BRODSTONE MEMORIAL HOSPITAL: Form 990, tax year 2012
View the entire original 990 at ProPublica ↗
- Organization
- BRODSTONE MEMORIAL HOSPITAL (EIN 47-0388012)
- Tax period
- 2012-05-01 to 2013-04-30
- Filed
- 2013-09-04
- IRS object ID
- 201312479349300506
- Schema version
- 2012v2.1
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2013-09-04T09:33:12-05:00 | Timestamp |
| Tax Period End Date | 2013-04-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 476097913 | EIN |
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SEIM JOHNSON LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 18081 BURT STREET SUITE 200 | AddressLine1 |
| City | OMAHA | City |
| State | NE | State |
| ZIP Code | 680224722 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2012-05-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 470388012 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BRODSTONE MEMORIAL HOSPITAL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | BROD | NameControl |
| Phone | 4028793281 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 520 EAST 10TH STREET | AddressLine1 |
| City | SUPERIOR | City |
| State | NE | State |
| ZIP Code | 689781225 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | JOHN KEELAN | Name |
| Title | CEO | Title |
| Phone | 4028793281 | Phone |
| Date Signed | 2013-08-28 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | BARBARA J FAJEN | Name |
| PTIN | P00400874 | PTIN |
| Phone | 4023302660 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2012 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | JOHN KEELAN | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 520 EAST 10TH STREET | AddressLine1 |
| City | SUPERIOR | City |
| State | NE | State |
| ZIP Code | 689781225 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 22277675 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.BRODSTONEHOSPITAL.ORG | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1927 | YearFormation |
| State Legal Domicile | NE | StateLegalDomicile |
| Activity Or Mission Description | BRODSTONE MEMORIAL HOSPITAL IS A NOT-FOR-PROFIT CRITICAL ACCESS HOSPITAL ESTABLISHED TO DELIVER QUALITY, AFFORDABLE HEALTH CARE IN A CARING, SAFE AND COMPASSIONATE ENVIRONMENT TO ALL PERSONS OF SUCH NEED IN A TOTALLY NON-DISCRIMINATORY MANNER. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 6 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 6 | NbrIndependentVotingMembers |
| Total Nbr Employees | 216 | TotalNbrEmployees |
| Total Nbr Volunteers | 80 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 553137 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 917518 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 19052036 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 21238748 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 52949 | InvestmentIncomePriorYear |
| Investment Income Current Year | 77139 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 0 | OtherRevenuePriorYear |
| Other Revenue Current Year | 38405 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 19658122 | TotalRevenuePriorYear |
| Total Revenue Current Year | 22271810 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 0 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 0 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 10730012 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 11318806 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 7960668 | OtherExpensePriorYear |
| Other Expenses Current Year | 9473148 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 18690680 | TotalExpensesPriorYear |
| Total Expenses Current Year | 20791954 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 967442 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 1479856 | RevenuesLessExpensesCY |
| Total Assets BOY | 23510397 | TotalAssetsBOY |
| Total Assets EOY | 26565636 | TotalAssetsEOY |
| Total Liabilities BOY | 11592140 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 11619240 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 11918257 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 14946396 | NetAssetsOrFundBalancesEOY |
| Mission Description | BRODSTONE MEMORIAL HOSPITAL IS A NOT-FOR-PROFIT CRITICAL ACCESS HOSPITAL ESTABLISHED TO DELIVER QUALITY, AFFORDABLE HEALTH CARE IN A CARING, SAFE AND COMPASSIONATE ENVIRONMENT TO ALL PERSONS OF SUCH NEED IN A TOTALLY NON-DISCRIMINATORY MANNER. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 19198126 | Expense |
| Revenue | 21238748 | Revenue |
| Description | BRODSTONE MEMORIAL HOPSITAL PROVIDES SHORT TERM INPATIENT AND OUTPATIENT SERVICES SUCH AS ACUTE CARE, ICU, OB, AND NURSERY WITHIN THE SCOPE OF ITS HOSPITAL LICENSE TO ALL PATIENTS IN A NON-DISCRIMINATORY MANNER. THE HOSPITAL ALSO OPERATES TWO RURAL HEALTH CLINICS. | Description |
| Total Program Service Expense | 19198126 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 1 | LobbyingActivities |
| Subject To Proxy Tax | 0 | SubjectToProxyTax |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 1 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 1 | ReportLandBldgEquip |
| Report Invest Oth Securities | 0 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 1 | ReportOtherAssets |
| Report Other Liabilities | 0 | ReportOtherLiabilities |
| Report Fin48 Footnote | 1 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 1 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 0 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 0 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 1 | Hospital |
| Financial Stmt Attached | 1 | FinancialStmtAttached |
| Grants To Organizations | 0 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 0 | TaxExemptBonds |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 0 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 0 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 0 | RelatedEntity |
| Related Org Controlled Entity | 0 | RelatedOrgControlledEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 24 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 216 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 0 | UnrelatedBusinessIncome |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributions |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 6 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 6 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 0 | MembersOrStockholders |
| Election Of Board Members | 0 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 0 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 1 | CompensationProcessCEO |
| Compensation Process Other | 1 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | SANDRA J BORDEN CFO | NamePerson |
| Telephone Number | 4028793281 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 520 EAST 10TH STREET | AddressLine1 |
| City | SUPERIOR | City |
| State | NE | State |
| ZIP Code | 68978 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (13 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|
| PAT MCCORD | |||||||
| PRESIDENT | 2.00 | X | X | 0 | 0 | 0 | |
| LYNN CULBERTSON | |||||||
| VICE-PRESIDENT | 2.00 | X | X | 0 | 0 | 0 | |
| KATHY ESSINK | |||||||
| SECRETARY | 2.00 | X | X | 0 | 0 | 0 | |
| JULIE SIMONSEN | |||||||
| TREASURER | 2.00 | X | X | 0 | 0 | 0 | |
| JUDY GROVE | |||||||
| MEMBER | 2.00 | X | 0 | 0 | 0 | ||
| MARLIN MEYER | |||||||
| MEMBER | 2.00 | X | 0 | 0 | 0 | ||
| JOHN KEELAN | |||||||
| CEO | 40.00 | X | 187180 | 0 | 27497 | ||
| SANDRA BORDEN | |||||||
| CFO | 40.00 | X | 126019 | 0 | 23978 | ||
| TIMOTHY BLECHA | |||||||
| MEDICAL STAFF DIRECTOR | 40.00 | 272621 | 0 | 37190 | X | ||
| JULIE THEIS | |||||||
| PHYSICIAN | 40.00 | 177643 | 0 | 33152 | X | ||
| ROBERT LEIBEL | |||||||
| PHYSICIAN | 40.00 | 170149 | 0 | 32382 | X | ||
| JASON HASS | |||||||
| PHYSICIAN ASSISTANT | 40.00 | 118083 | 0 | 32572 | X | ||
| BRADLEY GARDNER | |||||||
| DIRECTOR OF PHYSICAL THERAPY | 40.00 | 101345 | 0 | 31847 | X | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 1153040 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 218618 | TotalOtherCompensation |
| Number Individuals GT100 K | 7 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| CARDINAL HEALTH | |||||
| 21377 NETWORK PLACE | CHICAGO | IL | 60673 | PHARMACY MGMT | 1185730 |
| CAREFUSION SOL LLC | |||||
| 3750 TORREY VIEW CT | SAN DIEGO | CA | 92130 | PYXIS EQUIPMENT/MAINTENANCE | 245069 |
| HEALTHLAND | |||||
| 625 S LAKESHORE DR | GLENWOOD | MN | 56334 | SOFTWARE MAINTENANCE | 198214 |
| GE HEALTHCARE | |||||
| PO BOX 96483 | CHICAGO | IL | 60693 | X-RAY EQUIPMENT MAINTENANCE | 197403 |
| PRAIRIE WINDS ANESTH LLC | |||||
| 2551 Z ROAD | WEBBER | KS | 66970 | CRNA | 195206 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 10 | NumberOfContractorsGT100K |
| Fundraising Events | 12360 | FundraisingEvents |
| Government Grants | 261250 | GovernmentGrants |
| All Other Contributions | 643908 | AllOtherContributions |
| Total Contributions | 917518 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (5 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|
| MEDICARE/MEDICAID | 621110 | 11931895 | 11931895 |
| NET PATIENT SERVICE REVENUE | 621110 | 6687360 | 6687360 |
| PHARMACY | 446110 | 2478474 | 2478474 |
| HOME HEALTH CARE | 621610 | 87954 | 87954 |
| MISCELLANEOUS INCOME | 621990 | 53065 | 53065 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 21238748 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 74905 | TotalRevenueColumn |
| Exclusion | $74,905 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 3526 | Other |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 1292 | Other |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 2234 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 2234 | TotalRevenueColumn |
| Exclusion | $2,234 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Income Fundraising Events | 1872 | GrossIncomeFundraisingEvents |
| Cntrbtns Rprtd Fundraising Events | 12360 | CntrbtnsRprtdFundraisingEvents |
| Fundraising Direct Expenses | 4573 | FundraisingDirectExpenses |
Net Income From Fundraising Events NetIncomeFromFundraisingEvents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -2701 | TotalRevenueColumn |
| Exclusion | -$2,701 | ExclusionAmount |
Other Revenue Misc OtherRevenueMisc
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | CAFETERIA REVENUE | Description |
| Business Code | 900099 | BusinessCode |
| Total Revenue Column | 41106 | TotalRevenueColumn |
| Exclusion | $41,106 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 41106 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 22271810 | TotalRevenueColumn |
| Related Or Exempt Function Income | 21238748 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $115,544 | ExclusionAmount |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 364675 | Total |
| Management And General | 364675 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 8594815 | Total |
| Program Services | 7869237 | ProgramServices |
| Management And General | 725578 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1803333 | Total |
| Program Services | 1638517 | ProgramServices |
| Management And General | 164816 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 555983 | Total |
| Program Services | 491149 | ProgramServices |
| Management And General | 64834 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 587766 | Total |
| Program Services | 512181 | ProgramServices |
| Management And General | 75585 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 57185 | Total |
| Program Services | 57185 | ProgramServices |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 959890 | Total |
| Program Services | 902930 | ProgramServices |
| Management And General | 56960 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 381066 | Total |
