TY 2018 Form 990

(A) Name and Title	(B) Average hours per week (list any hours for related organizations below dotted line)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)
(1) NICHOLAS CUSICK CHAIRPERSON	2.0 ................. 1.0	X	X	0	0	0
(2) SCOTT YOUNG VICE CHAIRPERSON	2.0 ................. 0	X	X	0	0	0
(3) JOHN DECKER JR SECRETARY	2.0 ................. 0	X	X	0	0	0
(4) SHANNON HARNER TREASURER	2.0 ................. 0	X	X	0	0	0
(5) KIMBERLY RUSSEL CHIEF EXECUTIVE OFFICER	35.0 ................. 36.0	X	X	0	1,420,038	39,757
(6) JOHN WOODRICH PRESIDENT & CHIEF OPERATING OFFICER	69.0 ................. 1.0	X	X	763,622	0	42,944
(7) STEVE ERWIN TRUSTEE	1.0 ................. 1.0	X		0	0	0
(8) RICHARD EVNEN TRUSTEE	1.0 ................. 1.0	X		0	0	0
(9) DARLA EISENHAUER-SPIRES MD TRUSTEE	2.0 ................. 0	X		0	0	0
(10) BRENDA FRANKLIN RN TRUSTEE	2.0 ................. 0	X		0	0	0
(11) KENNETH GROSS MD TRUSTEE	2.0 ................. 0	X		0	0	0
(12) JACK HUCK TRUSTEE	2.0 ................. 0	X		0	0	0
(13) DAVID KECK PHD TRUSTEE	2.0 ................. 0	X		0	0	0
(14) Edward Mlinek MD TRUSTEE	2.0 ................. 0	X		0	0	0
(15) ANGELA MUHLEISEN TRUSTEE	2.0 ................. 0	X		0	0	0
(16) PATRICIA PANSING BROOKS TRUSTEE	2.0 ................. 0	X		0	0	0
(17) ARDEN (BEAU) REID III TRUSTEE	2.0 ................. 0	X		0	0	0

(A) Name and business address	(B) Description of services	(C) Compensation
INPATIENT PHYSICIAN ASSOCIATES 2300 SOUTH 16TH STREET LINCOLN,NE68502	MEDICAL SERVICES	9,469,704
Leidos Health LLC PO BOX 223866 PITTSBURGH,PA15251	CONSULTING	6,544,470
OXFORD GLOBAL RESOURCES PO Box 3256 Boston,MA022413256	Consulting	4,510,275
Optimum Healthcare IT LLC 1300 Marsh Landing Pkwy Ste 105 Jacksonville Beach,FL32250	CONSULTING	4,224,772
FOCUSONE SOLUTIONS LLC PO BOX 3037 OMAHA,NE68103	Temporary Labor	3,317,092
2 Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization 68

- TIN:

SCHEDULE A
(Form 990 or 990EZ)

Department of the Treasury
Internal Revenue Service

Public Charity Status and Public Support

Complete if the organization is a section 501(c)(3) organization or a section 4947(a)(1) nonexempt charitable trust.
right arrow

Attach to Form 990 or Form 990-EZ.
right arrow

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2018

Open to Public
Inspection

Name of the organization

BRYAN MEDICAL CENTER

Employer identification number

47-0376552

Part I

Reason for Public Charity Status (All organizations must complete this part.) See instructions.

The organization is not a private foundation because it is: (For lines 1 through 12, check only one box.)

A church, convention of churches, or association of churches described in section 170(b)(1)(A)(i).

A school described in section 170(b)(1)(A)(ii). (Attach Schedule E (Form 990 or 990-EZ).)

A hospital or a cooperative hospital service organization described in section 170(b)(1)(A)(iii).

A medical research organization operated in conjunction with a hospital described in section 170(b)(1)(A)(iii). Enter the hospital's name, city, and state:

An organization operated for the benefit of a college or university owned or operated by a governmental unit described in section 170(b)(1)(A)(iv). (Complete Part II.)

A federal, state, or local government or governmental unit described in section 170(b)(1)(A)(v).

An organization that normally receives a substantial part of its support from a governmental unit or from the general public described in section 170(b)(1)(A)(vi). (Complete Part II.)

A community trust described in section 170(b)(1)(A)(vi). (Complete Part II.)

An agricultural research organization described in 170(b)(1)(A)(ix) operated in conjunction with a land-grant college or university or a non-land grant college of agriculture. See instructions. Enter the name, city, and state of the college or university:

An organization that normally receives: (1) more than 331/3% of its support from contributions, membership fees, and gross receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)

An organization organized and operated exclusively to test for public safety. See section 509(a)(4).

An organization organized and operated exclusively for the benefit of, to perform the functions of, or to carry out the purposes of one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2). See section 509(a)(3). Check the box in lines 12a through 12d that describes the type of supporting organization and complete lines 12e, 12f, and 12g.

Type I. A supporting organization operated, supervised, or controlled by its supported organization(s), typically by giving the supported organization(s) the power to regularly appoint or elect a majority of the directors or trustees of the supporting organization. You must complete Part IV, Sections A and B.

Type II. A supporting organization supervised or controlled in connection with its supported organization(s), by having control or management of the supporting organization vested in the same persons that control or manage the supported organization(s). You must complete Part IV, Sections A and C.

Type III functionally integrated. A supporting organization operated in connection with, and functionally integrated with, its supported organization(s) (see instructions). You must complete Part IV, Sections A, D, and E.

Type III non-functionally integrated. A supporting organization operated in connection with its supported organization(s) that is not functionally integrated. The organization generally must satisfy a distribution requirement and an attentiveness requirement (see instructions). You must complete Part IV, Sections A and D, and Part V.

Check this box if the organization received a written determination from the IRS that it is a Type I, Type II, Type III functionally integrated, or Type III non-functionally integrated supporting organization.

Enter the number of supported organizations ...............................

Provide the following information about the supported organization(s).

(i) Name of supported organization	(ii) EIN	(iv) Is the organization listed in your governing document?		(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)
(i) Name of supported organization	(ii) EIN	Yes	No	(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)


Total

For Paperwork Reduction Act Notice, see the Instructions for
Form 990 or 990-EZ.

Cat. No. 11285F

Schedule A (Form 990 or 990-EZ) 2018

Page 2

Part II

Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv), 170(b)(1)(A)(vi), and 170(b)(1)(A)(ix)
(Complete only if you checked the box on line 5, 7, 8, or 9 of Part I or if the organization failed to qualify under Part III. If the organization fails to qualify under the tests listed below, please complete Part III.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2014	(b) 2015	(c) 2016	(d) 2017	(e) 2018	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") ..
2	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf....
3	The value of services or facilities furnished by a governmental unit to the organization without charge..
4	Total. Add lines 1 through 3
5	The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f)..
6	Public support. Subtract line 5 from line 4.

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2014	(b) 2015	(c) 2016	(d) 2017	(e) 2018	(f) Total
7	Amounts from line 4..
8	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...
9	Net income from unrelated business activities, whether or not the business is regularly carried on..
10	Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.)..
11	Total support. Add lines 7 through 10

Gross receipts from related activities, etc. (see instructions) ..................

First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization, check this box and stop here........................................ right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2018 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2017 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2018. If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization ....................... right arrow

33 1/3% support test—2017. If the organization did not check a box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization ..................... right arrow

17a

10%-facts-and-circumstances test—2018. If the organization did not check a box on line 13, 16a, or 16b, and line 14
is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here. Explain
in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported
organization ..................................................... right arrow

10%-facts-and-circumstances test—2017. If the organization did not check a box on line 13, 16a, 16b, or 17a, and line
15 is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here.
Explain in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly
supported organization ................................................ right arrow

Private foundation. If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see
instructions ..................................................... right arrow

Schedule A (Form 990 or 990-EZ) 2018

Page 3

Part III

Support Schedule for Organizations Described in Section 509(a)(2)
(Complete only if you checked the box on line 10 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2014	(b) 2015	(c) 2016	(d) 2017	(e) 2018	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
2	Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose
3	Gross receipts from activities that are not an unrelated trade or business under section 513 .....
4	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
5	The value of services or facilities furnished by a governmental unit to the organization without charge
6	Total. Add lines 1 through 5
7a	Amounts included on lines 1, 2, and 3 received from disqualified persons
b	Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.
c	Add lines 7a and 7b..
8	Public support. (Subtract line 7c from line 6.)

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2014	(b) 2015	(c) 2016	(d) 2017	(e) 2018	(f) Total
9	Amounts from line 6...
10a	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
b	Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c	Add lines 10a and 10b.
11	Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.
12	Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.) ..
13	Total support. (Add lines 9, 10c, 11, and 12.)..

First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization,
check this box and stop here............................................. right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2018 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2017 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2018 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2017 Schedule A, Part III, line 17 .............

19a

331/3% support tests—2018. If the organization did not check the box on line 14, and line 15 is more than 33 1/3%, and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization ....... right arrow

33 1/3% support tests—2017. If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization .... right arrow

Private foundation. If the organization did not check a box on line 14, 19a, or 19b, check this box and see instructions .... right arrow

Schedule A (Form 990 or 990-EZ) 2018

Page 4

Part IV

Supporting Organizations

(Complete only if you checked a box on line 12 of Part I. If you checked 12a of Part I, complete Sections A and B. If you checked 12b of Part I, complete Sections A and C. If you checked 12c of Part I, complete Sections A, D, and E. If you checked 12d of Part I, complete Sections A and D, and complete Part V.)

Section A. All Supporting Organizations

Yes

Are all of the organization’s supported organizations listed by name in the organization’s governing documents?
If "No," describe in Part VI how the supported organizations are designated. If designated by class or purpose,
describe the designation. If historic and continuing relationship, explain.

Did the organization have any supported organization that does not have an IRS determination of status under section 509(a)(1) or (2)? If "Yes," explain in Part VI how the organization determined that the supported organization was described in section 509(a)(1) or (2).

Did the organization have a supported organization described in section 501(c)(4), (5), or (6)? If "Yes," answer (b) and (c) below.

Did the organization confirm that each supported organization qualified under section 501(c)(4), (5), or (6) and satisfied the public support tests under section 509(a)(2)? If "Yes," describe in Part VI when and how the organization made the determination.

Did the organization ensure that all support to such organizations was used exclusively for section 170(c)(2)(B) purposes? If "Yes," explain in Part VI what controls the organization put in place to ensure such use.

Was any supported organization not organized in the United States ("foreign supported organization")? If “Yes” and if you checked 12a or 12b in Part I, answer (b) and (c) below.

Did the organization have ultimate control and discretion in deciding whether to make grants to the foreign supported organization? If “Yes,” describe in Part VI how the organization had such control and discretion despite being controlled or supervised by or in connection with its supported organizations.

Did the organization support any foreign supported organization that does not have an IRS determination under sections 501(c)(3) and 509(a)(1) or (2)? If “Yes,” explain in Part VI what controls the organization used to ensure that all support to the foreign supported organization was used exclusively for section 170(c)(2)(B) purposes.

Did the organization add, substitute, or remove any supported organizations during the tax year? If “Yes,” answer (b) and (c) below (if applicable). Also, provide detail in Part VI, including (i) the names and EIN numbers of the supported organizations added, substituted, or removed; (ii) the reasons for each such action; (iii) the authority under the organization's organizing document authorizing such action; and (iv) how the action was accomplished (such as by amendment to the organizing document).

Type I or Type II only. Was any added or substituted supported organization part of a class already designated in the organization's organizing document?

Substitutions only. Was the substitution the result of an event beyond the organization's control?

Did the organization provide support (whether in the form of grants or the provision of services or facilities) to anyone other than (i) its supported organizations, (ii) individuals that are part of the charitable class benefited by one or more of its supported organizations, or (iii) other supporting organizations that also support or benefit one or more of the filing organization’s supported organizations? If “Yes,” provide detail in Part VI.

Did the organization provide a grant, loan, compensation, or other similar payment to a substantial contributor (defined in section 4958(c)(3)(C)), a family member of a substantial contributor, or a 35% controlled entity with regard to a substantial contributor? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ) .

Did the organization make a loan to a disqualified person (as defined in section 4958) not described in line 7? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ).

Was the organization controlled directly or indirectly at any time during the tax year by one or more disqualified persons as defined in section 4946 (other than foundation managers and organizations described in section 509(a)(1) or (2))? If “Yes,” provide detail in Part VI.

Did one or more disqualified persons (as defined in line 9a) hold a controlling interest in any entity in which the supporting organization had an interest? If “Yes,” provide detail in Part VI.

Did a disqualified person (as defined in line 9a) have an ownership interest in, or derive any personal benefit from, assets in which the supporting organization also had an interest? If “Yes,” provide detail in Part VI.

10a

Was the organization subject to the excess business holdings rules of section 4943 because of section 4943(f) (regarding certain Type II supporting organizations, and all Type III non-functionally integrated supporting organizations)? If “Yes,” answer line 10b below.

10a

Did the organization have any excess business holdings in the tax year? (Use Schedule C, Form 4720, to determine whether the organization had excess business holdings).

10b

Schedule A (Form 990 or 990-EZ) 2018

Page 5

Part IV

Supporting Organizations (continued)

Yes

Has the organization accepted a gift or contribution from any of the following persons?

A person who directly or indirectly controls, either alone or together with persons described in (b) and (c) below, the governing body of a supported organization?

11a

A family member of a person described in (a) above?

11b

A 35% controlled entity of a person described in (a) or (b) above? If “Yes” to a, b, or c, provide detail in Part VI.

11c

Section B. Type I Supporting Organizations

Yes

Did the directors, trustees, or membership of one or more supported organizations have the power to regularly appoint or elect at least a majority of the organization’s directors or trustees at all times during the tax year? If “No,” describe in Part VI how the supported organization(s) effectively operated, supervised, or controlled the organization’s activities. If the organization had more than one supported organization, describe how the powers to appoint and/or remove directors or trustees were allocated among the supported organizations and what conditions or restrictions, if any, applied to such powers during the tax year.

Did the organization operate for the benefit of any supported organization other than the supported organization(s) that operated, supervised, or controlled the supporting organization? If “Yes,” explain in Part VI how providing such benefit carried out the purposes of the supported organization(s) that operated, supervised or controlled the supporting organization.

Section C. Type II Supporting Organizations

Yes

Were a majority of the organization’s directors or trustees during the tax year also a majority of the directors or trustees of each of the organization’s supported organization(s)? If “No,” describe in Part VI how control or management of the supporting organization was vested in the same persons that controlled or managed the supported organization(s).

Section D. All Type III Supporting Organizations

Yes

Did the organization provide to each of its supported organizations, by the last day of the fifth month of the organization’s tax year, (i) a written notice describing the type and amount of support provided during the prior tax year, (ii) a copy of the Form 990 that was most recently filed as of the date of notification, and (iii) copies of the organization’s governing documents in effect on the date of notification, to the extent not previously provided?

Were any of the organization’s officers, directors, or trustees either (i) appointed or elected by the supported organization(s) or (ii) serving on the governing body of a supported organization? If "No," explain in Part VI how the organization maintained a close and continuous working relationship with the supported organization(s).

By reason of the relationship described in (2), did the organization’s supported organizations have a significant voice in the organization’s investment policies and in directing the use of the organization’s income or assets at all times during the tax year? If "Yes," describe in Part VI the role the organization’s supported organizations played in this regard.

Section E. Type III Functionally-Integrated Supporting Organizations

Check the box next to the method that the organization used to satisfy the Integral Part Test during the year (see instructions):

The organization satisfied the Activities Test. Complete line 2 below.

The organization is the parent of each of its supported organizations. Complete line 3 below.

The organization supported a governmental entity. Describe in Part VI how you supported a government entity (see instructions)

Activities Test. Answer (a) and (b) below.

Yes

Did substantially all of the organization’s activities during the tax year directly further the exempt purposes of the supported organization(s) to which the organization was responsive? If "Yes," then in Part VI identify those supported organizations and explain how these activities directly furthered their exempt purposes, how the organization was responsive to those supported organizations, and how the organization determined that these activities constituted substantially all of its activities.

Did the activities described in (a) constitute activities that, but for the organization’s involvement, one or more of the organization’s supported organization(s) would have been engaged in? If "Yes," explain in Part VI the reasons for the organization’s position that its supported organization(s) would have engaged in these activities but for the organization’s involvement.

Parent of Supported Organizations. Answer (a) and (b) below.

Did the organization have the power to regularly appoint or elect a majority of the officers, directors, or trustees of each of the supported organizations? Provide details in Part VI.

Did the organization exercise a substantial degree of direction over the policies, programs and activities of each of its supported organizations? If "Yes," describe in Part VI. the role played by the organization in this regard.

Schedule A (Form 990 or 990-EZ) 2018

Page 6

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations

Check here if the organization satisfied the Integral Part Test as a qualifying trust on Nov. 20, 1970 (explain in Part VI). See instructions. All other Type III non-functionally integrated supporting organizations must complete Sections A through E.

	Section A - Adjusted Net Income		(A) Prior Year	(B) Current Year (optional)
1	Net short-term capital gain	1
2	Recoveries of prior-year distributions	2
3	Other gross income (see instructions)	3
4	Add lines 1 through 3	4
5	Depreciation and depletion	5
6	Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions)	6
7	Other expenses (see instructions)	7
8	Adjusted Net Income (subtract lines 5, 6 and 7 from line 4)	8

	Section B - Minimum Asset Amount		(A) Prior Year	(B) Current Year (optional)
1	Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year):	1
a	Average monthly value of securities	1a
b	Average monthly cash balances	1b
c	Fair market value of other non-exempt-use assets	1c
d	Total (add lines 1a, 1b, and 1c)	1d
e	Discount claimed for blockage or other factors (explain in detail in Part VI):
2	Acquisition indebtedness applicable to non-exempt use assets	2
3	Subtract line 2 from line 1d	3
4	Cash deemed held for exempt use. Enter 1-1/2% of line 3 (for greater amount, see instructions).	4
5	Net value of non-exempt-use assets (subtract line 4 from line 3)	5
6	Multiply line 5 by .035	6
7	Recoveries of prior-year distributions	7
8	Minimum Asset Amount (add line 7 to line 6)	8

	Section C - Distributable Amount		Current Year
1	Adjusted net income for prior year (from Section A, line 8, Column A)	1
2	Enter 85% of line 1	2
3	Minimum asset amount for prior year (from Section B, line 8, Column A)	3
4	Enter greater of line 2 or line 3	4
5	Income tax imposed in prior year	5
6	Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions)	6

Check here if the current year is the organization's first as a non-functionally-integrated Type III supporting organization (see instructions)

Schedule A (Form 990 or 990-EZ) 2018

Page 7

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations (continued)

Section D - Distributions		Current Year
1 Amounts paid to supported organizations to accomplish exempt purposes
2 Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity
3 Administrative expenses paid to accomplish exempt purposes of supported organizations
4 Amounts paid to acquire exempt-use assets
5 Qualified set-aside amounts (prior IRS approval required)
6 Other distributions (describe in Part VI). See instructions
7Total annual distributions. Add lines 1 through 6.
8 Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions
9 Distributable amount for 2018 from Section C, line 6
10 Line 8 amount divided by Line 9 amount

Section E - Distribution Allocations (see instructions)		(i) Excess Distributions	(ii) Underdistributions Pre-2018	(iii) Distributable Amount for 2018
1 Distributable amount for 2018 from Section C, line 6
2 Underdistributions, if any, for years prior to 2018 (reasonable cause required-- explain in Part VI). See instructions.
3 Excess distributions carryover, if any, to 2018:
a From 2013.......
b From 2014.......
c From 2015.......
d From 2016.......
e From 2017.......
fTotal of lines 3a through e
g Applied to underdistributions of prior years
h Applied to 2018 distributable amount
i Carryover from 2013 not applied (see instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from 3f.
4Distributions for 2018 from Section D, line 7:
$
a Applied to underdistributions of prior years
b Applied to 2018 distributable amount
c Remainder. Subtract lines 4a and 4b from 4.
5 Remaining underdistributions for years prior to 2018, if any. Subtract lines 3g and 4a from line 2. If the amount is greater than zero, explain in Part VI. See instructions.
6 Remaining underdistributions for 2018. Subtract lines 3h and 4b from line 1. If the amount is greater than zero, explain in Part VI. See instructions.
7 Excess distributions carryover to 2019. Add lines 3j and 4c.
8 Breakdown of line 7:
a Excess from 2014......
b Excess from 2015.....
c Excess from 2016.....
d Excess from 2017.....
e Excess from 2018.....

Schedule A (Form 990 or 990-EZ) (2018)

Schedule A (Form 990 or 990-EZ) 2018

Page 8

Part VI

Supplemental Information. Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; Part III, line 12; Part IV, Section A, lines 1, 2, 3b, 3c, 4b, 4c, 5a, 6, 9a, 9b, 9c, 11a, 11b, and 11c; Part IV, Section B, lines 1 and 2; Part IV, Section C, line 1; Part IV, Section D, lines 2 and 3; Part IV, Section E, lines 1c, 2a, 2b, 3a and 3b; Part V, line 1; Part V, Section B, line 1e; Part V Section D, lines 5, 6, and 8; and Part V, Section E, lines 2, 5, and 6. Also complete this part for any additional information. (See instructions).

Facts And Circumstances Test

Return Reference	Explanation

Schedule A (Form 990 or 990-EZ) 2018

Additional Data

Software ID:	18007697
Software Version:	2018v3.1

- TIN:

Schedule B
(Form 990, 990-EZ,
or 990-PF)

Department of the Treasury
Internal Revenue Service

Schedule of Contributors

Attach to Form 990, 990-EZ, or 990-PF.

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2018

Name of the organization

BRYAN MEDICAL CENTER

Employer identification number

47-0376552

Organization type (check one):

Filers of:

Section:

Form 990 or 990-EZ

501(c)( ) (enter number) organization

4947(a)(1) nonexempt charitable trust not treated as a private foundation

527 political organization

Form 990-PF

501(c)(3) exempt private foundation

4947(a)(1) nonexempt charitable trust treated as a private foundation

501(c)(3) taxable private foundation

Check if your organization is covered by the General Rule or a Special Rule.
Note. Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.

General Rule

For an organization filing Form 990, 990-EZ, or 990-PF that received, during the year, contributions totaling $5,000 or more (in money or other property) from any one contributor. Complete Parts I and II. See instructions for determining a contributor's total contributions.

Special Rules

For an organization described in section 501(c)(3) filing Form 990 or 990-EZ that met the 33¹/3% support test of the regulations
under sections 509(a)(1) and 170(b)(1)(A)(vi), that checked Schedule A (Form 990 or 990-EZ), Part II, line 13, 16a, or 16b, and that received from any one contributor, during the year, total contributions of the greater of (1) $5,000 or (2) 2% of the amount on (i) Form 990, Part VIII, line 1h, or (ii) Form 990-EZ, line 1. Complete Parts I and II.

For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, total contributions of more than $1,000 exclusively for religious, charitable, scientific, literary, or educational purposes, or for the prevention of cruelty to children or animals. Complete Parts I, II, and III.

For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, contributions exclusively for religious, charitable, etc., purposes, but no such contributions totaled more than $1,000. If this box is checked, enter here the total contributions that were received during the year for an exclusively religious, charitable, etc., purpose. Don't complete any of the parts unless the General Rule applies to this organization because it received nonexclusively religious, charitable, etc., contributions totaling $5,000 or more during the year ......... Arrow Bullet

Caution. An organization that isn't covered by the General Rule and/or the Special Rules doesn't file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2, of its Form 990; or check the box on line H of its
Form 990-EZ or on its Form 990PF, Part I, line 2, to certify that it doesn't meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).

For Paperwork Reduction Act Notice, see the Instructions
for Form 990, 990-EZ, or 990-PF.

Cat. No. 30613XSchedule B (Form 990, 990-EZ, or 990-PF) (2018)

Schedule B (Form 990, 990-EZ, or 990-PF) (2018) Page 2

Name of organization BRYAN MEDICAL CENTER

Part I	Contributors (See instructions). Use duplicate copies of Part I if additional space is needed.
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
RESTRICTED	,	$ RESTRICTED	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2018)

Schedule B (Form 990, 990-EZ, or 990-PF) (2018)

Page 3

Name of organization BRYAN MEDICAL CENTER		Employer identification number 47-0376552

Part II	Noncash Property (See instructions). Use duplicate copies of Part II if additional space is needed.
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
Schedule B (Form 990, 990-EZ, or 990-PF) (2018)

Schedule B (Form 990, 990-EZ, or 990-PF) (2018)

Page 4


Name of organization BRYAN MEDICAL CENTER			Employer identification number 47-0376552
Part III Exclusively religious, charitable, etc., contributions to organizations described in section 501(c)(7), (8), or (10) that total more than $1,000 for the year from any one contributor. Complete columns (a) through (e) and the following line entry. For organizations completing Part III, enter the total of exclusively religious, charitable, etc., contributions of $1,000 or less for the year. (Enter this information once. See instructions.) $ Use duplicate copies of Part III if additional space is needed.

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

Schedule B (Form 990, 990-EZ, or 990-PF) (2018)

Additional Data

Software ID:	18007697
Software Version:	2018v3.1

- TIN:

SCHEDULE C
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Political Campaign and Lobbying Activities

For Organizations Exempt From Income Tax Under section 501(c) and section 527

SchCMd Bullet

Complete if the organization is described below. SchCMd Bullet

Attach to Form 990 or Form 990-EZ.
SchCMd Bullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2018

Open to Public
Inspection

If the organization answered "Yes" on Form 990, Part IV, Line 3, or Form 990-EZ, Part V, line 46 (Political Campaign Activities), then
Round Bullet

Section 501(c)(3) organizations: Complete Parts I-A and B. Do not complete Part I-C.
Round Bullet

Section 501(c) (other than section 501(c)(3)) organizations: Complete Parts I-A and C below. Do not complete Part I-B.
Round Bullet

Section 527 organizations: Complete Part I-A only.
If the organization answered "Yes" on Form 990, Part IV, Line 4, or Form 990-EZ, Part VI, line 47 (Lobbying Activities), then
Round Bullet

Section 501(c)(3) organizations that have filed Form 5768 (election under section 501(h)): Complete Part II-A. Do not complete Part II-B.
Round Bullet

Section 501(c)(3) organizations that have NOT filed Form 5768 (election under section 501(h)): Complete Part II-B. Do not complete Part II-A.
If the organization answered "Yes" on Form 990, Part IV, Line 5 (Proxy Tax) (see separate instructions) or Form 990-EZ, Part V, line 35c (Proxy Tax) (see separate instructions), then
Round Bullet

Section 501(c)(4), (5), or (6) organizations: Complete Part III.

Name of the organization

BRYAN MEDICAL CENTER

Employer identification number

47-0376552

Part I-A

Complete if the organization is exempt under section 501(c) or is a section 527 organization.

Provide a description of the organization’s direct and indirect political campaign activities in Part IV (see instructions for definition of “political campaign activities")

Political campaign activity expenditures (see instructions) .................................................................... SchCMd Bullet

Volunteer hours for political campaign activities (see instructions) ..................................................................

Part I-B

Complete if the organization is exempt under section 501(c)(3).

Enter the amount of any excise tax incurred by the organization under section 4955 ................................ SchCMd Bullet

Enter the amount of any excise tax incurred by organization managers under section 4955 ....................... SchCMd Bullet

If the organization incurred a section 4955 tax, did it file Form 4720 for this year? .........................................

Yes No

Was a correction made? ......................................................................................................................

Yes No

If "Yes," describe in Part IV.

Part I-C

Complete if the organization is exempt under section 501(c), except section 501(c)(3).

Enter the amount directly expended by the filing organization for section 527 exempt function activities ..... SchCMd Bullet

Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt function activities ............................................................................................................................ SchCMd Bullet

Total exempt function expenditures. Add lines 1 and 2. Enter here and on Form 1120-POL, line 17b........... SchCMd Bullet

Did the filing organization file Form 1120-POL for this year? ...................................................................

Yes No

Enter the names, addresses and employer identification number (EIN) of all section 527 political organizations to which the filing
organization made payments. For each organization listed, enter the amount paid from the filing organization’s funds. Also enter the amount of political contributions received that were promptly and directly delivered to a separate political organization, such as a separate segregated fund or a political action committee (PAC). If additional space is needed, provide information in Part IV.

(a) Name	(b) Address	(c) EIN	(d) Amount paid from filing organization's funds. If none, enter -0-.	(e) Amount of political contributions received and promptly and directly delivered to a separate political organization. If none, enter -0-.
1
2
3
4
5
6

For Paperwork Reduction Act Notice, see the instructions for Form 990 or 990-EZ.

Cat. No. 50084S

Schedule C (Form 990 or 990-EZ) 2018

Page 2

Part II-A

Complete if the organization is exempt under section 501(c)(3) and filed Form 5768 (election under section 501(h)).

A Check SchCMd Bullet

if the filing organization belongs to an affiliated group (and list in Part IV each affiliated group member's name, address, EIN, expenses, and share of excess lobbying expenditures).
B Check SchCMd Bullet

if the filing organization checked box A and "limited control" provisions apply.

Limits on Lobbying Expenditures (The term "expenditures" means amounts paid or incurred.)		(b) Affiliated group totals
1a	Total lobbying expenditures to influence public opinion (grass roots lobbying) ......................
b	Total lobbying expenditures to influence a legislative body (direct lobbying) ...............................
c	Total lobbying expenditures (add lines 1a and 1b) ...................................................................
d	Other exempt purpose expenditures ........................................................................
e	Total exempt purpose expenditures (add lines 1c and 1d) ...............................................
f	Lobbying nontaxable amount. Enter the amount from the following table in both columns.
	If the amount on line 1e, column (a) or (b) is:The lobbying nontaxable amount is:
	Not over $500,00020% of the amount on line 1e.
	Over $500,000 but not over $1,000,000$100,000 plus 15% of the excess over $500,000.
	Over $1,000,000 but not over $1,500,000$175,000 plus 10% of the excess over $1,000,000.
	Over $1,500,000 but not over $17,000,000$225,000 plus 5% of the excess over $1,500,000.
	Over $17,000,000$1,000,000.

g	Grassroots nontaxable amount (enter 25% of line 1f) .................................................
h	Subtract line 1g from line 1a. If zero or less, enter -0-. ................................................
i	Subtract line 1f from line 1c. If zero or less, enter -0-. ................................................
j	If there is an amount other than zero on either line 1h or line 1i, did the organization file Form 4720 reporting section 4911 tax for this year? ...................................................................................................................	Yes No

4-Year Averaging Period Under section 501(h) (Some organizations that made a section 501(h) election do not have to complete all of the five columns below. See the separate instructions for lines 2a through 2f.)
Lobbying Expenditures During 4-Year Averaging Period
	Calendar year (or fiscal year beginning in)	(a) 2015	(b) 2016	(c) 2017	(d) 2018	(e) Total

2a	Lobbying nontaxable amount

b	Lobbying ceiling amount (150% of line 2a, column(e))

c	Total lobbying expenditures

d	Grassroots nontaxable amount

e	Grassroots ceiling amount (150% of line 2d, column (e))

f	Grassroots lobbying expenditures

Schedule C (Form 990 or 990-EZ) 2018

Page 3

Part II-B

Complete if the organization is exempt under section 501(c)(3) and has NOT filed Form 5768 (election under section 501(h)).

For each "Yes" response on lines 1a through 1i below, provide in Part IV a detailed description of the lobbying activity.

(a)

Yes

(b)

Amount

During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:

Volunteers? ...........................................................................................................

Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ........

Yes

Media advertisements? ...................................................................................................

Mailings to members, legislators, or the public? .............................................................................

Publications, or published or broadcast statements? ...........................................................

Grants to other organizations for lobbying purposes? ..........................................................

Direct contact with legislators, their staffs, government officials, or a legislative body? .......................

Yes

Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ..................

Other activities? ...................................................................................................................

Yes

13,260

Total. Add lines 1c through 1i ....................................................................................................

13,260

Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....

If "Yes," enter the amount of any tax incurred under section 4912 ...........................................

If "Yes," enter the amount of any tax incurred by organization managers under section 4912 ...................

If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year? ........................

Part III-A

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).

Yes

Were substantially all (90% or more) dues received nondeductible by members? ...............................................

Did the organization make only in-house lobbying expenditures of $2,000 or less? ............................................

Did the organization agree to carry over lobbying and political expenditures from the prior year? .................................

Part III-B

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) and if either (a) BOTH Part III-A, lines 1 and 2, are answered "No" OR (b) Part III-A, line 3, is answered “Yes."

Dues, assessments and similar amounts from members ......................................................................

Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of political expenses for which the section 527(f) tax was paid).

Current year .............................................................................................................................

Carryover from last year ............................................................................................................

Total ...........................................................................................................................................

Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .

If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political expenditure next year? ......................................................................................................................

Taxable amount of lobbying and political expenditures (see instructions) .........................................

Part IV

Supplemental Information

Provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, line 5; Part II-A (affiliated group list); Part II-A, lines 1 and 2 (see instructions), and Part ll-B, line 1. Also, complete this part for any additional information.

Return Reference	Explanation
Schedule C, Part II-B, Line 1 DETAILED DESCRIPTION OF THE LOBBYING ACTIVITY	BRYAN MEDICAL CENTER IS A MEMBER OF THE NEBRASKA HOSPITAL ASSOCIATION (NHA). DURING THE CURRENT YEAR, THE REPORTING ORGANIZATION MADE PAYMENTS FOR THE MEMBERSHIP DUES TO THE NHA OF $126,046; OF THIS AMOUNT THE NHA REPORTED THAT 10.52% OR $13,260 OF THE TOTAL DUES PAID WERE USED FOR LOBBYING ACTIVITIES. On various occasions throughout the year, the CEO met with state and local legislators to discuss issues related to healthcare. While some related to healthcare reform, other issues discussed included meeting the needs of the indigent/uninsured and underinsured patients, as well as the ongoing need for health services including mental health services for the community.

Return Reference

Explanation

Schedule C, Part II-B, Line 1 DETAILED DESCRIPTION OF THE LOBBYING ACTIVITY

BRYAN MEDICAL CENTER IS A MEMBER OF THE NEBRASKA HOSPITAL ASSOCIATION (NHA). DURING THE CURRENT YEAR, THE REPORTING ORGANIZATION MADE PAYMENTS FOR THE MEMBERSHIP DUES TO THE NHA OF $126,046; OF THIS AMOUNT THE NHA REPORTED THAT 10.52% OR $13,260 OF THE TOTAL DUES PAID WERE USED FOR LOBBYING ACTIVITIES. On various occasions throughout the year, the CEO met with state and local legislators to discuss issues related to healthcare. While some related to healthcare reform, other issues discussed included meeting the needs of the indigent/uninsured and underinsured patients, as well as the ongoing need for health services including mental health services for the community.

Schedule C (Form 990 or 990EZ) 2018

Additional Data

Software ID:	18007697
Software Version:	2018v3.1

- TIN:

SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

Complete if the organization answered "Yes," on Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b.
SchDMd Bullet

Attach to Form 990.
SchDMd Bullet

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2018

Open to Public Inspection

Name of the organization

BRYAN MEDICAL CENTER

Employer identification number

47-0376552

Part I

Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" on Form 990, Part IV, line 6.

		(a) Donor advised funds	(b) Funds and other accounts
1	Total number at end of year .........
2	Aggregate value of contributions to (during year)
3	Aggregate value of grants from (during year)
4	Aggregate value at end of year ........

Did the organization inform all donors and donor advisors in writing that the assets held in donor advised funds are the organization’s property, subject to the organization’s exclusive legal control? ............

Yes No

Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? ...................................

Yes No

Part II

Conservation Easements. Complete if the organization answered "Yes" on Form 990, Part IV, line 7.

Purpose(s) of conservation easements held by the organization (check all that apply).

Preservation of land for public use (e.g., recreation or education) Preservation of an historically important land area

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.


a	Total number of conservation easements ......................	2a
b	Total acreage restricted by conservation easements ....................	2b
c	Number of conservation easements on a certified historic structure included in (a) .....	2c
d	Number of conservation easements included in (c) acquired after 7/25/06, and not on a historic structure listed in the National Register ...	2d

Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during the
tax year SchDMd Bullet

Number of states where property subject to conservation easement is located SchDMd Bullet

Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and enforcement of the conservation easements it holds? ............

Yes No

Staff and volunteer hours devoted to monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet

Amount of expenses incurred in monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet

Does each conservation easement reported on line 2(d) above satisfy the requirements of section 170(h)(4)(B)(i) and section 170(h)(4)(B)(ii)? .............................

Yes No

In Part XIII, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" on Form 990, Part IV, line 8.

If the organization elected, as permitted under SFAS 116 (ASC 958), not to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide, in Part XIII, the text of the footnote to its financial statements that describes these items.

If the organization elected, as permitted under SFAS 116 (ASC 958), to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide the following amounts relating to these items:

(i)

Revenue included on Form 990, Part VIII, line 1 ......................... SchDMd Bullet

(ii)

Assets included in Form 990, Part X ............................... SchDMd Bullet

If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under SFAS 116 (ASC 958) relating to these items:

Revenue included on Form 990, Part VIII, line 1 .......................... SchDMd Bullet

Assets included in Form 990, Part X ............................... SchDMd Bullet

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 52283D

Schedule D (Form 990) 2018

Page 2

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)

Using the organization’s acquisition, accession, and other records, check any of the following that are a significant use of its collection items (check all that apply):

Public exhibition

Loan or exchange programs

Scholarly research

Other

Preservation for future generations

Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.

During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?...

Yes No

Part IV

Escrow and Custodial Arrangements. Complete if the organization answered "Yes" on Form 990, Part IV, line 9, or reported an amount on Form 990, Part X, line 21.

Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................

Yes No


b	If "Yes," explain the arrangement in Part XIII and complete the following table:		Amount
c	Beginning balance .............................	1c
d	Additions during the year ............................	1d
e	Distributions during the year ..........................	1e
f	Ending balance ................................	1f

Did the organization include an amount on Form 990, Part X, line 21, for escrow or custodial account liability? ...

Yes No

If "Yes," explain the arrangement in Part XIII. Check here if the explanation has been provided in Part XIII ....

Part V

Endowment Funds. Complete if the organization answered "Yes" on Form 990, Part IV, line 10.

		(a)Current year	(b)Prior year	(c)Two years back	(d)Three years back	(e)Four years back

1a	Beginning of year balance ....	580,758	694,914	1,322,608	1,030,723	785,063
b	Contributions ...	0	726	-628,231	290,541	331,955
c	Net investment earnings, gains, and losses	10,745	-23,058	5,199	4,414	3,772
d	Grants or scholarships ...	0		0	0	0
e	Other expenditures for facilities and programs ...	0	1	0	0	86,958
f	Administrative expenses ....	3,677	91,823	4,662	3,070	3,109
g	End of year balance ......	587,826	580,758	694,914	1,322,608	1,030,723

Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:

Board designated or quasi-endowment SchDMd Bullet

0 %

Permanent endowment SchDMd Bullet

0 %

Temporarily restricted endowment SchDMd Bullet

100 %

The percentages on lines 2a, 2b, and 2c should equal 100%.

Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes

(i) unrelated organizations .................

3a(i)

(ii) related organizations .................

3a(ii)

If "Yes" on 3a(ii), are the related organizations listed as required on Schedule R? .........

Describe in Part XIII the intended uses of the organization's endowment funds.

Part VI

Land, Buildings, and Equipment.
Complete if the organization answered "Yes" on Form 990, Part IV, line 11a. See Form 990, Part X, line 10.

Description of property		(a) Cost or other basis (investment)	(b) Cost or other basis (other)	(c) Accumulated depreciation	(d) Book value

1a	Land .....	13,528,074		13,528,074
b	Buildings ....	495,331,128	258,395,991	236,935,137
c	Leasehold improvements	1,036,605	789,763	246,842
d	Equipment ....	425,233,850	276,111,237	149,122,613
e	Other .....	20,879,931	3,596,573	17,283,358
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..				417,116,024

Schedule D (Form 990) 2018

Page 3

Part VII

InvestmentsOther Securities. Complete if the organization answered "Yes" on Form 990, Part IV, line 11b. See Form 990, Part X, line 12.

(a) Description of security or category (including name of security)	(b) Book value	(c) Method of valuation: Cost or end-of-year market value
(1) Financial derivatives.........
(2) Closely-held equity interests........
(3)Other
(A)
(B)
(C)
(D)
(E)
(F)
(G)
(H)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)

Part VIII

InvestmentsProgram Related. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11c. See Form 990, Part X, line 13.

(a) Description of investment	(b) Book value	(c) Method of valuation: Cost or end-of-year market value

(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)

Part IX

Other Assets. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11d. See Form 990, Part X, line 15.

(a) Description				(b) Book value

(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........

Part X

Other Liabilities. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11e or 11f. See Form 990, Part X, line 25.

1.(a) Description of liability	(b) Book value
(1) Federal income taxes
INTEREST RATE SWAP LIABILITY	7,198,190
HOSPITALIST SVCS CTRT PAYABLE	0
SELF INSURANCE LIABILITY	3,475,103
OTHER LIABILITIES	12,724,208
CURRENT PORTION INTEREST RATE SWAPS	1,479,276
ORIGINAL ISSUE PREMIUM	0
ACCRUED PENSION BENEFIT OBLIGATION	25,237,262
College Grants	369,728
Third Party Payor Settlements	1,470,838
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)	51,954,605
2. Liability for uncertain tax positions. In Part XIII, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC 740). Check here if the text of the footnote has been provided in Part XIII

Schedule D (Form 990) 2018

Page 4

Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1	Total revenue, gains, and other support per audited financial statements .......		1
2	Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a	Net unrealized gains (losses) on investments ....	2a
b	Donated services and use of facilities .........	2b
c	Recoveries of prior year grants ...........	2c
d	Other (Describe in Part XIII.) ............	2d
e	Add lines 2a through 2d .....................		2e
3	Subtract line 2e from line 1..................		3
4	Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b .	4a
b	Other (Describe in Part XIII.) ...........	4b
c	Add lines 4a and 4b....................		4c
5	Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ......		5

Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1	Total expenses and losses per audited financial statements ...........		1
2	Amounts included on line 1 but not on Form 990, Part IX, line 25:
a	Donated services and use of facilities .........	2a
b	Prior year adjustments ............	2b
c	Other losses ................	2c
d	Other (Describe in Part XIII.) ............	2d
e	Add lines 2a through 2d....................		2e
3	Subtract line 2e from line 1...................		3
4	Amounts included on Form 990, Part IX, line 25, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b ..	4a
b	Other (Describe in Part XIII.) ............	4b
c	Add lines 4a and 4b.....................		4c
5	Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ......		5

Part XIII

Supplemental Information

Provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b; Part V, line 4; Part X, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information.

Return Reference	Explanation
Schedule D, Part III, Line 4 Collections of art - description of collections	BRYAN MEDICAL CENTER IS THE OWNER OF THE WILLIAM JENNINGS BRYAN HOUSE, ALSO KNOWN AS FAIRVIEW. FAIRVIEW IS A HISTORIC HOUSE BUILT IN 1902-1903 IN LINCOLN, NEBRASKA, IN 1922, THE HOUSE AND SURROUNDING LAND WAS DONATED TO THE NEBRASKA METHODIST CONFERENCE, WHICH THEN FORMED A SEPARATE NONPROFIT ORGANIZATION FOR PURPOSES OF ESTABLISHING BRYAN MEMORIAL HOSPITAL AND AFFILIATED SCHOOL OF NURSING. FAIRVIEW WAS DECLARED A NATIONAL HISTORIC LANDMARK IN 1963. THE HOUSE IS NOW USED FOR BRYAN MEETINGS AND FUNCTIONS. IN ADDITION, APPROXIMATELY 500 VISITORS TOUR THE HOME ANNUALLY. THIS ASSET IS FULLY DEPRECIATED, AND REPORTED ON THE BALANCE SHEET AT A NET AMOUNT OF ZERO.
Schedule D, Part V, Line 4 Intended uses of endowment funds	BRYAN MEDICAL CENTER'S ("MEDICAL CENTER") ENDOWMENT FUNDS ARE ESTABLISHED TO PROVIDE FOR LOANS FOR THE STUDENTS WHO ATTEND THE BRYAN COLLEGE OF HEALTH SCIENCES. BRYAN COLLEGE OF HEALTH SCIENCES PROVIDES HEALTHCARE PROFESSIONAL EDUCATION WITH PROGRAMS LEADING TO GRADUATE AND UNDERGRADUATE ACADEMIC DEGREES. BRYAN COLLEGE OF HEALTH SCIENCES IS PART OF THE MEDICAL CENTER AND ITS OPERATIONS ARE INCLUDED IN THE MEDICAL CENTER'S FORM 990.
Schedule D, Part X, Line 2 FIN 48 (ASC 740) footnote	Under Accounting Standards Codification(ASC), Subtopic 740-10, Income Taxes, the System must recognize the tax benefit from an uncertain tax position only if it is "more-likely-than-not" that the tax position will be sustained on examination by the applicable taxing authorities, based on the technical merits of the position. The tax benefits recognized in the consolidated financial statements from such a position are measured based on the largest benefit that has a greater than 50 percent likelihood of being realized upon ultimate settlement. ASC Subtopic 740-10 also provides guidance on derecognition, classification, interest and penalties on income taxes and accounting in interim periods and requires increased disclosure. There were no uncertain tax benefits identified at December 31, 2018 and 2017. The System does not expect the total amount of unrecognized tax benefits to significantly change in the next 12 months. Tax returns filed by the System are subject to examination by the IRS up to three years from the extended due date of each return. The System recognizes interest and/or penalties related to income tax matters in income tax expense. The System did not have any amounts accrued for interest and penalties at December 31, 2018 and 2017. Tax returns filed by the System and its subsidiaries are no longer subject to examination for the years ended December 31, 2014 and prior.

Schedule D (Form 990) 2018

Additional Data

Software ID:	18007697
Software Version:	2018v3.1

- TIN:

SCHEDULE H
(Form 990)

Department of the Treasury
Internal Revenue Service

Hospitals

Complete if the organization answered "Yes" on Form 990, Part IV, question 20.
MediumBullet

Attach to Form 990.
MediumBullet

Go to www.irs.gov/Form990EZ for instructions and the latest information.

OMB No. 1545-0047

2018

Open to Public Inspection

Name of the organization

BRYAN MEDICAL CENTER

Employer identification number

47-0376552

Part I

Financial Assistance and Certain Other Community Benefits at Cost

Yes

Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a . . . .

Yes

If "Yes," was it a written policy? ......................

Yes

If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.

Applied uniformly to all hospital facilities Applied uniformly to most hospital facilities Generally tailored to individual hospital facilities

Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.

Did the organization use Federal Poverty Guidelines (FPG) as a factor in determining eligibility for providing free care?

If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:

Yes

100% 150% 200% Other %

Did the organization use FPG as a factor in determining eligibility for providing discounted care? If "Yes," indicate

which of the following was the family income limit for eligibility for discounted care: . . . . . . . .

Yes

200% 250% 300% 350% 400% Other %

If the organization used factors other than FPG in determining eligibility, describe in Part VI the criteria used for determining eligibility for free or discounted care. Include in the description whether the organization used an asset test or other threshold, regardless of income, as a factor in determining eligibility for free or discounted care.

Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? . . . . . . . . . . . . .

Yes

Did the organization budget amounts for free or discounted care provided under its financial assistance policy during
the tax year? . . . . . . . . . . . . . . . . . . . . . . .

Yes

If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? . . . . . .

If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discountedcare to a patient who was eligibile for free or discounted care? . . . . . . . . . . . . .

Did the organization prepare a community benefit report during the tax year? . . . . . . . . .

Yes

If "Yes," did the organization make it available to the public? . . . . . . . . . . . . .

Yes

Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.

Financial Assistance and Certain Other Community Benefits at Cost

Financial Assistance and Means-Tested Government Programs		(a) Number of activities or programs (optional)	(b) Persons served (optional)	(c) Total community benefit expense	(d) Direct offsetting revenue	(e) Net community benefit expense	(f) Percent of total expense
a	Financial Assistance at cost (from Worksheet 1) . . .			12,465,408		12,465,408	2.22 %
b	Medicaid (from Worksheet 3, column a) . . . . .			55,145,472	33,777,484	21,367,988	3.80 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) . .					0	0 %
d	Total Financial Assistance and Means-Tested Government Programs . . . . .	0	0	67,610,880	33,777,484	33,833,396	6.02 %
Other Benefits
e	Community health improvement services and community benefit operations (from Worksheet 4).			1,206,475		1,206,475	0.21 %
f	Health professions education (from Worksheet 5) . . .			15,002,556	12,506,520	2,496,036	0.44 %
g	Subsidized health services (from Worksheet 6) . . . .			475,857	237,880	237,977	0.04 %
h	Research (from Worksheet 7) .					0	0 %
i	Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .			675,965		675,965	0.12 %
j	Total. Other Benefits . .	0	0	17,360,853	12,744,400	4,616,453	0.82 %
k	Total. Add lines 7d and 7j .	0	0	84,971,733	46,521,884	38,449,849	6.84 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2018

Schedule H (Form 990) 2018

Page

Part II

Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.

		(a) Number of activities or programs (optional)	(b) Persons served (optional)	(c) Total community building expense	(d) Direct offsetting revenue	(e) Net community building expense
1	Physical improvements and housing			2,780		2,780
2	Economic development			2,000		2,000
3	Community support					0
4	Environmental improvements					0
5	Leadership development and training for community members					0
6	Coalition building					0
7	Community health improvement advocacy					0
8	Workforce development					0
9	Other					0
10	Total	0	0	4,780	0	4,780

Part III

Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense

Yes

Did the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15? ..........................

Yes

Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......

32,095,375

Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy. Explain in Part VI the methodology used by the organization to estimate this amount and the rationale, if any, for including this portion of bad debt as community benefit. ......

Provide in Part VI the text of the footnote to the organization’s financial statements that describes bad debt expense or the page number on which this footnote is contained in the attached financial statements.

Section B. Medicare

Enter total revenue received from Medicare (including DSH and IME).....

201,555,418

Enter Medicare allowable costs of care relating to payments on line 5.....

240,440,235

Subtract line 6 from line 5. This is the surplus (or shortfall)........

-38,884,817

Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.Check the box that describes the method used:

Cost accounting system Cost to charge ratio Other

Section C. Collection Practices

Did the organization have a written debt collection policy during the tax year? ..........

Yes

If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year
contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI .........................

Yes

Part IV

Management Companies and Joint Ventures(owned 10% or more by officers, directors, trustees, key employees, and physicians—see instructions)

(a) Name of entity	(b) Description of primary activity of entity	(c) Organization's profit % or stock ownership %	(d) Officers, directors, trustees, or key employees' profit % or stock ownership %	(e) Physicians' profit % or stock ownership %
1Doctors Outpatient Surgery Center	Outpatient Surgery Center	51 %	0 %	49 %
2Lincoln Digestive Health Center LLC	Ambulatory Surgery Center	51 %	0 %	49 %
3Head and Neck Surgical Partners LLC	Ambulatory Surgery Center	51 %	0 %	49 %
4
5
6
7
8
9
10
11
12
13

Schedule H (Form 990) 2018

Page

Part VFacility Information

Section A. Hospital Facilities (list in order of size from largest to smallest—see instructions)How many hospital facilities did the organization operate during the tax year?2Name, address, primary website address, and state license number (and if a group return, the name and EIN of the subordinate hospital organization that operates the hospital facility)							Facility reporting group
1	Bryan Medical Center East 1600 South 48th St Lincoln,NE68506 www.bryanhealth.com 500001	X	X	X		X	A
2	BRYAN MEDICAL CENTER WEST 2300 SOUTH 16TH ST LINCOLN,NE68502 www.bryanhealth.com 500003	X	X	X	X	X	A

Schedule H (Form 990) 2018

Page 4

Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)

	A
Name of hospital facility or letter of facility reporting group

Line number of hospital facility, or line numbers of hospital facilities in a facility
reporting group (from Part V, Section A):

Yes

Community Health Needs Assessment

Was the hospital facility first licensed, registered, or similarly recognized by a state as a hospital facility in the current tax year or the immediately preceding tax year?........................

Was the hospital facility acquired or placed into service as a tax-exempt hospital in the current tax year or the immediately preceding tax year? If “Yes,” provide details of the acquisition in Section C...............

During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 12......................

Yes

If "Yes," indicate what the CHNA report describes (check all that apply):

A definition of the community served by the hospital facility

Demographics of the community

Existing health care facilities and resources within the community that are available to respond to the health needs of the community

How data was obtained

The significant health needs of the community

Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups

The process for identifying and prioritizing community health needs and services to meet the community health needs

The process for consulting with persons representing the community’s interests

The impact of any actions taken to address the significant health needs identified in the hospital facility's prior CHNA(s)

Other (describe in Section C)

Indicate the tax year the hospital facility last conducted a CHNA: 20 18

In conducting its most recent CHNA, did the hospital facility take into account input from persons who represent the broad interests of the community served by the hospital facility, including those with special knowledge of or expertise in public health? If "Yes," describe in Section C how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted .................

Yes

6 a

Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Section C..................................

Yes

Was the hospital facility’s CHNA conducted with one or more organizations other than hospital facilities?” If “Yes,” list the other organizations in Section C. ............................

Yes

Did the hospital facility make its CHNA report widely available to the public?..............

Yes

If "Yes," indicate how the CHNA report was made widely available (check all that apply):

Hospital facility’s website (list url): www.bryanhealth.com/about-bryan-health/community-health-needs-assessment/

Other website (list url):

Made a paper copy available for public inspection without charge at the hospital facility

Other (describe in Section C)

Did the hospital facility adopt an implementation strategy to meet the significant community health needs
identified through its most recently conducted CHNA? If "No," skip to line 11. ..............

Yes

Indicate the tax year the hospital facility last adopted an implementation strategy: 20 18

Is the hospital facility's most recently adopted implementation strategy posted on a website?.........

Yes

If "Yes" (list url): www.bryanhealth.com/about-bryan-health/community-health-needs-assessment/

If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ......

10b

Describe in Section C how the hospital facility is addressing the significant needs identified in its most recently conducted CHNA and any such needs that are not being addressed together with the reasons why such needs are not being addressed.

12a

Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)?...............................

12a

If "Yes" on line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........

12b

If "Yes" on line 12b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $

Schedule H (Form 990) 2018

Page 5

Part VFacility Information (continued)

Financial Assistance Policy (FAP)

	A
Name of hospital facility or letter of facility reporting group

Yes

Did the hospital facility have in place during the tax year a written financial assistance policy that:

Explained eligibility criteria for financial assistance, and whether such assistance included free or discounted care?

Yes

If “Yes,” indicate the eligibility criteria explained in the FAP:

Federal poverty guidelines (FPG), with FPG family income limit for eligibility for free care of 200.0% and FPG family income limit for eligibility for discounted care of 400.0%

Income level other than FPG (describe in Section C)

Asset level

Medical indigency

Insurance status

Underinsurance discount

Residency

Other (describe in Section C)

Explained the basis for calculating amounts charged to patients?.................

Yes

Explained the method for applying for financial assistance?...................

Yes

If “Yes,” indicate how the hospital facility’s FAP or FAP application form (including accompanying instructions) explained the method for applying for financial assistance (check all that apply):

Described the information the hospital facility may require an individual to provide as part of his or her application

Described the supporting documentation the hospital facility may require an individual to submit as part of his or
her application

Provided the contact information of hospital facility staff who can provide an individual with information about the
FAP and FAP application process

Provided the contact information of nonprofit organizations or government agencies that may be sources of
assistance with FAP applications

Other (describe in Section C)

Was widely publicized within the community served by the hospital facility?........

Yes

If "Yes," indicate how the hospital facility publicized the policy (check all that apply):

The FAP was widely available on a website (list url):

www.bryanhealth.com/patients-visitors/pricing-insurance-financial-assistance-billing

The FAP application form was widely available on a website (list url):

www.bryanhealth.com/patients-visitors/pricing-insurance-financial-assistance-billing

A plain language summary of the FAP was widely available on a website (list url):
www.bryanhealth.com/patients-visitors/pricing-insurance-financial-assistance-billing

The FAP was available upon request and without charge (in public locations in the hospital facility and by mail)

The FAP application form was available upon request and without charge (in public locations in the hospital facility
and by mail)

A plain language summary of the FAP was available upon request and without charge (in public locations in the
hospital facility and by mail)

Individuals were notified about the FAP by being offered a paper copy of the plain language summary of the FAP, by
receiving a conspicuous written notice about the FAP on their billing statements, and via conspicuous public displays or
other measures reasonably calculated to attract patients' attention

Notified members of the community who are most likely to require financial assistance about availability of the FAP

The FAP, FAP application form, and plain language summary of the FAP were translated into the primary language(s)
spoken by LEP populations

Other (describe in Section C)

Schedule H (Form 990) 2018

Page 6

Part VFacility Information (continued)

Billing and Collections

	A
Name of hospital facility or letter of facility reporting group

Yes

Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained all of the actions the hospital facility or other authorized party may take upon nonpayment?..................................

Yes

Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Deferring, denying, or requiring a payment before providing medically necessary care due to nonpayment of a previous
bill for care covered under the hospital facility's FAP

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

None of these actions or other similar actions were permitted

Did the hospital facility or other authorized party perform any of the following actions during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP?............

If "Yes," check all actions in which the hospital facility or a third party engaged:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Deferring , denying, or requiring a payment before providing medically necessary care due to nonpayment of a previous
bill for care covered under the hospital facility's FAP

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

Indicate which efforts the hospital facility or other authorized party made before initiating any of the actions listed (whether or not checked) in line 19. (check all that apply):

Provided a written notice about upcoming ECAs (Extraordinary Collection Action) and a plain language summary of the
FAP at least 30 days before initiating those ECAs

Made a reasonable effort to orally notify individuals about the FAP and FAP application process

Processed incomplete and complete FAP applications

Made presumptive eligibility determinations

Other (describe in Section C)

None of these efforts were made

Policy Relating to Emergency Medical Care

Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that required the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?..................

Yes

If "No," indicate why:

The hospital facility did not provide care for any emergency medical conditions

The hospital facility’s policy was not in writing

The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Section C)

Other (describe in Section C)

Schedule H (Form 990) 2018

Page 7

Part VFacility Information (continued)

Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)

	A
Name of hospital facility or letter of facility reporting group

Yes

Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.

The hospital facility used a look-back method based on claims allowed by Medicare fee-for-service during a prior 12-month period

The hospital facility used a look-back method based on claims allowed by Medicare fee-for-service and all private health insurers that pay claims to the hospital facility during a prior 12-month period

The hospital facility used a look-back method based on claims allowed by Medicaid, either alone or in combination with
Medicare fee-for-service and all private health insurers that pay claims to the hospital facility during a prior 12-month
period

The hospital facility used a prospective Medicare or Medicaid method

During the tax year, did the hospital facility charge any FAP-eligible individual to whom the hospital facility provided emergency or other medically necessary services more than the amounts generally billed to individuals who had insurance covering such care? ...............................

If "Yes," explain in Section C.

During the tax year, did the hospital facility charge any FAP-eligible individual an amount equal to the gross charge for any service provided to that individual? ...........................

If "Yes," explain in Section C.

Schedule H (Form 990) 2018

Page 8

Part V

Facility Information (continued)

Section C. Supplemental Information for Part V, Section B. Provide descriptions required for Part V, Section B, lines 2, 3j, 5, 6a, 6b, 7d, 11, 13b, 13h, 15e, 16j, 18e, 19e, 20e, 21c, 21d, 23, and 24. If applicable, provide separate descriptions for each hospital facility in a facility reporting group, designated by facility reporting group letter and hospital facility line number from Part V, Section A (“A, 1,” “A, 4,” “B, 2,” “B, 3,” etc.) and name of hospital facility.
Form and Line Reference	Explanation
Schedule H, Part V, Section B, Line 3E	The significant health needs are a prioritized description of the significant health needs of the community and identified through the CHNA.
Schedule H, Part V, Section B, Line 5 Facility A, 1	Facility A, 1 - BRYAN MEDICAL CENTER EAST CAMPUS AND BRYAN MEDICAL CENTER WEST CAMPUS. IN CONDUCTING THE COMMUNITY HEALTH NEEDS ASSESSMENT, REPRESENTATIVES FROM BRYAN MEDICAL CENTER PARTICIPATED IN THE MOBILIZING FOR ACTION THROUGH PLANNING AND PARTNERSHIPS (MAPP) PROCESS UNDER THE GUIDANCE OF THE LINCOLN-LANCASTER COUNTY HEALTH DEPARTMENT. THE 70+ MEMBER MAPP COMMITTEE IS A BROAD-BASED REPRESENTATION OF THE HEALTH DEPARTMENT'S COMMUNITY PARTNERS AND STAKEHOLDERS including public health and non-profit organization and coalition representatives with knowledge and expertise of the underserved and low income populations of Lancaster County. MEMBERS OF THE MAPP COMMITTEE INCLUDED REPRESENTATIVES FROM THE LINCOLN-LANCASTER COUNTY HEALTH DEPARTMENT, COMMUNITY HEALTH ENDOWMENT OF LINCOLN, LOCAL HOSPITALS, COMMUNITY STAKEHOLDERS AND LOCAL CONSULTANTS from Lancaster County.
Schedule H, Part V, Section B, Line 6a Facility A, 1	Facility A, 1 - BRYAN MEDICAL CENTER EAST CAMPUS AND BRYAN MEDICAL CENTER WEST CAMPUS. SEE SCHEDULE H, PART V, SECTION B, LINE 5
Schedule H, Part V, Section B, Line 6b Facility A, 1	Facility A, 1 - BRYAN MEDICAL CENTER EAST CAMPUS AND BRYAN MEDICAL CENTER WEST CAMPUS. THE HOSPITAL'S CHNA WAS A COLLABORATIVE EFFORT OF THE MEMBERSHIP OF THE LINCOLN -LANCASTER COUNTY MOBILIZING FOR ACTION THROUGH PLANNING AND PARTNERSHIP (MAPP), A 70+ MEMBER COMMITTEE (SEE SCHEDULE H, PART V, 5 DESCRIPTION) UNDER THE GUIDANCE OF THE LINCOLN - LANCASTER COUNTY HEALTH DEPARTMENT.
Schedule H, Part V, Section B, Line 11 Facility A, 1	Facility A, 1 - Bryan Medical Center East Campus and Bryan Medical Center West Campus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ontinued in Schedule H, Part VI
Schedule H, Part V, Section B, Line 13 Facility A, 1	Facility A, 1 - Bryan Medical Center East Campus and Bryan Medical Center West Campus. Eligibility for financial assistance - Eligibility for full or discounted financial assistance will only be considered for those patients who: 1) are uninsured or, underinsured; 2) ineligible for any government health care benefit program; 3) are unable to pay for their care, based upon a determination of financial need in accordance with the policy; 4) cooperate with Bryan's policies and procedures; 5) supply all required information to process the application; and 5) reimburse Bryan for any monies paid directly to the patient by insurance.

Schedule H (Form 990) 2018

Page 9

Part VFacility Information (continued)

Section D. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility (list in order of size, from largest to smallest) How many non-hospital health care facilities did the organization operate during the tax year?12
Name and address		Type of Facility (describe)
1	BRYAN MEDICAL CENTER COUNSELING CENTER 2221 SOUTH 17TH ST SUITE 310 LINCOLN,NE68502	COUNSELING SERVICES
2	BRYAN MEDICAL CENTER PEDIATRIC REHABILITATION SERV 1500 S 48TH ST SUITE 709 LINCOLN,NE68502	PEDIATRIC REHABILITATION SERVICES
3	BRYAN MEDICAL CENTER 1600 S 48TH ST SUITE 600 ROOM 1 LINCOLN,NE68506	CARDIAC OUTPATIENT SERVICES
4	BRYAN MEDICAL CENTER OUTPATIENT SERVICES 1500 SOUTH 48TH STREET 1ST FLOOR LINCOLN,NE68506	LAB & RADIOLOGY SERVICES
5	BRYAN MEDICAL CENTER LABORATORY 2221 SOUTH 17TH STREET SUITE 100 LINCOLN,NE68502	LABORATORY SERVICES
6	BRYAN MEDICAL CENTER OUTPATIENT RADIOLOGY 3901 PINE LAKE ROAD SUITE 110 LINCOLN,NE68516	OUTPATIENT RADIOLOGY SERVICES
7	BRYAN MEDICAL CENTER MRI Services 2222 S 16TH ST TOWER B SUITE 100 LINCOLN,NE68502	MRI SERVICES
8	BRYAN MEDICAL CENTER COUNSELING CENTER 2221 SOUTH 17TH ST SUITE 201 LINCOLN,NE68502	COUNSELING SERVICES
9	BRYAN MEDICAL CENTER THERAPY SERVICES 7501 S 27TH STREET LINCOLN,NE68512	THERAPY SERVICES
10	BRYAN MEDICAL CENTER CARDIAC-VASCULAR OUTPATIENTS 1600 SOUTH 48TH STREET SUITE 301 LINCOLN,NE68506	VASCULAR OUTPATIENT SERVICES
11	BRYAN MEDICAL CENTER 2222 S 16TH ST TOWER B SUITE 110 LINCOLN,NE68502	RADIOLOGY SERVICES

Schedule H (Form 990) 2018

Page 10

Part VI

Supplemental Information

Provide the following information.

1	Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II and Part III, lines 2, 3, 4, 8 and 9b.
2	Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any CHNAs reported in Part V, Section B.
3	Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4	Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5	Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6	Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7	State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.

Form and Line Reference	Explanation
Schedule H, Part V, Section B, Line 11 How Hospital Facility is Addressing Needs Identified in CHNA	1.ACCESS TO CARE BRYAN HEALTH CONTINUES TO WORK WITH COMMUNITY ORGANIZATIONS, OTHER PROVIDERS, AND THE BUSINESS COMMUNITY TO IMPROVE ACCESS TO COMPREHENSIVE, HIGH-QUALITY AND AFFORDABLE HEALTH CARE SERVICES FOR ALL RESIDENTS OF BRYAN'S SERVICE AREA. SINCE COMPLETION OF THE CHNA, BRYAN HEALTH HAS EXPANDED ITS USE OF NURSE NAVIGATORS TO INCLUDE THREE ONCOLOGY NAVIGATORS THAT FOCUS ON PATIENTS WITH LUNG, BREAST, AND COLORECTAL CANCER. BRYAN ALSO PROVIDES PATIENT NAVIGATORS FOR ORTHOPEDICS AND PULMONARY DISEASES. AS PART OF BRYAN HEALTH, BRYAN HEART HAS ALSO IMPLEMENTED HEART FAILURE NURSE NAVIGATORS TO IDENTIFY POTENTIAL CARE GAPS THAT CAN LEAD TO READMISSIONS. THESE INDIVIDUALS ASSIST PATIENTS AND THEIR FAMILIES TO MAKE INFORMED HEALTH CARE DECISIONS AND ACCESS APPROPRIATE HEALTHCARE SERVICES. BRYAN HEALTH ALSO CONTINUES TO SUPPORT COMMUNITY HEALTH CENTERS, SUCH AS BLUESTEM HEALTH AND CLINIC WITH A HEART, THAT SERVE INDIVIDUALS THAT MIGHT NOT OTHERWISE BE ABLE TO AFFORD PRIMARY CARE SERVICES. Beginning in 2018, BRYAN HEALTH HAS MADE PROGRESS IN DEVELOPING THE INFRASTRUCTURE NEEDED TO CREATE A MEDICAL HOME WITH THE ROLLOUT OF MYCHART, THE PATIENT PORTAL TIED TO EPIC, BRYAN HEALTH'S NEW ELECTRONIC HEALTH RECORDS SYSTEM. TO PROVIDE ADDITIONAL ACCESS TO PRIMARY CARE SERVICES, BRYAN HEALTH ALSO HAS CONTINUED ITS EZVISIT SERVICE, WHICH IS A VIRTUAL CARE MODEL WITH 24/7 ACCESS TO A NEBRASKA BOARD CERTIFIED PHYSICIAN VIA COMPUTER OR MOBILE DEVICE. BRYAN'S ED CONNECTIONS PROGRAM CONTINUES to find medical homes for patients who have been using the emergency department for their primary care, help individuals who are unable to pay for certain approved prescriptions given in the emergency department, and donates medical equipment to people who are unable to afford or attain it. ED Connections also enacts a narcotic monitoring and diversion service for individuals who have been identified as inappropriately using the emergency department to obtain narcotics or controlled medications. WITHIN LANCASTER COUNTY AND BEYOND, BRYAN HEALTH OFFERS ONLINE, MOBILE, AND ON-SITE SCREENINGS TO IDENTIFY INDIVIDUALS WITH HIGH-RISK FOR CERTAIN CONDITIONS AND TO ENSURE THEY GET TIMELY ACCESS TO PREVENTATIVE CARE. A SCREENING THAT HAS BEEN EMBRACED IS FOR FAMILY MEMBERS OF PATIENTS WITH BICUSPID AORTIC VALVE (BAV). Close relatives of those diagnosed with BAV also are at risk for an aneurysm of the aortic root and ascending aorta. Early detection is critical since up to 40 percent of BAV patients will experience complications by the time they reach 50. To assist with the lack of mental health providers and services in the vast underserved areas of the state, Bryan Health offers behavioral health evaluations via telehealth to several emergency department providers across the state. By providing this service we assist with providing a quality evaluation and plan recommendations that reduce preventable inpatient admissions and assignment to other higher levels of care. BRYAN HEALTH ALSO PARTNERS WITH MANY CITY OF LINCOLN DEPARTMENTS AS WELL AS PRIVATE BUSINESSES TO PROVIDE MOBILE SCREENINGS, EDUCATION AND HEALTH FAIRS. ONE OF THE MAJOR ACTIONS THAT BRYAN HEALTH HAS TAKEN TO INCREASE ACCESS IS THE DECISION SEVERAL YEARS AGO TO PROVIDE AN ADDITIONAL SUBSIDY FOR HEALTH INSURANCE PREMIUMS FOR BRYAN HEALTH EMPLOYEES UNDER A CERTAIN WAGE LEVEL. THIS PROGRAM WAS CREATED BECAUSE A LARGE GROUP OF LOWER WAGE EMPLOYEES ELECTED NOT TO ENROLL IN BRYAN'S INSURANCE PLAN, AND ELECTED TO REMAIN UNINSURED DUE TO PREMIUM COSTS. THE ADDITIONAL SUBSIDY HAS PROVIDED ACCESS TO INSURANCE FOR CLOSE TO 400 EMPLOYEES AND THEIR DEPENDENTS ON AN ANNUAL BASIS. WE BELIEVE THIS IS A SMALL STEP TOWARD ASSISTING UNINSURED INDIVIDUALS IN OUR COMMUNITY AS INSURED INDIVIDUALS GENERALLY HAVE BETTER ACCESS TO SERVICES. DURING 2018, BRYAN MEDICAL CENTER PROVIDED LIFE-SAVING PROCEDURES AND MEDICATIONS FOR 9,365 INDIVIDUALS WHO WERE NOT ELIGIBLE FOR ANY GOVERNMENT OR STATE SUPPORT, AND DID NOT HAVE THE FINANCIAL RESOURCES TO PAY THEIR HEALTH CARE SERVICES. THERE ARE MANY REASONS BEHIND LACK OF ACCESS TO HEALTH CARE SERVICES; THE SHORTAGE OF HEALTH CARE PROFESSIONALS IS JUST ONE OF THESE REASONS. BRYAN HEALTH IS A HUGE SUPPORTER OF EDUCATION FOR HEALTH CARE PROFESSIONALS - INCLUDING ONGOING FINANCIAL SUPPORT FOR: 1) THE BRYAN COLLEGE OF HEALTH SCIENCES, WITH MORE THAN 710 STUDENTS ENROLLED IN GRADUATE AND UNDERGRADUATE DEGREE PROGRAMS THROUGH BRYAN'S SCHOOL OF NURSING, HEALTH PROFESSION AND NURSE ANESTHESIA PROGRAMS, AND 2) THE LINCOLN MEDICAL EDUCATION PARTNERSHIP RESIDENCY PROGRAM FOR FUTURE PRIMARY CARE PROVIDERS. IN ADDITION, BRYAN ALSO SERVES AS A CLINICAL TRAINING SITE FOR A LONG LIST OF HEALTH CARE DISCIPLINES; INCLUDING RADIOLOGY, LAB, PHYSICAL THERAPY, PHARMACY, EMTS AND PARAMEDICS, ETC. THIS COMMITMENT TO EDUCATION OF THE NEXT GENERATION OF HEALTH CARE PROFESSIONALS ULTIMATELY IMPROVES ACCESS TO HEALTHCARE IN OUR REGION. MADONNA IS THE DESIGNATED ORGANIZATION IN THE LINCOLN COMMUNITY THAT PROVIDES HANDICAP-ACCESSIBLE BUS TRANSPORTATION FOR COMMUNITY MEMBERS TO/FROM DOCTORS' APPOINTMENTS, THERAPY AND OTHER OUTPATIENT APPOINTMENTS. BRYAN PROVIDES AN ANNUAL CONTRIBUTION OF $25,000 FOR THESE SERVICES SO THAT FINANCIALLY CHALLENGED MEMBERS OF OUR COMMUNITY WILL HAVE ACCESS TO MEDICAL CARE. MANY PRIVATE PRACTICE PHYSICIANS IN LINCOLN HAVE ELECTED NOT TO SERVE MEDICAID AND/OR MEDICARE PATIENTS IN THEIR OUTPATIENT CLINICS FOR FINANCIAL REASONS. BRYAN PHYSICIAN NETWORK PHYSICIANS ACCEPT MEDICAID/MEDICARE PATIENTS INTO THEIR PRACTICE BY POLICY; THEREFORE, AS BRYAN PHYSICIAN NETWORK CONTINUES TO EXPAND WITHIN THE COMMUNITY, SO DOES ACCESS TO PHYSICIAN CARE FOR AREA MEDICAID/MEDICARE PATIENTS. IN JULY 2018, BRYAN PHYSICIAN NETWORK ESTABLISHED BRYAN NORTHPOINTE FAMILY MEDICINE WHICH INCLUDES A TEAM OF THREE FAMILY PRACTICE PHYSICIANS AND FOUR PHYSICIAN ASSISTANTS. Doctors Outpatient Surgery Center (DOSC) and Lincoln Digestive Health Center (LDHC) are joint ventures between Bryan Medical Center and area physician groups that began seeing patients in 2018. DOSC will provide a lower cost outpatient alternative to the community where general and specialty surgeries will be performed, including orthopedics, gynecology, podiatry, plastics and dental. LDHC will increase the capacity of lower cost gastrointestinal screenings (colonoscopies) and gastrointestinal services to the community. Over the last four years Bryan Medical Center has increased the number of staffed beds by 90 on both campuses to meet the community's demand. THE COMMUNITY HEALTH ENDOWMENT (CHE) IS THE DESIGNATED ORGANIZATION IN LINCOLN TO COORDINATE A WIDE VARIETY OF COMMUNITY HEALTH EFFORTS TO FURTHER THE HEALTH AND SAFETY OF THE COMMUNITY. CHE'S MISSION IS FOR LINCOLN TO BE THE HEALTHIEST CITY IN THE NATION. BRYAN FULLY SUPPORTS CHE's WORK. Continued Below.
Schedule H, Part V, Section B, Line 11 How Hospital Facility is Addressing Needs Identified in CHNA	2.BEHAVIORAL HEALTH BRYAN HEALTH CONTINUES TO SUPPORT CHANGE AND INNOVATION IN PILOT PROGRAMS SUCH AS DRUG COURT, AS WELL AS WORKING WITH LAW ENFORCEMENT AND THE CRISIS CENTER TO SUPPORT ENHANCED PRE-CRISIS CARE. OVERALL BRYAN HEALTH HAS MADE PROGRESS IN SUPPORTING BEHAVIORAL HEALTH IN THE COMMUNITY WITH ITS INDEPENDENCE CENTER FACILITY FOR SUBSTANCE ABUSE TREATMENT. THIS STATE OF THE ART FACILITY PROVIDES A CARING ENVIRONMENT FOR TREATMENT AND HEALING FOR INDIVIDUALS IN LANCASTER COUNTY AND BEYOND WHO ARE SEEKING INPATIENT OR OUTPATIENT TREATMENT FOR SUBSTANCE ABUSE. THE INDEPENDENCE CENTER ALSO CONTINUES TO PROVIDE INTERVENTION NURSES AT THE BEDSIDE TO ASSESS SUBSTANCE ABUSE. THE INDEPENDENCE CENTER SUPPORTS A POSITION TITLED ADOLESCENT COMMUNITY SUPPORT LIAISON. THIS INDIVIDUAL HELPS ADOLESCENTS AND THEIR FAMILIES NAVIGATE THE PROVIDER COMMUNITY AND CONNECTS THEM WITH THE SERVICES NEEDED. THIS POSITION ALSO ASSISTS THOSE WHO ARE RETURNING FROM RESIDENTIAL SERVICES BACK INTO THE HOME, SCHOOL AND COMMUNITY. BRYAN HEALTH HAS ALSO STARTED THE COMMUNITY TRANSITIONS PROGRAM, OPERATED BY PEERS AND A SOCIAL WORKER, TO PROVIDE FOLLOW-UP TO IDENTIFIED ADULTS WHO REGULARLY USE OUR MENTAL HEALTH SERVICES. FURTHERMORE, BRYAN HEALTH SUPPORTS EFFORTS IN THE COMMUNITY TO PROVIDE AN INTEGRATED BEHAVIORAL HEALTH SAFETY NET AND EXPAND ACCESS TO BEHAVIORAL HEALTH PROVIDERS WHO SERVE POOR, UNINSURED, AND MEDICAID ELIGIBLE POPULATIONS. THESE EFFORTS INCLUDE PROVIDING A SEGREGATED MENTAL HEALTH EMERGENCY DEPARTMENT STAFFED WITH SPECIALLY TRAINED BEHAVIORAL HEALTH NURSES, SOCIAL WORKERS and Peer Specialists. In order to further leverage these specially trained staff to assist with the lack of mental health providers and services in the vast underserved areas of the state, Bryan Health offers behavioral health evaluations via telehealth to several emergency department providers across the state. By providing this service we assist with providing a quality evaluation and plan recommendations that reduce preventable inpatient admissions and assignment to other higher levels of care. IN A SPECIAL PROJECT, BRYAN HEALTH'S MENTAL HEALTH EMERGENCY DEPARTMENT HAS PARTNERED WITH SEVERAL COMMUNITY PROVIDERS TO CREATE COMMUNITY PLANS FOR AN IDENTIFIED HIGH USER PATIENT GROUP TO AIDE IN PREVENTING REPEAT HOSPITAL INPATIENT ADMISSIONS. Also in this area, Bryan Health utilizes peer specialists who hold three community wellness groups a week at no cost to the participants. This includes a separate group for ages 14-18. AS THE ONLY ACUTE CARE HOSPITAL IN LINCOLN PROVIDING BEHAVIORAL HEALTH SERVICES, BRYAN ACTIVELY ENGAGES WITH AREA PROVIDERS TO SUPPORT THE EXPANDED ROLE OF BEHAVIORAL HEALTH TREATMENT IN THE COMMUNITY AND REGION. BRYAN HAS MADE IT A PRIORITY TO SERVE AS A TRAINING SITE FOR COUNSELORS, SOCIAL WORKERS, NURSES, PHYSICIAN ASSISTANTS, AND PRIMARY CARE PHYSICIANS THROUGH THE LINCOLN MEDICAL EDUCATION PROGRAM, SOUTHEAST COMMUNITY COLLEGE, DOANE University, BRYAN COLLEGE OF HEALTH SCIENCES, UNIVERSITY OF NEBRASKA AND OTHER EDUCATIONAL INSTITUTIONS. ONLINE SCREENINGS FOR DEPRESSION, ANXIETY, POST-TRAUMATIC STRESS DISORDER, ALCOHOL ABUSE AND ADOLESCENT DEPRESSION ARE AVAILABLE AT NO COST TO THE PUBLIC ON THE BRYAN HEALTH WEBSITE. BRYAN HEALTH WORKS WITH OTHER LINCOLN PROVIDERS AND GROUPS ACROSS THE STATE TO ADDRESS GAPS AND SPECIAL NEEDS IN THE POPULATION AS WELL AS THOSE WHO ARE UNDERSERVED. THESE INCLUDE HEALTH 360 INTEGRATED HOME; THE BRIDGE BEHAVIORAL HEALTH TO IMPROVE COORDINATION OF CARE FOR CLIENTS REQUIRING EMERGENCY DETOXIFICATION; THE BEHAVIORAL HEALTH EDUCATION CENTER OF NEBRASKA FOR WORKFORCE DEVELOPMENT OF Behavioral Health Providers; and Nebraska Department of Health and Human Services. WE ARE PROUD TO CO-SPONSOR AND HOST MENTAL ILLNESS AWARENESS WEEK TO PROVIDE COMMUNITY EDUCATION WITH ADDITIONAL OFFERINGS THROUGHOUT THE YEAR ON TOPICS SUCH AS, TRAUMA INFORMED CARE, ELDER ABUSE, GUARDIANSHIPS, Chronic pain and opioid use, NE Prescription Drug Monitoring System, Holistic Self-Care, ETC. BRYAN MEDICAL CENTER MENTAL HEALTH HAS BEEN A LEADER IN SUICIDE PREVENTION FOR OUR COMMUNITY AND STATE. ONE OF THE MANAGERS FOR BRYAN MENTAL HEALTH helped to start the Nebraska State Suicide Prevention Coalition in 1999 and continues to SERVE on the Executive Committee AS THE past CO-CHAIR OF THE NEBRASKA STATE SUICIDE PREVENTION COALITION AND SERVES ON THE LEADERSHIP GROUP of THE LINCOLN SUICIDE PREVENTION coalition. IN ADDITION, THIS BRYAN MENTAL HEALTH MANAGER PROVIDED LEADERSHIP IN DEVELOPING THE FIRST LOCAL OUTREACH TO SUICIDE SURVIVORS (LOSS) TEAM IN NEBRASKA AND IS ASSISTING WITH PROVIDING DIRECTION IN THE DEVELOPMENT OF LOSS TEAMS IN OTHER PARTS OF THE STATE. Additional teams have been developed in Omaha, Kearney, Norfolk and Chadron. Bryan is also working to start new LOSS teams in Scottsbluff, North Platte, Columbus, Seward, Grand Island/Hastings and Beatrice. DEVELOPING AND IMPLEMENTING THE LOSS TEAM WAS A COLLABORATIVE EFFORT IN WORKING WITH LAW ENFORCEMENT AND POLICE CHAPLAINS AS WELL AS OTHER COMMUNITY AND COUNTY AGENCIES. A LOSS TEAM IS A GROUP OF THREE PEOPLE WHO ARE ONCALL (TWO PEOPLE WHO HAVE LOST SOMEONE TO SUICIDE AND A CLINICIAN) AND THEY RESPOND TO FAMILIES WHO HAVE LOST SOMEONE TO SUICIDE AND PROVIDE RESOURCES. CONNECTING SUICIDE SURVIVORS TO OTHER SUICIDE SURVIVORS AND RESOURCES IS CONSIDERED SUICIDE POSTVENTION WHICH IS ALSO PREVENTION. In response to the growing presence and awareness of opioid misuse and abuse in the community and across the nation, Bryan Health created the Pain Management and Opioid Stewardship Program in summer 2018. Local pain management specialist Kelly Zach, MD leads a 24-member steering team to run the program. The team includes representation from medical staff, hospital administration, pharmacy, nursing, behavioral health, substance abuse, physical therapy and organizational quality. This ongoing program will evaluate and utilize evidence-based best practices to achieve safe and appropriate pain management, while reducing the risk of opioid addiction, overdose and deaths. Continued Below.
Schedule H, Part V, Section B, Line 11 How Hospital Facility is Addressing Needs Identified in CHNA	3.CHRONIC DISEASE PREVENTION BRYAN MEDICAL CENTER, AS PART OF BRYAN HEALTH, CONTINUES TO SUPPORT EFFORTS IN THE COMMUNITY TO PROMOTE A HEALTHY LIFESTYLE AND ADDRESS THE NEEDS OF THOSE WITH CHRONIC DISEASE. AS MENTIONED UNDER ACCESS TO CARE, SEVERAL ONLINE SCREENING TOOLS CONTINUE TO BE AVAILABLE ON BRYAN HEALTH'S WEBSITE AND THE EARLY DETECTION CENTER HAS CONTINUED TO ENHANCE ITS SERVICES BY PROVIDING THE NEW BICUSPID AORTIC VALVE (BAV) SCREENING TO FAMILY MEMBERS OF THOSE WITH A BAV DIAGNOSIS. TO SUPPORT THE PREVENTION AND TREATMENT OF CANCER IN THE COMMUNITY, BRYAN HEALTH CONTINUES TO SPONSOR CANCER CONFERENCES WEEKLY, WITH SPECIAL THORACIC CONFERENCES HELD TWICE MONTHLY. LIFESPRING CANCER RECOVERY PROGRAM STILL PROVIDES SUPPORT AND EXPERTISE FOR CANCER PATIENTS AND SURVIVORS WITHIN LINCOLN AND THE SURROUNDING AREA. BRYAN MEDICAL CENTER ALSO PARTICIPATES WITH THE NEBRASKA CANCER RESEARCH CENTER (NCRC) AND THE CANCER ALLIANCE OF NEBRASKA TO OFFER CLINICAL TRIAL OPPORTUNITIES LOCALLY TO CANCER PATIENTS. Education on cancer prevention and screening, as well as other cancer-related topics, are presented to service groups and organizations as part of Bryan Medical Center's community outreach. Bryan also hosts educational classes on smoking cessation, radon prevention, the links between obesity and cancer, and caring for a loved one with cancer. Bryan also raises community awareness surrounding lung cancer every November with its Shine a Light on Lung Cancer event. TO PROTECT THE FUTURE OF THE COMMUNITY, BRYAN HEALTH MAINTAINS ITS SUPPORT OF LINCOLN PUBLIC SCHOOLS IN PROMOTING HEALTH AND WELLNESS TO ELEMENTARY SCHOOL AGE CHILDREN AND HOLDS A POSITION ON THE BOARD OF DIRECTORS FOR PARTNERSHIP FOR A HEALTHY LINCOLN. A PRIMARY POPULATION THAT HAS RECEIVED BRYAN FOCUS FOR DISEASE PREVENTION IS OUR OWN EMPLOYEES. WE FELT THIS WOULD BE A GOOD START FOR OUR COMMUNITY BECAUSE BRYAN IS one of THE LARGEST PRIVATE EMPLOYERs IN LINCOLN. EXTENSIVE WELLNESS PROGRAMMING HAS BEEN ADDED FOR OUR EMPLOYEES, INCLUDING WEIGHT MANAGEMENT, DIABETES PREVENTION AND SMOKING CESSATION. MUCH RESEARCH SUPPORTS BREAST FEEDING AS AN IMPORTANT DETERMINANT OF FUTURE HEALTH, INCLUDING OBESITY PREVENTION. BRYAN HAS BEEN INVOLVED IN A COMMUNITY-WIDE EFFORT TO PROMOTE BREAST FEEDING AMONG OUR NEW MOMS - THIS HAS INCLUDED ADOPTION OF CONSISTENT EDUCATION STANDARDS BY ALL PROVIDERS IN LINCOLN. BRYAN HEALTH THROUGH BRYAN LIFEPOINTE REACHES OUT AND PROVIDES EXTENSIVE EDUCATIONAL OPPORTUNITIES TO THE COMMUNITY THAT PROMOTES EXERCISE, AND TEACHES WELLNESS STRATEGIES AND DISEASE MANAGEMENT. THE BRYAN LIFEPOINTE NATIONAL DIABETES PREVENTION PROGRAM COMPLEMENTS CLASSES IT ALREADY OFFERS FOR THOSE MANAGING AN EXISTING DIABETES DIAGNOSIS. Bryan also holds an annual diabetes conference, directed toward internal staff as well as educators across the state, offering classes and training sessions to keep participants abreast of current standards and best practices. BRYAN LIFEPOINTE CONTINUES TO OFFER PHYSICAL AND OCCUPATIONAL THERAPY, CARDIAC AND PULMONARY REHAB, AND AQUATIC THERAPY. THE WEIGHT MANAGEMENT PROGRAM LIFETRACKS, AS WELL AS THE PHYSICIAN REFERRED, LIFEFIT, CONTINUE TO SEE MORE CLIENTS AND ARE GENERATING INTEREST IN THE COMMUNITY. BRYAN LIFEPOINTE ALSO PLAYS AN INTEGRAL PART IN THE CONTINUUM OF CARE FOR BRYAN BARIATRIC ADVANTAGE SURGERY PATIENTS. In addition, Bryan LifePointe offers a variety of health programming and seminars, and women's and men's health symposiums to the public, encouraging and supporting individuals toward a healthy and sustainable lifestyle. To further reach the public, Bryan Health also began publishing podcasts twice per month in 2016, educating listeners on a variety of topics, including childhood development, mental health, blood pressure guidelines, postpartum depression, cancer screenings, diabetes management, and more. ALL OF THIS COMMUNITY EDUCATION IS PROVIDED AT NO COST TO PARTICIPANTS. Continued Below.
Schedule H, Part V, Section B, Line 11 How Hospital Facility is Addressing Needs Identified in CHNA	4. INJURY PREVENTION BRYAN HEALTH HOSTS A CHILD RESTRAINT SYSTEM CHECKUP CLINIC ONCE A YEAR AND THE MATERNAL AND CHILDBIRTH PROGRAM ALSO PROVIDES GUIDANCE TO PARENTS ON SAFETY MEASURES. SAFE SITTER CLASSES ALSO ARE HELD TEN TIMES A YEAR TO EQUIP TEENAGERS AND OTHER CAREGIVERS IN THE COMMUNITY WITH THE SKILLS NECESSARY TO CARE FOR CHILDREN AND AVOID ANY UNINTENTIONAL INJURY OR HARM. BRYAN HEALTH CONTINUES TO WORK WITH OTHER ORGANIZATIONS IN THE COMMUNITY TO PROMOTE ACCIDENT PREVENTION THROUGH PUBLIC EDUCATION. THIS INCLUDES INVOLVEMENT WITH SAFEKIDS NEBRASKA INJURY PREVENTION EFFORTS, PARTICIPATION IN SEVERAL KIDS FAIRS INCLUDING THE BRYAN KIDS CLUB KIDS FAIR and the DEVELOPMENT OF A BICYCLE HELMET PROGRAM which BRYAN MEDICAL CENTER offers a free bicycle helmet to anyone who comes into its emergency department with a bicycle related accident, trauma or otherwise. Bryan also distributes free bicycle helmets at many of its community events. Bryan Health is a member of the Drive Smart Nebraska Coalition which is dedicated to eliminating injuries and deaths on Nebraska roads. THE TRAUMA DEPARTMENT HAS ALSO DEVELOPED A TRAUMA SURVIVORS NETWORK WITHIN THE COMMUNITY TO RAISE AWARENESS AS WELL AS CREATE A SUPPORT SYSTEM FOR THOSE WHO HAVE SURVIVED ACCIDENTS AND OTHER TRAUMAS. BRYAN HEALTH SHOWS A CONTINUED COMMITMENT TO TRAUMA CARE THROUGH ITS REVERIFICATION BY THE AMERICAN COLLEGE OF SURGEONS AS A LEVEL 2 TRAUMA CENTER AND PARTICIPATION IN THE STATE OF NEBRASKA STATEWIDE TRAUMA SYSTEM. ADDITIONALLY, MEMBERS OF THE TRAUMA PROGRAM HOLD POSITIONS ON THE STATEWIDE TRAUMA ADVISORY BOARD. TO RAISE AWARENESS OF THE EMERGENCY RESPONSE SYSTEM IN THE COMMUNITY, BRYAN HEALTH HOSTS A TRIBUTE TO TRAUMA CHAMPIONS EVENT EACH YEAR, RECOGNIZING A TRAUMA SURVIVOR AND ALL OF THE CAREGIVERS FROM FIRST RESPONDERS, TO TRAUMA CENTER TEAM MEMBERS, TO REHABILITATION AND THERAPY TEAMS THROUGHOUT THE COMMUNITY. Bryan Health provides free programs and training to the public as part of the Stop the Bleed campaign. Stop the Bleed is a national campaign that teaches individuals how to stop life-threatening bleeding. Bryan Health has trained over 5,700 participants of the program to apply a tourniquet, pack an open wound and keep the injured person alert and calm. Bryan Health's trauma outreach coordinator gives human trafficking education to the community. This general course addresses topics such as what human trafficking is; the degree to which human trafficking exists in Nebraska; what to look for and what to do if you suspect human trafficking; and nearby organizations to contact when you witness or suspect human trafficking. Bryan Trauma Center also continues its involvement with Operation Tipping Point, which provides help for members of gangs and others involved in violence who seek alternatives in their lives.
Schedule H, Part I, Line 6a Community benefit report prepared by related organization	Bryan Health
Schedule H, Part I, Line 7g Subsidized Health Services	n/a - there are no cost associated with a physician clinic on line 7g
Schedule H, Part I, Line 7 Bad Debt Expense excluded from financial assistance calculation	32095375
Schedule H, Part I, Line 7 Costing Methodology used to calculate financial assistance	Bryan Medical Center's Uncompensated Care Cost-to-Charge ratio was used to calculate the amount on line 7A. Direct and Indirect costs were deducted from payments to calculate the amounts on 7B. For lines 7E, 7F, 7G, and 7I, any offsetting revenue was deducted from expenses directly attributable to the community benefit activity.
Schedule H, Part II Community Building Activities	THE COSTS REPORTED IN PART II COMMUNITY BUILDING ACTIVITIES ARE FOR THE UPKEEP OF A COMMUNITY PARK AND GARDEN.
Schedule H, Part III, Line 2 Bad debt expense - methodology used to estimate amount	Bad Debt Expense is based upon management's assessment of historical and expected collections of accounts receivable considering business and economic conditions, trends in healthcare coverage, and other collection indicators.
Schedule H, Part III, Line 3 Bad Debt Expense Methodology	THE AMOUNT OF THE MEDICAL CENTER'S BAD DEBT EXPENSE AT COST ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE MEDICAL CENTER'S CHARITY CARE POLICY IS ESTIMATED TO BE ZERO BASED ON THE FOLLOWING: (1) BRYAN MEDICAL CENTER HAS ESTABLISHED POLICIES THAT DEFINE CHARITY CARE AND PROVIDE GUIDELINES FOR ASSESSING A PATIENT'S ABILITY TO PAY; AND ONCE ELIGIBILITY IS VERIFIED, THE MEDICAL CENTER WILL WRITE ACCOUNTS OFF TO CHARITY CARE AND NO LONGER PURSUE DEBT COLLECTION PROCEDURES; (2) BRYAN MEDICAL CENTER HAS COUNSELORS AVAILABLE TO WORK WITH ANY PATIENT BOTH PRE AND POST DISCHARGE TO ASSESS FINANCIAL NEED AND RECOMMEND APPROPRIATE ASSISTANCE; (3) BRYAN MEDICAL CENTER PROVIDES PRESUMPTIVE FINANCIAL ASSISTANCE WHEN A PATIENT MAY APPEAR ELIGIBLE FOR CHARITY CARE DISCOUNTS, BUT THERE IS NO FINANCIAL ASSISTANCE FORM ON FILE DUE TO THE LACK OF SUPPORTING DOCUMENTATION. ONCE DETERMINED, DUE TO THE INHERENT NATURE OF PRESUMPTIVE CIRCUMSTANCES, THE ONLY DISCOUNT THAT CAN BE GRANTED IS A 100% WRITE-OFF OF THE ACCOUNT BALANCE.
Schedule H, Part III, Line 4 Bad debt expense - financial statement footnote	AS STATED ON PAGE 10 OF THE AUDITED CONSOLIDATED FINANCIAL STATEMENTS: The provision for bad debts is based upon management's assessment of historical and expected collections of accounts receivable considering business and economic conditions, trends in healthcare coverage, and other collection indicators. Accounts receivable are written off and charged to the provision for bad debts after collection efforts have been made in accordance with the System's policies. Recoveries are treated as a reduction to the provision for patient bad debts.
Schedule H, Part III, Line 8 Community benefit & methodology for determining medicare costs	THE ENTIRE MEDICARE SHORTFALL AS REPORTED IN PART III, LINE 7 SHOULD BE TREATED AS A COMMUNITY BENEFIT. BRYAN MEDICAL CENTER PROVIDES CARE TO MEDICARE PATIENTS, AND MEDICARE DOES NOT PROVIDE SUFFICIENT REIMBURSEMENT TO COVER THE ENTIRE COST OF PROVIDING CARE TO THESE PATIENTS CAUSING A SHORTFALL, OR LOSS TO THE ORGANIZATION. THE FUNDS BRYAN MEDICAL CENTER USES TO COVER THIS SHORTFALL SHOULD BE CONSIDERED A COMMUNITY BENEFIT BECAUSE THE ORGANIZATION IS RELIEVING THE GOVERNMENT OF THE FINANCIAL BURDEN OF PAYING THE FULL COSTS OF CARE FOR MEDICARE BENEFICIARIES. THE COSTING METHODOLOGY USED TO DETERMINE THE MEDICARE ALLOWABLE COSTS REPORTED IN THE MEDICAL CENTER'S MEDICARE COST REPORT IS THE STEP-DOWN METHOD OF COST ALLOCATION.
Schedule H, Part III, Line 9b Collection practices for patients eligible for financial assistance	IT IS BRYAN'S POLICY TO OFFER PATIENTS A PAYMENT PLAN AND/OR FINANCIAL ASSISTANCE WHEN IT BECOMES KNOWN THAT A PATIENT IS IN NEED OF ASSISTANCE TO HELP PAY FOR THEIR HOSPITAL BILL. IF BRYAN IS AWARE THAT A PATIENT QUALIFIES FOR 100% FINANCIAL ASSISTANCE, THIS ACCOUNT WILL NEVER BE REFERRED TO A COLLECTION AGENCY. IF AN ACCOUNT HAS BEEN SENT TO A COLLECTION AGENCY, AND THE COLLECTION AGENCY OBTAINS DOCUMENTATION TO DETERMINE THAT THE PATIENT IS ELIGIBLE FOR CHARITY, THE ACCOUNT IS RETURNED TO BRYAN FOR A CHARITY ADJUSTMENT AND NO FURTHER COLLECTION EFFORT IS MADE.
Schedule H, Part V, Section B, Line 16a FAP website	A - Bryan Medical Center East: Line 16a URL: www.bryanhealth.com/patients-visitors/pricing-insurance-financial-assistance-billing;
Schedule H, Part V, Section B, Line 16b FAP Application website	A - Bryan Medical Center East: Line 16b URL: www.bryanhealth.com/patients-visitors/pricing-insurance-financial-assistance-billing;
Schedule H, Part V, Section B, Line 16c FAP plain language summary website	A - Bryan Medical Center East: Line 16c URL: www.bryanhealth.com/patients-visitors/pricing-insurance-financial-assistance-billing;
Schedule H, Part VI, Line 2 Needs assessment	AS A HEALTHCARE LEADER IN NEBRASKA, BRYAN MEDICAL CENTER IS COMMITTED TO IMPROVING THE HEALTH OF OUR COMMUNITY BY CONTINUALLY WORKING WITH COMMUNITY PARTNERS TO ASSESS THE HEALTH NEEDS OF THE COMMUNITY. DURING THE FISCAL YEAR ENDED DECEMBER 31, 2018, Bryan Medical Center, CHI St. Elizabeth and the Lincoln-Lancaster County Health Department hosted meetings (or in one case, surveys sent via email) with representatives from public health partners and other non-profit organizations and coalitions, allowing them to provide updates and insights based on their particular areas of service or expertise. Then the group evaluated the 2015 CHNA's goals, priorities and objectives in detail, discussing the current situations in Lincoln and determining whether the goals were still relevant or appropriate as they had been originally laid out. Voting systems were used to determine whether objectives within a priority needed to be tweaked at a minor level, rewritten at a major level or left with no revisions. The four priority health needs identified in the Community Health Needs Assessment were Access to Care, Behavioral Health Care, Chronic Disease Prevention, and Injury Prevention. More than 70 members of the MAPP process came together across four meetings to review each goal separately. This process is outlined in the 2018 Community Health Needs Assessment. The assessment identifies the geographic area and population served, available health care resources, the methods with which the priority health needs were reviewed and adjusted. BRYAN USED THE PRIORITIES FROM THE COMMUNITY HEALTH NEEDS ASSESSMENT TO DEVELOP A DETAILED IMPLEMENTATION STRATEGY TO ENSURE THAT OUR STRENGTHS AND AVAILABLE RESOURCES ARE ALIGNED WITH THE HEALTH NEEDS OF OUR COMMUNITY. BRYAN MEDICAL CENTER'S BOARD OF TRUSTEES ADOPTED THIS IMPLEMENTATION STRATEGY on November 26, 2018 AND IT IS POSTED ON THE BRYAN WEBSITE. THIS IMPLEMENTATION STRATEGY SERVES AS THE FOUNDATION FOR BRYAN'S COMMUNITY HEALTH IMPROVEMENT EFFORTS (SEE BRYAN COMMUNITY HEALTH NEEDS ASSESSMENT) AND IS REVIEWED ANNUALLY. BRYAN HAS ALSO PARTICIPATED OVER THE PAST sevenTEEN YEARS IN COMMUNITY NEEDS ASSESSMENTS IN COOPERATION WITH OTHER HEALTH CARE PROVIDERS AND THE LINCOLN-LANCASTER COUNTY HEALTH DEPARTMENT, AS WELL AS PARTICIPATING IN THE DEVELOPMENT OF HEALTHY PEOPLE 2020 PLAN FOR LINCOLN-LANCASTER COUNTY. IN ADDITION TO PARTICIPATION IN COMMUNITY HEALTH NEEDS ASSESSMENTS, BRYAN CONDUCTS ON-GOING COMMUNITY PERCEPTION SURVEYS. THE SURVEY ASSESSES PERCEPTION OF THE QUALITY AND AVAILABILITY OF HEALTH CARE PROVIDERS IN THE REGION. BRYAN ALSO ASSESSES MARKET SHARE AND UTILIZATION TRENDS AS WELL AS CHANGES IN POPULATION DEMOGRAPHICS. Beyond this, The Center for the Child and the Community convened an Early Childhood Comprehensive Health Working Group comprised of school administrators, community endowment representatives, mental health representatives and health care representatives. This group, sponsored by the Community Health Endowment and led by the Center for the Child and the Community, conducted its own community health assessment specifically on early childhood in Lancaster County using the MAPP process. Two representatives from Bryan Medical Center participated in this group.
Schedule H, Part VI, Line 3 Patient education of eligibility for assistance	IN KEEPING WITH BRYAN MEDICAL CENTER'S MISSION TO TREAT ALL PATIENTS WITH COMPASSION, BRYAN OFFERS A FINANCIAL ASSISTANCE PROGRAM TO PATIENTS WHO CANNOT AFFORD TO PAY FOR PART OR ALL OF THE CARE THEY RECEIVE. EDUCATION REGARDING OUR FINANCIAL ASSISTANCE PROGRAM IS PROVIDED AT EACH NEW EMPLOYEE ORIENTATION SO THAT EACH EMPLOYEE WILL HAVE A CLEAR UNDERSTANDING OF THE FINANCIAL ASSISTANCE THAT IS AVAILABLE TO OUR PATIENTS. BRYAN HAS TRAINED FINANCIAL COUNSELORS WHO WORK INDIVIDUALLY WITH PATIENTS PRE-REGISTRATION AND POST-DISCHARGE; OR AT ANY OTHER TIME THE STAFF ENCOUNTERS INFORMATION DETAILING THE PATIENTS FINANCIAL NEED. UNINSURED PATIENTS WHO ARE ADMITTED TO BRYAN WILL AUTOMATICALLY RECEIVE A CONSULTATION WITH A FINANCIAL COUNSELOR. THE COUNSELORS RECOMMEND APPROPRIATE ASSISTANCE SUCH AS FEDERAL, STATE OR LOCAL PROGRAMS, OR ELIGIBILITY FOR ASSISTANCE UNDER THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY. WHEN APPLICABLE, THE FINANCIAL COUNSELORS PROVIDE ASSISTANCE FOR QUALIFYING FOR THE FINANCIAL ASSISTANCE POLICY OR VARIOUS GOVERNMENT PROGRAMS, SUCH AS MEDICAID. A SUMMARY OF THE FINANCIAL ASSISTANCE POLICY; INCLUDING THE PHONE NUMBER TO CONTACT A BILLING CUSTOMER SERVICE REPRESENTATIVE, IS PROVIDED: 1) ON BRYAN'S WEBSITE, 2) IN ALL HOSPITAL REGISTRATION AREAS, INCLUDING THE EMERGENCY DEPARTMENT, 3) IN BILLING OFFICES, 4) IN ALL INPATIENT ADMISSION PACKETS; AND 5) ON EACH BILLING STATEMENT. THE ORGANIZATION'S PROCEDURE IS TO MAIL THE FINANCIAL ASSISTANCE POLICY AND APPLICATION FORM TO PATIENTS FREE OF CHARGE UPON REQUEST. PATIENTS MAY APPLY FOR FINANCIAL ASSISTANCE AT ANY POINT FROM PRE-ADMISSION TO THE FINAL PAYMENT OF THE BILL, AS WE RECOGNIZE THAT A PATIENTS ABILITY TO PAY OVER AN EXTENDED PERIOD OF TIME MAY BE SUBSTANTIALLY ALTERED DUE TO ILLNESS OR FINANCIAL HARDSHIP, RESULTING IN A NEED FOR FINANCIAL ASSISTANCE. ANNUALLY, ALL HOSPITAL EMPLOYEES ARE REQUIRED TO RECEIVE TRAINING REGARDING THE FINANCIAL ASSISTANCE POLICY INCLUDING HOW TO ANSWER QUESTIONS FROM A PATIENT REGARDING WHERE THE PATIENT CAN RECEIVE ADDITIONAL INFORMATION REGARDING THE POLICY.
Schedule H, Part VI, Line 4 Community information	BRYAN MEDICAL CENTER PROVIDES A NETWORK OF COMPREHENSIVE HEALTH CARE SERVICES TO THE RESIDENTS OF THE COMMUNITIES WE SERVE. BRYAN IS LOCATED IN THE CAPITAL CITY OF LINCOLN, NEBRASKA, THE STATE'S SECOND LARGEST METROPOLITAN AREA. WHILE BRYAN SERVES A REGIONAL GEOGRAPHIC AREA EXTENDING BEYOND THE COUNTY, LANCASTER COUNTY RESIDENTS ACCOUNT FOR NEARLY 68 PERCENT OF INPATIENTS AND 83 PERCENT OF OUTPATIENTS. THE MEDIAN INCOME IN LANCASTER COUNTY WAS ESTIMATED AT $55,747, AND 14.0% OF THE POPULATION HAD FAMILY INCOMES BELOW THE POVERTY LEVEL. THE PERCENT OF UNINSURED ADULTS AGED 19 TO 64 in Lancaster County HAS BEEN ESTIMATED AT A RATE OF 11.5% IN 2017. CANCER REMAINED THE LEADING CAUSE OF DEATH FOR LANCASTER COUNTY IN 2017, FOLLOWED BY HEART DISEASE, CHRONIC LUNG DISEASE, CEREBROVASCULAR DISEASE, ACCIDENTAL DEATHS, ALZHEIMER'S DISEASE, AND RENAL DISEASE. BRYAN AND CHI HEALTH-ST. ELIZABETH ARE THE PRIMARY HOSPITALS SERVING LANCASTER COUNTY. THE CENSUS BUREAU REPORTS THAT THE COUNTY'S POPULATION GREW FROM 250,291 IN 2000 TO AN ESTIMATED 317,272 IN 2018. POPULATION IS PROJECTED TO BE OVER 412,000 BY 2040, WITH GROWTH EXPECTED AMONG ALL MAJOR AGE GROUPS. THE 65 AND OVER AGE GROUP IS PROJECTED TO HAVE THE HIGHEST RATE OF GROWTH, INCREASING FROM AN ESTIMATED 44,000 IN 2018 TO AN ESTIMATED 75,000 IN 2040. BECAUSE OF LINCOLN'S SIZE, RELATIVELY STABLE ECONOMY, AND EDUCATIONAL OPPORTUNITIES, THE U.S. STATE DEPARTMENT DESIGNATED LINCOLN AS "REFUGEE FRIENDLY" IN THE 1970S. SINCE THE 70S, WAVES OF IMMIGRANTS FROM ACROSS THE WORLD HAVE RESETTLED IN LINCOLN. LINCOLN PUBLIC SCHOOLS NOW INCLUDE CHILDREN SPEAKING APPROXIMATELY 100 LANGUAGES OTHER THAN ENGLISH. THE MINORITY POPULATION IN LANCASTER COUNTY IS ESTIMATED TO BE 19.2% AS OF JULY 1, 2018. PERSONS OF HISPANIC ORIGIN (MAY BE OF ANY RACE) ARE ESTIMATED TO BE 7.2% IN 2018, WHILE PERSONS REPORTING AS ASIAN ALONE ARE ESTIMATED TO BE 4.8% OF THE POPULATION, AND PERSONS REPORTING TO BE BLACK OR AFRICAN AMERICAN ALONE ARE ESTIMATED TO BE 4.2%. PROJECTED GROWTH IN MINORITY POPULATIONS CHALLENGES US TO ACCOMMODATE DIVERSE LANGUAGE AND CULTURAL NEEDS. WITH THE SERVICE AREA RAPIDLY EXPANDING AND THE OVER 65 AGE GROUP EXPECTED TO INCREASE, BRYAN RECOGNIZES THE IMMENSE NEEDS OF OUR SERVICE AREA ARE EXPANDING AND CHANGING.
Schedule H, Part VI, Line 5 Promotion of community health	BRYAN MEDICAL CENTER HAS PROVIDED HIGH QUALITY, COMPREHENSIVE MEDICAL SERVICES TO BENEFIT THE COMMUNITY FOR OVER 92 YEARS, AND IS COMMITTED TO IDENTIFYING AND ADDRESSING NEEDS IN THE COMMUNITY IN ORDER TO PROMOTE THE PHYSICAL, EDUCATIONAL AND ECONOMIC HEALTH OF OUR COMMUNITY IN THE FUTURE. FUNDAMENTAL TO OUR COMMUNITY COMMITMENT IS THE LEADERSHIP OF OUR LOCAL GOVERNING BOARD. The majority of BRYAN'S GOVERNING BOARD CONSISTS OF MEDICAL PROFESSIONALS, BUSINESS PROFESSIONALS, AND COMMUNITY LEADERS who are independent, and ALL OF WHOM RESIDE IN THE HOSPITAL'S PRIMARY SERVICE AREA, AND UNDERSTAND THE NEEDS OF THE COMMUNITY. THESE VOLUNTEERS DEDICATE THEIR TIME, WISDOM, INSIGHTS, AND EXPERTISE TO SET POLICY AND STRATEGIC DIRECTION TO ENSURE THAT BRYAN'S VISION, MISSION AND STRATEGIC PLANS ARE ALIGNED WITH ITS CHARITABLE PURPOSE. THE MAJORITY OF THE BOARD MEMBERS ARE INDEPENDENT BOARD MEMBERS WHO ARE NEITHER EMPLOYEES NOR INDEPENDENT CONTRACTORS OF THE ORGANIZATION. THE MEDICAL STAFF OF THE ORGANIZATION IS OPEN TO ALL PHYSICIANS IN THE COMMUNITY WHO MEET MEMBERSHIP AND CLINICAL PRIVILEGES REQUIREMENTS. AS OF DECEMBER 31, 2018, BRYAN HAD AN ORGANIZED MEDICAL STAFF OF OVER 650 PHYSICIANS AND 280 ADVANCE PRACTICE PROVIDERS. AS A NON-PROFIT MEDICAL CENTER, SURPLUS FUNDS ARE CONTINUOUSLY UTILIZED TO MAINTAIN ACCESS TO LIMITED PATIENT SERVICES AND TO EXPAND ACCESS POINTS OF CARE TO PATIENTS THROUGHOUT THE COMMUNITY; INCLUDING BUT NOT LIMITED TO: 1) PROVIDING A COMPLETE DIAGNOSTIC AND INTERVENTIONAL CARDIAC PROGRAM; 2) PROVIDING A COMPREHENSIVE LEVEL II TRAUMA CENTER FOR SOUTHEAST NEBRASKA WHICH PROVIDES 24-HOUR COVERAGE OF EMERGENCY SERVICES; 3) PROVIDING A HOSPITAL-BASED RESIDENTIAL TREATMENT SUBSTANCE ABUSE FACILITY IN LINCOLN, WHICH SERVES PATIENTS THAT STRUGGLE WITH ADDICTION TO DRUGS AND ALCOHOL FROM SOUTHEAST NEBRASKA AND MANY OTHER STATES ; 4) PROVIDING HOSPITAL-BASED MENTAL HEALTH CARE TO LINCOLN AND SURROUNDING COMMUNITIES; AND 5) PROVIDING A STATE-OF-THE-ART WOMEN AND CHILDREN'S TOWER WHICH INCLUDES A NEONATAL INTENSIVE CARE UNIT. BRYAN IS COMMITTED TO TEACHING AND TRAINING THE HEALTH CARE PROFESSIONALS OF TOMORROW. OUR COLLEGE OF HEALTH SCIENCES OFFERS GRADUATE AND UNDERGRADUATE DEGREES THROUGH ITS SCHOOL OF NURSING, SCHOOL OF HEALTH PROFESSIONALS, AND SCHOOL OF NURSE ANESTHESIA PROGRAMS. MANY OF THE GRADUATES STAY IN LINCOLN OR THE SURROUNDING AREA, THEREBY PROVIDING A CONTINUOUS SUPPLY OF MEDICAL PROFESSIONALS FOR THE COMMUNITY. IN ADDITION, THE MEDICAL CENTER ASSURES CONTINUING QUALITY HEALTH IN OUR COMMUNITY THROUGH RESIDENCY PROGRAMS, WORKSHOPS AND SEMINARS, AND CLINICAL EDUCATION PROGRAMS.
Schedule H, Part VI, Line 6 Affiliated health care system	BRYAN MEDICAL CENTER IS PART OF BRYAN HEALTH, ONE OF THE LARGEST NON-PROFIT HEALTH CARE ORGANIZATIONS IN THE REGION. BRYAN HEALTH EXISTS TO: PROMOTE AND PROVIDE ACCESS TO QUALITY HEALTH CARE; PROVIDE MEDICAL EDUCATION, AND COMMUNITY SERVICE. THE COMMUNITY BENEFITS PROVIDED BY BRYAN HEALTH INCLUDE: 1) PROVIDING FREE OR DISCOUNTED HEALTH CARE TO THE UNINSURED AND UNDERINSURED, 2) PROVIDING GOVERNMENTAL SPONSORED PROGRAMS SUCH AS MEDICARE AND MEDICAID; 3) HEALTH PROFESSIONALS' EDUCATION 4) COMMUNITY HEALTH IMPROVEMENT SERVICES AND 5) CASH AND IN-KIND CONTRIBUTIONS TO OTHER NON-PROFIT ORGANIZATIONS. BRYAN HEALTH PROVIDES A FULL SPECTRUM OF PREVENTION, WELLNESS, ACUTE CARE AND REHABILITATION SERVICES TO URBAN, SUBURBAN AND RURAL COMMUNITIES IN NEBRASKA, KANSAS, IOWA, AND MISSOURI. BRYAN HEALTH CONSISTS OF Four ACUTE-CARE HOSPITALS, NUMEROUS OUTPATIENT CLINICS, A PHYSICIAN NETWORK, A COLLEGE, AN URGENT CARE CENTER, A HEALTH AND WELLNESS FACILITY, A PHILANTHROPIC FOUNDATION, A PHYSICIAN HOSPITAL ORGANIZATION, AN ACCOUNTABLE CARE ORGANIZATION, AND OTHER HEALTHCARE PROVIDERS. PREMIER SERVICES INCLUDE CARDIOLOGY, NEUROSCIENCE, ORTHOPEDICS, VASCULAR, TRAUMA AND EMERGENCY CENTERS, INTENSIVE CARE, WOMEN'S AND CHILDREN'S HEALTH, ONCOLOGY, IMAGING AND MENTAL HEALTH.

Schedule H (Form 990) 2018

Additional Data

Software ID:	18007697
Software Version:	2018v3.1

- TIN:

Note: To capture the full content of this document, please select landscape mode (11" x 8.5") when printing.

Schedule I
(Form 990)

Department of the Treasury
Internal Revenue Service

Grants and Other Assistance to Organizations,
Governments and Individuals in the United States

Complete if the organization answered "Yes," on Form 990, Part IV, line 21 or 22.
lBullet

Attach to Form 990.
lBullet

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2018

Open to Public
Inspection

Name of the organization
BRYAN MEDICAL CENTER

Employer identification number
47-0376552

Part I

General Information on Grants and Assistance

Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ........................

Yes No

Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.

Part II

Grants and Other Assistance to Domestic Organizations and Domestic Governments. Complete if the organization answered "Yes" on Form 990, Part IV, line 21, for any recipient

that received more than $5,000. Part II can be duplicated if additional space is needed.

(a) Name and address of organization or government	(b) EIN	(c) IRC section (if applicable)	(d) Amount of cash grant	(h) Purpose of grant or assistance
(1) American Heart Association 7272 Greenville Avenue Dallas,TX75231	13-5613797	501(C)3	12,500	GENERAL OPERATIONS
(2) Clinic With a Heart 1701 South 17th Street 4G Lincoln,NE68502	20-2850139	501(c)3	24,500	General Operations
(3) Community Action Partnership of Lancaster and Saunders County 210 O Street Lincoln,NE68508	47-0491162	501(c)3	12,500	General Operations
(4) Heartland Cancer Foudation 211 N 14th St Lincoln,NE68508	20-5952202	501(c)3	7,500	General Operations
(5) Lincoln Arts Council 211 N 14th St Lincoln,NE68508	47-6046691	501(c)3	6,000	General Operations
(6) Lincoln Police Department 575 S 10th St Lincoln,NE68508		City of Lincoln	26,000	Purchase of AED's
(7) Mourning Hope 4919 Baldwin Avenue Lincoln,NE68504	47-0782915	501(c)3	36,000	General Operations
(8) Partnership for Health Lincoln 4600 Valley Rd 250 Lincoln,NE68510	36-3832796	501(c)3	10,000	General Operations

Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Bullet Image

Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50055P

Schedule I (Form 990) 2018

Page 2

Part III

Grants and Other Assistance to Domestic Individuals. Complete if the organization answered "Yes" on Form 990, Part IV, line 22.
Part III can be duplicated if additional space is needed.

(a) Type of grant or assistance	(b) Number of recipients	(c) Amount of cash grant	(d) Amount of noncash assistance	(e) Method of valuation (book, FMV, appraisal, other)	(f) Description of noncash assistance

(1)
(2)
(3)
(4)
(5)
(6)
(7)

Part IV

Supplemental Information. Provide the information required in Part I, line 2; Part III, column (b); and any other additional information.

Return Reference	Explanation
Schedule I, Part I, Line 2 Procedures for monitoring use of grant funds.	The Contributions Committee of Bryan Health oversees the grant allocation and management for this organization. Each potential recipient is required to apply for a grant. The Contributions Committee reviews and discusses all submitted requests in detail. Grants are awarded based on need and eligibility.

Schedule I (Form 990) 2018

Additional Data

Software ID:	18007697
Software Version:	2018v3.1

- TIN:

Schedule J
(Form 990)

Department of the Treasury
Internal Revenue Service

Compensation Information

For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet

Complete if the organization answered "Yes" on Form 990, Part IV, line 23.
SchJMediumBullet

Attach to Form 990.
SchJMediumBullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2018

Open to Public Inspection

Name of the organization

BRYAN MEDICAL CENTER

Employer identification number

47-0376552

Part I

Questions Regarding Compensation

Yes

Check the appropiate box(es) if the organization provided any of the following to or for a person listed on Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.

First-class or charter travel Housing allowance or residence for personal use

Travel for companions Payments for business use of personal residence

Tax idemnification and gross-up payments Health or social club dues or initiation fees

Discretionary spending account Personal services (e.g., maid, chauffeur, chef)

If any of the boxes in line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all of the expenses described above? If "No," complete Part III to explain .........

Yes

Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
directors, trustees, officers, including the CEO/Executive Director, regarding the items checked in line 1a? ..

Yes

Indicate which, if any, of the following the filing organization used to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.

Compensation committee Written employment contract

Independent compensation consultant Compensation survey or study

Form 990 of other organizations Approval by the board or compensation committee

During the year, did any person listed on Form 990, Part VII, Section A, line 1a, with respect to the filing organization or a related organization:

Receive a severance payment or change-of-control payment? .............

Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........

Yes

Participate in, or receive payment from, an equity-based compensation arrangement? .........

If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.

Only 501(c)(3), 501(c)(4), and 501(c)(29) organizations must complete lines 5-9.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:

The organization? ....................

Any related organization? .......................

If "Yes," on line 5a or 5b, describe in Part III.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:

The organization? ..................

Any related organization? ......................

If "Yes," on line 6a or 6b, describe in Part III.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization provide any nonfixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............

Yes

Were any amounts reported on Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe
in Part III ..........................

If "Yes" on line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50053T

Schedule J (Form 990) 2018

Page 2

Part II

Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use duplicate copies if additional space is needed.

For each individual whose compensation must be reported on Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions, on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.
Note. The sum of columns (B)(i)-(iii) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and (E) amounts for that individual.

(A) Name and Title		(B) Breakdown of W-2 and/or 1099-MISC compensation			(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)	(F) Compensation in column (B) reported as deferred on prior Form 990
(A) Name and Title		(i) Base compensation	(ii) Bonus & incentive compensation	(iii) Other reportable compensation	(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)
1KIMBERLY RUSSEL CHIEF EXECUTIVE OFFICER	(i) (ii)	0 ------------- 891,112	0 ------------- 156,845	0 ------------- 372,081	0 ------------- 17,875	0 ------------- 21,882	0 ------------- 1,459,795	0 ------------- 0
2JOHN WOODRICH PRESIDENT & CHIEF OPERATING OFFICER	(i) (ii)	484,912 ------------- 0	70,049 ------------- 0	208,661 ------------- 0	14,634 ------------- 0	28,310 ------------- 0	806,566 ------------- 0	0 ------------- 0
3LISA VAIL VP-PATIENT CARE SERVICES/CNO, TRUSTEE	(i) (ii)	270,258 ------------- 0	38,975 ------------- 0	118,920 ------------- 0	11,704 ------------- 0	20,066 ------------- 0	459,923 ------------- 0	0 ------------- 0
4RUSSELL GRONEWOLD VP FINANCE & CHIEF FINANCIAL OFFICER	(i) (ii)	0 ------------- 538,776	0 ------------- 55,519	0 ------------- 179,302	0 ------------- 15,125	0 ------------- 24,583	0 ------------- 813,305	0 ------------- 0
5RICHARD LLOYD President - College of Health Sciences	(i) (ii)	232,610 ------------- 0	24,816 ------------- 0	59,043 ------------- 0	14,361 ------------- 0	17,260 ------------- 0	348,090 ------------- 0	0 ------------- 0
6DAVID REESE VP - CLINICAL & SUPPORT SERVICES	(i) (ii)	272,289 ------------- 0	34,871 ------------- 0	57,510 ------------- 0	23,000 ------------- 0	25,720 ------------- 0	413,390 ------------- 0	0 ------------- 0
7WARREN ENGLER MENTAL HEALTH SERVICES DIRECTOR	(i) (ii)	160,565 ------------- 0	16,211 ------------- 0	3,552 ------------- 0	11,909 ------------- 0	21,346 ------------- 0	213,584 ------------- 0	0 ------------- 0
8SHARON HADENFELDT DEAN OF NURSE ANESTHESIA, BRYAN COLLEGE OF HEALTH SCIENCES	(i) (ii)	222,602 ------------- 0	7,387 ------------- 0	6,640 ------------- 0	22,058 ------------- 0	3,601 ------------- 0	262,288 ------------- 0	0 ------------- 0
9TROY HOTTOVY INFORMATION TECHNOLOGY DIRECTOR	(i) (ii)	182,870 ------------- 0	18,283 ------------- 0	2,782 ------------- 0	11,517 ------------- 0	25,834 ------------- 0	241,286 ------------- 0	0 ------------- 0
10SHANNON PECKA ASSOCIATE PROFESSOR-Nurse Anesthesia	(i) (ii)	190,681 ------------- 0	520 ------------- 0	2,601 ------------- 0	10,860 ------------- 0	21,897 ------------- 0	226,559 ------------- 0	0 ------------- 0
11JEROME WOHLEB PHARMACY DIRECTOR	(i) (ii)	208,965 ------------- 0	17,269 ------------- 0	6,952 ------------- 0	11,868 ------------- 0	22,263 ------------- 0	267,318 ------------- 0	0 ------------- 0

Schedule J (Form 990) 2018

Page 3

Part III

Supplemental Information

Provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4a, 4b, 4c, 5a, 5b, 6a, 6b, 7, and 8, and for Part II. Also complete this part for any additional information.

