2024-11-12T12:17:59-06:00 2023-12-31 390758449 WIPFLI LLP 1502 LONDON ROAD SUITE 200 DULUTH MN 55812 990 2023-01-01 470566524 PROVIDENCE MEDICAL CENTER PROV 4023753800 1200 PROVIDENCE RD WAYNE NE 68787 BRUCE CRAVEN CFO 4023753800 2024-11-11 1 0 MICHAEL J PETERSON CPA P01833529 2187224705 2024-11-11 2023 2024-10-15 13:58:12Z BRUCE CRAVEN 1200 PROVIDENCE RD WAYNE NE 68787 32401494 0 X WWW.PROVIDENCEMEDICAL.COM X 1975 NE SEE SCHEDULE O. 7 7 215 30 0 0 1206415 166164 27622182 30766177 -24767 428694 180244 200772 28984074 31561807 6723 880 0 0 13945826 13747010 0 0 0 14993725 16867461 28946274 30615351 37800 946456 47729681 50617441 17020880 18307365 30708801 32310076 THE MISSION OF PROVIDENCE MEDICAL CENTER IS TO PROVIDE QUALITY HEALTH CARE IN THE SPIRIT OF CHRIST. 0 0 24322633 880 30766661 PROVIDENCE MEDICAL CENTER IS A NOT-FOR-PROFIT, 21 BED, CRITICAL ACCESS HOSPITAL LOCATED IN WAYNE, NEBRASKA. PROVIDENCE SERVES OVER 15,000 AREA RESIDENTS IN NORTHEAST NEBRASKA AND EMPLOYS OVER 219 PEOPLE. PROVIDENCE OFFERS ACUTE, SKILLED, AND OBSTETRICAL CARE ALONG WITH 24 HOURS A DAY, SEVEN DAYS A WEEK EMERGENCY CARE AND AMBULANCE SERVICES. THE HOSPITAL ALSO PROVIDES DIAGNOSTIC IMAGING, SURGICAL, THERAPY, LABORATORY, ONCOLOGY, RESPIRATORY, HOME HEALTH, BEHAVIORAL HEALTH AND MANY OTHER HEALTH AND WELLNESS SERVICES. THERE ARE OVER 30 SPECIALTY CLINIC DOCTORS OF DIFFERENT SPECIALTIES THAT CONDUCT CLINICS AT THE HOSPITAL IN ORDER TO BRING SPECIALIZED CARE TO THE COMMUNITY. 24322633 1 1 0 1 0 0 0 0 0 1 1 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 56 0 215 1 0 0 0 0 0 0 0 0 0 0 0 0 X 7 7 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 1 1 0 NE X BRUCE CRAVEN 4023753800 1200 PROVIDENCE RD WAYNE NE 68787 RICHARD BRANDOW CHAIR 1.00 X X 0 0 0 MATTHEW LEY VICE CHAIR 1.00 X X 0 0 0 ERIC KNUTSON SECRETARY/TREASURER 1.00 X X 0 0 0 STEVEN ELLIOTT DIRECTOR (TERM 12/04/23) 1.00 X 0 0 0 MELISSA GRAHAM DIRECTOR 1.00 X 0 0 0 ROSS HANSEN DIRECTOR 1.00 X 0 0 0 JODI PULFER DIRECTOR 1.00 X 0 0 0 NATHAN RAABE DIRECTOR (TERM 12/31/23) 1.00 X 0 0 0 KIMBERLY HIXSON CFO 40.00 X 138600 0 7998 DANIELLE GEARHART CEO 40.00 X 224471 0 33242 KIMBERLY LUEDERS DIRECTOR OF PHARMACY 40.00 X 166162 0 9098 CASSANDRA KORTH RETAIL PHARMACY COORDINATOR 40.00 X 124422 0 6379 ANDREA BLECKE DIRECTOR OF THERAPY 40.00 X 115497 0 19471 NICOLE HAGLUND VP OF NURSING 40.00 X 112606 0 37008 881758 0 113196 6 0 1 0 FAITH REGIONAL PHYSICIAN SERVICES LLC 110 NORTH 29TH STREET SUITE 201 NORFOLK NE 68701 ER OB AND C-SECTION DOCTOR COVERAGE 653391 T AND D ANESTHESIA LLC 13606 SOUTH 226TH AVENUE GRETNA NE 68028 CRNA SERVICES 605000 PSYCHIATRIC MEDICAL CARE LLC 8 CADILLAC DRIVE 230 BRENTWOOD TN 37027 SENIOR LIFE PSYCHIATRIC DOCTORS 409797 MOMENTA PAIN CARE 1805 N 145TH ST OMAHA NE 68154 ANESTHESIA SERVICES 188000 MEDUIT HEALTH SERVICES 200 14TH AVENUE EAST SARTELL MN 56377 HEALTHCARE REVENUE CYCLE MANAGEMENT 147176 8 166164 166164 PATIENT SERVICE REVENUE 621990 28205518 28205518 PHARMACY 621990 2324956 2324956 FITNESS REVENUE 621990 192057 192057 DIETARY INCOME 900099 43646 43646 30766177 335936 335936 200772 0 200772 200772 200772 908905 23540 839687 0 69218 23540 92758 92758 31561807 30766177 0 629466 X 880 880 404311 404311 10483512 8900154 1583358 356850 295770 61080 1743937 1412805 331132 758400 604933 153467 30925 30925 29033 1939 27094 73458 73458 2431 2431 3620562 3011272 609290 207266 1273 205993 300091 176313 123778 1234498 81203 1153295 499129 499115 14 60596 59677 919 96085 56476 39609 314807 228658 86149 3170512 2302877 867635 265266 265266 SUPPLIES AND PHARMACEUT 5198938 5178197 20741 EQUIPMENT RENTAL & MAIN 841431 647160 194271 PROVISIONS FOR BAD DEBT 835968 835968 86465 27963 58502 30615351 24322633 6292718 0 671114 1712153 3486828 3661760 4133031 4562308 732382 673167 336478 340465 58788932 26937265 29684260 31851667 6507886 6552894 290602 291719 1887100 971308 47729681 50617441 2627823 2408135 73410 57028 14098195 15064200 221452 778002 17020880 18307365 X 29967124 31493479 741677 816597 30708801 32310076 47729681 50617441 X 946456 579899 74920 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 2431 2431 0 PART II-B, LINE 1: PROVIDENCE MEDICAL CENTER ("PMC") PAYS ANNUAL ASSOCIATION MEMBERSHIP DUES TO THE NEBRASKA HOSPITAL ASSOCIATION (NHA) AND THE AMERICAN HOSPITAL ASSOCIATION (AHA). THESE DUES ARE PRIMARILY TO ACCESS EDUCATIONAL MATERIALS AND FOR STAFF TRAINING. THE NHA HAS NOTIFIED PMC THAT APPROXIMATELY $1,426 OF THE ANNUAL DUES PAID WERE USED IN CONJUNCTION WITH LOBBYING ACTIVITIES WITH THE GOAL OF IMPROVING THE OVERALL HEALTHCARE ENVIRONMENT. THE AMOUNT OF DUES PAID TO AHA DETERMINED TO BE FOR LOBBYING IS $1,005 82357 6530 88887 87009 -4652 82357 77078 9931 87009 74377 2701 77078 64417 9960 74377 0.00000 0.00000 1.00000 1 0 91932 91932 34632221 16881794 17750427 14439487 10055471 4384016 9625292 9625292 31851667 OPERATING LEASE LIABILITIES 105171 DEFERRED COMPENSATION PLAN 26648 PAYABLE TO THIRD-PARTY REIMBURSEMENT PROGRAMS 615000 FINANCE LEASE OBLIGATIONS 31183 778002 31176816 579899 579899 30596917 964890 964890 31561807 29779383 0 29779383 835968 835968 30615351 PART V, LINE 4: PROVIDENCE MEDICAL CENTER HAS ONE ENDOWMENT FUND HELD BY PROVIDENCE MEDICAL CENTER FOUNDATION. THE ENDOWMENT WAS SET ASIDE BY DONORS TO PROVIDE INVESTMENT INCOME IN WHICH TO PROVIDE FOR FUTURE CAPITAL AND PROGRAM NEEDS OF THE HOSPITAL. PART XI, LINE 4B - OTHER ADJUSTMENTS: PROVISION FOR BAD DEBTS 835,968. FOUNDATION CONTRIBUTIONS 128,922. PART XII, LINE 4B - OTHER ADJUSTMENTS: PROVISION FOR BAD DEBTS 835,968. 1 1 X 1 X 1 X 1 1 1 0 0 311999 311999 0.01020 1799334 1167828 631506 0.02060 2111333 1167828 943505 0.03080 583043 281937 301106 0.00980 583043 281937 301106 0.00980 2694376 1449765 1244611 0.04060 0 598697 375772 10142059 10201588 -59529 X 1 1 1 1 PROVIDENCE MEDICAL CENTER 1200 PROVIDENCE ROAD WAYNE NE 68787 WWW.PROVIDENCEMEDICAL.COM 800001 X X X X AMBULANCE SERVICE PROVIDENCE MEDICAL CENTER 1 0 0 1 X X X X X X X X X 22 1 1 1 1 X SEE SUPPLEMENTAL SECTION 1 22 1 SEE SUPPLEMENTAL SECTION 0 1 X 150.000000000000 300.000000000000 X X X X 1 1 X X X X 1 X SEE SUPPLEMENTAL SECTION X SEE SUPPLEMENTAL SECTION X SEE SUPPLEMENTAL SECTION X X X X X X 1 X 0 X X X X 1 X 0 0 PROVIDENCE MEDICAL CENTER PART V, SECTION B, LINE 5: THE REPORT WAS PREPARED BY STAFF OF THE FOLLOWING: NORTHEAST NEBRASKA RURAL HEALTH NETWORK;IN CONJUNCTION WITH VISIONFUSION AND INTERSECTIONS CONSULTING;AND STAFF FROM PARTNER MEMBERS INCLUDING:PENDER COMMUNITY HOSPITAL;PROVIDENCE MEDICAL CENTER;WINNEBAGO PUBLIC HEALTH DEPARTMENT;MIDTOWN HEALTH CENTER;UNIVERSITY OF NEBRASKA MEDICAL CENTER; ANDNORTHEAST