2021-11-09T19:07:13-06:00 2020-12-31 470617373 COMMONSPIRIT HEALTH 198 INVERNESS DRIVE WEST ENGLEWOOD CO 80112 990 2020-01-01 470426285 MEMORIAL COMMUNITY HOSPITAL MEMO 4024262182 810 NORTH 22ND STREET BLAIR NE 68008 TIM SCHNACK CFO 4024262182 2021-11-09 1 TIM SCHNACK XXX-XX-XXXX ANGELA NOEL P01051055 3032989100 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z TIM SCHNACK 810 NORTH 22ND STREET BLAIR NE 68008 40390497 0 X WWW.MCHHS.ORG X 1956 NE AS AN ENGAGED TEAM OF PHYSICIANS, MEDICAL PROFESSIONALS, AND SUPPORT STAFF WE ARE COMMITTED TO DELIVERING STATE-OF-THE-ART HEALTH CARE TAILORED TO OUR UNIQUE COMMUNITY AND SECOND TO NONE IN THE AREA. 7 6 317 31 177 0 320359 391675 33611588 38626247 228933 352157 915658 1016780 35076538 40386859 98054 110386 0 0 18447461 19404964 0 0 0 15669446 17397812 34214961 36913162 861577 3473697 46354480 51670710 17088494 18573707 29265986 33097003 X AS A COMMUNITY HOSPITAL, MEMORIAL COMMUNITY HOSPITAL AND HEALTH SYSTEM OF BLAIR HAS STAYED COMMITTED TO KEEPING RESIDENTS OF WASHINGTON AND BURT COUNTY IN GOOD HEALTH. MEMORIAL COMMUNITY HOSPITAL HAS STRIVEN TO IMPROVE THE HEALTH STATUS OF RURAL NEBRASKA RESIDENTS THROUGH THE FOLLOWING SERVICES: 24-HOUR EMERGENCY CARE WITH HELIPORT ACCOMMODATIONS, LABOR AND DELIVERY AND CARDIOVASCULAR. CARDIOVASCULAR SERVICES INCLUDE THE FOLLOWING NON-INVASIVE DIAGNOSTICS STUDIES SUCH AS EKG, TELEMETRY MONITORING, TREADMILL STRESS TESTING, ECHO CARDIOGRAM, AND STRESS ECHO CARDIOGRAM. MEMORIAL COMMUNITY HOSPITAL AND HEALTH SYSTEM PROVIDES A VARIETY OF SPECIALTY CLINICS LOCATED IN BLAIR. ALLERGY/ASTHMA/IMMUNOLOGY, PAIN MANAGEMENT/ANESTHESIA, CARDIOLOGY, ENDOCRINOLOGY, ENT, GENERAL SURGERY, OB/GYN, NEPHROLOGY, NEUROLOGY, NEUROSURGERY, ONCOLOGY, ORTHOPEDICS, ORTHOTICS/PROSTHETICS, PLASTIC SURGERY, DERMATOLOGY, AND PODIATRY. 0 0 7886884 25377 8886448 MEMORIAL COMMUNITY HOSPITAL OF BLAIR PROVIDES HEALTH CLINICS FOR THE RESIDENTS OF BLAIR AND SURROUNDING COMMUNITIES WITH HEALTH CARE PROVIDERS IN A VARIETY OF MEDICAL SPECIALTIES. 1399782 12761 4468642 MEMORIAL COMMUNITY HOSPITAL OF BLAIR PROVIDES THE RESIDENTS OF BLAIR AND SURROUNDING COMMUNITIES WITH A VARIETY OF THERAPY SERVICES, INCLUDING PHYSICAL AND OCCUPATIONAL THERAPY, SPEECH THERAPY, SLEEP STUDIES, AND RESPIRATORY THERAPY. 2237805 12481 4370480 MEMORIAL COMMUNITY HOSPITAL OF BLAIR PROVIDES THE RESIDENTS OF BLAIR AND SURROUNDING COMMUNITIES 24 HOUR EMERGENCY ROOM SERVICES. 17718631 59767 20929458 17718631 59767 20929458 29243102 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 10 0 1 317 1 0 0 0 0 0 0 0 0 0 0 0 0 X 7 6 0 1 0 0 1 1 0 1 1 0 0 0 1 1 1 0 1 1 1 1 0 X TIM SCHNACK 4024262182 810 NORTH 22ND STREET BLAIR NE 68008 X SANDRA BAUMBERGER MD BOARD MEMBER 40.00 0.00 X 304786 0 37145 SARAH CHATT CHAIR 1.00 1.00 X X 0 0 0 ROSE LEAVITT VICE CHAIR 1.00 0.00 X X 0 0 0 NEIL SMITH SECRETARY 1.00 0.00 X X 0 0 0 KYLE ACRE TREASURER 1.00 0.00 X X 0 0 0 MARILYN RHOTEN BOARD MEMBER 1.00 0.00 X 0 0 0 GREGG DRABEK MD BOARD MEMBER 1.00 0.00 X 0 0 0 MANUELA BANNER-WOLF PRESIDENT & CEO 40.00 1.00 X 0 0 0 TIM SCHNACK CFO 40.00 1.00 X 0 0 0 CHARLES SMITH MD PHYSICIAN 40.00 0.00 X 357351 0 36831 MAURICE BIRDWELL MD PHYSICIAN 40.00 0.00 X 344834 0 36635 JEREMY LEE MD PHYSICIAN 40.00 0.00 X 334130 0 23620 PAULA THIELEN-KOCHAROV MD PHYSICIAN 40.00 0.00 X 326728 0 16339 ALISHA SCOTT MD PHYSICIAN 40.00 0.00 X 308218 0 15504 1976047 0 166074 33 0 1 1 CHI HEALTH 198 INVERNESS DRIVE WEST ENGLEWOOD CO 80112 MGMT FEES/HEALTH SVCS 1455336 SIGNATURE PERFORMANCE 10330 REGENCY PARKWAY DR 335 OMAHA NE 68114 BUSINESS OFFICE SERVICES 646803 RURAL PARTNERS IN MEDICINE 11880 AIRPORT WAY BROOMFIELD CO 80021 MEDICAL SERVICES 540446 PSYCHIATRIC MEDICAL CARE LLC 8 CADILLAC DRIVE 230 BRENTWOOD TN 37027 MEDICAL SERVICES 384426 CHI HEALTH LABORATORY 4955 F ST OMAHA NE 68117 LABORATORY SERVICES 305577 14 33218 290236 68221 391675 NET PATIENT REVENUE 621110 38626247 38626247 38626247 352157 177 351980 131528 3638 127890 127890 127890 PHARMACY 446110 757734 757734 DIETARY 621110 68774 68774 REBATES 900099 33601 33601 28781 28781 888890 40386859 38655028 177 1339979 110386 110386 15770727 