2011-12-15T14:44:24-06:00 2011-04-30 DOHMAN AKERLUND & EDDY LLC PO BOX 470 AURORA NE 688180470 990 2010-05-01 470388012 BRODSTONE MEMORIAL HOSPITAL BROD 4028793281 520 EAST 10TH STREET SUPERIOR NE 689781225 JOHN KEELAN 4028793281 2011-12-12 true SONJA A CATTAU 4026946404 2011-12-12 2010 2016-02-24 21:20:13Z JOHN KEELAN 520 EAST 10TH STREET SUPERIOR NE 689781225 18847568 false X WWW.BRODSTONEHOSPITAL.ORG X 1927 NE BRODSTONE MEMAORIAL HOSPITAL IS A NOT-FOR-PROFIT CRITICAL ACCESS HOSPITAL ESTABLISHED TO DELIVER QUALITY, AFFORDABLE HEALTH CARE IN A CARING, SAFE AND COMPASSIONATE ENVIRONMENT TO ALL PERSONS OF SUCH NEED IN A TOTALLY NON-DISCRIMINATORY MANNER. 6 6 216 0 378389 646043 16608604 18193410 59872 -62663 0 17046865 18776790 0 0 9570880 10228809 0 0 6723243 7849094 16294123 18077903 752742 698887 16920612 20547524 6663800 9591825 10256812 10955699 X BRODSTONE MEMAORIAL HOSPITAL IS A NOT-FOR-PROFIT CRITICAL ACCESS HOSPITAL ESTABLISHED TO DELIVER QUALITY, AFFORDABLE HEALTH CARE IN A CARING, SAFE AND COMPASSIONATE ENVIRONMENT TO ALL PERSONS OF SUCH NEED IN A TOTALLY NON-DISCRIMINATORY MANNER. false false 18077903 BRODSTONE MEMORIAL HOSPITAL PROVIDES SHORT TERM INPATIENT AND OUTPATIENT SERVICES SUCH AS ACUTE CARE, ICU, OB, AND NURSERY WITHIN THE SCOPE OF ITS HOSPITAL LICENSE TO ALL PATIENTS IN A NON-DISCRIMINATORY MANNER. 18077903 true true false false false false false false false true true false false false true false true false false false false false false false false false true true false false true false false false false false false false false false false false false false false false false false false true 19 0 216 true false false false false false false false false false false X 6 6 false false false false false false false true true false false true true true true true true true true false X SANDRA J BORDEN CFO 4028793281 520 EAST TENTH STREET SUPERIOR NE 68978 KATHY ESSINK 2.00 X X 0 0 0 LYNN CULBERTSON 2.00 X 0 0 0 PAT MCCORD 2.00 X X 0 0 0 LANE HAWLEY 2.00 X X 0 0 0 ROBERT TRAPP 2.00 X 0 0 0 JULIE SIMONSEN 2.00 X X 0 0 0 JOHN KEELAN 40.00 X 172755 0 14207 SANDRA BORDEN 40.00 X 113807 0 20760 KORI FIELD 40.00 X 74242 0 21678 TIMOTHY BLECHA 40.00 X 255982 0 21115 JULIE THEIS 40.00 X 176147 0 19135 ROBERT LEIBEL 40.00 X 167690 0 21115 JASON HASS 40.00 X 123062 0 21115 1083685 139125 6 false true false BD CONSTRUCTION PO BOX 726 209 E 6TH STREET KEARNEY NE 68848 BLDG CONTRACTOR 3121212 GE HEALTHCARE PO BOX 96483 CHICAGO IL 60693 EQUIPMENT, SERV 