2025-11-05T08:27:29-06:00 2024-12-31 393647910 WIPFLI ADVISORY LLC 1502 LONDON ROAD SUITE 200 DULUTH MN 55812 990 2024-01-01 470566524 PROVIDENCE MEDICAL CENTER PROV 4023753800 1200 PROVIDENCE RD WAYNE NE 68787 NICOLE HAGLUND CNO/INTERIM CEO 4023753800 2025-10-29 1 1 MICHAEL J PETERSON CPA P01833529 2187224705 2025-10-24 2024 2025-03-06 01:10:19Z NICOLE HAGLUND 1200 PROVIDENCE RD WAYNE NE 68787 33985616 0 X WWW.PROVIDENCEMEDICAL.COM X 1975 NE SEE SCHEDULE O. 4 4 254 30 0 0 166164 48924 30766177 33281536 428694 405789 200772 249367 31561807 33985616 880 0 0 0 13747010 14965047 0 0 0 16867461 19630343 30615351 34595390 946456 -609774 50617441 49371980 18307365 17067790 32310076 32304190 THE MISSION OF PROVIDENCE MEDICAL CENTER IS TO PROVIDE QUALITY HEALTH CARE IN THE SPIRIT OF CHRIST. 0 0 26871958 0 33281536 PROVIDENCE MEDICAL CENTER IS A NOT-FOR-PROFIT, 21 BED, CRITICAL ACCESS HOSPITAL LOCATED IN WAYNE, NEBRASKA. PROVIDENCE SERVES OVER 15,000 AREA RESIDENTS IN NORTHEAST NEBRASKA AND EMPLOYS OVER 219 PEOPLE. PROVIDENCE OFFERS ACUTE, SKILLED, AND OBSTETRICAL CARE ALONG WITH 24 HOURS A DAY, SEVEN DAYS A WEEK EMERGENCY CARE AND AMBULANCE SERVICES. THE HOSPITAL ALSO PROVIDES DIAGNOSTIC IMAGING, SURGICAL, THERAPY, LABORATORY, ONCOLOGY, RESPIRATORY, HOME HEALTH, BEHAVIORAL HEALTH AND MANY OTHER HEALTH AND WELLNESS SERVICES. THERE ARE OVER 30 SPECIALTY CLINIC DOCTORS OF DIFFERENT SPECIALTIES THAT CONDUCT CLINICS AT THE HOSPITAL IN ORDER TO BRING SPECIALIZED CARE TO THE COMMUNITY. 26871958 1 1 0 1 0 0 0 0 0 1 1 0 0 0 1 0 1 0 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 0 0 0 1 84 0 254 1 0 0 0 0 0 0 0 0 0 0 0 0 X 4 4 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 NE X NICOLE HAGLUND 4023753800 1200 PROVIDENCE RD WAYNE NE 68787 RICHARD BRANDOW CHAIR 1.00 X X 0 0 0 MATTHEW LEY VICE CHAIR (THRU 12/24) 1.00 X X 0 0 0 MELISSA GRAHAM SECRETARY/TREASURER 1.00 X X 0 0 0 STEVEN AUSDEMORE DIRECTOR (THRU 6/24) 1.00 X 0 0 0 KRISTI FOX DIRECTOR (THRU 1/24) 1.00 X 0 0 0 ROSS HANSEN DIRECTOR (THRU 12/24) 1.00 X 0 0 0 JODI PULFER DIRECTOR 1.00 X 0 0 0 NICOLE HAGLUND CNO/INTERIM CEO 40.00 X 168899 0 44052 DANIELLE GEARHART CEO (THRU 7/24) 40.00 X 180290 0 41347 BRUCE CRAVEN CFO 40.00 X 101032 0 6789 KIMBERLY HIXSON CFO (THRU 1/24) 40.00 X 0 0 0 KIMBERLY LUEDERS DIRECTOR OF PHARMACY 40.00 X 177199 0 37945 HEATHER KREBER APP 40.00 X 149825 0 12964 MAKAYLA GARCIA APP 40.00 X 140259 0 45898 TRISHA GOEMBEL APP 40.00 X 131795 0 35689 SCOT SURBER PHARMACIST 40.00 X 120319 0 43637 1169618 0 268321 15 0 1 0 NI2 HEALTH INC 4516 SETON CENTER PARKWAY BUILDING AUSTIN TX 78759 REVENUE CYCLE MANAGEMENT SERVICES 677806 T AND D ANESTHESIA LLC 13606 S 226TH AVE GRETNA NE 68028 CRNA SERVICES 650500 PSYCHIATRIC MEDICAL CARE LLC 8 CADILLAC DRIVE 230 BRENTWOOD TN 37027 SENIOR LIFE PSYCHIATRY SERVICES 478861 LRS HEALTHCARE LLC 1120 N 103RD PLAZA SUITE 300 OMAHA NE 68114 HEALTH PROFESSIONAL STAFFING 303695 EIDE BAILLY LLP 4310 17TH AVENUE SOUTH MINNEAPOLIS MN 581082545 ACCOUNTING SERVICES 254939 16 32187 16737 48924 PATIENT SERVICE REVENUE 621990 30059456 30059456 PHARMACY 621990 2863013 2863013 FITNESS REVENUE 621990 192021 192021 DIETARY INCOME 900099 45361 45361 121685 121685 33281536 405789 405789 210865 0 210865 210865 210865 38502 38502 38502 33985616 33281536 0 655156 X 542410 542410 10733059 9257327 1475732 350237 310097 40140 2568458 2117943 450515 770883 621656 149227 14458 14458 137793 137793 3061 3061 5155213 3249155 1906058 240995 5550 235445 143386 46135 97251 242999 55888 187111 491928 491928 53204 50510 2694 85753 50026 35727 367722 267092 100630 3289169 2389062 900107 270074 270074 SUPPLIES AND PHARMACEUT 5181003 5151276 29727 EQUIPMENT RENTAL & MAIN 1654146 822065 832081 PROVISIONS FOR BAD DEBT 1652373 1652373 DIETARY EXPENSE 92588 92588 554478 241287 313191 34595390 26871958 7723432 0 1712153 373772 3661760 4788488 4562308 4431227 673167 692936 340465 398297 60591625 30498095 31851667 30093530 6552894 7155946 291719 292075 971308 1145709 50617441 49371980 2408135 2446553 57028 58168 15064200 14251033 778002 312036 18307365 17067790 X 31493479 31311904 816597 992286 32310076 32304190 50617441 49371980 X -609774 380287 223601 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 3061 3061 0 PART II-B, LINE 1: PROVIDENCE MEDICAL CENTER ("PMC") PAYS ANNUAL ASSOCIATION MEMBERSHIP DUES TO THE NEBRASKA HOSPITAL ASSOCIATION (NHA) AND THE AMERICAN HOSPITAL ASSOCIATION (AHA). THESE DUES ARE PRIMARILY TO ACCESS EDUCATIONAL MATERIALS AND FOR STAFF TRAINING. THE NHA HAS NOTIFIED PMC THAT APPROXIMATELY $1,598 OF THE ANNUAL DUES PAID WERE USED IN CONJUNCTION WITH LOBBYING ACTIVITIES WITH THE GOAL OF IMPROVING THE OVERALL HEALTHCARE ENVIRONMENT. THE AMOUNT OF DUES PAID TO AHA DETERMINED TO BE FOR LOBBYING IS $1,463. 88887 8529 97416 82357 6530 88887 87009 -4652 82357 77078 9931 87009 74377 2701 77078 0.00000 0.00000 1.00000 0 1 1 91932 91932 45019610 19330956 25688654 15223537 11167139 4056398 256546 256546 30093530 OPERATING LEASE LIABILITIES 60302 DEFERRED COMPENSATION PLAN 18846 PAYABLE TO THIRD-PARTY REIMBURSEMENT PROGRAMS 211586 FINANCE LEASE OBLIGATIONS 21302 312036 32713530 380287 380287 32333243 1652373 1652373 33985616 32943017 0 32943017 1652373 1652373 34595390 PART V, LINE 4: PROVIDENCE MEDICAL CENTER HAS ONE ENDOWMENT FUND HELD BY PROVIDENCE MEDICAL CENTER FOUNDATION. THE ENDOWMENT WAS SET ASIDE BY DONORS TO PROVIDE INVESTMENT INCOME IN WHICH TO PROVIDE FOR FUTURE CAPITAL AND PROGRAM NEEDS OF THE HOSPITAL. PART XI, LINE 4B - OTHER ADJUSTMENTS: PROVISION FOR BAD DEBTS 1,652,373. PART XII, LINE 4B - OTHER ADJUSTMENTS: PROVISION FOR BAD DEBTS 1,652,373. 1 1 X 1 X 1 X 1 1 0 0 421593 421593 0.01280 2299427 1667656 631771 0.01920 2721020 1667656 1053364 0.03200 930011 420127 509884 0.01550 930011 420127 509884 0.01550 3651031 2087783 1563248 0.04750 0 1179291 740182 9745194 9801573 -56379 X 1 1 1 1 PROVIDENCE MEDICAL CENTER 1200 PROVIDENCE ROAD WAYNE NE 68787 WWW.PROVIDENCEMEDICAL.COM 800001 X X X X AMBULANCE SERVICE PROVIDENCE MEDICAL CENTER 1 0 0 1 X X X X X X X X X 22 1 1 1 1 X SEE SUPPLEMENTAL INFORMATION 1 22 1 SEE SUPPLEMENTAL INFORMATION 0 1 X 150.000000000000 300.000000000000 X X X X 1 1 X X X X 1 X HTTPS://PROVIDENCEMEDICAL.COM/PATIENTS-VISITORS/PATIENTS/BILLING-FINANCE/ X HTTPS://PROVIDENCEMEDICAL.COM/PATIENTS-VISITORS/PATIENTS/BILLING-FINANCE/ X HTTPS://PROVIDENCEMEDICAL.COM/PATIENTS-VISITORS/PATIENTS/BILLING-FINANCE/ X X X X X X 1 X 0 X X X X 1 X 0 0 PROVIDENCE MEDICAL CENTER PART V, SECTION B, LINE 5: THE REPORT WAS PREPARED BY STAFF OF THE FOLLOWING: NORTHEAST NEBRASKA RURAL HEALTH NETWORK;IN CONJUNCTION WITH VISIONFUSION AND INTERSECTIONS CONSULTING;AND STAFF FROM PARTNER MEMBERS INCLUDING:- PENDER COMMUNITY HOSPITAL- PROVIDENCE MEDICAL CENTER- WINNEBAGO PUBLIC HEALTH DEPARTMENT- MIDTOWN HEALTH CENTER- UNIVERSITY OF NEBRASKA MEDICAL CENTER- NORTHEAST NEBRASKA PUBLIC HEALTH DEPARTMENTTHE FOLLOWING AGENCIES PROVIDED INPUT INTO CERTAIN SECTIONS OF THE REPORT: - CARL T. CURTIS HEALTH CENTER- CEDAR COUNTY TRANSIT- EDUCATIONAL SERVICE UNIT #1- HARTINGTON SENIOR CENTER- HAVEN HOUSE- LA MICHUACANA- LEAGUE OF HUMAN DIGNITY- LUNA'S CAF- MIDTOWN HEALTH CENTER- NEBRASKA ASSOCIATION OF LOCAL HEALTH DIRECTORS- NEBRASKA DEPARTMENT OF HEALTH AND HUMAN SERVICES- NEBRASKA EXTENSION- NORTHEAST NEBRASKA COMMUNITY ACTION PARTNERSHIP- NORTHEAST NEBRASKA PUBLIC HEALTH DEPARTMENT- PEARL STREET COUNSELING- PENDER MEDICAL CLINIC- PENDER COMMUNITY HOSPITAL- PROVIDENCE MEDICAL CENTER- RURAL REGION ONE MEDICAL RESPONSE SYSTEM- UNIVERSITY OF NEBRASKA COLLEGE OF NURSING NORTHERN DIVISION- UNIVERSITY OF NEBRASKA COLLEGE OF PUBLIC HEALTH- WAYNE ASSOCIATION OF CONGREGATIONS AND MINISTERS- WAYNE COMMUNITY SCHOOLS- WAYNE FAMILY COALITION- WAYNE HERALD- WAYNE COMMUNITY HOUSING DEVELOPMENT COMMISSION- WAYNE STATE COLLEGE- WINNEBAGO HEALTH DEPARTMENTOVER SIX HUNDRED SURVEYS WERE COLLECTED FROM ACROSS THE HEALTH DISTRICT. LIVE LISTENING SESSIONS WERE CONDUCTED IN CEDAR, DIXON AND WAYNE COUNTIES AND THURSTON COUNTY PARTICIPATED IN A VIRTUAL SESSION. LISTENING SESSIONS WITH THE AREA'S HISPANIC POPULATION, WITH INTERPRETATION BY NNPHD STAFF, WERE FACILITATED BY OUR HEALTH DIRECTOR. THIS LED TO THE FORMATION OF A HEALTH CONSUMER FOCUSED ADVISORY COUNCIL COMPOSED OF MEMBERS OF THE AREA'S LATINO COMMUNITY. A SERIES OF FIVE VIRTUAL CONVERSATIONS WERE HELD TO UPDATE THE FINDINGS OF OUR 2019 LOCAL PUBLIC HEALTH SYSTEM ASSESSMENT USING THE RECENTLY UPDATED 10 ESSENTIAL SERVICES OF PUBLIC HEALTH, AS WELL AS THE LOCAL SYSTEM'S EXPERIENCE WITH THE COVID-19 PANDEMIC. A HEALTH EQUITY ADVISORY COUNCIL WAS STARTED IN DECEMBER 2021 WHICH HAS ALSO GIVEN US FEEDBACK. PROVIDENCE MEDICAL CENTER PART V, SECTION B, LINE 6A: - PENDER COMMUNITY HOSPITAL PROVIDENCE MEDICAL CENTER PART V, SECTION B, LINE 6B: - NORTHEAST NEBRASKA PUBLIC HEALTH DEPARTMENT - WINNEBAGO PUBLIC HEALTH DEPARTMENT- MIDTOWN HEALTH CENTER- UNIVERSITY OF NEBRASKA MEDICAL CENTERPROVIDENCE MEDICAL CENTER:PART V, SECTION B, LINE 7A: HTTPS://PROVIDENCEMEDICAL.COM/ABOUT-US/COMMUNITY-HEALTH-ASSESSMENT/PROVIDENCE MEDICAL CENTER:PART V, SECTION B, LINE 10A: HTTPS://PROVIDENCEMEDICAL.COM/ABOUT-US/COMMUNITY-HEALTH-ASSESSMENT/ PROVIDENCE MEDICAL CENTER PART V, SECTION B, LINE 11: PRIORITY ONE: CREATE A PREVENTATIVE APPROACH TO HEALTHCARETHE AFFORDABLE CARE ACT HAS HAD A HUGE IMPACT ON THE WAY HOSPITALS ARE BEING COMPENSATED FOR HEALTHCARE. THAT HAS DRIVEN HOSPITALS TO LOOK AT HEALTHCARE DIFFERENTLY. ONE OF THE AREAS THE COMMUNITY FELT NEEDED TO BE ADDRESSED WAS IN CREATING A POSITIVE PREVENTATIVE APPROACH TO HEALTHCARE. THIS WOULD INCLUDE EDUCATION PARTNERING WITH BUSINESSES AND EDUCATION ON INSURANCE PROGRAMS.ACTIONS TO BE TAKEN:1. CREATE A PREVENTATIVE HEALTH SCREENING PROGRAM2. HOLD A COMMUNITY HEALTH FAIR3. DEVELOP PARTNERSHIPS WITH BUSINESSES FOR PREVENTION4. EDUCATE THE PUBLIC ON HEALTH INSURANCEPRIORITY TWO: MENTAL HEALTH PROGRAMALTHOUGH PMC CURRENTLY HAS A MENTAL HEALTH PROGRAM, IT IS NOT AS STRONG AS IT NEEDS TO BE FOR THE COMMUNITY. WAYNE COUNTY'S RATIO IS FAR BELOW THE US TOP PERFORMERS AND THE STATE RATIOS. PMC ALSO SEES A NEED TO ASSIST IN THIS AREA GIVEN THERE IS A COLLEGE IN TOWN THAT MAY NEED ASSISTANCE IN DEALING WITH MENTAL HEALTH ISSUES AS WELL AS SUBSTANCE ABUSE ISSUES.ACTIONS TO BE TAKEN:1. EXPLORE SUBSTANCE ABUSE PROGRAM2. EXPLORE ADOLESCENT CARE PROGRAMS3. EXPLORE SUICIDE PREVENTION AND GRIEF COUNSELING PROGRAMS4. EXPLORE PARTNERSHIP WITH COLLEGE ON MENTAL HEALTH ISSUESPRIORITY THREE: PROMOTE CURRENT SERVICEFINALLY, PMC BECAME AWARE THERE IS A LACK OF KNOWLEDGE ABOUT THE SERVICES AND THE QUALITY OF CARE CURRENTLY BEING OFFERED BY PMC. AS A RESULT, PEOPLE IN THE COMMUNITY ARE SEEKING HEALTHCARE IN OTHER AREAS THEY COULD BE RECEIVING CLOSER TO HOME. THIS LEADS TO FRUSTRATION ON THE PART OF THE PATIENT. PMC ALSO PROVIDES SOME UNIQUE SERVICES THAT ARE NOT AVAILABLE IN MANY HOSPITALS IN THE STATE.ACTIONS TO BE TAKEN:1. IMPLEMENT SOCIAL MEDIA MARKETING STRATEGY2. PROMOTE SPECIALIZED SERVICES (AMPS, PARKINSONS, VERTIGO THERAPY, SPHENOCATH, ETC.)3. REVIEW EFFECTIVENESS OF CURRENT PRINT AND MEDIA STRATEGY4. CONDUCT A DID YOU KNOW CAMPAIGN5. MARKET SERVICES FOR THE ELDERLY DURING COMMUNITY EVENTS PROVIDENCE MEDICAL CENTER PART V, SECTION B, LINE 15E: PROVIDENCE MEDICAL CENTER MAY ASSIST PATIENTS IN APPLYING FOR MEDICARE, MEDICAID, AND OTHER GOVERNMENTAL MEDICAL ASSISTANCE PROGRAMS. 3 1 - PROVIDENCE COMMUNITY PHARMACY 803 PROVIDENCE ROAD SUITE 101 WAYNE NE 68787 PHARMACY 2 - LAUREL THERAPY SERVICES 699 CEDAR AVENUE LAUREL NE 68745 OUTREACH THERAPY CLINIC 3 - WAKEFIELD THERAPY SERVICES 308 ASH STREET WAKEFIELD NE 68784 OUTREACH THERAPY CLINIC PART I, LINE 3C: UNINSURED, UNDERINSURED, AND INDIGENT BY DESIGN PATIENTS WHOSE INCOME/FAMILY INCOME IS GREATER THAN 400% OF THE FEDERAL POVERTY GUIDELINES MAY BE ELIGIBLE FOR DISCOUNTED CARE BASED ON THEIR PARTICULAR CIRCUMSTANCES. SUCH DISCOUNTS ARE AT THE DISCRETION OF THE ORGANIZATION AND WILL NOT BE COUNTED AS CHARITY CARE. PART I, LINE 7: THE COSTING METHODOLOGY USED ON FORM 990 IS BASED ON A COST-TO-CHARGE RATIO WHICH IS DEVELOPED BASED ON THE HOSPITAL'S TOTAL OPERATING EXPENSES LESS THE PROVISION FOR BAD DEBT DIVIDED BY GROSS PATIENT SERVICE REVENUE. THIS COST-TO-CHARGE RATIO IS APPLIED AGAINST VARIOUS REVENUE AND EXPENSE CATEGORIES TO COMPUTE THE ESTIMATED COMMUNITY BENEFIT EXPENSE UNDER IRS SUGGESTED COSTING METHODS FOR THE FORM 990. PART I, LINE 7G: SUBSIDIZED SERVICES INCLUDE HOSPICE AND HOME HEALTH SERVICES. 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 $ 1,652,373. PART III, LINE 2: THE COSTING METHODOLOGY USED ON FORM 990 IS BASED ON A COST-TO-CHARGE RATIO, WHICH IS DEVELOPED BASED ON THE HOSPITAL'S TOTAL OPERATING EXPENSES EXCLUDING THE PROVISION FOR BAD DEBT, DIVIDED BY GROSS PATIENT SERVICE REVENUE. THIS COST-TO-CHARGE RATIO IS APPLIED AGAINST THE TOTAL CHARGES THAT ARE WRITTEN OFF DURING THE YEAR TO ESTIMATE THE COST OF CARE OF PATIENTS WHO HAVE ACCOUNTS THAT ARE DEEMED TO BE BAD DEBTS TO THE HOSPITAL. THE HOSPITAL ALSO RECOGNIZES THAT IT ALSO PROVIDES A DISCOUNT TO SELF-PAY OR UNINSURED PATIENTS. THESE AMOUNTS ARE EXCLUDED FROM GROSS PATIENT SERVICE REVENUE ON THE FINANCIAL STATEMENTS AND ARE NOT INCLUDED IN THE RATIO AS DESCRIBED ABOVE AND APPROVED BY THE IRS FOR USE ON FORM 990. IF CONSIDERED, THESE ADDITIONAL WRITE-OFF AMOUNTS TO UNINSURED ACCOUNTS WOULD ALSO INCREASE THE ESTIMATED BAD DEBT EXPENSE AMOUNT ASSOCIATED WITH THESE UNCOLLECTIBLE ACCOUNTS TO THE HOSPITAL. PART III, LINE 3: MANAGEMENT PROVIDES FOR PROBABLE UNCOLLECTIBLE AMOUNTS, PRIMARILY UNINSURED PATIENTS AND AMOUNTS PATIENTS ARE PERSONALLY RESPONSIBLE FOR, THROUGH A CHARGE TO OPERATIONS AND A CREDIT TO A VALUATION ALLOWANCE BASED ON ITS ASSESSMENT OF HISTORICAL COLLECTION LIKELIHOOD AND THE CURRENT STATUS OF INDIVIDUAL ACCOUNTS. BALANCES THAT ARE STILL OUTSTANDING AFTER THE HOSPITAL HAS USED REASONABLE COLLECTION EFFORTS ARE WRITTEN OFF THROUGH A CHARGE TO THE VALUATION ALLOWANCE AND A CREDIT TO ACCOUNTS RECEIVABLE. PART III, LINE 4: IN EVALUATING THE COLLECTABILITY OF ACCOUNTS RECEIVABLE, THE HOSPITAL ANALYZES PAST RESULTS AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS AND PROVISION FOR BAD DEBTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYOR SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS. SPECIFICALLY, FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE HOSPITAL ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS AND A PROVISION FOR BAD DEBTS FOR EXPECTED UNCOLLECTIBLE DEDUCTIBLES AND COPAYMENTS ON ACCOUNTS FOR WHICH THE THIRD-PARTY PAYOR HAS NOT YET PAID, OR FOR PAYORS AND PATIENTS WHO ARE KNOWN TO BE HAVING FINANCIAL DIFFICULTIES THAT MAKE THE REALIZATION OF AMOUNTS DUE UNLIKELY. FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), THE HOSPITAL RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES, IF NEGOTIATED) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS. THE AUDITED FINANCIAL STATEMENTS DO NOT CONTAIN A SEPARATE FOOTNOTE REGARDING BAD DEBT EXPENSE. PART III, LINE 8: THE COSTING METHOD USED ABOVE FOR IRS FORM 990 COMPLIANCE REPORTING IS ALSO BASED ON AN OVERALL AVERAGE COST-TO-CHARGE RATIO AND DOES NOT CONSIDER MEDICARE NON-ALLOWABLE EXPENSES AS IT IS BASED ON TOTAL HOSPITAL PATIENT SERVICE REVENUE (IGNORING CONTRACTUAL ADJUSTMENTS ON FEE SCHEDULE REIMBURSED ITEMS AND NON-ALLOWABLE MEDICARE EXPENSES AS NOTED ABOVE) DIVIDED BY TOTAL OPERATING EXPENSES LESS THE PROVISION FOR BAD DEBT EXPENSE. THIS RATIO IS THEN MULTIPLIED BY THE TOTAL MEDICARE SERVICES WHICH ARE REIMBURSED ON A COST METHODOLOGY EXCLUDING THE FEE SCHEDULE ITEMS LIKE PHYSICIAN SERVICES AND THE HOSPITAL WOULD SHOW A LARGE LOSS ON THESE SERVICES.WHETHER THERE IS A SHORTFALL OR SURPLUS FROM SERVICES PROVIDED TO MEDICARE BENEFICIARIES, THESE PEOPLE, WHO ARE TYPICALLY ELDERLY MEMBERS OF THE COMMUNITY, ARE AN UNDERSERVED POPULATION WHO EXPERIENCE ISSUES WITH ACCESS TO HEALTHCARE SERVICES. WITHOUT TAX-EXEMPT HOSPITALS PROVIDING MEDICARE PATIENT SERVICES, THE CENTERS FOR MEDICARE AND MEDICAID (CMS) WOULD BEAR THE BURDEN OF DIRECTLY PROVIDING SERVICES TO THE ELDERLY AND DISABLED MEMBERS OF THE COMMUNITY.THE SHORTFALL SHOULD BE TREATED AS A COMMUNITY BENEFIT EXPENSE BECAUSE PROVIDING MEDICAL CARE AT A SHORTFALL IMPACTS THE HOSPITAL'S OPERATIONS AND GROWTH. THE CARE IS PROVIDED BECAUSE THERE IS A NEED AND A DESIRE TO PROVIDE MEDICAL CARE IN THIS COMMUNITY. PART III, LINE 9B: PROVIDENCE MEDICAL CENTER HAS A STRONG COMMITMENT TO THE COMMUNITY AND TO THE PATIENTS THAT WE SERVE. MEDICAL TREATMENT IS PROVIDED TO ALL PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. IN DOING SO, WE SHALL: INFORM THE PUBLIC OF THE AVAILABILITY OF ALTERNATIVE PAYMENT ARRANGEMENTS, INCLUDING PAYMENT PLANS AND FINANCIAL ASSISTANCE PROGRAMS; PROVIDE FINANCIAL COUNSELING TO PATIENTS ABOUT THEIR HOSPITAL BILLS; RESPOND PROMPTLY TO PATIENTS' QUESTIONS ABOUT THEIR BILLS AND REQUESTS FOR FINANCIAL HELP THROUGH AN ACCEPTABLE PAYMENT PLAN AND/OR THROUGH FINANCIAL ASSISTANCE; AND PURSUE COLLECTION OF ACCOUNTS FAIRLY AND CONSISTENTLY AND WITHIN OUR WRITTEN GUIDELINES AND ENSURE THAT AGENCIES ACTING ON OUR BEHALF IN THE COLLECTION OF DEBT ALSO ACT IN ACCORDANCE WITH OUR MISSION AND GUIDELINES. PART VI, LINE 2: PMC WORKS WITH THE STATE OF NEBRASKA AND THE NEBRASKA HOSPITAL ASSOCIATION TO REVIEW PATIENT DATA AND OUTCOMES. ONE OF THE PRODUCTS USED IS COMS (CLINICAL OUTCOMES MEASUREMENT SYSTEM) WHICH GIVES OUTCOME DATA FOR MORBIDITY AND MORTALITY FOR THE STATE OF NEBRASKA AND OUR SERVICE AREA. PMC ALSO HAS WORKED WITH THE NORTHEAST NEBRASKA PUBLIC HEALTH DEPARTMENT WITH MAPP WHICH IS "MOBILIZING FOR ACTION THROUGH PLANNING AND PARTNERSHIP," WHICH IDENTIFIES PUBLIC HEALTH ISSUES AND FINDS RESOURCES TO ADDRESS THEM. PART VI, LINE 3: PAYMENT POLICIES AND FINANCIAL ASSISTANCE INSTRUCTIONS ARE GIVEN WITH ADMISSION DOCUMENTS, INCLUDED WITH EACH BILL, UPLOADED ON PMC'S WEBSITE, AND POSTED THROUGHOUT PMC'S FACILITIES. PART VI, LINE 4: THE HEALTHCARE FACILITY IS LOCATED IN WAYNE, NEBRASKA WHERE IT SERVES RESIDENTS OF NORTHEASTERN NEBRASKA. THE POPULATION BASE FROM THE NEARBY COMMUNITIES IS APPROXIMATELY 9,600 WITH AN AVERAGE INCOME OF APPROXIMATELY $45,000. PART VI, LINE 5: THE HOSPITAL HAS A COMMUNITY BOARD WITH MEMBERS THAT REPRESENT DIFFERENT TOWNS IN OUR SERVICE AREA. WE STRIVE TO INVEST OUR FUNDS IN BANKS WITHIN OUR SERVICE AREA. ALSO THE HOSPITAL'S ADMITTING PHYSICIANS ARE PRIMARILY PRACTITIONERS IN THE LOCAL AREA. PART VI, LINE 6: THE HOSPITAL IS NOT AFFILIATED WITH ANY OTHER HEALTH SYSTEMS. PART VI, LINE 7, REPORTS FILED WITH STATES NE X X 1 0 0 0 0 0 0 0 0 DANIELLE GEARHART CEO (THRU 7/24) 134608 0 600 0 45082 0 24339 0 17008 0 221637 0 0 0 KIMBERLY LUEDERS DIRECTOR OF PHARMACY 176274 0 800 0 125 0 23018 0 14927 0 215144 0 0 0 NICOLE HAGLUND CNO/INTERIM CEO 168774 0 0 0 125 0 5965 0 38087 0 212951 0 0 0 MAKAYLA GARCIA APP 131000 0 9134 0 125 0 11311 0 34587 0 186157 0 0 0 TRISHA GOEMBEL APP 129740 0 1930 0 125 0 12990 0 22699 0 167484 0 0 0 SCOT SURBER PHARMACIST 120044 0 150 0 125 0 5550 0 38087 0 163956 0 0 0 HEATHER KREBER APP 144500 0 5200 0 125 0 12231 0 733 0 162789 0 0 0 PART I, LINE 4A DANIELLE GEARHART - $45,000 SEVERANCE PAYMENT A THE COUNTY OF WAYNE IN THE STATE OF NEBRASKA 476006517 NONEAVAIL 2015-07-31 8400000 TO CONSTRUCT AND EQUIP HOSPITAL FACILITY 0 0 0 B THE COUNTY OF WAYNE IN THE STATE OF NEBRASKA 476006517 NONEAVAIL 2016-03-08 4100000 TO CONSTRUCT AND EQUIP HOSPITAL FACILITY 0 0 0 C THE COUNTY OF WAYNE IN THE STATE OF NEBRASKA 476006517 NONEAVAIL 2021-06-22 6988641 TO CONSTRUCT AND EQUIP HOSPITAL FACILITY 0 0 0 A 3481231 8400000 264021 297702 8400000 2017 0 0 1 1 B 526759 4100000 264021 32759 4100000 2017 0 0 1 1 C 401383 6988641 134839 106524 6988641 2022 0 0 1 1 A 0 0 0 0 0 0 0 B 0 0 0 0 0 0 0 C 0 0 0 0 0 0 0 A 0 0 1 0 0 0 0 0 1 B 0 0 1 0 0 0 0 0 1 C 0 1 0 0 0 0 0 0 1 A 1 B 1 C 1 FORM 990, PART I, LINE 1, DESCRIPTION OF ORGANIZATION MISSION: WE BELIEVE THAT THE PATIENT IS THE MOST IMPORTANT PERSON IN OUR MEDICAL CENTER, THAT LIFE IS A GIFT FROM GOD, AND THAT ALL PERSONS ARE CREATED EQUAL. WE BELIEVE THAT EVERY PATIENT HAS A RIGHT TO BE ADMITTED WHEN IN NEED OF SERVICES WHICH OUR FACILITY IS EQUIPPED TO PROVIDE, PRIVACY, PROFESSIONAL DISCRETION, CONSENT TO OR REFUSAL OF TREATMENT AND MAY REQUEST THE MINISTER OF HIS/HER CHOICE. WE BELIEVE THAT OUR MEDICAL CENTER HAS THE RESPONSIBILITY TO PROVIDE ADEQUATE AND COMPETENT STAFF AND DIAGNOSTIC, PREVENTATIVE AND THERAPEUTIC FACILITIES TO ENSURE HIGH QUALITY MEDICAL CARE TO THE PATIENT, AND THAT THIS CAN ONLY BE ACHIEVED THROUGH COOPERATION AND SUPPORT AMONG THE STAFF AND COMMUNITY. WE BELIEVE THAT THE EMPLOYEES ARE ENTITLED TO JUST WAGES FOR HONEST WORK AND TO OPPORTUNITIES FOR PERSONAL AND PROFESSIONAL GROWTH. WE BELIEVE THAT OUR MEDICAL CENTER NEEDS TO PARTICIPATE ACTIVELY IN COMMUNITY PLANNING OF HEALTH AND MEDICAL CARE FACILITIES AND OPERATE IN ACCORDANCE WITH THE NEEDS OF THE CIVIC COMMUNITY. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS REVIEWED AND APPROVED BY THE HOSPITAL CEO AND CFO PRIOR TO FILING. ALSO, THE FORM 990 IS DISTRIBUTED TO THE BOARD OF DIRECTORS PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C PMC'S BOARD AND ADMINISTRATIVE MEMBERS ARE REQUIRED TO SIGN A NEW CONFLICT OF INTEREST STATEMENT AND DISCLOSURE ANNUALLY. ANY CONFLICTS ARE REVIEWED BY THE BOARD. FORM 990, PART VI, SECTION B, LINE 15 THE COMPENSATION PROCESS FOR OFFICERS' SALARIES AND FOR ALL EMPLOYEES ARE BASED ON THE NEBRASKA HOSPITAL ASSOCIATION'S (NHA) ANNUAL SALARY SURVEY. THE SURVEY IS CATEGORIZED BY JOB TITLES AND DETAILED BY HOURLY SALARY RANGES. NHA IS AN EXEMPT ORGANIZATION UNDER SECTION 501(C)(6) OF THE INTERNAL REVENUE CODE (TRADE ASSOCIATION), WITH ITS MEMBERS BEING THE HOSPITALS IN THE STATE OF NEBRASKA. EXECUTIVE WAGES OR SALARIES ARE NOT EVALUATED ANY DIFFERENTLY THAN OTHER EMPLOYEES. THEY RECEIVE NO PREFERENTIAL TREATMENT UNLESS THE GOVERNING BOARD MAKES A SPECIAL RECOMMENDATION. THE GUIDELINES INCLUDE: 1. A DETERMINATION OF THE FEASIBILITY OF BONUSES BASED ON AVAILABILITY OF CASH FLOW AND EXCESS REVENUE FOR THE CURRENT FISCAL YEAR, 2. DETERMINATION OF PMC'S OVERALL WAGE LEVELS BASED ON AN ANALYSIS OF WAGES AGAINST THE NHA'S SALARY SURVEY AND EMPLOYEE TIME OF SERVICE, 3. HOURLY WAGE INCREASES MAY ALSO BE GIVEN IF NEEDED TO BE COMPATIBLE OR TO COMPENSATE FOR A CHANGE IN JOB DESCRIPTIONS, AND 4. THE GOVERNING BOARD MAKES FINAL APPROVAL OF THE BUDGET WHICH WOULD INCLUDE ALL SALARIES AND BONUSES. FORM 990, PART VI, SECTION C, LINE 19 PROVIDENCE MEDICAL CENTER MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST AT ITS HOSPITAL BUSINESS LOCATION DURING NORMAL BUSINESS HOURS. FORM 990, PART IX, LINE 11G ANESTHESIA SERVICES PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 539,825. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 539,825. EMERGENCY SERVICES: PROGRAM SERVICE EXPENSES 279,068. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 279,068. HOSPICE PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 258,052. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 258,052. LABORATORY PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 123,567. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 123,567. OTHER PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 1,864,075. MANAGEMENT AND GENERAL EXPENSES 1,906,058. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,770,133. QUALITY ASSURANCE PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 73,840. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 73,840. RADIOLOGY PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 110,728. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 110,728. FORM 990, PART XI, LINE 9: NET CHANGE IN TEMPORARILY RESTRICTED NET ASSETS OF FOUNDATION 223,601. PROVIDENCE MEDICAL CENTER FOUNDATION 1200 PROVIDENCE ROAD WAYNE NE 68787 476032846 SUPPORT PROVIDENCE MEDICAL CENTER NE 501(C)(3) LINE 12A, I PROVIDENCE MEDICAL CENTER 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0