JENNIE M MELHAM MEMORIAL MEDICAL CENTER INC: Form 990, tax year 2015
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- Organization
- JENNIE M MELHAM MEMORIAL MEDICAL CENTER INC (EIN 47-0426530)
- Tax period
- 2015-10-01 to 2016-09-30
- Filed
- 2017-08-10
- IRS object ID
- 201732229349301473
- Schema version
- 2015v3.0
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2017-08-10T14:27:00-05:00 | ReturnTs |
| Tax Period End | 2016-09-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 476097913 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SEIM JOHNSON LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 18081 BURT STREET SUITE 200 | AddressLine1Txt |
| City | OMAHA | CityNm |
| State Abbreviation | NE | StateAbbreviationCd |
| ZIP | 680224722 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2015-10-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 470426530 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | JENNIE M MELHAM MEMORIAL MEDICAL | BusinessNameLine1Txt |
| Business Name Line2 | CENTER INC | BusinessNameLine2Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | JENN | BusinessNameControlTxt |
| Phone | 3088724162 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 250 | AddressLine1Txt |
| City | BROKEN BOW | CityNm |
| State Abbreviation | NE | StateAbbreviationCd |
| ZIP | 68822 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | MICHAEL J STECKLER | PersonNm |
| Person Title | PRESIDENT/CEO | PersonTitleTxt |
| Phone | 3088724162 | PhoneNum |
| Signature | 2017-08-09 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | WENDY R COOLEY | PreparerPersonNm |
| PTIN | P01523804 | PTIN |
| Phone | 4023302660 | PhoneNum |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2015 | TaxYr |
| Build TS | 2021-01-29 14:40:06Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Change | Yes (X) | AddressChangeInd |
| Principal Officer | MICHAEL J STECKLER | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 250 | AddressLine1Txt |
| City | BROKEN BOW | CityNm |
| State Abbreviation | NE | StateAbbreviationCd |
| ZIP | 68822 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $19,194,182 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.MELHAM.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1962 | FormationYr |
| Legal Domicile State | NE | LegalDomicileStateCd |
| Activity Or Mission | THE PRIMARY MISSION AND PURPOSE OF THE JENNIE M. MELHAM MEMORIAL MEDICAL CENTER IS TO IMPROVE THE QUALITY OF LIFE IN ITS SURROUNDING SERVICE AREA BY PROVIDING AN ENVIRONMENT WHICH PROMOTES THE BEST POSSIBLE DELIVERY OF EMERGENCY, INPATIENT, SNF/SWING BED, OUTPATIENT, AMBULATORY CARE, NURSING HOME, DOMICILIARY, AND INDEPENDENT LIVING APARTMENT SERVICES. | ActivityOrMissionDesc |
| Voting Members Governing Body | 5 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 5 | VotingMembersIndependentCnt |
| Total Employee | 204 | TotalEmployeeCnt |
| Total Volunteers | 75 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $48,025 | PYContributionsGrantsAmt |
| CY Contributions Grants | $64,952 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $18,639,708 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $18,489,375 | CYProgramServiceRevenueAmt |
| PY Investment Income | $608,677 | PYInvestmentIncomeAmt |
| CY Investment Income | $492,650 | CYInvestmentIncomeAmt |
| PY Other Revenue | $109,431 | PYOtherRevenueAmt |
| CY Other Revenue | $125,785 | CYOtherRevenueAmt |
| PY Total Revenue | $19,405,841 | PYTotalRevenueAmt |
| CY Total Revenue | $19,172,762 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $8,708,659 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $8,878,989 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $5,402 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $4,356 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $4,356 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $8,571,536 | PYOtherExpensesAmt |
| CY Other Expenses | $8,290,106 | CYOtherExpensesAmt |
| PY Total Expenses | $17,285,597 | PYTotalExpensesAmt |
| CY Total Expenses | $17,173,451 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $2,120,244 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $1,999,311 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $41,681,801 | TotalAssetsBOYAmt |
| Total Assets EOY | $42,219,218 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $3,275,115 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $1,673,768 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $38,406,686 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $40,545,450 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | JMMMC IS DEDICATED TO PROVIDING A CONTINUUM OF HIGH QUALITY, PROFESSIONAL HEALTHCARE SERVICES TO OUR RURAL SERVICE AREA THROUGH A COMPASSIONATE AND CARING STAFF. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $10,878,551 | ExpenseAmt |
| Revenue | $10,274,607 | RevenueAmt |
| Desc | JENNIE MELHAM MEMORIAL MEDICAL CENTER (JMMMC) OPERATES A 23-BED CRITICAL ACCESS HOSPITAL. IN ADDITION, THERE ARE 20 APARTMENTS DESIGNATED FOR THE ELDERLY. JMMMC PROVIDES LABOR AND DELIVERY SERVICES, OUTPATIENT SPECIALTY CLINICS AND SURGERY SERVICES. | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $2,603,078 | ExpenseAmt |
| Revenue | $2,704,549 | RevenueAmt |
| Desc | JMMMC PROVIDES HIGH QUALITY, LOW COST ACUTE CARE TO OUR LOCAL COMMUNITY. THE ACUTE CARE DEPARTMENT EXPERIENCED 2,441 DAYS OF CARE. THIS INCLUDES SWING BED, INPATIENT AND OUTPATIENT OBSERVATION. THIS PROVIDES LOCAL ACCESS FOR OUR RESIDENTS TO OBTAIN QUALITY CARE. | Desc |
Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $821,822 | ExpenseAmt |
| Revenue | $1,026,904 | RevenueAmt |
| Desc | JMMMC PROVIDES 24/7 EMERGENCY SERVICES TO OUR COMMUNITY. WE ENCOUNTERED 2,353 EMERGENCY ROOM VISITS. | Desc |
Prog Srvc Accom Acty Other ProgSrvcAccomActyOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $701,860 | ExpenseAmt |
| Revenue | $4,483,315 | RevenueAmt |
| Desc | JMMMC PROVIDES RADIOLOGY SERVICES WHICH INCLUDES MOBILE MRI SERVICES, X-RAY, DIGITAL MAMMOGRAPHY, BONE DENSITOMETRY AND CT. | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Prog Srvc Expense | $701,860 | TotalOtherProgSrvcExpenseAmt |
| Total Other Prog Srvc Revenue | $4,483,315 | TotalOtherProgSrvcRevenueAmt |
| Total Program Service Expenses | $15,005,311 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | Yes (1) | CreditCounselingInd |
| Temp Or Permanent Endowments | Yes (1) | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | Yes (1) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | 0 | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 30 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 204 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 5 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 5 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | MICHAEL J STECKLER CEO | PersonNm |
| Phone | 3088724160 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 250 | AddressLine1Txt |
| City | BROKEN BOW | CityNm |
| State Abbreviation | NE | StateAbbreviationCd |
| ZIP | 68822 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (9 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| DON CANTRELL | ||||||||
| CHAIRMAN | 4.00 | 4.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| JOHN SMITH | ||||||||
| VICE-CHAIRMAN | 4.00 | 4.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| JOYCE RICHARDSON | ||||||||
| SECRETARY | 4.00 | 4.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| MIKE FLINT | ||||||||
| TREASURER | 4.00 | 4.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| DANIEL ZACH | ||||||||
| MEMBER THRU 01/16 | 4.00 | 4.00 | Yes (X) | $0 | $0 | $0 | ||
| MIKE BORDERS | ||||||||
| MEMBER | 4.00 | 4.00 | Yes (X) | $0 | $0 | $0 | ||
| MICHAEL J STECKLER | ||||||||
| PRESIDENT/CEO | 40.00 | 4.00 | Yes (X) | $217,105 | $0 | $24,047 | ||
| TIMOTHY L SHUCKMAN | ||||||||
| VP/CFO | 40.00 | 0.00 | Yes (X) | $115,776 | $0 | $19,325 | ||
| JEFFREY BREZINA | ||||||||
| PHARMACIST | 40.00 | 0.00 | $115,704 | $0 | $20,383 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $448,585 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $63,755 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 3 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| SANDHILLS ANESTHESIA SERVICES LLC | |||||
| 79568 SUMNER ROAD | BROKEN BOW | NE | 68822 | ANESTHESIA SERVICES | $528,396 |
| BRYAN MEDICAL CENTER | |||||
| PO BOX 82557 | LINCOLN | NE | 68501 | MOBILE PATIENT SERVICES | $232,494 |
| MCMEEN PHYSICAL THERAPY PC | |||||
| PO BOX 435 | BROKEN BOW | NE | 68822 | PHYSICAL THERAPY SERVICES | $166,572 |
| MEDICAL STAFFING NETWORK | |||||
| PO BOX 840292 | DALLAS | TX | 75284 | TEMPORARY STAFFING | $130,692 |
| DAVE MINNICK | |||||
| 152 SOUTH E STREET | BROKEN BOW | NE | 68822 | PHYSICIAN ER SERVICES | $122,663 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 9 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $23,557 | RelatedOrganizationsAmt |
| Government Grants | $16,656 | GovernmentGrantsAmt |
| All Other Contributions | $24,739 | AllOtherContributionsAmt |
| Total Contributions | $64,952 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (4 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| PATIENT SERVICE - PRIVATE PAY | 621110 | $9,353,767 | $9,353,767 |
| PATIENT SERVICE - MEDICARE/MEDICA | 621110 | $8,901,366 | $8,901,366 |
| WELLNESS CENTER REVENUE | 624100 | $87,761 | $87,761 |
| EHR INCENTIVE | 621110 | $42,152 | $42,152 |
Total Oth Program Service Rev TotalOthProgramServiceRevGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $104,329 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $104,329 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $18,489,375 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $491,375 | TotalRevenueColumnAmt |
| Exclusion | $491,375 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $46,220 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $21,420 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $24,800 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $24,800 | TotalRevenueColumnAmt |
| Exclusion | $24,800 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $1,275 | OtherAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $0 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $1,275 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,275 | TotalRevenueColumnAmt |
| Exclusion | $1,275 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | CAFETERIA SALES | Desc |
| Business | 722210 | BusinessCd |
| Total Revenue Column | $100,985 | TotalRevenueColumnAmt |
| Exclusion | $100,985 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $100,985 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $19,172,762 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $18,489,375 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $618,435 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $376,253 | TotalAmt |
| Management And General | $376,253 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,808,543 | TotalAmt |
| Program Services | $5,267,614 | ProgramServicesAmt |
| Management And General | $540,929 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $142,355 | TotalAmt |
| Program Services | $125,263 | ProgramServicesAmt |
| Management And General | $17,092 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,072,431 | TotalAmt |
| Program Services | $1,753,275 | ProgramServicesAmt |
