CHADRON COMMUNITY HOSPITAL CORP: Form 990, tax year 2013
View the entire original 990 at ProPublica ↗
- Organization
- CHADRON COMMUNITY HOSPITAL CORP (EIN 47-0482234)
- Tax period
- 2013-10-01 to 2014-09-30
- Filed
- 2015-08-17
- IRS object ID
- 201512299349302681
- Schema version
- 2013v4.0
- 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
- Form 990
- Schedule A
- Schedule B
- Schedule D
- Schedule H
- Schedule J
- Schedule L
- Schedule M
- Schedule O
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2015-08-17T15:07:10-05:00 | ReturnTs |
| Tax Period End | 2014-09-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 470691351 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | FRED A LOCKWOOD & CO PC | BusinessNameLine1 |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 201 MAIN STREET P O BOX 447 | AddressLine1 |
| City | CHADRON | City |
| State | NE | State |
| ZIP Code | 69337 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2013-10-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 470482234 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CHADRON COMMUNITY HOSPITAL CORPORATION | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | CHAD | BusinessNameControlTxt |
| Phone | 3084325586 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 825 CENTENNIAL DRIVE | AddressLine1 |
| City | CHADRON | City |
| State | NE | State |
| ZIP Code | 69337 | ZIPCode |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | HAROLD KRUEGER | PersonNm |
| Person Title | CEO | PersonTitleTxt |
| Phone | 3084322737 | PhoneNum |
| Signature | 2015-05-15 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | ANDREANNA LOUTZENHISER | PreparerPersonNm |
| PTIN | P00285945 | PTIN |
| Phone | 3084324465 | PhoneNum |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2013 | TaxYr |
| Build TS | 2016-03-07 17:11:31Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | HAROLD KRUEGER | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 825 CENTENNIAL DRIVE | AddressLine1 |
| City | CHADRON | City |
| State | NE | State |
| ZIP Code | 69337 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $22,535,589 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | N/A | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1957 | FormationYr |
| Legal Domicile State | NE | LegalDomicileStateCd |
| Activity Or Mission | TO PROVIDE AND SUPPORT HEALTH CARE AND COMMUNITY SERVICE PROGRAMS OF EXCELLENCE IN THE COMMUNITIES WE SERVE. | ActivityOrMissionDesc |
| Voting Members Governing Body | 13 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 13 | VotingMembersIndependentCnt |
| Total Employee | 251 | TotalEmployeeCnt |
| Total Volunteers | 11 | TotalVolunteersCnt |
| Total Gross UBI | -$208,202 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $2,807,411 | PYContributionsGrantsAmt |
| CY Contributions Grants | $3,057,211 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $15,440,809 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $17,768,727 | CYProgramServiceRevenueAmt |
| PY Investment Income | $3,782 | PYInvestmentIncomeAmt |
| CY Investment Income | $7,516 | CYInvestmentIncomeAmt |
| PY Other Revenue | $395,793 | PYOtherRevenueAmt |
| CY Other Revenue | $1,092,389 | CYOtherRevenueAmt |
| PY Total Revenue | $18,647,795 | PYTotalRevenueAmt |
| CY Total Revenue | $21,925,843 | 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 | $8,711,574 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $9,497,758 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $11,901,739 | PYOtherExpensesAmt |
| CY Other Expenses | $12,369,424 | CYOtherExpensesAmt |
| PY Total Expenses | $20,613,313 | PYTotalExpensesAmt |
| CY Total Expenses | $21,867,182 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$1,965,518 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $58,661 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $29,064,364 | TotalAssetsBOYAmt |
