MEMORIAL HEALTH CARE SYSTEMS: Form 990, tax year 2010
View the entire original 990 at ProPublica ↗
- Organization
- MEMORIAL HEALTH CARE SYSTEMS (EIN 47-0375220)
- Tax period
- 2010-10-01 to 2011-09-30
- Filed
- 2012-08-07
- IRS object ID
- 201202209349300740
- Schema version
- 2010v3.4
- 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 ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2012-08-07T11:57:46-05:00 | Timestamp |
| Tax Period End Date | 2011-09-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
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 | 2010-10-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 470375220 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MEMORIAL HEALTH CARE SYSTEMS | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | MEMO | NameControl |
| Phone | 4026432971 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 300 NORTH COLUMBIA AVENUE | AddressLine1 |
| City | SEWARD | City |
| State | NE | State |
| ZIP Code | 68434 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | GREG JERGER | Name |
| Title | CHIEF FINANCIAL OFFICER | Title |
| Phone | 4026432971 | Phone |
| Date Signed | 2012-08-03 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | BARBARA J FAJEN | Name |
| Phone | 4023302660 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2010 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | GREG JERGER | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 300 NORTH COLUMBIA AVENUE | AddressLine1 |
| City | SEWARD | City |
| State | NE | State |
| ZIP Code | 68434 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 25966700 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.MHCS.US | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1956 | YearFormation |
| State Legal Domicile | NE | StateLegalDomicile |
| Activity Or Mission Description | WE PROVIDE HOSPITAL ACUTE INPATIENT, SKILLED NURSING, AND OUTPATIENT SERVICES FOR THE RESIDENTS OF OUR COMMUNITY. WE PROVIDE FAMILY PRACTICE PHYSICIAN CLINIC SERVICES TO THE COMMUNITIES IN OUR SERVICE AREA. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 7 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 7 | NbrIndependentVotingMembers |
| Total Nbr Employees | 273 | TotalNbrEmployees |
| Total Nbr Volunteers | 35 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 876360 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 50624 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 23756529 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 24960170 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 817390 | InvestmentIncomePriorYear |
| Investment Income Current Year | 701979 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 248362 | OtherRevenuePriorYear |
| Other Revenue Current Year | 249246 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 25698641 | TotalRevenuePriorYear |
| Total Revenue Current Year | 25962019 | 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 | 13174375 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 13661165 | 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 | 9509629 | OtherExpensePriorYear |
| Other Expenses Current Year | 9955152 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 22684004 | TotalExpensesPriorYear |
| Total Expenses Current Year | 23616317 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 3014637 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 2345702 | RevenuesLessExpensesCY |
| Total Assets BOY | 37522998 | TotalAssetsBOY |
| Total Assets EOY | 41733037 | TotalAssetsEOY |
| Total Liabilities BOY | 2890419 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 3680334 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 34632579 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 38052703 | NetAssetsOrFundBalancesEOY |
| Mission Description | WE ENHANCE THE QUALITY OF LIFE FOR INDIVIDUALS IN OUR COMMUNITIES BY PROVIDING EXCELLENCE IN HEALTH CARE SERVICES IN THE MOST APPROPRIATE SETTINGS. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 9881980 | Expense |
| Revenue | 12504424 | Revenue |
| Description | HOSPITAL OUTPATIENT SERVICES | Description |
Activity2 Activity2
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 4262242 | Expense |
| Revenue | 5393341 | Revenue |
| Description | HOSPITAL ACUTE INPATIENT AND SKILLED NURSING SERVICES | Description |
Activity3 Activity3
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 6255123 | Expense |
| Revenue | 7163801 | Revenue |
| Description | FAMILY PRACTICE PHYSICIAN CLINIC SERVICES | Description |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expense | 20399345 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 1 | LobbyingActivities |
| 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 | 1 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 0 | ReportOtherAssets |
| Report Other Liabilities | 1 | ReportOtherLiabilities |
| Report Fin48 Footnote | 1 | 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 | 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 | 0 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 0 | 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 |
| Transaction Related Entity | 0 | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 55 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 273 | 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 | 7 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 7 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | 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 | 1 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 0 | 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 | 1 | CompensationProcessCEO |
| Compensation Process Other | 1 | 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 | GREG JERGER | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 4026464628 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 300 NORTH COLUMBIA | AddressLine1 |
| City | SEWARD | City |
| State | NE | State |
| ZIP Code | 68434 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (14 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|
| MIKE HECKER | |||||||
| CHAIRPERSON | 6.00 | X | X | 0 | 0 | 0 | |
| LARRY LINDQUIST | |||||||
| VICE CHAIR | 6.00 | X | X | 0 | 0 | 0 | |
| JAMES SWANSON | |||||||
| SECRETARY/TREASURER | 6.00 | X | X | 0 | 0 | 0 | |
| DONNA HAVENER | |||||||
| DIRECTOR | 4.00 | X | 0 | 0 | 0 | ||
| TRISH LINDNER | |||||||
| DIRECTOR | 4.00 | X | 0 | 0 | 0 | ||
| MARLIN POZEHL | |||||||
| DIRECTOR | 4.00 | X | 0 | 0 | 0 | ||
| BYRON WINTER | |||||||
| DIRECTOR | 4.00 | X | 0 | 0 | 0 | ||
| ROGER REAMER | |||||||
| CHIEF EXECUTIVE OFFICER | 50.00 | X | 216941 | 0 | 21929 | ||
| GREG JERGER | |||||||
| CHIEF FINANCIAL OFFICER | 50.00 | X | 204605 | 0 | 28816 | ||
| JARED KETNER | |||||||
| MEDICAL DOCTOR | 55.00 | 258805 | 0 | 29030 | X | ||
| LORANCE NEWBURN | |||||||
| MEDICAL DOCTOR | 55.00 | 353302 | 0 | 30141 | X | ||
| CONNIE NOVAK | |||||||
| MEDICAL DOCTOR | 55.00 | 247006 | 0 | 35388 | X | ||
| JAMES PLASEK | |||||||
| MEDICAL DOCTOR | 55.00 | 339761 | 0 | 33449 | X | ||
| ROBERT WERGIN | |||||||
| MEDICAL DOCTOR | 55.00 | 355171 | 0 | 40345 | X | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 1975591 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 219098 | TotalOtherCompensation |
| Number Individuals GT100 K | 15 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 1 | 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 |
|---|---|---|---|---|---|
| SAMPSON CONSTRUCTION COMPANY | |||||
| 3730 SOUTH 14TH ST | LINCOLN | NE | 68502 | CONSTRUCTION SERVICES | 1030206 |
| BRYANLGH MEDICAL CENTER | |||||
| 1600 S 48TH STREET | LINCOLN | NE | 68506 | DIAGNOSTIC TESTING | 277362 |
| COMPUTER INNOVATIONS LLC | |||||
| 112 E 11TH ST | SCHUYLER | NE | 68661 | INFORMATION SYSTEMS SUPPORT | 151435 |
| SHARED MEDICAL SERVICES | |||||
| PO BOX 330 | COTTAGE GROVE | WI | 53527 | DIAGNOSTIC TESTING | 119885 |
| SOUTHEAST NEBRASKA MOBILE DIAGNOSTIC SER | |||||
| 245 S 84TH ST | LINCOLN | NE | 68510 | DIAGNOSTIC TESTING | 104114 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 5 | NumberOfContractorsGT100K |
| All Other Contributions | 50624 | AllOtherContributions |
| Total Contributions | 50624 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (4 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|
| NET PATIENT REVENUE | 621400 | 17234372 | 17234372 |
| MEDICARE | 621400 | 6935652 | 6935652 |
| MEDICAID | 621400 | 769662 | 769662 |
| HEALTH FAIR | 624100 | 20484 | 20484 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 24960170 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 703490 | TotalRevenueColumn |
| Exclusion | $703,490 | ExclusionAmount |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 1511 | Other |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | -1511 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -1511 | TotalRevenueColumn |
| Exclusion | -$1,511 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Income Fundraising Events | 7895 | GrossIncomeFundraisingEvents |
| Fundraising Direct Expenses | 3170 | FundraisingDirectExpenses |
Net Income From Fundraising Events NetIncomeFromFundraisingEvents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 4725 | TotalRevenueColumn |
| Exclusion | $4,725 | ExclusionAmount |
Other Revenue Misc OtherRevenueMisc (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome | ExclusionExclusionAmount |
|---|---|---|---|---|
| MISCELLANEOUS | 624100 | 105186 | 101396 | $3,790 |
| DAY CARE REVENUE | 624100 | 91951 | $91,951 | |
| DIETARY REVENUE | 623990 | 47384 | $47,384 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 244521 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 25962019 | TotalRevenueColumn |
| Related Or Exempt Function Income | 25061566 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $849,829 | ExclusionAmount |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 472291 | Total |
| Management And General | 472291 | ManagementAndGeneral |
Comp Disqual Persons CompDisqualPersons
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 66896 | Total |
| Program Services | 66896 | ProgramServices |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 11004608 | Total |
| Program Services | 9687775 | ProgramServices |
| Management And General | 1316833 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 265401 | Total |
| Program Services | 235457 | ProgramServices |
| Management And General | 29944 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1136079 | Total |
| Program Services | 997112 | ProgramServices |
| Management And General | 138967 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 715890 | Total |
| Program Services | 607608 | ProgramServices |
| Management And General | 108282 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 27861 | Total |
| Management And General | 27861 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 29831 | Total |
| Management And General | 29831 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2095500 | Total |
| Program Services | 1643252 | ProgramServices |
| Management And General | 452248 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 115597 | Total |
| Program Services | 73766 | ProgramServices |
| Management And General | 41831 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 4846747 | Total |
| Program Services | 4616638 | ProgramServices |
| Management And General | 230109 | ManagementAndGeneral |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 6086 | Total |
| Program Services | 6086 | ProgramServices |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 372321 | Total |
| Program Services | 372321 | ProgramServices |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 742 | Total |
| Program Services | 742 | ProgramServices |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1357 | Total |
| Program Services | 1357 | ProgramServices |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1506261 | Total |
| Program Services | 1248900 | ProgramServices |
| Management And General | 257361 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 248224 | Total |
| Program Services | 207112 | ProgramServices |
| Management And General | 41112 | ManagementAndGeneral |
Other Expenses OtherExpenses (5 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| BAD DEBTS | 524141 | 524141 | |
| TRAINING & EDUCATION | 77726 | 50662 | 27064 |
| DUES & SUBSCRIPTIONS | 75880 | 34766 | 41114 |
| PHYSICIAN EXPENSES | 22707 | 22707 | |
| FOUNDATION EXPENSES | 1176 | 1176 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2995 | Total |
| Program Services | 871 | ProgramServices |
| Management And General | 2124 | ManagementAndGeneral |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 23616317 | Total |
| Program Services | 20399345 | ProgramServices |
| Management And General | 3216972 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 250 | BOY |
| EOY | 250 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 16812331 | BOY |
| EOY | 17675139 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2693016 | BOY |
| EOY | 2883144 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 564612 | BOY |
| EOY | 608325 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 162951 | BOY |
| EOY | 181169 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 26805121 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 15263279 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 11601673 | BOY |
| EOY | 11541842 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 2159889 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4872306 | BOY |
| EOY | 6016035 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 815859 | BOY |
| EOY | 667244 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 37522998 | BOY |
| EOY | 41733037 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2244409 | BOY |
| EOY | 2489584 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 646010 | BOY |
| EOY | 1190750 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2890419 | BOY |
| EOY | 3680334 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 28211132 | BOY |
| EOY | 30532255 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 88050 | BOY |
| EOY | 39302 | EOY |
Permanently Restricted Net Assets PermanentlyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6333397 | BOY |
| EOY | 7481146 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 34632579 | BOY |
| EOY | 38052703 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 37522998 | BOY |
| EOY | 41733037 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | 2345702 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | 1074422 | 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 |
| Audit Committee | 1 | AuditCommittee |
| Financial Statement Separate | X | FinancialStatementSeparate |
| 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 | $3,829 | OtherActivitiesAmount |
| Total Lobbying Expenditures IIB | 3829 | TotalLobbyingExpendituresIIB |
| Not Described In501c3 | 0 | NotDescribedIn501c3 |
Form990 Schedule C Part IV Form990ScheduleCPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | EXPLANATION OF OTHER LOBBYING ACTIVITIES: | Identifier |
| Return Reference | PART II-B, LINE 1I: | ReturnReference |
| Explanation | A PORTION OF DUES PAID TO NHA AND AHA IS DEDICATED TO LOBBYING ACTIVITIES. | Explanation |
Schedule D IRS990ScheduleD
Current Year CurrentYear
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 1549141 | BeginningOfYearBalance |
| Contributions | 4020 | Contributions |
| Investment Earnings Or Losses | -48748 | InvestmentEarningsOrLosses |
| End Of Year Balance | 1504413 | EndOfYearBalance |
Current Year Minus1 Year CurrentYearMinus1Year
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 655664 | BeginningOfYearBalance |
| Contributions | 823751 | Contributions |
| Investment Earnings Or Losses | 69726 | InvestmentEarningsOrLosses |
| End Of Year Balance | 1549141 | EndOfYearBalance |
Current Year Minus2 Years CurrentYearMinus2Years
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 578536 | BeginningOfYearBalance |
| Contributions | 520 | Contributions |
| Investment Earnings Or Losses | 76608 | InvestmentEarningsOrLosses |
| End Of Year Balance | 655664 | EndOfYearBalance |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Designated EOY Balance | 0.00000 | BoardDesignatedEOYBalance |
| Permanent Endowment EOY Balance | 1.00000 | 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 | 320907 | OtherCostOrOtherBasis |
| Book Value | 320907 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 9333563 | OtherCostOrOtherBasis |
| Depreciation | 5434525 | Depreciation |
| Book Value | 3899038 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 15677195 | OtherCostOrOtherBasis |
| Depreciation | 9258378 | Depreciation |
| Book Value | 6418817 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 1473456 | OtherCostOrOtherBasis |
| Depreciation | 570376 | Depreciation |
| Book Value | 903080 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 11541842 | TotalOfBookValueLandBuildings |
Other Securities OtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | BENEFICIAL INTEREST IN A PERPETUAL TRUST | Description |
| Book Value | 6016035 | BookValue |
| Method Of Valuation | F | MethodOfValuation |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Securities | 6016035 | TotalOfBookValueSecurities |
Other Liabilities OtherLiabilities (2 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| EST. THIRD PARTY SETTLEMENTS | $523,693 |
| DEFERRED COMPENSATION LIABILITY | $667,057 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 1190750 | TotalOfAmounts |
| Total Revenue | 25962019 | TotalRevenue |
| Total Expenses | 23616317 | TotalExpenses |
| Excess Or Deficit For Year | 2345702 | ExcessOrDeficitForYear |
| Net Unrealized GL On Investments | -69307 | NetUnrealizedGLOnInvestments |
| Other | $1,143,729 | OtherAmount |
| Total Adjustments | 1074422 | TotalAdjustments |
| Excess Or Deficit Per FS | 3420124 | ExcessOrDeficitPerFS |
| Tot Revenue Etc Audited Fincl Stmt | 27036441 | TotRevenueEtcAuditedFinclStmt |
| Net Unrealized Gains Investments | -69307 | NetUnrealizedGainsInvestments |
| Other Revenues | 1143729 | OtherRevenues |
| Revenue Not Rptd F990 | 1074422 | RevenueNotRptdF990 |
| Revenue Subtotal | 25962019 | RevenueSubtotal |
| Revenue Not Rptd On Fin Stmt | 0 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 25962019 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 23616317 | TotExpensesEtcAuditedFinclStmt |
| Expenses Not Rptd F990 | 0 | ExpensesNotRptdF990 |
| Expenses Subtotal | 23616317 | ExpensesSubtotal |
| Expenses Not Rptd On Fin Stmt | 0 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 23616317 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV (4 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: | PART V, LINE 4: | INCOME FROM THE HOSPITAL ENDOWMENT FUND WILL BE USED FOR MEMORIAL HOSPITAL TO ENHANCE AND IMPROVE THE QUALITY OF HOSPITAL SERVICES PROVIDED TO THE COMMUNITY. THIS COULD TAKE THE FORM OF KEEPING UP WITH CHANGING TECHNOLOGY, ACQUIRING THE BEST EQUIPMENT, OR IMPROVING OUR BUILDING FACILITIES. |
| DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: | PART X: | THE SYSTEM IS A NOT-FOR-PROFIT CORPORATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND IS EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. THE INTERNAL REVENUE SERVICE HAS ESTABLISHED STANDARDS TO BE MET TO MAINTAIN TAX EXEMPT STATUS. IN GENERAL, SUCH STANDARDS REQUIRE THE SYSTEM TO MEET A COMMUNITY BENEFIT STANDARD AND COMPLY WITH VARIOUS LAWS AND REGULATIONS. THE SYSTEM ACCOUNTS FOR UNCERTAINTIES IN ACCOUNTING FOR INCOME TAX ASSETS AND LIABILITIES USING GUIDANCE INCLUDED IN FASB ASC 740, INCOME TAXES. THE SYSTEM RECOGNIZES THE EFFECT OF INCOME TAX POSITIONS ONLY IF THOSE POSITIONS ARE MORE LIKELY THAN NOT OF BEING SUSTAINED. DURING 2011 AND 2010, MANAGEMENT DETERMINED THAT THERE ARE NO INCOME TAX PROVISIONS REQUIRING RECOGNITION AND AT SEPTEMBER 30, 2011 AND 2010, THE SYSTEM HAD NO UNCERTAIN TAX POSITIONS ACCRUED. |
| PART XI, LINE 8 - OTHER ADJUSTMENTS: | CHANGE IN INTEREST IN BENEFICIAL TRUST 1,143,729. | |
| PART XII, LINE 2D - OTHER ADJUSTMENTS: | CHANGE IN INTEREST IN BENEFICIAL TRUST 1,143,729. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | 1 | CharityCarePolicy |
| Written Policy | 1 | WrittenPolicy |
| FPG Reference Free Care | 1 | FPGReferenceFreeCare |
| Pcent150 | X | Pcent150 |
| 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 | 0 | ExpensesExceededBudget |
| Annual Community Benefit Report | 0 | AnnualCommunityBenefitReport |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 122812 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 122812 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00530 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 1257761 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 1011859 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 245902 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01060 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 1380573 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 1011859 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 368714 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01590 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 1380573 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 1011859 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 368714 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01590 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 0 | BadDebtExpenseReported |
| Bad Debt Expense | $394,573 | BadDebtExpenseAmount |
| Amount Reimbursed By Medicare | 8805967 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 8861026 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | -55059 | 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 | 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 | MEMORIAL HOSPITAL | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 300 N COLUMBIA AVE | AddressLine1 |
| City | SEWARD | City |
| State | NE | State |
| ZIP Code | 68434 | 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 APPLICABLE | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Other Facilities | 4 | NumberOfOtherFacilities |
Other Facilities OtherFacilities (4 entries)
| Address Line1Address/AddressLine1 | CityAddress/City | StateAddress/State | ZIP CodeAddress/ZIPCode | Facility TypeFacilityType |
|---|---|---|---|---|
| SEWARD FAMILY MEDICAL CENTER | ||||
| 250 N COLUMBIA AVE | SEWARD | NE | 68434 | RURAL HEALTH CLINIC |
| SEWARD FAMILY PHARMACY | ||||
| 250 N COLUMBIA AVE | SEWARD | NE | 68434 | PHARMACY - CONVENIENCE OF PATIENT/EMPLOYEE |
| MILFORD FAMILY MEDICAL CENTER | ||||
| 119 S C ST | MILFORD | NE | 68405 | RURAL HEALTH CLINIC |
| UTICA FAMILY MEDICAL CENTER | ||||
| 100 4TH ST | UTICA | NE | 68456 | RURAL HEALTH CLINIC |
Form990 Schedule H Part VI Form990ScheduleHPartVI (12 entries)
| ExplanationExplanation |
|---|
| PART I, LINE 7: THE ORGANIZATION USED THE COST-TO-CHARGE RATIO FROM WORKSHEET 2, RATIO OF PATIENT CARE COST-TO-CHARGES, PROVIDED BY THE IRS IN THE INSTRUCTIONS OF FORM 990, SCHEDULE H. |
| PART I, LINE 7G: THERE ARE NO COSTS REPORTED ON LINE 7G. THEREFORE, THERE WOULD BE NO COSTS ATTRIBUTABLE TO A PHYSICIAN CLINIC INCLUDED ON LINE 7G. |
| PART I, L7 COL(F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 24, COLUMN (A) BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $524,141. |
| PART II: THERE ARE NOT COMMUNITY BUILDING ACTIVITIES TO REPORT. |
| PART III, LINE 4: THERE IS NO FOOTNOTE IN THE ORGANIZATION'S FINANCIAL STATEMENTS THAT DESCRIBES BAD DEBT EXPENSE. HOWEVER, THE FOLLOWING IS THE TEXT OF THE FOOTNOTE TITLED "PATIENT ACCOUNTS RECEIVABLE, NET":THE SYSTEM REPORTS PATIENT ACCOUNTS RECEIVABLE FOR SERVICES RENDERED AT NET REALIZABLE AMOUNTS FROM THIRD-PARTY PAYERS, PATIENTS AND OTHERS. THE SYSTEM PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS BASED UPON A REVIEW OF OUTSTANDING RECEIVABLES, HISTORICAL COLLECTION INFORMATION AND EXISTING ECONOMIC CONDITIONS.THE FOLLOWING IS THE TEXT OF THE FOOTNOTE TITLED "NET PATIENT SERVICE REVENUE":NET PATIENT SERVICE REVENUE IS REPORTED AT THE ESTIMATED NET REALIZABLE AMOUNTS FROM PATIENTS, THIRD-PARTY PAYORS, AND OTHERS FOR SERVICES RENDERED, INCLUDING ESTIMATED RETROACTIVE ADJUSTMENTS UNDER REIMBURSEMENT AGREEMENTS WITH THIRD-PARTY PAYORS. RETROACTIVE ADJUSTMENTS ARE ACCRUED ON AN ESTIMATED BASIS IN THE PERIOD THE RELATED SERVICES ARE RENDERED AND ADJUSTED IN FUTURE PERIODS AS FINAL SETTLEMENTS ARE DETERMINED.THE FOLLOWING IS THE TEXT OF THE FOOTNOTE TITLED "CHARITY CARE":THE SYSTEM 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 SYSTEM DOES NOT PURSUE COLLECTION OF AMOUNTS DETERMINED TO QUALIFY AS CHARITY CARE, THEY ARE NOT REPORTED IN THE STATEMENTS OF OPERATIONS.THE SYSTEM IS DEDICATED TO PROVIDING COMPREHENSIVE HEALTHCARE SERVICES TO ALL SEGMENTS OF SOCIETY, INCLUDING THE AGED AND OTHERWISE ECONOMICALLY DISADVANTAGED. IN ADDITION, THE SYSTEM PROVIDES A VARIETY OF COMMUNITY HEALTH SERVICES AT OR BELOW COST.THE ORGANIZATION USED THE COST TO CHARGE RATIO CALCULATED IN WORKSHEET A OF THE MEDICARE COST REPORT FOR THE YEAR ENDED SEPTEMBER 30,2011. THERE IS LIKELY A PORTION OF THE COST OF BAD DEBT THAT SHOULD BE CONSIDERED COMMUNITY BENEFITS AS SOME OF THOSE PEOPLE LIKELY WOULD HAVE QUALIFIED FOR CHARITY CARE. HOWEVER, THE ORGANIZATION IS UNABLE TO DETERMINE AN ESTIMATED AMOUNT FOR THIS AND HAVE NOT INCLUDED ANY OF THE COST OF BAD DEBTS ON PART III, LINE 3. |
| PART III, LINE 8: THE ORGANIZATION USED VARIOUS WORKSHEETS FROM THE MEDICARE COST REPORT FOR THE YEAR ENDED SEPTEMBER 30, 2011 TO CALCULATE PART III, LINES 5 AND 6. MEDICARE CURRENTLY PAYS CRITICAL ACCESS HOSPITALS (CAH) 101% OF ALLOWABLE COSTS. MEDICARE PAYS THE ORGANIZATION'S RURAL HEALTH CLINICS (RHC) AT COST SUBJECT TO CERTAIN LIMITS. THERE IS GENERALLY NO MEDICARE SHORTFALL ON CAH AND RHC SERVICES. THE SHORTFALL IS ALL GENERATED BY NON-RHC PHYSICIAN SERVICES THAT ARE PAID UNDER THE MEDICARE FEE SCHEDULE. MEDICARE SHORTFALLS IN PAYMENT SHOULD BE CONSIDERED A COMMUNITY BENEFIT AS IT IS PART OF THE ORGANIZATION'S MISSION TO PROVIDE THESE SERVICES EVEN IF MEDICARE REIMBURSEMENT IS BELOW COST. |
| PART III, LINE 9B: PATIENTS THAT ARE KNOWN TO QUALIFY FOR CHARITY CARE EITHER RECEIVE FREE EMERGENCY AND URGENT CARE IN THE HOSPITAL IF THEY ARE AT OR BELOW 150% OF POVERTY, OR A SLIDING DISCOUNT IF THEY ARE AT OR BELOW 250% OF POVERTY. SHOULD THESE PATIENTS OWE A PORTION OF THEIR BILL, THE ORGANIZATION FOLLOWS THE SAME COLLECTION POLICY AS IT DOES FOR PATIENTS WHO DO NOT QUALIFY FOR CHARITY CARE. |
| PART VI, LINE 2: THE ORGANIZATION IS GOVERNED BY A VOLUNTEER BOARD OF DIRECTORS WHICH HAS 7 MEMBERS FROM THE COMMUNITY. THE BOARD OF DIRECTORS ASSISTS HOSPITAL ADMINISTRATION IN IDENTIFYING SERVICES NEEDED BY THE COMMUNITIES SERVED. |
| PART VI, LINE 3: THE BUSINESS OFFICE IS EDUCATED ON HOW TO INFORM PATIENTS ABOUT THE PROCESS OF APPLYING FOR MEDICAID COVERAGE. THE OPPORTUNITY FOR FINANCIAL ASSISTANCE THROUGH OUR CHARITY CARE POLICY IS LISTED ON THE ORGANIZATION'S WEB-SITE, AND A STATEMENT ABOUT THIS IS INCLUDED WITH THE FINANCIAL AGREEMENT EACH PATIENT SIGNS AND IS ALSO INCLUDED WITH BILLINGS STATEMENTS SENT TO THE PATIENT. |
| PART VI, LINE 4: THE ORGANIZATION'S PRIMARY SERVICE AREA IS SEWARD COUNTY, NEBRASKA, WHICH HAS A POPULATION OF AROUND 17,000. IT MAINLY PROVIDE PRIMARY CARE SERVICES WITH SOME SPECIALTY CARE OFFERED BY VISITING SPECIALISTS THAT PRACTICE HERE MAINLY OUT OF LINCOLN, NEBRASKA. |
| PART VI, LINE 6: THE ORGANIZATION OFFERS EXTENSIVE HEALTHCARE AND WELLNESS EDUCATION TO THE COMMUNITY ON AN ON-GOING BASIS. THE COSTS FOR THESE SERVICES ARE NOT SEPARATELY IDENTIFIED AS "COMMUNITY BENEFIT" EXPENSES ELSEWHERE IN THIS RETURN. IT IS LIKELY THESE COSTS EXCEED $100,000 PER YEAR, AND THERE IS NO OFFSETTING REVENUE. THE HOSPITAL MAINTAINS AN OPEN MEDICAL STAFF AND HAS A GOVERNING BOARD OF DIRECTORS WHICH ARE ALL MEMBERS OF THE COMMUNITY SERVED. ALL SURPLUS FUNDS ARE USED TO FURTHER THE MISSION OF PROVIDING EXCELLENT HEALTHCARE SERVICES TO THE MEMBERS OF THE COMMUNITIES SERVED. |
| PART VI, LINE 7: N/A |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Idemnification Gross Up Payments | X | IdemnificationGrossUpPayments |
| Written Policy Re T And E Expenses | 1 | WrittenPolicyReTAndEExpenses |
| Substantiation Required | 1 | SubstantiationRequired |
| Written Employment Contract | X | WrittenEmploymentContract |
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | 0 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 1 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 1 | 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 (7 entries)
| 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| ROGER REAMER | |||||||||||||
| 182431 | 0 | 34510 | 0 | 0 | 0 | 6142 | 0 | 15787 | 0 | 238870 | 0 | 0 | 0 |
| GREG JERGER | |||||||||||||
| 171347 | 0 | 33258 | 0 | 0 | 0 | 5875 | 0 | 22941 | 0 | 233421 | 0 | 0 | 0 |
| JARED KETNER | |||||||||||||
| 155404 | 0 | 103401 | 0 | 0 | 0 | 7350 | 0 | 21680 | 0 | 287835 | 0 | 0 | 0 |
| LORANCE NEWBURN | |||||||||||||
| 155404 | 0 | 197898 | 0 | 0 | 0 | 7350 | 0 | 22791 | 0 | 383443 | 0 | 0 | 0 |
| CONNIE NOVAK | |||||||||||||
| 155404 | 0 | 91602 | 0 | 0 | 0 | 7350 | 0 | 28038 | 0 | 282394 | 0 | 0 | 0 |
| JAMES PLASEK | |||||||||||||
| 155404 | 0 | 184357 | 0 | 0 | 0 | 7350 | 0 | 26099 | 0 | 373210 | 0 | 0 | 0 |
| ROBERT WERGIN | |||||||||||||
| 155404 | 0 | 199767 | 0 | 0 | 0 | 21750 | 0 | 18595 | 0 | 395516 | 0 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII (3 entries)
| Return ReferenceReturnReference | ExplanationExplanation |
|---|---|
| PART I, LINE 1A | THE ORGANIZATION PROVIDES A SECTION 162 BONUS PLAN IN WHICH THE CHIEF EXECUTIVE OFFICER AND CHIEF FINANCIAL OFFICER RECEIVE TAXABLE COMPENSATION ON AN ANNUAL BASIS TO PURCHASE LIFE INSURANCE AND/OR DISABILITY INSURANCE. THE BONUS PLAN AND AMOUNT WERE ESTABLISHED BY THE BOARD OF DIRECTORS AND ARE GROSSED-UP PER THE PLAN DESIGN IN ORDER TO PROVIDE A FIXED AMOUNT AFTER TAXES THAT IS AVAILABLE FOR INSURANCE PREMIUMS. THE FULL TAXABLE AMOUNT IS INCLUDED IN BOX 5 OF THE W-2 AND HAS BEEN INCLUDED IN PART II OF THIS SCHEDULE J UNDER COLUMN B(II). |
| PART I, LINE 4B | $14,400 WAS CONTRIBUTED INTO A 457(F) DEFERRED COMPENSATION PLAN FOR ROBERT WERGIN, MD. |
| PART I, LINE 5 | PHYSICIANS RECEIVE BONUSES BASED ON THEIR INDIVIDUAL PROFESSIONAL CHARGES. |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (10 entries)
| IdentifierIdentifier | ExplanationExplanation | Return ReferenceReturnReference |
|---|---|---|
| FORM 990, PART VI, SECTION A, LINE 6 | MEMORIAL HEALTH CARE SYSTEMS IS A CORPORATION THAT HAS MEMBERS. ANYONE DONATING $100 TO MEMORIAL HEALTH CARE SYSTEMS CAN FILL OUT AN APPLICATION AND BECOME A MEMBER. MEMORIAL HEALTH CARE SYSTEMS CURRENTLY HAS ABOUT 604 CORPORATE MEMBERS. | |
| FORM 990, PART VI, SECTION A, LINE 7A | THE MEMBERS OF MEMORIAL HEALTH CARE SYSTEMS (AS DESCRIBED ON FORM 990, PART VI, SECTION A, LINE 6) ELECT THE BOARD OF DIRECTORS. | |
| FORM 990, PART VI, SECTION A, LINE 7B | THE MEMBERS OF MEMORIAL HEALTH CARE SYSTEMS (AS DESCRIBED ON FORM 990, PART VI, SECTION A, LINE 6) APPROVE ANY CHANGES IN THE ARTICLES OF INCORPORATION AND ANY CHANGES TO THE BYLAWS THAT EFFECT THE ELECTION OF THE BOARD OF DIRECTORS (VOTING RIGHTS). THE MEMBERS WOULD ALSO APPROVE ANY SIGNIFICANT DECISIONS, SUCH AS THE SALE OR MERGER OF THE CORPORATION OR A SALE OF ALL OF THE ASSETS OF THE CORPORATION. | |
| FORM 990, PART VI, SECTION A, LINE 8B | THERE ARE NO COMMITTEES WITH THE AUTHORITY TO ACT ON BEHALF OF THE BOARD. ANY COMMITTEE WHICH REPORTS TO THE BOARD HAS ITS REPORT DOCUMENTED IN THE MINUTES OF THE BOARD OF DIRECTORS. | |
| FORM 990, PART VI, SECTION B, LINE 11 | THE CHIEF FINANCIAL OFFICER IS RESPONSIBLE FOR THE TIMELY FILING OF THE FORM 990 AND ENSURING COMPLIANCE WITH ALL RELATED RULES AND REGULATIONS. THE ACTUAL FORM 990 IS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM. ALL INFORMATION IS PROVIDED BY THE ORGANIZATION TO THE ACCOUNTING FIRM WHO THEN PREPARES THE FORM 990 FOR SUBMITTAL TO THE IRS. PRIOR TO SUBMISSION TO THE IRS, THE CFO OF THE ORGANIZATION WILL REVIEW THE FORM 990 AND APPROVE IT FOR SUBMITTAL. A COPY OF THE FORM 990 WILL BE MADE AVAILABLE TO THE BOARD OF DIRECTORS AFTER THE FORM 990 IS FILED. | |
| EACH MEMBER OF THE BOARD OF DIRECTORS AND ALL SENIOR MANAGEMENT OFFICIALS OF THE ORGANIZATION FILE AN ANNUAL CONFLICT OF INTEREST FORM IN WHICH THEY ARE REQUIRED TO LIST ALL CONFLICTS OF INTEREST. ADMINISTRATION REVIEWS THE ANNUAL CONFLICT OF INTEREST STATEMENTS AND ALL CONFLICTS ARE REPORTED TO THE BOARD CHAIRPERSON. | FORM 990, PART VI, SECTION B, LINE 12C | |
| THE BOARD OF DIRECTORS PERFORMS AN ANALYSIS OF THE FAIR MARKET VALUE OF COMPENSATION FOR BOTH THE CHIEF EXECUTIVE OFFICER AND CHIEF FINANCIAL OFFICER. LONGEVITY, QUALITY OF THE HEALTHCARE SERVICES PROVIDED, COMMUNITY PERCEPTION, AND FINANCIAL PERFORMANCE ARE ALL FACTORED INTO THE ANALYSIS. THE BOARD OF DIRECTORS THEN APPROVES THE COMPENSATION PACKAGES. THE LAST FULL REVIEW AND ANALYSIS WAS DONE IN DECEMBER 2008 AND ANNUAL COMPENSATION WAS SET UNDER THE CEO CONTRACT FOR A 5 YEAR PERIOD OF 2009 THROUGH 2013. THE CFO COMPENSATION WAS REVIEWED BY THE BOARD OF DIRECTORS AT THE SAME TIME AND THE CEO WAS DELEGATED THE AUTHORITY TO ADJUST AND MONITOR CFO COMPENSATION WITHIN THE PARAMETERS SET BY THE BOARD OF DIRECTORS. | FORM 990, PART VI, SECTION B, LINE 15 | |
| THE ORGANIZATION DOES NOT MAKE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, OR ITS FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC. HOWEVER, THE CORPORATE MEMBERSHIP OF THE ORGANIZATION CONSISTS OF OVER 600 MEMBERS OF THE COMMUNITY SERVED. THE CORPORATE MEMBERSHIP APPROVES THE ARTICLES OF INCORPORATION AND THEY RECEIVE AN ANNUAL REPORT CONTAINING SUMMARY FINANCIAL STATEMENTS. | FORM 990, PART VI, SECTION C, LINE 19 | |
| CHANGES IN NET ASSETS OR FUND BALANCES: | NET UNREALIZED GAINS ON INVESTMENTS: 1,074,422. | FORM 990, PART XI, LINE 5: |
| THE FINANCE COMMITTEE OF THE BOARD OF DIRECTORS ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF ITS FINANCIAL STATEMENTS AND SELECTION OF THE INDEPENDENT ACCOUNTANT. THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. | FORM 990, PART XI, LINE 2C: |