PHELPS MEMORIAL HEALTH CENTER: Form 990, tax year 2012
View the entire original 990 at ProPublica ↗
- Organization
- PHELPS MEMORIAL HEALTH CENTER (EIN 47-0481628)
- Tax period
- 2012-01-01 to 2012-12-31
- Filed
- 2013-11-12
- IRS object ID
- 201343169349303959
- 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 C
- Schedule D
- Schedule H
- Schedule I
- Schedule J
- Schedule L
- Schedule O
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2013-11-12T12:05:17-06:00 | Timestamp |
| Tax Period End Date | 2012-12-31 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 476097913 | EIN |
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SEIM JOHNSON LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 18081 BURT STREET SUITE 200 | AddressLine1 |
| City | OMAHA | City |
| State | NE | State |
| ZIP Code | 680224722 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2012-01-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 470481628 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PHELPS MEMORIAL HEALTH CENTER | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | PHEL | NameControl |
| Phone | 3089952211 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1215 TIBBALS | AddressLine1 |
| City | HOLDREGE | City |
| State | NE | State |
| ZIP Code | 68949 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | LOREN SCHRODER | Name |
| Title | CHIEF FINANCIAL OFFICER | Title |
| Phone | 3089952211 | Phone |
| Date Signed | 2013-11-12 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | JULIE M GERKEN | Name |
| PTIN | P00400882 | PTIN |
| Phone | 4023302660 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2012 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | MARK HARREL | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1215 TIBBALS | AddressLine1 |
| City | HOLDREGE | City |
| State | NE | State |
| ZIP Code | 68949 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 30773552 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.PHELPSMEMORIAL.COM | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1963 | YearFormation |
| State Legal Domicile | NE | StateLegalDomicile |
| Activity Or Mission Description | PHELPS MEMORIAL HEALTH CENTER IS A PROGRESSIVE FAMILY-CENTERED HEALTH CARE PROVIDER DELIVERING A CONTINUUM OF CARE THAT ENHANCES THE QUALITY OF LIFE FOR PEOPLE WE SERVE. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 13 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 9 | NbrIndependentVotingMembers |
| Total Nbr Employees | 263 | TotalNbrEmployees |
| Total Nbr Volunteers | 250 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 22699 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 86559 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 27281699 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 30395664 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 657716 | InvestmentIncomePriorYear |
| Investment Income Current Year | 213853 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 50672 | OtherRevenuePriorYear |
| Other Revenue Current Year | 61461 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 28012786 | TotalRevenuePriorYear |
| Total Revenue Current Year | 30757537 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 31528 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 187997 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 10677047 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 11763614 | 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 | 12661394 | OtherExpensePriorYear |
| Other Expenses Current Year | 15475064 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 23369969 | TotalExpensesPriorYear |
| Total Expenses Current Year | 27426675 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 4642817 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 3330862 | RevenuesLessExpensesCY |
| Total Assets BOY | 52322538 | TotalAssetsBOY |
| Total Assets EOY | 59037639 | TotalAssetsEOY |
| Total Liabilities BOY | 4196134 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 7144023 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 48126404 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 51893616 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | PHELPS MEMORIAL HEALTH CENTER IS A PROGRESSIVE FAMILY-CENTERED HEALTH CARE PROVIDER DELIVERING A CONTINUUM OF CARE THAT ENHANCES THE QUALITY OF LIFE FOR PEOPLE WE SERVE. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 2004190 | Expense |
| Revenue | 5354065 | Revenue |
| Description | PHYSICAL THERAPY - THE THERAPY CENTER INCLUDES A LARGE GYM FOR TRAINING AND REHABILITATION, A WHIRLPOOL ROOM FOR WOUND CARE AND A SPORTS FLOOR FOR ATHLETIC TRAINING. PHYSICAL THERAPY ALLOWS INDIVIDUALS TO DEVELOP, RESTORE AND MAINTAIN MAXIMUM MOVEMENT AND FUNCTIONAL ABILITY THROUGHOUT LIFE. THIS INCLUDES PROVIDING SERVICES IN CIRCUMSTANCES WHERE MOVEMENT AND FUNCTION ARE THREATENED BY AGING, INJURY OR DISEASE. THE HYDROWORX THERAPY POOL HELPS PATIENTS RECOVER FROM SURGERY AND ARTHRITIC SYMPTOMS, AS WELL AS, ATHLETIC REHABILITATION. OCCUPATIONAL THERAPY INCORPORATES MEANINGFUL AND PURPOSEFUL OCCUPATION TO ENABLE PEOPLE WITH LIMITATIONS OR IMPAIRMENTS TO PARTICIPATE IN EVERYDAY LIFE. OCCUPATIONAL THERAPISTS WORK WITH INDIVIDUALS, FAMILIES, GROUPS AND POPULATIONS TO FACILITATE HEALTH AND WELL-BEING THROUGH ENGAGEMENT OR RE-ENGAGEMENT IN OCCUPATIONS AND EVERYDAY ACTIVITIES. OCCUPATIONAL THERAPY MAY INCLUDE RESTORING FUNCTION, ADAPTING THE PATIENT'S ENVIRONMENT, OR EVEN HELPING PATIENTS FIND EQUIPMENT TO HELP THEM PARTICIPATE MORE INDEPENDENTLY IN THEIR EVERYDAY ACTIVITIES. OCCUPATIONAL THERAPY HAS MORE ROOM TO EXPAND THEIR SERVICES AND BETTER SERVE THEIR PATIENTS. SPEECH THERAPY ADDRESSES PEOPLE'S SPEECH PRODUCTION, VOCAL PRODUCTION, SWALLOWING DIFFICULTIES AND LANGUAGE NEEDS. | Description |
Activity2 Activity2
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 1170725 | Expense |
| Revenue | 11098315 | Revenue |
