CHADRON COMMUNITY HOSPITAL CORP: Form 990, tax year 2012
View the entire original 990 at ProPublica ↗
- Organization
- CHADRON COMMUNITY HOSPITAL CORP (EIN 47-0482234)
- Tax period
- 2012-10-01 to 2013-09-30
- Filed
- 2014-08-15
- IRS object ID
- 201412279349301801
- Schema version
- 2012v2.1
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule D
- Schedule H
- Schedule J
- Schedule L
- Schedule M
- Schedule O
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2014-08-15T09:42:32-05:00 | Timestamp |
| Tax Period End Date | 2013-09-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 470691351 | EIN |
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | FRED A LOCKWOOD & CO PC | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 201 MAIN STREET P O BOX 447 | AddressLine1 |
| City | CHADRON | City |
| State | NE | State |
| ZIP Code | 69337 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2012-10-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 470482234 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CHADRON COMMUNITY HOSPITAL CORPORATION | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | CHAD | NameControl |
| Phone | 3084325586 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 825 CENTENNIAL DRIVE | AddressLine1 |
| City | CHADRON | City |
| State | NE | State |
| ZIP Code | 69337 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | HAROLD KRUEGER | Name |
| Title | CEO | Title |
| Phone | 3084322737 | Phone |
| Date Signed | 2014-08-15 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | ANDREANNA LOUTZENHISER | Name |
| PTIN | P00285945 | PTIN |
| Phone | 3084324465 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2012 | TaxYear |
| Build TS | 2015-11-30 17:44:51Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | HAROLD KRUEGER | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 825 CENTENNIAL DRIVE | AddressLine1 |
| City | CHADRON | City |
| State | NE | State |
| ZIP Code | 69337 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 19221714 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | N/A | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1957 | YearFormation |
| State Legal Domicile | NE | StateLegalDomicile |
| Activity Or Mission Description | TO PROVIDE AND SUPPORT HEALTH CARE AND COMMUNITY SERVICE PROGRAMS OF EXCELLENCE IN THE COMMUNITIES WE SERVE. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 13 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 13 | NbrIndependentVotingMembers |
| Total Nbr Employees | 240 | TotalNbrEmployees |
| Total Nbr Volunteers | 13 | TotalNbrVolunteers |
| Total Gross UBI | -207643 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 2471375 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 2807411 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 15420610 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 15440809 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 5425 | InvestmentIncomePriorYear |
| Investment Income Current Year | 3782 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 1306649 | OtherRevenuePriorYear |
| Other Revenue Current Year | 395793 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 19204059 | TotalRevenuePriorYear |
| Total Revenue Current Year | 18647795 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 0 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 0 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 8572370 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 8711574 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 10440408 | OtherExpensePriorYear |
| Other Expenses Current Year | 11901739 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 19012778 | TotalExpensesPriorYear |
| Total Expenses Current Year | 20613313 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 191281 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | -1965518 | RevenuesLessExpensesCY |
| Total Assets BOY | 31664233 | TotalAssetsBOY |
| Total Assets EOY | 29064364 | TotalAssetsEOY |
| Total Liabilities BOY | 21255004 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 20620653 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 10409229 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 8443711 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | TO PROVIDE AND SUPPORT HEALTH CARE AND COMMUNITY SERVICE PROGRAMS OF EXCELLENCE IN THE COMMUNITIES WE SERVE. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 17616979 | Expense |
