2025-10-27T15:05:06-05:00 2025-06-30 450250958 EIDE BAILLY LLP 18081 BURT ST STE 200 OMAHA NE 680224722 990 2024-07-01 237161473 OSMOND GENERAL HOSPITAL OSMO 4027483393 402 N MAPLE OSMOND NE 68765 LON M KNIEVEL CHIEF EXECUTIVE OFFICER 4027483393 2025-10-24 1 1 MEGAN L KOZIOL CPA P01544037 4023302660 2025-10-24 2024 2025-03-06 01:10:19Z LON M KNIEVEL 402 N MAPLE OSMOND NE 68765 10262385 0 X WWW.OSMONDHOSPITAL.ORG X 1966 NE PROVIDE HEALTHCARE SERVICES TO ALL INDIVIDUALS IN THE COMMUNITY REGARDLESS OF THEIR ABILITY TO PAY. 9 8 89 8 0 0 41311 46452 9179146 9838751 152042 342958 76455 34224 9448954 10262385 2000 2750 0 0 5175522 5210692 0 0 0 4122400 4683977 9299922 9897419 149032 364966 11572025 13138850 690369 1688168 10881656 11450682 OSMOND GENERAL HOSPITAL IS COMMITTED TO PROVIDING PATIENT CENTERED, HIGH-QUALITY HEALTHCARE IN A COST EFFECTIVE AND SAFE MANNER. 0 0 8367790 2750 9838751 OSMOND GENERAL HOSPITAL, INC SERVES ALL PATIENTS REGARDLESS OF THEIR ABILITY TO PAY AND DOES NOT LIMIT ITS SERVICES OR DISCRIMINATE BASED ON RACE, SEX, NATIONAL ORGIN, OR RELIGION. DURING 2024-2025, OSMOND PROVIDED 1,485 INPATIENT DAYS, 294 RELATED TO MEDICAL/SURGICAL AND 1,191 RELATED TO SWING-BED. THERE WERE A TOTAL OF 96 OPERATIONS PERFORMED AND THE EMERGENCY ROOM TREATED 585 PATIENTS. IN ADDITION TO PROVIDING DIRECT INPATIENT AND OUTPATIENT SERVICES, OSMOND GENERAL HOSPITAL, INC. PROVIDED THE FOLLOWING SPECIALTY CLINICS: UROLOGY, MAMMOGRAPHY, SURGERY, CARDIOLOGY, PULMONOLOGY, PAIN, AND TELEHEALTH. 8367790 1 0 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 0 0 0 0 0 0 0 0 0 1 38 0 1 89 1 0 0 0 0 0 0 0 0 0 0 0 0 X 9 8 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 0 1 1 1 0 X JODI ASCHOFF CFO 4027483393 OSMOND GEN HOSPITAL 402 NORTH MAPLE OSMOND NE 68765 LON M KNIEVEL MEMBER/CEO 40.00 X X 178904 0 39161 TIM KINT PRESIDENT 4.00 X X 0 0 0 DOUG KETELSEN VICE PRESIDENT 4.00 X X 0 0 0 THERESA STAPELMAN SECRETARY/TREASURER 2.00 X X 0 0 0 DOUG KOEHLER MEMBER 2.00 X 0 0 0 STEPHANIE ANDERSON MEMBER 2.00 X 0 0 0 KEVIN LAUCK PA MEMBER 2.00 X 0 0 0 WILLIAM HEFNER MEMBER 2.00 X 0 0 0 WALTER ASCHOFF MEMBER 2.00 X 0 0 0 JODI ASCHOFF CFO 40.00 X 100022 0 11757 ALICIA VANDERWALLE NURSE PRACTITIONER 40.00 X 156984 0 28101 SAMANTHA KIZZIRE CLINIC/HOSPITAL APRN 40.00 X 132161 0 28101 BOBBIE JO MILLER NURSE PRACTITIONER 40.00 X 152611 0 1998 DR KELLY BULLOCK DOCTOR 40.00 X 123226 0 28101 843908 0 137219 6 0 1 0 GREAT PLAINS HEALTH ALLIANCE 250 NO ROCK ROAD STE 160 WICHITA KS 67206 SOFTWARE SUPPORT 573383 PSYCHIATRIC MEDICAL PO BOX 734606 DALLAS TX 75373 ADMINISTRATOR FOR ELDERLY POPULATION 470802 AMERISOURCE BERGEN DRUG CORP 27550 NETWORK PLACE CHICAGO IL 606731275 PHARMACEUTICAL DISTRIBUTION SERVICES 392189 BLOOMFIELD MEDICAL PARTNERS 105 SOUTH BROADWAY BLOOMFIELD NE 68718 ER COVERAGE 