2020-11-13T08:31:17-06:00 2019-12-31 476097913 SEIM JOHNSON LLP 18081 BURT STREET SUITE 200 OMAHA NE 680224722 990 2019-01-01 470662290 NORTH PLATTE NEBRASKA HOSPITAL CORP NORT 3085688000 601 WEST LEOTA STREET NORTH PLATTE NE 69103 THOMAS LEGEL CFO 3085688000 2020-11-10 1 WENDY R COOLEY P01523804 4023302660 209.34.201.180 2020-11-10 10:08:28 CS P B9105B4A5C0EB5E2E793342CEF2BF4C203B466F0 5D066E2939FE45487034BD10C4A0DC94BE27FEF9 2019 2021-01-29 14:40:06Z GREAT PLAINS HEALTH THOMAS LEGEL 601 WEST LEOTA STREET NORTH PLATTE NE 69103 253763853 0 X WWW.GPHEALTH.ORG X 1971 NE PROVIDE ACUTE, PREVENTIVE AND OTHER HEALTHCARE SERVICES. 15 10 1328 199 73763 0 4152145 8120845 219938367 224528539 7344120 6328821 -2165542 65740 229269090 239043945 152793 139770 0 0 100125457 104377060 0 0 0 104184898 108818535 204463148 213335365 24805942 25708580 372161319 413695081 121946945 128844076 250214374 284851005 TO INSPIRE HEALTH AND HEALING BY PUTTING PATIENTS FIRST -- ALWAYS. 0 0 187238631 139770 197872264 GREAT PLAINS HEALTH IS A NOT-FOR-PROFIT HEALTH SYSTEM COMMITTED TO MEETING THE HEALTHCARE NEEDS OF THE COMMUNITIES WE SERVE. OUR MEDICAL STAFF, BOARD AND LEADERSHIP BELIEVE WE OFFER SPECIALTIES THAT PROVIDE HIGH QUALITY AND LOW COST CARE TO OUR PATIENTS. SPECIALTIES THAT ARE NEW AND HAVE GROWN IN THE PAST THREE YEARS ARE ONCOLOGY, CARDIOLOGY, ORTHOPEDICS, HYPERBARIC AND WOUND CARE, AND THE DIABETIC PROGRAM TO MEET THE HEALTH CHALLENGES OF OUR COMMUNITIES. 16499756 23527854 GREAT PLAINS HEALTH OPERATES A 116-BED INPATIENT HOSPITAL. THE INPATIENT CARE PROVIDED IN THOSE UNITS ARE THE FOLLOWING: MEDICAL, SURGICAL, INTENSIVE CARE, CORONARY CARE, OBSTETRICS, LABOR & DELIVERY, NICU, AND BEHAVIOR HEALTH SERVICES. GREAT PLAINS HEALTH PATIENTS COME FROM PRIMARY AND SECONDARY MARKETS. 1826661 2026704 GREAT PLAINS HEALTH IS DEDICATED TO MEETING THE BEHAVIORAL HEALTH NEEDS OF THE COMMUNITIES WE SERVE. TO HELP MEET THOSE NEEDS, WE OPERATE A DEDICATED BEHAVIORAL HEALTH UNIT/FLOOR AT THE HOSPITAL. THE UNIT ACCEPTS A WIDE VARIETY OF BEHAVIORAL DIAGNOSIS AND ISSUES. 205565048 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 1 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 1 1 0 0 0 1 150 0 1 1328 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 15 10 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 1 1 1 1 X THOMAS LEGEL CFO 3085687193 601 WEST LEOTA NORTH PLATTE NE 69103 MICHAEL SIMONSON MD VICE CHIEF OF STAFF/DIRECTOR 40.00 0.00 X 1149493 0 51553 RICHARD J MARKIEWICZ MD PHYSICIAN (GPH) 40.00 0.00 X 964659 0 50253 JOHN HANNAH MD PHYSICIAN (GPH) 40.00 0.00 X 927002 0 51333 HENRIK MIKE-MAYER MD PHYSICIAN (GPH) 40.00 0.00 X 887258 0 54053 JACOB WIESEN MD PHYSICIAN (GPH) 40.00 0.00 X 859139 0 51703 ANIL KUMAR MD PHYSICIAN (GPH) 40.00 0.00 X 743642 0 51703 NARAYANA KODURI MD CHIEF OF STAFF/DIRECTOR 40.00 0.00 X 704746 0 51703 JIM SMITH MD DIRECTOR 39.00 1.00 X 435807 0 53703 MELVIN MCNEA CEO 39.00 1.00 X 380501 0 41864 THOMAS LEGEL CFO 39.00 1.00 X 277129 0 48203 NEWTON MACK MD CHAIR 1.00 1.00 X X 0 0 0 DARREL SMITH VICE CHAIR 1.00 1.00 X X 0 0 0 JAY ENGEL SECRETARY/TREASURER 1.00 1.00 X X 0 0 0 BYRON BARKSDALE MD DIRECTOR 1.00 0.00 X 0 0 0 MARGE BEATTY DIRECTOR (THRU 2/2019) 1.00 0.00 X 0 0 0 TRACI DUGAN DIRECTOR 1.00 0.00 X 0 0 0 MIKE JACOBSON DIRECTOR 1.00 0.00 X 0 0 0 DWIGHT LIVINGSTON DIRECTOR 1.00 0.00 X 0 0 0 MARK OETTINGER DIRECTOR 1.00 0.00 X 0 0 0 DAN O'NEILL DIRECTOR 1.00 0.00 X 0 0 0 JOHN PATTERSON DIRECTOR 1.00 1.00 X 0 0 0 LANCE POLK DIRECTOR 1.00 1.00 X 0 0 0 JODY TOMANEK DIRECTOR 1.00 1.00 X 0 0 0 7329376 0 506071 126 0 1 0 SAMPSON CONSTRUCTION 440 REGENCY PKWY DR 131 OMAHA NE 68114 GENERAL CONTRACTOR 4218528 ARETE NURSE PROFESSIONALS LLC 2655 NORTHWINDS PKWY ALPHARETTA GA 30009 STAFFING SERVICES 3103494 SNELL SERVICES INC 2220 W FRONT ST NORTH PLATTE NE 69101 ELECTRICAL CONTRACTOR 2150812 WEATHERBY LOCUMS INC 7259 S BINGHAM JUNCTION BLVD MIDVALE UT 840474860 STAFFING SERVICES 1937448 AVANT HEALTHCARE PROFESSIONALS 1211 SEMORAN BLVD CASSELBERRY FL 32707 STAFFING SERVICES 1691820 61 8120845 8120845 PATIENT SERVICE REVENUE 624100 111117676 111117676 MEDICARE/MEDICAID PAYMENTS 624100 104735576 104735576 PATHOLOGY REVENUE 624100 7918428 7918428 OTHER OPERATING REVENUE 624100 742480 742480 MANAGEMENT FEES 624100 11450 11450 2929 2929 224528539 4080013 4080013 287455 0 287455 287455 287455 16889961 78755 14700677 19231 2189284 59524 2248808 2248808 CAFETERIA REVENUE 722210 806239 806239 NORTH PLATTE SURGICAL CENTER 621400 454268 454268 INVESTMENT IN HME 900099 153181 153181 -1635403 -1709166 73763 -221715 239043945 223426822 73763 7422515 X 139770 139770 3194702 2447005 747697 137265 137265 81403739 78763349 2640390 2440523 2365270 75253 12178634 11763099 415535 5022197 4827166 195031 271699 271699 649098 649098 111915 111915 397071 397071 34156637 32696388 1460249 477761 18026 459735 3973429 3831447 141982 3957172 3957172 3819840 3818296 1544 242449 224599 17850 3970436 3970436 14030032 14004164 25868 1073362 1073362 MEDICAL SUPPLIES 38384129 38384129 FOOD 957793 957793 BAD DEBTS 889610 889610 EDUCATION & TRAINING 642396 598006 44390 813706 698696 115010 213335365 205565048 7770317 0 341754 128900 160003321 155865313 35245935 23380765 1022780 956480 5761554 6096164 3299993 3464767 307800261 179742262 120153503 128057999 26590501 65063383 3081980 3089260 16659998 27592050 372161319 413695081 19083945 21906660 97222944 94619042 5640056 12318374 121946945 128844076 X 241570994 282443020 8643380 2407985 250214374 284851005 372161319 413695081 X 25708580 15163446 -6235395 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 12259 12259 0 PART II-B, LINE 1: THE $12,259 REPRESENTS THE PORTION OF THE DUES PAID TO THE NEBRASKA HOSPITAL ASSOCIATION AND THE AMERICAN HOSPITAL ASSOCIATION THAT ARE USED FOR LOBBYING BY THOSE ORGANIZATIONS. 1801085 1801085 150714300 62527394 88186906 3039354 1652959 1386395 136821617 111437246 25384371 15423905 4124663 11299242 128057999 MISCELLANEOUS RECEIVABLE 446892 DUE FROM AFFILIATES 2293195 DEFERRED COMPENSATION 5341066 RECEIVABLE ON INSURANCE CLAIM 510000 INTEREST IN GREAT PLAINS FOUNDATION 2466388 LAND HELD FOR FUTURE EXPANSION AND INVESTMENT 647594 PATIENT CUSTOMER CONTRACTS 9929283 OPERATING LEASES 5266583 RECRUITMENT ADVANCES 691049 27592050 ESTIMATED THIRD PARTY SETTLEMENTS 1710725 DEFERRED COMPENSATION 5341066 OPERATING LEASES LIABILITY 5266583 12318374 X PART X, LINE 2: GP HEALTH AND REGENCY ARE NOT-FOR-PROFIT CORPORATIONS AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. GP HEALTH AND REGENCY HAVE 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 TAX-EXEMPT STATUS. GPHEI IS A FOR-PROFIT CORPORATION THAT RECOGNIZED FEDERAL AND STATE INCOME TAX EXPENSE OF APPROXIMATELY $55,000 AND -0- IN 2019 AND 2018, RESPECTIVELY. THE INCOME TAX EXPENSE IS INCLUDED AS AN OTHER EXPENSE OF THE CONSOLIDATED STATEMENTS OF OPERATIONS IN 2019. GPHEI DID NOT RECOGNIZE ANY FEDERAL AND STATE INCOME TAX EXPENSE IN 2018 DUE TO OPERATING LOSSES INCURRED DURING THE YEAR. GPHIN IS A FOR-PROFIT CORPORATION SUBJECT TO FEDERAL AND STATE INCOME TAXES. GPHIN DID NOT RECOGNIZE ANY FEDERAL AND STATE INCOME TAX EXPENSE IN 2019 AND 2018 DUE TO OPERATING LOSSES INCURRED DURING THE YEAR. MNMV IS A LIMITED LIABILITY COMPANY OF WHICH GP HEALTH OWNS A 60% INTEREST. THE ORGANIZATION ACCOUNTS FOR UNCERTAINTIES IN ACCOUNTING FOR INCOME TAX ASSETS AND LIABILITIES USING GUIDANCE INCLUDED IN FASB ASC 740, INCOME TAXES. THE ORGANIZATION RECOGNIZES THE EFFECT OF INCOME TAX POSITIONS ONLY IF THOSE POSITIONS ARE MORE LIKELY THAN NOT OF BEING SUSTAINED. AT DECEMBER 31, 2019 AND 2018, THE ORGANIZATION HAD NO UNCERTAIN TAX POSITIONS ACCRUED. 1 1 X 1 X 1 X 1 1 0 1 1 1932 5305653 0 5305653 0.02500 3144 18259304 10579492 7679812 0.03610 5076 23564957 10579492 12985465 0.06110 19541 1812169 21913 1790256 0.00840 69 471001 0 471001 0.00220 2798 1347367 642575 704792 0.00330 290407 1045 289362 0.00140 20000 633377 0 633377 0.00300 42408 4554321 665533 3888788 0.01830 47484 28119278 11245025 16874253 0.07940 20000 1724 0 1724 0.00000 1500 3727 0 3727 0.00000 150 10496 0 10496 0.00000 21650 15947 15947 0.00000 0 889610 0 76564995 110693349 -34128354 X 1 1 1 PHYSICIAN HOSPITAL CONTRACTING ORGANIZATION NEGOTIATES HEALTHCARE CONTRACTS FOR PHYSICIANS AND THE HOSPITAL 0.50000 0.00000 0.50000 2 NORTH PLATTE SURGERY CENTER LLC PROVIDES