2022-02-01T08:23:13-06:00 2021-04-30 476097913 SEIM JOHNSON LLP 18081 BURT STREET SUITE 200 OMAHA NE 680224722 990 2020-05-01 470388012 BRODSTONE MEMORIAL HOSPITAL BROD 4028793281 520 EAST 10TH STREET SUPERIOR NE 689781225 TREG VYZOUREK CEO 4028793281 2022-01-31 1 TREG VYZOUREK 999009999 MEGAN L KOZIOL P01544037 4023302660 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z TREG VYZOUREK 520 EAST 10TH STREET SUPERIOR NE 689781225 37258240 0 X WWW.BRODSTONEHOSPITAL.ORG X 1927 NE BRODSTONE MEMORIAL HOSPITAL IS A NOT-FOR-PROFIT CRITICAL ACCESS HOSPITAL DELIVERING INPATIENT, OUTPATIENT AND AMBULATORY CARE. 6 6 237 220 0 0 1050094 3496334 30074690 33286875 405693 215059 90651 54979 31621128 37053247 0 14181 0 0 15549730 16791009 0 0 42429 12637904 13828981 28187634 30634171 3433494 6419076 49966697 49224428 18964744 11181163 31001953 38043265 X COMPASSIONATE. DEDICATED. UNIFIED. WE CARE FOR YOU. 0 0 18853211 14181 18191850 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, NUCLEAR MEDICINE AND EMERGENCY SERVICES.DURING 2021, BRODSTONE HAD 1,496 EMERGENCY ROOM VISITS AND PERFORMED 539 SURGERIES. THE LABORATORY PERFORMED 52,594 TESTS AND PHYSICAL THERAPY SERVICES PROVIDED 10,086 TREATMENTS. 3478691 2992443 PHYSICIAN' CLINICS - BRODSTONE MEMORIAL HOSPITAL OWNS 3 RURAL HEALTH CLINICS IN SUPERIOR, NELSON, AND EDGAR, NE. THREE BOARD CERTIFIED FAMILY PRACTICE PHYSICIANS, TWO PA-C, AND TWO APRNS SERVE ALL AGES FROM CHILDREN TO SENIOR CITIZENS. 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 13,373 VISITS IN 2021. 3395701 3189383 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 1,307 PATIENT DAYS OF INPATIENT CARE AND 686 PATIENT DAYS OF SWING BED CARE IN 2021. 1959174 8913199 PHARMACY AND INTRAVENOUS THERAPY - 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. 1959174 8913199 27686777 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 1 0 0 0 1 0 0 0 0 1 1 1 0 0 1 42 0 1 237 1 0 0 0 0 0 0 0 0 0 0 0 0 X 6 6 1 0 0 0 0 0 0 1 1 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 0.20 X X 0 0 0 JANET EGGERS VICE-PRESIDENT 2.00 0.00 X X 0 0 0 JUDY GROVE SECRETARY 2.00 0.20 X X 0 0 0 JODENE CLABAUGH TREASURER 2.00 0.00 X X 0 0 0 JACKI PORTER DIRECTOR 2.00 0.00 X 0 0 0 BETH SIEBECKER DIRECTOR 2.00 0.00 X 0 0 0 TREG VYZOUREK CEO 39.80 0.20 X 260500 0 45555 SANDRA BORDEN CFO 40.00 0.00 X 169119 0 33937 TIMOTHY BLECHA MD PHYSICIAN 40.00 0.00 X 320522 0 38218 JULIE THEIS MD PHYSICIAN 40.00 0.00 X 286270 0 46178 MATTHEW GATLIN PA-C PHYSICIAN ASSISTANT 40.00 0.00 X 226915 0 34368 ROBERT LEIBEL MD PHYSICIAN 40.00 0.00 X 202057 0 44345 JASON HASS PA-C PHYSICIAN ASSISTANT 40.00 0.00 X 183666 0 44543 1649049 0 287144 17 0 1 0 BD CONSTRUCTION 209 E 6TH STREET PO BOX 726 KEARNEY NE 68848 CONSTRUCTION SERVICES 2219973 CARDINAL HEALTH PHARMACY SERVICES LLC 21377 NETWORK PLACE CHICAGO IL 60673 PHARMACY SERVICES 622467 CG-ID LLC 319 E FRANCIS SUITE 101 NORTH PLATTE NE 69101 ARCHITECTURE SERVICES 452588 UNMC PHYSICIANS 983135 NEBRASKA MEDICAL CENTER OMAHA NE 68198 LAB SERVICES 268103 IP PATHWAYS LLC 5940 S 118TH CIR OMAHA NE 68137 SOFTWARE MAINTENANCE SERVICES 264526 14 121510 3293046 81778 78227 3496334 ANCILLARY SERVICES 621110 17982441 17982441 PHARMACY & INTRAVENOUS THERAPY 621110 5620449 5620449 340B PHARMACY REVENUE 446110 3292750 3292750 NURSING SERVICES 621110 3189383 3189383 PHYSICIAN CLINICS 621110 2992443 2992443 209409 209409 33286875 212775 212775 207277 195948 9045 11329 -9045 2284 2284 CAFETERIA REVENUE 900099 54979 54979 54979 37053247 33286875 0 270038 X 14181 14181 509111 509111 12056781 11161672 864415 30694 3386398 3105816 280582 838719 751963 86756 80645 80645 68404 68404 39594 39594 3506538 3353707 152831 3298 3298 1691579 1485893 193951 11735 626861 561736 65125 312177 280103 32074 165081 161441 3640 165124 141417 23707 1723293 1475874 247419 181158 155149 26009 MEDICAL SUPPLIES 4261800 4261800 BAD DEBT EXPENSE 571616 571616 DIETARY FOOD & SUPPLIES 152942 152942 MISCELLANEOUS EXPENSES 150901 150901 127970 48169 79801 30634171 27686777 2904965 42429 4478275 1450347 19779958 17807851 2698402 3026702 24316 27126 260999 320015 375011 498707 38651820 19431719 17254832 19220101 3270278 4079521 1824626 2794058 49966697 49224428 2626241 3501757 4498843 3996290 2655400 2655400 660516 9184260 367200 18964744 11181163 X 29382756 36136859 1619197 1906406 31001953 38043265 49966697 49224428 X 6419076 332862 289374 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 2605 2605 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. 1443862 364430 55867 19189 1733236 1535156 -16648 44846 29800 1443862 1718248 68028 221036 30084 1535156 1745868 96344 93784 30180 1718248 1675710 150828 51354 29316 1745868 0.00000 1.00000 0.00000 1 0 117890 117890 22832401 9537099 13295302 12423101 9708230 2714871 3278428 186390 3092038 19220101 BENEFICIAL INTEREST IN TRUSTS 1733236 INTEREST RECEIVABLE 6205 DEFERRED COMPENSATION 367200 ESTIMATED THIRD-PARTY PAYOR SETTLEMENT 237400 PATIENT CUSTOMER CONTRACTS 450017 2794058 DEFERRED COMPENSATION LIABILITIES 367200 367200 X PART V, LINE 4: INTEREST EARNINGS MAY BE USED FOR OPERATIONS, HOWEVER THE PRINCIPAL IS TO BE MAINTAINED AS A PERMANENT ENDOWMENT. PART X, LINE 2: THE HOSPITAL IS A NOT-FOR-PROFIT CORPORATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND IS EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. THE INTERNAL REVENUE SERVICE HAS ESTABLISHED STANDARDS TO BE MET TO MAINTAIN TAX EXEMPT STATUS. IN GENERAL, SUCH STANDARDS REQUIRE THE HOSPITAL TO MEET A COMMUNITY BENEFIT STANDARD AND COMPLY WITH VARIOUS LAWS AND REGULATIONS. 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, 2021 AND 2020, THE HOSPITAL HAD NO UNCERTAIN TAX POSITIONS ACCRUED. 1 1 X 1 X 1 X 1 1 1 0 1 1 52 198818 198818 0.00660 1670898 1185883 485015 0.01610 52 1869716 1185883 683833 0.02270 22 1509 180203 9679 170524 0.00570 56 346129 7500 338629 0.01130 22 1565 526332 17179 509153 0.01700 22 1617 2396048 1203062 1192986 0.03970 2000 8000 0 8000 0.00030 2000 8000 8000 0.00030 1 571616 0 15884864 14748688 1136176 X 1 1 1 1 BRODSTONE MEMORIAL HOSPITAL 520 E 10TH SUPERIOR NE 68978 HTTPS://WWW.BRODSTONEHOSPITAL.ORG 570001 X X X X BRODSTONE MEMORIAL HOSPITAL 1 0 0 1 X X X X X X X X X X 18 1 1 1 1 X HTTPS://WWW.BRODSTONEHOSPITAL.ORG/PATIENTS-AND-VISITORS/COMMUNITY-HEALTH-NE X 1 18 1 HTTPS://WWW.BRODSTONEHOSPITAL.ORG/PATIENTS-AND-VISITORS/COMMUNITY-HEALTH-NE 0 1 X 100.000000000000 200.000000000000 X X 1 1 X X X X X 1 X HTTPS://WWW.BRODSTONEHOSPITAL.ORG/PATIENTS-AND-VISITORS/FINANCE-SERVICES/ X HTTPS://WWW.BRODSTONEHOSPITAL.ORG/PATIENTS-AND-VISITORS/FINANCE-SERVICES/ X HTTPS://WWW.BRODSTONEHOSPITAL.ORG/PATIENTS-AND-VISITORS/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 (2018 THROUGH 2021) AND THE COMMUNITY HEALTH IMPROVEMENT PLAN (2018 THROUGH 2021) FIRST YEAR ENDED 4/30/2020. 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 GAPS IN SERVICES, WHERE COMMUNITY MEMBERS GO FOR HEALTHCARE, WHERE DO THEY GET THEIR HEALTH INFORMATION, THEIR BIGGEST HEATHCARE CONCERNS, AND WHAT HEALTHCARE SERVICES ARE USED (OR NOT USED) BY THE PEOPLE THEY KNOW. ALSO DISCUSSED WERE THE STRENGTHS OF LOCAL HEALTHCARE AND FUTURE DEMANDS.THIS WAS A COLLABORATION BETWEEN SOUTH HEARTLAND DISTRICT HEALTH DEPARTMENT, MARY LANNING HEALTHCARE IN HASTINGS, WEBSTER COUNTY HOSPITAL IN RED CLOUD, CLAY COUNTY HEALTH DEPARTMENT IN CLAY COUNTY AND BRODSTONE MEMORIAL HOSPITAL IN SUPERIOR. A REPORT FOR THE FIRST YEAR OF THE PLAN MAY BE FOUND ON THE WEBSITE BRODSTONEHOSPITAL.ORG. BRODSTONE MEMORIAL HOSPITAL PART V, SECTION B, LINE 6A: BRODSTONE'S CHNA WAS CONDUCTED WITH WEBSTER COUNTY COMMUNITY HOSPITAL AND MARY LANNING HEALTHCARE. BRODSTONE MEMORIAL HOSPITAL PART V, SECTION B, LINE 6B: BRODSTONE'S CHNA WAS CONDUCTED WITH SOUTH HEARTLAND DISTRICT HEALTH DEPARTMENT AND THE CLAY COUNTY HEALTH DEPARTMENT AS THAT COUNTY DOES NOT HAVE A HOSPITAL. 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 SERVICE AND INCREASE NEW SUBSCRIBERS. WE INTEND TO USE THE PORTAL FOR TEXT APPOINTMENT REMINDERS, BUT WE ARE NOT ABLE TO AUTOMATE THE TEXTS AT THIS POINT.CENTRALIZED SCHEDULING IS ALSO IN OUR FUTURE PLANS FOR BRODSTONE.ENT PROVIDER DAYS WERE ADDED THIS FY. THE ADDITION OF ENDOCRINOLOGY IS ALSO IN PROCESS. WE CONTINUE TO WORK TO ADD OTHER SPECIALTIES AND ADDITIONAL DAYS FOR EXISTING SERVICES. WE CONTINUE TO WORK ON RECRUITING AN ADDITIONAL PROVIDER FOR OUR RURAL HEALTH CLINIC. THIS IS AN ONGOING PROCESS. PURCHASED VAN TO PROVIDE TRANSPORTATION TO SENIORS IN NEED OF OUTPATIENT BEHAVIORAL HEALTH SERVICES WHO OTHERWISE WERE NOT ABLE TO ACCESS SERVICES. WE DO PROVIDE TRANSPORTATION FOR THRIVE CENTER (MENTAL HEALTH) PATIENTS THAT HAVE NO OTHER MODE OF TRANSPORTATION FOR THEIR APPOINTMENTS. CURRENTLY EVALUATING EXPANSION OF TRANSPORTATION FOR OTHER AREAS OF NEED.BRODSTONE HAS A DESIGNATED FINANCIAL COUNSELOR THAT WORKS WITH PATIENTS THROUGH OUR FINANCIAL ASSISTANCE PROGRAM FOR CHARITY CARE, BANK LOANS AND SELF-PAYMENT PLANS. WE HAVE HELPED 115 PATIENTS WITH FINANCING THROUGH OUR MEDICAL LOAN PROGRAM.WE HAVE ADDED CHARGE PROFILES TO OUR PATIENT LIABILITY ESTIMATOR (PLE) TOOL. AS OF JANUARY 1, 2021, PATIENTS ARE NOW ABLE TO RUN ESTIMATES ONLINE FROM OUR WEBSITE.WE DO STILL PLAN TO DEVELOP A PATIENT ADVISORY TEAM; HOWEVER, WE DO NOT HAVE ONE AT THIS TIME.BECAUSE OF COVID-19, OUR HEALTH FAIR FORMAT CHANGED THIS FY. THE HEALTH FAIR WAS HELD WITHIN THE HOSPITAL AND CLINICS AND INCLUDED THE FOLLOWING SERVICES: BLOOD PROFILE, VITAMIN D, PSA, CAROTID ARTERY DOPPLER SCREENING, ABDOMINAL AORTIC ANEURYSM SCREENING, AND FOREARM BONE DENSITY SCREENING. HEALTH FAIRS WERE HELD AT THREE SCHOOLS, SUPERIOR PUBLIC SCHOOLS, SOUTH CENTRAL USD #5 LAWRENCE/NELSON AND SOUTH CENTRAL USD #5 SANDY CREEK FOR STAFF AND AT ONE EMPLOYER, SOUTH CENTRAL PUBLIC POWER DISTRICT IN NELSON.A SPORTS MEDICINE PROGRAM IS ESTABLISHED WITH THREE SCHOOLS, SUPERIOR PUBLIC SCHOOLS, SOUTH CENTRAL USD #5 LAWRENCE/NELSON AND SOUTH CENTRAL USD #5 SANDY CREEK.A SPORTS METRICS PROGRAM HAS BEEN DEPLOYED IN ONE SCHOOL WITH PLANS OF EXPANDING TO OTHERS.THE EXPANSION OF THE BUSINESS WELLNESS PROGRAM IS ADDRESSED IN PRIORITY #4.HEALTH PRIORITY GOAL #2: MENTAL HEALTHBRODSTONE MEMORIAL HOSPITAL CONTINUES TO CONTRACT WITH BOYS TOWN PSYCHIATRY TO BE A HUB FOR THEIR SERVICES. BECAUSE OF THIS AGREEMENT, SERVICES ARE AVAILABLE TO AREA YOUTH, AGES 5 TO 18 YEARS, BOTH AT BRODSTONE SPECIALTY CLINIC AND SUPERIOR PUBLIC SCHOOLS. WHILE