2025-05-15T12:12:52-05:00 2024-06-30 450250958 EIDE BAILLY LLP 18081 BURT ST STE 200 OMAHA NE 680224722 990 2023-07-01 470533373 COMMUNITY HOSPITAL ASSOCIATION OF MCCOOK COMM 3083442650 1301 EAST H STREET PO BOX 1328 MCCOOK NE 69001 SEAN WOLFE CHIEF FINANCIAL OFFICER 3083442650 2025-05-15 1 1 WENDY R COOLEY CPA P01523804 4023302660 2025-05-15 2023 2025-03-06 01:10:19Z SEAN WOLFE 1301 EAST H STREET PO BOX 1328 MCCOOK NE 69001 66266441 0 X WWW.CHMCCOOK.ORG X 1974 NE TO PROVIDE FOR THE HEALTHCARE NEEDS OF OUR REGION. 9 8 378 25 0 0 1924082 667289 56537518 63188048 887554 1268951 625743 964016 59974897 66088304 294782 416376 0 0 30441643 33053335 0 0 248164 29383898 32478343 60120323 65948054 -145426 140250 92073756 91587690 33192371 32519348 58881385 59068342 LEADING OUR REGION TO A HEALTHIER FUTURE. 0 0 54921433 416376 63555238 25-BED CRITICAL ACCESS ACUTE CARE HOSPITAL PROVIDING INPATIENT AND OUTPATIENT CARE, DIAGNOSTIC, REHABILITATION, SURGICAL, NURSERY, VISITING MEDICAL SPECIALISTS, HOME HEALTH AND HOSPICE, TWO RURAL HEALTH CLINICS, AND HEALTH AND EDUCATION PROGRAMS. 54921433 1 1 0 1 0 0 0 0 0 1 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 1 1 1 0 0 1 79 0 1 378 1 0 0 0 0 0 0 0 0 0 0 0 0 X 9 8 0 0 1 0 0 0 0 1 0 0 0 1 1 1 1 1 1 1 1 0 X SEAN WOLFE 3083448306 1301 EAST H - PO BOX 1328 MCCOOK NE 69001 MATTHEW NIELSEN CHAIR 1.00 1.00 X X 0 0 0 KURT VOSBURG VICE CHAIR 1.00 1.00 X X 0 0 0 MICHAEL LORD SECRETARY 1.00 X X 0 0 0 MATTHEW DAVIDSON TREASURER 1.00 X X 0 0 0 KRISTIN STAGEMEYER CPA CHAIR THRU 12/24 1.00 1.00 X X 0 0 0 GARRETT RIPPEN VICE CHAIR THRU 12/24 1.00 X X 0 0 0 GRANT NORGAARD DIRECTOR 1.00 X 0 0 0 DARREN ESCH DIRECTOR 1.00 X 0 0 0 JANA KMOCH DIRECTOR 1.00 X 0 0 0 ASHLEY VONTZ DIRECTOR 1.00 1.00 X 0 0 0 KAREN CRAW DIRECTOR 1.00 1.00 X 0 0 0 TROY BRUNTZ CEO 39.00 1.00 X 320646 0 45198 SEAN WOLFE CFO 40.00 X 215729 0 53862 RICHARD LAWTON ORTHO PHYSICAN 40.00 X 723133 0 60234 JENNIFER CRAIG EMERGENCY DEPT PHYSICIAN 40.00 X 430544 0 48292 EVAN GEILENKIRCHEN CRNA 40.00 X 317692 0 52433 ROSS BEAVERS CRNA 40.00 X 354641 0 23770 ANTHONY RODEWALD PHARMACY DIRECTOR 40.00 X 207766 0 53539 2570151 0 337328 42 0 1 0 RUTTS HEATING & AC 1001 W 1ST ST HASTINGS NE 68901 CONSTRUCTION 1586514 SOUTHWEST NEBRASKA PHYSICAL THERAPY 1301 EAST H STREET MCCOOK NE 69001 PHYSICAL THERAPY SERVICES 1500864 MCCOOK CLINIC 1401 EAST H STREET MCCOOK NE 69001 ER COVERAGE 1404595 PATHOLOGY SERVICES PO BOX 1289 NORTH PLATTE NE 69103 LAB FEES 482223 RURALMED MANAGEMENT RESOURCES PO BOX 470 HOLDREGE NE 68949 MEDICAL RESOURCES 359434 16 437927 229362 667289 PATIENT SERVICE REVENUE 621400 62708466 62708466 OUT-SOURCE SERVICES 621400 291779 291779 340B PAYMENT 621400 187803 187803 63188048 1331510 1331510 316014 0 316014 316014 316014 115578 178137 -62559 -62559 -62559 CAFETERIA/MEALS 900099 280812 280812 HOUSEKEEPING INCOME 900099 107363 107363 259827 259827 648002 66088304 63555238 0 1865777 X 416376 416376 648323 648323 96542 96542 24004726 18904734 4907225 192767 1373340 1103074 270266 5119914 4101326 1018588 1810490 1422428 370365 17697 83969 83969 97008 97008 10763654 10296036 467618 192708 192708 1181286 640810 537155 3321 245941 189942 55999 1119545 1113911 5634 58654 35121 23533 872965 444112 423588 5265 1102586 1097520 5066 5465073 5064574 400499 400854 399185 1669 MEDICAL SUPPLIES 9585542 9585542 MISCELLANEOUS 1234143 1205029 29114 MEMBERSHIPS & DUES 74415 10200 64215 65948054 54921433 10778457 248164 1600 1600 31335385 29564598 7835220 9586319 1922883 2165529 2638840 2895604 106277948 63839047 43188817 42438901 3495268 3596728 464702 660411 1191041 678000 92073756 91587690 4336469 4262501 493584 671128 28345753 27574730 16565 10989 33192371 32519348 X 58881385 59068342 58881385 59068342 92073756 91587690 140250 46707 0 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 5682 5682 0 PART II-B, LINE 1: ITEM 1I - A PORTION OF DUES PAID TO THE AMERICAN HOSPITAL ASSOCIATION AND NEBRASKA HOSPITAL ASSOCIATION ARE USED FOR LOBBYING AND POLITICAL ACTIVITIES. MANAGEMENT IS ACTIVE IN NEBRASKA HOSPITAL ASSOCIATION'S PAC, AHA'S ADVOCACY DAY, AND OTHER INDUSTRY FUNCTIONS. 