2018-11-09T13:01:38-06:00 2017-12-31 350921680 CROWE LLP 9600 Brownsboro Road Suite 400 Louisville KY 402411122 990 2017-01-01 470841285 CRETE AREA MEDICAL CENTER CRET 4024811111 2910 BETTEN DRIVE CRETE NE 683330220 RUSSELL GRONEWOLD VP - FINANCE & CFO 2018-11-09 false Rachel Spurlock P00520729 5023263996 2017 2019-02-21 02:37:17Z RUSSELL GRONEWOLD 1600 SOUTH 48TH STREET LINCOLN NE 68506 25495565 false X WWW.BRYANHEALTH.ORG/CAMC X 2001 NE CRETE AREA MEDICAL CENTER IS COMMITTED TO ADVANCING THE HEALTH OF THE COMMUNITIES AND REGION WE SERVE, THROUGH COLLABORATION, PREVENTION, INNOVATION, AND EXCEPTIONAL CARE. During 2017, Crete Area Medical Center has provided Charity Care to 657 patients at a cost of $411,000. 8 3 196 120 0 0 81338 502280 22130040 24583840 72303 142996 245411 245509 22529092 25474625 12198 7172 0 0 11520475 12267291 0 0 0 9772456 10713769 21305129 22988232 1223963 2486393 34404427 24693018 14639663 2169674 19764764 22523344 CRETE AREA MEDICAL CENTER'S (CAMC) MISSION IS TO ADVANCE THE HEALTH OF THE COMMUNITIES AND REGION WE SERVE, THROUGH COLLABORATION, PREVENTION, INNOVATION, AND EXCEPTIONAL CARE. CAMC'S VISION IS THE COMMUNITIES WE SERVE WILL CHOOSE CRETE AREA MEDICAL CENTER AS THEIR FIRST CHOICE FOR HEALTH. CAMC IS COMMITTED TO THE FOLLOWING FUNDAMENTAL BELIEFS: INTEGRITY - OUR FOUNDATION; SERVICE - OUR STANDARD; EXCELLENCE - OUR DISTINCTION; COLLABORATION - OUR INVESTMENT; AND LEADERSHIP - OUR FUTURE. false false 20832514 7172 24583840 CRETE AREA MEDICAL CENTER ("CAMC") IS AN AFFILIATE OF BRYAN HEALTH. CAMC, LOCATED IN CRETE, NEBRASKA, IS A NEBRASKA NONPROFIT CORPORATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND HAS RECEIVED DETERMINATION THAT IT IS EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE IN ORDER TO PROVIDE HEALTH CARE SERVICES. CAMC WAS INCORPORATED IN APRIL 2001 AND OPERATES A 24-LICENSED BED CRITICAL ACCESS HOSPITAL AND THREE PHYSICIAN CLINICS SERVING PATIENTS AND RESIDENTS PRINCIPALLY FROM SALINE AND LANCASTER COUNTIES. DURING THE YEAR ENDING DECEMBER 31, 2017, CAMC PROVIDED INPATIENT ACUTE, SWING BED AND NURSERY SERVICES TO 341 PATIENTS. CAMC PERFORMED 782 SURGICAL PROCEDURES AND PROVIDED PRIMARY CARE PHYSICIAN SERVICES WITH 26,597 VISITS. In 2017, CAMC also provided charity care to 657 patients and served 615 medicaid patients. 20832514 true true false true false false false false false false true false false false false true true true false false false false false false false false true true false true true false false false false false false true false false false false false false true false false false true 45 0 true 196 true false false false false false false true false false false X 8 3 false false true false true true true true true false false true true true true true true true true true true NE X Kurt Kadlec 4028267948 2910 BETTEN DRIVE CRETE NE 68333 REBEKAH MUSSMAN PRESIDENT/CEO 60.0 0 X X 163420 0 37479 TAD EICKMAN Chairperson 1.0 0 X X 0 0 0 TOM KOZISEK VICE CHAIRPERSON 1.0 0 X X 0 0 0 MIKE PAVELKA Secretary & TREASURER 1.0 0 X X 0 0 0 ROBERT RAVENSCROFT Trustee 1.0 59.0 X 0 458635 42130 DAVID REESE Trustee 1.0 59.0 X 0 373492 45574 LINDA STONES Trustee 1.0 49.0 X 0 173760 14323 TROY MILLER MD TRUSTEE - PHYSICIAN 50.0 0 X 276059 0 40872 KURTIS KADLEC Chief Financial Officer (Effective 6/19/2017) 50.0 0 X 51553 0 12826 Doug Kucera Chief Financial Officer (Resignation 5/10/2017) 50.0 0 X 54559 0 5108 RUSSELL GRONEWOLD System VP FINANCE & CFO 1.0 59.0 X 0 759176 39724 RUSSELL EBKE MD PHYSICIAN 50.0 0 X 212693 0 41365 MITCHELL EBKE CERTIFIED REGISTERED NURSE ANESTHETIST 50.0 0 X 300562 0 40747 KATE HESSER MD PHYSICIAN 50.0 0 X 245464 0 39858 JASON HESSER MD PHYSICIAN 50.0 0 X 263404 0 16193 AMY VERTIN MD PHYSICIAN 50.0 0 X 275716 0 39020 1843430 1765064 415219 20 false true false BRESTER CONSTRUCTION INC 1200 Infinity Court LINCOLN NE 68512 Construction 308496 CloudWave Dept CH 19800 Palatine IL 60055 Hosting Software 230584 Medical Information Technology Inc PO Box 74569 Chicago IL 60696 Medical Information 147688 Early Out Services Inc 5807 N 102 St Omaha NE 68134 Collection Agency 109149 4 X 502280 502280 NET PATIENT CARE REVENUE 621990 22237547 22237547 PHARMACY 446110 2228052 2228052 Health Information Services 621300 8057 8057 ATHLETIC TRAINING OUTREACH 624100 110184 110184 0 0 0 0 24583840 138794 138794 43246 11796 31450 0 31450 31450 13346 9144 0 4202 4202 4202 CAFETERIA SALES 722210 66109 66109 PURCHASED DISCOUNTS 900099 29176 29176 Gift Shop Revenue 900099 551 551 118223 0 0 118223 214059 25474625 24583840 0 388505 7172 7172 641876 316930 324946 9141851 8604206 537645 377656 355446 22210 1470931 1384423 86508 634977 597633 37344 23157 23157 80873 80873 1951488 1836718 114770 0 99878 99878 2266781 2133468 133313 253512 238603 14909 342046 321930 20116 3592 3020 572 50790 50790 1628824 1533031 95793 117761 110835 6926 Drugs 1416896 1416896 Medical Supplies 576159 576159 Corporate Cost Allocation 535954 535954 Provision for patient Bad Debt 1012316 1012316 353742 332938 20804 0 22988232 20832514 2155718 0 4784542 5156136 2351089 2599145 0 0 0 224148 215121 105068 77703 30045441 21161509 9548681 8883932 16800758 7498484 0 4378 585763 262497 34404427 24693018 2686173 2169674 0 11953490 0 14639663 2169674 X 19764764 22523344 19764764 22523344 34404427 24693018 X 2486393 59910 212277 X false true X true false X false false false false false false true false true 1184 1184 false Schedule C, Part II-B, Line 1 DETAILED DESCRIPTION OF THE LOBBYING ACTIVITY 1) g ) On various occasions throughout the year, the CEO met with state and local legislators to discuss issues related to healthcare. While some related to healthcare reform, other issues discussed included meeting the needs of indigent/uninsured and underinsured patients, as well as the ongoing need for health services for the community. 1) i) CAMC paid annual dues to the Nebraska Hospital Association. A portion of these dues were determined to be used for lobbying activities. The related amount has been reported in Part II-B, Line 1i. Schedule C, Part II-B, Line 1 DETAILED DESCRIPTION OF THE LOBBYING ACTIVITY 1) g ) On various occasions throughout the year, the CEO met with state and local legislators to discuss issues related to healthcare. While some related to healthcare reform, other issues discussed included meeting the needs of indigent/uninsured and underinsured patients, as well as the ongoing need for health services for the community. 1) i) CAMC paid annual dues to the Nebraska Hospital Association. A portion of these dues were determined to be used for lobbying activities. The related amount has been reported in Part II-B, Line 1i. 61247 61247 14483372 8295216 6188156 10347 2840 7507 14260594 11943203 2317391 1229881 920250 309631 8883932 SWAP AGREEMENT 0 LONG TERM DEBT INTERCOMPANY LOAN 0 0 X 25758609 59911 224073 283984 25474625 0 0 25474625 23000028 11796 11796 22988232 0 0 22988232 Schedule D, Part X, Line 2 FIN 48 (ASC 740) footnote CAMC is a not-for-profit and is exempt from income taxes under Section 501(a) of the Code and a similar provision of state law. However, they are subject to federal income tax on any unrelated business taxable income. CAMC accounts for uncertainties in accounting for income tax assets and liabilities using guidance included in FASB Accounting Standards Codification (ASC) Topic 740, Income Taxes. CAMC recognizes the effect of income tax provisions only if those positions are more likely than not of being sustained. At December 31, 2017 and 2016, CAMC had no uncertain tax positions accrued. Schedule D, Part XI, Line 2(d) Other revenues in audited financial statements not in form 990 Change in Value of Swap Agreement - 76816 Office Building Rental Expense - 11796 Transfers From Related Entities - 135461 Schedule D, Part XII, Line 2(d) Other expenses in audited financial statements not in form 990 Office Building Rental Expense - 11796 true true X true X true X true true true false false 410552 410552 0.0187 1379936 1379936 0 0.0 0 0.0 0 0 1790488 1379936 410552 0.0187 209756 11939 197817 0.0090 0 0.0 0 0.0 0 0.0 0 0.0 0 0 209756 11939 197817 0.0090 0 0 2000244 1391875 608369 0.0277 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0 0 0 0 0.0 true 1012316 128000 6194381 6253648 -59267 X true true 1 1 CRETE AREA MEDICAL CENTER 2910 BETTEN DRIVE CRETE NE 68333 www.bryanhealth.org 670001NE X X X CRETE AREA MEDICAL CENTER 1 false false true X X X X X X X X X 15 true true true true X www.bryanhealth.com/locations/hospitals/crete-area-medical-center/camc-community-health-needs-assess X true 16 true www.bryanhealth.com/locations/hospitals/crete-area-medical-center/camc-community-health-needs-assess false true X 200.0 400.0 X X X X X X true true X X X X true X www.bryanhealth.com/patients-visitors/pricing-insurance-financial-assistance-billing X www.bryanhealth.com/patients-visitors/pricing-insurance-financial-assistance-billing X www.bryanhealth.com/patients-visitors/pricing-insurance-financial-assistance-billing X X X X X X true X false X X X X true X false false Schedule H, Part V, Section B, Line 3E The significant health needs of the community are identified and prioritized through the CHNA. Schedule H, Part V, Section B, Line 5 Facility , 1 Facility , 1 - Crete Area Medical Center. Invitations were sent to persons believed to represent the broad interests of the community, including health care providers, dentists, the county board of health, colleges, schools, police, fire and rescue, city and county officials, area business leaders, pharmacists, and religious organizations. Those in attendance provided input during focus group discussions which was utilized to prioritize health issues. Schedule H, Part V, Section B, Line 6a Facility , 1 Facility , 1 - Crete Area Medical Center. Hospital facilities that participated include Crete Area Medical Center and Bryan Medical Center. Schedule H, Part V, Section B, Line 6b Facility , 1 Facility , 1 - PUBLIC HEALTH SOLUTIONS. Public Health Solutions (PHS) is a District Health Department responsible for promoting and protecting the health of the residents of Gage, Jefferson, Fillmore, Thayer and Saline Counties in Nebraska. PHS works to identify health threats and actions needed to promote wellness. PHS works with other community agencies, organizations, healthcare providers and citizens to determine priorities and strategies for addressing health problems. PHS assures that priorities and strategies are implemented within the community. Schedule H, Part V, Section B, Line 11 Facility , 1 Facility , 1 - Crete Area Medical Center. CAMC COMMUNITY HEALTH NEEDS ASSESSMENT IMPLEMENTATION PLAN EVALUATION FOLLOWING THE COMPLETION OF THE COMMUNITY HEALTH NEEDS ASSESSMENT IN 2015, CRETE AREA MEDICAL CENTER (CAMC) WORKED WITH ITS COMMUNITY PARTNERS TO OUTLINE GOALS FOR ADDRESSING EACH COMMUNITY PRIORITY AS WELL AS IMPLEMENTATION ACTIONS THAT WOULD WORK TOWARD ACHIEVING EACH OF THESE GOALS WITHIN THE CRETE COMMUNITY AND SALINE COUNTY. THE FOLLOWING EVALUATION OF THE IMPLEMENTATION PLAN SHOWS THAT TREMENDOUS PROGRESS HAS BEEN MADE BY CAMC AND OTHER COMMUNITY PARTNERS TO ADDRESS THE FOUR KEY PRIORITIES ESTABLISHED IN THE PREVIOUS COMMUNITY HEALTH NEEDS ASSESSMENT. 1) LIFESTYLE/HEALTH & WELLNESS: GOAL A: MOTIVATE INDIVIDUALS TO TAKE AN ACTIVE INTEREST IN A LIFESTYLE THAT PROMOTES GOOD HEALTH AND WELLNESS. CAMC HAS TAKEN SEVERAL STEPS TO CONVENE LOCAL AGENCIES AND PROVIDERS TO COLLABORATE ON A PLAN TO PROVIDE INCREASED EDUCATIONAL PROGRAMS AND HEALTH SCREENINGS. CAMC HOSTS A COMMUNITY PICNIC WHICH INCLUDES VARIOUS HEALTH EDUCATION OPPORTUNITIES INCLUDING FIRST AID AND SUN PROTECTION AMONG OTHERS. CAMC HOSTS A BI-ANNUAL HEALTH FAIR AND PROVIDES PREVENTATIVE SCREENINGS AT REDUCED RATES FOR COMMUNITY MEMBERS. LAB SCREENINGS AND FLU SHOTS WERE PROVIDED FOR THE COMMUNITIES OF CRETE, FRIEND AND WILBER AT A REDUCED RATE; BLOOD PRESSURE SCREENINGS AND CANCER RELATED HEALTH EDUCATION ARE PROVIDED TO THE COMMUNITY; FLU SHOTS WERE PROVIDED TO BUSINESS AT THEIR PLACE OF EMPLOYMENT FOR A REDUCED RATE; ALSO ATTENDANCE AT THE SALINE COUNTY FARM SHOW PROVIDED FREE HEALTH SCREENINGS AND HEALTH EDUCATION RELATED TO CANCER. GOAL B: DEVELOP COMPREHENSIVE COMMUNITY HEALTH INITIATIVES. CAMC HAS BUILT ON CRETE MASTER PLANNING EFFORTS TO INCORPORATE EXERCISE AND WELLNESS BY EXPANDING THE WALKING TRAIL AT CAMC IN SEPTEMBER 2013 AND ASSISTING WITH FUTURE PLANS TO EXPAND THE TRAIL TO CONNECT CAMC TO WALMART. MULTIPLE ACCESS POINTS HAVE ALSO BEEN IDENTIFIED FOR HEALTH EDUCATION, EXERCISE, AND WELLNESS ACTIVITIES INCLUDING THE CARDIAC RISK ASSESSMENT TOOL AVAILABLE ON THE CAMC WEBSITE. CAMC HAS ALSO WORKED WITH ELEMENTARY AND MIDDLE SCHOOLS TO TARGET FITNESS, NUTRITION, AND OBESITY THROUGH EVENTS AND ACTIVITIES SUCH AS YOUTH DAY, KIDS CLUB, AND A WALKING TRAIL EVENT. ADDITIONALLY, THROUGH EXPLORING DEVELOPMENT OF MEDICAL WELLNESS PROGRAMS IN THE COUNTY, CAMC HAS BEEN ABLE TO PROVIDE A DIABETIC EDUCATION PROGRAM AS WELL AS AN ACTIVE LIFESTYLE PROGRAM THAT ALLOWS MEMBERS TO USE CAMC EXERCISE EQUIPMENT. 2) BEHAVIORAL HEALTH: GOAL A: REDUCE BEHAVIORAL HEALTH DISORDERS THROUGH EARLY INTERVENTION AND TREATMENT. CAMC IS PROVIDING GREATER ACCESS TO BEHAVIORAL HEALTH EDUCATION MATERIALS THROUGHOUT THE COUNTY BY PARTNERING WITH BRYAN HEALTH TO SUPPLY BEHAVIORAL AND MENTAL HEALTH BROCHURES THAT INCLUDE BEHAVIORAL HEALTH COUNSELING SERVICES AVAILABLE TO THE COMMUNITY AND THE CONTACT INFORMATION TO REQUEST COUNSELING SERVICES. THESE BROCHURES ARE MADE READILY AVAILABLE FOR WILBER SCHOOLS, WILBER POLICE DEPARTMENT AND THE SALINE COUNTY SHERIFF'S OFFICE. CAMC HAS ALSO BEEN DILIGENT IN PROVIDING TRAINING TO KEY INDIVIDUALS IN THE EARLY IDENTIFICATION OF BEHAVIORAL HEALTH ISSUES. CAMC CONTINUES TO PARTICIPATE IN THE YOUTH SUICIDE PREVENTION COALITION. A FIVE YEAR SUICIDE PREVENTION PLAN IS NOW IN PLACE FOR ALL LOCAL SCHOOLS AND THE ORGANIZATION IS PARTICIPATING IN A COUNTY-WIDE INITIATIVE AIMED AT IDENTIFYING THE NEEDS OF CHILDREN AGE 1-8 ENTITLED "ROOTED IN RELATIONSHIPS." INCREASED ACCESS TO ONLINE SCREENING TOOLS IS NOW PROVIDED THROUGH A BEHAVIORAL HEALTH SCREENING TOOL AVAILABLE ON THE BRYAN HEALTH WEBSITE. IN ADDITION TO INCREASED ACCESS TO SCREENING, CAMC HAS ALSO IMPROVED ACCESS TO TREATMENT FACILITIES BY PROVIDING CHILD AND ADULT PSYCHOLOGY SERVICES AT THE CRETE CLINIC AND CHILD PSYCHOLOGY SERVICES AT THE WILBER CLINIC AS WELL AS PROVIDING PSYCHIATRY SERVICES THROUGH TELEMEDICINE AND ON-SITE. 3) PREVENTION/CHRONIC DISEASE: GOAL A: EXCEED STATE AVERAGE BY 5% IN CANCER SCREENING AREAS. TO AID IN RAISING PUBLIC AWARENESS AND PROMOTING SCREENING PROGRAMS, CAMC MAILS REMINDER LETTERS TO THEIR PATIENTS. IN ADDRESSING CHANGES IN CRITERIA TO THE EVERY WOMAN MATTERS PROGRAM, CAMC PARTNERED WITH THE LOCAL HEALTH DEPARTMENT, PUBLIC HEALTH SOLUTIONS, TO PROVIDE MAMMOGRAMS AND BREAST EXAMS TO PATIENTS WHO DID NOT QUALIFY FOR THE EVERY WOMAN MATTERS PROGRAM. EXAMS WERE PAID FOR BY PUBLIC HEALTH SOLUTIONS (PHS). CAMC ALSO WORKS TO PROMOTE THE POSITIVE ASPECTS OF SCREENING TO REDUCE FEAR OF SCREENINGS SUCH AS COLONOSCOPY BY PROVIDING EDUCATION FOR LOCAL EMPLOYERS AND AT COMMUNITY EVENTS. GOAL B: ENHANCE THE AVAILABILITY OF RESOURCES TO HELP MANAGE CHRONIC DISEASE PROACTIVELY TO REDUCE MORBIDITY AND MORTALITY IN SALINE COUNTY. CAMC CONTINUES TO WORK WITH AREA PROVIDERS TO SUPPORT ACCESS TO TESTS, TREATMENT, AND MEDICATION FOR THE UNINSURED AND UNDERINSURED. THE ORGANIZATION HAS FINANCIAL ASSISTANCE AVAILABLE FOR QUALIFYING PATIENTS AND NOW OBESITY CARE CAN BE PART OF MEDICAL HOME CARE PLANS. AS MENTIONED PREVIOUSLY, DIABETES EDUCATION CLASSES ARE ALSO OFFERED AT CAMC. TO DEVELOP SMOKING CESSATION PROGRAMS WHICH RECOGNIZE ETHNIC DIVERSITY AND ATTITUDES TOWARD SMOKING, CAMC RESPIRATORY THERAPISTS RECEIVED SPECIAL TRAINING IN ORDER TO PROVIDE SMOKING CESSATION EDUCATION. 4) ACCESS TO CARE/EMERGENCY SERVICES: GOAL A: MAINTAIN ACCESS TO EMERGENCY MEDICAL SERVICES THROUGHOUT SALINE COUNTY. CLASSES ARE AVAILABLE THROUGH SOUTHEAST COMMUNITY COLLEGE FOR AMBULANCE CREWS, AND SINCE 2013 CAMC HAS PROVIDED ADVANCED LIFE SUPPORT INTERCEPT SERVICES FOR RURAL VOLUNTEER RESCUE SQUADS IN SURROUNDING COMMUNITIES. Crete Area Medical Center maintains a helicopter base space and has a service agreement with Air Methods. Air Methods provides emergency air medical transportation services to Crete and the surrounding communities. The agreement is for helipad space at CAMC as well as living quarters for their flight crew. This agreement serves as a great benefit to the community as it ensures prompt transport for the most critical patients the hospital serves. 3 WILBER MEDICAL CLINIC 203 W 4TH STREET WILBER NE 68465 RURAL HEALTH CLINIC Friend Medical Clinic 1210 2nd St Friend NE 68359 Rural Health Clinic CRETE MEDICAL CLINIC 2910 BETTEN DRIVE CRETE NE 68333 RURAL HEALTH CLINIC Schedule H, Part I, Line 6a Community Benefit Report Crete Area Medical Center's Community Benefit Report was included in the Bryan Health Consolidated Report to the Community. Schedule H, Part I, Line 7 Bad Debt Expense excluded from financial assistance calculation 1012316 Schedule H, Part I, Line 7 Costing Methodology used to calculate financial assistance Crete Area Medical Center's Uncompensated Care Cost-to-Charge ratio was used to calculate the amount on line 7A. For line 7E, any offsetting revenue was deducted from expenses directly attributable to the community benefit activity. Schedule H, Part III, Line 2 Bad debt expense - methodology used to estimate amount CAMC 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. Schedule H, Part III, Line 3 Bad Debt Expense Methodology ABOUT 1 OF 5 FINANCIAL ASSISTANCE (CHARITY CARE) APPLICATIONS IS DENIED BECAUSE THE PATIENT WOULD NOT PROVIDE THE SUPPORTING INFORMATION REQUIRED PER THE POLICY AND PROCEDURE. WITHOUT SUPPORTING DOCUMENTATION, FINANCIAL ASSISTANCE IS DIFFICULT TO PROCESS. FINANCIAL INFORMATION IS NECESSARY TO DETERMINE THE PATIENT'S ABILITY OR INABILITY TO PAY BASED ON ESTABLISHED GUIDELINES IN THE FINANCIAL ASSISTANCE POLICY. No portion of bad debt has been included as community benefit. Schedule H, Part III, Line 4 Bad debt expense - financial statement footnote SEE CAMC'S AUDITED FINANCIAL REPORT, PAGE 7, SECTION E, "PATIENT RECEIVABLES, NET" FOR THE TEXT OF THE FOOTNOTE THAT DESCRIBES BAD DEBT EXPENSE. Schedule H, Part III, Line 8 Community benefit & methodology for determining medicare costs THE ENTIRE MEDICARE SHORTFALL AS REPORTED IN PART III, LINE 7 SHOULD BE TREATED AS A COMMUNITY BENEFIT. CRETE AREA MEDICAL CENTER PROVIDES CARE TO MEDICARE PATIENTS, AND MEDICARE DOES NOT PROVIDE SUFFICIENT REIMBURSEMENT TO COVER THE ENTIRE COST OF PROVIDING CARE TO THESE PATIENTS CAUSING A SHORTFALL, OR LOSS TO THE ORGANIZATION. THE FUNDS CRETE AREA MEDICAL CENTER USES TO COVER THIS SHORTFALL SHOULD BE CONSIDERED A COMMUNITY BENEFIT BECAUSE THE ORGANIZATION IS RELIEVING THE GOVERNMENT OF THE FINANCIAL BURDEN OF PAYING THE FULL COSTS OF CARE FOR MEDICARE BENEFICIARIES. THE COSTING METHODOLOGY USED TO DETERMINE THE MEDICARE ALLOWABLE COSTS REPORTED IN CRETE AREA MEDICAL CENTER'S MEDICARE COST REPORT IS THE STEP-DOWN METHOD OF COST ALLOCATION. Schedule H, Part III, Line 9b Collection practices for patients eligible for financial assistance THE ORGANIZATION'S DEBT COLLECTION POLICY PROHIBITS ANY COLLECTION EFFORTS FOR THE PORTION OF THE PATIENT ACCOUNT BALANCE THAT QUALIFIES FOR FINANCIAL ASSISTANCE UNDER THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY. Schedule H, Part V, Section B, Line 16a FAP website - CRETE AREA MEDICAL CENTER: Line 16a URL: www.bryanhealth.com/patients-visitors/pricing-insurance-financial-assistance-billing; Schedule H, Part V, Section B, Line 16b FAP Application website - CRETE AREA MEDICAL CENTER: Line 16b URL: www.bryanhealth.com/patients-visitors/pricing-insurance-financial-assistance-billing; Schedule H, Part V, Section B, Line 16c FAP plain language summary website - CRETE AREA MEDICAL CENTER: Line 16c URL: www.bryanhealth.com/patients-visitors/pricing-insurance-financial-assistance-billing; Schedule H, Part VI, Line 2 Needs assessment Crete Area MEDICAL CENTER ("CAMC") IS COMMITTED TO IMPROVING THE HEALTH OF OUR COMMUNITY BY CONTINUALLY WORKING WITH COMMUNITY PARTNERS TO ASSESS THE HEALTH NEEDS OF THE COMMUNITY. DURING YEAR ENDED December 31, 2015, CAMC PARTNERED WITH PUBLIC HEALTH SOLUTIONS, LOCATED IN CRETE, TO COMPLETE A COMMUNITY HEALTH NEEDS ASSESSMENT FOR SALINE COUNTY. THE HEALTH NEEDS IDENTIFIED FROM THE ASSESSMENT WERE PRIORITIZED BY A REPRESENTATIVE GROUP OF STAKEHOLDERS FROM THROUGHOUT THE COUNTY AND UTILIZED TO DEVELOP A COMMUNITY HEALTH NEEDS ASSESSMENT FOR SALINE COUNTY. CAMC'S COMMUNITY HEALTH NEEDS ASSESSMENT IMPLEMENTATION STRATEGY WAS DEVELOPED TO ENSURE THAT OUR STRENGTHS AND AVAILABLE RESOURCES ARE ALIGNED WITH THE HEALTH NEEDS OF OUR COMMUNITY. CAMC ALSO REVIEWS INFORMATION ON THE APPROPRIATE NUMBER OF PHYSICIANS FOR OUR SERVICE AREA AND WILL ACTIVELY RECRUIT PHYSICIANS OR OTHER PROVIDERS AS NEEDED TO THE COMMUNITY. Schedule H, Part VI, Line 3 Patient education of eligibility for assistance FINANCIAL ASSISTANCE INFORMATION IS PROVIDED TO PATIENTS DURING ADMISSION IN THEIR INFORMATION PACKET. PATIENTS MAY CONTACT THE HOSPITAL AT ANYTIME TO REQUEST A FINANCIAL ASSISTANCE APPLICATION. HOSPITAL PATIENT ACCOUNT COLLECTORS WILL ALSO INFORM PATIENTS ABOUT OUR FINANCIAL ASSISTANCE PROGRAM IF THEY ARE UNABLE TO PAY THEIR BILL AND MAY QUALIFY FOR FINANCIAL ASSISTANCE BASED ON INFORMATION PROVIDED. IN ADDITION, INFORMATION REGARDING FINANCIAL ASSISTANCE IS PROVIDED ON THE WEBSITE, IN ALL HOSPITAL REGISTRATION AREAS, INCLUDING THE EMERGENCY DEPARTMENT, AND ON EACH BILLING STATEMENT. Schedule H, Part VI, Line 4 Community information CRETE AREA MEDICAL CENTER ("CAMC") IS LOCATED IN CRETE, NEBRASKA. CRETE HAS AN Estimated POPULATION OF 7,160 PEOPLE AND INCLUDES DIVERSE ETHNIC BACKGROUNDS. THE CITY OF CRETE HAS THE FASTEST-GROWING HISPANIC POPULATION IN NEBRASKA. THE 2017 AMERICAN COMMUNITY SURVEY ESTIMATES INDICATE THAT PERSONS OF HISPANIC ORIGIN MAKE UP 25.7% OF THE POPULATION IN SALINE COUNTY, VERSUS 11.0% FOR NEBRASKA. CRETE HAS THREE PRIMARY EMPLOYERS: BUNGE MILLING, SMITHFIELD-FARMLAND, AND NESTLE/PURINA. IN ADDITION, CRETE IS HOME TO DOANE COLLEGE, A PRIVATE, LIBERAL ARTS COLLEGE. CAMC SERVES PEOPLE IN CRETE AND THE SURROUNDING COMMUNITIES IN SALINE AND LANCASTER COUNTIES. OUR PRIMARY SERVICE AREA IS A 30-MILE RADIUS OF CRETE. Schedule H, Part VI, Line 5 Promotion of community health CRETE AREA MEDICAL CENTER ("CAMC") IS A NEBRASKA NONPROFIT CORPORATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. CAMC OPERATES A 24-LICENSED BED CRITICAL ACCESS HOSPITAL AND THREE PHYSICIAN CLINICS. CAMC HAS AN OPEN MEDICAL STAFF. THE HOSPITAL BOARD OF TRUSTEES INCLUDES MEMBERS FROM THE COMMUNITY. CAMC IS COMMITTED TO SERVING OUR PATIENTS AND OUR COMMUNITY BY INVESTING FUNDS IN FACILITIES, TECHNOLOGY, PHYSICIANS, AND STAFF TO DELIVER PREMIUM HEALTHCARE IN OUR FACILITIES. CAMC PARTICIPATES IN LOCAL ORGANIZATIONAL EVENTS AND PROVIDES UNCOMPENSATED AND CHARITY CARE TO OUR PATIENTS. CAMC SUPPORTS EDUCATIONAL OPPORTUNITIES FOR STAFF, HIGH SCHOOL STUDENTS, LOCAL EMS VOLUNTEERS, AND COMMUNITY MEMBERS. PUBLIC ASSISTANCE WITH TRANSLATION SERVICES, AND HEALTHY LIFESTYLE PROGRAMS ARE ALSO OFFERED AT CAMC. Schedule H, Part VI, Line 6 Affiliated health care system CRETE AREA MEDICAL CENTER IS PART OF BRYAN HEALTH, ONE OF THE LARGEST NON-PROFIT, LOCALLY GOVERNED HEALTH CARE ORGANIZATIONS IN THE REGION. BRYAN HEALTH EXISTS TO: PROMOTE AND PROVIDE ACCESS TO QUALITY HEALTH CARE; PROVIDE MEDICAL EDUCATION, AND COMMUNITY SERVICE. THE COMMUNITY BENEFITS PROVIDED BY THE SYSTEM INCLUDE: 1) PROVIDING FREE OR DISCOUNTED HEALTH CARE TO THE UNINSURED AND UNDERINSURED, 2) PROVIDING GOVERNMENTAL SPONSORED PROGRAMS SUCH AS MEDICARE AND MEDICAID; 3) HEALTH PROFESSIONALS' EDUCATION 4) COMMUNITY HEALTH IMPROVEMENT SERVICES AND 5) CASH AND IN-KIND CONTRIBUTIONS TO OTHER NON-PROFIT ORGANIZATIONS. BRYAN HEALTH PROVIDES A FULL SPECTRUM OF PREVENTION, WELLNESS, ACUTE CARE AND REHABILITATION SERVICES TO URBAN, SUBURBAN AND RURAL COMMUNITIES IN NEBRASKA, KANSAS, IOWA, MISSOURI AND SOUTH DAKOTA. BRYAN HEALTH CONSISTS OF FOUR ACUTE-CARE HOSPITALS, NUMEROUS OUTPATIENT CLINICS, A PHYSICIAN NETWORK, A COLLEGE, AN URGENT CARE CENTER, A HEALTH AND WELLNESS FACILITY, A PHILANTHROPIC FOUNDATION, A PHYSICIAN HOSPITAL ORGANIZATION, AN ACCOUNTABLE CARE ORGANIZATION, AND OTHER HEALTHCARE PROVIDERS. PREMIER SERVICES INCLUDE CARDIOLOGY, NEUROSCIENCE, ORTHOPEDICS, VASCULAR, TRAUMA AND EMERGENCY CENTERS, INTENSIVE CARE, WOMEN'S AND CHILDREN'S HEALTH, ONCOLOGY, IMAGING AND MENTAL HEALTH. true SCHOLARSHIPS 2 7172 Schedule I, Part I, Line 2 Procedures for monitoring use of grant funds. THE CRETE AREA HEALTH CARE FOUNDATION AWARDS THE SCHOLARSHIPS AND CRETE AREA MEDICAL CENTER DISTRIBUTES THE FUNDS. EACH POTENTIAL RECIPIENT IS REQUIRED TO APPLY FOR A SCHOLARSHIP. THE FOUNDATION REVIEWS AND DISCUSSES ALL SUBMITTED REQUESTS IN DETAIL SCHOLARSHIPS ARE AWARDED BASED ON ELIGIBILITY. false true false false false false false true false REBEKAH MUSSMAN PRESIDENT/CEO 146774 0 12579 0 4067 0 9543 0 27936 0 200899 0 0 0 ROBERT RAVENSCROFT Trustee 0 305089 0 53065 0 100481 0 14850 0 27280 0 500765 0 0 DAVID REESE Trustee 0 266897 0 49135 0 57460 0 22628 0 22946 0 419066 0 0 LINDA STONES Trustee 0 135724 0 17351 0 20686 0 9393 0 4930 0 188083 0 0 TROY MILLER MD TRUSTEE - PHYSICIAN 121232 0 143988 0 10839 0 14591 0 26281 0 316931 0 0 0 RUSSELL GRONEWOLD System VP FINANCE & CFO 0 506483 0 76567 0 176125 0 14850 0 24875 0 798900 0 0 RUSSELL EBKE MD PHYSICIAN 200280 0 0 0 12413 0 13938 0 27427 0 254058 0 0 0 MITCHELL EBKE CERTIFIED REGISTERED NURSE ANESTHETIST 299981 0 0 0 581 0 14850 0 25897 0 341309 0 0 0 KATE HESSER MD PHYSICIAN 143443 0 74142 0 27879 0 11978 0 27880 0 285322 0 0 0 JASON HESSER MD PHYSICIAN 151161 0 92329 0 19914 0 12531 0 3662 0 279597 0 0 0 AMY VERTIN MD PHYSICIAN 266033 0 0 0 9683 0 14044 0 24976 0 314736 0 0 0 Schedule J, Part II COMPENSATION OF OFFICERS, DIRECTORS, TRUSTEES & KEY EMPLOYEES IN KEEPING WITH BRYAN HEALTH'S BELIEFS AND STANDARDS OF BEHAVIOR REGARDING STEWARDSHIP, NO BOARD MEMBER SERVING ON THIS ORGANIZATION'S BOARD IS COMPENSATED FOR THEIR SERVICES AS A BOARD MEMBER. COMPENSATION AMOUNTS REPORTED IN SCHEDULE J, PART II ARE FOR SERVICES PERFORMED AS EMPLOYED PHYSICIANS AND EXECUTIVES; AND NOT FOR SERVICES PERFORMED AS BOARD MEMBERS. Schedule J, Part I, Line 3 Arrangement used to establish the top management official's compensation THE PROCESS FOR REVIEWING AND EVALUATING COMPENSATION FOR THIS ORGANIZATION'S CEO AND FOR ALL RURAL HOSPITAL CEOS EMPLOYED BY BRYAN HEALTH, IS OVERSEEN BY BRYAN HEALTH'S HUMAN RESOURCES DEPARTMENT. THE PROCESS INCLUDES AN ANNUAL ASSESSMENT OF CEO COMPENSATION INCLUDING BENCHMARKING SALARIES TO SEVERAL NATIONAL SALARY SURVEYS TO DETERMINE THAT THE COMPENSATION IS CONSISTENT WITH THE ORGANIZATION'S CHARITABLE MISSION AND REASONABLE COMPARED WITH FAIR MARKET VALUE IN THE INDUSTRY. BRYAN HEALTH TARGETS BASE SALARY FOR RURAL HOSPITAL CEOS AT THE 50TH PERCENTILE OF THE MARKET. THE LAST ASSESSMENT WAS COMPLETED IN APRIL 2017. TWO BOARD MEMBERS OF THIS ORGANIZATION ARE MEMBERS OF THE BRYAN HEALTH SENIOR MANAGEMENT TEAM. BRYAN HEALTH'S BOARD OF TRUSTEES BELIEVES COMPENSATION FOR THE SENIOR MANAGEMENT TEAM, MUST REFLECT THE COMPLEXITIES OF LEADING AND MANAGING A MULTI-HOSPITAL HEALTH SYSTEM THAT PROVIDES SERVICES THROUGHOUT MUCH OF THE STATE. RECOGNIZING THAT ITS LEADERS ARE RESPONSIBLE FOR THE QUALITY OF CARE, PATIENT SERVICES AND OVERALL FINANCIAL HEALTH OF THE LARGEST PRIVATE EMPLOYER IN LINCOLN/LANCASTER COUNTY, BRYAN HEALTH'S BOARD HAS ESTABLISHED A COMPENSATION PLAN THAT MATCHES THIS LEVEL OF RESPONSIBILITY. THIS PLAN, KNOWN AS THE SENIOR MANAGEMENT COMPENSATION PHILOSOPHY IS REVIEWED AT LEAST ANNUALLY BY BRYAN HEALTH'S COMPENSATION COMMITTEE. THIS COMPENSATION PHILOSOPHY TARGETS BASE SALARY FOR SENIOR MANAGERS AT THE 50TH PERCENTILE OF THE MARKET. THE COMPENSATION COMMITTEE IS APPOINTED BY BRYAN HEALTH'S BOARD OF TRUSTEES AND IS MADE UP OF INDEPENDENT COMMUNITY LEADERS WHO ALL SERVE VOLUNTARILY, AND WHO MUST ADHERE TO A STRINGENT CONFLICT OF INTEREST POLICY. EXECUTIVE COMPENSATION IS DETERMINED AND REVIEWED PURSUANT TO GUIDELINES OUTLINED IN THE INTERMEDIATE SANCTION RULES UNDER IRC SECTION 4958 INCLUDING TAKING STEPS TO MEET THE REBUTTABLE PRESUMPTION STANDARD OF REASONABLENESS UNDER TREASURY REGULATION SECTION 53.4958-6. THE COMPENSATION COMMITTEE CONDUCTS A COMPREHENSIVE ANNUAL REVIEW OF ALL COMPENSATION PROVIDED BY THE ORGANIZATION TO THE SENIOR MANAGEMENT TEAM. THIS REVIEW IS CONDUCTED BY THE COMMITTEE BY UTILIZING NATIONAL SALARY SURVEYS, CONDUCTED BY INDEPENDENT EXTERNAL FIRMS. COMPENSATION FOR SENIOR MANAGERS IS COMPARED TO COMPENSATION OF SENIOR MANAGERS AT LIKE INSTITUTIONS ACROSS THE U.S. TO DETERMINE THAT THE VALUE OF COMPENSATION PROVIDED IS REASONABLE AND AT FAIR MARKET VALUE. THE COMPENSATION COMMITTEE ALSO WORKS DIRECTLY WITH AN EXTERNAL INDEPENDENT COMPENSATION CONSULTANT TO REVIEW THE REASONABLENESS OF TOTAL COMPENSATION PROVIDED TO THE SENIOR MANAGEMENT TEAM, AND TO ASSURE THAT THE TOTAL COMPENSATION PAID CONFORMS TO THE OVERALL COMPENSATION PHILOSOPHY. THE COMPENSATION CONSULTANT PROVIDES WRITTEN OPINIONS TO THE COMPENSATION COMMITTEE THAT ASSESSES THE REASONABLENESS OF THE TOTAL EXECUTIVE COMPENSATION PAID TO SENIOR MANAGERS. THE ANNUAL COMPENSATION REVIEW PROCEDURE WAS COMPLETED BY THE COMPENSATION COMMITTEE ON APRIL 25, 2017. ALL DECISIONS OF THE COMPENSATION COMMITTEE ARE CONTEMPORANEOUSLY DOCUMENTED IN THE COMPENSATION COMMITTEE MINUTES WHICH ARE TIMELY REVIEWED AND APPROVED BY THE COMMITTEE. EMPLOYED PHYSICIAN COMPENSATION IS UNDER THE PURVIEW OF THE BRYAN HEALTH COMPENSATION COMMITTEE. THE COMPENSATION COMMITTEE HAS ESTABLISHED A POLICY REGARDING PHYSICIAN COMPENSATION WHICH ASSURES THAT PHYSICIAN COMPENSATION MEETS FAIR MARKET VALUE AND ALL OTHER LEGAL REQUIREMENTS. PHYSICIAN COMPENSATION IS BENCHMARKED AGAINST SEVERAL INDEPENDENT PHYSICIAN SPECIALTY - SPECIFIC SALARY SURVEYS AND IS REGULARLY REVIEWED BY THE COMPENSATION COMMITTEE. Schedule J, Part I, Line 4b Supplemental nonqualified retirement plan IN ORDER TO ATTRACT AND RETAIN TALENTED, EXPERIENCED EXECUTIVES, BRYAN HEALTH OFFERS A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN TO ELIGIBLE EMPLOYEES. THE FOLLOWING PEOPLE LISTED IN FORM 990, PART VII, SECTION A, LINE 1A PARTICIPATED IN, OR RECEIVED A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN DURING 2017: RUSSELL GRONEWOLD $151,750, ROBERT RAVENSCROFT $81,475 AND DAVID REESE $47,551. Schedule J, Part I, Line 7 Non-fixed payments CRETE AREA MEDICAL CENTER OFFERS AN INCENTIVE COMPENSATION PROGRAM FOR ALL EMPLOYEES. INCENTIVE COMPENSATION IS BASED ON ACHIEVING OBJECTIVE ORGANIZATIONAL, DEPARTMENTAL, AND INDIVIDUAL GOALS. THE WEIGHTS ASSIGNED TO EACH GOAL MAY CHANGE ON AN ANNUAL BASIS. Kate Hesser MD Family member of a former board member from 2014 245464 Compensation false Form 990, Part VI, Line 2 DESCRIPTION OF FAMILY OR BUSINESS RELATIONSHIPS MANY OF THE PERSONS LISTED IN PART VII, SECTION A HAVE A "BUSINESS RELATIONSHIP" WITH EACH OTHER BY VIRTUE OF THEIR EMPLOYMENT BY A BRYAN HEALTH ENTITY. Form 990, Part VI, Line 1a Delegate broad authority to a committee The Executive Committee shall consist of the Chairperson and Vice-Chairperson of the Board. In addition, the Chief Executive Officer of The System and Corporation President/Chief Executive Officer shall be ex officio voting members of the Executive Committee. The Executive Committee shall have and may exercise all of the authority and power of the Board, as delegated thereby, when the Board is not in session. The designation and appointment of an Executive Committee and the delegation thereto of authority shall not operate to relieve the Board, or any individual trustee, of any responsibility imposed upon it or him/her by law. Form 990, Part VI, Line 4 Significant changes to organizational documents Effective January 1, 2017, the By-Laws were changed that the board shall consist of up to eight members instead of ten. Up to three voting members shall be nominated by the Board for approval by the System. Up to three voting members shall be appointed by the System without the necessity of approval by the board. There is no change to the two members that are ex offico voting trustees. Effective May 10, 2017, the Articles of Incorporation were amended to remove an activity listed under the purpose for which the corporation was organized. The deleted activity was to establish, equip, operate and maintain a facility to provide such nursing home, assisted living and other long term care. Form 990, Part VI, Line 6 Classes of members or stockholders AS STATED IN THE CORPORATION'S ORGANIZING DOCUMENTS, THE SOLE MEMBER OF CRETE AREA MEDICAL CENTER IS BRYAN HEALTH. BRYAN HEALTH HAS THE RIGHTS UNDER THE ORGANIZING DOCUMENTS TO: 1) APPROVE SIGNIFICANT DECISIONS OF THE ORGANIZATION'S GOVERNING BODY; 2) ELECT THE MEMBERS OF THE GOVERNING BODY; AND 3) RECEIVE ANY REMAINING ASSETS AFTER DISSOLUTION OF THE ORGANIZATION. Form 990, Part VI, Line 7a Members or stockholders electing members of governing body BRYAN HEALTH, AS SOLE CORPORATE MEMBER OF CRETE AREA MEDICAL CENTER, HAS THE RIGHT UNDER THE ORGANIZING DOCUMENTS TO REMOVE ANY TRUSTEE FROM OFFICE AT ANY TIME, WITH OR WITHOUT CAUSE BY A TWO-THIRDS (2/3) VOTE OF THE VOTING TRUSTEES OF BRYAN HEALTH. Form 990, Part VI, Line 7b Decisions requiring approval by members or stockholders BRYAN HEALTH IS THE SOLE CORPORATE MEMBER OF CRETE AREA MEDICAL CENTER ("CAMC"). PURSUANT TO THE GOVERNING DOCUMENTS, THE BOARD OF CAMC MAY MANAGE THE AFFAIRS OF THE CORPORATION; HOWEVER, THE BOARD MAY NOT, WITHOUT THE PRIOR APPROVAL OF BRYAN HEALTH: (1) ADOPT ANY LONG-TERM CAPITAL OPERATIONAL BUDGET; (2) ADOPT ANY CHANGES IN ANY ANNUAL OR LONG-TERM CAPITAL BUDGET OR OPERATIONAL EXPENSE BUDGET EXCEEDING $250,000 IN ANY SINGLE TRANSACTION OR $1,000,000 IN ANY CORPORATION FISCAL YEAR; (3) ADOPT SUBSTANTIVE CHANGES TO EXISTING LONG-TERM OR MASTER INSTITUTIONAL PLANS OF THE CORPORATION; (4) AMEND THE BYLAWS OR ARTICLES OF INCORPORATION (5) APPROVE THE TRANSFER, SALE OR OTHER DISPOSITION OF CAPITAL ASSETS IN ANY SINGLE TRANSACTION IN EXCESS OF $250,000, OR A TOTAL OF $1,000,000 IN ANY CORPORATION FISCAL YEAR; (6) ORGANIZE OR ACQUIRE, OR AUTHORIZE THE ORGANIZATION OR ACQUISITION OF ANY CORPORATION, SHARED SERVICE ARRANGEMENT, ASSOCIATION, LIMITED LIABILITY COMPANY, PARTNERSHIP, TRUST, JOINT VENTURE OR OTHER ENTITY, DIRECTLY OR INDIRECTLY, WHERE THE CAPITAL EXPENDITURE OR OPERATING EXPENSES BY THE CORPORATION IN CONNECTION WITH SUCH ORGANIZATION OR ACQUISITION WHEN IT EXCEEDS $500,000 IN A SINGLE TRANSACTION OR A TOTAL OF $1,000,000 IN ANY CORPORATION FISCAL YEAR; (7) INCUR ANY INDEBTEDNESS INVOLVING A MORTGAGE OR LIEN OF ANY KIND OR NATURE ON ASSETS OF THE CORPORATION WHERE THE BORROWING OR INDEBTEDNESS EXCEEDS $250,000 IN ANY SINGLE TRANSACTION OR A TOTAL OF $1,000,000 IN ANY CORPORATION FISCAL YEAR; (8) ELECT OR APPOINT TRUSTEES OF THE CORPORATION; (9) APPOINT OR TERMINATE THE PRESIDENT/CHIEF EXECUTIVE OFFICER OF THE CORPORATION; 10) PURCHASE INSURANCE COVERAGE FOR THE CORPORATION AND ITS OPERATIONS; 11) SELECT THE AUDITOR TO PERFORM THE ANNUAL AUDIT OF THE RECORDS OF THE CORPORATION; AND 12) TAKE ANY OTHER ACTIONS WHICH MAY BE INCONSISTENT WITH BRYAN HEALTH'S GOALS AND OBJECTIVES. Form 990, Part VI, Line 11b Review of form 990 by governing body THIS 990 WAS PREPARED BY BRYAN HEALTH'S TAX DIVISION. DURING THE RETURN PREPARATION PROCESS, THE TAX DIVISION WORKS DILIGENTLY WITH CRETE AREA MEDICAL CENTER'S CFO AND OTHER DEPARTMENTS, INCLUDING HUMAN RESOURCES, FINANCE, LEGAL, AND DEVELOPMENT, TO GATHER INFORMATION TO COMPLETE FORM 990 AND ATTACHED SCHEDULES IN AN ACCURATE AND THOROUGH MANNER. THIS 990 WAS REVIEWED BY THE CEO AND CFO OF CRETE AREA MEDICAL CENTER. IN ADDITION, THIS 990 WAS REVIEWED BY THE CEO AND CFO OF BRYAN HEALTH. THIS 990 WAS ALSO REVIEWED BY AN INDEPENDENT ACCOUNTING FIRM. THE 990 WAS DISTRIBUTED FOR REVIEW TO EACH MEMBER OF CRETE AREA MEDICAL CENTER'S BOARD OF TRUSTEES, AND TO BRYAN HEALTH'S AUDIT COMMITTEE PRIOR TO FILING THE FORM WITH THE INTERNAL REVENUE SERVICE. Form 990, Part VI, Line 12c Conflict of interest policy CRETE AREA MEDICAL CENTER ("CAMC") HAS ADOPTED A WRITTEN CONFLICT OF INTEREST POLICY THAT IS MONITORED AND ENFORCED BY THE CAMC BOARD OF TRUSTEES. BOARD MEMBERS, OFFICERS AND KEY EMPLOYEES ARE REQUIRED TO ANNUALLY COMPLETE A CONFLICT OF INTEREST AND DISCLOSURE QUESTIONNAIRE TO IDENTIFY ANY FAMILY AND BUSINESS RELATIONSHIPS AND TRANSACTIONS, OR OTHER TRANSACTIONS THAT MAY POSE A POTENTIAL CONFLICT. THE QUESTIONNAIRES REQUIRES EACH COVERED PERSON TO SIGN A STATEMENT CERTIFYING THAT HE/SHE: (1) HAS REPORTED INFORMATION THAT IS CORRECT AND COMPLETE TO THE BEST OF THEIR KNOWLEDGE; (2) HAS READ THE CONFLICT OF INTEREST POLICY AND UNDERSTANDS THE POLICY, AND (3) AGREES TO COMPLY WITH ALL REQUIREMENTS OF THE POLICY. COVERED PERSONS ARE ALSO REQUIRED TO DISCLOSE REAL OR POTENTIAL CONFLICTS AT THE TIME SUCH CONFLICTS ARISE. PERSONS WHO HAVE NOT RETURNED QUESTIONNAIRES ARE CONTACTED ADDITIONAL TIMES IN AN EFFORT TO RECEIVE COMPLETE AND ACCURATE RESPONSES FROM ALL PERSONS. FAILURE TO COMPLETE THE QUESTIONNAIRE CAN RESULT IN DISCIPLINARY ACTIONS. THE QUESTIONNAIRES ARE REVIEWED IN DETAIL BY THE GOVERNANCE COMMITTEE OF BRYAN HEALTH. CONFLICTS ARE CLOSELY MONITORED BY MEMBERS OF THE GOVERNANCE COMMITTEE. THE CONFLICT OF INTEREST POLICY HAS RESTRICTIONS FOR ANY BOARD MEMBER WITH A CONFLICT OF INTEREST; SUCH AS, PROHIBITING THEM FROM PARTICIPATING IN DELIBERATIONS AND VOTING WITH REGARD TO CERTAIN TRANSACTIONS IN WHICH THEY HAVE AN INTEREST. Form 990, Part VI, Line 15a Process to establish compensation of top management official THE PROCESS FOR REVIEWING AND EVALUATING COMPENSATION FOR THIS ORGANIZATION'S CEO AND FOR ALL RURAL HOSPITAL CEOS EMPLOYED BY BRYAN HEALTH, IS OVERSEEN BY BRYAN HEALTH'S HUMAN RESOURCES DEPARTMENT. THE PROCESS INCLUDES AN ANNUAL ASSESSMENT OF CEO COMPENSATION INCLUDING BENCHMARKING SALARIES TO SEVERAL NATIONAL SALARY SURVEYS TO DETERMINE THAT THE COMPENSATION IS CONSISTENT WITH THE ORGANIZATION'S CHARITABLE MISSION AND REASONABLE COMPARED WITH FAIR MARKET VALUE IN THE INDUSTRY. BRYAN HEALTH TARGETS BASE SALARY FOR RURAL HOSPITAL CEOS AT THE 50TH PERCENTILE OF THE MARKET. THE LAST ASSESSMENT WAS COMPLETED IN APRIL 2017. TWO BOARD MEMBERS OF THIS ORGANIZATION ARE MEMBERS OF THE BRYAN HEALTH SENIOR MANAGEMENT TEAM. BRYAN HEALTH'S BOARD OF TRUSTEES BELIEVES COMPENSATION FOR THE SENIOR MANAGEMENT TEAM, MUST REFLECT THE COMPLEXITIES OF LEADING AND MANAGING A MULTI-HOSPITAL HEALTH SYSTEM THAT PROVIDES SERVICES THROUGHOUT MUCH OF THE STATE. RECOGNIZING THAT ITS LEADERS ARE RESPONSIBLE FOR THE QUALITY OF CARE, PATIENT SERVICES AND OVERALL FINANCIAL HEALTH OF THE LARGEST PRIVATE EMPLOYER IN LINCOLN/LANCASTER COUNTY, BRYAN HEALTH'S BOARD HAS ESTABLISHED A COMPENSATION PLAN THAT MATCHES THIS LEVEL OF RESPONSIBILITY. THIS