2015-08-17T15:07:10-05:00 2014-09-30 470691351 FRED A LOCKWOOD & CO PC 201 MAIN STREET P O BOX 447 CHADRON NE 69337 990 2013-10-01 470482234 CHADRON COMMUNITY HOSPITAL CORPORATION CHAD 3084325586 825 CENTENNIAL DRIVE CHADRON NE 69337 HAROLD KRUEGER CEO 3084322737 2015-05-15 1 ANDREANNA LOUTZENHISER P00285945 3084324465 2013 2016-03-07 17:11:31Z HAROLD KRUEGER 825 CENTENNIAL DRIVE CHADRON NE 69337 22535589 0 X N/A X 1957 NE TO PROVIDE AND SUPPORT HEALTH CARE AND COMMUNITY SERVICE PROGRAMS OF EXCELLENCE IN THE COMMUNITIES WE SERVE. 13 13 251 11 -208202 0 2807411 3057211 15440809 17768727 3782 7516 395793 1092389 18647795 21925843 0 0 0 0 8711574 9497758 0 0 0 11901739 12369424 20613313 21867182 -1965518 58661 29064364 28454286 20620653 19951914 8443711 8502372 X TO PROVIDE AND SUPPORT HEALTH CARE AND COMMUNITY SERVICE PROGRAMS OF EXCELLENCE IN THE COMMUNITIES WE SERVE. 0 0 18869787 17768727 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. 18869787 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 1 0 1 0 0 1 0 0 0 0 0 0 0 0 1 35 0 1 251 1 0 0 0 0 0 0 0 0 X 13 13 0 1 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 0 0 0 X HAROLD KRUEGER ADMINISTRATOR 3084325586 825 CENTENNIAL DRIVE CHADRON NE 69337 JACK MANN MEMBER 2.00 X 0 0 0 LARRY PROVANCE MEMBER 2.00 X 0 0 0 DAVID KAY MEMBER 2.00 X 0 0 0 MARY HANSEN MEMBER 2.00 X 0 0 0 SHARON RICKENBACH 1ST VICE PRESIDENT 2.00 X X 0 0 0 JERRY MCCANCE MEMBER 2.00 X 0 0 0 KERRY BAILEY MEMBER 2.00 X 0 0 0 LEEANN FERLEY SECRETARY/TREASURER 2.00 X X 0 0 0 DR JERRY MCLAIN CHIEF OF STAFF 2.00 X 0 0 0 CATIE LIMBACK PAST PRESIDENT 2.00 X X 0 0 0 BRYCE LANDEN PRESIDENT 2.00 X X 0 0 0 KARLA ADAMS CRAWFORD CITY COUNCIL REPR 2.00 X 0 0 0 BRAD HENCEY 2ND VICE PRESIDENT 2.00 X X 0 0 0 LARRY JOHNSON MEMBER 2.00 X 0 0 0 SHELLEY GRAVES PHARMACIST 40.00 X 146069 0 7035 CHERYL CASSIDAY DIR OF NURSIN 40.00 X 119933 0 6074 ANNA TURMAN COO-CIO 40.00 X 117744 0 5994 RUSS BOHNENKAMP CHIEF FINANCIAL OFFICER 40.00 X 130364 0 6458 KEITH BLAYLOCK PHYSICAL THERAPIST DIRECTOR 40.00 X 115905 0 5926 630015 0 31487 8 0 1 0 REGIONAL CARE INC 905 WEST 27TH ST SCOTTSBLUFF NE 69361 INSURANCE 1291912 CARDINAL HEALTH 4875 FLORENCE ST DENVER CO 80238 DRUGS 962069 CHADRON MEDICAL CLINIC PO BOX 431 CHADRON NE 69337 ON CALL LBHS CLINIC 625896 KOTA ANESTHESIA 821 MOREHEAD CHADRON NE 69337 ANESTHESIA 360269 NTT DATA 100 CITY SQUARE BOSTON MA 02129 EHR SYSTEM 344606 16 595928 2461283 303675 3057211 HOSPITAL ANCILLARY REVE 621990 13641218 13641218 HOSPITAL ROUTINE REVENU 621990 2822619 2822619 RETIREMENT APARTMENTS 623990 956745 956745 RURAL HEALTH CLINIC 621300 348145 348145 17768727 7516 7516 153000 351976 49568 560178 103432 -208202 -104770 -208202 103432 MISCELLANEOUS 900099 920622 920622 INSERVICE REVENU 611710 115886 115886 NONPATIENT SALES 446110 112097 112097 48554 48554 1197159 21925843 17768727 -208202 1308107 7594237 6462922 1131315 142956 116628 26328 1320419 1086673 233746 440146 363703 76443 227521 227521 39936 39936 46590 46590 82296 82296 34146 4195 29951 23510 19180 4330 15095 15095 754976 712629 42347 86356 55657 30699 32592 22242 10350 1012266 844032 168234 2242120 1839489 402631 218437 178487 39950 SUPPLIES 2584244 2541330 42914 PROFESSIONAL FEES/PURCH 1931837 1931837 PROVISIONS FOR BAD DEBT 1531576 1531576 UTILITIES 551409 464463 86946 954517 694744 259773 21867182 18869787 2997395 0 1374722 1355270 3231248 4146688 52000 52000 244993 301037 158818 179780 39187962 17993390 22828030 21194572 1174553 1224939 29064364 28454286 1557811 1556619 215613 198973 18847229 18196322 20620653 19951914 X 0 0 0 0 8443711 8502372 8443711 8502372 29064364 28454286 58661 0 X 0 0 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 272446 272446 30851589 11999917 18851672 896783 359452 537331 7069636 5546456 1523180 97508 87565 9943 21194572 21004013 -921830 -921830 21925843 0 21925843 20945352 -921830 -921830 21867182 0 21867182 PART XI, LINE 2D - OTHER ADJUSTMENTS: RENT EXPENSE -921,830. PART XII, LINE 2D - OTHER ADJUSTMENTS: RENT EXPENSE -921,830. 1 1 1 X 1 X 1 1 1 0 1 1 318186 318186 0.01460 155521 155521 0.00710 473707 473707 0.02170 473707 473707 0.02170 531981 547620 -15639 0.00000 29142 29142 359824 360414 -590 0.00000 5642 5642 926589 942818 -16229 1 1531576 318186 9852400 2332196 7520204 X 1 1 1 1 CHADRON COMMUNITY HOSPITAL 825 CENTENNIAL DRIVE CHADRON NE 69337 H000117 X X X X NOT REQUIRED 1 1 X X X X X X X X X 12 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 NOT REQUIRED PART V, SECTION B, LINE 3: REGIONAL HOSPITALS WORKED TOGETHER WITH THE LOCAL PUBLIC HEALTH DEPARTMENT TO COMPLETE THE CHNA. 2 PRAIRIE PINES LODGE 900 W 7TH ST CHADRON NE 69337 ASSISTED LIVING LEGEND BUTTES HEALTH SERVICES 11 PADDOCK CRAWFORD NE 69339 CLINIC SERVICES 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. 1 0 0 0 0 0 0 0 0 0 SHELLEY GRAVES PHARMACIST 146069 0 0 0 0 0 0 0 7035 0 153104 0 0 0 990 SCH J PART II HAROLD KREUGER, CEO, IS PAID BY REGIONAL WEST MEDICAL CENTER. THE HOSPITAL CONTRACTS FOR THIS SERVICE. PRAIRIE SKY CONDOS PROPERTY DEVELOPMENT X 65000 0 1 1 E&T DEVELOPERS LLC MEMBERS OF LLC ARE ON THE BOARD OF DIRECTORS 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. 0 X 1 DETERMINED BY ENTITY 0 0 0 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