| Program Services | 381066 | ProgramServices |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 76646 | Total |
| Program Services | 54691 | ProgramServices |
| Management And General | 21955 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 504740 | Total |
| Program Services | 504740 | ProgramServices |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1497683 | Total |
| Program Services | 1497683 | ProgramServices |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 156469 | Total |
| Program Services | 156469 | ProgramServices |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| MEDICAL SUPPLIES | 4419252 | 4419252 | |
| BAD DEBT EXPENSE | 691737 | 691737 | |
| MISCELLANEOUS EXPENSE | 87167 | 3645 | 83522 |
| DUES AND SUBSCRIPTIONS | 53547 | 17644 | 35903 |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 20791954 | Total |
| Program Services | 19198126 | ProgramServices |
| Management And General | 1593828 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3026962 | BOY |
| EOY | 200 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 886650 | BOY |
| EOY | 7798627 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3610303 | BOY |
| EOY | 2748484 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 222871 | BOY |
| EOY | 224567 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 437068 | BOY |
| EOY | 478272 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 22896555 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 9836727 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 13285321 | BOY |
| EOY | 13059828 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 295370 | BOY |
| EOY | 328242 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 13718 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1745852 | BOY |
| EOY | 1913698 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 23510397 | BOY |
| EOY | 26565636 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1361802 | BOY |
| EOY | 1573379 | EOY |
Deferred Revenue DeferredRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 296284 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 9918868 | BOY |
| EOY | 9749577 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 311470 | BOY |
| EOY | 0 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 11592140 | BOY |
| EOY | 11619240 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 11500271 | BOY |
| EOY | 13216233 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 417986 | BOY |
| EOY | 203314 | EOY |
Permanently Restricted Net Assets PermanentlyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 1526849 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 11918257 | BOY |
| EOY | 14946396 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 23510397 | BOY |
| EOY | 26565636 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | 1479856 | ReconcilationRevenueExpenses |
| Reconciliation Unrealized Invest | 21434 | ReconciliationUnrealizedInvest |
| Reconcilation Other Changes | 1526849 | ReconcilationOtherChanges |
| Info In Schedule O Part XII | X | InfoInScheduleOPartXII |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
FS Audited Basis FSAuditedBasis
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Statement Separate | X | FinancialStatementSeparate |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | 1 | AuditCommittee |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| 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) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | Volunteers |
| Paid Staff Or Management | 0 | PaidStaffOrManagement |
| Media Advertisements | 0 | MediaAdvertisements |
| Mailings Members | 0 | MailingsMembers |
| Publications Or Broadcast | 0 | PublicationsOrBroadcast |
| Grants Other Organizations | 0 | GrantsOtherOrganizations |
| Direct Contact Legislators | 0 | DirectContactLegislators |
| Rallies Demonstrations | 0 | RalliesDemonstrations |
| Other Activities | 1 | OtherActivities |
| Other Activities | $1,788 | OtherActivitiesAmount |
| Total Lobbying Expenditures IIB | 1788 | TotalLobbyingExpendituresIIB |
| Not Described In501c3 | 0 | NotDescribedIn501c3 |
Form990 Schedule C Part IV Form990ScheduleCPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | EXPLANATION OF LOBBYING ACTIVITIES: | Identifier |
| Return Reference | PART II-B, LINE 1: | ReturnReference |
| Explanation | PORTION OF NEBRASKA HOSPITAL ASSOCIATION AND AMERICAN HOSPITAL ASSOCIATION DUES ALLOCABLE TO LOBBYING ACTIVITIES. | Explanation |
Schedule D IRS990ScheduleD
Current Year CurrentYear
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 1395429 | BeginningOfYearBalance |
| Contributions | 85539 | Contributions |
| Investment Earnings Or Losses | 104553 | InvestmentEarningsOrLosses |
| Grants Or Scholarships | 39140 | GrantsOrScholarships |
| Administrative Expenses | 19532 | AdministrativeExpenses |
| End Of Year Balance | 1526849 | EndOfYearBalance |
Current Year Minus1 Year CurrentYearMinus1Year
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 1403603 | BeginningOfYearBalance |
| Investment Earnings Or Losses | -8174 | InvestmentEarningsOrLosses |
| End Of Year Balance | 1395429 | EndOfYearBalance |
Current Year Minus2 Years CurrentYearMinus2Years
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 1294935 | BeginningOfYearBalance |
| Investment Earnings Or Losses | 108665 | InvestmentEarningsOrLosses |
| End Of Year Balance | 1403603 | EndOfYearBalance |
Current Year Minus3 Years CurrentYearMinus3Years
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 1098170 | BeginningOfYearBalance |
| Investment Earnings Or Losses | 196765 | InvestmentEarningsOrLosses |
| End Of Year Balance | 1294935 | EndOfYearBalance |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Designated EOY Balance | 0.00000 | BoardDesignatedEOYBalance |
| Permanent Endowment EOY Balance | 1.00000 | PermanentEndowmentEOYBalance |
