2021-02-03T11:23:05-06:00 2020-04-30 476097913 SEIM JOHNSON LLP 18081 BURT STREET SUITE 200 OMAHA NE 680224722 990 2019-05-01 470388012 BRODSTONE MEMORIAL HOSPITAL BROD 4028793281 520 EAST 10TH STREET SUPERIOR NE 689781225 TREG VYZOUREK CEO 4028793281 2021-02-03 1 MEGAN L KOZIOL P01544037 4023302660 2019 2022-09-23 18:48:47Z TREG VYZOUREK 520 EAST 10TH STREET SUPERIOR NE 689781225 32333265 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 6 210 220 0 0 782555 1050094 28050231 30074690 345403 405693 64194 90651 29242383 31621128 0 0 0 0 13703435 15549730 0 0 27665 12465713 12637904 26169148 28187634 3073235 3433494 35421440 49966697 7643741 18964744 27777699 31001953 X COMPASSIONATE. DEDICATED. UNIFIED. WE CARE FOR YOU. 0 0 17155111 16070419 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 2020, BRODSTONE HAD 1,623 EMERGENCY ROOM VISITS AND PERFORMED 579 SURGERIES. THE LABORATORY PERFORMED 48,751 TESTS AND PHYSICAL THERAPY SERVICES PROVIDED 10,698 TREATMENTS. 3376520 3056678 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 15,348 VISITS IN 2020. 2947448 2789834 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 1,266 PATIENT DAYS OF INPATIENT CARE AND 938 PATIENT DAYS OF SWING BED CARE IN 2020. 2006274 8157759 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. 2006274 8157759 25485353 1 1 0 1 0 0 0 0 0 1 1 0 0 0 1 1 1 0 0 0 0 0 0 0 1 1 1 1 0 0 1 1 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 1 1 1 0 0 1 33 0 1 210 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 SANDRA J BORDEN CFO 4022071517 520 EAST 10TH STREET SUPERIOR NE 68978 TIMOTHY BLECHA MD PHYSICIAN 40.00 0.00 X 448671 0 36875 JULIE THEIS MD PHYSICIAN 40.00 0.00 X 349885 0 45490 TREG VYZOUREK CEO 40.00 0.00 X 229346 0 37454 MATTHEW GATLIN PA-C PHYSICIAN ASSISTANT 40.00 0.00 X 228200 0 39799 ROBERT LEIBEL MD PHYSICIAN 40.00 0.00 X 212453 0 43043 JASON HASS PA-C PHYSICIAN ASSISTANT 40.00 0.00 X 185191 0 43946 SANDRA BORDEN CFO 40.00 0.00 X 159221 0 32610 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 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 1812967 0 279217 12 0 1 0 CG-ID LLC 319 E FRANCIS SUITE 101 NORTH PLATTE NE 69101 ARCHITECT SERVICES 840876 CARDINAL HEALTH PHARMACY SERVICES LLC 21377 NETWORK PLACE CHICAGO IL 60673 PHARMACY SERVICES 633563 BD CONSTRUCTION 209 E 6TH STREET PO BOX 726 KEARNEY NE 68848 CONSTRUCTION 272949 UNMC PHYSICIANS 983135 NEBRASKA MEDICAL CENTER OMAHA NE 68198 LAB SERVICES 220285 CPSI 6600 WALL ST PO BOX 850309 MOBILE AL 36695 MAINTENANCE SERVICES 216634 14 60875 67146 864233 57840 1050094 ANCILLARY SERVICES 621110 15950113 15950113 PHARMACY & INTRAVENOUS THERAPY 621110 4922396 4922396 340B PHARMACY REVENUE 446110 3235362 3235362 PHYSICIAN CLINICS 621110 3056678 3056678 NURSING SERVICES 621110 2789834 2789834 120307 120307 30074690 271122 271122 787617 10415 663461 0 124156 10415 134571 134571 65992 60875 40052 25940 25940 17450 8624 8826 8826 CAFETERIA REVENUE 900099 55885 55885 55885 31621128 30074690 0 496344 X 458631 458631 10992063 10234034 735216 22813 3328934 3062713 266221 770102 695640 74462 86983 86983 83290 83290 37703 37703 3032103 2928107 103996 4441 4441 1584436 1349056 230528 4852 486158 438056 48102 314737 282885 31852 207783 183312 24471 159133 135803 23330 1858861 1586342 272519 211291 180315 30976 MEDICAL SUPPLIES 3649088 3649088 BAD DEBT EXPENSE 574090 574090 DIETARY FOOD & SUPPLIES 135243 135243 DUES AND SUBSCRIPTIONS 96880 18516 78364 115684 27712 87972 28187634 25485353 2674616 27665 1821934 4478275 6875696 19779958 3066822 2698402 24316 224659 260999 400244 375011 36250507 18995675 17609297 17254832 3215934 3270278 2206854 1824626 35421440 49966697 2217569 2626241 4758 5179267 4498843 2655400 242147 9184260 7643741 18964744 X 26009704 29382756 1767995 1619197 27777699 31001953 35421440 49966697 X 3433494 -117946 -91294 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 2450 2450 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. 1535156 -16648 44846 29800 1443862 1718248 68028 221036 30084 1535156 1745868 96344 93784 30180 1718248 1675710 150828 51354 29316 1745868 1773531 -46451 16136 35234 1675710 0.00000 1.00000 0.00000 1 0 117890 117890 22965966 9412625 13553341 11830906 9274207 2556699 1335745 308843 1026902 17254832 DEFERRED COMPENSATION LIABILITIES 278276 ESTIMATED THIRD-PARTY PAYOR SETTLEMENTS 1031800 MEDICARE REIMBURSEMENT ADVANCE 7874184 9184260 X 29688752 -117946 -19113 -137059 29825811 1795317 1795317 31621128 26440993 48676 48676 26392317 1795317 1795317 28187634 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, 2020 AND 2019, THE HOSPITAL HAD NO UNCERTAIN TAX POSITIONS ACCRUED. PART XI, LINE 2D - OTHER ADJUSTMENTS: CHANGE IN BENEFICIAL INTEREST IN TRUSTS -91,294. FUNDRAISING EXPENSES 48,676. ASSETS RELEASED FROM RESTRICTIONS 23,505. PART XI, LINE 4B - OTHER ADJUSTMENTS: PROVISION FOR BAD DEBTS 574,090. 340B CONTRACTED SERVICES EXPENSE 1,193,562. FUNDRAISING EXPENSES INCLUDED IN NET OPERATING GAINS 27,665. PART XII, LINE 2D - OTHER ADJUSTMENTS: FUNDRAISING EXPENSES 48,676. PART XII, LINE 4B - OTHER ADJUSTMENTS: PROVISION FOR BAD DEBTS 574,090. 340B CONTRACTED SERVICES EXPENSE 1,193,562. FUNDRAISING EXPENSES INCLUDED IN NET OPERATING GAINS 27,665. HARVEST MOON GALA 121833 57794 64039 7243 7365 5999 17432 NELSON GOLF TOURNAMENT 5034 3081 1953 1153 324 477 59 126867 60875 65992 1153 324 7243 7842 5999 17491 40052 25940 17450 8110 514 0 17450 8110 514 8624 8826 NE 1 0 1 0 0.00000 1.00000 NORRISA FLORES 520 E 10TH SUPERIOR NE 68978 0 NORRISA FLORES SETTING UP CREDIT CARD PROCESSING, DEPOSITING CASH, PREPARING A REPORT OF INCOME AND EXPENSES. X 1 8826 1 1 X 1 X 1 X 1 1 1 0 1 1 366093 366093 0.01330 1886764 1118215 768549 0.02780 2252857 1118215 1134642 0.04110 941 382751 10297 372454 0.01350 411 31928 13291 18637 0.00070 130 12460 0 12460 0.00050 1482 427139 23588 403551 0.01470 1482 2679996 1141803 1538193 0.05580 12325 0 12325 0.00040 2486 0 2486 0.00010 14811 14811 0.00050 1 574090 0 14752852 14883368 -130516 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 X X 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 CAREBRODSTONE MEMORIAL HOSPITAL TRANSITIONED TO A NEW PROVIDER FOR THE PATIENT PORTAL. WE CONTINUE TO ENHANCE THE SERVICE AND SIGN UP NEW SUBSCRIBERS. WE INTEND TO USE THE PORTAL FOR TEXT APPOINTMENT REMINDERS, BUT HAVE NOT DONE SO AT THIS TIME. CENTRALIZED SCHEDULING IS ALSO IN OUR FUTURE PLANS FOR BRODSTONE.UROLOGY, EXPANDED OPTIONS FOR MENTAL HEALTH AND MORE MENTAL HEALTH PROVIDER DAYS WERE ADDED THIS FY. 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.WE HAVE NOT DEVELOPED A TRANSPORTATION PLAN FOR PATIENTS, HOWEVER WE DO PROVIDE TRANSPORTATION FOR THRIVE CENTER (MENTAL HEALTH) PATIENTS THAT HAVE NO OTHER MODE OF TRANSPORTATION FOR THEIR APPOINTMENTS.BRODSTONE HAS A DESIGNATED FINANCIAL COUNSELOR THAT WORKS WITH PATIENTS THROUGH OUR FINANCIAL ASSISTANCE PROGRAM FOR CHARITY CARE, BANK LOANS AND SELF-PAYMENT PLANS. A LIST OF CHARGES IS LOCATED ON OUR WEBSITE FOR ACCESS BY THE PUBLIC TO DETERMINE THE COST OF OUR SERVICES. A PATIENT LIABILITY ESTIMATOR IS AVAILABLE TO THE PUBLIC BY CALLING BRODSTONE'S FINANCIAL COUNSELOR. 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 HAD TO BE POSTPONED IN THIS FY. A SPORTS MEDICINE PROGRAM HAS BEEN ESTABLISHED WITH THREE SCHOOLS, SUPERIOR PUBLIC SCHOOLS, SOUTH CENTRAL USD #5 IN NELSON AND SOUTH CENTRAL USD #5 IN SANDY CREEK. THE EMPLOYMENT OF A PHYSICAL THERAPY ASSISTANT, ALONG WITH EXISTING SPORTS MEDICINE PERSONNEL AIDED IN THIS PROJECT.THE EXPANSION OF THE BUSINESS WELLNESS PROGRAM IS ADDRESSED IN PRIORITY #4.HEALTH PRIORITY GOAL #2: MENTAL HEALTHBRODSTONE MEMORIAL HOSPITAL CONTRACTED WITH BOYS TOWN PSYCHIATRY TO BE A HUB FOR THEIR SERVICES IN FY20. 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, THIS WAS ALSO MADE AVAILABLE AT SUPERIOR SCHOOLS THIS LAST FISCAL YEAR.BRODSTONE ALSO DEVELOPED A MENTAL HEALTH PROGRAM FOR SENIORS, AGE 55+, FOR BOTH GROUP AND INDIVIDUAL THERAPY. IN THE LAST FISCAL YEAR, THERE WERE 1,096 VISITS TO THE THRIVE CENTER.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 ON NEXT YEAR'S REPORT. 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.OUR GOAL WAS TO DECREASE OUR 30 DAY, ALL CAUSE, READMIT PERCENTAGE. AT THE END OF FY19 WE HAD A READMIT PERCENTAGE OF 12.4%, AND OUR RATE AT THE END OF FY20 WAS 8.5%.WE HAVE NOT FORMALIZED OUR TRANSITIONAL CARE PROGRAM. THIS IS STILL A WORK IN PROGRESS.OUR GOAL WAS TO INSTITUTE A TEAM BASED CARE PROGRAM WITH 80% ATTENDANCE OF ALL DEPARTMENTS INVOLVED. TOTAL STAFF ATTENDANCE WAS AT 97%.WE CONTINUE TO RECRUIT BUSINESSES FOR A BUSINESS HEALTH PROGRAM TO IMPROVE OUR CONTINUITY OF CARE BETWEEN LOCAL HEALTHCARE ORGANIZATIONS. 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 HAVE INCREASED THE AQUA THERAPY POOL USAGE FROM 208 VISITS IN FY19 TO 312 VISITS IN FY20, AN INCREASE OF 66%. OUR GOAL WAS 25%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. CHEMOTHERAPY INFUSION BECAME AVAILABLE AT BRODSTONE IN APRIL, 2020. WE HAD PLANNED TO HAVE THIS SERVICE AVAILABLE BY JANUARY 1, 2020, BUT HAD SOME SETBACKS DUE TO CONSTRUCTION. WE HAD A GOAL OF TREATING 3 TO 5 PATIENTS IN THE FIRST THREE MONTHS OF OPERATION, HOWEVER OUR FIRST PATIENT WAS JUST 2 WEEKS BEFORE THE END OF THE FY. WE SHOULD BE ABLE TO MEET THE GOAL OF 3 TO 5 PATIENTS IN THE FIRST QUARTER, HOWEVER THAT WILL BE REPORTED NEXT YEAR. WE WILL CONTINUE TO PROMOTE THIS SERVICE SO OUR PATIENTS DO NOT HAVE TO TRAVEL SO FAR FOR THERAPY. BRODSTONE MEMORIAL HOSPITAL PART V, SECTION B, LINE 13B: PATIENTS WHOSE FAMILY INCOME EXCEEDS 200% OF THE FPL MAY BE ELIGIBLE TO RECEIVE DISCOUNTED RATES ON A CASE-BY-CASE BASIS BASED ON THEIR SPECIFIC CIRCUMSTANCES, SUCH AS CATASTROPHIC ILLNESS OR MEDICAL INDIGENCE, AT THE DISCRETION OF BRODSTONE MEMORIAL HOSPITAL. 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 402-879-4432 EXT. 5110 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 $ 574,090. 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: IN EVALUATING THE COLLECTIBILITY OF ACCOUNTS RECEIVABLE, THE HOSPITAL ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL 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 DOUBTFUL ACCOUNTS. FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE HOSPITAL ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR BAD DEBTS FOR THOSE ACCOUNTS OVER A CERTAIN AGE BASED ON DISCHARGE 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 DOUBTFUL ACCOUNTS. PART III, LINE 3: IN ACCORDANCE WITH ITS MISSION OBJECTIVES, THE HOSPITAL PROVIDES FREE CARE TO PATIENTS WHO LACK FINANCIAL RESOURCES TO PAY FOR THE SERVICES THEY RECEIVE. INCLUDED IN THE PROVISION FOR CONTRACTUAL ALLOWANCES IS THE VALUE (AT STANDARD CHARGES) OF THESE SERVICES TO PATIENTS WHO ARE UNABLE TO PAY, THAT IS ELIMINATED FROM NET PATIENT SERVICE REVENUES WHEN IT IS DETERMINED THEY QUALIFY UNDER THE HOSPITAL'S CHARITY CARE POLICY. THE ESTIMATED COST INCURRED BY THE HOSPITAL TO PROVIDE THESE SERVICES TO PATIENTS WHO ARE UNABLE TO PAY WAS APPROXIMATELY $251,000 AND $242,000 FOR THE YEARS ENDED APRIL 30, 2020 AND 2019, 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, 2020 AND 2019, THE HOSPITAL RECEIVED NO FUNDS 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 AND 10 OF THE ATTACHED AUDITED FINANCIAL STATEMENTS INCLUDE FOOTNOTES TITLED "PATIENT RECEIVABLES, NET", "NET PATIENT SERVICE REVENUE AND "CHARITY CARE". 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 1,828 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 $42,055 COMPARED TO THE U.S. AVERAGE AT $61,937 AND THE NEBRASKA AVERAGE OF $59,566. THE AREA POPULATION IS PREDOMINATELY WHITE ELDERLY AND LOW INCOME. 48.3% 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. X X X X 0 0 0 1 0 0 0 0 0 TIMOTHY BLECHA MD PHYSICIAN 336966 0 110364 0 1341 0 8250 0 28625 0 485546 0 0 0 JULIE THEIS MD PHYSICIAN 304466 0 45165 0 254 0 8104 0 37386 0 395375 0 0 0 TREG VYZOUREK CEO 224038 0 5000 0 308 0 2615 0 34839 0 266800 0 0 0 MATTHEW GATLIN PA-C PHYSICIAN ASSISTANT 201596 0 26496 0 108 0 6245 0 33554 0 267999 0 0 0 ROBERT LEIBEL MD PHYSICIAN 211463 0 0 0 990 0 6591 0 36452 0 255496 0 0 0 JASON HASS PA-C PHYSICIAN ASSISTANT 185038 0 0 0 153 0 5870 0 38076 0 229137 0 0 0 SANDRA BORDEN CFO 158322 0 0 0 899 0 4941 0 27669 0 191831 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 1614849 4000000 4000000 2010 1 0 1 1 B 1614849 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 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 1,827,125. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,827,125. ANESTHESIA: PROGRAM SERVICE EXPENSES 416,642. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 416,642. LABORATORY: PROGRAM SERVICE EXPENSES 150,654. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 150,654. NUCLEAR MEDICINE: PROGRAM SERVICE EXPENSES 105,832. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 105,832. OTHER FEES FOR SERVICE: PROGRAM SERVICE EXPENSES 427,854. MANAGEMENT AND GENERAL EXPENSES 103,996. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 531,850. FORM 990, PART XI, LINE 9: CHANGE IN BENEFICIAL INTEREST IN TRUSTS -91,294. 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 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 PNC VESTEY TRUST C 67146 FMV