| Description | RADIOLOGY - THE RADIOLOGY DEPARTMENT AT PHELPS MEMORIAL HEALTH CENTER IS A PROGRESSIVE IMAGING CENTER. WE ARE A FULLY ACCREDITED IMAGING CENTER WITH STATE OF THE ART EQUIPMENT. FEATURING MRI, CT, GENERAL ULTRASOUND, CARDIOVASCULAR ULTRASOUND, NUCLEAR MEDICINE, MAMMOGRAPHY, AS WELL AS STANDARD X-RAYS. WE ARE A FULLY STAFFED, HIGHLY EDUCATED AND EXPERIENCED DEPARTMENT. OUR STAFF IS NOT ONLY EXPERIENCED BUT FRIENDLY AND WILLING TO SERVE YOU BEYOND YOUR EXPECTATIONS. WE ARE VERY "PATIENT" ORIENTED, FOCUSING ON YOUR NEEDS AS A PATIENT. TRYING TO MAKE YOUR EXPERIENCE AS COMFORTABLE AS POSSIBLE. | Description |
Activity3 Activity3
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 703375 | Expense |
| Revenue | 3825646 | Revenue |
| Description | MED/SURG - PHELPS MEMORIAL HEALTH CENTER HAS A LOT TO OFFER YOU AND YOUR FAMILY. WE ARE A 25 BED CRITICAL ACCESS HOSPITAL WITH ALL PRIVATE ROOMS. WE HAVE AN EXPERIENCED SURGICAL TEAM WHICH INCLUDES PHYSICIANS/SURGEONS, NURSE ANESTHETIST (CRNA'S), AND SURGICAL NURSES. WE OFFER A WIDE VARIETY OF SURGICAL SERVICES RANGING FROM MINOR PROCEDURES TO MAJOR SURGERIES. OUR GOALS ARE PATIENT-ORIENTED, FOCUSING ON SAFETY, CARE, AND PAIN MANAGEMENT. OUR NURSES COLLABORATE WITH THE PHYSICIANS AND OTHER DEPARTMENTS TO DELIVER A CONTINUUM OF CARE THAT ENHANCES THE QUALITY OF LIFE FOR OUR PATIENTS AND THEIR FAMILIES. | Description |
Activity Other ActivityOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 19769389 | Expense |
| Grants | 187997 | Grants |
| Revenue | 10117638 | Revenue |
| Description | OTHER MISCELLANEOUS PROGRAM SERVICES | Description |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Other Program Service Exp | 19769389 | TotalOfOtherProgramServiceExp |
| Total Of Other Program Service Grnt | 187997 | TotalOfOtherProgramServiceGrnt |
| Total Of Other Program Service Rev | 10117638 | TotalOfOtherProgramServiceRev |
| Total Program Service Expense | 23647679 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 1 | 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 | 1 | 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 | 1 | 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 | 1 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 0 | TaxExemptBonds |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 1 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 1 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | 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 | 20 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 263 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | 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 |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 13 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 9 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 1 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 1 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 1 | MembersOrStockholders |
| Election Of Board Members | 1 | 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 | 1 | 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 | 1 | 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 | LOREN D SCHRODER CFO | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 3089952211 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1215 TIBBALS | AddressLine1 |
| City | HOLDREGE | City |
| State | NE | State |
| ZIP Code | 68949 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (19 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Average Hours Per Week RelatedAverageHoursPerWeekRelated | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|---|
| CHARLES REESER | ||||||||
| PRESIDENT | 2.00 | 0.00 | X | X | 0 | 0 | 0 | |
| KATHRYN CANADA | ||||||||
| VICE PRESIDENT | 2.00 | 0.00 | X | X | 0 | 0 | 0 | |
| DAVID DANNEHL | ||||||||
| TREASURER | 2.00 | 0.00 | X | X | 0 | 0 | 0 | |
| ROGER PETERSON | ||||||||
| SECRETARY | 2.00 | 0.00 | X | X | 0 | 0 | 0 | |
| NANCY GARRELTS | ||||||||
| MEMBER | 2.00 | 0.00 | X | 0 | 0 | 0 | ||
| PHIL HINRICHS | ||||||||
| MEMBER | 2.00 | 0.00 | X | 0 | 0 | 0 | ||
| GARY BERGSTEN | ||||||||
| MEMBER | 2.00 | 0.00 | X | 0 | 0 | 0 | ||
| JEFFREY BERNEY MD | ||||||||
| MEMBER | 2.00 | 0.00 | X | 0 | 0 | 0 | ||
| SHERYL MCCLYMONT | ||||||||
| MEMBER | 2.00 | 0.00 | X | 0 | 0 | 0 | ||
| STEVE KNESS | ||||||||
| MEMBER | 2.00 | 0.00 | X | 0 | 0 | 0 | ||
| DAROLD TAGGE | ||||||||
| MEMBER | 2.00 | 0.00 | X | 0 | 0 | 0 | ||
| RONA VANDELL | ||||||||
| MEMBER | 2.00 | 0.00 | X | 0 | 0 | 0 | ||
| LARRY MYERS | ||||||||
| MEMBER | 2.00 | 0.00 | X | 0 | 0 | 0 | ||
| SCOTT EHRESMAN MD | ||||||||
| CHIEF OF STAFF | 2.00 | 0.00 | X | 0 | 0 | 0 | ||
| MARK HARREL | ||||||||
| CEO | 40.00 | 0.00 | X | 184498 | 0 | 45073 | ||
| LOREN SCHRODER | ||||||||
| CFO | 40.00 | 0.00 | X | 130815 | 0 | 34392 | ||
| ROBERT MILLER | ||||||||
| PHARMACY LEADER | 40.00 | 0.00 | 135238 | 0 | 7759 | X | ||
| LEORA D SMITH | ||||||||
| CHIEF NURSING OFFICER | 40.00 | 0.00 | 130744 | 0 | 20708 | X | ||
| JERRY L HOWARD II | ||||||||
| SURGEON | 30.00 | 0.00 | 159341 | 0 | 0 | X | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 740636 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 107932 | TotalOtherCompensation |
| Number Individuals GT100 K | 5 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 1 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| BRASFIELD & GORRIE LLC | |||||
| PO BOX 11407 | BIRMINGHAM | AL | 35246 | CONSTRUCTION | 9460323 |
| NEW WEST ORTHOPAEDIC & SPORTS REHAB | |||||
| 3219 CENTRAL AVE STE 104 | KEARNEY | NE | 68847 | THERAPY | 1978995 |
| QUORUM HEALTH RESOURCES | |||||
| 105 CONTINENTAL PLACE | BRENTWOOD | TN | 37027 | MANAGEMENT SERVICE | 723756 |
| HOLDREGE MEDICAL CLINIC | |||||
| 516 WEST 14TH AVE | HOLDREGE | NE | 68949 | PHYSICIAN ON-CALL | 652823 |
| ANESTHESIA SERVICES OF NEBRASKA LLC | |||||
| 113 BENNETT DRIVE | LEXINGTON | NE | 68850 | ANESTHESISTS | 607754 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 13 | NumberOfContractorsGT100K |
