2017-11-15T10:02:53-06:00 2016-12-31 470617373 CATHOLIC HEALTH INITIATIVES 12809 WEST DODGE ROAD OMAHA NE 68154 990 2016-01-01 470426285 Memorial Community Hospital MEMO 4024262182 810 North 22nd Street Blair NE 68008 Tim Schnack CFO 2017-11-15 true ANGELA NOEL P01051055 4023434413 2016 2017-02-10 21:41:12Z Tim Schnack 810 North 22nd Street Blair NE 68008 35122997 false 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. 10 9 349 100 330 0 66145 64505 35023730 33673856 2849 96270 1008949 1288366 36101673 35122997 1602851 1148492 0 20093703 19080615 0 0 13940587 14411323 35637141 34640430 464532 482567 46130488 45333931 19937711 18658587 26192777 26675344 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. false false 6633002 482425 9148787 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. 2027867 239422 4264237 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. 1965582 196643 3877031 MEMORIAL COMMUNITY HOSPITAL OF BLAIR PROVIDES THE RESIDENTS OF BLAIR AND SURROUNDING COMMUNITIES 24 HOUR EMERGENCY ROOM SERVICES. 16688930 230002 17669425 16688930 230002 17669425 27315381 true true false false false false false false false false true false false false true true false true false false false false false false false false true true false true true true false false false false false false false false false false false false false false false true true true false false true 18 0 true 349 true false false false false false false false false false false X 10 9 false true false false true true false true true false false false true true true false true true true true false X TIM SCHNACK 4024262182 810 NORTH 22ND STREET BLAIR NE 68008 DANIEL HUNT CHAIRMAN 1.0 0.0 X X 0 0 0 RODNEY TRIPLETT Former Vice-Chairman 1.0 0.0 X X 0 0 0 Sarah Chatt Treasurer 1.0 0.0 X X 0 0 0 Thomas Ruma MD VICE CHAIRMAN 1.0 0.0 X X 0 0 0 Neil Smith SECRETARY 1.0 0.0 X X 0 0 0 DONNA MAHLENDORF Board Member 1.0 0.0 X 0 0 0 ANN SCHUMACHER Board Member 1.0 0.0 X 0 0 0 Teresa Hawlik BOARD MEMBER 1.0 0.0 X 0 0 0 John Simonson MD PHYSICIAN 40.0 0.0 X 263724 0 12947 Jim Nelson BOARD MEMBER 1.0 0.0 X 0 0 0 ROBERT Copple FORMER CEO 40.0 1.0 X 0 0 0 Tim Schnack CFO 40.0 1.0 X 0 0 0 TIMOTHY PLANTE CEO 40.0 1.0 X 0 0 0 Maurice Birdwell MD Physician 40.0 0.0 X 280684 0 21266 BRAD SAWTELLE MD Physician 40.0 0.0 X 373934 0 15118 CHARLES SMITH MD PHYSICIAN 40.0 0.0 X 440167 0 16722 Amber Beckenhauer MD PHYSICIAN 40.0 0.0 X 477006 0 19759 Jill Reel MD Physician 40.0 0.0 X 258076 0 5986 2093591 0 91798 22 false true true CHI Health 198 Inverness Drive West Englewood CO 80112 Mgmt Fees/ Health Svcs 1106088 AVEC HEALTH SOLUTIONS 6995 UNION PARK CENTER COTTONWOOD HEIGHTS UT 84047 BUSINESS OFFICE SERVICES 463740 AOSNC LLC 9140 W DODGE RD 100 OMAHA NE 68114 IT SERVICES 343805 Fusion Medical Staffing LLC 11808 Grant Street 100 Omaha NE 68164 Staffing Consultant 317330 QUADRAMED CORPORATION 2300 CORPORATE PARK DR Suite 400 HERNDON VA 20171 SOFTWARE 264086 11 X 55485 9020 64505 Net Patient Revenue 621110 33673856 33673856 0 0 0 0 33673856 96270 330 95940 239855 239855 0 239855 239855 0 0 Rebates 900099 87396 87396 Dietary 621110 76828 76828 