2022-06-15T08:05:18-05:00 2021-07-31 470585450 DOHMAN AKERLUND & EDDY LLC PO BOX 470 AURORA NE 688180470 990 2020-08-01 470421272 COMMUNITY MEDICAL CENTER INC COMM 4022456500 3307 BARADA STREET FALLS CITY NE 68355 RICK SICORA CFO 4022456501 2022-06-08 true RICK SICORA 999009999 TIMOTHY J COUFAL CPA P00964304 4026946404 2022-06-08 2020 2022-09-23 18:48:47Z RYAN LARSEN SAME AS C ABOVE FALLS CITY NE 68355 31372246 false X HTTP://CMCFC.ORG X 1995 NE 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. 10 9 228 0 1974461 5287028 26905508 25900807 280611 177874 0 29160580 31365709 0 0 12001199 12911698 0 0 14267592 13476647 26268791 26388345 2891789 4977364 49460698 48885584 20460074 14907596 29000624 33977988 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. false false 21128039 25900807 COMMUNITY MEDICAL CENTER PROVIDES MEDICAL SERVICES TO MEET THE NEEDS OF THE PEOPLE OF RICHARDSON COUNTY AND THE SURROUNDING COMMUNITIES. COMMUNITY MEDICAL CENTER PROVIDED 1,588 INPATIENT DAYS, 660 SWING-BED DAYS, 12,588 CLINIC VISITS AND NUMEREOUS OUTPATIENT SERVICES DURING THE YEAR. COMMUNITY BENEFITS INCLUDE 1,074,948 OF SUBSIDIZED HEALTH SERVICES, 679,938 OF TRADITIONAL CHARITY CARE, 32,632 OF BAD DEBT, 10,010 OF COMMUNITY ACTIVITIES, 7,619 OF COMMUNITY SERVICES, AND 5,500 OF HEALTH EDUCATION. 21128039 true true false true false false false false false true true false false false true true false true false false false false false false false false true true false false true true false false false false false false false true false false false false false false false true false false false true 86 0 true 228 true false false false false false false false false X 10 9 false false false false false false false true true false false false true true true false true true false false X RICK SICORA 4022456501 3307 BARADA STREET FALLS CITY NE 68355 NICOLE MASON CHAIRPERSON 1.00 X 0 0 0 BONNIE KANEL VICE-CHAIR 1.00 X 0 0 0 JOHN MARTIN TREASURER 1.00 X 0 0 0 STEVE SEVERIN SECRETARY 1.00 X 0 0 0 CHARLES JAMES DIRECTOR 1.00 X 0 0 0 MARGARET MCINTEER DIRECTOR 1.00 X 0 0 0 BARB HOWARD DIRECTOR 1.00 X 0 0 0 TRENT SCHEITEL DIRECTOR 1.00 X 0 0 0 JAREN PIPPITT DIRECTOR 1.00 X 0 0 0 ALLAN TRAMP DIRECTOR 4.00 X 55306 0 0 RYAN LARSEN CEO 40.00 2.00 X 214772 0 34267 RICK SICORA CFO 40.00 2.00 X 57119 0 2794 SCOTT SAWYER CFO (PARTIAL 40.00 2.00 X 62450 0 7000 KARI HOLDSWORTH CCO 40.00 X 99104 0 18990 DAVID BORG PHYSICIAN 40.00 X 195351 0 28388 SANDRA CATLIN APRN 40.00 X 167936 0 25580 ROBIN ALEXANDER CRNA 40.00 X 193079 0 24388 ALYSSA FINCK PHYSICIAN 40.00 X 280018 0 36300 JUSTIN WESTENGAARD PHYSICIAN 40.00 X 322257 0 36996 1647392 214703 16 false true false NATIONAL THERAPEUTIC ASSOCATION 11623 ARBOR STREET OMAHA NE 68144 PT/OT SERVICES 703591 CARDINAL HEALTH 21337 NETWORK PLACE CHICAGO IL 60673 PHARMACY SVCS 562756 SHARED MEDICAL SERVICES 209 LIMESTONE PASS COTTAGE GROVE WI 53527 MRI SERVICES 270445 GRACE ANESTHESIA SERVICES LLC PO BOX 535 CARROLL IA 51401 ANESTHESIA SVCS 256789 PREMIER SPECIALTY NETWORK LLC 1835 E REPUBLIC ROAD SUITE 200 SPRINGFIELD MO 65804 PHYS. CLINIC 224542 8 10000 5044988 232040 5287028 NET PATIENT SERVICE REVENUE 621110 24521464 24521464 PHARMACY 446110 1091681 1091681 MISCELLANEOUS HOSPITAL REV 621110 195339 195339 CAFETERIA 722320 70558 70558 LIFELINE 900099 21765 21765 25900807 182311 182311 2100 6537 -4437 -4437 -4437 31365709 25896370 182311 X 433445 433445 9796499 8080674 1715825 439121 355542 83579 1579600 1012592 567008 663033 517738 145295 79657 79657 46449 46449 3824952 3387976 436976 63106 17991 45115 141059 61551 79508 409321 408270 1051 28736 26381 2355 18362 15624 2738 302450 28889 273561 2325590 1939542 386048 102547 13975 88572 PHARMACY 2592129 2592129 REPAIR AND MAINTENANCE 1152594 763090 389504 ADMIN OFFICE 565306 198823 366483 CENTRAL SUPPLY 558989 558989 1265400 1148263 117137 26388345 21128039 5260306 0 20836895 10100863 3845623 15041553 2870114 2997951 477845 539888 626939 531405 44118165 24982815 19648427 19135350 5855 8574 1149000 530000 49460698 48885584 2313085 2031298 7318253 6695157 4531522 4154341 2000000 4297214 2026800 20460074 14907596 X 29000624 33977988 29000624 33977988 49460698 48885584 4977364 X false true X true true true X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 2806 2806 false SCHEDULE C, PART II-B, LINE 1 THE PORTION OF ORGANIZATION DUES THAT ARE RELATED TO LOBBING ARE AS FOLLOWS: NEBRASKA HOSPITAL ASSOCIATION - 1,527, AMERICAN HOSPITAL ASSOCIATION 1,279 3672159 1314311 865 100 4987235 4130577 535306 6395 1000120 3672159 3569532 555297 5898 150 4130577 3766040 1655000 3427 1854935 3569532 3966835 6043400 2316 6246511 3766040 1.00000 false false 1184880 1184880 26841990 13050349 13791641 1847234 1199396 647838 14127497 10733070 3394427 116564 116564 19135350 CONDITIONAL CONTRIBUTION 1225000 EST THIRD-PARTY PAYOR SETTLEMENTS 675000 PROVIDER RELIEF FUNDS 200000 DEBT ISSUE COST -73200 2026800 X SCHEDULE D, PAGE 2, PART V, LINE 4 THE FUNDS INCLUDE 4,231,675 DESIGNATED BY THE BOARD FOR CAPITAL IMPROVEMENTS, 70,551 DESIGNATED BY THE BOARD FOR DEFERRED COMPENSATION AND 685,009 DESIGNATED BY A LONG-TERM DEBT COVENANT ON THE AMERICAN NATIONAL BANK LOAN. SCHEDULE D, PAGE 3, PART X AS OF JULY 31, 2021 AND 2020, THERE IS NO RESERVE FOR UNCERTAIN TAX POSITIONS. true true X true X true X true true false true true 679938 679938 0.02580 679938 679938 0.02580 7619 7619 0.00030 5500 5500 0.00020 1074948 1074948 0.04070 5600 5600 0.00020 1093667 1093667 0.04140 1773605 1773605 0.06720 5000 5000 0.00020 5010 5010 0.00020 10010 10010 0.00040 true 14490516 14370638 119878 X true true 1 1 COMMUNITY MEDICAL CENTER 3307 BARADA STREET FALLS CITY NE 68355 WWW.CMCFC.ORG H000112 X X X X COMMUNITY MEDICAL CENTER 1 false false true X X X X X X X X 18 true false false true X WWW.CMCFC.ORG X X true 18 true WWW.CMCFC.ORG false false true X 200.000000000000 300.000000000000 true true X X X true X WWW.CMCFC.ORG/PATIENTS-VISITORS/ X WWW.CMCFC.ORG/PATIENTS-VISITORS/ X WWW.CMCFC.ORG/PATIENTS-VISITORS/ X X X X true X false X X X X true X false false FACILITY 1, COMMUNITY MEDICAL CENTER - PART V, LINE 3E SIGNIFICANT HEALTH NEEDS OF THE COMMUNITY INCLUDE: 1. BEHAVIORAL HEALTH - RICHARDSON COUNTY NEEDS ADDITIONAL BEHAVIORAL HEALTH RESOURCES, FORMAL AND INFORMAL. THIS INCLUDES IMPROVING SCREENING TOOLS AND SENSITIVITY TO THESES ISSUES AMONG THE PUBLIC AND CLINICIANS, INCREASED AVAILABILITY OF COUNSELING AND SUPPORT SERVICES, BETTER COORDINATION AMONG CONCERNED PARTIES, AND FINDING FUNDING AND EFFICIENCIES SO SUCH SERVICES CAN BE AFFORDABLE AND SELF-SUSTAINING. SUBSTANCE ABUSE EFFORTS SHOULD INCLUDE REDUCING THE LIKELIHOOD OF ABUSE OR ADDICTION, INCREASING THE AVAILABILITY OF TREATMENT OPTIONS, AND PROVIDING ONGOING SUPPORT TO THOSE IN RECOVERY. 2. FITNESS AND OBESITY - OBESITY LEVELS IN RICHARDSON COUNTY MUST BE REDUCED TO AVOID THE DISABLING HEALTH ISSUES THAT IMPACT HEALTH AND FUNCTIONING. WE SHOULD SUPPORT EFFORTS TO INCREASE HEALTHY ACTIVITY LEVELS AND IMPROVE EATING HABITS AT ALL AGES AND ECONOMIC LEVELS. EFFORTS THAT LEVERAGE EXISTING CULTURAL AND PEER SUPPORT SYSTEMS ARE ESPECIALLY ATTRACTIVE FOR INCREASING THE EFFECTIVENESS AND DURABILITY OF IMPROVEMENTS. 3. CHRONIC DISEASES AND CANCER - WE WILL IMPROVE USE OF SCREENING TOOLS AND OTHER METHODS FOR EARLY DETECTION OF DISEASE. WE WILL PROVIDE EDUCATION, TOOLS AND SUPPORT TO THOSE WITH CHRONIC DISEASES TO IMPROVE MANAGEMENT AND AVOID COMPLICATIONS AND MAINTAIN QUALITY OF LIFE. WE BELIEVE SUCH EFFORTS ARE BEST DONE IN COLLABORATION AMONG PATIENTS, FAMILY AND COMMUNITY SUPPORTS, AND CLINICIANS. FACILITY 1, COMMUNITY MEDICAL CENTER - PART V, LINE 5 A SURVEY WAS CONDUCTED BY COMMUNITY MEDICAL CENTER WITH THE HEALTH DEPARTMENT AND UNMC COLLEGE OF PUBLIC HEALTH. THE HOSPITAL RECEIVED INPUT FROM MEDICAL STAFF, LAW ENFORCEMENT, CHURCHES, HEALTH DEPARTMENT, OTHER CARE PROVIDERS AND COMMUNITY MEMBERS. 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 HAS DEVELOPED A DETAILED IMPLEMENTATION PLAN THAT INCLUDED GOALS/OBJECTIVES, KEY ACTIVITIES, KEY PARTIES AND THE HOSPITAL'S CONTRIBUTIONS FOR THE TOP HEALTH AREAS OF CONCERN. TOP PRIORITIES INCLUDE BEHAVIORAL HEALTH (INCLUDING SUBSTANCE ABUSE), FITNESS AND OBESITY, AND CANCER AND CHRONIC DISEASES. OTHER CONCERNS INCLUDE ACCESS TO CARE, EMERGENCY SERVICES, HOME HEALTH, COST OF CARE, MEDICATION AFFORDABILIY, UNDERSTANDING HOW TO DISCUSS AND PLAN FOR END-OF-LIFE WISHES. 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. 2 FAMILY MEDICINE 3307 BARADA STREET FALLS CITY NE 68355 RURAL HEALTH CLINIC HUMBOLDT FAMILY MEDICINE 1120 GRAND AVENUE HUMBOLDT NE 68376 RURAL HEALTH CLINIC 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 5,000 TO FALLS CITY ECONMIC DEVELOPMENT AND GROWTH ENTERPRISE (EDGE) TO SUPPORT ECONOMIC DEVELOPMENT IN FALLS CITY AND RICHARDSON COUNTY. THE ORGANIZATION ALSO CONTRIBUTED 5,010 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. X X X false false false true false false false false false RYAN LARSEN CEO 194049 20000 723 11175 23092 249039 DAVID BORG PHYSICIAN 160544 34807 10475 17913 223739 SANDRA CATLIN APRN 51322 116614 9041 16539 193516 ROBIN ALEXANDER CRNA 179504 13575 10563 13825 217467 ALYSSA FINCK PHYSICIAN 240768 23000 16250 13816 22484 316318 JUSTIN WESTENGAARD PHYSICIAN 256932 55554 9771 14510 22486 359253 SCHEDULE J, PAGE 1, PART I, LINE 5A PROVIDER PRODUCTIVITY BONUSES ARE CALCULATED BASED ON RHC REVENUE PRODUCED. BONUSES BASED ON REVENUES: SANDRA CATLIN 112,114 DAVID BORG 31,757 JUSTIN WESTENGAARD 32,554 A CITY OF FALLS CITY NEBRASKA 476006187 2015-12-23 9945000 REFUND 2009 NEW HOSPITAL DEBT false false false A 3249843 9945000 400000 9945000 2015 true false true true A false false true false false false false true A false true true false true false false false true A true PURPOSE OF ISSUE DESCRIPTION CITY OF FALLS CITY, NEBRASKA REFUND 2009 NEW HOSPITAL DEBT ALLAN TRAMP BOARD MEMBER 55306 SUPERVISOR/PHYSICIAN false 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 20,212 0 COLLECTION FEES 0 17,517 0 BILLING FEES 6,526 32,805 0 COMPUTER MAINTENANCE 129 74,956 0 SERVICE AND LICENSE FEES 19,116 14,128 0 BANK/CREDIT CARD FEES 0 45,093 0 CONTRACT LABOR 161,557 73,338 0 PURCHASED SERVICE 1,412,343 158,927 0 CONTRACT SERVICE 1,704,151 0 0 DIETARY CONTRACT SERVICE 48,154 0 0 TOTAL 3,387,976 436,976 0 COMMUNITY MEDICAL CENTER FOUNDATION 3307 BARADA STREET FALLS CITY NE 68355 463491851 SUPPORT NE 501C3 12A CMC COMMUNITY MEDICAL CENTER INC false false false true false false false false false false false false false false false false false false false false COMMUNITY MEDICAL CENTER FOUNDATION C 10000 CONTRIBUTION