OUTPATIENT SURGERY SERVICES 0.50000 0.00000 0.50000 3 MID-NE MEDICAL VENTURES LEASES OF PHYSICIAN'S OFFICE BUILDING 0.60000 0.05000 0.35000 1 1 GREAT PLAINS HEALTH 601 WEST LEOTA NORTH PLATTE NE 69101 WWW.GPHEALTH.ORG 510001 X X X GREAT PLAINS HEALTH 1 0 0 1 X X X X X X X X X X 19 1 0 0 1 X WWW.GPHEALTH.ORG/ABOUT-US/COMMUNITY-IMPACT 1 19 1 WWW.GPHEALTH.ORG/ABOUT-US/COMMUNITY-IMPACT 0 1 X 150.000000000000 250.000000000000 X X X X 1 1 X X X 1 X WWW.GPHEALTH.ORG/PATIENTS-VISITORS/BILLING-INFORMATION/FINANCIAL-ASSISTANCE X WWW.GPHEALTH.ORG/PATIENTS-VISITORS/BILLING-INFORMATION/FINANCIAL-ASSISTANCE X WWW.GPHEALTH.ORG/PATIENTS-VISITORS/BILLING-INFORMATION/FINANCIAL-ASSISTANCE X X X X X X X 1 X 0 X X X X X 1 X 0 0 GREAT PLAINS HEALTH PART V, SECTION B, LINE 3J: THE GREAT PLAINS HEALTH COMMUNITY HEALTH NEEDS ASSESSMENT WAS CONDUCTED FROM JUNE TO OCTOBER 2019.GREAT PLAINS HEALTH EXECUTIVES, REPRESENTATIVES FROM PARTNERING AGENCIES AND THE COMMUNITY ANALYZED THE MOST UP-TO-DATE HEALTH DATA AVAILABLE, INCLUDING RELEVANT DEMOGRAPHICS AND COMMUNITY STAKEHOLDER INPUT. THE PROCESS LED TO THE IDENTIFICATION OF FIVE PRIORITY AREAS:1. INCREASE ACCESS TO MENTAL AND BEHAVIORAL HEALTHCARE.2. INCREASE PREVENTION EDUCATION TO REDUCE THE PREVALENCE OF CHRONIC DISEASES, PREVENTABLE CONDITIONS, READMISSIONS AND HIGH MORTALITY RATES.3. INCREASE ACCESS TO SAFE AND AFFORDABLE HOUSING.4. IMPROVE ACCESS TO MEDICAL AND DENTAL CARE.5. RECRUIT AND RETAIN QUALITY HEALTHCARE PROFESSIONALS. GREAT PLAINS HEALTH PART V, SECTION B, LINE 5: DURING THE RESEARCH AND COLLABORATION OF CHNA DEVELOPMENT, GREAT PLAINS HEALTH CONDUCTED ONE-ON-ONE PHONE INTERVIEWS WITH INDIVIDUALS WHO REPRESENT THE BROAD INTERESTS OF THE COMMUNITY AND THOSE WITH AN EXPERTISE RELEVANT TO THE HEALTH OF THE COMMUNITY, INCLUDING STATE, LOCAL, TRIBAL OR REGIONAL GOVERNMENTAL PUBLIC HEALTH DEPARTMENT EQUIVALENT DEPARTMENT OR AGENCY; MEMBERS OF A MEDICALLY UNDERSERVED, LOW-INCOME OR MINORITY POPULATIONS IN THE COMMUNITY, OR INDIVIDUALS OR ORGANIZATIONS SERVING OR REPRESENTING THE INTERESTS OF SUCH POPULATIONS AND COMMUNITY LEADERS. DURING THESE INTERVIEWS, THE HEALTH NEEDS OF THE COMMUNITY, ACCESS ISSUES, BARRIERS AND ISSUES RELATED TO SPECIFIC POPULATIONS WERE DISCUSSED. GREAT PLAINS HEALTH PART V, SECTION B, LINE 11: GREAT PLAINS HEALTH LEADERSHIP PRIORITIZED AND DECIDED TO ADDRESS ALL OF THE PRIORITIZED NEEDS IN VARIOUS CAPACITIES THROUGH A HOSPITAL SPECIFIC IMPLEMENTATION PLAN.THE FINAL LIST OF PRIORITIZED NEEDS IS LISTED BELOW IN DESCENDING ORDER:1. INCREASE ACCESS TO MENTAL AND BEHAVIORAL HEALTH CARE.2. INCREASE PREVENTION AND EDUCATION TO REDUCE THE PREVALENCE OF CHRONIC DISEASES, PREVENTABLE CONDITIONS, READMISSIONS AND HIGH MORTALITY RATES.3. INCREASE ACCESS TO SAFE AND AFFORDABLE HOUSING.4. IMPROVE ACCESS TO MEDICAL AND DENTAL CARE.5. RECRUIT AND RETAIN QUALITY HEALTHCARE PROFESSIONALS.THE GREAT PLAINS HEALTH LEADERSHIP TEAM DEVELOPED THE FOLLOWING IMPLEMENTATION PLAN TO IDENTIFY SPECIFIC ACTIVITIES AND SERVICES WHICH DIRECTLY ADDRESS THESE PRIORITIES. THE OBJECTIVES WERE IDENTIFIED BY STUDYING THE PRIORITIZED HEALTH NEEDS, WITHIN THE CONTEXT OF THE HEALTH SYSTEM'S OVERALL STRATEGIC PLAN, AND THE AVAILABILITY OF FINITE RESOURCES. THE PLAN INCLUDES A RATIONALE FOR EACH PRIORITY, FOLLOWED BY OBJECTIVES, SPECIFIC IMPLEMENTATION ACTIVITIES AND THE ANTICIPATED IMPACT AND EVALUATION.PRIORITY ONE: INCREASE ACCESS TO MENTAL AND BEHAVIORAL HEALTH CARE. IMPLEMENTATION ACTIVITIES INCLUDE PARTICIPATING IN COMMUNITY DISCUSSION ABOUT THE EXPANSION OF A DETOX SERVICE IN THE COMMUNITY, IMPLEMENTING TELE-PSYCHIATRY IN MAJOR NURSING HOMES IN PSA, EXPLORE TELEHEALTH IN SCHOOLS, PARTICIPATING IN SUICIDE PREVENTION ACTIVITIES AND RESOURCES, COLLABORATING WITH SCHOOLS AND CONTINUING TO AUGMENT DEPRESSION SCREENING SERVICES.PRIORITY TWO: INCREASE PREVENTION EDUCATION TO REDUCE CHRONIC DISEASES, PREVENTABLE CONDITIONS, READMISSIONS AND HIGH MORTALITY RATES. IMPLEMENTATION ACTIVITIES INCLUDE OFFERING COMMUNITY HEALTH INFORMATION AND CLASSES, OFFERING HEALTH SCREENINGS, PARTICIPATING IN LOCAL SPEAKERS BUREAU TO PROVIDE HEALTH EDUCATION, PROVIDING SPORTS MEDICINE SERVICES AT NO COST TO MORE THAN 15 SCHOOLS, UTILIZE SOCIAL MEDIA TO EDUCATE THE PUBLIC ON CHRONIC DISEASE MANAGEMENT AND TOOLS, CONTINUE TO GROW THE CARE COORDINATION PROGRAM WHICH IS SPECIFICALLY FOCUSED ON IMPROVING OUTCOMES AND REDUCING READMISSIONS FOR HIGH RISK PATIENTS.PRIORITY THREE: INCREASE ACCESS TO SAFE AND AFFORDABLE HOUSING. IMPLEMENTATION ACTIVITIES INCLUDE PARTICIPATING IN LOCAL HOUSING TASK FORCES, ASSISTING WITH DOWN PAYMENT ASSISTANCE FOR REGISTERED NURSES EMPLOYED AT GPH AND ASSISTING FAMILIES OR FRIENDS OF PATIENTS WHO ARE SUBJECT TO HOSPITAL STAYS.PRIORITY FOUR: IMPROVE ACCESS TO MEDICAL AND DENTAL CARE. IMPLEMENTATION ACTIVITIES INCLUDE EXPANDING IN-BOUND AND OUT-BOUND TELEHEALTH SERVICES, IMPLEMENT A TELE-VISIT PROGRAM FOR QUALIFYING PATIENTS, ORGANIZE A TASK FORCE TO IDENTIFY BARRIERS TO PROVIDING INDIGENT DENTAL CARE AND THEN WORK TO OVERCOME THOSE BARRIERS, CONTINUE TO OFFER FINANCIAL SUPPORT THROUGH THE GREAT PLAINS MEDICATION ASSISTANCE PROGRAM TO HELP THOSE WHO CANNOT AFFORD THEIR LONG-TERM MEDICATIONS, CONTINUE TO OFFER A GENEROUS FINANCIAL ASSISTANCE PROGRAM FOR THOSE UNABLE TO PAY FOR EMERGENCY MEDICAL AND NON-ELECTIVE SERVICES WHO MEET REQUIRED ELIGIBILITY GUIDELINES.PRIORITY FIVE: RECRUIT AND RETAIN QUALITY HEALTHCARE PROFESSIONALS. IMPLEMENTATION ACTIVITIES INCLUDE PRIORITIZING PHYSICIAN RECRUITMENT IDENTIFIED IN MEDICAL STAFF NEEDS ASSESSMENT, PARTICIPATING IN PHYSICIAN RETENTION STRATEGIES OUTLINED IN THE ORGANIZATION STRATEGIC PLAN, LEADERSHIP WILL PARTICIPATE IN LOCAL TASK FORCES, BOARDS AND COMMITTEES WHOSE GOAL IS TO IMPROVE THE QUALITY OF LIFE IN THE PSA, CONTINUE NURSE RESIDENCY PROGRAM AND PRECEPTOR PROGRAMS, ENHANCE COMMUNICATION AMONG PROVIDERS AND PATIENTS THROUGH THE CLINICAL INTEGRATION PROGRAM, ENGAGE WITH LOCAL COMMUNITY COLLEGE STUDENTS AND HIGH SCHOOL CAREER ACADEMY CLASSES, CONTINUE PROMOTING SERVICES, OFFERINGS AND SPECIALTIES THROUGH SOCIAL MEDIA, LOCAL NEWSPAPERS, RADIO ADS, DIRECT MAIL AND BILLBOARDS.THERE ARE NOT ANY SIGNIFICANT NEEDS IDENTIFIED IN THE MOST RECENT CHNA THAT ARE NOT BEING ADDRESSED. GREAT PLAINS HEALTH PART V, SECTION B, LINE 13B: IF A PATIENT'S COMBINED OUTSTANDING MEDICAL BILLS, AFTER INSURANCE PAYS, EXCEEDS 7.5% OF THEIR ANNUAL GROSS INCOME, THEY WILL RECEIVE AN ADDITIONAL 25% DISCOUNT ON TOP OF THE FINANCIAL ASSISTANCE DISCOUNT WITH THE COMBINED DISCOUNT NOT TO EXCEED 100% OF THE OUTSTANDING BALANCE. OUTSTANDING MEDICAL BILLS ARE NOT RESTRICTED TO JUST GREAT PLAINS HEALTH SERVICES BUT CAN BE ANY MEDICAL SERVICES. CURRENT STATEMENTS MUST BE PROVIDED SHOWING THE OUTSTANDING BALANCES CLAIMED. GREAT PLAINS HEALTH PART V, SECTION B, LINE 16J: THE WRITTEN FINANCIAL ASSISTANCE POLICY IS ON GPH'S WEBSITE, AS WELL AS PRINTED ON THE BACK SIDE OF EACH PAGE OF THE PATIENT BILLING STATEMENT. POSTERS REGARDING AVAILABILITY OF FINANCIAL ASSISTANCE ARE POSTED AT PATIENT POINTS OF ENTRY THROUGHOUT THE HOSPITAL FACILITY. GREAT PLAINS HEALTH PART V, SECTION B, LINE 20E: GPH WORKS WITH PATIENTS THROUGH PHONE AND IN-PERSON INTERVIEWS TO DETERMINE THE PATIENT'S FINANCIAL SITUATION AND TO DETERMINE IF THE INDIVIDUAL QUALIFIES FOR ASSISTANCE, SUCH AS MEDICAID. 1 1 - NORTH PLATTE SURGERY CENTER LLC 621 WEST FRANCIS STREET NORTH PLATTE NE 69101 OUTPATIENT SURGERIES PART I, LINE 3C: GREAT PLAINS HEALTH (GPH) MAY MAKE A DETERMINATION OF ELIGIBILTY AT ANY STAGE OF THE PROCESS, INCLUDING PAST ASSIGNMENT TO AN OUTSIDE COLLECTION AGENCY. EACH PATIENT REQUESTING FINANCIAL ASSISTANCE WILL BE ASKED TO COMPLETE A FINANCIAL QUESTIONNAIRE AND TO PROVIDE COPIES OF DOCUMENTATION INCLUDING THEIR MOST RECENT FEDERAL INCOME TAX FORM, COPIES OF RECENT PAY STUBS, BANK STATEMENTS AND OTHER APPROPRIATE INDICATORS OF INCOME. A REFERRAL FOR FINANCIAL ASSITANCE MAY BE RECOMMENDED BY THE PATIENT, FAMILY MEMBER, PHYSICIAN OR HOSPITAL DEPARTMENTS AND PROVIDED BASED ON INFORMATION FROM OTHER SOURCES. FULL FINANCIAL ASSISTANCE WILL GENERALLY BE PROVIDED WHEN GROSS HOUSEHOLD INCOME IS EQUAL TO OR LESS THAN 150% OF THE FEDERAL POVERTY GUIDELINES. A SLIDING FEE SCALE DISCOUNT WILL BE APPLIED FOR HOUSEHOLD INCOME UP TO 250% OF THE FEDERAL POVERTY GUIDELINES. THE INCOME LEVELS WILL BE UPDATED ANNUALLY BASED UPON THE MOST CURRENT FEDERAL POVERTY GUIDELINES. PART I, LINE 6A: GPH'S COMMUNITY BENEFIT REPORT IS PREPARED BY THE STAFF OF GPH. PART I, LINE 7: GPH UTILIZED AN OVERALL COST TO CHARGE RATIO (TOTAL EXPENSES - BAD DEBT) / GROSS PATIENT SERVICE REVENUE = PERCENTAGE OF COST TO CHARGE. PART I, LINE 7G: SUBSIDIZED HEALTH SERVICES REPORTED ON LINE 7G INCLUDE TRAINING FOR EMS, OUTREACH, LIFE SUPPORT OUTSIDE, AND ER, TRAUMA, AND LIFE SUPPORT FOR HOSPITAL EDUCATION. 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 $ 889,610. PART II, COMMUNITY BUILDING ACTIVITIES: GPH HAS MANY ACTIVITES TO PROMOTE HEALTH IN THE COMMUNITIES IT SERVES. THESE ACTIVITIES INCLUDE: RECRUITMENT OF PHYSICIANS TO MEET NEED, SPONSORING HEALTH FAIR, SPORTS CLINICS AND SUPPORT GROUPS, PHYSICIANS SERVING ON COMMUNITY BOARDS, EDUCATION PROGRAMS AND MEDICATION ASSISTANCE. THE DONATED SERVICES AND FUNDS HELP FURTHER THE MISSION AND GOALS OF COMMUNITY ORGANIZATIONS WHICH, IN TURN, HELP IMPROVE OVERALL HEALTH STATUS AND QUALITY OF LIFE OF THE COMMUNITIES SERVED. 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 ORGANIZATION PROVIDES SERVICES TO UNINSURED PATIENTS, AND OFFERS THOSE UNINSURED PATIENTS A DISCOUNT, EITHER BY POLICY OR LAW, FROM STANDARD CHARGES. THE ORGANIZATION 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 CONTRACTUAL ADJUSTMENTS, 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 YEARS ENDED DECEMBER 31, 2019 AND 2018, 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: IN ACCORDANCE WITH ITS MISSION OBJECTIVES, THE ORGANIZATION PROVIDES FREE CARE TO PATIENTS WHO LACK FINANCIAL RESOURCES TO PAY FOR THE SERVICES THEY RECEIVE. IT IS THE POLICY OF THE ORGANIZATION NOT TO PURSUE COLLECTION OF AMOUNTS DETERMINED TO BE PATIENT FINANCIAL ASSISTANCE. ACCORDINGLY, THE ORGANIZATION DOES NOT REPORT THESE AMOUNTS IN PATIENT SERVICE REVENUE. THE ESTIMATED COST INCURRED BY THE ORGANIZATION TO PROVIDE THESE SERVICES TO PATIENTS WHO ARE UNABLE TO PAY WAS APPROXIMATELY $7,900,000 AND $5,000,000 FOR THE YEAR ENDED DECEMBER 31, 2019 AND 2018, RESPECTIVELY. THE ESTIMATED COST OF THESE SERVICES WAS DETERMINED USING A RATIO OF COSTS TO STANDARD CHARGES AND APPLYING THAT RATIO TO THE STANDARD CHARGES ASSOCIATED WITH PROVIDING CHARITY CARE FOR THE PERIOD. STANDARD CHARGES ASSOCIATED WITH PROVIDING CARE TO CHARITY PATIENTS INCLUDES ONLY THE RELATED CHARGES FOR THOSE PATIENTS WHO ARE FINANCIALLY UNABLE TO PAY AND QUALIFY UNDER THE ORGANIZATION'S PATIENT FINANCIAL ASSISTANCE/CHARITY CARE POLICY AND THAT DO NOT OTHERWISE QUALIFY FOR REIMBURSEMENT FROM A GOVERNMENTAL PROGRAM. PART III, LINE 4: THE COSTING METHODOLOGY USED IN DETERMINING THE BAD DEBT EXPENSES INCLUDES CALCULATING ON A MONTHLY BASIS THE TOTAL ESTIMATED AMOUNTS BASED ON HISTORICAL WRITE OFFS.THE ORGANIZATION'S FINANCIAL STATEMENTS DO NOT CONTAIN A SPECIFIC FOOTNOTE DESCRIBING BAD DEBT. FOOTNOTES TITLED "PATIENT RECEIVABLES," "PATIENT CARE SERVICE REVENUE, AND "FINANCIAL ASSISTANCE/CHARITY CARE" CAN BE FOUND ON PAGES 9, 11, 12, AND 13 OF THE ATTACHED AUDITED FINANCIAL STATEMENTS. PART III, LINE 8: THE MEDICARE SHORTFALL IS BASED ON THE INFORMATION FROM THE COST REPORT. THESE COSTS ARE MEDICARE REIMBURSABLE COSTS, NOT ALL COSTS. THESE MEDICARE REIMBURSABLE COSTS SHOULD BE TREATED AS A COMMUNITY BENEFIT TO THE EXTENT THAT MEDICARE REVENUES DO NOT COVER THE COSTS. WE DO NOT USE ANY NEGOTIATION TOOL WITH MEDICARE FOR OUR RATES; THE RATES THAT WE ARE PAID ARE MANDATED. HENCE, THIS DOES NOT GIVE US THE ABILITY AS A PROVIDER TO RECEIVE SUFFICIENT REVENUES TO COVER THE MEDICARE COSTS. AS A FACILITY WE ARE WORKING TOWARD COSTS SAVINGS. PART III, LINE 9B: IF THE COLLECTION AGENCY LEARNS INFORMATION THAT INDICATES THAT THE PATIENT MAY BE ELIGIBLE FOR FINANCIAL ASSISTANCE UNDER THE GPH CHARITY CARE POLICY, THEN THE COLLECTION AGENCY SHALL PROMPTLY NOTIFY THE PATIENT FINANCIAL SERVICES DIRECTOR AND CEASE ANY FURTHER COLLECTION ACTIVITY UNTIL GPH DETERMINES THE PATIENT ELIGIBILITY. PART VI, LINE 2: GPH USES STRATEGIC PLANNING PROCESSES, MARKET STUDIES, OPEN FORUMS WITH PHYSICIANS, COMMUNITY FOCUS GROUPS, CUSTOMER SERVICE SURVEYS AND COMMUNITY SURVEYS TO ASSESS THE HEALTH CARE NEEDS OF THE COMMUNITIES GPH SERVES. PATIENT CARE AND SUPPORT SERVICES PROVIDED BY GPH ARE BASED ON GPH'S MISSION, VISION, VALUES AND STANDARDS OF BEHAVIOR. PATIENT CARE AND ANCILLARY SERVICES ARE ORGANIZED IN RESPONSE TO PATIENT NEEDS AS IDENTIFIED THROUGH THE STRATEGIC PLANNING PROCESS. THE GPH STRATEGIC PLAN FOCUSES ON ACHIEVING A CONTINUUM OF CARE TO MEET THE NEEDS OF THE COMMUNITY SERVED. THE STRATEGIC PLANNING PROCESS IS COMPLETED APPROXIMATELY EVERY THREE TO FIVE YEARS. PART VI, LINE 3: FOR PATIENTS THAT GPH DETERMINES ARE FINANCIALLY INDIGENT, THE PATIENT/GUARANTOR WILL BE NOTIFIED AND ASSISTED BY THE GPH PATIENT FINANCIAL SERVICES IN APPLYING FOR FINANCIAL ASSISTANCE. IF NO SOURCE OF FINANCIAL ASSISTANCE IS AVAILABLE, THE ACCOUNT WILL BE REVIEWED FOR A CHARITY ALLOWANCE ACCORDING TO THE HOSPITAL'S CHARITY POLICY (ADMINISTRATIVE POLICY 8210-0008). CASE MANAGERS ARE AVAILABLE AT GPH TO ASSIST PATIENTS AND THEIR FAMILIES WITH THE FINANCIAL AND SOCIAL STRESS THAT ACCOMPANY ILLNESS AND HOSPITALIZATION. CASE MANAGERS HAVE A WORKING KNOWLEDGE OF SOCIAL WORK THEORIES AND ARE ABLE TO ASSIST PATIENTS WITH CONTACTING COMMUNITY AGENCIES THAT CAN ASSIST THEM IN RECOVERY AND FINANCIAL NEEDS. AN OUTSIDE AGENCY IS USED TO PROVIDE ASSISTANCE TO PATIENTS IN DETERMINING THEIR ELIGIBILITY FOR MEDICAID. ONE-ON-ONE FINANCIAL COUNSELING IS AVAILABLE TO EVERY PATIENT, UPON REQUEST. PART VI, LINE 4: GREAT PLAINS HEALTH IS THE ONLY HOSPITAL IN LINCOLN COUNTY AND IS A REGIONAL REFERRAL HOSPITAL FOR NINETEEN OTHER COUNTIES IN NEBRASKA. GPH SERVES A MARKET OF OVER 134,000 RESIDENTS. OVER NINETY-THREE PERCENT OF GPH'S INPATIENT ADMISSIONS COME FROM WITHIN THIS MARKET. SEVENTY-TWO PERCENT OF THE PATIENTS COME FROM LINCOLN COUNTY. THE PRIMARY SERVICE AREA IS DEFINED AS LINCOLN COUNTY. THE SECONDARY SERVICE AREA INCLUDES THE FOLLOWING NINETEEN COUNTIES: ARTHUR, FRONTIER, HOOKER, PERKINS, CHASE, GRANT, GOSPER, KEITH, RED WILLOW, FURNAS, DUNDY, CHERRY, CUSTER, HAYES, LOGAN, THOMAS, DAWSON, HITCHCOCK, AND MCPHERSON. THE TOTAL POPULATION OF THE SECONDARY SERVICE AREA IS ABOUT 99,000.THE POPULATION IN THE SERVICE AREA IS EXPECTED TO CONTINUE THE SHIFT TOWARDS AN AGING POPULATION THAT WOULD INCREASE SERVICE UTILIZATION. HOSPITALS IN THE SECONDARY SERVICE AREA ARE: CHASE COUNTY COMMUNITY HOSPITAL (CHASE COUNTY), CHERRY COUNTY HOSPITAL (CHERRY COUNTY), CALLAWAY DISTRICT HOSPITAL (CUSTER COUNTY), JENNIE M. MELHAM MEMORIAL HOSPITAL (CUSTER COUNTY), COZAD COMMUNITY HOSPITAL (DAWSON COUNTY), GOTHENBURG MEMORIAL HOSPITAL (DAWSON COUNTY), TRI COUNTY HOSPITAL (DAWSON COUNTY), DUNDY COUNTY HOSPITAL (DUNDY COUNTY), TRI VALLEY HEALTH SYSTEM (FURNAS COUNTY), OGALLALA COMMUNITY HOSPITAL (KEITH COUNTY), PERKINS COUNTY HEALTH SERVICES (PERKINS COUNTY), AND COMMUNITY HOSPITAL (RED WILLOW COUNTY).MARKET OVERVIEWPRIMARY SERVICE AREA- CONSISTS OF LINCOLN COUNTY- ACCOUNTS FOR NEARLY 64.8% GPH'S INPATIENT CASES- THE 2019 POPULATION WAS 36,338SECONDARY SERVICE AREA- CONSISTS OF NINETEEN COUNTIES EXTENDING NORTH TO SOUTH DAKOTA, SOUTH TO KANSAS AND WEST TO COLORADO - ACCOUNTS FOR 29.0% OF GPH'S INPATIENT CASES - POPULATION 101,938 IN 2019 - LARGEST EMPLOYER IS UNION PACIFIC PART VI, LINE 5: GPH HAS MANY ACTIVITES TO PROMOTE HEALTH IN THE COMMUNITIES IT SERVES. THESE ACTIVITIES INCLUDE: RECRUITMENT OF PHYSICIANS TO MEET NEED, SPONSORING HEALTH FAIR, SPORTS CLINICS AND SUPPORT GROUPS, PHYSICIANS SERVING ON COMMUNITY BOARDS, EDUCATION PROGRAMS AND MEDICATION ASSISTANCE. THE DONATED SERVICES AND FUNDS HELP FURTHER THE MISSION AND GOALS OF COMMUNITY ORGANIZATIONS WHICH, IN TURN, HELP IMPROVE OVERALL HEALTH STATUS AND QUALITY OF LIFE OF THE COMMUNITIES SERVED. PART VI, LINE 6: GREAT PLAINS HEALTH IS NOT PART OF AN AFFILIATED HEALTHCARE SYSTEM, BUT ASSISTS IN IDENTIFYING AND RECRUITING TOP PHYSICIANS IN NEEDED SPECIALTIES. GPH PROVIDES EDUCATION TO THE COMMUNITY ON VARIOUS HEALTH PROGRAMS FOR EMPLOYEES, EMPLOYERS AND THE COMMUNITY GPH SERVES. MANY MEMBERS OF THE STAFF HOLD SPEAKING ENGAGEMENTS TO PROVIDE MEDICAL INFORMATION TO THE COMMUNITY. THE MEDICATION ASSISTANCE PROGRAM ASSISTS PATIENTS TO FIND OTHER MEANS TO AFFORD THEIR PRESCRIPTIONS.THE HEALTH CENTER OPERATES ACUTE AND PSYCHIATRIC CARE BEDS, A HOME HEALTH AGENCY, AND PROVIDES VARIOUS OUTPATIENT AND EMERGENCY MEDICAL TREATMENT SERVICES. THE AFFILIATES LEASE AND SELL HOME MEDICAL EQUIPMENT TO THE PUBLIC, RENT OFFICE SPACE TO PHYSICIAN PRACTICES, RENT INDEPENDENT LIVING APARTMENTS TO THE ELDERLY AND PROVIDE PHYSICIAN PROFESSIONAL MEDICAL SERVICES AND OTHER PROGRAMS TO PATIENTS. PART VI, LINE 7: GPH DOES NOT FILE A COMMUNITY BENEFIT REPORT WITH ANY STATE. 1 NEBRASKALAND DAYS INC PO BOX 706 NORTH PLATTE NE 69103 470521025 501(C)(4) 16000 SPONSOR OF EVENTS PLATTE RIVER FITNESS SERIES 1300 MCDONALD ROAD NORTH PLATTE NE 69101 476006297 GOVERNMENTAL 17500 SPONSOR OF EVENTS CREATIVITY UNLIMITED ARTS COUNCIL PO BOX 266 NORTH PLATTE NE 69103 202209105 501(C)(3) 20000 FOR RENOVATION TO THE PRAIRIE ARTS CENTER MID-NEBRASKA COMMUNITY FOUNDATION INC 121 N DEWEY ST 112 NORTH PLATTE NE 69103 470604965 501(C)(3) 5250 NORTH PLATTE TRAIL NETWORK NORTH PLATTE AMERICAN RED CROSS 1111 S COTTONWOOD NORTH PLATTE NE 69101 470378981 501(C)(3) 5000 NEBRASKA FLOOD RELIEF 2019 BLUEPRINT NEBRASKA PO BOX 94985 LINCOLN NE 685094985 831190170 501(C)(3) 5000 SUPPORT STATEWIDE STRATEGIC PLAN 5 1 PART I, LINE 2: GREAT PLAINS HEALTH PROVIDES SPONSORSHIP DOLLARS TO CHARITABLE EVENTS IN THE LOCAL AREA. THE ORGANIZATION GIVES TO CHARITABLE ORGANIZATIONS IN THE AREA WHICH BENEFIT THE LOCAL COMMUNITY. X X X X 0 0 0 0 0 0 0 1 0 MICHAEL SIMONSON MD VICE CHIEF OF STAFF/DIRECTOR 1074250 0 70396 0 4847 0 11200 0 40353 0 1201046 0 0 0 RICHARD J MARKIEWICZ MD PHYSICIAN (GPH) 953529 0 975 0 10155 0 11200 0 39053 0 1014912 0 0 0 JOHN HANNAH MD PHYSICIAN (GPH) 799900 0 126423 0 679 0 11200 0 40133 0 978335 0 0 0 HENRIK MIKE-MAYER MD PHYSICIAN (GPH) 834835 0 1423 0 51000 0 11200 0 42853 0 941311 0 0 0 JACOB WIESEN MD PHYSICIAN (GPH) 784244 0 43283 0 31612 0 11200 0 40503 0 910842 0 0 0 ANIL KUMAR MD PHYSICIAN (GPH) 716104 0 27243 0 295 0 11200 0 40503 0 795345 0 0 0 NARAYANA KODURI MD CHIEF OF STAFF/DIRECTOR 655944 0 48507 0 295 0 11200 0 40503 0 756449 0 0 0 JIM SMITH MD DIRECTOR 425462 0 6438 0 3907 0 11200 0 42503 0 489510 0 0 0 MELVIN MCNEA CEO 366785 0 11767 0 1949 0 11200 0 30664 0 422365 0 0 0 THOMAS LEGEL CFO 263413 0 11767 0 1949 0 11200 0 37003 0 325332 0 0 0 PART I, LINE 7 PHYSICIANS ARE ELIGIBLE FOR NON-FIXED QUALITY COMPENSATION BONUSES. QUALITY INDICATORS FOR QUALITY COMPENSATION SHALL BE OBJECTIVE, IDENTIFIABLE STANDARDS THAT ARE ESTABLISHED BY GPH, THE PHYSICIAN AND EXECUTIVE DIRECTOR IN WRITING ON AN ANNUAL BASIS PRIOR TO THE BEGINNING OF A NEW CONTRACT YEAR. SAID QUALITY METRICS SHALL NOT RELATE IN ANY MANNER TO THE VOLUME OR VALUE OF REFERRALS OR OTHER BUSINESS GENERATED BY PHYSICIAN FOR HOSPITAL OR AFFILIATES THEREOF OR BASED UPON REDUCING OR REFUSING CARE PROVIDED TO BENEFICIARIES OF FEDERAL PROGRAMS. THE FOLLOWING PHYSICIANS RECEIVED BONUSES DURING THE YEAR: MICHAEL SIMONSON, MD RICHARD MARKIEWICZ, MD JOHN HANNAH, MD HENRIK MIKE-MAYER, MD JACOB WIESEN, MD ANIL KUMAR, MD NARAYANA KODURI, MD JIM SMITH, MD A HOSPITAL AUTHORITY NO 1 OF LINCOLN COUNTY NEBRASKA 971837633 533282BQ1 2012-11-15 109560864 SEE PART IV CONSTRUCT/UPDATE FACILITIES AND REFUND PRIOR REVENUE BONDS 0 0 0 A 10555000 109877098 1189899 99296247 9390952 2015 1 1 1 1 A 0 0 1 1 0 0.00000 0.00000 0.00000 0 0 1 A 0 0 1 1 0 0 0 1 1 A 1 PART II, LINE 3: THE TOTAL PROCEEDS DO NOT AGREE TO THE ISSUE PRICE IN PART I, COLUMN (E) DUE TO INVESTMENT EARNINGS. PART III, LINE 3(A): WHILE THE HOSPITAL HAS MANAGEMENT OR SERVICE CONTRACTS THAT MAY RESULT IN PRIVATE BUSINESS USE OF BOND-FINANCED PROPERTY, SUCH CONTRACTS DO NOT GIVE RISE TO PRIVATE USE UNDER THE PRINCIPLES OF REV. PROC. 97-13. PART IV; LINE 2C: DATE THE REBATE COMPUTATION WAS PERFORMED: 10/31/2017. NOTE REGARDING THE REBATE COMPUTATION: SINCE THE BOND PROCEEDS HAVE BEEN SPENT AND THE DEBT SERVICE FUND WAS OPERATED ON A BONA FIDE BASIS, NO FURTHER REBATE CALCULATIONS ARE NECESSARY. BYRON L BARKSDALE MR. BARKSDALE, A DIRECTOR, IS THE OWNER OF PATHOLOGY SERVICES, PC 383097 PATHOLOGY SERVICES 0 MICHELLE L MCNEA SPOUSE OF MELVIN MCNEA, OFFICER. 73786 EMPLOYMENT WITH THE HOSPITAL 0 MOLLY H WALKER DAUGHTER OF MELVIN MCNEA, OFFICER. 14340 EMPLOYMENT WITH THE HOSPITAL 0 TRISHA A JORGENSEN STEP-DAUGHTER OF DWIGHT LIVINGSTON, DIRECTOR. 49139 EMPLOYMENT WITH THE HOSPITAL 0 FORM 990, PART VI, SECTION B, LINE 11B COPIES OF THE FORM 990 ARE AVAILABLE TO THE BOARD MEMBERS UPON A WRITTEN REQUEST. FORM 990, PART VI, SECTION B, LINE 12C GPH PROVIDES A CONFLICT OF INTEREST QUESTIONNAIRE TO EACH OFFICER AND DIRECTOR. THE CONFLICT OF INTEREST QUESTIONNAIRE IS COMPLETED AND RETURNED ANNUALLY. ANY QUESTIONABLE SITUATION IS DISCLOSED ON THE QUESTIONNAIRE. FURTHERMORE, ANY POTENTIAL CONFLICTS ARISING DURING THE YEAR ARE TO BE REPORTED TO ADMINISTRATION. THE CONFLICTS REVIEW COMMITTEE REVIEWS ANY TRANSACTIONS THAT MAY BE CONSIDERED TO HAVE A CONFLICT OF INTEREST. FORM 990, PART VI, SECTION B, LINE 15 THE GREAT PLAINS HEALTH BOARD OF DIRECTORS STRIVES TO COMPENSATE OFFICERS AT LEVELS THAT ARE COMPETITIVE IN THE MARKETPLACE, COST EFFECTIVE AND, AS MUCH AS POSSIBLE, INTERNALLY EQUITABLE. THE EXECUTIVE COMMITTEE FOR THE BOARD OF DIRECTORS MEETS NO LESS THAN ANNUALLY TO REVIEW COMPENSATION PACKAGES FOR GPH'S PRESIDENT AND OFFICERS. COMPENSATION DATA IS GATHERED BY AN INDEPENDENT EXECUTIVE COMPENSATION CONSULTANT BY SURVEYING COMPARABLE POSITIONS AT PEER INSTITUTIONS, ENSURING THAT COMPENSATION PACKAGES ARE MEETING FAIR MARKET VALUE. A COMPLETE ANALYSIS OF DATA IS REQUESTED FROM THE CONSULTANT AT LEAST EVERY FOUR YEARS. THE INDEPENDENT EXECUTIVE COMPENSATION CONSULTANT IS ULTIMATELY ACCOUNTABLE TO THE EXECUTIVE COMMITTEE AND THE BOARD. THE EXECUTIVE COMMITTEE ANNUALLY RECOMMENDS TO THE BOARD THE SELECTION/RETENTION OF THE INDEPENDENT EXECUTIVE COMPENSATION CONSULTANT; REVIEWS COMPENSATION RECOMMENDATIONS; AND DETERMINES THOSE OFFICERS FOR WHOM WRITTEN EMPLOYMENT CONTRACTS WILL BE REQUIRED. THE BOARD OF DIRECTORS HAS THE AUTHORITY TO ANNUALLY AUTHORIZE MANAGEMENT TO PROCEED WITH IMPLEMENTATION OF PROPOSED COMPENSATION OF OFFICERS. FORM 990, PART VI, SECTION C, LINE 19 GREAT PLAINS HEALTH DOES NOT MAKE ITS CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC. UPON WRITTEN REQUEST TO THE CFO, GOVERNING DOCUMENTS WILL BE MADE AVAILABLE TO THE PUBLIC FOR REVIEW AT THE HOSPITAL'S ADMINSTRATIVE OFFICE. FORM 990, PART IX, LINE 11G OTHER FEES: PROGRAM SERVICE EXPENSES 1,868,559. MANAGEMENT AND GENERAL EXPENSES 270,802. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,139,361. PHYSICIAN FEES: PROGRAM SERVICE EXPENSES 8,891,710. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 8,891,710. SERVICE CONTRACTS: PROGRAM SERVICE EXPENSES 9,713,383. MANAGEMENT AND GENERAL EXPENSES 458,741. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 10,172,124. CONTRACT LABOR: PROGRAM SERVICE EXPENSES 11,499,975. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 11,499,975. PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 722,761. MANAGEMENT AND GENERAL EXPENSES 730,706. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,453,467. FORM 990, PART XI, LINE 9: CHANGE IN INTEREST IN GREAT PLAINS HEALTH CARE FOUNDATION -6,235,395. FORM 990, PART XII, LINE 2C: THE BOARD OF DIRECTORS OF GREAT PLAINS HEALTH ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF ITS FINANCIAL STATEMENTS AND SELECTION OF AN INDEPENDENT ACCOUNTANT. THIS PROCESS HAS NOT CHANGED FROM PRIOR YEARS. REGENCY RETIREMENT RESIDENCE OF NORTH PLATTE 700 WEST PHILIP NORTH PLATTE NE 69101 470792670 RETIREMENT APARTMENTS NE 501(C)(3) LINE 10 NORTH PLATTE NEBRASKA HOSPITAL CORP 1 NORTH PLATTE SURGERY CENTER LLC 621 W FRANCIS STE 270 NORTH PLATTE NE 69101 800016588 AMBULATORY SURGERY CENTER NE GREAT PLAINS HEALTH RELATED 1529906 2131595 0 1 0.50000 MID-NEBRASKA MEDICAL VENTURES LLC 601 W LEOTA STREET NORTH PLATTE NE 69101 811815353 REAL ESTATE NE GREAT PLAINS HEALTH RELATED 1034018 7649108 0 1 0.60000 GREAT PLAINS HOMECARE EQUIPMENT INC PO BOX 1596 NORTH PLATTE NE 69101 470786518 SELLING OF HOME MEDICAL EQUIPMENT NE GREAT PLAINS HEALTH C 1610991 706644 1.00000 1 GREAT PLAINS PHO INC PO BOX 1167 NORTH PLATTE NE 69103 470786942 DEVELOPMENT OF A NETWORK OF HEALTH CARE PROVIDERS NE GREAT PLAINS HEALTH C 150819 111117 1.00000 1 0 0 0 1 0 0 0 0 0 0 1 1 0 1 1 0 0 0 0 REGENCY RETIREMENT RESIDENCE OF NORTH PLATTE A 38596 FMV