2023-12-15T08:46:17-06:00 2023-06-30 450250958 EIDE BAILLY LLP 18081 BURT ST STE 200 OMAHA NE 680224722 990 2022-07-01 470366569 HENDERSON HEALTH CARE SERVICES INC HEND 4027234512 1621 FRONT ST HENDERSON NE 683710217 CHERYL BROWN CHIEF EXECUTIVE OFFICER 4027234512 2023-12-08 1 CHERYL BROWN 999009999 1 MEGAN L KOZIOL CPA P01544037 4023302660 2023-12-08 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z CHERYL BROWN 1621 FRONT ST HENDERSON NE 683710217 19916535 0 X WWW.HENDERSONHEALTHCARE.ORG X 1949 NE TO PROMOTE PROFESSIONAL, COMPETENT, ETHICAL AND COMPASSIONATE HEALTH CARE. 8 8 186 30 0 0 1551104 630546 15405641 18672951 595334 39552 13716 16849 17565795 19359898 0 0 0 0 9904079 11116011 0 0 0 4465846 6270220 14369925 17386231 3195870 1973667 33867009 41875215 4154811 8970159 29712198 32905056 X WE ARE A NONPROFIT, COMMUNITY BASED HEALTH CARE NETWORK WHOSE MISSION IS TO PROMOTE PROFESSIONAL, COMPETENT, ETHICAL AND COMPASSIONATE HEALTH CARE IN THE NAME OF CHRIST TO INDIVIDUALS, FAMILIES AND COMMUNITY. 0 0 10090801 10137786 ANCILLARY SERVICES - HENDERSON HEALTH CARE SERVICES IS A 13-BED COMMUNITY-BASED HEALTH CARE NETWORK LOCATED IN THE HEART OF RURAL NEBRASKA. ANCILLARY SERVICES PROVIDED INCLUDE RADIOLOGY, LABORATORY, OPERATING AND RECOVERY ROOMS, PHYSICAL, RESPIRATORY, INTRAVENOUS, OCCUPATIONAL AND SPEECH THERAPIES, CENTRAL SERVICES, EMERGENCY ROOM, SPECIALTY CLINIC, ANESTHESIOLOGY, ELECTROCARDIOLOGY, CARDIAC AND PULMONARY REHABILITATION, LABOR AND DELIVERY ROOMS AND DIABETIC EDUCATION.IN FISCAL YEAR 2023, THE HOSPITAL PROVIDED 2,930 RADIOLOGY PROCEDURES AND 2,994 PHYSICAL THERAPY VISITS, SAW 740 VISITS TO THE EMERGENCY ROOM AND PERFORMED 221 OPERATIONS. HENDERSON PROVIDED 286 PATIENT DAYS OF ACUTE CARE AND 505 PATIENT DAYS OF SWING-BED CARE. 2144140 2818571 RURAL HEALTH CLINICS - THIS ENCOMPASSES TWO PROVIDER BASED RHCS, ONE LOCATED ADJACENT TO THE CAH AND ONE SATELLITE CLINIC IN SUTTON WHICH OFFERS EXPANDED LAB AND X-RAY. WE EMPLOY 3 MDS AND 4 PAS TO STAFF THESE CLINICS ALONG WITH NURSING AND ADMISSION STAFF. BEING LOCATED NEAR THE INTERSTATE WE ARE ABLE TO SERVE THOSE TRAVELING THROUGH WITH HEALTHCARE NEEDS, BUT OUR GENERAL SERVICE AREA INCLUDES HENDERSON, YORK, HAMPTON, BRADSHAW, MCCOOL, SUTTON, CLAY CENTER, AND AURORA. WE AVERAGE OVER 10,000 CLINIC VISITS BETWEEN THE TWO LOCATIONS AND WE PROVIDE FAMILY PRACTICE SERVICES INCLUDING OBSTETRIC CARE, GERIATRIC CARE, AND PEDIATRIC CARE. 1922279 2558167 PHARMACY/ONCOLOGY - SALARIES INCLUDE A FULL TIME PHARMACIST AND PART TIME PHARMACY TECHNICIAN THAT PERFORMS MEDICATION ORDER REVIEWS FOR ALL MEDICATIONS ORDERED FOR THE HHCS CAH, THIS PHARMACIST ALSO PERFORMS THE MONTHLY INTERNAL REVIEW OF PHARMACY/MEDICATION FOR THE CAH AND LTC. SUPPLIES EXPENSE IS MOSTLY COMPOSED OF MEDICATION COSTS FOR ALL THE MEDICATIONS ADMINISTERED TO THE ER, OP, IP, SK AND OPO PATIENTS AT HHCS. MEDICATIONS ARE PURCHASED MOSTLY THROUGH CARDINAL. 1861906 3158427 LTC NURSING - WE ARE A 40-BED LTC NON-MEDICARE CERTIFIED FACILITY, WE SERVE A MIXTURE OF PRIVATE AND MEDICAID PATIENTS AND FOR FISCAL YEAR 2023 WE HAD 87% OCCUPANCY. THE LARGEST SINGLE COST WITHIN THIS DEPARTMENT IS SALARIES AS THEY CARRY 26.3 FTES IN THIS DEPARTMENT, WHICH INCLUDES AN ASSISTANT ADMINISTRATOR, DIRECTOR OF NURSING, AND ASSISTANT DIRECTOR OF NURSING. THE NEXT HIGHEST COSTS ARE THE EMPLOYEE BENEFITS FOR THE STAFF, INCLUDING HEALTH INSURANCE AND RETIREMENT PLAN. WE ALSO INCUR A QUARTERLY ASSESSMENT TAX FROM NE DHHS, ASSESSED AT $3.50 PER BED PER RESIDENT DAY SO APPROXIMATELY $44,000 PER YEAR. 1861906 3158427 16019126 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 1 52 0 1 186 1 0 0 0 0 0 0 0 0 0 0 0 0 X 8 8 0 0 0 0 1 1 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X JILL MYERS 4027234512 1621 FRONT STREET HENDERSON NE 683710217 JAMES OHRT PHYSICIAN 96.00 X 569003 0 27687 LINDSEY NELSON PHYSICIAN 79.00 X 369710 0 17578 CHRISTOPHER VANDERNECK PHYSICIAN 67.00 X 298389 0 27426 CHERYL BROWN CEO 50.00 X 219179 0 9465 SHELLY AMACK PROFESSIONAL SERVICES OFFICER 49.00 X 209689 0 5894 JILL MYERS CFO 50.00 X 182589 0 18850 JOSHUA REINERS PA 66.00 X 171181 0 15226 CURTIS COGSWELL VICE CHAIRMAN 1.00 X X 0 0 0 ALAN JANZEN SECRETARY 1.00 X X 0 0 0 ROSELYN KORB SECRETARY THRU 11/22 1.00 X X 0 0 0 STACEY STARK TREASURER 1.00 X X 0 0 0 RICK BOARDMAN MEMBER 1.00 X 0 0 0 BLAKE BURGESS MEMBER 1.00 X 0 0 0 BRAD FRIESEN MEMBER 1.00 X 0 0 0 HOLLY HERZBERG MEMBER 1.00 X 0 0 0 JOHN VAN KIRK MEMBER 1.00 X 0 0 0 LOWELL HIEBNER CHAIRMAN 1.00 X 0 0 0 2019740 0 122126 15 0 1 0 SAMPSON CONSTRUCTION CO INC 5825 S 14TH STREET LINCOLN NE 68512 CONSTRUCTION 4708239 HEALTHLAND CPSI PO BOX 11407 BIRMINGHAM AL 35246 EMR SERVICE PROVIDER 141586 2 266602 363944 46000 630546 ANCILLARY SERVICES 621400 8337871 8337871 LONG-TERM-CARE NURSING 621400 3158427 3158427 RURAL HEALTH CLINICS 621400 2818571 2818571 PHARMACY/ONCOLOGY 621400 2558167 2558167 340B PROGRAM REVENUE 621400 721575 721575 1078340 1078340 18672951 286094 286094 15000 3736 11264 11264 11264 306359 352939 199962 -46580 -199962 -246542 -246542 CAFETERIA SALES 900099 5585 5585 5585 19359898 18672951 0 56401 430083 430083 8455136 8080064 375072 214406 202503 11903 1442926 1330544 112382 573460 524695 48765 1377 1377 53809 53809 9760 9760 896293 864751 31542 21277 21277 317181 304982 12199 165015 150393 14622 284330 273203 11127 7348 5449 1899 21532 19685 1847 3520 3442 78 1521594 1501114 20480 181755 173915 7840 MEDICAL SUPPLIES 2241549 2241549 FOOD 189712 189712 BAD DEBTS 163705 163705 LICENSES AND PERMITS 87922 81538 6384 102541 71587 30954 17386231 16019126 1367105 0 5069963 6883083 1622185 3153990 391189 306324 107524 138461 36414705 10822806 22404824 25591899 4271324 4914159 887299 33867009 41875215 2429036 3199099 164307 5119933 863050 698418 651127 4154811 8970159 X 29586567 31904310 125631 1000746 29712198 32905056 33867009 41875215 X 1973667 331892 807715 79584 X X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 896 896 0 PART II-B, LINE 1: A PORTION OF THE DUES PAID TO THE NEBRASKA HOSPITAL ASSOCIATION (NHA) ARE USED BY THOSE ORGANIZATIONS FOR LOBBYING ACTIVITIES. 825783 825783 25483926 6649276 18834650 5525267 4085696 1439571 4579729 87834 4491895 25591899 DEFERRED COMPENSATION 643627 ADVANCE FEES 7500 651127 X 19601645 331892 83320 415212 19186433 9760 163705 173465 19359898 17216502 3736 3736 17212766 9760 163705 173465 17386231 PART X, LINE 2: HHCS ACCOUNTS FOR UNCERTAINTIES IN ACCOUNTING FOR INCOME TAX ASSETS AND LIABILITIES USING GUIDANCE INCLUDED IN FASB ASC 740, INCOME TAXES. HHCS RECOGNIZES THE EFFECT OF INCOME TAX POSITIONS ONLY IF THOSE POSITIONS ARE MORE LIKELY THAN NOT OF BEING SUSTAINED. AT JUNE 30, 2023 AND 2022, HHCS HAD NO UNCERTAIN TAX POSITIONS ACCRUED. PART XI, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES 3,736. GAIN ON BENEFICIAL INTEREST IN TRUSTS 79,584. PART XI, LINE 4B - OTHER ADJUSTMENTS: IMPLICIT PRICE CONCESSIONS 163,705. PART XII, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES 3,736. PART XII, LINE 4B - OTHER ADJUSTMENTS: IMPLICIT PRICE CONCESSIONS 163,705. 1 1 X 1 X 300.000000000000 1 X 1 1 0 0 33465 16804 16661 0.00100 997053 640955 356098 0.02070 1030518 657759 372759 0.02170 5 904 62537 10415 52122 0.00300 2 350 935 0 935 0.00010 7 1254 63472 10415 53057 0.00310 7 1254 1093990 668174 425816 0.02480 1 163705 32741 4989513 5076498 -86985 X 1 1 1 1 HENDERSON HEALTH CARE SERVICES 1621 FRONT ST HENDERSON NE 68371 WWW.HENDERSONHEALTHCARE.ORG 820001 X X X X HENDERSON HEALTH CARE SERVICES INC 1 0 0 1 X X X X X X X X 21 1 0 1 1 X HTTPS://HENDERSONHEALTHCARE.ORG/ABOUT/COMMUNITY-HEALTH.HTML X 1 21 1 HTTPS://HENDERSONHEALTHCARE.ORG/ABOUT/COMMUNITY-HEALTH.HTML 0 1 X 300.000000000000 300.000000000000 X X X 1 1 X X X 1 X WWW.HENDERSONHEALTHCARE.ORG/PATIENT-INFORMATION/FINANCIAL-ASSISTANCE/ X WWW.HENDERSONHEALTHCARE.ORG/PATIENT-INFORMATION/FINANCIAL-ASSISTANCE/ X WWW.HENDERSONHEALTHCARE.ORG/PATIENT-INFORMATION/FINANCIAL-ASSISTANCE/ X X X X X X 1 X 0 X X X X 1 X 0 0 HENDERSON HEALTH CARE SERVICES INC PART V, SECTION B, LINE 5: THIS ASSESSMENT FOCUSES ON COLLECTING THE COMMUNITY'S PERSPECTIVE ON ISSUES SUCH AS HEALTH CARE, EDUCATION, CARE FOR OLDER ADULTS, JOBS, SUPPORT NETWORKS, HEALTH PROBLEMS, AND RISKY BEHAVIORS. A SURVEY WAS DESIGNED BY UTILIZING A SAMPLE SURVEY PROVIDED BY NACCHO. AN UPDATED SURVEY WAS DESIGNED AND DISTRIBUTED IN 2021. THE SURVEY WAS DISTRIBUTED THROUGHOUT THE DISTRICT TO COMMUNITY MEETINGS SUCH AS ROTARY, KIWANIS, OR SERTOMA CLUBS. THEY WERE TAKEN TO AREA CHURCHES, SCHOOL EVENTS, COUNTY FAIRS, ETC. THE SURVEY WAS ALSO AVAILABLE ONLINE AT SURVEY MONKEY. RESPONSES WERE RECEIVED FROM 1,701 INDIVIDUALS. HENDERSON HEALTH CARE SERVICES INC PART V, SECTION B, LINE 6B: FOUR CORNERS HEALTH DEPARTMENT HENDERSON HEALTH CARE SERVICES INC PART V, SECTION B, LINE 11: HENDERSON HEALTH CARE SERVICES, INC. CONTINUES TO PUT FORTH RESOURCES TO ADDRESS THE IDENTIFIED NEEDS AS FOLLOWS:1) OBESITY/NUTRITION/PHYSICAL ACTIVITY: HHCS PROMOTES HEALTHY LIFESTYLES BY PARTNERING WITH FOUR CORNERS HEALTH DEPARTMENT, SPONSORING AN ANNUAL COMMUNITY WEIGHT LOSS CHALLENGE, OFFERING AN ANNUAL HEALTH FAIR TO EMPLOYEES AND THE GENERAL PUBLIC, OFFERING WELLNESS CENTER ACCESS TO EMPLOYEES AND THE PUBLIC, AND PROVIDING NUTRITIONAL COUNSELING AND DIABETIC EDUCATION TO PATIENTS. 2) CANCER: HHCS CONTINUES TO PROMOTE CANCER AWARENESS BY PARTNERING WITH FOUR CORNERS HEALTH DEPARTMENT, RELEASING MESSAGES TO THE PUBLIC ENCOURAGING SCREENING AND EARLY DETECTION IN THE LOCAL NEWSPAPER, WEBSITE OR QUARTERLY NEWSLETTER, AND HOST COMMUNITY HEALTH EVENTS.3) MENTAL HEALTH: HHCS PROMOTES MENTAL HEALTH BY MAKING APPROPRIATE MENTAL HEALTH REFERRALS WHEN DEEMED NECESSARY AND DEVELOPING A CLEAR AND CONSISTENT MESSAGE TO THE GENERAL PUBLIC AND PATIENTS OF HHCS. THIS INCLUDES SPONSORING A SPEAKER AT THE HEARTLAND COMMUNITY SCHOOL AND SUTTON PUBLIC SCHOOL FOCUSING ON SUICIDE PREVENTION/MENTAL HEALTH AMONGST TEENAGERS, CYBER BULLYING AND RISKY BEHAVIORS, AND CONTRACTING FOR EMERGENCY SERVICES WHERE MENTAL HEALTH COORDINATION CAN BE INITIATED.4) ALCOHOL/DRUG ABUSE: HHCS PROVIDES SUPPORT FOR ALCOHOL/DRUG ABUSE BY COLLABORATING WITH THE LOCAL PUBLIC HEALTH SYSTEM TO EDUCATE AND BE A RESOURCE FOR MEMBERS OF THE COMMUNITY. OF THE NEEDS IDENTIFIED, THERE WERE NO SIGNIFICANT NEEDS THAT ARE NOT BEING ADDRESSED. 4 1 - HENDERSON FAMILY CARE 1621 FRONT STREET HENDERSON NE 68371 RURAL HEALTH CLINIC 2 - SUTTON FAMILY PRACTICE 1106 N SAUNDERS SUITE 2 SUTTON NE 68979 RURAL HEALTH CLINIC 3 - LEGACY SQUARE 1621 FRONT STREET HENDERSON NE 68371 LONG-TERM CARE 4 - ROSEWOOD COURT 1621 FRONT STREET HENDERSON NE 68371 ASSISTED LIVING PART I, LINE 3C: A PATIENT KNOWS IF THEY ARE ELIGIBLE AFTER THEY SUBMIT AN APPLICATION AND IT IS REVIEWED BY THE CFO THEN SUBMITTED TO THE CEO OR BOARD OF DIRECTORS FOR FINAL DETERMINATION. ONCE A DETERMINATION IS MADE, A FORMAL LETTER IS DRAFTED AND SENT TO THE PATIENT LETTING THEM KNOW OF THE DECISION. THERE IS PRESUMPTIVE ELIGIBILITY AND MEDICALLY INDIGENT AVAILABLE FOR QUALIFYING OPTIONS. PART I, LINE 6A: THE ORGANIZATION DID NOT PREPARE A COMMUNITY BENEFIT REPORT DURING THE YEAR. PART I, LINE 7: HENDERSON HEALTH CARE SERVICES, INC. USED THE WORKSHEETS PROVIDED IN THE IRS INSTRUCTIONS FOR SCHEDULE H IN ADDITION TO THE INTERNAL COST ACCOUNTING SYSTEM. PART I, LN 7 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 $163,705. PART II, COMMUNITY BUILDING ACTIVITIES: HHCS IS THE LARGEST EMPLOYER IN THE COMMUNITY WITH APPROXIMATELY 160 EMPLOYEES FROM THE SURROUNDING COMMUNITIES. THE DIRECTOR OF NURSING STAFF AND HUMAN RESOURCES REGULARLY ATTENDS JOB FAIRS PROMOTING HEALTH CARE POSITIONS. HHCS ALSO HOSTS THE HENDERSON HEARTLAND SCHOOL JUNIOR HIGH FOR A CAREER DAY IN WHICH THEY COME FOR A TOUR OF THE FACILITY TO LEARN ABOUT THE VAST ARRAY OF JOBS OFFERED WITHIN THE HEALTHCARE INDUSTRY. THE HOSPITAL OFFERS AN ANNUAL HEALTH FAIR LAB PROGRAM THAT PROVIDES REDUCED COST TESTS FOR THE PUBLIC, HHCS ALSO PROMOTES HEALTHCARE AT THE SUTTON AND HENDERSON ANNUAL HOME SHOWS. PART III, LINE 2: CONSISTENT WITH HHCS' MISSION, CARE IS PROVIDED TO PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. THEREFORE, HHCS HAS PROVIDED IMPLICIT PRICE CONCESSIONS TO UNINSURED PATIENTS AND PATIENTS WITH UNINSURED BALANCES (COPAYS AND DEDUCTIBLES). THE IMPLICIT PRICE CONCESSIONS INCLUDED IN ESTIMATING TRANSACTION PRICE REPRESENT THE DIFFERENCE BETWEEN AMOUNTS BILLED TO PATIENTS AND THE AMOUNTS HHCS EXPECTS TO COLLECT BASED ON COLLECTION HISTORY WITH THOSE PATIENTS. PART III, LINE 3: THE ORGANIZATION REVIEWED THEIR BAD DEBTS WRITTEN OFF DURING THE YEAR AS WELL AS PAST EXPERIENCE WITH PATIENTS SERVED AND DETERMINED APPROXIMATELY 20% OF BAD DEBT ACCOUNTS WRITTEN OFF WOULD HAVE QUALIFIED FOR CHARITY CARE IF THE INDIVIDUALS WOULD HAVE COMPLETED THE APPLICATION PROCESS. PART III, LINE 4: THE HOSPITAL'S FINANCIAL STATMENTS DO NOT CONTAIN A SPECIFIC FOOTNOTE DESCRIBING BAD DEBT. HOWEVER, PAGES 10, 12, 13 AND 14 OF THE ATTACHED AUDITED FINANCIAL STATEMENTS INCLUDE FOOTNOTES TITLED "PATIENT RECEIVABLES", "PATIENT SERVICE REVENUE AND "PATIENT FINANCIAL ASSISTANCE". PART III, LINE 8: THE INFORMATION IS FROM THE MEDICARE COST REPORT WHICH IS BASED ON ROUTINE COST PER DAY AND COST TO CHARGE RATIOS. A SHORTFALL REPRESENTS ACTUAL UNREIMBURSED COSTS INCURRED BY THE HOSPITAL IN PROVIDING SERVICES TO INDIVIDUALS ELIGIBLE FOR MEDICARE. THIS IS A BENEFIT TO THE COMMUNITY AS IT IS PROVIDED BELOW COST. PART III, LINE 9B: HHCS RESERVES THE RIGHT TO PROVIDE FINANCIAL ASSISTANCE EVEN THOUGH AN APPLICATION HAS NOT BEEN SUBMITTED FOR THE APPLICABLE CARE. HHCS MAY UTILIZE PREVIOUS FAP APPLICATIONS TO DETERMINE THE ASSISTANCE PROVIDED TO THE PATIENT. IF THE PATIENT IS PROVIDED LESS THAN THE MAXIMUM POSSIBLE LEVEL OF FINANCIAL ASSISTANCE, HHCS WILL: - NOTIFY THE PATIENT REGARDING THE BASIS FOR THE PRESUMPTIVE FINANCIAL ASSISTANCE; - NOTIFY THE PATIENT AS TO HOW TO APPLY FOR POTENTIALLY MORE FINANCIAL ASSISTANCE; - GIVE THE PATIENT A REASONABLE AMOUNT OF TIME TO APPLY FOR MORE GENEROUS ASSISTANCE BEFORE INITIATING COLLECTION ACTIONS; AND - IF THE INDIVIDUAL SUBMITS A COMPLETED APPLICATION SEEKING ADDITIONAL FINANCIAL ASSISTANCE DURING THE LATER OF THE APPLICATION PERIOD OR THE RESPONSE TIME SET FORTH IN THE NOTICE, PROCESS THE APPLICATION IN ACCORDANCE WITH THE POLICY. PART VI, LINE 2: MEDICAL STAFF MEETINGS (INCLUDES ADMINISTRATION, DONS, ALL EMPLOYED PROVIDERS, PHARMACISTS) AND PROVIDER MEETINGS (INCLUDES ONLY EMPLOYED PROVIDERS, CEO AND DON) ARE HELD MONTHLY DURING WHICH OUR MEDICAL STAFF HAVE AN OPPORTUNITY TO SHARE WHAT THEY ARE SEEING FOR RECURRING CASES OF DISEASE MANAGEMENT IN THEIR PATIENTS. IF A TREND IS IDENTIFIED THROUGH THAT DISCUSSION THEN WE TRY TO DEVELOP AN OUTREACH TO THE COMMUNITY. FOR EXAMPLE, PATIENT EDUCATION IN THE NEWSLETTER OR PAMPHLETS IN THE CLINIC EXAM ROOMS, IT BECOMES A FOCUS POINT FOR ALL PROVIDERS WHEN SEEING THEIR PATIENTS. WE MAY ALSO TURN TO COMMUNITY OUTREACH EDUCATION SESSIONS WHERE OUR STAFF HOLD "TOWN HALL" MEETINGS TO EDUCATE THOSE INTERESTED IN ATTENDING. WE ALSO HOLD ANNUAL HEALTH FAIR LABS AND WE COLLECTIVELY LOOK AT RESULTS TO DETERMINE ANY TRENDS IN HEALTH MANAGEMENT THAT NEED TO BE A FOCUS FOR OUR PROVIDERS FOR THE NEXT YEAR. THIS CAN HELP US IDENTIFY ADDITIONAL LAB OR RADIOLOGY TESTS THAT WE NEED TO OFFER IN OUR FACILITY. IT CAN ALSO TELL US IF WE NEED TO FOCUS ON A SPECIALTY CLINIC THAT MAY NEED TO BE RECRUITED TO PROVIDE THE SERVICE IN-HOUSE. LASTLY, WE HAVE PURCHASED KPI NINJA SOFTWARE THAT WILL ALLOW US TO DATA MINE OUR CLAIMS AND DIAGNOSIS SO WE CAN ANALYZE TO SEE WHAT TYPES OF HEALTH MANAGEMENT ARE PREVALENT IN OUR COMMUNITIES. PART VI, LINE 3: IT IS NOTED THAT HENDERSON HEALTH CARE OFFERS CHARITY CARE IN THE ADMISSION FORMS THAT ALL PATIENTS SIGN WHEN THEY COME TO THE CLINIC AND HOSPITAL AND THE FAP IS POSTED IN THE HOSPITAL WAITING ROOMS. ALSO, IN COLLECTION LETTERS, PATIENTS ARE ENCOURAGED TO CONTACT THE HOSPITAL IF THEY ARE INTERESTED IN APPLYING FOR CHARITY CARE. LASTLY, CHARITY CARE IS VERBALLY EXPLAINED TO PATIENTS IF THEY CALL STATING THEY CAN'T PAY FOR THEIR MEDICAL BILL. HHCS ALSO PUBLISHES A NOTICE ANNUALLY IN A NEWSLETTER THAT WE OFFER CHARITY CARE, AND WE PROVIDE OUR POLICY AND APPLICATIONS TO THE CLAY COUNTY AND YORK COUNTY HEALTH DEPARTMENT IN AN EFFORT TO REACH THOSE IN NEED. ALL PATIENT STATEMENTS INCLUDE THE NOTICE THAT FINANCIAL ASSISTANCE IS OFFERED AND INCLUDES CONTACT INFORMATION TO OBTAIN THE APPLICATION. PART VI, LINE 4: HENDERSON HEALTH CARE SERVICES IS LOCATED IN HENDERSON, NEBRASKA PROVIDING HEALTH CARE SERVICES TO RURAL COMMUNITIES THAT PRIMARILY INCLUDE YORK COUNTY (13,665), CLAY COUNTY (6,624), AND HAMILTON COUNTY (9,132) RESPECTIVELY; APPROXIMATELY 30,000 IN TOTAL. HENDERSON HEALTH CARE PROVIDES HEALTH CARE SERVICES TO INFANTS, CHILDREN, ADOLESCENTS, ADULT MEN AND WOMEN, AND THE AGED. THERE IS AN AVERAGE OF 16.67 PERSONS PER SQUARE MILE IN THE SERVICE AREA COMPARED TO ABOUT 80 PER SQUARE MILE ACROSS THE UNITED STATES. THE RESIDENTS OF THESE COUNTIES ARE 97.44% WHITE WITH 17.64% OVER THE AGE OF 65 YEARS AND 5.94% BELOW POVERTY LEVEL. PART VI, LINE 5: HHCS OFFERS A FULL ARRAY OF HEALTH CARE SERVICES FROM BIRTH TO DEATH BY PROVIDING OBSTETRIC CARE ALL THE WAY TO LONG TERM CARE NEEDS AND RESPITE NEEDS. THE HOSPITAL BRINGS SPECIALISTS OF MANY AREAS TO THE LOCAL COMMUNITY BY PROVIDING SPECIALTY CLINICS WITHIN THE COMMUNITY. THE HOSPITAL ALSO OFFERS A BABY BOOT CAMP FOR EXPECTING MOTHERS TO PROMOTE POSITIVE PRENATAL HEALTH AND EDUCATION FOR MOTHERS ABOUT PROPER BABY SAFETY AND IMMUNIZATIONS. PHYSICIANS DO SPEAKING ENGAGEMENTS AT THE SUTTON AND HENDERSON SCHOOLS ON VARIOUS HEALTH TOPICS RELATED TO THEIR AGE GROUP. HHCS HOSTS MEDICAL STUDENTS FOR ROTATION AND STRIVES TO EDUCATE THESE STUDENTS AND RESIDENTS. A QUARTERLY NEWSLETTER IS ISSUED THAT SPOTLIGHTS OUR NEW SERVICES BUT ALSO OFFERS A QUESTION AND ANSWER SESSION FOR HOT TOPICS WITH THE PROVIDERS. HHCS OFFERS 24 HOUR ER CARE AND WORKS WITH AVERA EMERGENCY PROGRAM TO PROVIDE THE BEST TRAUMA AND CRITICAL CARE TO ER PATIENTS. THE HOSPITAL ALSO OFFERS A DIABETES PREVENTION CLASS TO THE PUBLIC WHICH MEETS WEEKLY TO PROVIDE EDUCATION AND SUPPORT FOR ATTENDEES. AN EMPLOYED PHYSICAL THERAPIST IS PROVIDED TO THREE AREA SCHOOLS TO SERVE ON A WEEKLY BASIS AS THEIR ATHLETIC TRAINER; AT NO COST TO THE SCHOOL OR STUDENT. PART VI, LINE 6: HENDERSON HEALTH CARE SERVICES, INC. IS NOT A PART OF AN AFFILIATED HEALTH CARE SYSTEM. X X 0 0 0 0 0 0 0 1 0 JAMES OHRT PHYSICIAN 494379 0 74624 0 0 0 11668 0 16019 0 596690 0 0 0 LINDSEY NELSON PHYSICIAN 365574 0 4136 0 0 0 12200 0 5378 0 387288 0 0 0 CHRISTOPHER VANDERNECK PHYSICIAN 298389 0 0 0 0 0 12200 0 15226 0 325815 0 0 0 CHERYL BROWN CEO 214559 0 4620 0 0 0 8000 0 1465 0 228644 0 0 0 SHELLY AMACK PROFESSIONAL SERVICES OFFICER 206349 0 3340 0 0 0 5875 0 19 0 215583 0 0 0 JILL MYERS CFO 178503 0 4086 0 0 0 7091 0 11759 0 201439 0 0 0 JOSHUA REINERS PA 171181 0 0 0 0 0 0 0 15226 0 186407 0 0 0 PART I, LINE 7 PHYSICIAN BONUSES ARE DEPENDENT UPON THE INDIVIDUAL PHYSICIAN'S CHARGED FEES (ADJUSTED FOR CONTRACTUAL AGREEMENTS AND PHYSICIAN'S PERSONAL PROFESSIONAL SERVICES) AND ARE PAID OUT AS A PERCENTAGE OF REVENUE ABOVE A THRESHOLD, WHICH VARIES WITH PHYSICIAN'S PRODUCTIVITY. JAMES OHRT AND LINDSEY NELSON RECEIVED A PRODUCTIVITY BONUS DURING THE YEAR. X 2 46000 FMV 1 0 1 0 FORM 990, PART VI, SECTION A, LINE 1A THE EXECUTIVE COMMITTEE CONSISTS OF THE CHAIR, VICE CHAIR, SECRETARY, AND TREASURER. EXCEPT FOR POWER TO AMEND THE ARTICLES OF INCORPORATION AND BY-LAWS, THE EXECUTIVE COMMITTEE SHALL HAVE ALL OF THE POWERS AND AUTHORITY OF THE BOARD OF DIRECTORS IN THE INTERVALS BETWEEN REGULAR MEETINGS OF THE BOARD OF DIRECTORS, SUBJECT TO THE DIRECTION AND CONTROL OF THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION A, LINE 6 EVERY PERSON, SOCIETY, BUSINESS OR CONGREGATION WHO HAS DONATED ONE HUNDRED DOLLARS OR MORE FOR THE BENEFIT OF HENDERSON HEALTH CARE SERVICES, INC.(HHCS) DURING THEIR LIFETIME SHALL BE A MEMBER OF HHCS. NO PERSON, SOCIETY, BUSINESS OR CONGREGATION SHALL BE ENTITLED TO MORE THAN ONE VOTE REGARDLESS OF THE CONTRIBUTIONS IN EXCESS OF ONE HUNDRED DOLLARS, AND A PERSON MUST BE OF LEGAL AGE TO EXERCISE VOTING PRIVILEGES. ACCEPTANCE OF ANY DONATION OF $100.00 OR MORE CONSTITUTES APPROVAL OF A LIFETIME MEMBERSHIP. THE MEMBERSHIP IS NOT TRANSFERABLE OR ASSIGNABLE. FORM 990, PART VI, SECTION A, LINE 7A THE BOARD OF DIRECTORS ARE ELECTED BY THE MEMBERSHIP AT THE ANNUAL MEMBERSHIP MEETING. FORM 990, PART VI, SECTION B, LINE 11B FORM 990 IS PREPARED BY AN OUTSIDE ACCOUNTING FIRM AND REVIEWED BY MANAGEMENT. A FINAL COPY OF THE FORM 990 IS PROVIDED TO THE BOARD OF DIRECTORS PRIOR TO FILING WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C EACH DIRECTOR, OFFICER AND MEMBER OF A COMMITTEE WITH BOARD-DELEGATED POWERS SHALL ANNUALLY SIGN A STATEMENT THAT AFFIRMS THAT SUCH PERSON: 1) HAS RECEIVED A COPY OF THE CONFLICT OF INTEREST POLICY, 2) HAS READ AND UNDERSTANDS THE POLICY, 3) HAS AGREED TO COMPLY WITH THE POLICY, AND 4) UNDERSTANDS THAT THE CORPORATION IS A TAX EXEMPT CHARITABLE ORGANIZATION AND THAT IN ORDER TO MAINTAIN ITS FEDERAL TAX EXEMPTION IT MUST ENGAGE PRIMARILY IN ACTIVITIES THAT ACCOMPLISH ONE OR MORE OF ITS TAX-EXEMPT PURPOSES. AFTER DISCLOSURE OF THE FINANCIAL INTEREST AND ALL MATERIAL FACTS, AND AFTER ANY DISCUSSION WITH THE INTERESTED PERSON, HE/SHE SHALL LEAVE THE BOARD OR COMMITTEE MEETING WHILE THE DETERMINATION OF A CONFLICT OF INTEREST IS DISCUSSED AND VOTED UPON. ANY PERSON WITH A POSSIBLE CONFLICT OF INTEREST IN ANY MATTER SHOULD NOT VOTE OR USE HIS/HER PERSONAL INFLUENCE ON THE MATTER. FORM 990, PART VI, SECTION B, LINE 15 COMPENSATION FOR THE CEO IS DETERMINED BY A FACILITY EVALUATION TOOL COMPLETED BY THE BOARD PRESIDENT AND REVIEWED WITH AND APPROVED BY THE BOARD OF DIRECTORS. THE CEO OVERSEES THE REMAINING OFFICERS AND COMPLETES THE FACILITY EVALUATION TOOL FOR THOSE OFFICERS. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS AND THE CONFLICT OF INTEREST POLICY ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST. THE FINANCIAL STATEMENTS ARE DISTRIBUTED AT THE ANNUAL MEETING TO THOSE IN ATTENDANCE AND ARE ALSO AVAILABLE UPON REQUEST. FORM 990, PART XI, LINE 9: GAIN ON BENEFICIAL INTEREST IN TRUSTS 79,584. FORM 990, PART XI, LINE 2C: THE BOARD OF DIRECTORS ASSUMES THE RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF HHCS'S FINANCIAL STATEMENTS AND SELECTION OF AN INDEPENDENT ACCOUNTANT. THIS PROCESS HAS NOT CHANGED SINCE THE PRIOR YEAR.