NEBRASKA PUBLIC HEALTH DEPARTMENT.THE FOLLOWING AGENCIES PROVIDED INPUT INTO CERTAIN SECTIONS OF THE REPORT: CARL T. CURTIS HEALTH CENTERCEDAR COUNTY TRANSITEDUCATIONAL SERVICE UNIT #1HARTINGTON SENIOR CENTERHAVEN HOUSELA MICHUACANALEAGUE OF HUMAN DIGNITYLUNA'S CAFEMIDTOWN HEALTH CENTERNEBRASKA ASSOCIATION OF LOCAL HEALTH DIRECTORSNEBRASKA DEPARTMENT OF HEALTH AND HUMAN SERVICESNEBRASKA EXTENSIONNORTHEAST NEBRASKA COMMUNITY ACTION PARTNERSHIPNORTHEAST NEBRASKA PUBLIC HEALTH DEPARTMENTPEARL STREET COUNSELINGPENDER MEDICAL CLINICPENDER COMMUNITY HOSPITALPROVIDENCE MEDICAL CENTERRURAL REGION ONE MEDICAL RESPONSE SYSTEMUNIVERSITY OF NEBRASKA COLLEGE OF NURSING NORTHERN DIVISIONUNIVERSITY OF NEBRASKA COLLEGE OF PUBLIC HEALTHWAYNE ASSOCIATION OF CONGREGATIONS AND MINISTERSWAYNE COMMUNITY SCHOOLSWAYNE FAMILY COALITIONWAYNE HERALDWAYNE COMMUNITY HOUSING DEVELOPMENT COMMISSIONWAYNE STATE COLLEGEWINNEBAGO HEALTH DEPARTMENTOVER SIX HUNDRED SURVEYS WERE COLLECTED FROM ACROSS THE HEALTH DISTRICT. LIVE LISTENING SESSIONS WERE CONDUCTED IN CEDAR, DIXON AND WAYNE COUNTIES AND THURSTON COUNTY PARTICIPATED IN A VIRTUAL SESSION. LISTENING SESSIONS WITH THE AREA'S HISPANIC POPULATION, WITH INTERPRETATION BY NNPHD STAFF, WERE FACILITATED BY OUR HEALTH DIRECTOR. THIS LED TO THE FORMATION OF A HEALTH CONSUMER FOCUSED ADVISORY COUNCIL COMPOSED OF MEMBERS OF THE AREA'S LATINO COMMUNITY. A SERIES OF FIVE VIRTUAL CONVERSATIONS WERE HELD TO UPDATE THE FINDINGS OF OUR 2019 LOCAL PUBLIC HEALTH SYSTEM ASSESSMENT USING THE RECENTLY UPDATED 10 ESSENTIAL SERVICES OF PUBLIC HEALTH, AS WELL AS THE LOCAL SYSTEM'S EXPERIENCE WITH THE COVID-19 PANDEMIC. A HEALTH EQUITY ADVISORY COUNCIL WAS STARTED IN DECEMBER 2021 WHICH HAS ALSO GIVEN US FEEDBACK. PROVIDENCE MEDICAL CENTER PART V, SECTION B, LINE 6A: PENDER COMMUNITY HOSPITAL PROVIDENCE MEDICAL CENTER PART V, SECTION B, LINE 6B: NORTHEAST NEBRASKA PUBLIC HEALTH DEPARTMENT WINNEBAGO PUBLIC HEALTH DEPARTMENTMIDTOWN HEALTH CENTERUNIVERSITY OF NEBRASKA MEDICAL CENTERPROVIDENCE MEDICAL CENTER:PART V, SECTION B, LINE 7A: HTTPS://PROVIDENCEMEDICAL.COM/ABOUT-US/COMMUNITY-HEALTH-ASSESSMENT/PROVIDENCE MEDICAL CENTER:PART V, SECTION B, LINE 10A: HTTPS://PROVIDENCEMEDICAL.COM/ABOUT-US/COMMUNITY-HEALTH-ASSESSMENT/ PROVIDENCE MEDICAL CENTER PART V, SECTION B, LINE 11: THE ORGANIZATION COMPLETED THE CURRENT CHNA IN 2022 AND THE ORGANIZATION ALONG WITH THE OTHER PARTICIPANTS IN THE CHNA DETERMINED THE FOLLOWING KEY HEALTH OUTCOMES, KEY HEALTH FACTORS AND KEY DISPARITIES IMPACTING THEM. FINALLY, THEY DETERMINED THE TOP CONCERNS AND ACTION ITEMS TOWARD THEM. KEY HEALTH OUTCOMES: HEALTH OUTCOMES WHERE HEALTH DISTRICT AVERAGES, AS WELL AS THOSE OF ONE OR MORE OF OUR COUNTIES, ARE WORSE THAN STATE AVERAGES ARE LISTED BELOW ALONG WITH ACTIONS WE HAVE TAKEN TO ADDRESS: CANCER-COLON AND RECTUM - PROVIDE COLONOSCOPIES WHICH INCLUDE REMOVAL OF TUMOR POLYPS CANCER-LUNG - PROVIDE MRI, CT AND OTHER SCREENING SERVICES CANCER-PROSTATE - PROVIDE PROSTATE BIOPSIESTHE HOSPITAL HAS AN ONCOLOGY/INFUSION DEPARTMENT WHERE WE ARE ABLE TO CARE FOR PATIENTS WITH CANCER IN MULTIPLE WAYS, ADMINISTER CHEMO, BLOOD PRODUCTS, HYDRATION, CENTRAL LINE CARE, ETC. SO PATIENTS CAN RECEIVE TREATMENT CLOSER TO HOME. CANCER-PROSTATE: WE ALSO DO PSA TESTING AT PMC AND HOLD A COMMUNITY OFFERING FOR PSA TESTING AT A REDUCED COST TO INDIVIDUALS DURING PROSTATE AWARENESS MONTH IN SEPTEMBER EVERY YEAR. CHRONIC OBSTRUCTIVE PULMONARY DISEASE - PROVIDE TELE PULMONOLOGY WHICH FACILITIES TREATMENT LOCALLYTHE HOSPITAL HAS BOTH IN PERSON AND TELEHEALTH PULMONOLOGY SERVICES IN OUTPATIENT CLINICS, WE HAVE TELEHEALTH INPATIENT SERVICES. WE OFFER RESPIRATORY THERAPY REHABILITATION AND PULMONARY FUNCTION TESTING. DIABETES (MEDICARE) THE HOSPITAL HAS PROVIDED DIETICIAN SERVICES FROM A CERTIFIED DIABETIC EDUCATOR FOR DIABETIC PATIENTS HEART DISEASE - PROVIDE CARDIO STRESS TESTS, ECGS AND IMPLANT DEFIBRILLATORS THE HOSPITAL HAS A WEEKLY CARDIOLOGY CLINIC CHECK IN, AS WELL AS ECHOCARDIOGRAMS, HAVE A CARDIAC REHABILITATION PROGRAM AND A PERIPHERAL ARTERY DISEASE PROGRAM AVAILABLE. KIDNEY DISEASE - PROVIDE NEPHROLOGY CARE WHICH IS LED BY OUR NEPHROLOGIST HIGH BLOOD PRESSURE - SERVICES INCLUDE WELLNESS AND CARDIAC REHAB DEATHS OF DESPAIR - PROVIDE MENTAL HEALTH PROVIDERS INCLUDING A SENIOR BEHAVIORAL HEALTH THERAPY MORTALITY-CANCER - PROVIDE MRI, CT AND OTHER IMAGING, CHEMOTHERAPY, IMMUNOTHERAPY, SURGERY AND CARDIAC REHAB MORTALITY-CORONARY HEART DISEASE - SEE ABOVE MORTALITY-HEART DISEASE - SEE ABOVE MORTALITY-MOTOR VEHICLE CRASH, ALCOHOL-INVOLVED - PROVIDE AMBULANCE SERVICE AND LEVEL 4 TRAUMA MORTALITY-YEARS OF POTENTIAL LIFE LOST - PROVIDE WELLNESS THROUGH PALLIATIVE CARE MORTALITY-STROKE - WE ARE STARTING A NEURO TELEHEALTH PROGRAM WHICH ENABLES US TO TREAT PATIENTS LOCALLY. PMC IS DESIGNATED AS A "STROKE READY HOSPITAL" WE ARE THE ONLY CRITICAL ACCESS HOSPITAL IN NEBRASKA WITH THIS DESIGNATION FOR THE QUALITY STROKE CARE WE PROVIDE. MORTALITY-UNINTENTIONAL INJURY-ACCIDENT - PROVIDE AMBULANCE SERVICE AND LEVEL 4 TRAUMA OBESITY - PROVIDE NUTRITIONAL COUNSELLING WITH OUR REGISTERED DIETICIANKEY HEALTH FACTORS: HEALTH FACTORS WHERE HEALTH DISTRICT AVERAGES ARE WORSE THAN STATE AVERAGES INCLUDE: LOW PROPORTION OF FOOD BUDGET ON FRUITS AND VEGETABLES - PROVIDE NUTRITIONAL COUNSELING HIGH PROPORTION OF FOOD BUDGET SPENT ON SODA - SEE ABOVE PHYSICAL INACTIVITY - PROVIDE WELLNESS PROGRAM CURRENT SMOKERS TOBACCO EXPENDITURES HEAVY ALCOHOL CONSUMPTION CHLAMYDIA INCIDENCE - PROVIDE A STUDENT HEALTH CLINICKEY DISPARITIES: LANGUAGE - OVER 500 OF OUR RESIDENTS ARE NOT PROFICIENT IN ENGLISH - PROVIDE INTERPRETIVE SERVICES TO PATIENTS EDUCATION - NUTRITION COUNSELLING INCOME - PROVIDE A FINANCIAL COUNSELLOR TO HELP WITH ADMISSION PROCESS SCHEDULE OF HEALTH CARE VERSUS JOB SCHEDULE AND TRANSPORTATION OPTIONS LOCATIONS AND TRANSPORTATION OPTIONSTOP CONCERNS AND NEEDS: COVID-19, EVEN IN 2022, WAS EXPRESSED AS A WORRY OF APPROXIMATELY ONE-THIRD OF SURVEY RESPONDENTS AND CITED AS ONE OF THE TOP 3 CONCERNS WHEN ASKED TO PICK FROM A LIST. MENTAL HEALTH REMAINED A TOP WORRY OF SURVEY RESPONDENTS (SIMILAR TO 2019). SOCIAL ISOLATION WAS IDENTIFIED AS A STRESSOR WHICH CONTRIBUTED TO ANXIETY AND DEPRESSION. PROVIDE BEHAVIORAL HEALTH AND PSYCHIATRY SERVICES CANCER WAS A TOP WORRY OF SURVEY RESPONDENTS, BUT THE AREA HAS BEEN UNDERPERFORMING IN TERMS OF SCREENINGS. WHILE "OBESITY" WAS NOT ONE OF THE CHOICES FOR THE CLOSED ENDED QUESTIONS, RESPONDENTS EXPRESSED CONCERNS ABOUT ACCESS TO HEALTHY AFFORDABLE FOOD, THE NEED TO BE MORE PHYSICALLY ACTIVE AND MAINTAINING A HEALTHY WEIGHT WERE MENTIONED FREQUENTLY IN THE OPEN-ENDED QUESTIONS.- PROVIDE NUTRITIONAL COUNSELLING AFFORDING OUT-OF-POCKET COSTS FOR MEDICAL CARE, AS WELL AS MAINTAINING INSURANCE, WERE IDENTIFIED AS CONCERNS. PROVIDE FINANCIAL COUNSELOR BEING ABLE TO GET EMERGENCY OR SPECIALTY CARE AS NEEDED, GIVEN DISTANCES TO FACILITIES, IS A CONCERN. - OPERATE AMBULANCE SERVICE LONG-TERM CARE IS ANOTHER AREA OF CONCERN SINCE A LOCAL FACILITY RECENTLY CLOSED PROVIDE SWING INPATIENT CARE AND HOME CARE AND HOSPICE PROVIDENCE MEDICAL CENTER PART V, SECTION B, LINE 15E: PROVIDENCE MEDICAL CENTER MAY ASSIST PATIENTS IN APPLYING FOR MEDICARE, MEDICAID, AND OTHER GOVERNMENTAL MEDICAL ASSISTANCE PROGRAMS. PART V, SECTION B - LINE 16A HTTPS://PROVIDENCEMEDICAL.COM/PATIENTS-VISITORS/PATIENTS/BILLING-FINANCE/ PART V, SECTION B - LINE 16B HTTPS://PROVIDENCEMEDICAL.COM/PATIENTS-VISITORS/PATIENTS/BILLING-FINANCE/ PART V, SECTION B - LINE 16C HTTPS://PROVIDENCEMEDICAL.COM/PATIENTS-VISITORS/PATIENTS/BILLING-FINANCE/ 3 1 - PROVIDENCE COMMUNITY PHARMACY 803 PROVIDENCE ROAD SUITE 101 WAYNE NE 68787 PHARMACY 2 - LAUREL THERAPY SERVICES 699 CEDAR AVENUE LAUREL NE 68745 OUTREACH THERAPY CLINIC 3 - WAKEFIELD THERAPY SERVICES 308 ASH STREET WAKEFIELD NE 68784 OUTREACH THERAPY CLINIC PART I, LINE 3C: UNINSURED, UNDERINSURED, AND INDIGENT BY DESIGN PATIENTS WHOSE INCOME/FAMILY INCOME IS GREATER THAN 400% OF THE FEDERAL POVERTY GUIDELINES MAY BE ELIGIBLE FOR DISCOUNTED CARE BASED ON THEIR PARTICULAR CIRCUMSTANCES. SUCH DISCOUNTS ARE AT THE DISCRETION OF THE ORGANIZATION AND WILL NOT BE COUNTED AS CHARITY CARE. PART I, LINE 7: THE COSTING METHODOLOGY USED ON FORM 990 IS BASED ON A COST-TO-CHARGE RATIO WHICH IS DEVELOPED BASED ON THE HOSPITAL'S TOTAL OPERATING EXPENSES LESS THE PROVISION FOR BAD DEBT DIVIDED BY GROSS PATIENT SERVICE REVENUE. THIS COST-TO-CHARGE RATIO IS APPLIED AGAINST VARIOUS REVENUE AND EXPENSE CATEGORIES TO COMPUTE THE ESTIMATED COMMUNITY BENEFIT EXPENSE UNDER IRS SUGGESTED COSTING METHODS FOR THE FORM 990. PART I, LINE 7G: SUBSIDIZED SERVICES INCLUDE HOSPICE AND HOME HEALTH SERVICES. PART III, LINE 2: THE COSTING METHODOLOGY USED ON FORM 990 IS BASED ON A COST-TO-CHARGE RATIO, WHICH IS DEVELOPED BASED ON THE HOSPITAL'S TOTAL OPERATING EXPENSES EXCLUDING THE PROVISION FOR BAD DEBT, DIVIDED BY GROSS PATIENT SERVICE REVENUE. THIS COST-TO-CHARGE RATIO IS APPLIED AGAINST THE TOTAL CHARGES THAT ARE WRITTEN OFF DURING THE YEAR TO ESTIMATE THE COST OF CARE OF PATIENTS WHO HAVE ACCOUNTS THAT ARE DEEMED TO BE BAD DEBTS TO THE HOSPITAL. THE HOSPITAL ALSO RECOGNIZES THAT IT ALSO PROVIDES A DISCOUNT TO SELF-PAY OR UNINSURED PATIENTS. THESE AMOUNTS ARE EXCLUDED FROM GROSS PATIENT SERVICE REVENUE ON THE FINANCIAL STATEMENTS AND ARE NOT INCLUDED IN THE RATIO AS DESCRIBED ABOVE AND APPROVED BY THE IRS FOR USE ON FORM 990. IF CONSIDERED, THESE ADDITIONAL WRITE-OFF AMOUNTS TO UNINSURED ACCOUNTS WOULD ALSO INCREASE THE ESTIMATED BAD DEBT EXPENSE AMOUNT ASSOCIATED WITH THESE UNCOLLECTIBLE ACCOUNTS TO THE HOSPITAL. PART III, LINE 3: MANAGEMENT PROVIDES FOR PROBABLE UNCOLLECTIBLE AMOUNTS, PRIMARILY UNINSURED PATIENTS AND AMOUNTS PATIENTS ARE PERSONALLY RESPONSIBLE FOR, THROUGH A CHARGE TO OPERATIONS AND A CREDIT TO A VALUATION ALLOWANCE BASED ON ITS ASSESSMENT OF HISTORICAL COLLECTION LIKELIHOOD AND THE CURRENT STATUS OF INDIVIDUAL ACCOUNTS. BALANCES THAT ARE STILL OUTSTANDING AFTER THE HOSPITAL HAS USED REASONABLE COLLECTION EFFORTS ARE WRITTEN OFF THROUGH A CHARGE TO THE VALUATION ALLOWANCE AND A CREDIT TO ACCOUNTS RECEIVABLE. PART III, LINE 4: IN EVALUATING THE COLLECTABILITY OF ACCOUNTS RECEIVABLE, THE HOSPITAL ANALYZES PAST RESULTS AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS AND PROVISION FOR BAD DEBTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYOR SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS. SPECIFICALLY, FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE HOSPITAL ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS AND A PROVISION FOR BAD DEBTS FOR EXPECTED UNCOLLECTIBLE DEDUCTIBLES AND COPAYMENTS ON ACCOUNTS FOR WHICH THE THIRD-PARTY PAYOR HAS NOT YET PAID, OR FOR PAYORS AND PATIENTS WHO ARE KNOWN TO BE HAVING FINANCIAL DIFFICULTIES THAT MAKE THE REALIZATION OF AMOUNTS DUE UNLIKELY. FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), THE HOSPITAL RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES, IF NEGOTIATED) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS. THE AUDITED FINANCIAL STATEMENTS DO NOT CONTAIN A SEPARATE FOOTNOTE REGARDING BAD DEBT EXPENSE. PART III, LINE 8: THE SHORTFALL SHOULD BE TREATED AS A COMMUNITY BENEFITS EXPENSE BECAUSE PROVIDING MEDICAL CARE AT A SHORTFALL IMPACTS THE HOSPITAL'S OPERATIONS AND GROWTH. THE CARE IS PROVIDED BECAUSE THERE IS A NEED AND A DESIRE TO PROVIDE MEDICAL CARE IN THIS COMMUNITY.THE COSTING METHOD USED ABOVE FOR IRS FORM 990 COMPLIANCE REPORTING IS ALSO BASED ON AN OVERALL AVERAGE COST-TO-CHARGE RATIO AND DOES NOT CONSIDER MEDICARE NON-ALLOWABLE EXPENSES AS IT IS BASED ON TOTAL HOSPITAL PATIENT SERVICE REVENUE (IGNORING CONTRACTUAL ADJUSTMENTS ON FEE SCHEDULE REIMBURSED ITEMS AND NON-ALLOWABLE MEDICARE EXPENSES AS NOTED ABOVE) DIVIDED BY TOTAL OPERATING EXPENSES LESS THE PROVISION FOR BAD DEBT EXPENSE. THIS RATIO IS THEN MULTIPLIED BY THE TOTAL MEDICARE SERVICES WHICH ARE REIMBURSED ON A COST METHODOLOGY EXCLUDING THE FEE SCHEDULE ITEMS LIKE PHYSICIAN SERVICES AND THE HOSPITAL WOULD SHOW A LARGE LOSS ON THESE SERVICES.WHETHER THERE IS A SHORTFALL OR SURPLUS FROM SERVICES PROVIDED TO MEDICARE BENEFICIARIES, THESE PEOPLE, WHO ARE TYPICALLY ELDERLY MEMBERS OF THE COMMUNITY, ARE AN UNDERSERVED POPULATION WHO EXPERIENCE ISSUES WITH ACCESS TO HEALTHCARE SERVICES. WITHOUT TAX-EXEMPT HOSPITALS PROVIDING MEDICARE PATIENT SERVICES, THE CENTERS FOR MEDICARE AND MEDICAID (CMS) WOULD BEAR THE BURDEN OF DIRECTLY PROVIDING SERVICES TO THE ELDERLY AND DISABLED MEMBERS OF THE COMMUNITY.THE SHORTFALL SHOULD BE TREATED AS A COMMUNITY BENEFITS EXPENSE BECAUSE PROVIDING MEDICAL CARE AT A SHORTFALL IMPACTS THE HOSPITAL'S OPERATIONS AND GROWTH. THE CARE IS PROVIDED BECAUSE THERE IS A NEED AND A DESIRE TO PROVIDE MEDICAL CARE IN THIS COMMUNITY. PART III, LINE 9B: PROVIDENCE MEDICAL CENTER HAS A STRONG COMMITMENT TO THE COMMUNITY AND TO THE PATIENTS THAT WE SERVE. MEDICAL TREATMENT IS PROVIDED TO ALL PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. IN DOING SO, WE SHALL: INFORM THE PUBLIC OF THE AVAILABILITY OF ALTERNATIVE PAYMENT ARRANGEMENTS, INCLUDING PAYMENT PLANS AND FINANCIAL ASSISTANCE PROGRAMS; PROVIDE FINANCIAL COUNSELING TO PATIENTS ABOUT THEIR HOSPITAL BILLS; RESPOND PROMPTLY TO PATIENTS' QUESTIONS ABOUT THEIR BILLS AND REQUESTS FOR FINANCIAL HELP THROUGH AN ACCEPTABLE PAYMENT PLAN AND/OR THROUGH FINANCIAL ASSISTANCE; AND PURSUE COLLECTION OF ACCOUNTS FAIRLY AND CONSISTENTLY AND WITHIN OUR WRITTEN GUIDELINES AND ENSURE THAT AGENCIES ACTING ON OUR BEHALF IN THE COLLECTION OF DEBT ALSO ACT IN ACCORDANCE WITH OUR MISSION AND GUIDELINES. PART VI, LINE 2: PMC WORKS WITH THE STATE OF NEBRASKA AND THE NEBRASKA HOSPITAL ASSOCIATION TO REVIEW PATIENT DATA AND OUTCOMES. ONE OF THE PRODUCTS USED IS COMS (CLINICAL OUTCOMES MEASUREMENT SYSTEM) WHICH GIVES OUTCOME DATA FOR MORBIDITY AND MORTALITY FOR THE STATE OF NEBRASKA AND OUR SERVICE AREA. PMC ALSO HAS WORKED WITH THE NORTHEAST NEBRASKA PUBLIC HEALTH DEPARTMENT WITH MAPP WHICH IS "MOBILIZING FOR ACTION THROUGH PLANNING AND PARTNERSHIP," WHICH IDENTIFIES PUBLIC HEALTH ISSUES AND FINDS RESOURCES TO ADDRESS THEM. PART VI, LINE 3: PAYMENT POLICIES AND FINANCIAL ASSISTANCE INSTRUCTIONS ARE GIVEN WITH ADMISSION DOCUMENTS, INCLUDED WITH EACH BILL, UPLOADED ON PMC'S WEBSITE, AND POSTED THROUGHOUT PMC'S FACILITIES. PART VI, LINE 4: THE HEALTHCARE FACILITY IS LOCATED IN WAYNE, NEBRASKA WHERE IT SERVES RESIDENTS OF NORTHEASTERN NEBRASKA. THE POPULATION BASE FROM THE NEARBY COMMUNITIES IS APPROXIMATELY 9,600 WITH AN AVERAGE INCOME OF APPROXIMATELY $45,000. PART VI, LINE 5: THE HOSPITAL HAS A COMMUNITY BOARD WITH MEMBERS THAT REPRESENT DIFFERENT TOWNS IN OUR SERVICE AREA. WE STRIVE TO INVEST OUR FUNDS IN BANKS WITHIN OUR SERVICE AREA. ALSO, THE HOSPITAL'S ADMITTING PHYSICIANS ARE PRIMARILY PRACTITIONERS IN THE LOCAL AREA. PART VI, LINE 6: THE HOSPITAL IS NOT AFFILIATED WITH ANY OTHER HEALTH SYSTEMS. PART VI, LINE 7, REPORTS FILED WITH STATES NE X X 0 0 0 0 0 0 0 0 0 DANIELLE GEARHART CEO 211996 0 11450 0 1025 0 8419 0 24823 0 257713 0 0 0 KIMBERLY LUEDERS DIRECTOR OF PHARMACY 165237 0 200 0 725 0 6629 0 2469 0 175260 0 0 0 A THE COUNTY OF WAYNE IN THE STATE OF NEBRASKA 476006517 NONEAVAIL 2015-07-31 8400000 TO CONSTRUCT AND EQUIP HOSPITAL FACILITY 0 0 0 B THE COUNTY OF WAYNE IN THE STATE OF NEBRASKA 476006517 NONEAVAIL 2016-03-08 4100000 TO CONSTRUCT AND EQUIP HOSPITAL FACILITY 0 0 0 C THE COUNTY OF WAYNE IN THE STATE OF NEBRASKA 476006517 NONEAVAIL 2021-06-22 6988641 TO CONSTRUCT AND EQUIP HOSPITAL FACILITY 0 0 0 A 3089456 8400000 264021 297702 8400000 2017 0 0 1 1 B 347818 4100000 264021 32759 4100000 2017 0 0 1 1 C 133401 6988641 134839 106524 6988641 2022 0 0 1 1 A 0 0 0 0 0 0 0 B 0 0 0 0 0 0 0 C 0 0 0 0 0 0 0 A 0 0 1 0 0 0 0 0 1 B 0 0 1 0 0 0 0 0 1 C 0 1 0 0 0 0 0 0 1 A 1 B 1 C 1 FORM 990, PART I, LINE 1, DESCRIPTION OF ORGANIZATION MISSION: WE BELIEVE THAT THE PATIENT IS THE MOST IMPORTANT PERSON IN OUR MEDICAL CENTER, THAT LIFE IS A GIFT FROM GOD, AND THAT ALL PERSONS ARE CREATED EQUAL. WE BELIEVE THAT EVERY PATIENT HAS A RIGHT TO BE ADMITTED WHEN IN NEED OF SERVICES WHICH OUR FACILITY IS EQUIPPED TO PROVIDE, PRIVACY, PROFESSIONAL DISCRETION, CONSENT TO OR REFUSAL OF TREATMENT AND MAY REQUEST THE MINISTER OF HIS/HER CHOICE. WE BELIEVE THAT OUR MEDICAL CENTER HAS THE RESPONSIBILITY TO PROVIDE ADEQUATE AND COMPETENT STAFF AND DIAGNOSTIC, PREVENTATIVE AND THERAPEUTIC FACILITIES TO ENSURE HIGH QUALITY MEDICAL CARE TO THE PATIENT, AND THAT THIS CAN ONLY BE ACHIEVED THROUGH COOPERATION AND SUPPORT AMONG THE STAFF AND COMMUNITY. WE BELIEVE THAT THE EMPLOYEES ARE ENTITLED TO JUST WAGES FOR HONEST WORK AND TO OPPORTUNITIES FOR PERSONAL AND PROFESSIONAL GROWTH. WE BELIEVE THAT OUR MEDICAL CENTER NEEDS TO PARTICIPATE ACTIVELY IN COMMUNITY PLANNING OF HEALTH AND MEDICAL CARE FACILITIES AND OPERATE IN ACCORDANCE WITH THE NEEDS OF THE CIVIC COMMUNITY. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS REVIEWED AND APPROVED BY THE HOSPITAL CEO AND CFO PRIOR TO FILING. ALSO, THE FORM 990 IS DISTRIBUTED TO THE BOARD OF DIRECTORS PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C PMC'S BOARD AND ADMINISTRATIVE MEMBERS ARE REQUIRED TO SIGN A NEW CONFLICT OF INTEREST STATEMENT AND DISCLOSURE ANNUALLY. ANY CONFLICTS ARE REVIEWED BY THE BOARD. FORM 990, PART VI, SECTION B, LINE 15 COMPENSATION PROCESS FOR OFFICERS' SALARIES AND FOR ALL EMPLOYEES ARE BASED ON THE NEBRASKA HOSPITAL ASSOCIATION'S (NHA) ANNUAL SALARY SURVEY. THE SURVEY IS CATEGORIZED BY JOB TITLES AND DETAILED BY HOURLY SALARY RANGES. NHA IS AN EXEMPT ORGANIZATION UNDER SECTION 501(C)(6) OF THE INTERNAL REVENUE CODE (TRADE ASSOCIATION), WITH ITS MEMBERS BEING THE HOSPITALS IN THE STATE OF NEBRASKA. EXECUTIVE WAGES OR SALARIES ARE NOT EVALUATED ANY DIFFERENTLY THAN OTHER EMPLOYEES. THEY RECEIVE NO PREFERENTIAL TREATMENT UNLESS THE GOVERNING BOARD MAKES A SPECIAL RECOMMENDATION. THE GUIDELINES INCLUDE: 1. A DETERMINATION OF THE FEASIBILITY OF BONUSES BASED ON AVAILABILITY OF CASH FLOW AND EXCESS REVENUE FOR THE CURRENT FISCAL YEAR, 2. DETERMINATION OF PMC'S OVERALL WAGE LEVELS BASED ON AN ANALYSIS OF WAGES AGAINST THE NHA'S SALARY SURVEY AND EMPLOYEE TIME OF SERVICE, 3. HOURLY WAGE INCREASES MAY ALSO BE GIVEN IF NEEDED TO BE COMPATIBLE OR TO COMPENSATE FOR A CHANGE IN JOB DESCRIPTIONS, AND 4. THE GOVERNING BOARD MAKES FINAL APPROVAL OF THE BUDGET WHICH WOULD INCLUDE ALL SALARIES AND BONUSES. FORM 990, PART VI, SECTION C, LINE 19 PROVIDENCE MEDICAL CENTER MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST AT ITS HOSPITAL BUSINESS LOCATION DURING NORMAL BUSINESS HOURS. FORM 990, PART IX, LINE 11G ANESTHESIA SERVICES PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 460,000. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 460,000. EMERGENCY SERVICES: PROGRAM SERVICE EXPENSES 750,948. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 750,948. HOSPICE PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 89,722. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 89,722. LABORATORY PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 100,925. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 100,925. OTHER PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 1,311,615. MANAGEMENT AND GENERAL EXPENSES 609,290. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,920,905. QUALITY ASSURANCE PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 64,973. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 64,973. RADIOLOGY PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 201,341. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 201,341. WOUND CARE PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 31,748. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 31,748. FORM 990, PART XI, LINE 9: NET CHANGE IN TEMPORARILY RESTRICTED NET ASSETS OF FOUNDATION 74,920.