Pharmacy 446110 599303 596561 2742 284984 284984 0 0 1048511 35122997 34959480 330 98682 1148492 1148492 15617500 12549027 3068473 338868 272288 66580 2130351 1711787 418564 993896 772766 221130 456026 456026 28440 28440 77460 77460 555688 273715 281973 0 113599 89478 24121 20312 9944 10368 525867 525867 70671 63856 6815 108923 101499 7424 861995 861995 2441257 2425809 15448 171116 12674 158442 Supplies 3507211 2708710 798501 Bad Debt 2486445 2486445 Equipment Rental & Maintenance 850281 638553 211728 Purchased Services 1875436 564593 1310843 260596 97883 162713 0 34640430 27315381 7325049 0 12087228 14069394 5123377 3858832 0 0 0 458105 465713 301261 284318 49634661 29307690 21799777 20326971 6036426 6060684 0 0 324314 268019 46130488 45333931 2977748 3146034 15015135 13712903 1944828 1799650 19937711 18658587 X 26192777 26675344 26192777 26675344 46130488 45333931 482567 0 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 663787 663787 19509494 8711167 10798327 26411301 19033009 7378292 3050079 1563514 1486565 20326971 Estimated Third-Party Settlements 493711 Interest Rate Swap Liability 1305939 MRI Capital Lease 1799650 X Schedule D, Part X, Line 2 FIN 48 (ASC 740) footnote FIN 48 FOOTNOTE IN ACCORDANCE WITH FASB INTERPRETATION NO 48, ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES, INCLUDED IN FASB ASC SUBTOPIC 741-10 - 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 2016 AND 2015 MANAGEMENT DETERMINED THAT THERE ARE NO INCOME TAX POSITIONS REQUIRING RECOGNITION IN THE CONSOLIDATED FINANCIAL STATEMENTS. true true X false false true true false true true 169 675042 675042 0.0195 0 0.0 0 0.0 0 169 675042 0 675042 0.0195 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0 0 0 0 0.0 0 169 675042 0 675042 0.0195 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0 0 0 0 0.0 true 1539110 0 10635449 10081403 554046 X true true 1 1 MEMORIAL COMMUNITY HOSPITAL 810 NORTH 22ND STREET BLAIR NE 68008 WWW.MCHHS.ORG 790001 X X X X MEMORIAL COMMUNITY HOSPITAL 1 false false true X X X X X X X X X 16 true true true true X https://mchhs.org/resources/chip-chna X http://www.threeriverspublichealth.org/HealthDepartment/CommunityConcern/HealthAdvisories.aspx X true 16 true https://mchhs.org/resources/chip-chna false true X X X true true X X X true X https://mchhs.org/services#patient-financial-services X https://mchhs.org/services#patient-financial-services X https://mchhs.org/services#patient-financial-services X X X X true X false X X X X true X false false Schedule H, Part V, Section B, Line 5 Facility , 1 Facility , 1 - MEMORIAL COMMUNITY HOSPITAL. IN 2016, 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, and 2012. THE TRPHD HAS COMPLETED A CHNA AND DEVELOPED A COMMUNITY HEALTH IMPROVEMENT PLAN (CHIP) USING THE MOBILIZING FOR ACTION THROUGH PLANNING AND PARTNERSHIP (MAP) 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 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. Schedule H, Part V, Section B, Line 6a Facility , 1 Facility , 1 - MEMORIAL COMMUNITY HOSPITAL. FREMONT AREA MEDICAL CENTER Schedule H, Part V, Section B, Line 6a Facility , 2 Facility , 2 - MEMORIAL COMMUNITY HOSPITAL. SAUNDERS COUNTY COMMUNITY HOSPITAL Schedule H, Part V, Section B, Line 6b Facility , 1 Facility , 1 - MEMORIAL COMMUNITY HOSPITAL. THREE RIVERS HEALTH DEPARTMENT Schedule H, Part V, Section B, Line 11 Facility , 1 Facility , 1 - MEMORIAL COMMUNITY HOSPITAL. MCH&HS has chosen three strategic issues to work on from the local hospital and clinic level for the next 3-5 years. The process in which these issues were chosen was based on the recurrence of specific issues in Washington County. The first two initiatives fall under the Mental Health, Behavioral Health and Substance Abuse Priority Area. First, MCH is implementing and managing controlled substance refills in a proactive approach to minimize prescription drug abuse in the Washington County area. Second, MCH is implementing Telehealth to include Behavioral and Mental Health coverage by partnering with Catholic Health Initiatives. MCH is focusing on Priority Area, Obesity, Cardiovascular Disease and Diabetes for the third strategic issue. The initiative determined by MCH will be to lower diabetic patients A1C if greater than 9. Schedule H, Part V, Section B, Line 13 Facility , 1 Facility , 1 - MEMORIAL COMMUNITY HOSPITAL. 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. 0 BLAIR CLINIC 812 NORTH 22ND STREET BLAIR NE 68008 PRIMARY CARE CLINIC FORT CALHOUN CLINIC 4929 County Road P-43 FORT CALHOUN NE 68023 PRIMARY CARE CLINIC COTTONWOOD CLINIC 120 SOUTH 9TH STREET TEKAMAH NE 68061 PRIMARY CARE CLINIC BURT-WASHINGTON HOME HEALTH & HOSPICE 670 SOUTH 19TH STREET BLAIR NE 68008 HOME HEALTH AND HOSPICE AGENCY 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. Schedule H, Part I, Line 7 COLUMN(F) THE AMOUNT USED TO COMPUTE COLUMN (F) IS FROM THE AMOUNT REPORTED ON FORM 990, PART IX, LINE 25, COLUMN (A) MINUS BAD DEBT EXPENSE OF $2,486,445. Schedule H, Part III, Line 9b MEMORIAL COMMUNITY HOSPITAL'S COLLECTION POLICY DOES NOT CONTAIN PROVISIONS OF THE COLLECTION PRACTICES TO BE FOLLOWED FOR PATIENTS WHO ARE KNOWN TO QUALIFY FOR CHARITY CARE OR FINANCIAL ASSISTANCE. Schedule H, Part V, Section B, Line 11 MEMORIAL COMMUNITY HOSPITAL WILL PLACE A PRIMARY FOCUS ON ACCESS TO HEALTHCARE. MEMORIAL COMMUNITY HOSPITAL & HEALTH SYSTEM WILL PARTNER WITH THREE RIVERS PUBLIC HEALTH DEPARTMENT TO IDENTIFY RESOURCES AND GAPS IN SERVICE AND POSSIBLE SOLUTION. ALSO PARTNERING ON A GRANT TO AUGMENT AREA ACCESS VIA A CENTRAL CALL LINE AND PHARMACY RESOURCES FOR UNDERINSURED AND UNINSURED PATIENTS. Schedule H, Part I, Line 3c Eligibility criteria for free or discounted care 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. Schedule H, Part I, Line 7g Subsidized Health Services MEMORIAL COMMUNITY HOSPITAL DOES NOT PROVIDE SUBSIDIZED HEALTH SERVICES. Schedule H, Part I, Line 7 Costing Methodology used to calculate financial assistance 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 2016 COST REPORT. Schedule H, Part III, Line 2 Bad debt expense - methodology used to estimate amount COSTING METHODOLOGY FOR AMOUNTS REPORTED ON LINE 2 IS DETERMINED USING THE ORGANIZATION'S COST/CHARGE RATIO OF 61.90%. WHEN DISCOUNTS ARE EXTENDED TO SELF-PAY PATIENTS, THESE PATIENT ACCOUNT DISCOUNTS ARE RECORDED AS A REDUCTION IN REVENUE, NOT AS BAD DEBT EXPENSE. Schedule H, Part III, Line 4 Bad debt expense - financial statement footnote 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. Schedule H, Part III, Line 8 Community benefit & methodology for determining medicare costs THE MEDICARE CHARGES REPORTED ON LINE 5 AND LINE 6 ARE FROM THE 2016 FILED COST REPORT WHICH USED A COST TO CHARGE RATIO. Schedule H, Part III, Line 9b Collection practices for patients eligible for financial assistance 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. Schedule H, Part V, Section B, Line 16a FAP website - MEMORIAL COMMUNITY HOSPITAL: Line 16a URL: https://mchhs.org/services#patient-financial-services; Schedule H, Part V, Section B, Line 16b FAP Application website - MEMORIAL COMMUNITY HOSPITAL: Line 16b URL: https://mchhs.org/services#patient-financial-services; Schedule H, Part V, Section B, Line 16c FAP plain language summary website - MEMORIAL COMMUNITY HOSPITAL: Line 16c URL: https://mchhs.org/services#patient-financial-services; Schedule H, Part VI, Line 2 Needs assessment MEMORIAL COMMUNITY HOSPITAL ASSESSES THE HEALTH CARE NEEDS OF THE COMMUNITIES IT SERVES THROUGH MULTIPLE CHANNELS INCLUDING COMMUNITY HEALTH FAIRS, WELLNESS PROGRAMS, PROVING OCCUPATIONAL HEALTH SERVICES, LISTENING TO PATIENT AND COMMUNITY VOICES AS WELL AS WATCHING NATIONAL TRENDS. Schedule H, Part VI, Line 3 Patient education of eligibility for assistance 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. Schedule H, Part VI, Line 4 Community information MEMORIAL COMMUNITY HOSPITAL AND HEALTH SYSTEMS OF BLAIR, NEBRASKA SERVES BOTH WASHINGTON AND BURT COUNTIES IN NEBRASKA. WASHINGTON COUNTY NEBRASKA HAS AN ESTIMATED POPULATION OF 20,234. CENSUS ESTIMATES SHOW THAT WASHINTON COUNTY'S RACIAL AND ETHNIC MAKE UP IS 95.7% WHITE, 0.9% SOME OTHER RACE ALONE, 0.6% TWO OR MORE RACES, 1.3% HISPANIC OR LATINO. IT'S MEDIAN HOUSEHOLD INCOME IS $59,181 COMPARED TO $47,470 FOR THE STATE OF NEBRASKA. APPROXIMATELY 15% OF THE STUDENTS IN WASHINGTON COUNTY RECEIVE FREE OR REDUCED LUNCH. BURT COUNTY HAS AN ESTIMATED POPULATION OF 6,858. CENSUS ESTIMATES SHOW THAT BURT COUNTY'S RACIAL AND ETHNIC MAKE UP IS 95.9% WHITE, 1.1% SOME OTHER RACE ALONE, 1.2% TWO OR MORE RACES, 1.8% HISPANIC OR LATINO. IT'S MEDIAN HOUSEHOLD INCOME IS $42,242 COMPARED TO $47,470 FOR THE STATE OF NEBRASKA APPROXIMATELY ONE THIRD OF THE STUDENTS IN EACH OF THE SCHOOL DISTRICTS RECEIVE FREE OR REDUCED LUNCH. Schedule H, Part VI, Line 5 Promotion of community health 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 ALEGENT CREIGHTON 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 true CHARITY CARE 169 1148492 BOOK MEDICAL CARE Schedule I, Part I, Line 2 Procedures for monitoring use of grant funds. 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 false false false false false false false false false John Simonson MD PHYSICIAN 188586 0 75138 0 0 0 6961 0 5986 0 276671 0 0 0 Maurice Birdwell MD Physician 278659 0 2025 0 0 0 11569 0 9697 0 301950 0 0 0 BRAD SAWTELLE MD Physician 183614 0 190320 0 0 0 5571 0 9547 0 389052 0 0 0 CHARLES SMITH MD PHYSICIAN 233020 0 207147 0 0 0 7025 0 9697 0 456889 0 0 0 Amber Beckenhauer MD PHYSICIAN 240331 0 218909 0 17766 0 10062 0 9697 0 496765 0 0 0 Jill Reel MD Physician 257195 0 881 0 0 0 0 0 5986 0 264062 0 0 0 A HOSPITAL AUTH #1 OF WASHINGTON CNTY NE 521441599 2007-06-19 9250000 CONSTRUCTION OF FACILITY false false false B HOSPITAL AUTH #1 OF WASHINGTON CNTY NE 521441599 2008-05-22 8000000 CONSTRUCTION OF FACILITY false false false C HOSPITAL AUTH #1 OF WASHINGTON CNTY NE 521441599 2009-02-12 3950000 CONSTRUCTION OF FACILITY false false false A 2521411 9493722 173747 9319975 false false true true B 1980209 8059333 65000 7994333 false false true true C 2985477 3953609 11450 3942159 false false true true A false false false false 0.0 false false B false false false false 0.0 false false false C false false false false 0.0 false false A false false true true false false false false false B false true true true true FNB OF OMAHA 201.0 true false false false false C false false true true true false false false false A false B false C false 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. Form 990, Part III, Line 4d Description of other program services (Expenses $ 16,688,930 including grants of $ 230,002)(Revenue $ 17,669,425) Form 990, Part VI, Line 3 Delegation of management duties 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, Line 11b Review of form 990 by governing body NO REVIEW WAS OR WILL BE CONDUCTED. Form 990, Part VI, Line 19 Required documents available to the public 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 VIII, Line 11d Other Miscellaneous Revenue Other - Total Revenue: 284984, Related or Exempt Function Revenue: 284984, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: ; 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 15A & B 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 A, LINE 6 AND 7A MEMORIAL COMMUNITY HOSPITAL CORPORATION (HOSPITAL) HAS TWO MEMBERS - MEMORIAL COMMUNITY HEALTH SYSTEM, INC (MCHS) AND ALEGENT HEALTH - IMMANUEL MEDICAL CENTER (IMMANUEL). 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 VII, SECTION A, LINE 1A TIM SCHNACK & TIMOTHY PLANTE TIM SCHNACK & TIMOTHY PLANTE ARE THE CFO AND CEO OF MEMORIAL COMMUNITY HOSPITAL, RESPECTFULLY, AND ARE PAID BY CATHOLIC HEALTH INITIATIVES (CHI). MEMORIAL COMMUNITY HOSPITAL PAID CHI FOR THEIR SERVICES PROVIDED. THEREFORE, TIM SCHNACK & TIMOTHY PLANTE SHOW $0 REPORTABLE COMPENSATION FROM THE FILING ORGANIZATION AND FROM ANY RELATED ORGANIZATION AS THEY WERE DIRECTLY PAID BY CHI. FORM 990, PART VI, SECTION B, LINE 16B 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. MEMORIAL COMMUNITY HOSPITAL FOUNDATION 810 N 22ND STREET BLAIR NE 68008 113660156 SUPPORT NE 501(c)(3) 7 NA false MEMORIAL COMMUNITY HEALTH SYSTEM 810 N 22ND STREET BLAIR NE 68008 470718840 HEALTH SYSTEM NE 501(c)(3) 7 NA false MCH AUXILIARY THRIFT SHOP 810 N 22ND STREET BLAIR NE 68008 470748162 AUXILIARY NE 501(c)(3) 7 NA true false false true false false false false false false false false false true false true false true false false MCH AUXILIARY THRIFT SHOP C 65000 BOOK