| Management And General | $319,156 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $479,407 | TotalAmt |
| Program Services | $418,186 | ProgramServicesAmt |
| Management And General | $61,221 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $28,095 | TotalAmt |
| Management And General | $28,095 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $56,838 | TotalAmt |
| Management And General | $56,838 | ManagementAndGeneralAmt |
Fees For Services Prof Fundraising FeesForServicesProfFundraising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,356 | TotalAmt |
| Fundraising | $4,356 | FundraisingAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,560,674 | TotalAmt |
| Program Services | $2,506,823 | ProgramServicesAmt |
| Management And General | $53,851 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $389,665 | TotalAmt |
| Program Services | $296,108 | ProgramServicesAmt |
| Management And General | $93,557 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $364,482 | TotalAmt |
| Management And General | $364,482 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $349,593 | TotalAmt |
| Program Services | $325,693 | ProgramServicesAmt |
| Management And General | $23,900 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,229 | TotalAmt |
| Program Services | $964 | ProgramServicesAmt |
| Management And General | $3,265 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $26,952 | TotalAmt |
| Program Services | $10,507 | ProgramServicesAmt |
| Management And General | $16,445 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,639,619 | TotalAmt |
| Program Services | $1,527,525 | ProgramServicesAmt |
| Management And General | $112,094 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $99,526 | TotalAmt |
| Program Services | $80,227 | ProgramServicesAmt |
| Management And General | $19,299 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| MEDICAL SUPPLIES | $1,693,933 | $1,693,933 | |
| BAD DEBT | $608,831 | $608,831 | |
| FOOD | $280,036 | $280,036 | |
| DUES AND SUBSCRIPTIONS | $54,224 | $26,427 | $27,797 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $133,409 | TotalAmt |
| Program Services | $83,899 | ProgramServicesAmt |
| Management And General | $49,510 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $17,173,451 | TotalAmt |
| Program Services | $15,005,311 | ProgramServicesAmt |
| Management And General | $2,163,784 | ManagementAndGeneralAmt |
| Fundraising | $4,356 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $145 | BOYAmt |
| EOY | $145 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,672,623 | BOYAmt |
| EOY | $7,453,487 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,521,985 | BOYAmt |
| EOY | $2,198,574 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,882 | BOYAmt |
| EOY | $11,968 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $489,760 | BOYAmt |
| EOY | $504,952 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $230,378 | BOYAmt |
| EOY | $196,672 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $35,606,367 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $18,685,125 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $18,413,650 | BOYAmt |
| EOY | $16,921,242 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $16,034,890 | BOYAmt |
| EOY | $14,544,287 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $306,488 | BOYAmt |
| EOY | $387,891 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $41,681,801 | BOYAmt |
| EOY | $42,219,218 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,213,417 | BOYAmt |
| EOY | $1,459,720 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,061,698 | BOYAmt |
| EOY | $214,048 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,275,115 | BOYAmt |
| EOY | $1,673,768 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $38,406,686 | BOYAmt |
| EOY | $40,545,450 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $38,406,686 | BOYAmt |
| EOY | $40,545,450 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $41,681,801 | BOYAmt |
| EOY | $42,219,218 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $1,999,311 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $139,453 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Info In Schedule O Part XII | Yes (X) | InfoInScheduleOPartXIIInd |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Agent Trustee Etc | Yes (1) | AgentTrusteeEtcInd |
| Beginning Balance | $893 | BeginningBalanceAmt |
| Additions During Year | $3,281 | AdditionsDuringYearAmt |
| Distributions During Year | $3,107 | DistributionsDuringYearAmt |
| Ending Balance | $1,067 | EndingBalanceAmt |
| Incl Escrow Custodial Acct Liab | 0 | InclEscrowCustodialAcctLiabInd |
CY Endwmt Fund CYEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $34,050 | BeginningYearBalanceAmt |
| Contributions | $1,000 | ContributionsAmt |
| End Year Balance | $35,050 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $33,927 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $123 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $34,050 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $32,550 | BeginningYearBalanceAmt |
| Contributions | $1,250 | ContributionsAmt |
| Investment Earnings Or Losses | $127 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $33,927 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $31,550 | BeginningYearBalanceAmt |
| Contributions | $1,000 | ContributionsAmt |
| End Year Balance | $32,550 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $30,550 | BeginningYearBalanceAmt |
| Contributions | $1,000 | ContributionsAmt |
| End Year Balance | $31,550 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Designated Balance EOY | 0.00000 | BoardDesignatedBalanceEOYPct |
| Prmnnt Endowment Balance EOY | 1.00000 | PrmnntEndowmentBalanceEOYPct |
