Niobrara Valley Hospital

“The executive committee, consisting of the president and at least three other designated board members, has the ability to act on behalf of the governing body.”

“Niobrara valley hospital has a service contract with faith regional health services for management services.”

“The governing board reviews the form 990 and related schedules before the form is submitted to the irs. The form 990 is also reviewed by the administrator and the cfo.”

“Upon completion of each fiscal year, directors and management employees (responsible persons) are required to submit a signed conflict of interest disclosure statement. Responsible persons are also required to submit written signed acknowledgement affirming that he or she: 1) has received and read a copy of the conflict of interest policy, 2) agrees to comply with this policy and 3) understands that niobrara valley hospital is a charitable organization. In addition to the annual disclosure process, all responsible persons have a duty to immediately disclose any new or modified financial interest or relationship in writing to the executive committee chair or the administrator. Disclosures made under this shall be forwarded to the executive committee for evaluation and decision regarding the potential existence of a conflict of interest.”

“The nebraska hospital association salary survey was used for comparison.”

“The organization does not make its governing documents, conflict of interest policy or financial statements available to the public.”

“Other fees for service: program service expenses 197,656. Management and general expenses 58,238. Fundraising expenses 0. Total expenses 255,894. Emergency room physicians: program service expenses 122,306. Management and general expenses 0. Fundraising expenses 0. Total expenses 122,306. Consulting services: program service expenses 872,060. Management and general expenses 19,219. Fundraising expenses 0. Total expenses 891,279. Recruitment fees: program service expenses 2,500. Management and general expenses 13,139. Fundraising expenses 0. Total expenses 15,639.”

“The hospital administrator is paid by faith regional health services, an unrelated entity. The compensation for this individual is reported on part ix, line 11a, column c.”

“Change in interest in niobrara valley hospital foundation -20,693.”

“The board of directors of niobrara valley hospital assumes responsibility for oversight of the audit of the financial statements and the selection of the independent accountant. This process has not changed from the prior year.”