13058503 2712224 404374 334830 69544 2194327 1816950 377377 1035536 840655 194881 548636 548636 12716 12716 23200 23200 5663 5663 1350773 850773 500000 125071 125071 42293 36152 6141 551891 551891 10149 3005 7144 26095 23462 2633 462297 462297 2929596 2914148 15448 194037 2961 191076 SUPPLIES 5951910 4833722 1118188 PURCHASED SERVICES 2998183 1500340 1497843 BAD DEBT 1179516 1179516 EQUIPMENT RENTAL AND MA 678776 489882 188894 307010 102895 204115 36913162 29243102 7670060 0 14149265 20257312 4162563 4956078 461152 459065 245345 315124 59786170 40696782 20969294 19089388 6198290 6241630 168571 352113 46354480 51670710 3769214 4012500 9884052 8830465 3435228 5730742 17088494 18573707 X 29265986 33097003 29265986 33097003 46354480 51670710 3473697 357320 0 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 5663 5663 0 PART II-B, LINE 1: THE PORTION OF ORGANIZATION DUES THAT ARE RELATED TO LOBBYING ARE AS FOLLOWS: AMERICAN HOSPITAL ASSOCIATION - $4,059 CATHOLIC HEALTH ASSOCIATION - $1,604 663787 663787 21882563 11426449 10456114 33474198 27045987 6428211 3765622 2224346 1541276 19089388 ESTIMATED THIRD-PARTY SETTLEMENTS 348812 INTEREST RATE SWAP LIABILITY 1141965 ADVANCED GRANTS - COVID-19 FUNDS 4239965 5730742 X PART X, LINE 2: IN ACCORDANCE WITH FASB INTERPRETATION NO 48, ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES, INCLUDED IN FASB ASC SUBTOPIC 740-10 - INCOME TAXES - THE HOSPITAL RECOGNIZES THE EFFECT OF INCOME TAX POSITIONS ONLY IF THOSE POSITIONS ARE MORE LIKELY THAN NOT OF BEING SUSTAINED. RECOGNIZED INCOME TAX POSITIONS ARE MEASURED AT THE LARGEST AMOUNT THIS IS GREATER THAN 50% LIKELY OF BEING REALIZED. CHANGES IN RECOGNITION OR MEASUREMENT ARE REFLECTED IN THE PERIOD IN WHICH THE CHANGE IN JUDGEMENT OCCURS. IN 2020 AND 2019, MANAGEMENT DETERMINED THAT THERE ARE NO INCOME TAX POSITIONS REQUIRING RECOGNITION IN THE CONSOLIDATED FINANCIAL STATEMENTS. 1 1 X 0 0 1 1 0 1 1 223 80310 80310 0.00220 2062490 1921203 141287 0.00400 223 2142800 1921203 221597 0.00620 9 1949 58274 58274 0.00160 7 159 67677 67677 0.00190 32 4258 52260 52260 0.00150 48 6366 178211 178211 0.00500 48 6589 2321011 1921203 399808 0.01120 8 190 5121 5121 0.00010 1 15 345 345 0.00000 1 11 932 932 0.00000 10 216 6398 6398 0.00010 1 1179516 0 12409685 12469414 -59729 X 1 1 1 1 MEMORIAL COMMUNITY HOSPITAL 810 NORTH 22ND STREET BLAIR NE 68008 WWW.MCHHS.ORG 790001 X X X X MEMORIAL COMMUNITY HOSPITAL 1 0 0 1 X X X X X X X X X 19 1 1 1 1 X HTTPS://MCHHS.ORG/CHIP-CHNA/ X HTTPS://WWW.THREERIVERSPUBLICHEALTH.ORG/ABOUT-US/CHA-AND-CHIP X 1 19 1 HTTPS://MCHHS.ORG/CHIP-CHNA/ 0 1 X X X 1 1 X X X 1 X MCHHS.ORG/WP-CONTENT/UPLOADS/2020/06/601.103-FINANCIAL-ASSISTANCE.PDF X HTTPS://MCHHS.ORG/WP-CONTENT/UPLOADS/2021/03/MCH-FINANCIAL-BROCHURE.PDF X HTTPS://MCHHS.ORG/WP-CONTENT/UPLOADS/2018/09/MCHHS_PLAIN_SPEAK.PDF X X X X 1 X 0 X X X X 1 X 0 0 MEMORIAL COMMUNITY HOSPITAL PART V, SECTION B, LINE 5: IN 2019, LEADERSHIP FROM MEMORIAL COMMUNITY HOSPITAL COLLABORATED WITH THE THREE RIVERS PUBLIC HEALTH DEPARTMENT (TRPHD) AND SCHMEECKLE RESEARCH GROUP TO CONDUCT A COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) FOR THE THREE RURAL COUNTIES SERVED BY THE TRPHD, WHICH INCLUDES WASHINGTON COUNTY, THE COUNTY IN WHICH MEMORIAL COMMUNITY HOSPITAL & HEALTH SYSTEM IS LOCATED. THE CHNA IS A FOLLOW-UP TO AND EXPANSION OF SIMILAR REPORTS CONDUCTED IN 2003, 2007, 2012, AND 2016. THE TRPHD HAS COMPLETED A CHNA AND DEVELOPED A COMMUNITY HEALTH IMPROVEMENT PLAN (CHIP) USING THE MOBILIZING FOR ACTION THROUGH PLANNING AND PARTNERSHIP (MAPP) PROCESS. MEMORIAL COMMUNITY HOSPITAL & HEALTH SYSTEM'S LEADERSHIP AND STAFF HAVE BEEN INVOLVED IN THE CHNA PLANNING PROCESS THROUGH SERVICE ON THE CHNA STEERING COMMITTEE AND PARTICIPATION IN THE MAPP PROCESS. A LARGE FOCUS GROUP COMPOSED OF DIVERSE MEMBERS OF THE COMMUNITY WAS AN IMPORTANT COMPONENT OF THE CHNA AND CHIP PLANNING PROCESS. MCH&HS LEADERS PARTICIPATED IN THE FORUM AND COMMUNITY DIALOGUE TO REVIEW THE CHNA AND IDENTIFY COMMUNITY HEALTH PRIORITIES, ASSETS AND GAPS IN WASHINGTON COUNTY. THE CHNA HAS ALSO BEEN SHARED WITH THE MEMORIAL COMMUNITY HOSPITAL & HEALTH SYSTEM BOARD OF DIRECTORS. THE MCH&HS CHNA IS LOCATED ON MCH&HS WEBSITE WWW.MCHHS.ORG AND THE FULL REPORT IS LOCATED AT WWW.THREERIVERSPUBLICHEALTH.ORG. MEMORIAL COMMUNITY HOSPITAL & HEALTH SYSTEM LEADERSHIP USED THIS CHNA DURING ITS ANNUAL STRATEGIC AND BUDGETING AND PROVIDED A MEMORIAL COMMUNITY HOSPITAL & HEALTH SYSTEM IMPLEMENTATION PLAN TO ADDRESS THE PRIORITIZED HEALTH NEEDS. MEMORIAL COMMUNITY HOSPITAL PART V, SECTION B, LINE 6A: FREMONT AREA MEDICAL CENTER & SAUNDERS COUNTY COMMUNITY HOSPITAL MEMORIAL COMMUNITY HOSPITAL PART V, SECTION B, LINE 6B: THREE RIVERS HEALTH DEPARTMENT MEMORIAL COMMUNITY HOSPITAL PART V, SECTION B, LINE 11: 2020 WAS THE SECOND YEAR IN THE CURRENT, THREE-YEAR COMMUNITY HEALTH IMPROVEMENT PLAN FOR MEMORIAL COMMUNITY HOSPITAL AND HEALTH SYSTEM (MCH). THE 2019 CHIP IDENTIFIED THREE MAIN PRIORITIES. FIRST, ACCESS TO AFFORDABLE, ACCEPTABLE, QUALITY HEALTH CARE (INCLUSIVE OF MENTAL HEALTH SERVICES), SECOND, RISKY BEHAVIORS, AND THIRD, PREVENTION AND SCREENING. THE FOLLOWING PARAGRAPHS WILL EXPLAIN THE GOALS AND STRATEGIES UNDER EACH PRIORITY LEVEL. IT IS IMPORTANT TO NOTE, COVID-19 CHANGED, STALLED, OR ELIMINATED SOME OF THE GOALS DUE TO CHANGING PRIORITIES. WHILE THE GOALS HAD TO CHANGE TO REACT TO THE PANDEMIC, MCH REMAINED COMMITTED TO PROVIDING HEALTHCARE SERVICES AND COVID RELATED TREATMENT, VACCINATION AND PREVENTION. THIS WAS A TALL ORDER BUT MCH REMAINED COMMITTED TO PROVIDING QUALITY AND ACCESSIBLE HEALTH CARE AMIDST A PANDEMIC.ACCESS TO AFFORDABLE, ACCEPTABLE, QUALITY HEALTH CARETHE FIRST PRIORITY IS ACCESS TO AFFORDABLE, ACCEPTABLE, QUALITY HEALTH CARE (INCLUSIVE OF MENTAL HEALTH SERVICES). FOUR GOALS WERE DETERMINED TO MEET THIS NEED. FIRST, INCREASING BEHAVIORAL HEALTH OFFERINGS IN THE MCH SERVICE AREA. UNDER THIS GOAL, THE HOSPITAL IMPLEMENTED SENIOR LIFE SOLUTIONS AND NOW HAS A STEADY STREAM OF PATIENTS UTILIZING THE PROGRAM. SECOND, MCH RESEARCHED AND EVALUATED A POSSIBLE SOLUTION FOR AN INTEGRATED MENTAL HEALTH PROGRAM IN THE MCH CLINICS BUT HAS EXTENDED THE GOAL AND ARE INSTEAD RESEARCHING A TELEHEALTH OPTION. THE THIRD PART, LEADING A JOINT INITIATIVE WITH THE LOCAL AREA HIGH SCHOOLS TO DISTRIBUTE MENTAL HEALTH INFORMATION, IS ONGOING. FINALLY, PARTNERING WITH THE THREE RIVERS PUBLIC HEALTH DEPARTMENT FOR A PUBLIC AWARENESS CAMPAIGN SURROUNDING MENTAL HEALTH LED TO THE CREATION OF A COMMUNITY WIDE MENTAL HEALTH FLYER WITH ALL THE AREA ORGANIZATIONS AND CONTACT INFORMATION. SOCIAL MEDIA POSTS FOR MCH ARE NOW A REGULAR MONTHLY OCCURRENCE FOCUSED ON MENTAL HEALTH. THE SECOND GOAL IS TO IMPROVE THE CONTINUITY OF CARE FOR RURAL HEALTH CARE PATIENTS. MCH CREATED A PROCESS TO IDENTIFY AND CLOSE PATIENT CARE GAP ISSUES WITH INSURANCE COMPANIES AND PROVIDE QUALITY, CARE COORDINATION OF ALL HOSPITALIZED PATIENTS. THERE WAS A SET BACK DUE TO COVID BUT MANY INSURANCE COMPANIES HAVE BEEN CONTACTED AND CARE GAP PROCESSES IMPROVED.THE THIRD GOAL IS TO IMPROVE AFFORDABILITY FOR PATIENTS WITHIN THE MCH SERVICE AREA. MCH CONTINUES TO EDUCATE PATIENTS ON THE BENEFITS OF THE MDSAVE PROGRAM AND IS SEEING THE UTILIZATION WITH MDSAVE RISE. MDSAVE ALSO OFFERS AFFORDABLE HEALTH SCREENINGS FOR PATIENTS. THE NEED FOR MEDICATION ASSISTANCE REMAINS AND MCH HELPS BY CONNECTING PATIENTS TO THE RIGHT RESOURCES. FINALLY, THE LAST GOAL, IS TO GENERATE ACCESSIBLE CARE AND APPROPRIATE CLINICAL STAFFING FOR THE CARE NEEDS OF OUR SERVICE AREA. MCH IS ALWAYS IDENTIFYING CURRENT EMPLOYEES TO DEVELOP INTO OPEN POSITIONS AND HAS PROMOTED VARIOUS EMPLOYEES INTO NEW ROLES THROUGHOUT THE YEAR. MCH ALSO ADDED TELEHOSPITALISTS, A NEW PRIMARY CARE PHYSICIAN, AND AN ORTHOPEDIC SURGEON DURING 2020, ASSURING APPROPRIATE LEVEL OF PRIMARY CARE PROVIDERS AND SUB-SPECIALTY PROVIDERS FOR THE NEEDS OF THE COMMUNITY. RISKY BEHAVIORSTHE SECOND INITIATIVE IS RISKY BEHAVIORS (INCLUDING CAUSES OF OBESITY). THE FIRST GOAL IS REDUCING VAPING RATES AMONG THE YOUTH IN OUR COMMUNITY. MCH'S INITIATIVE WAS PARTNERING WITH AREA HIGH SCHOOLS AND LOCAL LAW ENFORCEMENT TO EDUCATE THE YOUTH ABOUT THE RISKS OF VAPING, IMPLEMENTING A PUBLIC AWARENESS CAMPAIGN TO EDUCATE DIFFERENT TARGET AUDIENCES ABOUT VAPING, ACTIVELY ADVOCATING WITH STATE AND FEDERAL LEGISLATURE AROUND VAPING LAWS, AND ASSISTING PATIENTS TO STOP NICOTINE DEPENDENCY. UNFORTUNATELY, MOST INITIATIVES WHERE ORGANIZATIONS WERE PARTNERING TOGETHER, WERE PUT ON HOLD DURING 2020. MCH DISTRIBUTES A HEALTHCARE MAGAZINE FOCUSED ON TEENS, WHICH ALSO COVERS THE RISK OF VAPING, AND HAD STAFF ATTEND LEGISLATIVE EVENTS TO ACTIVELY ADVOCATE WITH STATE AND FEDERAL LEGISLATIVE LAWMAKERS. MEETINGS, SPEAKING EVENTS AND PUBLIC PROGRAMS AROUND SMOKING CESSATION WERE CANCELLED BUT WILL REMAIN IN THE PLAN FOR THE FUTURE.THE SECOND GOAL IS TO INCREASE AWARENESS OF DISTRACTED DRIVING. STRATEGIES INCLUDE, PARTNERING WITH AREA SCHOOLS TO EDUCATE STUDENTS AND PARENTS TO IMPLEMENT STRATEGIES TO LOWER THE TEXTING WHILE DRIVING RATES, AND IMPLEMENTING MARKETING STRATEGIES AROUND DRIVING SAFETY. ALL ACTIVITIES WITH THE SCHOOLS AND THREE RIVERS PUBLIC HEALTH DEPARTMENT WERE PUT ON HOLD DURING THE PANDEMIC HOWEVER SOCIAL MEDIA EDUCATION IS ONGOING.THE THIRD GOAL WAS TO REDUCE THE NUMBER OF INDIVIDUALS WHO ARE OBESE BY ADDRESSING RELATED HEALTH CONDITIONS THROUGH EXERCISE AND NUTRITION. MCH PLANNED TO ACCOMPLISH THIS GOAL BY PARTNERING WITH AREA SCHOOLS TO INTRODUCE A FUN, EASY EXERCISE ACTIVITY AND PURCHASE JUMP ROPES FOR ALL AREA SCHOOL CHILDREN, INCREASE PEDIATRIC NUTRITIONAL EDUCATION WITH YOUTH VISITS, SPONSOR AND PARTICIPATE IN AREA EVENTS FOCUSED ON HEALTH AND WELLNESS, AND FINALLY OFFER NUTRITIONAL COUNSELING TO PATIENTS AND COMMUNITY ORGANIZATIONS. MCH DID PARTNER WITH THE SCHOOLS AND MANY OTHER ORGANIZATIONS BY SPONSORING HEALTHY ACTIVITIES BUT DID NOT BUY JUMP ROPES DUE TO THE CLOSURE OF SCHOOL IN THE SPRING OF 2020. OUR PEDIATRICIAN CONTINUED HER NUTRITIONAL EDUCATION WITH ALL FAMILIES. GOALS NOT MET WILL BE GOING FORWARD.PREVENTION AND SCREENINGTHE FINAL INITIATIVE, PREVENTION AND SCREENING, WILL FOCUS ON TWO GOALS. ONE, INCREASE SCREENINGS FOR COMMON HEALTH ISSUES AND TWO, IMPLEMENTING CHRONIC CARE MANAGEMENT TO IMPROVE THE HEALTH OF ALL CITIZENS IN OUR SERVICE AREA. STRATEGIES OF GOAL NUMBER ONE INCLUDE INCREASING THE NUMBER OF DEPRESSION, SUICIDE, AND OTHER SCREENINGS IN CARDIO PULMONARY, THE CLINICS, ER, MED/SURG AND PEDIATRICS, AND EDUCATING THE PUBLIC ABOUT THE IMPORTANCE OF TIMELY SCREENINGS AND WHAT AGE AND FREQUENCY RECOMMENDATIONS ARE FOR SCREENINGS. THIS IS AN ONGOING PROCESS BY VARIOUS DEPARTMENTS AND THE MARKETING DEPARTMENT. NEWSPAPER ARTICLES AND SOCIAL MEDIA POSTS WERE PRIMARILY USED TO ACCOMPLISH THIS. THE LAST STRATEGY IS TO EDUCATE PATIENTS ABOUT PROGRAMS SUCH AS THE LIVING WELL- CHRONIC DISEASE SELF-MANAGEMENT PROGRAM, EVERY WOMAN MATTERS AND THE DIABETES PREVENTION PROGRAM AND PROVIDE THEM REFERRAL TOOLS AND METHODS. CHRONIC CARE MANAGEMENT IS UNDERWAY WITH DEDICATED STAFF. STRATEGIES OF THE SECOND GOAL INCLUDED HIRING AN ADDITIONAL POPULATION HEALTH NURSE AND DEVELOPING A PLAN TO PROVIDE CHRONIC CARE MANAGEMENT TO OUR COMMUNITY WHICH WAS COMPLETED. AND FINALLY, PARTNERING WITH THREE RIVERS PUBLIC HEALTH DEPARTMENT TO CREATE AWARENESS AROUND THE LIVING WELL-CHRONIC DISEASE MANAGEMENT PROGRAM. THIS GOAL WAS COMPLETED ON AN INTERNAL LEVEL DUE TO THE OVERWHELMING WORK LOAD THE HEALTH DEPARTMENT FACED IN 2020 FROM THE PANDEMIC. IN ADDITION, MCH PROVIDED MASS VACCINATION CLINICS IN ORDER TO ASSIST IN THE PREVENTION OF THE SPREAD OF COVID. THESE WERE OFFERED COMPLETELY FREE TO THE PUBLIC AND OFFERED AT VARIOUS TIMES TO MAKE THEM VERY ACCESSIBLE TO THE PUBLIC. WRAPPING UP THE 2019 CHIPWE ANTICIPATE NEXT YEAR AND THE SUBSEQUENT COMMUNITY HEALTH IMPROVEMENT PLAN TO PICK UP SOME OF THE OPPORTUNITY REMAINING UPON THE WRAP UP OF 2019. IN 2020, COVID-19 TOOK TIME, EFFORT, AND FUNDING AWAY FROM MANY OF THE GOALS AND INITIATIVES THAT WERE SLATED TO START. IN ADDITION, MANY ORGANIZATIONS MCH WAS PARTNERING WITH HAD THEIR PRIORITIES CHANGE AS WELL. MEMORIAL COMMUNITY HOSPITAL PART V, SECTION B, LINE 13B: THE AMOUNT OF FINANCIAL ASSISTANCE WRITE-OFF FOR MEMORIAL COMMUNITY HOSPITAL AND HEALTH SYSTEM IS BASED ON A FINANCIAL ASSISTANCE SLIDING FEE SCHEDULE UTILIZING A DERIVATIVE OF THE CURRENT US DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT (HUD) VERY LOW INCOME GUIDELINES, WHICH ARE UPDATED ANNUALLY. FINANCIAL ASSISTANCE MAY ALSO BE GRANTED IN CERTAIN CIRCUMSTANCES INVOLVING A CATASTROPHIC OCCURRENCE RESULTING IN MEDICAL BILLS GROSSLY EXCEEDING THE PATIENT'S ABILITY TO PAY AND IN THESE SITUATIONS, THE PATIENT'S RESPONSIBILITY WILL BE LIMITED TO 30% OF THE FAMILY'S GROSS ANNUAL INCOME. 3 1 - BLAIR CLINIC 812 NORTH 22ND STREET BLAIR NE 68008 PRIMARY CARE CLINIC 2 - FORT CALHOUN CLINIC 4929 COUNTY ROAD P-43 FORT CALHOUN NE 68023 PRIMARY CARE CLINIC 3 - COTTONWOOD CLINIC 3519 HIGHWAY 32 TEKAMAH NE 68061 PRIMARY CARE CLINIC PART I, LINE 3C: THE AMOUNT OF FINANCIAL ASSISTANCE WRITE-OFF FOR MEMORIAL COMMUNITY HOSPITAL AND HEALTH SYSTEM IS BASED ON A FINANCIAL ASSISTANCE SLIDING FEE SCHEDULE UTILIZING A DERIVATIVE OF THE CURRENT US DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT (HUD) VERY LOW INCOME GUIDELINES, WHICH ARE UPDATED ANNUALLY. DESIGNEES OF MCH HELP PATIENTS SEEK REIMBURSEMENT FROM LOCAL, STATE, AND FEDERAL PROGRAMS AT NO CHARGE TO THE PATIENT WHEN THERE IS NO OTHER SOURCE OF PAYMENT. AFTER THESE EFFORTS/RESOURCES HAVE BEEN EXHAUSTED, PATIENTS ARE ASSISTED IN THE APPLICATION PROCESS FOR FINANCIAL ASSISTANCE. THE APPLICATION PROCESS INCLUDES COMPLETING A PERSONAL FINANCIAL APPLICATION AND PROVIDING VERIFICATION DOCUMENTS. THESE VERIFICATION DOCUMENTS MAY INCLUDE, BUT ARE NOT LIMITED TO, RECEIVING A COPY OF THE APPLICANT'S FEDERAL TAX RETURN, PAY STUB, BANK STATEMENTS, A CALL TO EMPLOYERS, OR A CREDIT REPORT, THE APPLICANT'S NET WORTH AND/OR LIQUID ASSETS, AND REASONABLE HOUSEHOLD OR BUSINESS EXPENSES. FINANCIAL ASSISTANCE MAY ALSO BE GRANTED IN CERTAIN CIRCUMSTANCES INVOLVING A CATASTROPHIC OCCURRENCE RESULTING IN MEDICAL BILLS GROSSLY EXCEEDING THE PATIENT'S ABILITY TO PAY AND IN THESE SITUATIONS, THE PATIENT'S RESPONSIBILITY WILL BE LIMITED TO 30% OF THE FAMILY'S GROSS ANNUAL INCOME. PART I, LINE 7: THE COSTING METHODOLOGY USED TO CALCULATE THE AMOUNTS REPORTED IN THE TABLE WERE WORKSHEETS WITHIN THE SCHEDULE H INSTRUCTIONS. THE COST TO CHARGE RATIO USED IN THE CALCULATION WAS DERIVED FROM THE FILED 2020 COST REPORT. PART I, LINE 7G: MEMORIAL COMMUNITY HOSPITAL DOES NOT PROVIDE SUBSIDIZED HEALTH SERVICES. PART I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 1,179,516. SCHEDULE H, PART I, LINE 6A MEMORIAL COMMUNITY HOSPITAL PRODUCES A COMMUNITY BENEFIT REPORT THAT IS SENT TO THE NEBRASKA HOSPITAL ASSOCIATION FOR DATA COLLECTION PURPOSES. PART II, COMMUNITY BUILDING ACTIVITIES: MEMORIAL COMMUNITY HOSPITAL AND HEALTH SYSTEM'S MISSION IS TO HEAL, NURTURE AND PROMOTE HEALTH IN THE COMMUNITIES WE SERVE. 2020 BEGAN BY PARTNERING WITH COMMUNITY ORGANIZATIONS AND PLANNING EVENTS FOR THE YEAR, BUT QUICKLY CHANGED WHEN THE PANDEMIC STARTED. AFTER THE INITIAL 2-3 MONTHS OF THE PANDEMIC SHUTDOWN, MOST EVENTS WERE CANCELED OR CHANGED SUBSTANTIALLY TO BE RESPONSIBLE STEWARDS OF THE ONGOING PUBLIC HEALTH CRISIS. WE WERE ABLE TO EVENTUALLY CONTINUE STUDENT SHADOWING OPPORTUNITIES FOR MEDICAL STUDENTS, OFFER LUNCH AND LEARNS TO THE COMMUNITY WHEN THE COVID NUMBERS WANED, HOST TAI CHI AND SENIOR EXERCISE CLASSES, TEACH STOP-THE-BLEED CLASSES, AND PARTICIPATE IN COMMUNITY BLOOD DRIVES AT OUR FACILITY. PARTICIPATION THAT MAY ONCE HAVE INCLUDED IN-PERSON EVENTS WERE NOW SPONSORSHIPS AND DONATIONS. HOWEVER, THE LARGEST COMMUNITY OUTREACH ACTIVITY OF THE YEAR WAS OUR PARTICIPATION IN TEST NEBRASKA AND THE BEGINNING OF THE VACCINE CLINICS FOR HEALTHCARE WORKERS AND FIRST RESPONDERS IN OUR COMMUNITY. HUNDREDS OF HOURS OF STAFF TIME WERE DEDICATED TO TESTING THE MEMBERS OF OUR COMMUNITY IN A DRIVE THROUGH LOCATION. MCH ALSO PARTNERED WITH LOCAL NURSING HOMES AND THREE RIVERS PUBLIC HEALTH DEPARTMENT TO HELP EDUCATE THE PUBLIC ON NEW COVID PROTOCOLS, INCLUDING INFECTION CONTROL. BY AND LARGE, COVID-19 CHANGED THE WAY WE ALL DID BUSINESS SO WE ADAPTED AS BEST WE COULD WHILE REACHING OUT TO THE COMMUNITY. PART III, LINE 2: COSTING METHODOLOGY FOR AMOUNTS REPORTED ON LINE 2 IS DETERMINED USING THE ORGANIZATION'S COST/CHARGE RATIO OF 70.51%. WHEN DISCOUNTS ARE EXTENDED TO SELF-PAY PATIENTS, THESE PATIENT ACCOUNT DISCOUNTS ARE RECORDED AS A REDUCTION IN REVENUE, NOT AS BAD DEBT EXPENSE. PART III, LINE 3: COMMUNITY MEMORIAL HOSPITAL DOES NOT BELIEVE THAT ANY PORTION OF BAD DEBT EXPENSE COULD REASONABLY BE ATTRIBUTED TO PATIENTS WHO QUALIFY FOR FINANCIAL ASSISTANCE SINCE AMOUNTS DUE FROM THOSE INDIVIDUALS' ACCOUNTS WILL BE RECLASSIFIED FROM BAD DEBT EXPENSE TO CHARITY CARE WITHIN 30 DAYS FOLLOWING THE DATE THAT THE PATIENT IS DETERMINED TO QUALIFY FOR CHARITY CARE. PART III, LINE 4: THE AUDITED FOOTNOTES FOR MEMORIAL COMMUNITY HOSPITAL AND MEDICAL CENTER DO NOT CONTAIN FOOTNOTES RELATED TO BAD DEBT EXPENSE. BAD DEBT EXPENSE IS IDENTIFIED ON THE CONSOLIDATED STATEMENT OF OPERATION WHICH IS CONSISTENT WITH THE REPORTING PRACTICE OF OTHER HEALTH CARE ORGANIZATIONS. BAD DEBT EXPENSE AT 100% CHARGE VALUE WAS MULTIPLIED BY THE RATIO DERIVED FROM THE SCHEDULE H WORKSHEETS IN THE SCHEDULE H INSTRUCTIONS TO ARRIVE AT AN APPROXIMATE COST VALUE. PART III, LINE 8: MEMORIAL COMMUNITY HOSPITAL EXCLUDED MEDICARE SHORTFALLS FROM THE OVERALL COMMUNITY BENEFIT REPORT.THE MEDICARE CHARGES REPORTED ON LINE 5 AND LINE 6 ARE FROM THE 2020 FILED COST REPORT WHICH USED A COST TO CHARGE RATIO. PART III, LINE 9B: ALL ACCOUNTS MUST HAVE GONE THROUGH A MINIMUM OF THREE STATEMENT CYCLES ENSURING THE GUARANTOR HAS HAD TIME TO REVIEW AND PAY ON THE ACCOUNTS OWED ON. NO ACCOUNT WILL BE PREPARED FOR COLLECTIONS BEFORE IT HAS REACHED 121 DAYS FROM THE DATE OF POST DISCHARGE BILLING. ALL ACCOUNTS MUST HAVE ONE DOCUMENTED, ATTEMPTED PHONE CALL TO THE GUARANTOR. PATIENTS WILL BE GIVEN THE OPPORTUNITY TO APPLY FOR MCHHS' FINANCIAL ASSISTANCE PROGRAM IN THE EVENT THAT THEY ARE UNABLE TO MEET THEIR FINANCIAL OBLIGATIONS. THE FINANCIAL CLASS ON THE EFFECTED EPISODES WILL BE CHANGED TO "FA AND A FINAL ATTEMPT LETTER WHICH INCLUDES INFORMATION REGARDING THE MCH FINANCIAL ASSISTANCE PROGRAM AND IT'S AVAILABILITY TO QUALIFIED APPLICANTS WILL BE SENT INDICATING THAT A PAYMENT OR RESPONSE IS NECESSARY OR ELSE THE ACCOUNT WOULD BE SENT TO AN OUTSIDE AGENCY FOR COLLECTION ATTEMPTS. IF A PATIENT CONTACTS MCHHS TO INQUIRE ABOUT FINANCIAL ASSISTANCE AND THE ACCOUNT IS LESS THAN 240 DAYS, THEN ALL COLLECTION EFFORTS WILL BE CEASED AND THE PATIENT WILL BE GIVEN 2 WEEKS TO COMPLETE AND RETURN THE REQUIRED APPLICATION AND DOCUMENTS. SHOULD THE PATIENT NOT QUALIFY AND/OR NOT RETURN THE REQUIRED APPLICATION, THEN COLLECTION EFFORTS SHALL RESUME. SHOULD PATIENTS COMPLETE AND RETURN THE REQUIRED APPLICATION AND DOCUMENTS AT ANY TIME PRIOR TO 241 DAYS, THEN COLLECTION EFFORTS WILL CEASE UNTIL THE APPLICATION IS REVIEWED.MEMORIAL COMMUNITY HOSPITAL'S COLLECTION POLICY DOES CONTAIN PROVISIONS OF THE COLLECTION PRACTICES TO BE FOLLOWED FOR PATIENTS WHO ARE KNOWN TO QUALIFY FOR CHARITY CARE OR FINANCIAL ASSISTANCE. PART VI, LINE 2: MEMORIAL COMMUNITY HOSPITAL ASSESSES THE HEALTH CARE NEEDS OF THE COMMUNITIES IT SERVES THROUGH MULTIPLE CHANNELS INCLUDING COMMUNITY HEALTH FAIRS, WELLNESS PROGRAMS, PROVIDING OCCUPATIONAL HEALTH SERVICES, LISTENING TO PATIENT AND COMMUNITY VOICES AS WELL AS WATCHING NATIONAL TRENDS. PART VI, LINE 3: THERE ARE SEVERAL FINANCIAL ASSISTANCE ACCESS POINTS THROUGHOUT A PATIENT'S CARE CYCLE. BILLS CONTAIN FINANCIAL ASSISTANCE VERBIAGE, BROCHURES ARE AVAILABLE IN CLINICS AND THE HOSPITAL, AND THERE IS INFORMATION ON FINANCIAL ASSISTANCE POSTED AT REGISTRATION POINTS THROUGHOUT CLINICS AND THE HOSPITAL. INFORMATION ON THE MCH FINANCIAL ASSISTANCE POLICIES IS LOCATED AT WWW.MCHHS.ORG. DESIGNEES SUCH AS FINANCIAL COUNSELORS OF MCH HELP PATIENTS SEEK REIMBURSEMENT FROM LOCAL, STATE AND FEDERAL PROGRAMS AT NO CHARGE TO THE PATIENT, WHEN THERE IS NO OTHER SOURCE OF PAYMENT. AFTER THESE EFFORTS/RESOURCES HAVE BEEN EXHAUSTED, PATIENTS ARE ASSISTED IN THE APPLICATION PROCESS FOR FINANCIAL ASSISTANCE. PART VI, LINE 4: MEMORIAL COMMUNITY HOSPITAL AND HEALTH SYSTEM OF BLAIR, NEBRASKA SERVES BOTH WASHINGTON AND BURT COUNTIES IN NEBRASKA. WASHINGTON COUNTY NEBRASKA HAS AN ESTIMATED POPULATION OF 20,667 AND APPROXIMATELY 61.2% OF THE POPULATION IN WASHINGTON COUNTY IS CONSIDERED RURAL. CENSUS ESTIMATES SHOW THAT WASHINGTON COUNTY'S RACIAL AND ETHNIC MAKEUP IS 5.3% OF THE POPULATION AND ITS MEDIAN AGE IS 41.2 AS COMPARED TO THE STATE AT 36.3. THE MEDIAN HOUSEHOLD INCOME IS $66,485 COMPARED TO $56,675 FOR THE STATE OF NEBRASKA. 23.1% OF SCHOOL AGE CHILDREN WERE ELIGIBLE FOR FREE OR REDUCED LUNCH IN WASHINGTON COUNTY DURING THE 2018-2019 SCHOOL YEAR. BURT COUNTY HAS A POPULATION OF 6,459 AND IT'S ETHNIC AND RACIAL MAKEUP IS 5.3% OF THE POPULATION. THE MEDIAN HOUSEHOLD INCOME IS $51,482 AND APPROXIMATELY 36% OF CHILDREN IN BURT COUNTY ARE ON FREE AND REDUCED LUNCH AT SCHOOL. PART VI, LINE 5: MCH&HS PROMOTES THE HEALTH OF ITS COMMUNITY THROUGH FINANCIAL AND IN-KIND DONATIONS. BOARD OF DIRECTORS - THE BOARD OF DIRECTORS MANAGE THE AFFAIRS OF MEMORIAL COMMUNITY HOSPITAL IN BLAIR, NEBRASKA. THERE ARE SEVEN DIRECTORS WHO SERVE ON THE BOARD: THREE MEMBERS FROM THE COMMUNITY, THREE MEMBERS FROM CHI HEALTH AND ONE MEMBER FROM THE MCH&HS MEDICAL STAFF. THE BOARD OF DIRECTORS IS COMPROMISED OF INDIVIDUALS WHO ARE LEADERS IN THE FIELDS OF BUSINESS, HEALTHCARE, ACCOUNTING AND MEDICINE AND WHO UNDERSTAND THEIR ROLE IN PROVIDING STRONG CORPORATE GOVERNANCE. EMERGENCY DEPARTMENT - MEMORIAL COMMUNITY HEALTH HAS A FULL-TIME EMERGENCY DEPARTMENT THAT IS OPEN TO THE PUBLIC AND PROVIDES MEDICAL SCREENING, EXAMINATION, AND STABILIZING TREATMENT WITHIN THE CAPABILITIES AND CAPACITIES OF THE HOSPITAL REGARDLESS OF BUT NOT LIMITED TO THE PATIENT'S RACE, COLOR, SEX, AGE AND/OR ABILITY TO PAY. MCH&HS IS IN COMPLIANCE WITH THE FEDERAL EMTALA GUIDELINES. MEDICAL STAFF - MCH&HS MAINTAIN AN OPEN MEDICAL STAFF. ALL QUALIFIED MDS, DSO, OTHER HEALTHCARE PRACTITIONERS, AND MID-LEVEL PRACTITIONERS ARE ELIGIBLE TO APPLY FOR PRIVILEGES AT THE HOSPITAL. MCH&HS POLICY ON PHYSICIAN CREDENTIALING IS THAT NO INDIVIDUAL IS TO BE DENIED MEDICAL STAFF APPOINTMENT BASED ON SEX, RACE, CREED, COLOR OR NATIONAL ORIGIN. THE STANDARDS A PHYSICIAN MUST MEET FOR APPOINTMENT RELATE TO (1) EDUCATIONAL QUALIFICATION AND LICENSING, (2) PROFESSIONAL COMPETENCE, (3) CHARACTER, (4) ETHICAL STANDING, AND (5) ABILITY TO RELATE TO AND WORK WITH OTHERS. APPLICATIONS ARE REVIEWED AT SEVERAL LEVELS WITHIN THE ORGANIZATION. PHYSICIANS WHO HAVE BEEN GRANTED STAFF PRIVILEGES AUTOMATICALLY BECOME A MEMBER OF THE MEDICAL STAFF AT THE HOSPITAL FOR WHICH PRIVILEGES HAVE BEEN GRANTED. SCHEDULE H, PART VI, LINE 7 STATE FILING OF COMMUNITY BENEFIT REPORT: NE 1 CHARITY CARE 223 110386 BOOK MEDICAL CARE PART I, LINE 2: MONITORING OF GRANT FUNDS MEMORIAL COMMUNITY HOSPITAL DOES NOT GIVE OUT GRANTS. INSTEAD, IT PROVIDES FINANCIAL ASSISTANCE TO THOSE PATIENTS IN NEED THAT QUALIFY UNDER THE HOSPITAL CHARITY CARE POLICY. X X X 0 0 0 1 1 0 0 0 0 CHARLES SMITH MD PHYSICIAN 244729 0 112622 0 0 0 26000 0 10831 0 394182 0 0 0 MAURICE BIRDWELL MD PHYSICIAN 331401 0 13433 0 0 0 25941 0 10694 0 381469 0 0 0 JEREMY LEE MD PHYSICIAN 308072 0 26058 0 0 0 19500 0 4120 0 357750 0 0 0 PAULA THIELEN-KOCHAROV MD PHYSICIAN 256521 0 70207 0 0 0 14594 0 1745 0 343067 0 0 0 SANDRA BAUMBERGER MD BOARD MEMBER 248155 0 56631 0 0 0 26000 0 11145 0 341931 0 0 0 ALISHA SCOTT MD PHYSICIAN 178909 0 129309 0 0 0 13486 0 2018 0 323722 0 0 0 PART I, LINE 5 ON A QUARTERLY BASIS, PHYSICIANS ARE ELIGIBLE FOR A BONUS IF THEIR OWN PERSONAL GROSS REVENUE PRODUCTION (WITH CERTAIN LIMITS ON WHAT IS INCLUDED) EXCEED A THRESHOLD. THEY THEN GET X% OF THE AMOUNT OVER THAT GROSS REVENUE THRESHOLD. THEY ARE ALSO ELIGIBLE FOR A KEY PERFORMANCE INDICATOR (KPI) ANNUAL BONUS ONLY IF THE COMBINED EBIDA (MCH AND ITS RELATED ORGANIZATION) TARGET IS ACHIEVED. THE KPI ANNUAL BONUSES ARE NOT BASED ON THE PHYSICIANS' SALARIES BUT BASED ON HOW THEY PERFORM ON THE 5 METRICS OF THE KPI PLAN. MCH PHYSICIANS ARE ELIGIBLE FOR A KEY PERFORMANCE INDICATOR (KPI) ANNUAL BONUS ONLY IF THE COMBINED EBIDA (MCH AND ITS RELATED ORGANIZATION) TARGET IS ACHIEVED. THE KPI ANNUAL BONUSES ARE NOT BASED ON THE PHYSICIANS' SALARIES BUT BASED ON HOW THEY PERFORM ON THE 5 METRICS OF THE KPI PLAN. A HOSPITAL AUTH #1 OF WASHINGTON CNTY NE 521441599 2007-06-19 9250000 CONSTRUCTION OF FACILITY 0 0 0 B HOSPITAL AUTH #1 OF WASHINGTON CNTY NE 521441599 2008-05-22 8000000 CONSTRUCTION OF FACILITY 0 0 0 A 4809170 9493722 173747 9319975 0 0 1 1 B 3610365 8059333 65000 7994333 0 0 1 1 A 0 0 0 0 0 0 0 B 0 0 0 0 0 0 0 A 0 0 1 1 0 0 0 0 0 B 0 0 1 1 1 1 FNB OF OMAHA 201.000000000000 1 0 0 0 0 A 0 B 0 SCHEDULE K, PART I NOTE REGARDING THE REBATE COMPUTATION SINCE THE BOND PROCEEDS HAVE BEEN SPENT, A SPENDING EXCEPTION WAS MET, AND THE DEBT SERVICE FUND WAS OPERATED ON A BONA FIDE BASIS, NO FURTHER REBATE CALCULATIONS ARE NECESSARY. SCHEDULE K, PART I, COLUMN (A) BOND RENEWAL IN 2017, MEMORIAL COMMUNITY HOSPITAL AMENDED ITS 2007 BOND SERIES WITH A NEW INTEREST RATE OF 3.01%. FORM 990, PART VI, SECTION A, LINE 3 THE CEO AND CFO OF MEMORIAL COMMUNITY HOSPITAL CORPORATION (HOSPITAL) ARE PROVIDED BY CHI HEALTH. THE CEO & CFO ARE EMPLOYEES OF CHI HEALTH, AND THE HOSPITAL REIMBURSES CHI HEALTH FOR THEIR COMPENSATION AND BENEFITS. THE HOSPITAL PAYS CHI HEALTH A MANAGEMENT FEE EQUAL TO THE DIRECT COST OF THEIR COMPENSATION AND BENEFITS PLUS 10% OF EARNINGS BEFORE INTEREST, DEPRECIATION, AND AMORTIZATION. FORM 990, PART VI, SECTION A, LINE 6 BOARD MEMBERS MEMORIAL COMMUNITY HOSPITAL CORPORATION (HOSPITAL) HAS TWO MEMBERS - MEMORIAL COMMUNITY HEALTH SYSTEM, INC (MCHS) AND ALEGENT HEALTH - IMMANUEL MEDICAL CENTER (IMMANUEL). FORM 990, PART VI, SECTION A, LINE 7A BOARD MEMBERS THE HOSPITAL HAS A SEVEN MEMBER BOARD OF DIRECTORS. MCHS APPOINTS THREE OF THESE BOARD MEMBERS, IMMANUEL APPOINTS THREE, AND THE MEDICAL STAFF APPOINTS ONE MEMBER, WHO IS ALWAYS THE MEDICAL STAFF PRESIDENT. ALL OFFICIAL ACTIONS OF THE BOARD REQUIRE AN AFFIRMATIVE VOTE OF TWO-THIRDS OF THE ENTIRE BOARD OF DIRECTORS. A SIMPLE MAJORITY OF THE BOARD OF DIRECTORS CONSTITUTES A QUORUM FROM THE TRANSACTION OF BUSINESS. FORM 990, PART VI, SECTION B, LINE 11B NO REVIEW WAS OR WILL BE CONDUCTED. FORM 990, PART VI, SECTION B, LINE 12C ANNUALLY, EACH BOARD MEMBER SIGNS A CONFLICT OF INTEREST STATEMENT AND IS GIVEN A COPY OF THE CONFLICT OF INTEREST POLICY. THE CHAIRMAN OF THE BOARD REVIEWS THESE STATEMENTS AND ENSURES THAT BOARD MEMBERS EXCUSE THEMSELVES FROM DISCUSSIONS AT BOARD MEETINGS ON TOPICS WHERE THEY HAVE A CONFLICT OF INTEREST. FORM 990, PART VI, SECTION B, LINE 15 EXECUTIVE COMPENSATION THE OFFICERS OF THE BOARD ARE NOT COMPENSATED FOR THEIR DUTIES, THEY ARE VOLUNTEERS. THE OFFICERS OF THE CORPORATION (THE EXECUTIVES) ARE COMPENSATED BASED ON RECOMMENDATION OF THE COMPENSATION COMMITTEE OF THE BOARD. THE COMPENSATION COMMITTEE LOOKS AT COMPARATIVE HOSPITAL AND INDUSTRY SALARY INFORMATION IN SETTING BASE SALARIES AND REVIEWS AND APPROVES THE INDIVIDUAL GOALS PROPOSED BY THE EXECUTIVE TEAM FOR INCENTIVE COMPENSATION. FORM 990, PART VI, SECTION C, LINE 19 MEMORIAL COMMUNITY HOSPITAL'S AUDIT REPORT IS MADE AVAILABLE TO THE PUBLIC. THE CONFLICT OF INTEREST POLICY AND GOVERNING DOCUMENTS ARE NOT AVAILABLE TO THE PUBLIC. FORM 990, PART VI, SECTION B, LINE 16B JOINT VENTURE POLICY MEMORIAL COMMUNITY HOSPITAL HAS NOT FORMALLY ADOPTED A WRITTEN POLICY OR WRITTEN PROCEDURE REGARDING JOINT VENTURES. HOWEVER, MCH EVALUATES THE JOINT VENTURE BEFORE ENTERING INTO AN AGREEMENT, TO ENSURE THEY DO NOT ENTER INTO ANY JOINT VENTURE THAT WOULD JEOPARDIZE THE HOSPITALS' EXEMPT PURPOSE. FORM 990, PART VII, SECTION A, LINE 1A TIM SCHNACK & MANUELA WOLF'S COMPENSATION TIM SCHNACK & MANUELA WOLF ARE THE CFO AND CEO OF MEMORIAL COMMUNITY HOSPITAL, RESPECTFULLY, AND ARE PAID BY CHI HEALTH. MEMORIAL COMMUNITY HOSPITAL PAID CHI HEALTH FOR THEIR SERVICES PROVIDED. THEREFORE, TIM SCHNACK & MANUELA WOLF SHOW $0 REPORTABLE COMPENSATION FROM THE FILING ORGANIZATION AND FROM ANY RELATED ORGANIZATION AS THEY WERE DIRECTLY PAID BY CHI HEALTH. MEMORIAL COMMUNITY HOSPITAL FOUNDATION 810 N 22ND STREET BLAIR NE 68008 113660156 SUPPORT NE 501(C)(3) LINE 7 N/A 0 MEMORIAL COMMUNITY HEALTH SYSTEM 810 N 22ND STREET BLAIR NE 68008 470718840 HEALTH SYSTEM NE 501(C)(3) LINE 7 N/A 0 MCH AUXILIARY THRIFT SHOP 810 N 22ND STREET BLAIR NE 68008 470748162 AUXILIARY NE 501(C)(3) LINE 7 N/A 1 0 0 1 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0