BRODSTONE MEMORIAL HOSPITAL: Form 990, tax year 2018
View the entire original 990 at ProPublica ↗
- Organization
- BRODSTONE MEMORIAL HOSPITAL (EIN 47-0388012)
- Tax period
- 2018-05-01 to 2019-04-30
- Filed
- 2019-09-04
- IRS object ID
- 201932479349300308
- Schema version
- 2018v3.1
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule G
- Schedule H
- Schedule J
- Schedule K
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2019-09-04T08:23:53-05:00 | ReturnTs |
| Tax Period End | 2019-04-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 476097913 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SEIM JOHNSON LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 18081 BURT STREET SUITE 200 | AddressLine1Txt |
| City | OMAHA | CityNm |
| State Abbreviation | NE | StateAbbreviationCd |
| ZIP | 680224722 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2018-05-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 470388012 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BRODSTONE MEMORIAL HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | BROD | BusinessNameControlTxt |
| Phone | 4028793281 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 520 EAST 10TH STREET | AddressLine1Txt |
| City | SUPERIOR | CityNm |
| State Abbreviation | NE | StateAbbreviationCd |
| ZIP | 689781225 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | TREG VYZOUREK | PersonNm |
| Person Title | CEO | PersonTitleTxt |
| Phone | 4028793281 | PhoneNum |
| Signature | 2019-08-28 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | MEGAN L KOZIOL | PreparerPersonNm |
| PTIN | P01544037 | PTIN |
| Phone | 4023302660 | PhoneNum |
Filing Security Information FilingSecurityInformation
IP Address IPAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| I Pv4 Address | 209.34.201.180 | IPv4AddressTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IP | 2019-08-28 | IPDt |
| IP Tm | 14:25:53 | IPTm |
| IP Timezone | CD | IPTimezoneCd |
| Filing License Type | P | FilingLicenseTypeCd |
| At Submission Creation Device Id | 4492BEC4F3BAD6652306010BEE5B0619D04D8C2F | AtSubmissionCreationDeviceId |
| At Submission Filing Device Id | B319C935D5CD5DD24452FA9CD51ABCBD1A9C8C2C | AtSubmissionFilingDeviceId |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2018 | TaxYr |
| Build TS | 2019-02-21 02:37:17Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | TREG VYZOUREK | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 520 EAST 10TH STREET | AddressLine1Txt |
| City | SUPERIOR | CityNm |
| State Abbreviation | NE | StateAbbreviationCd |
| ZIP | 689781225 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $29,320,816 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.BRODSTONEHOSPITAL.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1927 | FormationYr |
| Legal Domicile State | NE | LegalDomicileStateCd |
| Activity Or Mission | BRODSTONE MEMORIAL HOSPITAL IS A NOT-FOR-PROFIT CRITICAL ACCESS HOSPITAL DELIVERING INPATIENT, OUTPATIENT AND AMBULATORY CARE. | ActivityOrMissionDesc |
| Voting Members Governing Body | 6 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 6 | VotingMembersIndependentCnt |
| Total Employee | 218 | TotalEmployeeCnt |
| Total Volunteers | 220 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $260,928 | PYContributionsGrantsAmt |
| CY Contributions Grants | $782,555 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $27,340,323 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $28,050,231 | CYProgramServiceRevenueAmt |
| PY Investment Income | $101,400 | PYInvestmentIncomeAmt |
| CY Investment Income | $345,403 | CYInvestmentIncomeAmt |
| PY Other Revenue | $58,070 | PYOtherRevenueAmt |
| CY Other Revenue | $64,194 | CYOtherRevenueAmt |
| PY Total Revenue | $27,760,721 | PYTotalRevenueAmt |
| CY Total Revenue | $29,242,383 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $12,795,162 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $13,703,435 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $12,906,456 | PYOtherExpensesAmt |
| CY Other Expenses | $12,465,713 | CYOtherExpensesAmt |
| PY Total Expenses | $25,701,618 | PYTotalExpensesAmt |
| CY Total Expenses | $26,169,148 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $2,059,103 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $3,073,235 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $33,066,255 | TotalAssetsBOYAmt |
| Total Assets EOY | $35,421,440 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $8,132,167 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $7,643,741 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $24,934,088 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $27,777,699 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | COMPASSIONATE. DEDICATED. UNIFIED. WE CARE FOR YOU. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $15,740,107 | ExpenseAmt |
| Revenue | $15,481,611 | RevenueAmt |
| Desc | 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, NUCLEAR MEDICINE AND EMERGENCY SERVICES.DURING 2019, BRODSTONE HAD 1,799 EMERGENCY ROOM VISITS AND PERFORMED 520 SURGERIES. THE LABORATORY PERFORMED 48,016 TESTS AND PHYSICAL THERAPY SERVICES PROVIDED 12,206 TREATMENTS. | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $3,313,516 | ExpenseAmt |
| Revenue | $3,116,785 | RevenueAmt |
| Desc | 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 16,142 VISITS IN 2019. | Desc |
Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $2,605,886 | ExpenseAmt |
| Revenue | $2,425,193 | RevenueAmt |
| Desc | 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 1,195 PATIENT DAYS OF INPATIENT CARE AND 553 PATIENT DAYS OF SWING BED CARE IN 2019. | Desc |
Prog Srvc Accom Acty Other ProgSrvcAccomActyOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $2,065,609 | ExpenseAmt |
| Revenue | $7,026,642 | RevenueAmt |
| Desc | 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. | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Prog Srvc Expense | $2,065,609 | TotalOtherProgSrvcExpenseAmt |
| Total Other Prog Srvc Revenue | $7,026,642 | TotalOtherProgSrvcRevenueAmt |
| Total Program Service Expenses | $23,725,118 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (1) | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Temp Or Permanent Endowments | Yes (1) | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (1) | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (1) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | 0 | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | Yes (1) | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | Yes (1) | TaxExemptBondsInd |
| Invest Tax Exempt Bonds | 0 | InvestTaxExemptBondsInd |
| Escrow Account | 0 | EscrowAccountInd |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuerInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | Yes (1) | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | Yes (1) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | Yes (1) | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 34 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 218 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | 0 | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | 0 | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 6 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 6 | IndependentVotingMemberCnt |
| Family Or Business Rln | Yes (1) | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | 0 | MembersOrStockholdersInd |
| Election Of Board Members | 0 | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | SANDRA J BORDEN CFO | PersonNm |
| Phone | 4028793281 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 520 EAST 10TH STREET | AddressLine1Txt |
| City | SUPERIOR | CityNm |
| State Abbreviation | NE | StateAbbreviationCd |
| ZIP | 68978 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (14 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| PAT MCCORD | ||||||||
| PRESIDENT | 2.00 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| JANET EGGERS | ||||||||
| VICE-PRESIDENT | 2.00 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| MARLIN MEYER | ||||||||
| VICE-PRESIDENT THRU 7/18 | 2.00 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| JUDY GROVE | ||||||||
| SECRETARY | 2.00 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| JODENE CLABAUGH | ||||||||
| TREASURER | 2.00 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| JACKI PORTER | ||||||||
| DIRECTOR | 2.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| BETH SIEBECKER | ||||||||
| DIRECTOR | 2.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| TREG VYZOUREK | ||||||||
| CEO | 40.00 | 0.00 | Yes (X) | $216,499 | $0 | $31,001 | ||
| SANDRA BORDEN | ||||||||
| CFO | 40.00 | 0.00 | Yes (X) | $174,985 | $0 | $34,438 | ||
| TIMOTHY BLECHA MD | ||||||||
| PHYSICIAN | 40.00 | 0.00 | $407,901 | $0 | $38,420 | Yes (X) | ||
| JULIE THEIS MD | ||||||||
| PHYSICIAN | 40.00 | 0.00 | $309,242 | $0 | $47,984 | Yes (X) | ||
| ROBERT LEIBEL MD | ||||||||
| PHYSICIAN | 40.00 | 0.00 | $224,737 | $0 | $44,867 | Yes (X) | ||
| JASON HASS PA-C | ||||||||
| PHYSICIAN ASSISTANT | 40.00 | 0.00 | $193,970 | $0 | $45,278 | Yes (X) | ||
| MATTHEW GATLIN PA-C | ||||||||
| PHYSICIAN ASSISTANT | 40.00 | 0.00 | $172,337 | $0 | $42,883 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,699,671 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $284,871 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 12 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| CARDINAL HEALTH-OWEN | |||||
| 21377 NETWORK PLACE | CHICAGO | IL | 60673 | PHARMACY SERVICES | $551,937 |
| CPSI | |||||
| 6600 WALL ST PO BOX 850309 | MOBILE | AL | 36695 | MAINTENANCE SERVICES | $283,772 |
| RENEE R SINCLAIR | |||||
| 2551 Z ROAD | WEBBER | KS | 66970 | CRNA | $188,873 |
| LORI HARRIS | |||||
| 3207 NORTHWOOD CT | NEWTON | KS | 67114 | CRNA | $188,873 |
| MINDRAY DS USA INC | |||||
| 24312 NETWORK PLACE | CHICAGO | IL | 60673 | MAINTENANCE SERVICES | $149,756 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 7 | CntrctRcvdGreaterThan100KCnt |
| Fundraising | $38,133 | FundraisingAmt |
| Related Organizations | $243,620 | RelatedOrganizationsAmt |
| All Other Contributions | $500,802 | AllOtherContributionsAmt |
| Total Contributions | $782,555 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (5 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| ANCILLARY SERVICES | 621110 | $15,433,713 | $15,433,713 |
| PHARMACY & INTRAVENOUS THERAPY | 621110 | $4,108,736 | $4,108,736 |
| PHYSICIAN CLINICS | 621110 | $3,116,785 | $3,116,785 |
| 340B PHARMACY REVENUE | 446110 | $2,917,906 | $2,917,906 |
| NURSING SERVICES | 621110 | $2,425,193 | $2,425,193 |
Total Oth Program Service Rev TotalOthProgramServiceRevGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $47,898 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $47,898 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $28,050,231 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $229,646 | TotalRevenueColumnAmt |
| Exclusion | $229,646 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $157,408 | SecuritiesAmt |
| Other | $8,000 | OtherAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $49,651 | SecuritiesAmt |
| Other | $0 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $107,757 | SecuritiesAmt |
| Other | $8,000 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $115,757 | TotalRevenueColumnAmt |
