI, LINE 4: MOST OF THE AREA THAT THE HOSPITAL SERVES IS LOCATED IN CHEYENNE COUNTY, NEBRASKA WHICH HAS A POPULATION OF APPROXIMATELY 9,511 PEOPLE. THE CITIES OF SIDNEY, LODGEPOLE, POTTER, DALTON, GURLEY, AND SUNOL ARE LOCATED WITHIN THE COUNTY AND ARE GENERALLY WITHIN APPROXIMATELY 30 MILES FROM THE HOSPITAL. ACCORDING TO THE US CENSUS BUREAU, THE 2022 DEMOGRAPHIC IS AROUND 94.5% CAUCASIAN. THE AVERAGE HOUSEHOLD INCOME IN CHEYENNE COUNTY IS $53,674 WITH A POVERTY RATE OF 11.9%. PART VI, LINE 5: IN ADDITION TO ACTIVITIES ADDRESSED IN THE CHNA REPORT, THE HOSPITAL SUPPORTED THE LOCAL FAIR IN 2022 AND THE HEALTH CENTER FOUNDATION ANNUAL GOLF TOURNAMENT, PROVIDES OUTREACH SERVICE TO LOCAL BUSINESSES TO ASSURE FLU SHOTS AND IMMUNIZATIONS ARE UP TO DATE AS WELL AS DOING BLOOD PRESSURE SCREENINGS. SRMC ALSO CONDUCTS DIABETES EDUCATION CLASSES AND PARTICIPATES IN THE NATIONAL DIABETES PREVENTION PROGRAM. SRMC OFFERS IN-HOME FOLLOW UP VISITS TO ANY MOTHERS WITH NEW BABIES NO MATTER WHERE THEY DELIVERED THEIR BABY, AND COLLABORATES WITH THE SCHOOL TO PROVIDE FOLLOWUP THERAPY CONSULTATIONS AFTER SPORTING EVENTS. THE HOSPITAL CONTINUES TO PROVIDE OB AND DELIVERY SERVICES EVEN THOUGH MANY SMALLER HOSPITALS HAVE DISCONTINUED SUPPORT OF THEIR COMMUNITIES IN THIS ARENA. COMMUNITY EDUCATION IS PROVIDED THRU RADIO BROADCASTS EACH WEEK WITH VARYING TOPICS. PART VI, LINE 6: SIDNEY REGIONAL MEDICAL CENTER IS NOT PART OF AN AFFILIATED HEALTH CARE ORGANIZATION. 1 DICKEY AND ASSOCIATES AUCTIONEERS 1616 BIRCH STREET SIDNEY NE 69162 822544780 501(C)(3) 0 8000 YOUTH LIVESTOCK SPONSORSHIP KIDS PLUS INC PO BOX 296 SIDNEY NE 69162 470715249 501(C)(3) 0 13250 SIDNEY PARK PROJECT 2 0 PART I, LINE 2: IF THE DONEE ORGANIZATION IS NOT A GOVERNMENTAL ENTITY OR IDENTIFIED AS A CHARITABLE ORGANIZATION ON GUIDESTAR, THE DONEE ORGANIZATION IS RESEARCHED TO ASSURE THEIR NOT-FOR-PROFIT STATUS. THE DONEE ORGANIZATION'S MISSION INFORMATION, THEIR FINANCIAL DATA AND THEIR FORM 990 (IF AVAILABLE) IS REVIEWED AND CONSIDERED BY THE BOARD OF DIRECTORS. THE BOARD OF DIRECTORS MUST APPROVE, BY A MAJORITY VOTE OF THE QUORUM IN ATTENDANCE, THE DONATION TO THE ORGANIZATION OR GOVERNMENTAL ENTITY. DURING THE FOLLOWING 12 TO 24 MONTHS AFTER THE DONATION IS DISTRIBUTED, CONTINUED MONITORING OF THE PROJECT OR DONATION RESTRICTIONS, IF APPLICABLE, SHALL BE REPORTED TO THE BOARD OF DIRECTORS. THE DONEE ORGANIZATION'S FORM 990 (IF AVAILABLE) FOR THE YEAR OF THE DONATION AND ANY OTHER SUBSEQUENT YEARS REQUESTED SHALL BE MADE AVAILABLE TO THE BOARD MEMBERS FOR FOLLOW UP REVIEW. X X X X 0 0 0 0 0 0 0 0 0 REBECCA L ALLARD MD PHYSICIAN AT LARGE 731572 0 25000 0 596 0 15250 0 33758 0 806176 0 0 0 MATTHEW JANSEN MD DOCTOR 663810 0 20000 0 498 0 15250 0 33758 0 733316 0 0 0 JAMES POPOVICH MD DOCTOR 630824 0 45000 0 453 0 15250 0 33758 0 725285 0 0 0 SARA SHOLAR MD CHIEF OF STAFF 636616 0 45000 0 680 0 13257 0 22457 0 718010 0 0 0 KELLY CASEY MD DOCTOR 539110 0 0 0 1201 0 15250 0 33758 0 589319 0 0 0 APRIL SMITH MD DOCTOR 443021 0 50000 0 460 0 9108 0 35309 0 537898 0 0 0 THERESA SIMMONS CRNA 398381 0 0 0 1661 0 15250 0 33758 0 449050 0 0 0 KELLY UTLEY CFO 217643 0 22705 0 2039 0 27000 0 22457 0 291844 0 0 0 SCHEDULE J, PART III: JASON PETIK, CEO, RECEIVES COMPENSATION FROM POUDRE VALLEY MEDICAL GROUP, AN UNRELATED ENTITY. POUDRE VALLEY MEDICAL GROUP PROVIDES MANAGEMENT SERVICES TO ITS CLIENTS, INCLUDING THE SIDNEY REGIONAL MEDICAL CENTER. THE SIDNEY REGIONAL MEDICAL CENTER'S BOARD OF DIRECTORS SETS THE COMPENSATION FOR MR. PETIK. MR. PETIK RECEIVED TOTAL COMPENSATION OF $274,459. MR. PETIK'S COMPENSATION IS REFLECTED IN PART IX, LINE 11A. A THE COUNTY OF DEUEL NEBRASKA 476006452 251476AA5 2014-10-16 10000000 CONSTRUCT HOSPITAL 0 0 0 A 2543076 10000000 10000000 2015 0 0 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 A 0 0 1 0 1 0 0 0 1 A 1 SUSAN PETIK EMPLOYEE OF ORGANIZATION AND SPOUSE OF JASON PETIK, CEO 108987 EMPLOYEE COMPENSATION 1 FORM 990, PART VI, SECTION A, LINE 1A THE EXECUTIVE COMMITTEE IS MADE UP OF 4 MEMBERS OF THE BOARD. THE EXECUTIVE COMMITTEE HAS THE SAME AUTHORITY TO ACT AS THE FULL BOARD. FORM 990, PART VI, SECTION A, LINE 3 POUDRE VALLEY MEDICAL GROUP CURRENTLY EMPLOYS THE CHIEF EXECUTIVE OFFICER FOR SIDNEY REGIONAL MEDICAL CENTER. FORM 990, PART VI, SECTION B, LINE 11B THE ORGANIZATION'S ACCOUNTING DEPARTMENT PROVIDES DOCUMENTATION TO THE INDEPENDENT ACCOUNTING FIRM FOR THE PREPARATION OF THE FORM 990. COMMUNICATIONS BETWEEN THE ACCOUNTING FIRM AND THE ACCOUNTING DEPARTMENT FINALIZE THE PREPARATION OF THE FORM 990. THE CEO AND CFO THEN REVIEW THE FORM 990 AND E-MAIL THE PUBLIC DISCLOSURE COPY TO ALL MEMBERS OF THE BOARD OF DIRECTORS FOR THEIR REVIEW. ONCE THE 990 RETURN HAS BEEN APPROVED BY ALL PARTIES IT IS SUBMITTED TO THE IRS ON OR BEFORE THE REGULAR OR EXTENDED DUE DATE. FORM 990, PART VI, SECTION B, LINE 12C EACH YEAR ALL BOARD MEMBERS ARE REQUIRED TO DISCLOSE ANY CONFLICTS OF INTEREST. ANY DUALITY OF INTEREST OR POTENTIAL CONFLICT OF INTEREST ON THE PART OF ANY OFFICER, DIRECTOR, COMMITTEE MEMBER, OR ANY KEY EMPLOYEE IS DISCLOSED TO THE BOARD OF DIRECTORS AND MADE A MATTER OF RECORD WHENEVER IT ARISES. WHENEVER IT INVOLVES A MATTER OF BOARD ACTION, ANY OFFICER, DIRECTOR, COMMITTEE MEMBER, OR KEY EMPLOYEE HAVING A DUALITY OF INTEREST OR A POSSIBLE CONFLICT OF INTEREST IN ANY MATTER DOES NOT VOTE OR ABSTAINS FROM THE VOTE, IF PRESENT IN THE ROOM. OFTEN THE BOARD MEMBER IS ASKED TO LEAVE THE MEETING DURING DISCUSSION PERIODS AND FOR THE VOTE ON ISSUES FOR WHICH CONFLICT EXISTS. THESE INDIVIDUALS DO NOT USE THEIR PERSONAL INFLUENCE ON THE MATTERS. FORM 990, PART VI, SECTION B, LINE 15 POUDRE VALLEY MEDICAL GROUP PROVIDES ADMINISTRATIVE SERVICES TO SIDNEY REGIONAL MEDICAL CENTER (SRMC). THIS INCLUDES PROVIDING THE HOSPITAL'S CHIEF EXECUTIVE OFFICER. SRMC'S METHOD TO DETERMINE EXECUTIVE SALARY RANGES IS TO ANNUALLY PULL SALARY RANGES FROM NO LESS THAN TWO SURVEY SOURCES (THREE WHEN POSSIBLE) TO DETERMINE THE AVERAGE SALARY RANGE FOR EACH EXECUTIVE POSITION BY GEOGRAPHICAL REGION. THESE ARE REVIEWED AND PRESENTED TO THE HUMAN RESOURCE COMMITTEE OF THE BOARD OF DIRECTORS FOR REVIEW AND APPROVAL/RECOMMENDATIONS. FORM 990, PART VI, SECTION C, LINE 19 THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE MADE AVAILABLE UPON REQUEST. ALSO, THE FINANCIAL STATEMENTS ARE SENT ANNUALLY TO COMMUNITY LEADERS. FORM 990, PART VII, SECTION A, LINE 5: JASON PETIK RECEIVES COMPENSATION FROM AN UNRELATED ORGANIZATION, POUDRE VALLEY MEDICAL GROUP, WHICH PROVIDES MANAGEMENT SERVICES TO SIDNEY REGIONAL MEDICAL CENTER. FORM 990, PART IX, LINE 11G PROFESSIONAL FEES - OTHER: PROGRAM SERVICE EXPENSES 5,808,336. MANAGEMENT AND GENERAL EXPENSES 744,967. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 6,553,303. CONTRACT SERVICES - SURGERY PROFESSIONALS: PROGRAM SERVICE EXPENSES 2,325,343. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,325,343. CONTRACT SERVICES - ANESTHESIA PROFESSIONALS: PROGRAM SERVICE EXPENSES 218,454. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 218,454. FORM 990, PART XI, LINE 2C: THE BOARD OF DIRECTORS ASSUMES THE RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF SRMC'S FINANCIAL STATEMENTS AND SELECTION OF AN INDEPENDENT ACCOUNTANT. THIS PROCESS HAS NOT CHANGED SINCE THE PRIOR YEAR. CHEYENNE COUNTY HOSPITAL AND HEALTH CENTER FOUNDATION 1000 POLE CREEK CROSSING SIDNEY NE 69162 470686476 SUPPORT SIDNEY REGIONAL MEDICAL CENTER NE 501(C)(3) LINE 12C, III-FI N/A 0 0 1 1 0 0 0 0 0 0 0 0 0 1 1 1 1 1 0 0