2022-08-15T10:58:19-05:00 2021-09-30 460403496 CASEY PETERSON LTD 909 ST JOSEPH ST STE 101 RAPID CITY SD 57701 990 2020-10-01 470482234 CHADRON COMMUNITY HOSPITAL CORPORATION CHAD 3084320286 825 CENTENNIAL DRIVE CHADRON NE 69337 NATHAN HOUGH CEO 3084320286 2022-08-12 1 NATHAN HOUGH 999009999 KAYLA GIESEY CPA P01874520 6053481930 2022-08-15 3 AAL1 IAL1 2020 2022-09-23 18:48:47Z CHADRON COMMUNITY HOSPITAL AND HEALTH SERVICES NATHAN HOUGH 825 CENTENNIAL DRIVE CHADRON NE 69337 36360540 0 X HTTPS://WWW.CHADRONHOSPITAL.COM/ X 1957 NE TO PROVIDE AND SUPPORT HEALTH CARE AND COMMUNITY SERVICE PROGRAMS OF EXCELLENCE IN THE COMMUNITIES WE SERVE. 12 11 295 35 0 0 1214482 7919178 26037907 28253993 20490 -224680 215434 161210 27488313 36109701 49278 49700 0 0 12275150 13083604 0 0 17081 14629926 15913134 26954354 29046438 533959 7063263 35177876 35212147 26301598 19272606 8876278 15939541 X TO PROVIDE AND SUPPORT HEALTH CARE AND COMMUNITY SERVICE PROGRAMS OF EXCELLENCE IN THE COMMUNITIES WE SERVE. 0 0 26645992 49700 28415203 CHADRON COMMUNITY HOSPITAL CORPORATION OFFERS ACCESS TO CARE. INDIVIDUALS SHALL BE ACCORDED IMPARTIAL ACCESS TO TREATMENT OR ACCOMMODATIONS THAT ARE AVAILABLE, AND MEDICALLY INDICATED, REGARDLESS OF RACE, CREED, SEX, NATIONAL ORIGIN, HANDICAP, RELIGION, ABILITY TO PAY, OR SOURCES OF PAYMENT FOR CARE. DURING THE FISCAL YEAR CHADRON COMMUNITY HOSPITAL CORPORATION PROVIDED INPATIENT SERVICES AS FOLLOWS: PATIENT DAYS ADULT AND PEDIATRICS 1585 SWING BED - SKILLED 300 NURSERY 189 TOTAL 2074 CHADRON COMMUNITY HOSPITAL CORPORATION EMERGENCY ROOM TREATED 2699 PATIENTS AND 371 SURGICAL PROCEDURES WERE PERFORMED IN THE SURGERY AREA. IN ADDITION TO PROVIDING DIRECT INPATIENT AND OUTPATIENT SERVICES, CHADRON COMMUNITY HOSPITAL PROVIDED OUR COMMUNITY/COUNTY RESIDENTS ACCESS TO A VARIETY OF SPECIALISTS. THE FOLLOWING TYPES OF SPECIALTY CLINICS AND SERVICES WERE PROVIDED: CARDIOLOGY, ORTHOPEDICS, EAR, NOSE AND THROAT, UROLOGY, INTERNAL MEDICINE, DERMATOLOGY, ONCOLOGY, VASCULAR, OPHTHALMOLOGY, AND PODIATRY. THE FOLLOWING COMMUNITY SERVICES WERE PROVIDED AT A MINIMAL OR NO COST BASIS: 1. REGISTERED NURSE SUPPORT WAS PROVIDED TO OUR AREA FIRE AND RESCUE VOLUNTEERS AND LOCAL LAW ENFORCEMENT OFFICERS AND TEACHERS TO ADMINISTER VACCINATIONS.2. OUR HOME HEALTH PROFESSIONALS PROVIDE PRO TIME TESTING TO VETERANS, FREE OF CHARGE.3. WE PROVIDED FREE DIETARY COUNSELING SERVICES AND EDUCATION FOR DIABETIC AND LOW INCOME FAMILIES.4. MAMMOGRAPHY SERVICES ARE OFFERED TO WOMEN AT A GREATLY REDUCED PRICE, THROUGH THE EVERY WOMAN MATTERS PROGRAM.5. MEETING ROOMS ARE PROVIDED FREE OF CHARGE TO ALL OUTSIDE SERVICE ORGANIZATIONS WHO ARE PROMOTING GOOD HEALTH.6. WE PROVIDE HEALTH CARE PROFESSIONALS TO SPEAK AT VARIOUS ORGANIZATIONS/MEETING TO HELP EDUCATE AND PROMOTE HEALTH CARE CONCERNS AND ISSUES, FREE OF CHARGE. 7. COMMUNITY PRENATAL/MATERNITY CLASSES ARE PROVIDED AT NO COST TO ENSURE AVAILABILITY TO THESE SERVICES FOR THOSE WHO CANNOT AFFORD THE CLASS. PROFESSIONAL STAFF ARE PAID THEIR REGULAR SALARY FOR THESE SERVICES.8. CHADRON COMMUNITY HOSPITAL PROVIDES RECRUITMENT ASSISTANCE TO THE LOCAL COMMUNITY IN EFFORTS TO ATTRACT AND RETAIN NEEDED PRIMARY/FAMILY PRACTICE PHYSICIANS.9. STAFF HAS CONDUCTED NUMEROUS EDUCATIONAL PROGRAMS FOR THE SENIOR CITIZEN CENTER AND VARIOUS SERVICE ORGANIZATIONS INFORMING THEM OF THE ADVANCED DIRECTIVE PROGRAM AND THE VARIOUS PROPOSED HEALTH CARE BILLS.10. ADMINISTRATION HAS PROVIDED THE LOCAL/COUNTY RESIDENTS WITH NUMEROUS PUBLICATIONS PRINTED IN THE LOCAL NEWSPAPERS DEALING WITH ALL ASPECTS OF HEALTH CARE, TO INCLUDE THE RIGHTS AFFORDED TO ALL MEDICARE RECIPIENTS.11. A FOOD PANTRY IS OFFERED TO AREA RESIDENTS THAT HAVE UNIQUE CIRCUMSTANCES AND ARE NOT ELIGIBLE FOR OTHER FOOD ASSISTANCE.12. HOSPITAL STAFF VOLUNTEERS AT THE LOCAL SOUP KITCHEN "CLOSER TO HOME" ON A MONTHLY BASIS.13. OCCUPATIONAL THERAPY STAFF HAS ORGANIZED A BRAIN INJURY SUPPORT GROUP.14. THE HOSPITAL PURCHASED AN AED DEVICE AND PROVIDED TRAINING FOR THE COMMUNITY WELLNESS CENTER.15. THE HOSPITAL CONTRIBUTED TO THE FUNDING FOR THE COMMUNITY WELLNESS CENTER PROJECT.16. THE HOSPICE PROGRAM OFFERS REMEMBRANCE CEREMONIES TO ASSIST COMMUNITY MEMBERS IN DEALING WITH GRIEF.17. THE HOSPITAL PROVIDES ASSISTANCE TO AREA CANCER PATIENTS FOR MEDICAL EXPENSES THROUGH A PROGRAM CALLED "CIRCLE OF LIGHT".18. THE HOSPITAL DISTRIBUTES SAFETY INFORMATION TO AREA RESIDENTS VIA THE SCHOOLS AND LOCAL BUSINESSES.19. THE HOSPITAL PROVIDED COMMUNITY ACCESS TO FREE COVID TESTING, BEGINNING IN THE SUMMER OF 2020 AND PROVIDES ACCESS TO COVID VACCINATIONS AND TEST KITS THROUGH FEDERAL PROGRAMS. 26645992 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 1 1 0 1 1 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 1 52 0 1 295 1 0 0 0 0 0 0 0 0 0 0 0 0 X 12 11 0 1 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 0 0 0 X THE ORGANIZATION 3084320286 825 CENTENNIAL DRIVE CHADRON NE 69337 X DAVID KAY PRESIDENT 2.00 X X 0 0 0 CURT PLOOSTER 1ST VICE PRESIDENT 2.00 X X 0 0 0 LARRY JOHNSON 2ND VICE PRESIDENT 2.00 X X 0 0 0 ROB BILA SECRETARY/TREASURER 2.00 X X 0 0 0 KERRY BAILEY PAST PRESIDENT 2.00 X X 0 0 0 LEEANN FERLEY MEMBER 2.00 X 0 0 0 RUTH HAMAKER MEMBER 2.00 X 0 0 0 MARY HANSEN MEMBER 2.00 X 0 0 0 LOIS BARTLETT MEMBER 2.00 X 0 0 0 JAMES NERUD MEMBER 2.00 X 0 0 0 MIKE PROVANCE MEMBER 2.00 X 0 0 0 LYNN WEBSTER MEMBER 2.00 X 0 0 0 SHELLEY GRAVES PHARMACY DIRECTOR 40.00 X 155774 0 16606 LISA MILBURN PHARMACIST 40.00 X 128323 0 15998 KEITH BLAYLOCK REHAB DIRECTOR 40.00 X 125664 0 13958 LEAH FRYE PHARMACIST 40.00 X 133178 0 4933 BRENDA JOHNSON NURSE PRACTITIONER 40.00 X 123337 0 5486 666276 0 56981 10 0 1 0 CHADRON MEDICAL CLINIC PO BOX 431 CHADRON NE 69337 PROVIDER SERVICES 727594 REGIONAL WEST 4021 AVE B SCOTTSBLUFF NE 69361 HEALTHCARE AND MANAGEMENT SERVICES 628857 FOCUSONE SOLUTIONS LLC 13609 CALIFORNIA ST OMAHA NE 68154 LOCUM TENENS 562816 RURAL PARTNERS IN MEDICINE LLC PO BOX 772519 BROOMFIELD CO 80021 PROVIDER SERVICES 480424 PSYCHIATRIC MEDICAL CARE LLC PO BOX 734606 DALLAS TX 75373 PROVIDER SERVICES; CONTRACT STAFFING 421182 7 6695625 1223553 554230 7919178 PATIENT SERVICE REVENUE 621110 26202518 26202518 INDEPENDENT/ASSISTED LIVING APART 623990 1380604 1380604 WCHR PATIENT REVENUES 621400 584342 584342 CAFETERIA SALES 722514 83037 83037 OTHER OPERATING REVENUES 900099 3492 3492 28253993 26159 26159 161063 0 161063 161063 161063 250839 -250839 -250839 -250839 MISCELLANEOUS REVENUE 900099 147 147 147 36109701 28415203 0 -224680 X 49700 49700 10398933 9826158 561909 10866 207879 196429 11450 1881062 1470405 410657 595730 564778 30952 557027 557027 50383 50383 34063 34063 4768680 4594789 173471 420 102255 67207 34649 399 247941 69021 178186 734 218003 178342 39661 613592 538362 75036 194 44186 40147 3902 137 52917 47987 4798 132 578735 554968 23767 1777326 1696268 80714 344 271762 261084 10678 MEDICAL SUPPLIES 3786657 3752544 30459 3654 BAD DEBT EXPENSE 1162143 1162143 REPAIRS AND MAINTENANCE 613904 600293 13573 38 EQUIPMENT RENTAL 495966 475859 20107 537594 499508 37923 163 29046438 26645992 2383365 17081 13909792 13973206 1230865 1840533 4953574 4720351 25684 9795 477498 501919 251305 267623 42434299 28535579 14329158 13898720 35177876 35212147 2335571 2886649 4235178 153787 13639306 12802580 1738435 0 4353108 3429590 26301598 19272606 X 8605173 15674211 271105 265330 8876278 15939541 35177876 35212147 7063263 0 X 0 1 X 0 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 202752 202752 32062292 21841461 10220831 105382 82202 23180 9307922 6611916 2696006 755951 755951 13898720 MEDICARE ADVANCED AND ACCELERATED PAYMENTS LIABILITY 3339670 SECURITY DEPOSITS - INDEPENDENT LIVING 89920 3429590 X 35015337 67779 -1162143 -1094364 36109701 0 36109701 27952074 67779 67779 27884295 1162143 1162143 29046438 PART X, LINE 2: THE HOSPITAL IS A NOT-FOR-PROFIT CORPORATION AND HAS BEEN RECOGNIZED AS TAX EXEMPT PURSUANT TO SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND IS NOT A PRIVATE FOUNDATION. THE HOSPITAL IS NOT LIABLE FOR INCOME TAXES IF IT OPERATES WITHIN THE CONFINES OF ITS EXEMPT STATUS, THOUGH THE HOSPITAL MAY BE RESPONSIBLE FOR TAXES ON UNRELATED BUSINESS ACTIVITIES. IN THE EVENT OF AN EXAMINATION OF THE INCOME TAX RETURNS, THE TAX LIABILITY OF THE HOSPITAL COULD BE CHANGED IF TAXING AUTHORITIES MAKE ADJUSTMENTS TO THE TAX-EXEMPT PURPOSE OF THE HOSPITAL OR IF TAXING AUTHORITIES DETERMINE ACTIVITIES ARE SUBJECT TO UNRELATED BUSINESS INCOME. AS OF SEPTEMBER 30, 2021, THE HOSPITAL HAD NO UNCERTAIN TAX POSITIONS THAT QUALIFY FOR EITHER RECOGNITION OR DISCLOSURE IN THE FINANCIAL STATEMENTS. THE HOSPITAL'S INCOME TAX FILLINGS ARE SUBJECT TO AUDIT BY VARIOUS TAXING AUTHORITIES. THE HOSPITAL IS NO LONGER SUBJECT TO FEDERAL AND STATE INCOME TAX EXAMINATIONS BY TAXING AUTHORITIES FOR YEARS BEFORE 2017. MANAGEMENT CONTINUALLY EVALUATES EXPIRING STATUTES OF LIMITATION, AUDITS, PROPOSED SETTLEMENTS, CHANGES IN TAX LAW, AND NEW AUTHORITATIVE RULINGS. THE HOSPITAL BELIEVES THEIR ESTIMATES ARE APPROPRIATE BASED ON CURRENT FACTS AND CIRCUMSTANCES. INTEREST AND PENALTIES ASSESSED BY INCOME TAXING AUTHORITIES, IF ANY, ARE INCLUDED IN INTEREST EXPENSE. PART XI, LINE 2D - OTHER ADJUSTMENTS: BAD DEBT EXPENSE -1,162,143. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE 1,162,143. SCHEDULE D, PARTS XI AND XII AT THE TIME OF FILING THE FORM 990, THE AUDIT OF CHADRON COMMUNITY HOSPITAL CORPORATION SERVICES FOR THE YEAR ENDED SEPTEMBER 30, 2021 WAS IN PROGRESS. THE RECONCILIATION OF REVENUE AND EXPENSES PER THE AUDITED FINANCIAL STATEMENTS TO THE RETURN WAS COMPLETED USING AMOUNTS FROM THE DRAFT FISCAL YEAR 2021 FINANCIAL STATEMENTS. 1 1 X 1 X 1 X 1 1 1 0 0 71082 71082 0.00250 2273206 1739252 533954 0.01910 2344288 1739252 605036 0.02160 2344288 1739252 605036 0.02160 4 136293 158630 0 0.00000 1 7468 1164 6304 0.00020 5 1503449 1721518 0 0.00000 1 24266 0 24266 0.00090 11 1671476 1881312 30570 0.00110 1 1162143 147592 11196255 11299657 -103402 X 1 1 1 1 CHADRON COMMUNITY HOSPITAL 825 CENTENNIAL DRIVE CHADRON NE 69337 HTTPS://WWW.CHADRONHOSPITAL.COM/ X X X X CHADRON COMMUNITY HOSPITAL 1 0 0 1 X X X X X X X X X 19 1 1 1 1 X HTTPS://WWW.CHADRONHOSPITAL.COM X 1 19 1 HTTP://WWW.PPHD.ORG/PAGES/CHIP.HTML 0 1 X 100.000000000000 250.000000000000 X X 1 1 X X X 1 X HTTPS://WWW.CHADRONHOSPITAL.COM/PATIENT-INFORMATION/FINANCIAL-SERVICES.HTML X HTTPS://WWW.CHADRONHOSPITAL.COM/PATIENT-INFORMATION/FINANCIAL-SERVICES.HTML X HTTPS://WWW.CHADRONHOSPITAL.COM/PATIENT-INFORMATION/FINANCIAL-SERVICES.HTML X X X X X 1 X 0 X 1 X 0 0 CHADRON COMMUNITY HOSPITAL PART V, SECTION B, LINE 5: THE COMMUNITY HEALTH SURVEY WAS DISTRIBUTED TO PANHANDLE RESIDENTS IN OCTOBER AND NOVEMBER OF 2019 VIA PAPER AND ELECTRONIC SURVEY. PAPER COPIES OF THE SURVEY WERE DISTRIBUTED BY HOSPITALS AND COMMUNITY-BASED ORGANIZATIONS. THE ELECTRONIC COPY WAS ADMINISTERED USING QUALTRICS, AND SHARED ONLINE BY WEBSITE, SOCIAL MEDIA, AND EMAIL BY PANHANDLE PUBLIC HEALTH DISTRICT (PPHD), LOCAL HOSPITALS, AND OTHER COMMUNITY ORGANIZATIONS. COUNTS AND PERCENTAGES FROM THE SURVEY RESPONSES WERE CALCULATED USING MICROSOFT EXCEL. RESPONSES WERE RECEIVED FROM 139 PEOPLE WHO LIVE IN CHADRON OR SIOUX COUNTIES, OR RESIDE ELSEWHERE BUT INDICATE THEY RECEIVE THEIR HEALTHCARE FROM CHADRON COMMUNITY HOSPITAL.PPHD COLLABORATED WITH BOX BUTTE GENERAL HOSPITAL, CHADRON COMMUNITY HOSPITAL, GORDON MEMORIAL HOSPITAL, KIMBALL HEALTH SERVICES, MORRILL COUNTY COMMUNITY HOSPITAL, REGIONAL WEST GARDEN COUNTY, REGIONAL WEST MEDICAL CENTER, AND SIDNEY REGIONAL MEDICAL CENTER TO HOLD A SERIES OF FOCUS GROUPS ACROSS THE PANHANDLE REGION. THE PURPOSE OF THE FOCUS GROUP WAS TO GATHER INPUT FROM COMMUNITY MEMBERS IN ORDER TO DEVELOP A BETTER UNDERSTANDING OF THE ISSUES THEY FEEL ARE IMPORTANT, THEIR CONCERNS, AND THEIR OVERALL PERCEPTION OF THEIR COMMUNITY. FOCUS GROUPS WERE LARGELY CONDUCTED IN SPRING OF THE YEAR 2020. BECAUSE OF THE COVID-19 PANDEMIC, A HANDFUL OF FOCUS GROUPS WERE COMPLETED VIA OPEN-ENDED SURVEY RATHER THAN IN PERSON.IN ADDITION, COMMUNITY MEMBERS SERVE ON THE HOSPITAL BOARD OF DIRECTORS. CHADRON COMMUNITY HOSPITAL PART V, SECTION B, LINE 6A: BOX BUTTE GENERAL HOSPITALGORDON MEMORIAL HOSPITALMORRILL COUNTY COMMUNITY HOSPITALPERKINS COUNTY HEALTH SERVICESREGIONAL WEST GARDEN COUNTYREGIONAL WEST MEDICAL CENTERSIDNEY REGIONAL MEDICAL CENTER CHADRON COMMUNITY HOSPITAL PART V, SECTION B, LINE 6B: RURAL NEBRASKA HEALTHCARE NETWORKSCOTTS BLUFF COUNTY HEALTH DEPARTMENTKIMBALL HEALTH SERVICESPANHANDLE PARTNERSHIPPANHANDLE AREA DEVELOPMENT DISTRICTNEBRASKA DEPARTMENT OF HEALTH AND HUMAN SERVICES CHADRON COMMUNITY HOSPITAL PART V, SECTION B, LINE 11: THE SIGNIFICANT NEEDS IDENTIFIED WERE REDUCING THE RATE OF EMERGENCY DEPARTMENT VISITS DUE TO FALLS AMONG OLDER ADULTS, INCREASING THE PROPORTION OF PEOPLE WHO DISCUSS INTERVENTIONS TO PREVENT CANCER WITH THEIR PROVIDERS, REDUCING THE PERCENT OF PEOPLE WHO HAVE EVER BEEN TOLD THEY HAVE HIGH BLOOD PRESSURE, INCREASING THE PROPORTION OF PERSONS WITH CO-OCCURRING SUBSTANCE USE DISORDERS AND MENTAL HEALTH DISORDERS WHO RECEIVE TREATMENT FOR BOTH DISORDERS, REDUCING FATAL AND NON-FATAL CHILD ABUSE AND NEGLECT, AND REDUCING THE ANNUAL NUMBER OF NEW CASES OF DIAGNOSED DIABETES IN THE POPULATION. THE HOSPITAL PLANS TO ADDRESS THESE NEEDS BY PROVIDING CHRONIC CARE MANAGEMENT WITH PATIENTS IN NEED, INCREASING REFERRALS TO FREE FECAL OCCULT BLOOD TESTS, PROMOTING PRESCRIPTION ASSISTANCE PROGRAMS TO PATIENTS WITH HYPERTENSION, DEVELOPING A NEW PHARMACOGENOMICS (PGX) MENTAL HEALTH SERVICE OPTION TO PATIENTS, MAINTAINING CIRCLE OF SECURITY CLASSES, MAINTAINING THE FAST PROGRAM IN THE COMMUNITY AND SCHOOLS, AND PROVIDING THE OPPORTUNITY FOR ALL CHADRON COMMUNITY HOSPITAL EMPLOYEES AND TO COMPLETE A HEALTH EVALUATION AND BIOMETRIC SCREENING. 3 1 - PRAIRIE PINES LODGE 900 W 7TH ST CHADRON NE 69337 ASSISTED LIVING 2 - LEGEND BUTTES HEALTH SERVICES 11 PADDOCK ST CRAWFORD NE 69339 CLINIC SERVICES 3 - WESTERN COMMUNITY HEALTH SERVICES 300 SHELTON ST CHADRON NE 69337 COMMUNITY HEALTH SERVICES PART I, LN 7 COL(F): THE HOSPITAL PROVIDES FOR AN ALLOWANCE FOR DOUBTFUL ACCOUNTS BASED ON A REVIEW OF EXISTING RECEIVABLES, HISTORICAL COLLECTION INFORMATION, AND EXISTING ECONOMIC CONDITIONS. DELINQUENT RECEIVABLES ARE WRITTEN OFF BASED ON INDIVIDUAL CREDIT EVALUATION AND SPECIFIC CIRCUMSTANCES OF THE PATIENT AND OTHER THIRD-PARTY PAYORS. BAD DEBT RECOVERIES ARE CHARGED AGAINST THE ALLOWANCE AS REALIZED. PART II, COMMUNITY BUILDING ACTIVITIES: THE HOSPITAL PARTICIPATES IN SEVERAL COMMUNITY BUILDING ACTIVITES, INCLUDING PARTICIPATING IN AND PROMOTING EMPLOYEE WELLNESS INITIATIVES, ADVANCED DIRECTIVE EDUCATION FOR THE COMMUNITY, PROVIDING INFLUENZA VACCINATIONS TO FIRST RESPONDERS AND EDUCATORS, FREE IN-HOME WELL BABY CHECKS TO LOW INCOME PATIENTS, FREE DIETARY COUNSELING AND DIABETIC EDUCATION, LOW-COST MAMMOGRAPHY TO QUALIFYING PATIENTS, FREE COMMUNITY PRENATAL CLASSES, SUPPORT GROUPS RUN BY HOSPITAL PROFESSIONALS, AND FINANCIAL ASSISTANCE TO AREA CANCER PATIENTS. PART III, LINE 2: THE HOSPITAL PROVIDES FOR AN ALLOWANCE FOR DOUBTFUL ACCOUNTS BASED ON A REVIEW OF EXISTING RECEIVABLES, HISTORICAL COLLECTION INFORMATION, AND EXISTING ECONOMIC CONDITIONS. DELINQUENT RECEIVABLES ARE WRITTEN OFF BASED ON INDIVIDUAL CREDIT EVALUATION AND SPECIFIC CIRCUMSTANCES OF THE PATIENT AND OTHER THIRD-PARTY PAYORS. BAD DEBT RECOVERIES ARE CHARGED AGAINST THE ALLOWANCE AS REALIZED. PART III, LINE 9B: THE HOSPITAL PROVIDES CARE TO PATIENTS WHO LACK FINANCIAL RESOURCES AND ARE DEEMED TO BE MEDICALLY INDIGENT BASED ON CRITERIA ESTABLISHED UNDER THE HOSPITAL'S CHARITY CARE POLICY. THIS CARE IS PROVIDED WITHOUT CHARGE OR AT AMOUNTS LESS THAN ITS ESTABLISHED RATES. BECAUSE THE HOSPITAL DOES NOT PURSUE COLLECTION OF AMOUNTS DETERMINED TO QUALIFY AS CHARITY CARE, SUCH AMOUNTS ARE NOT REPORTED AS REVENUE. THE HOSPITAL MAINTAINS RECORDS TO IDENTIFY AND MONITOR THE LEVEL OF CHARITY CARE PROVIDED. THESE RECORDS INCLUDE THE AMOUNT OF CHARGES FORGONE FOR SERVICES AND SUPPLIES FURNISHED UNDER ITS CHARITY CARE POLICY. THE CHARGES RELATED TO THIS CARE TOTALED $290,520 AND $268,854 IN FISCAL YEARS 2021 AND 2020, RESPECTIVELY. IN ADDITION, THE HOSPITAL PROVIDES SERVICES TO OTHER MEDICALLY INDIGENT PATIENTS UNDER VARIOUS STATE MEDICAID PROGRAMS. SUCH PROGRAMS PAY AMOUNTS THAT ARE LESS THAN THE COST OF THE SERVICES PROVIDED TO THE RECIPIENTS. PART VI, LINE 2: OUR ORGANIZATION MONITORS PATIENT TRENDS IN ORDER TO ADDRESS ADDITIONAL NEEDS NOT IDENTIFIED IN THE CHNA. FOR EXAMPLE, DURING THE PANDEMIC THE NEED FOR ACCESS TO FREE TESTING WAS IDENTIFIED AND WE WERE ONE OF THE FIRST HOSPITALS IN THE PANHANDLE TO PARTNER WITH TESTNEBRASKA TO PROVIDE FREE COVID TESTING OPPORTUNITIES IN OUR COMMUNITY. IN ADDITION, OUR ADMINISTRATIVE TEAM COMMUNICATES DIRECTLY WITH THE SCHOOL SYSTEMS, CHADRON STATE COLLEGE, AND THE CITY OF CHADRON IN EFFORT TO IDENTIFY HEALTHCARE NEEDS OUTSIDE OF THE CHNA. ANOTHER EXAMPLE OF OUR RESPONSE TO THIS IS PROVIDING FREE FLU SHOTS TO TEACHERS AND FIRST RESPONDERS. FOR THE LAST SEVERAL YEARS, OUR EMPLOYEES HAVE WENT ONSITE TO THESE ORGANIZATIONS TO PROVIDE FLU SHOTS. WE BELIEVE THAT BY BRINGING THE IMMUNIZATION TO THE SCHOOL AND TO THE FIRE STATIONS FOR EXAMPLE, GREATER PARTICIPATION IS ACHIEVED. PART VI, LINE 3: THE HOSPITAL NOTIFIES PATIENTS OF THE FINANCIAL ASSISTANCE POLICY (FAP) IN MULTIPLE WAYS: SIGNS POSTED THROUGHOUT THE HOSPITAL, DISTRIBUTING A PLAIN LANGUAGE SUMMARY BEFORE DISCHARGE, INCLUDING A PLAIN LANGUAGE SUMMARY OF THE POLICY WITH EACH BILL, POSTING THE POLICY ON THE HOSPITAL WEBSITE, AND COMMUNICATING THE FAP VERBALLY TO PATIENTS. PART VI, LINE 4: CHADRON COMMUNITY HOSPITAL SERVES THE NORTHWEST CORNER OF NEBRASKA, INCLUDING THE COUNTIES OF DAWES, SIOUX, AND SHERIDAN, AND THE COMMUNITIES OF HARRISON, CRAWFORD, CHADRON, HAY SPRINGS, AND RUSHVILLE. IN ADDITION, DUE TO THE FARMING AND RANCHING ECONOMY, THE HOSPITAL SERVES A GREAT DEAL OF RURAL RESIDENTS. PART VI, LINE 5: THE COMMUNITY IS DESIGNATED AS A SHORTAGE AREA FOR FAMILY PRACTICE PROVIDERS, SO THE HOSPITAL OFFERS RECRUITMENT ASSISTANCE IN EFFORT TO ATTRACT AND RETAIN NEEDED FAMILY PRACTICE PHYSICIANS. THE HOSPITAL HAS ALSO MADE SIGNIFICANT CONTRIBUTIONS TO COMMUNITY PROJECTS SUCH AS A COMMUNITY WELLNESS CENTER. IN ADDITION TO CONTRIBUTING FUNDS FOR THE CONSTRUCTION, THE HOSPITAL PURCHASED AN AED FOR THE FACILITY AND PROVIDED THE APPROPRIATE TRAINING TO THE COMMUNITY WELLNESS CENTER STAFF. 1 CASH GRANTS TO CANCER PATIENTS 20 49700 PART I, LINE 2: THE HOSPITAL MAINTAINS DETAILED RECORDS TO SUBSTANTIATE THE AMOUNT OF AWARDS TO GRANTEES. A FORMAL APPLICATION IS COMPLETED BY POTENTIAL GRANTEES AND SUBMITTED TO THE HOSPITAL. APPLICATIONS ARE REVIEWED AND GRANTS ARE AWARDED BASED ON ELIGIBILITY AND FINANCIAL NEED. 1 0 0 0 0 0 0 0 0 0 SHELLEY GRAVES PHARMACY DIRECTOR 155774 0 0 0 0 0 5021 0 11585 0 172380 0 0 0 CULLIGAN WATER CONDITIONING OF CHADRON NE INTERESTED PERSON IS OWNED BY 1ST VICE PRESIDENT OF BOARD (CURT PLOOSTER) 132975 PURCHASE OF REVERSE OSMOSIS EQUIPMENT FOR DIALYSIS DEPARTMENT. THE INTERESTED PARTY ABSTAINED FROM ANY BOARD VOTE RELATED TO THE PURCHASE. 0 X 1 554230 FMV ON DONATION DATE 0 0 0 PART I, COLUMN (B): SECURITIES WERE RECEIVED FROM ONE DONOR IN FY 2021 FORM 990, PART IV, LINE 20B AT THE TIME OF FILING THE FORM 990, THE AUDIT OF CHADRON COMMUNITY HOSPITAL CORPORATION SERVICES'S FINANCIAL STATEMENTS FOR THE YEAR ENDED SEPTEMBER 30, 2021 WAS IN PROGRESS. AS A RESULT, THE FISCAL YEAR 2021 AUDITED FINANCIAL STATEMENTS ARE NOT AVAILABLE; INSTEAD THE FISCAL YEAR 2020 AUDITED FINANCIAL STATEMENTS (THE MOST RECENT AUDITED FINANCIAL STATEMENTS) ARE ATTACHED. THE 2021 FINANCIAL STATEMENT AUDIT ALSO INCLUDES A SINGLE AUDIT OF FEDERAL FUND EXPENDITURES, WHICH IS ALSO IN PROGRESS AS OF THE DATE OF FILING. FORM 990, PART VI, SECTION A, LINE 3 THE HOSPITAL CEO AND CFO ARE EMPLOYED BY REGIONAL WEST MEDICAL CENTER, A HEALTHCARE ORGANIZATION PAID BY CHADRON COMMUNITY HOSPITAL CORPORATION FOR THEIR MANAGEMENT SERVICES. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS REVIEWED AND APPROVED BY THE CHIEF EXECUTIVE OFFICER AND CHIEF FINANCIAL OFFICER PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C BOARD MEMBERS COMPLETE CONFLICT OF INTEREST DISCLOSURES ANNUALLY. BOARD MEMBERS DECLARE ANY CONFLICTS OF INTEREST AT THE BEGINNING OF EACH BOARD MEETING. FORM 990, PART VI, SECTION C, LINE 18 THE ORGANIZATION MAKES THE FORM 1023 AND FORM 990 AVAILABLE UPON REQUEST. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART IX, LINE 11G PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 3,019,393. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,019,393. OTHER PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 1,575,396. MANAGEMENT AND GENERAL EXPENSES 173,471. FUNDRAISING EXPENSES 420. TOTAL EXPENSES 1,749,287.