234365 CSI LLC 338 STREETER DRIVE STE 100 NORTH SIOUX CITY SD 57049 IT SUPPORT 157665 6 40231 6221 46452 PATIENT SERVICE REVENUE 621110 9391905 9391905 340B PHARMACY REVENUE 456110 322777 322777 124069 124069 9838751 342958 342958 21216 0 21216 21216 21216 CAFETERIA 624200 13008 13008 13008 10262385 9838751 0 377182 X 2750 2750 329844 329844 3666194 3215488 450706 87750 70202 17548 846352 613725 232627 280552 235296 45256 4685 4685 74405 74405 2330620 2063554 267066 171644 158329 13315 156813 155943 870 8050 6631 1419 6589 3685 2904 439331 419504 19827 93019 88821 4198 MEDICAL SUPPLIES 1270095 1255756 14339 MISCELLANEOUS 108948 75793 33155 LICENSES & FEES 18532 1067 17465 DUES AND SUBSCRIPTIONS 1246 1246 9897419 8367790 1529629 0 525 525 7124322 7949341 617827 951500 114421 113860 57997 58895 8879517 7169272 2080964 1710245 1470070 2174130 105899 180354 11572025 13138850 686469 751402 3900 936766 690369 1688168 X 10881656 11450682 10881656 11450682 11572025 13138850 364966 204060 0 X X 0 1 X 1 0 X 0 0 0 0 0 0 0 0 1 1796 1796 0 PART II-B, LINE 1: OSMOND GENERAL HOSPITAL PAYS DUES TO THE NEBRASKA HOSPITAL ASSOCIATION (NHA) AND THE AMERICAN HOSPITAL ASSOCIATION (AHA) OF WHICH A PORTION IS USED FOR LOBBYING ACTIVITIES. 15342 15342 6517140 5403727 1113413 2248205 1668772 579433 98830 96773 2057 1710245 ESTIMATED THIRD-PARTY PAYOR SETTLEMENTS - MEDICAID 936766 936766 X 10466445 204060 204060 10262385 0 10262385 9897419 0 9897419 0 9897419 PART X, LINE 2: THE HOSPITAL 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 HOSPITAL 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. 1 1 X 1 X 1 X 150.000000000000 1 0 0 20000 20000 0.00200 441792 441792 461792 441792 20000 0.00200 260194 260194 1 11 2750 0 2750 0.00030 1428548 1076813 351735 0.03550 1 11 1691492 1337007 354485 0.03580 1 11 2153284 1778799 374485 0.03780 1 8562 1036 4191241 4216814 -25573 X 1 1 1 1 OSMOND GENERAL HOSPITAL 402 NORTH MAPLE OSMOND NE 68765 OSMONDHOSPITAL.ORG 620001 X X X X OSMOND GENERAL HOSPITAL 1 0 0 1 X X X X X X X X X 24 1 1 1 1 X WWW.OSMONDHOSPITAL.ORG/PATIENT-VISITOR-INFORMATION/NEW-PATIENT-FORMS/ X HTTPS://DASHBOARDS.MYSIDEWALK.COM/NCDHD-CHA-CHIP-0E6E23454337 X 1 24 1 WWW.OSMONDHOSPITAL.ORG/PATIENT-VISITOR-INFORMATION/NEW-PATIENT-FORMS/ 0 1 X 100.000000000000 150.000000000000 X X X 1 1 X X X 1 X WWW.OSMONDHOSPITAL.ORG/PATIENT-VISITOR-INFORMATION/FINANCIAL-ASSISTANCE/ X WWW.OSMONDHOSPITAL.ORG/PATIENT-VISITOR-INFORMATION/FINANCIAL-ASSISTANCE/ X WWW.OSMONDHOSPITAL.ORG/PATIENT-VISITOR-INFORMATION/FINANCIAL-ASSISTANCE/ X X X X X 1 X 0 X X X X 1 X 0 0 OSMOND GENERAL HOSPITAL PART V, SECTION B, LINE 5: BEGINNING IN JULY OF 2024 AND RUNNING THROUGH MARCH 2025, OSMOND GENERAL HOSPITAL WORKED IN COORDINATION WITH THE NORTH CENTRAL DISTRICT HEALTH DEPARTMENT TO EMPLOY THE MAPP 2.0 FRAMEWORK. THE MAPP APPROACH ENGAGES COMMUNITY MEMBERS, STAKEHOLDERS, AND HEALTHCARE PROFESSIONALS IN ASSESSING THE OVERALL HEALTH STATUS OF THE COMMUNITY. THE MAPP APPROACH USED THREE DIFFERENT BUT INTERRELATED PROCESSES TO ASSESS OVERALL HEALTH STATUS; A COMMUNITY CONTEXT ASSESSMENT, A COMMUNITY STATUS ASSESSMENT AND A COMMUNITY PARTNER ASSESSMENT. OSMOND GENERAL HOSPITAL PART V, SECTION B, LINE 6A: - ANTELOPE MEMORIAL - CHI PLAINVIEW - AVERA CREIGHTON HOSPITAL- AVERA ST. ANTHONY'S- CHERRY COUNTY HOSPITAL- WEST HOLT MEMORIAL HOSPITAL- NIOBRARA VALLEY HOSPITAL- MIDTOWN HEALTH OSMOND GENERAL HOSPITAL PART V, SECTION B, LINE 6B: AINSWORTH CHAMBER OF COMMERCE, ASERCARE HOSPICE, BOYDE COUNTY SCHOOLS, BRIGHT HORIZONS, BROWN COUNTY EMERGENCY MANAGEMENT, BROWN COUNTY SHERRIF'S OFFICE, BUILDING BLOCKS, CITY OF CREIGHTON, DEPARTMENT OF HEALTH AND HUMAN SERVICES, ELGIN PUBLIC SCHOOLS, EMERGENCY MANAGER OF CHERRY COUNTY, EDUCATIONAL SERVICE UNIT 17, FAMILY SERVICE LINCOLN, GREATER SANDHILLS FAMILY HEALTHCARE, HEARTLAND COUNSELING SERVICES, HOLT COUNTY ECONOMIC DEVELOPMENT, HOLT BOYD COUNTY CONNECTIONS COLLABORATIVE, LIONS CLUB, MIDTOWN HEALTH CENTER, NORTH CENTRAL DISTRICT HEALTH DEPARTMENT, NCDHD BOARD OF HEALTH, NEBRASKA CRITICAL INCIDENT STRESS MANAGEMENT PROGRAM, NORTHEAST COMMUNITY COLLEGE, O'NEILL CHAMBER OF COMMERCE, O'NEILL COMMUNITY FOUNDATION, OSMOND SCHOOL BOARD, PIERCE CHAMBER OF COMMERCE, PLAINVIEW MINISTERIAL, REGIONAL 11 EMERGENCY MANAGEMENT, RROMRS, ROTARY CLUB, SANTEE HEALTH CENTER, UNIVERSITY OF NEBRASKA-LINCOLN EXTENSION, VALENTINE POLICE, WEST HOLT MINISTRIES OSMOND GENERAL HOSPITAL PART V, SECTION B, LINE 11: IN THE MOST RECENTLY COMPLETED (2025-2027) CHNA, THREE MAIN AREAS FOR IMPROVEMENT WERE IDENTIFIED.1. LIFESTYLE CHANGES TO REDUCE MENTAL HEALTH RELATED ISSUES, SUBSTANCE ABUSE, AND CHRONIC DISEASE,2. SOCIO-ECONOMIC STABILITY AS IT RELATES TO HOUSING AND FOOD INSECURITIES,3. ACCESS TO CARE TO INCLUDE THE COST OF CARE, SERVICES AVAILABLE LOCALLY, ACCESS TO CHILDCARE AND THE AVAILABILITY OF TRANSPORTATION.OSMOND GENERAL HOSPITAL (OGH) WILL NOT BE ADDRESSING SPECIFICALLY THE LIFESTYLE CHANGES THAT WERE IDENTIFIED WITHIN THE COMMUNITY HEALTH NEEDS ASSESSMENT, NOR WILL OGH BE ADDRESSING HOUSING INSECURITY OR ACCESS TO CHILDCARE AS WE FEEL THESE FALL OUTSIDE OF OUR ABILITY TO TACKLE OR FUND. THROUGH ITS PARTNERSHIP WITH THE NORTH CENTRAL DISTRICT HEALTH DEPARTMENT, OGH FEELS THAT THERE ARE OTHER ENTITIES BETTER EQUIPPED TO MEET THOSE IMPROVEMENT OBJECTIVES.NO EFFORTS WERE TAKEN RELATED TO THE 2025 NEEDS IDENTIFIED DUE TO THE TIMING OF THE COMPLETION OF THE ASSESSMENT. ACTIONS TAKEN IN THE CURRENT YEAR WERE RELATED TO THE PRIOR ASSESSMENT.DURING THE YEAR, OSMOND GENERAL HOSPITAL CONTINUED ITS FOCUS ON CARDIOVASCULAR HEALTH BY PROMOTING PHYSICAL ACTIVITY AND BETTER NUTRITIONAL ALTERNATIVES. IN PARTNERSHIP WITH THE AMERICAN HEART ASSOCIATION AND THE AMERICAN MEDICAL ASSOCIATION, THE OGH MEDICAL CLINICS PARTICIPATED IN A PROGRAM OF SELF-MEASURED BLOOD PRESSURE BY PROVIDING MONITOR DEVICES TO LOW-INCOME PATIENTS.OSMOND GENERAL HOSPITAL ALSO CONTINUED ITS EFFORTS IN REDUCING SUICIDE RATES BY OFFERING MENTAL HEALTH SERVICES THROUGH THE WAUSA MEDICAL CLINIC AND A GROUP THERAPY PROGRAM FOR THE ELDERLY AT THE HOSPITAL. OGH ALSO PARTICIPATED IN SUICIDE PREVENTION AWARENESS AND MENTAL HEALTH AWARENESS MONTHS THROUGH SOCIAL MEDIA, YARD SIGNS AND OTHER MEDIA PUBLICATIONS. 2 1 - RANDOLPH CLINIC 106 EAST WAYNE RANDOLPH NE 68771 MEDICAL CLINIC 2 - WAUSA CLINIC 100 N LINCOLN WAUSA NE 68786 MEDICAL CLINIC PART I, LINE 3C: IN ADDITION TO FEDERAL POVERTY GUIDELINES, THE HOSPITAL USES ASSET LEVEL, INSURANCE STATUS, AND UNDERINSURANCE STATUS TO DETERMINE ELIGIBILITY FOR PROVIDING FREE OR DISCOUNTED CARE. PART I, LINE 6A: A COMMUNITY BENEFIT REPORT WAS NOT PREPARED IN THE CURRENT YEAR. 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, AND SUBSIDIZED HEALTH SERVICES ON LINE 7G, WERE CALCULATED USING THE COSTING METHODS TO PREPARE THE COST REPORTS. COMMUNITY HEALTH IMPROVEMENT SERVICES, LINE 7E, AND HEALTH PROFESSIONS EDUCATION, LINE 7F, ARE REPORTED BASED ON ACTUAL EXPENSES REPORTED IN THE GENERAL LEDGER. PART I, LINE 7G: NO COSTS ASSOCIATED WITH PHYSICIAN CLINICS WERE INCLUDED AS SUBSIDIZED HEALTH SERVICES. PART II, COMMUNITY BUILDING ACTIVITIES: THERE ARE NO COMMUNITY BUILDING ACTIVITIES REPORTED. 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 VARIOUS CLASSES OF PATIENTS. PART III, LINE 3: THE ESTIMATED AMOUNT OF THE ORGANIZATION'S IMPLICIT PRICE CONCESSIONS ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S CHARITY CARE POLICY IS CALCULATED BASED ON AN APPROXIMATE 12.1% OF INDIVIDUALS LIVING BELOW THE POVERTY LEVEL IN THE SERVICE AREA. PART III, LINE 4: THE FOOTNOTE TO THE ORGANIZATION'S FINANCIAL STATEMENTS THAT DESCRIBES IMPLICIT PRICE CONCESSIONS IS LOCATED IN FOOTNOTE 1 ON PAGES 10 AND 11 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.HOSPITAL SERVICES RENDERED ON A FEE SCHEDULE ARE NOT INCLUDED IN THE MEDICARE CALCULATIONS PER THE 990 INSTRUCTIONS. HAD THIS BEEN REPORTED THE HOSPITAL WOULD HAVE HAD A GREATER LOSS FROM MEDICARE SERVICES OF $120,432.MEDICARE FEE SCHEDULE REVENUE $23,647MEDICARE ESTIMATED COSTS OF CARE RELATING TO PAYMENTS $144,080NET (SHORTAGE) $(120,432) PART III, LINE 9B: THE HOSPITAL WILL NOT TAKE EXTRAORDINARY COLLECTION ACTIONS 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. THE CEO IS RESPONSIBLE TO DETERMINE WHETHER THE HOSPITAL HAS ENGAGED IN REASONABLE EFFORTS TO DETERMINE WHETHER A PATIENT IS ELIGIBLE FOR FINANCIAL ASSISTANCE. IF A PATIENT IS ELIGIBLE FOR FINANCIAL ASSISTANCE OTHER THAN FREE CARE, THE HOSPITAL WILL: 1. PROVIDE THE PATIENT WITH A REVISED BILL SETTING FORTH: (I) THE AMOUNT THE PATIENT OWES FOR CARE PROVIDED AFTER FINANCIAL ASSISTANCE, (II) HOW THE REVISED AMOUNT WAS DETERMINED; AND (III) EITHER THE AGB FOR THE CARE PROVIDED OR INSTRUCTIONS ON HOW THE PATIENT CAN OBTAIN INFORMATION REGARDING THE ABG FOR THE CARE PROVIDED;2. PROVIDE THE PATIENT WITH A REFUND FOR ANY AMOUNT THE PATIENT HAS PAID IN EXCESS OF THE AMOUNT OWED TO THE HOSPITAL (UNLESS SUCH AMOUNT IS LESS THAN $5); AND 3. TAKE REASONABLE MEASURES TO REVERSE ANY ECAS TAKEN AGAINST THE PATIENT. PART VI, LINE 2: OUTSIDE RESOURCES FROM THE HEALTH DEPARTMENT ARE UTILIZED TO IDENTIFY THE CURRENT PATIENT DEMOGRAPHIC TRENDS, HEALTH CARE CONCERNS IN OUR COUNTY AND STATE, PHYSICIAN NEED, ETC. WITH THIS DATA, THE ORGANIZATION IS ABLE TO PINPOINT THE NEEDS OF THE COMMUNITY AND MOLD PROGRAMS AND INITIATIVES TO TARGET THOSE NEEDS. PART VI, LINE 3: THE HOSPITAL ENCOURAGES PATIENTS WHO MAY QUALIFY TO APPLY FOR FINANCIAL ASSISTANCE. PATIENTS CAN APPLY FOR FINANCIAL ASSISTANCE BY COMPLETING AND SUBMITTING A FINANCIAL ASSISTANCE APPLICATION TO PATIENT FINANCIAL SERVICES AT THE HOSPITAL. A COPY OF THE POLICY AND A FINANCIAL ASSISTANCE APPLICATION MAY BE OBTAINED AT NO CHARGE BY GOING TO THE HOSPITAL'S WEBSITE OR BY VISITING THE HOSPITAL'S PATIENT FINANCIAL SERVICES. THE POLICY AND A FINANCIAL ASSISTANCE APPLICATION MAY ALSO BE SENT TO A PATIENT BY MAIL FREE OF CHARGE BY CONTACTING PATIENT FINANCIAL SERVICES PART VI, LINE 4: THE ORGANIZATION SERVES THE COMMUNITIES OF OSMOND, RANDOLPH AND WAUSA IN NORTHEASTERN NEBRASKA. THE ORGANIZATION ALSO SERVES THE COMMUNITIES OF PIERCE, COLERIDGE AND PLAINVIEW WITH ITS OUTREACH CLINICS AND OTHER SERVICES. OSMOND GENERAL HOSPITAL'S SERVICE AREA INCLUDES A POPULATION OF APPROXIMATELY 16,000. THE MEDIAN HOUSEHOLD INCOME FOR THE COMMUNITY IS $37,938 COMPARED TO THE U.S. AVERAGE OF $51,324 AND THE NEBRASKA AVERAGE OF $51,381. THE AREA POPULATION IS PREDOMINATELY WHITE ELDERLY AND LOW INCOME. PART VI, LINE 5: THE ORGANIZATION HAS MANY WAYS THAT IT FURTHERS ITS EXEMPT PURPOSE. THE ORGANIZATION PUBLISHES HEALTH RELATED ARTICLES IN AREA NEWSPAPERS, HOLDS THE CARDIAC REHAB CLINIC, AS WELL AS MULTIPLE WELLNESS ACTIVITIES INCLUDING THE FUNWALK AND WELLNESS WEDNESDAYS. FOR WELLNESS WEDNESDAY, ON THE FIRST WEDNESDAY OF EACH MONTH, PATIENTS CALL IN TO SCHEDULE AN APPOINTMENT TO TAKE ADVANTAGE OF THE SAME LAB TESTING AND EKGS THAT WERE PREVIOUSLY OFFERED AT OUR COMMUNITY HEALTH FAIRS AT A DISCOUNTED PRICE. PART VI, LINE 6: THE HOSPITAL IS NOT PART OF AN AFFILIATED HEALTH CARE SYSTEM. X X X X 0 0 0 0 0 0 0 0 0 LON M KNIEVEL MEMBER/CEO 175904 0 3000 0 0 0 7486 0 31675 0 218065 0 0 0 ALICIA VANDERWALLE NURSE PRACTITIONER 153984 0 3000 0 0 0 0 0 33567 0 190551 0 0 0 SAMANTHA KIZZIRE CLINIC/HOSPITAL APRN 130161 0 2000 0 0 0 0 0 33248 0 165409 0 0 0 BOBBIE JO MILLER NURSE PRACTITIONER 149611 0 3000 0 0 0 0 0 9115 0 161726 0 0 0 DR KELLY BULLOCK DOCTOR 121426 0 1800 0 0 0 0 0 31004 0 154230 0 0 0 FORM 990, PART VI, SECTION A, LINE 1A THE EXECUTIVE COMMITTEE HAS THE AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY. FORM 990, PART VI, SECTION B, LINE 11B THE ORGANIZATION'S 990 IS REVIEWED BY THE CEO AND CFO. IT IS PRESENTED TO THE BOARD AS SOON AS THE REVIEWS ARE COMPLETE, AND PRIOR TO FILING WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C THE BOARD OF DIRECTORS REVIEWS THE CONFLICT OF INTEREST POLICY ANNUALLY. THE CONFLICT OF INTEREST FORMS ARE SIGNED BY THE BOARD AT THIS TIME. WHEN A CONFLICT IS PRESENT, THE BOARD MEMBER WITH THE CONFLICT ABSTAINS FROM DISCUSSION AND VOTE. THIS IS DOCUMENTED IN BOARD MINUTES WHEN THE OCCASION ARISES. FORM 990, PART VI, SECTION B, LINE 15 THE CEO COMPARES EMPLOYEES' SALARIES AND WAGES WITH OTHER NEBRASKA HOSPITALS USING A SURVEY FROM THE NEBRASKA HOSPITAL ASSOCIATION. FOLLOWING COMPARISON STUDIES, HE RECOMMENDS A PERCENTAGE INCREASE TO THE BOARD. THE FINAL WAGE ADJUSTMENT IS DETERMINED BY THE BOARD OF DIRECTORS. THE CEO AND CFO WAGE SCALES ARE COMPARED TO AREA HOSPITALS AND THE NHA SURVEY RESULTS. THE BOARD DISCUSSES AND DETERMINES THE LEVEL OF COMPENSATION. THE PHYSICIAN PAY SCALES ARE COMPARED TO PUBLISHED NATIONAL STANDARDS. FORM 990, PART VI, SECTION C, LINE 19 OSMOND GENERAL HOSPITAL DOES NOT MAKE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, OR FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC. FORM 990, PART IX, LINE 11G PHYSICAL THERAPY FEES: PROGRAM SERVICE EXPENSES 80,478. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 80,478. OTHER FEES FOR SERVICES: PROGRAM SERVICE EXPENSES 1,486,941. MANAGEMENT AND GENERAL EXPENSES 267,066. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,754,007. ANESTHESIA SERVICES: PROGRAM SERVICE EXPENSES 58,016. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 58,016. PHARMACY SERVICES: PROGRAM SERVICE EXPENSES 143,792. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 143,792. LAB FEES: PROGRAM SERVICE EXPENSES 24,922. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 24,922. EMERGENCY ROOM PHYSICIANS FEES: PROGRAM SERVICE EXPENSES 269,405. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 269,405. FORM 990, PART XII, LINE 2C: THE FINANCE COMMITTEE IS COMPRISED OF THE TREASURER OF THE BOARD OF DIRECTORS AND AT LEAST THREE OTHER DIRECTORS. THE JOB OF THE FINANCE COMMITTEE IS TO SUPERVISE ALL CURRENT AND FUTURE FINANCES OF THE CORPORATION, INCLUDING THE REVIEW OF THE AUDITED FINANCIAL STATEMENTS AND SELECTION OF THE INDEPENDENT ACCOUNTANT. THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR.