2026-08-12T09:43:18-05:00 2025-09-30 423603499 EIDE BAILLY ADVISORY LLC 14010 FNB PKWY STE 600 OMAHA NE 681545206 990 2024-10-01 470482234 CHADRON COMMUNITY HOSPITAL CORPORATION CHAD 3084320286 825 CENTENNIAL DR CHADRON NE 69337 JENNIFER L BROWN CFO 3084320286 2026-08-11 1 1 MEGAN L KOZIOL P01544037 4023302660 2026-08-11 2024 2025-03-06 01:10:19Z CHADRON COMMUNITY HOSPITAL AND HEALT JON REINERS 825 CENTENNIAL DR CHADRON NE 69337 36675017 0 X HTTPS://WWW.CHADRONHOSPITAL.COM/ X 1957 NE TO PROVIDE AND SUPPORT HEALTH CARE AND COMMUNITY SERVICE PROGRAMS. 12 8 338 210 0 0 1819692 1588915 29816266 34576580 191025 1333 353676 324436 32180659 36491264 57000 89400 0 0 15437517 17125635 0 0 18905 17771382 20383167 33265899 37598202 -1085240 -1106938 30833911 30665119 15836772 16774918 14997139 13890201 X TO PROVIDE AND SUPPORT HEALTH CARE AND COMMUNITY SERVICE PROGRAMS OF EXCELLENCE IN THE COMMUNITIES WE SERVE. 0 0 34898891 89400 34616858 CHADRON COMMUNITY HOSPITAL CORPORATION OFFERS ACCESS TO CARE. INDIVIDUALS SHALL BE ACCORDED IMPARTIAL ACCESS TO TREATMENT OR ACCOMMODATIONS THAT ARE AVAILABLE, AND MEDICALLY INDICATED, REGARDLESS OF RACE, CREED, SEX, NATIONAL ORIGIN, HANDICAP, RELIGION, ABILITY TO PAY, OR SOURCES OF PAYMENT FOR CARE. DURING THE FISCAL YEAR CHADRON COMMUNITY HOSPITAL CORPORATION PROVIDED INPATIENT SERVICES AS FOLLOWS: PATIENT DAYS ADULT AND PEDIATRICS: 1,323 SWING BED - SKILLED: 493 NURSERY: 137 TOTAL: 1,953THE HOSPITAL ALSO OPERATES WESTERN COMMUNITY HEALTH RESOURCES (WCHR). THIS DEPARTMENT COLLABORATES WITH COMMUNITIES IN THE PROVISION OF QUALITY HEALTH AND HUMAN SERVICES. THE FOLLOWING PROGRAM AREAS ARE MANAGED WITHIN THE ORGANIZATION:- HEALTH - CONSISTS OF FAMILY REPRODUCTIVE HEALTH SERVICES, HIV EDUCATION AND TESTING, EVERY WOMAN MATTERS, DIABETES PREVENTION, PATIENT PRESCRIPTION ADVOCACY, AND IMMUNIZATION PROGRAMS.- BEHAVIORAL HEALTH - CONSISTS OF COMMUNITY SUPPORT SERVICES, SUPPORTED EMPLOYMENT, EMERGENCY COMMUNITY SUPPORT SERVICES, YOUTH TRANSITION SERVICES, AND MENTAL HEALTH OUTREACH/TELEHEALTH PROGRAMS.- NUTRITION - CONSISTS OF WOMEN, INFANTS, AND CHILDREN GRANT PROGRAM (WIC) AND COMMODITY SUPPLEMENTAL FOOD PROGRAMS.- FAMILY SERVICES - CONSISTS OF RESPITE, CAR SEAT SAFETY, EARLY DEVELOPMENT NETWORK, COMMUNITY ESSENTIALS PANTRY, AND CHILDREN'S OUTREACH PROGRAMS.- EDUCATION - CONSISTS OF SUICIDE PREVENTION, COMMUNITY ORGANIZING, CIRCLE OF SECURITY, FAST -FAMILIES & SCHOOLS TOGETHER, AND LOVE & LOGIC PROGRAMS.- OTHER - CONSISTS OF SMALLER GRANTS FOR HEALTHCARE SERVICES. 34898891 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 1 1 0 0 0 0 0 0 0 1 0 1 1 0 1 1 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 1 70 0 1 338 1 0 0 0 0 0 1 1 0 0 0 0 0 0 X 12 8 0 0 0 0 1 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X JENNIFER BROWN 3084320286 825 CENTENNIAL DRIVE CHADRON NE 69337 TONY HEITING PRESIDENT 1.00 X X 0 0 0 SHANE SHEPHERD 1ST VICE PRESIDENT 1.00 X X 0 0 0 LYNN WEBSTER 2ND VICE PRESIDENT 1.00 X X 0 0 0 LYNN MATHIS SECRETARY/TREASURER 1.00 X X 0 0 0 GARY BIEGANSKI TRUSTEE 1.00 X 0 0 0 MARK GRAVES TRUSTEE 1.00 X 0 0 0 NICHOLAS FISHER TRUSTEE 1.00 X 0 0 0 CHIP HARTMAN TRUSTEE 1.00 X 0 0 0 TY HULS TRUSTEE 1.00 X 0 0 0 CURT PLOOSTER TRUSTEE 1.00 X 0 0 0 JAMES NERUD TRUSTEE 1.00 X 0 0 0 AARON SPROCK TRUSTEE 1.00 X 0 0 0 JON REINERS CEO (FROM 01/2025) 40.00 X 0 0 0 JENNIFER BROWN CFO 40.00 X 174672 0 42615 SEAN WOLFE INTERIM CEO (THRU 01/2025) 40.00 X 0 0 0 BRENDA RHEMBRANDT VP OF PATIENT CARE 40.00 X 161840 0 49251 KEITH BLAYLOCK PHYSICAL THERAPIST/REHAB D 40.00 X 132032 0 47583 DANNY ANDERSON VP OF HR & SUPPORT SERVICES 40.00 X 127002 0 24478 LEAH FRYE PHARMACIST 40.00 X 141819 0 38234 JANET LACEY SURGERY DIRECTOR 40.00 X 159280 0 20661 896645 0 222822 17 0 1 0 MEDICAL SOLUTIONS PO BOX 850737 MINNEAPOLIS MN 554850737 CONTRACT STAFFING 2287365 CHADRON MEDICAL CLINIC PC PO BOX 431 CHADRON NE 69337 CONTRACT STAFFING - ED COVERAGE 767662 RURAL PARTNERS IN MEDICINE PO BOX 772519 STEAMBOAT SPRINGS CO 80477 SPECIALTY PROVIDERS 755546 RURAL PARTNERS IN MEDICINE HOLDINGS LLC 100 TECHNOLOGY DRIVE BUILDING C S BROOMFIELD SD 80021 IMPLANTABLES 211200 MIDWEST ANESTHESIA SERVICES LLC 133 LAKE AVENUE WORTHINGTON MN 56187 CRNA COVERAGE 109556 5 5450 58077 1104617 420771 1588915 PATIENT SERVICE REVENUE 621110 32204663 32204663 PRAIRIE PINES LODGE 623990 1651556 1651556 COMMUNITY HEALTH SERVICE 621110 449664 449664 270697 270697 34576580 149165 149165 178502 0 178502 178502 178502 21300 169132 -147832 -147832 -147832 7050 58077 14621 -7571 -7571 CAFETERIA REVENUE 722514 113227 113227 PHARMACY REVENUE 456110 40278 40278 153505 36491264 34616858 0 285491 X 89400 89400 255777 255777 322231 322231 13168563 12104300 1051538 12725 2378605 1926254 450387 1964 1000459 899346 100056 1057 86697 86697 65841 65841 88012 2313 85674 25 7112711 7056692 55737 282 121521 104935 16361 225 742322 645825 96497 593876 556455 37421 3776782 3567814 208409 559 118590 114685 3635 270 64561 62449 1976 136 392940 377222 15718 2150233 2052759 96925 549 544989 523309 21680 MEDICAL SUPPLIES 3814612 3813499 1113 DUES AND SUBSCRIPTIONS 267286 252820 14466 WHCR EXPENSES 238138 234503 3635 MINOR EQUIPMENT 201756 189872 11884 2300 2208 92 37598202 34898891 2680406 18905 5625652 3374455 1839884 1948742 6991662 6337188 596330 609113 280756 353090 47007760 35629707 12628538 11378053 1239116 1063336 1631973 5601142 30833911 30665119 3326335 5330394 11432996 10562735 1077441 881789 15836772 16774918 X 14688096 13567371 309043 322830 14997139 13890201 30833911 30665119 -1106938 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 3492 3492 0 PART II-B, LINE 1: CHADRON COMMUNITY HOSPITAL CORPORATION PAYS MEMBERSHIP DUES TO THE NEBRASKA HOSPITAL ASSOCIATION AND THE AMERICAN HOSPITAL ASSOCIATION. THE PORTION OF THE DUES PAID THAT ARE USED FOR LOBBYING PURPOSES IS $3,492. 202752 202752 33257156 26394375 6862781 12342084 9235332 3106752 1205768 1205768 11378053 ESTIMATED THIRD PARTY PAYOR SETTLEMENTS 5237553 RESTRICTED CASH 88896 RIGHT OF USE ASSET 274693 5601142 RESIDENT DEPOSITS - INDEPENDENT LIVING 88896 ESTIMATED THIRD PARTY PAYOR SETTLEMENTS 518200 LEASE LIABILITY 274693 881789 X 36505916 14652 14652 36491264 0 36491264 37612854 14652 14652 37598202 0 37598202 PART X, LINE 2: THE HOSPITAL ACCOUNTS FOR UNCERTAINTIES IN ACCOUNTING FOR INCOME TAX ASSETS AND LIABILITIES USING GUIDANCE INCLUDED IN TOPIC 740 OF THE ACCOUNTING STANDARDS CODIFICATION, INCOME TAXES. THE HOSPITAL RECOGNIZES THE EFFECT OF INCOME TAX POSITIONS ONLY IF THOSE POSITIONS ARE MORE LIKELY THAN NOT OF BEING SUSTAINED. AT SEPTEMBER 30, 2025 AND 2024, THE HOSPITAL HAD NO UNCERTAIN TAX POSITIONS ACCRUED. PART XI, LINE 2D - OTHER ADJUSTMENTS: FUNDRAISING EVENTS 14,652. PART XII, LINE 2D - OTHER ADJUSTMENTS: FUNDRAISING EVENTS 14,652. CIRCLE OF LIGHT GALA 8390 5990 2400 125 4155 800 144 CIRCLE OF LIGHT - SHOW THE LIGHT 56737 52087 4650 1325 8072 65127 58077 7050 125 5480 800 8216 14621 -7571 1 1 X 1 X 1 X 1 1 1 0 0 601000 601000 0.01600 4990460 4990460 5591460 4990460 601000 0.01600 2114062 1898391 215671 0.00570 5266339 2797486 2468853 0.06570 7380401 4695877 2684524 0.07140 12971861 9686337 3285524 0.08740 1 849289 135037 12836999 12812965 24034 X 1 1 1 1 CHADRON COMMUNITY HOSPITAL 825 CENTENNIAL DRIVE CHADRON NE 69337 HTTPS://WWW.CHADRONHOSPITAL.COM/ H000117 X X X X CHADRON COMMUNITY HOSPITAL 1 0 0 1 X X X X X X X X X 22 1 1 1 1 X HTTPS://WWW.CHADRONHOSPITAL.COM/PATIENT-INFORMATION/RESOURCES.HTML X 1 22 1 HTTPS://WWW.CHADRONHOSPITAL.COM/PATIENT-INFORMATION/RESOURCES.HTML 0 1 X 100.000000000000 250.000000000000 X X X X 1 1 X X X 1 X HTTPS://WWW.CHADRONHOSPITAL.COM/PATIENT-INFORMATION/FINANCIAL-SERVICES.HTML X HTTPS://WWW.CHADRONHOSPITAL.COM/PATIENT-INFORMATION/FINANCIAL-SERVICES.HTML X HTTPS://WWW.CHADRONHOSPITAL.COM/PATIENT-INFORMATION/FINANCIAL-SERVICES.HTML X X X X X 1 X 0 X 1 X 0 0 CHADRON COMMUNITY HOSPITAL PART V, SECTION B, LINE 5: CHADRON COMMUNITY HOSPITAL PARTNERS WITH PANHANDLE PUBLIC HEALTH DISTRICT FOR COMPLETING THE CHNA. PPHD FACILITATES A JOINT CHNA AND PLANNING PROCESS WITH EIGHT HOSPITALS IN THE NEBRASKA PANHANDLE, ALL OF WHICH ARE MEMBERS OF THE RURAL NEBRASKA HEALTHCARE NETWORK (RNHN). MULTIPLE REPRESENTATIVE AND COMMUNITY MEMBERS FROM THE PANHANDLE COMMUNITIES PARTICIPATE IN THE PROCESS. CHADRON COMMUNITY HOSPITAL PART V, SECTION B, LINE 6A: GORDON MEMORIAL HOSPITALMORRILL COUNTY COMMUNITY HOSPITALPERKINS COUNTY HEALTH SERVICESREGIONAL WEST GARDEN COUNTYREGIONAL WEST MEDICAL CENTERSIDNEY REGIONAL MEDICAL CENTER CHADRON COMMUNITY HOSPITAL PART V, SECTION B, LINE 6B: SCOTTS BLUFF COUNTY HEALTH DEPARTMENTKIMBALL HEALTH SERVICESPANHANDLE PARTNERSHIPPANHANDLE AREA DEVELOPMENT DISTRICTNEBRASKA DEPARTMENT OF HEALTH AND HUMAN SERVICES CHADRON COMMUNITY HOSPITAL PART V, SECTION B, LINE 11: THE MOST RECENTLY CONDUCTED CHNA IDENTIFIED THE FOLLOWING AS SIGNIFICANT NEEDS: RECREATIONAL OPPORTUNITIES, INCLUDING ACCESS TO TRANSPORTATION AND TYPES OF OPPROTUNITIES, INCREASING HEALTHY DIET AND PHYSICAL ACTIVITY INCLUDING ACCESS TO HEALTHY FOOD, AFFORDABLE HOUSING, AND BEHAVIORAL HEALTH INCLUDING SUBSTANCE MISUSE AND MENTAL HEALTH, AWARENESS OF OPTIONS AND REDUCING STIGMA. DURING THE YEAR, THE HOSPITAL ADDRESSED THESE NEEDS WITH BELOW LISTED ACTIONS:IMPROVE COMMUNITY RECREATION OPPORTUNITIES1. COMPLETED WALK AUDITS AROUND SCHOOLS AND COMMUNITY AND CREATED MAPS WITH SAFE ROUTES FOR DISTRIBUTION.2. CONTINUED WORK TO SUPPORT ENHANCING COMMUNITY BIKING INFRASTRUCTURE AND BIKING TRAILS.IMPROVE ACCESS TO BEHAVIORAL HEALTH RESOURCES1. EXPANDED PATIENT CAPACITY FOR BH SERVICES AT RURAL HEALTH CLINIC.2. ADDED VISITING PSYCHIATRIST IN HOSPITAL OUTPATIENT CLINIC.3. CONTINUED COLLABORATION WITH REGION TO DEVELOP CRISIS STABILIZATION CENTER TO ADDRESS EMERGENCY BEHAVIORAL HEALTH AND SUBSTANCE ABUSE NEEDS IN THE AREA.4. COMMUNITY HEALTH CLINIC OWNED BY THE HOSPITAL HAS CONTINUED TO OFFER CRISIS SUPPORT FOR INDIVIDUALS IN NEED, PARTICULARLY IN THE ER AWAITING PLACEMENT WITH A BH FACILITY.IMPROVE ACCESS TO AFFORDABLE HOUSING1. CONTINUED WORK WITH CITY OF CHADRON AS PART OF A BROWNFIELD GRANT TO ASSESS POSSIBLE HOUSING DEVELOPMENTS FOR VACANT PROPERTY THAT WAS THE SITE OF OUR OLD HOSPITAL.2. THE HOSPITAL CEO AND EXECUTIVE TEAM PARTICIPATE IN OPPORTUNITIES TO MEET WITH COMMUNITY GROUPS FOCUSED ON IMPROVING ACCESS TO AFFORDABLE HOUSING IN THE COMMUNITY, INCLUDING SERVING ON BOARDS FOCUSED ON ECONOMIC DEVELOPMENT, HOUSING AND CHILDCARE ACCESS.IMPROVE ACCESS TO HEALTHY FOOD1. CONTINUING PARTNERSHIPS WITH LOCAL PUBLIC SCHOOLS AND LOCAL STATE COLLEGE FOR INITIATIVES FOCUSED ON HEALTHY FOOD ACCESS AND CULINARY DEMONSTRATIONS.2. WE CONTINUE TO OFFER A FREE DIABETES PREVENTION CLASS TO MEMBERS OF THE COMMUNITY THAT FOCUSES ON HEALTHY EATING AND EXERCISES, INCLUDING RECIPES AND GROUP DISCUSSION. WE RECENTLY HAD OUR LARGEST CLASS YET FOR THIS PROGRAM.THERE WERE NO SIGINIFICANT NEEDS IDENTIFIED THAT ARE NOT CURRENTLY BEING ADDRESSED. 3 1 - PRAIRIE PINES LODGE 900 W 7TH ST CHADRON NE 69337 ASSISTED LIVING 2 - LEGEND BUTTES HEALTH SERVICES 11 PADDOCK ST CRAWFORD NE 69339 CLINIC SERVICES 3 - WESTERN COMMUNITY HEALTH SERVICES 300 SHELTON ST CHADRON NE 69337 COMMUNITY HEALTH SERVICES PART I, LINE 3C: OTHER THAN FEDERAL POVERTY GUIDELINES, THE HOSPITAL ALSO USES INSURANCE STATUS, UNDER INSURANCE STATUS, ASSET LEVEL AND MEDICAL INDIGENCY TO DETERMINE ELIGIBILITY FOR FREE OR DISCOUNTED CARE. 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, LINE 7B, AND SUBSIDIZED HEALTH SERVICES, LINE 7G, WERE CALCULATED USING THE COSTING METHODS TO PREPARE THE COST REPORTS. COMMUNITY HEALTH IMPROVEMENT SERVICES, LINE 7E, ARE REPORTED BASED ON ACTUAL EXPENSES REPORTED IN THE GENERAL LEDGER. PART I, LINE 7G: THERE ARE COSTS ATTRIBUTABLE TO A PHYSICIAN CLINIC INCLUDED ON LINE 7G. TOTAL REVENUE RECEIVED RELATED TO PHYSICIAN CLINICS INCLUDES $1,149,873 WITH ESTIMATED COSTS OF CARE RELATING TO PAYMENTS OF $2,186,806. 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 15.9% 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 14 AND 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.HOSPITAL SERVICES REIMBURSED ON A FEE SCHEDULE ARE NOT INCLUDED IN THE MEDICARE CALCULATION PER THE 990 INSTRUCTIONS. HAD THIS BEEN REPORTED, THE HOSPITAL WOULD HAVE HAD A GREATER LOSS FROM MEDICARE SERVICES OF $245,876.MEDICARE FEE SCHEDULE REVENUE $ 210,842MEDICARE ESTIMATED COSTS OF CARE RELATING TO PAYMENTS (456,718)NET (SHORTAGE) $ (245,876) PART III, LINE 9B: INDIVIDUALS THAT QUALIFY FOR FINANCIAL ASSISTANCE ARE ASSISTED THROUGH THE PROCESS. IF THEY QUALIFY FOR A DISCOUNT, RATHER THAN FULL WRITE-OFF, WE WORK WITH THEM TO SET UP A PAYMENT PLAN FOR THE REMAINING BALANCE. IF THEY ARE ABLE TO PAY OFF THE DEBT WITHIN 12 MONTHS, WE KEEP THE BALANCE IN-HOUSE. IF THEY ARE NOT ABLE TO, WE OFFER THEM A BANK LOAN OPTION. WE PARTNER WITH A COMPANY CALLED ENCORE FOR PRE-COLLECT/ 501R COMPLIANCE AND A SEPARATE COLLECTION AGENCY FOR AFTER AN ACCOUNT RUNS THROUGH PRE-COLLECT WITH NO RESPONSE.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. 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. PART VI, LINE 2: CCH HAS A BOARD OF 12 MEMBERS, INCLUDING REPRESENTATIVES FROM THE MEDICAL STAFF AND NEIGHBORING COMMUNITIES. IN ADDITION TO THE CHNA, THE BOARD REPRESENTATIVES ARE THE VOICE OF THE COMMUNITY'S HEALTH CARE NEEDS. ADDITIONALLY, WE ENCOURAGE STAFF TO BE STEWARDS IN THE COMMUNITY AND THIS NATURALLY OPENS THE DOOR FOR CONVERSATIONS RELATED TO COMMUNITY NEEDS. MEMBERS OF OUR EXECUTIVE TEAM SERVE ON BOARDS THROUGHOUT THE COMMUNITY IN ORDER TO STAY CONNECTED TO COMMUNITY NEEDS SUCH AS HOUSING, CHILDCARE AND FOOD INSECURITY. PART VI, LINE 3: THE HOSPITAL NOTIFIES PATIENTS OF THE FINANCIAL ASSISTANCE POLICY (FAP) IN MULTIPLE WAYS: SIGNS POSTED THROUGHOUT THE HOSPITAL, DISTRIBUTING A PLAIN LANGUAGE SUMMARY BEFORE DISCHARGE, INCLUDING A PLAIN LANGUAGE SUMMARY OF THE POLICY WITH EACH BILL, POSTING THE POLICY ON THE HOSPITAL WEBSITE, AND COMMUNICATING THE FAP VERBALLY TO PATIENTS. THE HOSPITAL ADDED AN INDIVIDUAL IN THE BILLING OFFICE WHOSE TIME IS DEDICATED TO FINANCIAL ASSISTANCE AND COUNSELING. THIS HAS GREATLY INCREASED THE NUMBER OF COMPLETED FINANCIAL ASSISTANCE APPLICATIONS THAT WE ARE RECEIVING. PART VI, LINE 4: CHADRON COMMUNITY HOSPITAL SERVES THE NORTHWEST CORNER OF NEBRASKA, INCLUDING THE COUNTIES OF DAWES, SIOUX, AND SHERIDAN, AND THE COMMUNITIES OF HARRISON, CRAWFORD, CHADRON, HAY SPRINGS, AND RUSHVILLE. IN ADDITION, DUE TO THE FARMING AND RANCHING ECONOMY, THE HOSPITAL SERVES A GREAT DEAL OF RURAL RESIDENTS. AT $51,925, HOUSEHOLD INCOME IN THE COUNTY IS WELL BELOW THE MEDIAN FOR BOTH NEBRASKA AND THE NATION. APPROXIMATELY 13.1% OF DAWES COUNTY RESIDENTS ARE BELOW THE POVERTY LINE. PART VI, LINE 5: THE HOSPITAL PARTICIPATES IN SEVERAL ACTIVITES TO PROMOTE THE HEALTH OF THE COMMUNITY, INCLUDING PARTICIPATING IN AND PROMOTING EMPLOYEE WELLNESS INITIATIVES, ADVANCED DIRECTIVE EDUCATION FOR THE COMMUNITY, PROVIDING INFLUENZA VACCINATIONS TO FIRST RESPONDERS AND EDUCATORS, FREE IN-HOME WELL BABY CHECKS TO LOW INCOME PATIENTS, FREE DIETARY COUNSELING AND DIABETIC EDUCATION, LOW-COST MAMMOGRAPHY TO QUALIFYING PATIENTS, FREE COMMUNITY PRENATAL CLASSES, SUPPORT GROUPS RUN BY HOSPITAL PROFESSIONALS, AND FINANCIAL ASSISTANCE TO AREA CANCER PATIENTS.RECOGNIZING THAT DIABETIC AND PRE-DIABETIC EDUCATION ARE A SIGNIFICANT NEED FOR OUR POPULATION, WE HAVE MADE THE DECISION TO OFFER THESE CONSULATIONS FREE OF CHARGE TO OUR COMMUNITY. ADDITIONALLY WE MAKE THE EFFORT TO OFFER SERVICES TO OUR REGION THAT ARE NEEDED BUT MAY NOT BE REVENUE CENTERS, SUCH AS DIALYSIS AND HOME HEALTH AND HOSPICE SERVICES. OUR BOARD SUPPORTS THE CONTINUATION OF THESE SERVICES EVEN IF THEY ARE NOT SELF-SUPPORTING. 1 CANCER PATIENT GRANT 37 89400 PART I, LINE 2: THE HOSPITAL MAINTAINS DETAILED RECORDS TO SUBSTANTIATE THE AMOUNT OF AWARDS TO GRANTEES. A FORMAL APPLICATION IS COMPLETED BY POTENTIAL GRANTEES AND SUBMITTED TO THE HOSPITAL. APPLICATIONS ARE REVIEWED AND GRANTS ARE AWARDED BASED ON ELIGIBILITY AND FINANCIAL NEED. X X 0 0 0 0 0 0 0 0 0 JENNIFER BROWN CFO 174438 0 0 0 234 0 1793 0 40822 0 217287 0 0 0 BRENDA RHEMBRANDT VP OF PATIENT CARE 161635 0 0 0 205 0 5230 0 44021 0 211091 0 0 0 LEAH FRYE PHARMACIST 141709 0 0 0 110 0 4296 0 33938 0 180053 0 0 0 JANET LACEY SURGERY DIRECTOR 153599 0 5250 0 431 0 712 0 19949 0 179941 0 0 0 KEITH BLAYLOCK PHYSICAL THERAPIST/REHAB D 131303 0 0 0 729 0 4283 0 43300 0 179615 0 0 0 DANNY ANDERSON VP OF HR & SUPPORT SERVICES 126858 0 0 0 144 0 3899 0 20579 0 151480 0 0 0 SCHEDULE J, PART II: THE ORGANIZATION PAID COMMUNITY HOSPITAL (MCCOOK), AN UNRELATED ORGANIZATION, $86,697 FOR MANAGEMENT SERVICES PROVIDED BY SEAN WOLFE, INTERIM CEO THROUGH JANUARY 2025. JESSICA HARTMAN SPOUSE OF BOARD MEMBER 89297 EMPLOYEE WAGES 0 SHELLEY GRAVES SPOUSE OF BOARD MEMBER 92890 EMPLOYEE WAGES 0 KRISTLE SPROCK SPOUSE OF BOARD MEMBER 140045 EMPLOYEE WAGES 0 SDS CONSTRUCTION OWNED BY SHANE SHEPHERD, BOARD MEMBER 193472 CONSTRUCTION SERVICES 0 FORM 990, PART VI, SECTION A, LINE 1A THE EXECUTIVE COMMITTEE, COMPOSED OF THE PRESIDENT, FIRST VICE PRESIDENT, SECOND VICE PRESIDENT, SECRETARY/TREASURER AND IMMEDIATE PAST PRESIDENT, HAS THE POWER TO TRANSACT ALL REGULAR BUSINESS OF THE CORPORATION DURING THE INTERIM BETWEEN MEETINGS OF THE BOARD OF TRUSTEES, PROVIDED THAT ANY ACTION WHICH IT MAY TAKE SHALL NOT CONFLICT WITH THE POLICIES AND EXPRESS WISHES OF THE BOARD. FORM 990, PART VI, SECTION A, LINE 6 THERE IS ONLY ONE CLASS OF MEMBERS. THESE ARE PERSONS THAT HAVE CONTRIBUTED $50 OR MORE TO THE CORPORATION AND SHALL BE CARRIED ON THE RECORDS OF THE CORPORATION AS SUCH. IF $100 IS CONTRIBUTED FOR A HUSBAND AND WIFE, THEY EACH SHALL BE ENTITLED TO SEPARATE AND INDIVIDUAL MEMBERSHIPS. FORM 990, PART VI, SECTION B, LINE 11B THE 990 IS GENERALLY REVIEWED BY THE CEO AND CFO AND THEN A FULL COPY IS PROVIDED TO THE BOARD IN THEIR BOARD PACKET. FORM 990, PART VI, SECTION B, LINE 12C BOARD MEMBERS COMPLETE CONFLICT OF INTEREST DISCLOSURES ANNUALLY. BOARD MEMBERS DECLARE ANY CONFLICTS OF INTEREST AT THE BEGINNING OF EACH BOARD MEETING. ANY BOARD MEMBER DETERMINED TO HAVE A CONFLICT SHALL REFRAIN FROM VOTING ON THAT MATTER. FORM 990, PART VI, SECTION B, LINE 15 COMPARABILITY DATA FROM THE NHA SALARY SURVEY IS USED TO DETERMINE THE APPROPRIATE RANGE OF COMPENSATION FOR THE CEO. APPROPRIATE COMPENSATION IS THEN DETERMINED BASED ON PERFORMANCE AND EXPERIENCE. ALL DELIBERATIONS AND DECISIONS ARE DOCUMENTED BY THE BOARD OF DIRECTORS. COMPENSATION FOR OTHER OFFICERS AND KEY EMPLOYEES IS DETERMINED BY THE CEO AND INCLUDED IN THE BUDGET APPROVED BY THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART IX, LINE 11G OTHER FEES: PROGRAM SERVICE EXPENSES 3,244,505. MANAGEMENT AND GENERAL EXPENSES 55,737. FUNDRAISING EXPENSES 282. TOTAL EXPENSES 3,300,524. PHARMACY SERVICES: PROGRAM SERVICE EXPENSES 426,394. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 426,394. NURSING SERVICES: PROGRAM SERVICE EXPENSES 1,857,929. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,857,929. ANESTHESIA SERVICES: PROGRAM SERVICE EXPENSES 837,015. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 837,015. EMERGENCY ROOM SERVICES: PROGRAM SERVICE EXPENSES 690,849. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 690,849. FORM 990, PART XII, LINE 2C: THE BOARD OF DIRECTORS ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT AND SELECTION OF AN INDEPENDENT ACCOUNTANT. THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR.