2025-02-07T14:24:22-06:00 2024-04-30 450250958 EIDE BAILLY LLP 18081 BURT ST STE 200 OMAHA NE 680224722 990 2023-05-01 470388012 BRODSTONE MEMORIAL HOSPITAL BROD 4028793281 520 E 10TH ST PO BOX 187 SUPERIOR NE 689781225 TREG VYZOUREK CEO 4028793281 2025-01-30 1 1 MEGAN L KOZIOL CPA P01544037 4023302660 2025-01-30 2023 2025-03-06 01:10:19Z BRODSTONE HEALTHCARE TREG VYZOUREK 520 E 10TH ST PO BOX 187 SUPERIOR NE 689781225 43610771 0 X WWW.BRODSTONEHEALTHCARE.ORG/ X 1927 NE TO DELIVER INPATIENT, OUTPATIENT AND AMBULATORY CARE. 6 6 284 45 0 0 2713464 2287066 38216831 38761209 47630 1040031 73896 82110 41051821 42170416 55379 130178 0 0 19696607 21226626 0 0 2663 16915226 16956996 36667212 38313800 4384609 3856616 64397101 70431891 14622400 16650012 49774701 53781879 X OUR MISSION IS TO PROVIDE EXCEPTIONAL AND PROGRESSIVE HEALTHCARE TO THE COMMUNITIES WE SERVE. 0 0 23553685 130178 23417762 ANCILLARY SERVICES - BRODSTONE MEMORIAL HOSPITAL IS A 25 BED CRITICAL ACCESS HOSPITAL. SERVICES PROVIDED BY BRODSTONE INCLUDE ANESTHESIOLOGY, RADIOLOGY, CT SCANS, LABORATORY, BLOOD ADMINISTRATION, INHALATION THERAPY, SLEEP STUDIES, PHYSICAL AND OCCUPATIONAL THERAPY, SPEECH THERAPY, ELECTROCARDIOLOGY AND ECHOCARDIOLOGY, BEHAVIORAL HEALTH, CHEMOTHERAPY, NUCLEAR MEDICINE AND EMERGENCY SERVICES.DURING 2024, BRODSTONE HAD 1,752 EMERGENCY ROOM VISITS AND PERFORMED 768 SURGERIES. THE LABORATORY PERFORMED 53,742 TESTS AND PHYSICAL THERAPY SERVICES PROVIDED 13,220 TREATMENTS. 4534926 4404571 PHYSICIAN' CLINICS - BRODSTONE MEMORIAL HOSPITAL OWNS 3 RURAL HEALTH CLINICS IN SUPERIOR, NELSON, AND EDGAR, NE. THREE BOARD CERTIFIED FAMILY PRACTICE PHYSICIANS, THREE PA-C, AND THREE APRNS SERVE ALL AGES FROM CHILDREN TO SENIOR CITIZENS. ONE APRN IS PSYCHIATRIC-MENTAL HEALTH NP CERTIFIED TO PROVIDE BEHAVIORAL HEALTH SERVICES. IN ADDITION TO DIAGNOSING AND TREATING ILLNESS, THEY ALSO PROVIDE PREVENTIVE CARE, ROUTINE CHECKUPS, IMMUNIZATION AND SCREENING TESTS, AND HOSPITALIZATION AND NURSING HOME CARE, AND OBSTETRICS. THE CLINICS HAD 13,883 VISITS IN 2024. 4377998 3770404 NURSING SERVICES - BRODSTONE MEMORIAL HOSPITAL IS A 25 BED CRITICAL ACCESS HOSPITAL, WHICH DEBUTED THE NEWLY CONSTRUCTED 41,900 SQUARE FOOT ADDITION FEATURING A NEW ER, PATIENT WING, INFUSION SUITES AND HEALING GARDEN. THE NEW SPACE HAS ENHANCED PATIENT SAFETY, SECURITY AND PRIVACY AND FEATURES 17 NEW PATIENT ROOMS INCLUDING AN OB/NURSERY AREA. 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 958 PATIENT DAYS OF INPATIENT CARE, 560 PATIENT DAYS OF SWING BED CARE, 45 DAYS OF NURSERY CARE IN 2024. 2528211 7168472 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. 2528211 7168472 34994820 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 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 82 0 1 284 1 0 0 0 0 0 0 0 0 0 0 0 0 X 6 6 0 0 0 0 0 0 0 1 0 0 0 1 1 1 1 1 1 1 1 0 X CRYSTAL WYATT 4028793281 520 EAST 10TH STREET SUPERIOR NE 68978 PAT MCCORD PRESIDENT 2.00 0.00 X X 0 0 0 JANET EGGERS VICE-PRESIDENT 2.00 0.00 X X 0 0 0 PIPER HODGE SECRETARY 2.00 0.20 X X 0 0 0 BETH SIEBECKER TREASURER 2.00 0.00 X X 0 0 0 JACKI PORTER DIRECTOR 2.00 0.00 X 0 0 0 ROYCE SCHOTT DIRECTOR 2.00 0.20 X 0 0 0 TREG VYZOUREK CEO 39.80 0.20 X 406312 0 75255 CRYSTAL WYATT CFO 39.80 0.20 X 126292 0 41905 TIMOTHY BLECHA MD PHYSICIAN 40.00 0.00 X 386464 0 45197 JULIE THEIS MD PHYSICIAN 40.00 0.00 X 361652 0 59496 MATTHEW GATLIN PA-C PHYSICIAN ASSISTANT 40.00 0.00 X 297510 0 39678 JASON HASS PA-C PHYSICIAN ASSISTANT 40.00 0.00 X 184608 0 45997 BETH SCHLICHTMAN CHRO 40.00 0.00 X 153318 0 4052 1916156 0 311580 28 0 1 0 CARDINAL HEALTH-OWEN PHARMACY SERVICE 21377 NETWORK PLACE CHICAGO IL 60673 MEDICAL SERVICES 2964701 BD CONSTRUCTION 209 E 6TH STREET KEARNEY NE 68848 CONSTRUCTION SERVICES 1804492 C&A INDUSTRIES INC DBA FOCUSONE SOLUTION PO BOX 850861 MINNEAPOLIS MN 55485 CONTRACTED LABOR 926728 RURAL PARTNERS IN MEDICINE LLC 8181 ARISTA PLACE SUITE 100 BROOMFIELD CO 80021 MEDICAL SERVICES 771149 RENEE SINCLAIR 2551 Z RD WEBBER KS 66970 MEDICAL SERVICES 329683 15 136055 13011 2138000 2287066 NET PATIENT SERVICE REVENUE 621110 34950900 34950900 340B PHARMACY REVENUE 456110 3406386 3406386 403923 403923 38761209 972386 972386 1500000 8000 1429670 10685 70330 -2685 67645 67645 CAFETERIA REVENUE 900099 82110 82110 82110 42170416 38761209 0 1122141 122178 122178 8000 8000 630167 630167 15532365 14717234 815131 529529 501330 28199 3447485 3211357 236128 1087080 994642 92438 129845 129845 140782 140782 51917 51917 3207484 3203223 4261 91012 696 90316 3334629 2777749 554217 2663 338404 309248 29156 466000 433092 32908 159496 143201 16295 2337896 2099038 238858 285289 256142 29147 PHARMACY EXPENSES 3395341 3395341 MEDICAL SUPPLIES 2592364 2572034 20330 DIETARY FOOD & SUPPLIES 250350 250315 35 COLLECTIONS EXPENSE 175642 175642 545 545 38313800 34994820 3316317 2663 3095412 3693878 15434771 19700378 5066406 5766495 90437 71980 404178 394203 558542 570559 56829227 25099683 32340617 31729544 3929503 4187193 3477235 4317661 64397101 70431891 4925298 4263223 9116379 11874912 580723 511877 14622400 16650012 X 48076194 52127491 1698507 1654388 49774701 53781879 64397101 70431891 X 3856616 78830 71732 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 3531 3531 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. 1452743 227635 100989 26333 28580 1524476 1545374 30725 93698 29658 1452743 1733236 -95776 56892 35193 1545374 1443862 364430 55867 19189 1733236 1535156 -16648 44846 29800 1443862 0.00000 1.00000 0.00000 1 0 117890 117890 38411500 12899050 25512450 15991098 11966285 4024813 2308739 234348 2074391 31729544 BENEFICIAL INTEREST IN TRUSTS 1524476 DEFERRED COMPENSATION 423664 ESTIMATED THIRD-PARTY PAYOR SETTLEMENTS 2232000 INTEREST RECEIVABLE 431 RIGHT OF USE ASSETS 137090 4317661 DEFERRED COMPENSATION 374639 RIGHT OF USE LIABILITIES 137238 511877 X PART V, LINE 4: INTEREST EARNINGS MAY BE USED FOR OPERATIONS, HOWEVER THE PRINCIPLE IS TO BE MAINTAINED AS A PERMANENT ENDOWMENT. PART X, LINE 2: THE HOSPITAL ACCOUNTS FOR UNCERTAINTIES IN ACCOUNTING FOR INCOME TAX ASSETS AND LIABILITIES USING GUIDANCE INCLUDED IN FINANCIAL ACCOUNTING STANDARDS BOARD (FASB) ASC 740, INCOME TAXES. THE HOSPITAL RECOGNIZES THE EFFECT OF INCOME TAX POSITIONS ONLY IF THOSE POSITIONS ARE MORE LIKELY THAN NOT OF BEING SUSTAINED. AT APRIL 30, 2024 AND 2023, THE HOSPITAL HAD NO UNCERTAIN TAX POSITIONS ACCRUED. 