| Revenue | 15440809 | Revenue |
| Description | CHADRON COMMUNITY HOSPITAL CORPORATION OFFERS ACCESS TO CARE. INDIVIDUALS SHALL BE ACCORDED IMPARTIAL ACCESS TO TREATMENT OR ACCOMMODATIONS THAT ARE AVAILABLE, AND MEDICALLY INDICATED, REGARDLESS OF RACE, CREED, SEX, NATIONAL ORIGIN, HANDICAP, RELIGION, ABILITY TO PAY, OR SOURCES OF PAYMENT FOR CARE. DURING THE FISCAL YEAR CHADRON COMMUNITY HOSPITAL CORPORATION PROVIDED INPATIENT SERVICES TO THE FOLLOWING:PATIENT DAYSADULT AND PEDIATRICS 1,998SWING BED - SKILLED 244NURSERY 248TOTAL 2,490 CHADRON COMMUNITY HOSPITAL CORPORATION EMERGENCY ROOM TREATED 2,591 PATIENTS AND 590 SURGICAL PROCEDURES WERE PERFORMED IN THE SURGERY AREA. IN ADDITION TO PROVIDING DIRECT INPATIENT AND OUTPATIENT SERVICES, CHADRON COMMUNITY HOSPITAL PROVIDED OUR COMMUNITY/COUNTY RESIDENTS ACCESS TO A VARIETY OF SPECIALISTS THROUGH FREE USE OF THE HOSPITAL'S CLINIC SPACE. THE FOLLOWING TYPES OF SPECIALTY CLINICS AND SERVICES WERE PROVIDED.CARDIOLOGYORTHOPEDICSEAR, NOSE AND THROATUROLOGYINTERNAL MEDICINEVASCULAROPHTHALMOLOGYPODIATRYTHE FOLLOWING COMMUNITY SERVICES WERE PROVIDED AT A MINIMAL OR NO COST BASIS:*DURING OUR ANNUAL HEALTH FAIR, CHADRON COMMUNITY HOSPITAL PROVIDED AT NO COST, INFORMATION ON MAMMOGRAPHY SCREENING, COLORECTAL CANCER TESTS AND FREE COLORECTAL KITS, GLAUCOMA TESTING, BLOOD PRESSURE TESTS, DIABETES/BLOOD SUGAR TESTING, DRUG AND ALCOHOL TESTING, HUNDREDS OF PAMPHLETS RELATING TO MAINTAINING HEALTH.*REGISTERED NURSE SUPPORT WAS PROVIDED TO OUR AREA/COUNTY SCHOOLS TO ASSIST IN YEARLY PHYSICALS.*REGISTERED NURSE SUPPORT WAS PROVIDED TO OUR AREA FIRE AND RESCUE VOLUNTEERS AND LOCAL LAW ENFORCEMENT OFFICERS TO ADMINISTER HEPATITIS VACCINATIONS.*OUR HOME HEALTH PROFESSIONALS PROVIDE BLOOD PRESSURE AND BLOOD SUGAR SCREENING ON A REGULAR BASIS AT THE LOCAL SALE BARN AND THE SENIOR CITIZENS CENTER, FREE OF CHARGE.*HOME HEALTH PROFESSIONALS PROVIDE PRENATAL HOME VISITS ON ALL NEWBORNS WITHIN THE CHADRON/DAWES/SIOUX AND SHERIDAN COUNTIES.*WE PROVIDE FREE DIETARY COUNSELING SERVICES FOR DIABETIC AND LOW INCOME FAMILIES WHO NEED THESE SERVICES.*WE PROVIDE 'LIFELINE' EMERGENCY SERVICES TO THE ELDERLY, HANDICAPPED AND SHUT-INS FOR A FEE EQUAL TO OUR COSTS. THIS IS A 24-HOUR A DAY, 7 DAYS PER WEEK MONITORING SERVICE.*SCREENING MAMMOGRAPHY SERVICES ARE PERIODICALLY PROVIDED TO ALL WOMEN AT A GREATLY REDUCED PRICE.*MEETING ROOMS ARE PROVIDED FREE OF CHARGE TO ALL OUTSIDE SERVICE ORGANIZATIONS WHO ARE PROMOTING GOOD HEALTH.*WE PROVIDE HEALTH CARE PROFESSIONALS TO SPEAK AT VARIOUS ORGANIZATIONS/MEETING TO HELP EDUCATE AND PROMOTE HEALTH CARE CONCERNS AND ISSUES, FREE OF CHARGE.*ADMINISTRATION PARTICIPATES ON THE BOARD OF COMMISSIONERS FOR THE LOCAL "LOW INCOME HOUSING AUTHORITY".*FREE OSTOMY IN-SERVICES AND COMMUNITY TRAINING IS PROVIDED VIA OUR HOME HEALTH CARE AGENCY.*COMMUNITY PRENATAL/MATERNITY CLASSES ARE PROVIDED AT NO COST TO INSURE AVAILABILITY TO THESE SERVICES FOR THOSE WHO CANNOT AFFORD THE CLASS. PROFESSIONAL STAFF ARE PAID THEIR REGULAR SALARY FOR THESE SERVICES.*CHADRON COMMUNITY HOSPITAL ADMINISTRATION PROVIDED IN-KIND ASSISTANCE TO THE LOCAL COMMUNITY IN EFFORTS TO ATTRACT AND RETAIN NEEDED PRIMARY/FAMILY PRACTICE PHYSICIANS.*REDUCED AND FREE CHOLESTEROL SCREENINGS HAVE BEEN PROVIDED TO OUR COMMUNITY/COUNTY MEMBERS WITH INFORMATION REGARDING THEIR IMPORTANCE TO THEIR HEALTH.*ADMINISTRATION HAS CONDUCTED NUMEROUS EDUCATIONAL PROGRAMS FOR THE SENIOR CITIZEN CENTER AND VARIOUS SERVICE ORGANIZATIONS INFORMING THEM OF THE ADVANCED DIRECTIVE PROGRAM AND THE VARIOUS PROPOSED HEALTH CARE BILLS.*ADMINISTRATION HAS PROVIDED THE LOCAL/COUNTY RESIDENTS WITH NUMEROUS PUBLICATIONS PRINTED IN THE LOCAL NEWSPAPERS DEALING WITH ALL ASPECTS OF HEALTH CARE, TO INCLUDE THE RIGHTS AFFORDED TO ALL MEDICARE RECIPIENTS.CHADRON COMMUNITY HOSPITAL PROVIDED $739,611 OF CHARGES RELATED PRIMARILY TO BAD DEBTS. OVER 47% OF CHADRON COMMUNITY HOSPITAL'S REVENUE WAS DERIVED FROM MEDICARE AND MEDICAID BENEFICIARIES FOR WHICH CHADRON COMMUNITY HOSPITAL WAS REQUIRED TO CONTRACTUALLY REDUCE THEIR CHARGES BY 2,713,695 TO REFLECT ACTUAL PAYMENT FROM VARIOUS MEDICARE AND MEDICAID AGENCIES. | Description |
| Total Program Service Expense | 17616979 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 0 | LobbyingActivities |
| Subject To Proxy Tax | 0 | SubjectToProxyTax |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 0 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 1 | ReportLandBldgEquip |
| Report Invest Oth Securities | 0 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 0 | ReportOtherAssets |
| Report Other Liabilities | 0 | ReportOtherLiabilities |
| Report Fin48 Footnote | 0 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 1 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 0 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 0 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 1 | Hospital |
| Financial Stmt Attached | 1 | FinancialStmtAttached |
| Grants To Organizations | 0 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 0 | ScheduleJRequired |
| Tax Exempt Bonds | 0 | TaxExemptBonds |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 1 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 1 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 0 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 0 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 1 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 0 | RelatedEntity |
| Related Org Controlled Entity | 0 | RelatedOrgControlledEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 36 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 240 | NumberOfEmployees |
| Employment Tax Returns Filed | 0 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 0 | UnrelatedBusinessIncome |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributions |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 13 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 13 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 1 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 0 | MembersOrStockholders |
| Election Of Board Members | 0 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 0 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 0 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 0 | CompensationProcessCEO |
| Compensation Process Other | 0 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | HAROLD KRUEGER ADMINISTRATOR | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 3084325586 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 825 CENTENNIAL DRIVE | AddressLine1 |
| City | CHADRON | City |
| State | NE | State |
| ZIP Code | 69337 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (19 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | OfficerOfficer | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|
| JACK MANN | |||||||
| MEMBER | 2.00 | X | 0 | 0 | 0 | ||
| LARRY PROVANCE | |||||||
| MEMBER | 2.00 | X | 0 | 0 | 0 | ||
| DAVID KAY | |||||||
| PAST PRESIDENT | 2.00 | X | 0 | 0 | 0 | X | |
| MARY HANSEN | |||||||
| MEMBER | 2.00 | X | 0 | 0 | 0 | ||
| SHARON RICKENBACH | |||||||
| 2ND VICE PRESIDENT | 2.00 | X | 0 | 0 | 0 | X | |
| JERRY MCCANCE | |||||||
| MEMBER | 2.00 | X | 0 | 0 | 0 | ||
| KERRY BAILEY | |||||||
| MEMBER | 2.00 | X | 0 | 0 | 0 | ||
| LEEANN FERLEY | |||||||
| MEMBER | 2.00 | X | 0 | 0 | 0 | ||
| DR JERRY MCLAIN | |||||||
| CHIEF OF STAFF | 2.00 | X | 0 | 0 | 0 | ||
| CATIE LIMBACK | |||||||
| PRESIDENT | 2.00 | X | 0 | 0 | 0 | X | |
| BRYCE LANDEN | |||||||
| 1ST VICE PRESIDENT | 2.00 | X | 0 | 0 | 0 | X | |
| KARLA ADAMS | |||||||
| CRAWFORD CITY COUNCIL REPR | 2.00 | X | 0 | 0 | 0 | ||
| BRAD HENCEY | |||||||
| SECRETARY/TREASURER | 2.00 | X | 0 | 0 | 0 | X | |
| LARRY JOHNSON | |||||||
| MEMBER | 2.00 | X | 0 | 0 | 0 | ||
| SHELLEY GRAVES | |||||||
| PHARMACIST | 40.00 | 139418 | 0 | 4208 | X | ||
| CHERYL CASSIDAY | |||||||
| DIR OF NURSIN | 40.00 | 126736 | 0 | 3825 | X | ||
| HAILEY WANG | |||||||
| PHARMACIST | 40.00 | 106318 | 0 | 19 | X | ||
| ALLEN VAN DRIEL | |||||||
| CHIEF OPERATING OFFICER | 40.00 | 112034 | 0 | 3381 | X | ||
| RUSS BOHNENKAMP | |||||||
| CHIEF FINANCIAL OFFICER | 40.00 | 114830 | 0 | 3466 | X | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 599336 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 14899 | TotalOtherCompensation |
| Number Individuals GT100 K | 7 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 0 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| FNB OF CHADRON NP | |||||
| 315 W 3RD ST | CHADRON | NE | 69337 | LOAN DIST | 1318930 |
| REGIONAL CARE INC | |||||
| 905 WEST 27TH ST | SCOTTSBLUFF | NE | 69361 | INSURANCE | 1155797 |
| CARDINAL HEALTH | |||||
| 4875 FLORENCE ST | DENVER | CO | 80238 | DRUGS | 910434 |
| KOTA ANESTHESIA | |||||
| 821 MOREHEAD | CHADRON | NE | 69337 | ANESTHESIA | 382196 |
| REGIONAL WEST MEDICAL CTR | |||||
| 4021 AVENUE B | SCOTTSBLUFF | NE | 69361 | MEDICAL SERVICES | 322844 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 17 | NumberOfContractorsGT100K |
| Government Grants | 594051 | GovernmentGrants |
| All Other Contributions | 2213360 | AllOtherContributions |
| Noncash Contributions | 311425 | NoncashContributions |
| Total Contributions | 2807411 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (4 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|
| HOSPITAL ANCILLARY REVE | 621990 | 11463576 | 11463576 |
| HOSPITAL ROUTINE REVENU | 621990 | 2615128 | 2615128 |
| RETIREMENT APARTMENTS | 623990 | 988414 | 988414 |
| RURAL HEALTH CLINIC | 621300 | 373691 | 373691 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 15440809 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 3782 | TotalRevenueColumn |
| Exclusion | $3,782 | ExclusionAmount |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 153000 | Real |
| Personal | 338816 | Personal |
Less Rental Expenses LessRentalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 27460 | Real |
| Personal | 546459 | Personal |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 125540 | Real |
| Personal | -207643 | Personal |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -82103 | TotalRevenueColumn |
| Unrelated Business Revenue | -207643 | UnrelatedBusinessRevenue |
| Exclusion | $125,540 | ExclusionAmount |
Other Revenue Misc OtherRevenueMisc (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | ExclusionExclusionAmount |
|---|---|---|---|
| MISCELLANEOUS | 900099 | 178308 | $178,308 |
| NONPATIENT SALES | 446110 | 146064 | $146,064 |
| INSERVICE REVENU | 611710 | 108277 | $108,277 |
Miscellaneous Revenue MiscellaneousRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 45247 | TotalRevenueColumn |
| Exclusion | $45,247 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 477896 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 18647795 | TotalRevenueColumn |
| Related Or Exempt Function Income | 15440809 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | -207643 | UnrelatedBusinessRevenue |
| Exclusion | $607,218 | ExclusionAmount |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 7292428 | Total |
| Program Services | 6208313 | ProgramServices |
| Management And General | 1084115 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 137872 | Total |
| Program Services | 112830 | ProgramServices |
| Management And General | 25042 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 855650 | Total |
| Program Services | 709119 | ProgramServices |
| Management And General | 146531 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 425624 | Total |
| Program Services | 351906 | ProgramServices |
| Management And General | 73718 | ManagementAndGeneral |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 264537 | Total |
| Management And General | 264537 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 51322 | Total |
| Management And General | 51322 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 42085 | Total |
| Management And General | 42085 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 83256 | Total |
| Management And General | 83256 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 52010 | Total |
| Program Services | 4974 | ProgramServices |
| Management And General | 47036 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 22943 | Total |
| Program Services | 18776 | ProgramServices |
| Management And General | 4167 | ManagementAndGeneral |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 12120 | Total |
| Management And General | 12120 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 800377 | Total |
| Program Services | 748160 | ProgramServices |
| Management And General | 52217 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 89494 | Total |
| Program Services | 46463 | ProgramServices |
| Management And General | 43031 | ManagementAndGeneral |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 42622 | Total |
| Program Services | 19425 | ProgramServices |
| Management And General | 23197 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1096227 | Total |
| Program Services | 916929 | ProgramServices |
| Management And General | 179298 | ManagementAndGeneral |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2307070 | Total |
| Program Services | 1898066 | ProgramServices |
| Management And General | 409004 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 220009 | Total |
| Program Services | 180307 | ProgramServices |
| Management And General | 39702 | ManagementAndGeneral |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| SUPPLIES | 2586764 | 2559208 | 27556 |
| PROVISIONS FOR BAD DEBT | 1393848 | 1393848 | |
| PROFESSIONAL FEES/PURCH | 1264664 | 1264664 | |
| UTILITIES | 627501 | 527387 | 100114 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 944890 | Total |
| Program Services | 656604 | ProgramServices |
| Management And General | 288286 | ManagementAndGeneral |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 20613313 | Total |
| Program Services | 17616979 | ProgramServices |
| Management And General | 2996334 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1916150 | BOY |
| EOY | 1374722 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3811884 | BOY |
| EOY | 3231248 | EOY |
Other Notes Loans Receivable Net OtherNotesLoansReceivableNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 95215 | BOY |
| EOY | 52000 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 236468 | BOY |
| EOY | 244993 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 129403 | BOY |
| EOY | 158818 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 38546468 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 15718438 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 24329842 | BOY |
| EOY | 22828030 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1145271 | BOY |
| EOY | 1174553 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 31664233 | BOY |
| EOY | 29064364 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1578669 | BOY |
| EOY | 1557811 | EOY |
Deferred Revenue DeferredRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 209307 | BOY |
| EOY | 215613 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 19467028 | BOY |
| EOY | 18847229 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 21255004 | BOY |
| EOY | 20620653 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Do Not Follow SFAS117 | X | DoNotFollowSFAS117 |
Cap Stck Trst Prin Current Funds CapStckTrstPrinCurrentFunds
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Paid In Cap Srpls Land Bldg Eqp Fund PaidInCapSrplsLandBldgEqpFund
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Retained Earnings Endowment Etc RetainedEarningsEndowmentEtc
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 10409229 | BOY |
| EOY | 8443711 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 10409229 | BOY |
| EOY | 8443711 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 31664233 | BOY |
| EOY | 29064364 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expenses | -1965518 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | 0 | ReconcilationOtherChanges |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 0 | FSAudited |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| 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) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule D IRS990ScheduleD
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 192452 | OtherCostOrOtherBasis |
| Book Value | 192452 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 30916037 | OtherCostOrOtherBasis |
| Depreciation | 10175680 | Depreciation |
| Book Value | 20740357 | BookValue |
Leasehold Improvements LeaseholdImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 572027 | OtherCostOrOtherBasis |
| Depreciation | 341464 | Depreciation |
| Book Value | 230563 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 6768545 | OtherCostOrOtherBasis |
| Depreciation | 5117820 | Depreciation |
| Book Value | 1650725 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 97407 | OtherCostOrOtherBasis |
| Depreciation | 83474 | Depreciation |
| Book Value | 13933 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 22828030 | TotalOfBookValueLandBuildings |
| Tot Revenue Etc Audited Fincl Stmt | 19221714 | TotRevenueEtcAuditedFinclStmt |
| Other Revenues | 573919 | OtherRevenues |
| Revenue Not Rptd F990 | 573919 | RevenueNotRptdF990 |
| Revenue Subtotal | 18647795 | RevenueSubtotal |
| Revenue Not Rptd On Fin Stmt | 0 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 18647795 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 21187233 | TotExpensesEtcAuditedFinclStmt |
| Other Expenses Included | 573920 | OtherExpensesIncluded |
| Expenses Not Rptd F990 | 573920 | ExpensesNotRptdF990 |
| Expenses Subtotal | 20613313 | ExpensesSubtotal |
| Expenses Not Rptd On Fin Stmt | 0 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 20613313 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIII Form990ScheduleDPartXIII (2 entries)
| IdentifierIdentifier | ExplanationExplanation |
|---|---|
| PART XI, LINE 2D - OTHER ADJUSTMENTS: | RENT EXPENSE 573,919. ROUNDING |
| PART XII, LINE 2D - OTHER ADJUSTMENTS: | RENT EXPENSE 573,919. ROUNDING 1. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | 1 | CharityCarePolicy |
| Written Policy | 1 | WrittenPolicy |
| FPG Reference Free Care | 1 | FPGReferenceFreeCare |
| Pcent100 | X | Pcent100 |
| FPG Reference Discounted Care | 1 | FPGReferenceDiscountedCare |
| Pcent200 D | X | Pcent200D |
| Free Disc Care Medically Indigent | 1 | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | 1 | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | 1 | ExpensesExceededBudget |
| Unable To Provide Care | 0 | UnableToProvideCare |
| Annual Community Benefit Report | 1 | AnnualCommunityBenefitReport |
| Report Publically Available | 1 | ReportPublicallyAvailable |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 412090 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 412090 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.02000 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 423256 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 423256 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.02050 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 835346 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 835346 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.04050 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 835346 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 835346 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.04050 | PercentOfTotalExpense |
Community Support CommunitySupport
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 502007 | TotalCommunityBuildingExpense |
| Direct Offsetting Revenue | 500061 | DirectOffsettingRevenue |
| Net Community Building Expense | 1946 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00010 | PercentOfTotalExpense |
Coalition Building CoalitionBuilding
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 18876 | TotalCommunityBuildingExpense |
| Direct Offsetting Revenue | 18876 | DirectOffsettingRevenue |
Health Improvement Advocacy HealthImprovementAdvocacy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 521098 | TotalCommunityBuildingExpense |
| Direct Offsetting Revenue | 521735 | DirectOffsettingRevenue |
| Net Community Building Expense | -637 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00000 | PercentOfTotalExpense |
Workforce Development WorkforceDevelopment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 1205 | TotalCommunityBuildingExpense |
| Direct Offsetting Revenue | 1205 | DirectOffsettingRevenue |
Total Total
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 1043186 | TotalCommunityBuildingExpense |
| Direct Offsetting Revenue | 1041877 | DirectOffsettingRevenue |
| Net Community Building Expense | 1309 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00010 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 1 | BadDebtExpenseReported |
| Bad Debt Expense | $1,393,429 | BadDebtExpenseAmount |
| Amount Attributable To | 514172 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 9552956 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 3033335 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | 6519621 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost Accounting System | X | CostAccountingSystem |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | 1 | WrittenDebtCollectionPolicy |
| Provision For Charity Care | 1 | ProvisionForCharityCare |
| Number Of Hospital Facilities | 1 | NumberOfHospitalFacilities |
Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility Number | 1 | FacilityNumber |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CHADRON COMMUNITY HOSPITAL | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 825 CENTENNIAL DRIVE | AddressLine1 |
| City | CHADRON | City |
| State | NE | State |
| ZIP Code | 69337 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | X | LicensedHospital |
| General Medical And Surgical | X | GeneralMedicalAndSurgical |
| Critical Access Hospital | X | CriticalAccessHospital |
| Er24 Hours | X | Er24Hours |
Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | NOT REQUIRED | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
| CHNA Conducted | 1 | CHNAConducted |
| Community Definition | X | CommunityDefinition |
| Community Demographics | X | CommunityDemographics |
| Existing Resources | X | ExistingResources |
| How Data Obtained | X | HowDataObtained |
| Community Health Needs | X | CommunityHealthNeeds |
| Other Health Issues | X | OtherHealthIssues |
| Identifying Process | X | IdentifyingProcess |
| Consulting Process | X | ConsultingProcess |
| Information Gaps | X | InformationGaps |
| Needs Assessment Conducted | 12 | NeedsAssessmentConducted |
| Take Into Account | 1 | TakeIntoAccount |
| Other Facilities | 0 | OtherFacilities |
| CHNA Widely Available | 0 | CHNAWidelyAvailable |
| All Needs Addressed | 1 | AllNeedsAddressed |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTax |
| Eligibility Criteria Explained | 0 | EligibilityCriteriaExplained |
| Uses FPG Free | 0 | UsesFPGFree |
| Uses FPG Discounted | 0 | UsesFPGDiscounted |
| Explains Basis | 0 | ExplainsBasis |
| Explains Application Method | 0 | ExplainsApplicationMethod |
| Includes Publicity Measures | 0 | IncludesPublicityMeasures |
| Actions On Nonpayment | 0 | ActionsOnNonpayment |
| Collection Activities | 0 | CollectionActivities |
| Nondiscrim Emergency Care Policy | 0 | NondiscrimEmergencyCarePolicy |
| Amounts Generally Billed | 0 | AmountsGenerallyBilled |
| Gross Charges | 0 | GrossCharges |
Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Other Facilities | 2 | NumberOfOtherFacilities |
Other Facilities OtherFacilities (2 entries)
| Address Line1Address/AddressLine1 | CityAddress/City | StateAddress/State | ZIP CodeAddress/ZIPCode | Facility TypeFacilityType |
|---|---|---|---|---|
| PRAIRIE PINES LODGE | ||||
| 900 W 7TH ST | CHADRON | NE | 69337 | ASSISTED LIVING |
| LEGEND BUTTES HEALTH SERVICES | ||||
| 11 PADDOCK | CRAWFORD | NE | 69339 | CLINIC SERVICES |
Form990 Schedule H Part VI Form990ScheduleHPartVI (5 entries)
| ExplanationExplanation | IdentifierIdentifier |
|---|---|
| PART I, LINE 7: THE HOSPITAL COMPUTES ITS ESTIMATED CHARITY CARE COSTS BY APPLYING ITS OVERALL COST TO CHARGE RATIO (TOTAL OPERATING COSTS DIVIDED BY GROSS PATIENT SERVICE REVENUE) TO THE GROSS CHARGES FORGONE UNDER ITS CHARITY CARE POLICY. | |
| PART III, LINE 4: THE HOSPITAL PROVIDES FOR AN ALLOWANCE FOR DOUBTFUL ACCOUNTS BASED ON A REVIEW OF EXISTING RECEIVABLES, HISTORICAL COLLECTION INFORAMTION AND EXISTING ECONOMIC CONDITIONS. DELINQUENT RECEIVABLES ARE WRITTEN OFF BASED ON INDIVIDUAL CREDIT EVALUATION AND SPECIFIC CIRCUMSTANCES OF THE PATIENT AND OTHER THIRD-PARTY PAYORS. BAD DEBT RECOVERS ARE CHARGED AGAINST THE ALLOWANCE ACCOUNT AS REALIZED. | |
| PART III, LINE 8: 100% OF THE SHORTFALL SHOULD BE TREATED AS A COMMUNITY BENEFIT. THE COSTING METHODOLOGY USED TO DETERMINE THE AMOUNT WAS DETERMINED FROM THE MEDICARE COST REPORT. | |
| PART III, LINE 9B: THE HOSPITAL PROVIDES CARE TO PATIENTS WHO LACK FINANCIAL RESOURCES AND ARE DEEMED TO BE MEDICALLY INDIGENT BASED ON CRITERIA ESTABLISHED UNDER THE HOSPITALS CHARITY CARE POLICY. THIS CARE IS PROVIDED WITHOUT CHARGE OR AT AMOUNTS LESS THAN ITS ESTABLISHED RATES. BECAUSE THE HOSPITAL DOES NOT PURSUE COLLECTION OF AMOUNTS DETERMINED TO QUALIFY AS CHARITY CARE, SUCH AMOUNTS ARE NOT REPORTED AS REVENUE. THE HOSPITAL MAINTAINS RECORDS TO IDENTIFY AND MONITOR THE LEVEL OF CHARITY CARE PROVIDED. THESE RECORDS INCLUDE THE AMOUNT OF CHARGES FORGONE FOR SERVICES AND SUPPLIES FURNISHED UNDER ITS CHARITY CARE POLICY. THE CHARGES RELATED TO THIS CARE TOTALED $166,850 AND $71,402 IN 2010 AND 2009, RESPECTIVELY. IN ADDITION, THE HOSPITAL PROVIDES SERVICES TO OTHER MEDICALLY INDIGENT PATIENTS UNDER VARIOUS STATE MEDICAID PROGRAMS. SUCH PROGRAMS PAY AMOUNTS THAT ARE LESS THAN THE COST OF THE SERVICES PROVIDED TO THE RECIPIENTS. | |
| PART V, SECTION B, LINE 3: REGIONAL HOSPITALS WORKED TOGETHER WITH THE LOCAL PUBLIC HEALTH DEPARTMENT TO COMPLETE THE CHNA. | NOT REQUIRED |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Substantiation Required | 1 | SubstantiationRequired |
| Severance Payment | 0 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 0 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 0 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 0 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 0 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 0 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part III Form990ScheduleJPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | SUPPLEMENTAL INFORMATION | Identifier |
| Return Reference | PART III | ReturnReference |
| Explanation | HAROLD KREUGER, CEO, IS PAID BY REGIONAL WEST MEDICAL CENTER. THE HOSPITAL CONTRACTS FOR THIS SERVICE. | Explanation |
Schedule L IRS990ScheduleL
Loan Table LoanTable
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PRAIRIE SKY CONDOS | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Purpose Of Loan | PROPERTY DEVELOPMENT | PurposeOfLoan |
| Loan From Organization | X | LoanFromOrganization |
| Original Principal | $65,000 | OriginalPrincipalAmount |
| Default | 0 | Default |
| Approved By Board | 1 | ApprovedByBoard |
| Written Agreement | 1 | WrittenAgreement |
Form990 Schedule L Part IV Form990ScheduleLPartIV
Name Of Interested Person NameOfInterestedPerson
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | E&T DEVELOPERS LLC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Relationship | MEMBERS OF LLC ARE ON THE BOARD OF DIRECTORS | Relationship |
| Amount Of Transaction | 65000 | AmountOfTransaction |
| Description Of Transaction | THE HOSPITAL SOLD LOT 1, BLOCK 1, WEST HILLS SEVENTH ADDITION TO E&T DEVELOPERS. THE TOTAL SALE PRICE OF THE PROPERTY WAS $65,000. THE HOSPITAL IS CARRYING THE LOAN WITH A 4.95% ANNUAL RATE. PAYMENTS ARE DUE AS EACH DUPLEX UNIT IS CONSTRUCTED AND SOLD. AT THE TIME OF A SALE OF A UNIT 1/5 OF THE PURCHASE PRICE PER UNIT OR THE SUM OF $13,000 IS DUE TO THE HOSPITAL TOGETHER WITH INTEREST ACCRUED ON THAT PORTION OF THE UNPAID PURCHASE PRICE. THE LAND AND ANY IMPROVEMENTS COLLATERALIZE THE LOAN. | DescriptionOfTransaction |
| Sharing Of Revenues | 0 | SharingOfRevenues |
Schedule M IRS990ScheduleM
Food Inventory FoodInventory
| Field | Value | IRS element (for citing) |
|---|---|---|
| Non Cash Checkbox | X | NonCashCheckbox |
| Number Of Contributions | 1 | NumberOfContributions |
| Method Of Determining Revenues | DETERMINED BY ENTITY | MethodOfDeterminingRevenues |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Any Property That Must Be Held | 0 | AnyPropertyThatMustBeHeld |
| Review Process Unusual NC Gifts | 0 | ReviewProcessUnusualNCGifts |
| Third Parties Used | 0 | ThirdPartiesUsed |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (4 entries)
| Return ReferenceReturnReference | ExplanationExplanation |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 3 | THE HOSPITAL ADMINISTRATOR (CEO) IS CONTRACTED WITH REGIONAL WEST MEDICAL CENTER. |
| FORM 990, PART VI, SECTION B, LINE 11 | FORM 990 IS REVIEWED AND APPROVED BY THE CHEIF EXECUTIVE OFFICER AND CHIEF FINANCIAL OFFICER PRIOR TO FILING. |
| FORM 990, PART VI, SECTION B, LINE 12C | ADDRESSED ANNUALLY OR WITH EACH CHANGE IN BOARD OF DIRECTORS MEMBERS |
| FORM 990, PART VI, SECTION C, LINE 19 | UPON REQUEST |