| All Other Contributions | 86559 | AllOtherContributions |
| Noncash Contributions | 12000 | NoncashContributions |
| Total Contributions | 86559 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (5 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|
| MEDICARE/MEDICAID PAYM | 624100 | 16365597 | 16365597 |
| NET PATIENT REVENUE | 624100 | 12604158 | 12604158 |
| EHR INCENTIVE PAYMENT | 624100 | 893976 | 893976 |
| SUPPLY SALES/MISC OPER | 624100 | 467333 | 467333 |
| CHILD SERVICES OP OTHE | 624100 | 64600 | 64600 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 30395664 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 224796 | TotalRevenueColumn |
| Exclusion | $224,796 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 72 | Securities |
| Other | 5000 | Other |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 0 | Securities |
| Other | 16015 | Other |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 72 | Securities |
| Other | -11015 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -10943 | TotalRevenueColumn |
| Exclusion | -$10,943 | ExclusionAmount |
Other Revenue Misc OtherRevenueMisc
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | CAFETERIA | Description |
| Business Code | 722210 | BusinessCode |
| Total Revenue Column | 61461 | TotalRevenueColumn |
| Exclusion | $61,461 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 61461 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 30757537 | TotalRevenueColumn |
| Related Or Exempt Function Income | 30395664 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $275,314 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | X | InfoInScheduleOPartIX |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 187997 | Total |
| Program Services | 187997 | ProgramServices |
Comp Disqual Persons CompDisqualPersons
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 133368 | Total |
| Program Services | 133368 | ProgramServices |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 9099885 | Total |
| Program Services | 7379691 | ProgramServices |
| Management And General | 1720194 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 191649 | Total |
| Program Services | 155944 | ProgramServices |
| Management And General | 35705 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1713962 | Total |
| Program Services | 1608502 | ProgramServices |
| Management And General | 105460 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 624750 | Total |
| Program Services | 508356 | ProgramServices |
| Management And General | 116394 | ManagementAndGeneral |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 394778 | Total |
| Management And General | 394778 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 89586 | Total |
| Management And General | 89586 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 98561 | Total |
| Management And General | 98561 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 4772265 | Total |
| Program Services | 4622302 | ProgramServices |
| Management And General | 149963 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 78159 | Total |
| Management And General | 78159 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1478163 | Total |
| Program Services | 949365 | ProgramServices |
| Management And General | 528798 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 773312 | Total |
| Program Services | 435690 | ProgramServices |
| Management And General | 337622 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 193195 | Total |
| Program Services | 128979 | ProgramServices |
| Management And General | 64216 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 18646 | Total |
| Program Services | 18646 | ProgramServices |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2869768 | Total |
| Program Services | 2869768 | ProgramServices |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 105280 | Total |
| Program Services | 105280 | ProgramServices |
Other Expenses OtherExpenses (3 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| MEDICAL SUPPLIES | 3348543 | 3348543 | |
| BAD DEBTS | 1152887 | 1152887 | |
| DUES AND SUBSCRIPTIONS | 101921 | 42361 | 59560 |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 27426675 | Total |
| Program Services | 23647679 | ProgramServices |
| Management And General | 3778996 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 425 | BOY |
| EOY | 425 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 11344139 | BOY |
| EOY | 4278419 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4832129 | BOY |
| EOY | 5356409 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 561755 | BOY |
| EOY | 626531 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 177245 | BOY |
| EOY | 228533 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 67654364 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 26318697 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 28939076 | BOY |
| EOY | 41335667 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6036527 | BOY |
| EOY | 5996290 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 387516 | BOY |
| EOY | 354506 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 43726 | BOY |
| EOY | 860859 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 52322538 | BOY |
| EOY | 59037639 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3630482 | BOY |
| EOY | 5536120 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 335652 | BOY |
| EOY | 1527903 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 230000 | BOY |
| EOY | 80000 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4196134 | BOY |
| EOY | 7144023 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 47839632 | BOY |
| EOY | 51587884 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 86438 | BOY |
| EOY | 95952 | EOY |
Permanently Restricted Net Assets PermanentlyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 200334 | BOY |
| EOY | 209780 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 48126404 | BOY |
| EOY | 51893616 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 52322538 | BOY |
| EOY | 59037639 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expenses | 3330862 | ReconcilationRevenueExpenses |
| Reconciliation Unrealized Invest | 436350 | ReconciliationUnrealizedInvest |
| Reconcilation Other Changes | 0 | ReconcilationOtherChanges |
| Info In Schedule O Part XII | X | InfoInScheduleOPartXII |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
FS Audited Basis FSAuditedBasis
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Statement Separate | X | FinancialStatementSeparate |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | 1 | AuditCommittee |
| 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 C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | Volunteers |
| Paid Staff Or Management | 0 | PaidStaffOrManagement |
| Media Advertisements | 0 | MediaAdvertisements |
| Mailings Members | 0 | MailingsMembers |
| Publications Or Broadcast | 0 | PublicationsOrBroadcast |
| Grants Other Organizations | 0 | GrantsOtherOrganizations |
| Direct Contact Legislators | 0 | DirectContactLegislators |
| Rallies Demonstrations | 0 | RalliesDemonstrations |
| Other Activities | 1 | OtherActivities |
| Other Activities | $1,794 | OtherActivitiesAmount |
| Total Lobbying Expenditures IIB | 1794 | TotalLobbyingExpendituresIIB |
| Not Described In501c3 | 0 | NotDescribedIn501c3 |
Form990 Schedule C Part IV Form990ScheduleCPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | EXPLANATION OF LOBBYING ACTIVITIES: | Identifier |
| Return Reference | PART II-B, LINE 1: | ReturnReference |
| Explanation | DUES PAID TO NHA & AHA CONTAIN A PORTION FOR LOBBYING EXPENSES. | Explanation |
Schedule D IRS990ScheduleD
Current Year CurrentYear
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 417219 | BeginningOfYearBalance |
| Investment Earnings Or Losses | 14848 | InvestmentEarningsOrLosses |
| End Of Year Balance | 432067 | EndOfYearBalance |
Current Year Minus1 Year CurrentYearMinus1Year
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 401558 | BeginningOfYearBalance |
| Investment Earnings Or Losses | 15661 | InvestmentEarningsOrLosses |
| End Of Year Balance | 417219 | EndOfYearBalance |
Current Year Minus2 Years CurrentYearMinus2Years
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 383151 | BeginningOfYearBalance |
| Investment Earnings Or Losses | 18407 | InvestmentEarningsOrLosses |
| End Of Year Balance | 401558 | EndOfYearBalance |
Current Year Minus3 Years CurrentYearMinus3Years
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 368643 | BeginningOfYearBalance |
| Contributions | 100 | Contributions |
| Investment Earnings Or Losses | 14408 | InvestmentEarningsOrLosses |
| End Of Year Balance | 383151 | EndOfYearBalance |
Current Year Minus4 Years CurrentYearMinus4Years
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 345888 | BeginningOfYearBalance |
| Contributions | 6296 | Contributions |
| Investment Earnings Or Losses | 16459 | InvestmentEarningsOrLosses |
| End Of Year Balance | 368643 | EndOfYearBalance |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Designated EOY Balance | 0.51000 | BoardDesignatedEOYBalance |
| Permanent Endowment EOY Balance | 0.49000 | PermanentEndowmentEOYBalance |
| Term Endowment EOY Balance | 0.00000 | TermEndowmentEOYBalance |
| Endowments Held By Unrelated Orgs | 0 | EndowmentsHeldByUnrelatedOrgs |
| Endowments Held By Related Orgs | 0 | EndowmentsHeldByRelatedOrgs |
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 246511 | OtherCostOrOtherBasis |
| Book Value | 246511 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 38005643 | OtherCostOrOtherBasis |
| Depreciation | 13557784 | Depreciation |
| Book Value | 24447859 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 16841840 | OtherCostOrOtherBasis |
| Depreciation | 12486525 | Depreciation |
| Book Value | 4355315 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 12560370 | OtherCostOrOtherBasis |
| Depreciation | 274388 | Depreciation |
| Book Value | 12285982 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 41335667 | TotalOfBookValueLandBuildings |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | PLEDGE PAYABLE - PHELPS COUNTY DEVELOPMENT CORP | Description |
| Amount | $80,000 | Amount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 80000 | TotalOfAmounts |
| Tot Revenue Etc Audited Fincl Stmt | 31193887 | TotRevenueEtcAuditedFinclStmt |
| Net Unrealized Gains Investments | 436350 | NetUnrealizedGainsInvestments |
| Revenue Not Rptd F990 | 436350 | RevenueNotRptdF990 |
| Revenue Subtotal | 30757537 | RevenueSubtotal |
| Revenue Not Rptd On Fin Stmt | 0 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 30757537 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 27426675 | TotExpensesEtcAuditedFinclStmt |
| Expenses Not Rptd F990 | 0 | ExpensesNotRptdF990 |
| Expenses Subtotal | 27426675 | ExpensesSubtotal |
| Expenses Not Rptd On Fin Stmt | 0 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 27426675 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIII Form990ScheduleDPartXIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: | Identifier |
| Return Reference | PART V, LINE 4: | ReturnReference |
| Explanation | THE INTENDED USES FOR THE ENDOWMENT FUNDS ARE HEALTH CARE SCHOLARSHIPS, CHILD HEALTHCARE AND UNUSUAL HARDSHIP COSTS. | Explanation |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | 1 | CharityCarePolicy |
| Written Policy | 1 | WrittenPolicy |
| FPG Reference Free Care | 1 | FPGReferenceFreeCare |
Other Percentage OtherPercentage
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | X | Other |
| Free Other Percentage | 125.000000000000 | FreeOtherPercentage |
| Field | Value | IRS element (for citing) |
|---|---|---|
| FPG Reference Discounted Care | 1 | FPGReferenceDiscountedCare |
| Pcent250 | X | Pcent250 |
| 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 | 324593 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 324593 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01180 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 324593 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 324593 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01180 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 26380 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 8 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 26372 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00100 | PercentOfTotalExpense |
Health Professions Education HealthProfessionsEducation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 48770 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 48770 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00180 | PercentOfTotalExpense |
Subsidized Health Services SubsidizedHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 1841484 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 959955 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 881529 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.03210 | PercentOfTotalExpense |
Cash And In Kind Contributions CashAndInKindContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 248633 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 248633 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00910 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 2165267 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 959963 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1205304 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.04400 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 2489860 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 959963 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1529897 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.05580 | PercentOfTotalExpense |
Coalition Building CoalitionBuilding
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 4510 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 4510 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00020 | PercentOfTotalExpense |
Total Total
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 4510 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 4510 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00020 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 0 | BadDebtExpenseReported |
| Bad Debt Expense | $1,152,887 | BadDebtExpenseAmount |
| Amount Attributable To | 451182 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 12042883 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 12028615 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | 14268 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | X | CostToChargeRatio |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | 1 | WrittenDebtCollectionPolicy |
| Provision For Charity Care | 0 | 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 | PHELPS MEMORIAL HEALTH CENTER | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1215 TIBBALS | AddressLine1 |
| City | HOLDREGE | City |
| State | NE | State |
| ZIP Code | 68949 | 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 | PHELPS MEMORIAL HEALTH CENTER | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
| Eligibility Criteria Explained | 1 | EligibilityCriteriaExplained |
| Uses FPG Free | 1 | UsesFPGFree |
| FPG Free Percent | 125.000000000000 | FPGFreePercent |
| Uses FPG Discounted | 1 | UsesFPGDiscounted |
| FPG Discount Percent | 250.000000000000 | FPGDiscountPercent |
| Explains Basis | 0 | ExplainsBasis |
| Explains Application Method | 1 | ExplainsApplicationMethod |
| Includes Publicity Measures | 1 | IncludesPublicityMeasures |
| Available On Request | X | AvailableOnRequest |
| Actions On Nonpayment | 1 | ActionsOnNonpayment |
| Collection Activities | 0 | CollectionActivities |
| Notify Upon Admission | X | NotifyUponAdmission |
| Notify Before Discharge | X | NotifyBeforeDischarge |
| Notified All Patients | X | NotifiedAllPatients |
| Nondiscrim Emergency Care Policy | 1 | NondiscrimEmergencyCarePolicy |
| Average Negotiated Rates | X | AverageNegotiatedRates |
| Amounts Generally Billed | 0 | AmountsGenerallyBilled |
| Gross Charges | 0 | GrossCharges |
Form990 Schedule H Part VI Form990ScheduleHPartVI (16 entries)
| ExplanationExplanation | IdentifierIdentifier | Return ReferenceReturnReference |
|---|---|---|
| PART I, LINE 3C: PHELPS MEMORIAL HEALTH CENTER (PMHC) USES FEDERAL POVERTY GUIDELINES TO DETERMINE ELIGIBILITY FOR PROVIDING FREE AND DISCOUNTED CARE. | ||
| PART I, LINE 6A: THE COMMUNITY BENEFIT REPORT IS PREPARED BY THE STAFF AT PMHC. | ||
| PART I, LINE 7: THE COSTING METHODOLOGY USED TO CALCULATE THE AMOUNTS REPORTED IN THE TABLE WAS A COST-TO-CHARGE RATIO. THE RATIO WAS DERIVED FROM THE COST REPORT FOR FINANCIAL ASSISTANCE. | ||
| PART I, LINE 7G: NO COSTS ASSOCIATED WITH PHYSICIAN CLINICS WERE INCLUDED AS SUBSIDIZED HEALTH SERVICES. | ||
| PART I, L7 COL(F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $1,152,887. | ||
| PART II: ONE OF THE MAJOR COMMUNITY BUILDING ACTIVITIES THAT PMHC HELPS LEAD IS THE SAFE COMMUNITIES COALITION. PMHC EMPLOYEES THREE COALITION MEMBERS, INCLUDING THE COALITION COORDINATOR WHO IS RESPONSIBLE FOR THE DAY TO DAY ORGANIZATIONAL RESPONSIBILITIES, MINUTES, AGENDAS, AND PROGRAM AND EVENT COORDINATION. SAFE COMMUNITIES COALITION IS A GROUP OF REPRESENTATIVES FROM SEVERAL COMMUNITY AGENCIES, INCLUDING PHELPS MEMORIAL HEALTH CENTER, HOLDREGE POLICE DEPARTMENT, PHELPS COUNTY SHERIFF'S DEPARTMENT, NEBRASKA STATE PATROL, YMCA OF THE PRAIRIE, AMERICAN FAMILY INSURANCE, SAFE CENTER, TWO RIVERS PUBLIC HEALTH DEPARTMENT, HOLDREGE, LOOMIS, AND BERTRAND SCHOOLS, AND OTHERS. | ||
| IN EVALUATING THE COLLECTIBILITY OF ACCOUNTS RECEIVABLE, THE HEALTH CENTER ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYER SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYER SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE HEALTH CENTER ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR BAD DEBTS FOR THOSE ACCOUNTS OVER A CERTAIN AGE BASED ON DISCHARGE THAT MAKE THE REALIZATION OF AMOUNTS DUE UNLIKELY. FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), THE HEALTH CENTER RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES IF NEGOTIATED) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. | METHODOLOGY USED BY THE ORGANIZATION TO ESTIMATE BAD DEBT EXPENSE: | PART III, LINE 2: |
| PART III, LINE 4: THE ORGANIZATION'S FINANCIAL STATEMENTS DO NOT CONTAIN A SPECIFIC FOOTNOTE DESCRIBING BAD DEBT. HOWEVER, THE FOLLOWING IS THE TEXT OF THE FOOTNOTES TITLED "PATIENT ACCOUNTS RECEIVABLE, NET," "NET PATIENT SERVICE REVENUE," AND "CHARITY CARE":PATIENT ACCOUNTS RECEIVABLE, NET:THE HEALTH CENTER REPORTS PATIENT ACCOUNTS RECEIVABLE FOR SERVICES RENDERED AT NET REALIZABLE AMOUNTS FROM THIRD-PARTY PAYERS, PATIENTS AND OTHERS. ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS. IN EVALUATING THE COLLECTIBILITY OF ACCOUNTS RECEIVABLE, THE HEALTH CENTER ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYER SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYER SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE HEALTH CENTER ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR BAD DEBTS FOR THOSE ACCOUNTS OVER A CERTAIN AGE BASED ON DISCHARGE THAT MAKE THE REALIZATION OF AMOUNTS DUE UNLIKELY. FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), THE HEALTH CENTER RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES IF NEGOTIATED) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS.NET PATIENT SERVICE REVENUE:NET PATIENT SERVICE REVENUE IS REPORTED AT THE ESTIMATED NET REALIZABLE AMOUNTS FROM PATIENTS, THIRD-PARTY PAYERS, AND OTHERS FOR SERVICES RENDERED AND INCLUDES ESTIMATED RETROACTIVE REVENUE ADJUSTMENTS DUE TO FUTURE AUDITS, REVIEWS, AND INVESTIGATIONS. RETROACTIVE ADJUSTMENTS ARE CONSIDERED IN THE RECOGNITION OF REVENUE ON AN ESTIMATED BASIS IN THE PERIOD THE RELATED SERVICES ARE RENDERED AND SUCH AMOUNTS ARE ADJUSTED IN FUTURE PERIODS AS ADJUSTMENTS BECOME KNOWN OR AS YEARS ARE NO LONGER SUBJECT TO SUCH AUDITS, REVIEWS, AND INVESTIGATIONS.CHARITY CARE:THE HEALTH CENTER PROVIDES CARE TO PATIENTS WHO MEET CERTAIN CRITERIA UNDER ITS CHARITY CARE POLICY WITHOUT CHARGE OR AT AMOUNTS LESS THAN ITS ESTABLISHED RATES. BECAUSE THE HEALTH CENTER DOES NOT PURSUE COLLECTION OF AMOUNTS DETERMINED TO QUALIFY AS CHARITY CARE, THEY ARE NOT REPORTED IN THE STATEMENTS OF OPERATIONS. THE HEALTH CENTER IS DEDICATED TO PROVIDING COMPREHENSIVE HEALTHCARE SERVICES TO ALL SEGMENTS OF SOCIETY, INCLUDING THE AGED AND OTHERWISE ECONOMICALLY DISADVANTAGED. IN ADDITION, THE HEALTH CENTER PROVIDES A VARIETY OF COMMUNITY HEALTH SERVICES AT OR BELOW COST.ESTIMATED BAD DEBT FOR PATIENTS ELIGIBLE FOR CHARITY CARE WAS DETERMINED BY APPLYING CHARITY CARE GUIDELINES BASED ON AVERAGE PER HOUSEHOLD INCOME FOR PHELPS COUNTY. THE HEALTH CENTER PROVIDES CARE TO PATIENTS WHO MEET CERTAIN CRITERIA UNDER ITS CHARITY CARE POLICY WITHOUT CHARGE OR AT AMOUNTS LESS THAN ITS ESTABLISHED RATES. BECAUSE THE HEALTH CENTER DOES NOT PURSUE COLLECTION OF AMOUNTS DETERMINED TO QUALIFY AS CHARITY CARE, THEY ARE NOT REPORTED IN THE STATEMENTS OF OPERATIONS. | ||
| PART III, LINE 8: THE ORGANIZATION USED THE MEDICARE COST REPORT FOR FISCAL YEAR 2012 TO REPORT THE AMOUNTS OF TOTAL REVENUE RECEIVED FROM MEDICARE AND RELATED MEDICARE ALLOWABLE COSTS. | ||
| PART III, LINE 9B: IF A PATIENT IS UNABLE TO MAKE FULL PAYMENT OF THE PATIENT BALANCE WHEN DUE, PERIODIC, PARTIAL PAYMENTS MAY BE APPROVED IN ACCORDANCE WITH CREDIT AND COLLECTION PROCEDURES, AS AUTHORIZED BY THE CHIEF FINANCIAL OFFICER. A PATIENT FINANCIAL STATEMENT MAY BE REQUESTED TO DETERMINE APPROPRIATE PAYMENT ARRANGEMENTS.IF A PATIENT IS DETERMINED TO BE FINANCIALLY INDIGENT, THE PATIENT FINANCIAL SERVICES DEPARTMENT WILL ASSIST THE PATIENT IN APPLYING FOR OTHER FINANCIAL ASSISTANCE. IF NO SOURCE OF FINANCIAL ASSISTANCE IS AVAILABLE, THE HOSPITAL WILL REVIEW THE ACCOUNT FOR CHARITY CARE ALLOWANCE. ALL CHARITY CARE ALLOWANCE MUST BE APPROVED BY THE CHIEF FINANCIAL OFFICER AND PATIENT FINANCIAL SEVICES LEADER.IF PAYMENT ARRANGEMENTS HAVE NOT BEEN MADE AFTER 120 DAYS THE FIRST NOTICE IS RECEIVED, THE PATIENT IS SENT A LETTER STATING THAT THE ACCOUNT IS BEING FORWARDED TO A COLLECTION AGENCY. | ||
| PART VI, LINE 2: PHELPS MEMORIAL HEALTH CENTER MANAGEMENT, BOARD OF DIRECTORS AND MEDICAL STAFF MEET EVERY 3 TO 5 YEARS FOR A MAJOR STRATEGIC PLANNING AGENDA THAT INCLUDES ASSESSMENT OF THE HEALTH CARE NEEDS OF THE COMMUNITY. OUTSIDE RESOURCES ARE UTILIZED TO IDENTIFY THE CURRENT PATIENT DEMOGRAPHIC TRENDS, HEALTH CARE CONCERNS IN OUR COUNTY AND STATE, PHYSICIAN NEED, ETC. EVERY YEAR MANAGEMENT, BOARD OF DIRECTORS AND MEDICAL STAFF MEET TO DISCUSS AND ASSESS THE ONGOING HEALTH CARE NEEDS OF THE COMMUNITY AND DEVELOP AN ANNUAL BUSINESS PLAN TO ADDRESS THESE NEEDS IN THE UPCOMING YEAR. | ||
| PART VI, LINE 3: PHELPS MEMORIAL HEALTH CENTER SOCIAL SERVICES DEPARTMENT MONITORS PATIENTS WITHIN THE HOSPITAL AND INDENTIFIES POSSIBLE PATIENTS THAT COULD QUALIFY FOR ASSISTANCE UNDER FEDERAL, STATE OR LOCAL GOVERNMENT. A REPRESENTATIVE OF SOCIAL SERVICES THEN MEETS WITH THE PATIENT TO ASSIST IN REGISTERING FOR SUCH ASSISTANCE. EVERY PATIENT REGISTERING AT PHELPS MEMORIAL HEALTH CENTER IS GIVEN A BILLING PAMPLET THAT EXPLAINS THE FINANCIAL ASSISTANCE PROGRAM. ATTACHED TO EVERY STATEMENT THERE IS A PAYMENT OPTIONS LETTER THAT ALLOWS PATIENTS TO INQUIRE ABOUT THE FINANCIAL ASSISTANCE PROGRAM. EVERY PATIENT WITH A SELF PAY BALANCE IS SENT A LETTER INFORMING THEM PHELPS MEMORIAL HEALTH CENTER HAS A FINANCIAL ASSISTANCE PROGRAM THAT THEY MAY APPLY FOR. | ||
| PART VI, LINE 4: PHELPS COUNTY NEBRASKA IS LOCATED ON THE HIGH PLAINS IN RURAL NEBRASKSA. THE PRIMARY INDUSTRY IS AGRICULTURE INCLUDING CROPS AND LIVESTOCK. ADDITIONAL INDUSTRY INCLUDES MANUFACTURING. PMHC'S PRIMARY SERVICE AREA IS THE COUNTY OF PHELPS AND PORTIONS OF SURROUNDING COUNTIES WITH A TOTAL SERVICE POPULATION OF APPROXIMATELY 20,000. | ||
| PART VI, LINE 5: PHELPS MEMORIAL HEALTH CENTER IS THE LEADING ENTITY FOR HEALTH PROMOTION IN THE COMMUNITY IN PARTNERSHIP WITH LOCAL PHYSICIANS, OTHER HEALTH CARE PROFESSIONALS AND THE LOCAL PUBLIC HEALTH DEPARTMENT. THE HOSPITAL IS GOVERNED BY A VOLUNTEER GROUP OF LOCAL CITIZENS REPRESENTING ALL ASPECTS OF THE COMMUNITY. THE MEDICAL STAFF IS OPEN TO ALL PHYSICIANS AND MEDICAL STAFF PROFESSIONALS THAT MEET CREDENTIALING CRITERIA. PHELPS MEMORIAL HEALTH CENTER MAINTAINS A PERMANENT SUB-COMMITTEE OF THE BOARD THAT SUPPORTS AND PROMOTES COMMUNITY HEALTH PROJECTS THROUGH GRANT FUNDING AND OTHER ASSISTANCE. IN ADDITION, THE HOSPITAL PROVIDES MULTIPLE HEALTH RELATED ANNUAL EVENTS TO THE PUBLIC AT NO CHARGE THAT ADDRESS HEALTH CARE NEEDS AND RISKS OF THE COMMUNITY. | ||
| PART VI, LINE 6: PMHC IS NOT PART OF AN AFFILIATED HEALTH CARE SYSTEM. | ||
| NE | REPORTS FILED WITH STATES | PART VI, LINE 7 |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Records Maintained | 1 | RecordsMaintained |
Recipient Table RecipientTable (9 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EIN Of RecipientEINOfRecipient | IRC SectionIRCSection | Amount Of Cash GrantAmountOfCashGrant | Purpose Of GrantPurposeOfGrant |
|---|---|---|---|---|---|---|---|
| BERTRAND COMMUNITY SCHOOL | |||||||
| 503 SCHOOL STREET | BERTRAND | NE | 68927 | 476004725 | SCHOOL | 5000 | SAFETY COMMITTEE |
| CITY OF HOLDREGE | |||||||
| 502 EAST AVE | HOLDREGE | NE | 68949 | 476006232 | GOV ENTITY | 9461 | FOR THE PURCHASE OF AED'S (AUTOMATED EXTERNAL DEFIBRILLATOR) |
| HOLDREGE AREA PUBLIC LIBRARY | |||||||
| 604 EAST AVE | HOLDREGE | NE | 68949 | 470523813 | GOV ENTITY | 18900 | FOR THE PURCHASE OF AN ELEVATOR |
| BERTRAND RESCUE SQUAD | |||||||
| MINOR AVE | BERTRAND | NE | 68927 | 476006103 | GOV ENTITY | 15000 | FOR THE PURCHASE OF AN AMBULANCE |
| COURT APPOINTED SPECIAL ADVOCATES (CASA) | |||||||
| 715 5TH AVE | HOLDREGE | NE | 68949 | 476006496 | GOV ENTITY | 9000 | HELP SUPPORT CASA PROGRAM (CASA IMPROVES THE QUALITY OF REPRESENTATION PROVIDED TO CHILD VICTIMS OF ABUSE AND NEGLECT. |
| CHRISTIAN HOMES | |||||||
| 1923 WEST 4TH | HOLDREGE | NE | 68949 | 470378776 | 501(C)(3) | 9602 | FOR THE PURCHASE OF A BUS |
| YMCA | |||||||
| 1415 BROADWAY STREET | HOLDREGE | NE | 68949 | 470807617 | 501(C)(3) | 7219 | FOR THE PURCHASE OF A POOL SALT SYSTEM |
| CHRISTIAN CHARITY FUND PHELPS CO MINISTERIAL ASSOCIATION | |||||||
| 1419 EAST AVE | HOLDREGE | NE | 68949 | 201308219 | CHURCH | 8115 | FUNDS DISPENSED TO THOSE IN NEED OF FINANCIAL AID |
| PHELPS COUNTY DEVELOPMENT CORPORATION | |||||||
| PO BOX 522 | HOLDREGE | NE | 68949 | 470814669 | 501(C)(6) | 100000 | ECONOMIC DEVELOPMENT IN PHELPS COUNTY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Nbr Of501 C3 And Govt Grants | 8 | TotalNbrOf501C3AndGovtGrants |
| Total Nbr Of Other Organizations | 1 | TotalNbrOfOtherOrganizations |
Form990 Schedule I Part IV Form990ScheduleIPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | PROCEDURE FOR MONITORING GRANTS IN THE U.S.: | Identifier |
| Return Reference | PART I, LINE 2: | ReturnReference |
| Explanation | SCHEDULE I, PART I, LINE 2: ALL GRANTS MADE TO LOCAL ORGANIZATIONS IN PHELPS COUNTY AND SURROUNDING COUNTIES. THERE IS CRITERIA IN PLACE TO ENSURE GRANTS ARE AWARDED TO ORGANIZATION MEETING FOUNDATION GUIDELINES. | Explanation |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Club Dues Or Fees | X | ClubDuesOrFees |
| Written Policy Re T And E Expenses | 0 | WrittenPolicyReTAndEExpenses |
| Substantiation Required | 1 | SubstantiationRequired |
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| 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 II Form990ScheduleJPartII (4 entries)
| TitleTitle | Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| MARK HARREL | ||||||||||||||
| CEO | 172834 | 0 | 11664 | 0 | 0 | 0 | 2767 | 0 | 42306 | 0 | 229571 | 0 | 0 | 0 |
| LOREN SCHRODER | ||||||||||||||
| CFO | 129151 | 0 | 1664 | 0 | 0 | 0 | 1962 | 0 | 32430 | 0 | 165207 | 0 | 0 | 0 |
| LEORA D SMITH | ||||||||||||||
| CHIEF NURSING OFFICER | 116849 | 0 | 13895 | 0 | 0 | 0 | 18014 | 0 | 2694 | 0 | 151452 | 0 | 0 | 0 |
| JERRY L HOWARD II | ||||||||||||||
| SURGEON | 159341 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 159341 | 0 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII (2 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| PART I, LINE 1A | PHELPS MEMORIAL HEALTH CENTER PROVIDES A MEMBERSHIP TO A COUNTRY CLUB FOR THE CEO OF THE ORGANIZATION. THE MEMBERSHIP ALLOWS THE CEO AND OTHER MEMBERS OF THE STAFF TO TAKE EMPLOYEES, CLIENTS AND VENDORS OUT TO THE COUNTRY CLUB. FURTHERMORE, THE ORGANIZATION UTILIZES THE COUNTRY CLUB'S FACILITY FOR MEETINGS AND OTHER EVENTS. | |
| PART III | MARK HARREL AND LOREN SCHRODER RECEIVE COMPENSATION FROM QUORUM HEALTH RESOURCES, AN UNRELATED ENTITY, WHICH PROVIDES MANAGEMENT SERVICES TO ITS CLIENTS. THE PHELPS MEMORIAL HEALTH CENTER BOARD OF DIRECTORS SETS THE SALARY AND BENEFITS FOR MR. HARREL AND MR. SCHRODER. QUORUM HEALTH RESOURCES CHARGES PHELPS MEMORIAL HEALTH CENTER FOR THE SERVICES MR. HARREL AND MR. SCHRODER PROVIDE TO THE ORGANIZATION. | SUPPLEMENTAL INFORMATION |
Schedule L IRS990ScheduleL
Form990 Schedule L Part IV Form990ScheduleLPartIV (7 entries)
| RelationshipRelationship | Amount Of TransactionAmountOfTransaction | Description Of TransactionDescriptionOfTransaction | Sharing Of RevenuesSharingOfRevenues |
|---|---|---|---|
| SHERYL MCCLYMONT | |||
| SISTER IS AN EMPLOYEE | 55272 | EMPLOYEE WAGES | 0 |
| RONA VANDELL | |||
| SISTER-IN-LAW IS AN EMPLOYEE | 66307 | EMPLOYEE WAGES | 0 |
| SCOTT EHRESMAN MD | |||
| PARTNERSHIP MORE THAN 5% OWNED BY SCOTT EHRESMAN, CURRENT BOARD MEMBER | 652823 | PAID FAMILY MEDICAL SPECIALTIES FOR EMERGENCY ROOM, CARDIAC REHABILITIATION, AND RESPIRATORY REHABILITATION COVERAGE | 0 |
| JEFFREY R BERNEY MD | |||
| PARTNERSHIP MORE THAN 5% OWNED BY JEFFREY R. BERNEY, CURRENT BOARD MEMBER | 652823 | PAID FAMILY MEDICAL SPECIALTIES FOR EMERGENCY ROOM, CARDIAC REHABILITATION, AND RESPIRATORY REHABILITATION COVERAGE | 0 |
| DAROLD TAGGE | |||
| GRANDDAUGHTER IS AN EMPLOYEE | 11789 | EMPLOYEE WAGES | 0 |
| SCOTT EHRESMAN MD | |||
| PARTNERSHIP MORE THAN 5% OWNED BY SCOTT EHRESMAN, CURRENT BOARD MEMBER | 345796 | RENT RECEIVED FROM FAMILY MEDICAL SPECIALTIES | 0 |
| JEFFREY R BERNEY MD | |||
| PARTNERSHIP MORE THAN 5% OWNED BY JEFFREY R. BERNEY, CURRENT BOARD MEMBER | 345796 | RENT RECEIVED FROM FAMILY MEDICAL SPECIALTIES | 0 |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (11 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| FORM 990, PART VI, SECTION A, LINE 2 | JEFF BERNEY, MD AND THOMAS SMITH, MD BOTH OFFICERS ON THE BOARD, HAVE A BUSINESS RELATIONSHIP. | |
| FORM 990, PART VI, SECTION A, LINE 3 | QUORUM HEALTH RESOURCES, LLC ("QHR") AND PHELPS MEMORIAL HEALTH CENTER ("PMHC") HAVE AN AGREEMENT IN PLACE FOR ADMINISTRATIVE SERVICES. QHR PROVIDES THE HOSPITAL THE SERVICES OF INDIVIDUALS TO SERVE AS THE CEO & CFO AT PMHC. THE CEO & CFO SHALL OVERSEE THE EXECUTION AND PERFORMANCE OF THE ADMINISTRATIVE FUNCTIONS OF PMHC AND COMMUNICATE THE BUSINESS AND OPERATIONAL ACTIVITY OF PMHC WITH THE BOARD OR BOARD REPRESENTATIVE ROUTINELY. THE CFO REPORTS TO THE CEO, AND THE CEO IS ACCOUNTABLE AND REPORTS DIRECTLY TO THE BOARD. | |
| FORM 990, PART VI, SECTION A, LINE 6 | EVERY DONOR OF A GIFT OF $100 OR MORE TO PHELPS COUNTY MEMORIAL HOSPITAL ASSOCIATION SHALL BE A MEMBER OF PHELPS MEMORIAL HEALTH CENTER. | |
| FORM 990, PART VI, SECTION A, LINE 7A | EACH MEMBER OF PHELPS MEMORIAL HEALTH CENTER HAS ONE VOTE IN THE ELECTION OF DIRECTORS. | |
| FORM 990, PART VI, SECTION B, LINE 11 | YES, A COPY OF THE FORM 990 WILL BE DISTRIBUTED TO THE BOARD OF DIRECTORS A WEEK BEFORE THE MEETING. DURING THE BOARD OF DIRECTORS MEETING THE FORM 990 WILL BE THOROUGHLY REVIEWED AND DISCUSSED IN ORDER TO ADDRESS ANY QUESTIONS PRIOR TO SUBMISSION. | |
| FORM 990, PART VI, SECTION B, LINE 12C | PMHC BOARD OF TRUSTEES DISCLOSE CONFLICTS OF INTEREST ON AN ANNUAL BASIS BY SIGNING A CONFLICT OF INTEREST STATEMENT. ALL MEMBERS OF THE BOARD OF DIRECTORS, THE TOP MANAGEMENT OFFICIAL (CEO) AND THE TOP FINANCIAL OFFICIAL (CFO) ARE REQUIRED TO DISCLOSE, ON AN ANNUAL BASIS, ALL INTERESTS THAT COULD GIVE RISE TO A CONFLICT OF INTEREST. THESE DISCLOSURES ARE REVIEWED BY THE BOARD OF DIRECTORS, THE CEO AND THE ORGANIZATION'S COMPLIANCE OFFICER. ACTUAL CONFLICTS ARE ALSO REVIEWED BY THE ENTIRE BOARD OF DIRECTORS. UPON A DIRECTOR'S DISCLOSURE OF A CONFLICT OF INTEREST, THAT DIRECTOR WITHDRAWS FROM BOARD CONSIDERATION AND DISCUSSION, DOES NOT PARTICIPATE IN THE VOTING OR DECISION-MAKING AND, AT THE REQUEST OF THE PRESIDENT, IS EXCUSED FROM THE BOARD MEETING DURING DISCUSSION AND VOTING. ALL EMPLOYEES, INCLUDING SENIOR LEADERSHIP AND DEPARTMENT LEADERS ALSO DISCLOSE AND SIGN A CONFLICT OF INTEREST STATEMENT DURING THEIR ANNUAL REVIEWS. | |
| FORM 990, PART VI, SECTION B, LINE 15A | QUORUM HEALTH RESOURCES, LLC ("QHR") PROVIDES ADMINISTRATIVE SERVICES TO PHELPS MEMORIAL HEALTH CENTER ("PMHC"). THIS INCLUDES THE HOSPITAL'S CHIEF EXECUTIVE OFFICER AND THE HOSPITAL'S CHIEF FINANCIAL OFFICER. THE BOARD OF DIRECTORS CONDUCTS AN ANNUAL EVALUATION FOR THE CEO AND CFO. A NATIONAL COMPARATIVE BENCHMARK FROM QHR IS PRESENTED TO THE BOARD OF DIRECTORS. THIS COMPARATIVE DATA IS BASED ON SIMILAR HOSPITAL SIZE AND SIMILAR ANNUAL NET REVENUE. THIS DATA IS UTILIZED BY THE BOARD OF DIRECTORS IN ADDITION TO THE ANNUAL PERFORMANCE OF THE CEO AND CFO TO DETERMINE COMPENSATION. MARKET ADJUSTMENTS ARE DETERMINED ANNUALLY BY THE HR LEADER, CEO AND CFO WITH APPROPRIATE DEPARTMENT LEADERS. PAY INCREASES SHALL BE DETERMINED BY THE PERFORMANCE APPRAISAL OVERALL SCORE. ANNUAL PAY INCREASES ARE EFFECTIVE ON THE SECOND PAY PERIOD IN AUGUST EACH YEAR PROVIDED AN ANNUAL PERFORMANCE APPRAISAL HAS BEEN COMPLETED ELECTRONICALLY. THE HUMAN RESOURCE LEADER AND CEO SHALL BE RESPONSIBLE FOR COMPLETION OF AN ANNUAL COMPETENCY REPORT TO BE SUBMITTED TO THE BOARD OF DIRECTORS. THIS REPORT SHALL INCLUDE COMPETENCY OF ALL HOSPITAL EMPLOYEES. | |
| FORM 990, PART VI, SECTION C, LINE 19 | PMHC DOES NOT MAKE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY OR FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC. | |
| FORM 990, PART IX, LINE 11G | PHYSICIAN FEES: PROGRAM SERVICE EXPENSES 1,086,221. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,086,221. OUTSIDE PHYSICAL AND OCCUPATIONAL THERAPY FEES: PROGRAM SERVICE EXPENSES 1,936,496. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,936,496. ANESTEHESIOLOGY FEES: PROGRAM SERVICE EXPENSES 598,954. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 598,954. OTHER FEES FOR SERVICE: PROGRAM SERVICE EXPENSES 1,000,631. MANAGEMENT AND GENERAL EXPENSES 149,963. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,150,594. | OTHER FEES |
| FORM 990, PART IX, LINE 5: | THE CEO AND CFO OF PHELPS MEMORIAL HEALTH CENTER ARE PAID BY QUORUM HEALTH RESOURCES, LLC, AN UNRELATED ENTITY THAT IS PAID TO PROVIDE ADMINSTRATIVE SERVICES TO THE HEALTH CENTER. THE COMPENSATION FOR THESE INDIVIDUALS ARE REPORTED ON LINE 11A, COLUMN C. | |
| FORM 990, PART XII, LINE 2C: | PHELPS MEMORIAL HEALTH CENTER HAS A BOARD OF DIRECTORS THAT IS ORGANIZED INTO SIX STANDING COMMITTEES: EXECUTIVE COMMITTEE; FINANCE COMMITTEE; QUALITY & COMMUNITY HEALTH COMMITTEE; GOVERNANCE COMMITTEE; SPECIALTY RECRUITMENT COMMITTEE; AND FOUNDATION COMMITTEE. IT IS THE FINANCE COMMITTEE'S DUTY TO PROVIDE INPUT INTO THE ANNUAL BUDGET PREPARATION, THE THREE YEAR CAPITAL AND LAND USE PROJECTIONS, MONITOR INVESTMENT FUNDS, PROVIDE FOR AN ANNUAL OUTSIDE AUDIT AND IN GENERAL SEE TO THE OVERALL FINANCIAL WELL BEING OF THE FACILITY. THE OVERSIGHT PROCESS OF THE AUDIT AND THE SELECTION PROCESS OF AN INDEPENDENT ACCOUNTANT HAS NOT CHANGED FROM THE PRIOR YEAR. |