2026-03-05T07:53:33-06:00 2025-04-30 450250958 Eide Bailly LLP 18081 Burt St Ste 200 Omaha NE 680224722 990 2024-05-01 476028103 Cambridge Memorial Hospital Inc CAMB 3086973329 1305 W Hwy 6 34 Cambridge NE 69022 Clay Jordan Chief Executive Officer 3086973329 2026-03-04 1 1 Wendy R Cooley CPA P01523804 4023302660 2026-03-03 2024 2025-03-06 01:10:19Z Tri Valley Health System Clay Jordan 1305 W Hwy 6 34 Cambridge NE 69022 29598878 0 X www.trivalleyhealth.com X 1955 NE Providing quality, compassionate, local healthcare services. 9 9 224 50 0 0 404372 779841 25103567 27750284 253507 267972 26428 37994 25787874 28836091 0 0 0 0 13780702 13865928 0 0 0 13255901 13774709 27036603 27640637 -1248729 1195454 26799880 28085284 14422009 14235264 12377871 13850020 X To improve the lives we touch by providing care of the highest quality throughout life's journey. 0 0 19023507 22344194 Cambridge Memorial Hospital, Inc., dba Tri Valley Health System operates a 20-bed critical access hospital located in Cambridge, Nebraska. The hospital provides short-term inpatient and outpatient care. Tri Valley Health System operates a full-time emergency room and provides emergency care regardless of the ability to pay. The emergency room had 1,153 emergency center visits this year. Through its integrated network of providers, Tri Valley Health System provides emergency and non-emergency services to the communities it serves. Tri Valley Health System initiated a "walk-in" clinic through one of their Rural Health Clinics. Statement continued on Schedule O.Throughout the year, 3,784 patients were seen through the "walk-in" clinics.Services are accessible to the communities through participation in government programs like Medicare and Medicaid and by offering assistance through the Tri Valley Health System Charity Program. The Tri Valley Health System Charity Program provides discounted and free services to patients who lack the resources to be fully responsible for the health care they receive. The Charity Program is designed to ensure the communities served by Tri Valley Health System have access to needed healthcare services. The Tri Valley Health System Board of Trustees oversees services delivered under the Charity Care Policy including assessing community needs, approving eligibility criteria and monitoring the effectiveness of the program in providing community access to medical care. Records are maintained to identify and monitor the level of charity care provided. The estimated cost of providing these services was $52,000 for the year ended April 30, 2025 calculated by multiplying the ratio of cost to gross charges for the Health System by the gross uncompensated charges associated with providing charity to its patients.In addition, the Health System provides services to other patients under certain government-reimbursed public aid programs. Such programs pay providers amounts which are less than established charges for the services provided to the recipients, and for some services the payments are less than the cost of rendering the services provided.The Health System also commits significant time and resources to endeavors and critical services which meet otherwise unfulfilled community needs. Many of these activities are sponsored with the knowledge that they will not be self-supporting or financially viable. 3830526 4655825 Tri Valley Health System has rural health clinics in Arapahoe, Indianola, and Cambridge, Nebraska. During the year, the clinics had 11,182 visits. The employed physicians are active in the community and provide support services such as attendance at community sport programs and medical directors for EMT groups. They also offer educational programs for the local school systems and people in the community with programs such as "Healthier Me", a diabetes prevention program. Yearly the clinics provides "flu clinics" in which flu vaccinations are provided at reduced rates. Also, the clinics annually offer a "health fair" to the communities they serve. Statement continued on Schedule O.Health fair lab profile testing completed which normally would cost the Health System $885 (based on an average ratio of cost to gross charges) is reduced to a fee of approximately $35 (depending on tests requested). 744417 750265 Tri Valley Health System's other programs include an Assisted Living Facility and an Independent Living Facility. Additional services are provided including a home monitoring system, Meals on Wheels, and Public Transportation. During the fiscal year, Tri Valley's Assisted Living Facility averaged 19 residents a day. Tri Valley Health System is encouraging community members to stay as independent as possible and assuring the patients/residents are in the appropriate location based on their level of care needs. 23598450 1 1 0 0 0 0 0 0 0 0 1 0 0 1 1 1 1 0 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 1 103 0 1 224 1 0 0 0 0 0 0 0 0 0 0 0 0 X 9 9 0 0 0 0 1 1 0 1 0 0 0 1 1 1 1 1 1 1 0 0 X Clay Jordan 3086973329 1305 W Hwy 6 34 Cambridge NE 69022 LaVern Banzhaf President 3.00 X X 0 0 0 James McGowen Vice President 3.00 X X 0 0 0 Nanette Witte Secretary until December 3.00 X X 0 0 0 Derek Downer - Trustee until Dec/Secretary as of Dec 3.00 X X 0 0 0 John Paulsen Treasurer 3.00 X X 0 0 0 Marcus Vontz Trustee 3.00 X 0 0 0 Logan Baker Trustee 3.00 X 0 0 0 James Jones Trustee until Dec 3.00 X 0 0 0 Jason Neseth Trustee 3.00 X 0 0 0 Genny Kubik Trustee as of December 3.00 X 0 0 0 Ginella Sweeney Trustee as of December 3.00 X 0 0 0 Clay Jordan CEO 40.00 X 192987 0 38855 Diana Swindler CFO 40.00 X 134179 0 16894 Shiuvaun Jaeger MD Family Practice/Obstetrics 40.00 X 560019 0 41967 Lennie Deaver MD Family Practice/Obstetrics 40.00 X 442583 0 26898 Rachelle Kaspar-Cope MD Family Practice/Obstetrics 40.00 X 424487 0 44528 Cristin Soucie Pharmacist 40.00 X 146988 0 40031 Cherl Mues APRN Family Practice 40.00 X 143367 0 7183 Jessica Fisher Former CEO 40.00 X 391181 0 10380 2435791 0 226736 13 1 1 0 Inspire Rehabilitation 8181 Arista Pl Ste 100 Broomfield CO 80021 Rehabilitation services 1308953 Psychiatric Medical Care LLC PO BOX 734606 Dallas TX 75373 Behavioral healthcare services 561797 C & A Industries PO Box 850861 Minneapolis MN 554850861 Contract staffing 559481 Holly Lashment Dba Shadow Anesthesia Ser 604 Simpson Street Bartley NE 69020 Anesthesia services 374176 Med-Care INC 152 Ponderosa Court Grand Island NE 68803 Contract staffing 333425 10 451086 328755 223837 779841 Patient & Resident Revenue 621400 27309311 27309311 Cafeteria Revenue 900099 112017 112017 Wellness & Rehab 900099 59163 59163 Pharmacy Revenue 900099 40490 40490 229303 229303 27750284 346731 346731 8200 0 8200 8200 8200 655336 705098 28997 -49762 -28997 -78759 -78759 58486 28692 29794 29794 28836091 27750284 0 305966 X 409243 409243 297722 106953 190769 10192473 8828735 1363738 372623 317806 54817 1848986 1550142 298844 744881 613325 131556 34058 34058 129179 129179 2274 2274 6166938 5868161 298777 186778 4867 181911 401520 245106 156414 564976 564976 156187 130119 26068 516500 436618 79882 1748538 1605342 143196 428009 428009 Medical Supplies 2232275 2232275 Repairs and Maintenance 664250 664250 Food Costs 199542 199542 343685 230233 113452 27640637 23598450 4042187 0 922604 1769970 196051 188000 3727979 4199347 88432 203765 568159 516889 366108 370640 40704766 32181658 9452390 8523108 6963322 7828039 117015 200006 4397820 4285520 26799880 28085284 2389507 2312061 92400 16011 11364668 10585520 575434 1321672 14422009 14235264 X 8377261 9806804 4000610 4043216 12377871 13850020 26799880 28085284 X 1195454 256167 20528 X X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 113289 113289 23949153 18341636 5607517 13746651 11551617 2195034 2895673 2288405 607268 8523108 Interest in Tri Valley Medical Foundation 3682738 Insurance Escrow 290822 Software service contract 70000 Estimated third-party payor settlements 85215 Right of Use Asset - Finance Leases 156745 4285520 Estimated third-party payor settlements 1159000 Finance lease liability 162672 1321672 X 29110512 256167 20528 276695 28833817 2274 2274 28836091 27638363 0 27638363 2274 2274 27640637 Part X, Line 2: The Health System believes that it has appropriate support for any tax positions taken affecting its annual filing requirements, and as such, does not have any uncertain tax positions that are material to the financial statements. The Health System would recognize future accrued interest and penalties related to unrecognized tax benefits and liabilities in income tax expense, if such interest and penalties are incurred. Part XI, Line 2d - Other Adjustments: Change in interest in net assets of Tri Vally Medical Foundation 20,528. 1 1 X 1 X 1 X 1 1 0 0 52000 52000 0.00190 52000 52000 0.00190 3015066 1679508 1335558 0.04830 3015066 1679508 1335558 0.04830 3067066 1679508 1387558 0.05020 1 783101 96321 10254369 10342447 -88078 X 1 1 1 1 Cambridge Memorial Hospital Inc 1305 W Hwy 6 34 Cambridge NE 69022 www.trivalleyhealth.com 310001 X X X X 3 provider based rural health clinics Cambridge Memorial Hospital Inc 1 0 0 1 X X X X X X X X X 24 1 1 1 1 X See Part V, Section C X 1 24 1 See Part V, Section C 0 1 X 100.000000000000 200.000000000000 X X X 1 1 X X X X 1 X https://www.trivalleyhealth.com/financial-assistance.html X https://www.trivalleyhealth.com/financial-assistance.html X https://www.trivalleyhealth.com/financial-assistance.html X X X X X X 1 X 0 X X X X 1 X 0 0 Cambridge Memorial Hospital, Inc. Part V, Section B, Line 5: TVHS conducted online surveys to stakeholders and the general public on November 1, 2024. These surveys were collected surveys through 12/6/2024. A CHNA Town Hall meeting was held on February 20, 2025 with council members, the Southwest Nebraska Public Health Department, local residents, Tri Valley Health System employees, law enforcement, local schools, EMS personnel, and mental health representatives. Cambridge Memorial Hospital, Inc. Part V, Section B, Line 6a: Community Hospital Cambridge Memorial Hospital, Inc. Part V, Section B, Line 6b: Collaborated with Southwest Nebraska Public Health Department Cambridge Memorial Hospital, Inc. Part V, Section B, Line 11: A community health needs assessment was completed in FY2025. The following needs were identified: 1. Mental Health (diagnosis, treatment, aftercare, provider access)2. Housing (affordable, accessible, quality)3. Poverty4. Cancer5. Substance Abuse (alcohol, drugs, and vaping)6. Preventative Health (obesity)Housing and poverty are health needs the hospital will not address as they are community social determinants, and not part of the Hospital's mission or critical operations. Tri Valley Health System will partner with other organizations as appropriate.Tri Valley Health System completed the latest CHNA at the end of FY2025, therefore they will begin addressing the needs identified in the next fiscal year.The following details how the Hospital addressed the needs in FY2025 for the CHNA completed in FY2022.- Senior Health - TVHS continued senior transportation for Healthcare and Mental Health services. New senior activities/programs are continually offered to keep seniors active and engaged. TVHS continues to pursue grants that assist with Senior activities and facilities. - Awareness of Healthcare Services - TVHS continues to promote existing healthcare services, facilities, and specialists. The Hospital participated in local events, activities, and programs to promote and publicize facilities and services. TVHS hosted local sporting events where healthcare staff can describe various services to different demographics. TVHS also hosted an annual career fair. Several areas identified were not part of the hospital's critical operations. These needs include Mental Health (Diagnosis, Placement, Aftercare, and Providers), Child Care, Uninsured/Underinsured, Dental Services taking Medicaid, Housing, Healthy Food, Nutrition and School Health.Even though TVHS determined to not address these needs, TVHS has partnered with others to address the community needs identified in the most recent CHNA. Cambridge Memorial Hospital, Inc. Part V, Section B, Line 16j: A plain language summary is conspicuously displayed in Hospital patient waiting areas and in the Patient Accounting Department in a manner that is reasonably calculated to attract visitors' attention. A plain language summary of this Policy and a copy of the financial assistance application will be included in all admission packets provided to inpatients upon admission to the Hospital. A plain language summary of this policy will be offered to all outpatients registering for services. The Hospital publishes the plain language summary of the Policy in the local newspaper on at least an annual basis and may publicize the Policy using other media at the option of Hospital administration. Schedule H, Part V, Section B, Line 7a and 10a: https://www.trivalleyhealth.com/community-health-needs.html 2 1 - Heritage Plaza 1205 Nelson Street Cambridge NE 69022 Independent living 2 - Tri Valley Assisted Living Facility 711 Mousel Avenue Cambridge NE 69022 Assisted living Part I, Line 7: Charity care expense was converted to cost on line 7a based on an overall cost-to-charge ratio addressing all payor segments. The cost for subsidized health services reported on line 7g was determined using the Medicare Cost Report. Part III, Line 2: The amount reported on line 2 represents implicit price concessions. The Health System determines its estimate of implicit price concessions based on its historical collection experience with this class of patients and residents. Part III, Line 3: The Health Center reasonably estimates the portion of implicit price concessions that could have qualified for charity care by identifying the uninsured, underinsured, and account balances assigned to a collection agency in the current year.In Furnas County, Nebraska, the percentage of residents that are at or below poverty level is 12.3%. We can assume that the same percentage of implicit price concessions are attributable to patients potentially eligible for charity care. Part III, Line 4: The footnote to the Organization's financial statements can be found on page 13 and 14 of the attached audited financial statements. Part III, Line 8: Tri Valley Health System had a Medicare shortfall. The Health System provides services to Medicare patients because access to healthcare is important to the Hospital. This is a key advantage to the community. Medicare allowable costs of care are based on the Medicare cost report. The Medicare cost report is completed based on the rules and regulations set forth by the Centers for Medicare and Medicaid Services.Hospital services reimbursed on a fee schedule are not included in the Medicare calculation per the 990 instructions. Had this been reported the total loss from Medicare services would have been $235,670.Medicare fee schedule revenue $ 243,251Medicare estimated costs of care relating to payments (478,921)Net (Shortage) $ (235,670) Part III, Line 9b: Incomplete applications will receive a written notice providing the patient with at least 30 days to provide the required information. The policy further states the hospital may refer a patient's bill to a collection agency 120 days from the date the first bill for care was provided to the patient.The application period for applying for financial assistance begins on the date care is provided to the patient and ends on the later of the 240th day after the date of the first post-discharge billing statement is provided to the patient or not less than 30 days after the date the hospital provides the patient the requisite final notice to commence extraordinary collection actions. If a patient completes an application during the 240 days and is approved for financial assistance all collection activities stop. Part VI, Line 2: In addition to the community health needs assessment, the Hospital assesses the health care needs of the community it serves through patient feedback using various surveys. The surveys are provided by an outside vendor for inpatient care, Emergency Department, and Rural Health Clinics. In-house surveys are completed by various departments. Part VI, Line 3: The Financial Assistance Policy, an application, a plain language summary of the Policy, and any notices or publications regarding the Policy will be made available on the Hospital's website. The Policy, applications, and plain language summaries are available upon request, without charge at the Patient Accounting Department and by mail.A plain language summary is conspicuously displayed in Hospital patient waiting areas and in the Patient Accounting Department in a manner that is reasonably calculated to attract visitors' attention. A plain language summary of the Policy and a copy of the Financial Assistance Application will be included in all admission packets provided to inpatients upon admission to the Hospital. A plain language summary of the Policy is offered to all outpatients registering for services.The Hospital will publish the plain language summary of the Policy in the local newspaper on at least an annual basis and may publicize the Policy using other media at the option of Hospital Administration.Social services staff discusses with patients the availability of state programs (i.e. Medicaid), and assists them with the necessary paperwork. This is usually done primarily for inpatients and nursing home residents. Social Services contacts patient accounting staff about any other individuals in need of our Charity Care Program. We ask all patients having financial hardships to please contact our patient accounting office. After self-pay accounts generate a patient statement, they are reviewed by self-pay patient accounting staff. When deemed appropriate, an explanatory letter and financial application are mailed to the patient. We provide them with all the necessary contact information and documentation requirements. Numerous attempts are made to obtain the needed information to qualify our patients for either charity care and/or Medicaid, if appropriate. Part VI, Line 4: Tri Valley Health System's service area includes the southwest Nebraska counties of Furnas, Frontier, Gosper, and Red Willow. Median household income in the service area was $60,625 in 2023. These income values are below the median and average for both the state of Nebraska and the United States. About 12.3% of the population was below the poverty level.From 2022 to 2023, employment in Furnas County, NE declined at a rate of 5.05%, from 2.22k employees to 2.11k employees.The most common job groups, by number of people living in Furnas County, NE, are Management Occupations, Office & Administrative Support Occupations, and Transportation Occupations. Part VI, Line 5: Tri Valley Health System is governed by a Board of Trustees whose members reside within the Health System's primary service area and have no immediate family ties to any employees. These individuals also do not benefit financially through their businesses by means of contracts or other agreements. Surplus funds, if available, are used to purchase equipment or are re-invested in the facility to improve patient care. Tri Valley Health System extends medical staff privileges to all qualified physicians in the community. Throughout Tri Valley Health System's fiscal year, strides were made to increase the community outreach and education as well as the health of the communities. Tri Valley Health System operates the Healthy Living Center which includes a Wellness and Rehab Center. Everyday people with chronic diseases, such as diabetes and heart failure, are monitored, educated, and cared for by dedicated health care professionals who help them enjoy the best quality of life possible. The Health System has a "Healthy Living" program directed toward diabetes and obesity through the Nutrition Education Department. The Hospital opens its doors to the community to use conference areas for groups such as Alcohol Anonymous, ministerial associations, Weight Watchers, and community volunteer emergency medical technician training. Other improvements to community outreach and education were accomplished through more frequent healthy living lunch lectures, and the development of Fitness Reaching Older Generations (FROG) classes within the Cambridge Community. Tri Valley Health System is reaching out to the communities through the school system and providing education to students in topics such as smoking cessation, bone health, spinal trauma and thyroid issues. Tri Valley Health System also provided baseline trauma testing to football players in all the schools in the communities they serve as well as offering athletic trainers to the school systems at no cost. As a critical access hospital, Tri Valley Health System invites specialists throughout the state to conduct weekly or monthly clinics in the specialty clinic. Services offered to patients during the fiscal year were cardiology, general surgery, mental health, obstetrics/gynecology, orthopedics, ophthalmology, otolaryngology, podiatry, pulmonology, and urology. Tri Valley Health System also offers telehealth psychiatric services. X X 1 1 X X 1 0 0 0 0 0 0 0 0 Shiuvaun Jaeger MD Family Practice/Obstetrics 422547 0 137472 0 0 0 9698 0 33127 0 602844 0 0 0 Lennie Deaver MD Family Practice/Obstetrics 403996 0 38587 0 0 0 12233 0 15410 0 470226 0 0 0 Rachelle Kaspar-Cope MD Family Practice/Obstetrics 330450 0 94037 0 0 0 13649 0 31721 0 469857 0 0 0 Jessica Fisher Former CEO 120487 0 88596 0 182098 0 7849 0 2657 0 401687 0 0 0 Clay Jordan CEO 192987 0 0 0 0 0 8383 0 30808 0 232178 0 0 0 Cristin Soucie Pharmacist 146988 0 0 0 0 0 6259 0 34314 0 187561 0 0 0 Diana Swindler CFO 134179 0 0 0 0 0 5605 0 11694 0 151478 0 0 0 Cherl Mues APRN Family Practice 143367 0 0 0 0 0 5731 0 1956 0 151054 0 0 0 Part I, Line 1a Board Members are allowed to bring their spouse with them on business trips. The maximum allowable in a year for each spouse is less than $600. Providers are allowed memberships to the golf course or the health club. Part I, Line 4a Jessica Fisher, Former CEO - Change of control payment - $182,098. Maranda Lee Family member of Diana Swindler, CFO 106953 Compensation and benefits as employee 0 X 4 223837 Selling Price 0 0 0 0 Part I, Column (b): The organization is reporting the number of items contributed in Part I, column (b). Form 990, Part VI, Section A, line 6 Members pay an annual membership fee of $10. Form 990, Part VI, Section A, line 7a Members select the Board of Trustees at the annual meeting. All members have the same voting rights. Form 990, Part VI, Section A, line 8b There are no committees with the authority to act on behalf of the governing body. Form 990, Part VI, Section B, line 11b The CEO and CFO will review the Form 990. The 990 will then be electronically distributed to the Board Trustees prior to it being filed. Form 990, Part VI, Section B, line 12c At the November board meeting the newly elected Board of Trustees complete an annual disclosure. At the January board meeting all Board of Trustees, CEO, and CFO complete an annual disclosure. The CEO reviews the disclosures. Anyone with a conflict must abstain from voting on the issue and is not able to participate in discussions regarding the issue. Form 990, Part VI, Section B, line 15a The Board of Trustees determines compensation and benefits for the CEO through an employment contract. Review and determination of compensation is done on an annual basis using the Nebraska Hospital Association Compensation Survey as comparability data. Documentation is provided in the CEO's personnel file. For the CFO, the Human Resources department participates in the Nebraska Hospital Association Compensation Survey on an annual basis. Once the results are received, they review the staffs' years of experience as well as their position responsibilities to determine if the salary range is appropriate. A wage range is recommended to the CEO and the CEO determines the final wage for the CFO. This process is completed on an annual basis and documentation is made in the CFO's personnel file. Market Wage Adjustments are made on an as-needed basis to adjust salaries that fall outside the survey guidelines. Form 990, Part VI, Section C, line 19 The governing documents, conflict of interest policy and financial statements are available upon request. The financial statements are also attached to the Form 990. Form 990, Part IX, line 11g Professional Fees: Program service expenses 4,024,145. Management and general expenses 0. Fundraising expenses 0. Total expenses 4,024,145. Purchased Services: Program service expenses 1,696,646. Management and general expenses 203,558. Fundraising expenses 0. Total expenses 1,900,204. Pharmacy Fees: Program service expenses 35,440. Management and general expenses 0. Fundraising expenses 0. Total expenses 35,440. Other Fees: Program service expenses 111,930. Management and general expenses 95,219. Fundraising expenses 0. Total expenses 207,149. Form 990, Part XI, line 9: Change in interest in net assets of Tri Valley Medical Foundation 20,528. Form 990, Part XII, Line 2c: The Board of Trustees assumes responsibility for oversight of the audit and selection of an independent accountant.