| Term Endowment EOY Balance | 0.00000 | TermEndowmentEOYBalance |
| Endowments Held By Unrelated Orgs | 1 | EndowmentsHeldByUnrelatedOrgs |
| Endowments Held By Related Orgs | 0 | EndowmentsHeldByRelatedOrgs |
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 117890 | OtherCostOrOtherBasis |
| Book Value | 117890 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 14145747 | OtherCostOrOtherBasis |
| Depreciation | 4755219 | Depreciation |
| Book Value | 9390528 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 8618268 | OtherCostOrOtherBasis |
| Depreciation | 5081508 | Depreciation |
| Book Value | 3536760 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 14650 | OtherCostOrOtherBasis |
| Book Value | 14650 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 13059828 | TotalOfBookValueLandBuildings |
Other Assets OtherAssets (3 entries)
| DescriptionDescription | Book ValueBookValue |
|---|---|
| ESTIMATED CONTRACTUAL ESTTLEMENT REC | 365000 |
| DEFERRED FINANCING COSTS, NET | 21849 |
| BENEFICIAL INTEREST IN TRUSTS | 1526849 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | 1913698 | TotalBookValueOtherAssets |
| Footnote In Part XIII | X | FootnoteInPartXIII |
| Tot Revenue Etc Audited Fincl Stmt | 23824666 | TotRevenueEtcAuditedFinclStmt |
| Net Unrealized Gains Investments | 21434 | NetUnrealizedGainsInvestments |
| Other Revenues | 1531422 | OtherRevenues |
| Revenue Not Rptd F990 | 1552856 | RevenueNotRptdF990 |
| Revenue Subtotal | 22271810 | RevenueSubtotal |
| Revenue Not Rptd On Fin Stmt | 0 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 22271810 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 20796527 | TotExpensesEtcAuditedFinclStmt |
| Other Expenses Included | 4573 | OtherExpensesIncluded |
| Expenses Not Rptd F990 | 4573 | ExpensesNotRptdF990 |
| Expenses Subtotal | 20791954 | ExpensesSubtotal |
| Expenses Not Rptd On Fin Stmt | 0 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 20791954 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIII Form990ScheduleDPartXIII (4 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: | PART V, LINE 4: | INTEREST EARNINGS MAY BE USED FOR OPERATIONS, HOWEVER THE PRINCIPAL IS TO BE MAINTAINED AS A PERMANENT ENDOWMENT. DUE TO INADVERTANT OMISSION OF CERTAIN FUNDS FROM PRESENTATION, CONTRIBUTIONS FOR THE YEAR HAVE BEEN ADJUSTED BY $39,920 TO REFLECT PROPER END OF YEAR BALANCE. |
| DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: | PART X, LINE 2: | THE HOSPITAL ACCOUNTS FOR UNCERTAINTIES IN ACCOUNTING FOR INCOME TAX ASSETS AND LIABILITIES USING GUIDANCE INCLUDED IN FASB ASC 740, INCOME TAXES. THE HOSPITAL RECOGNIZES THE EFFECT OF INCOME TAX POSITIONS ONLY IF THOSE POSITIONS ARE MORE LIKELY THAN NOT OF BEING SUSTAINED. AT APRIL 30, 2013 AND 2012, THE HOSPITAL HAD NO UNCERTAIN TAX POSITIONS ACCRUED. WITH FEW EXCEPTIONS, THE HOSPITAL IS NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS BY THE U.S. FEDERAL, STATE OR LOCAL TAX AUTHORITIES FOR YEARS ENDED PRIOR TO APRIL 30, 2010. |
| PART XI, LINE 2D - OTHER ADJUSTMENTS: | CHANGE IN BENEFICIAL INTEREST IN TRUSTS 1,526,849. FUNDRAISING EXPENSES 4,573. | |
| PART XII, LINE 2D - OTHER ADJUSTMENTS: | FUNDRAISING EXPENSES 4,573. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | 1 | CharityCarePolicy |
| Written Policy | 1 | WrittenPolicy |
| Policy Applied To All Hospitals | X | PolicyAppliedToAllHospitals |
| FPG Reference Free Care | 1 | FPGReferenceFreeCare |
| Pcent100 | X | Pcent100 |
| FPG Reference Discounted Care | 1 | FPGReferenceDiscountedCare |
| Pcent200 D | X | Pcent200D |
| Free Disc Care Medically Indigent | 1 | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | 1 | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | 1 | ExpensesExceededBudget |
| Unable To Provide Care | 0 | UnableToProvideCare |
| Annual Community Benefit Report | 1 | AnnualCommunityBenefitReport |
| Report Publically Available | 1 | ReportPublicallyAvailable |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 279074 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 279074 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01390 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 993546 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 778493 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 215053 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01070 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 1272620 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 778493 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 494127 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.02460 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 27 | NumberOfActivitiesOrPrograms |
| Persons Served | 2528 | PersonsServed |
| Total Community Benefit Expense | 361750 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 51069 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 310681 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01550 | PercentOfTotalExpense |
Health Professions Education HealthProfessionsEducation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 4 | NumberOfActivitiesOrPrograms |
| Total Community Benefit Expense | 53112 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 53112 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00260 | PercentOfTotalExpense |
Cash And In Kind Contributions CashAndInKindContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 7666 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 7666 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00040 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 31 | NumberOfActivitiesOrPrograms |
| Persons Served | 2528 | PersonsServed |
| Total Community Benefit Expense | 422528 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 51069 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 371459 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01850 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 31 | NumberOfActivitiesOrPrograms |
| Persons Served | 2528 | PersonsServed |
| Total Community Benefit Expense | 1695148 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 829562 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 865586 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.04310 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 1 | BadDebtExpenseReported |
| Bad Debt Expense | $691,737 | BadDebtExpenseAmount |
| Amount Attributable To | 0 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 10836595 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 10434507 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | 402088 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | X | CostToChargeRatio |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | 1 | WrittenDebtCollectionPolicy |
| Provision For Charity Care | 1 | ProvisionForCharityCare |
| Number Of Hospital Facilities | 1 | NumberOfHospitalFacilities |
Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility Number | 1 | FacilityNumber |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BRODSTONE MEMORIAL HOSPITAL | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 520 E 10TH | AddressLine1 |
| City | SUPERIOR | City |
| State | NE | State |
| ZIP Code | 68978 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | X | LicensedHospital |
| General Medical And Surgical | X | GeneralMedicalAndSurgical |
| Critical Access Hospital | X | CriticalAccessHospital |
| Er24 Hours | X | Er24Hours |
Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BRODSTONE MEMORIAL HOSPITAL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
| CHNA Conducted | 1 | CHNAConducted |
| Community Definition | X | CommunityDefinition |
| Community Demographics | X | CommunityDemographics |
| Existing Resources | X | ExistingResources |
| How Data Obtained | X | HowDataObtained |
| Community Health Needs | X | CommunityHealthNeeds |
| Other Health Issues | X | OtherHealthIssues |
| Identifying Process | X | IdentifyingProcess |
| Consulting Process | X | ConsultingProcess |
| Information Gaps | X | InformationGaps |
| Other | X | Other |
| Needs Assessment Conducted | 12 | NeedsAssessmentConducted |
| Take Into Account | 1 | TakeIntoAccount |
| Other Facilities | 1 | OtherFacilities |
| CHNA Widely Available | 1 | CHNAWidelyAvailable |
| Own Website | X | OwnWebsite |
| On Request | X | OnRequest |
| Other Method | X | OtherMethod |
| Include Operational Plans | X | IncludeOperationalPlans |
| Adopt Budget | X | AdoptBudget |
| Prioritize Health Needs | X | PrioritizeHealthNeeds |
| Prioritize Services | X | PrioritizeServices |
| All Needs Addressed | 0 | AllNeedsAddressed |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTax |
| Eligibility Criteria Explained | 1 | EligibilityCriteriaExplained |
| Uses FPG Free | 1 | UsesFPGFree |
| FPG Free Percent | 100.000000000000 | FPGFreePercent |
| Uses FPG Discounted | 1 | UsesFPGDiscounted |
| FPG Discount Percent | 200.000000000000 | FPGDiscountPercent |
| Explains Basis | 1 | ExplainsBasis |
| Income Level | X | IncomeLevel |
| Asset Level | X | AssetLevel |
| Medical Indigency | X | MedicalIndigency |
| Uninsured Discount | X | UninsuredDiscount |
| Medicaid Medicare | X | MedicaidMedicare |
| Other Factors | X | OtherFactors |
| Explains Application Method | 1 | ExplainsApplicationMethod |
| Includes Publicity Measures | 1 | IncludesPublicityMeasures |
| Posted On Website | X | PostedOnWebsite |
| Posted In Emergency Room | X | PostedInEmergencyRoom |
| Posted In Admission Office | X | PostedInAdmissionOffice |
| Provided On Admission | X | ProvidedOnAdmission |
| Available On Request | X | AvailableOnRequest |
| Other Publicity | X | OtherPublicity |
| Actions On Nonpayment | 1 | ActionsOnNonpayment |
| Collection Activities | 0 | CollectionActivities |
| Nondiscrim Emergency Care Policy | 1 | NondiscrimEmergencyCarePolicy |
| Lowest Negotiated Rates | X | LowestNegotiatedRates |
| Amounts Generally Billed | 0 | AmountsGenerallyBilled |
| Gross Charges | 0 | GrossCharges |
Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Other Facilities | 2 | NumberOfOtherFacilities |
Other Facilities OtherFacilities (2 entries)
| Address Line1Address/AddressLine1 | CityAddress/City | StateAddress/State | ZIP CodeAddress/ZIPCode | Facility TypeFacilityType |
|---|---|---|---|---|
| SUPERIOR FAMILY MEDICAL CENTER | ||||
| 525 E 11TH ST | SUPERIOR | NE | 68978 | RURAL HEALTH CLINIC |
| NELSON FAMILY MEDICAL CENTER | ||||
| 76 W 8TH ST | NELSON | NE | 68961 | RURAL HEALTH CLINIC |
Form990 Schedule H Part VI Form990ScheduleHPartVI (24 entries)
| ExplanationExplanation | IdentifierIdentifier | Return ReferenceReturnReference |
|---|---|---|
| PART I, LINE 3C: NOT APPLICABLE: FEDERAL POVERTY GUIDELINES ARE USED TO DETERMINE ELIGIBILITY FOR PROVIDING FREE CARE AND DISCOUNTED CARE TO LOW INCOME INDIVIDUALS. | ||
| PART I, LINE 6A: BRODSTONE'S COMMUNITY BENEFIT REPORT IS NOT PREPARED BY A RELATED ORGANIZATION. | ||
| PART I, LINE 7: THE COST TO CHARGE RATIO AS FOLLOWS WAS USED TO DETERMINE CHARITY CARE AND MEANS-TESTED GOVERNMENT PROGRAMS AT COST: (TOTAL EXPENSES - BAD DEBT) / GROSS PATIENT SERVICE REVENUE = PERCENTAGE OF COST TO CHARGE. OTHER COMMUNITY BENEFIT EXPENSES ARE STATED AT COST BASED ON BRODSTONE'S INTERNAL ACCOUNTING RECORDS. | ||
| PART I, LINE 7G: THERE ARE NO COSTS ATTRIBUTABLE TO A PHYSICIAN CLINIC INCLUDED ON LINE 7G. | ||
| PART I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 691737. | ||
| PART II: THERE ARE NO ACTIVITIES REPORTED IN PART II, HOWEVER, BRODSTONE HAS MANY ACTIVITES TO PROMOTE HEALTH IN THE COMMUNITIES SERVED. THESE ACTIVITIES INCLUDE: SPONSOR OF HEALTH FAIR, SUPPORT GROUPS, EDUCATION PROGRAMS, AND MEDICATION ASSISTANCE. THE DONATED SERVICES AND FUNDS HELP FURTHER THE MISSION AND GOALS OF COMMUNITY ORGANIZATIONS WHICH, IN TURN, HELP IMPROVE OVERALL HEALTH STATUS AND QUALITY OF LIFE OF THE COMMUNITIES SERVED. | ||
| PART III, LINE 4: EXPENSES INCLUDE A PROVISION FOR DOUBTFUL ACCOUNTS BAD DEBTS TO ALLOW FOR ESTIMATED UNCOLLECTIBLE ACCOUNTS. THIS PROVISION IS BASED ON PAST EXPERIENCE AND ON ANALYSIS OF CURRENT ACCOUNTS RECEIVABLE. COLLECTIBILITY ACCOUNTS ARE CONSIDERED DELINQUENT BASED ON PASSAGE OF A SPECIFIED PERIOD OF TIME AND CONSIDERATION OF PAYMENT HISTORY. AS A RESULT, THERE IS AT LEAST A REASONABLE POSSIBILITY THAT RECORDED ESTIMATES WILL CHANGE BY A MATERIAL AMOUNT IN THE NEAR TERM. ACCOUNTS DEEMED UNCOLLECTIBLE ARE CHARGED TO THE ALLOWANCE IN THE YEAR THEY ARE DEEMED UNCOLLECTIBLE. THE COSTING METHODOLOGY FOR LINE 2 IS ACTUAL REVENUE WRITTEN OFF AND SENT TO COLLECTIONS. BRODSTONE'S FINANCIAL STATMENTS DO NOT CONTAIN A SPECIFIC FOOTNOTE DESCRIBING BAD DEBT. HOWEVER, THE FOLLOWING IS THE TEXT OF THE FOOTNOTE TITLED "PATIENT RECEIVABLES, NET" AND "CHARITY CARE":"PATIENT RECEIVABLES, NET"THE HOSPITAL REPORTS PATIENT ACCOUNTS RECEIVABLE FOR SERVICES RENDERED AT NET REALIZABLE AMOUNTS FROM THIRD-PARTY PAYERS, PATIENTS AND OTHERS. ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS. IN EVALUATING THE COLLECTIBILITY OF ACCOUNTS RECEIVABLE, THE HOSPITAL ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYER SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYER SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE HOSPITAL ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR BAD DEBTS FOR THOSE ACCOUNTS OVER A CERTAIN AGE BASED ON DISCHARGE THAT MAKE THE REALIZATION OF AMOUNTS DUE UNLIKELY. FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), THE HOSPITAL RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES IF NEGOTIATED) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS.THE HOSPITAL ALSO MAINTAINS A CHARITY CARE POLICY AS DESCRIBED IN NOTE 1(O)."CHARIY CARE": THE HOSPITAL PROVIDES CARE TO PATIENTS WHO MEET CERTAIN CRITERIA UNDER ITS CHARITY CARE POLICY WITHOUT CHARGE OR AT AMOUNTS LESS THAN ITS ESTABLISHED RATES. BECAUSE THE HOSPITAL DOES NOT PURSUE COLLECTION OF AMOUNTS DETERMINED TO QUALIFY AS CHARITY CARE, THEY ARE NOT REPORTED AS REVENUE IN THE STATEMENTS OF OPERATIONS. MANAGEMENT'S DISCLOSURE OF CHARITY CARE COSTS IS DESCRIBED IN NOTE 3.IN ACCORDANCE WITH ITS MISSION OBJECTIVES, THE HOSPITAL PROVIDES FREE CARE TO PATIENTS WHO LACK FINANCIAL RESOURCES TO PAY FOR THE SERVICES THEY RECEIVE. INCLUDED IN THE PROVISION FOR CONTRACTUAL ALLOWANCES IS THE VALUE (AT STANDARD CHARGES) OF THESE SERVICES TO PATIENTS WHO ARE UNABLE TO PAY, THAT IS ELIMINATED FROM NET PATIENT SERVICE REVENUES WHEN IT IS DETERMINED THEY QUALIFY UNDER THE HOSPITAL'S CHARITY CARE POLICY. THE ESTIMATED COST INCURRED BY THE HOSPITAL TO PROVIDE THESE SERVICES TO PATIENTS WHO ARE UNABLE TO PAY WAS APPROXIMATELY $449,000 AND $314,000 FOR THE YEARS ENDED APRIL 30, 2013 AND 2012, RESPECTIVELY. THE ESTIMATED COST OF THESE CHARITY CARE SERVICES WAS DETERMINED USING A RATIO OF COSTS TO GROSS CHARGES AND APPLYING THAT RATIO TO THE GROSS CHARGES ASSOCIATED WITH PROVIDING CARE TO CHARITY PATIENTS FOR THE PERIOD. GROSS CHARGES ASSOCIATED WITH PROVIDING CARE TO CHARITY PATIENTS INCLUDES ONLY THE RELATED CHARGES FOR THOSE PATIENTS WHO ARE FINANCIALLY UNABLE TO PAY AND QUALIFY UNDER THE HOSPITAL'S CHARITY CARE POLICY AND THAT DO NOT OTHERWISE QUALIFY FOR REIMBURSEMENT FROM A GOVERNMENTAL PROGRAM. DURING THE YEARS ENDED APRIL 30, 2013 AND 2012, THE HOSPITAL RECEIVED NO FUNDS TO HELP DEFRAY THE COSTS OF INDIGENT CARE. | ||
| PART III, LINE 8: "MEDICARE ALLOWABLE COSTS OF CARE" WAS CALCULATED FROM INFORMATION IN THE MEDICARE COST REPORT D, E, H & M WORKSHEETS, OR PS&R. THESE COSTS ARE MEDICARE REIMBURSABLE COSTS, NOT ALL COSTS. | ||
| PART III, LINE 9B: PATIENTS WHO QUALIFY FOR MEDICAID WILL AUTOMATICALLY QUALIFY FOR FINANCIAL ASSISTANCE AND MAY QUALIFY FOR MORE IF THEY COMPLETE THE FINANCIAL ASSISTANCE APPLICATION. THESE PATIENTS WILL NOT BE SENT TO COLLECTIONS IF THEY PAY THE AMOUNT FOR WHICH THEY QUALIFY.BRODSTONE'S POLICIES AND PROCEDURES FOR INTERNAL AND EXTERNAL COLLECTION PRACTICES TAKE INTO ACCOUNT THE EXTENT TO WHICH THE PATIENT QUALIFIES FOR CHARITY, A PATIENT'S GOOD FAITH EFFORT TO APPLY FOR A GOVERNMENTAL PROGRAM OR FOR CHARITY FROM THE HOSPITAL, AND A PATIENT'S GOOD FAITH EFFORT TO COMPLY WITH HIS OR HER PAYMENT AGREEMENTS WITH THE HOSPITAL. FOR PATIENTS WHO QUALIFY FOR CHARITY AND WHO ARE COOPERATING IN GOOD FAITH TO RESOLVE THEIR BILLS, BRODSTONE MAY OFFER EXTENDED PAYMENT PLANS TO ELIGIBLE PATIENTS, WILL NOT IMPOSE WAGE GARNISHMENTS OR LIENS, AND WILL NOT SEND UNPAID BILLS TO OUTSIDE COLLECTION AGENCIES AND WILL CEASE ALL COLLECTION EFFORTS. | ||
| PART V, SECTION B, LINE 1J: COMMUNITY HEALTH NEEDS ASSESSMENT SOUTH HEARTLAND'S PROCESSTHE SHDHD MAPP/CHIP PROCESS BEGAN WITH IDENTIFICATION OF CORE PLANNING TEAM MEMBERS WHOSE RESPONSIBILITIES WERE TO REVIEW THE MAPP PROCESS, COMPLETE A READINESS ASSESSMENT, DISCUSS AND DEFINE "COMMUNITY" FOR EACH HOSPITAL, REVIEW STAKEHOLDER CATEGORIES, IDENTIFY STAKEHOLDERS, DETERMINE TIMELINES AND DISCUSS RESOURCES TO IMPLEMENT THE PROCESS. ALL THREE HOSPITALS IN THE DISTRICT COMMITTED TO PARTICIPATE WITH SHDHD IN MAPP AND SIGNED MEMORANDA OF UNDERSTANDING OUTLINING THEIR CONTRIBUTIONS INCLUDING RESOURCES. HOSPITAL ADMINISTRATORS IDENTIFIED STAFF MEMBERS TO PARTICIPATE IN THE CORE TEAM. THIS TEAM WAS ALSO RESPONSIBLE FOR OVERSEEING THE IMPLEMENTATION AND MANAGEMENT OF THE PROCESS. THE CORE TEAM INCLUDED EIGHT MEMBERS: HOSPITAL ADMINISTRATORS AND/OR APPOINTED STAFF FROM BRODSTONE MEMORIAL HOSPITAL, MARY LANNING HEALTHCARE, WEBSTER COUNTY COMMUNITY HOSPITAL, CLAY COUNTY HEALTH DEPARTMENT DIRECTOR, SHDHD BOARD OF HEALTH PRESIDENT, AND SHDHD DIRECTOR. THE FIRST PLANNING MEETING WAS HELD SEPTEMBER 2, 2011. THE ASSESSMENT PHASE CONSISTED OF IMPLEMENTING ALL FOUR OF THE MAPP ASSESSMENTS AND WAS CARRIED OUT, WITH ASSISTANCE FROM A CONTRACTED FACILITATOR, DURING THE PERIOD OF OCTOBER 1, 2011 AUGUST 30, 2012. FOLLOWING THE ASSESSMENT PHASE, THE COMMUNITY (VIA STAKEHOLDER WORK GROUPS) IDENTIFIED STRATEGIC ISSUES AND FORMULATED GOALS AND STRATEGIES FOR ADDRESSING EACH ISSUE. COMMUNITY STAKEHOLDERS COLLABORATED IN A FACILITATED DEVELOPMENT OF A COMMUNITY (DISTRICT-WIDE) HEALTH IMPROVEMENT PLAN (CHIP). IN 2013 AND BEYOND, WORK GROUPS FOR EACH PRIORITY WILL MOVE THE PLAN COMPONENTS INTO THE ACTION PHASE (CHIP IMPLEMENTATION), WITH OVERSIGHT AND EVALUATION PLANNING FROM THE MAPP/CHIP CORE TEAM, WHICH WILL CONTINUE TO MEET 1-2 TIMES A YEAR FOR THE DURATION OF THE CHIP. BRODSTONE SELECTED A CORE TEAM TO BE INVOLVED WITH THE PROCESS. KAREN TINKHAM, ADMINISTRATIVE ASSISTANT, KORI FIELD, DIRECTOR OF NURSING AND MICHELL HARRIS, REGISTERED NURSE, WERE SELECTED AS BRODSTONE'S REPRESENTATIVES. THESE REPRESENTATIVES REPORTED DIRECTLY TO BRODSTONE'S ADMINISTRATIVE TEAM, THE TEAM RESPONSIBLE FOR THE NEEDS ASSESSMENT AND THE IMPLEMENTATION STRATEGY.THE CHNA ALSO INCLUDED BRODSTONE MEMORIAL HOSPITAL'S ACTION PLAN ALONG WITH THE IMPLEMENTATION STRATEGY, TIME FRAME, AND RESPONSIBLE PARTY. | BRODSTONE MEMORIAL HOSPITAL | |
| PART V, SECTION B, LINE 3: MOBILIZING FOR ACTION THROUGH PLANNING AND PARTNERSHIPS (MAPP) IS A STRATEGIC APPROACH TO COMMUNITY HEALTH IMPROVEMENT. SOUTH HEARTLAND DISTRICT HEALTH DEPARTMENT (SHDHD) USED THIS TOOL TO FACILITATE THE 4-COUNTY HEALTH DISTRICT IN EFFORTS TO IMPROVE HEALTH AND QUALITY OF LIFE THROUGH COMMUNITY-WIDE AND COMMUNITY-DRIVEN STRATEGIC PLANNING. THIS PROCESS HELPED THE DISTRICT IDENTIFY AND PLAN THE USE OF RESOURCES TAKING INTO ACCOUNT THE UNIQUE CIRCUMSTANCES AND NEEDS OF THE DISTRICT AND THE INDIVIDUAL COMPONENT COUNTIES. IT ALSO PROMOTED NEW AND SOLIDIFIED EXISTING PARTNERSHIPS IN OUR COMMUNITIES AND ACROSS THE DISTRICT. THE MAPP ASSESSMENT PROCESS LEADS TO THE DEVELOPMENT OF A COMMUNITY-WIDE HEALTH IMPROVEMENT PLAN (CHIP), WHICH CAN ONLY BE ADOPTED AND REALISTICALLY IMPLEMENTED IF THE COMMUNITY HAS CONTRIBUTED TO THE PLAN DEVELOPMENT. SHDHD WORKED TO ENSURE PARTICIPATION BY A BROAD CROSS SECTION OF THE DISTRICT INVITING REPRESENTATIVES FROM MANY SECTORS OF OUR COMMUNITIES. IN ADDITION, MAPP ALSO SUPPORTS ORGANIZATIONAL ACTION PLAN DEVELOPMENT BY EACH OF THE PARTICIPATING ENTITIES INCLUDING THE KEY HOSPITAL PARTNERS FOR THEIR SERVICE AREAS.THROUGH THE MAPP PROCESS, THE SOUTH HEARTLAND DISTRICT CONTINUED TO STRENGTHEN THE LOCAL PUBLIC HEALTH SYSTEM. WE DEFINED THE LOCAL PUBLIC HEALTH SYSTEM AS ALL OF THE ENTITIES THAT CONTRIBUTE TO THE DELIVERY OF PUBLIC HEALTH SERVICES WITHIN OUR COMMUNITIES. THIS INCLUDED PUBLIC AND PRIVATE ENTITIES, CIVIC AND FAITH-BASED ORGANIZATIONS, INDIVIDUALS, INFORMAL ASSOCIATIONS, FRONT-LINE AND GRASSROOTS WORKERS AND POLICY MAKERS. USING MAPP AS THE FRAMEWORK FOR THE COMMUNITY NEEDS ASSESSMENT ALLOWED SHDHD TO FOCUS ON THE 10 ESSENTIAL SERVICES OF PUBLIC HEALTH TO DEFINE WHO IS RESPONSIBLE FOR THE COMMUNITY'S HEALTH AND WELL-BEING.THE 10 ESSENTIAL PUBLIC HEALTH SERVICES ARE:1. MONITOR HEALTH STATUS TO IDENTIFY COMMUNITY HEALTH PROBLEMS. 2. DIAGNOSE AND INVESTIGATE HEALTH PROBLEMS AND HEALTH HAZARDS IN THE COMMUNITY.3. INFORM, EDUCATE, AND EMPOWER PEOPLE ABOUT HEALTH ISSUES.4. MOBILIZE COMMUNITY PARTNERSHIPS TO IDENTIFY AND SOLVE HEALTH PROBLEMS.5. DEVELOP POLICIES AND PLANS THAT SUPPORT INDIVIDUAL AND COMMUNITY HEALTH EFFORTS.6. ENFORCE LAWS AND REGULATIONS THAT PROTECT HEALTH AND ENSURE SAFETY.7. LINK PEOPLE TO NEEDED PERSONAL HEALTH SERVICES AND ASSURE THE PROVISION OF HEALTH CARE WHEN OTHERWISE UNAVAILABLE.8. ASSURE A COMPETENT PUBLIC HEALTH AND PERSONAL HEALTH CARE WORKFORCE.9. EVALUATE EFFECTIVENESS, ACCESSIBILITY, AND QUALITY OF PERSONAL AND POPULATION-BASED HEALTH SERVICES.10. RESEARCH FOR NEW INSIGHTS AND INNOVATIVE SOLUTIONS TO HEALTH PROBLEMS.IN THIS MODEL, THE PHASES OF THE PROCESS ARE DIAGRAMED IN THE CENTER. THE ENTIRE PROCESS IS INFORMED BY DATA AND THE FOUR ASSESSMENTS THAT PRODUCE THESE DATA ARE SHOWN IN THE ARROWS AROUND THE OUTSIDE. THE PHASES OF THE MAPP PROCESS ARE: ORGANIZING/PARTNERSHIP DEVELOPMENT, VISIONING, ASSESSMENT, IDENTIFYING STRATEGIC ISSUES, FORMULATING GOALS AND STRATEGIES, AND THE ACTION CYCLE FOR THE RESULTING COMMUNITY HEALTH IMPROVEMENT PLAN (CHIP). | BRODSTONE MEMORIAL HOSPITAL | |
| PART V, SECTION B, LINE 4: BRODSTONE'S CHNA WAS CONDUCTED WITH WEBSTER COUNTY COMMUNITY HOSPITAL AND MARY LANNING MEMORIAL HEALTHCARE. | BRODSTONE MEMORIAL HOSPITAL | |
| PART V, SECTION B, LINE 5C: COPIES OF THE CHNA REPORT IS AVAILABLE AT ADMISSIONS. | BRODSTONE MEMORIAL HOSPITAL | |
| PART V, SECTION B, LINE 7: THE MAJORITY OF THE ACTION NEEDED TO BE ADDRESSED IN THE CATEGORIES OF CANCER, MENTAL HEALTH AND SUBSTANCE ABUSE FALL OUT OF THE SCOPE OF EXPERTISE AND RESOURCES OF THE HOSPITAL. | BRODSTONE MEMORIAL HOSPITAL | |
| PART V, SECTION B, LINE 10: BRODSTONE MEMORIAL HOSPITAL REQUIRES A FINANCIAL ASSISTANCE FORM TO BE COMPLETED BEFORE DETERMINING THE AMOUNT OF ASSISTANCE FOR WHICH THE PERSON IS ELIGIBLE. THE HOUSEHOLD INCOME AND NET WORTH ARE USED TO DETERMINE THE AMOUNT USING FEDERAL POVERTY GUIDELINES. PATIENTS ARE ELIGIBLE FOR 100% FREE CARE IF AT OR BELOW THE FEDERAL POVERTY LEVEL. | BRODSTONE MEMORIAL HOSPITAL | |
| PART V, SECTION B, LINE 11: BRODSTONE MEMORIAL HOSPITAL REQUIRES A FINANCIAL ASSISTANCE FORM BE COMPLETED BEFORE DETERMING THE AMOUNT OF ASSISTANCE FOR WHICH THE PERSON IS ELIGIBLE. THE HOUSEHOLD INCOME AND NET WORTH ARE USED TO DETERMINE THE AMOUNT OF DISCOUNTED CARE USING THE FEDERAL POVERTY GUIDELINES. PATIENTS ARE ELIGIBLE FOR UP TO 80% DISCOUNTED CARE AT 200% OF THE FEDERAL POVERTY LEVEL. | BRODSTONE MEMORIAL HOSPITAL | |
| PART V, SECTION B, LINE 12H: BRODSTONE MEMORIAL HOSPITAL USES THE COST OF SUPPLIES, SALARIES, AND OTHER EXPENSES TO DETERMINE BRODESTONE'S CHARGES TO PATIENTS. BRODSTONE PERIODICALLY USES CHARGEMASTER REVIEWS FOR REVIEW OF CHARGES. | BRODSTONE MEMORIAL HOSPITAL | |
| PART V, SECTION B, LINE 14G: BRODSTONE MEMORIAL HOSPITAL POSTS THE WRITTEN FINANCIAL ASSISTANCE POLICY ON ITS WEBSITE, HAS BROCHURES AVAILABLE WHERE PATIENTS ARE ADMITTED, INCLUDES THE POLICY IN PATIENT HANDBOOKS, AND SENDS THE POLICY TO PATIENTS UPON REQUEST. | BRODSTONE MEMORIAL HOSPITAL | |
| PART VI, LINE 2: BRODSTONE ASSESSES THE HEALTH CARE NEEDS OF THE COMMUNITY IT SERVES THROUGH A SURVEY. THE BUDGETING PROCESS PUBLISHES SUGGESTIONS AND STRATEGIC PLANNING. HOSPITAL STAFF ALSO NETWORKS WITH OTHER HEALTH CARE ORGANIZATIONS TO DEVELOP IDEAS OF WHAT WE CAN DO TO IMPROVE THE AVAILABILITY OF SERVICES IN OUR COMMUNITY. | ||
| PART VI, LINE 3: BRODSTONE HAS A BROCHURE CALLED CHARITY POLICY THAT ADDRESSESS OUR FINANCIAL ASSISTANCE AVAILABILITY. IT IS POSTED AT OUR ADMISSIONS AREAS AND EMERGENCY ROOM. THE CHARITY POLICY IS DISCUSSED WHEN MAKING PAYMENT ARRANGEMENTS. | ||
| PART VI, LINE 4: SUPERIOR HAS A POPULATION OF 1,959 AND IS LOCATED ON THE NEBRASKA-KANSAS BORDER. BRODSTONE'S SERVICE AREA COVERS ALL OF NUCKOLLS COUNTY AND PARTS OF 2 OTHER COUNTIES IN NEBRASKA AND 3 COUNTIES IN KANSAS. THE MEDIAN HOUSEHOLD INCOME FOR NUCKOLLS COUNTY IS $27,948 COMPARED TO THE U.S. AVERAGE AT $50,221 AND THE NEBRASKA AVERAGE OF $47,357. THE AREA POPULATION IS PREDOMINATELY WHITE ELDERLY AND LOW INCOME. 74 OF THE HOSPITAL'S PATIENTS ARE MEDICARE PATIENTS. | ||
| PART VI, LINE 5: BRODSTONE'S GOVERNING BODY CONSISTS OF 2 MEN AND 4 WOMEN WITH NO IMMEDIATE FAMILY TIES TO ANY EMPLOYEE NOR ARE THEY CONTRACTORS OF OUR ORGANIZATION. ALL BOARD MEMBERS ARE RESIDENTS OF NUCKOLLS COUNTY, NE. ALL FAMILY PRACTICE PHYSIANS AND MIDLEVELS IN OUR AREA WHO HAVE REQUESTED MEDICAL STAFF PRIVILEGES AND MEET THE REQUIREMENTS HAVE PRIVILIGES AT THE HOSPITAL. TWO DENTISTS HAVE COURTESY PRIVELEGES. ALL SURPLUS FUNDS OF THE ORGANIZATION ARE USED TO FUND THE BUDGET FOR THE COMING YEARS OR SET ASIDE FOR FUTURE PROJECTS. | ||
| PART VI, LINE 6: BRODESTONE MEMORIAL HOSPITAL IS NOT PART OF AN AFFILIATED HEALTH CARE SYSTEM. | ||
| BRODSTONE DOES NOT FILE A COMMUNITY BENEFIT REPORT WITH ANY STATE. | PART VI, LINE 7: |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Club Dues Or Fees | X | ClubDuesOrFees |
| Written Policy Re T And E Expenses | 1 | WrittenPolicyReTAndEExpenses |
| Substantiation Required | 1 | SubstantiationRequired |
| Written Employment Contract | X | WrittenEmploymentContract |
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | 0 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 0 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 1 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 0 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 0 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 0 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (5 entries)
| TitleTitle | Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| JOHN KEELAN | ||||||||||||||
| CEO | 183680 | 0 | 3500 | 0 | 0 | 0 | 5798 | 0 | 21699 | 0 | 214677 | 0 | 0 | 0 |
| TIMOTHY BLECHA | ||||||||||||||
| MEDICAL STAFF DIRECTOR | 188618 | 0 | 84003 | 0 | 0 | 0 | 7500 | 0 | 29690 | 0 | 309811 | 0 | 0 | 0 |
| JULIE THEIS | ||||||||||||||
| PHYSICIAN | 177643 | 0 | 0 | 0 | 0 | 0 | 5628 | 0 | 27524 | 0 | 210795 | 0 | 0 | 0 |
| ROBERT LEIBEL | ||||||||||||||
| PHYSICIAN | 170149 | 0 | 0 | 0 | 0 | 0 | 5296 | 0 | 27086 | 0 | 202531 | 0 | 0 | 0 |
| JASON HASS | ||||||||||||||
| PHYSICIAN ASSISTANT | 112021 | 0 | 6062 | 0 | 0 | 0 | 3794 | 0 | 28778 | 0 | 150655 | 0 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII (2 entries)
| Return ReferenceReturnReference | ExplanationExplanation |
|---|---|
| PART I, LINE 1A | JOHN KEELAN, CEO, IS PROVIDED THE LOCAL COUNTRY CLUB MEMBERSHIP |
| PART I, LINE 5 | IN ACCORDANCE WITH RELATED EMPLOYMENT CONTRACTS, ADDITIONAL COMPENSATION IS PAID BASED ON REVENUES GENERATED BY EACH MEDICAL PROVIDER, AS DEFINED. THESE ADDITIONAL AMOUNTS HAVE BEEN LISTED AS INCENTIVE COMPENSATION IN PART II OF THIS SCHEDULE |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (6 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| FORM 990, PART VI, SECTION B, LINE 11 | THE FORM 990 IS PREPARED BY AN OUTSIDE ACCOUNTING FIRM. BEFORE IT IS FILED, IT IS GIVEN A DETAILED REVIEW BY MANAGEMENT AND THEN A GENERAL REVIEW BY THE BOARD OF DIRECTORS AT A REGULARLY SCHEDULED BOARD MEETING. A FINAL COPY OF THE FORM 990 WILL BE ELECTRONICALLY FILED AFTER APPROVAL. | |
| FORM 990, PART VI, SECTION B, LINE 12C | BOARD MEMBERS WHO HAVE A CONFLICT OF INTEREST WOULD REFRAIN FROM DISCUSSION AND VOTING ON THOSE MATTERS. THERE IS AN ANNUAL BOARD MEMBER TRAINING THAT COVERS THIS POLICY. ADDITIONALLY, ALL BOARD MEMBERS ARE WELL ACQUAINTED WITH EACH OTHER SO IF THERE WAS A CONFLICT OF INTEREST AND THE BOARD MEMBER DID NOT DISCLOSE, THE OTHER BOARD MEMBERS WOULD BRING IT TO THE BOARD'S ATTENTION. | |
| FORM 990, PART VI, SECTION B, LINE 15 | THE HR DIRECTOR PREPARES A SALARY SURVEY ANNUALLY FOR ALL JOBS DESCRIPTIONS WITH HOSPITALS OF SIMILAR SIZE AND REVENUES. THE BOARD OF DIRECTORS REVIEWS THE SURVEY AND PRIOR SALARY INCREASES FOR THE CEO BEFORE GRANTING PAY INCREASES. THE HR DIRECTOR AND CFO MAKE RECOMMENDATIONS TO THE CEO FOR OTHER EMPLOYEES. THE CEO REVIEWS THE SURVEY, PRIOR SALARY INCREASES, AND RECOMMENDATIONS BEFORE APPROVING PAY INCREASES FOR EMPLOYEES. THE PAY INCREASES ARE APPROVED BY THE BOARD OF DIRECTORS DURING THE BUDGET PROCESS. | |
| FORM 990, PART VI, SECTION C, LINE 19 | GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE NOT MADE AVAILABLE TO THE PUBLIC. | |
| FORM 990, PART XI, LINE 9: | CHANGE IN BENEFICIAL INTEREST IN TRUSTS 1,526,849. | CHANGES IN NET ASSETS OR FUND BALANCES: |
| FORM 990, PART XII, LINE 2C: | THE BOARD OF DIRECTORS IS RESPONSIBLE FOR THE OVERSIGHT OF THE AUDIT AND THE SELECTION OF THE INDEPENDENT AUDITOR. THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. |