MEMORIAL COMMUNITY HOSPITAL CORPORATION: Form 990, tax year 2015
View the entire original 990 at ProPublica ↗
- Organization
- MEMORIAL COMMUNITY HOSPITAL CORPORATION (EIN 47-0426285)
- Tax period
- 2015-01-01 to 2015-12-31
- Filed
- 2016-11-14
- IRS object ID
- 201603199349306935
- Schema version
- 2015v2.1
- 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
- Form 990
- Schedule A
- Schedule B
- Schedule D
- Schedule H
- Schedule I
- Schedule J
- Schedule K
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2016-11-14T14:02:05-06:00 | ReturnTs |
| Tax Period End | 2015-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 470617373 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CATHOLIC HEALTH INITIATIVES | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 12809 WEST DODGE ROAD | AddressLine1Txt |
| City | OMAHA | CityNm |
| State Abbreviation | NE | StateAbbreviationCd |
| ZIP | 68154 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2015-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 470426285 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Memorial Community Hospital | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | MEMO | BusinessNameControlTxt |
| Phone | 4024262182 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 810 North 22nd Street | AddressLine1Txt |
| City | Blair | CityNm |
| State Abbreviation | NE | StateAbbreviationCd |
| ZIP | 68008 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Tim Schnack | PersonNm |
| Person Title | CFO | PersonTitleTxt |
| Signature | 2016-11-14 | SignatureDt |
| Discuss With Paid Preparer | Yes (true) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | ANGELA LEA | PreparerPersonNm |
| PTIN | P01051055 | PTIN |
| Phone | 4023434413 | PhoneNum |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2015 | TaxYr |
| Build TS | 2017-02-10 21:41:12Z | BuildTS |
Form 990 IRS990
Principal Ofcr Business Name PrincipalOfcrBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Tim Schnack | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 810 North 22nd Street | AddressLine1Txt |
| City | Blair | CityNm |
| State Abbreviation | NE | StateAbbreviationCd |
| ZIP | 68008 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $36,101,673 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | www.mchhs.org | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1956 | FormationYr |
| Legal Domicile State | NE | LegalDomicileStateCd |
| Activity Or Mission | 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. | ActivityOrMissionDesc |
| Voting Members Governing Body | 7 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 6 | VotingMembersIndependentCnt |
| Total Employee | 363 | TotalEmployeeCnt |
| Total Volunteers | 100 | TotalVolunteersCnt |
| Total Gross UBI | $430 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $67,815 | PYContributionsGrantsAmt |
| CY Contributions Grants | $66,145 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $37,273,177 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $35,023,730 | CYProgramServiceRevenueAmt |
| PY Investment Income | $35,058 | PYInvestmentIncomeAmt |
| CY Investment Income | $2,849 | CYInvestmentIncomeAmt |
| PY Other Revenue | $733,130 | PYOtherRevenueAmt |
| CY Other Revenue | $1,008,949 | CYOtherRevenueAmt |
| PY Total Revenue | $38,109,180 | PYTotalRevenueAmt |
| CY Total Revenue | $36,101,673 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $997,668 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $1,602,851 | CYGrantsAndSimilarPaidAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $19,839,513 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $20,093,703 | CYSalariesCompEmpBnftPaidAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $15,890,673 | PYOtherExpensesAmt |
| CY Other Expenses | $13,940,587 | CYOtherExpensesAmt |
| PY Total Expenses | $36,727,854 | PYTotalExpensesAmt |
| CY Total Expenses | $35,637,141 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $1,381,326 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $464,532 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $48,798,478 | TotalAssetsBOYAmt |
| Total Assets EOY | $46,130,488 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $23,070,233 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $19,937,711 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $25,728,245 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $26,192,777 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | 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. | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $6,648,741 | ExpenseAmt |
| Grant | $462,251 | GrantAmt |
| Revenue | $9,227,146 | RevenueAmt |
| Desc | 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. | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $2,161,393 | ExpenseAmt |
| Grant | $205,224 | GrantAmt |
| Revenue | $4,096,537 | RevenueAmt |
| Desc | MEMORIAL COMMUNITY HOSPITAL OF BLAIR PROVIDES THE RESIDENTS OF BLAIR AND SURROUNDING COMMUNITIES 24 HOUR EMERGENCY ROOM SERVICES. | Desc |
Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $1,428,196 | ExpenseAmt |
| Grant | $229,377 | GrantAmt |