| Term Endowment Balance EOY | 0.00000 | TermEndowmentBalanceEOYPct |
| Endowments Held Unrelated Org | 0 | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | Yes (1) | EndowmentsHeldRelatedOrgInd |
| Related Org List Sch R | Yes (1) | RelatedOrgListSchRInd |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $70,442 | OtherCostOrOtherBasisAmt |
| Book Value | $70,442 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $18,740,266 | OtherCostOrOtherBasisAmt |
| Depreciation | $9,171,450 | DepreciationAmt |
| Book Value | $9,568,816 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $8,512,415 | OtherCostOrOtherBasisAmt |
| Depreciation | $7,016,539 | DepreciationAmt |
| Book Value | $1,495,876 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $8,283,244 | OtherCostOrOtherBasisAmt |
| Depreciation | $2,497,136 | DepreciationAmt |
| Book Value | $5,786,108 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $16,921,242 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | 457 PENSION LIABILITIES | Desc |
| Amt | $214,048 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $214,048 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART IV, LINE 1B: | JENNIE M. MELHAM MEMORIAL MEDICAL CENTER MANAGES A RESIDENT ACCOUNT TRUST FOR RESIDENTS IN THE LONGTERM CARE UNIT. |
| PART V, LINE 4: | PROVIDE SUPPORT TO ENSURE CONTINUED OPERATION OF JENNIE M. MELHAM MEMORIAL MEDICAL CENTER. |
| PART X, LINE 2: | THE HOSPITAL AND FOUNDATION ARE NOT-FOR-PROFIT CORPORATIONS AS DESCRIBED IN SECTION 501(C)(3) OF THE CODE AND HAVE RECEIVED DETERMINATION LETTERS THAT THEY ARE EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. THE INTERNAL REVENUE SERVICE HAS ESTABLISHED STANDARDS TO BE MET TO MAINTAIN THE HOSPITAL'S TAX EXEMPT STATUS. IN GENERAL, SUCH STANDARDS REQUIRE THE HOSPITAL TO MEET A COMMUNITY BENEFITS STANDARD AND COMPLY WITH VARIOUS LAWS AND REGULATIONS. THE MEDICAL CENTER ACCOUNTS FOR UNCERTAINTIES IN ACCOUNTING FOR INCOME TAX ASSETS AND LIABILITIES USING GUIDANCE INCLUDED IN FASB ASC 740, INCOME TAXES. THE MEDICAL CENTER RECOGNIZES THE EFFECT OF INCOME TAX POSITIONS ONLY IF THOSE POSITIONS ARE MORE LIKELY THAN NOT OF BEING SUSTAINED. AT SEPTEMBER 30, 2016 AND 2015, THE MEDICAL CENTER HAD NO UNCERTAIN TAX POSITIONS ACCRUED. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
| Percent100 | Yes (X) | Percent100Ind |
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
| Percent200 D | Yes (X) | Percent200DInd |
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | Yes (1) | ExpensesExceedBudgetInd |
| Unable To Provide Care | Yes (1) | UnableToProvideCareInd |
| Annual Community Bnft Report | Yes (1) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (1) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $26,076 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $26,076 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00160 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,052,165 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $918,937 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $133,228 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00800 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,078,241 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $918,937 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $159,304 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00960 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $74,588 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $74,588 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00450 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $103,396 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $103,396 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00620 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $36,741 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $36,741 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00220 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $214,725 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $214,725 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01290 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,292,966 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $918,937 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $374,029 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02250 | TotalExpensePct |
Economic Development EconomicDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,500 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $2,500 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00020 | TotalExpensePct |
Community Support CommunitySupportGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $11,811 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $11,811 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00070 | TotalExpensePct |
Coalition Building CoalitionBuildingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,125 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $1,125 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00010 | TotalExpensePct |
Health Improvement Advocacy HealthImprovementAdvocacyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $9,644 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $9,644 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00060 | TotalExpensePct |
Workforce Development WorkforceDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $5,000 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $5,000 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00030 | TotalExpensePct |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $30,080 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $30,080 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00190 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 0 | BadDebtExpenseReportedInd |
| Bad Debt Expense | $608,831 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $0 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $6,792,002 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $6,828,413 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$36,411 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | Yes (X) | CostToChargeRatioInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (1) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | JENNIE M MELHAM MEMORIAL MEDICAL CENTER | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 250 | AddressLine1Txt |
| City | BROKEN BOW | CityNm |
| State Abbreviation | NE | StateAbbreviationCd |
| ZIP | 68822 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | WWW.MELHAM.ORG | WebsiteAddressTxt |
| State License | 100004 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Critical Access Hospital | Yes (X) | CriticalAccessHospitalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
| Other | LONGTERM CARE UNIT, ASSISTED LIVING, AND APARTMENTS | OtherDesc |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | JENNIE M MELHAM MEMORIAL MED CTR INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | 0 | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | 0 | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (1) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Information Gaps | Yes (X) | InformationGapsInd |
| CHNA Conducted | 15 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | 0 | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | Yes (1) | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | WWW.MELHAM.ORG | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 15 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | WWW.MELHAM.ORG | StrategyWebsiteURLTxt |
| Strategy Attached | 0 | StrategyAttachedInd |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 100.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 200.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Explained Basis | 0 | ExplainedBasisInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | WWW.MELHAM.ORG | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | WWW.MELHAM.ORG | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | WWW.MELHAM.ORG | FAPSummaryOnWebsiteURLTxt |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| FAP Notified All Patients | Yes (X) | FAPNotifiedAllPatientsInd |
| Documented Elig Determination | Yes (X) | DocumentedEligDeterminationInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Other Method Used | Yes (X) | OtherMethodUsedInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| JENNIE M. MELHAM MEMORIAL MED. CTR. INC. | PART V, SECTION B, LINE 5: IN ORDER TO UPDATE THE 2013 CHNA THE MEDICAL CENTER'S ADMINISTRATION COLLECTED AND ANALYZED THE MOST CURRENT STATE, FEDERAL AND COMMUNITY DATABASES TO UNDERSTAND THE DEMOGRAPHIC MAKEUP AND TRENDS IN THE SERVICE AREA. A STUDY DONE BY NE PUBLIC POWER ENTITLED ECONOMIC AND DEMOGRAPHIC TRENDS WAS USED IN THE DEVELOPMENT OF THE CHNA DOCUMENT. ALL OF THIS INFORMATION WAS USED TO BETTER UNDERSTAND HOW THESE TRENDS AFFECT THE MEDICAL CENTER'S CURRENT AND FUTURE PROVISION OF HEALTHCARE TO MEET THE COMMUNITY AND COUNTY'S HEALTH NEEDS. THE MEDICAL CENTER PARTNERED WITH THE LOUP BASIN PUBLIC HEALTH DEPARTMENT (LBPHD) IN DEVELOPMENT AND ADMINISTRATION OF A 2016 COMMUNITY THEMES AND STRENGTHS ASSESSMENT SURVEY OF RESIDENTS HEALTHCARE STATUS AND NEEDS IN THE LBPHD'S NINE COUNTY SERVICE AREA. LBPHD USED THE SURVEY INFORMATION TO CREATE THE 2016 MOBILIZING FOR ACTION THROUGH PLANNING AND PARTNERSHIP (MAPP) DOCUMENT FOR THEIR NINE COUNTY SERVICE AREA. THE MEDICAL CENTER PARTICIPATED IN PROMOTING THIS SURVEY IN THE SERVICE AREA. THE HOSPITAL IN ORD, NE, ST. PAUL, NE AND CALLAWAY, NE ALSO PARTICIPATED IN PROMOTING THIS ASSESSMENT SURVEY. THE RESULTS OF THE SURVEY WERE SEGREGATED OUT BY CITY/COUNTY SO THAT THIS INFORMATION COULD BE BROKEN DOWN AND USED BY EACH OF THE HOSPITALS IN THE REGION FOR PLANNING PURPOSES. THE MEDICAL CENTER USED THE BROKEN BOW AND CUSTER COUNTY SURVEY RESULTS IN THE 2016 CHNA PLANNING PROCESS. |
| JENNIE M. MELHAM MEMORIAL MED. CTR. INC. | PART V, SECTION B, LINE 6B: LOUP BASIN PUBLIC HEALTH DEPARTMENT |
| JENNIE M. MELHAM MEMORIAL MED. CTR. INC. | PART V, SECTION B, LINE 11: THE ASSESSMENT SURVEY IDENTIFIED THE FOLLOWING KEY NEED AREAS; 1. ACCESS TO HEALTH SCREENING SERVICES AND HEALTH EDUCATION SERVICES2. ADEQUATE NUTRITION PROGRAMS FOR RESIDENTS OF THE COMMUNITY3. OBESITY/PHYSICAL ACTIVITY/EXERCISE AND WEIGHT LOSS4. ACCESS TO MENTAL HEALTH SERVICESTHE MEDICAL CENTER USED THE INFORMATION FROM THE LBPHD SURVEY AND MAPP PROCESS TO ASSIST IN UPDATING PLANS FOR HEALTH SCREENING, HEALTH EDUCATION AND WELLNESS ACTIVITIES IN THE COMMUNITY. FEEDBACK ON THE CHNA AND CHIP WAS SOUGHT FROM THE PBPHD, MEDICAL CENTER BOARD OF DIRECTORS, LOCAL MEDICAL STAFF AND THE CUSTER COUNTY HEALTH COALITION MEMBERS. ALL FEEDBACK WAS USED TO REFINE THE 2016 CHNA AND CHIP FOR THE MEDICAL CENTER'S SERVICE AREA. SOME OF THE ACTIVITIES THAT WERE DEVELOPED AND IMPLEMENTED BY THE MEDICAL CENTER AS A RESULT OF THE 2016 CHNA AND CHIP FOR OUR SERVICE AREA; A GROUP OF EMPLOYEES AND AREA VOLUNTEERS PLANNED AND IMPLEMENTED THE 2016 HEALTH FAIR. THE COSTS OF THIS EVENT WERE PAID FOR BY THE MEDICAL CENTER. THIS EVENT PROVIDED MANY OPPORTUNITIES FOR HEALTH SCREENING AND PROVISION OF HEALTH INFORMATION TO THE COMMUNITY. THE MEDICAL CENTER DEVELOPED A MULTI-YEAR PROGRAM CALLED "THE WELLNESS CHALLENGE - TOUR DE HEALTH". THIS PROGRAM PROVIDES EDUCATION ON HEALTH TOPICS ALONG WITH EXERCISE AND WEIGHT CONTROL OPPORTUNITIES FOR PARTICIPANTS. A 5K FUN RUN/WALK, WALKING/HIKING BIKING CLUBS, PRIZES AND FINANCIAL AWARDS ARE BEING PROVIDED BY THE MEDICAL CENTER TO GIVE PARTICIPANTS INCENTIVES FOR MAXIMUM PARTICIPATION IN THIS PROGRAM. THE MEDICAL CENTER BECAME THE SITE FOR THE LOCAL WEIGHT WATCHERS PROGRAM AND PROMOTED THIS PROGRAM AMONG MEDICAL CENTER STAFF AND THE PUBLIC. THIS HAS RESULTED IN EXPANDED PARTICIPATION BY MEMBERS OF THE COMMUNITY AND HOSPITAL STAFF. HEALTHY FOOD CHOICES HAVE BEEN DEVELOPED AND INCORPORATED INTO THE MEDICAL CENTERS MENU FOR BOTH PATIENTS AND EMPLOYEES IN THE CAFETERIA. THE MEDICAL CENTER HAS ARRANGED FOR ACCESS TO MENTAL HEALTH SERVICES VIA TELE-VIDEO USING THE EQUIPMENT LOCATED IN THE MEDICAL CENTER'S SPECIALTY CLINIC IN CONJUNCTION WITH THE MID-NE TELEVIDEO NETWORK. THIS HAS BEEN WELL RECEIVED AND HELPS PROVIDE ACCESS TO MANY AREA RESIDENTS TO MENTAL HEALTH CONSULTING SERVICES. LACK OF HUMAN RESOURCES AND OTHER EDUCATIONAL RESOURCES HAS LIMITED THE SUCCESS IN MEETING SOME OF THE GOALS SET IN THE ORIGINAL CHNA. WE ARE TRYING TO ADDRESS THESE ISSUES AND FEEL THAT WE ARE DEVELOPING SOME SOLUTIONS THAT WILL ALLOW US TO HAVE GREATER SUCCESS IN THE NEXT YEAR IN ADDRESSING THESE LOCAL HEALTH NEEDS. |
| JENNIE M. MELHAM MEMORIAL MED. CTR. INC. | PART V, SECTION B, LINE 22D: JMMMC CHARGES THE SAME AMOUNT FOR ALL PATIENTS. PATIENTS FAP-ELIGIBLE HAVE ACCOUNTS ADJUSTED AS A PERCENT OF CHARGES UP TO 100% OF CHARGES BASED UPON A SLIDING SCALE OF ASSISTANCE. THE FAP AND THE SLIDING SCALE OF ASSISTANCE IS BASED ON FEDERAL POVERTY GUIDELINES. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 3 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (3 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| 1 - HERITAGE HALL | ||||
| PO BOX 250 | BROKEN BOW | NE | 68822 | 50-BED LONG TERM CARE CENTER |
| 2 - INDEPENDENCE HALL | ||||
| PO BOX 250 | BROKEN BOW | NE | 68822 | 12-BED ASSISTED LIVING CENTER |
| 3 - LIBERTY SQUARE APARTMENTS | ||||
| PO BOX 250 | BROKEN BOW | NE | 68822 | SENIOR INDEPENDENT LIVING APARTMENT COMPLEX |
Supplemental Information Detail SupplementalInformationDetail (15 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 3C: | PATIENTS MAY COMPLETE AN APPLICATION FOR CHARITY CARE ASSISTANCE. THE APPLICATION IS REVIEWED, VERIFIED, THEN PRESENTED TO THE BOARD OF DIRECTORS FOR A DECISION. ELIGIBILITY IS MAINLY BASED UPON FEDERAL POVERTY GUIDELINES, HOWEVER, OTHER FACTORS WILL COME INTO THE DECISION MAKING PROCESS. THESE FACTORS INCLUDE AGE, EXISTING MEDICAL DEBT, EXISTING NON-MEDICAL DEBT, ASSET OWNERSHIP, INVESTMENTS AND ANY OTHER PERTINENT INFORMATION. THE INCOME GUIDELINES ALLOW FOR ASSISTANCE, BASED UPON A SLIDING SCALE, WHERE INCOME IS FROM ANYWHERE FROM 100% TO 200% OF FEDERAL POVERTY GUIDLINES. |
| PART I, LINE 6A: | JMMMMC'S COMMUNITY BENEFIT REPORT IS NOT PREPARED BY A RELATED ORGANIZATION. |
| PART I, LINE 7: | JMMMMC USED THE SEPTEMBER 30, 2016 COST REPORT AND AUDITED FINANCIAL STATEMENTS TO CALCULATE THE AMOUNT REPORTED ON PART I, LINE 7. JMMMMC TOOK CHARITY CARE CHARGES FROM THE AUDITED FINANCIAL STATMENTS THEN REDUCED THOSE NUMBER TO A COST BASIS USING A COST-TO-CHARGE RATIO. |
| PART I, LN 7 COL(F): | THE BAD DEBT THAT HAS BEEN SUBTRACTED FROM TOTAL EXPENSES TO DETERMINE THE DENOMINATOR IN THE PERCENTAGES FOR COLUMN (F) IS $608,831. |
| PART II, COMMUNITY BUILDING ACTIVITIES: | JMMMC'S COMMUNITY BUILDING ACTIVITIES INCLUDE DISASTER TRAINING ACTIVITIES EXPENSES. JMMMC HAS WORKED WITH COMMUNITY AND REGIONAL ORGANIZATIONS TO DEVELOP DISASTER PLANS AND TRAIN BOTH OUR STAFF AND OTHER EXTERNAL ORGANIZATION'S STAFF FOR ANY POTENTIAL DISASTER RESPONSE. MEETING ROOMS, INCLUDING SOME WITH TELE VIDEO CAPABILITIES ARE AVAILABLE AND USED BY AREA ORGANIZATIONS FREE OF CHARGE. THIS SAVES THESE ORGANIZATIONS SIGNIFICANT SUMS OF MONEY, KEEPING THEIR STAFF AND VOLUNTEERS HERE LOCALLY AS OPPOSED TO COMMUTING UPWARDS OF 200 MILES OR MORE FOR CERTAIN TRAINING EVENTS. |
| PART III, LINE 2: | IN EVALUATING THE COLLECTIBILITY OF ACCOUNTS RECEIVABLE, THE MEDICAL CENTER ANALYZES ITS HISTORICAL COLLECTIONS AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYER SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYER SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE MEDICAL CENTER ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR BAD DEBTS FOR THOSE ACCOUNTS OVER A CERTAIN AGE BASED ON DISCHARGE THAT MAKE THE REALIZATION OF AMOUNTS DUE UNLIKELY. FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), THE MEDICAL CENTER RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES IF NEGOTIATED) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. |
| PART III, LINE 4: | THERE IS NO FOOTNOTE TO JMMMMC'S FINANCIAL STATEMENTS THAT DESCRIBES BAD DEBT. HOWEVER, PAGES 9-11 OF THE ATTACHED AUDITED FINANCIAL STATEMENTS INCLUDE FOOTNOTES TITLED "PATIENT RECEIVABLES, NET", "NET PATIENT SERVICE REVENUE", AND "CHARITY CARE". |
| PART III, LINE 8: | JMMMMC USED THE SEPTEMBER 30, 2016 COST REPORT TO CALCULATE THE AMOUNT REPORTED ON PART III, LINE 6. NO MEDICARE SHORTFALL IS TREATED AS COMMUNITY BENEFITS. |
| PART III, LINE 9B: | IF A PATIENT IS IDENTIFIED THAT IS KNOWN TO QUALIFY FOR FINANCIAL ASSISTANCE, EFFORTS TO REACH OUT TO THIS INDIVIDUAL OR THE INDIVIDUAL'S FAMILY ARE MADE. THE PATIENT OR FAMILY IS REQUESTED TO COMPLETE A CHARITY CARE APPLICATION TO FORMALIZE THE PROCESS. AT THE TIME A COMPLETED APPLICATION IS RECEIVED, ALL COLLECTION EFFORTS ARE CEASED UNTIL A DETERMINATION IS MADE TO THE QUALIFICATION OF THE INDIVIDUAL. |
| PART VI, LINE 2: | THERE IS NO FORMAL POLICY TO ASSESS THE HEALTH CARE NEEDS OF THE COMMUNITY JMMMMC SERVES OTHER THAN THE NEEDS ASSESSMENT THAT WAS CONDUCTED DURING THE 2015 TAX YEAR. |
| PART VI, LINE 3: | ALL PRIVATE PAY PATIENT ACCOUNTS ARE REVIEWED BY THE BILLING STAFF. DURING THE REVIEW PROCESS, PATIENTS THAT ARE IDENTIFIED AS POTENTIAL CANDIDATES FOR ELIGIBILTY AND ASSISTANCE ARE CONTACTED BY THE BILLING STAFF. THE BILLING STAFF ENCOURAGES THE PATIENTS TO CONTACT THE APPROPRIATE AGENCY, MAINLY THE STATE MEDICAID PROGRAM, IN ORDER FOR THEM TO ASCERTAIN THEIR ELIGIBILITY. KNOWN INDIGENT PATIENTS ARE ENCOURAGED TO COMPLETE A CHARITY CARE APPLICATION. |
| PART VI, LINE 4: | JENNIE M. MELHAM MEMORIAL MEDICAL CENTER SERVES THE PEOPLE OF CENTRAL NEBRASKA. LOCATED IN BROKEN BOW, THE COUNTY SEAT, THE PRIMARY SERVICE AREA ENCOMPASSES CUSTER COUNTY, BLAINE COUNTY, THOMAS COUNTY, LOUP COUNTY AND PARTS OF SHERMAN COUNTY. THE SERVICE AREA IS A VERY RURAL AREA. SOME COUNTIES OR PARTS THEREOF SERVED ARE AMONG THE SPARCEST POPULATED AREAS IN THE UNITED STATES. THE PRIMARY SERVICE AREA CONSISTS OF A POPULATION BASIS OF APPROXIMATELY 12,000. A LARGE PORTION OF THE POPULATION SERVED IS OVER AGE 65, RESULTING IN A LARGE NUMBER OF PATIENTS SEEN AT THE MEDICAL CENTER BEING COVERED BY THE MEDICARE PROGRAM. OVER 48% OF GROSS PATIENT REVENUE GENERATED AT THE MEDICAL CENTER IS MEDICARE. ADDITIONALLY, 8% OF GROSS PATIENT REVENUE IS RECEIVED FROM THE MEDICAID PROGRAM. |
| PART VI, LINE 5: | JMMMMC FURTHER PROMOTES THE HEALTH OF THE COMMUNITY BY THE FOLLOWING ACTIONS AND INITIATIVES:JMMMMC PARTICIPATES WITH AREA COMMUNITY COLLEGES BY SERVING AS A CLINICAL ROTATION SITE FOR PHYSICIAN, PHYSICIAN ASSISTANT, PHARMACY, MEDICAL TECHNOLOGY, LPN, RN, MEDICAL TRANSCRIPTIONIST, PHYSICAL THERAPIST AND RADIOLOGY TECHNOLOGY STUDENTS. SPACE AND STAFF OVERSIGHT IS PROVIDED AT NO COST TO THE COLLEGE OR THE STUDENT. JMMMMC ALSO OWNS A RESIDENTIAL HOUSE THAT IS USED TO MAKE FREE HOUSING AVAILABLE TO MANY OF THE STUDENTS WHO COME FROM OUT OF TOWN TO PARTICIPATE IN THE ABOVE STATED TRAINING PROGRAMS. JMMMMC COVERS THE COSTS RELATED TO MAINTENANCE, HEATING, COOLING, LIGHTING, LAUNDRY/LINEN, INTERNET, AND OTHER COSTS FOR THIS HOUSE.JMMMMC ASSISTS WITH LOCAL ECONOMIC DEVELOPMENT CORPORATION PROGRAMS THAT ARE DESIGNED TO PROMOTE INTEREST IN HEALTH CARE CAREERS. IT IS JMMMMC'S HOPE THAT BY CREATING LOCAL INTEREST IN HEALTH CARE CAREERS JMMMMC WILL INSPIRE LOCAL RESIDENTS TO SEEK OUT TRAINING AND THEN RETURN TO THE COMMUNITY TO PURSUE A CAREER IN HEALTH CARE. JMMMMC ALSO PARTNERS WITH LOCAL HIGH SCHOOLS TO PROMOTE HEALTHCARE CAREERS TO LOCAL STUDENTS. A LOCAL "HOME GROWN" WORKFORCE IS ESSENTIAL TO THE OPERATIONS OF JMMMMC AND THUS THE DELIVERY OF HEALTHCARE IN THE AREA. JMMMMC PROVIDES SPEAKERS TO LOCAL SCHOOLS ABOUT HEALTHCARE CAREERS AND PROVIDES TOURS, AS REQUESTED. IN THIS WAY, THE MEDICAL CENTER PROMOTES HEALTH CARE TO A FUTURE WORKFORCE TO CONTINUE LOCAL HEALTHCARE OPERATIONS.NOT ALL PATIENTS HAVE AN ABILITY TO PAY AT TIME OF SERVICE. THEREFORE, JMMMMC HAS DEVELOPED FAIRLY LIBERAL CREDIT GUIDELINES. THESE GUIDELINES DO NOT REQUIRE PAYMENT IN FULL AT TIME OF SERVICE FOR EMERGENT, URGENT OR ELECTIVE SERVICES AND ALLOWS FOR EXTENDED PERIODS OF TIME FOR PAYMENT OF THE DEBT AND NO INTEREST CHARGES ARE INCURRED. EVERY EFFORT IS MADE BY JMMMMC TO KEEP HEALTHCARE AFFORDABLE FOR AREA PATIENTS.MEDICAL CENTER MEETING ROOMS ARE PROVIDED FREE OF CHARGE TO OUTSIDE COMMUNITY SERVICE ORGANIZATIONS WHO ARE PROMOTING HEALTHY LIFESTYLES AND WELLNESS PROMOTION.FREE BROADBAND ACCESS AND COMPUTER RESOURCES ARE PROVIDED FREE OF CHARGE TO LOCAL EMT VOLUNTEERS ALLOWING THEM TO BE MORE EFFICIENT IN THEIR DUTIES. THIS ALLOWS FOR BETTER PARTICIPATION IN THE EMT PROGRAM, THUS EXTENDING EMERGENCY TRANSFER SERVICES TO LOCAL RESIDENTS AND VISITORS. TELEVIDEO EQUIPMENT IS PROVIDED FREE OF CHARGE TO AREA EMT VOLUNTEERS. THIS ALLOWS FOR QUARTERLY TRAINING TO BE PROVIDED LOCALLY THAT IS REQUIRED TO MEET THEIR CONTINUING EDUCATION REQUIREMENTS AND MAINTAIN THEIR CERTIFICATION. THE AVAILABILITY OF THIS SERVICE FOR THE EMTS RESULTS IN SIGNIFICANT SAVINGS IN TERMS OF TRAVEL COSTS AND TRAVEL TIME, HELPING BOOST MORALE AND ENCOURAGING PARTICIPATION OF THIS EXTREMELY IMPORTANT SERVICE. IN THIS RURAL COMMUNITY, THERE IS NO OTHER EMERGENCY AMBULANCE SERVICE OTHER THAN THE LOCAL VOLUNTEERS. LOCAL LAW ENFORCEMENT, THE COUNTY ATTORNEY AND HEALTH DEPARTMENTS ALSO MAKE USE OF THE TELEVIDEO EQUIPMENT TO PROMOTE HEALTH AND SAFETY IN THE COMMUNITY. JMMMMC PROVIDES SPACE FREE OF CHARGE TO THE CUSTER COUNTY COMMUNICATIONS DEPARTMENT. THIS COMMUNICATION CENTER HANDLES ALL RADIO COMMUNICATION BETWEEN THE LAW ENFORCEMENT AGENCIES, FIRE DEPARTMENTS AND EMERGENCY RESPONDERS FOR CUSTER COUNTY. THIS SPACE HOUSES EQUIPMENT THAT SERVES AS A BACKUP TO THEIR PRIMARY COMMUNICATION EQUIPMENT. IN SITUATIONS WHERE THE PRIMARY EQUIPMENT FAILS, THIS ALLOWS THE CUSTER COUNTY TO HAVE EMERGENCY BACKUP EQUIPMENT TO CONTINUE TO PROVIDE THE CRITICAL COMMUNICATION NEEDS OF CUSTER COUNTY.JMMMMC'S EMERGENCY ROOM SERVICES ARE PROVIDED 24 HOURS PER DAY, 7 DAYS PER WEEK. THIS DEPARTMENT OPERATES AT A SIGNIFICANT LOSS BUT ENSURES THAT PATIENTS HAVE ACCESS TO EMERGENCY HEALTHCARE AT ALL TIMES. THE ER IS CERTIFIED AS A LEVEL I TRAUMA CENTER AND THE SERVICE AREA EXTENDS APPROXIMATELY 100 MILES EAST TO WEST ALONG THE HIGHWAY 2 CORRIDOR. THIS IS THE MAIN HIGHWAY HORIZONTALLY BISECTING NEBRASKA AND IS USED BY MANY TRAVELERS AND VACATIONERS, GIVING THEM ACCESS TO EMERGENCY AND TRAUMA CARE. JMMMMC'S EMERGENCY ROOM PROVIDES AROUND 2,400 EMERGENCY ROOM VISITS PER YEAR. THE MEDICAL CENTER PAYS LOCAL PHYSICIANS TO CARRY A PAGER AND BE AVAILABLE TO PROVIDE EMERGENCY ROOMS SERVICES 24 HOURS PER DAY, 365 DAYS PER YEAR. |
| PART VI, LINE 6: | JMMMMC IS NOT PART OF AN AFFILIATED HEALTH CARE SYSTEM. |
| REQUIRED DISCLOSURE IN ACCORDANCE WITH SEC. 7 OF REV. PROC. 2015-21: | THE HOSPITAL'S CHARITY CARE POLICY AS IT EXISTED PRIOR TO 10/1/16 DID NOT ADDRESS THE BASIS FOR CALCULATING AMOUNTS CHARGED TO PATIENTS WHO WERE ELIGIBLE FOR FINANCIAL ASSISTANCE. THE LACK OF THIS LANGUAGE IN THE POLICY WAS AN INADVERTENT ERROR BECAUSE THE HOSPITAL WAS NEVERTHELESS APPLYING DISCOUNTS TO THE AMOUNTS GENERALLY BILLED BY THE HOSPITAL EVEN THOUGH THE REQUIREMENT TO DO SO WAS MISSING IN THE WRITTEN POLICY. CONSEQUENTLY, THERE WERE NO ADVERSE EFFECTS AGAINST ANY INDIVIDUAL PATIENTS. THE HOSPITAL WAS IN THE PROCESS OF REVISING THE FINANCIAL ASSISTANCE POLICY DURING THE 2015 TAX YEAR AND THE ISSUE WAS CORRECTED WHEN THE HOSPITAL'S BOARD OF DIRECTORS ADOPTED ITS CURRENT FINANCIAL ASSISTANCE POLICY WITH AN EFFECTIVE DATE OF 10/1/16. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | MICHAEL J STECKLER | PersonNm |
| Title | PRESIDENT/CEO | TitleTxt |
| Base Compensation Filing Org | $187,105 | BaseCompensationFilingOrgAmt |
| Compensation Based On Rltd Orgs | $0 | CompensationBasedOnRltdOrgsAmt |
| Bonus Filing Organization | $30,000 | BonusFilingOrganizationAmount |
| Bonus Related Organizations | $0 | BonusRelatedOrganizationsAmt |
| Other Compensation Filing Org | $0 | OtherCompensationFilingOrgAmt |
| Other Compensation Rltd Orgs | $0 | OtherCompensationRltdOrgsAmt |
| Deferred Compensation Flng Org | $7,968 | DeferredCompensationFlngOrgAmt |
| Deferred Comp Rltd Orgs | $0 | DeferredCompRltdOrgsAmt |
| Nontaxable Benefits Filing Org | $16,079 | NontaxableBenefitsFilingOrgAmt |
| Nontaxable Benefits Rltd Orgs | $0 | NontaxableBenefitsRltdOrgsAmt |
| Total Compensation Filing Org | $241,152 | TotalCompensationFilingOrgAmt |
| Total Compensation Rltd Orgs | $0 | TotalCompensationRltdOrgsAmt |
| Comp Report Prior990 Filing Org | $0 | CompReportPrior990FilingOrgAmt |
| Comp Report Prior990 Rltd Orgs | $0 | CompReportPrior990RltdOrgsAmt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (8 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 6 | THE MEMBERS CONSIST OF ALL PERSONS WHO CONTRIBUTE TO THE CORPORATION THE SUM OF NOT LESS THAN $25 AT ANY TIME DURING THE EXISTENCE OF THE CORPORATION. |
| FORM 990, PART VI, SECTION A, LINE 7A | THE MEMBERS ELECT THE BOARD OF DIRECTORS AT THE ANNUAL MEETING EACH YEAR. |
| FORM 990, PART VI, SECTION B, LINE 11 | THE FORM 990 WILL BE PRESENTED TO THE BOARD OF DIRECTORS AT A REGULARLY SCHEDULED BOARD MEETING PRIOR TO FILING THE FORM 990. DIRECTORS WILL BE ALLOWED TO REVIEW THE FORM AT THE MEETING. IF ADDITIONAL TIME IS NEEDED ON THEIR PART FOR REVIEW, NECESSARY TIME WILL BE ALLOTTED TO THEM TO REVIEW THE DOCUMENT PRIOR TO FILING. |
| FORM 990, PART VI, SECTION B, LINE 12C | THE CONFLICT OF INTEREST POLICY IS PRESENTED ANNUALLY TO THE BOARD OF DIRECTORS. THIS FORM IS REVIEWED AND DISCUSSED WITH THEM. THE BOARD MEMBERS ARE REQUIRED TO SIGN A CONFLICT OF INTEREST DISCLOSURE FORM. THE CHAIRMAN CAN POINT OUT ANY KNOWN CONFLICTS OF INTEREST. INDIVIDUAL BOARD MEMBERS ARE ALSO RESPONSIBLE FOR DECLARING CONFLICTS AND UPON A CONFLICT, THEY ARE EXCLUDED FROM THE VOTE BUT NOT FROM THE DISCUSSION. |
| FORM 990, PART VI, SECTION B, LINE 15 | THE BOARD OF DIRECTORS IS PRESENTED WITH COMPARATIVE INFORMATION FROM WAGE STUDIES PERFORMED BY THE NEBRASKA HOSPITAL ASSOCIATION. NHA GATHERS THE WAGE INFORMATION ANNUALY FROM MOST, IF NOT ALL, OF THE HOSPITALS IN THE STATE. THE DATA CAN BE ANALYZED IN A VARIETY OF FORMATS, ALLOWING FOR EXCELLENT WAGE COMPARISON. THE BOARD SETS THE CEO SALARY BASED UPON THIS INFORMATION. |
| FORM 990, PART VI, SECTION C, LINE 19 | JENNIE M. MELHAM MEMORIAL MEDICAL CENTER DOES NOT MAKE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, OR FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC. |
| FORM 990, PART IX, LINE 11G | PATIENT TEST FEES: PROGRAM SERVICE EXPENSES 405,100. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 405,100. PHYSICAL THERAPY: PROGRAM SERVICE EXPENSES 117,713. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 117,713. LAB TEST FEES: PROGRAM SERVICE EXPENSES 114,994. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 114,994. LONG TERM CARE FEES: PROGRAM SERVICE EXPENSES 229,574. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 229,574. OTHER FEES FOR SERVICE: PROGRAM SERVICE EXPENSES 900,155. MANAGEMENT AND GENERAL EXPENSES 53,851. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 954,006. PHYSICIAN ER CALL PAYMENTS: PROGRAM SERVICE EXPENSES 739,287. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 739,287. |
| FORM 990, PART XI, LINE 2C: | THE BOARD OF DIRECTORS ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF ITS FINANCIAL STATEMENTS AND SELECTION OF AN INDEPENDENT ACCOUNTANT. THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp
Disregarded Entity Name DisregardedEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | THE MELHAM MEDICAL CENTER FOUNDATION INC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 250 | AddressLine1Txt |
| City | BROKEN BOW | CityNm |
| State Abbreviation | NE | StateAbbreviationCd |
| ZIP | 68822 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 470795995 | EIN |
| Primary Activities | SUPPORTING THE OPERATIONS OF A CRITICAL ACCESS HOSPITAL | PrimaryActivitiesTxt |
| Legal Domicile State | NE | LegalDomicileStateCd |
| Exempt Code Section | 501(C)(3) | ExemptCodeSectionTxt |
| Public Charity Status | LINE 11B, II | PublicCharityStatusTxt |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | JENNIE M MELHAM MEMORIAL MEDICAL CENTER INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Controlled Organization | Yes (1) | ControlledOrganizationInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (1) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | 0 | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (1) | SharingOfFacilitiesInd |
| Paid Employees Sharing | 0 | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |