2012-11-27T08:37:15-06:00 2012-04-30 DOHMAN AKERLUND & EDDY LLC PO BOX 470 AURORA NE 688180470 990 2011-05-01 470388012 BRODSTONE MEMORIAL HOSPITAL BROD 4028793281 520 EAST 10TH STREET SUPERIOR NE 689781225 JOHN KEELAN 4028793281 2012-11-12 true SONJA A CATTAU 4026946404 2012-11-12 2011 2016-02-24 21:20:13Z JOHN KEELAN 520 EAST 10TH STREET SUPERIOR NE 689781225 19697398 false X WWW.BRODSTONEHOSPITAL.ORG X 1927 NE 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. 6 6 212 0 646043 553137 18193410 19052036 -62663 52949 0 18776790 19658122 0 0 10228809 10730012 0 0 7849094 7960668 18077903 18690680 698887 967442 20547524 23510397 9591825 11592140 10955699 11918257 X 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. false false 18690680 BRODSTONE MEMORIAL HOSPITAL 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. 18690680 true true false false false false false false false true true false false true true false true false false false false false false false false false true true false false true false false false false true false false false false false false false false false false false false false true 30 0 212 true false false false false false false false false false false X 6 6 false false false false false false false true true false false true true true true true true true true false X X SANDRA J BORDEN CFO 4028793281 520 EAST TENTH STREET SUPERIOR NE 68978 KATHY ESSINK 2.00 X X 0 0 0 LYNN CULBERTSON 2.00 X 0 0 0 JUDY GROVE 2.00 X 0 0 0 LANE HAWLEY 2.00 X X 0 0 0 ROBERT TRAPP 2.00 X X 0 0 0 JULIE SIMONSEN 2.00 X X 0 0 0 JOHN KEELAN 40.00 X 176910 0 21366 SANDRA BORDEN 40.00 X 117343 0 19895 KORI FIELD 40.00 X 73930 0 23306 TIMOTHY BLECHA 40.00 X 272753 0 31391 JULIE THEIS 40.00 X 190883 0 26849 ROBERT LEIBEL 40.00 X 168241 0 28256 JASON HASS 40.00 X 112599 0 26586 1112659 177649 6 false true false PRAIRIE WINDS ANESTHESIA LLC 2551 Z ROAD WEBBER KS 66970 CRNA SERVICES 181837 13 8631 544506 553137 NET PATIENT SERVICE REVENUE 18407812 18407812 EHR INCENTIVE 285723 285723 340B PROGRAM 269836 269836 CAFETERIA 44521 44521 MISCELLANEOUS 43301 43301 843 843 19052036 60306 60306 31919 39276 -7357 -7357 -7357 19658122 18400455 704530 8229851 8229851 200831 200831 1731893 1731893 567437 567437 28137 28137 43702 43702 485604 485604 498790 498790 1468499 1468499 186957 186957 SUPPLIES, FEES & PURCH SE 4062464 4062464 PROVISION FOR BAD DEBTS 547408 547408 DATA PROCESSING 298391 298391 ADMINISTRATIVE EXPENSES 170787 170787 169929 169929 18690680 18690680 0 0 1721238 3026962 363641 886650 2999529 3610303 228705 222871 206126 437068 23035706 9750385 14238285 13285321 295370 790000 1745852 20547524 23510397 2410010 1361802 7075554 9918868 106261 311470 9591825 11592140 X 10334594 11500271 621105 417986 10955699 11918257 20547524 23510397 967442 -4884 X false true true X false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false 1403603 -8174 1395429 1294935 108665 1403600 1098170 196765 1294935 1.00000 true false false 117890 117890 13718637 3980519 9738118 427780 195150 232630 8771399 5574716 3196683 13285321 ESTIMATED CONTRACTUAL SETTLEMENT REC 1416126 OTHER ACCOUNTS RECEIVABLE 305844 DEFERRED FINANCING COSTS, NET 23882 1745852 DEFERRED REVENUE 311470 DUE TO THIRD PARTY PAYORS 311470 19658122 18690680 967442 967442 19658122 19658122 19658122 18690680 18690680 18690680 INTENDED USES FOR ENDOWMENT FUNDS SCHEDULE D, PAGE 2, PART V, LINE 4 INTEREST EARNINGS MAY BE USED FOR OPERATIONS, HOWEVER THE PRINCIPAL IS TO BE MAINTAINED AS A PERMANENT ENDOWMENT. true true X true X true X true true true false false 260457 7469 252988 0.01390 7794 7794 0.00040 268251 7469 260782 0.01430 15 13011 2229 10782 0.00060 1 3000 3000 0.00020 8 115225 55718 59507 0.00330 1 650 650 25 131886 57947 73939 0.00410 25 400137 65416 334721 0.01840 65700 655 65045 0.00360 70609 70609 0.00390 136309 655 135654 0.00750 true 523990 100327 9877150 9840016 37134 X true true 1 1 BRODSTONE MEMORIAL HOSPITAL

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X X X X BRODSTONE MEMORIAL HOSPITAL 1 false true true 100.0 true 200.0 true X X X X X true true X X X X X X true X X X true X X X X X X X true X false false 3 SUPERIOR FAMILY MEDICAL CENTER

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RURAL HEALTH CLINIC NELSON FAMILY MEDICAL CENTER

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RURAL HEALTH CLINIC EDGAR FAMILY MEDICAL CENTER

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RURAL HEALTH CLINIC EXCLUSIONS FROM PERCENT OF TOTAL EXPENSE PART I LINE 7 COLUMN F 547408 BAD DEBT EXPENSE WAS EXCLUDED FROM PERCENT OF TOTAL EXPENSE COMMUNITY BUILDING ACTIVITIES PART II BRODSTONE MEMORIAL HOSPITAL SOCIAL SERVICES DEPARTMENT ASSISTS LOW INCOME CITIZENS AND PATIENTS WITHOUT HEALTH INSURANCE WITH FILING FOR MEDICAID BENEFITS SOCIAL SECURITY DISABILITY PCIP INSURANCE AND OTHER BENEFITS THAT THE PERSON MAY BE ELIGIBLE FOR BUT ARE NOT CAPABLE OF FILING THE NECESSARY FORMS THEMSELVES BAD DEBT EXPENSE EXPLANATION 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 RESONABLE 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 COSTING METHODOLOGY FOR LINE 2 IS ACTUAL REVENUE WRITTEN OFF AND SENT TO COLLECTION MULTIPLIED BY THE OVERALL COSTCHARGE RATIO PER THE FINANCIAL STATEMENTS COSTING METHODOLOGY FOR LINE 3 IS ACTUAL REVENUE WRITTEN OFF ESTIMATED FROM A REVIEW OF DEMOGRAPHICS AND THEN MULTIPLIED BY THE OVERALL COSTCHARGE RATIO PER THE FINANCIAL STATEMENTS MEDICARE EXPLANATION PART III LINE 8 THE MEDICARE SHORTFALL SHOULD BE TREATED AS A COMMUNITY BENEFIT BECUASE OTHER AGENCIES DONT HAVE TO SUBSIDIZE MEDICAL CARE AND THE MEDICAL CARE IMPROVES QUALITY OF LIFE TO PATIENTS COLLECTION PRACTICES EXPLANATION PART III LINE 9B PATIENTS WHO QUALIFY FOR MEDICAID WILL AUTOMATICALLY QUALIFY FOR 20 FINANCIAL ASSISTANCE AND MAY QUALIFY FOR MORE IF THEY FILL OUT THE FINANCIAL ASSISTANCE APPLICATION THESE PATIENTS WILL NOT BE SENT TO COLLECTIONS IF THEY PAY THE THEY QUALIFY FOR NEEDS ASSESSMENT PART VI BRODSTONE ASSESSES THE HEALTH CARE NEEDS OF THE COMMUNITY IT SERVES THROUGH SURVEY THE BUDGETING PROCESS PUBLICH 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 PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE PART VI BRODSTONE HAS A BROCHURE CALLED CHARITY POLICY THAT ADDRESSESS OUR FINANCIAL ASSISTANCE AVAILABILITY AND IT IS POSTED AT OUR ADMISSIONS AREAS AND EMERGENCY ROOM THE CHARITY POLICY IS DISCUSSED WHEN MAKING PAYMENT ARRAGEMENTS COMMUNITY INFORMATION PART VI SUPERIOR HAS A POPULATION OF 2055 AND IS LOCATED ON THE NEKS BORDER BRODSTONES 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 31761 COMPARED TO THE US AVERAGE AT 51914 AND THE NEBRASKA AVERAGE OF 49342 THE AREA POPULATION IS PREDOMINATELY WHITE ELDERLY AND LOW INCOME 74 OF THE HOSPITALS PATIENTS ARE MEDICARE PATIENTS HEALTH OF COMMUNITY IN RELATION TO EXEMPT PURPOSE PART VI BRODSTONES 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 PHYSICIANS AND MIDLEVELS IN OUR AREA WHO HAVE REQUESTED MEDICAL STAFF PRIVILEGES AND MEET THE REQUIREMENTS HAVE PREVILEGES 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 BRODSTONE MEMORIAL HOSPITAL LINE NUMBER 1 PART V LINE 13G PART V LINE 13G ACCOUNT COLLECTORS INFORM THE PATIENT THAT THEY MIGHT BE ELIGIBLE FOR FINANCIAL ASSISTANCE BRODSTONE MEMORIAL HOSPITAL LINE NUMBER 1 PART V LINE 15E PART V LINE 15E REFER TO COLLECTION AGENCY BRODSTONE MEMORIAL HOSPITAL LINE NUMBER 1 PART V LINE 16E PART V LINE 16E GARNISHMENT OF WAGES AND LIEN ON BANK ACCOUNT X true true X X X false false false true false false false false false JOHN KEELAN 176910 21366 198276 172755 TIMOTHY BLECHA 188750 84003 31391 304144 277097 JULIE THEIS 185978 4905 26849 217732 195282 ROBERT LEIBEL 168241 28256 196497 188805 FRINGE OR EXPENSE EXPLANATION SCHEDULE J, PAGE 1, PART I, LINE 1A JOHN KEELAN, CEO, IS PROVIDED THE LOCAL COUNTRY CLUB MEMBERSHIP. COMPENSATION CONTINGENT UPON REVENUES OF ORGANIZATION SCHEDULE J, PAGE 1, PART I, LINE 5A 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. SPENSOR TRAPP SON OF BOD PRESIDENT 1000 SCHOLARSHIP ORGANIZATION'S MISSION FORM 990 - ORGANIZATION'S MISSION 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. ORGANIZATION'S PROCESS USED TO REVIEW FORM 990 FORM 990, PAGE 6, PART VI, LINE 11B A FINAL COPY OF FORM 990, AS WILL BE ELECTRONICALLY FILED, WAS REVIEWED BY ALL VOTING MEMBERS OF THE BOARD. THIS REVIEW WAS COMPLETED AT A REGULAR BOARD MEETING BEFORE THIS RETURN WAS ELECTRONICALLY FILED. A DETAIL REVIEW WAS DONE BY MANAGEMENT AND THEN A GENERAL REVIEW WAS DONE BY THE BOARD. ENFORCEMENT OF CONFLICTS POLICY FORM 990, PAGE 6, PART VI, 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 MEMBER DID NOT DISCLOSE, THE OTHER BOARD MEMBERS WOULD BRING IT TO THE BOARD'S ATTENTION. COMPENSATION PROCESS FOR TOP OFFICIAL FORM 990, PAGE 6, PART VI, LINE 15A THE HR DIRECTOR PREPARES A SALARY SURVEY ANNUALLY FOR ALL JOB 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. COMPENSATION PROCESS FOR OFFICERS FORM 990, PAGE 6, PART VI, LINE 15B THE HR DIRECTOR PREPARES A SALARY SURVEY ANNUALLY FOR ALL JOB DESCRIPTIONS WITH HOSPITALS OF SIMILAR SIZE AND REVENUES. THE HR DIRECTOR AND CFO MAKE RECOMMENDATIONS TO THE CEO. 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. GOVERNING DOCUMENTS DISCLOSURE EXPLANATION FORM 990, PAGE 6, PART VI, LINE 19 GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE NOT MADE AVAILABLE TO THE PUBLIC.