2025-11-14T15:58:31-06:00 2024-12-31 470617373 COMMONSPIRIT HEALTH 198 INVERNESS DRIVE WEST ENGLEWOOD CO 80112 990 2024-01-01 470426285 MEMORIAL COMMUNITY HOSPITAL MEMO 4024262182 810 NORTH 22ND STREET BLAIR NE 68008 TIM SCHNACK VP OPERATIONAL FINANCE & CFO 4024261295 2025-11-14 1 0 MARK STOCKI P00642127 3032989100 2024 2025-03-06 01:10:19Z JENNIFER NEWBY 810 NORTH 22ND STREET BLAIR NE 68008 55603244 0 X WWW.MCHHS.ORG X 1956 NE AS AN ENGAGED TEAM OF PHYSICIANS, MEDICAL PROFESSIONALS, AND SUPPORT STAFF WE ARE COMMITTED TO DELIVERING STATE-OF-THE-ART HEALTH CARE TAILORED TO OUR UNIQUE COMMUNITY AND SECOND TO NONE IN THE AREA. 7 6 365 7 0 0 365246 15575 50570975 51510931 401719 717109 2785495 3359629 54123435 55603244 0 0 0 0 27425875 29839953 0 0 0 19603487 20087412 47029362 49927365 7094073 5675879 63204493 69743498 11549306 12248466 51655187 57495032 X AS A COMMUNITY HOSPITAL, MEMORIAL COMMUNITY HOSPITAL AND HEALTH SYSTEM OF BLAIR HAS STAYED COMMITTED TO KEEPING RESIDENTS OF WASHINGTON AND BURT COUNTY IN GOOD HEALTH. MEMORIAL COMMUNITY HOSPITAL HAS STRIVEN TO IMPROVE THE HEALTH STATUS OF RURAL NEBRASKA RESIDENTS THROUGH THE FOLLOWING SERVICES: 24-HOUR EMERGENCY CARE WITH HELIPORT ACCOMMODATIONS, LABOR AND DELIVERY AND CARDIOVASCULAR. CARDIOVASCULAR SERVICES INCLUDE THE FOLLOWING NON-INVASIVE DIAGNOSTICS STUDIES SUCH AS EKG, TELEMETRY MONITORING, TREADMILL STRESS TESTING, ECHO CARDIOGRAM, AND STRESS ECHO CARDIOGRAM. MEMORIAL COMMUNITY HOSPITAL AND HEALTH SYSTEM PROVIDES A VARIETY OF SPECIALTY CLINICS LOCATED IN BLAIR. ALLERGY/ASTHMA/IMMUNOLOGY, PAIN MANAGEMENT/ANESTHESIA, CARDIOLOGY, ENDOCRINOLOGY, ENT, GENERAL SURGERY, OB/GYN, NEPHROLOGY, NEUROLOGY, NEUROSURGERY, ONCOLOGY, ORTHOPEDICS, ORTHOTICS/PROSTHETICS, PLASTIC SURGERY, DERMATOLOGY, AND PODIATRY. 0 0 6105550 9268362 MEMORIAL COMMUNITY HOSPITAL OF BLAIR PROVIDES HEALTH CLINICS FOR THE RESIDENTS OF BLAIR AND SURROUNDING COMMUNITIES WITH HEALTH CARE PROVIDERS IN A VARIETY OF MEDICAL SPECIALTIES. THE HEALTH CLINICS REVENUE OF $ 9,268,362 IS THE GROSS REVENUE AFTER CONTRACTUAL ADJUSTMENTS. 2299916 5231598 MEMORIAL COMMUNITY HOSPITAL OF BLAIR PROVIDES THE RESIDENTS OF BLAIR AND SURROUNDING COMMUNITIES WITH A VARIETY OF THERAPY SERVICES, INCLUDING PHYSICAL AND OCCUPATIONAL THERAPY, SPEECH THERAPY, SLEEP STUDIES, AND RESPIRATORY THERAPY. THE THERAPY SERVICES REVENUE OF $5,231,598 IS THE GROSS REVENUE AFTER CONTRACTUAL ADJUSTMENTS. 1909524 4084487 MEMORIAL COMMUNITY HOSPITAL OF BLAIR PROVIDES THE RESIDENTS OF BLAIR AND SURROUNDING COMMUNITIES 24 HOUR EMERGENCY ROOM SERVICES. THE EMERGENCY SERVICES REVENUE OF $4,084,487 IS THE GROSS REVENUE AFTER CONTRACTUAL ADJUSTMENTS. 22611943 32926484 22611943 32926484 32926933 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 10 0 1 365 1 0 0 0 0 0 0 0 0 0 0 0 0 X 7 6 0 1 0 0 1 1 0 1 1 0 0 0 1 1 1 0 1 0 0 1 0 X JENNIFER NEWBY 4024262182 810 NORTH 22ND STREET BLAIR NE 68008 X SARAH CHATT TREASURER (END 04/24) 1.00 0.00 X X 0 0 0 NEIL SMITH SECRETARY 1.00 0.00 X X 0 0 0 KYLE ACRE CHAIR 1.00 1.00 X X 0 0 0 ROBIN CONYERS BOARD MEMBER 1.00 0.00 X 0 0 0 GREGG DRABEK MD VICE CHAIR 25.00 0.00 X X 0 0 0 LORI NAHNSEN BOARD MEMBER 1.00 0.00 X 0 0 0 JOHN SIMONSON MD BOARD MEMBER/PHYSICIAN 40.00 0.00 X 310193 0 8846 DAVE LADWIG TREASURER (BEG 04/24) 1.00 0.00 X X 0 0 0 MANUELA BANNER PRESIDENT & CEO 40.00 1.00 X 0 0 0 JENNIFER NEWBY CFO 40.00 1.00 X 0 0 0 KEVIN SISK MD PHYSICIAN 40.00 0.00 X 510972 0 11423 JEREMY LEE MD PHYSICIAN 40.00 0.00 X 406417 0 4768 AMANDA DUXBURY MD PHYISICAN 40.00 0.00 X 358961 0 11503 SANTOSH KUMAR MD PHYSICIAN 40.00 0.00 X 402902 0 12623 SEAN ERIKSON MD PHYSICIAN 40.00 0.00 X 415242 0 12615 2404687 0 61778 57 0 1 1 CHI HEALTH 198 INVERNESS DR WEST ENGLEWOOD CO 80112 MGMT FEES/HEALTH SVCS 1677065 7ER GROUP LLC 4610 S 133RD SUITE 105 OMAHA NE 68137 CONSTRUCTION CONTRACTORS 1203084 JW SERVICES PO BOX 641340 OMAHA NE 68164 CLEANING SERVICES 1168915 SIGNATURE PERFORMANCE 10330 REGENCY PARKWAY DR 335 OMAHA NE 68114 BUSINESS OFFICE SERVICES 1040891 RURAL PARTNERS IN MEDICINE 11880 AIRPORT WAY BROOMFIELD CO 80021 MEDICAL SERVICES 628514 23 2263 13312 15575 NET PATIENT REVENUE 621110 51510931 51510931 51510931 717109 717109 127134 0 127134 127134 127134 PHARMACY 456110 3102545 3102545 DIETARY 621110 93540 93540 OTHER MISC REVENUES 900099 36410 36410 3232495 55603244 51510931 0 4076738 319040 212878 106162 24291649 16208430 8083219 593360 395915 197445 3101725 2069604 1032121 1534179 1023670 510509 500000 500000 15170 15170 51000 51000 7705 7705 1540739 1028047 512692 102393 68321 34072 78827 52597 26230 626244 626244 19312 12886 6426 114095 76129 37966 235424 235424 2339574 1561064 778510 447009 447009 SUPPLIES 8681716 5792813 2888903 PURCHASED SERVICES 4038404 2694596 1343808 EQUIPMENT RENTAL AND MA 872074 581885 290189 DUES & SUBSCRIPTIONS 170569 113811 56758 247157 164914 82243 49927365 32926933 17000432 0 26134868 31293656 11335576 10167318 792139 934993 232194 250841 70887355 50485009 18003842 20402346 6344081 6505833 361793 188511 63204493 69743498 5431440 5798487 5372919 4115004 744947 2334975 11549306 12248466 X 51655187 57495032 51655187 57495032 63204493 69743498 5675879 163966 0 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 7705 7705 0 PART II-B, LINE 1: THE PORTION OF ORGANIZATION DUES THAT ARE RELATED TO LOBBYING ARE AS FOLLOWS: AMERICAN HOSPITAL ASSOCIATION - $5,094 NEBRASKA HOSPITAL ASSOCIATION - $2,611 886525 886525 24800354 14119638 10680716 41015790 33619440 7396350 4184686 2745931 1438755 20402346 ESTIMATED THIRD-PARTY SETTLEMENTS 2276192 INTEREST RATE SWAP LIABILITY 58783 2334975 X PART X, LINE 2: IN ACCORDANCE WITH FASB INTERPRETATION NO 48, ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES, INCLUDED IN FASB ASC SUBTOPIC 740-10 - INCOME TAXES - THE HOSPITAL RECOGNIZES THE EFFECT OF INCOME TAX POSITIONS ONLY IF THOSE POSITIONS ARE MORE LIKELY THAN NOT OF BEING SUSTAINED. RECOGNIZED INCOME TAX POSITIONS ARE MEASURED AT THE LARGEST AMOUNT THIS IS GREATER THAN 50% LIKELY OF BEING REALIZED. CHANGES IN RECOGNITION OR MEASUREMENT ARE REFLECTED IN THE PERIOD IN WHICH THE CHANGE IN JUDGEMENT OCCURS. IN 2024 AND 2023, MANAGEMENT DETERMINED THAT THERE ARE NO INCOME TAX POSITIONS REQUIRING RECOGNITION IN THE CONSOLIDATED FINANCIAL STATEMENTS. 1 1 X 0 0 1 1 0 1 1 286 867049 867049 0.01740 3630967 2893449 737518 0.01480 286 4498016 2893449 1604567 0.03220 26 492 72375 72375 0.00140 9 212 41530 41530 0.00080 1 58 1014335 409903 604432 0.01210 17 38447 38447 0.00080 53 762 1166687 409903 756784 0.01510 53 1048 5664703 3303352 2361351 0.04730 2 15125 15125 0.00030 23 400 8680 8680 0.00020 10 1560 1560 0.00000 1 2500 2500 0.00010 3 65 3540 3540 0.00010 39 465 31405 31405 0.00070 1 752624 13348241 13321019 27222 X 1 1 1 1 MEMORIAL COMMUNITY HOSPITAL 810 NORTH 22ND STREET BLAIR NE 68008 WWW.MCHHS.ORG 790001 X X X X MEMORIAL COMMUNITY HOSPITAL 1 0 0 1 X X X X X X X X X 22 1 1 1 1 X HTTPS://MCHHS.ORG/CHIP-CHNA/ X SEE PART V, PAGE 8 X 1 22 1 HTTPS://MCHHS.ORG/CHIP-CHNA/ 0 1 X X X 1 1 X X X 1 X HTTPS://MCHHS.ORG/PATIENT-BILLING-FINANCIAL-ASSISTANCE/ X HTTPS://MCHHS.ORG/PATIENT-BILLING-FINANCIAL-ASSISTANCE/ X HTTPS://MCHHS.ORG/PATIENT-BILLING-FINANCIAL-ASSISTANCE/ X X X X 1 X 0 X X X X 1 X 0 0 MEMORIAL COMMUNITY HOSPITAL PART V, SECTION B, LINE 5: IN 2022, LEADERSHIP FROM MEMORIAL COMMUNITY HOSPITAL COLLABORATED WITH THE THREE RIVERS PUBLIC HEALTH DEPARTMENT (TRPHD) AND SCHMEECKLE RESEARCH GROUP TO CONDUCT A COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) FOR THE THREE RURAL COUNTIES SERVED BY THE TRPHD, WHICH INCLUDES WASHINGTON COUNTY, THE COUNTY IN WHICH MEMORIAL COMMUNITY HOSPITAL & HEALTH SYSTEM IS LOCATED. THE CHNA IS A FOLLOW-UP TO AND EXPANSION OF SIMILAR REPORTS CONDUCTED IN 2003, 2007, 2012, 2016 AND 2019. THE TRPHD HAS COMPLETED A CHNA AND DEVELOPED A COMMUNITY HEALTH IMPROVEMENT PLAN (CHIP) USING THE MOBILIZING FOR ACTION THROUGH PLANNING AND PARTNERSHIP (MAPP) PROCESS. MEMORIAL COMMUNITY HOSPITAL & HEALTH SYSTEM'S LEADERSHIP AND STAFF HAVE BEEN INVOLVED IN THE CHNA PLANNING PROCESS THROUGH SERVICE ON THE CHNA STEERING COMMITTEE AND PARTICIPATION IN THE MAPP PROCESS. A LARGE FOCUS GROUP COMPOSED OF DIVERSE MEMBERS OF THE COMMUNITY WAS AN IMPORTANT COMPONENT OF THE CHNA AND CHIP PLANNING PROCESS. MCH&HS LEADERS PARTICIPATED IN THE FORUM AND COMMUNITY DIALOGUE TO REVIEW THE CHNA AND IDENTIFY COMMUNITY HEALTH PRIORITIES, ASSETS AND GAPS IN WASHINGTON COUNTY. THE CHNA HAS ALSO BEEN SHARED WITH THE MEMORIAL COMMUNITY HOSPITAL & HEALTH SYSTEM BOARD OF DIRECTORS. THE MCH&HS CHNA IS LOCATED ON MCH&HS WEBSITE WWW.MCHHS.ORG AND THE FULL REPORT IS LOCATED AT WWW.THREERIVERSPUBLICHEALTH.ORG. MEMORIAL COMMUNITY HOSPITAL & HEALTH SYSTEM LEADERSHIP USED THIS CHNA DURING ITS ANNUAL STRATEGIC AND BUDGETING AND PROVIDED A MEMORIAL COMMUNITY HOSPITAL & HEALTH SYSTEM IMPLEMENTATION PLAN TO ADDRESS THE PRIORITIZED HEALTH NEEDS. MEMORIAL COMMUNITY HOSPITAL PART V, SECTION B, LINE 6A: FREMONT AREA MEDICAL CENTER & SAUNDERS COUNTY COMMUNITY HOSPITAL MEMORIAL COMMUNITY HOSPITAL PART V, SECTION B, LINE 6B: THREE RIVERS HEALTH DEPARTMENT MEMORIAL COMMUNITY HOSPITAL PART V, SECTION B, LINE 11: IN 2024, MEMORIAL COMMUNITY HOSPITAL & HEALTH SYSTEM (MCH) CONTINUED ITS COMMITMENT TO SUPPORTING BEHAVIORAL HEALTH AND PROMOTING HEALTHY LIFESTYLES ACROSS DODGE, SAUNDERS, AND WASHINGTON COUNTIES. THROUGH EDUCATION, OUTREACH, AND STRATEGIC PARTNERSHIPS, MCH STRENGTHENED ITS ROLE IN IMPROVING ACCESS TO CARE, RAISING AWARENESS, AND ENCOURAGING OVERALL COMMUNITY WELLNESS.BEHAVIORAL HEALTH INITIATIVES MIND MATTERS BLOG SERIES - LAUNCHED ON JANUARY 5, 2024, MIND MATTERS FEATURED TWICE-MONTHLY BLOG POSTS FOR SEVEN MONTHS, PROVIDING EDUCATIONAL CONTENT FOCUSED ON STRESS MANAGEMENT, COPING SKILLS, AND REDUCING THE STIGMA SURROUNDING MENTAL HEALTH. BEHAVIORAL HEALTH MESSAGING CAMPAIGN - BEGINNING IN JANUARY, MENTAL HEALTH AWARENESS MESSAGES WERE DISPLAYED ON DIGITAL LOBBY MONITORS THROUGHOUT MCH FACILITIES. THE CAMPAIGN ENCOURAGED OPEN CONVERSATIONS ABOUT BEHAVIORAL HEALTH AND CONNECTED COMMUNITY MEMBERS TO AVAILABLE RESOURCES. SENIOR LIFE SOLUTIONS (SLS) OUTREACH - OUTREACH EFFORTS CONTINUED THROUGH COMMUNITY DISPLAY TABLES HIGHLIGHTING SLS SERVICES AND INCREASED ENGAGEMENT THROUGH SOCIAL MEDIA TO EXPAND PROGRAM VISIBILITY AND PARTICIPATION. BEHAVIORAL HEALTH STAFFING & LEADERSHIP INVOLVEMENT- A SOCIAL WORKER WAS HIRED IN JUNE 2024 TO ENHANCE BEHAVIORAL HEALTH SUPPORT AND CONTINUITY OF CARE.- AMY Z. SERVED ON THE REGION VI BEHAVIORAL HEALTH ADVISORY COMMITTEE, REPRESENTING MCH IN REGIONAL PLANNING EFFORTS.- THE VICE PRESIDENT OF BEHAVIORAL HEALTH SERVICES AT CHI JOINED THE MCH HOSPITAL BOARD, STRENGTHENING COLLABORATION AND ALIGNMENT OF BEHAVIORAL HEALTH PRIORITIES.UNHEALTHY LIFESTYLES/OBESITY COMMUNITY EVENTS AND PARTNERSHIPS - MCH PARTICIPATED IN THE BIKE RODEO SAFETY EVENT, PROMOTING SAFE AND HEALTHY HABITS FOR LOCAL YOUTH. ADDITIONALLY, MCH SPONSORED A 9 SQUARE GAME FOR BLAIR COMMUNITY SCHOOLS' ELEMENTARY PHYSICAL EDUCATION PROGRAM TO ENCOURAGE PHYSICAL ACTIVITY AND TEAMWORK. HEALTH FAIR PLANNING - A COMMUNITY HEALTH FAIR WAS ORIGINALLY SCHEDULED FOR OCTOBER 19, 2024, BUT WAS POSTPONED TO SPRING 2025 TO ALLOW FOR EXPANDED PLANNING AND OUTREACH FOLLOWING STAFF TRANSITIONS.MCH'S 2024 EFFORTS REFLECT A CONTINUED DEDICATION TO IMPROVING BEHAVIORAL HEALTH ACCESS AND SUPPORTING HEALTHY LIVING WITHIN THE COMMUNITY. FROM EDUCATIONAL CAMPAIGNS TO ACTIVE LEADERSHIP PARTICIPATION AND COMMUNITY PARTNERSHIPS, MCH REMAINS FOCUSED ON FOSTERING RESILIENCE, PROMOTING WELLNESS, AND BUILDING A HEALTHIER FUTURE FOR ALL RESIDENTS. MEMORIAL COMMUNITY HOSPITAL PART V, SECTION B, LINE 13B: THE AMOUNT OF FINANCIAL ASSISTANCE WRITE-OFF FOR MEMORIAL COMMUNITY HOSPITAL AND HEALTH SYSTEM IS BASED ON A FINANCIAL ASSISTANCE SLIDING FEE SCHEDULE UTILIZING A DERIVATIVE OF THE CURRENT US DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT (HUD) VERY LOW INCOME GUIDELINES, WHICH ARE UPDATED ANNUALLY. FINANCIAL ASSISTANCE MAY ALSO BE GRANTED IN CERTAIN CIRCUMSTANCES INVOLVING A CATASTROPHIC OCCURRENCE RESULTING IN MEDICAL BILLS GROSSLY EXCEEDING THE PATIENT'S ABILITY TO PAY AND IN THESE SITUATIONS, THE PATIENT'S RESPONSIBILITY WILL BE LIMITED TO 30% OF THE FAMILY'S GROSS ANNUAL INCOME. SCHEDULE H, PART V, SECTION B, LINE 7B HTTPS://WWW.THREERIVERSPUBLICHEALTH.ORG/RESOURCES/DATA/COMMUNITY-HEALTH-IMPROVEMENT-PLAN-CHIP 3 1 - BLAIR CLINIC 812 NORTH 22ND STREET BLAIR NE 68008 PRIMARY CARE CLINIC 2 - FORT CALHOUN CLINIC 4929 COUNTY ROAD P-43 FORT CALHOUN NE 68023 PRIMARY CARE CLINIC 3 - COTTONWOOD CLINIC 3519 HIGHWAY 32 TEKAMAH NE 68061 PRIMARY CARE CLINIC PART I, LINE 3C: THE AMOUNT OF FINANCIAL ASSISTANCE WRITE-OFF FOR MEMORIAL COMMUNITY HOSPITAL AND HEALTH SYSTEM IS BASED ON A FINANCIAL ASSISTANCE SLIDING FEE SCHEDULE UTILIZING A DERIVATIVE OF THE CURRENT US DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT (HUD) VERY LOW INCOME GUIDELINES, WHICH ARE UPDATED ANNUALLY. DESIGNEES OF MCH HELP PATIENTS SEEK REIMBURSEMENT FROM LOCAL, STATE, AND FEDERAL PROGRAMS AT NO CHARGE TO THE PATIENT WHEN THERE IS NO OTHER SOURCE OF PAYMENT. AFTER THESE EFFORTS/RESOURCES HAVE BEEN EXHAUSTED, PATIENTS ARE ASSISTED IN THE APPLICATION PROCESS FOR FINANCIAL ASSISTANCE. THE APPLICATION PROCESS INCLUDES COMPLETING A PERSONAL FINANCIAL APPLICATION AND PROVIDING VERIFICATION DOCUMENTS. THESE VERIFICATION DOCUMENTS MAY INCLUDE, BUT ARE NOT LIMITED TO, RECEIVING A COPY OF THE APPLICANT'S FEDERAL TAX RETURN, PAY STUB, BANK STATEMENTS, A CALL TO EMPLOYERS, OR A CREDIT REPORT, THE APPLICANT'S NET WORTH AND/OR LIQUID ASSETS, AND REASONABLE HOUSEHOLD OR BUSINESS EXPENSES. FINANCIAL ASSISTANCE MAY ALSO BE GRANTED IN CERTAIN CIRCUMSTANCES INVOLVING A CATASTROPHIC OCCURRENCE RESULTING IN MEDICAL BILLS GROSSLY EXCEEDING THE PATIENT'S ABILITY TO PAY AND IN THESE SITUATIONS, THE PATIENT'S RESPONSIBILITY WILL BE LIMITED TO 30% OF THE FAMILY'S GROSS ANNUAL INCOME. PART I, LINE 7: THE COSTING METHODOLOGY USED TO CALCULATE THE AMOUNTS REPORTED IN THE TABLE WERE WORKSHEETS WITHIN THE SCHEDULE H INSTRUCTIONS. THE COST TO CHARGE RATIO USED IN THE CALCULATION WAS DERIVED FROM THE FILED 2024 COST REPORT. PART I, LINE 7G: MEMORIAL COMMUNITY HOSPITAL DOES NOT PROVIDE SUBSIDIZED HEALTH SERVICES. SCHEDULE H, PART I, LINE 6A MEMORIAL COMMUNITY HOSPITAL PRODUCES A COMMUNITY BENEFIT REPORT THAT IS SENT TO THE NEBRASKA HOSPITAL ASSOCIATION FOR DATA COLLECTION PURPOSES. PART II, COMMUNITY BUILDING ACTIVITIES: IN 2024, MEMORIAL COMMUNITY HOSPITAL & HEALTH SYSTEM (MCH) CONTINUED TO STRENGTHEN ITS COMMITMENT TO COMMUNITY ENGAGEMENT, EDUCATION, AND SERVICE THROUGH A WIDE RANGE OF INITIATIVES DESIGNED TO CONNECT WITH RESIDENTS, SUPPORT LOCAL ORGANIZATIONS, AND PROMOTE WELLNESS THROUGHOUT WASHINGTON COUNTY AND BEYOND.MCH WELCOMED NUMEROUS HIGH SCHOOL AND COLLEGE STUDENTS FOR SHADOWING EXPERIENCES, PROVIDING VALUABLE EXPOSURE TO VARIOUS HEALTHCARE CAREERS AND HELPING INSPIRE THE NEXT GENERATION OF MEDICAL PROFESSIONALS. THE PATIENT AND FAMILY ADVISORY COUNCIL (PFAC) ALSO CONTINUED ITS IMPORTANT WORK, MEETING EVERY OTHER MONTH TO SHARE INSIGHTS AND GUIDE PATIENT-CENTERED IMPROVEMENTS.THROUGHOUT THE YEAR, MCH HOSTED 11 COMMUNITY LUNCH & LEARN SESSIONS, OFFERING FREE, EDUCATIONAL OPPORTUNITIES ON A VARIETY OF HEALTH AND WELLNESS TOPICS. ADDITIONALLY, TWO BABY EXPOS WERE HELD TO HIGHLIGHT MCH'S LABOR & DELIVERY SERVICES AND CONNECT EXPECTANT FAMILIES WITH LOCAL RESOURCES.IN PARTNERSHIP WITH THE AMERICAN RED CROSS, MCH ORGANIZED SIX COMMUNITY BLOOD DRIVES, HELD EVERY OTHER MONTH, HELPING ENSURE A STEADY AND RELIABLE LOCAL BLOOD SUPPLY. BEYOND HEALTHCARE, STAFF PROUDLY REPRESENTED MCH AT NUMEROUS COMMUNITY PARADES, CHAMBER OF COMMERCE EVENTS, AND SENIOR EXERCISE CLASSES, DEEPENING RELATIONSHIPS ACROSS THE REGION.MCH LEADERSHIP AND STAFF DEMONSTRATED EXCEPTIONAL COMMUNITY INVOLVEMENT BY SERVING ON KEY BOARDS AND COMMITTEES, INCLUDING THE WASHINGTON COUNTY CHAMBER BOARD, GATEWAY DEVELOPMENT BOARD, UNITED WAY BOARD, THE BRIDGE BOARD, AND THE WASHINGTON COUNTY EXTENSION BOARD. ADDITIONALLY, AN MCH TEAM MEMBER CONTINUED TO SERVE AS A CHAMBER AMBASSADOR, REPRESENTING THE ORGANIZATION IN LOCAL OUTREACH AND BUSINESS ENGAGEMENT.SERVICE EXTENDED BEYOND THE HOSPITAL WALLS, WITH STAFF VOLUNTEERING AT THE WASHINGTON COUNTY RECYCLING CENTER ON MULTIPLE OCCASIONS AND PARTICIPATING IN OR SPONSORING SEVERAL LOCAL GOLF TOURNAMENTS THAT BENEFITED ORGANIZATIONS SUCH AS THE LIONS CLUB, WASHINGTON COUNTY CHAMBER OF COMMERCE, AND THE FARMER'S DAY OFF TOURNAMENT.THESE EFFORTS UNDERSCORE MCH'S ONGOING DEDICATION TO BEING AN ACTIVE, ENGAGED COMMUNITY PARTNER PROMOTING HEALTH, CONNECTION, AND SERVICE IN EVERY CORNER OF THE REGION IT SERVES. PART III, LINE 2: COSTING METHODOLOGY FOR AMOUNTS REPORTED ON LINE 2 IS DETERMINED USING THE ORGANIZATION'S COST/CHARGE RATIO OF 61.71%. WHEN DISCOUNTS ARE EXTENDED TO SELF-PAY PATIENTS, THESE PATIENT ACCOUNT DISCOUNTS ARE RECORDED AS A REDUCTION IN REVENUE, NOT AS BAD DEBT EXPENSE. PART III, LINE 3: COMMUNITY MEMORIAL HOSPITAL DOES NOT BELIEVE THAT ANY PORTION OF BAD DEBT EXPENSE COULD REASONABLY BE ATTRIBUTED TO PATIENTS WHO QUALIFY FOR FINANCIAL ASSISTANCE SINCE AMOUNTS DUE FROM THOSE INDIVIDUALS' ACCOUNTS WILL BE RECLASSIFIED FROM BAD DEBT EXPENSE TO CHARITY CARE WITHIN 30 DAYS FOLLOWING THE DATE THAT THE PATIENT IS DETERMINED TO QUALIFY FOR CHARITY CARE. PART III, LINE 4: THE AUDITED FOOTNOTES FOR MEMORIAL COMMUNITY HOSPITAL AND MEDICAL CENTER DO NOT CONTAIN FOOTNOTES RELATED TO BAD DEBT EXPENSE. BAD DEBT EXPENSE IS IDENTIFIED ON THE CONSOLIDATED STATEMENT OF OPERATION WHICH IS CONSISTENT WITH THE REPORTING PRACTICE OF OTHER HEALTH CARE ORGANIZATIONS. BAD DEBT EXPENSE AT 100% CHARGE VALUE WAS MULTIPLIED BY THE RATIO DERIVED FROM THE SCHEDULE H WORKSHEETS IN THE SCHEDULE H INSTRUCTIONS TO ARRIVE AT AN APPROXIMATE COST VALUE. PART III, LINE 8: MEMORIAL COMMUNITY HOSPITAL EXCLUDED MEDICARE SHORTFALLS FROM THE OVERALL COMMUNITY BENEFIT REPORT.THE MEDICARE CHARGES REPORTED ON LINE 5 AND LINE 6 ARE FROM THE 2024 FILED COST REPORT WHICH USED A COST TO CHARGE RATIO. PART III, LINE 9B: ALL ACCOUNTS MUST HAVE GONE THROUGH A MINIMUM OF THREE STATEMENT CYCLES ENSURING THE GUARANTOR HAS HAD TIME TO REVIEW AND PAY ON THE ACCOUNTS OWED ON. NO ACCOUNT WILL BE PREPARED FOR COLLECTIONS BEFORE IT HAS REACHED 121 DAYS FROM THE DATE OF POST DISCHARGE BILLING. ALL ACCOUNTS MUST HAVE ONE DOCUMENTED, ATTEMPTED PHONE CALL TO THE GUARANTOR. PATIENTS WILL BE GIVEN THE OPPORTUNITY TO APPLY FOR MCHHS' FINANCIAL ASSISTANCE PROGRAM IN THE EVENT THAT THEY ARE UNABLE TO MEET THEIR FINANCIAL OBLIGATIONS. THE FINANCIAL CLASS ON THE EFFECTED EPISODES WILL BE CHANGED TO "FA AND A FINAL ATTEMPT LETTER WHICH INCLUDES INFORMATION REGARDING THE MCH FINANCIAL ASSISTANCE PROGRAM AND IT'S AVAILABILITY TO QUALIFIED APPLICANTS WILL BE SENT INDICATING THAT A PAYMENT OR RESPONSE IS NECESSARY OR ELSE THE ACCOUNT WOULD BE SENT TO AN OUTSIDE AGENCY FOR COLLECTION ATTEMPTS. IF A PATIENT CONTACTS MCHHS TO INQUIRE ABOUT FINANCIAL ASSISTANCE AND THE ACCOUNT IS LESS THAN 240 DAYS, THEN ALL COLLECTION EFFORTS WILL BE CEASED AND THE PATIENT WILL BE GIVEN 2 WEEKS TO COMPLETE AND RETURN THE REQUIRED APPLICATION AND DOCUMENTS. SHOULD THE PATIENT NOT QUALIFY AND/OR NOT RETURN THE REQUIRED APPLICATION, THEN COLLECTION EFFORTS SHALL RESUME. SHOULD PATIENTS COMPLETE AND RETURN THE REQUIRED APPLICATION AND DOCUMENTS AT ANY TIME PRIOR TO 241 DAYS, THEN COLLECTION EFFORTS WILL CEASE UNTIL THE APPLICATION IS REVIEWED.MEMORIAL COMMUNITY HOSPITAL'S COLLECTION POLICY DOES CONTAIN PROVISIONS OF THE COLLECTION PRACTICES TO BE FOLLOWED FOR PATIENTS WHO ARE KNOWN TO QUALIFY FOR CHARITY CARE OR FINANCIAL ASSISTANCE. PART VI, LINE 2: MEMORIAL COMMUNITY HOSPITAL ASSESSES THE HEALTH CARE NEEDS OF THE COMMUNITIES IT SERVES THROUGH MULTIPLE CHANNELS INCLUDING COMMUNITY HEALTH FAIRS, WELLNESS PROGRAMS, PROVIDING OCCUPATIONAL HEALTH SERVICES, LISTENING TO PATIENT AND COMMUNITY VOICES AS WELL AS WATCHING NATIONAL TRENDS. PART VI, LINE 3: THERE ARE SEVERAL FINANCIAL ASSISTANCE ACCESS POINTS THROUGHOUT A PATIENT'S CARE CYCLE. BILLS CONTAIN FINANCIAL ASSISTANCE VERBIAGE, BROCHURES ARE AVAILABLE IN CLINICS AND THE HOSPITAL, AND THERE IS INFORMATION ON FINANCIAL ASSISTANCE POSTED AT REGISTRATION POINTS THROUGHOUT CLINICS AND THE HOSPITAL. INFORMATION ON THE MCH FINANCIAL ASSISTANCE POLICIES IS LOCATED AT WWW.MCHHS.ORG. DESIGNEES SUCH AS FINANCIAL COUNSELORS OF MCH HELP PATIENTS SEEK REIMBURSEMENT FROM LOCAL, STATE AND FEDERAL PROGRAMS AT NO CHARGE TO THE PATIENT, WHEN THERE IS NO OTHER SOURCE OF PAYMENT. AFTER THESE EFFORTS/RESOURCES HAVE BEEN EXHAUSTED, PATIENTS ARE ASSISTED IN THE APPLICATION PROCESS FOR FINANCIAL ASSISTANCE. PART VI, LINE 4: MEMORIAL COMMUNITY HOSPITAL AND HEALTH SYSTEM OF BLAIR, NEBRASKA SERVES BOTH WASHINGTON AND BURT COUNTIES IN NEBRASKA. WASHINGTON COUNTY NEBRASKA HAS AN ESTIMATED POPULATION OF 21,167 AND APPROXIMATELY 61% OF THE POPULATION IN WASHINGTON COUNTY IS CONSIDERED RURAL. CENSUS ESTIMATES SHOW THAT WASHINGTON COUNTY'S RACIAL AND ETHNIC MAKEUP IS 4.4% OF THE POPULATION AND ITS MEDIAN AGE IS 41.5 AS COMPARED TO THE STATE AT 36.6. THE MEDIAN HOUSEHOLD INCOME IS $83,491 COMPARED TO $73,360 FOR THE STATE OF NEBRASKA. IN WASHINGTON COUNTY, 25.6% OF SCHOOL AGE CHILDREN IN BLAIR, 14.1% IN FORT CALHOUN, AND 21.9 % IN ARLINGTON WERE ELIGIBLE FOR FREE OR REDUCED LUNCH BASED ON DATA FROM JUNE 2023, COMPARED TO 45.2% IN THE STATE. BURT COUNTY HAS A POPULATION OF 6,727 AND IT'S ETHNIC AND RACIAL MAKEUP IS 7% OF THE POPULATION. THE MEDIAN HOUSEHOLD INCOME IS $55,769. IN BURT COUNTY, 33.6% OF TEKAMAH SCHOOL AGE CHILDREN, 9.6 % IN OAKLAND/CRAIG AND 51.5% IN LYONS/DECATUR RECEIVED FREE OR REDUCED LUNCH AT SCHOOL. PART VI, LINE 5: MCH&HS PROMOTES THE HEALTH OF ITS COMMUNITY THROUGH FINANCIAL AND IN-KIND DONATIONS. BOARD OF DIRECTORS - THE BOARD OF DIRECTORS MANAGE THE AFFAIRS OF MEMORIAL COMMUNITY HOSPITAL IN BLAIR, NEBRASKA. THERE ARE SEVEN DIRECTORS WHO SERVE ON THE BOARD: THREE MEMBERS FROM THE COMMUNITY, THREE MEMBERS FROM CHI HEALTH AND ONE MEMBER FROM THE MCH&HS MEDICAL STAFF. THE BOARD OF DIRECTORS IS COMPROMISED OF INDIVIDUALS WHO ARE LEADERS IN THE FIELDS OF BUSINESS, HEALTHCARE, ACCOUNTING AND MEDICINE AND WHO UNDERSTAND THEIR ROLE IN PROVIDING STRONG CORPORATE GOVERNANCE. EMERGENCY DEPARTMENT - MEMORIAL COMMUNITY HEALTH HAS A FULL-TIME EMERGENCY DEPARTMENT THAT IS OPEN TO THE PUBLIC AND PROVIDES MEDICAL SCREENING, EXAMINATION, AND STABILIZING TREATMENT WITHIN THE CAPABILITIES AND CAPACITIES OF THE HOSPITAL REGARDLESS OF BUT NOT LIMITED TO THE PATIENT'S RACE, COLOR, SEX, AGE AND/OR ABILITY TO PAY. MCH&HS IS IN COMPLIANCE WITH THE FEDERAL EMTALA GUIDELINES. MEDICAL STAFF - MCH&HS MAINTAIN AN OPEN MEDICAL STAFF. ALL QUALIFIED MDS, DSO, OTHER HEALTHCARE PRACTITIONERS, AND MID-LEVEL PRACTITIONERS ARE ELIGIBLE TO APPLY FOR PRIVILEGES AT THE HOSPITAL. MCH&HS POLICY ON PHYSICIAN CREDENTIALING IS THAT NO INDIVIDUAL IS TO BE DENIED MEDICAL STAFF APPOINTMENT BASED ON SEX, RACE, CREED, COLOR OR NATIONAL ORIGIN. THE STANDARDS A PHYSICIAN MUST MEET FOR APPOINTMENT RELATE TO (1) EDUCATIONAL QUALIFICATION AND LICENSING, (2) PROFESSIONAL COMPETENCE, (3) CHARACTER, (4) ETHICAL STANDING, AND (5) ABILITY TO RELATE TO AND WORK WITH OTHERS. APPLICATIONS ARE REVIEWED AT SEVERAL LEVELS WITHIN THE ORGANIZATION. PHYSICIANS WHO HAVE BEEN GRANTED STAFF PRIVILEGES AUTOMATICALLY BECOME A MEMBER OF THE MEDICAL STAFF AT THE HOSPITAL FOR WHICH PRIVILEGES HAVE BEEN GRANTED. SCHEDULE H, PART VI, LINE 7 STATE FILING OF COMMUNITY BENEFIT REPORT: NE 0 0 0 1 1 0 0 0 0 KEVIN SISK MD PHYSICIAN 270966 0 240006 0 0 0 0 0 11423 0 522395 0 0 0 SEAN ERIKSON MD PHYSICIAN 287835 0 127407 0 0 0 0 0 12615 0 427857 0 0 0 SANTOSH KUMAR MD PHYSICIAN 384096 0 18806 0 0 0 0 0 12623 0 415525 0 0 0 JEREMY LEE MD PHYSICIAN 398195 0 8222 0 0 0 0 0 4768 0 411185 0 0 0 AMANDA DUXBURY MD PHYISICAN 253920 0 105041 0 0 0 0 0 11503 0 370464 0 0 0 JOHN SIMONSON MD BOARD MEMBER/PHYSICIAN 225327 0 84866 0 0 0 0 0 8846 0 319039 0 0 0 PART I, LINE 3 DURING THE CALENDAR YEAR 2024, COMPENSATION FOR THE CEO WAS ESTABLISHED AND PAID BY CHI HEALTH, AN UNRELATED ORGANIZATION. CHI HEALTH USED THE FOLLOWING METHODS TO ESTABLISH THE COMPENSATION: (1) COMPENSATION SURVEYS OR STUDIES AND (2) INDEPENDENT COMPENSATION CONSULTANT. PART I, LINE 5 ON A QUARTERLY BASIS, PHYSICIANS ARE ELIGIBLE FOR A BONUS IF THEIR OWN PERSONAL GROSS REVENUE PRODUCTION (WITH CERTAIN LIMITS ON WHAT IS INCLUDED) EXCEED A THRESHOLD. THEY THEN GET 40% OF THE AMOUNT OVER THAT GROSS REVENUE THRESHOLD. THEY ARE ALSO ELIGIBLE FOR A KEY PERFORMANCE INDICATOR (KPI) ANNUAL BONUS ONLY IF THE COMBINED EBIDA (MCH AND ITS RELATED ORGANIZATION) TARGET IS ACHIEVED. THE KPI ANNUAL BONUSES ARE NOT BASED ON THE PHYSICIANS' SALARIES BUT BASED ON HOW THEY PERFORM ON THE 6 METRICS OF THE KPI PLAN. MCH PHYSICIANS ARE ELIGIBLE FOR A KEY PERFORMANCE INDICATOR (KPI) ANNUAL BONUS ONLY IF THE COMBINED EBIDA (MCH AND ITS RELATED ORGANIZATION) TARGET IS ACHIEVED. THE KPI ANNUAL BONUSES ARE NOT BASED ON THE PHYSICIANS' SALARIES BUT BASED ON HOW THEY PERFORM ON THE 6 METRICS OF THE KPI PLAN. A HOSPITAL AUTH #1 OF WASHINGTON CNTY NE 521441599 2007-06-19 9250000 CONSTRUCTION OF FACILITY 0 0 0 B HOSPITAL AUTH #1 OF WASHINGTON CNTY NE 521441599 2008-05-22 8000000 CONSTRUCTION OF FACILITY 0 0 0 A 7437027 9493722 173747 9319975 0 0 1 1 B 5697968 8059333 65000 7994333 0 0 1 1 A 0 0 0 0 0 0 0 B 0 0 0 0 0 0 0 A 0 0 1 1 0 0 0 0 0 B 0 0 1 1 1 1 FNB OF OMAHA 201.000000000000 1 0 0 0 0 A 0 B 0 SCHEDULE K, PART I NOTE REGARDING THE REBATE COMPUTATION SINCE THE BOND PROCEEDS HAVE BEEN SPENT, A SPENDING EXCEPTION WAS MET, AND THE DEBT SERVICE FUND WAS OPERATED ON A BONA FIDE BASIS, NO FURTHER REBATE CALCULATIONS ARE NECESSARY. SCHEDULE K, PART I, COLUMN (A) BOND RENEWAL IN 2017, MEMORIAL COMMUNITY HOSPITAL AMENDED ITS 2007 BOND SERIES WITH A NEW INTEREST RATE OF 3.01%. FORM 990, PART VI, SECTION A, LINE 3 THE CEO AND CFO OF MEMORIAL COMMUNITY HOSPITAL CORPORATION (HOSPITAL) ARE PROVIDED BY CHI HEALTH. THE CEO & CFO ARE EMPLOYEES OF CHI HEALTH, AND THE HOSPITAL REIMBURSES CHI HEALTH FOR THEIR COMPENSATION AND BENEFITS. THE HOSPITAL PAYS CHI HEALTH A MANAGEMENT FEE EQUAL TO THE DIRECT COST OF THEIR COMPENSATION AND BENEFITS PLUS 10% OF EARNINGS BEFORE INTEREST, DEPRECIATION, AND AMORTIZATION. FORM 990, PART VI, SECTION A, LINE 6 CORPORATE MEMBERS MEMORIAL COMMUNITY HOSPITAL CORPORATION (HOSPITAL) HAS TWO MEMBERS - MEMORIAL COMMUNITY HEALTH SYSTEM, INC (MCHS) AND ALEGENT HEALTH - IMMANUEL MEDICAL CENTER (IMMANUEL). FORM 990, PART VI, SECTION A, LINE 7A BOARD MEMBERS THE HOSPITAL HAS A SEVEN MEMBER BOARD OF DIRECTORS. MCHS APPOINTS THREE OF THESE BOARD MEMBERS, IMMANUEL APPOINTS THREE, AND THE MEDICAL STAFF APPOINTS ONE MEMBER, WHO IS ALWAYS THE MEDICAL STAFF PRESIDENT. ALL OFFICIAL ACTIONS OF THE BOARD REQUIRE AN AFFIRMATIVE VOTE OF TWO-THIRDS OF THE ENTIRE BOARD OF DIRECTORS. A SIMPLE MAJORITY OF THE BOARD OF DIRECTORS CONSTITUTES A QUORUM FROM THE TRANSACTION OF BUSINESS. FORM 990, PART VI, SECTION B, LINE 11B NO REVIEW WAS OR WILL BE CONDUCTED. FORM 990, PART VI, SECTION B, LINE 12C ANNUALLY, EACH BOARD MEMBER SIGNS A CONFLICT OF INTEREST STATEMENT AND IS GIVEN A COPY OF THE CONFLICT OF INTEREST POLICY. THE CHAIRMAN OF THE BOARD REVIEWS THESE STATEMENTS AND ENSURES THAT BOARD MEMBERS EXCUSE THEMSELVES FROM DISCUSSIONS AT BOARD MEETINGS ON TOPICS WHERE THEY HAVE A CONFLICT OF INTEREST. FORM 990, PART VI, SECTION C, LINE 19 MEMORIAL COMMUNITY HOSPITAL'S AUDIT REPORT IS MADE AVAILABLE TO THE PUBLIC. THE CONFLICT OF INTEREST POLICY AND GOVERNING DOCUMENTS ARE NOT AVAILABLE TO THE PUBLIC. FORM 990, PART VI, SECTION B, LINE 16B JOINT VENTURE POLICY MEMORIAL COMMUNITY HOSPITAL HAS NOT FORMALLY ADOPTED A WRITTEN POLICY OR WRITTEN PROCEDURE REGARDING JOINT VENTURES. HOWEVER, MCH EVALUATES THE JOINT VENTURE BEFORE ENTERING INTO AN AGREEMENT, TO ENSURE THEY DO NOT ENTER INTO ANY JOINT VENTURE THAT WOULD JEOPARDIZE THE HOSPITALS' EXEMPT PURPOSE. FORM 990, PART VII, SECTION A, LINE 1A JENNIFER NEWBY & MANUELA BANNER'S COMPENSATION JENNIFER NEWBY & MANUELA BANNER ARE THE CFO AND CEO OF MEMORIAL COMMUNITY HOSPITAL, RESPECTFULLY, AND ARE PAID BY CHI HEALTH. MEMORIAL COMMUNITY HOSPITAL PAID CHI HEALTH FOR THEIR SERVICES PROVIDED. THEREFORE, JENNIFER NWEBY & MANUELA BANNER SHOW $0 REPORTABLE COMPENSATION FROM THE FILING ORGANIZATION AND FROM ANY RELATED ORGANIZATION AS THEY WERE DIRECTLY PAID BY CHI HEALTH. FORM 990, PART VII, SECTION A, LINE 5 DR. DRABEK PROVIDES MEDICAL DIRECTOR AND SURGICAL SERVICES TO MEMORIAL COMMUNITY HOSPITAL (MCH). DR. DRABEK IS AN EMPLOYEE OF ALEGENT CREIGHTON CLINIC WHO LEASES DR. DRABEK TO MCH ON A PART TIME BASIS. MCH PAYS ALEGENT CREIGHTON CLINIC FOR DR. DRABEK'S SERVICES. MEMORIAL COMMUNITY HOSPITAL FOUNDATION 810 N 22ND STREET BLAIR NE 68008 113660156 SUPPORT NE 501(C)(3) LINE 7 N/A 0 MEMORIAL COMMUNITY HEALTH SYSTEM 810 N 22ND STREET BLAIR NE 68008 470718840 HEALTH SYSTEM NE 501(C)(3) LINE 7 N/A 0 MCH AUXILIARY THRIFT SHOP 810 N 22ND STREET BLAIR NE 68008 470748162 AUXILIARY NE 501(C)(3) LINE 7 N/A 1 0 0 1 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0