| Exclusion | $115,757 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Fundraising Gross Income | $31,169 | FundraisingGrossIncomeAmt |
| Contri Rpt Fundraising Event | $38,133 | ContriRptFundraisingEventAmt |
| Fundraising Direct Expenses | $28,782 | FundraisingDirectExpensesAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $2,387 | TotalRevenueColumnAmt |
| Exclusion | $2,387 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | CAFETERIA REVENUE | Desc |
| Business | 900099 | BusinessCd |
| Total Revenue Column | $61,807 | TotalRevenueColumnAmt |
| Exclusion | $61,807 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $61,807 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $29,242,383 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $28,050,231 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $409,597 | ExclusionAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $456,923 | TotalAmt |
| Management And General | $456,923 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $10,416,007 | TotalAmt |
| Program Services | $9,827,457 | ProgramServicesAmt |
| Management And General | $588,550 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,119,645 | TotalAmt |
| Program Services | $1,986,987 | ProgramServicesAmt |
| Management And General | $132,658 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $710,860 | TotalAmt |
| Program Services | $646,885 | ProgramServicesAmt |
| Management And General | $63,975 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $70,472 | TotalAmt |
| Management And General | $70,472 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $68,330 | TotalAmt |
| Management And General | $68,330 | ManagementAndGeneralAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $30,022 | TotalAmt |
| Management And General | $30,022 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,559,629 | TotalAmt |
| Program Services | $2,367,524 | ProgramServicesAmt |
| Management And General | $192,105 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,211 | TotalAmt |
| Program Services | $5,211 | ProgramServicesAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,493,136 | TotalAmt |
| Program Services | $1,244,770 | ProgramServicesAmt |
| Management And General | $248,366 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $475,611 | TotalAmt |
| Program Services | $432,482 | ProgramServicesAmt |
| Management And General | $43,129 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $281,985 | TotalAmt |
| Program Services | $251,807 | ProgramServicesAmt |
| Management And General | $30,178 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $112,555 | TotalAmt |
| Program Services | $76,945 | ProgramServicesAmt |
| Management And General | $35,610 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $171,962 | TotalAmt |
| Program Services | $146,751 | ProgramServicesAmt |
| Management And General | $25,211 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,013,909 | TotalAmt |
| Program Services | $1,718,659 | ProgramServicesAmt |
| Management And General | $295,250 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $198,934 | TotalAmt |
| Program Services | $169,769 | ProgramServicesAmt |
| Management And General | $29,165 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| MEDICAL SUPPLIES | $3,858,665 | $3,858,665 | |
| BAD DEBT EXPENSE | $806,578 | $806,578 | |
| DIETARY FOOD & SUPPLIES | $146,334 | $146,334 | |
| MISCELLANEOUS EXPENSES | $78,040 | $78,040 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $94,340 | TotalAmt |
| Program Services | $38,294 | ProgramServicesAmt |
| Management And General | $56,046 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $26,169,148 | TotalAmt |
| Program Services | $23,725,118 | ProgramServicesAmt |
| Management And General | $2,444,030 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $200 | BOYAmt |
| EOY | $1,821,934 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,206,671 | BOYAmt |
| EOY | $6,875,696 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,089,221 | BOYAmt |
| EOY | $3,066,822 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $204,749 | BOYAmt |
| EOY | $224,659 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $491,610 | BOYAmt |
| EOY | $400,244 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $34,777,998 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $17,168,701 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $18,995,697 | BOYAmt |
| EOY | $17,609,297 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,306,237 | BOYAmt |
| EOY | $3,215,934 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,771,870 | BOYAmt |
| EOY | $2,206,854 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $33,066,255 | BOYAmt |
| EOY | $35,421,440 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,238,631 | BOYAmt |
| EOY | $2,217,569 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $33,690 | BOYAmt |
| EOY | $4,758 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,663,983 | BOYAmt |
| EOY | $5,179,267 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $195,863 | BOYAmt |
| EOY | $242,147 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,132,167 | BOYAmt |
| EOY | $7,643,741 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $23,013,924 | BOYAmt |
| EOY | $26,009,704 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $201,916 | BOYAmt |
| EOY | $232,839 | EOYAmt |
Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,718,248 | BOYAmt |
| EOY | $1,535,156 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $24,934,088 | BOYAmt |
| EOY | $27,777,699 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $33,066,255 | BOYAmt |
| EOY | $35,421,440 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $3,073,235 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | -$46,532 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | -$183,092 | OtherChangesInNetAssetsAmt |
| Info In Schedule O Part XII | Yes (X) | InfoInScheduleOPartXIIInd |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Separate Basis Fincl Stmt | Yes (X) | SeparateBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | VolunteersInd |
| Paid Staff Or Management | 0 | PaidStaffOrManagementInd |
| Media Advertisements | 0 | MediaAdvertisementsInd |
| Mailings Members | 0 | MailingsMembersInd |
| Publications Or Broadcast | 0 | PublicationsOrBroadcastInd |
| Grants Other Organizations | 0 | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | 0 | DirectContactLegislatorsInd |
| Rallies Demonstrations | 0 | RalliesDemonstrationsInd |
| Other Activities | Yes (1) | OtherActivitiesInd |
| Other Activities | $2,358 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $2,358 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | 0 | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART II-B, LINE 1: | FormAndLineReferenceDesc |
| Explanation | 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. | ExplanationTxt |
Schedule D IRS990ScheduleD
CY Endwmt Fund CYEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $1,718,248 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $68,028 | InvestmentEarningsOrLossesAmt |
| Grants Or Scholarships | $221,036 | GrantsOrScholarshipsAmt |
| Administrative Expenses | $30,084 | AdministrativeExpensesAmt |
| End Year Balance | $1,535,156 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $1,745,868 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $96,344 | InvestmentEarningsOrLossesAmt |
| Grants Or Scholarships | $93,784 | GrantsOrScholarshipsAmt |
| Administrative Expenses | $30,180 | AdministrativeExpensesAmt |
| End Year Balance | $1,718,248 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $1,675,710 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $150,828 | InvestmentEarningsOrLossesAmt |
| Grants Or Scholarships | $51,354 | GrantsOrScholarshipsAmt |
| Administrative Expenses | $29,316 | AdministrativeExpensesAmt |
| End Year Balance | $1,745,868 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $1,773,531 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | -$46,451 | InvestmentEarningsOrLossesAmt |
| Grants Or Scholarships | $16,136 | GrantsOrScholarshipsAmt |
| Administrative Expenses | $35,234 | AdministrativeExpensesAmt |
| End Year Balance | $1,675,710 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $1,642,133 | BeginningYearBalanceAmt |
| Contributions | $80,806 | ContributionsAmt |
| Investment Earnings Or Losses | $99,760 | InvestmentEarningsOrLossesAmt |
| Grants Or Scholarships | $17,706 | GrantsOrScholarshipsAmt |
| Administrative Expenses | $31,462 | AdministrativeExpensesAmt |
| End Year Balance | $1,773,531 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Designated Balance EOY | 0.00000 | BoardDesignatedBalanceEOYPct |
| Prmnnt Endowment Balance EOY | 1.00000 | PrmnntEndowmentBalanceEOYPct |
| Term Endowment Balance EOY | 0.00000 | TermEndowmentBalanceEOYPct |
| Endowments Held Unrelated Org | Yes (1) | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | 0 | EndowmentsHeldRelatedOrgInd |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $117,890 | OtherCostOrOtherBasisAmt |
| Book Value | $117,890 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $22,667,151 | OtherCostOrOtherBasisAmt |
| Depreciation | $8,331,263 | DepreciationAmt |
| Book Value | $14,335,888 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $11,495,840 | OtherCostOrOtherBasisAmt |
| Depreciation | $8,547,357 | DepreciationAmt |
| Book Value | $2,948,483 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $497,117 | OtherCostOrOtherBasisAmt |
| Depreciation | $290,081 | DepreciationAmt |
| Book Value | $207,036 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $17,609,297 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp (4 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| BENEFICIAL INTEREST IN TRUSTS | $1,535,156 |
| INTEREST RECEIVABLE | $30,651 |
| DEFERRED COMPENSATION | $242,147 |
| ESTIMATED THIRD-PARTY PAYOR SETTLEMENT | $398,900 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $2,206,854 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | DEFERRED COMPENSATION LIABILITIES | Desc |
| Amt | $242,147 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $242,147 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $27,214,652 | TotalRevEtcAuditedFinclStmtAmt |
| Net Unrealized Gains Invst | -$46,532 | NetUnrealizedGainsInvstAmt |
| Other Revenue | -$108,114 | OtherRevenueAmt |
| Revenue Not Reported | -$154,646 | RevenueNotReportedAmt |
| Revenue Subtotal | $27,369,298 | RevenueSubtotalAmt |
| Other Revenues Not Included | $1,873,085 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | $1,873,085 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $29,242,383 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $24,324,845 | TotExpnsEtcAuditedFinclStmtAmt |
| Other Expenses Included | $28,782 | OtherExpensesIncludedAmt |
| Expenses Not Reported | $28,782 | ExpensesNotReportedAmt |
| Expenses Subtotal | $24,296,063 | ExpensesSubtotalAmt |
| Other Expenses Not Included | $1,873,085 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $1,873,085 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $26,169,148 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (6 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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 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, 2019 AND 2018, THE HOSPITAL HAD NO UNCERTAIN TAX POSITIONS ACCRUED. |
| PART XI, LINE 2D - OTHER ADJUSTMENTS: | CHANGE IN BENEFICIAL INTEREST IN TRUSTS -183,092. FUNDRAISING EXPENSES 28,782. ASSETS RELEASED FROM RESTRICTIONS 46,196. |
| PART XI, LINE 4B - OTHER ADJUSTMENTS: | PROVISION FOR BAD DEBTS 806,578. 340B CONTRACTED SERVICES EXPENSE 1,066,507. |
| PART XII, LINE 2D - OTHER ADJUSTMENTS: | FUNDRAISING EXPENSES 28,782. |
| PART XII, LINE 4B - OTHER ADJUSTMENTS: | PROVISION FOR BAD DEBTS 806,578. 340B CONTRACTED SERVICES EXPENSE 1,066,507. |
Schedule G IRS990ScheduleG
Fundraising Event Information FundraisingEventInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Event1 | HARVEST MOON GALA | Event1Nm |
| Gross Receipts Event1 | $57,190 | GrossReceiptsEvent1Amt |
| Charitable Contri Event1 | $28,645 | CharitableContriEvent1Amt |
| Gross Revenue Event1 | $28,545 | GrossRevenueEvent1Amt |
| Non Cash Prizes Event1 | $2,754 | NonCashPrizesEvent1Amt |
| Rent Facility Costs Event1 | $5,529 | RentFacilityCostsEvent1Amt |
| Food And Beverage Event1 | $8,575 | FoodAndBeverageEvent1Amt |
| Entertainment Event1 | $5,560 | EntertainmentEvent1Amt |
| Other Direct Expenses Event1 | $3,666 | OtherDirectExpensesEvent1Amt |
| Event2 | SUPERIOR GOLF TOURNAMENT | Event2Nm |
| Gross Receipts Event2 | $12,112 | GrossReceiptsEvent2Amt |
| Charitable Contri Event2 | $9,488 | CharitableContriEvent2Amt |
| Gross Revenue Event2 | $2,624 | GrossRevenueEvent2Amt |
| Cash Prizes Event2 | $1,280 | CashPrizesEvent2Amt |
| Non Cash Prizes Event2 | $450 | NonCashPrizesEvent2Amt |
| Food And Beverage Event2 | $894 | FoodAndBeverageEvent2Amt |
| Other Direct Expenses Event2 | $74 | OtherDirectExpensesEvent2Amt |
| Gross Receipts Total | $69,302 | GrossReceiptsTotalAmt |
| Charitable Contributions Tot | $38,133 | CharitableContributionsTotAmt |
| Gross Revenue Total Events | $31,169 | GrossRevenueTotalEventsAmt |
| Cash Prizes Total Events | $1,280 | CashPrizesTotalEventsAmt |
| Non Cash Prizes Total Events | $3,204 | NonCashPrizesTotalEventsAmt |
| Rent Fclty Costs Total Events | $5,529 | RentFcltyCostsTotalEventsAmt |
| Food And Beverage Total Events | $9,469 | FoodAndBeverageTotalEventsAmt |
| Entertainment Total Events | $5,560 | EntertainmentTotalEventsAmt |
| Oth Direct Expnss Total Events | $3,740 | OthDirectExpnssTotalEventsAmt |
| Direct Expense Summary Events | $28,782 | DirectExpenseSummaryEventsAmt |
| Net Income Summary | $2,387 | NetIncomeSummaryAmt |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
| Percent100 | Yes (X) | Percent100Ind |
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
| Percent200 D | Yes (X) | Percent200DInd |
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | Yes (1) | ExpensesExceedBudgetInd |
| Unable To Provide Care | 0 | UnableToProvideCareInd |
| Annual Community Bnft Report | Yes (1) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (1) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $266,758 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $266,758 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01050 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,375,816 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,128,986 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $246,830 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00970 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,642,574 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,128,986 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $513,588 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02020 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 771 | PersonsServedCnt |
| Total Community Benefit Expns | $168,160 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $165,340 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,820 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00010 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 1109 | PersonsServedCnt |
| Total Community Benefit Expns | $151,795 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $39,296 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $112,499 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00440 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 125 | PersonsServedCnt |
| Total Community Benefit Expns | $8,560 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $8,560 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00030 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 2005 | PersonsServedCnt |
| Total Community Benefit Expns | $328,515 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $204,636 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $123,879 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00480 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 2005 | PersonsServedCnt |
| Total Community Benefit Expns | $1,971,089 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,333,622 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $637,467 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02500 | TotalExpensePct |
Community Support CommunitySupportGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $18,990 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $18,990 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00070 | TotalExpensePct |
Health Improvement Advocacy HealthImprovementAdvocacyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $20,272 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $20,272 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00080 | TotalExpensePct |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $39,262 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $39,262 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00150 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $806,578 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $0 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $13,665,625 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $13,760,451 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$94,826 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | Yes (X) | CostToChargeRatioInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (1) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BRODSTONE MEMORIAL HOSPITAL | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 520 E 10TH | AddressLine1Txt |
| City | SUPERIOR | CityNm |
| State Abbreviation | NE | StateAbbreviationCd |
| ZIP | 68978 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | HTTPS://WWW.BRODSTONEHOSPITAL.ORG | WebsiteAddressTxt |
| State License | 570001 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Critical Access Hospital | Yes (X) | CriticalAccessHospitalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BRODSTONE MEMORIAL HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | 0 | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | 0 | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (1) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Prior CHNA Impact | Yes (X) | PriorCHNAImpactInd |
| Other | Yes (X) | OtherInd |
| CHNA Conducted | 18 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | Yes (1) | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | Yes (1) | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | HTTPS://WWW.BRODSTONEHOSPITAL.ORG/PATIENTS-AND-VISITORS/COMMUNITY_HEALTH_NE | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 18 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | HTTPS://WWW.BRODSTONEHOSPITAL.ORG/PATIENTS-AND-VISITORS/COMMUNITY_HEALTH_NE | StrategyWebsiteURLTxt |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 100.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 200.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Income Level Criteria | Yes (X) | IncomeLevelCriteriaInd |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| Other Criteria | Yes (X) | OtherCriteriaInd |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Provided Nonprofit Contact | Yes (X) | ProvidedNonprofitContactInd |
| Other Method | Yes (X) | OtherMethodInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | HTTPS://WWW.BRODSTONEHOSPITAL.ORG/PATIENTS-AND-VISITORS/FINANCE-SERVICES/FI | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | HTTPS://WWW.BRODSTONEHOSPITAL.ORG/PATIENTS-AND-VISITORS/FINANCE-SERVICES/FI | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | HTTPS://WWW.BRODSTONEHOSPITAL.ORG/PATIENTS-AND-VISITORS/FINANCE-SERVICES/FI | FAPSummaryOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| Notified FAP Copy Bill Display | Yes (X) | NotifiedFAPCopyBillDisplayInd |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| Provided Written Notice | Yes (X) | ProvidedWrittenNoticeInd |
| Made Effort Orally Notify | Yes (X) | MadeEffortOrallyNotifyInd |
| Processed FAP Application | Yes (X) | ProcessedFAPApplicationInd |
| Made Presumptive Elig Determ | Yes (X) | MadePresumptiveEligDetermInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Look Back Medicare | Yes (X) | LookBackMedicareInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (8 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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 A COMMUNITY HEALTH IMPROVEMENT PLAN FOR THE DISTRICT. 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 7 MONTH PROCESS CONDUCTED APRIL THROUGH OCTOBER, 2018. THE SOUTH HEARTLAND DISTRICT HEALTH DEPARTMENT SPEARHEADED THE ASSESSMENT IN PARTNERSHIP WITH MARY LANNING HEALTHCARE IN HASTINGS, WEBSTER COUNTY HOSPITAL IN RED CLOUD, CLAY COUNTY HEALTH DEPARTMENT IN CLAY COUNTY AND BRODSTONE MEMORIAL HOSPITAL IN SUPERIOR. INPUT WAS SOUGHT AND RECEIVED BY THE LOCAL PUBLIC HEALTH SYSTEM AND ALL OF THE ENTITIES THAT CONTRIBUTE TO THE DELIVERY OF PUBLIC HEALTH SERVICES IN OUR COMMUNITY. THIS INCLUDES PUBLIC, PRIVATE ENTITIES, CIVIC AND FAITH-BASED ORGANIZATIONS, INDIVIDUALS AND INFORMAL ASSOCIATIONS, FRONT-LINE AND GRASSROOTS WORKERS, AND POLICY MAKERS. ALSO INCLUDED AND NOT LIMITED TO EMS, SCHOOLS, NEIGHBORHOOD ORGANIZATIONS, NURSING HOMES, COMMUNITY CENTERS, HOSPITALS, DRUG TREATMENT CENTERS, HOME HEALTH, LABORATORIES, HEALTHCARE PROVIDERS, LAW ENFORCEMENT, EMPLOYERS, CORRECTIONS, ELECTED OFFICIALS, FIRE, TRANSIT AGENCIES, MENTAL HEALTH PROVIDERS, AND TRIBAL HEALTH. |
| 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:ACCESS TO CARE:RECRUIT PROVIDERS FOR OUR SPECIALTY CLINIC. OUR GOAL WAS TO RECRUIT 3 ADDITIONAL PROVIDERS. IN THE LAST FISCAL WE RECRUITED A UROLOGIST, A MENTAL HEALTH PROVIDER VIA TELEHEALTH, AND A PODIATRIST. WE CONTINUE TO SEARCH FOR A FAMILY PRACTICE PHYSICIAN. WE JOINED A GROUP TO HAVE A RESIDENCY PROGRAM AND THAT IS SLOWLY BUILDING, ALTHOUGH, WE HAVE YET TO HAVE A CANDIDATE.THE PROMOTION OF THE USE OF BALANCE ASSESSMENT EQUIPMENT HAS BEEN DELAYED UNTIL THE NEXT FISCAL YEAR. A CONTRACT IS BEING SOUGHT WITH 3 AREA SCHOOLS TO PROVIDE THERAPY SERVICES AND THE BALANCE ASSESSMENT EQUIPMENT WILL BE USED WITH THE SCHOOL SYSTEM ONCE WE HAVE THE CONTRACT SIGNED.THE HANDY BUS IS CONTROLLED BY ANOTHER ENTITY AND WE ARE NOT ABLE TO PROMOTE THAT AS PLANNED.OUR HEALTH LIVING PROGRAM IS ONGOING. WE CONTINUE TO MAINTAIN THE NUMBER OF PARTICIPANTS.WE CONTINUE TO PROMOTE OUR DIABETES SUPPORT GROUP, HOWEVER ATTENDANCE HAS BEEN MAINTAINED, WITH NO INCREASE. WE ALWAYS SEND A FLYER TO ALL PARTICIPANTS THAT DESIRE AN INVITATION, WHICH IS APPROXIMATELY 165 COMMUNITY MEMBERS. THE FLYER INCLUDES TIPS FOR A HEALTHY LIFESTYLE AND EVEN THOUGH THEY ARE NOT ABLE TO ATTEND THE SUPPORT GROUPS, THEY ARE PROVIDED EDUCATIONAL MATERIALS.BECAUSE OF STAFFING WE WERE NOT ABLE TO IMPLEMENT AN ALZHEIMER'S/DEMENTIA SUPPORT GROUP.CANCER:DUE TO STAFFING ISSUES, WE HAVE BEEN UNABLE TO IMPLEMENT A "TIME TO HEAL" PROGRAM.WE HAVE USED RADIO, NEWSPAPER AND SOCIAL MEDIA TO EDUCATE THE COMMUNITY ON THE SCREENINGS AVAILABLE FOR CANCER PREVENTION. THIS WAS ALSO DONE AT THE ANNUAL HEALTH FAIR.WE DID NOT PROCEED WITH OUR PLANS TO HAVE A "PINK NIGHT" FOR EDUCATIONAL PURPOSES, HOWEVER WE HAVE BEEN FUND RAISING AND WORKING ON EDUCATING STAFF TO BE ABLE TO PROVIDE CHEMOTHERAPY AT OUR FACILITY.BRODSTONE EMPLOYEES DONATED $741.19 TO THE NUCKOLLS COUNTY CANCER STOMP IN THE LAST FISCAL YEAR.BRODSTONE DONATED TO THE GOLF TOURNAMENT RALLY FOR A CURE.TWELVE NUCKOLLS COUNTY RESIDENTS WERE REFERRED TO THE NUCKOLLS COUNTY CANCER STOMP.MENTAL HEALTH:IN THE LAST FISCAL YEAR, OUR BEHAVIORAL HEALTH PROVIDER HAS INCREASED HER ON SITE DAYS FROM THREE TIME A MONTH TO FOUR TIMES A MONTH. WE HAVE ALSO ADDED THE AVAILABILITY OF COUNSELING VIA TELEHEALTH EVERY WEEKDAY. THE LANNING CENTER FROM HASTINGS IS ALSO PROVIDING COUNSELING SERVICES 2 DAYS A MONTH VIA TELEHEALTH.OBESITY:BRODSTONE WAS PROVIDING SPACE FOR OVEREATERS ANONYMOUS HOWEVER THE GROUP DISBANDED DUE TO LACK OF PARTICIPATION.A WALK/RUN WAS HELD IN MAY WITH 150 PARTICIPANTS.THE FIRECRACKER RUN WAS HELD IN JULY. BRODSTONE MAKES A MONETARY DONATION TO THIS EVENT AND A LARGE NUMBER OF EMPLOYEES HELP WITH THE EVENT AND/OR PARTICIPATE.A WALKING CHALLENGE WAS HELD IN MAY/JUNE WITH 167 PARTICIPANTS. THIS IS A 6 WEEK CHALLENGE AND TEAMS ARE FORMED AT THE HOSPITAL AND FROM THE COMMUNITY.A WALKING SCHOOL BUS PROGRAM WAS DEVELOPED WITH ADULTS ORGANIZING WALKING WEDNESDAYS FROM THE CITY PARK TO THE SCHOOL. PARTICIPATION IS BASED ON WEATHER CONDITIONS WITH ANYWHERE FROM 6 TO 12 CHILDREN WALKING TO SCHOOL. THIS IS DONE FOR 6 WEEKS IN THE FALL AND 4 WEEKS IN THE SPRING.THE HOSPITAL HAS BEEN WORKING WITH A COALITION TO PROMOTE WALKING ON A TEMPORARY PATH THAT WAS PAINTED ALONG 6TH STREET FROM THE CITY PARK TO THE SCHOOL. FACEBOOK POSTS, NEWSPAPER STORIES AND THE WALKING SCHOOL BUS HAVE ALL HELPED TO PROMOTE THIS PATH.BRODSTONE HAS BEEN WORKING WITH THE VENDING MACHINE COMPANY TO HAVE HEALTHIER CHOICES IN THE MACHINES. FRUIT IS NOW AVAILABLE IN THE DINING ROOM THROUGHOUT THE DAY. A HEALTHY MEAL OPTION IS NOW OFFERED 5 DAYS A WEEK.BRODSTONE STAFF DONATED 6,035 POUNDS OF FOOD TO THE NUCKOLLS COUNTY FOOD PANTRY.SUBSTANCE ABUSE:DUE TO STAFF CHANGES, THE SMOKING CESSATION CLASSES WERE ON HOLD UNTIL A NEW INSTRUCTOR WAS EDUCATED. WE INTEND TO OFFER THOSE CLASSES AGAIN IN THE FUTURE. COACHES ARE BEING SOUGHT. AN EDUCATIONAL BROCHURE WILL BE DEVELOPED WHEN A NEW INSTRUCTOR HAS BEEN EDUCATED.DISPOSAL OF NARCOTICS AND OTHER MEDICATIONS IS AVAILABLE AT THE LOCAL PHARMACY ON A DAILY BASIS. THE PHARMACY HAS BEEN PROMOTING THAT INFORMATION. INFORMATION IS ALSO AVAILABLE AT THE ANNUAL HEALTH FAIR.THE "LIFE OF AN ATHLETE" PROGRAM EDUCATION IS BEING PROVIDED BY OUR LOCAL HEALTH DEPARTMENT. WE ARE ON THE LIST TO PARTICIPATE WHEN THAT EDUCATION IS AGAIN AVAILABLE.BECAUSE OF A STAFFING CHANGE, MARIJUANA EDUCATION HAS BEEN POSTPONED. |
| 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 402-879-3281 EXT. 5115 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. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 3 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (3 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| 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 |
Supplemental Information Detail SupplementalInformationDetail (17 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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 $ 806,578. |
| 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 $245,000 AND $206,000 FOR THE YEARS ENDED APRIL 30, 2019 AND 2018, 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, 2019 AND 2018, 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 1,933 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 $41,576 COMPARED TO THE U.S. AVERAGE AT $61,372 AND THE NEBRASKA AVERAGE OF $56,927. THE AREA POPULATION IS PREDOMINATELY WHITE ELDERLY AND LOW INCOME. 49.7% 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. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form990 Of Other Organizations | Yes (X) | Form990OfOtherOrganizationsInd |
| Written Employment Contract | Yes (X) | WrittenEmploymentContractInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | Yes (1) | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (7 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| TREG VYZOUREK | ||||||||||||||
| CEO | $216,499 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $31,001 | $0 | $247,500 | $0 | $0 | $0 |
| SANDRA BORDEN | ||||||||||||||
| CFO | $174,985 | $0 | $0 | $0 | $0 | $0 | $5,428 | $0 | $29,010 | $0 | $209,423 | $0 | $0 | $0 |
| TIMOTHY BLECHA MD | ||||||||||||||
| PHYSICIAN | $264,056 | $0 | $143,845 | $0 | $0 | $0 | $8,250 | $0 | $30,170 | $0 | $446,321 | $0 | $0 | $0 |
| JULIE THEIS MD | ||||||||||||||
| PHYSICIAN | $266,360 | $0 | $42,882 | $0 | $0 | $0 | $8,250 | $0 | $39,734 | $0 | $357,226 | $0 | $0 | $0 |
| ROBERT LEIBEL MD | ||||||||||||||
| PHYSICIAN | $224,737 | $0 | $0 | $0 | $0 | $0 | $6,961 | $0 | $37,906 | $0 | $269,604 | $0 | $0 | $0 |
| JASON HASS PA-C | ||||||||||||||
| PHYSICIAN ASSISTANT | $193,970 | $0 | $0 | $0 | $0 | $0 | $6,077 | $0 | $39,201 | $0 | $239,248 | $0 | $0 | $0 |
| MATTHEW GATLIN PA-C | ||||||||||||||
| PHYSICIAN ASSISTANT | $155,772 | $0 | $16,565 | $0 | $0 | $0 | $5,377 | $0 | $37,506 | $0 | $215,220 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 5 | FormAndLineReferenceDesc |
| Explanation | 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. | ExplanationTxt |
Schedule K IRS990ScheduleK
Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp (2 entries)
| Bond ReferenceBondReferenceCd | Bond Issuer EINBondIssuerEIN | Bond IssuedBondIssuedDt | Issue PriceIssuePriceAmt | PurposePurposeDesc | DefeasedDefeasedInd | On Behalf Of IssuerOnBehalfOfIssuerInd | Pool FinancingPoolFinancingInd |
|---|---|---|---|---|---|---|---|
| THE CITY OF SUPERIOR NEBRASKA | |||||||
| A | 476006376 | 2013-05-22 | $4,000,000 | REFUND ISSUES (9/9/03, 9/10/09, 9/10/09) | 0 | 0 | 0 |
| THE COUNTY OF NUCKOLLS NEBRASKA | |||||||
| B | 476006492 | 2013-05-22 | $4,000,000 | REFUND ISSUES (9/9/03, 9/10/09, 9/10/09) | 0 | 0 | 0 |
Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp (2 entries)
| Bond ReferenceBondReferenceCd | RetiredRetiredAmt | Total ProceedsTotalProceedsAmt | Other Spent ProceedsOtherSpentProceedsAmt | Substantial CompletionSubstantialCompletionYr | Refunding Tax Exempt BondsRefundingTaxExemptBondsInd | Refunding Taxable BondsRefundingTaxableBondsInd | Final Allocation MadeFinalAllocationMadeInd | Adequate Books And Rec MaintAdequateBooksAndRecMaintInd |
|---|---|---|---|---|---|---|---|---|
| A | $871,555 | $4,000,000 | $4,000,000 | 2010 | Yes (1) | 0 | Yes (1) | Yes (1) |
| B | $871,555 | $4,000,000 | $4,000,000 | 2010 | Yes (1) | 0 | Yes (1) | Yes (1) |
Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp (2 entries)
| Bond ReferenceBondReferenceCd | Owning Bond Financed PropertyOwningBondFinancedPropertyInd | Any Lease ArrangementsAnyLeaseArrangementsInd | Mgmt Contract Bond Fincd PropMgmtContractBondFincdPropInd | Any Research AgreementsAnyResearchAgreementsInd | Private Bus Use By OthersPrivateBusUseByOthersPct | Private Bus Concerning UBIPrivateBusConcerningUBIPct | Total Private Business UseTotalPrivateBusinessUsePct | Bond Iss Meet Prvt Sec Pymt TestBondIssMeetPrvtSecPymtTestInd | Change In Use Bond Financed PropChangeInUseBondFinancedPropInd | Procs Nonqualified Bond RemdtdProcsNonqualifiedBondRemdtdInd |
|---|---|---|---|---|---|---|---|---|---|---|
| A | 0 | 0 | 0 | 0 | 0.00000 | 0.00000 | 0.00000 | 0 | 0 | Yes (1) |
| B | 0 | 0 | 0 | 0 | 0.00000 | 0.00000 | 0.00000 | 0 | 0 | Yes (1) |
Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp (2 entries)
| Bond ReferenceBondReferenceCd | Form8038 T FiledForm8038TFiledInd | Rebate Not Due YetRebateNotDueYetInd | Exception To RebateExceptionToRebateInd | No Rebate DueNoRebateDueInd | Variable Rate IssueVariableRateIssueInd | Hedge Identified In Bks And RecHedgeIdentifiedInBksAndRecInd | Gross Proceeds Invested In GICGrossProceedsInvestedInGICInd | Gross Proceeds InvestedGrossProceedsInvestedInd | Written Proc To Monitor ReqsWrittenProcToMonitorReqsInd |
|---|---|---|---|---|---|---|---|---|---|
| A | 0 | 0 | Yes (1) | Yes (1) | 0 | 0 | 0 | 0 | Yes (1) |
| B | 0 | 0 | Yes (1) | Yes (1) | 0 | 0 | 0 | 0 | Yes (1) |
Procedures Corrective Action ProceduresCorrectiveActionGrp (2 entries)
| Bond ReferenceBondReferenceCd | Procedures Corrective ActionProceduresCorrectiveActionInd |
|---|---|
| A | Yes (1) |
| B | Yes (1) |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE K, PART IV, LINE 2C: | FormAndLineReferenceDesc |
| Explanation | (A) ISSUER NAME: CITY OF SUPERIOR, NEBRASKA DATE THE REBATE COMPUTATION WAS PERFORMED: 05/22/2013 (B) ISSUER NAME: THE COUNTY OF NUCKOLLS, NEBRASKA DATE THE REBATE COMPUTATION WAS PERFORMED: 05/22/2013 NOTE REGARDING THE 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. | ExplanationTxt |
Schedule L IRS990ScheduleL
Grnt Asst Bnft Interested Prsn GrntAsstBnftInterestedPrsnGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | BEN VYZOUREK | PersonNm |
| Relationship With Org | BEN IS THE SON OF THE CEO, TREG VYZOUREK. | RelationshipWithOrgTxt |
| Cash Grant | $1,000 | CashGrantAmt |
| Type Of Assistance | CASH GRANT | TypeOfAssistanceTxt |
| Assistance Purpose | HEALTH CAREER EDUCATION | AssistancePurposeTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (7 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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 XI, LINE 9: | CHANGE IN BENEFICIAL INTEREST IN TRUSTS -183,092. |
| 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. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp
Disregarded Entity Name DisregardedEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PNC VESTEY TRUST UA UNB & NORTHERN CO SUCC BENEFIT BRODSTONE MEM HOSP | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 116 ALLEGHENY CENTER MALL | AddressLine1Txt |
| City | PITTSBURGH | CityNm |
| State Abbreviation | PA | StateAbbreviationCd |
| ZIP | 15212 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 226023351 | EIN |
| Primary Activities | ASSISTING IN THE OPERATIONS OF BRODSTONE MEMORIAL HOSPITAL | PrimaryActivitiesTxt |
| Legal Domicile State | PA | LegalDomicileStateCd |
| Exempt Code Section | 4947(A)(1) | ExemptCodeSectionTxt |
| Public Charity Status | PF | PublicCharityStatusTxt |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BRODSTONE MEMORIAL HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Controlled Organization | Yes (1) | ControlledOrganizationInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (1) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | 0 | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | 0 | SharingOfFacilitiesInd |
| Paid Employees Sharing | 0 | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp
Other Organization Name OtherOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PNC VESTEY TRUST | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Transaction Type | C | TransactionTypeTxt |
| Involved | $243,620 | InvolvedAmt |
| Method Of Amount Determination | FMV | MethodOfAmountDeterminationTxt |