PROVIDENCE MEDICAL CENTER: Form 990, tax year 2016
View the entire original 990 at ProPublica ↗
- Organization
- PROVIDENCE MEDICAL CENTER (EIN 47-0566524)
- Tax period
- 2016-01-01 to 2016-12-31
- Filed
- 2017-11-13
- IRS object ID
- 201703179349302835
- Schema version
- 2016v3.0
- 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 | 2017-11-13T12:23:16-06:00 | ReturnTs |
| Tax Period End | 2016-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 390758449 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Wipfli LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3703 Oakwood Hills Pkwy | AddressLine1Txt |
| City | Eau Claire | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 54701 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2016-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 470566524 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PROVIDENCE MEDICAL CENTER | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | PROV | BusinessNameControlTxt |
| Phone | 4023753800 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1200 PROVIDENCE RD | AddressLine1Txt |
| City | WAYNE | CityNm |
| State Abbreviation | NE | StateAbbreviationCd |
| ZIP | 68787 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | JAMES FRANK | PersonNm |
| Person Title | CEO | PersonTitleTxt |
| Phone | 4023753800 | PhoneNum |
| Signature | 2017-11-13 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | PAUL M TRACZEK CPA | PreparerPersonNm |
| PTIN | P01368830 | PTIN |
| Phone | 7158323407 | PhoneNum |
| Preparation | 2017-11-13 | PreparationDt |
Filing Security Information FilingSecurityInformation
IP Address IPAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| I Pv4 Address | 216.54.158.12 | IPv4AddressTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IP | 2017-11-13 | IPDt |
| IP Tm | 08:05:08 | IPTm |
| IP Timezone | CS | IPTimezoneCd |
| Filing License Type | P | FilingLicenseTypeCd |
| At Submission Creation Device Id | F91C726111BE61894B067C8320C81C46540231E8 | AtSubmissionCreationDeviceId |
| At Submission Filing Device Id | 2F3CDBAF1037015F68690DD19EBC2430D808C728 | AtSubmissionFilingDeviceId |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2016 | TaxYr |
| Build TS | 2017-02-10 21:41:12Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | JAMES FRANK | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1200 PROVIDENCE RD | AddressLine1Txt |
| City | WAYNE | CityNm |
| State Abbreviation | NE | StateAbbreviationCd |
| ZIP | 68787 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $21,545,296 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.PROVIDENCEMEDICAL.COM | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1975 | FormationYr |
| Legal Domicile State | NE | LegalDomicileStateCd |
| Activity Or Mission | See Schedule O | ActivityOrMissionDesc |
| Voting Members Governing Body | 7 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 5 | VotingMembersIndependentCnt |
| Total Employee | 241 | TotalEmployeeCnt |
| Total Volunteers | 23 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $142,040 | PYContributionsGrantsAmt |
| CY Contributions Grants | $152,158 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $18,547,722 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $20,554,619 | CYProgramServiceRevenueAmt |
| PY Investment Income | $63,682 | PYInvestmentIncomeAmt |
| CY Investment Income | $16,116 | CYInvestmentIncomeAmt |
| PY Other Revenue | $1,083,173 | PYOtherRevenueAmt |
| CY Other Revenue | $128,086 | CYOtherRevenueAmt |
| PY Total Revenue | $19,836,617 | PYTotalRevenueAmt |
| CY Total Revenue | $20,850,979 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $13,763 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $19,039 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $9,826,060 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $10,005,031 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $54,000 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $54,000 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $8,344,205 | PYOtherExpensesAmt |
| CY Other Expenses | $10,310,630 | CYOtherExpensesAmt |
| PY Total Expenses | $18,184,028 | PYTotalExpensesAmt |
| CY Total Expenses | $20,388,700 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $1,652,589 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $462,279 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $19,426,909 | TotalAssetsBOYAmt |
| Total Assets EOY | $28,744,717 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $3,161,614 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $11,335,523 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $16,265,295 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $17,409,194 | NetAssetsOrFundBalancesEOYAmt |
| Mission | THE MISSION OF PROVIDENCE MEDICAL CENTER IS TO PROVIDE QUALITY HEALTH CARE IN THE SPIRIT OF CHRIST. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $16,100,160 | ExpenseAmt |
| Grant | $19,039 | GrantAmt |
| Revenue | $20,554,619 | RevenueAmt |
| Desc | Providence Medical Center is a not-for-profit, 25 bed, Critical Access Hospital located in Wayne, Nebraska. Providence serves over 15,000 area residents in Northeast Nebraska and employs over 200 people. Providence offers acute, skilled, and obstetrical care along with 24 hours a day, seven days a week emergency care and ambulance services. The hospial also provides diagnostic imaging, surgical, therapy, laboratory, oncology, respiratory, hospice, fitness and wellness, home health, and many other health and wellness services. There are over 23 specialty clinic doctors of different specialties that conduct clinics at the hospital in order to bring specialized care to the community. | Desc |
| Total Program Service Expenses | $16,100,160 | 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 | Yes (1) | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | 0 | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | 0 | 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 | Yes (1) | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | 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 | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | Yes (1) | 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 | 0 | RelatedOrganizationCtrlEntInd |
| 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 |
| Employee | 241 | 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 |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 7 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 5 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | 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 |
| States Where Copy Of Return Is Fld | NE | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Kim Hixson | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 4023757673 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1200 Providence Rd | AddressLine1Txt |
| City | Wayne | CityNm |
| State Abbreviation | NE | StateAbbreviationCd |
| ZIP | 68787 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (11 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| LELAND MINER | ||||||||
| CHAIR | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| KAREN HARRINGTON | ||||||||
| VICE CHAIR | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| NATHAN RAABE | ||||||||
| SECRETARY/TREASURER | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| ROSS HANSEN PA-C | ||||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| LYNETTE JOSLIN | ||||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| MATTHEW LEY | ||||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| RANDALL PEDERSEN | ||||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| JAMES FRANK | ||||||||
| CEO | 40.00 | Yes (X) | $152,556 | $0 | $24,815 | 1.00 | ||
| KIMBERLY HIXSON | ||||||||
| CFO | 40.00 | Yes (X) | $103,938 | $0 | $5,430 | |||
| KIMBERLY BENTJEN | ||||||||
| PHARMACIST | 40.00 | $120,770 | $0 | $12,036 | Yes (X) | |||
| KRISTINE GIESE | ||||||||
| COO | 40.00 | $137,700 | $0 | $7,508 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $514,964 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $49,789 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 4 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (3 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| TODD LUEDEKE | |||||
| 85726 575 Avenue | WAYNE | NE | 68787 | CRNA SERVICES | $656,286 |
| HARRISON WOC SERVICES LLC | |||||
| PO BOX 266 | THURSTON | NE | 680620266 | WOUND CARE SERVICES | $141,996 |
| SHARED IMAGING | |||||
| PO BOX 88544 | MILWAUKEE | WI | 532880544 | RADIOLOGY RECORD STORAGE | $124,200 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 3 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $50,814 | RelatedOrganizationsAmt |
| Government Grants | $37,213 | GovernmentGrantsAmt |
| All Other Contributions | $64,131 | AllOtherContributionsAmt |
| Total Contributions | $152,158 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (4 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| PAITENT SERVICE REVENUE | 621990 | $20,212,204 | $20,212,204 |
| FITNESS REVENUE | 621990 | $152,787 | $152,787 |
| DIETARY INCOME | 722210 | $53,879 | $53,879 |
| LIFELINE | 642191 | $33,560 | $33,560 |
Total Oth Program Service Rev TotalOthProgramServiceRevGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $102,189 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $102,189 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $20,554,619 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $25,598 | TotalRevenueColumnAmt |
| Exclusion | $25,598 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $128,086 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $0 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $128,086 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $128,086 | TotalRevenueColumnAmt |
| Exclusion | $128,086 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $681,876 | SecuritiesAmt |
| Other | $2,959 | OtherAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $694,317 | SecuritiesAmt |
| Other | $0 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | -$12,441 | SecuritiesAmt |
| Other | $2,959 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$9,482 | TotalRevenueColumnAmt |
| Exclusion | -$9,482 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $20,850,979 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $20,554,619 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $144,202 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $19,039 | TotalAmt |
| Program Services | $19,039 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $286,739 | TotalAmt |
| Management And General | $286,739 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $7,859,312 | TotalAmt |
| Program Services | $6,087,285 | ProgramServicesAmt |
| Management And General | $1,772,027 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $212,048 | TotalAmt |
| Program Services | $146,810 | ProgramServicesAmt |
| Management And General | $65,238 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,078,271 | TotalAmt |
| Program Services | $671,515 | ProgramServicesAmt |
| Management And General | $406,756 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $568,661 | TotalAmt |
| Program Services | $428,859 | ProgramServicesAmt |
| Management And General | $139,802 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,387 | TotalAmt |
| Management And General | $6,387 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $56,042 | TotalAmt |
| Program Services | $6,025 | ProgramServicesAmt |
| Management And General | $50,017 | ManagementAndGeneralAmt |
Fees For Services Prof Fundraising FeesForServicesProfFundraising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $54,000 | TotalAmt |
| Fundraising | $54,000 | FundraisingAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $17,366 | TotalAmt |
| Management And General | $17,366 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,417,280 | TotalAmt |
| Program Services | $1,909,357 | ProgramServicesAmt |
| Management And General | $507,923 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $86,299 | TotalAmt |
| Management And General | $86,299 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $163,942 | TotalAmt |
| Program Services | $90,897 | ProgramServicesAmt |
| Management And General | $73,045 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $524,017 | TotalAmt |
| Program Services | $63,284 | ProgramServicesAmt |
| Management And General | $460,733 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $399,053 | TotalAmt |
| Program Services | $369,309 | ProgramServicesAmt |
| Management And General | $29,744 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $61,938 | TotalAmt |
| Program Services | $56,362 | ProgramServicesAmt |
| Management And General | $5,576 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $53,997 | TotalAmt |
| Program Services | $32,187 | ProgramServicesAmt |
| Management And General | $21,810 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $18,640 | TotalAmt |
| Program Services | $18,640 | ProgramServicesAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,680,163 | TotalAmt |
| Program Services | $1,680,163 | ProgramServicesAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $152,243 | TotalAmt |
| Management And General | $152,243 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (3 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| SUPPLIES AND PHARMACEUT | $2,512,933 | $2,509,852 | $3,081 |
| PROVISIONS FOR BAD DEBT | $1,051,330 | $1,051,330 | |
| EQUIPMENT RENTAL & MAIN | $1,046,075 | $923,520 | $122,555 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $62,925 | TotalAmt |
| Program Services | $35,726 | ProgramServicesAmt |
| Management And General | $27,199 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $20,388,700 | TotalAmt |
| Program Services | $16,100,160 | ProgramServicesAmt |
| Management And General | $4,234,540 | ManagementAndGeneralAmt |
| Fundraising | $54,000 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $200 | BOYAmt |
| EOY | $200 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,326,935 | BOYAmt |
| EOY | $1,419,796 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,656,909 | BOYAmt |
| EOY | $3,310,809 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $360,227 | BOYAmt |
| EOY | $363,137 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $204,573 | BOYAmt |
| EOY | $225,147 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $31,724,758 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $12,970,371 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,991,098 | BOYAmt |
| EOY | $18,754,387 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,275,015 | BOYAmt |
| EOY | $1,976,082 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $1,982,063 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $611,952 | BOYAmt |
| EOY | $713,096 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $19,426,909 | BOYAmt |
| EOY | $28,744,717 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,771,557 | BOYAmt |
| EOY | $2,349,859 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $746,948 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $647,731 | BOYAmt |
| EOY | $7,804,688 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $625,590 | BOYAmt |
| EOY | $434,028 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $116,736 | BOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,161,614 | BOYAmt |
| EOY | $11,335,523 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $16,235,350 | BOYAmt |
| EOY | $16,789,739 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,945 | BOYAmt |
| EOY | $571,262 | EOYAmt |
Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $20,000 | BOYAmt |
| EOY | $48,193 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $16,265,295 | BOYAmt |
| EOY | $17,409,194 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $19,426,909 | BOYAmt |
| EOY | $28,744,717 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $462,279 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $62,166 | NetUnrlzdGainsLossesInvstAmt |
| Prior Period Adjustments | $747,658 | PriorPeriodAdjustmentsAmt |
| Other Changes In Net Assets | -$128,204 | 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
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
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 | $1,975 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $1,975 | 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 | PROVIDENCE MEDICAL CENTER ("PMC") PAYS ANNUAL ASSOCIATION MEMBERSHIP DUES TO THE AMERICAN HOSPITAL ASSOCIATION (AHA) AND THE NEBRASKA HOSPITAL ASSOCIATION (NHA). THESE DUES ARE PRIMARILY TO ACCESS EDUCATIONAL MATERIALS AND FOR STAFF TRAINING. THE AHA AND NHA HAVE NOTIFIED PMC THAT APPROXIMATELY $1,975 OF THE ANNUAL DUES PAID WERE USED IN CONJUNCTION WITH LOBBYING ACTIVITIES WITH THE GOAL OF IMPROVING THE OVERALL HEALTHCARE ENVIRONMENT. | ExplanationTxt |
Schedule D IRS990ScheduleD
CY Endwmt Fund CYEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $20,000 | BeginningYearBalanceAmt |
| Contributions | $48,193 | ContributionsAmt |
| Investment Earnings Or Losses | $10,790 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $20,000 | OtherExpendituresAmt |
| End Year Balance | $58,983 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $20,000 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $95 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $95 | OtherExpendituresAmt |
| End Year Balance | $20,000 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $20,000 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $116 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $116 | OtherExpendituresAmt |
| End Year Balance | $20,000 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $20,000 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $104 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $104 | OtherExpendituresAmt |
| End Year Balance | $20,000 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $20,000 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $50 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $50 | OtherExpendituresAmt |
| End Year Balance | $20,000 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Prmnnt Endowment Balance EOY | 0.81710 | PrmnntEndowmentBalanceEOYPct |
| Term Endowment Balance EOY | 0.18290 | TermEndowmentBalanceEOYPct |
| Endowments Held Unrelated Org | 0 | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | Yes (1) | EndowmentsHeldRelatedOrgInd |
| Related Org List Sch R | Yes (1) | RelatedOrgListSchRInd |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $42,600 | OtherCostOrOtherBasisAmt |
| Book Value | $42,600 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $293,566 | OtherCostOrOtherBasisAmt |
| Depreciation | $221,884 | DepreciationAmt |
| Book Value | $71,682 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $11,286,693 | OtherCostOrOtherBasisAmt |
| Depreciation | $5,617,209 | DepreciationAmt |
| Book Value | $5,669,484 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $9,782,085 | OtherCostOrOtherBasisAmt |
| Depreciation | $6,460,370 | DepreciationAmt |
| Book Value | $3,321,715 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $10,319,814 | OtherCostOrOtherBasisAmt |
| Depreciation | $670,908 | DepreciationAmt |
| Book Value | $9,648,906 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $18,754,387 | TotalBookValueLandBuildingsAmt |
Other Securities OtherSecuritiesGrp (2 entries)
| DescDesc | Book ValueBookValueAmt | Method ValuationMethodValuationCd |
|---|---|---|
| CD'S AND MONEY MARKET ACCOUNTS | $1,980,312 | C |
| ACCRUED INTEREST | $1,751 | C |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Securities | $1,982,063 | TotalBookValueSecuritiesAmt |
| Total Rev Etc Audited Fincl Stmt | $19,748,835 | TotalRevEtcAuditedFinclStmtAmt |
| Revenue Not Reported | $0 | RevenueNotReportedAmt |
| Revenue Subtotal | $19,748,835 | RevenueSubtotalAmt |
| Other Revenues Not Included | $1,102,144 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | $1,102,144 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $20,850,979 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $19,337,370 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Not Reported | $0 | ExpensesNotReportedAmt |
| Expenses Subtotal | $19,337,370 | ExpensesSubtotalAmt |
| Other Expenses Not Included | $1,051,330 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $1,051,330 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $20,388,700 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part V, Line 4: | PROVIDENCE MEDICAL CENTER HAS ONE ENDOWMENT FUND HELD BY PROVIDENCE MEDICAL CENTER FOUNDATION. THE ENDOWMENT WAS SET ASIDE BY DONORS TO PROVIDE INVESTMENT INCOME IN WHICH TO PROVIDE FOR FUTURE CAPITAL AND PROGRAM NEEDS OF THE HOSPITAL. |
| Part XI, Line 4b - Other Adjustments: | Provision for bad debts net against revenue on financial statements 1,051,330. CONTRIBUTIONS FROM RELATED ORGANIZATIONS 50,814. |
| Part XII, Line 4b - Other Adjustments: | Provision for bad debts net against revenue on financial statements 1,051,330. |
Schedule G IRS990ScheduleG
| Field | Value | IRS element (for citing) |
|---|---|---|
| Mail Solicitations | Yes (X) | MailSolicitationsInd |
| Phone Solicitations | Yes (X) | PhoneSolicitationsInd |
| In Person Solicitations | Yes (X) | InPersonSolicitationsInd |
| Solicitation Of Non Govt Grants | Yes (X) | SolicitationOfNonGovtGrantsInd |
| Solicitation Of Govt Grants | Yes (X) | SolicitationOfGovtGrantsInd |
| Agrmt Prof Fundraising Acty | Yes (1) | AgrmtProfFundraisingActyInd |
Fundraiser Activity Info FundraiserActivityInfoGrp
Organization Business Name OrganizationBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PAUL J STRAWHECKER INC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 4913 DODGE STREET | AddressLine1Txt |
| City | OMAHA | CityNm |
| State Abbreviation | NE | StateAbbreviationCd |
| ZIP | 68132 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activity | FUNDRAISING FOR A CAPITAL CAMPAIGN | ActivityTxt |
| Fundraiser Control Of Funds | 0 | FundraiserControlOfFundsInd |
| Gross Receipts | $121,500 | GrossReceiptsAmt |
| Retained By Contractor | $54,000 | RetainedByContractorAmt |
| Net To Organization | $121,500 | NetToOrganizationAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Gross Receipts | $121,500 | TotalGrossReceiptsAmt |
| Total Retained By Contractors | $54,000 | TotalRetainedByContractorsAmt |
| Total Net To Organization | $121,500 | TotalNetToOrganizationAmt |
| Licensed States | NE | LicensedStatesCd |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
| Percent100 | Yes (X) | Percent100Ind |
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
Discounted Care Oth Percentage DiscountedCareOthPercentageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Discounted Care Other | 290.000000000000 | DiscountedCareOtherPct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| 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 | 0 | AnnualCommunityBnftReportInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $114,571 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $114,571 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00590 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $950,906 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $634,335 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $316,571 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01640 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,065,477 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $634,335 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $431,142 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02230 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $991,530 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $650,388 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $341,142 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01760 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $991,530 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $650,388 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $341,142 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01760 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,057,007 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,284,723 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $772,284 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.03990 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 0 | BadDebtExpenseReportedInd |
| Bad Debt Expense | $844,341 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $422,171 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $7,916,666 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $7,993,373 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$76,707 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| 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 | PROVIDENCE MEDICAL CENTER | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1200 PROVIDENCE ROAD | AddressLine1Txt |
| City | WAYNE | CityNm |
| State Abbreviation | NE | StateAbbreviationCd |
| ZIP | 68787 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | WWW.PROVIDENCEMEDICAL.COM | WebsiteAddressTxt |
| State License | 800001 | 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 | PROVIDENCE MEDICAL CENTER | 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 |
| CHNA Conducted | 16 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | 0 | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | 0 | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | WWW.PROVIDENCEMEDICAL.COM | OwnWebsiteURLTxt |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 16 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | WWW.PROVIDENCEMEDICAL.COM | 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 | 290.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Income Level Criteria | Yes (X) | IncomeLevelCriteriaInd |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| 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 |
| 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.providencemedical.com/vnews/display.v/SEC/Patient%20Info%7CFina | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | https://www.providencemedical.com/vnews/display.v/SEC/Patient%20Info%7CFina | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | https://www.providencemedical.com/vnews/display.v/SEC/Patient%20Info%7CFina | 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 |
| 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 |
| Prospective Medicare Medicaid | Yes (X) | ProspectiveMedicareMedicaidInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PROVIDENCE MEDICAL CENTER | Part V, Section B, Line 5: Two meetings with community members were held to complete the CHNA. A survey was conducted in between meetings to gather the appropriate data to make final decisions on which health needs were appropriate to address in this fiscal year.The first meeting was a general review of health information on a county level. During that meeting, Providence Medical Center reviewed and refined an electronic survey that would be distributed throughout the service area and in local businesses.The survey was further revised in conjunction with our consultant, Focus and Execute, to ensure the questions asked would help the committee decide on the best course of action for the Hospital. Once the questions were determined and edited, the survey was translated into Spanish to reach out to aN OFTEN silent portion of the community. |
| PROVIDENCE MEDICAL CENTER | Part V, Section B, Line 11: Priority One: Create a Preventative Approach to Healthcare The Affordable Care Act has had a huge impact on the way hospitals are being compensated for healthcare. That has driven hospitals to look at healthcare differently. One of the areas the community felt needed to be addressed was in creating a positive preventative approach to healthcare. This would include education partnering with businesses and education on insurance programs.Actions to be taken:1. Create a preventative health screening program2. Hold a community health fair3. Develop partnerships with businesses for prevention4. Educate the public on health insurancePriority Two: Mental Health ProgramAlthough PMC currently has a mental health program, it is not as strong as it needs to be for the community. Wayne County's ratio is far below the US top performers and the state ratios. PMC also sees a need to assist in this arena given there is a college in town that may need assistance in dealing with mental health issues as well as substance abuse issues.Actions to be taken:1. Explore substance abuse program2. Explore adolescent care programs3. Explore suicide prevention and grief counseling programs4. Explore Partnership with college on Mental Health issuesPriority Three: Promote Current ServiceFinally PMC became aware there is a lack of knowledge about the services and the quality of care currently being offered by PMC. As a result people in the community are seeking healthcare in other areas they could be receiving closer to home. This leads to a frustration on the part of the patient. PMC also provides some unique services are not available in many hospitals in the state.Actions to be taken:1. Implement social media marketing strategy2. Promote specialized services (AMPS, Parkinsons, Vertigo Therapy, Sphenocath, etc.)3. Review effectiveness of current print and media strategy4. Conduct a did you know campaign5. Market services for the elderly during community events |
| PROVIDENCE MEDICAL CENTER | Part V, Section B, Line 15e: Providence Medical Center may assist patients in applying for Medicare, Medicaid, and other governmental medical assistance programs. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 2 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| 1 - LAUREL THERAPY SERVICES | ||||
| 699 CEDAR AVENUE | LAUREL | NE | 68745 | OUTREACH THERAPY CLINIC |
| 2 - WAKEFIELD THERAPY SERVICES | ||||
| 308 ASH STREET | WAKEFIELD | NE | 68784 | OUTREACH THERAPY CLINIC |
Supplemental Information Detail SupplementalInformationDetail (11 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part I, Line 7: | THE COSTING METHODOLOGY USED ON FORM 990 IS BASED ON A COST-TO-CHARGE RATIO WHICH IS DEVELOPED BASED ON THE HOSPITAL'S TOTAL OPERATING EXPENSES LESS THE PROVISION FOR BAD DEBT DIVIDED BY GROSS PATIENT SERVICE REVENUE. THIS COST-TO-CHARGE RATIO IS APPLIED AGAINST VARIOUS REVENUE AND EXPENSE CATEGORIES TO COMPUTE THE ESTIMATED COMMUNITY BENEFIT EXPENSE UNDER IRS SUGGESTED COSTING METHODS FOR THE FORM 990. |
| 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 $ 1,051,330. |
| Part III, Line 2: | The costing methodology used on Form 990 is based on a cost-to-charge ratio, which is developed based on the hospital's total operating expenses excluding the provision for bad debt, divided by gross patient service revenue. This cost-to-charge ratio is applied against the total charges that are written off during the year to estimate the cost of care of patients who have accounts that are deemed to be bad debts to the hospital. The hospital also recognizes that it also provides a discount to self-pay or uninsured patients. These amounts are excluded from gross patient service revenue on the financial statements and are not included in the ratio as described above and approved by the IRS for use on Form 990. If considered, these additional write-off amounts to uninsured accounts would also increase the estimated bad debt expense amount associated with these uncollectible accounts to the hospital. |
| Part III, Line 4: | In evaluating the collectability of accounts receivable, the Hospital analyzes past results and identifies trends for each of its major payor sources of revenue to estimate the appropriate allowance for uncollectible 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 uncollectible accounts. Specifically, for receivables associated with services provided to patients who have third-party coverage, the Hospital analyzes contractually due amounts and provides an allowance for uncollectible accounts and a provision for bad debts for expected uncollectible deductibles and copayments on accounts for which the third-party payor has not yet paid, or for payors and patients who are known to be having financial difficulties 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 uncollectible accounts. The audited financial statements do not contain a separate footnote regarding bad debt expense. |
| Part III, Line 8: | THE SHORTFALL SHOULD BE TREATED AS A COMMUNITY BENEFITS EXPENSE BECAUSEPROVIDING MEDICAL CARE AT A SHORTFALL IMPACTS THE HOSPITAL'S OPERATIONSAND GROWTH. THE CARE IS PROVIDED BECAUSE THERE IS A NEED AND A DESIRE TOPROVIDE MEDICAL CARE IN THIS COMMUNITY.THE COSTING METHOD USED ABOVE FOR IRS Form 990 COMPLIANCE REPORTING IS ALSO BASED ON AN OVERALL AVERAGE COST-TO-CHARGE RATIO AND DOES NOT CONSIDER MEDICARE NON-ALLOWABLE EXPENSES AS IT IS BASED ON TOTAL HOSPITAL PATIENT SERVICE REVENUE (IGNORING CONTRACTUAL ADJUSTMENTS ON FEE SCHEDULE REIMBURSED ITEMS AND NON-ALLOWABLE MEDICARE EXPENSES AS NOTED ABOVE) DIVIDED BY TOTAL OPERATING EXPENSES LESS THE PROVISION FOR BAD DEBT EXPENSE. THIS RATIO IS THEN MULTIPLIED BY THE TOTAL MEDICARE SERVICES WHICH ARE REIMBURSED ON A COST METHODOLOGY EXCLUDING THE FEE SCHEDULE ITEMS LIKE PHYSICIAN SERVICES AND THE HOSPITAL WOULD SHOW A LARGE LOSS ON THESE SERVICES.WHETHER THERE IS A SHORTFALL OR SURPLUS FROM SERVICES PROVIDED TO MEDICARE BENEFICIARIES, THESE PEOPLE, WHO ARE TYPICALLY ELDERLY MEMBERS OF THE COMMUNITY, ARE AN UNDERSERVED POPULATION WHO EXPERIENCE ISSUES WITH ACCESS TO HEALTHCARE SERVICES. WITHOUT TAX-EXEMPT HOSPITALS PROVIDING MEDICARE PATIENT SERVICES, THE CENTERS FOR MEDICARE AND MEDICAID (CMS) WOULD BEAR THE BURDEN OF DIRECTLY PROVIDING SERVICES TO THE ELDERLY AND DISABLED MEMBERS OF THE COMMUNITY. |
| Part III, Line 9b: | PROVIDENCE MEDICAL CENTER HAS A STRONG COMMITMENT TO THE COMMUNITY AND TO THE PATIENTS THAT WE SERVE. MEDICAL TREATMENT IS PROVIDED TO ALL PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. IN DOING SO, WE SHALL: INFORM THE PUBLIC OF THE AVAILABILITY OF ALTERNATIVE PAYMENT ARRANGEMENTS, INCLUDING PAYMENT PLANS AND FINANCIAL ASSISTANCE PROGRAMS; PROVIDE FINANCIALCOUNSELING TO PATIENTS ABOUT THEIR HOSPITAL BILLS; RESPOND PROMPTLY TO PATIENTS' QUESTIONS ABOUT THEIR BILLS AND REQUESTS FOR FINANCIAL HELP THROUGH AN ACCEPTABLE PAYMENT PLAN AND/OR THROUGH FINANCIAL ASSISTANCE; AND PURSUE COLLECTION OF ACCOUNTS FAIRLY AND CONSISTENTLY AND WITHIN OUR WRITTEN GUIDELINES AND ENSURE THAT AGENCIES ACTING ON OUR BEHALF IN THECOLLECTION OF DEBT ALSO ACT IN ACCORDANCE WITH OUR MISSION AND GUIDELINES. |
| Part VI, Line 2: | PMC works with the state of Nebraska and the Nebraska Hospital Association to review patient data and outcomes. One of the products used is COMS (Clinical Outcomes Measurement System) which gives outcome data for morbidity and mortality for the state of Nebraska and our service area. PMC also has worked with the Northeast Nebraska Public Health Department with MAPP which is "Mobilizing for action throuh planning and Partnership," which identifies public health issues and finds resources to address them. |
| Part VI, Line 3: | Payment policies and financial assistance instructions are given with admission documents, included with each bill, uploaded on PMC's website, and posted througout PMC's facilites. |
| Part VI, Line 4: | The healthcare facility is located in Wayne, Nebraska where it serves residents of Northeastern Nebraska. The population base from the nearby communities is approximately 9,600 with an average income of approximately $45,000. |
| Part VI, Line 5: | The hospital has a community board with members that represent different towns in our service area. We strive to invest our funds in banks through our service area. Also the hospital's admitting physicians are primarily practitioners in the local area. |
| Part VI, Line 6: | The hospital is not affiliated with any other health systems. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| 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 | 0 | 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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | JAMES FRANK | PersonNm |
| Title | CEO | TitleTxt |
| Base Compensation Filing Org | $152,556 | BaseCompensationFilingOrgAmt |
| Compensation Based On Rltd Orgs | $0 | CompensationBasedOnRltdOrgsAmt |
| Bonus Filing Organization | $0 | BonusFilingOrganizationAmount |
| Bonus Related Organizations | $0 | BonusRelatedOrganizationsAmt |
| Other Compensation Filing Org | $0 | OtherCompensationFilingOrgAmt |
| Other Compensation Rltd Orgs | $0 | OtherCompensationRltdOrgsAmt |
| Deferred Compensation Flng Org | $4,971 | DeferredCompensationFlngOrgAmt |
| Deferred Comp Rltd Orgs | $0 | DeferredCompRltdOrgsAmt |
| Nontaxable Benefits Filing Org | $19,844 | NontaxableBenefitsFilingOrgAmt |
| Nontaxable Benefits Rltd Orgs | $0 | NontaxableBenefitsRltdOrgsAmt |
| Total Compensation Filing Org | $177,371 | TotalCompensationFilingOrgAmt |
| Total Compensation Rltd Orgs | $0 | TotalCompensationRltdOrgsAmt |
| Comp Report Prior990 Filing Org | $0 | CompReportPrior990FilingOrgAmt |
| Comp Report Prior990 Rltd Orgs | $0 | CompReportPrior990RltdOrgsAmt |
Schedule K IRS990ScheduleK
Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
Issuer Name IssuerName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | THE COUNTY OF WAYNE IN THE STATE OF NEBRASKA | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Issuer EIN | 476006517 | BondIssuerEIN |
| CUSIP | NONEAVAIL | CUSIPNum |
| Bond Issued | 2015-07-31 | BondIssuedDt |
| Issue Price | $8,400,000 | IssuePriceAmt |
| Purpose | TO CONSTRUCT AND EQUIP HOSPITAL FACILITY | PurposeDesc |
| Defeased | 0 | DefeasedInd |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuerInd |
| Pool Financing | 0 | PoolFinancingInd |
Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Total Proceeds | $8,400,000 | TotalProceedsAmt |
| Capitalized Interest | $104,188 | CapitalizedInterestAmt |
| Issuance Costs From Proceeds | $263,936 | IssuanceCostsFromProceedsAmt |
| Capital Expenditures | $7,767,025 | CapitalExpendituresAmt |
| Unspent | $264,851 | UnspentAmt |
| Current Refunding | 0 | CurrentRefundingInd |
| Advance Refunding | 0 | AdvanceRefundingInd |
| Final Allocation Made | 0 | FinalAllocationMadeInd |
| Adequate Books And Rec Maint | 0 | AdequateBooksAndRecMaintInd |
Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Owning Bond Financed Property | 0 | OwningBondFinancedPropertyInd |
| Any Lease Arrangements | 0 | AnyLeaseArrangementsInd |
| Mgmt Contract Bond Fincd Prop | 0 | MgmtContractBondFincdPropInd |
| Any Research Agreements | 0 | AnyResearchAgreementsInd |
| Bond Iss Meet Prvt Sec Pymt Test | 0 | BondIssMeetPrvtSecPymtTestInd |
| Change In Use Bond Financed Prop | 0 | ChangeInUseBondFinancedPropInd |
| Procs Nonqualified Bond Remdtd | 0 | ProcsNonqualifiedBondRemdtdInd |
Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Form8038 T Filed | 0 | Form8038TFiledInd |
| Rebate Not Due Yet | Yes (1) | RebateNotDueYetInd |
| Exception To Rebate | 0 | ExceptionToRebateInd |
| No Rebate Due | 0 | NoRebateDueInd |
| Variable Rate Issue | 0 | VariableRateIssueInd |
| Hedge Identified In Bks And Rec | 0 | HedgeIdentifiedInBksAndRecInd |
| Gross Proceeds Invested In GIC | 0 | GrossProceedsInvestedInGICInd |
| Gross Proceeds Invested | 0 | GrossProceedsInvestedInd |
| Written Proc To Monitor Reqs | Yes (1) | WrittenProcToMonitorReqsInd |
Procedures Corrective Action ProceduresCorrectiveActionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Procedures Corrective Action | Yes (1) | ProceduresCorrectiveActionInd |
Schedule L IRS990ScheduleL
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp (2 entries)
| Relationship DescriptionRelationshipDescriptionTxt | TransactionTransactionAmt | TransactionTransactionDesc | Sharing Of RevenuesSharingOfRevenuesInd |
|---|---|---|---|
| MICHELE THEIS | |||
| DAUGHTER OF BOARD MEMBER | $77,831 | OCCUPATIONAL THERAPIST | 0 |
| SUE HANSEN | |||
| MOTHER OF BOARD MEMBER | $75,096 | OUTPATIENT SERVICES EMPLOYEE | 0 |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (7 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART I, LINE 1, DESCRIPTION OF ORGANIZATION MISSION: | WE BELIEVE THAT THE PATIENT IS THE MOST IMPORTANT PERSON IN OUR MEDICAL CENTER, THAT LIFE IS A GIFT FROM GOD, AND THAT ALL PERSONS ARE CREATED EQUAL. WE BELIEVE THAT EVERY PATIENT HAS A RIGHT TO BE ADMITTED WHEN IN NEED OF SERVICES WHICH OUR FACILITY IS EQUIPPED TO PROVIDE, PRIVACY, PROFESSIONAL DISCRETION, CONSENT TO OR REFUSAL OF TREATMENT AND MAY REQUEST THE MINISTER OF HIS/HER CHOICE. WE BELIEVE THAT OUR MEDICAL CENTER HAS THE RESPONSIBILITY TO PROVIDE ADEQUATE AND COMPETENT STAFF AND DIAGNOSTIC, PREVENTATIVE AND THERAPEUTIC FACILITIES TO ENSURE HIGH QUALITY MEDICAL CARE TO THE PATIENT, AND THAT THIS CAN ONLY BE ACHIEVED THROUGH COOPERATION AND SUPPORT AMONG THE STAFF AND COMMUNITY. WE BELIEVE THAT THE EMPLOYEES ARE ENTITLED TO JUST WAGES FOR HONEST WORK AND TO OPPORTUNITIES FOR PERSONAL AND PROFESSIONAL GROWTH. WE BELIEVE THAT OUR MEDICAL CENTER NEEDS TO PARTICIPATE ACTIVELY IN COMMUNITY PLANNING OF HEALTH AND MEDICAL CARE FACILITIES AND OPERATE IN ACCORDANCE WITH THE NEEDS OF THE CIVIC COMMUNITY. |
| Form 990, Part VI, Section B, line 11b | THE FORM 990 IS REVIEWED AND APPROVED BY THE HOSPITAL CEO AND CFO PRIOR TO FILING. ALSO, THE FORM 990 IS DISTRIBUTED TO THE BOARD OF DIRECTORS PRIOR TO FILING AND REVIEWED IN DETAIL AT THE NEXT BOARD OF DIRECTORS MEETING FOLLOWING DISTRIBUTION. |
| Form 990, Part VI, Section B, line 12c | PMC'S BOARD MEMBERS ARE REQUIRED TO SIGN A NEW CONFLICT OF INTEREST STATEMENT AND DISCLOSURE ANNUALLY. ANY CONFLICTS ARE REVIEWED BY THE BOARD. |
| Form 990, Part VI, Section B, line 15 | COMPENSATION PROCESS FOR OFFICERS' SALARIES AND FOR ALL EMPLOYEES ARE BASED ON THE NEBRASKA HOSPITAL ASSOCIATION'S (NHA) ANNUAL SALARY SURVEY. THE SURVEY IS CATEGORIZED BY JOB TITLES AND DETAILED BY HOURLY SALARY RANGES. NHA IS AN EXEMPT ORGANIZATION UNDER SECTION 501(C)(6) OF THE INTERNAL REVENUE CODE (TRADE ASSOCIATION), WITH ITS MEMBERS BEING THE HOSPITALS IN THE STATE OF NEBRASKA. EXECUTIVE WAGES OR SALARIES ARE NOT EVALUATED ANY DIFFERENTLY THAN OTHER EMPLOYEES. THEY RECEIVE NO PREFERENTIAL TREATMENT UNLESS THE GOVERNING BOARD MAKES A SPECIAL RECOMMENDATION. THE GUIDELINES INCLUDE: 1. A DETERMINATION OF THE FEASIBILITY OF BONUSES BASED ON AVAILABILITY OF CASH FLOW AND EXCESS REVENUE FOR THE CURRENT FISCAL YEAR, 2. DETERMINATION OF PMC'S OVERALL WAGE LEVELS BASED ON AN ANALYSIS OF WAGES AGAINST THE NHA'S SALARY SURVEY AND EMPLOYEE TIME OF SERVICE, 3. HOURLY WAGE INCREASES MAY ALSO BE GIVEN IF NEEDED TO BE COMPATIBLE OR TO COMPENSATE FOR A CHANGE IN JOB DESCRIPTIONS, AND 4. THE GOVERNING BOARD MAKES FINAL APPROVAL OF THE BUDGET WHICH WOULD INCLUDE ALL SALARIES AND BONUSES. |
| Form 990, Part VI, Section C, line 19 | PROVIDENCE MEDICAL CENTER MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST AT ITS HOSPITAL BUSINESS LOCATION DURING NORMAL BUSINESS HOURS. |
| Form 990, Part IX, line 11g | PURCHASED SERVICES: Program service expenses 1,909,357. Management and general expenses 507,923. Fundraising expenses 0. Total expenses 2,417,280. |
| Form 990, Part XI, line 9: | NET CHANGE IN TEMPORARILY RESTRICTED NET ASSETS OF FOUNDATION -77,390. NET ASSETS RELEASED FROM RESTRICTIONS -50,814. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp
Disregarded Entity Name DisregardedEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PROVIDENCE MEDICAL CENTER FOUNDATION | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1200 PROVIDENCE ROAD | AddressLine1Txt |
| City | WAYNE | CityNm |
| State Abbreviation | NE | StateAbbreviationCd |
| ZIP | 68787 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 476032846 | EIN |
| Primary Activities | FUNDRAISING FOR PROVIDENCE MEDICAL CENTER | PrimaryActivitiesTxt |
| Legal Domicile State | NE | LegalDomicileStateCd |
| Exempt Code Section | 501(c)(1) | ExemptCodeSectionTxt |
| Public Charity Status | LINE 11A, I | PublicCharityStatusTxt |
| Direct Controlling NA | N/A | DirectControllingNACd |
| Controlled Organization | 0 | 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 | Yes (1) | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (1) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (1) | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (1) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (1) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
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