COLUMBUS COMMUNITY HOSPITAL INC: Form 990, tax year 2013

View the entire original 990 at ProPublica ↗

Organization: COLUMBUS COMMUNITY HOSPITAL INC (EIN 47-0542043)
Tax period: 2013-05-01 to 2014-04-30
Filed: 2014-12-11
IRS object ID: 201403459349301105
Schema version: 2013v3.1
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 C
Schedule D
Schedule H
Schedule I
Schedule J
Schedule O
Schedule R

Return header ReturnHeader

Field	Value	IRS element (for citing)
Return	2014-12-11T16:58:45-06:00	ReturnTs
Tax Period End	2014-04-30	TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

Preparer Firm Name PreparerFirmName

Field	Value	IRS element (for citing)
Business Name Line1	KPMG LLP	BusinessNameLine1

Preparer US Address PreparerUSAddress

Field	Value	IRS element (for citing)
Address Line1	1212 North 96th Street Suite 300	AddressLine1
City	Omaha	City
State	NE	State
ZIP Code	68114	ZIPCode

Field	Value	IRS element (for citing)
Return Type	990	ReturnTypeCd
Tax Period Begin	2013-05-01	TaxPeriodBeginDt

Filer Filer

Field	Value	IRS element (for citing)
EIN	470542043	EIN

Business Name BusinessName

Field	Value	IRS element (for citing)
Business Name Line1	COLUMBUS COMMUNITY HOSPITAL INC	BusinessNameLine1

Field	Value	IRS element (for citing)
In Care Of	% MIKE ADAMY	InCareOfNm
Business Name Control	COLU	BusinessNameControlTxt
Phone	4025623357	PhoneNum

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	PO BOX 1800	AddressLine1
Address Line2	Suite	AddressLine2
City	COLUMBUS	City
State	NE	State
ZIP Code	68602	ZIPCode

Business Officer BusinessOfficerGrp

Field	Value	IRS element (for citing)
Person	MICHAEL T HANSEN	PersonNm
Person Title	CHIEF EXECUTIVE OFFICER	PersonTitleTxt
Phone	4025623357	PhoneNum
Signature	2014-12-08	SignatureDt
Discuss With Paid Preparer	Yes (true)	DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

Field	Value	IRS element (for citing)
Preparer Person	Donald Neal Jr	PreparerPersonNm
PTIN	P00798244	PTIN
Phone	4025623357	PhoneNum

Field	Value	IRS element (for citing)
Tax	2013	TaxYr
Build TS	2015-11-30 17:44:51Z	BuildTS

Form 990 IRS990

Field	Value	IRS element (for citing)
Principal Officer	J Joseph Barbaglia	PrincipalOfficerNm

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	4600 38th Street	AddressLine1
City	Columbus	City
State	NE	State
ZIP Code	68601	ZIPCode

Field	Value	IRS element (for citing)
Gross Receipts	$80,292,003	GrossReceiptsAmt
Group Return For Affiliates	false	GroupReturnForAffiliatesInd
Organization501c3	Yes (X)	Organization501c3Ind
Website Address	www.columbushosp.org	WebsiteAddressTxt
Type Of Organization Corp	Yes (X)	TypeOfOrganizationCorpInd
Formation	1972	FormationYr
Legal Domicile State	NE	LegalDomicileStateCd
Activity Or Mission	OUR MISSION IS TO IMPROVE THE HEALTH OF THE COMMUNITIES WE SERVE.	ActivityOrMissionDesc
Voting Members Governing Body	11	VotingMembersGoverningBodyCnt
Voting Members Independent	11	VotingMembersIndependentCnt
Total Employee	662	TotalEmployeeCnt
Total Volunteers	323	TotalVolunteersCnt
Total Gross UBI	$18,606	TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm	-$44,222	NetUnrelatedBusTxblIncmAmt
PY Contributions Grants	$117,549	PYContributionsGrantsAmt
CY Contributions Grants	$61,455	CYContributionsGrantsAmt
PY Program Service Revenue	$72,520,573	PYProgramServiceRevenueAmt
CY Program Service Revenue	$79,026,667	CYProgramServiceRevenueAmt
PY Investment Income	$321,804	PYInvestmentIncomeAmt
CY Investment Income	$364,263	CYInvestmentIncomeAmt
PY Other Revenue	$1,025,030	PYOtherRevenueAmt
CY Other Revenue	$839,618	CYOtherRevenueAmt
PY Total Revenue	$73,984,956	PYTotalRevenueAmt
CY Total Revenue	$80,292,003	CYTotalRevenueAmt
PY Grants And Similar Paid	$1,469,342	PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid	$1,510,490	CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members	$0	PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members	$0	CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid	$33,905,776	PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid	$35,614,672	CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns	$0	PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns	$0	CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense	$0	CYTotalFundraisingExpenseAmt
PY Other Expenses	$29,781,927	PYOtherExpensesAmt
CY Other Expenses	$31,211,175	CYOtherExpensesAmt
PY Total Expenses	$65,157,045	PYTotalExpensesAmt
CY Total Expenses	$68,336,337	CYTotalExpensesAmt
PY Revenues Less Expenses	$8,827,911	PYRevenuesLessExpensesAmt
CY Revenues Less Expenses	$11,955,666	CYRevenuesLessExpensesAmt
Total Assets BOY	$97,892,656	TotalAssetsBOYAmt
Total Assets EOY	$108,463,254	TotalAssetsEOYAmt
Total Liabilities BOY	$6,956,170	TotalLiabilitiesBOYAmt
Total Liabilities EOY	$6,261,385	TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY	$90,936,486	NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY	$102,201,869	NetAssetsOrFundBalancesEOYAmt
Info In Schedule O Part III	Yes (X)	InfoInScheduleOPartIIIInd
Mission	OUR MISSION IS TO IMPROVE THE HEALTH OF THE COMMUNITIES WE SERVE.	MissionDesc
Significant New Program Srvc	false	SignificantNewProgramSrvcInd
Significant Change	false	SignificantChangeInd
Expense	$64,945,322	ExpenseAmt
Grant	$52,500	GrantAmt
Revenue	$79,576,037	RevenueAmt
Desc	General hospital and health care: Columbus Community Hospital ("CCH") is a 47 bed acute care hospital which currently employs over 600 people. It is a significant, positive economic force for the Columbus area, returning dollars into the economy through local purchases by the organization, and salaries that return to the community. It is also a needed asset for the local communities where patients can obtain quality healthcare without the need to drive over 50 miles for care. In providing the care necessary for local communities, CCH has a variety of services. Following is a brief summary of some of the areas of service provided by CCH. a) The main focus is acute care services for patients. All 47 acute care beds at CCH are also certified as swing beds. b) To assist our non-English speaking patients, CCH uses competent, certified, dedicated Medical Interpreters as a liaison between the care providers and the patient. Since this is the interpreters' full time job at the hospital, they are available when needed, in house or on call 24/7. c) To make the patient's stay successful and comfortable, CCH provides ICU, Medical Surgical, OB, and an Orthopedic Service Line along with a variety of complimentary ancillary services (Wound Care, Diabetic Education, Cardiac Rehab) and Clinical Pharmacy Services. CCH uses Bar-Coded Medication Administrated, Smart Pumps, and Computerized Physician Order Entry to enhance safety. d) CCH offers Rehabilitative Services such as Physical Therapy, Speech Therapy, Occupational Therapy and Drivers Rehab Therapy, so patients don't have to travel so far to get adult therapy. Pediatric Physical Therapy, Speech Therapy, and Occupational Therapy are offered at our off-site location, Wiggles & Giggles Therapy (includes Physical, Speech, and Occupational Therapies) for kids. CCH has Physical Therapists, Occupational Therapists and Speech Therapists with specialized certification in cancer rehab. We launched our certified Star Program at Columbus Community Hospital in November of 2012. We are one of only three hospitals in Nebraska to have achieved the star program certification for Cancer Rehabilitation. Star stands for Survivorship Training and Rehab. We have had at least 74 formal Star Program referrals resulting in consultations for potential rehabilitation needs. Many of our Star Program Participants have needed physical therapy, speech therapy or occupational therapy and some have needed nutritional consults as well as psychosocial referrals. Some patients who have participated have had pulmonary concerns and cardiovascular factors. There also have been some Star Program graduates that have transitioned to medical wellness here at CCH. Star Program co-coordinators are Jill Jakub MOTR/L, CLT, and Michell Ruskamp MS, CCC-SLP. They are joined by 23 other clinicians including Physicians, Nurses, Respiratory Therapists, Dieticians, Social Workers, and therapists who are Star Program certified at CCH. The star program cancer rehab certification at CCH is funded by the Columbus Community Hospital Foundation. Our certified Provider Team for the Star Program is made up of 3 physicians, 6 Physical Therapists, 4 Occupational Therapists, 2 Speech Therapists, 5 Nurses, 1 Respiratory Therapist, 2 Social Workers and 2 Nutritionists. CCH has a Specialized Parkinson's Treatment approach which facilitates support groups for Parkinson's, plus a support group for TBI and Stroke Patients. In March 2014 CCH added an Oncology Nurse Specialist who is now also a STAR Certified Clinician. e) Nurses in the Same Day Services Department prepare patients for surgery and, if going home the same day, care for them after surgery. The department oversees several outpatient procedures, including 90 to 100 Endoscopy Procedures each month, blood transfusions, and Chemotherapy Infusions. f) CCH offers some of the most advanced imaging services including MRI, CT, Digital Mammography, Ultrasound, etc. Radiologists are on campus and/or available 24-7 to read the various scans. The dictation used by the Radiologists is voice recognized and becomes part of the digital image. All images are digital, meaning there are no films. g) CCH has an up to date Laboratory which performs over 13,000 tests on average per month, for both Inpatients and Outpatients. h) CCH has highly trained, employed Emergency Physicians and Nurses in their Emergency Department (ED) and offers 24-7 care. The Department includes support from qualified staff in Respiratory Care, Social Work, Laboratory, Medical Interpreting, and Diagnostic Imaging. The ED was designated as a Level III Trauma Center in May, 2006. The Medical Staff and Personnel in the Trauma Center have received specialized training to resuscitate and stabilize trauma patients. The trauma program provides systematic review of the trauma care and participates in injury prevention activities throughout the community. i) CCH opened Wound Care Services in August of 2008. The identified service area includes a 45-mile radius around Columbus. By January, 2009 a second day was added to support the demand. This service has taken off far beyond what was expected. Previously, patients seeking this specialized treatment were required to travel on average 75 miles to see a wound clinic specialist. It was a much needed service for the local communities. Columbus Community Hospital currently sees about 100 patients per month for wound care. j) Centering on services outside the Hospital, the larger services are Home Health and Hospice Services. Home Health is skilled health services for patients at their place of residence. The program is medically directed, therefore, it must be ordered by the attending physician. The Program is Medicare and Medicaid certified and meets the requirements of the Joint Commission. Services provided within the Program are: 1. Supervision and administration of medications 2. Intravenous Therapy 3. Teaching diabetic management 4. Nutritional Assessments 5. Home Health aides 6. Personal Care Services 7. Occupational, Speech and Physical Therapies 8. Hospice services are provided to persons who are no longer receiving curative treatment and whose life expectancy is six months or less. Care is provided by an interdisciplinary team which consists of the Physician, Nurse, Social Worker, Therapist, Home Health Aide, Spiritual Advisor, Volunteer and other health professionals. k) Our local Healthy Family Nebraska program (HFN) targets young, primarily single, pregnant mothers and their families. Our Voluntary HFN Home Visitation Program targets the most vulnerable young women and their families by offering them, intense, in home education, support and resources. This Home Visiting Program covers families in a four county area. The HFN requires each mother/family to actively participate in building an individualized family plan. This strength based approach promotes self- improvement, and enhances self-esteem and independence for our young parents that will help them make better decisions, and break out of destructive cycles. l) CCH's Sleep Lab offers complete Polysomnographic Sleep Testing for the purpose of diagnosing obstructive/central sleep apnea by trained and licensed Sleep Technicians. Both daytime and night sleep studies are performed. m) Occupational Health Services (OHS) offers a menu of health care services designed to prevent and treat injuries in the workplace. Partnering with employers in more than 800 companies and with other health care professionals, OHS provides the Columbus and regional area business and industry with a comprehensive range of services designed to support and maintain a healthy, safe workforce while assisting to meet OSHA and DOT compliance regulations. Their full range of services include: 1. A comprehensive testing procedure called the Physical Capacity Profile (PCP) that matches employees to the job and is designed to accommodate individuals with handicaps. The PCP System was developed by an Orthopedic Physician. Through use of this testing, musculoskeletal imbalances are detected which helps employers place employees in the appropriate job to minimize the potential of injury. 2. Drug and Alcohol Testing Services 24/7 3. DOT Physicals 4. Pre Employment/Post Job Offer Physical Assessments 5. On Site Nursing Services 6. Hearing/Vision Testing 7. Hearing Conservation Program Management 8. Respiratory Fit Testing 9. Respiratory Evaluation Services 10. Flu Shots and Immunization Programs 11. Wellness Programs n) Lifeline, an in home emergency response program, provides the vital safety net that many people need to continue living at home in familiar and comforting surroundings. The program is completely focused on ensuring the patient's independence, safety and well-being in their home. It operates with a bracelet worn by the patient with a button that can be pressed if help is needed. Predetermined responders are summoned to their home or emergency transfer can be called if n	Desc

Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp

Field	Value	IRS element (for citing)
Expense	$1,370,490	ExpenseAmt
Grant	$1,370,490	GrantAmt
Revenue	$0	RevenueAmt
Desc	Charity Care: CCH offers a Charity/Financial Aid Program to provide uncompensated services to people who are unable to pay. CCH Charity/Financial Aid Policy reflects the Mission, Vision and Values of CCH. It is intended to assist low-income, underinsured, and uninsured individuals whose financial status, under the Hospital's qualification criteria, makes it impractical or Impossible to pay for necessary medical services. CCH has a fiduciary responsibility to seek payment for services from those who can pay, and every effort will be made to apply consistent, fair and equitable financial aid practices in a manner consistent with all applicable Federal and State Laws and Regulations. CCH follows the Federal Poverty Guidelines (FPG) to determine both eligibility for free care, 100% of FPG, and discounted care, 200% FPG. CCH also offers Catastrophic Charity Assistance. If the applicant qualifies for partial charity/financial assistance and the total balance after all write-off's is greater than $1,200, an additional write-off will be done as outlined below. Reduce to $1,200; adjustments will be done from oldest to newest.	Desc

Field	Value	IRS element (for citing)
Total Program Service Expenses	$66,315,812	TotalProgramServiceExpensesAmt
Described In Section501c3	Yes (true)	DescribedInSection501c3Ind
Schedule B Required	Yes (true)	ScheduleBRequiredInd
Political Campaign Acty	false	PoliticalCampaignActyInd
Lobbying Activities	Yes (true)	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	Yes (true)	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	false	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	Yes (true)	GrantsToOrganizationsInd
Grants To Individuals	Yes (true)	GrantsToIndividualsInd
Schedule J Required	Yes (true)	ScheduleJRequiredInd
Tax Exempt Bonds	false	TaxExemptBondsInd
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	Yes (true)	RelatedOrganizationCtrlEntInd
Transaction With Control Ent	Yes (true)	TransactionWithControlEntInd
Trnsfr Exmpt Non Chrtbl Rltd Org	Yes (true)	TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted Prtshp	false	ActivitiesConductedPrtshpInd
Schedule O Required	Yes (true)	ScheduleORequiredInd
IRP Document	32	IRPDocumentCnt
IRP Document W2 G	0	IRPDocumentW2GCnt
Backup Wthld Compliance	Yes (true)	BackupWthldComplianceInd
Employee	662	EmployeeCnt
Employment Tax Returns Filed	Yes (true)	EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over Limit	Yes (true)	UnrelatedBusIncmOverLimitInd
Form990 T Filed	Yes (true)	Form990TFiledInd
Foreign Financial Account	false	ForeignFinancialAccountInd
Prohibited Tax Shelter Trans	false	ProhibitedTaxShelterTransInd
Taxable Party Notification	false	TaxablePartyNotificationInd
Nondeductible Contributions	false	NondeductibleContributionsInd
Quid Pro Quo Contributions	false	QuidProQuoContributionsInd
Form8282 Property Disposed Of	false	Form8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft Cntrct	false	RcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft Cntrct	false	PayPremiumsPrsnlBnftCntrctInd
Indoor Tanning Services	false	IndoorTanningServicesInd
Info In Schedule O Part VI	Yes (X)	InfoInScheduleOPartVIInd
Governing Body Voting Members	11	GoverningBodyVotingMembersCnt
Independent Voting Member	11	IndependentVotingMemberCnt
Family Or Business Rln	false	FamilyOrBusinessRlnInd
Delegation Of Mgmt Duties	false	DelegationOfMgmtDutiesInd
Change To Org Documents	false	ChangeToOrgDocumentsInd
Material Diversion Or Misuse	false	MaterialDiversionOrMisuseInd
Members Or Stockholders	false	MembersOrStockholdersInd
Election Of Board Members	false	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	Yes (true)	Form990ProvidedToGvrnBodyInd
Conflict Of Interest Policy	Yes (true)	ConflictOfInterestPolicyInd
Annual Disclosure Covered Prsn	Yes (true)	AnnualDisclosureCoveredPrsnInd
Regular Monitoring Enfrc	Yes (true)	RegularMonitoringEnfrcInd
Whistleblower Policy	Yes (true)	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

Field	Value	IRS element (for citing)
Person	MIKE ADAMY	PersonNm
Phone	4025623382	PhoneNum

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	4600 38TH STREET	AddressLine1
City	COLUMBUS	City
State	NE	State
ZIP Code	68601	ZIPCode

Field	Value	IRS element (for citing)
Info In Schedule O Part VII	Yes (X)	InfoInScheduleOPartVIIInd

Form990 Part VII Section A Form990PartVIISectionAGrp (21 entries)

TitleTitleTxt	Average Hours Per WeekAverageHoursPerWeekRt	Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt	Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd	Reportable Comp From OrgReportableCompFromOrgAmt	Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt	Other CompensationOtherCompensationAmt	OfficerOfficerInd	Highest Compensated EmployeeHighestCompensatedEmployeeInd
JAMES PILLEN DVM
DIRECTOR	1.0	0.0	Yes (X)	$0	$0	$0
ANTHONY RAIMONDO JR
DIRECTOR	1.0	0.0	Yes (X)	$0	$0	$0
JEFFREY GOTSCHALL MD
CHAIR	1.0	0.0	Yes (X)	$0	$0	$0	Yes (X)
RONALD ERNST MD
DIRECTOR	1.0	0.0	Yes (X)	$0	$0	$0
JOHN C MCCLURE
DIRECTOR	1.0	0.0	Yes (X)	$0	$0	$0
REBECCA RAYMAN
DIRECTOR	1.0	0.0	Yes (X)	$0	$0	$0
BONNIE MCPHILLIPS
DIRECTOR	1.0	0.0	Yes (X)	$0	$0	$0
BRIAN SCHMIDT
VICE CHAIR	1.0	0.0	Yes (X)	$0	$0	$0	Yes (X)
CLARK LEHR
TREASURER	1.0	0.0	Yes (X)	$0	$0	$0	Yes (X)
BETH PRZYMUS
DIRECTOR	1.0	0.0	Yes (X)	$0	$0	$0
KIPTON ANDERSON MD
DIRECTOR/MED STAFF PRES	1.0	0.0	Yes (X)	$0	$0	$0
MICHAEL HANSEN
PRESIDENT/CEO/SECRETARY	39.0	1.0		$353,520	$0	$58,664	Yes (X)
AMY BLASER
VP BUSINESS DEVELOPMENT	40.0	0.0		$131,886	$0	$34,611	Yes (X)
J JOSEPH BARBAGLIA
VP FINANCE	40.0	0.0		$201,239	$0	$29,975	Yes (X)
LINDA WALLINE
VP NURSING	40.0	0.0		$195,596	$0	$27,760	Yes (X)
JAMES GOULET
VP OPERATIONS	40.0	0.0		$197,792	$0	$29,814	Yes (X)
ROBERT MILLER MD
PHYSICIAN	40.0	0.0		$289,212	$0	$23,698		Yes (X)
MICHAEL MCGUIRE MD
PHYSICIAN	40.0	0.0		$574,777	$0	$16,882		Yes (X)
RICHARD CIMPL MD
PHYSICIAN	40.0	0.0		$647,167	$0	$26,164		Yes (X)
EDWARD FEHRINGER MD
PHYSICIAN	40.0	0.0		$569,295	$0	$30,142		Yes (X)
MARK HOWERTER MD
PHYSICIAN	40.0	0.0		$462,500	$0	$30,142		Yes (X)

Field	Value	IRS element (for citing)
Total Reportable Comp From Org	$3,622,984	TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org	$0	TotReportableCompRltdOrgAmt
Total Other Compensation	$307,852	TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K	22	IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed	false	FormerOfcrEmployeesListedInd
Total Comp Greater Than150 K	Yes (true)	TotalCompGreaterThan150KInd
Compensation From Other Srcs	false	CompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (4 entries)

Address Line1ContractorAddress/USAddress/AddressLine1	CityContractorAddress/USAddress/City	StateContractorAddress/USAddress/State	ZIP CodeContractorAddress/USAddress/ZIPCode	ServicesServicesDesc	CompensationCompensationAmt
INPATIENT PHYSICIAN ASSOC
3200 PINE LAKE RD STE A	LINCOLN	NE	68516	HOSPITALIST SVCS	$523,246
TSP CONSTRUCTION SERVICES INC
1112 N WEST AVE	SIOUX FALLS	SD	571041333	CONSTRUCTION SVCS	$795,668
RENOVO SOLUTIONS LLC
1801 E PARK COURT PLAZA STE 206	SANTA ANA	CA	92701	EQUIPMENT MAINT	$112,698
MCKESSON TECHNOLOGIES INC
PO Box 98347	CHICAGO	IL	60693	IT Consulting	$815,109

Field	Value	IRS element (for citing)
Cntrct Rcvd Greater Than100 K	4	CntrctRcvdGreaterThan100KCnt
Related Organizations	$61,455	RelatedOrganizationsAmt
Total Contributions	$61,455	TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (2 entries)

DescDesc	BusinessBusinessCd	Total Revenue ColumnTotalRevenueColumnAmt	Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
NET PATIENT SVC REVENUE	621110	$77,687,200	$77,687,200
MEANINGFUL USE PAYMENT	900099	$1,339,467	$1,339,467

Field	Value	IRS element (for citing)
Total Program Service Revenue	$79,026,667	TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$284,463	TotalRevenueColumnAmt
Exclusion	$284,463	ExclusionAmt

Incm From Invest Bond Proceeds IncmFromInvestBondProceedsGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$0	TotalRevenueColumnAmt

Royalties Revenue RoyaltiesRevenueGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$0	TotalRevenueColumnAmt

Rental Income Or Loss RentalIncomeOrLossGrp

Field	Value	IRS element (for citing)
Real	$0	RealAmt
Personal	$0	PersonalAmt

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$0	TotalRevenueColumnAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

Field	Value	IRS element (for citing)
Other	$79,800	OtherAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

Field	Value	IRS element (for citing)
Other	$0	OtherAmt

Gain Or Loss GainOrLossGrp

Field	Value	IRS element (for citing)
Other	$79,800	OtherAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$79,800	TotalRevenueColumnAmt
Exclusion	$79,800	ExclusionAmt

Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$0	TotalRevenueColumnAmt

Net Income From Gaming NetIncomeFromGamingGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$0	TotalRevenueColumnAmt

Net Income Or Loss NetIncomeOrLossGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$0	TotalRevenueColumnAmt

Other Revenue Misc OtherRevenueMiscGrp (3 entries)

DescDesc	BusinessBusinessCd	Total Revenue ColumnTotalRevenueColumnAmt	Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt	ExclusionExclusionAmt
MEALS ON WHEELS	900099	$56,141	$56,141
CAFETERIA	722100	$271,642		$271,642
HEALTH WATCH	900099	$56,262	$56,262

Miscellaneous Revenue MiscellaneousRevenueGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$455,573	TotalRevenueColumnAmt
Related Or Exempt Func Income	$436,967	RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue	$18,606	UnrelatedBusinessRevenueAmt

Field	Value	IRS element (for citing)
Other Revenue Total	$839,618	OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$80,292,003	TotalRevenueColumnAmt
Related Or Exempt Func Income	$79,576,037	RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue	$18,606	UnrelatedBusinessRevenueAmt
Exclusion	$635,905	ExclusionAmt

Grants To Domestic Orgs GrantsToDomesticOrgsGrp

Field	Value	IRS element (for citing)
Total	$140,000	TotalAmt
Program Services	$140,000	ProgramServicesAmt

Grants To Domestic Individuals GrantsToDomesticIndividualsGrp

Field	Value	IRS element (for citing)
Total	$1,370,490	TotalAmt
Program Services	$1,370,490	ProgramServicesAmt

Foreign Grants ForeignGrantsGrp

Field	Value	IRS element (for citing)
Total	$0	TotalAmt

Benefits To Members BenefitsToMembersGrp

Field	Value	IRS element (for citing)
Total	$0	TotalAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

Field	Value	IRS element (for citing)
Total	$1,080,033	TotalAmt
Management And General	$1,080,033	ManagementAndGeneralAmt

Comp Disqual Persons CompDisqualPersonsGrp

Field	Value	IRS element (for citing)
Total	$0	TotalAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

Field	Value	IRS element (for citing)
Total	$28,316,154	TotalAmt
Program Services	$28,316,154	ProgramServicesAmt

Pension Plan Contributions PensionPlanContributionsGrp

Field	Value	IRS element (for citing)
Total	$1,053,018	TotalAmt
Program Services	$1,053,018	ProgramServicesAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

Field	Value	IRS element (for citing)
Total	$3,191,396	TotalAmt
Program Services	$3,191,396	ProgramServicesAmt

Payroll Taxes PayrollTaxesGrp

Field	Value	IRS element (for citing)
Total	$1,974,071	TotalAmt
Program Services	$1,974,071	ProgramServicesAmt

Fees For Services Management FeesForServicesManagementGrp

Field	Value	IRS element (for citing)
Total	$0	TotalAmt

Fees For Services Legal FeesForServicesLegalGrp

Field	Value	IRS element (for citing)
Total	$24,478	TotalAmt
Management And General	$24,478	ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

Field	Value	IRS element (for citing)
Total	$198,141	TotalAmt
Management And General	$198,141	ManagementAndGeneralAmt

Fees For Services Lobbying FeesForServicesLobbyingGrp

Field	Value	IRS element (for citing)
Total	$5,966	TotalAmt
Management And General	$5,966	ManagementAndGeneralAmt

Fees For Services Prof Fundraising FeesForServicesProfFundraising

Field	Value	IRS element (for citing)
Total	$0	TotalAmt

Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp

Field	Value	IRS element (for citing)
Total	$0	TotalAmt

Fees For Services Other FeesForServicesOtherGrp

Field	Value	IRS element (for citing)
Total	$1,407,577	TotalAmt
Program Services	$1,407,577	ProgramServicesAmt

Advertising AdvertisingGrp

Field	Value	IRS element (for citing)
Total	$162,267	TotalAmt
Management And General	$162,267	ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

Field	Value	IRS element (for citing)
Total	$10,867,164	TotalAmt
Program Services	$10,624,254	ProgramServicesAmt
Management And General	$242,910	ManagementAndGeneralAmt

Information Technology InformationTechnologyGrp

Field	Value	IRS element (for citing)
Total	$1,571,297	TotalAmt
Program Services	$1,571,297	ProgramServicesAmt

Royalties RoyaltiesGrp

Field	Value	IRS element (for citing)
Total	$0	TotalAmt

Occupancy OccupancyGrp

Field	Value	IRS element (for citing)
Total	$1,086,641	TotalAmt
Program Services	$1,086,641	ProgramServicesAmt

Travel TravelGrp

Field	Value	IRS element (for citing)
Total	$197,408	TotalAmt
Management And General	$197,408	ManagementAndGeneralAmt

Pymt Travel Entrtnmnt Pub Ofcl PymtTravelEntrtnmntPubOfclGrp

Field	Value	IRS element (for citing)
Total	$0	TotalAmt

Conferences Meetings ConferencesMeetingsGrp

Field	Value	IRS element (for citing)
Total	$109,322	TotalAmt
Management And General	$109,322	ManagementAndGeneralAmt

Interest InterestGrp

Field	Value	IRS element (for citing)
Total	$0	TotalAmt

Payments To Affiliates PaymentsToAffiliatesGrp

Field	Value	IRS element (for citing)
Total	$0	TotalAmt

Depreciation Depletion DepreciationDepletionGrp

Field	Value	IRS element (for citing)
Total	$4,935,220	TotalAmt
Program Services	$4,935,220	ProgramServicesAmt

Insurance InsuranceGrp

Field	Value	IRS element (for citing)
Total	$192,756	TotalAmt
Program Services	$192,756	ProgramServicesAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDesc	TotalTotalAmt	Program ServicesProgramServicesAmt
PROVISION FOR BAD DEBTS	$5,512,231	$5,512,231
MINOR EQUIP. & FINANCING AGRMT	$1,788,872	$1,788,872
PURCHASED SERVICES	$1,605,145	$1,605,145
RECRUITING	$243,212	$243,212

All Other Expenses AllOtherExpensesGrp

Field	Value	IRS element (for citing)
Total	$1,303,478	TotalAmt
Program Services	$1,303,478	ProgramServicesAmt

Total Functional Expenses TotalFunctionalExpensesGrp

Field	Value	IRS element (for citing)
Total	$68,336,337	TotalAmt
Program Services	$66,315,812	ProgramServicesAmt
Management And General	$2,020,525	ManagementAndGeneralAmt
Fundraising	$0	FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

Field	Value	IRS element (for citing)
BOY	$1,933,467	BOYAmt
EOY	$5,961,224	EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

Field	Value	IRS element (for citing)
BOY	$0	BOYAmt
EOY	$0	EOYAmt

Pledges And Grants Receivable PledgesAndGrantsReceivableGrp

Field	Value	IRS element (for citing)
BOY	$0	BOYAmt
EOY	$0	EOYAmt

Accounts Receivable AccountsReceivableGrp

Field	Value	IRS element (for citing)
BOY	$9,233,671	BOYAmt
EOY	$9,015,656	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
EOY	$0	EOYAmt

Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp

Field	Value	IRS element (for citing)
BOY	$0	BOYAmt
EOY	$0	EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

Field	Value	IRS element (for citing)
BOY	$1,077,673	BOYAmt
EOY	$1,348,807	EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

Field	Value	IRS element (for citing)
BOY	$1,512,950	BOYAmt
EOY	$1,828,137	EOYAmt

Field	Value	IRS element (for citing)
Land Bldg Equip Cost Or Other Bss	$92,315,034	LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec	$53,664,675	LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

Field	Value	IRS element (for citing)
BOY	$37,701,715	BOYAmt
EOY	$38,650,359	EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

Field	Value	IRS element (for citing)
BOY	$46,218,318	BOYAmt
EOY	$51,402,269	EOYAmt

Investments Other Securities InvestmentsOtherSecuritiesGrp

Field	Value	IRS element (for citing)
BOY	$0	BOYAmt
EOY	$0	EOYAmt

Investments Program Related InvestmentsProgramRelatedGrp

Field	Value	IRS element (for citing)
BOY	$0	BOYAmt
EOY	$0	EOYAmt

Intangible Assets IntangibleAssetsGrp

Field	Value	IRS element (for citing)
BOY	$0	BOYAmt
EOY	$0	EOYAmt

Other Assets Total OtherAssetsTotalGrp

Field	Value	IRS element (for citing)
BOY	$214,862	BOYAmt
EOY	$256,802	EOYAmt

Total Assets TotalAssetsGrp

Field	Value	IRS element (for citing)
BOY	$97,892,656	BOYAmt
EOY	$108,463,254	EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

Field	Value	IRS element (for citing)
BOY	$6,956,170	BOYAmt
EOY	$6,261,385	EOYAmt

Grants Payable GrantsPayableGrp

Field	Value	IRS element (for citing)
BOY	$0	BOYAmt
EOY	$0	EOYAmt

Deferred Revenue DeferredRevenueGrp

Field	Value	IRS element (for citing)
BOY	$0	BOYAmt
EOY	$0	EOYAmt

Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$0	BOYAmt
EOY	$0	EOYAmt

Escrow Account Liability EscrowAccountLiabilityGrp

Field	Value	IRS element (for citing)
BOY	$0	BOYAmt
EOY	$0	EOYAmt

Loans From Officers Directors LoansFromOfficersDirectorsGrp

Field	Value	IRS element (for citing)
BOY	$0	BOYAmt
EOY	$0	EOYAmt

Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp

Field	Value	IRS element (for citing)
BOY	$0	BOYAmt
EOY	$0	EOYAmt

Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp

Field	Value	IRS element (for citing)
BOY	$0	BOYAmt
EOY	$0	EOYAmt

Other Liabilities OtherLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$0	BOYAmt
EOY	$0	EOYAmt

Total Liabilities TotalLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$6,956,170	BOYAmt
EOY	$6,261,385	EOYAmt

Field	Value	IRS element (for citing)
Organization Follows SFAS117	Yes (X)	OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

Field	Value	IRS element (for citing)
BOY	$90,936,486	BOYAmt
EOY	$102,201,869	EOYAmt

Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp

Field	Value	IRS element (for citing)
BOY	$0	BOYAmt
EOY	$0	EOYAmt

Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp

Field	Value	IRS element (for citing)
BOY	$0	BOYAmt
EOY	$0	EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

Field	Value	IRS element (for citing)
BOY	$90,936,486	BOYAmt
EOY	$102,201,869	EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

Field	Value	IRS element (for citing)
BOY	$97,892,656	BOYAmt
EOY	$108,463,254	EOYAmt

Field	Value	IRS element (for citing)
Info In Schedule O Part XI	Yes (X)	InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss	$11,955,666	ReconcilationRevenueExpnssAmt
Other Changes In Net Assets	-$690,283	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 C IRS990ScheduleC

Field	Value	IRS element (for citing)
Total Grassroots Lobbying		TotalGrassrootsLobbyingGrp
Total Direct Lobbying		TotalDirectLobbyingGrp
Total Lobbying Expend		TotalLobbyingExpendGrp
Other Exempt Purpose Expend		OtherExemptPurposeExpendGrp
Total Exempt Purpose Expend		TotalExemptPurposeExpendGrp
Lobbying Nontaxable Amount		LobbyingNontaxableAmountGrp
Grassroots Nontaxable		GrassrootsNontaxableGrp
Tot Lbbyng Grassroot Mns Non Tx		TotLbbyngGrassrootMnsNonTxGrp
Tot Lbby Expend Mns Lbbyng Non Tx		TotLbbyExpendMnsLbbyngNonTxGrp
Volunteers	false	VolunteersInd
Paid Staff Or Management	false	PaidStaffOrManagementInd
Media Advertisements	false	MediaAdvertisementsInd
Mailings Members	false	MailingsMembersInd
Publications Or Broadcast	false	PublicationsOrBroadcastInd
Grants Other Organizations	false	GrantsOtherOrganizationsInd
Direct Contact Legislators	false	DirectContactLegislatorsInd
Rallies Demonstrations	false	RalliesDemonstrationsInd
Other Activities	Yes (true)	OtherActivitiesInd
Other Activities	$5,966	OtherActivitiesAmt
Total Lobbying Expenditures	$5,966	TotalLobbyingExpendituresAmt
Not Described Section501c3	false	NotDescribedSection501c3Ind

Supplemental Information Detail SupplementalInformationDetail

Field	Value	IRS element (for citing)
Form And Line Reference	SCHEDULE C, PART II-B, LINE 1I	FormAndLineReferenceDesc
Explanation	DUES PAID TO AMERICAN HOSPITAL ASSOCIATION ALLOCATED TO LOBBYING $3,108 DUES PAID TO NEBRASKA HOSPITAL ASSOCIATION ALLOCATED TO LOBBYING $2,858	ExplanationTxt

Schedule D IRS990ScheduleD

Field	Value	IRS element (for citing)
Art Public Exhibition Amounts		ArtPublicExhibitionAmountsGrp
Held Works Art		HeldWorksArtGrp

CY Endwmt Fund CYEndwmtFundGrp

Field	Value	IRS element (for citing)
Beginning Year Balance	$1,742,125	BeginningYearBalanceAmt
Contributions	$56,121	ContributionsAmt
End Year Balance	$1,798,246	EndYearBalanceAmt

CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp

Field	Value	IRS element (for citing)
Beginning Year Balance	$1,667,736	BeginningYearBalanceAmt
Contributions	$74,389	ContributionsAmt
End Year Balance	$1,742,125	EndYearBalanceAmt

CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp

Field	Value	IRS element (for citing)
Beginning Year Balance	$1,573,063	BeginningYearBalanceAmt
Contributions	$94,673	ContributionsAmt
End Year Balance	$1,667,736	EndYearBalanceAmt

CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp

Field	Value	IRS element (for citing)
Beginning Year Balance	$1,506,660	BeginningYearBalanceAmt
Contributions	$66,403	ContributionsAmt
End Year Balance	$1,573,063	EndYearBalanceAmt

CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp

Field	Value	IRS element (for citing)
Beginning Year Balance	$1,426,826	BeginningYearBalanceAmt
Contributions	$79,844	ContributionsAmt
Investment Earnings Or Losses	-$10	InvestmentEarningsOrLossesAmt
End Year Balance	$1,506,660	EndYearBalanceAmt

Field	Value	IRS element (for citing)
Prmnnt Endowment Balance EOY	1.00000	PrmnntEndowmentBalanceEOYPct
Endowments Held Unrelated Org	false	EndowmentsHeldUnrelatedOrgInd
Endowments Held Related Org	Yes (true)	EndowmentsHeldRelatedOrgInd
Related Org List Sch R	Yes (true)	RelatedOrgListSchRInd

Land LandGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$1,279,072	OtherCostOrOtherBasisAmt
Book Value	$1,279,072	BookValueAmt

Buildings BuildingsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$44,122,186	OtherCostOrOtherBasisAmt
Depreciation	$20,225,508	DepreciationAmt
Book Value	$23,896,678	BookValueAmt

Field	Value	IRS element (for citing)
Leasehold Improvements		LeaseholdImprovementsGrp

Equipment EquipmentGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$40,630,741	OtherCostOrOtherBasisAmt
Depreciation	$31,491,864	DepreciationAmt
Book Value	$9,138,877	BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$6,283,035	OtherCostOrOtherBasisAmt
Depreciation	$1,947,303	DepreciationAmt
Book Value	$4,335,732	BookValueAmt

Field	Value	IRS element (for citing)
Total Book Value Land Buildings	$38,650,359	TotalBookValueLandBuildingsAmt
Federal Income Tax Liability	$0	FederalIncomeTaxLiabilityAmt
Total Liability	$0	TotalLiabilityAmt
Footnote Text	Yes (X)	FootnoteTextInd

Supplemental Information Detail SupplementalInformationDetail (2 entries)

Form And Line ReferenceFormAndLineReferenceDesc

ExplanationExplanationTxt

FIN 48 FOOTNOTE

SCHEDULE D, PART X The Hospital adopted Financial Accounting Standards Board (FASB) Interpretation No. 48, Accounting for Uncertainty in Income Taxes - an Interpretation of FASB Statement No. 109 (FIN 48). FIN 48 provides specific guidance on how to address uncertainty in accounting for income tax assets and liabilities, prescribing recognition thresholds and measurement attributes. The adoption of FIN 48 by Columbus Community Hospital did not have a material impact on the Hospital's financial position, results of operations, or cash flows. In Fiscal Years Ending 2014 and 2013, management determined that there are no income tax positions requiring recognition in the financial statements.

SCHEDULE D, Part V, Line 4

ENDOWMENT FUNDS ARE HELD AND MAINTAINED BY COLUMBUS COMMUNITY HOSPITAL FOUNDATION. THE ENDOWMENT FUNDS EXIST IN SUPPORT OF IMPROVED HEALTH SERVICES BY COLUMBUS COMMUNITY HOSPITAL.

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	Yes (true)	FPGReferenceFreeCareInd
Percent100	Yes (X)	Percent100Ind
FPG Reference Discounted Care	Yes (true)	FPGReferenceDiscountedCareInd
Percent200 D	Yes (X)	Percent200DInd
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	761	PersonsServedCnt
Total Community Benefit Expns	$761,444	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$761,444	NetCommunityBenefitExpnsAmt
Total Expense	0.01210	TotalExpensePct

Unreimbursed Medicaid UnreimbursedMedicaidGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$4,775,514	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$1,507,026	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$3,268,488	NetCommunityBenefitExpnsAmt
Total Expense	0.05200	TotalExpensePct

Total Financial Assistance Typ TotalFinancialAssistanceTyp

Field	Value	IRS element (for citing)
Persons Served	761	PersonsServedCnt
Total Community Benefit Expns	$5,536,958	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$1,507,026	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$4,029,932	NetCommunityBenefitExpnsAmt
Total Expense	0.06410	TotalExpensePct

Community Health Services CommunityHealthServicesGrp

Field	Value	IRS element (for citing)
Persons Served	77619	PersonsServedCnt
Total Community Benefit Expns	$465,978	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$3,550	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$462,428	NetCommunityBenefitExpnsAmt
Total Expense	0.00740	TotalExpensePct

Health Professions Education HealthProfessionsEducationGrp

Field	Value	IRS element (for citing)
Persons Served	848	PersonsServedCnt
Total Community Benefit Expns	$804,395	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$10,470	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$793,925	NetCommunityBenefitExpnsAmt
Total Expense	0.01260	TotalExpensePct

Cash And In Kind Contributions CashAndInKindContributionsGrp

Field	Value	IRS element (for citing)
Persons Served	132	PersonsServedCnt
Total Community Benefit Expns	$99,867	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$99,867	NetCommunityBenefitExpnsAmt
Total Expense	0.00160	TotalExpensePct

Total Other Benefits TotalOtherBenefitsGrp

Field	Value	IRS element (for citing)
Persons Served	78599	PersonsServedCnt
Total Community Benefit Expns	$1,370,240	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$14,020	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$1,356,220	NetCommunityBenefitExpnsAmt
Total Expense	0.02160	TotalExpensePct

Total Community Benefits TotalCommunityBenefitsGrp

Field	Value	IRS element (for citing)
Persons Served	79360	PersonsServedCnt
Total Community Benefit Expns	$6,907,198	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$1,521,046	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$5,386,152	NetCommunityBenefitExpnsAmt
Total Expense	0.08570	TotalExpensePct

Community Support CommunitySupportGrp

Field	Value	IRS element (for citing)
Persons Served	1	PersonsServedCnt
Total Community Benefit Expns	$1,950	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$1,950	NetCommunityBenefitExpnsAmt

Environmental Improvements EnvironmentalImprovementsGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$2,360	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$2,360	NetCommunityBenefitExpnsAmt

Coalition Building CoalitionBuildingGrp

Field	Value	IRS element (for citing)
Persons Served	1560	PersonsServedCnt
Total Community Benefit Expns	$27,531	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$11,959	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$15,572	NetCommunityBenefitExpnsAmt
Total Expense	0.00020	TotalExpensePct

Workforce Development WorkforceDevelopmentGrp

Field	Value	IRS element (for citing)
Persons Served	3512	PersonsServedCnt
Total Community Benefit Expns	$8,780	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$1,085	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$7,695	NetCommunityBenefitExpnsAmt
Total Expense	0.00010	TotalExpensePct

Total Communtity Building Acty TotalCommuntityBuildingActyGrp

Field	Value	IRS element (for citing)
Persons Served	5073	PersonsServedCnt
Total Community Benefit Expns	$40,621	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$13,044	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$27,577	NetCommunityBenefitExpnsAmt
Total Expense	0.00030	TotalExpensePct

Field	Value	IRS element (for citing)
Bad Debt Expense Reported	false	BadDebtExpenseReportedInd
Bad Debt Expense	$5,512,231	BadDebtExpenseAmt
Reimbursed By Medicare	$20,400,882	ReimbursedByMedicareAmt
Cost Of Care Reimbursed By Medcr	$21,641,103	CostOfCareReimbursedByMedcrAmt
Medicare Surplus Or Shortfall	-$1,240,221	MedicareSurplusOrShortfallAmt

Costing Methodology Used CostingMethodologyUsedGrp

Field	Value	IRS element (for citing)
Other	Yes (X)	OtherInd

Field	Value	IRS element (for citing)
Written Debt Collection Policy	Yes (true)	WrittenDebtCollectionPolicyInd
Financial Assistance Prvsn	Yes (true)	FinancialAssistancePrvsnInd

Management Co And Jnt Ventures ManagementCoAndJntVenturesGrp (2 entries)

Primary ActivitiesPrimaryActivitiesTxt	Physicians Profit Or OwnershipPhysiciansProfitOrOwnershipPct
HEALTHPARK LLC
PROPERTY MANAGEMENT	0.72790
ZARZ LLC
PROPERTY MANAGEMENT	0.55550

Field	Value	IRS element (for citing)
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	Columbus Community Hospital INC	BusinessNameLine1

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	4600 38th Street	AddressLine1
City	Columbus	City
State	NE	State
ZIP Code	686011800	ZIPCode

Field	Value	IRS element (for citing)
Website Address	www.columbushosp.org	WebsiteAddressTxt
State License	License #: 630001	StateLicenseNum
Licensed Hospital	Yes (X)	LicensedHospitalInd
General Medical And Surgical	Yes (X)	GeneralMedicalAndSurgicalInd
Emergency Room24 Hrs	Yes (X)	EmergencyRoom24HrsInd
Other	47 Bed acute care Hospital w/ 24 HR ER Services	OtherDesc

Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp

Hospital Facility Name HospitalFacilityName

Field	Value	IRS element (for citing)
Business Name Line1	COLUMBUS COMMUNITY HOSPITAL INC	BusinessNameLine1

Field	Value	IRS element (for citing)
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	12	CHNAConductedYr
Take Into Account Others Input	Yes (true)	TakeIntoAccountOthersInputInd
CHNA Conducted With Other Fclts	Yes (true)	CHNAConductedWithOtherFcltsInd
CHNA Report Widely Available	Yes (true)	CHNAReportWidelyAvailableInd
Rpt Available On Own Website	Yes (X)	RptAvailableOnOwnWebsiteInd
Own Website URL	SEE SECTION C	OwnWebsiteURLTxt
Rpt Available Upon Request	Yes (X)	RptAvailableUponRequestInd
Rpt Available Thru Other Method	Yes (X)	RptAvailableThruOtherMethodInd
Adopt Implementation Strategy	Yes (X)	AdoptImplementationStrategyInd
Exec Implementation Strategy	Yes (X)	ExecImplementationStrategyInd
Develop Community Wide Plan	Yes (X)	DevelopCommunityWidePlanInd
Exec Community Wide Plan	Yes (X)	ExecCommunityWidePlanInd
Include Operational Plan	Yes (X)	IncludeOperationalPlanInd
Prioritize Health Needs	Yes (X)	PrioritizeHealthNeedsInd
Prioritize Services	Yes (X)	PrioritizeServicesInd
All Needs Addressed	false	AllNeedsAddressedInd
Organization Incur Excise Tax	false	OrganizationIncurExciseTaxInd
Elig Criteria Explained	Yes (true)	EligCriteriaExplainedInd
FPG Used Deter Elig Free Care	Yes (true)	FPGUsedDeterEligFreeCareInd
FPG Family Incm Lmt Free Care	100	FPGFamilyIncmLmtFreeCarePct
FPG Used Determ Elig Dscnt Care	Yes (true)	FPGUsedDetermEligDscntCareInd
FPG Family Incm Lmt Dscnt Care	200.	FPGFamilyIncmLmtDscntCarePct
Explained Basis	Yes (true)	ExplainedBasisInd
Income Level	Yes (X)	IncomeLevelInd
Medical Indigency	Yes (X)	MedicalIndigencyInd
Insurance Status	Yes (X)	InsuranceStatusInd
Medicaid Medicare	Yes (X)	MedicaidMedicareInd
App Financial Asst Expln	Yes (true)	AppFinancialAsstExplnInd
Includes Publicity Measures	Yes (true)	IncludesPublicityMeasuresInd
Posted On Website	Yes (X)	PostedOnWebsiteInd
Attached To Invoice	Yes (X)	AttachedToInvoiceInd
Posted In Emergency Room	Yes (X)	PostedInEmergencyRoomInd
Posted In Admission Office	Yes (X)	PostedInAdmissionOfficeInd
Provided On Admission	Yes (X)	ProvidedOnAdmissionInd
Available On Request	Yes (X)	AvailableOnRequestInd
Other Publicity	Yes (X)	OtherPublicityInd
FAP Actions On Nonpayment	Yes (true)	FAPActionsOnNonpaymentInd
Collection Activities	false	CollectionActivitiesInd
Nondis Emergency Care Policy	Yes (true)	NondisEmergencyCarePolicyInd
Average Negotiated Rates	Yes (X)	AverageNegotiatedRatesInd
Amounts Generally Billed	false	AmountsGenerallyBilledInd
Gross Charges	false	GrossChargesInd

Supplemental Information SupplementalInformationGrp (5 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
PART V, SECTION B, LINE 3	MOBILIZING FOR ACTION THROUGH PLANNING AND PARTNERSHIP (MAPP) PROCESS WAS DEVELOPED BY AND IS RECOMMENDED FOR COMMUNITY ASSESSMENT BY THE NATIONAL ASSOCIATION OF CITY AND COUNTY HEALTH OFFICIALS (NACCHO) AND CENTER FOR DISEASE CONTROL (CDC). MAPP WAS ALSO A RECOMMENDED COMMUNITY ASSESSMENT BY THE NEBRASKA RURAL HEALTH ASSOCIATION IN ITS "COMMUNITY HEALTH ASSESSMENT COLLABORATIVE PRELIMINARY RECOMMENDATIONS FOR NEBRASKA'S COMMUNITY, NONPROFIT HOSPITALS TO COMPLY WITH NEW REQUIREMENTS FOR TAX EXEMPT STATUS ENACTED BY THE PATIENT PROTECTION AND AFFORDABLE CARE ACT" (SEPTEMBER OF 2011). MAPP allows for input from parties who represent broad interests in the communities. Input from diverse sectors including medically underserved, low-income, minority populations and individuals from diverse age groups was obtained through surveys, targeted focus groups, open public meetings and target invitations to community leaders and agencies. The Hospital's participation in the current MAPP assessment is the most thorough to date with over 100 individuals in the District participating in the process. This does not count the 1,000 individual surveys or focus group participants.
PART V, SECTION B, LINE 4	-ALEGENT HEALTH MEMORIAL HOSPITAL, SCHUYLER -GENOA COMMUNITY HOSPITAL -BOONE COUNTY HEALTH CENTER
PART V, SECTION B, LINE 5A & 5D	THE DETAILED ASSESSMENT AND RELATED COMPONENTS ARE AVAILABLE VIA LINK ON https://www.columbushosp. org/news_events/community_health_needs_assessment_chna.aspx OR AVAILABLE ON REQUEST AND AVAILABLE FOR REVIEW AT COLUMBUS COMMUNITY HOSPITAL. THE IMPLEMENTATION STRATEGY IS AVAILABLE VIA LINK ON https://www.columbushosp.org/news_events/chip_implementation_plan.aspx
PART V, SECTION B, LINE 7	We have identified priorities for areas that we are not directly addressing. We will maintain active partnerships with and remain supportive of the lead organizations focused on these priorities.
PART V, SECTION B, LINE 14G	INFORMATION BROCHURES ON FINANCIAL/CHARITY ASSISTANCE (F/C) ARE AVAILABLE IN KEY AREAS OF THE HOSPITAL. THE CCH WEBSITE HAS INFORMATION REGARDING F/C ASSISTANCE, AS WELL AS APPLICATIONS IN BOTH SPANISH AND ENGLISH. THE PATIENT STATEMENTS HAve INFORMATION REGARDING F/C ASSISTANCE. THE F/C APPLICATIONS ARE AVAILABLE TO ALL STAFF ON THE H DRIVE UNDER FORMS. THE EMERGENCY REGISTRATION, MAIN REGISTRATION, PATIENT ACCOUNTS AND SOCIAL SERVICES DEPARTMENTS HAVE THE F/C APPLICATIONS IN BOTH ENGLISH AND SPANISH AVAILABLE.

Field	Value	IRS element (for citing)
Facility	9	FacilityNum

Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp

Oth Hlth Care Fclts OthHlthCareFcltsGrp (9 entries)

Address Line1USAddress/AddressLine1	CityUSAddress/City	StateUSAddress/State	ZIP CodeUSAddress/ZIPCode	FacilityFacilityTxt
PREMIER PHYSICAL THERAPY OF CCH
US 30 CTR BLDG 3100-23RD st ste 15	COLUMBUS	NE	686013161	PHYSICAL & AQUATIC THERAPY, SPORTS TRAINING SERVICES
WIGGLES & GIGGLES THERAPY FOR KIDS
2108-13TH STREET	COLUMBUS	NE	686015100	PEDIATRIC THERAPY SERVICES
OCCUPATIONAL HEALTH SERVICES OF CCH
3005-19TH ST SUITE 300	COLUMBUS	NE	686014252	EMP. HEALTH CARE SVCS TO PREVENT & TREAT WORK INJURIES
WOUND HEALING CENTER
4600-38TH STREET SUITE 165	COLUMBUS	NE	68601	WOUND TREATMENT CENTER
HUMPHREY CLINIC OF CCH
3003 MAIN STREET	HUMPHREY	NE	686423155	CLINIC IN SMALL TOWN TO OFFER MEDICAL SVCS TO RESIDENTS
HOSPICE OF COLUMBUS COMMUNITY HOSPITAL
3005-19TH STREET SUITE 600	COLUMBUS	NE	686014248	HOSPICE SERVICES
COLUMBUS COMMUNITY HOSPITAL SLEEP LAB
3020-19TH STREET SUITE 100	COLUMBUS	NE	686014252	POLYSOMNOGRAPHIC SLEEP TESTING
HOME HEALTH OF COLUMBUS COMMUNITY HOSP
3005-19TH STREET SUITE 600	COLUMBUS	NE	686014248	HOME HEALTH SERVICES
COLUMBUS ORTHOPEDIC & SPORTS MED CLINIC
4508 38TH STREET STE 133	COLUMBUS	NE	686011668	FREE STANDING CLINIC

Supplemental Information Detail SupplementalInformationDetail (13 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
PART I, LINE 3C	N/A
PART I, LINE 6A	A Community Benefit report is included each year in the Hospital's quarterly newsletter "Housecall" with an electronic version of the newsletter housed on the Hospital's website. A separate landing page on the website was also created for the report to provide easy access to the report.
PART I, LINE 7B	The revenue generated by Medicaid patients is multiplied by the cost to charge ratio developed in worksheet 2. The remaining product is the calculated cost associated with the charges from Medicaid patients. These costs are reduced by the reimbursements collected for the Medicaid charges. The remaining number is the net community benefit expense. Part I, Line 7e Expenses represent wages along with services and supplies purchased by the Hospital. Direct offsetting revenues represent cash collected for these services. Part I, Line 7f Expenses represent wages along with services and supplies purchased by the Hospital. Direct offsetting revenues represent cash collected for these services. Part I, Line 7i Cash donations represent the majority of these donations, the largest amount, $87,500, going to the East Central District Health Department to support Community Health Programs. Other cash donations were made to smaller organizations for programs or events relating to health. The in-kind donations, $369, were items like boxes of gloves, bottles of hand sanitizer to Special Olympics Teams, etc. Part I, Line 7, Column (f) The amount of 62,824,106 used as the denominator to compute Column (f) is calculated by taking total functional expenses of 68,336,337 minus Bad Debt expense of 5,512,231.
PART II	COMMUNITY BUILDING ACTIVITIES - The Hospital continues to collaborate with the local Chamber of Commerce to recruit skilled professionals to fill job openings in the community. The Hospital also provides support and staff time to assist in highlighting the healthcare community, providing specific department or Hospital tours in order to recruit skilled professionals to live and work here in the community. - The Hospital donated land to the City of Columbus providing space for a twelve-acre urban lake and 20 acres of land for a future fire station on this property. The urban lake is equipped with a nice wooden dock making it very accessible for strollers, wheelchairs and other assistive devices to fish or watch the water fowl on the lake. Local assisted living and nursing care centers can drive to the accessible dock, allowing their residents to have convenient access to the lake as well. This urban lake, waterfowl area provides a community space within the City limits for the whole community, young and old alike. - The Hospital continues to partner with our local District Public Health Department and Community Health Center (CHC) on several projects and community disease prevention initiatives. The Hospital provides financial support and professional staff time as liaisons to these community partnerships throughout the year working on multiple chronic disease and accident prevention strategies. Some of these community initiatives include Type II Diabetes, Hypertension and Heart Disease, Pre and Post Natal Newborn care, Physical Activity and Exercise, Colon Cancer Prevention and Early Detection as well as Community Preparedness to natural and manmade disasters. Several other initiatives are addressed throughout the year as community health issues arise. Thousands of community members are reached with these community initiative campaigns each year and making a real difference in the lives of people living with chronic health issues. The Hospital also provides free flu shots to residents of Harbor of Hope, a homeless shelter. - Additionally, CCH participates in over a dozen community health fairs/community events each year, providing medical screenings and information for all community members. - CCH also partners with local day cares, schools and colleges to provide speakers and hands on learning events for students to encourage entry into the medical professions. Additionally, the CCH Board has approved the construction of a day care center that will provide not only day care, but pre-school learning using the Educare Model. - The CCH Board of Directors has approved the construction of a $21.0 million, 85,723 square feet Community Wellness Facility that will be leased, below fair market value, to the YMCA. The Wellness Center will be available for use by the entire community and include 2 gyms, pool, weights and exercise equipment, all in 62,397 square feet. Classes for wellness and fitness will be provided by healthcare professionals from the Hospital and YMCA staff. The facility will also house the Hospital's Adult Therapies and Pediatric Therapy in separate areas.
PART III, Section A, LINE 2	The methodology used to estimate the bad debt expense is to take the private pay write-offs for the year and divide them by the total revenue generated from self-pay patients and multiply the product by the self-pay accounts receivable. This gives the amount of reserve necessary to cover the potential bad debt in current self-pay accounts receivable. Bad debt expense for the fiscal year is the amount of additional expense necessary to bring that reserve account to the calculated (estimated) balance. Part III, Section A, Line 3 N/A Part III, Section A, Line 4 Financial statements do not include any text for bad debt. The amount in Line 2 is the book bad debt amount. Charity care is kept separate from bad debt.
PART III, Section B, LINE 8	In accordance with 42 CFR 413.24, Columbus Community Hospital uses the "step-down method" as its costing methodology. Departments within a provider are usually divided into two types: 1) those that produce patient care revenue (e.g., routing services, radiology), and 2) those that do not directly generate patient care revenue, but are utilized as a service by other departments (e.g., laundry and linen, dietary). The two types of departments are commonly referred to as "revenue-producing cost centers" and "nonrevenue-producing cost centers", respectively. Although nonrevenue-producing cost centers do not directly produce patient care revenue, they contribute indirectly to patient care revenue generated by "serving" as a service to the revenue-producing centers and also to other nonrevenue-producing centers. Therefore, for the purpose of proper matching of revenue and expenses, the cost of the revenue-producing centers should include both its direct expenses and its proportionate share of the costs of each nonrevenue-producing center (indirect costs) based on the amount of services received. The process of allocating the cost of a particular nonrevenue-producing center to other nonrevenue-producing centers and revenue-producing centers is performed by utilizing a set of statistics (e.g., pounds of laundry for allocating "laundry and linen" costs, square feet for allocating "depreciation building" costs). Every nonrevenue-producing cost center has the potential of being allocated to every other nonrevenue-producing cost centers in addition to the revenue-producing cost centers. This precludes a simple allocation of the direct expense of the nonrevenue-producing cost center because the indirect costs derived from allocation of other nonrevenue-producing cost centers must be computed in determining the "full cost" (direct and indirect costs) of the nonrevenue-producing cost center being allocated. The "step-down method" recognizes that services furnished by certain nonrevenue-producing departments are utilized by certain other nonrevenue-producing centers as well as by the revenue-producing centers. All costs of nonrevenue-producing centers are allocated to all centers that they serve, regardless of whether or not these centers produce revenue. The cost of the nonrevenue-producing center serving the greatest number of other centers, while receiving benefits from the least number of centers, is apportioned first. Following the apportionment of the cost of the nonrevenue-producing center, that center will be considered "closed" and no further costs are apportioned to that center. This applies even though it may have received some service from a center whose cost is apportioned later. Generally, if two centers furnish services to an equal number of centers while receiving benefits from an equal number, that center which has the greatest amount of expense should be allocated first.
PART III, Section C, LINE 9B	Charity (financial aid) program policy/procedure Columbus Community Hospital (CCH) offers a charity/financial aid program to provide uncompensated services to people who are unable to pay. CCH charity/financial aid policy reflects the mission, vision and values of CCH. It is intended to assist low-income, underinsured and uninsured individuals whose financial status, under the Hospital's qualification criteria, makes it impractical or impossible to pay for necessary medical services. CCH has a fiduciary responsibility to seek payment for services from those who can pay, and every effort will be made to apply consistent, fair and equitable financial aid practices in a manner consistent with all applicable Federal and State laws and regulations. 1. Charity Policy A. Our charity/financial aid policy does not eliminate the personal responsibility and financial discounts are always secondary to other Government-sponsored programs. However, CCH is committed serving those without the means to pay and works with Good Neighbor Community Health Center and Medicaid services to provide services to this segment. 2. Health Insurance A. If a patient or guarantor has access to employer-based or Government-sponsored health insurance, yet elected not to enroll or failed to maintain eligibility, they may be considered. They will be encouraged to obtain coverage at the next eligible period. B. If a patient or guarantor has a medical savings account, this must be expended before they are eligible for assistance. C."Presumptive" financial assistance may be taken into consideration when a patient has expired and there is no estate. An incomplete financial assistance form may be on file because documentation was lacking that would support the provision of financial aid. In this case: I. A family member is contacted to ensure no estate exists. II. A family member may be asked to sign and date a statement to the effect that no estate exists. III. The County in which the deceased patient resided in is contacted to verify that no estate exists. D. CCH's charity/financial aid is not a substitute for employer-sponsored, public or individually-purchased insurance, nor is CCH's financial aid policy a substitute for the responsibility of Government and employers to expand access to healthcare coverage for all persons. 3. Accounts with a balance A. Charity/financial aid may apply to balances due from insured patients for deductibles, co-payments, or co-insurance, or other types of patient payment responsibility. 4. Receiving an application A. CCH is diligent in its efforts to determine, at the earliest point in time, the patient's ability to pay. Information on charity/financial assistance is available in key areas of the Hospital and how to apply or obtain further information, as well as information on the Hospital website and patient statements. I. Hospital staff who work closely with patients are well educated on communicating financial aid availability and how to direct patients to staff responsible for the financial aid application process. II. Staff members are trained to treat financial aid applicants with courtesy, confidentiality and cultural sensitivity. III. These principles and guidelines are for those patients who truly cannot afford healthcare services. B. Any person requesting financial aid information is directed to the Patient Accounts or Social Services departments. An application for the charity/financial aid program is completed prior to making an eligibility determination. The application is also available in Spanish. Once the application is submitted with written proof of income, a determination is made in a timely manner. One of more of the following is required as verification of income. I. A letter or rejection from the Department of Social Services (Medicaid) if applicable. II. Signed copy of previous year's tax return III. Copy of most recent pay stub, with accumulative earnings. IV. Copy of recent three months of bank statements with an explanation of all deposits. V. Copy of any compensation received, e.g., unemployment, if applicable VI. Social Security determination if applicable. C. A family is defined as anyone living together in a household; this will include college students who received financial support from their parents, regardless of their residence. 5. Review process A. All completed applications are reviewed and approved by the Patient Financial Services Director and overseen by the Vice-President of Finance. B. Any applications that are in need of further assistance are taken to the Vice-President of Finance. C. All write-offs greater than $5,000 are reviewed by the Vice-President of Finance. D. The Vice-President of Finance oversees the charity and Medicare bad debt statistical reports on a monthly basis. E. If the applicant's income is above poverty guidelines, but is still in need of assistance, a sliding scale is used. This scale is adjusted according to the current year's poverty guidelines. If the applicant qualifies for partial charity/financial assistance, acceptable monthly payment arrangements must be agreed upon. F. If the applicant qualifies for partial charity/financial assistance and the total balance, after all write-off's, is $1,200 or greater, an additional write-off will be done as outlined below. - Reduce to $1,200; adjustments will be done from the oldest to the newest. G. A letter will be sent to the guarantor informing them of the determination for charity/financial assistance along with a monthly payment agreement for those who qualified for partial approval or denied applicants. This agreement is signed and returned to the Patient Accounts Department within 10 days. 6. Documentation of processed accounts A. The Patient Financial Services Director will maintain an annual log of all applicants. Documentation is also maintained for those accounts which have been approved or written off. 7. Archived applications A. All charity applications are scanned into MPF under document type `Charity Applications`.
NEEDS ASSESSMENT	In 2010, Columbus Community Hospital began implementing a five year strategic plan. The plan includes a thorough assessment of the organization's external environment in terms of opportunities and threats, as well as an assessment of the organizations internal strengths and weaknesses. The plan also includes strategic issues, goals, and related strategies for future organizational effectiveness. Six organizational pillars were identified: Quality, Culture, People, Service, Facilities and Finance. 1)Quality - Quality efforts have been focused on Evidence Based Processes (EBP) and educating staff on the importance of using and integrating these processes in daily operations. CCH has implemented an electronic medical record to afford ease of information access and communication across the continuum of care. The Clinical Leadership Group for Nursing and Respiratory Therapy have initiated a review of how to integrate EBP into the clinical areas and will be starting classes to educate staff within and outside nursing. 2)Culture - In an effort to achieve a high performance organization, CCH is in the process of implementing a 4-part culture improvement initiative including TeamSTEPPS, Just Culture, Studer and Lean/Six Sigma Process Improvement. The Hospital continues to work with the Studer Group to hardwire appropriate tools, focusing on improving patient outcomes and creating a culture/environment where staff want to work and physicians want to bring their patients. 3)People - CCH has continued to be aggressive in its recruitment efforts to attract and retain the workforce needed to support strategic growth initiatives across all service lines. CCH is initiating a new onboarding process for new employees. In addition, nursing has updated their orientation program and has trained preceptors and nurse mentors/coaches. 4)Services - CCH performs an annual, comprehensive program review of existing and new services and has ranked priority service line development to begin in the areas of hospital medicine, orthopedics, cardiology, cancer and rehab services. 5)Facilities - CCH has developed a comprehensive master facilities plan that can adapt to current and future patient care needs. An emergency department expansion was completed in 2012 and we now are in the process of building a new Medical Office Building which will house our Visiting Physicians and W.O.C. Health Center (Wound, Ostomy and Continence Care). 6)Finance - CCH will work diligently to maintain financial stability. Their approach includes: work to extend the Demonstration Project with a plan in place if the program is discontinued, maintain a conservative successful investment strategy and grow the CCH Foundation/Auxiliary.
PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE	Here is a sample of what is available on our CCH web site with detailed links. A hard copy with information is also available in a special wall unit located inside each patient room as well as in brochures located in outpatient areas. There is also a tutorial listing each step and letting the patient know what they will need to bring along or have available for copying purposes. A) Monthly Payment Option 1. If you are unable to pay your balance in full, please call the Patient Accounts Department to set up an acceptable payment arrangement. B) Patient Charity/Financial Assistance Program 1. If you feel your income is not sufficient to pay for your services at Columbus Community Hospital, please contact the Patient Accounts Department and/or Social Workers for information regarding charity/financial assistance. 2. Further information about Medicare/Medicaid/Charity Care is provided in both English and Spanish. The State has Medicaid applications available online. Our Patient Accounts and Social Services staff have financial/charity applications available in both English and Spanish to provide to our patients. 3. Additionally, signage is posted directing patients to call as needed for financial help, and referrals are built into the medical admission software, so if patients voice concerns about the cost, or their lack of coverage a referral is generated to Social Services staff who will see patients individually and counsel on specific circumstances. 4. Monthly statements have the following information on them: a. Payment Plans b. Charity/Financial Assistance Program c. 27/7 online business office, which includes information on payment plans, charity/financial assistance, and downloadable financial/charity applications (available in English and Spanish).
COMMUNITY INFORMATION	The local economy- Columbus Community Hospital is located in Columbus, Nebraska, which is the largest city in Platte County. With a growing population of 33,066, Platte County is the largest county of the seven county service areas. From July 31, 2013 to July 31, 2014, unemployment in the City of Columbus decreased slightly from 3.9% rate or 756 and Jobless to 3.3% rate or 610 jobless. During this same period of time, the Nebraska jobless rate was 3.6% and the National average was reported at 6.2%. As reported in Money Magazine, Columbus is listed as the third best place in the U.S. to find employment and in the "Top 100 best small towns to live". Three counties in Nebraska were listed in the top ten counties in the U.S. to live and work, including Platte, Madison (which is contiguous to Platte County) and Sarpy County near Lincoln, Nebraska. Our local economy is based on agriculture and manufacturing, with many industrial companies attracted by plentiful, low-priced hydroelectric power. Among the major employers are Archer Daniels Midland (ADM), an ethanol manufacturing company; Flex-Con; Central Confinement Service; Pillen Family Farms; Vishay; BD Medical Plants, a medical equipment company; Behlen Manufacturing, which manufactures steel buildings; and Nebraska Public Power, with headquarters located in Columbus. Due to successful economic and industrial development in our area, this large manufacturing base remains intact. A hard-working, well-educated workforce, low energy costs and a local environment friendly to business, provide encouragement for strong economic and industrial development within our service area. According to the Nebraska Department of Labor, Columbus is considered a major hub for the manufacturing industry and has a greater share of manufacturing employment than other Nebraska metropolitan areas. We continue to see an influx of single and young families moving into our area seeking employment. Our community growth correlates to our continuing increase in Hospital outpatient visits. Outpatient visits reached 44,613 visits for the fiscal year ending April 2014. In 2005, our outpatient visits over a twelve month period totaled 38,129. This 17% increase in our outpatient visits over the past nine years is a reflection of the significant impact the Demonstration Project has had on our Hospital. SERVICE CAPACITY: The W.O.C. Health Center opened August of 2008. It has grown to 1,107 patients/visits as of April 30, 2014. The identified service area includes a 45-mile radius around Columbus. The W.O.C. Health Center is located in the Visiting Physician office suite of the attached medical office building. The Center has scheduled visits two days per week. Additional nurse staff time is spent each week assisting outpatient clients with wound applications, as well as assisting with applications of wound vacs in surgery or on our medical floor, scheduling appointments and other responsibilities such as ordering supplies and maintaining compliance with National Standards. Previously, patients seeking this specialized treatment were required to travel on average 75 miles to see a Wound Center Specialist. The volume we are seeing at this W.O.C. Health Center reinforces the amount of community need that existed for this service and has greatly increased the local access to for so many of our higher acuity patients and their families. Our nurses are WCOM certified, so in addition to wound care, our patients who have challenges with ostomy appliances and continence problems can be addressed. CCH installed a new CT Scanner, new Radiologic/Fluoroscopy System and Nuclear Medicine Camera. These replaced existing systems. We recently opened a Women's Imaging Area within the Hospital which is separate from the Radiology Department. A new registration area recently opened which provides patient privacy. We reduced our Mammography procedure pricing 21% on February 8, 2012 and sought and received a Susan G. Komen Grant, which the Hospital Foundation matched, to promote mammography screening for women in the community. In 2010 we changed our Bone Density Service from contracting with a mobile service unit to purchasing our own Bone Density stationary equipment, the necessary support equipment and trained staff. The benefits to the community include increased access for patients and providers who no longer have to wait diagnosis with the mobile units' intermittent service. This is another new program made possible by the Demonstration Project that increases access and eliminates the need to travel to out of town for prompt diagnosis. Columbus Community Hospital is a 47 bed, acute care hospital serving needs offering a variety of surgical procedures and short term hospitalizations. All 47 beds are licensed for either acute care or swing bed patients. In addition, we provide comprehensive outpatient Laboratory, Radiology, Respiratory and Rehabilitative services. We also provide free interpreter services 24/7. Our facility offers comprehensive care, including Intensive Care, Medical-Surgical Care, Inpatient and Outpatient Surgical Procedures (General, ENT, Urology, Podiatry, Orthopedic), as well as other complimentary ancillary services including Respiratory, Wound Care, Diabetes Education, Endoscopies and Cardiopulmonary Rehabilitation. In 2006, the Hospital's Emergency Department was designated as a Level III Trauma Center with nurses certified in TNCC, ACLS and PALS. Eight of the Emergency Department nurses are also certified in ENPC. A 30,000 square foot, addition in 2012 provided the Emergency Department with expanded space. The ED added two trauma bays, a two-bay ambulance garage, a dedicated decontamination area, a dedicated family grief and counseling room, covered drive-up access and a negative air-pressure room, which allows patients with communicable diseases to be treated while protecting other patients and staff. Our Home Health/Hospice Interdisciplinary Services are provided to patients within a 30 mile radius of Columbus and can provide in home telehealth monitoring. The Hospital's Sleep Lab provides Polysomnographic Sleep Testing. In addition, we have available both daytime and home sleep tests. In January 2010, the Hospital hired a fulltime RN as the Orthopedic Service Line Coordinator. A multi-disciplinary team was organized to review, standardize and improve the patient's Total Joint Process from diagnosis to post-surgical recovery and in November. In March, 2012 the Hospital acquired Columbus Orthopedic and Sports Medicine Clinic, enabling the Hospital to expand the service line and ensure the community's aging population Orthopedic Services close to home. In May 2013, we expanded the RN Coordinators responsibility into case management in the Transitional Care Department. This expansion of her duties enables us to plan for continuity of care post hospitalization. Three Cardiologists have relocated to Columbus, providing full time Cardiology Services to the area. Since 2010, 63 Physicians in total have been recruited to service the needs of our Primary and Secondary Service Areas to include 55 MDs, 1 DPM and 7 Midlevels, 34 are full time providers and the other 29 are serving the community is a visiting capacity. The Hospital has completed construction on three road projects on and around the campus to increase access to the facility. Two clinic buildings, one for a Family Practice Group and one for a Pharmacy have been completed as well. The Hospital's Board of Directors has authorized the construction of a $21.0 million, 85,723 square feet Community Wellness Center for use by the entire community. The facility will be leased to the YMCA, with 62,397 square feet containing 2 gyms, pool, weights and exercise equipment promoting exercise and wellness in our community. The facility will also house the Hospital's adult therapies and pediatric therapy.
PROMOTION OF COMMUNITY HEALTH	-THE HOSPITAL REINVESTS CAPITAL TO IMPROVE PATIENT CARE, ATTRACT THE BEST QUALIFIED STAFF TO PROVIDE QUALITY CARE FOR OUR PATIENTS, PROVIDE MEDICAL EDUCATION AND PREVENTION ACTIVITIES IN THE COMMUNITY. -OUR HOSPITAL IS LIVING OUR MISSION AND VISION WITHIN THE COMMUNITY: OUR MISSION IS TO IMPROVE THE HEALTH OF THE COMMUNITIES WE SERVE OUR VISION IS TO COMPASSIONATELY DELIVER THE STATE'S HIGHEST QUALITY PATIENT CARE -CORE VALUES CCH CORE VALUES ARE: INTEGRITY COMPASSION (CHANGED FROM "COMMITMENT" AS PART OF THE COMMUNICATION OF THIS STRATEGIC PLAN) ACCOUNTABILITY RESPECT EXCELLENCE -THE HOSPITAL HAS PRIORITIZED OUR CAPITAL REINVESTMENT BY ALIGNING IT TO THE STRATEGIC PLAN. OUR PLAN CONSISTS OF SIX ORGANIZATIONAL PILLARS WITH GOALS AND STRATEGIES ASSOCIATED WITH EACH. THE SIX PILLARS OF EXCELLENCE CONSIST OF: QUALITY CULTURE PEOPLE SERVICES FACILITIES *FINANCE MEASUREMENT OF ONGOING OPERATIONAL PERFORMANCE IS ORGANIZED AROUND THESE PILLARS OF EXCELLENCE. THESE PILLARS WERE STRATEGICALLY IDENTIFIED AS COMMON MEASURES AROUND WHICH OPERATIONAL PERFORMANCE IS ORGANIZED IN MANY HEALTH CARE INSTITUTIONS AND ADAPTED FOR CCH. COLUMBUS COMMUNITY HOSPITAL HAS AN INDEPENDENT BOARD OF DIRECTORS MADE UP OF COMMUNITY LEADERS WITH DIVERSE BACKGROUNDS. COLUMBUS COMMUNITY HOSPITAL HAS AN OPEN EMERGENCY ROOM AVAILABLE TO ALL IN NEED NO MATTER OF RACE, CREED, AGE, OR ABILITY TO PAY. THE HOSPITAL ALSO HAS AN OPEN MEDICAL STAFF.
AFFILIATED HEALTH CARE SYSTEM	N/A
STATE FILING OF COMMUNITY BENEFIT REPORT	NONE

Schedule I IRS990ScheduleI

Field	Value	IRS element (for citing)
Grant Records Maintained	Yes (true)	GrantRecordsMaintainedInd

Recipient Table RecipientTable (2 entries)

Address Line1USAddress/AddressLine1	CityUSAddress/City	StateUSAddress/State	ZIP CodeUSAddress/ZIPCode	Recipient EINRecipientEIN	Cash GrantCashGrantAmt	Purpose Of GrantPurposeOfGrantTxt	IRC SectionIRCSectionDesc
East Central District HEALTH DEpt
1453 29th AVENUE	COLUMBUS	NE	68601	470835183	$87,500	Support Community
COLUMBUS COMMUNITY HOSPITAL FOUNDATION
4600 38TH STREET	COLUMBUS	NE	68601	470836747	$52,500	TO SUPPORT EXEMPT	501(C)(3)

Field	Value	IRS element (for citing)
Total501c3 Org	1	Total501c3OrgCnt
Total Other Org	0	TotalOtherOrgCnt

Grants Other Asst To Indiv In US GrantsOtherAsstToIndivInUSGrp

Field	Value	IRS element (for citing)
Grant Type	CHARITY CARE TO PATIENTS	GrantTypeTxt
Recipient	761	RecipientCnt
Non Cash Assistance	$1,370,490	NonCashAssistanceAmt
Valuation Method Used	BOOK	ValuationMethodUsedDesc
Non Cash Assistance	WRITE-OFF OF MED EXP	NonCashAssistanceDesc

Supplemental Information Detail SupplementalInformationDetail

Field	Value	IRS element (for citing)
Form And Line Reference	GENERAL INFORMATION ON GRANTS AND ASSISTANCE	FormAndLineReferenceDesc
Explanation	Schedule I, Part I, Line 2 COLUMBUS COMMUNITY HOSPITAL DOES NOT TYPICALLY GIVE OUT DONATIONS, BUT OCCASIONALLY A REQUEST IS BROUGHT FORWARD AND THE BOARD DETERMINES THAT IT IS IN THE BEST INTEREST OF THE COMMUNITY TO PROVIDE A PARTICULAR GRANT. PRIOR TO PROVIDING THE GRANT, THE HOSPITAL DETERMINES THAT THE ORGANIZATION IT GIVES TO IS A 501(C)(3) ORGANIZATION OR A GOVERNMENT AGENCY. THE HOSPITAL WILL ALSO MAKE GRANTS TO THEIR RELATED ORGANIZATIONS AS NECESSARY TO SUPPORT THEIR EXEMPT PURPOSE.	ExplanationTxt

Schedule J IRS990ScheduleJ

Field	Value	IRS element (for citing)
Club Dues Or Fees	Yes (X)	ClubDuesOrFeesInd
Written Policy Ref T And E Expnss	Yes (true)	WrittenPolicyRefTAndEExpnssInd
Substantiation Required	Yes (true)	SubstantiationRequiredInd
Compensation Committee	Yes (X)	CompensationCommitteeInd
Independent Consultant	Yes (X)	IndependentConsultantInd
Form990 Of Other Organizations	Yes (X)	Form990OfOtherOrganizationsInd
Written Employment Contract	Yes (X)	WrittenEmploymentContractInd
Compensation Survey	Yes (X)	CompensationSurveyInd
Board Or Committee Approval	Yes (X)	BoardOrCommitteeApprovalInd
Severance Payment	false	SeverancePaymentInd
Supplemental Nonqual Rtr Plan	Yes (true)	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	Yes (true)	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 (10 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
MICHAEL HANSEN
PRESIDENT/CEO/SECRETARY	$298,520	$0	$37,500	$0	$17,500	$0	$42,700	$0	$21,013	$0	$417,233	$0	$0	$0
AMY BLASER
VP BUSINESS DEVELOPMENT	$120,317	$0	$11,569	$0	$0	$0	$14,669	$0	$21,958	$0	$168,513	$0	$0	$0
J JOSEPH BARBAGLIA
VP FINANCE	$165,866	$0	$17,873	$0	$17,500	$0	$10,033	$0	$22,946	$0	$234,218	$0	$0	$0
LINDA WALLINE
VP NURSING	$150,978	$0	$27,118	$0	$17,500	$0	$7,818	$0	$22,495	$0	$225,909	$0	$0	$0
JAMES GOULET
VP OPERATIONS	$133,731	$0	$29,563	$0	$34,498	$0	$9,872	$0	$22,726	$0	$230,390	$0	$0	$0
ROBERT MILLER MD
PHYSICIAN	$289,212	$0	$0	$0	$0	$0	$9,034	$0	$18,516	$0	$316,762	$0	$0	$0
MICHAEL MCGUIRE MD
PHYSICIAN	$574,777	$0	$0	$0	$0	$0	$10,200	$0	$13,377	$0	$598,354	$0	$0	$0
RICHARD CIMPL MD
PHYSICIAN	$629,667	$0	$0	$0	$17,500	$0	$10,200	$0	$22,716	$0	$680,083	$0	$0	$0
EDWARD FEHRINGER MD
PHYSICIAN	$551,795	$0	$0	$0	$17,500	$0	$10,200	$0	$27,444	$0	$606,939	$0	$0	$0
MARK HOWERTER MD
PHYSICIAN	$462,500	$0	$0	$0	$0	$0	$10,200	$0	$25,645	$0	$498,345	$0	$0	$0

Supplemental Information Detail SupplementalInformationDetail (3 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
QUESTIONS REGARDING COMPENSATION	PART I, LINE 1A THE ORGANIZATION PAID FOR SOCIAL AND HEALTH CLUB DUES AS PART OF THE CEO'S EMPLOYMENT AGREEMENT. These amounts were reflected on the CEO's W-2.
PART I, LINE 4B	The following reportable individuals participated in a supplemental nonqualified retirement plan during the 2013 calendar year. Amounts deferred from the plan were included in Column C of the Schedule J: Michael Hansen - $32,500 Amy Blaser - $9,440
PART I, LINE 6A	WITH THE ASSISTANCE OF IHSTRATEGIES, EXECUTIVE COMPENSATION CONSULTANTS, THE BOARD AUTHORIZED PAYING AN INCENTIVE TO THE EXECUTIVES FOR MEETING SPECIFIC BOARD- ESTABLISHED DIRECTIVES. THE BOARD AUTHORIZED PAYING 25% OF BASE COMPENSATION FOR Michael Hansen and 20% FOR THE following VPS: JOSEPH BARBAGLIA JIM GOULET LINDA WALLINE AMY BLASER THE INCENTIVE IS BASED ON GOALS ESTABLISHED BY THE BOARD WHICH ARE NOW REVIEWED ANNUALLY. ONE OF THE GOALS IS THE HOSPITALS OPERATING MARGIN. THE BOARD DETERMINES THE ASSOCIATED METRICS FOR EACH INDIVIDUAL GOAL. EACH OF THE GOALS IS THEN ASSIGNED A WEIGHT BASED ON THE LEVEL OF IMPORTANCE, AS DETERMINED BY THE BOARD. THE RESULTS ARE ENTERED AND THE METRIC IS TABULATED. THAT NUMBER IS MULTIPLIED BY THE CORRESPONDING WEIGHT. ONCE WEIGHTED, THE FIGURES ARE ADDED IN TOTAL TO ESTABLISH A SCORE BETWEEN 1-5. NO INCENTIVE IS PAID IF THE HOSPITALS OPERATING MARGIN FALLS BELOW 5.0%, REGARDLESS OF THE OUTCOMES OF THE OTHER MEASURES. THE INCENTIVES WERE PAID IN THIS FISCAL YEAR FOR WORK DONE IN THE PREVIOUS FISCAL YEAR. THE BONUSES PAID WERE: MICHAEL HANSEN - $37,500 JOE BARBAGLIA - $17,873 JIM GOULET - $29,563 LINDA WALLINE - $27,118 AMY BLASER - $11,569

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (2 entries)

Form And Line ReferenceFormAndLineReferenceDesc

ExplanationExplanationTxt

GOVERNANCE, MANAGEMENT AND DISCLOSURE

PART VI, LINE 11B The form 990 will be available for all members of the Finance Committee to review. Upon Committee review, the 990 will then be submitted to the Board for review and the Board will make any corrections if applicable. Form 990, Part VI, Line 12C Columbus Community Hospital monitors any conflict of interest based on their conflict of interest policy. Employees and Volunteers are required to fully disclose any conflict of interest that may exist or appears to exist. Hospital reviews any of these conflicts and works with the Vice President or CEO to determine if a conflict exists. If one does exist, the hospital initiates actions to manage, reduce, or eliminate the conflict. FORM 990, PART VI, LINE 15 The Hospital's Executive Compensation Committee, made up of independent Hospital Board members, reviews the CEO's compensation annually. The wage range is compared to information provided by third party consultants. Decisions are documented. Form 990, Part VI, Line 19 At Columbus Community Hospital, a 3-ring binder exists in the Executive Assistant's office labeled "For Public Disclosure" which includes the most current of the following: a) Governing documents which are the hospital bylaws b) Conflict of interest policy c) Audited financial statements d) Forms 990 and 990-t

RECONCILIATION OF NET ASSETS

PART XI, LINE 9 CHANGE IN INTEREST IN HEALTHPARK LLC & ZARZ LLC (690,283)

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (2 entries)

Address Line1USAddress/AddressLine1	CityUSAddress/City	StateUSAddress/State	ZIP CodeUSAddress/ZIPCode	EINEIN	Primary ActivitiesPrimaryActivitiesTxt	Legal Domicile StateLegalDomicileStateCd	Exempt Code SectionExemptCodeSectionTxt	Public Charity StatusPublicCharityStatusTxt	Business Name Line1DirectControllingEntityName/BusinessNameLine1	Controlled OrganizationControlledOrganizationInd
COLUMBUS COMMUNITY HOSPITAL FOUNDATION
4600 38TH STREET	COLUMBUS	NE	68601	470836747	FUNDRAISING	NE	501(c)(3)	LINE 11, I	CCH	Yes (true)
HEALTHPARK TITLE CO
4600 38TH STREET	COLUMBUS	NE	68601	470830945	HOLDING CO.	NE	501(c)(2)	N/A	CCH	Yes (true)

Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (2 entries)

Address Line1USAddress/AddressLine1	CityUSAddress/City	StateUSAddress/State	ZIP CodeUSAddress/ZIPCode	EINEIN	Primary ActivitiesPrimaryActivitiesTxt	Legal Domicile StateLegalDomicileStateCd	Business Name Line1DirectControllingEntityName/BusinessNameLine1	Predominant Income TypePredominantIncomeTypeTxt	Share Of Total IncomeShareOfTotalIncomeAmt	Share Of EOY AssetsShareOfEOYAssetsAmt	Disproportionate AllocationsDisproportionateAllocationsInd	UBI Code VUBICodeVAmt	General Or Managing PartnerGeneralOrManagingPartnerInd	OwnershipOwnershipPct
ZARZ LLC
PO BOX 1800	COLUMBUS	NE	68602	273676428	PROPERTY MGMT	NE	HLTHPK TITLE CO	RELATED	$0	$0	false	$0	false	0.44450
HEALTHPARK LLC
PO BOX 1800	COLUMBUS	NE	68602	470836733	PROPERTY MGMT	NE	HLTHPK TITLE CO	RELATED	$0	$0	false	$0	false	0.27210

Field	Value	IRS element (for citing)
Receipt Of Int Annts Rnts Rylts	false	ReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth Org	Yes (true)	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	Yes (true)	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	Yes (true)	RentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth Org	Yes (true)	RentalOfFcltsFromOthOrgInd
Perform Of Services For Oth Org	false	PerformOfServicesForOthOrgInd
Perform Of Services By Other Org	Yes (true)	PerformOfServicesByOtherOrgInd
Sharing Of Facilities	Yes (true)	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

Transactions Related Org TransactionsRelatedOrgGrp (4 entries)

Transaction TypeTransactionTypeTxt	InvolvedInvolvedAmt	Method Of Amount DeterminationMethodOfAmountDeterminationTxt
COLUMBUS COMMUNITY HOSPITAL FOUNDATION
b	$52,500	Cash
COLUMBUS COMMUNITY HOSPITAL FOUNDATION
c	$61,455	cash
COLUMBUS COMMUNITY HOSPITAL FOUNDATION
e	$94,809	BOOK
HEALTHPARK TITLE COMPANY
k	$295,772	BOOK

Supplemental Information Detail SupplementalInformationDetail

Field	Value	IRS element (for citing)
Form And Line Reference	Part V, Line 2 (3)	FormAndLineReferenceDesc
Explanation	COLUMBUS COMMUNITY HOSPITAL FOUNDATION IS LISTED AS BACKING THE COLUMBUS COMMUNITY HOSPITAL, INC.'S TAX EXEMPT BOND. THIS IS COVERED WITH THE FOUNDATION'S NON-ENDOWED FUNDS. The bonds were paid off In January, 2013.	ExplanationTxt