OSMOND GENERAL HOSPITAL INC: Form 990, tax year 2020
View the entire original 990 at ProPublica ↗
- Organization
- OSMOND GENERAL HOSPITAL INC (EIN 23-7161473)
- Tax period
- 2020-07-01 to 2021-06-30
- Filed
- 2022-05-12
- IRS object ID
- 202231329349300328
- Schema version
- 2020v4.2
- 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 O
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2022-05-12T09:08:52-05:00 | ReturnTs |
| Tax Period End | 2021-06-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 476097913 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SEIM JOHNSON LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 18081 BURT STREET SUITE 200 | AddressLine1Txt |
| City | OMAHA | CityNm |
| State Abbreviation | NE | StateAbbreviationCd |
| ZIP | 680224722 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2020-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 237161473 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | OSMOND GENERAL HOSPITAL INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | OSMO | BusinessNameControlTxt |
| Phone | 4027483393 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 402 NORTH MAPLE | AddressLine1Txt |
| City | OSMOND | CityNm |
| State Abbreviation | NE | StateAbbreviationCd |
| ZIP | 68765 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | LON M KNIEVEL | PersonNm |
| Person Title | CHIEF EXECUTIVE OFFICER | PersonTitleTxt |
| Phone | 4027483393 | PhoneNum |
| Signature | 2022-05-10 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | LON | PersonFirstNm |
| Person Last | KNIEVEL | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | MEGAN L KOZIOL | PreparerPersonNm |
| PTIN | P01544037 | PTIN |
| Phone | 4023302660 | PhoneNum |
Additional Filer Information AdditionalFilerInformation
Trusted Customer TrustedCustomerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | 2 | TrustedCustomerCd |
| Authentication Assurance Level | AAL1 | AuthenticationAssuranceLevelCd |
| Identity Assurance Level | IAL1 | IdentityAssuranceLevelCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2020 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | LON M KNIEVEL | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 402 NORTH MAPLE | AddressLine1Txt |
| City | OSMOND | CityNm |
| State Abbreviation | NE | StateAbbreviationCd |
| ZIP | 68765 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $12,039,600 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.OSMONDHOSPITAL.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1966 | FormationYr |
| Legal Domicile State | NE | LegalDomicileStateCd |
| Activity Or Mission | PROVIDE HEALTHCARE SERVICES TO ALL INDIVIDUALS IN THE COMMUNITY REGARDLESS OF THEIR ABILITY TO PAY. | ActivityOrMissionDesc |
| Voting Members Governing Body | 9 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 8 | VotingMembersIndependentCnt |
| Total Employee | 80 | TotalEmployeeCnt |
| Total Volunteers | 8 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $72,062 | PYContributionsGrantsAmt |
| CY Contributions Grants | $3,180,894 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $8,420,643 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $8,216,423 | CYProgramServiceRevenueAmt |
| PY Investment Income | -$27,679 | PYInvestmentIncomeAmt |
| CY Investment Income | $62,882 | CYInvestmentIncomeAmt |
| PY Other Revenue | $42,564 | PYOtherRevenueAmt |
| CY Other Revenue | $570,422 | CYOtherRevenueAmt |
| PY Total Revenue | $8,507,590 | PYTotalRevenueAmt |
| CY Total Revenue | $12,030,621 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $4,051,012 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $4,754,425 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $4,040,898 | PYOtherExpensesAmt |
| CY Other Expenses | $3,832,324 | CYOtherExpensesAmt |
| PY Total Expenses | $8,091,910 | PYTotalExpensesAmt |
| CY Total Expenses | $8,586,749 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $415,680 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $3,443,872 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $13,512,500 | TotalAssetsBOYAmt |
| Total Assets EOY | $12,251,639 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $7,873,743 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $2,847,453 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $5,638,757 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $9,404,186 | NetAssetsOrFundBalancesEOYAmt |
| Mission | OSMOND GENERAL HOSPITAL IS COMMITTED TO IMPROVING THE HEALTH OF OSMOND AND THE SURROUNDING COMMUNITIES BY PROVIDING HIGH QUALITY, PERSONALIZED, AND TECHNOLOGICALLY CURRENT HEALTH CARE WITH COMPASSION, DIGNITY, AND RESPECT IN A COST EFFECTIVE AND SAFE MANNER. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $7,155,223 | ExpenseAmt |
| Revenue | $8,745,497 | RevenueAmt |
| Desc | OSMOND GENERAL HOSPITAL, INC SERVES ALL PATIENTS REGARDLESS OF THEIR ABILITY TO PAY AND DOES NOT LIMIT ITS SERVICES OR DISCRIMINATE BASED ON RACE, SEX, NATIONAL ORGIN, OR RELIGION. DURING 2020-2021, OSMOND PROVIDED 1,773 INPATIENT DAYS, 353 RELATED TO MEDICAL/SURGICAL AND 1,420 RELATED TO SWING-BED. THERE WERE A TOTAL OF 133 OPERATIONS PERFORMED AND THE EMERGENCY ROOM TREATED 525 PATIENTS. IN ADDITION TO PROVIDING DIRECT INPATIENT AND OUTPATIENT SERVICES, OSMOND GENERAL HOSPITAL, INC. PROVIDED THE FOLLOWING SPECIALTY CLINICS: PODIATRY, UROLOGY, MOBILE MRI, MAMMOGRAPHY, SURGERY, ECHOCARDIOGRAPHY, CARDIOLOGY, AND ULTRASOUND. | Desc |
| Total Program Service Expenses | $7,155,223 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (1) | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | 0 | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (1) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | 0 | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | Yes (1) | TaxExemptBondsInd |
| Invest Tax Exempt Bonds | 0 | InvestTaxExemptBondsInd |
| Escrow Account | 0 | EscrowAccountInd |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuerInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | 0 | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | 0 | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 37 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 80 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | 0 | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | 0 | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 9 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 8 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | 0 | MembersOrStockholdersInd |
| Election Of Board Members | 0 | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | 0 | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | JODI ASCHOFF CFO | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 4027483393 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | OSMOND GEN HOSPITAL 402 NORTH MAPLE | AddressLine1Txt |
| City | OSMOND | CityNm |
| State Abbreviation | NE | StateAbbreviationCd |
| ZIP | 68765 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (13 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|
| LON M KNIEVEL | |||||||
| MEMBER/CEO | 40.00 | Yes (X) | Yes (X) | $155,344 | $0 | $46,167 | |
| ALICIA MAVIS | |||||||
| NURSE PRACTITIONER | 40.00 | $140,669 | $0 | $24,571 | Yes (X) | ||
| DR KELLY ELLIS | |||||||
| DOCTOR | 40.00 | $128,452 | $0 | $23,286 | Yes (X) | ||
| BOBBIE JO MILLER | |||||||
| NURSE PRACTITIONER | 40.00 | $134,883 | $0 | $9,952 | Yes (X) | ||
| JODI ASCHOFF | |||||||
| CFO | 40.00 | Yes (X) | $68,060 | $0 | $12,631 | ||
| TIM KINT | |||||||
| PRESIDENT | 4.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| DOUG KETELSEN | |||||||
| VICE PRESIDENT | 4.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| THERESA STAPELMAN | |||||||
| SECRETARY/TREASURER | 2.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| WALTER ASCHOFF | |||||||
| MEMBER | 2.00 | Yes (X) | $0 | $0 | $0 | ||
| DOUG KOEHLER | |||||||
| MEMBER | 2.00 | Yes (X) | $0 | $0 | $0 | ||
| KEVIN LAUCK PA | |||||||
| MEMBER | 2.00 | Yes (X) | $0 | $0 | $0 | ||
| LORI MUNTER | |||||||
| MEMBER | 2.00 | Yes (X) | $0 | $0 | $0 | ||
| LARRY PAULSEN | |||||||
| MEMBER | 2.00 | Yes (X) | $0 | $0 | $0 | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $627,408 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $116,607 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 4 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| MHS DATA CENTER | |||||
| 625 3RD STREET PO BOX 366 | PHILLIPSBURG | KS | 67661 | SOFTWARE SUPPORT | $523,411 |
| PSYCHIATRIC MEDICAL | |||||
| PO BOX 734606 | DALLAS | TX | 75373 | ADMINISTRATOR FOR ELDERLY POPULATION | $367,142 |
| BLOOMFIELD MEDICAL PARTNERS | |||||
| 105 SOUTH BROADWAY | BLOOMFIELD | NE | 68718 | ER COVERAGE | $299,773 |
| AMERISOURCE BERGEN | |||||
| 27550 NETWORK PLACE | CHICAGO | IL | 60673 | PHARMACY | $177,786 |
| OVERLAND REHABILITATION | |||||
| 3300 W 8TH ST SUITE 1 | YANKTON | SD | 57078 | REHABILITATION | $115,148 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 7 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $3,083,009 | GovernmentGrantsAmt |
| All Other Contributions | $97,885 | AllOtherContributionsAmt |
| Total Contributions | $3,180,894 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| MEDICARE/MEDICAID | 621110 | $5,116,312 | $5,116,312 |
| PATIENT SERVICE REVENUE | 621110 | $3,056,589 | $3,056,589 |
Total Oth Program Service Rev TotalOthProgramServiceRevGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $43,522 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $43,522 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $8,216,423 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $71,861 | TotalRevenueColumnAmt |
| Exclusion | $71,861 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $22,216 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $0 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $22,216 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $22,216 | TotalRevenueColumnAmt |
| Exclusion | $22,216 | ExclusionAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $8,979 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | -$8,979 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$8,979 | TotalRevenueColumnAmt |
| Exclusion | -$8,979 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt | ExclusionExclusionAmt |
|---|---|---|---|---|
| BAD DEBT RECOVERIES | 624100 | $529,074 | $529,074 | |
| CAFETERIA | 624200 | $18,059 | $18,059 | |
| PHARMACY | 624100 | $1,073 | $1,073 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $548,206 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $12,030,621 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $8,745,497 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $104,230 | 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 | $282,202 | TotalAmt |
| Management And General | $282,202 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,434,815 | TotalAmt |
| Program Services | $2,923,788 | ProgramServicesAmt |
| Management And General | $511,027 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $779,879 | TotalAmt |
| Program Services | $585,726 | ProgramServicesAmt |
| Management And General | $194,153 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $257,529 | TotalAmt |
| Program Services | $207,029 | ProgramServicesAmt |
| Management And General | $50,500 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $42,169 | TotalAmt |
| Management And General | $42,169 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $59,781 | TotalAmt |
| Management And General | $59,781 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,967,478 | TotalAmt |
| Program Services | $1,811,604 | ProgramServicesAmt |
| Management And General | $155,874 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $330,043 | TotalAmt |
| Program Services | $292,871 | ProgramServicesAmt |
| Management And General | $37,172 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $129,112 | TotalAmt |
| Program Services | $127,914 | ProgramServicesAmt |
| Management And General | $1,198 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,605 | TotalAmt |
| Program Services | $6,294 | ProgramServicesAmt |
| Management And General | $311 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,734 | TotalAmt |
| Program Services | $4,484 | ProgramServicesAmt |
| Management And General | $2,250 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $30,756 | TotalAmt |
| Program Services | $30,100 | ProgramServicesAmt |
| Management And General | $656 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $421,390 | TotalAmt |
| Program Services | $412,400 | ProgramServicesAmt |
| Management And General | $8,990 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $62,410 | TotalAmt |
| Program Services | $61,079 | ProgramServicesAmt |
| Management And General | $1,331 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| MEDICAL SUPPLIES | $609,906 | $598,469 | $11,437 |
| MISCELLANEOUS | $145,217 | $91,300 | $53,917 |
| LICENSES & FEES | $18,647 | $1,105 | $17,542 |
| DUES AND SUBSCRIPTIONS | $2,076 | $1,060 | $1,016 |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $8,586,749 | TotalAmt |
| Program Services | $7,155,223 | ProgramServicesAmt |
| Management And General | $1,431,526 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $527 | BOYAmt |
| EOY | $525 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,975,398 | BOYAmt |
| EOY | $7,654,523 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $931,357 | BOYAmt |
| EOY | $801,988 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $77,246 | BOYAmt |
| EOY | $82,690 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $22,386 | BOYAmt |
| EOY | $19,693 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $8,452,803 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $6,008,848 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,614,086 | BOYAmt |
| EOY | $2,443,955 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $891,500 | BOYAmt |
| EOY | $1,248,265 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $13,512,500 | BOYAmt |
| EOY | $12,251,639 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $536,071 | BOYAmt |
| EOY | $530,600 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,809,905 | BOYAmt |
| EOY | $895,333 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,527,767 | BOYAmt |
| EOY | $1,421,520 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,873,743 | BOYAmt |
| EOY | $2,847,453 | 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 | $5,638,757 | BOYAmt |
| EOY | $9,404,186 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,638,757 | BOYAmt |
| EOY | $9,404,186 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $13,512,500 | BOYAmt |
| EOY | $12,251,639 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $3,443,872 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $321,557 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Info In Schedule O Part XII | Yes (X) | InfoInScheduleOPartXIIInd |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Separate Basis Fincl Stmt | Yes (X) | SeparateBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | 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) |
|---|---|---|
| Organization Belongs Afflt Grp | Yes (X) | OrganizationBelongsAffltGrpInd |
| Volunteers | 0 | VolunteersInd |
| Paid Staff Or Management | 0 | PaidStaffOrManagementInd |
| Media Advertisements | 0 | MediaAdvertisementsInd |
| Mailings Members | 0 | MailingsMembersInd |
| Publications Or Broadcast | 0 | PublicationsOrBroadcastInd |
| Grants Other Organizations | 0 | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | 0 | DirectContactLegislatorsInd |
| Rallies Demonstrations | 0 | RalliesDemonstrationsInd |
| Other Activities | Yes (1) | OtherActivitiesInd |
| Other Activities | $1,147 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $1,147 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | 0 | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART II-B, LINE 1: | FormAndLineReferenceDesc |
| Explanation | OSMOND GENERAL HOSPITAL PAYS DUES TO THE NEBRASKA HOSPITAL ASSOCIATION (NHA) AND THE AMERICAN HOSPITAL ASSOCIATION (AHA) OF WHICH A PORTION IS USED FOR LOBBYING ACTIVITIES. FOR FISCAL YEAR 2021, 11.36% OF THE DUES PAID TO NHA AND 23.32% OF THE DUES PAID TO AHA WERE USED FOR LOBBYING. | ExplanationTxt |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | $47,806 | InvestmentCostOrOtherBasisAmt |
| Other Cost Or Other Basis | $15,461 | OtherCostOrOtherBasisAmt |
| Book Value | $63,267 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $5,958,687 | OtherCostOrOtherBasisAmt |
| Depreciation | $4,371,639 | DepreciationAmt |
| Book Value | $1,587,048 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $2,332,019 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,544,690 | DepreciationAmt |
| Book Value | $787,329 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $98,830 | OtherCostOrOtherBasisAmt |
| Depreciation | $92,519 | DepreciationAmt |
| Book Value | $6,311 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $2,443,955 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)
| DescDesc | AmtAmt |
|---|---|
| ESTIMATED THIRD-PARTY PAYOR SETTLEMENTS | $641,337 |
| REFUNDABLE ADVANCES | $780,183 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $1,421,520 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $12,352,178 | TotalRevEtcAuditedFinclStmtAmt |
| Net Unrealized Gains Invst | $321,557 | NetUnrealizedGainsInvstAmt |
| Revenue Not Reported | $321,557 | RevenueNotReportedAmt |
| Revenue Subtotal | $12,030,621 | RevenueSubtotalAmt |
| Revenue Not Reported Fincl Stmt | $0 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $12,030,621 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $8,586,749 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Not Reported | $0 | ExpensesNotReportedAmt |
| Expenses Subtotal | $8,586,749 | ExpensesSubtotalAmt |
| Expenses Not Rpt Fincl Stmt | $0 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $8,586,749 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART X, LINE 2: | FormAndLineReferenceDesc |
| Explanation | THE HOSPITAL IS A NOT-FOR-PROFIT CORPORATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND HAS RECEIVED A DETERMINATION LETTER THAT IT IS EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE INTERNAL REVENUE CODE. THE INTERNAL REVENUE SERVICE HAS ESTABLISHED STANDARDS TO BE MET TO MAINTAIN THE HOSPITAL'S TAX EXEMPT STATUS. THE HOSPITAL ACCOUNTS FOR UNCERTAINTIES IN ACCOUNTING FOR INCOME TAX ASSETS AND LIABILITIES USING THE GUIDANCE INCLUDED IN FASB ASC TOPIC 740, INCOME TAXES. THE HOSPITAL RECOGNIZES THE EFFECT OF INCOME TAX POSITIONS ONLY IF THOSE POSITIONS ARE MORE LIKELY THAN NOT OF BEING SUSTAINED. AT JUNE 30, 2021, THE HOSPITAL HAD NO UNCERTAIN TAX POSITIONS ACCRUED. | ExplanationTxt |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
| Percent100 | Yes (X) | Percent100Ind |
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
Discounted Care Oth Percentage DiscountedCareOthPercentageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Discounted Care Other | 150.000000000000 | DiscountedCareOtherPct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | 0 | FinancialAssistanceBudgetInd |
| Annual Community Bnft Report | 0 | AnnualCommunityBnftReportInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $415,830 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $415,830 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.04840 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $274,584 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $191,771 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $82,813 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00960 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $690,414 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $191,771 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $498,643 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.05800 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $123,557 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $123,557 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01440 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 1 | ActivitiesOrProgramsCnt |
| Persons Served | 16 | PersonsServedCnt |
| Total Community Benefit Expns | $4,000 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $4,000 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00050 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 1 | ActivitiesOrProgramsCnt |
| Persons Served | 16 | PersonsServedCnt |
| Total Community Benefit Expns | $127,557 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $127,557 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01490 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 1 | ActivitiesOrProgramsCnt |
| Persons Served | 16 | PersonsServedCnt |
| Total Community Benefit Expns | $817,971 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $191,771 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $626,200 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.07290 | TotalExpensePct |
Health Improvement Advocacy HealthImprovementAdvocacyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $13,371 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $13,371 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00160 | TotalExpensePct |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $13,371 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $13,371 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00160 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $0 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $0 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $5,240,253 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $4,946,246 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | $294,007 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | Yes (X) | CostToChargeRatioInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (1) | 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 | OSMOND GENERAL HOSPITAL | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 402 NORTH MAPLE | AddressLine1Txt |
| City | OSMOND | CityNm |
| State Abbreviation | NE | StateAbbreviationCd |
| ZIP | 68765 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | OSMONDHOSPITAL.COM | WebsiteAddressTxt |
| State License | 620001 | 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 | OSMOND GENERAL HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | 0 | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | 0 | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (1) | 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 |
| Prior CHNA Impact | Yes (X) | PriorCHNAImpactInd |
| CHNA Conducted | 18 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | Yes (1) | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | Yes (1) | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | HTTPS://WWW.OSMONDHOSPITAL.ORG/COMMUNITY-EDUCATION/ | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 18 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | HTTPS://WWW.OSMONDHOSPITAL.ORG/COMMUNITY-EDUCATION/ | StrategyWebsiteURLTxt |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 100.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 150.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | HTTPS://WWW.OSMONDHOSPITAL.ORG/PATIENT-VISITOR/FINANCIAL-ASSISTANCE/ | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | HTTPS://WWW.OSMONDHOSPITAL.ORG/PATIENT-VISITOR/FINANCIAL-ASSISTANCE/ | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | HTTPS://WWW.OSMONDHOSPITAL.ORG/PATIENT-VISITOR/FINANCIAL-ASSISTANCE/ | 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 |
| Notified FAP Copy Bill Display | Yes (X) | NotifiedFAPCopyBillDisplayInd |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | 0 | 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 (1) | NondisEmergencyCarePolicyInd |
| Look Back Medicaid Medcr Prvt | Yes (X) | LookBackMedicaidMedcrPrvtInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| OSMOND GENERAL HOSPITAL | PART V, SECTION B, LINE 5: OSMOND GENERAL HOSPITAL WORKED WITH THE NORTH CENTRAL DISTRICT HEALTH DEPARTMENT TO COMPLETE THE COMMUNITY HEALTH NEEDS ASSESSMENT PLAN. |
| OSMOND GENERAL HOSPITAL | PART V, SECTION B, LINE 6A: - ANTELOPE MEMORIAL IN NELIGH, NE- PLAINVIEW COMMUNITY HOSPITAL IN PLAINVIEW, NE- AVERA CREIGHTON HOSPITAL IN KNOX COUNTY, NE- AVERA ST. ANTHONY'S IN O'NEILL, NE- BROWN COUNTY HOSPITAL IN AINSWORTH, NE- CHERRY COUNTY HOSPITAL IN VALENTINE, NE- ROCK COUNTY HOSPITAL IN BASSETT, NE- WEST HOLT MEMORIAL HOSPITAL IN ATKINSON, NE- NIOBRARA VALLEY HOSPITAL IN LYNCH, NE |
| OSMOND GENERAL HOSPITAL | PART V, SECTION B, LINE 6B: NORTH CENTRAL DISTRICT HEALTH DEPARTMENT |
| OSMOND GENERAL HOSPITAL | PART V, SECTION B, LINE 11: THROUGH THE PROCESS OF COMPLETING THE COMMUNITY HEALTH NEEDS ASSESSMENT, AS WELL AS ASSESSING THE RESOURCES AVAILABLE TO THIS ORGANIZATION AND SURROUNDING COMMUNITIES, IT WAS DETERMINED THAT THE MOST SIGNIFICANT NEED TO BE ADDRESSED BY OSMOND GENERAL HOSPITAL IS THE DETECTION AND MANAGEMENT OF CHRONIC DISEASE, WITH A FOCUS PRIMARILY ON HEART DISEASE. BY TACKLING THIS SPECIFIC HEALTH ISSUE, OSMOND HOSPITAL HAS THE OPPORTUNITY TO VASTLY DECREASE THE OCCURRENCES AND SEVERITY OF LIFE THREATING DISEASES SUCH AS CARDIOVASCULAR DISEASE, DIABETES AND CHRONIC OBSTRUCTIVE PULMONARY DISEASE.OSMOND GENERAL HOSPITAL WILL CONTINUE TO UTILIZE PROVEN COMMUNITY WEIGHT LOSS ACTIVITIES AS WELL AS INTRODUCE NEW STRATEGIES TO WORK WITH OTHER COMMUNITY PARTNERS TO INCREASE AWARENESS OF AND PROMOTE BETTER NUTRITIONAL ALTERNATIVES AND OPPORTUNITIES FOR PHYSICAL ACTIVITY. THIS GOAL WILL BE ACCOMPLISHED THROUGH THE DEVELOPMENT AND STRENGTHENING OF COMMUNITY PARTNERSHIPS, WORKPLACE WELLNESS PROGRAMS, NUTRITION AND PHYSICAL ACTIVITY EDUCATIONAL SESSIONS AS WELL AS PROGRAMS TO INVOLVE COMMUNITY MEMBERS IN WEIGHT LOSS AND PHYSICAL ACTIVITY CHALLENGES.AS A SECONDARY PRIORITY, OSMOND GENERAL HOSPITAL WILL ALSO EXPAND IT'S EFFORTS INTO ADDRESSING THE MENTAL HEALTH NEEDS OF THE COMMUNITIES IT SERVES WITH THE GOAL OF REDUCING THE SUICIDE RATE AMONG IT CITIZENS. OSMOND GENERAL HOSPITAL WILL UTILIZE TWO NEW SERVICES OFFERED ON AN OUTPATIENT BASIS; SENIOR LIFE SOLUTIONS, WHICH IS A GROUP MENTAL HEALTH THERAPY PROGRAM DIRECTED TOWARDS SENIORS; TELE-PSYCH IS OFFERED THROUGH A PARTNERSHIP WITH BRYAN TELE-MEDICINE AND GENESIS PSYCHIATRIC GROUP IN LINCOLN, NEBRASKA. OGH WILL ALSO PROMOTE MENTAL HEALTH AND SUICIDE PREVENTION THROUGH PUBLICATIONS AND ADVERTISEMENT.THERE WERE NO HEALTH NEEDS IDENTIFIED IN THE LATEST CHNA THAT ARE NOT BEING ADDRESSED. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 3 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (3 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| 1 - RANDOLPH CLINIC | ||||
| 106 EAST WAYNE | RANDOLPH | NE | 68771 | MEDICAL CLINIC |
| 2 - WAUSA CLINIC | ||||
| 100 N LINCOLN | WAUSA | NE | 68786 | MEDICAL CLINIC |
| 3 - OSMOND FAMILY PRACTICE | ||||
| PO BOX 370 | OSMOND | NE | 68765 | MEDICAL CLINIC |
Supplemental Information Detail SupplementalInformationDetail (14 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 3C: | NO OTHER CRITERIA WAS USED TO DETERMINE ELIGIBILITY FOR FREE OR DISCOUNTED CARE. |
| PART I, LINE 6A: | A COMMUNITY BENEFIT REPORT WAS NOT PREPARED IN THE CURRENT YEAR. |
| PART I, LN 7 COL(F): | DURING THE YEAR ENDED JUNE 30, 2021, THE BAD DEBT RECOVERIES EXCEEDED THE BAD DEBT EXPENSE. THERE IS NO BAD DEBT EXPENSE INCLUDED ON FORM 990, PART XI, LINE 25. |
| PART II, COMMUNITY BUILDING ACTIVITIES: | OSMOND GENERAL HOSPITAL HELD SEVERAL VACCINATION CLINICS AND BLOOD DRIVES, PROVIDED SPACE FOR WEEKLY AA MEETINGS, AS WELL AS PROVIDED CANCER KITS TO FAMILIES IN THE COMMUNITY. |
| PART III, LINE 2: | GENERALLY, PATIENTS WHO ARE COVERED BY THIRD-PARTY PAYORS ARE RESPONSIBLE FOR RELATED DEDUCTIBLES AND COINSURANCE, WHICH VARY IN AMOUNT. THE HOSPITAL PROVIDES SERVICES TO UNINSURED PATIENTS, AND OFFERS THOSE UNINSURED PATIENTS A DISCOUNT, EITHER BY POLICY OR LAW, FROM STANDARD CHARGES. THE HOSPITAL ESTIMATES THE TRANSACTION PRICE FOR PATIENTS WITH DEDUCTIBLES AND COINSURANCE AND FROM THOSE WHO ARE UNINSURED BASED ON HISTORICAL EXPERIENCE AND CURRENT MARKET CONDITIONS. THE INITIAL ESTIMATE OF THE TRANSACTION PRICE IS DETERMINED BY REDUCING THE STANDARD CHARGE BY ANY CONTRACTUALADJUSTMENTS, DISCOUNTS AND IMPLICIT PRICE CONCESSIONS. SUBSEQUENT CHANGES TO THE ESTIMATE OF THE TRANSACTION PRICE ARE RECORDED AS ADJUSTMENTS TO PATIENT SERVICE REVENUE IN THE PERIOD OF CHANGE.FOR THE YEAR ENDED JUNE 30, 2021, NO SIGNIFICANT ADJUSTMENTS TO REVENUE WERE RECOGNIZED DUE TO CHANGES IN ESTIMATES OF IMPLICIT PRICE CONCESSIONS FOR PERFORMANCE OBLIGATIONS SATISFIED IN PRIOR YEARS. SUBSEQUENT CHANGES THAT ARE DETERMINED TO BE THE RESULT OF AN ADVERSE CHANGE IN THE PATIENT'S ABILITY TO PAY ARE RECORDED AS BAD DEBT EXPENSE. |
| PART III, LINE 3: | THE HOSPITAL PROVIDES PATIENT FINANCIAL ASSISTANCE TO PATIENTS WHO ARE FINANCIALLY UNABLE TO PAY FOR THE HEALTHCARE SERVICES THEY RECEIVE. IT IS THE POLICY OF THE HOSPITAL NOT TO PURSUE COLLECTION OF AMOUNTS DETERMINED TO QUALIFY AS PATIENT FINANCIAL ASSISTANCE. ACCORDINGLY, THE HOSPITAL DOES NOT REPORT THESE AMOUNTS IN PATIENT SERVICE REVENUE. THE HOSPITAL DETERMINES THE COSTS ASSOCIATED WITH PROVIDING CHARITY CARE BY AGGREGATING THE DIRECT AND INDIRECT COSTS, INCLUDING SALARIES, BENEFITS, SUPPLIES, AND OTHER OPERATINGEXPENSES, BASED ON AN OVERALL COST TO CHARGE RATIO. THE COSTS FOR CARING FOR THESE PATIENTS FOR THE YEAR ENDED JUNE 30, 2021 WAS APPROXIMATELY $307,000. |
| PART III, LINE 4: | THE HOSPITAL'S FINANCIAL STATMENTS DO NOT CONTAIN A SPECIFIC FOOTNOTE DESCRIBING BAD DEBT. HOWEVER, PAGES 7, 9 AND 10 OF THE ATTACHED AUDITED FINANCIAL STATEMENTS INCLUDE FOOTNOTES TITLED "PATIENT ACCOUNTS RECEIVABLES", "PATIENT SERVICE REVENUE AND "PATIENT FINANCIAL ASSISTANCE". |
| PART III, LINE 8: | THE ORGANIZATION USED WORKSHEETS D-1, D-3, E, E-2 AND E-3 OF THE JUNE 30, 2021 COST REPORT. IT DOES NOT INCLUDE ALL OF THE MEDICARE REVENUES AND COSTS. IF ALL OF THE MEDICARE REVENUES AND COSTS WERE INCLUDED, THERE WOULD BE A LARGE SHORTFALL SHOWN ON LINE 7. THE SHORTFALL REPRESENTS ACTUAL UNREIMBURSED COSTS INCURRED BY OSMOND GENERAL HOSPITAL IN PROVIDING SERVICES TO INDIVIDUALS ELIGIBLE FOR MEDICARE. THE COMMUNITY BENEFITS BECAUSE THE HOSPITAL APPLIES OTHER REVENUES TO COVER THE COSTS OF CARING FOR MEDICARE PATIENTS. |
| PART III, LINE 9B: | THE HOSPITAL WILL NOT TAKE EXTRAORDINARY COLLECTION ACTIONS AGAINST A PATIENT OR ANY OTHER INDIVIDUAL WHO HAS ACCEPTED OR IS REQUIRED TO ACCEPT FINANCIAL RESPONSIBILITY FOR A PATIENT UNLESS AND UNTIL THE HOSPITAL HAS MADE "REASONABLE EFFORTS" TO DETERMINE WHETHER THE PATIENT IS ELIGIBLE FOR FINANCIAL ASSISTANCE UNDER THIS POLICY. THE CEO IS RESPONSIBLE TO DETERMINE WHETHER THE HOSPITAL HAS ENGAGED IN REASONABLE EFFORTS TO DETERMINE WHETHER A PATIENT IS ELIGIBLE FOR FINANCIAL ASSISTANCE. |
| PART VI, LINE 2: | THE ORGANIZATION USES DATA PROVIDED BY THE HEALTH DEPARTMENT TO DETERMINE THE HEALTH CARE NEEDS OF THE COMMUNITY IT SERVES. WITH THIS DATA, THE ORGANIZATION IS ABLE TO PINPOINT NEEDS OF THE COMMUNITY AND MOLD PROGRAMS AND INITIATIVES TO TARGET THOSE NEEDS. |
| PART VI, LINE 3: | IN THE HOSPITAL AND CLINICS, THE BILLING AND CHARITY CARE POLICIES ARE POSTED IN MULTIPLE LOCATIONS. |
| PART VI, LINE 4: | THE ORGANIZATION SERVES THE COMMUNITIES OF OSMOND, RANDOLPH AND WAUSA IN NORTHEASTERN NEBRASKA. THE ORGANIZATION ALSO SERVES THE COMMUNITIES OF PIERCE, COLERIDGE AND PLAINVIEW WITH ITS OUTREACH CLINICS AND OTHER SERVICES. OSMOND GENERAL HOSPITAL'S SERVICE AREA INCLUDES A POPULATION OF APPROXIMATELY 16,000. THE MEDIAN HOUSEHOLD INCOME FOR THE COMMUNITY IS $37,938 COMPARED TO THE U.S. AVERAGE OF $51,324 AND THE NEBRASKA AVERAGE OF $51,381. THE AREA POPULATION IS PREDOMINATELY WHITE ELDERLY AND LOW INCOME. |
| PART VI, LINE 5: | THE ORGANIZATION HAS MANY WAYS THAT IT FURTHERS ITS EXEMPT PURPOSE. THE ORGANIZATION PUBLISHES HEALTH RELATED ARTICLES IN AREA NEWSPAPERS, HOLDS THE CARDIAC REHAB CLINIC, AND MULTIPLE WELLNESS ACTIVITIES INCLUDING THE MAYO CLINIC DIET. THESE ACTIVITIES INCLUDE THE FUNWALK, SCHOOL HEALTH FAIRS, AND COMMUNITY HEALTH FAIRS. |
| PART VI, LINE 6: | THE ORGANIZATION HAS WORKED WITH HEARTLAND HEALTH AND THE NORTH CENTRAL HEALTH DEPARTMENT BUT DOES NOT HAVE ANY ACTIVITIES TO REPORT. THE ORGANIZATION IS OPEN TO WORKING WITH THESE AFFILIATES IN THE FUTURE TO PROMOTE THE HEALTH OF THE COMMUNITIES SERVED. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form990 Of Other Organizations | Yes (X) | Form990OfOtherOrganizationsInd |
| Written Employment Contract | Yes (X) | WrittenEmploymentContractInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (3 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| LON M KNIEVEL | ||||||||||||||
| MEMBER/CEO | $155,344 | $0 | $0 | $0 | $0 | $0 | $6,656 | $0 | $39,511 | $0 | $201,511 | $0 | $0 | $0 |
| ALICIA MAVIS | ||||||||||||||
| NURSE PRACTITIONER | $140,669 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $24,571 | $0 | $165,240 | $0 | $0 | $0 |
| DR KELLY ELLIS | ||||||||||||||
| DOCTOR | $128,452 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $23,286 | $0 | $151,738 | $0 | $0 | $0 |
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 | HOSPITAL AUTHORITY NO 1 OF PIERCE COUNTY NEBRASKA | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Issuer EIN | 900198234 | BondIssuerEIN |
| Bond Issued | 2017-02-28 | BondIssuedDt |
| Issue Price | $1,688,000 | IssuePriceAmt |
| Purpose | REFUNDING HOSPITAL REVENUE BONDS DATED 01/05/11 AND 10/11/11 | PurposeDesc |
| Defeased | 0 | DefeasedInd |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuerInd |
| Pool Financing | 0 | PoolFinancingInd |
Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Retired | $792,667 | RetiredAmt |
| Total Proceeds | $1,688,000 | TotalProceedsAmt |
| Issuance Costs From Proceeds | $25,148 | IssuanceCostsFromProceedsAmt |
| Capital Expenditures | $1,688,000 | CapitalExpendituresAmt |
| Refunding Tax Exempt Bonds | Yes (1) | RefundingTaxExemptBondsInd |
| Refunding Taxable Bonds | 0 | RefundingTaxableBondsInd |
| Final Allocation Made | Yes (1) | FinalAllocationMadeInd |
| Adequate Books And Rec Maint | Yes (1) | AdequateBooksAndRecMaintInd |
Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Owning Bond Financed Property | 0 | OwningBondFinancedPropertyInd |
| Any Lease Arrangements | 0 | AnyLeaseArrangementsInd |
| Mgmt Contract Bond Fincd Prop | 0 | MgmtContractBondFincdPropInd |
| Any Research Agreements | 0 | AnyResearchAgreementsInd |
| Private Bus Use By Others | 0.00000 | PrivateBusUseByOthersPct |
| Private Bus Concerning UBI | 0.00000 | PrivateBusConcerningUBIPct |
| Total Private Business Use | 0.00000 | TotalPrivateBusinessUsePct |
| Bond Iss Meet Prvt Sec Pymt Test | 0 | BondIssMeetPrvtSecPymtTestInd |
| Change In Use Bond Financed Prop | 0 | ChangeInUseBondFinancedPropInd |
| Procs Nonqualified Bond Remdtd | Yes (1) | ProcsNonqualifiedBondRemdtdInd |
Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Form8038 T Filed | 0 | Form8038TFiledInd |
| Rebate Not Due Yet | Yes (1) | RebateNotDueYetInd |
| Exception To Rebate | Yes (1) | ExceptionToRebateInd |
| No Rebate Due | 0 | NoRebateDueInd |
| Variable Rate Issue | 0 | VariableRateIssueInd |
| Hedge Identified In Bks And Rec | 0 | HedgeIdentifiedInBksAndRecInd |
| Gross Proceeds Invested In GIC | 0 | GrossProceedsInvestedInGICInd |
| Gross Proceeds Invested | 0 | GrossProceedsInvestedInd |
| Written Proc To Monitor Reqs | Yes (1) | WrittenProcToMonitorReqsInd |
Procedures Corrective Action ProceduresCorrectiveActionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Procedures Corrective Action | Yes (1) | ProceduresCorrectiveActionInd |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (6 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION B, LINE 11B | THE ORGANIZATION'S 990 IS REVIEWED BY THE CEO AND CFO. IT IS PRESENTED TO THE BOARD AS SOON AS THE REVIEWS ARE COMPLETE, AND PRIOR TO FILING WITH THE IRS. |
| FORM 990, PART VI, SECTION B, LINE 12C | THE BOARD OF DIRECTORS REVIEWS OF THE CONFLICT OF INTEREST POLICY ANNUALLY. THE CONFLICT OF INTEREST FORMS ARE SIGNED BY THE BOARD AT THIS TIME. WHEN A CONFLICT IS PRESENT, THE BOARD MEMBER WITH THE CONFLICT ABSTAINS FROM DISCUSSION AND VOTE. THIS IS DOCUMENTED IN BOARD MINUTES WHEN THE OCCASION ARISES. |
| FORM 990, PART VI, SECTION B, LINE 15 | THE CEO COMPARES EMPLOYEES' SALARIES AND WAGES WITH OTHER NEBRASKA HOSPITALS USING A SURVEY FROM THE NEBRASKA HOSPITAL ASSOCIATION. FOLLOWING COMPARISON STUDIES, HE RECOMMENDS A PERCENTAGE INCREASE TO THE BOARD. THE FINAL WAGE ADJUSTMENT IS DETERMINED BY THE BOARD OF DIRECTORS. THE CEO AND CFO WAGE SCALES ARE COMPARED TO AREA HOSPITALS AND THE NHA SURVEY RESULTS. THE BOARD DISCUSSES AND DETERMINES THE LEVEL OF COMPENSATION. THE PHYSICIAN PAY SCALES ARE COMPARED TO PUBLISHED NATIONAL STANDARDS. |
| FORM 990, PART VI, SECTION C, LINE 19 | OSMOND GENERAL HOSPITAL DOES NOT MAKE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, OR FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC. |
| FORM 990, PART IX, LINE 11G | PHYSICAL THERAPY FEES: PROGRAM SERVICE EXPENSES 109,249. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 109,249. OTHER FEES FOR SERVICES: PROGRAM SERVICE EXPENSES 1,214,531. MANAGEMENT AND GENERAL EXPENSES 155,874. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,370,405. ANESTHESIA: PROGRAM SERVICE EXPENSES 67,272. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 67,272. PHARMACY SERVICES: PROGRAM SERVICE EXPENSES 57,692. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 57,692. LAB FEES: PROGRAM SERVICE EXPENSES 29,527. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 29,527. EMERGENCY ROOM PHYSICIANS FEES: PROGRAM SERVICE EXPENSES 333,333. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 333,333. |
| FORM 990, PART XII, LINE 2C: | THE FINANCE COMMITTEE IS COMPRISED OF THE TREASURER OF THE BOARD OF DIRECTORS AND AT LEAST THREE OTHER DIRECTORS. THE JOB OF THE FINANCE COMMITTEE IS TO SUPERVISE ALL CURRENT AND FUTURE FINANCES OF THE CORPORATION, INCLUDING THE REVIEW OF THE AUDITED FINANCIAL STATEMENTS AND SELECTION OF THE INDEPENDENT ACCOUNTANT. THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. |