3660864 3766 446030 165441 3945219 3482371 5110 214711 41328 3660864 3811948 5826 -260507 74896 3482371 3290398 12744 508806 3811948 3130914 4680 180448 10800 11875 2969 3290398 0.59310 0.40690 0.00000 0 1 1 101803 101803 39250408 38709740 540668 58570863 25129307 33441556 8354874 8354874 42438901 REFUNDABLE ADVANCES 10989 10989 X PART V, LINE 4: THE ENDOWMENT FUNDS ARE HELD BY THE COMMUNITY HOSPITAL HEALTH FOUNDATION OF MCCOOK (A RELATED PARTY) AND ARE USED IN SUPPORT OF THE HOSPITAL'S PROGRAMS AND PROJECTS, INCLUDING PROPERTY AND EQUIPMENT PURCHASES, SCHOLARSHIPS, HOSPICE PROGRAMS, REHABILITATION SERVICES AND OTHERS. PART X, LINE 2: THE HOSPITAL AND FOUNDATION ACCOUNT FOR UNCERTAINTIES IN ACCOUNTING FOR INCOME TAX ASSETS AND LIABILITIES USING GUIDANCE INCLUDED IN FASB ASC 740, INCOME TAXES. THE HOSPITAL AND FOUNDATION RECOGNIZE THE EFFECT OF INCOME TAX POSITIONS ONLY IF THOSE POSITIONS ARE MORE LIKELY THAN NOT OF BEING SUSTAINED. AT JUNE 30, 2024 AND 2023, THE HOSPITAL AND FOUNDATION HAD NO UNCERTAIN TAX POSITIONS ACCRUED. 1 1 X 1 X 0 1 1 1 0 1 1 712914 0 712914 0.01080 5282822 4183331 1099491 0.01670 5995736 4183331 1812405 0.02750 20570 0 20570 0.00030 380757 0 380757 0.00580 401327 401327 0.00610 6397063 4183331 2213732 0.03360 1 1511589 226738 25766823 26821490 -1054667 X 1 1 1 1 COMMUNITY HOSPITAL ASSOCIATION OF MCCOOK 1301 EAST H STREET - PO BOX 1328 MCCOOK NE 69001 WWW.CHMCCOOK.ORG 320007 X X X X COMMUNITY HOSPITAL ASSOCIATION OF MCCOOK 1 0 0 1 X X X X X X X X X 22 1 0 0 1 X SEE PART V, PAGE 8 X 1 22 1 SEE PART V, PAGE 8 0 1 X 150.000000000000 X X 1 1 X X X 1 X HTTPS://CHMCCOOK.ORG/FOR-PATIENTS/FINANCIAL-ASSISTANCE.HTML X HTTPS://CHMCCOOK.ORG/FOR-PATIENTS/FINANCIAL-ASSISTANCE.HTML X HTTPS://CHMCCOOK.ORG/FOR-PATIENTS/FINANCIAL-ASSISTANCE.HTML X X X X X X X 1 X 0 X X X X 1 X 0 0 COMMUNITY HOSPITAL ASSOCIATION OF MCCOOK PART V, SECTION B, LINE 5: COMMUNITY HOSPITAL WORKED WITH COMMUNITY HOSPITAL CONSULTING TO COLLECT DATA THAT WAS USED TO IDENTIFY THE NEEDS OF OUR REGION. ACCORDING TO THE CHNA PROCESS AND METHODOLOGY, "CHC CONSULTING CONDUCTED THE FOLLOWING RESEARCH: A DEMOGRAPHIC ANALYSIS OF THE STUDY AREA UTILIZING DEMOGRAPHIC DATA FROM THE STRATASAN AND LOCAL REPORTS, A STUDY OF THE MOST RECENT HEALTH DATA AVAILABLE, ONE-ON-ONE PHONE INTERVIEWS WITH INDIVIDUALS WHO HAVE SPECIAL KNOWLEDGE OF THE COMMUNITIES. IN ADDITION THEY ANALYZED THOSE RESULTS AND FACILITATED THE REVIEW OF COLLECTED DATA IN MARCH 2022 WITH THE CHNA TEAM." COMMUNITY HOSPITAL ASSOCIATION OF MCCOOK PART V, SECTION B, LINE 11: SIX PRIORITY AREAS WERE IDENTIFIED BY THE CHNA TEAM AND WERE DOCUMENTED ON THE CHNA IMPLEMENTATION PLAN TRACKING DOCUMENT THAT IS UPDATED EACH QUARTER. THE SIX PRIORITY AREAS ARE: PREVENTION, EDUCATION AND SERVICES TO ADDRESS HIGH MORTALITY RATES, CHRONIC DISEASES, PREVENTABLE CONDITIONS AND UNHEALTHY LIFESTYLES; FOCUS ON THE NEEDS OF THE AGING POPULATION; CONTINUED EMPHASIS ON PHYSICIAN RECRUITMENT AND RETENTION; ACCESS TO AFFORDABLE CARE AND REDUCING HEALTH DISPARITIES AMONG SPECIFIC POPULATIONS, ACCESS TO MENTAL AND BEHAVIORAL HEALTH CARE SERVICES AND PROVIDERS; AND CONTINUED FOCUS ON COVID-19 PREVENTION & RESPONSE.PRIORITY ONE: PREVENTION, EDUCATION AND SERVICES TO ADDRESS HIGH MORTALITY RATES - ACTIONS DURING THE YEAR INCLUDED HEALTHY CONNECTIONS, SOCIAL MEDIA PROMOTION FOR EVENTS, VIRTUAL WELLNESS FAIR, PROGRAMS LIKE EAT SMART GET FIT AND HEALTHY HEART INITIATIVE. COMMUNITY CONNECT WAS CREATED TO OFFER MORE WELLNESS RELATED TOPICS TO THE COMMUNITY AT LARGE TO REACH BEYOND OUR COMMUNITY PARTNERS. THE FREEDOM RUN WAS HELD IN JULY WITH OVER 100 RUNNERS PARTICIPATING. OTHER EVENTS INCLUDED HERITAGE DAYS RACE IN PARTNERSHIP WITH THE YMCA, HEALTHY KIDS DAY AT THE YMCA, AND THE WELLNESS FAIR IN CURTIS AND MCCOOK. THE HOSPITAL PROVIDED FUNDING AND PRIZES TO THE HEALTH DEPARTMENT FOR WALK TO HEALTH PROGRAM AND PARTICIPATED IN THE SENIOR FUN FAIR WITH HOME HEALTH AND THE CHHF. RADON EDUCATION WAS PROVIDED IN THE VIRTUAL WELLNESS FAIR AND INCLUDED LINKS TO GET RADON TEST OR TO GATHER MORE INFORMATION.PRIORITY TWO: FOCUS ON THE NEEDS OF THE AGING POPULATION - EVERY THURSDAY CH STAFF VOLUNTEER TIME TO DO AN HOUR SHIFT DELIVERING MEALS. LUNCH AND LEARNS WERE HELD EVERY OTHER MONTH ON HEALTH-RELATED TOPICS FOR THE ELDERLY. CH HELD FITNESS REACHING OLDER GENERATIONS CLASSES IN SIX DIFFERENT TOWNS TO ELDERLY RESIDENTS TO PROMOTE PHYSICAL ACTIVITY AMONG SENIORS. CH PROVIDED FUNDING FOR CNA CLASSES TO SUPPORT AND ENCOURAGE INTERESTED INDIVIDUALS TO PURSUE OPPORTUNITIES AS A PRACTICING CNA OR RA IN THE COMMUNITY.PRIORITY THREE: CONTINUED EMPHASIS ON PHYSICIAN RECRUITMENT AND RETENTION - DURING THE YEAR, A NEW PHYSICIAN FOR ORTHO SERVICES WAS ADDED, AND THE BRYAN CARDIOVASCULAR TRUCK WAS SCHEDULED FOR AUGUST TO OFFER SCREENINGS TO THE COMMUNITY. 40 STUDENTS ATTENDED BISON DAYS IN FEBRUARY. CAREER DISCOVERY DAYS HAD 9 SCHOOLS IN ATTENDANCE AND AROUND 100 STUDENTS REGISTERED. HEALTH CAREERS CLASS ATTENDED THROUGHOUT THE SEMESTER AND VARIOUS DEPARTMENTS PARTICIPATED. CH PARTICIPATED IN THE CONNECT THE DOTS PROGRAM WITH THE UNL EXTENSION. OTHER EVENTS INCLUDED THE UNK SCIENCE EXPLORERS CAMP FOR SEVENTH AND EIGHTH GRADE STUDENTS, SENIOR INDUSTRIAL TOUR AND MANY OTHER SHADOW OPPORTUNITIES.PRIORITY FOUR: ACCESS TO AFFORDABLE CARE AND REDUCING HEALTH DISPARITIES AMONG SPECIFIC POPULATIONS - EVENTS HELD DURING THE YEAR INCLUDED THE COMMUNITY HOSPITAL HEALTH FOUNDATION TEDDY BEAR TOSS, PRO AM, CONCERT FOR HEALTHCARE AND THE PINK OUT RODEO FOR CANCER AWARENESS HELD IN JULY. MONTHLY CAR SEAT CHECKS WERE PROVIDED AT THE FIRE STATION FOR FREE. MAGNETS WERE DISTRIBUTED TO THE COMMUNITY REGARDING TRANSPORTATION SERVICES. CH WORKED WITH THE COMMUNITIES OF EXCELLENCE PROGRAM TO PROVIDE UPDATES ON INCREASING ACCESS TO TRANSPORTATION SERVICES IN THE COMMUNITY. BOTH ENDOCRINOLOGY AND SPEECH WERE ADDED AS TELEHEALTH SERVICES DURING THE YEAR.PRIORITY FIVE: ACCESS TO MENTAL AND BEHAVIORAL HEALTH CARE SERVICES AND PROVIDERS - NEW MENTAL HEALTH PROVIDERS WERE HIRED DURING THE YEAR, AND THE BEHAVIORAL HEALTH DEPARTMENT (BH) CREATED AN UPDATED LIST OF AREA PROVIDERS AND SERVICES. BH WORKED TO CREATE SUPPORT GROUPS FOR YOUTH AND IN DECEMBER PRESENTED ON THE EFFECTS OF STRESS FROM THE HOLIDAYS. CH CONTINUES TO PROVIDE MONTHLY NEWSLETTERS AND WEBINARS FOR DIRECTORS ON MENTAL HEALTH TOPICS THROUGH THE EMPLOYEE ASSISTANCE PROGRAM.PRIORITY SIX: CONTINUED FOCUS ON COVID-19 PREVENTION & RESPONSE - THIS NEED WAS NOT SPECIFICALLY ADDRESSED DURING THE YEAR AS MANY OF THE ACTION STEPS LAID OUT IN THE IMPLEMENTATION STRATEGY HAVE BEEN PREVIOUSLY COMPLETED. COMMUNITY HOSPITAL ASSOCIATION OF MCCOOK PART V, SECTION B, LINE 13B: DISCOUNTING OR 100% WRITE-OFF TO CHARITY CARE IS ALLOWED ABOVE 150% OF THE FEDERAL POVERTY GUIDELINE BASED ON AN ANALYSIS OF INDIVIDUAL NEED AND DETERMINATION OF THE PATIENT BEING MEDICALLY INDIGENT; THIS ANALYSIS INCLUDES FACTORS SUCH AS INCOME, ACCESSIBLE ASSETS, MEDICAL AND/OR OTHER DEBTS, THE LIKELIHOOD OF ONGOING MEDICAL CARE AND THE INDIVIDUAL'S OVERALL ABILITY TO PAY.PATIENTS WHO QUALIFY FOR FINANCIAL ASSISTANCE AS MEDICALLY INDIGENT WILL BE RESPONSIBLE FOR THEIR MEDICAL BILLS UP TO A PERCENT OF THE GREATER OF THEIR HOUSEHOLD INCOME OR NET WORTH BASED ON AMOUNTS PROVIDED IN THE FINANCIAL ASSISTANCE POLICY. THERE IS NO LIMIT TO THE FPG INCOME, BUT PATIENTS OVER 501% OF FEDERAL POVERTY GUIDELINES MAY RECEIVE A DISCOUNT IF THEIR FAMILY'S MEDICAL BILLS AND RELATED DEBT ARE NO MORE THAN THE GREATER OF 20% OF HOUSEHOLD INCOME OR 10% OF NET WORTH.THE HOSPITAL MAY USE PRESUMPTIVE ELIGIBILITY AND PREVIOUS FINANCIAL ASSISTANCE DETERMINATIONS TO PROVIDE FINANCIAL ASSISTANCE IN CERTAIN CIRCUMSTANCES WHEN A PATIENT FAILS TO SUPPLY SUFFICIENT INFORMATION TO SUPPORT ELIGIBILITY. COMMUNITY HOSPITAL ASSOCIATION OF MCCOOK PART V, SECTION B, LINE 16J: THE HOSPITAL PUBLICIZED THE FINANCIAL ASSISTANCE POLICY ON BILLING INVOICES, ON POSTERS IN THE ER AND WAITING ROOMS, AT THE ADMISSIONS DESKS, INCLUDING UPON ADMISSIONS WITH SUMMARY NOTICES OF THE POLICIES. THE COMPLETE POLICY WAS AVAILABLE ON THE HOSPITAL'S WEBSITE AND UPON REQUEST. THE HOSPITAL ALSO PUBLICIZED THE POLICY THROUGH REFERRALS BY CLINICAL, SOCIAL WORKERS, AND OTHER STAFF TO THE HOSPITAL'S FINANCIAL COUNSELORS. COMMUNITY HOSPITAL ASSOCIATION OF MCCOOK DOES NOT HAVE AN LEP POPULATION OF A SINGLE PRIMARY LANGUAGE THAT REACHES 1,000 INDIVIDUALS OR 5% OF THE COMMUNITY SERVED BY THE HOSPITAL. HOWEVER, WITH SPANISH AS THE PREDOMINANT NON-ENGLISH LANGUAGE WE HAVE OPTED TO OFFER A FAP APPLICATION FORM IN THAT LANGUAGE FOR OUR PATIENTS' CONVENIENCE. SCHEDULE H, PART V, SECTION B, LINE 7A AND 10A: COMMUNITY HEALTH NEEDS ASSESSMENT AND IMPLEMENTATION STRATEGY WEBSITE:HTTPS://CHMCCOOK.ORG/ABOUT/COMMUNITY-HEALTH-NEEDS-ASSESSMENT.HTML 3 1 - COMMUNITY HEALTHCARE & HOSPICE 407 WEST 5TH STREET MCCOOK NE 69001 HOME HEALTH AND HOSPICE SERVICES 2 - CURTIS MEDICAL CENTER 302 EAST 6TH STREET CURTIS NE 69025 RURAL HEALTH CLINIC-OUTPATIENT SERVICES 3 - TRENTON MEDICAL CLINIC 406 EAST 1ST STREET TRENTON NE 69044 RURAL HEALTH CLINIC-OUTPATIENT SERVICES PART I, LINE 3C: CHARITY CARE IS GRANTED TO ALL INDIVIDUALS WHOSE HOUSEHOLD INCOME IS BELOW 150% OF THE FEDERAL POVERTY GUIDELINE AT THE 100% WRITE-OFF LEVEL. DISCOUNTING OR 100% WRITE-OFF TO CHARITY CARE IS ALLOWED ABOVE 150% OF THE FEDERAL POVERTY GUIDELINE BASED ON AN ANALYSIS OF INDIVIDUAL NEED AND DETERMINATION OF THE PATIENT BEING MEDICALLY INDIGENT; THIS ANALYSIS INCLUDES FACTORS SUCH AS INCOME, ACCESSIBLE ASSETS, MEDICAL OR/AND OTHER DEBTS, THE LIKELIHOOD OF ONGOING MEDICAL CARE AND THE INDIVIDUAL'S OVERALL ABILITY TO PAY.PATIENTS WHO QUALIFY FOR FINANCIAL ASSISTANCE AS MEDICALLY INDIGENT WILL BE RESPONSIBLE FOR THEIR MEDICAL BILLS UP TO A PERCENT OF THE GREATER OF THEIR HOUSEHOLD INCOME OR NET WORTH BASED ON AMOUNTS PROVIDED IN THE FINANCIAL ASSISTANCE POLICY. THERE IS NO LIMIT TO THE FPG INCOME, BUT PATIENTS OVER 501% OF FEDERAL POVERTY GUIDELINES MAY RECEIVE A DISCOUNT IF THEIR FAMILY'S MEDICAL BILLS AND RELATED DEBT ARE NO MORE THAN THE GREATER OF 20% OF HOUSEHOLD INCOME OR 10% OF NET WORTH.THE HOSPITAL MAY USE PRESUMPTIVE ELIGIBILITY AND PREVIOUS FINANCIAL ASSISTANCE DETERMINATIONS TO PROVIDE FINANCIAL ASSISTANCE IN CERTAIN CIRCUMSTANCES WHEN A PATIENT FAILS TO SUPPLY SUFFICIENT INFORMATION TO SUPPORT ELIGIBILITY. PART I, LINE 7: CHARITY CARE EXPENSE WAS CONVERTED TO COST ON LINE 7A BASED ON AN OVERALL COST-TO-CHARGE RATIO ADDRESSING ALL PATIENT SEGMENTS. UNREIMBURSED MEDICAID ON LINE 7B WAS CALCULATED USING THE COSTING METHODS TO PREPARE THE COST REPORTS. COMMUNITY HEALTH IMPROVEMENT SERVICES, LINE 7E, AND CASH AND IN-KIND CONTRIBUTIONS, LINE 7I, ARE REPORTED BASED ON ACTUAL EXPENSES REPORTED IN THE GENERAL LEDGER. PART III, LINE 2: THE AMOUNT ON LINE 2 REPRESENTS IMPLICIT PRICE CONCESSIONS. THE ORGANIZATION DETERMINES ITS ESTIMATE OF IMPLICIT PRICE CONCESSION BASED ON ITS HISTORICAL COLLECTION EXPERIENCE WITH THIS CLASS OF PATIENTS. FOR THE FISCAL YEAR, THE AMOUNT OF IMPLICIT PRICE CONCESSIONS REPORTED IS $1,511,589. PART III, LINE 3: BASED ON A COMBINATION OF PAST EXPERIENCE AND CENSUS DATA AVAILABLE, THE HOSPITAL ESTIMATES 15% OF THE PATIENT IMPLICIT PRICE CONCESSIONS IS ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY. IN ACCORDANCE WITH ITS MISSION OBJECTIVES, THE HOSPITAL PROVIDES FINANCIAL ASSISTANCE TO PATIENTS WHO LACK FINANCIAL RESOURCES TO PAY FOR THE SERVICES THEY RECEIVE, AND THE HOSPITAL RECOGNIZES THE SPECIAL CONCERNS OF INDIVIDUALS AND HOUSEHOLDS WITH LIMITED FINANCIAL RESOURCES OR WHO ARE OTHERWISE VULNERABLE WITHIN THE COMMUNITY THE HOSPITAL SERVICES. PART III, LINE 4: THE FOOTNOTE TO THE ORGANIZATION'S FINANCIAL STATEMENTS THAT DESCRIBES IMPLICIT PRICE CONCESSIONS IS LOCATED IN FOOTNOTE 1 ON PAGES 13 THROUGH 15 OF THE ATTACHED FINANCIAL STATEMENTS. PART III, LINE 8: THE ENTIRE MEDICARE SHORTFALL IS CONSIDERED A COMMUNITY BENEFIT. SERVICES ARE PROVIDED TO PATIENTS UNDER THE MEDICARE PROGRAM EVEN THOUGH THE HOSPITAL KNOWS THEY WILL NOT RECOVER ALL OF THE COSTS FROM PROVIDING THE SERVICES. THIS PROGRAM IS CONSIDERED SUBSIDIZED BY THE HOSPITAL AND OTHER PAYORS. PATIENTS RELY ON THESE SERVICES FOR THEIR HEALTH AND WELL-BEING AND ARE ESSENTIAL FOR THEIR ACCESS TO HEALTHCARE. TOTAL REVENUE RECEIVED FROM MEDICARE IS THE GROSS REIMBURSEMENT PLUS SETTLEMENT. BOTH TOTAL REVENUE RECEIVED FROM MEDICARE AND THE MEDICARE ALLOWABLE COSTS ARE REPORTED FROM THE MEDICARE COST REPORT. THE MEDICARE COST REPORT IS COMPLETED BASED ON THE RULES AND REGULATIONS SET FORTH BY CENTERS FOR MEDICARE AND MEDICAID SERVICES. PART III, LINE 9B: THE HOSPITAL WILL NOT TAKE ECAS AGAINST A PATIENT OR ANY OTHER INDIVIDUAL WHO HAS ACCEPTED OR IS REQUIRED TO ACCEPT FINANCIAL RESPONSIBILITY FOR A PATIENT UNLESS AND UNTIL THE HOSPITAL HAS MADE "REASONABLE EFFORTS" TO DETERMINE WHETHER THE PATIENT IS ELIGIBLE FOR FINANCIAL ASSISTANCE UNDER THIS POLICY. PATIENT FINANCIAL COUNSELING IS RESPONSIBLE TO DETERMINE WHETHER THE HOSPITAL HAS ENGAGED IN REASONABLE EFFORTS TO DETERMINE WHETHER A PATIENT IS ELIGIBLE FOR FINANCIAL ASSISTANCE.THE HOSPITAL DOES NOT TAKE ECAS AGAINST THE PATIENTS FOR AT LEAST 120 DAYS FROM THE DATE THE HOSPITAL PROVIDES THE PATIENT WITH THE FIRST POST-DISCHARGE BILL FOR CARE. A WRITTEN NOTICE IS SENT TO THE PATIENT AT LEAST 30 DAYS PRIOR TO ANY ECAS. THE NOTICE CONTAINS THE FOLLOWING INFORMATION:1. NOTIFIES THE PATIENT OF THE AVAILABILITY OF FINANCIAL ASSISTANCE,2. IDENTIFIES THE SPECIFIC ECA(S) THE HOSPITAL INTENDS TO INITIATE AGAINST THE PATIENT,3. STATES A DEADLINE AFTER WHICH ECAS MAY BE INITIATED THAT IS NO EARLIER THAN 30 DAYS AFTER THE DATE THE NOTICE IS PROVIDED TO THE PATIENT;5. PROVIDES A PLAIN LANGUAGE SUMMARY OF THE FINANCIAL ASSISTANCE POLICY WITH THE AFOREMENTIONED NOTICE; ANDMAKES A REASONABLE EFFORT TO ORALLY NOTIFY THE PATIENT ABOUT THE POTENTIAL AVAILABILITY OF FINANCIAL ASSISTANCE AT LEAST 30 DAYS PRIOR TO INITIATING ECAS AGAINST THE PATIENT DESCRIBING HOW THE INDIVIDUAL MAY OBTAIN ASSISTANCE WITH THE FINANCIAL ASSISTANCE APPLICATION PROCESS. PART VI, LINE 2: IN ADDITION TO THE CHNA, COMMUNITY HOSPITAL CONTINUES TO ASSESS THE HEALTH NEEDS OF THE COMMUNITY THROUGH A VARIETY OF WAYS, INCLUDING (BUT NOT LIMITED TO) THE FOLLOWING:1) COMMUNITY HOSPITAL IS A KEY MEMBER OF MCCOOK ON THE MOVE INITIATIVE. THIS INCLUDES FOUR KEY COMMUNITY GROUPS THAT MEET REGULARLY AND LEAD/COORDINATE ACTIVITIES WITHIN THE COMMUNITY, WHICH INCLUDE THE FAMILY, EDUCATION, HEALTH, AND ECONOMIC DEVELOPMENT PILLARS. THE HEALTH PILLAR ATTEMPTS TO BRING TOGETHER ALL THE MAJOR HEALTHCARE PROVIDERS AND PUBLIC HEALTH AGENCIES QUARTERLY TO MAINTAIN AWARENESS AND WORK WITH EACH OTHER TO ADDRESS ISSUES AS THEY EMERGE. THE HEALTH PILLAR ALSO FOCUSES ON PROJECTS THAT PROMOTE A HEALTHY LIFESTYLE. 2) COMMUNITY HOSPITAL REGULARLY SCREENS PATIENTS FOR SOCIAL DETERMINANTS OF HEALTH; INCLUDING FINANCIAL, TRANSPORTATION CONCERNS, ISSUES RELATED TO LIVING ALONE, AND OTHER SOCIAL AND FINANCIAL ISSUES THAT IMPACT THE PATIENT'S HEALTH. WE HAVE PUT VARIOUS PROCESSES IN PLACE TO HELP THESE PATIENTS ADDRESS THESE CONCERNS AND ISSUES AS THEY ARE IDENTIFIED.3) COMMUNITY HOSPITAL REGULARLY MEETS WITH OUR NURSING HOMES AND OTHER LONG TERM ASSISTED CARE FACILITIES AS WELL AS OTHER PROVIDERS IN THE REGION TO ASSURE THAT THE CONTINUUM OF CARE FOR PATIENTS ARE WELL MET AND THAT WE ARE AWARE OF AND CAN ADDRESS ANY CONCERNS AS THEY COME TO OUR ATTENTION. PART VI, LINE 3: IDENTIFICATION OF PATIENTS WITH A POTENTIAL NEED FOR FINANCIAL ASSISTANCE WILL BE ACCOMPLISHED BY BOTH AN OPEN AND PUBLICIZED APPLICATION PROCESS AND A VARIETY OF SCREENING OPPORTUNITIES INCLUDING:A. ADMISSIONS/REGISTRATION PERSONNEL BASED UPON INFORMATION RECEIVED DURING THE REGISTRATION PROCESS.B. SOCIAL SERVICES PERSONNEL BASED UPON INFORMATION DURING THE INITIAL VISIT AND DISCHARGE PLANNING.C. NURSING STAFF BASED UPON INFORMATION RECEIVED DURING DISCUSSIONS WITH FAMILY AND/OR PATIENT.D. BUSINESS OFFICE PERSONNEL BASED UPON STATUS OF ACCOUNTS AND DISCUSSIONS WITH RESPONSIBLE PARTY.E. ACCOUNTS RECEIVABLE REPORTS.HOSPITAL STAFF OR THE NOTIFIED PATIENT ADVOCATE WILL EDUCATE THE PATIENT OR GUARANTOR ABOUT THE FINANCIAL ASSISTANCE POLICY AND WILL PROVIDE THEM AN APPLICATION FOR FINANCIAL ASSISTANCE. IF NECESSARY, THE PATIENT FINANCIAL COUNSELOR OR OTHER HOSPITAL STAFF MAY ASSIST THE PATIENT IN COMPLETING THE APPLICATION; HOWEVER, THE COMPLETION OF AN APPLICATION AND PROVIDING ALL NECESSARY SUPPORTING DOCUMENTATION IS THE PATIENT'S RESPONSIBILITY. PATIENTS MAY ALSO REQUEST AN APPLICATION OR ADDITIONAL INFORMATION IN PERSON AT THE ADMISSIONS OFFICE OR BY CALLING OR WRITING THE PATIENT FINANCIAL COUNSELOR AND AN APPLICATION WILL BE MAILED.IF A PATIENT SUBMITS A COMPLETED FINANCIAL ASSISTANCE APPLICATION DURING THE APPLICATION PERIOD AND THE HOSPITAL DETERMINES THAT THE PATIENT MAY BE ELIGIBLE FOR PARTICIPATION IN MEDICAID, THE HOSPITAL WILL NOTIFY THE PATIENT IN WRITING OF SUCH POTENTIAL ELIGIBILITY AND REQUEST THAT THE PATIENT TAKE STEPS NECESSARY TO ENROLL IN SUCH PROGRAM. IN SUCH CIRCUMSTANCES THE HOSPITAL WILL DELAY THE PROCESSING OF THE PATIENT'S FINANCIAL ASSISTANCE APPLICATION UNTIL THE PATIENT'S APPLICATION FOR MEDICAID IS COMPLETED, SUBMITTED TO THE REQUISITE GOVERNMENTAL AUTHORITY, AND A DETERMINATION HAS BEEN MADE. PART VI, LINE 4: COMMUNITY HOSPITAL SERVES A PRIMARY MARKET OF RED WILLOW COUNTY, WHICH IS LOCATED ON THE SOUTHERN BORDER OF NEBRASKA. IT IS 717 SQUARE MILES AND HAS APPROXIMATELY 15.0 PEOPLE PER SQUARE MILE. MCCOOK IS THE COUNTY SEAT. COMMUNITY HOSPITAL ALSO SERVES A SECONDARY MARKET INCLUDING NORTHERN KANSAS AND SOUTHWEST NEBRASKA, WHICH CONSISTS OF FURNAS, NE, HITCHCOCK, NE, DECATUR, KS, CHEYENNE, KS, FRONTIER, NE, RAWLINS, KS AND HAYES, NE. THE TOTAL ESTIMATED POPULATION FOR COMMUNITY HOSPITAL'S SERVICE AREA IS APPROXIMATELY 30,348. RED WILLOW COUNTY HAS A POPULATION OF APPROXIMATELY 10,747. THE GROUP OF COUNTIES WHICH MAKE UP THE SECONDARY MARKET FOR COMMUNITY HOSPITAL HAVE A POPULATION OF APPROXIMATELY 19,601. THE HOUSEHOLD INCOME AVERAGES FOR THESE AREAS ARE AS FOLLOWS:11.75% $0 - 15K14.5% $15K - 25K29% $25K - 50K18.5% $50K - 75K12.5% $75K - 100K13.5% $100K+ PART VI, LINE 5: COMMUNITY HOSPITAL IS THE LARGEST HOSPITAL WITHIN AN HOUR TRAVEL TIME FOR MOST OF THE COMMUNITY SERVED. THE HOSPITAL PROVIDES THE PHYSICIANS OF MCCOOK A HOSPITAL IN WHICH TO PRACTICE MEDICINE. WITHOUT THE HOSPITAL OUR PATIENTS WOULD HAVE EXTREMELY LONG DISTANCES TO TRAVEL FOR EVERYTHING FROM EMERGENCY TO ROUTINE CARE. OUR HOSPITAL IS OVERSEEN BY A NON-COMPENSATED BOARD OF INDEPENDENT COMMUNITY MEMBERS. ANY PROFITS FROM THE OPERATION OF THE HOSPITAL ARE REINVESTED BACK INTO THE FACILITIES, EQUIPMENT AND STAFF TO PROVIDE OUR COMMUNITY WITH CURRENT AND HIGH QUALITY MEDICAL SERVICES CLOSE TO HOME. PART VI, LINE 7, REPORTS FILED WITH STATES NE 1 COMMUNITY HOSPITAL HEALTH FOUNDATION 1301 E H ST MCCOOK NE 69001 470693261 501(C)(3) 82586 0 TO SUPPORT THE MISSION OF THE FOUNDATION MCCOOK COLLEGE FOUNDATION 1205 EAST 1ST ST MCCOOK NE 69001 476089800 501(C)(3) 5600 0 SPONSOR OF HORMEL COMPETITION AND SPORTS SPONSORSHIP UNIVERSITY OF NEBRASKA FOUNDATION 1010 LINCOLN MALL SUITE 300 LINCOLN NE 68508 470379839 501(C)(3) 30000 0 DONATION TO SUPPORT THE HEALTH SCIENCES PROGRAM (KHOP) YMCA OF MCCOOK PO BOX 408 MCCOOK NE 69001 470377999 501(C)(3) 201540 0 PLEDGE ON REMODEL CAMPAIGN AND VARIOUS TEAM SPONSORSHIPS NORTH PLATTE COMMUNITY COLLEGE FOUNDATION 601 WEST STATE FARM RD NORTH PLATTE NE 69101 202459157 501(C)(3) 10450 0 PLEDGE FOR HEALTH SCIENCES BUILDING AND SPORTS SPONSORSHIPS MCCOOK ECONOMIC DEVELOPMENT CORP 402 NORRIS AVE SUITE 301 MCCOOK NE 69001 470685662 501(C)(6) 23200 0 SPONSORING VARIOUS COMMUNITY DEVELOPMENT PROJECTS MCCOOK AREA CHAMBER OF COMMERCE 402 NORRIS AVE SUITE 316 MCCOOK NE 69001 470233780 501(C)(6) 8000 0 SPONSORSHIP RED WILLOW CO FAIR BOARD PO BOX 876 MCCOOK NE 69001 GOVERNMENTAL 30000 0 FAIR SPONSOR CITY OF MCCOOK 505 WEST C STREET MCCOOK NE 69001 GOVERNMENTAL 20000 0 MATCHING FUNDS FOR CCCFF GRANT 7 2 PART I, LINE 2: GRANTS ARE MADE ONLY TO SELECTED CHARITABLE OR OTHER EXEMPT ORGANIZATIONS. COMMUNITY HOSPITAL ASSOCIATION ENTERS INTO AGREEMENTS WITH GRANTEES THAT GRANT FUNDS WILL BE RESTRICTED TO SPECIFIED EXEMPT PURPOSES. X X X X 0 0 0 0 0 0 0 0 0 RICHARD LAWTON ORTHO PHYSICAN 704938 0 15423 0 2772 0 23100 0 38941 0 785174 0 0 0 JENNIFER CRAIG EMERGENCY DEPT PHYSICIAN 386420 0 43488 0 636 0 0 0 50864 0 481408 0 0 0 ROSS BEAVERS CRNA 349736 0 4275 0 630 0 23100 0 3243 0 380984 0 0 0 EVAN GEILENKIRCHEN CRNA 311611 0 4275 0 1806 0 22846 0 31936 0 372474 0 0 0 TROY BRUNTZ CEO 315180 0 4500 0 966 0 22829 0 28582 0 372057 0 0 0 SEAN WOLFE CFO 210859 0 4450 0 420 0 15817 0 40617 0 272163 0 0 0 ANTHONY RODEWALD PHARMACY DIRECTOR 202658 0 4500 0 608 0 15284 0 40827 0 263877 0 0 0 HANNAH TAYLOR BOARD MEMBER DARREN ESCH'S DAUGHTER 23644 EMPLOYEE WAGES 0 KATHERINE STAGEMEYER BOARD MEMBER KRISTIN STAGEMEYER'S DAUGHTER-IN-LAW 72898 EMPLOYEE WAGES 0 FORM 990, PART VI, SECTION A, LINE 4 COMMUNITY HOSPITAL REMOVED MEMBERSHIP FROM THE CORPORATION. IN ADDITION, THEY MADE THE SELECTION OF NEW BOARD MEMBERS A SELF PERPETUATING PROCESS INSTEAD OF AN ELECTION BY THE MEMBERSHIP. FORM 990, PART VI, SECTION A, LINE 8B THERE IS NO COMMITTEE WITH AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY. FORM 990, PART VI, SECTION B, LINE 11B COMMUNITY HOSPITAL'S FORM 990 & 990-T ARE PREPARED BY THE PUBLIC ACCOUNTING FIRM EIDE BAILLY. MANAGEMENT RECEIVES DRAFT COPIES OF THE COMPLETED FORMS FOR REVIEW. AFTER HOSPITAL MANAGEMENT HAS REVIEWED THE RETURNS, COMPLETE COPIES ARE DISTRIBUTED TO ALL MEMBERS OF THE BOARD OF DIRECTORS OF THE COMMUNITY HOSPITAL ASSOCIATION. FORM 990, PART VI, SECTION B, LINE 12C THE COMMUNITY HOSPITAL ASSOCIATION'S CODE OF CONDUCT REQUIRES ALL EMPLOYEES, CONTRACTORS, AND AGENTS TO REPORT ANY CONFLICTS OF INTEREST THAT ARISE. IN ADDITION, THE ASSOCIATION HAS A CONFLICT OF INTEREST POLICY APPLICABLE TO DIRECTORS, OFFICERS, MEMBERS OF COMMITTEES AND SUBCOMMITTEES WITH BOARD-DELEGATED POWERS, AND KEY EMPLOYEES THAT REQUIRES, AMONG OTHER THINGS, ALL APPLICABLE PERSONS DISCLOSE ANY RELATIONSHIPS THAT MAY CREATE A CONFLICT OF INTEREST AND ARE REQUIRED TO COMPLETE AN ANNUAL DISCLOSURE OF ALL SUCH RELATIONSHIPS. ALL SUCH RELATIONSHIPS ARE DISCLOSED TO THE ENTIRE BOARD AND SENIOR MANAGEMENT, AND ANY AND ALL CONFLICTS OR POTENTIAL CONFLICTS ARE MONITORED BY SENIOR MANAGEMENT AND THE ASSOCIATION'S COMPLIANCE FUNCTION. FORM 990, PART VI, SECTION B, LINE 15 COMMUNITY HOSPITAL'S PROCESS FOR DETERMINING THE COMPENSATION OF THE CEO IS AS FOLLOWS: THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS IS RESPONSIBLE FOR SETTING THE SALARY OF THE CEO. ANNUALLY, THE COMMITTEE CONDUCTS A REVIEW OF THE CEO'S PERFORMANCE, ABILITIES, AND OVERALL EFFECTIVENESS. THE COMMITTEE IS PRESENTED WITH SALARY AND COMPENSATION SURVEY DATA THAT IS COMPILED BY THE CEO AND THE HUMAN RESOURCE DEPARTMENT AND THE ACCURACY OF WHICH IS ATTESTED TO BY THE CFO. MULTIPLE SOURCES OF SURVEY DATA ARE USED, INCLUDING INFORMATION FROM THE NEBRASKA AND IOWA HOSPITAL ASSOCIATIONS, WHICH IS BROKEN DOWN TO SIMILARLY QUALIFIED PERSONS IN COMPARABLE POSITIONS AT SIMILARLY SIZED AND SITUATED ORGANIZATIONS. ALL SOURCE DOCUMENTATION IS GIVEN TO THE COMMITTEE AS WELL AS SUMMARIES PROVIDED FOR EASE OF REFERENCE. THE EXECUTIVE COMMITTEE CONDUCTS THE PERFORMANCE REVIEW WITH THE CEO; THEN MEETS IN PRIVATE CHAMBERS TO DISCUSS THE REVIEW AND TO DELIBERATE ANY AND ALL CHANGES TO THE EMPLOYMENT AGREEMENT, INCLUDING COMPENSATION, AND GOALS FOR THE FOLLOWING YEAR. CONTEMPORANEOUS RECORDS ARE KEPT OF ALL SURVEY AND COMPARABILITY DATA USED, AND THE RESULTS AND DECISIONS OF THE EXECUTIVE COMMITTEES MEETING ON COMPENSATION. COMPENSATION OF EMPLOYEES BELOW THE ROLE OF CEO ARE DETERMINED THROUGH THE USE OF SURVEY INFORMATION OF SIMILARLY QUALIFIED PERSONS IN COMPARABLE POSITIONS AT SIMILARLY SIZED AND SITUATED ORGANIZATIONS. THE CEO SETS THE COMPENSATION OF SENIOR MANAGEMENT BASED ON THOSE SURVEYS, TAKING IN CONSIDERATION PERFORMANCE AND EXPERIENCE OF EACH INDIVIDUAL. COMPENSATION RANGES OF EMPLOYEES BELOW SENIOR MANAGEMENT ARE SET BY HUMAN RESOURCES BASED ON MARKET WAGE RATES FOR SIMILARLY QUALIFIED PERSONS IN COMPARABLE POSITIONS AT SIMILARLY SIZED AND SITUATED ORGANIZATIONS. ALL EMPLOYEES HAVE AN ANNUAL REVIEW BY THEIR SUPERVISOR, WHICH DETERMINE WHERE IN THE SALARY RANGE AN EMPLOYEE WILL FALL. ALL SALARY RANGES, INCLUDING THOSE OF SENIOR MANAGEMENT, ARE ULTIMATELY APPROVED BY THE BOARD OF DIRECTORS DURING THE APPROVAL OF THE ANNUAL OPERATING BUDGET. FORM 990, PART VI, SECTION C, LINE 19 COMMUNITY HOSPITAL MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, FORM 990 & 990-T (CURRENT AND PAST YEARS AS REQUIRED BY LAW) AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. ANY INDIVIDUAL WHO WOULD LIKE A COPY OF ANY OF THE ABOVE MENTIONED DOCUMENTS MAY INSPECT THOSE DOCUMENTS IN PERSON AT THE HOSPITAL DURING NORMAL BUSINESS HOURS, OR REQUEST A COPY OF ANY OF THE ABOVE INFORMATION IN PERSON, BY PHONE, OR BY MAIL, AND WE WILL PROVIDE A COPY FREE OF CHARGE. FORM 990, PART IX, LINE 11G MISCELLANEOUS FEES FOR SERVICE: PROGRAM SERVICE EXPENSES 2,985,449. MANAGEMENT AND GENERAL EXPENSES 322,571. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,308,020. PHYSICIAN FEES: PROGRAM SERVICE EXPENSES 4,612,020. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,612,020. MAINTENANCE CONTRACTS: PROGRAM SERVICE EXPENSES 1,228,086. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,228,086. PT CONTRACT SERVICES: PROGRAM SERVICE EXPENSES 1,470,481. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,470,481. COLLECTION FEES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 145,047. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 145,047. FORM 990, PART XII, LINE 2C COMMUNITY HOSPITAL HAS A STANDING BOARD COMMITTEE, THE BUDGET AND FINANCE COMMITTEE, WHICH HAS THE AUTHORITY AND ASSUMES THE RESPONSIBILITY FOR THE SELECTION OF THE INDEPENDENT ACCOUNTING FIRM AND ALL RELATED OVERSIGHT, COMMUNICATION, AND REPORTING. THIS COMMITTEE APPROVES ALL ENGAGEMENT LETTERS AND RECEIVES ALL BOARD DIRECTED COMMUNICATION FROM THE INDEPENDENT ACCOUNTING FIRM. COPIES OF RECEIVED LETTERS/COMMUNICATIONS AND REPORTS ARE DISTRIBUTED TO ALL MEMBERS OF THE BOARD OF DIRECTORS IN ADDITION TO THE COMMITTEE MEMBERS. WHILE THE MEMBERS OF THE COMMITTEE HAVE CHANGED, THE PROCESS DESCRIBED HAS NOT CHANGED FROM THE PREVIOUS YEAR. COMMUNITY HOSPITAL HEALTH FOUNDATION 801 WEST C STREET PO BOX 1328 MCCOOK NE 69001 470693261 SUPPORTING ORGANIZATION PROVIDES FUNDRAISING FOR THE HOSPITAL NE 501(C)(3) LINE 12A, I COMMUNITY HOSPITAL ASSOCIATION OF MCCOOK 1 0 1 1 0 0 0 0 0 0 0 1 0 1 1 1 1 1 0 0 COMMUNITY HOSPITAL HEALTH FOUNDATION C 437927 CASH TRANSFERRED EQUALS FMV COMMUNITY HOSPITAL HEALTH FOUNDATION B 82586 CASH TRANSFERRED EQUALS FMV