| Total Assets EOY | $28,454,286 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $20,620,653 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $19,951,914 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $8,443,711 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $8,502,372 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | TO PROVIDE AND SUPPORT HEALTH CARE AND COMMUNITY SERVICE PROGRAMS OF EXCELLENCE IN THE COMMUNITIES WE SERVE. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $18,869,787 | ExpenseAmt |
| Revenue | $17,768,727 | RevenueAmt |
| Desc | CHADRON COMMUNITY HOSPITAL CORPORATION OFFERS ACCESS TO CARE. INDIVIDUALS SHALL BE ACCORDED IMPARTIAL ACCESS TO TREATMENT OR ACCOMMODATIONS THAT ARE AVAILABLE, AND MEDICALLY INDICATED, REGARDLESS OF RACE, CREED, SEX, NATIONAL ORIGIN, HANDICAP, RELIGION, ABILITY TO PAY, OR SOURCES OF PAYMENT FOR CARE. DURING THE FISCAL YEAR CHADRON COMMUNITY HOSPITAL CORPORATION PROVIDED INPATIENT SERVICES TO THE FOLLOWING:PATIENT DAYSADULT AND PEDIATRICS 1,439SWING BED - SKILLED 351NURSERY 231TOTAL 2,021 CHADRON COMMUNITY HOSPITAL CORPORATION EMERGENCY ROOM TREATED 2,591 PATIENTS AND 590 SURGICAL PROCEDURES WERE PERFORMED IN THE SURGERY AREA. IN ADDITION TO PROVIDING DIRECT INPATIENT AND OUTPATIENT SERVICES, CHADRON COMMUNITY HOSPITAL PROVIDED OUR COMMUNITY/COUNTY RESIDENTS ACCESS TO A VARIETY OF SPECIALISTS THROUGH FREE USE OF THE HOSPITAL'S CLINIC SPACE. THE FOLLOWING TYPES OF SPECIALTY CLINICS AND SERVICES WERE PROVIDED.CARDIOLOGYORTHOPEDICSEAR, NOSE AND THROATUROLOGYINTERNAL MEDICINEVASCULAROPHTHALMOLOGYPODIATRYTHE FOLLOWING COMMUNITY SERVICES WERE PROVIDED AT A MINIMAL OR NO COST BASIS:*DURING OUR ANNUAL HEALTH FAIR, CHADRON COMMUNITY HOSPITAL PROVIDED AT NO COST, INFORMATION ON MAMMOGRAPHY SCREENING, COLORECTAL CANCER TESTS AND FREE COLORECTAL KITS, GLAUCOMA TESTING, BLOOD PRESSURE TESTS, DIABETES/BLOOD SUGAR TESTING, DRUG AND ALCOHOL TESTING, HUNDREDS OF PAMPHLETS RELATING TO MAINTAINING HEALTH.*REGISTERED NURSE SUPPORT WAS PROVIDED TO OUR AREA/COUNTY SCHOOLS TO ASSIST IN YEARLY PHYSICALS.*REGISTERED NURSE SUPPORT WAS PROVIDED TO OUR AREA FIRE AND RESCUE VOLUNTEERS AND LOCAL LAW ENFORCEMENT OFFICERS TO ADMINISTER HEPATITIS VACCINATIONS.*OUR HOME HEALTH PROFESSIONALS PROVIDE BLOOD PRESSURE AND BLOOD SUGAR SCREENING ON A REGULAR BASIS AT THE LOCAL SALE BARN AND THE SENIOR CITIZENS CENTER, FREE OF CHARGE.*HOME HEALTH PROFESSIONALS PROVIDE PRENATAL HOME VISITS ON ALL NEWBORNS WITHIN THE CHADRON/DAWES/SIOUX AND SHERIDAN COUNTIES.*WE PROVIDE FREE DIETARY COUNSELING SERVICES FOR DIABETIC AND LOW INCOME FAMILIES WHO NEED THESE SERVICES.*WE PROVIDE 'LIFELINE' EMERGENCY SERVICES TO THE ELDERLY, HANDICAPPED AND SHUT-INS FOR A FEE EQUAL TO OUR COSTS. THIS IS A 24-HOUR A DAY, 7 DAYS PER WEEK MONITORING SERVICE.*SCREENING MAMMOGRAPHY SERVICES ARE PERIODICALLY PROVIDED TO ALL WOMEN AT A GREATLY REDUCED PRICE.*MEETING ROOMS ARE PROVIDED FREE OF CHARGE TO ALL OUTSIDE SERVICE ORGANIZATIONS WHO ARE PROMOTING GOOD HEALTH.*WE PROVIDE HEALTH CARE PROFESSIONALS TO SPEAK AT VARIOUS ORGANIZATIONS/MEETING TO HELP EDUCATE AND PROMOTE HEALTH CARE CONCERNS AND ISSUES, FREE OF CHARGE.*ADMINISTRATION PARTICIPATES ON THE BOARD OF COMMISSIONERS FOR THE LOCAL "LOW INCOME HOUSING AUTHORITY".*FREE OSTOMY IN-SERVICES AND COMMUNITY TRAINING IS PROVIDED VIA OUR HOME HEALTH CARE AGENCY.*COMMUNITY PRENATAL/MATERNITY CLASSES ARE PROVIDED AT NO COST TO INSURE AVAILABILITY TO THESE SERVICES FOR THOSE WHO CANNOT AFFORD THE CLASS. PROFESSIONAL STAFF ARE PAID THEIR REGULAR SALARY FOR THESE SERVICES.*CHADRON COMMUNITY HOSPITAL ADMINISTRATION PROVIDED IN-KIND ASSISTANCE TO THE LOCAL COMMUNITY IN EFFORTS TO ATTRACT AND RETAIN NEEDED PRIMARY/FAMILY PRACTICE PHYSICIANS.*REDUCED AND FREE CHOLESTEROL SCREENINGS HAVE BEEN PROVIDED TO OUR COMMUNITY/COUNTY MEMBERS WITH INFORMATION REGARDING THEIR IMPORTANCE TO THEIR HEALTH.*ADMINISTRATION HAS CONDUCTED NUMEROUS EDUCATIONAL PROGRAMS FOR THE SENIOR CITIZEN CENTER AND VARIOUS SERVICE ORGANIZATIONS INFORMING THEM OF THE ADVANCED DIRECTIVE PROGRAM AND THE VARIOUS PROPOSED HEALTH CARE BILLS.*ADMINISTRATION HAS PROVIDED THE LOCAL/COUNTY RESIDENTS WITH NUMEROUS PUBLICATIONS PRINTED IN THE LOCAL NEWSPAPERS DEALING WITH ALL ASPECTS OF HEALTH CARE, TO INCLUDE THE RIGHTS AFFORDED TO ALL MEDICARE RECIPIENTS.CHADRON COMMUNITY HOSPITAL PROVIDED $739,611 OF CHARGES RELATED PRIMARILY TO BAD DEBTS. OVER 47% OF CHADRON COMMUNITY HOSPITAL'S REVENUE WAS DERIVED FROM MEDICARE AND MEDICAID BENEFICIARIES FOR WHICH CHADRON COMMUNITY HOSPITAL WAS REQUIRED TO CONTRACTUALLY REDUCE THEIR CHARGES BY 2,713,695 TO REFLECT ACTUAL PAYMENT FROM VARIOUS MEDICARE AND MEDICAID AGENCIES. | Desc |
| Total Program Service Expenses | $18,869,787 | 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 | 0 | CreditCounselingInd |
| Temp Or Permanent Endowments | 0 | 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 | 0 | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | 0 | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (1) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | 0 | 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 | Yes (1) | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | Yes (1) | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | Yes (1) | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | 0 | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 35 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 251 | 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 |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 13 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 13 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | Yes (1) | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | 0 | MembersOrStockholdersInd |
| Election Of Board Members | 0 | 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 | 0 | 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 | 0 | CompensationProcessCEOInd |
| Compensation Process Other | 0 | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | HAROLD KRUEGER ADMINISTRATOR | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 3084325586 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 825 CENTENNIAL DRIVE | AddressLine1 |
| City | CHADRON | City |
| State | NE | State |
| ZIP Code | 69337 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionAGrp (19 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|
| JACK MANN | |||||||
| MEMBER | 2.00 | Yes (X) | $0 | $0 | $0 | ||
| LARRY PROVANCE | |||||||
| MEMBER | 2.00 | Yes (X) | $0 | $0 | $0 | ||
| DAVID KAY | |||||||
| MEMBER | 2.00 | Yes (X) | $0 | $0 | $0 | ||
| MARY HANSEN | |||||||
| MEMBER | 2.00 | Yes (X) | $0 | $0 | $0 | ||
| SHARON RICKENBACH | |||||||
| 1ST VICE PRESIDENT | 2.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| JERRY MCCANCE | |||||||
| MEMBER | 2.00 | Yes (X) | $0 | $0 | $0 | ||
| KERRY BAILEY | |||||||
| MEMBER | 2.00 | Yes (X) | $0 | $0 | $0 | ||
| LEEANN FERLEY | |||||||
| SECRETARY/TREASURER | 2.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| DR JERRY MCLAIN | |||||||
| CHIEF OF STAFF | 2.00 | Yes (X) | $0 | $0 | $0 | ||
| CATIE LIMBACK | |||||||
| PAST PRESIDENT | 2.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| BRYCE LANDEN | |||||||
| PRESIDENT | 2.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| KARLA ADAMS | |||||||
| CRAWFORD CITY COUNCIL REPR | 2.00 | Yes (X) | $0 | $0 | $0 | ||
| BRAD HENCEY | |||||||
| 2ND VICE PRESIDENT | 2.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| LARRY JOHNSON | |||||||
| MEMBER | 2.00 | Yes (X) | $0 | $0 | $0 | ||
| SHELLEY GRAVES | |||||||
| PHARMACIST | 40.00 | $146,069 | $0 | $7,035 | Yes (X) | ||
| CHERYL CASSIDAY | |||||||
| DIR OF NURSIN | 40.00 | $119,933 | $0 | $6,074 | Yes (X) | ||
| ANNA TURMAN | |||||||
| COO-CIO | 40.00 | $117,744 | $0 | $5,994 | Yes (X) | ||
| RUSS BOHNENKAMP | |||||||
| CHIEF FINANCIAL OFFICER | 40.00 | $130,364 | $0 | $6,458 | Yes (X) | ||
| KEITH BLAYLOCK | |||||||
| PHYSICAL THERAPIST DIRECTOR | 40.00 | $115,905 | $0 | $5,926 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $630,015 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $31,487 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 8 | 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/AddressLine1 | CityContractorAddress/USAddress/City | StateContractorAddress/USAddress/State | ZIP CodeContractorAddress/USAddress/ZIPCode | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| REGIONAL CARE INC | |||||
| 905 WEST 27TH ST | SCOTTSBLUFF | NE | 69361 | INSURANCE | $1,291,912 |
| CARDINAL HEALTH | |||||
| 4875 FLORENCE ST | DENVER | CO | 80238 | DRUGS | $962,069 |
| CHADRON MEDICAL CLINIC | |||||
| PO BOX 431 | CHADRON | NE | 69337 | ON CALL LBHS CLINIC | $625,896 |
| KOTA ANESTHESIA | |||||
| 821 MOREHEAD | CHADRON | NE | 69337 | ANESTHESIA | $360,269 |
| NTT DATA | |||||
| 100 CITY SQUARE | BOSTON | MA | 02129 | EHR SYSTEM | $344,606 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 16 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $595,928 | GovernmentGrantsAmt |
| All Other Contributions | $2,461,283 | AllOtherContributionsAmt |
| Noncash Contributions | $303,675 | NoncashContributionsAmt |
| Total Contributions | $3,057,211 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (4 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| HOSPITAL ANCILLARY REVE | 621990 | $13,641,218 | $13,641,218 |
| HOSPITAL ROUTINE REVENU | 621990 | $2,822,619 | $2,822,619 |
| RETIREMENT APARTMENTS | 623990 | $956,745 | $956,745 |
| RURAL HEALTH CLINIC | 621300 | $348,145 | $348,145 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $17,768,727 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $7,516 | TotalRevenueColumnAmt |
| Exclusion | $7,516 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $153,000 | RealAmt |
| Personal | $351,976 | PersonalAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $49,568 | RealAmt |
| Personal | $560,178 | PersonalAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $103,432 | RealAmt |
| Personal | -$208,202 | PersonalAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$104,770 | TotalRevenueColumnAmt |
| Unrelated Business Revenue | -$208,202 | UnrelatedBusinessRevenueAmt |
| Exclusion | $103,432 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | ExclusionExclusionAmt |
|---|---|---|---|
| MISCELLANEOUS | 900099 | $920,622 | $920,622 |
| INSERVICE REVENU | 611710 | $115,886 | $115,886 |
| NONPATIENT SALES | 446110 | $112,097 | $112,097 |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $48,554 | TotalRevenueColumnAmt |
| Exclusion | $48,554 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $1,197,159 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $21,925,843 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $17,768,727 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | -$208,202 | UnrelatedBusinessRevenueAmt |
| Exclusion | $1,308,107 | ExclusionAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $7,594,237 | TotalAmt |
| Program Services | $6,462,922 | ProgramServicesAmt |
| Management And General | $1,131,315 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $142,956 | TotalAmt |
| Program Services | $116,628 | ProgramServicesAmt |
| Management And General | $26,328 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,320,419 | TotalAmt |
| Program Services | $1,086,673 | ProgramServicesAmt |
| Management And General | $233,746 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $440,146 | TotalAmt |
| Program Services | $363,703 | ProgramServicesAmt |
| Management And General | $76,443 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $227,521 | TotalAmt |
| Management And General | $227,521 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $39,936 | TotalAmt |
| Management And General | $39,936 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $46,590 | TotalAmt |
| Management And General | $46,590 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $82,296 | TotalAmt |
| Management And General | $82,296 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $34,146 | TotalAmt |