1 1 X 1 X 1 X 1 1 0 1 1 230 172145 0 172145 0.00450 3124112 2097603 1026509 0.02680 230 3296257 2097603 1198654 0.03130 56 7664 112448 39476 72972 0.00190 230 104350 0 104350 0.00270 9 1600 8000 0 8000 0.00020 65 9494 224798 39476 185322 0.00480 65 9724 3521055 2137079 1383976 0.03610 1 939871 112785 17306765 17433470 -126705 X 1 1 1 1 BRODSTONE MEMORIAL HOSPITAL 520 E 10TH SUPERIOR NE 68978 HTTPS://WWW.BRODSTONEHEALTHCARE.ORG/ 570001 X X X X BRODSTONE MEMORIAL HOSPITAL 1 0 0 1 X X X X X X X X X X 21 1 1 1 1 X HTTPS://WWW.BRODSTONEHEALTHCARE.ORG/PATIENTS/COMMUNITY-HEALTH-NEEDS-ASSESSM X 1 21 1 HTTPS://WWW.BRODSTONEHEALTHCARE.ORG/PATIENTS/COMMUNITY-HEALTH-NEEDS-ASSESSM 0 1 X 100.000000000000 200.000000000000 X X 1 1 X X X X X 1 X HTTPS://WWW.BRODSTONEHEALTHCARE.ORG/PATIENTS/FINANCE-SERVICES X HTTPS://WWW.BRODSTONEHEALTHCARE.ORG/PATIENTS/FINANCE-SERVICES X HTTPS://WWW.BRODSTONEHEALTHCARE.ORG/PATIENTS/FINANCE-SERVICES X X X X X 1 X 0 X X X X 1 X 0 0 BRODSTONE MEMORIAL HOSPITAL PART V, SECTION B, LINE 3J: THE REPORT INCLUDES A LIST OF MEASURES IN THE THREE YEAR PLAN (2021 THROUGH 2024) AND THE COMMUNITY HEALTH IMPROVEMENT PLAN (2021 THROUGH 2024) FIRST YEAR ENDED 4/30/2022. THE PLAN INCLUDES PERFORMANCE MEASURES ALONG WITH STRATEGIES AND ACTIVITIES FOR THE PRIORITY AREAS OF ACCESS TO CARE, MENTAL HEALTH, SUBSTANCE MISUSE, OBESITY & RELATED HEALTH CONDITIONS, AND CANCER. BRODSTONE MEMORIAL HOSPITAL PART V, SECTION B, LINE 5: INCLUDED IN THE REPORT ARE RESULTS FROM A PUBLIC HEALTH SURVEY THAT WAS MADE AVAILABLE OVER A 4 COUNTY AREA (WEBSTER, ADAMS, CLAY AND NUCKOLLS), FOLLOWED BY A BROAD SPECTRUM OF STAKEHOLDERS THAT PARTICIPATED IN FOCUS GROUPS AND CONTRIBUTED TO EACH ASSESSMENT, DATA REVIEW, PRIORITY SETTING, AND STRATEGY MEETINGS. BRODSTONE MEMORIAL HOSPITAL PART V, SECTION B, LINE 6A: BRODSTONE'S CHNA WAS CONDUCTED WITH MARY LANNING HEALTHCARE. BRODSTONE MEMORIAL HOSPITAL PART V, SECTION B, LINE 6B: BRODSTONE'S CHNA WAS CONDUCTED WITH SOUTH HEARTLAND DISTRICT HEALTH DEPARTMENT, NEBRASKA DEPARTMENT OF HEALTH AND HUMAN SERVICES OFFICE OF COMMUNITY AND RURAL HEALTH, AND UNITED WAY OF SOUTH-CENTRAL NEBRASKA. BRODSTONE MEMORIAL HOSPITAL PART V, SECTION B, LINE 11: THE STRATEGIES THAT WERE SCHEDULED FOR THIS YEAR ON OUR COMMUNITY HEALTH IMPROVEMENT PLAN THAT WERE ACCOMPLISHED ARE AS FOLLOWS:HEALTH PRIORITY GOAL #1: ACCESS TO CARE-CONTINUED TO ENHANCE THE PATIENT PORTAL SERVICES AND INCREASE NEW SUBSCRIBERS ENDING THE YEAR WITH OVER 1845 PATIENTS USING THE SERVICE. UNFORTUNATELY, WE ARE NOT ABLE TO AUTOMATE THE TEXTS WITH OUR CURRENT SERVICE.-CENTRALIZED SCHEDULING IS ALSO IN OUR FUTURE PLANS FOR BRODSTONE.-CONTINUED WORK ON SPECIALTY CLINIC EXPANSION. WE INCREASED ORTHOPEDICS COVERAGE TO 8 DAYS PER MONTH AND PAIN MANAGEMENT TO 4 TIMES PER MONTH. TELEHEALTH ENDOCRINOLOGY WAS ADDED AS WELL AS AN ADDITIONAL CARDIOLOGIST. WE CONTINUED TO WORK TO ADD OTHER SPECIALTIES AND ADDITIONAL DAYS FOR EXISTING SERVICES.-TO HELP IMPROVE THE FINANCIAL LITERACY AND UNDERSTANDING OF THE HEALTHCARE BILLING PROCESS, BRODSTONE HIRED 2 FULLTIME EMPLOYEES TO IMPLEMENT A GOVERNMENT MANDATED NO SURPRISE BILLING PROGRAM FOR PATIENTS WHO ARE UNINSURED OR UNDERINSURED TO HELP REDUCE PATIENTS BEING TURNED OVER TO COLLECTIONS. -CURRENTLY EVALUATING EXPANSION OF TRANSPORTATION FOR OTHER AREAS OF NEED. -A PATIENT ADVISORY TEAM WAS NOT IMPLEMENTED DUE TO COVID PRECAUTIONS. THIS WILL BE RE-EVALUATED IN THE NEXT YEAR.-CURRENTLY IN DISCUSSION WITH SIX 3RD YEAR MEDICAL STUDENTS REGARDING EMPLOYMENT. THIS IS AN ONGOING PROCESS.-OPERATED AN ACL PREVENTION PROGRAM IN SUPERIOR SCHOOLS AND DEVELOPED SCAT 5 CONCUSSION TESTING AND BASELINE SCREENING IN SOUTH CENTRAL USD #5 SANDY CREEK, SOUTH CENTRAL USD #5 LAWRENCE/NELSON AND SUPERIOR SCHOOLS-DEVELOPED A BRODSTONE FIT PROGRAM OFFERING AN EARLY MORNING BOOT CAMP AND A WALKING CLUB 3 DAYS A WEEK FOR INDOOR ACTIVITY YEARROUND ENGAGING THE COMMUNITY OF SUPERIOR. -WELLNESS ACTIVITIES FOR THE COMMUNITY INCLUDED ASSISTING SOUTH HEARTLAND HEALTH DISTRICT WITH A FALL PREVENTION PROGRAM FOR SENIOR CITIZENS WHILE ALSO OFFERING SUPPORT AND RESOURCES TO AREA SCHOOLS.HEALTH PRIORITY GOAL #2: MENTAL HEALTH-DEVELOPED A NEW CRISIS SUPPORT GROUP THROUGH THRIVE BEHAVIOR HEALTH OUTPATIENT CLINIC IN RESPONSE TO MULTIPLE COMMUNITY CRISIS SITUATIONS-CONTINUED TO DEVELOP MENTAL HEALTH OUTPATIENT SERVICES TO HELP COMMUNITY AND STAFF.HEALTH PRIORITY GOAL #3: SUBSTANCE MISUSE-WE HAVE NOT ADDRESSED THIS YET. WITHIN THE NEXT 3 YEARS, WE HAVE PLANS TO PARTNER WITH THE CITY OF SUPERIOR AND LOCAL SCHOOLS ADDRESSING SUBSTANCE MISUSE.-EDUCATION WAS PROVIDED TO LAWRENCE/NELSON AND SANDY CREEK PUBLIC SCHOOLS ON VAPING MISUSE. INFORMATION WAS PROVIDED TO ALL MIDDLE SCHOOL AND HIGH SCHOOL STUDENTS AT BOTH LOCATIONS.HEALTH PRIORITY GOAL #4: OBESITY & RELATED HEALTH CONDITIONS-WE ARE EVALUATING AND FORMALIZING OUR TRANSITIONAL CARE PROGRAMS FOR COPD AND HEART FAILURE. -DEVELOPED DAILY INTERDISCIPLINARY TEAM (IDT) MEETINGS THROUGHOUT THE FACILITY INVOLVING ALL CLINICAL PATIENT CARE DEPARTMENTS. ATTENDANCE IS AT 97%. -CONTINUED TO PROVIDE PRE-EMPLOYMENT DRUG SCREENING AND EVALUATIONS WITH KINGSWOOD COURT IN SUPERIOR AND PARKVIEW HAVEN NURSING HOME IN DESHLER. -PROVIDED WELLNESS ACTIVITIES FOR THE COMMUNITY IN THE LAST FISCAL YEAR INCLUDING TWO COMMUNITY WALK/RUN EVENTS AND A WALKING SCHOOL BUS (TWO SESSIONS: SPRING AND FALL).-CONTINUED WORKING WITH HEALTHY LIVING PATIENTS; SAW 257 HEALTHY LIVING THERAPY POOL VISITS AND 392 THERAPY POOL VISITS.HEALTH PRIORITY GOAL #5: CANCER-OUR OBJECTIVE WAS TO ACHIEVE ACO GOALS BY BEING MORE PROACTIVE WITH PATIENT WELLNESS VISITS AND SCREENINGS. A FAVORABLE OUTCOME WOULD BE A 10% INCREASE. WE WILL CONTINUE TO WORK ON INCREASING THE INDIVIDUAL SCREENINGS OF COLON, BREAST AND BMI. -WE EDUCATED OUR STAFF FOR THE TOBACCO/VAPING CESSATION PROGRAM AND WILL PROMOTE THE PROGRAM IN THE NEXT FISCAL YEAR. -THE OUTPATIENT CHEMO INFUSION PROGRAM SAW 6 NEW PATIENTS IN FY 2023. CONSTRUCTION ON A NEW INFUSION SUITE IS ONGOING. 2 ADDITIONAL NURSES ARE WORKING TOWARDS CERTIFICATION. -WELLNESS ACTIVITIES FOR THE COMMUNITY IN THE LAST FISCAL YEAR INCLUDED: PROVISION OF SUN SCREEN AND SUN SAFETY EDUCATION FOR 2 LOCAL GOLF COURSES, YOUTH GOLF CAMP, SOFTBALL TOURNAMENTS AND LOCAL POOLS; PRESENTED RISKS/PREVENTION OF VAPING FOR TWO LOCAL SCHOOLS.DURING FY24, NEW EMR SOFTWARE WAS IMPLEMENTED, WHICH ALLOWED THE AUTOMATION OF TEXT MESSAGES FOR APPOINTMENT REMINDERS. SPECIALTY CLINIC ADDED AN ENT PROVIDER, WHICH HAS A CLINIC 1 DAY PER MONTH. THE THRIVE BEHAVIORAL HEALTH DEPARTMENT CONTINUES TO PROVIDE SUPPORT FOR COMMUNITY CRISIS SITUATIONS AS NEEDED. BRODSTONE IS NOW PROVIDING THE FIREKRACKER RUN ON JULY 4TH. THIS HELPS BRING MEMBERS OF AREA COMMUNITIES TO GO FOR A WALK OR RUN AND ENCOURAGE MOVEMENT.THERE WERE NO SIGNIFICANT NEEDS IDENTIFIED THAT ARE NOT BEING ADDRESSED. BRODSTONE MEMORIAL HOSPITAL PART V, SECTION B, LINE 13H: IN INSTANCES WHEN A PATIENT MAY APPEAR ELIGIBLE FOR FINANCIAL ASSISTANCE, BUT THERE IS NO FINANCIAL APPLICATION FORM ON FILE DUE TO A LACK OF SUPPORTING DOCUMENTATION, FINANCIAL ASSISTANCE MAY STILL BE GRANTED IN CERTAIN SITUATIONS BASED ON PRESUMPTIVE CIRCUMSTANCES. OFTEN THERE IS ADEQUATE INFORMATION PROVIDED BY THE PATIENT OR THROUGH OTHER SOURCES, WHICH COULD PROVIDE SUFFICIENT EVIDENCE TO PROVIDE THE PATIENT WITH FINANCIAL ASSISTANCE. IN THE EVENT THERE IS NO EVIDENCE TO SUPPORT A PATIENT'S ELIGIBILITY FOR FINANCIAL ASSISTANCE, BRODSTONE COULD USE OUTSIDE AGENCIES IN DETERMINING ESTIMATED INCOME AMOUNTS FOR THE BASIS OF DETERMINING FINANCIAL ASSISTANCE ELIGIBILITY AND POTENTIAL DISCOUNT AMOUNTS. PRESUMPTIVE ELIGIBILITY MAY BE DETERMINED IN CERTAIN SITUATIONS, AND BASED ON THE APPROVAL OF BRODSTONE'S MANAGEMENT, ON THE BASIS OF INDIVIDUAL LIFE CIRCUMSTANCES THAT MAY INCLUDE:A) STATE-FUNDED PRESCRIPTION PROGRAMS;B) TRANSIENT, HOMELESS OR RECEIVED CARE FROM A HOMELESS CLINIC, OR UNIDENTIFIED PERSONS;C) PARTICIPATION IN WOMEN, INFANTS AND CHILDREN PROGRAMS (WIC);D) FOOD STAMP ELIGIBILITY;E) ELIGIBILITY FOR OTHER STATE OR LOCAL ASSISTANCE PROGRAMS THAT ARE UNFUNDED (E.G., MEDICAID SPEND-DOWN);F) CRIME VICTIMS BILLED CHARGES AFTER STATE OR FEDERAL FUNDS HAVE PAID OR ARE EXHAUSTED;G) LOW INCOME/SUBSIDIZED HOUSING IS PROVIDED AS A VALID ADDRESS;H) PATIENT IS DECEASED WITH NO KNOWN ESTATE OR RESPONSIBLE PARTY; ANDI) PERSONS WHO INCOME IS AT OR BELOW 100% OF THE CURRENT POVERTY LEVEL. BRODSTONE MEMORIAL HOSPITAL PART V, SECTION B, LINE 15E: PATIENTS MAY APPLY FOR ASSISTANCE BY CALLING BRODSTONE MEMORIAL HOSPITAL AT 402-207-1539 AND REQUESTING A FINANCIAL ASSISTANCE APPLICATION; OR BY REQUESTING AN APPLICATION IN PERSON FROM REGISTRATION OR THE BUSINESS OFFICE. AN APPLICATION MAY BE DOWNLOADED FROM THE HOSPITAL'S WEBSITE. 3 1 - SUPERIOR FAMILY MEDICAL CENTER 525 E 11TH ST SUPERIOR NE 68978 RURAL HEALTH CLINIC 2 - NELSON FAMILY MEDICAL CENTER 76 W 8TH ST NELSON NE 68961 RURAL HEALTH CLINIC 3 - EDGAR MEDICAL CLINIC 315 N C ST EDGAR NE 68935 RURAL HEALTH CLINIC PART I, LINE 3C: IN ADDITION TO FEDERAL POVERTY GUIDELINES, THE HOSPITAL ALSO USES MEDICAL INDIGENCY TO DETERMINE ELIGIBILITY OF FREE OR DISCOUNTED CARE. 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. PART I, LINE 6A: BRODSTONE'S COMMUNITY BENEFIT REPORT IS NOT PREPARED BY A RELATED ORGANIZATION. PART I, LINE 7: CHARITY CARE EXPENSE WAS CONVERTED TO COST ON LINE 7A BASED ON AN OVERALL COST-TO-CHARGE RATIO ADDRESSING ALL PATIENT SEGMENTS. UNREIMBURSED MEDICAID ON LINE 7B WAS CALCULATED USING THE COSTING METHODS TO PREPARE THE COST REPORTS. COMMUNITY HEALTH IMPROVEMENT SERVICES, LINE 7E, HEALTH PROFESSIONS EDUCATION, LINE 7F, AND IN-KIND CONTRIBUTIONS FOR COMMUNITY BENEFIT, LINE 7I, ARE REPORTED BASED ON ACTUAL EXPENSES REPORTED IN THE GENERAL LEDGER. PART I, LINE 7G: NO COSTS ASSOCIATED WITH PHYSICIAN CLINICS WERE INCLUDED AS SUBSIDIZED HEALTH SERVICES. PART II, COMMUNITY BUILDING ACTIVITIES: THERE WERE NO COMMUNITY BUILDING ACTIVITIES REPORTED DURING THE YEAR. PART III, LINE 2: THE AMOUNT ON LINE 2 REPRESENTS IMPLICIT PRICE CONCESSIONS. THE ORGANIZATION DETERMINES ITS ESTIMATE OF IMPLICIT PRICE CONCESSION BASED ON ITS HISTORICAL COLLECTION EXPERIENCE WITH THIS CLASS OF PATIENTS. PART III, LINE 3: THE ESTIMATED AMOUNT OF THE ORGANIZATION'S IMPLICIT PRICE CONCESSIONS ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S CHARITY CARE POLICY IS CALCULATED BASED ON AN APPROXIMATE 12.0% OF INDIVIDUALS LIVING BELOW THE POVERTY LEVEL IN THE SERVICE AREA. PART III, LINE 4: THE FOOTNOTE TO THE ORGANIZATION'S FINANCIAL STATEMENTS THAT DESCRIBES IMPLICIT PRICE CONCESSIONS IS LOCATED IN FOOTNOTE 1 ON PAGES 12 THROUGH 14 OF THE ATTACHED FINANCIAL STATEMENTS. PART III, LINE 8: THE ENTIRE MEDICARE SHORTFALL IS CONSIDERED A COMMUNITY BENEFIT. SERVICES ARE PROVIDED TO PATIENTS UNDER THE MEDICARE PROGRAM EVEN THOUGH THE HOSPITAL KNOWS THEY WILL NOT RECOVER ALL OF THE COSTS FROM PROVIDING THE SERVICES. THIS PROGRAM IS CONSIDERED SUBSIDIZED BY THE HOSPITAL AND OTHER PAYORS. PATIENTS RELY ON THESE SERVICES FOR THEIR HEALTH AND WELL-BEING AND ARE ESSENTIAL FOR THEIR ACCESS TO HEALTHCARE. TOTAL REVENUE RECEIVED FROM MEDICARE IS THE GROSS REIMBURSEMENT PLUS SETTLEMENT. BOTH TOTAL REVENUE RECEIVED FROM MEDICARE AND THE MEDICARE ALLOWABLE COSTS ARE REPORTED FROM THE MEDICARE COST REPORT. THE MEDICARE COST REPORT IS COMPLETED BASED ON THE RULES AND REGULATIONS SET FORTH BY CENTERS FOR MEDICARE AND MEDICAID SERVICES. 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, AND PUBLISHES SUGGESTIONS AND STRATEGIC PLANNING RESULTS. HOSPITAL STAFF ALSO NETWORKS WITH OTHER HEALTH CARE ORGANIZATIONS TO DEVELOP IDEAS OF WHAT CAN BE DONE TO IMPROVE THE AVAILABILITY OF SERVICES IN THE COMMUNITY. PART VI, LINE 3: BRODSTONE HAS A BROCHURE CALLED CHARITY POLICY THAT ADDRESSESS THE FINANCIAL ASSISTANCE AVAILABILITY. IT IS POSTED AT THE ADMISSIONS AREAS AND EMERGENCY ROOM. THE CHARITY POLICY IS DISCUSSED WHEN MAKING PAYMENT ARRANGEMENTS. THIS POLICY IS ALSO AVAILABLE ON THE HOSPITAL'S WEBSITE. PART VI, LINE 4: SUPERIOR HAS A POPULATION OF 1,755 AND IS LOCATED ON THE NEBRASKA-KANSAS BORDER. BRODSTONE'S SERVICE AREA COVERS ALL OF NUCKOLLS COUNTY AND PARTS OF 2 OTHER COUNTIES IN NEBRASKA AND 3 COUNTIES IN KANSAS. THE MEDIAN HOUSEHOLD INCOME FOR NUCKOLLS COUNTY IS $43,388 COMPARED TO THE U.S. AVERAGE AT $62,843 AND THE NEBRASKA AVERAGE OF $61,439. THE AREA POPULATION IS PREDOMINATELY WHITE ELDERLY AND LOW INCOME. 49.6% OF THE HOSPITAL'S PATIENTS ARE MEDICARE PATIENTS. PART VI, LINE 5: BRODSTONE'S GOVERNING BODY CONSISTS OF INDIVIDUALS WITH NO IMMEDIATE FAMILY TIES TO ANY EMPLOYEE NOR ARE THEY CONTRACTORS OF THE ORGANIZATION. ALL BOARD MEMBERS HAVE SUPERIOR NEBRASKA ADDRESSES BUT 2 MEMBERS LIVE IN JEWELL COUNTY, KANSAS. ALL FAMILY PRACTICE PHYSIANS AND MIDLEVELS IN THE AREA WHO HAVE REQUESTED MEDICAL STAFF PRIVILEGES AND MEET THE REQUIREMENTS HAVE PRIVILEGES AT THE HOSPITAL. ONE DENTIST HAS COURTESY PRIVELEGES. ALL SURPLUS FUNDS OF THE ORGANIZATION ARE USED TO FUND THE BUDGET FOR THE COMING YEARS OR SET ASIDE FOR FUTURE PROJECTS. PART VI, LINE 6: BRODSTONE MEMORIAL HOSPITAL IS NOT PART OF AN AFFILIATED HEALTH CARE SYSTEM. PART VI, LINE 7: BRODSTONE DOES NOT FILE A COMMUNITY BENEFIT REPORT WITH ANY STATE. 1 BRODSTONE MEMORIAL HOSPITAL FOUNDATION 520 EAST 10TH STREET SUPERIOR NE 68978 851276014 501(C)(3) 122178 0 REIMBURSE FOUNDATION FOR FUNDRAISING EXPENSES AND CONTRIBUTE FUNDS FOR PROGRAM SUPPORT. 1 0 FOOD, BOTTLED WATER & SUNSCREEN 1600 8000 FAIR MARKET VALUE FOOD, BOTTLED WATER & SUNSCREEN 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 TREG VYZOUREK CEO 405374 0 0 0 938 0 38200 0 37055 0 481567 0 0 0 TIMOTHY BLECHA MD PHYSICIAN 261852 0 121672 0 2940 0 13200 0 31997 0 431661 0 0 0 JULIE THEIS MD PHYSICIAN 287412 0 73854 0 386 0 13200 0 46296 0 421148 0 0 0 MATTHEW GATLIN PA-C PHYSICIAN ASSISTANT 236572 0 60772 0 166 0 12118 0 27560 0 337188 0 0 0 JASON HASS PA-C PHYSICIAN ASSISTANT 184297 0 76 0 235 0 7769 0 38228 0 230605 0 0 0 CRYSTAL WYATT CFO 126210 0 0 0 82 0 5343 0 36562 0 168197 0 0 0 BETH SCHLICHTMAN CHRO 153023 0 0 0 295 0 0 0 4052 0 157370 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 2710821 4000000 4000000 2010 1 0 1 1 B 2710821 4000000 4000000 2010 1 0 1 1 C 480610 10000000 10000000 2024 0 0 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 B 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 C 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 