PLAN, KNOWN AS THE SENIOR MANAGEMENT COMPENSATION PHILOSOPHY IS REVIEWED AT LEAST ANNUALLY BY BRYAN HEALTH'S COMPENSATION COMMITTEE. THIS COMPENSATION PHILOSOPHY TARGETS BASE SALARY FOR SENIOR MANAGERS AT THE 50TH PERCENTILE OF THE MARKET. THE COMPENSATION COMMITTEE IS APPOINTED BY BRYAN HEALTH'S BOARD OF TRUSTEES AND IS MADE UP OF INDEPENDENT COMMUNITY LEADERS WHO ALL SERVE VOLUNTARILY, AND WHO MUST ADHERE TO A STRINGENT CONFLICT OF INTEREST POLICY. EXECUTIVE COMPENSATION IS DETERMINED AND REVIEWED PURSUANT TO GUIDELINES OUTLINED IN THE INTERMEDIATE SANCTION RULES UNDER IRC SECTION 4958 INCLUDING TAKING STEPS TO MEET THE REBUTTABLE PRESUMPTION STANDARD OF REASONABLENESS UNDER TREASURY REGULATION SECTION 53.4958-6. THE COMPENSATION COMMITTEE CONDUCTS A COMPREHENSIVE ANNUAL REVIEW OF ALL COMPENSATION PROVIDED BY THE ORGANIZATION TO THE SENIOR MANAGEMENT TEAM. THIS REVIEW IS CONDUCTED BY THE COMMITTEE BY UTILIZING NATIONAL SALARY SURVEYS, CONDUCTED BY INDEPENDENT EXTERNAL FIRMS. COMPENSATION FOR SENIOR MANAGERS IS COMPARED TO COMPENSATION OF SENIOR MANAGERS AT LIKE INSTITUTIONS ACROSS THE U.S. TO DETERMINE THAT THE VALUE OF COMPENSATION PROVIDED IS REASONABLE AND AT FAIR MARKET VALUE. THE COMPENSATION COMMITTEE ALSO WORKS DIRECTLY WITH AN EXTERNAL INDEPENDENT COMPENSATION CONSULTANT TO REVIEW THE REASONABLENESS OF TOTAL COMPENSATION PROVIDED TO THE SENIOR MANAGEMENT TEAM, AND TO ASSURE THAT THE TOTAL COMPENSATION PAID CONFORMS TO THE OVERALL COMPENSATION PHILOSOPHY. THE COMPENSATION CONSULTANT PROVIDES WRITTEN OPINIONS TO THE COMPENSATION COMMITTEE THAT ASSESSES THE REASONABLENESS OF THE TOTAL EXECUTIVE COMPENSATION PAID TO SENIOR MANAGERS. THE ANNUAL COMPENSATION REVIEW PROCEDURE WAS COMPLETED BY THE COMPENSATION COMMITTEE ON APRIL 25, 2017. ALL DECISIONS OF THE COMPENSATION COMMITTEE ARE CONTEMPORANEOUSLY DOCUMENTED IN THE COMPENSATION COMMITTEE MINUTES WHICH ARE TIMELY REVIEWED AND APPROVED BY THE COMMITTEE. EMPLOYED PHYSICIAN COMPENSATION IS UNDER THE PURVIEW OF THE BRYAN HEALTH COMPENSATION COMMITTEE. THE COMPENSATION COMMITTEE HAS ESTABLISHED A POLICY REGARDING PHYSICIAN COMPENSATION WHICH ASSURES THAT PHYSICIAN COMPENSATION MEETS FAIR MARKET VALUE AND ALL OTHER LEGAL REQUIREMENTS. PHYSICIAN COMPENSATION IS BENCHMARKED AGAINST SEVERAL INDEPENDENT PHYSICIAN SPECIALTY - SPECIFIC SALARY SURVEYS AND IS REGULARLY REVIEWED BY THE COMPENSATION COMMITTEE. Form 990, Part VI, Line 15b Process to establish compensation of other employees SEE THE NARRATIVE FOR FORM 990, PART VI, SECTION B, LINE 15A. Form 990, Part VI, Line 19 Required documents available to the public THE ORGANIZATION'S ARTICLES OF INCORPORATION AND AMENDMENTS ARE AVAILABLE TO THE PUBLIC ON THE NEBRASKA SECRETARY OF STATE'S WEBSITE AT WWW.SOS.NE.GOV. ALSO, THIS ORGANIZATION IS INCLUDED WITHIN THE CONSOLIDATED FINANCIAL STATEMENTS OF BRYAN HEALTH THAT ARE MADE AVAILABLE TO THE PUBLIC BY THE POSTING OF THESE DOCUMENTS THROUGH THE MUNICIPAL SECURITIES RULEMAKING BOARD WEBSITE AT EMMA.MSRB.ORG. THE ORGANIZATION'S OTHER GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE GENERALLY NOT MADE AVAILABLE TO THE PUBLIC. FEDERAL TAX LAWS DO NOT REQUIRE THAT GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICIES AND FINANCIAL STATEMENTS BE MADE AVAILABLE FOR PUBLIC INSPECTION. Form 990, Part VII, Section A, Line 1a, Column (D) COMPENSATION OF MEMBERS IN KEEPING WITH BRYAN HEALTH'S BELIEFS AND STANDARDS OF BEHAVIOR REGARDING STEWARDSHIP, NO BOARD MEMBER SERVING ON THIS ORGANIZATION'S BOARD IS COMPENSATED FOR THEIR SERVICES AS A BOARD MEMBER. COMPENSATION AMOUNTS REPORTED IN FORM 990, PART VII, SECTION A ARE FOR SERVICES PERFORMED AS PHYSICIANS AND EXECUTIVES OF CRETE AREA MEDICAL CENTER AND BRYAN HEALTH AND NOT FOR SERVICES PERFORMED AS BOARD MEMBERS. Form 990, Part VIII, Line 11d Other Miscellaneous Revenue Other - Total Revenue: 118223, Related or Exempt Function Revenue: , Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: 118223; Form 990, Part XI, Line 9 Other changes in net assets or fund balances Change in Value of Swap Agreement - 76816; Transfers from Related Parties - 135461; BRYAN HEALTH 1600 SOUTH 48TH STREET LINCOLN NE 68506 363414823 HEALTHCARE NE 501(c)(3) Type III-FI NA false BRYAN PHYSICIAN NETWORK 1600 SOUTH 48TH STREET LINCOLN NE 68506 201357375 HEALTHCARE NE 501(c)(3) 9 BRYAN HEALTH false BRYAN MEDICAL CENTER 1600 SOUTH 48TH STREET LINCOLN NE 68506 470376552 HEALTHCARE NE 501(c)(3) 3 BRYAN HEALTH false BRYAN FOUNDATION 1600 SOUTH 48TH STREET LINCOLN NE 68506 237005720 FUNDRAISING NE 501(c)(3) 7 BRYAN HEALTH false CRETE AREA HEALTH CARE FOUNDATION 2910 BETTEN DRIVE CRETE NE 68333 FUNDRAISING NE 501(c)(3) Type III-FI NA false MERRICK MEDICAL CENTER 1715 26TH STREET Central City NE 688269501 820906268 Healthcare NE 501(c)(3) 3 Bryan Health false Merrick Medical Center Foundation 1715 26th Street Central City NE 68826 470710738 Fundraising NE 501(c)(3) 7 Merrick Medical Center false BRYAN ENTERPRISES INC 1600 SOUTH 48TH STREET LINCOLN NE 68506 470701037 MEDICAL SERVICES NE BRYAN HEALTH C Corporation 0 false INTEGRATED CARDIOLOGY GROUP LLC 1600 SOUTH 48TH STREET LINCOLN NE 68506 470844961 CARDIOLOGY NE BRYAN HEALTH C Corporation 0 false BRYAN HEALTH CONNECT 1600 SOUTH 48TH STREET LINCOLN NE 68506 364771145 PHYSICIAN HOSPITAL ORGANIZATION NE BRYAN HEALTH C Corporation 0 false Bryan Health Connect ACO LLC 1600 S 48th St Lincoln NE 68506 821666184 Accountable Care Organization NE Bryan Health Connect C Corporation 0 false false false true false false false false false false false false false true false true true true true false