2024-03-03T19:09:54-06:00 2023-04-30 450250958 EIDE BAILLY LLP 18081 BURT ST STE 200 OMAHA NE 680224722 990 2022-05-01 470388012 BRODSTONE MEMORIAL HOSPITAL BROD 4028793281 PO BOX 187 SUPERIOR NE 689781225 TREG VYZOUREK CEO 4028793281 2024-03-01 1 TREG VYZOUREK 999009999 1 MEGAN L KOZIOL CPA P01544037 4023302660 2024-03-01 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z BRODSTONE HEALTHCARE TREG VYZOUREK PO BOX 187 SUPERIOR NE 689781225 41913594 0 X WWW.BRODSTONEHEALTHCARE.ORG/ X 1927 NE TO DELIVER INPATIENT, OUTPATIENT AND AMBULATORY CARE. 6 6 274 7 0 0 4322669 2713464 38012449 38216831 207637 47630 74378 73896 42617133 41051821 95661 55379 0 0 17165789 19696607 0 0 70076 17356513 16915226 34617963 36667212 7999170 4384609 55268917 64397101 9739927 14622400 45528990 49774701 X OUR MISSION IS TO PROVIDE EXCEPTIONAL AND PROGRESSIVE HEALTHCARE TO THE COMMUNITIES WE SERVE. 0 0 21746478 52379 22335627 ANCILLARY SERVICES - BRODSTONE MEMORIAL HOSPITAL IS A 25 BED CRITICAL ACCESS HOSPITAL. SERVICES PROVIDED BY BRODSTONE INCLUDE ANESTHESIOLOGY, RADIOLOGY, CT SCANS, LABORATORY, BLOOD ADMINISTRATION, INHALATION THERAPY, SLEEP STUDIES, PHYSICAL AND OCCUPATIONAL THERAPY, SPEECH THERAPY, ELECTROCARDIOLOGY AND ECHOCARDIOLOGY, BEHAVIORAL HEALTH, CHEMOTHERAPY, NUCLEAR MEDICINE AND EMERGENCY SERVICES.DURING 2023, BRODSTONE HAD 1,844 EMERGENCY ROOM VISITS AND PERFORMED 692 SURGERIES. THE LABORATORY PERFORMED 57,744 TESTS AND PHYSICAL THERAPY SERVICES PROVIDED 12,745 TREATMENTS. 4822066 3634647 NURSING SERVICES - BRODSTONE MEMORIAL HOSPITAL IS A 25 BED CRITICAL ACCESS HOSPITAL. NURSING SERVICES WORK WITH THE MEDICAL STAFF TO DELIVER QUALITY, AFFORDABLE HEALTH CARE IN A CARING, SAFE AND COMPASSIONATE ENVIRONMENT TO ALL PATIENTS. BRODSTONE PROVIDED 1,205 PATIENT DAYS OF INPATIENT CARE AND 801 PATIENT DAYS OF SWING BED CARE IN 2023. 4295441 3298077 PHYSICIAN' CLINICS - BRODSTONE MEMORIAL HOSPITAL OWNS 3 RURAL HEALTH CLINICS IN SUPERIOR, NELSON, AND EDGAR, NE. THREE BOARD CERTIFIED FAMILY PRACTICE PHYSICIANS, THREE PA-C, AND THREE APRNS SERVE ALL AGES FROM CHILDREN TO SENIOR CITIZENS. ONE APRN IS PSYCHIATRIC-MENTAL HEALTH NP CERTIFIED TO PROVIDE BEHAVIORAL HEALTH SERVICES. IN ADDITION TO DIAGNOSING AND TREATING ILLNESS, THEY ALSO PROVIDE PREVENTIVE CARE, ROUTINE CHECKUPS, IMMUNIZATION AND SCREENING TESTS, AND HOSPITALIZATION AND NURSING HOME CARE, AND OBSTETRICS. THE CLINICS HAD 15,442 VISITS IN 2023. 2857661 3000 8948480 BRODSTONE'S PHARMACY DEPARTMENT PREPARES AND DISPENSES MEDICATION BY REVIEWING AND INTERPRETING PHYSICIAN ORDERS. THE PHARMACISTS DETECT THERAPEUTIC INCOMPATIBILITIES, ADVISE INTERVENTIONS, ANSWER QUESTIONS FROM HEALTH PROFESSIONALS, AND COUNSEL PATIENTS ON DRUG THERAPIES. 2857661 3000 8948480 33721646 1 1 0 1 0 0 0 0 0 1 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 54 0 1 274 1 0 0 0 0 0 0 0 0 0 0 0 0 X 6 6 1 0 0 0 0 0 0 1 0 0 0 1 1 1 1 1 1 1 1 0 X CRYSTAL WYATT 4028793281 520 EAST 10TH STREET SUPERIOR NE 68978 PAT MCCORD PRESIDENT 2.00 0.00 X X 0 0 0 JANET EGGERS VICE-PRESIDENT 2.00 0.00 X X 0 0 0 JUDY GROVE SECRETARY 2.00 0.00 X X 0 0 0 BETH SIEBECKER TREASURER 2.00 0.20 X X 0 0 0 JACKI PORTER DIRECTOR 2.00 0.20 X 0 0 0 ROYCE SCHOTT DIRECTOR 2.00 0.00 X 0 0 0 TREG VYZOUREK CEO 39.80 0.20 X 383785 0 69496 CRYSTAL WYATT CFO 39.80 0.20 X 118805 0 45295 TIMOTHY BLECHA MD PHYSICIAN 40.00 0.00 X 413767 0 44316 JULIE THEIS MD PHYSICIAN 40.00 0.00 X 393808 0 52158 MATTHEW GATLIN PA-C PHYSICIAN ASSISTANT 40.00 0.00 X 301779 0 39788 ROBERT LEIBEL MD PHYSICIAN 40.00 0.00 X 189693 0 45685 JASON HASS PA-C PHYSICIAN ASSISTANT 40.00 0.00 X 174104 0 47134 1975741 0 343872 27 0 1 0 BD CONSTRUCTION 209 E 6TH STREET KEARNEY NE 68848 CONSTRUCTION SERVICES 9279865 CARDINAL HEALTH-OWEN PHARMACY SERVICE 21377 NETWORK PLACE CHICAGO IL 60673 MEDICAL SERVICES 2877914 FOCUSONE SOLUTIONS LLC PO BOX 850861 MINNEAPOLIS MN 55485 CONTRACTED LABOR 1093072 RURAL PARTNERS IN MEDICINE LLC 8181 ARISTA PLACE SUITE 100 BROOMFIELD CO 80021 MEDICAL SERVICES 759705 GRAND ISLAND PAIN RELIEF CENTER PC 403 LEXINGTON CIRCLE GRAND ISLAND NE 68803 MEDICAL SERVICES 294000 10 286331 1680421 746712 2713464 NET PATIENT SERVICE REVENUE 621110 35094714 35094714 340B PHARMACY REVENUE 456110 2860314 2860314 261803 261803 38216831 372265 372265 537138 584009 277764 -46871 -277764 -324635 -324635 CAFETERIA REVENUE 900099 73896 73896 73896 41051821 38216831 0 121526 X 52379 52379 3000 3000 617381 617381 14466781 13878245 575418 13118 3606276 3453907 152369 1006169 934461 71708 99701 99701 96637 96637 36074 36074 4443166 4250487 192679 1006 1006 2255461 1900214 298917 56330 855847 794377 61470 324413 287835 36578 561916 529916 31372 628 107776 92302 15474 1731945 1483284 248661 272343 233226 39117 PHARMACY EXPENSES 3297448 3297448 MEDICAL SUPPLIES 2302968 2302968 MISCELLANEOUS EXPENSES 226248 226248 DIETARY FOOD & SUPPLIES 193412 193412 108865 33179 75686 36667212 33721646 2875490 70076 1675779 3095412 16035388 15434771 4097740 5066406 36539 90437 429931 404178 547072 558542 55103413 22762796 25927498 32340617 3886291 3929503 2632679 3477235 55268917 64397101 4478661 4925298 3477100 9116379 160691 0 1623475 580723 9739927 14622400 X 43852243 48076194 1676747 1698507 45528990 49774701 55268917 64397101 X 4384609 -46267 -92631 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 3316 3316 0 PART II-B, LINE 1: BRODSTONE MEMORIAL HOSPITAL PAID DUES TO THE AMERICAN HOSPITAL ASSOCIATION AND THE NEBRASKA HOSPITAL ASSOCIATION, A PORTION OF THE DUES WERE USED FOR LOBBYING ACTIVITIES. 1545374 30725 93698 29658 1452743 1733236 -95776 56892 35193 1545374 1443862 364430 55867 19189 1733236 1535156 -16648 44846 29800 1443862 1718248 68028 221036 30084 1535156 0.00000 1.00000 0.00000 1 0 117890 117890 22407511 11375636 11031875 14362279 11168824 3193455 18215733 218336 17997397 32340617 BENEFICIAL INTEREST IN TRUSTS 1452743 INTEREST RECEIVABLE 237 DEFERRED COMPENSATION 385399 ESTIMATED THIRD-PARTY PAYOR SETTLEMENTS 1443532 LEASE RIGHT OF USE 195324 3477235 DEFERRED COMPENSATION LIABILITIES 385399 LEASE LIABILITIES 195324 580723 X PART V, LINE 4: INTEREST EARNINGS MAY BE USED FOR OPERATIONS, HOWEVER THE PRINCIPLE IS TO BE MAINTAINED AS A PERMANENT ENDOWMENT. PART X, LINE 2: THE HOSPITAL ACCOUNTS FOR UNCERTAINTIES IN ACCOUNTING FOR INCOME TAX ASSETS AND LIABILITIES USING GUIDANCE INCLUDED IN FINANCIAL ACCOUNTING STANDARDS BOARD (FASB) ASC 740, INCOME TAXES. THE HOSPITAL RECOGNIZES THE EFFECT OF INCOME TAX POSITIONS ONLY IF THOSE POSITIONS ARE MORE LIKELY THAN NOT OF BEING SUSTAINED. AT APRIL 30, 2023 AND 2022, THE HOSPITAL HAD NO UNCERTAIN TAX POSITIONS ACCRUED. 1 1 X 1 X 1 X 1 1 0 1 1 230 162592 162592 0.00450 3212733 1898242 1314491 0.03660 230 3375325 1898242 1477083 0.04110 16 2091 83851 39168 44683 0.00120 64 111180 0 111180 0.00310 2 270 6200 6200 0.00020 18 2425 201231 39168 162063 0.00450 18 2655 3576556 1937410 1639146 0.04560 4500 6000 0 6000 0.00020 61 360 0 360 0.00000 4561 6360 6360 0.00020 1 734753 0 18252833 18403896 -151063 X 1 1 1 1 BRODSTONE MEMORIAL HOSPITAL 520 E 10TH SUPERIOR NE 68978 HTTPS://WWW.BRODSTONEHEALTHCARE.ORG/ 570001 X X X X BRODSTONE MEMORIAL HOSPITAL 1 0 0 1 X X X X X X X X X X 21 1 1 1 1 X HTTPS://WWW.BRODSTONEHEALTHCARE.ORG/PATIENTS/COMMUNITY-HEALTH-NEEDS-ASSESSM X 1 21 1 HTTPS://WWW.BRODSTONEHEALTHCARE.ORG/PATIENTS/COMMUNITY-HEALTH-NEEDS-ASSESSM 0 1 X 100.000000000000 200.000000000000 X X 1 1 X X X X X 1 X HTTPS://WWW.BRODSTONEHEALTHCARE.ORG/PATIENTS/FINANCE-SERVICES X HTTPS://WWW.BRODSTONEHEALTHCARE.ORG/PATIENTS/FINANCE-SERVICES X HTTPS://WWW.BRODSTONEHEALTHCARE.ORG/PATIENTS/FINANCE-SERVICES X X X X X 1 X 0 X X X X 1 X 0 0 BRODSTONE MEMORIAL HOSPITAL PART V, SECTION B, LINE 3J: THE REPORT INCLUDES A LIST OF MEASURES IN THE THREE YEAR PLAN (2021 THROUGH 2024) AND THE COMMUNITY HEALTH IMPROVEMENT PLAN (2021 THROUGH 2024) FIRST YEAR ENDED 4/30/2022. THE PLAN INCLUDES PERFORMANCE MEASURES ALONG WITH STRATEGIES AND ACTIVITIES FOR THE PRIORITY AREAS OF ACCESS TO CARE, MENTAL HEALTH, SUBSTANCE MISUSE, OBESITY & RELATED HEALTH CONDITIONS, AND CANCER. BRODSTONE MEMORIAL HOSPITAL PART V, SECTION B, LINE 5: INCLUDED IN THE REPORT ARE RESULTS FROM A PUBLIC HEALTH SURVEY THAT WAS MADE AVAILABLE OVER A 4 COUNTY AREA (WEBSTER, ADAMS, CLAY AND NUCKOLLS), FOLLOWED BY A BROAD SPECTRUM OF STAKEHOLDERS THAT PARTICIPATED IN FOCUS GROUPS AND CONTRIBUTED TO EACH ASSESSMENT, DATA REVIEW, PRIORITY SETTING, AND STRATEGY MEETINGS. ITEMS FOR DISCUSSION WERE COST OF CARE AND INSURANCE, BARRIERS TO ACCESS, MENTAL HEALTH NEEDS AND OTHER SPECIFIC SERVICES NOT AVAILABLE IN THEIR COMMUNITY OR BARRIERS SUCH AS STIGMA, COST, LANGUAGE-RELATED THAT PREVENTED THEM FROM ACCESSING AVAILABLE SERVICES. THIS WAS A COLLABORATION BETWEEN SOUTH HEARTLAND DISTRICT HEALTH DEPARTMENT, NEBRASKA DEPARTMENT OF HEALTH AND HUMAN SERVICES OFFICE OF COMMUNITY AND RURAL HEALTH, UNITED WAY OF SOUTH CENTRAL NEBRASKA, MARY LANNING HEALTHCARE IN HASTINGS, AND BRODSTONE MEMORIAL HOSPITAL IN SUPERIOR. A REPORT FOR THE FIRST YEAR OF THE PLAN MAY BE FOUND ON THE WEBSITE BRODSTONEHEALTHCARE.ORG. BRODSTONE MEMORIAL HOSPITAL PART V, SECTION B, LINE 6A: BRODSTONE'S CHNA WAS CONDUCTED WITH MARY LANNING HEALTHCARE. BRODSTONE MEMORIAL HOSPITAL PART V, SECTION B, LINE 6B: BRODSTONE'S CHNA WAS CONDUCTED WITH SOUTH HEARTLAND DISTRICT HEALTH DEPARTMENT, NEBRASKA DEPARTMENT OF HEALTH AND HUMAN SERVICES OFFICE OF COMMUNITY AND RURAL HEALTH, AND UNITED WAY OF SOUTH-CENTRAL NEBRASKA. BRODSTONE MEMORIAL HOSPITAL PART V, SECTION B, LINE 11: THE STRATEGIES THAT WERE SCHEDULED FOR THIS YEAR ON OUR COMMUNITY HEALTH IMPROVEMENT PLAN THAT WERE ACCOMPLISHED ARE AS FOLLOWS:HEALTH PRIORITY GOAL #1: ACCESS TO CAREWE CONTINUE TO ENHANCE THE PATIENT PORTAL SERVICES AND INCREASE NEW SUBSCRIBERS ENDING THE YEAR WITH OVER 1845 PATIENTS USING THE SERVICE. WE ARE NOT ABLE TO AUTOMATE THE TEXTS WITH CURRENT SERVICE.CENTRALIZED SCHEDULING IS ALSO IN OUR FUTURE PLANS FOR BRODSTONE.SPECIALTY CLINIC EXPANSION IS AN ONGOING PROCESS. THIS YEAR WE HAVE INCREASED ORTHOPEDICS COVERAGE TO 8 DAYS PER MONTH AND PAIN MANAGEMENT TO 4 TIMES PER MONTH. TELEHEALTH ENDOCRINOLOGY WAS ADDED AND AS WELL AS AN ADDITIONAL CARDIOLOGIST. WE CONTINUE TO WORK TO ADD OTHER SPECIALTIES AND ADDITIONAL DAYS FOR EXISTING SERVICES.TO HELP IMPROVE THE FINANCIAL LITERACY AND UNDERSTANDING OF HEALTHCARE BILLING PROCESS, BRODSTONE HIRED 2 FULLTIME EMPLOYEES TO IMPLEMENT A GOVERNMENT MANDATED NO SURPRISE BILLING PROGRAM FOR PATIENTS WHO ARE UNINSURED OR UNDERINSURED TO HELP REDUCE PATIENTS BEING TURNED OVER TO COLLECTIONS. CURRENTLY EVALUATING EXPANSION OF TRANSPORTATION FOR OTHER AREAS OF NEED. A PATIENT ADVISORY TEAM WAS NOT IMPLEMENTED DUE TO COVID PRECAUTIONS. THIS WILL BE RE-EVALUATED IN THE NEXT YEAR.CURRENTLY IN DISCUSSION WITH SIX 3RD YEAR MEDICAL STUDENTS. THIS IS AN ONGOING PROCESS.OPERATING AN ACL PREVENTION PROGRAM IN SUPERIOR SCHOOLS AND DEVELOPED SCAT 5 CONCUSSION TESTING AND BASELINE SCREENING IN SOUTH CENTRAL USD #5 SANDY CREEK, SOUTH CENTRAL USD #5 LAWRENCE/NELSON AND SUPERIOR SCHOOLSDEVELOPED A BRODSTONE FIT PROGRAM OFFERING AN EARLY MORNING BOOT CAMP AND A WALKING CLUB 3 DAYS A WEEK FOR INDOOR ACTIVITY YEAR AROUND ENGAGING THE COMMUNITY OF SUPERIOR. WELLNESS ACTIVITIES FOR THE COMMUNITY INCLUDED ASSISTING SOUTH HEARTLAND HEALTH DISTRICT WITH FALL PREVENTION PROGRAM FOR SENIOR CITIZENS WHILE ALSO OFFERING SUPPORT AND RESOURCES TO AREA SCHOOLS.HEALTH PRIORITY GOAL #2: MENTAL HEALTHDEVELOPED NEW CRISIS SUPPORT GROUP THROUGH THRIVE BEHAVIOR HEALTH OUTPATIENT CLINIC IN RELATION TO MULTIPLE COMMUNITY CRISIS SITUATIONS; CONTINUING TO DEVELOP MENTAL HEALTH OUTPATIENT SERVICES TO HELP COMMUNITY AND STAFF.HEALTH PRIORITY GOAL #3: SUBSTANCE MISUSEWE HAVE NOT ADDRESSED THIS YET. WITHIN THE NEXT 3 YEARS, WE HAVE PLANS TO PARTNER WITH THE CITY OF SUPERIOR AND LOCAL SCHOOLS ADDRESSING SUBSTANCE MISUSE.EDUCATION WAS PROVIDED TO LAWRENCE/NELSON AND SANDY CREEK PUBLIC SCHOOLS ON VAPING MISUSE. INFORMATION PROVIDED TO ALL MIDDLE SCHOOL AND HIGH SCHOOL STUDENTS AT BOTH LOCATIONS.HEALTH PRIORITY GOAL #4: OBESITY & RELATED HEALTH CONDITIONSWE ARE EVALUATING AND FORMALIZING OUR TRANSITIONAL CARE PROGRAMS FOR COPD AND HEART FAILURE. DEVELOPED DAILY INTERDISCIPLINARY TEAM (IDT) MEETINGS THROUGHOUT FACILITY INVOLVING ALL CLINICAL PATIENT CARE DEPARTMENTS. ATTENDANCE IS AT 97%. CONTINUE TO PROVIDE PRE-EMPLOYMENT DRUG SCREENING AND EVALUATIONS WITH KINGSWOOD COURT IN SUPERIOR AND PARKVIEW HAVEN NURSING HOME IN DESHLER. WELLNESS ACTIVITIES FOR THE COMMUNITY IN THE LAST FISCAL YEAR INCLUDED TWO COMMUNITY WALK/RUN EVENTS, WALKING SCHOOL BUS (TWO SESSIONS: SPRING AND FALL).CONTINUING WITH HEALTHY LIVING PATIENTS; SAW 257 HEALTHY LIVING THERAPY POOL VISITS AND 392 THERAPY POOL VISITS.HEALTH PRIORITY GOAL #5: CANCEROUR OBJECTIVE WAS TO ACHIEVE ACO GOALS BY BEING MORE PROACTIVE WITH PATIENT WELLNESS VISITS AND SCREENINGS. A FAVORABLE OUTCOME WOULD BE A 10% INCREASE. WE WILL CONTINUE TO WORK ON INCREASING THE INDIVIDUAL SCREENINGS OF COLON, BREAST AND BMI. WE HAVE EDUCATED OUR STAFF FOR THE TOBACCO/VAPING CESSATION PROGRAM AND WILL PROMOTE THE PROGRAM IN THE NEXT FISCAL YEAR. OUTPATIENT CHEMO INFUSION PROGRAM SAW 6 NEW PATIENTS IN FY 2023. CONSTRUCTION ON NEW INFUSION SUITE IS ONGOING. 2 ADDITIONAL NURSES ARE WORKING TOWARDS CERTIFICATION. WELLNESS ACTIVITIES FOR THE COMMUNITY IN THE LAST FISCAL YEAR INCLUDED: PROVISION OF SUN SCREEN AND SUN SAFETY EDUCATION FOR 2 LOCAL GOLF COURSES, YOUTH GOLF CAMP, SOFTBALL TOURNAMENTS AND LOCAL POOLS; PRESENTED RISKS/PREVENTION OF VAPING FOR TWO LOCAL SCHOOLS. BRODSTONE MEMORIAL HOSPITAL PART V, SECTION B, LINE 13H: IN INSTANCES WHEN A PATIENT MAY APPEAR ELIGIBLE FOR FINANCIAL ASSISTANCE, BUT THERE IS NO FINANCIAL APPLICATION FORM ON FILE DUE TO A LACK OF SUPPORTING DOCUMENTATION, FINANCIAL ASSISTANCE MAY STILL BE GRANTED IN CERTAIN SITUATIONS BASED ON PRESUMPTIVE CIRCUMSTANCES. OFTEN THERE IS ADEQUATE INFORMATION PROVIDED BY THE PATIENT OR THROUGH OTHER SOURCES, WHICH COULD PROVIDE SUFFICIENT EVIDENCE TO PROVIDE THE PATIENT WITH FINANCIAL ASSISTANCE. IN THE EVENT THERE IS NO EVIDENCE TO SUPPORT A PATIENT'S ELIGIBILITY FOR FINANCIAL ASSISTANCE, BRODSTONE COULD USE OUTSIDE AGENCIES IN DETERMINING ESTIMATED INCOME AMOUNTS FOR THE BASIS OF DETERMINING FINANCIAL ASSISTANCE ELIGIBILITY AND POTENTIAL DISCOUNT AMOUNTS. PRESUMPTIVE ELIGIBILITY MAY BE DETERMINED IN CERTAIN SITUATIONS, AND BASED ON THE APPROVAL OF BRODSTONE'S MANAGEMENT, ON THE BASIS OF INDIVIDUAL LIFE CIRCUMSTANCES THAT MAY INCLUDE:A) STATE-FUNDED PRESCRIPTION PROGRAMS;B) TRANSIENT, HOMELESS OR RECEIVED CARE FROM A HOMELESS CLINIC, OR UNIDENTIFIED PERSONS;C) PARTICIPATION IN WOMEN, INFANTS AND CHILDREN PROGRAMS (WIC);D) FOOD STAMP ELIGIBILITY;E) ELIGIBILITY FOR OTHER STATE OR LOCAL ASSISTANCE PROGRAMS THAT ARE UNFUNDED (E.G., MEDICAID SPEND-DOWN);F) CRIME VICTIMS BILLED CHARGES AFTER STATE OR FEDERAL FUNDS HAVE PAID OR ARE EXHAUSTED;G) LOW INCOME/SUBSIDIZED HOUSING IS PROVIDED AS A VALID ADDRESS;H) PATIENT IS DECEASED WITH NO KNOWN ESTATE OR RESPONSIBLE PARTY; ANDI) PERSONS WHO INCOME IS AT OR BELOW 100% OF THE CURRENT POVERTY LEVEL. BRODSTONE MEMORIAL HOSPITAL PART V, SECTION B, LINE 15E: PATIENTS MAY APPLY FOR ASSISTANCE BY CALLING BRODSTONE MEMORIAL HOSPITAL AT 402-207-1539 AND REQUESTING A FINANCIAL ASSISTANCE APPLICATION; OR BY REQUESTING AN APPLICATION IN PERSON FROM REGISTRATION OR THE BUSINESS OFFICE. AN APPLICATION MAY BE DOWNLOADED FROM THE HOSPITAL'S WEBSITE. 3 1 - SUPERIOR FAMILY MEDICAL CENTER 525 E 11TH ST SUPERIOR NE 68978 RURAL HEALTH CLINIC 2 - NELSON FAMILY MEDICAL CENTER 76 W 8TH ST NELSON NE 68961 RURAL HEALTH CLINIC 3 - EDGAR MEDICAL CLINIC 315 N C ST EDGAR NE 68935 RURAL HEALTH CLINIC PART I, LINE 3C: IN INSTANCES WHEN A PATIENT MAY APPEAR ELIGIBLE FOR FINANCIAL ASSISTANCE, BUT THERE IS NO FINANCIAL APPLICATION FORM ON FILE DUE TO A LACK OF SUPPORTING DOCUMENTATION, FINANCIAL ASSISTANCE MAY STILL BE GRANTED IN CERTAIN SITUATIONS BASED ON PRESUMPTIVE CIRCUMSTANCES. SEE EXPLANATION FOR SCHEDULE H, PART V, SECTION B, LINE 13H. PART I, LINE 6A: BRODSTONE'S COMMUNITY BENEFIT REPORT IS NOT PREPARED BY A RELATED ORGANIZATION. PART I, LINE 7: THE COST TO CHARGE RATIO AS FOLLOWS WAS USED TO DETERMINE CHARITY CARE AND MEANS-TESTED GOVERNMENT PROGRAMS AT COST: (TOTAL EXPENSES - BAD DEBT) / GROSS PATIENT SERVICE REVENUE = PERCENTAGE OF COST TO CHARGE. OTHER COMMUNITY BENEFIT EXPENSES ARE STATED AT COST BASED ON BRODSTONE'S INTERNAL ACCOUNTING RECORDS. PART I, LINE 7G: THERE ARE NO COSTS ATTRIBUTABLE TO A PHYSICIAN CLINIC INCLUDED ON LINE 7G. PART I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 734,753. PART II, COMMUNITY BUILDING ACTIVITIES: BRODSTONE HAS MANY ACTIVITIES TO PROMOTE HEALTH IN THE COMMUNITIES SERVED. THESE ACTIVITIES INCLUDE: SPONSOR OF HEALTH FAIR, SUPPORT GROUPS, EDUCATION PROGRAMS AND MEDICATION ASSISTANCE. BRODSTONE HAS ADDED A WALKING CLUB TO PROMOTE WELLNESS. IN ADDITION, BRODSTONE HAS SUPPORTED NON-PROFIT ORGANIZATIONS THROUGH GRILLING FOR THEIR EVENTS. THIS HELPS BUILD RELATIONSHIPS WITHIN THE COMMUNITIES BRODSTONE SERVES. THE DONATED SERVICES AND FUNDS HELP FURTHER THE MISSION AND GOALS OF COMMUNITY ORGANIZATIONS WHICH, IN TURN, HELP IMPROVE OVERALL HEALTH STATUS AND QUALITY OF LIFE OF THE COMMUNITIES SERVED. PART III, LINE 2: THE HOSPITAL DETERMINES ITS ESTIMATE OF IMPLICIT PRICE CONCESSIONS BASED ON HISTORICAL COLLECTION EXPERIENCE WITH VARIOUS CLASSES OF PATIENTS. PART III, LINE 3: NO AMOUNT OF IMPLICIT PRICE CONCESSIONS IS CONSIDERED A COMMUNITY BENEFIT. PART III, LINE 4: THE HOSPITAL'S FINANCIAL STATEMENTS DO NOT CONTAIN A SPECIFIC FOOTNOTE DESCRIBING BAD DEBT. HOWEVER, PAGES 8, 10, 11, AND 12 OF THE ATTACHED AUDITED FINANCIAL STATEMENTS INCLUDE FOOTNOTES TITLED "PATIENT RECEIVABLES", "PATIENT SERVICE REVENUE AND "PATIENT FINANCIAL ASSISTANCE". PART III, LINE 8: "MEDICARE ALLOWABLE COSTS OF CARE" WAS CALCULATED FROM INFORMATION IN THE MEDICARE COST REPORT D, E, H & M WORKSHEETS, OR PS&R. THESE COSTS ARE MEDICARE REIMBURSABLE COSTS, NOT ALL COSTS. NO MEDICARE SHORTFALL IS TREATED AS COMMUNITY BENEFIT. PART III, LINE 9B: PATIENTS WHO QUALIFY FOR MEDICAID WILL AUTOMATICALLY QUALIFY FOR FINANCIAL ASSISTANCE AND MAY QUALIFY FOR MORE IF THEY COMPLETE THE FINANCIAL ASSISTANCE APPLICATION. THESE PATIENTS WILL NOT BE SENT TO COLLECTIONS IF THEY PAY THE AMOUNT FOR WHICH THEY QUALIFY.BRODSTONE'S POLICIES AND PROCEDURES FOR INTERNAL AND EXTERNAL COLLECTION PRACTICES TAKE INTO ACCOUNT THE EXTENT TO WHICH THE PATIENT QUALIFIES FOR CHARITY, A PATIENT'S GOOD FAITH EFFORT TO APPLY FOR A GOVERNMENTAL PROGRAM OR FOR CHARITY FROM THE HOSPITAL AND A PATIENT'S GOOD FAITH EFFORT TO COMPLY WITH HIS OR HER PAYMENT AGREEMENTS WITH THE HOSPITAL. FOR PATIENTS WHO QUALIFY FOR CHARITY AND WHO ARE COOPERATING IN GOOD FAITH TO RESOLVE THEIR BILLS, BRODSTONE MAY OFFER EXTENDED PAYMENT PLANS TO ELIGIBLE PATIENTS, WILL NOT IMPOSE WAGE GARNISHMENTS OR LIENS, WILL NOT SEND UNPAID BILLS TO OUTSIDE COLLECTION AGENCIES AND WILL CEASE ALL COLLECTION EFFORTS. PART VI, LINE 2: BRODSTONE ASSESSES THE HEALTH CARE NEEDS OF THE COMMUNITY IT SERVES THROUGH A SURVEY. THE BUDGETING PROCESS PUBLISHES SUGGESTIONS AND STRATEGIC PLANNING. HOSPITAL STAFF ALSO NETWORKS WITH OTHER HEALTH CARE ORGANIZATIONS TO DEVELOP IDEAS OF WHAT CAN BE DONE TO IMPROVE THE AVAILABILITY OF SERVICES IN THE COMMUNITY. PART VI, LINE 3: BRODSTONE HAS A BROCHURE CALLED CHARITY POLICY THAT ADDRESSESS THE FINANCIAL ASSISTANCE AVAILABILITY. IT IS POSTED AT THE ADMISSIONS AREAS AND EMERGENCY ROOM. THE CHARITY POLICY IS DISCUSSED WHEN MAKING PAYMENT ARRANGEMENTS. THIS POLICY IS ALSO AVAILABLE ON THE HOSPITAL'S WEBSITE. PART VI, LINE 4: SUPERIOR HAS A POPULATION OF 1,755 AND IS LOCATED ON THE NEBRASKA-KANSAS BORDER. BRODSTONE'S SERVICE AREA COVERS ALL OF NUCKOLLS COUNTY AND PARTS OF 2 OTHER COUNTIES IN NEBRASKA AND 3 COUNTIES IN KANSAS. THE MEDIAN HOUSEHOLD INCOME FOR NUCKOLLS COUNTY IS $43,388 COMPARED TO THE U.S. AVERAGE AT $62,843 AND THE NEBRASKA AVERAGE OF $61,439. THE AREA POPULATION IS PREDOMINATELY WHITE ELDERLY AND LOW INCOME. 49.6% OF THE HOSPITAL'S PATIENTS ARE MEDICARE PATIENTS. PART VI, LINE 5: BRODSTONE'S GOVERNING BODY CONSISTS OF INDIVIDUALS WITH NO IMMEDIATE FAMILY TIES TO ANY EMPLOYEE NOR ARE THEY CONTRACTORS OF THE ORGANIZATION. ALL BOARD MEMBERS HAVE SUPERIOR NEBRASKA ADDRESSES BUT 2 MEMBERS LIVE IN JEWELL COUNTY, KANSAS. ALL FAMILY PRACTICE PHYSIANS AND MIDLEVELS IN THE AREA WHO HAVE REQUESTED MEDICAL STAFF PRIVILEGES AND MEET THE REQUIREMENTS HAVE PRIVILEGES AT THE HOSPITAL. ONE DENTIST HAS COURTESY PRIVELEGES. ALL SURPLUS FUNDS OF THE ORGANIZATION ARE USED TO FUND THE BUDGET FOR THE COMING YEARS OR SET ASIDE FOR FUTURE PROJECTS. PART VI, LINE 6: BRODSTONE MEMORIAL HOSPITAL IS NOT PART OF AN AFFILIATED HEALTH CARE SYSTEM. PART VI, LINE 7: BRODSTONE DOES NOT FILE A COMMUNITY BENEFIT REPORT WITH ANY STATE. 1 BRODSTONE MEMORIAL HOSPITAL FOUNDATION 520 EAST 10TH STREET SUPERIOR NE 68978 851276014 501(C)(3) 52379 0 REIMBURSE FOUNDATION FOR FUNDRAISING EXPENSES AND CONTRIBUTE FUNDS FOR PROGRAM SUPPORT. 1 0 PART I, LINE 2: THE HOSPITAL ONLY GRANTS FUNDS TO ITS RELATED FOUNDATION. THEREFORE, IT IS ABLE TO MONITOR THE USE OF THE GRANT FUNDS. X X X X 0 0 0 1 0 0 0 0 0 TIMOTHY BLECHA MD PHYSICIAN 280119 0 131443 0 2205 0 12200 0 32116 0 458083 0 0 0 TREG VYZOUREK CEO 382847 0 0 0 938 0 32200 0 37296 0 453281 0 0 0 JULIE THEIS MD PHYSICIAN 292734 0 100822 0 252 0 12200 0 39958 0 445966 0 0 0 MATTHEW GATLIN PA-C PHYSICIAN ASSISTANT 251016 0 50597 0 166 0 12200 0 27588 0 341567 0 0 0 ROBERT LEIBEL MD PHYSICIAN 185635 0 2153 0 1905 0 7844 0 37841 0 235378 0 0 0 JASON HASS PA-C PHYSICIAN ASSISTANT 173639 0 230 0 235 0 7364 0 39770 0 221238 0 0 0 CRYSTAL WYATT CFO 118732 0 0 0 73 0 8816 0 36479 0 164100 0 0 0 PART I, LINE 5 IN ACCORDANCE WITH RELATED EMPLOYMENT CONTRACTS, ADDITIONAL COMPENSATION IS PAID BASED ON REVENUES GENERATED BY EACH MEDICAL PROVIDER, AS DEFINED. THESE ADDITIONAL AMOUNTS HAVE BEEN LISTED AS INCENTIVE COMPENSATION IN PART II OF THIS SCHEDULE. A THE CITY OF SUPERIOR NEBRASKA 476006376 2013-05-22 4000000 REFUND ISSUES (9/9/03, 9/10/09, 9/10/09) 0 0 0 B THE COUNTY OF NUCKOLLS NEBRASKA 476006492 2013-05-22 4000000 REFUND ISSUES (9/9/03, 9/10/09, 9/10/09) 0 0 0 C CITY OF SUPERIOR NEBRASKA 476006376 2019-12-12 10000000 CONSTRUCT AND EQUIP FACILITY 0 0 0 A 2430592 4000000 4000000 2010 1 0 1 1 B 2430592 4000000 4000000 2010 1 0 1 1 C 6225105 50001 6175104 0 0 0 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 B 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 C 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 A 0 0 0 1 0 0 0 0 1 B 0 0 0 1 0 0 0 0 1 C 0 1 0 0 1 0 0 0 1 A 1 B 1 C 1 SCHEDULE K, PART IV, LINE 2C: (A) ISSUER NAME: CITY OF SUPERIOR, NEBRASKA DATE THE REBATE COMPUTATION WAS PERFORMED: 08/07/2020 (B) ISSUER NAME: THE COUNTY OF NUCKOLLS, NEBRASKA DATE THE REBATE COMPUTATION WAS PERFORMED: 08/07/2020 NOTE REGARDING THE 8/7/2020 REBATE COMPUTATIONS: SINCE THE BOND PROCEEDS WERE SPENT ON THE ISSUE DATE, A SPENDING EXCEPTION WAS MET, AND THE DEBT SERVICE FUND WAS OPERATED ON A BONA FIDE BASIS, NO FURTHER REBATE CALCULATIONS ARE NECESSARY. PART II, LINE 3, COLUMN C - THE TOTAL PROCEEDS DO NOT AGREE TO THE ISSUE PRICE IN PART I, COLUMN (E) AS THIS DEBT WAS ISSUED ON A DRAW-DOWN BASIS AND THE TOTAL PRINCIPAL AVAILABLE HAS NOT YET BEEN DRAWN. FORM 990, PART VI, SECTION A, LINE 2 DIRECTORS JUDY GROVE AND JACKI PORTER HAVE A FAMILY RELATIONSHIP. FORM 990, PART VI, SECTION A, LINE 8B THERE ARE NO COMMITTEES WITH AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS PREPARED BY AN OUTSIDE ACCOUNTING FIRM. BEFORE IT IS FILED, IT IS GIVEN A DETAILED REVIEW BY MANAGEMENT AND THEN A GENERAL REVIEW BY THE BOARD OF DIRECTORS AT A REGULARLY SCHEDULED BOARD MEETING. A FINAL COPY OF THE FORM 990 WILL BE ELECTRONICALLY FILED AFTER APPROVAL. FORM 990, PART VI, SECTION B, LINE 12C BOARD MEMBERS WHO HAVE A CONFLICT OF INTEREST WOULD REFRAIN FROM DISCUSSION AND VOTING ON THOSE MATTERS. THERE IS AN ANNUAL BOARD MEMBER TRAINING THAT COVERS THIS POLICY. ADDITIONALLY, ALL BOARD MEMBERS ARE WELL ACQUAINTED WITH EACH OTHER SO IF THERE WAS A CONFLICT OF INTEREST AND THE BOARD MEMBER DID NOT DISCLOSE, THE OTHER BOARD MEMBERS WOULD BRING IT TO THE BOARD'S ATTENTION. FORM 990, PART VI, SECTION B, LINE 15 THE HUMAN RESOURCE DIRECTOR PREPARES A SALARY SURVEY ANNUALLY FOR ALL JOBS DESCRIPTIONS WITH HOSPITALS OF SIMILAR SIZE AND REVENUES. THE BOARD OF DIRECTORS REVIEWS THE SURVEY AND PRIOR SALARY INCREASES FOR THE CEO BEFORE GRANTING PAY INCREASES. THE HUMAN RESOURCE DIRECTOR AND CFO MAKE RECOMMENDATIONS TO THE CEO FOR OTHER EMPLOYEES. THE CEO REVIEWS THE SURVEY, PRIOR SALARY INCREASES, AND RECOMMENDATIONS BEFORE APPROVING PAY INCREASES FOR EMPLOYEES. THE PAY INCREASES ARE APPROVED BY THE BOARD OF DIRECTORS DURING THE BUDGET PROCESS. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION DOES NOT MAKE ITS GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY AVAILABLE TO THE PUBLIC, BUT FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. FORM 990, PART IX, LINE 11G PHARMACY: PROGRAM SERVICE EXPENSES 797,594. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 797,594. ANESTHESIA: PROGRAM SERVICE EXPENSES 582,993. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 582,993. LABORATORY: PROGRAM SERVICE EXPENSES 176,189. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 176,189. NUCLEAR MEDICINE: PROGRAM SERVICE EXPENSES 118,114. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 118,114. OTHER FEES FOR SERVICE: PROGRAM SERVICE EXPENSES 2,575,597. MANAGEMENT AND GENERAL EXPENSES 192,679. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,768,276. FORM 990, PART XI, LINE 9: CHANGE IN BENEFICIAL INTEREST IN TRUSTS -92,631. FORM 990, PART XII, LINE 2C: THE BOARD OF DIRECTORS ASSUMES THE RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF ITS FINANCIAL STATEMENTS AND THE SELECTION OF AN INDEPENDENT ACCOUNTANT. THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. PNC VESTEY TRUST UA UNB & NORTHERN CO SUCC BENEFIT BRODSTONE MEM HOSP 116 ALLEGHENY CENTER MALL PITTSBURGH PA 15212 226023351 ASSISTING IN THE OPERATIONS OF BRODSTONE MEMORIAL HOSPITAL PA 4947(A)(1) PF BRODSTONE MEMORIAL HOSPITAL 1 BRODSTONE MEMORIAL HOSPITAL FOUNDATION 520 EAST 10TH STREET SUPERIOR NE 68978 851276014 TO SUPPORT BRODSTONE MEMORIAL HOSPITAL NE 501(C)(3) LINE 12A, I BRODSTONE MEMORIAL HOSPITAL 1 0 1 1 0 0 0 0 0 0 0 0 0 1 1 1 1 1 0 0 PNC VESTEY TRUST C 65355 FMV BRODSTONE MEMORIAL HOSPITAL FOUNDATION B 52379 FMV BRODSTONE MEMORIAL HOSPITAL FOUNDATION C 220976 FMV