| Revenue | $4,578,678 | RevenueAmt |
| Desc | 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. | Desc |
Prog Srvc Accom Acty Other ProgSrvcAccomActyOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $18,668,006 | ExpenseAmt |
| Grant | $705,999 | GrantAmt |
| Revenue | $18,121,239 | RevenueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Prog Srvc Expense | $18,668,006 | TotalOtherProgSrvcExpenseAmt |
| Total Other Prog Srvc Grant | $705,999 | TotalOtherProgSrvcGrantAmt |
| Total Other Prog Srvc Revenue | $18,121,239 | TotalOtherProgSrvcRevenueAmt |
| Total Program Service Expenses | $28,906,336 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (true) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (true) | ScheduleBRequiredInd |
| Political Campaign Acty | false | PoliticalCampaignActyInd |
| Lobbying Activities | false | LobbyingActivitiesInd |
| Subject To Proxy Tax | false | SubjectToProxyTaxInd |
| Donor Advised Fund | false | DonorAdvisedFundInd |
| Conservation Easements | false | ConservationEasementsInd |
| Collections Of Art | false | CollectionsOfArtInd |
| Credit Counseling | false | CreditCounselingInd |
| Temp Or Permanent Endowments | false | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (true) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | false | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | false | ReportProgramRelatedInvstInd |
| Report Other Assets | false | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (true) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (true) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | false | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (true) | ConsolidatedAuditFinclStmtInd |
| School Operating | false | SchoolOperatingInd |
| Foreign Office | false | ForeignOfficeInd |
| Foreign Activities | false | ForeignActivitiesInd |
| More Than5000 K To Org | false | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividualsInd |
| Professional Fundraising | false | ProfessionalFundraisingInd |
| Fundraising Activities | false | FundraisingActivitiesInd |
| Gaming Activities | false | GamingActivitiesInd |
| Operate Hospital | Yes (true) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (true) | AuditedFinancialStmtAttInd |
| Grants To Organizations | false | GrantsToOrganizationsInd |
| Grants To Individuals | Yes (true) | GrantsToIndividualsInd |
| Schedule J Required | Yes (true) | ScheduleJRequiredInd |
| Tax Exempt Bonds | Yes (true) | TaxExemptBondsInd |
| Invest Tax Exempt Bonds | false | InvestTaxExemptBondsInd |
| Escrow Account | false | EscrowAccountInd |
| On Behalf Of Issuer | false | OnBehalfOfIssuerInd |
| Engaged In Excess Benefit Trans | false | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | false | PYExcessBenefitTransInd |
| Loan Outstanding | false | LoanOutstandingInd |
| Grant To Related Person | false | GrantToRelatedPersonInd |
| Business Rln With Org Mem | false | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | false | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | false | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | false | DeductibleNonCashContriInd |
| Deductible Art Contribution | false | DeductibleArtContributionInd |
| Terminate Operations | false | TerminateOperationsInd |
| Partial Liquidation | false | PartialLiquidationInd |
| Disregarded Entity | false | DisregardedEntityInd |
| Related Entity | Yes (true) | RelatedEntityInd |
| Related Organization Ctrl Ent | false | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | false | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | false | ActivitiesConductedPrtshpInd |
| Schedule O Required | false | ScheduleORequiredInd |
| IRP Document | 28 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (true) | BackupWthldComplianceInd |
| Employee | 363 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (true) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | false | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | false | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | false | TaxablePartyNotificationInd |
| Nondeductible Contributions | false | NondeductibleContributionsInd |
| Indoor Tanning Services | false | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 7 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 6 | IndependentVotingMemberCnt |
| Family Or Business Rln | false | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | Yes (true) | DelegationOfMgmtDutiesInd |
| Change To Org Documents | false | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (true) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (true) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | false | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (true) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (true) | MinutesOfCommitteesInd |
| Officer Mailing Address | false | OfficerMailingAddressInd |
| Local Chapters | false | LocalChaptersInd |
| Form990 Provided To Gvrn Body | false | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (true) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (true) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (true) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | false | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (true) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (true) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (true) | CompensationProcessOtherInd |
| Investment In Joint Venture | false | InvestmentInJointVentureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | TIM SCHNACK | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 4024262182 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 810 NORTH 22ND STREET | AddressLine1Txt |
| City | BLAIR | CityNm |
| State Abbreviation | NE | StateAbbreviationCd |
| ZIP | 68008 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (14 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 |
|---|---|---|---|---|---|---|---|---|
| LARRY BROWN MD | ||||||||
| Secretary | 1.0 | 0.0 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| DANIEL HUNT | ||||||||
| CHAIRMAN | 1.0 | 0.0 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| RODNEY TRIPLETT | ||||||||
| Vice-Chairman | 1.0 | 0.0 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| Sarah Chatt | ||||||||
| Treasurer | 1.0 | 0.0 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| DONNA MAHLENDORF | ||||||||
| Board Member | 1.0 | 0.0 | Yes (X) | $0 | $0 | $0 | ||
| ANN SCHUMACHER | ||||||||
| Board Member | 1.0 | 0.0 | Yes (X) | $0 | $0 | $0 | ||
| John Simonson MD | ||||||||
| PHYSICIAN | 40.0 | 0.0 | Yes (X) | $223,302 | $0 | $10,747 | ||
| ROBERT Copple | ||||||||
| CEO | 40.0 | 1.0 | Yes (X) | $0 | $0 | $0 | ||
| Tim Schnack | ||||||||
| CFO | 40.0 | 1.0 | Yes (X) | $0 | $0 | $0 | ||
| Maurice Birdwell MD | ||||||||
| Physician | 40.0 | 0.0 | $265,517 | $0 | $19,802 | Yes (X) | ||
| BRAD SAWTELLE MD | ||||||||
| Physician | 40.0 | 0.0 | $271,136 | $0 | $14,469 | Yes (X) | ||
| Andrea Vermaas MD | ||||||||
| Physician | 40.0 | 0.0 | $361,313 | $0 | $4,497 | Yes (X) | ||
| CHARLES SMITH | ||||||||
| PHYSICIAN | 40.0 | 0.0 | $389,474 | $0 | $15,322 | Yes (X) | ||
| Amber Beckenhauer | ||||||||
| PHYSICIAN | 40.0 | 0.0 | $396,409 | $0 | $16,328 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,907,151 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $81,165 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 24 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | false | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (true) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | Yes (true) | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt | Address Line2ContractorAddress/USAddress/AddressLine2Txt |
|---|---|---|---|---|---|---|
| CHI Health | ||||||
| 198 Inverness Drive West | Englewood | CO | 80112 | Mgmt Fees/ Health Svcs | $1,346,477 | |
| Cardinal Health 110 Inc | ||||||
| 7000 Cardinal Place | Dublin | OH | 43017 | Pharmaceuticals | $1,123,685 | |
| Fusion Medical Staffing LLC | ||||||
| 11808 Grant Street | Omaha | NE | 68164 | Staffing Consultant | $458,443 | 100 |
| McKinnis Roofing | ||||||
| 164 South 1st Street | Blair | NE | 68008 | Construction | $439,082 | |
| Aureus Group | ||||||
| 13609 California Street | Omaha | NE | 68154 | Staffing Consultant | $421,412 | Suite 100 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 23 | CntrctRcvdGreaterThan100KCnt |
| Info In Schedule O Part VIII | Yes (X) | InfoInScheduleOPartVIIIInd |
| Related Organizations | $66,145 | RelatedOrganizationsAmt |
| Total Contributions | $66,145 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | Net Patient Revenue | Desc |
| Business | 621110 | BusinessCd |
| Total Revenue Column | $35,023,730 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $35,023,730 | RelatedOrExemptFuncIncomeAmt |
Total Oth Program Service Rev TotalOthProgramServiceRevGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $0 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $0 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $35,023,730 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $2,849 | TotalRevenueColumnAmt |
| Unrelated Business Revenue | $430 | UnrelatedBusinessRevenueAmt |
| Exclusion | $2,419 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $218,020 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $218,020 | RealAmt |
| Personal | $0 | PersonalAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $218,020 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $218,020 | RelatedOrExemptFuncIncomeAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $0 | SecuritiesAmt |
| Other | $0 | OtherAmt |
Other Revenue Misc OtherRevenueMiscGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt | ExclusionExclusionAmt |
|---|---|---|---|---|
| Rebates | 900099 | $27,374 | $27,374 | |
| Dietary | 621110 | $78,470 | $78,470 | |
| Pharmacy | 446110 | $583,532 | $574,453 | $9,079 |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $101,553 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $101,553 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $0 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $790,929 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $36,101,673 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $36,023,600 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $430 | UnrelatedBusinessRevenueAmt |
| Exclusion | $11,498 | ExclusionAmt |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,602,851 | TotalAmt |
| Program Services | $1,602,851 | ProgramServicesAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $16,453,034 | TotalAmt |
| Program Services | $13,201,758 | ProgramServicesAmt |
| Management And General | $3,251,276 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $368,803 | TotalAmt |
| Program Services | $295,924 | ProgramServicesAmt |
| Management And General | $72,879 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,262,621 | TotalAmt |
| Program Services | $1,815,506 | ProgramServicesAmt |
| Management And General | $447,115 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,009,245 | TotalAmt |
| Program Services | $765,575 | ProgramServicesAmt |
| Management And General | $243,670 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $484,762 | TotalAmt |
| Management And General | $484,762 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,695 | TotalAmt |
| Management And General | $5,695 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $133,360 | TotalAmt |
| Management And General | $133,360 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $773,514 | TotalAmt |
| Program Services | $346,222 | ProgramServicesAmt |
| Management And General | $427,292 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $97,470 | TotalAmt |
| Program Services | $77,047 | ProgramServicesAmt |
| Management And General | $20,423 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $20,360 | TotalAmt |
| Program Services | $10,593 | ProgramServicesAmt |
| Management And General | $9,767 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $473,948 | TotalAmt |
| Program Services | $473,948 | ProgramServicesAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $80,223 | TotalAmt |
| Program Services | $71,140 | ProgramServicesAmt |
| Management And General | $9,083 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $102,842 | TotalAmt |
| Program Services | $100,825 | ProgramServicesAmt |
| Management And General | $2,017 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $926,182 | TotalAmt |
| Program Services | $926,182 | ProgramServicesAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,614,958 | TotalAmt |
| Program Services | $2,599,510 | ProgramServicesAmt |
| Management And General | $15,448 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $96,775 | TotalAmt |
| Program Services | $8,389 | ProgramServicesAmt |
| Management And General | $88,386 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| Supplies | $3,435,639 | $2,907,856 | $527,783 |
| Bad Debt | $2,366,117 | $2,366,117 | |
| Equipment Rental & Maintenance | $882,506 | $694,030 | $188,476 |
| Purchased Services | $1,210,729 | $517,278 | $693,451 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $235,507 | TotalAmt |
| Program Services | $125,585 | ProgramServicesAmt |
| Management And General | $109,922 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $35,637,141 | TotalAmt |
| Program Services | $28,906,336 | ProgramServicesAmt |
| Management And General | $6,730,805 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,117,017 | BOYAmt |
| EOY | $12,087,228 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,244,050 | BOYAmt |
| EOY | $5,123,377 | EOYAmt |
Receivables From Officers Etc ReceivablesFromOfficersEtcGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $555,560 | BOYAmt |
| EOY | $458,105 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $254,947 | BOYAmt |
| EOY | $301,261 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $48,681,657 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $26,881,880 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $24,065,059 | BOYAmt |
| EOY | $21,799,777 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,029,329 | BOYAmt |
| EOY | $6,036,426 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,532,516 | BOYAmt |
| EOY | $324,314 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $48,798,478 | BOYAmt |
| EOY | $46,130,488 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,694,637 | BOYAmt |
| EOY | $2,977,748 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $16,552,833 | BOYAmt |
| EOY | $15,015,135 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,822,763 | BOYAmt |
| EOY | $1,944,828 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $23,070,233 | BOYAmt |
| EOY | $19,937,711 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $25,707,596 | BOYAmt |
| EOY | $26,192,777 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $20,649 | BOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $25,728,245 | BOYAmt |
| EOY | $26,192,777 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $48,798,478 | BOYAmt |
| EOY | $46,130,488 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $464,532 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | false | AccountantCompileOrReviewInd |
| FS Audited | Yes (true) | 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 (true) | AuditCommitteeInd |
| Federal Grant Audit Required | false | 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
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $822,200 | OtherCostOrOtherBasisAmt |
| Book Value | $822,200 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $19,509,494 | OtherCostOrOtherBasisAmt |
| Depreciation | $7,963,417 | DepreciationAmt |
| Book Value | $11,546,077 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $25,545,584 | OtherCostOrOtherBasisAmt |
| Depreciation | $17,535,992 | DepreciationAmt |
| Book Value | $8,009,592 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $2,804,379 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,382,471 | DepreciationAmt |
| Book Value | $1,421,908 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $21,799,777 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (3 entries)
| DescDesc | AmtAmt |
|---|---|
| Estimated Third-Party Settlements | $385,950 |
| Interest Rate Swap Liability | $1,558,878 |
| MRI Capital Lease |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $1,944,828 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Schedule D, Part X, Line 2 FIN 48 (ASC 740) footnote | FormAndLineReferenceDesc |
| Explanation | 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 2015 AND 2014 MANAGEMENT DETERMINED THAT THERE ARE NO INCOME TAX POSITIONS REQUIRING RECOGNITION IN THE CONSOLIDATED FINANCIAL STATEMENTS. | ExplanationTxt |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (true) | FinancialAssistancePolicyInd |
| Written Policy | Yes (true) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | false | FPGReferenceFreeCareInd |
| FPG Reference Discounted Care | false | FPGReferenceDiscountedCareInd |
| Free Care Medically Indigent | Yes (true) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (true) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | false | ExpensesExceedBudgetInd |
| Annual Community Bnft Report | Yes (true) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (true) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 170 | PersonsServedCnt |
| Total Community Benefit Expns | $1,363,451 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $1,363,451 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0383 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Unreimbursed Costs UnreimbursedCostsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 0 | ActivitiesOrProgramsCnt |
| Persons Served | 170 | PersonsServedCnt |
| Total Community Benefit Expns | $1,363,451 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,363,451 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0383 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Research ResearchGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 0 | ActivitiesOrProgramsCnt |
| Persons Served | 0 | PersonsServedCnt |
| Total Community Benefit Expns | $0 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 0 | ActivitiesOrProgramsCnt |
| Persons Served | 170 | PersonsServedCnt |
| Total Community Benefit Expns | $1,363,451 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,363,451 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0383 | TotalExpensePct |
Physical Imprv And Housing PhysicalImprvAndHousingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Economic Development EconomicDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Community Support CommunitySupportGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Environmental Improvements EnvironmentalImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Leadership Development LeadershipDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Coalition Building CoalitionBuildingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Health Improvement Advocacy HealthImprovementAdvocacyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Workforce Development WorkforceDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Other Communtity Building Acty OtherCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 0 | ActivitiesOrProgramsCnt |
| Persons Served | 0 | PersonsServedCnt |
| Total Community Benefit Expns | $0 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (true) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $1,457,528 | BadDebtExpenseAmt |
| Reimbursed By Medicare | $11,397,738 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $11,770,318 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$372,580 | 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 (true) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | false | 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 | MEMORIAL COMMUNITY HOSPITAL | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 810 NORTH 22ND STREET | AddressLine1Txt |
| City | BLAIR | CityNm |
| State Abbreviation | NE | StateAbbreviationCd |
| ZIP | 68008 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | WWW.MCHHS.ORG | WebsiteAddressTxt |
| State License | 790001 | 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 |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MEMORIAL COMMUNITY HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | false | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | false | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (true) | 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 | 13 | CHNAConductedYr |
| Take Into Account Others Input | Yes (true) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | Yes (true) | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | Yes (true) | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (true) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | https://mchhs.org/images/AssessmentSummary.pdf | OwnWebsiteURLTxt |
| Other Website | Yes (X) | OtherWebsiteInd |
| Other Website URL | http//www.threeriverspublichealth.org/wp-content/uploads/2013/06/Final-CH A | OtherWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (true) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 13 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (true) | StrategyPostedWebsiteInd |
| Strategy Website URL | http//mchhs.org/resources/publication-press | StrategyWebsiteURLTxt |
| Strategy Attached | false | StrategyAttachedInd |
| Organization Incur Excise Tax | false | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (true) | EligCriteriaExplainedInd |
| Income Level Criteria | Yes (X) | IncomeLevelCriteriaInd |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Explained Basis | Yes (true) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (true) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Includes Publicity Measures | Yes (true) | IncludesPublicityMeasuresInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Notice Displayed | Yes (X) | FAPNoticeDisplayedInd |
| FAP Actions On Nonpayment | Yes (true) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | false | CollectionActivitiesInd |
| FAP Notified Upon Admission | Yes (X) | FAPNotifiedUponAdmissionInd |
| FAP Notified Before Discharge | Yes (X) | FAPNotifiedBeforeDischargeInd |
| FAP Notified All Patients | Yes (X) | FAPNotifiedAllPatientsInd |
| Documented Elig Determination | Yes (X) | DocumentedEligDeterminationInd |
| Nondis Emergency Care Policy | Yes (true) | NondisEmergencyCarePolicyInd |
| Other Method Used | Yes (X) | OtherMethodUsedInd |
| Amounts Generally Billed | false | AmountsGenerallyBilledInd |
| Gross Charges | false | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Schedule H, Part V, Section B, Line 5 Facility , 1 | Facility , 1 - MEMORIAL COMMUNITY HOSPITAL. IN 2012, LEADERSHIP FROM MEMORIAL COMMUNITY HOSPITAL COLLABORATED WITH THE THREE RIVERS HEALTH DEPARTMENT (TRHD) TO CONDUCT A COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) FOR THE THREE RURAL COUNTIES SERVED BY THE TRHD, 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 AND 2007. THE TRHD 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. FOCUS GROUPS WERE AN IMPORTANT COMPONENT OF THE CHNA. DURING THE MONTHS OF MARCH THROUGH SEPTEMBER, 2012 FOCUS GROUPS WERE HELD. FOCUS GROUP WERE BETWEEN 45 MINUTES AND ONE HOUR AND ALL GROUPS WERE ASKED THE SAME SERIES OF QUESTIONS. ALL RESPONSES RECORDED WERE ANONYMOUS SO THAT INDIVIDUALS WOULD FEEL COMFORTABLE ANSWERING QUESTIONS. MCH&HS LEADERS HAVE PARTICIPATED IN FORUMS AND COMMUNITY DIALOGUES TO REVIEW THE CHNA AND IDENTIFY COMMUNITY HEALTH PRIORITIES, ASSETS AND GAPS IN WASHINGTON COUNTY. 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 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. COMMUNITY HEALTH IMPROVEMENT PLAN UPDATE ACCESS TO HEALTH CARE 1. A RURAL HEALTH NETWORK HAS BEEN DEVELOPED TO COLLABORATE ON PROJECTS OF MUTUAL CONCERN, COORDINATE RESOURCES, AND ULTIMATELY DEVELOP AND MAINTAIN AN INTEGRATED RURAL HEALTH NETWORK FOR DODGE, SAUNDERS AND WASHINGTON COUNTIES IN NEBRASKA. 2. A HRSA RURAL HEALTH NETWORK DEVELOPMENT GRANT HAS BEEN WRITTEN AND SUBMITTED. 3. THE RURAL HEALTH NETWORK MEETS MONTHY - CEO ATTENDS THE MEETINGS. HEALTHY LIFESTYLE BEHAVIORS WITH A FOCUS ON DIABETS, OBESITY, HEALTHY EATING AND PHYSICAL ACTIVITY. (1) THE PROVIDERS CONTINUE TO PROVIDE FOCUSED DIABETES EDUCATION WITH ALL PATIENTS THAT ENTER OUR SYSTEM. (2) THE DATABASE IS BEING DEVELOPED SO THAT WE (MCH&HS) MAY EMAIL, TEXT, OR MAIL ADDITIONAL INFORMATION. (3) ALL PROVIDERS HAVE RX PADS THAT THEY CAN GIVE TO PATIENTS THAT WILL ALLOW THEM 1 FREE MONTH AT THE YMCA. (4) THE HEALTHY FAMILIES PROGRAM - THE YMCA, THREE RIVERS PUBLIC HEALTH, UNL EXTENSION OFFICE AND MCH&HS HAVE HAD AN ORGANIZATION MEETING AND OTHER MEETINGS ARE PLANNED. (5) ON MARCH 5TH, MCH&HS HAD A KICKOFF FOR THE "OWL" (OUR WEIGHT LOSS) PROGRAM. THIS IS AN 8 WEEK PROGRAM THAT ENCOURAGES EXERCISE AND HEALTHY EATING. |
| Schedule H, Part V, Section B, Line 22 Facility , 1 | Facility , 1 - MEMORIAL COMMUNITY HOSPITAL. MEANS USED TO DETERMINE AMOUNTS BILLED: INFORMATION ON THE MEMORIAL COMMUNITY HOSPITAL FINANCIAL ASSISTANCE POLITY AND APPLICATION IS AVAILABLE AT SEVERAL ACCESS POINTS THROUGHOUT THE HOSPITAL AND IS PROVIDED ON BILLING STATEMENTS. A SELF PAY PATIENT IS CHARGED FOR SERVICES BASED ON CHARGE MASTER RATES UNLESS IT IS DETERMINED THE PATIENT IS ELIGIBLE UNDER THE FINANCIAL ASSISTANCE POLITY (FAP). IF FAP ELIGIBLE, CHARGES ARE REDUCED ACCORDING TO THE FINANCIAL ASSISTANCE POLICY GUIDELINES. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 0 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (4 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| 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 |
Supplemental Information Detail SupplementalInformationDetail (14 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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 7g | MEMORIAL COMMUNITY HOSPITAL DOES NOT PROVIDE SUBSIDIZED HEALTH SERVICES. |
| 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 $2,366,117. |
| Schedule H, Part I, Line 7 | THE COSTING METHODOLOGY USED TO CALCULATE THE AMOUNTS REPORTED IN THE TABLE WERE WORKSHEETS WITHIN THE SCHEDULE H INSTRUCTIONS. THE COST TO CHARGE RATIO USED IN THE CALCULATION WAS DERIVED FROM THE FILED 2015 COST REPORT. |
| Schedule H, Part III, Line 4 | THE AUDITED FOOTNOTES FOR MEMORIAL COMMUNITY HOSPITAL AND MEDICAL CENTER DO NOT CONTAIN FOOTNOTES RELATED TO BAD DEBT EXPENSE. BAD DEBT EXPENSE IS IDENTIFIED ON THE CONSOLIDATED STATEMENT OF OPERATION WHICH IS CONSISTENT WITH THE REPORTING PRACTICE OF OTHER HEALTH CARE ORGANIZATIONS. BAD DEBT EXPENSE AT 100% CHARGE VALUE WAS MULTIPLIED BY THE RATIO DERIVED FROM THE SCHEDULE H WORKSHEETS IN THE SCHEDULE H INSTRUCTIONS TO ARRIVE AT AN APPROXIMATE COST VALUE. |
| Schedule H, Part III, Line 8 | THE MEDICARE CHARGES REPORTED ON LINE 5 AND LINE 6 ARE FROM THE 2015 FILED COST REPORT WHICH USED A COST TO CHARGE RATIO. |
| 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 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 97.2% 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. |
| Schedule H, Part VI, Line 6 Affiliated health care system | 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 I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (true) | GrantRecordsMaintainedInd |
Grants Other Asst To Indiv In US GrantsOtherAsstToIndivInUSGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Type | CHARITY CARE | GrantTypeTxt |
| Recipient | 170 | RecipientCnt |
| Non Cash Assistance | $1,602,851 | NonCashAssistanceAmt |
| Valuation Method Used | BOOK | ValuationMethodUsedDesc |
| Non Cash Assistance | MEDICAL CARE | NonCashAssistanceDesc |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Schedule I, Part I, Line 2 Procedures for monitoring use of grant funds. | FormAndLineReferenceDesc |
| Explanation | 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. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | false | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | false | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | false | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | false | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | false | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | false | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | false | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | false | AnyNonFixedPaymentsInd |
| Initial Contract Exception | false | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (6 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| John Simonson MD | ||||||||||||||
| PHYSICIAN | $124,751 | $0 | $98,551 | $0 | $0 | $0 | $5,267 | $0 | $5,480 | $0 | $234,049 | $0 | $0 | $0 |
| Maurice Birdwell MD | ||||||||||||||
| Physician | $255,753 | $0 | $9,764 | $0 | $0 | $0 | $10,632 | $0 | $9,170 | $0 | $285,319 | $0 | $0 | $0 |
| BRAD SAWTELLE MD | ||||||||||||||
| Physician | $125,419 | $0 | $145,717 | $0 | $0 | $0 | $5,449 | $0 | $9,020 | $0 | $285,605 | $0 | $0 | $0 |
| Andrea Vermaas MD | ||||||||||||||
| Physician | $128,612 | $0 | $232,701 | $0 | $0 | $0 | $4,497 | $0 | $0 | $0 | $365,810 | $0 | $0 | $0 |
| CHARLES SMITH | ||||||||||||||
| PHYSICIAN | $143,721 | $0 | $245,753 | $0 | $0 | $0 | $6,152 | $0 | $9,170 | $0 | $404,796 | $0 | $0 | $0 |
| Amber Beckenhauer | ||||||||||||||
| PHYSICIAN | $168,881 | $0 | $209,216 | $0 | $18,312 | $0 | $7,158 | $0 | $9,170 | $0 | $412,737 | $0 | $0 | $0 |
Schedule K IRS990ScheduleK
Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp (3 entries)
| Bond ReferenceBondReferenceCd | Bond Issuer EINBondIssuerEIN | Bond IssuedBondIssuedDt | Issue PriceIssuePriceAmt | PurposePurposeDesc | DefeasedDefeasedInd | On Behalf Of IssuerOnBehalfOfIssuerInd | Pool FinancingPoolFinancingInd |
|---|---|---|---|---|---|---|---|
| HOSPITAL AUTH #1 OF WASHINGTON CNTY NE | |||||||
| A | 521441599 | 2007-06-19 | $9,250,000 | CONSTRUCTION OF FACILITY | false | false | false |
| HOSPITAL AUTH #1 OF WASHINGTON CNTY NE | |||||||
| B | 521441599 | 2008-05-22 | $8,000,000 | CONSTRUCTION OF FACILITY | false | false | false |
| HOSPITAL AUTH #1 OF WASHINGTON CNTY NE | |||||||
| C | 521441599 | 2009-02-12 | $3,950,000 | CONSTRUCTION OF FACILITY | false | false | false |
Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp (3 entries)
| Bond ReferenceBondReferenceCd | RetiredRetiredAmt | Total ProceedsTotalProceedsAmt | Issuance Costs From ProceedsIssuanceCostsFromProceedsAmt | Working Capital ExpendituresWorkingCapitalExpendituresAmt | Current RefundingCurrentRefundingInd | Advance RefundingAdvanceRefundingInd | Final Allocation MadeFinalAllocationMadeInd | Adequate Books And Rec MaintAdequateBooksAndRecMaintInd |
|---|---|---|---|---|---|---|---|---|
| A | $2,069,657 | $9,493,722 | $173,747 | $9,319,975 | false | false | Yes (true) | Yes (true) |
| B | $1,632,723 | $8,059,333 | $65,000 | $7,994,333 | false | false | Yes (true) | Yes (true) |
| C | $2,482,485 | $3,953,609 | $11,450 | $3,942,159 | false | false | Yes (true) | Yes (true) |
Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp (3 entries)
| Bond ReferenceBondReferenceCd | Owning Bond Financed PropertyOwningBondFinancedPropertyInd | Any Lease ArrangementsAnyLeaseArrangementsInd | Mgmt Contract Bond Fincd PropMgmtContractBondFincdPropInd | Any Research AgreementsAnyResearchAgreementsInd | Total Private Business UseTotalPrivateBusinessUsePct | Change In Use Bond Financed PropChangeInUseBondFinancedPropInd | Procs Nonqualified Bond RemdtdProcsNonqualifiedBondRemdtdInd | Bond Iss Meet Prvt Sec Pymt TestBondIssMeetPrvtSecPymtTestInd |
|---|---|---|---|---|---|---|---|---|
| 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 |
Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp (3 entries)
| Bond ReferenceBondReferenceCd | Form8038 T FiledForm8038TFiledInd | Rebate Not Due YetRebateNotDueYetInd | Exception To RebateExceptionToRebateInd | No Rebate DueNoRebateDueInd | Variable Rate IssueVariableRateIssueInd | Hedge Identified In Bks And RecHedgeIdentifiedInBksAndRecInd | Term Of HedgeTermOfHedgePct | Superintegrated HedgeSuperintegratedHedgeInd | Hedge TerminatedHedgeTerminatedInd | Gross Proceeds Invested In GICGrossProceedsInvestedInGICInd | Gross Proceeds InvestedGrossProceedsInvestedInd | Written Proc To Monitor ReqsWrittenProcToMonitorReqsInd |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| (no name) | ||||||||||||
| A | false | false | Yes (true) | Yes (true) | false | false | ||||||
| FNB OF OMAHA | ||||||||||||
| B | false | Yes (true) | Yes (true) | Yes (true) | Yes (true) | 201.0 | Yes (true) | false | false | false | false | |
| (no name) | ||||||||||||
| C | false | false | Yes (true) | Yes (true) | Yes (true) | false | false | false | false | |||
Procedures Corrective Action ProceduresCorrectiveActionGrp (3 entries)
| Bond ReferenceBondReferenceCd | Procedures Corrective ActionProceduresCorrectiveActionInd |
|---|---|
| A | |
| B | false |
| C | false |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | NOTE REGARDING THE REBATE COMPUTATION | FormAndLineReferenceDesc |
| Explanation | 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. | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (8 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part III, Line 4d Description of other program services | (Expenses $ 18,668,006 including grants of $ 705,999)(Revenue $ 18,121,239) |
| 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 VIII, Line 11d Other Miscellaneous Revenue | Other Revenue - Total Revenue: 30054, Related or Exempt Function Revenue: 30054, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: ; Interest Rate Swap - Total Revenue: 71499, Related or Exempt Function Revenue: 71499, 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 & BOB COPPLE | TIM SCHNACK & BOB COPPLE 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 & BOB COPPLE SHOW $0 REPORTABLE COMPENSATION FROM THE FILING ORGANIZATION AND FROM ANY RELATED ORGANIZATION AS THEY WERE DIRECTLY PAID BY CHI. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (3 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Controlled OrganizationControlledOrganizationInd | Public Charity StatusPublicCharityStatusTxt |
|---|---|---|---|---|---|---|---|---|---|---|
| MEMORIAL COMMUNITY HOSPITAL FOUNDATION | ||||||||||
| 810 N 22ND STREET | BLAIR | NE | 68008 | 113660156 | SUPPORT | NE | 501(c)(3 | NA | false | |
| MEMORIAL COMMUNITY HEALTH SYSTEM | ||||||||||
| 810 NORTH 22ND STREET | BLAIR | NE | 68008 | 470718840 | HEALTH SYSTEM | NE | 501(c)(3 | NA | false | 7 |
| MCH AUXILIARY THRIFT SHOP | ||||||||||
| 810 NORTH 22ND STREET | BLAIR | NE | 68008 | 470748162 | AUXILIARY | NE | 501(c)(3 | NA | Yes (true) | 7 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | false | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | false | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (true) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | false | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | false | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | false | DivRelatedOrganizationInd |
| Asset Sale To Other Org | false | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | false | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | false | AssetExchangeInd |
| Rental Of Facilities To Oth Org | false | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | false | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | false | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (true) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | false | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (true) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | false | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (true) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | false | TransferToOtherOrgInd |
| Transfer From Other Org | false | TransferFromOtherOrgInd |