2016-05-16T10:53:58-05:00 2015-09-30 476097913 SEIM JOHNSON LLP 18081 BURT STREET SUITE 200 OMAHA NE 680224722 990 2014-10-01 470379834 BEATRICE COMMUNITY HOSPITAL & HEALTH CENTER INC BEAT 4022283344 4800 HOSPITAL PARKWAY PO BOX 278 BEATRICE NE 68310 ALAN STREETER CFO 4022283344 2016-05-12 1 BARBARA J FAJEN P00400874 4023302660 2014 2016-08-17 19:52:53Z ALAN STREETER 4800 HOSPITAL PARKWAY PO BOX 278 BEATRICE NE 68310 71133324 0 X WWW.BEATRICECOMMUNITYHOSPITAL.COM X 1968 NE BEATRICE COMMUNITY HOSPITAL AND HEALTH CENTER, INC. IS DEDICATED TO BEING THE HEALTHCARE RESOURCE FOR THE COMMUNITIES WE SERVE BY PROVIDING QUALITY SERVICES AND COMPASSIONATE CARE. OUR VISION STATEMENT IS: TO BE THE TRUSTED CHOICE FOR EXEMPLARY, COMPASSIONATE, PATIENT-AND-FAMILY-CENTERED HEALTHCARE FOR BEATRICE AND THE COMMUNITIES WE SERVE. 13 11 555 60 135586 127139 256268 195590 67217959 70184298 -12831 86617 546080 605740 68007476 71072245 251217 251106 0 0 35959289 38826040 0 0 0 28087811 29358142 64298317 68435288 3709159 2636957 91215226 94042491 49991177 50294602 41224049 43747889 X BEATRICE COMMUNITY HOSPITAL AND HEALTH CENTER IS DEDICATED TO BEING THE HEALTHCARE RESOURCE FOR THE COMMUNITIES WE SERVE BY PROVIDING QUALITY SERVICES AND COMPASSIONATE CARE. 0 0 46499520 56149576 HOSPITAL INPATIENT AND OUTPATIENT CARE: SERVICES INCLUDE ANCILLARY AND ACUTE CARE ALONG WITH SERVING AS A CLINICAL EDUCATION SITE FOR STUDENTS FOR AREAS INVOLVING THE PHYSICAL THERAPY DEPARTMENT, THE EMERGENCY DEPARTMENT, THE SPEECH PATHOLOGY DEPARTMENT, THE OCCUPATIONAL THERAPY DEPARTMENT AND THE NURSING DEPARTMENT. 8816000 9334349 PHYSICIAN CLINICS: SERVICES INCLUDE ACUTE CARE SERVICES AS WELL AS PROVIDING SPORTS PHYSICALS FOR LOCAL HIGH SCHOOL ATHLETES AND FOR PARTICIPANTS IN THE SPECIAL OLYMPICS. 2307273 2587000 HOSPICE/LONG-TERM CARE: SERVICES INCLUDE CARE-TAKING FOR THE ELDERLY ALONG WITH PROVIDING A GRIEF RECOVERY PROGRAM FOR THOSE PEOPLE WHO HAVE LOST A LOVED ONE TO DEATH.HOME HEALTH IS AVAILABLE FOR PEOPLE OF ALL AGES, ASSISTING THEM IN THE RECOVERY AND REHABILITATION FROM ALL TYPES OF ILLNESS, INJURIES AND OTHER HEALTH PROBLEMS. SKILLED INTERMITTENT HOME CARE THAT IS PHYSICIAN ORDERED IS PROVIDED BY REGISTERED NURSES, PHYSICAL, OCCUPATIONAL AND SPEECH THERAPISTS AND NURSE AIDES. AREAS SERVED INCLUDE: GAGE, JEFFERSON, PAWNEE AND SALINE COUNTIES. 503251 251106 2205904 OTHER PROGRAM 503251 251106 2205904 58126044 1 1 0 1 0 0 0 0 0 1 1 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 1 1 1 0 1 1 0 0 0 0 0 1 0 0 1 0 0 0 0 0 0 1 0 0 0 1 23 0 1 555 1 1 1 0 0 0 0 0 0 0 0 0 X 13 11 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X ALAN STREETER CFO 4022283344 4800 HOSPITAL PARKWAY PO BOX 278 BEATRICE NE 68310 MITCHELL DEINES CHAIRMAN 5.00 2.00 X X 0 0 0 LARRY THIMM VICE-CHAIRMAN 4.00 2.00 X X 0 0 0 LEROY JANZEN SECRETARY 4.00 1.00 X X 0 0 0 JAMES ENSZ TREASURER 4.00 2.00 X X 0 0 0 JIM BAUER MEMBER 2.00 2.00 X 0 0 0 CHRISTINE BECKMAN LMT MEMBER 2.00 0.00 X 0 0 0 BLAKE BUTLER MD MEMBER 40.00 0.00 X 531754 0 38978 BARBARA JOHNSEN CPA MEMBER 2.00 0.00 X 0 0 0 STEPHANIE PERKINS MEMBER 2.00 0.00 X 0 0 0 BOB REED MEMBER 2.00 0.00 X 0 0 0 ERIC THOMSEN MD MEMBER 40.00 0.00 X 256275 0 23638 VERDELLA VETROVSKY MEMBER 2.00 0.00 X 0 0 0 DR BRENDA MCNIFF MEMBER 2.00 0.00 X 0 0 0 DR JOHN FINDLEY BCH INTERIM CEO (JANUARY 2015-SEPTEMBER 2016) 36.00 4.00 X 0 0 0 THOMAS SOMMERS BCH CEO (LEAVE OF ABSENCE) 36.00 4.00 X 368839 0 38991 ALAN STREETER CFO 36.00 4.00 X 161223 0 37807 DEREK WEICHEL MD PHYSICIAN 40.00 0.00 X 591443 0 44819 BRETT STUDLEY MD PHYSICIAN 40.00 0.00 X 380685 0 45786 RONALD BEAR MD PHYSICIAN 40.00 0.00 X 415681 0 26693 DENISE CAPEK PHYSICIAN 40.00 0.00 X 331932 0 38830 MICHAEL HAVEKOST MD PHYSICIAN 40.00 0.00 X 363420 0 43333 3401252 0 338875 50 0 1 0 NEBRASKA LABLINC PO BOX 82643 LINCOLN NE 68501 LABORATORY SERVICES 273075 MODIS DEPT CH 10682 PALANTINE IL 60055 INFORMATION TECHNOLOGY STAFFING 272011 GOLDFISH PARTNERS 6865 WINCREST DRIVE SUITE 300 PLANO TX 75024 MEDICAL STAFFING 144405 ONWARD HEALTHCARE PO BOX 27421 NEW YORK NY 10087 MEDICAL STAFFING 139515 BAIRD HOLM LLP 1700 FARNAM STREET SUITE 1500 OMAHA NE 68102 LEGAL SERVICES 112396 7 164530 31060 195590 PATIENT SERVICE - PRIVATE PAY 621110 35631318 35631318 PATIENT SERVICE - MEDICARE & MEDI 621110 32439607 32439607 340B PROGRAM REVENUE 621300 1478074 1478074 PHARMACY REVENUE 621300 266487 266487 MANAGEMENT FEES 561000 165422 165422 203390 203390 70184298 124076 124076 60429 0 60429 60429 60429 23620 61079 -37459 -37459 -37459 CAFETERIA REVENUE 722210 281254 281254 MHR HOME CARE LLC 446199 135586 135586 PURCHASE DISCOUNTS 900099 92531 92531 35940 35940 545311 71072245 70276829 135586 464240 251106 251106 1428229 837047 591182 31542 31542 28725249 25335762 3389487 1349501 1193292 156209 5438430 4682504 755926 1853089 1611489 241600 118617 118617 17170 17170 4193655 2944177 1249478 324038 156861 167177 3251684 2561873 689811 1271005 46850 1224155 1179292 1154798 24494 147158 143254 3904 297364 199332 98032 2495213 2495213 5891659 4563118 1328541 248418 237077 11341 INCOME TAXES 21532 21532 MEDICAL SUPPLIES 7460429 7460429 BAD DEBTS 2057292 2057292 LICENSES & DUES 191951 107477 84474 191665 55551 136114 68435288 58126044 10309244 0 1030 1065 20676727 25563375 10494910 10355379 75206 34583 2293066 2336506 800939 947988 88956510 42262554 49095476 46693956 5134551 5003575 565500 486895 2077821 2619169 91215226 94042491 8101177 9219631 41890000 41074971 49991177 50294602 X 40844543 43477070 379506 270819 41224049 43747889 91215226 94042491 X 2636957 -4430 -108687 X X 1 X 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 5745 5745 0 PART II-B, LINE 1: BCH IS A MEMBER OF THE AMERICAN HOSPITAL ASSOCIATION(AHA) AND THE NEBRASKA HOSPITAL ASSOCIATION(NHA). FOR 2015, THE AHA AND NHA HAVE ESTIMATED THAT 23.65% AND 11.19%, RESPECTIVELY, OF MEMBERSHIP DUES WILL BE USED FOR LOBBYING ACTIVITIES. 1334989 186851 -27545 43343 1450952 1288188 46801 1334989 1184704 103484 1288188 1017976 5955 160773 1184704 1128237 6015 -116276 1017976 0.80880 0.16620 0.02500 0 1 1 901362 901362 22916170 9366102 13550068 56587294 31530582 25056712 270983 8280701 1365870 7185814 46693956 X 68901836 -4430 -108687 -113117 69014953 2057292 2057292 71072245 66377996 0 66377996 2057292 2057292 68435288 PART V, LINE 4: THE ENDOWMENT FUNDS ARE HELD BY BEATRICE COMMUNITY HOSPITAL FOUNDATION, INC., A SUPPORTING ORGANIZATION OF BEATRICE COMMUNITY HOSPITAL AND HEALTH CENTER. THESE FUNDS ARE BEING HELD TO PROVIDE HEALTH PROFESSIONAL SCHOLARSHIPS AND SUPPORT THE BEATRICE COMMUNITY HOSPITAL HOSPICE PROGRAM, CAPITAL IMPROVEMENTS AND SPIRITUAL LIFE. PART X, LINE 2: THE HOSPITAL IS A NOT-FOR-PROFIT CORPORATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. THE HOSPITAL HAS RECEIVED A DETERMINATION LETTER THAT IT IS EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE INTERNAL REVENUE CODE. THE INTERNAL REVENUE SERVICE HAS ESTABLISHED STANDARDS TO BE MET TO MAINTAIN TAX EXEMPT STATUS. IN GENERAL, SUCH STANDARDS REQUIRE THE HOSPITAL TO MEET A COMMUNITY BENEFIT STANDARD AND COMPLY WITH VARIOUS LAWS AND REGULATIONS. THE HOSPITAL ACCOUNTS FOR UNCERTAINTIES IN ACCOUNTING FOR INCOME TAX ASSETS AND LIABILITIES USING GUIDENCE INCLUDED IN FASB ASC TOPIC 740, INCOME TAXES. THE HOSPITAL RECOGNIZES THE EFFECT OF INCOME TAX POSITIONS ONLY IF THOSE POSITIONS ARE MORE LIKELY THAN NOT OF BEING SUSTAINED. AT SEPTEMBER 30, 2015, THE HOSPITAL HAD NO UNCERTAIN TAX POSITIONS ACCRUED. PART XI, LINE 2D - OTHER ADJUSTMENTS: CHANGE IN INTEREST IN BEATRICE COMMUNITY HOSPITAL FOUNDATION -108,687. PART XI, LINE 4B - OTHER ADJUSTMENTS: PROVISION FOR BAD DEBTS 2,057,292. PART XII, LINE 4B - OTHER ADJUSTMENTS: PROVISION FOR BAD DEBTS 2,057,292. 1 1 1 X 1 X 1 1 1 0 1 1 993790 0 993790 0.01500 6969164 6420658 548506 0.00830 7962954 6420658 1542296 0.02330 3354998 0 3354998 0.05050 603015 0 603015 0.00910 3958013 3958013 0.05960 11920967 6420658 5500309 0.08290 1 2057292 0 23365805 23042361 323444 X 1 1 1 1 BEATRICE COMMUNITY HOSPITAL AND HEALTH C 4800 HOSPITAL PARKWAY BEATRICE NE 683106906 WWW.BEATRICECOMMUNITYHOSPITAL.COM H000119 X X X X BEATRICE COMM HOSP & HEALTH CENTER INC 1 0 0 1 X X X X X X X X X 12 1 0 0 1 X WWW.BEATRICECOMMUNITYHOSPITAL.COM 1 12 1 WWW.BEATRICECOMMUNITYHOSPITAL.COM 0 0 1 X 200.000000000000 200.000000000000 X X X X X 1 1 X X X 1 X HTTP://WWW.BEATRICECOMMUNITYHOSPITAL.COM X HTTP://WWW.BEATRICECOMMUNITYHOSPITAL.COM X X X 1 0 X 1 X 0 0 BEATRICE COMM HOSP & HEALTH CENTER, INC. PART V, SECTION B, LINE 5: IN ORDER TO INCREASE COMMUNITY ACCOUNTABILITY AND LEVERAGE EXISTING RESOURCES, BCHHC CONVENED A STEERING COMMITTEE COMPRISED OF REPRESENTATIVES THAT SPAN PUBLIC AGENCIES AND PRIVATE ORGANIZATIONS, INCLUDING MENTAL HEALTH SERVICES, AGENCIES OF AGING, AND LOCAL PUBLIC SCHOOLS. BCHHC UTILIZED THREE FEEDBACK MECHANISMS TO CAPTURE COMMUNITY INPUT: - COMMUNITY SURVEY - COMMUNITY FOCUS GROUPS - COMMUNITY LEADER INTERVIEWS BEATRICE COMM HOSP & HEALTH CENTER, INC. PART V, SECTION B, LINE 11: CERTAIN STEPS, PROCEDURES AND PROGRAMS ARE BEING IMPLEMENTED ACCORDING TO THE IMPLEMENTATION PLAN FOR ALL NEEDS THAT BEATRICE COMMUNITY HOSPITAL AND HEALTH CENTER IS ABLE TO ADDRESS AT THIS TIME.THE IDENTIFIED NEEDS THAT ARE NOT BEING ADDRESSED CANNOT BE CURRENTLY SOLVED IN A MEANINGFUL WAY DUE TO FINANCIAL LIMITATION, LACK OF RESOURCES AND/OR LACK OF EXPERTISE. PART V, SECTION B, LINE 16 FINANCIAL ASSISTANCE POLICY WEBSITE AVAILABILITY BEATRICE COMM HOSP & HEALTH CENTER, INC. PART V, SECTION B, LINE 16A WEBSITE: HTTP://WWW.BEATRICECOMMUNITYHOSPITAL.COM BEATRICE COMM HOSP & HEALTH CENTER, INC. PART V, SECTION B, LINE 16B WEBSITE: HTTP://WWW.BEATRICECOMMUNITYHOSPITAL.COM 5 THE BEATRICE WOMEN'S & CHILDREN'S CLINIC 4800 HOSPITAL PARKWAY PO BOX 278 BEATRICE NE 68310 OUTPATIENT OB/GYN CLINIC WYMORE MEDICAL CLINIC 116 EAST H STREET WYMORE NE 68318 OUTPATIENT PHYSICIAN CLINIC GAGE COUNTY MEDICAL CLINIC 1101 N 10TH STREET BEATRICE NE 68310 OUTPATIENT PHYSICIAN CLINIC BEATRICE MEDICAL CENTER 805 W COURT STREET BEATRICE NE 68310 OUTPATIENT PHYSICIAN CLINIC BEATRICE INTERNAL MEDICINE 1201 N 10TH STREET BEATRICE NE 68310 OUTPATIENT PHYSICIAN CLINIC PART I, LINE 3C: FEDERAL POVERTY GUIDELINES ARE USED TO DETERMINE ELIGIBILITY FOR PROVIDING FREE AND DISCOUNTED CARE TO LOW INCOME INDIVIDUALS. PART I, LINE 6A: BEATRICE COMMUNITY HOSPITAL & HEALTH CENTER INC.'S COMMUNITY BENEFIT REPORT IS NOT PREPARED BY A RELATED ORGANIZATION. PART I, LINE 7: THE COST TO CHARGE RATIO WAS USED TO DETERMINE CHARITY CARE AND MEANS-TESTED GOVERNMENT PROGRAMS AT COST. OTHER COMMUNITY BENEFIT EXPENSES ARE STATED AT COST AS DERIVED FROM BEATRICE COMMUNITY HOSPITAL AND HEALTH CENTER'S INTERNAL ACCOUNTING RECORDS. PART I, LINE 7G: AS THERE ARE NO SUBSIDIZED HEALTH SERVICES REPORTED ON LINE 7G, THERE ARE NO COSTS ATTRIBUTABLE TO A PHYSICIAN CLINIC ON LINE 7G. PART I, LN 7 COL(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 $2,057,292. PART II, COMMUNITY BUILDING ACTIVITIES: NOT APPLICABLEOUR MOST SIGNIFICANT "COMMUNITY BENEFIT" ACTIVITIES WOULD INCLUDE:1. READY, SET, GO! BACK-TO-SCHOOL PROGRAM. BCHHC PARTNERS WITH THE BEATRICE SALVATION ARMY TO PROVIDE A VARIETY OF FREE SERVICES AND ITEMS TO MEET THE BACK-TO-SCHOOL NEEDS OF LOW-INCOME GAGE COUNTY RESIDENTS. DURING THIS EVENT, FAMILIES CAN RECEIVE FREE SCHOOL PHYSICALS, A PACKAGE OF PERSONAL CARE ITEMS LIKE A TOOTHBRUSH AND TOOTHPASTE, AND A BACKPACK WITH SCHOOL SUPPLIES. IN ADDITION, THERE ARE EDUCATIONAL BOOTHS ON NUTRITION AND DIABETES AS WELL AS INFORMATIONAL BOOTHS BY ORGANIZATIONS SUCH AS BOY SCOUTS AND GIRL SCOUTS.2. JOB SHADOWING. BCHHC OFFERS AN EXTENSIVE JOB SHADOWING PROGRAM THAT ALLOWS UPPER HIGH SCHOOL AND COLLEGE-AGED STUDENTS TO SHADOW PHYSICIANS AND CLINICAL STAFF IN ANY DEPARTMENT FOR A FIRST-HAND LOOK AT HEALTH-RELATED CAREERS. 3. PEOPLE CARING FOR PEOPLE. PEOPLE CARING FOR PEOPLE IS A FREE HOSPITAL SERVICE THAT SENDS A REGISTERED NURSE TO THE HOMES OF ALL NEWBORNS IN THE COUNTY TO ENSURE THAT NEWBORNS ARE THRIVING IN THE HOME AND PARENTS CAN ASK QUESTIONS AND LEARN ABOUT RESOURCES IN THE COMMUNITY. PART III, LINE 4: THE HOSPITAL'S FINANCIAL STATMENTS DO NOT CONTAIN A SPECIFIC FOOTNOTE DESCRIBING BAD DEBT. HOWEVER, PAGES 8, 9 AND 10 OF THE ATTACHED FINANCIAL STATEMENTS INCLUDE FOOTNOTES TITLED "PATIENT RECEIVABLES, NET," "NET PATIENT SERVICE REVENUE AND "CHARITY CARE". PART III, LINE 8: "MEDICARE ALLOWABLE COSTS OF CARE" WAS CALCULATED FROM INFORMATION IN THE MEDICARE COST REPORT, D, E, H AND M WORKSHEETS, OR PS&R. PART III, LINE 9B: CHARITY CARE DOCUMENTS AND EDUCATION ARE PROVIDED AT THE POINTS OF REGISTRATION (I.E., ED AND OUTPATIENT). INFORMATION RELATED TO AVAILABILITY IS IDENTIFIED ON THE MONTHLY STATEMENTS. THE PATIENT ACCOUNT REPRESENTATIVES FOR "SELF PAY" PATIENTS NOTIFY THE PATIENT/GUARANTOR DURING COLLECTION CALLS OF THE AVAILIBILITY OF FINANCIAL ASSISTANCE. THE FINANCIAL ASSISTANCE POLICY AND APPLICATION FOR FINANCIAL ASSISTANCE ARE AVAILABLE ON THE WEBSITE.THE COLLECTIONS - CHARITY WRITE-OFF POLICY PROVIDES THAT ONCE THE RESPONSIBLE PARTY HAS BEEN DETERMINED TO BE ELIGIBLE FOR PATIENT FINANCIAL ASSISTANCE, A LETTER TO THE RESPONSIBLE PARTY WILL BE SENT INDICATING THE FREE CARE AMOUNT AND THE REMAINING BALANCE DUE. THE BALANCE DUE MAY BE PAID BY INSTALLMENT PAYMENTS USING THE GUIDELINES OF THE HOSPITAL POLICY ON COLLECTIONS OF PRIVATE PAY ACCOUNTS. PART VI, LINE 2: THE DEMAND ANALYSIS PERFORMED BEGINS WITH THE ASSUMPTION THE HISTORICAL TRENDS WILL BE CONTINUED BUT AUGMENTED BY INCREASED GROWTH IN INPATIENT AND OUTPATIENT SERVICES. THE FOLLOWING ARE ELEMENTS OF PLANNING USED BY MANAGEMENT IN FORMULATING THE DEMAND FOR HOSPITAL SERVICES:- MARKET ASSESSMENT OF OTHER HEALTHCARE PROVIDERS WITHIN THE SERVICE AREA- HISTORIC AND FORECASTED INPATIENT AND OUTPATIENT UTILIZATION WITH THE SERVICE AREA- MARKET SHARE BY SERVICE AND HOSPITAL USE RATES- SERVICE AREA USE RATES- HOSPITAL'S MEDICAL STAFF PART VI, LINE 3: CHARITY CARE DOCUMENTS AND EDUCATION ARE PROVIDED AT THE POINTS OF REGISTRATION (I.E., ED AND OUTPATIENT). INFORMATION RELATED TO AVAILABILITY IS IDENTIFIED ON THE MONTHLY STATEMENTS. THE PATIENT ACCOUNT REPRESENTATIVES FOR "SELF PAY" PATIENTS NOTIFY THE PATIENT/GUARANTOR DURING COLLECTION CALLS OF THE AVAILIBILITY OF FINANCIAL ASSISTANCE. THE FINANCIAL ASSISTANCE POLICY AND APPLICATION FOR FINANCIAL ASSISTANCE ARE AVAILABLE ON THE WEBSITE. PART VI, LINE 4: BEATRICE, NE IS LOCATED IN GAGE COUNTY IN THE SOUTHEASTERN PART OF NEBRASKA. BEATRICE IS LOCATED 40 MILES SOUTH OF LINCOLN, NE. THE CLOSEST HOSPITAL FACILITY IS 32 MILES WEST. THE MAIN COMPETITION IS FROM TWO LINCOLN, NE HOSPITALS. THE PRIMARY SERVICE AREA (PSA) HAS BEEN DEFINED AS BEATRICE/ZIP CODE 68310 COUNTY AND HAS AN AGING POPULATION THAT UTILIZES HOSPITAL HEALTH SERVICES. THE AGE GROUP OF 65 AND OVER COMPRISES 20% OF THE TOTAL POPULATION OF THE PSA FOR THE HOSPITAL IN 2008 AND THAT AGE DEMOGRAPHIC IS PROJECTED TO INCREASE TO 21% IN THE NEXT TEN YEARS. PART VI, LINE 5: BEATRICE COMMUNITY HOSPITAL BUDGETS ANNUALLY SALARY EXPENSES OF APPROXIMATELY $45,000 FOR WELLNESS PROGRAMS TO BENEFIT THE HEALTH-RELATED PROGRAMS SPONSORED BY THE HOSPITAL AND OTHER ORGANIZATIONS IN THE COMMUNITY. THE HOSPITAL SPONSORS AN ANNUAL HEALTH FAIR EVERY SPRING WITH FREE OR REDUCED COST SCREENINGS AND A VARIETY OF EDUCATIONAL BOOTHS BY HOSPITAL DEPARTMENTS AND COMMUNITY PARTNERS.A FREE DIABETES HEALTH FAIR FOR THE COMMUNITY IS HELD IN THE FALL. DIABETES EDUCATORS PROVIDE EDUCATIONAL PROGRAMS, ALONG WITH FREE SCREENINGS.FREE ONGOING EDUCATIONAL PROGRAMS ON HEALTH TOPICS, KNOWN AS HEALTHY CONNECTIONS, ARE HELD THROUGHOUT THE YEAR FEATURING TOPICS SUCH AS DIABETES, NUTRITION, HEART DISEASE AND MEDICARE.EVENING IN PINK IS AN ANNUAL EDUCATIONAL AND FELLOWSHIP PROGRAM HELD IN OCTOBER TO RAISE AWARENESS ABOUT BREAST CANCER. IN ADDITION, THE HOSPITAL PARTICIPATES IN THE ANNUAL AMERICAN CANCER SOCIETY RELAY FOR LIFE EVENT BY SERVING A FREE MEAL TO ALL PARTICIPATING CANCER SURVIVORS TO KICK OFF THE RELAY EVENT.PEOPLE CARING FOR PEOPLE PROVIDES IN-HOME ASSESSMENTS AND EDUCATIONAL RESOURCES TO EACH FAMILY WITH A NEWBORN THAT RESIDES IN GAGE COUNTY. THE HOME VISITATION PROGRAM PROMOTES POSITIVE PARENTING SKILLS.A PARTNERSHIP OF BEATRICE COMMUNITY HOSPITAL, THE SALVATION ARMY AND THE BEATRICE COMMUNITY HOSPITAL FOUNDATION, ALONG WITH SERVICE ORGANIZATION DONATIONS, SPONSOR READY, SET, GO!, AN ANNUAL BACK-TO-SCHOOL PROGRAM. SOME OF THE ITEMS GIVEN AWAY INCLUDE: A BOOK BAG, SCHOOL SUPPLIES, SHAMPOO, SOAP, SCHOOL PHYSICALS, HAIRCUT VOUCHERS, CLOTHING VOUCHERS, SHOE DISCOUNT COUPONS, HEALTH INFORMATION AND MORE.FLU AND PNEUMONIA SHOT CLINICS ARE PROVIDED TO RESIDENTS OF GAGE COUNTY.THE HOSPITAL GIVES AWAY BOTTLES OF WATER AT THE GAGE COUNTY FAIR AND DURING HOMESTEAD DAYS CELEBRATION ACTIVITIES DURING THE SUMMER AS A WAY TO REDUCE DEHYDRATION AND HEALTH-RELATED ISSUES EXPERIENCED BY COMMUNITY MEMBERS DURING THESE HOT SUMMER OUTDOOR ACTIVITIES.CHILD CAR SEAT SAFETY INITIATIVES INCLUDE HAVING LABOR AND DELIVERY AND NURSERY NURSES CERTIFIED IN CHILD CAR SEAT SAFETY. A FREE ANNUAL CHILD CAR SEAT SAFETY EVENT IS HELD FOR COMMUNITY RESIDENTS.HOSPICE CONDUCTS A GRIEF EDUCATION AND SUPPORT PROGRAM FOR THOSE PEOPLE IN THE COMMUNITY WHO HAVE LOST A LOVED ONE TO DEATH. THIS PROGRAM IS HELD ON A QUARTERLY BASIS.AN EDUCATIONAL PROGRAM FOR FIRST-GRADERS IS OFFERED EVERY SPRING. AREA SCHOOLS ARE INVITED TO BRING THEIR FIRST-GRADERS TO THE HOSPITAL TO BECOME FAMILIAR WITH THE HOSPITAL, LEARN ABOUT COMMON CHILDHOOD HEALTH CONCERNS SUCH AS A BROKEN ARM, AND MEET DOCTORS AND NURSES.IN-KIND AND EMPLOYEE SUPPORT WAS GIVEN TO A VARIETY OF LOCAL HEALTHCARE-RELATED ORGANIZATIONS AND ACTIVITIES, SUCH AS UNITED WAY, BEATRICE PUBLIC SCHOOLS BACKPACK PROGRAM, ALZHEIMER'S MEMORY WALK, MOTHER TO MOTHER MINISTRY, PUBLIC HEALTH SOLUTIONS PUBLIC HEALTH DEPARTMENT, GREAT STRIDES FOR CYSTIC FIBROSIS, MOSAIC, BLUE VALLEY BEHAVIORAL HEALTH, WALK TO PREVENT SUICIDE, ETC.THE GAGE COUNTY AMBULANCE SERVICES UTILIZES HOSPITAL STAFF TO TRAIN AND PROVIDE CLINICAL PRACTICUM FOR THE EMT-I AND PARAMEDIC PROGRAM.EMPLOYEES SERVED CANCER SURVIVOR SUPPER AT THE ANNUAL RELAY FOR LIFE EVENT. OTHER EMPLOYEES WORKED WITH THESE ORGANIZATIONS ON BEHALF OF BEATRICE COMMUNITY HOSPITAL: AMERICAN CANCER SOCIETY, UNITED WAY, AMERICAN HEART ASSOCATION, BEATRICE MARY YMCA, ALZHEIMER'S ASSOCIATION, AMERICAN DIABETES ASSOCATION, MOTHER TO MOTHER MINISTRY AND OTHER PROFESSIONAL ORGANIZATIONS.THE HOSPITAL SPONSORS AN INFORMATIONAL RADIO PROGRAM THAT COVERS GENERAL HEALTHCARE TOPICS OF INTEREST TO THE COMMUNITY, SUCH AS ORGAN DONATION, STRESS DURING THE HOLIDAYS, DIABETES, NUTRITION, ETC.THE HOSPITAL WORKS WITH COLLEGES AND UNIVERSITIES TO SERVE AS A TRAINING SITE FOR NURSING AND OTHER HEALTH-CARE RELATED JOBS. THE HOSPITAL HAS AN EXTENSIVE JOB SHADOWING PROGRAM FOR HIGH SCHOOL AND COLLEGE STUDENTS INTERESTED IN HEALTHCARE. THE HOSPITAL IS A CERTIFIED AMERICAN HEART ASSOCIATION TRAINING SITE, AND PROVIDES CPR AND OTHER TRAINING TO LOCAL BUSINESSES AND EMERGENCY SERVICES. STAFF ALSO PARTICIPATE IN TEACHING HANDS ONLY CPR TO FIFTH-GRADERS AT THE ANNUAL PROGRESSIVE AGRICULTURE SAFETY DAY.THE CHIEF COMPLIANCE OFFICER SERVES ON THE BOARD OF DIRECTORS FOR THE 5-COUNTY DISTRICT PUBLIC HEALTH DEPARTMENT NAMED SOLUTIONS PUBLIC HEALTH.THE HOSPITAL CONDUCTED A COMMUNITY HEALTH NEEDS ASSESSMENT AND ACTION PLAN. ONE OF THE OUTCOMES IS TO WORK WITH PUBLIC HEALTH SOLUTIONS PUBLIC HEALTH DEPARTMENT ON A GAGE COUNTY PLANNING COMMITTEE TO ADDRESS OBESITY ISSUES IN THE COMMUNITY.THE HOSPITAL INVITES THE RED CROSS BLOODMOBILE BUS TO VISIT THE HOSPITAL CAMPUS SEVERAL TIMES A YEAR AND ENCOURAGES EMPLOYEES TO DONATE BLOOD DURING WORK HOURS TO SUPPORT THE HEALTHCARE INDUSTRY'S ONGOING NEED FOR BLOOD SUPPLIES AROUND THE COUNTRY. PART VI, LINE 6: NOT APPLICABLE 0 BEATRICE RETIREMENT INC 4800 HOSPITAL PARKWAY BEATRICE NE 68310 470649975 501(C)(3) 244098 CAPTIAL PROJECTS HEALTH SYSTEMS OF BEATRICE INC 4800 HOSPITAL PARKWAY BEATRICE NE 68310 470691891 501(C)(3) 7008 OPERATION EXPENSES 2 0 PART I, LINE 2: BECAUSE THE RECIPIENTS OF THE GRANT MONEY WERE BEATRICE RETIREMENT, INC. AND HEALTH SYSTEMS OF BEATRICE, INC., BOTH RELATED ORGANIZATIONS, BEATRICE COMMUNITY HOSPITAL AND HEALTH CENTER, INC. IS ABLE TO MONITOR THE USE OF THE GRANT FUNDS. X X X X 0 0 0 0 0 0 0 0 0 BLAKE BUTLER MD MEMBER 360658 0 171096 0 0 0 15300 0 23678 0 570732 0 0 0 ERIC THOMSEN MD MEMBER 249896 0 6379 0 0 0 0 0 23638 0 279913 0 0 0 THOMAS SOMMERS BCH CEO (LEAVE OF ABSENCE) 368839 0 0 0 0 0 15300 0 23691 0 407830 0 0 0 ALAN STREETER CFO 161223 0 0 0 0 0 9977 0 27830 0 199030 0 0 0 DEREK WEICHEL MD PHYSICIAN 591443 0 0 0 0 0 15300 0 29519 0 636262 0 0 0 BRETT STUDLEY MD PHYSICIAN 362299 0 18386 0 0 0 15300 0 30486 0 426471 0 0 0 RONALD BEAR MD PHYSICIAN 359633 0 56048 0 0 0 15300 0 11393 0 442374 0 0 0 DENISE CAPEK PHYSICIAN 275392 0 56540 0 0 0 15300 0 23530 0 370762 0 0 0 MICHAEL HAVEKOST MD PHYSICIAN 316390 0 47030 0 0 0 15300 0 28033 0 406753 0 0 0 A HOSPITAL AUTHORITY NO 1 OF GAGE COUNTY NEBRASKA 470785499 362615AH9 2010-06-08 15000000 REFUND PRIOR ISSUE 12/23/09 1 0 0 B HOSPITAL AUTHORITY NO 1 OF GAGE COUNTY NEBRASKA 470785499 362615AL0 2010-06-24 30000000 CONSTRUCTION OF FACILITY 0 0 0 C HOSPITAL AUTHORITY NO 1 OF GAGE COUNTY NEBRASKA 470785499 NONEAVAIL 2015-03-20 9934971 PARTIAL REFUND PRIOR BONDS (06/08/10) 0 0 0 A 13860000 15000000 1047042 15000000 2012 1 0 1 1 B 30150084 2094084 2181107 27968976 2012 0 0 1 1 C 9934971 693489 175362 9759609 2012 1 0 1 1 A 0 0 1 1 0 0.00000 0.00000 0.00000 0 0 1 B 0 0 1 1 0 0.00000 0.00000 0.00000 0 0 1 C 0 0 1 1 0 0.00000 0.00000 0.00000 0 0 1 A 0 0 1 1 0 0 0 0 1 B 0 0 1 1 0 0 0 0 1 C 0 1 1 0 0 0 0 0 1 A 1 B 1 C 1 PART IV, LINE 2C, COLUMN A AND B: ISSUER NAME: HOSPITAL AUTHORITY NO. 1 OF GAGE COUNTY, NE. DATE THE REBATE COMPUTATION WAS PERFORMED: 05/31/2015 PART II, LINE 3: THE TOTAL PROCEEDS DO NOT EQUAL THE SUMMATION OF LINES 4 - 12 DUE TO TRANSFERRED OR REPLACEMENT PROCEEDS IN LINE 4. PART II, LINE 3: THE TOTAL PROCEEDS DO NOT AGREE TO THE ISSUE PRICE IN PART I, COLUMN (E) DUE TO INVESTMENT EARNINGS. RONALD BEAR MD HIGHEST COMPENSATED EMPLOYEE COMPENSATION AGREEMENT X 40000 20000 0 1 1 DR JOHN FINDLEY INTERIM CEO COMPENSATION AGREEMENT X 25000 14583 0 1 1 34583 COLLEEN DEINES COLLEEN IS THE WIFE OF MITCHELL DEINES, BOARD MEMBER 31541 COLLEEN DEINES IS EMPLOYED BY BEATRICE COMMUNITY HOSPITAL AND HEALTH CENTER, INC. 0 FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 WAS MADE AVAILABLE TO ALL BOARD MEMBERS VIA THE BOARD PORTAL. THE FINANCE COMMITTEE WAS INSTRUCTED TO REVIEW THE FORM 990. ONCE THEY REVIEWED THE FORM 990, THEY RECOMMENDED SUBMISSION OF THE FORM 990 TO THE IRS. PRIOR TO FILING, EACH BOARD MEMBER WILL HAVE ACCESS TO THE FORM 990 VIA THE BOARD PORTAL. FORM 990, PART VI, SECTION B, LINE 12C EVERY BOARD MEMBER, ADMINISTRATIVE EMPLOYEE AND DEPARTMENT MANAGER IS REQUIRED TO FILL OUT A NEW CONFLICT OF INTEREST FORM DURING THE FIRST QUARTER OF THE YEAR. THESE ARE KEPT ON FILE WITH THE CHIEF COMPLIANCE OFFICER. FORM 990, PART VI, SECTION B, LINE 15 LISTED BELOW IS INFORMATION FROM OUR POLICY ON WAGE AND SALARY ADMINISTRATION. THIS POLICY APPLIES TO ALL EMPLOYEES EXCEPT EXECUTIVE LEVEL STAFF AND THOSE WITH WRITTEN CONTRACTS (PHYSICIANS, ALLIED HEALTH STAFF, ETC.). AN OUTSIDE CONSULTING FIRM MAKES COMPENSATION RECOMMENDATIONS TO THE BOARD OF DIRECTORS BASED UPON MARKET DATA FOR THE POSITION. A. STRUCTURE OF THE WAGE AND SALARY PLAN 1. PAY GRADES AND WAGE SCALES/RANGES ARE ESTABLISHED TO REWARD EMPLOYEES FOR DIFFERENT LEVELS OF SKILLS, RESPONSIBILITY AND KNOWLEDGE. JOB POSITIONS ARE ASSIGNED A PAY GRADE BASED UPON MARKET CONDITIONS, SKILLS, RESPONSIBILITY, EDUCATION EXPERIENCE, PHYSICAL DEMANDS AND WORKING CONDITIONS REQUIRED OF THE POSITION. EACH PAY GRADE HAS A RANGE OF PAY FROM MINIMUM TO MAXIMUM, ESTABLISHED TO REWARD EMPLOYEES FOR EXPERIENCE AND PERFORMANCE. B. ADJUSTMENTS TO THE WAGE AND SALARY PLAN: 1. THE WAGE PLAN IS REVIEWED AT LEAST ANNUALLY TO ENSURE COMPETITIVE SALARIES FOR ALL POSITIONS. LABOR MARKET SURVEYS ARE COMPLETED AND UTILIZED ON A REGULAR BASIS. BASED UPON MARKET INFORMATION AND/OR A REVIEW OF JOB DESCRIPTIONS, ADJUSTMENTS MAY BE MADE TO THE WAGE AND SALARY PLAN THAT INCLUDE ADJUSTMENTS TO THE OVERALL WAGE AND SALARY STRUCTURE OR REPOSITIONING OF A SPECIFIC JOB POSITION(S) TO A DIFFERENT PAY GRADE. FOR THE CEO POSITION THAT IS HELD BY THOMAS SOMMERS AND DR. JOHN FINDLEY (INTERIM CEO DURING MR. SOMMERS LEAVE OF ABSENCE) , THE BOARD CHAIR WORKS WITH A CONSULTING COMPANY, IH STRATEGIES, TO DETERMINE THE APPROPRIATE COMPENSATION. THIS INFORMATION IS APPROVED BY THE EXECUTIVE COMMITTEE OF THE HOSPITAL BOARD OF DIRECTORS. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART XI, LINE 9: CHANGE IN INTEREST IN BEATRICE COMMUNITY HOSPITAL FOUNDATION -108,687. FORM 990, PART XI, LINE 2C: THERE HAVE BEEN NO CHANGES FROM THE PRIOR YEAR. THE FINANCE COMMITTEE OF THE BOARD OF DIRECTORS SELECTS THE INDEPENDENT ACCOUNTANT AND HAS THE RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT. UPON COMPLETION OF THE AUDIT, THE AUDITING FIRM PRESENTS THE RESULTS AND FINDINGS TO THE FINANCE COMMITTEE. HEALTH SYSTEM OF BEATRICE INC 4800 HOSPITAL PARKWAY PO BOX 278 BEATRICE NE 683106906 470691891 MANAGEMENT COMPANY NE 501(C)(3) LINE 11C, III-FI N/A 0 HOMESTEAD VILLAGE INC 1119 MONROE STREET BEATRICE NE 68310 470591716 APARTMENTS FOR LOW INCOME ELDERLY INDIVIDUALS NE 501(C)(3) LINE 9 HEALTH SYSTEM OF BEATRICE INC 0 PARKVIEW VILLAGE INC 1200 SOUTH 8TH STREET BEATRICE NE 68310 363381263 APARTMENTS FOR LOW INCOME ELDERLY INDIVIDUALS NE 501(C)(3) LINE 9 HEALTH SYSTEM OF BEATRICE INC 0 BEATRICE COMMUNITY HOSP FOUNDATION INC 4800 HOSPITAL PARKWAY PO BOX 641 BEATRICE NE 68310 473024984 FINANCIAL SUPPORT FOR BEATRICE COMMUNITY HOSPITAL & HEALTH CENTER, INC. NE 501(C)(3) LINE 11C, III-FI HEALTH SYSTEM OF BEATRICE INC 0 BEATRICE RETIREMENT INC 4800 HOSPITAL PARKWAY PO BOX 278 BEATRICE NE 683106906 470649975 RETIREMENT FACILITY NE 501(C)(3) LINE 9 HEALTH SYSTEM OF BEATRICE INC 0 PHYSICIAN'S BUILDING INC 4800 HOSPITAL PARKWAY BEATRICE NE 68310 470697398 OFFICE RENTAL NE N/A C 0 0 1 1 1 0 0 0 0 0 0 1 1 0 1 1 0 1 0 0