1557858 CARDINAL HEALTH 21377 NETWORK PLACE CHICAGO IL 60673 PHARMACY 1226368 BROWN'S MEDICAL IMAGING 14315 C CIRCLE OMAHA NE 68144 EQUIPMENT, SERV 621265 MERITAIN HEALTH PO BOX 8000 DEPT 207 BUFFALO NY 14267 HEALTH INSURANC 443978 17 63910 582133 646043 NET PATIENT SERVICE REVENUE 18126239 18126239 CAFETERIA 38906 38906 MISCELLANEOUS 28268 28268 MEDICAL RECORDS TRANSCRIPTS 1246 1246 FINANCE CHARGES -1249 -1249 18193410 -25631 -25631 33746 70778 -37032 -37032 -37032 18776790 18089207 41540 286562 286562 7657627 7657627 189512 189512 1549204 1549204 545904 545904 32437 32437 28300 28300 507669 507669 303392 303392 1141732 1141732 216305 216305 SUPPLIES, FEES & PURCH SE 4342662 4342662 PROVISION FOR BAD DEBTS 581911 581911 DATA PROCESSING 320810 320810 ADMINISTRATIVE EXPENSES 201067 201067 COLLECTION FEES 128533 128533 44276 44276 18077903 18077903 0 0 2055969 1721238 580131 363641 2690295 2999529 216047 228705 240074 206126 22564895 8326610 10245849 14238285 662247 230000 790000 16920612 20547524 2396650 2410010 4043150 7075554 224000 106261 6663800 9591825 X 10066520 10334594 190292 621105 10256812 10955699 16920612 20547524 698887 X false true true X true true X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false 1294935 108665 1403600 1098170 196765 1294935 1375015 -276845 1098170 1.00000 true false false 117890 117890 13653898 3421826 10232072 431319 177802 253517 8361788 4726982 3634806 14238285 DUE TO THIRD PARTY PAYORS 106261 106261 18776790 18077903 698887 698887 18776790 18776790 18776790 18077903 18077903 18077903 INTENDED USES FOR ENDOWMENT FUNDS SCHEDULE D, PAGE 2, PART V, LINE 4 BOTH ENDOWMENT FUNDS LISTED ARE TO BE MAINTAINED AS A PERMANENT ENDOWMENT. THE TRUST FUND CAN BE USED FROM TIME TO TIME IN OR TOWARDS THE EXECUTION OF ANY NECESSARY OR PROPER IMPROVEMENTS IN OR ADDITIONS TO THE BUILDING OR FABRIC OF THE HOSPITAL AND SUBJECT THERETO IN OR TOWARDS PAYING THE ORDINARY CURRENT EXPENSES OF MANAGING, CONDUCTING, AND OPERATING THE HOSPITAL AND CONTINUE TO KEEP THE GRAVES AND MONUMENTS OF THE DONOR FAMILY IN GOOD REPAIR AND THE INSCRIPTIONS THEREON LEGIBLE. true true X true X true X true true true false false 166026 166026 0.00950 1128824 777625 351199 0.02010 1294850 777625 517225 0.02960 2058 135433 53463 81970 0.00470 11 18060 18060 0.00100 559 25184 9025 16159 0.00090 512 950 950 0.00010 3140 179627 62488 117139 0.00670 3140 1474477 840113 634364 0.03630 true 453972 98521 10366546 10299097 67449 X true true 1 1 BRODSTONE MEMORIAL HOSPITAL

520 E 10TH SUPERIOR NE 68978

X X X X BRODSTONE MEMORIAL HOSPITAL 1 false true true 100.0 true 200.0 true X X X X X true true X X X X X X true X X X true X X X X X X X true X false false 3 SUPERIOR FAMILY MEDICAL CENTER

525 E 11TH ST SUPERIOR NE 68978

RURAL HEALTH CLINIC NELSON FAMILY MEDICAL CENTER

76 W 8TH ST NELSON NE 68961

RURAL HEALTH CLINIC EDGAR FAMILY MEDICAL CENTER

315 N C ST EDGAR NE 68935

RURAL HEALTH CLINIC EXCLUSIONS FROM PERCENT OF TOTAL EXPENSE PART I LINE 7 COLUMN F 581911 BAD DEBT EXPENSE WAS EXCLUDED FROM PERCENT OF TOTAL EXPENSE BAD DEBT EXPENSE EXPLANATION PART III LINE 4 EXPENSES INCLUDE A PROVISION FOR DOUBTFUL ACCOUNTS BAD DEBTS TO ALLOW FOR ESTIMATED UNCOLLECTIBLE ACCOUNTS THIS PROVISION IS BASED ON PAST EXPERIENCE AND ON ANALYSIS OF CURRENT ACCOUNTS RECEIVABLE COLLECTIBILITY ACCOUNTS ARE CONSIDERED DELINQUENT BASED ON PASSAGE OF A SPECIFIED PERIOD OF TIME AND CONSIDERATION OF PAYMENT HISTORY AS A RESULT THERE IS AT LEAST A RESONABLE POSSIBILITY THAT RECORDED ESTIMATES WILL CHANGE BY A MATERIAL AMOUNT IN THE NEAR TERM ACCOUNTS DEEMED UNCOLLECTIBLE ARE CHARGED TO THE ALLOWANCE IN THE YEAR THEY ARE DEEMED UNCOLLECTIBLE COSTING METHODOLOGY FOR LINE 2 IS ACTUAL REVENUE WRITTEN OFF AND SENT TO COLLECTION MULTIPLIED BY THE OVERALL COSTCHARGE RATIO PER THE FINANCIAL STATEMENTS COSTING METHODOLOGY FOR LINE 3 IS ACTUAL REVENUE WRITTEN OFF ESTIMATED FROM A REVIEW OF DEMOGRAPHICS AND THEN MULTIPLIED BY THE OVERALL COSTCHARGE RATIO PER THE FINANCIAL STATEMENTS MEDICARE EXPLANATION PART III LINE 8 THE MEDICARE SHORTFALL SHOULD BE TREATED AS A COMMUNITY BENEFIT BECUASE OTHER AGENCIES DONT HAVE TO SUBSIDIZE MEDICAL CARE AND THE MEDICAL CARE IMPROVES QUALITY OF LIFE TO PATIENTS COLLECTION PRACTICES EXPLANATION PART III LINE 9B PATIENTS WHO QUALIFY FOR MEDICAID WILL AUTOMATICALLY QUALIFY FOR 20 FINANCIAL ASSISTANCE AND MAY QUALIFY FOR MORE IF THEY FILL OUT THE FINANCIAL ASSISTANCE APPLICATION THESE PATIENTS WILL NOT BE SENT TO COLLECTIONS IF THEY PAY THE THEY QUALIFY FOR NEEDS ASSESSMENT PART VI BRODSTONE MEMORIAL HOSPITAL HAS DONE COMMUNITY SURVEYS TO ASSESS THE HEALTH CARE NEEDS OF THE COMMUNITY WE ALSO GATHER INPUT FROM MEDICAL STAFF AND EMPLOYEES ON THE NEED FOR SERVICES PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE PART VI BRODSTONE MEMORIAL HOSPITAL MAKES AVAILABLE CHARITY CARE BROCHURES TO ALL PATIENTS AT THE HOSPITAL AND CLINIC THE FINANCIAL ASSISTANCE IS MENTIONED BY COLLECTORS WHEN SETTING UP PAYMENT PLANS PATIENTS WHO INQUIRE ARE GIVEN BROCHURES AND EXPLANATION COMMUNITY INFORMATION PART VI THE HOSPITAL SERVICE AREA INCLUDES RESIDENTS OF NUCKOLLS COUNTY AND POPULATION WITHIN 30 MILES OF NUCKOLLS COUNTY INCLUDING WEBSTER CLAY THAYER REPUBLIC AND JEWELL THE SERVICE AREA IS PRIMARILY RURAL WITH AN ESTIMATED COUNTY POPULATION OF 4334 THE POPULATION IS ESTIMATED AT 979 WHITE WITH LESS THAN 2 EACH OF OTHER DEMOGRAPHIC DECENT CATEGORIES THE MEDIAN HOUSEHOLD INCOME ESTIMATE IS 35086 WITH 132 OF PEOPLE WITH INCOME BELOW THE FEDERAL POVERTY LEVEL THE SERVICE AREA IS DESIGNATED AS A MEDICALLY UNDERSERVED AREA HEALTH OF COMMUNITY IN RELATION TO EXEMPT PURPOSE PART VI THE GOVERNING BOARD CONSISTS OF SIX PEOPLE WHO MUST BE MEMBERS OF THE COMMUNITY THE ORGANIZATION EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS AND MIDLEVEL PRACTITIONERS SURPLUS FUNDS ARE USED TO PURCHASE EQUIPMENT AND CAPITAL IMPROVEMENT PROJECTS TO IMPROVE PATIENT CARE BRODSTONE MEMORIAL HOSPITAL LINE NUMBER 1 PART V LINE 13G PART V LINE 13G ACCOUNT COLLECTORS INFORM THE PATIENT THAT THEY MIGHT BE ELIGIBLE FOR FINANCIAL ASSISTANCE BRODSTONE MEMORIAL HOSPITAL LINE NUMBER 1 PART V LINE 15E PART V LINE 15E REFER TO COLLECTION AGENCY BRODSTONE MEMORIAL HOSPITAL LINE NUMBER 1 PART V LINE 16E PART V LINE 16E GARNISHMENT OF WAGES AND LIEN ON BANK ACCOUNT X true true X X X false false false true false false false false false JOHN KEELAN 172755 14207 186962 167862 TIMOTHY BLECHA 193336 62646 21115 277097 267580 JULIE THEIS 175744 403 19135 195282 175795 ROBERT LEIBEL 167690 21115 188805 169665 FRINGE OR EXPENSE EXPLANATION SCHEDULE J, PAGE 1, PART I, LINE 1A JOHN KEELAN, CEO, IS PROVIDED THE LOCAL COUNTRY CLUB MEMBERSHIP. COMPENSATION CONTINGENT UPON REVENUES OF ORGANIZATION SCHEDULE J, PAGE 1, PART I, LINE 5A 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. ORGANIZATION'S MISSION FORM 990 - ORGANIZATION'S MISSION BRODSTONE MEMAORIAL HOSPITAL IS A NOT-FOR-PROFIT CRITICAL ACCESS HOSPITAL ESTABLISHED TO DELIVER QUALITY, AFFORDABLE HEALTH CARE IN A CARING, SAFE AND COMPASSIONATE ENVIRONMENT TO ALL PERSONS OF SUCH NEED IN A TOTALLY NON-DISCRIMINATORY MANNER. ORGANIZATION'S PROCESS USED TO REVIEW FORM 990 FORM 990, PAGE 6, PART VI, LINE 11B A FINAL COPY OF FORM 990, AS WILL BE ELECTRONICALLY FILED, WAS REVIEWED BY ALL VOTING MEMBERS OF THE BOARD. THIS REVIEW WAS COMPLETED AT THE REGULAR BOARD MEETING ON NOVEMBER 28, 2011 BEFORE THIS RETURN WAS ELECTRONICALLY FILED. A DETAIL REVIEW WAS DONE BY MANAGEMENT AND THEN A GENERAL REVIEW WAS DONE BY THE BOARD. ENFORCEMENT OF CONFLICTS POLICY FORM 990, PAGE 6, PART VI, 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 MEMBER DID NOT DISCLOSE, THE OTHER BOARD MEMBERS WOULD BRING IT TO THE BOARD'S ATTENTION. COMPENSATION PROCESS FOR TOP OFFICIAL FORM 990, PAGE 6, PART VI, LINE 15A THE HR DIRECTOR PREPARES A SALARY SURVEY ANNUALLY FOR ALL JOB 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. COMPENSATION PROCESS FOR OFFICERS FORM 990, PAGE 6, PART VI, LINE 15B THE HR DIRECTOR PREPARES A SALARY SURVEY ANNUALLY FOR ALL JOB DESCRIPTIONS WITH HOSPITALS OF SIMILAR SIZE AND REVENUES. THE HR DIRECTOR AND CFO MAKE RECOMMENDATIONS TO THE CEO. 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. GOVERNING DOCUMENTS DISCLOSURE EXPLANATION FORM 990, PAGE 6, PART VI, LINE 19 GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE NOT MADE AVAILABLE TO THE PUBLIC.