BRODSTONE HAS HAD MENTAL HEALTH SERVICES AVAILABLE VIA TELEHEALTH THROUGH THE UNIVERSITY OF NEBRASKA AT LINCOLN, IT IS ALSO AVAILABLE AT SUPERIOR SCHOOLS.BRODSTONE BEHAVIORAL HEALTH VISITS HAVE INCREASED NEARLY 75% WITH 1,926 VISITS TO THE THRIVE CENTER THIS FY.ERICA FERRELL, PSYCHIATRIC MENTAL HEALTH NURSE PRACTITIONER, INCREASED HER OFFICE DAYS AT BRODSTONE SPECIALTY CLINIC FROM TWICE A MONTH TO FIVE TIMES A MONTH, THUS INCREASING THE NUMBER OF APPOINTMENTS AVAILABLE TO PATIENTS.HEALTH PRIORITY GOAL #3: SUBSTANCE MISUSEWE CONTINUE TO DEVELOP BEST PRACTICE PROTOCOLS FOR LOW BACK PAIN, SEPSIS, OPIOID AND DIABETES. OUR GOAL IS TO REDUCE THE NUMBER OF OPIOID PRESCRIPTIONS BY 50 OVER THE THREE-YEAR PERIOD. WE DID NOT BEGIN TRACKING THE NUMBER OF PRESCRIPTIONS AT THE BEGINNING OF FY 19, WE DO NOT HAVE A BASELINE. WE ARE WORKING TO REPORT THESE NUMBERS. WE PLAN TO PARTNER WITH THE SCHOOL TO DEVELOP A DRUG EDUCATION PROGRAM, HOWEVER WE HAVE NOT DONE SO YET.HEALTH PRIORITY GOAL #4: OBESITY & RELATED HEALTH CONDITIONSBRODSTONE CONTINUES TO WORK ON CHRONIC CARE MANAGEMENT. OUR GOAL WAS TO HAVE A 5% INCREASE IN THE NUMBER OF PATIENTS SERVED. WE HAD A 14% DECREASE ON PATIENTS IN THE LAST FY.WE HAVE NOT FORMALIZED OUR TRANSITIONAL CARE PROGRAM. THIS IS STILL A WORK IN PROGRESS.WE HAVE WORKED ON TARGETED TRANSITIONAL CARE FOR COPD & HEART FAILURE.OUR GOAL WAS TO INSTITUTE A TEAM BASED CARE PROGRAM WITH 80% ATTENDANCE OF ALL DEPARTMENTS INVOLVED. TOTAL STAFF ATTENDANCE WAS AT 97%.WE HAVE NOT ACTIVELY EXPANDED OUR BUSINESS HEALTH PROGRAM THIS FY DUE TO COVID. AT THIS TIME OUR LAB IS PERFORMING THE DRUG SCREENINGS AND THERAPY FUNCTIONAL SCREENINGS FOR ONE BUSINESS. WELLNESS ACTIVITIES FOR THE COMMUNITY IN THE LAST FISCAL YEAR INCLUDED YOGA IN THE PARK, TWO WALK/RUN EVENTS, WALKING SCHOOL BUS AND GOLF COURSES WERE SUPPLIED WITH SUN SAFETY INFORMATION, SUN SCREEN AND BUG SPRAY. WE IMPLEMENTED A COMMUNITY FITNESS CHALLENGE 100 & 20 FOR 30 THIS FY. WE ALSO IMPLEMENTED A NEW PLATFORM FOR WELLNESS/FITNESS FOR OUR EMPLOYEES CALLED BURN ALONG. THIS ONLINE PLATFORM ALLOWS EMPLOYEES TO SHARE WELLNESS/FITNESS PROGRAMS WITH THEIR FAMILY AND FRIENDS.WE HAD A DECREASE IN USE OF THE AQUA THERAPY POOL. WE WENT FROM 312 VISITS IN FY20 TO 155 VISITS IN FY21. THIS DECREASE WAS DUE TO COVID.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. IN FY 20 WE HAD A 32% INCREASE IN WELLNESS VISITS. WE WILL CONTINUE TO WORK ON INCREASING THE INDIVIDUAL SCREENINGS OF COLON, BREAST AND BMI.WE HAVE EDUCATED OUR STAFF FOR THE TOBACCO CESSATION PROGRAM AND WILL PROMOTE THE PROGRAM IN THE NEXT FISCAL YEAR. WE HAVE HAD A SETBACK DUE TO COVID-19. 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: NOT APPLICABLE: FEDERAL POVERTY GUIDELINES ARE USED TO DETERMINE ELIGIBILITY FOR PROVIDING FREE CARE AND DISCOUNTED CARE TO LOW INCOME INDIVIDUALS. 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 $ 571,616. 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. 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: GENERALLY, PATIENTS WHO ARE COVERED BY THIRD-PARTY PAYORS ARE RESPONSIBLE FOR RELATED DEDUCTIBLES AND COINSURANCE, WHICH VARY IN AMOUNT. THE HOSPITAL PROVIDES SERVICES TO UNINSURED PATIENTS, AND OFFERS THOSE UNINSURED PATIENTS A DISCOUNT, EITHER BY POLICY OR LAW, FROM STANDARD CHARGES. THE HOSPITAL ESTIMATES THE TRANSACTION PRICE FOR PATIENTS WITH DEDUCTIBLES AND COINSURANCE AND FROM THOSE WHO ARE UNINSURED BASED ON HISTORICAL EXPERIENCE AND CURRENT MARKET CONDITIONS. THE INITIAL ESTIMATE OF THE TRANSACTION PRICE IS DETERMINED BY REDUCING THE STANDARD CHARGE BY ANY CONTRACTUAL ADJUSTMENTS, DISCOUNTS AND IMPLICIT PRICE CONCESSIONS. SUBSEQUENT CHANGES TO THE ESTIMATE OF THE TRANSACTION PRICE ARE RECORDED AS ADJUSTMENTS TO PATIENT SERVICE REVENUE IN THE PERIOD OF CHANGE. FOR THE YEARS ENDED APRIL 30, 2021 AND 2020, NO SIGNIFICANT ADJUSTMENTS TO REVENUE WERE RECOGNIZED DUE TO CHANGES IN ESTIMATES OF IMPLICIT PRICE CONCESSIONS FOR PERFORMANCE OBLIGATIONS SATISFIED IN PRIOR YEARS. SUBSEQUENT CHANGES THAT ARE DETERMINED TO BE THE RESULT OF AN ADVERSE CHANGE IN THE PATIENT'S ABILITY TO PAY ARE RECORDED AS BAD DEBT EXPENSE. PART III, LINE 3: THE HOSPITAL PROVIDES PATIENT FINANCIAL ASSISTANCE TO PATIENTS WHO ARE FINANCIALLY UNABLE TO PAY FOR THE HEALTHCARE SERVICES THEY RECEIVE. IT IS THE POLICY OF THE HOSPITAL NOT TO PURSUE COLLECTION OF AMOUNTS DETERMINED TO QUALIFY AS PATIENT FINANCIAL ASSISTANCE. ACCORDINGLY, THE HOSPITAL DOES NOT REPORT THESE AMOUNTS IN PATIENT SERVICE REVENUE. THE HOSPITAL DETERMINES THE COSTS ASSOCIATED WITH PROVIDING PATIENT FINANCIAL ASSISTANCE BY AGGREGATING THE DIRECT AND INDIRECT COSTS, INCLUDING SALARIES, BENEFITS, SUPPLIES, ANDOTHER OPERATING EXPENSES, BASED ON AN OVERALL COST TO CHARGE RATIO. THE COSTS OF CARING FOR THESE PATIENTS FOR THE YEARS ENDED APRIL 30, 2021 AND 2020 WAS APPROXIMATELY $147,000 AND $251,000, RESPECTIVELY. THE ESTIMATED COST OF THESE CHARITY CARE SERVICES WAS DETERMINED USING A RATIO OF COSTS TO GROSS CHARGES AND APPLYING THAT RATIO TO THE GROSS CHARGES ASSOCIATED WITH PROVIDING CARE TO CHARITY PATIENTS FOR THE PERIOD. GROSS CHARGES ASSOCIATED WITH PROVIDING CARE TO CHARITY PATIENTS INCLUDES ONLY THE RELATED CHARGES FOR THOSE PATIENTS WHO ARE FINANCIALLY UNABLE TO PAY AND QUALIFY UNDER THE HOSPITAL'S CHARITY CARE POLICY AND THAT DO NOT OTHERWISE QUALIFY FOR REIMBURSEMENT FROM A GOVERNMENTAL PROGRAM. DURING THE YEARS ENDED APRIL 30, 2021 AND 2020, THE HOSPITAL RECEIVED $3,079,683 AND $0 FROM THE HEALTH RESOURCES AND SERVICES ADMINISTRATION, RESPECTIVELY TO HELP DEFRAY THE COSTS OF INDIGENT CARE. PART III, LINE 4: THE HOSPITAL'S FINANCIAL STATMENTS DO NOT CONTAIN A SPECIFIC FOOTNOTE DESCRIBING BAD DEBT. HOWEVER, PAGES 8, 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 FEMALES 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) 14181 REIMBURSE FOUNDATION FOR FUNDRAISING EXPENSES. 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 231896 0 87285 0 1341 0 8550 0 29668 0 358740 0 0 0 JULIE THEIS MD PHYSICIAN 269928 0 16088 0 254 0 7584 0 38594 0 332448 0 0 0 TREG VYZOUREK CEO 260181 0 0 0 319 0 8007 0 37548 0 306055 0 0 0 MATTHEW GATLIN PA-C PHYSICIAN ASSISTANT 203099 0 23708 0 108 0 6953 0 27415 0 261283 0 0 0 ROBERT LEIBEL MD PHYSICIAN 199317 0 1750 0 990 0 6282 0 38063 0 246402 0 0 0 JASON HASS PA-C PHYSICIAN ASSISTANT 177681 0 5750 0 235 0 5776 0 38767 0 228209 0 0 0 SANDRA BORDEN CFO 168174 0 0 0 945 0 5194 0 28743 0 203056 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 1878489 4000000 4000000 2010 1 0 1 1 B 1878489 4000000 4000000 2010 1 0 1 1 C 50001 50001 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 1 1 0 0 0 0 1 B 0 0 1 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. BEN VYZOUREK BEN IS THE SON OF THE CEO, TREG VYZOUREK. 1000 CASH GRANT HEALTH CAREER EDUCATION X OTHER SUPPLIES 1 78227 FMV 0 1 0 FORM 990, PART VI, SECTION A, LINE 2 DIRECTORS JUDY GROVE AND JACKI PORTER HAVE A FAMILY RELATIONSHIP. 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 1,829,035. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,829,035. ANESTHESIA: PROGRAM SERVICE EXPENSES 427,990. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 427,990. LABORATORY: PROGRAM SERVICE EXPENSES 174,708. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 174,708. NUCLEAR MEDICINE: PROGRAM SERVICE EXPENSES 89,412. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 89,412. OTHER FEES FOR SERVICE: PROGRAM SERVICE EXPENSES 832,562. MANAGEMENT AND GENERAL EXPENSES 152,831. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 985,393. FORM 990, PART XI, LINE 9: CHANGE IN BENEFICIAL INTEREST IN TRUSTS 289,374. 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 0 1 0 0 PNC VESTEY TRUST C 66510 FMV BRODSTONE MEMORIAL HOSPITAL FOUNDATION C 55000 CASH