2014-08-15T09:42:32-05:00 2013-09-30 470691351 FRED A LOCKWOOD & CO PC 201 MAIN STREET P O BOX 447 CHADRON NE 69337 990 2012-10-01 470482234 CHADRON COMMUNITY HOSPITAL CORPORATION CHAD 3084325586 825 CENTENNIAL DRIVE CHADRON NE 69337 HAROLD KRUEGER 3084322737 2014-08-15 1 ANDREANNA LOUTZENHISER P00285945 3084324465 2012 2015-11-30 17:44:51Z HAROLD KRUEGER 825 CENTENNIAL DRIVE CHADRON NE 69337 19221714 0 X N/A X 1957 NE TO PROVIDE AND SUPPORT HEALTH CARE AND COMMUNITY SERVICE PROGRAMS OF EXCELLENCE IN THE COMMUNITIES WE SERVE. 13 13 240 13 -207643 0 2471375 2807411 15420610 15440809 5425 3782 1306649 395793 19204059 18647795 0 0 0 0 8572370 8711574 0 0 0 10440408 11901739 19012778 20613313 191281 -1965518 31664233 29064364 21255004 20620653 10409229 8443711 X TO PROVIDE AND SUPPORT HEALTH CARE AND COMMUNITY SERVICE PROGRAMS OF EXCELLENCE IN THE COMMUNITIES WE SERVE. 0 0 17616979 15440809 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. 17616979 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 1 0 1 0 0 1 0 0 0 0 0 0 0 0 1 36 0 1 240 0 0 0 0 0 0 0 0 0 X 13 13 0 1 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 0 0 0 X HAROLD KRUEGER ADMINISTRATOR 3084325586 825 CENTENNIAL DRIVE CHADRON NE 69337 JACK MANN 2.00 X 0 0 0 LARRY PROVANCE 2.00 X 0 0 0 DAVID KAY 2.00 X X 0 0 0 MARY HANSEN 2.00 X 0 0 0 SHARON RICKENBACH 2.00 X X 0 0 0 JERRY MCCANCE 2.00 X 0 0 0 KERRY BAILEY 2.00 X 0 0 0 LEEANN FERLEY 2.00 X 0 0 0 DR JERRY MCLAIN 2.00 X 0 0 0 CATIE LIMBACK 2.00 X X 0 0 0 BRYCE LANDEN 2.00 X X 0 0 0 KARLA ADAMS 2.00 X 0 0 0 BRAD HENCEY 2.00 X X 0 0 0 LARRY JOHNSON 2.00 X 0 0 0 SHELLEY GRAVES 40.00 X 139418 0 4208 CHERYL CASSIDAY 40.00 X 126736 0 3825 HAILEY WANG 40.00 X 106318 0 19 ALLEN VAN DRIEL 40.00 X 112034 0 3381 RUSS BOHNENKAMP 40.00 X 114830 0 3466 599336 0 14899 7 0 0 0 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 17 594051 2213360 311425 2807411 HOSPITAL ANCILLARY REVE 621990 11463576 11463576 HOSPITAL ROUTINE REVENU 621990 2615128 2615128 RETIREMENT APARTMENTS 623990 988414 988414 RURAL HEALTH CLINIC 621300 373691 373691 15440809 3782 3782 153000 338816 27460 546459 125540 -207643 -82103 -207643 125540 MISCELLANEOUS 900099 178308 178308 NONPATIENT SALES 446110 146064 146064 INSERVICE REVENU 611710 108277 108277 45247 45247 477896 18647795 15440809 -207643 607218 7292428 6208313 1084115 137872 112830 25042 855650 709119 146531 425624 351906 73718 264537 264537 51322 51322 42085 42085 83256 83256 52010 4974 47036 22943 18776 4167 12120 12120 800377 748160 52217 89494 46463 43031 42622 19425 23197 1096227 916929 179298 2307070 1898066 409004 220009 180307 39702 SUPPLIES 2586764 2559208 27556 PROVISIONS FOR BAD DEBT 1393848 1393848 PROFESSIONAL FEES/PURCH 1264664 1264664 UTILITIES 627501 527387 100114 944890 656604 288286 20613313 17616979 2996334 0 1916150 1374722 3811884 3231248 95215 52000 236468 244993 129403 158818 38546468 15718438 24329842 22828030 1145271 1174553 31664233 29064364 1578669 1557811 209307 215613 19467028 18847229 21255004 20620653 X 0 0 0 0 10409229 8443711 10409229 8443711 31664233 29064364 -1965518 0 X 0 0 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 192452 192452 30916037 10175680 20740357 572027 341464 230563 6768545 5117820 1650725 97407 83474 13933 22828030 19221714 573919 573919 18647795 0 18647795 21187233 573920 573920 20613313 0 20613313 PART XI, LINE 2D - OTHER ADJUSTMENTS: RENT EXPENSE 573,919. ROUNDING PART XII, LINE 2D - OTHER ADJUSTMENTS: RENT EXPENSE 573,919. ROUNDING 1. 1 1 1 X 1 X 1 1 1 0 1 1 412090 412090 0.02000 423256 423256 0.02050 835346 835346 0.04050 835346 835346 0.04050 502007 500061 1946 0.00010 18876 18876 521098 521735 -637 0.00000 1205 1205 1043186 1041877 1309 0.00010 1 1393429 514172 9552956 3033335 6519621 X 1 1 1 1 CHADRON COMMUNITY HOSPITAL

825 CENTENNIAL DRIVE CHADRON NE 69337

X X X X NOT REQUIRED 1 1 X X X X X X X X X 12 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 2 PRAIRIE PINES LODGE

900 W 7TH ST CHADRON NE 69337

ASSISTED LIVING LEGEND BUTTES HEALTH SERVICES

11 PADDOCK CRAWFORD NE 69339

CLINIC SERVICES PART I, LINE 7: THE HOSPITAL COMPUTES ITS ESTIMATED CHARITY CARE COSTS BY APPLYING ITS OVERALL COST TO CHARGE RATIO (TOTAL OPERATING COSTS DIVIDED BY GROSS PATIENT SERVICE REVENUE) TO THE GROSS CHARGES FORGONE UNDER ITS CHARITY CARE POLICY. PART III, LINE 4: THE HOSPITAL PROVIDES FOR AN ALLOWANCE FOR DOUBTFUL ACCOUNTS BASED ON A REVIEW OF EXISTING RECEIVABLES, HISTORICAL COLLECTION INFORAMTION AND EXISTING ECONOMIC CONDITIONS. DELINQUENT RECEIVABLES ARE WRITTEN OFF BASED ON INDIVIDUAL CREDIT EVALUATION AND SPECIFIC CIRCUMSTANCES OF THE PATIENT AND OTHER THIRD-PARTY PAYORS. BAD DEBT RECOVERS ARE CHARGED AGAINST THE ALLOWANCE ACCOUNT AS REALIZED. PART III, LINE 8: 100% OF THE SHORTFALL SHOULD BE TREATED AS A COMMUNITY BENEFIT. THE COSTING METHODOLOGY USED TO DETERMINE THE AMOUNT WAS DETERMINED FROM THE MEDICARE COST REPORT. PART III, LINE 9B: THE HOSPITAL PROVIDES CARE TO PATIENTS WHO LACK FINANCIAL RESOURCES AND ARE DEEMED TO BE MEDICALLY INDIGENT BASED ON CRITERIA ESTABLISHED UNDER THE HOSPITALS CHARITY CARE POLICY. THIS CARE IS PROVIDED WITHOUT CHARGE OR AT AMOUNTS LESS THAN ITS ESTABLISHED RATES. BECAUSE THE HOSPITAL DOES NOT PURSUE COLLECTION OF AMOUNTS DETERMINED TO QUALIFY AS CHARITY CARE, SUCH AMOUNTS ARE NOT REPORTED AS REVENUE. THE HOSPITAL MAINTAINS RECORDS TO IDENTIFY AND MONITOR THE LEVEL OF CHARITY CARE PROVIDED. THESE RECORDS INCLUDE THE AMOUNT OF CHARGES FORGONE FOR SERVICES AND SUPPLIES FURNISHED UNDER ITS CHARITY CARE POLICY. THE CHARGES RELATED TO THIS CARE TOTALED $166,850 AND $71,402 IN 2010 AND 2009, RESPECTIVELY. IN ADDITION, THE HOSPITAL PROVIDES SERVICES TO OTHER MEDICALLY INDIGENT PATIENTS UNDER VARIOUS STATE MEDICAID PROGRAMS. SUCH PROGRAMS PAY AMOUNTS THAT ARE LESS THAN THE COST OF THE SERVICES PROVIDED TO THE RECIPIENTS. NOT REQUIRED PART V, SECTION B, LINE 3: REGIONAL HOSPITALS WORKED TOGETHER WITH THE LOCAL PUBLIC HEALTH DEPARTMENT TO COMPLETE THE CHNA. 1 0 0 0 0 0 0 0 0 0 SUPPLEMENTAL INFORMATION PART III HAROLD KREUGER, CEO, IS PAID BY REGIONAL WEST MEDICAL CENTER. THE HOSPITAL CONTRACTS FOR THIS SERVICE. PRAIRIE SKY CONDOS PROPERTY DEVELOPMENT X 65000 0 1 1 E&T DEVELOPERS LLC MEMBERS OF LLC ARE ON THE BOARD OF DIRECTORS 65000 THE HOSPITAL SOLD LOT 1, BLOCK 1, WEST HILLS SEVENTH ADDITION TO E&T DEVELOPERS. THE TOTAL SALE PRICE OF THE PROPERTY WAS $65,000. THE HOSPITAL IS CARRYING THE LOAN WITH A 4.95% ANNUAL RATE. PAYMENTS ARE DUE AS EACH DUPLEX UNIT IS CONSTRUCTED AND SOLD. AT THE TIME OF A SALE OF A UNIT 1/5 OF THE PURCHASE PRICE PER UNIT OR THE SUM OF $13,000 IS DUE TO THE HOSPITAL TOGETHER WITH INTEREST ACCRUED ON THAT PORTION OF THE UNPAID PURCHASE PRICE. THE LAND AND ANY IMPROVEMENTS COLLATERALIZE THE LOAN. 0 X 1 DETERMINED BY ENTITY 0 0 0 FORM 990, PART VI, SECTION A, LINE 3 THE HOSPITAL ADMINISTRATOR (CEO) IS CONTRACTED WITH REGIONAL WEST MEDICAL CENTER. FORM 990, PART VI, SECTION B, LINE 11 FORM 990 IS REVIEWED AND APPROVED BY THE CHEIF EXECUTIVE OFFICER AND CHIEF FINANCIAL OFFICER PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C ADDRESSED ANNUALLY OR WITH EACH CHANGE IN BOARD OF DIRECTORS MEMBERS FORM 990, PART VI, SECTION C, LINE 19 UPON REQUEST