A 0 0 0 1 0 0 0 0 1 B 0 0 0 1 0 0 0 0 1 C 0 0 0 1 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 (C) ISSUER NAME: CITY OF SUPERIOR, NEBRASKA DATE THE REBATE COMPUTATION WAS PERFORMED: 03/31/2024 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. NOTE REGARDING THE 3/31/2024 REBATE COMPUTATION: SINCE THE BOND PROCEEDS ARE SPENT AND THE DEBT SERVICE FUND WAS OPERATED ON A BONA FIDE BASIS, NO FURTHER REBATE CALCULATIONS ARE NECESSARY. FORM 990, PART VI, SECTION A, LINE 8B THERE ARE NO COMMITTEES WITH AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS PREPARED BY AN OUTSIDE ACCOUNTING FIRM. BEFORE IT IS FILED, IT IS GIVEN A DETAILED REVIEW BY MANAGEMENT AND THEN A GENERAL REVIEW BY THE BOARD OF DIRECTORS AT A REGULARLY SCHEDULED BOARD MEETING. A FINAL COPY OF THE FORM 990 WILL BE ELECTRONICALLY FILED AFTER APPROVAL. FORM 990, PART VI, SECTION B, LINE 12C BOARD MEMBERS WHO HAVE A CONFLICT OF INTEREST WOULD REFRAIN FROM DISCUSSION AND VOTING ON THOSE MATTERS. THERE IS AN ANNUAL BOARD MEMBER TRAINING THAT COVERS THIS POLICY. ADDITIONALLY, ALL BOARD MEMBERS ARE WELL ACQUAINTED WITH EACH OTHER SO IF THERE WAS A CONFLICT OF INTEREST AND THE BOARD MEMBER DID NOT DISCLOSE, THE OTHER BOARD MEMBERS WOULD BRING IT TO THE BOARD'S ATTENTION. FORM 990, PART VI, SECTION B, LINE 15 THE HUMAN RESOURCE DIRECTOR PREPARES A SALARY SURVEY ANNUALLY FOR ALL JOBS DESCRIPTIONS WITH HOSPITALS OF SIMILAR SIZE AND REVENUES. THE BOARD OF DIRECTORS REVIEWS THE SURVEY AND PRIOR SALARY INCREASES FOR THE CEO BEFORE GRANTING PAY INCREASES. THE HUMAN RESOURCE DIRECTOR AND CFO MAKE RECOMMENDATIONS TO THE CEO FOR OTHER EMPLOYEES. THE CEO REVIEWS THE SURVEY, PRIOR SALARY INCREASES, AND RECOMMENDATIONS BEFORE APPROVING PAY INCREASES FOR EMPLOYEES. THE PAY INCREASES ARE APPROVED BY THE BOARD OF DIRECTORS DURING THE BUDGET PROCESS. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION DOES NOT MAKE ITS GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY AVAILABLE TO THE PUBLIC, BUT FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. FORM 990, PART XI, LINE 9: CHANGE IN BENEFICIAL INTEREST IN TRUSTS 71,732. FORM 990, PART XII, LINE 2C: THE BOARD OF DIRECTORS ASSUMES THE RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF ITS FINANCIAL STATEMENTS AND THE SELECTION OF AN INDEPENDENT ACCOUNTANT. THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. PNC VESTEY TRUST UA UNB & NORTHERN CO SUCC BENEFIT BRODSTONE MEM HOSP 116 ALLEGHENY CENTER MALL PITTSBURGH PA 15212 226023351 ASSISTING IN THE OPERATIONS OF BRODSTONE MEMORIAL HOSPITAL PA 4947(A)(1) PF BRODSTONE MEMORIAL HOSPITAL 1 BRODSTONE MEMORIAL HOSPITAL FOUNDATION 520 EAST 10TH STREET SUPERIOR NE 68978 851276014 TO SUPPORT BRODSTONE MEMORIAL HOSPITAL NE 501(C)(3) LINE 12A, I BRODSTONE MEMORIAL HOSPITAL 1 0 1 1 0 0 0 0 0 0 0 0 0 1 1 1 1 1 0 0 PNC VESTEY TRUST C 52409 FMV BRODSTONE MEMORIAL HOSPITAL FOUNDATION B 122178 FMV BRODSTONE MEMORIAL HOSPITAL FOUNDATION C 83646 FMV