| Program Services | $4,195 | ProgramServicesAmt |
| Management And General | $29,951 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $23,510 | TotalAmt |
| Program Services | $19,180 | ProgramServicesAmt |
| Management And General | $4,330 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $15,095 | TotalAmt |
| Management And General | $15,095 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $754,976 | TotalAmt |
| Program Services | $712,629 | ProgramServicesAmt |
| Management And General | $42,347 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $86,356 | TotalAmt |
| Program Services | $55,657 | ProgramServicesAmt |
| Management And General | $30,699 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $32,592 | TotalAmt |
| Program Services | $22,242 | ProgramServicesAmt |
| Management And General | $10,350 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,012,266 | TotalAmt |
| Program Services | $844,032 | ProgramServicesAmt |
| Management And General | $168,234 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,242,120 | TotalAmt |
| Program Services | $1,839,489 | ProgramServicesAmt |
| Management And General | $402,631 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $218,437 | TotalAmt |
| Program Services | $178,487 | ProgramServicesAmt |
| Management And General | $39,950 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| SUPPLIES | $2,584,244 | $2,541,330 | $42,914 |
| PROFESSIONAL FEES/PURCH | $1,931,837 | $1,931,837 | |
| PROVISIONS FOR BAD DEBT | $1,531,576 | $1,531,576 | |
| UTILITIES | $551,409 | $464,463 | $86,946 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $954,517 | TotalAmt |
| Program Services | $694,744 | ProgramServicesAmt |
| Management And General | $259,773 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $21,867,182 | TotalAmt |
| Program Services | $18,869,787 | ProgramServicesAmt |
| Management And General | $2,997,395 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,374,722 | BOYAmt |
| EOY | $1,355,270 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,231,248 | BOYAmt |
| EOY | $4,146,688 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $52,000 | BOYAmt |
| EOY | $52,000 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $244,993 | BOYAmt |
| EOY | $301,037 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $158,818 | BOYAmt |
| EOY | $179,780 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $39,187,962 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $17,993,390 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $22,828,030 | BOYAmt |
| EOY | $21,194,572 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,174,553 | BOYAmt |
| EOY | $1,224,939 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $29,064,364 | BOYAmt |
| EOY | $28,454,286 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,557,811 | BOYAmt |
| EOY | $1,556,619 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $215,613 | BOYAmt |
| EOY | $198,973 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $18,847,229 | BOYAmt |
| EOY | $18,196,322 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $20,620,653 | BOYAmt |
| EOY | $19,951,914 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Org Does Not Follow SFAS117 | Yes (X) | OrgDoesNotFollowSFAS117Ind |
Cap Stk Tr Prin Current Funds CapStkTrPrinCurrentFundsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Pd In Cap Srpls Land Bldg Eqp Fund PdInCapSrplsLandBldgEqpFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Rtn Earn Endowment Incm Oth Fnds RtnEarnEndowmentIncmOthFndsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,443,711 | BOYAmt |
| EOY | $8,502,372 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,443,711 | BOYAmt |
| EOY | $8,502,372 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $29,064,364 | BOYAmt |
| EOY | $28,454,286 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $58,661 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | 0 | FSAuditedInd |
| 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
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | $272,446 | InvestmentCostOrOtherBasisAmt |
| Book Value | $272,446 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | $30,851,589 | InvestmentCostOrOtherBasisAmt |
| Depreciation | $11,999,917 | DepreciationAmt |
| Book Value | $18,851,672 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | $896,783 | InvestmentCostOrOtherBasisAmt |
| Depreciation | $359,452 | DepreciationAmt |
| Book Value | $537,331 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | $7,069,636 | InvestmentCostOrOtherBasisAmt |
| Depreciation | $5,546,456 | DepreciationAmt |
| Book Value | $1,523,180 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | $97,508 | InvestmentCostOrOtherBasisAmt |
| Depreciation | $87,565 | DepreciationAmt |
| Book Value | $9,943 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $21,194,572 | TotalBookValueLandBuildingsAmt |
| Total Rev Etc Audited Fincl Stmt | $21,004,013 | TotalRevEtcAuditedFinclStmtAmt |
| Other Revenue | -$921,830 | OtherRevenueAmt |
| Revenue Not Reported | -$921,830 | RevenueNotReportedAmt |
| Revenue Subtotal | $21,925,843 | RevenueSubtotalAmt |
| Revenue Not Reported Fincl Stmt | $0 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $21,925,843 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $20,945,352 | TotExpnsEtcAuditedFinclStmtAmt |
| Other Expenses Included | -$921,830 | OtherExpensesIncludedAmt |
| Expenses Not Reported | -$921,830 | ExpensesNotReportedAmt |
| Expenses Subtotal | $21,867,182 | ExpensesSubtotalAmt |
| Expenses Not Rpt Fincl Stmt | $0 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $21,867,182 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART XI, LINE 2D - OTHER ADJUSTMENTS: | RENT EXPENSE -921,830. |
| PART XII, LINE 2D - OTHER ADJUSTMENTS: | RENT EXPENSE -921,830. |
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 | 0 | 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 | $318,186 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $318,186 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01460 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $155,521 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $155,521 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00710 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $473,707 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $473,707 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02170 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $473,707 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $473,707 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02170 | TotalExpensePct |
Community Support CommunitySupportGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $531,981 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $547,620 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | -$15,639 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Coalition Building CoalitionBuildingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $29,142 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $29,142 | DirectOffsettingRevenueAmt |
Health Improvement Advocacy HealthImprovementAdvocacyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $359,824 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $360,414 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | -$590 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Workforce Development WorkforceDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $5,642 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $5,642 | DirectOffsettingRevenueAmt |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $926,589 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $942,818 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | -$16,229 | NetCommunityBenefitExpnsAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $1,531,576 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $318,186 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $9,852,400 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $2,332,196 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | $7,520,204 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost Accounting System | Yes (X) | CostAccountingSystemInd |
| 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 | CHADRON COMMUNITY HOSPITAL | BusinessNameLine1 |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 825 CENTENNIAL DRIVE | AddressLine1 |
| City | CHADRON | City |
| State | NE | State |
| ZIP Code | 69337 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| State License | H000117 | 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 | NOT REQUIRED | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| 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 | 12 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | 0 | CHNAConductedWithOtherFcltsInd |
| CHNA Report Widely Available | 0 | CHNAReportWidelyAvailableInd |
| All Needs Addressed | Yes (1) | AllNeedsAddressedInd |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | 0 | EligCriteriaExplainedInd |
| FPG Used Deter Elig Free Care | 0 | FPGUsedDeterEligFreeCareInd |
| FPG Used Determ Elig Dscnt Care | 0 | FPGUsedDetermEligDscntCareInd |
| Explained Basis | 0 | ExplainedBasisInd |
| App Financial Asst Expln | 0 | AppFinancialAsstExplnInd |
| Includes Publicity Measures | 0 | IncludesPublicityMeasuresInd |
| FAP Actions On Nonpayment | 0 | FAPActionsOnNonpaymentInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| Nondis Emergency Care Policy | 0 | NondisEmergencyCarePolicyInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | NOT REQUIRED | FormAndLineReferenceDesc |
| Explanation | PART V, SECTION B, LINE 3: REGIONAL HOSPITALS WORKED TOGETHER WITH THE LOCAL PUBLIC HEALTH DEPARTMENT TO COMPLETE THE CHNA. | ExplanationTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 2 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (2 entries)
| Address Line1USAddress/AddressLine1 | CityUSAddress/City | StateUSAddress/State | ZIP CodeUSAddress/ZIPCode | FacilityFacilityTxt |
|---|---|---|---|---|
| PRAIRIE PINES LODGE | ||||
| 900 W 7TH ST | CHADRON | NE | 69337 | ASSISTED LIVING |
| LEGEND BUTTES HEALTH SERVICES | ||||
| 11 PADDOCK | CRAWFORD | NE | 69339 | CLINIC SERVICES |
Supplemental Information Detail SupplementalInformationDetail (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 7: | THE HOSPITAL COMPUTES ITS ESTIMATED CHARITY CARE COSTS BY APPLYING ITS OVERALL COST TO CHARGE RATIO (TOTAL OPERATING COSTS DIVIDED BY GROSS PATIENT SERVICE REVENUE) TO THE GROSS CHARGES FORGONE UNDER ITS CHARITY CARE POLICY. |
| PART III, LINE 4: | THE HOSPITAL PROVIDES FOR AN ALLOWANCE FOR DOUBTFUL ACCOUNTS BASED ON A REVIEW OF EXISTING RECEIVABLES, HISTORICAL COLLECTION INFORAMTION AND EXISTING ECONOMIC CONDITIONS. DELINQUENT RECEIVABLES ARE WRITTEN OFF BASED ON INDIVIDUAL CREDIT EVALUATION AND SPECIFIC CIRCUMSTANCES OF THE PATIENT AND OTHER THIRD-PARTY PAYORS. BAD DEBT RECOVERS ARE CHARGED AGAINST THE ALLOWANCE ACCOUNT AS REALIZED. |
| PART III, LINE 8: | 100% OF THE SHORTFALL SHOULD BE TREATED AS A COMMUNITY BENEFIT. THE COSTING METHODOLOGY USED TO DETERMINE THE AMOUNT WAS DETERMINED FROM THE MEDICARE COST REPORT. |
| PART III, LINE 9B: | THE HOSPITAL PROVIDES CARE TO PATIENTS WHO LACK FINANCIAL RESOURCES AND ARE DEEMED TO BE MEDICALLY INDIGENT BASED ON CRITERIA ESTABLISHED UNDER THE HOSPITALS CHARITY CARE POLICY. THIS CARE IS PROVIDED WITHOUT CHARGE OR AT AMOUNTS LESS THAN ITS ESTABLISHED RATES. BECAUSE THE HOSPITAL DOES NOT PURSUE COLLECTION OF AMOUNTS DETERMINED TO QUALIFY AS CHARITY CARE, SUCH AMOUNTS ARE NOT REPORTED AS REVENUE. THE HOSPITAL MAINTAINS RECORDS TO IDENTIFY AND MONITOR THE LEVEL OF CHARITY CARE PROVIDED. THESE RECORDS INCLUDE THE AMOUNT OF CHARGES FORGONE FOR SERVICES AND SUPPLIES FURNISHED UNDER ITS CHARITY CARE POLICY. THE CHARGES RELATED TO THIS CARE TOTALED $166,850 AND $71,402 IN 2010 AND 2009, RESPECTIVELY. IN ADDITION, THE HOSPITAL PROVIDES SERVICES TO OTHER MEDICALLY INDIGENT PATIENTS UNDER VARIOUS STATE MEDICAID PROGRAMS. SUCH PROGRAMS PAY AMOUNTS THAT ARE LESS THAN THE COST OF THE SERVICES PROVIDED TO THE RECIPIENTS. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Substantiation Required | Yes (1) | SubstantiationRequiredInd |
| 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 | SHELLEY GRAVES | PersonNm |
| Title | PHARMACIST | TitleTxt |
| Base Compensation Filing Org | $146,069 | BaseCompensationFilingOrgAmt |
| Compensation Based On Rltd Orgs | $0 | CompensationBasedOnRltdOrgsAmt |
| Bonus Filing Organization | $0 | BonusFilingOrganizationAmount |
| Bonus Related Organizations | $0 | BonusRelatedOrganizationsAmt |
| Other Compensation Filing Org | $0 | OtherCompensationFilingOrgAmt |
| Other Compensation Rltd Orgs | $0 | OtherCompensationRltdOrgsAmt |
| Deferred Compensation Flng Org | $0 | DeferredCompensationFlngOrgAmt |
| Deferred Comp Rltd Orgs | $0 | DeferredCompRltdOrgsAmt |
| Nontaxable Benefits Filing Org | $7,035 | NontaxableBenefitsFilingOrgAmt |
| Nontaxable Benefits Rltd Orgs | $0 | NontaxableBenefitsRltdOrgsAmt |
| Total Compensation Filing Org | $153,104 | TotalCompensationFilingOrgAmt |
| Total Compensation Rltd Orgs | $0 | TotalCompensationRltdOrgsAmt |
| Comp Report Prior990 Filing Org | $0 | CompReportPrior990FilingOrgAmt |
| Comp Report Prior990 Rltd Orgs | $0 | CompReportPrior990RltdOrgsAmt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | 990 SCH J PART II | FormAndLineReferenceDesc |
| Explanation | HAROLD KREUGER, CEO, IS PAID BY REGIONAL WEST MEDICAL CENTER. THE HOSPITAL CONTRACTS FOR THIS SERVICE. | ExplanationTxt |
Schedule L IRS990ScheduleL
Loans Btwn Org Interested Prsn LoansBtwnOrgInterestedPrsnGrp
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PRAIRIE SKY CONDOS | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Loan Purpose | PROPERTY DEVELOPMENT | LoanPurposeTxt |
| Loan From Organization | Yes (X) | LoanFromOrganizationInd |
| Original Principal | $65,000 | OriginalPrincipalAmt |
| Default | 0 | DefaultInd |
| Board Or Committee Approval | Yes (1) | BoardOrCommitteeApprovalInd |
| Written Agreement | Yes (1) | WrittenAgreementInd |
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp
Name Of Interested NameOfInterested
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | E&T DEVELOPERS LLC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Relationship Description | MEMBERS OF LLC ARE ON THE BOARD OF DIRECTORS | RelationshipDescriptionTxt |
| Transaction | THE HOSPITAL SOLD LOT 1, BLOCK 1, WEST HILLS SEVENTH ADDITION TO E&T DEVELOPERS. THE TOTAL SALE PRICE OF THE PROPERTY WAS $65,000. THE HOSPITAL IS CARRYING THE LOAN WITH A 4.95% ANNUAL RATE. PAYMENTS ARE DUE AS EACH DUPLEX UNIT IS CONSTRUCTED AND SOLD. AT THE TIME OF A SALE OF A UNIT 1/5 OF THE PURCHASE PRICE PER UNIT OR THE SUM OF $13,000 IS DUE TO THE HOSPITAL TOGETHER WITH INTEREST ACCRUED ON THAT PORTION OF THE UNPAID PURCHASE PRICE. THE LAND AND ANY IMPROVEMENTS COLLATERALIZE THE LOAN. | TransactionDesc |
| Sharing Of Revenues | 0 | SharingOfRevenuesInd |
Schedule M IRS990ScheduleM
Food Inventory FoodInventoryGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Non Cash Checkbox | Yes (X) | NonCashCheckboxInd |
| Contribution | 1 | ContributionCnt |
| Method Of Determining Revenues | DETERMINED BY ENTITY | MethodOfDeterminingRevenuesTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Any Property That Must Be Held | 0 | AnyPropertyThatMustBeHeldInd |
| Review Process Unusual NC Gifts | 0 | ReviewProcessUnusualNCGiftsInd |
| Third Parties Used | 0 | ThirdPartiesUsedInd |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 3 | THE HOSPITAL ADMINISTRATOR (CEO) IS CONTRACTED WITH REGIONAL WEST MEDICAL CENTER. |
| FORM 990, PART VI, SECTION B, LINE 11 | FORM 990 IS REVIEWED AND APPROVED BY THE CHEIF EXECUTIVE OFFICER AND CHIEF FINANCIAL OFFICER PRIOR TO FILING. |
| FORM 990, PART VI, SECTION B, LINE 12C | ADDRESSED ANNUALLY OR WITH EACH CHANGE IN BOARD OF DIRECTORS MEMBERS |
| FORM 990, PART VI, SECTION C, LINE 19 | UPON REQUEST |