2017-11-13T12:23:16-06:00 2016-12-31 390758449 Wipfli LLP 3703 Oakwood Hills Pkwy Eau Claire WI 54701 990 2016-01-01 470566524 PROVIDENCE MEDICAL CENTER PROV 4023753800 1200 PROVIDENCE RD WAYNE NE 68787 JAMES FRANK CEO 4023753800 2017-11-13 1 PAUL M TRACZEK CPA P01368830 7158323407 2017-11-13 216.54.158.12 2017-11-13 08:05:08 CS P F91C726111BE61894B067C8320C81C46540231E8 2F3CDBAF1037015F68690DD19EBC2430D808C728 2016 2017-02-10 21:41:12Z JAMES FRANK 1200 PROVIDENCE RD WAYNE NE 68787 21545296 0 X WWW.PROVIDENCEMEDICAL.COM X 1975 NE See Schedule O 7 5 241 23 0 0 142040 152158 18547722 20554619 63682 16116 1083173 128086 19836617 20850979 13763 19039 0 0 9826060 10005031 0 54000 54000 8344205 10310630 18184028 20388700 1652589 462279 19426909 28744717 3161614 11335523 16265295 17409194 THE MISSION OF PROVIDENCE MEDICAL CENTER IS TO PROVIDE QUALITY HEALTH CARE IN THE SPIRIT OF CHRIST. 0 0 16100160 19039 20554619 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. 16100160 1 1 0 1 0 0 0 0 0 1 1 1 0 0 0 0 1 0 0 0 0 0 0 1 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0 1 34 0 241 1 0 0 0 0 0 0 0 0 X 7 5 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 NE X Kim Hixson 4023757673 1200 Providence Rd Wayne NE 68787 LELAND MINER CHAIR 1.00 X X 0 0 0 KAREN HARRINGTON VICE CHAIR 1.00 X X 0 0 0 NATHAN RAABE SECRETARY/TREASURER 1.00 X X 0 0 0 ROSS HANSEN PA-C DIRECTOR 1.00 X 0 0 0 LYNETTE JOSLIN DIRECTOR 1.00 X 0 0 0 MATTHEW LEY DIRECTOR 1.00 X 0 0 0 RANDALL PEDERSEN DIRECTOR 1.00 X 0 0 0 JAMES FRANK CEO 40.00 1.00 X 152556 0 24815 KIMBERLY HIXSON CFO 40.00 X 103938 0 5430 KIMBERLY BENTJEN PHARMACIST 40.00 X 120770 0 12036 KRISTINE GIESE COO 40.00 X 137700 0 7508 514964 0 49789 4 0 1 0 TODD LUEDEKE 85726 575 Avenue WAYNE NE 68787 CRNA SERVICES 656286 HARRISON WOC SERVICES LLC PO BOX 266 THURSTON NE 680620266 WOUND CARE SERVICES 141996 SHARED IMAGING PO BOX 88544 MILWAUKEE WI 532880544 RADIOLOGY RECORD STORAGE 124200 3 50814 37213 64131 152158 PAITENT SERVICE REVENUE 621990 20212204 20212204 FITNESS REVENUE 621990 152787 152787 DIETARY INCOME 722210 53879 53879 LIFELINE 642191 33560 33560 102189 102189 20554619 25598 25598 128086 0 128086 128086 128086 681876 2959 694317 0 -12441 2959 -9482 -9482 20850979 20554619 0 144202 X 19039 19039 286739 286739 7859312 6087285 1772027 212048 146810 65238 1078271 671515 406756 568661 428859 139802 6387 6387 56042 6025 50017 54000 54000 17366 17366 2417280 1909357 507923 86299 86299 163942 90897 73045 524017 63284 460733 399053 369309 29744 61938 56362 5576 53997 32187 21810 18640 18640 1680163 1680163 152243 152243 SUPPLIES AND PHARMACEUT 2512933 2509852 3081 PROVISIONS FOR BAD DEBT 1051330 1051330 EQUIPMENT RENTAL & MAIN 1046075 923520 122555 62925 35726 27199 20388700 16100160 4234540 54000 200 200 1326935 1419796 3656909 3310809 360227 363137 204573 225147 31724758 12970371 11991098 18754387 1275015 1976082 1982063 611952 713096 19426909 28744717 1771557 2349859 746948 647731 7804688 625590 434028 116736 3161614 11335523 X 16235350 16789739 9945 571262 20000 48193 16265295 17409194 19426909 28744717 X 462279 62166 747658 -128204 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 1975 1975 0 Part II-B, Line 1: 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. 20000 48193 10790 20000 58983 20000 95 95 20000 20000 116 116 20000 20000 104 104 20000 20000 50 50 20000 0.81710 0.18290 0 1 1 42600 42600 293566 221884 71682 11286693 5617209 5669484 9782085 6460370 3321715 10319814 670908 9648906 18754387 CD'S AND MONEY MARKET ACCOUNTS 1980312 C ACCRUED INTEREST 1751 C 1982063 19748835 0 19748835 1102144 1102144 20850979 19337370 0 19337370 1051330 1051330 20388700 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. X X X X X 1 PAUL J STRAWHECKER INC 4913 DODGE STREET OMAHA NE 68132 FUNDRAISING FOR A CAPITAL CAMPAIGN 0 121500 54000 121500 121500 54000 121500 NE 1 1 1 X 1 X 290.000000000000 1 1 1 0 0 114571 114571 0.00590 950906 634335 316571 0.01640 1065477 634335 431142 0.02230 991530 650388 341142 0.01760 991530 650388 341142 0.01760 2057007 1284723 772284 0.03990 0 844341 422171 7916666 7993373 -76707 X 1 1 1 1 PROVIDENCE MEDICAL CENTER 1200 PROVIDENCE ROAD WAYNE NE 68787 WWW.PROVIDENCEMEDICAL.COM 800001 X X X X PROVIDENCE MEDICAL CENTER 1 0 0 1 X X X X X X X X X 16 1 0 0 1 X WWW.PROVIDENCEMEDICAL.COM 1 16 1 WWW.PROVIDENCEMEDICAL.COM 0 1 X 100.000000000000 290.000000000000 X X X X 1 1 X X X X 1 X https://www.providencemedical.com/vnews/display.v/SEC/Patient%20Info%7CFina X https://www.providencemedical.com/vnews/display.v/SEC/Patient%20Info%7CFina X https://www.providencemedical.com/vnews/display.v/SEC/Patient%20Info%7CFina X X X X 1 X 0 X X X X 1 X 0 0 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. 2 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 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. X X X 0 0 0 0 0 0 0 0 0 JAMES FRANK CEO 152556 0 0 0 0 0 4971 0 19844 0 177371 0 0 0 A THE COUNTY OF WAYNE IN THE STATE OF NEBRASKA 476006517 NONEAVAIL 2015-07-31 8400000 TO CONSTRUCT AND EQUIP HOSPITAL FACILITY 0 0 0 A 8400000 104188 263936 7767025 264851 0 0 0 0 A 0 0 0 0 0 0 0 A 0 1 0 0 0 0 0 0 1 A 1 MICHELE THEIS DAUGHTER OF BOARD MEMBER 77831 OCCUPATIONAL THERAPIST 0 SUE HANSEN MOTHER OF BOARD MEMBER 75096 OUTPATIENT SERVICES EMPLOYEE 0 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. PROVIDENCE MEDICAL CENTER FOUNDATION 1200 PROVIDENCE ROAD WAYNE NE 68787 476032846 FUNDRAISING FOR PROVIDENCE MEDICAL CENTER NE 501(c)(1) LINE 11A, I N/A 0 0 0 1 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0