Return Reference	Explanation
Schedule J, Part II COMPENSATION OF OFFICERS, DIRECTORS, TRUSTEES & KEY EMPLOYEES	IN KEEPING WITH BRYAN HEALTH'S BELIEFS AND STANDARDS OF BEHAVIOR REGARDING STEWARDSHIP, NO BOARD MEMBER SERVING ON THE BOARD OF TRUSTEES IS COMPENSATED FOR THEIR SERVICE AS A BOARD MEMBER. COMPENSATION AMOUNTS REPORTED ARE FOR SERVICES PROVIDED AS MEDICAL PROFESSIONALS OR EXECUTIVES OF THE ORGANIZATION, OR A RELATED ORGANIZATION.
Schedule J, Part I, Line 1a Travel for companions	The Majority OF THE MEMBERS OF THE BOARD OF THE TRUSTEES ARE INDEPENDENT COMMUNITY MEMBERS WHO ARE VOLUNTEER BOARD MEMBERS, AND DO NOT RECEIVE ANY COMPENSATION FOR THEIR TIME AND DUTIES AS MEMBERS OF THE BOARD OF TRUSTEES. RESPONSIBILITIES OF TRUSTEES ARE COMPLEX, AND EFFECTIVE GOVERNANCE DEPENDS UPON HAVING BOARD MEMBERS THAT ARE WELL EDUCATED ABOUT ALL ASPECTS OF HEALTH CARE AND HEALTH CARE GOVERNANCE. BRYAN MEDICAL CENTER ENCOURAGES ONGOING EDUCATION OF ITS TRUSTEES BY PROVIDING REIMBURSEMENT FOR REASONABLE TRAVEL EXPENSES THAT FURTHER THE MISSION OF BRYAN MEDICAL CENTER. REIMBURSEMENT FOR COMPANIONS OF VOLUNTEER TRUSTEES IS LIMITED BY THE BOARD OF TRUSTEES' TRAVEL POLICY TO AIR TRAVEL AT THE COACH LEVEL or the extended coach/extended leg room level. ALL TRAVEL OF COMPANIONS IS APPROVED IN ADVANCE BY THE CHIEF EXECUTIVE OFFICER OF BRYAN HEALTH, AND SUBSTANTIATION OF ALL TRAVEL RELATED EXPENSES IS REQUIRED BEFORE PAYMENT. THIS BENEFIT IS TREATED AS TAXABLE COMPENSATION TO THE TRUSTEES.
Schedule J, Part I, Line 3 Arrangement used to establish the top management official's compensation	BRYAN HEALTH'S BOARD OF TRUSTEES BELIEVES COMPENSATION FOR THE SENIOR MANAGEMENT TEAM MUST REFLECT THE COMPLEXITIES OF LEADING AND MANAGING A MULTI-HOSPITAL HEALTH SYSTEM THAT PROVIDES SERVICES THROUGHOUT MUCH OF THE STATE. RECOGNIZING THAT ITS LEADERS ARE RESPONSIBLE FOR THE QUALITY OF CARE, PATIENT SERVICES AND OVERALL FINANCIAL HEALTH OF one of THE LARGEST PRIVATE EMPLOYERs IN LINCOLN/LANCASTER COUNTY, BRYAN HEALTH'S BOARD HAS ESTABLISHED A COMPENSATION PLAN THAT MATCHES THIS LEVEL OF RESPONSIBILITY. THIS PLAN, KNOWN AS THE SENIOR MANAGEMENT COMPENSATION PHILOSOPHY IS REVIEWED AT LEAST ANNUALLY BY BRYAN HEALTH'S COMPENSATION COMMITTEE. THIS COMPENSATION PHILOSOPHY TARGETS BASE SALARY FOR SENIOR MANAGERS AT THE 50TH PERCENTILE OF THE MARKET. THE COMPENSATION COMMITTEE IS APPOINTED BY BRYAN HEALTH'S BOARD OF TRUSTEES AND IS MADE UP OF INDEPENDENT COMMUNITY LEADERS WHO ALL SERVE VOLUNTARILY, AND WHO MUST ADHERE TO A STRINGENT CONFLICT OF INTEREST POLICY. EXECUTIVE COMPENSATION IS DETERMINED AND REVIEWED PURSUANT TO GUIDELINES OUTLINED IN THE INTERMEDIATE SANCTION RULES UNDER IRC SECTION 4958 INCLUDING TAKING STEPS TO MEET THE REBUTTABLE PRESUMPTION STANDARD OF REASONABLENESS UNDER TREASURY REGULATION SECTION 53.4958-6. THE COMPENSATION COMMITTEE CONDUCTS A COMPREHENSIVE ANNUAL REVIEW OF ALL COMPENSATION PROVIDED BY THE ORGANIZATION TO THE SENIOR MANAGEMENT TEAM. THIS REVIEW IS CONDUCTED BY THE COMMITTEE BY UTILIZING NATIONAL SALARY SURVEYS, CONDUCTED BY INDEPENDENT EXTERNAL FIRMS. COMPENSATION FOR SENIOR MANAGERS IS COMPARED TO COMPENSATION OF SENIOR MANAGERS AT LIKE INSTITUTIONS ACROSS THE U.S. TO DETERMINE THAT THE VALUE OF COMPENSATION PROVIDED IS REASONABLE AND AT FAIR MARKET VALUE. THE COMPENSATION COMMITTEE ALSO WORKS DIRECTLY WITH AN EXTERNAL INDEPENDENT COMPENSATION CONSULTANT TO REVIEW THE REASONABLENESS OF TOTAL COMPENSATION PROVIDED TO THE SENIOR MANAGEMENT TEAM, AND TO ASSURE THAT THE TOTAL COMPENSATION PAID CONFORMS TO THE OVERALL COMPENSATION PHILOSOPHY. THE COMPENSATION CONSULTANT PROVIDES WRITTEN OPINIONS TO THE COMPENSATION COMMITTEE THAT ASSESSES THE REASONABLENESS OF THE TOTAL EXECUTIVE COMPENSATION PAID TO SENIOR MANAGERS. THE ANNUAL COMPENSATION REVIEW PROCEDURE WAS COMPLETED BY THE COMPENSATION COMMITTEE ON April 26, 2018. ALL DECISIONS OF THE COMPENSATION COMMITTEE ARE CONTEMPORANEOUSLY DOCUMENTED IN THE COMPENSATION COMMITTEE MINUTES WHICH ARE TIMELY REVIEWED AND APPROVED BY THE COMMITTEE.
Schedule J, Part I, Line 4b Supplemental nonqualified retirement plan	IN ORDER TO ATTRACT AND RETAIN TALENTED, EXPERIENCED EXECUTIVES, BRYAN HEALTH OFFERS A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN TO ELIGIBLE EMPLOYEES. THE FOLLOWING PEOPLE LISTED IN FORM 990, PART VII, SECTION A, LINE 1A PARTICIPATED IN A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN DURING 2018: RUSSELL GRONEWOLD $153,193, Rich Lloyd 49,647, DAVID REESE $48,140, KIMBERLY RUSSEL $304,909, JOHN WOODRICH $169,389, and LISA VAIL $82,490.
Schedule J, Part I, Line 7 Non-fixed payments	BRYAN HEALTH OFFERS A MARKET COMPETITIVE INCENTIVE COMPENSATION PROGRAM FOR MEMBERS OF MANAGEMENT. INCENTIVE COMPENSATION IS BASED ON ACHIEVING OBJECTIVE ORGANIZATIONAL AND INDIVIDUAL GOALS. THE WEIGHTS ASSIGNED TO EACH GOAL MAY CHANGE ON AN ANNUAL BASIS.

Schedule J (Form 990) 2018

Additional Data

Software ID:	18007697
Software Version:	2018v3.1

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Note: To capture the full content of this document, please select landscape mode (11" x 8.5") when printing.

Schedule K
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Information on Tax-Exempt Bonds

Complete if the organization answered "Yes" to Form 990, Part Ⅵ, line 24a. Provide descriptions,
explanations, and any additional information in Part Ⅵ.
SchKMediumBullet

Attach to Form 990.
SchKMediumBullet

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2018

Open to Public
Inspection

Name of the organization
BRYAN MEDICAL CENTER

Employer identification number
47-0376552

Part Ⅰ

Bond Issues

(a) Issuer name		(b) Issuer EIN	(c) CUSIP #	(d) Date issued	(e) Issue price	(f) Description of purpose	(g) Defeased		(h) On behalf of issuer		(i) Pool financing
(a) Issuer name		(b) Issuer EIN	(c) CUSIP #	(d) Date issued	(e) Issue price	(f) Description of purpose	Yes	No	Yes	No	Yes	No
A	HOSPITAL AUTHORITY NO 1 OF LANCASTER COUNTY NE	47-0721900	513886SR3	05-27-2008	115,216,759	SERIES 2008 A & B BONDS REFUNDED PRIOR ISSUES - (12/20/2002), (02/08/2007)		X		X		X
B	HOSPITAL AUTHORITY NO 1 OF SALINE COUNTY NE	47-0843167	79517TAW6	05-27-2008	13,480,000	SERIES 2008C BONDS REFUNDED PRIOR ISSUE - (2/8/2007)		X		X		X
C	HOSPITAL AUTHORITY NO 1 OF LANCASTER COUNTY NE	47-0490189	000000000	10-04-2016	32,430,000	SERIES 2016 BONDS REFUNDED PRIOR ISSUES - (12/21/2006),(09/18/1997), (10/31/1997)		X		X		X

Part Ⅱ

Proceeds

	A		B		C		D
	1 Amount of bonds retired ..................	53,760,000		3,445,000		13,042,500
2 Amount of bonds legally defeased ..............	0		0		0
3 Total proceeds of issue ..................	115,220,438		13,480,597		32,430,000
4 Gross proceeds in reserve funds .............	0		0		0
5 Capitalized interest from proceeds .............	0		0		0
6 Proceeds in refunding escrows ...............	0		0		0
7 Issuance costs from proceeds ...............	981,595		88,670		0
8 Credit enhancement from proceeds .............	859,107		141,505		0
9 Working capital expenditures from proceeds .............	0		0		0
10 Capital expenditures from proceeds .............	0		0		0
11 Other spent proceeds .............	113,379,736		13,250,422		32,430,000
12 Other unspent proceeds .............	0		0		0
13 Year of substantial completion .............	2008		2003		2001
	Yes	No	Yes	No	Yes	No	Yes	No
14 Were the bonds issued as part of a current refunding issue? ....	X		X		X
15 Were the bonds issued as part of an advance refunding issue? .....		X		X		X
16 Has the final allocation of proceeds been made? ..........	X		X		X
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? ..................	X		X		X

Part Ⅲ

Private Business Use

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Was the organization a partner in a partnership, or a member of an LLC, which owned property financed by tax-exempt bonds? .............
2 Are there any lease arrangements that may result in private business use of bond-financed property? ...............

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50193E

Schedule K (Form 990) 2018

Page 2

Part Ⅲ

Private Business Use (Continued)

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
3a Are there any management or service contracts that may result in private business use of bond-financed property? .............
b If "Yes" to line 3a, does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts relating to the financed property?
c Are there any research agreements that may result in private business use of bond-financed property? .............
d If "Yes" to line 3c, does the organization routinely engage bond counsel or other outside counsel to review any research agreements relating to the financed property?
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government ....
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government .........
6 Total of lines 4 and 5 .............	0 %		0 %		0 %
7 Does the bond issue meet the private security or payment test? ...
8a Has there been a sale or disposition of any of the bond-financed property to a nongovernmental person other than a 501(c)(3) organization since the bonds were issued?.............
b If "Yes" to line 8a, enter the percentage of bond-financed property sold or disposed of. ..
c If "Yes" to line 8a, was any remedial action taken pursuant to Regulations sections 1.141-12 and 1.145-2? .............
9 Has the organization established written procedures to ensure that all nonqualified bonds of the issue are remediated in accordance with the requirements under Regulations sections 1.141-12 and 1.145-2? ........

Part Ⅳ

Arbitrage

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Has the issuer filed Form 8038-T, Arbitrage Rebate, Yield Reduction and Penalty in Lieu of Arbitrage Rebate? ...		X		X		X
2 If "No" to line 1, did the following apply? ....
a Rebate not due yet? .......		X		X	X
b Exception to rebate? ........	X		X		X
c No rebate due? .........	X		X			X
If "Yes" to line 2c, provide in Part Ⅵ the date the rebate computation was performed ......
3 Is the bond issue a variable rate issue? .....	X		X			X
4a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?	X		X			X
b Name of provider ..........	PIPER JAFFRAY		PIPER JAFFRAY
c Term of hedge .........	2300 %		2300 %
d Was the hedge superintegrated? ......		X		X
e Was the hedge terminated? ........		X		X

Schedule K (Form 990) 2018

Page 3

Part Ⅳ

Arbitrage (Continued)

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
5a Were gross proceeds invested in a guaranteed investment contract (GIC)?		X		X		X
b Name of provider ..........
c Term of GIC .........
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? ........
6 Were any gross proceeds invested beyond an available temporary period?		X		X		X
7 Has the organization established written procedures to monitor the requirements of section 148? ...	X		X		X

Part Ⅴ

Procedures To Undertake Corrective Action

---------------------------------------------------------------------------------------------------------------	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
Has the organization established written procedures to ensure that violations of federal tax requirements are timely identified and corrected through the voluntary closing agreement program if self-remediation is not available under applicable regulations?	X		X		X

Part Ⅵ

Supplemental Information. Provide additional information for responses to questions on Schedule K (see instructions).

Return Reference	Explanation
Schedule K, Part I, Column (c) LINE A, COLUMN (C) CUSIP NUMBERS	The bond from HOSPITAL AUTHORITY NO. 1 OF LANCASTER COUNTY, NE has 3 separate CUSIP numbers: A: 513886SR3; B-1: 513886SS1; B-2: 513886ST9
Schedule K, Part II, Line 3 TOTAL PROCEEDS OF ISSUE	THE TOTAL PROCEEDS DO NOT AGREE TO THE ISSUE PRICE IN PART I, COLUMN (E) DUE TO INVESTMENT EARNINGS.
Schedule K, Part III PRIVATE BUSINESS USE	PART III HAS NOT BEEN COMPLETED GIVEN THAT ALL BONDS LISTED IN ROWS A THROUGH C OF PART I, WERE ISSUED SOLELY TO REFUND BONDS ISSUED PRIOR TO 2003.
Schedule K, Part IV, Line 2c Bond A	Issuer Name: Hospital Authority No. 1 of Lancaster County, NE: No rebate due. As described in the escrow verification report, the bond proceeds were held in a yield restricted escrow that was invested below the yield on the refunding bonds. As no rebatable arbitrage was earned on the escrow and the debt service fund was operated on a bona fide basis, no further rebate analysis is necessary.
Schedule K, Part IV, Line 2c Bond B	Issuer Name: Hospital authority No. 1 of Lancaster County, NE: No rebate due. Since the bond proceeds have been spent, a spending exception was met, and the debt service fund was operated on a bona fide basis, no further rebate calculations are necessary.
Schedule K, Part IV, Line 2c COLUMN A	Issuer name: HOSPITAL AUTHORITY NO. 1 OF LANCASTER COUNTY, NE The calculation for computing no rebate due was performed on 06/01/2011
Schedule K, Part IV, Line 2c COLUMN B	Issuer name: HOSPITAL AUTHORITY NO. 1 OF SALINE COUNTY, NE The calculation for computing no rebate due was performed on 06/01/2011

Schedule K (Form 990) 2018

Additional Data

Software ID:	18007697
Software Version:	2018v3.1

- TIN:

Schedule L
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Transactions with Interested Persons

Complete if the organization answered "Yes" on Form 990, Part IV, lines 25a, 25b, 26, 27, 28a, 28b, or 28c, or Form 990-EZ, Part V, line 38a or 40b.
MediumBullet

Attach to Form 990 or Form 990-EZ.
MediumBullet

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2018

Open to Public Inspection

Name of the organization

BRYAN MEDICAL CENTER

Employer identification number

47-0376552

Part I

Excess Benefit Transactions (section 501(c)(3), section 501(c)(4), and 501(c)(29) organizations only).
Complete if the organization answered "Yes" on Form 990, Part IV, line 25a or 25b, or Form 990-EZ, Part V, line 40b.

1(a) Name of disqualified person	(c) Description of transaction	(d) Corrected?
1(a) Name of disqualified person	(c) Description of transaction	Yes	No

Enter the amount of tax incurred by organization managers or disqualified persons during the year under section 4958. ........................... Bullet Image

Enter the amount of tax, if any, on line 2, above, reimbursed by the organization ........ Bullet Image

Part II

Loans to and/or From Interested Persons.
Complete if the organization answered "Yes" on Form 990-EZ, Part V, line 38a, or Form 990, Part IV, line 26; or if the organization reported an amount on Form 990, Part X, line 5, 6, or 22

(a) Name of interested person	(b) Relationship with organization	(c) Purpose of loan	(d) Loan to or from the organization?		(e)Original principal amount	(f)Balance due	(g) In default?		(h) Approved by board or committee?		(i)Written agreement?
(a) Name of interested person	(b) Relationship with organization	(c) Purpose of loan	To	From	(e)Original principal amount	(f)Balance due	Yes	No	Yes	No	Yes	No






Total ............... $

Part III

Grants or Assistance Benefiting Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 27.

(a) Name of interested person	(b) Relationship between interested person and the organization	(c) Amount of assistance	(d) Type of assistance	(e) Purpose of assistance

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

Cat. No. 50056A

Schedule L (Form 990 or 990-EZ) 2018

Page 2

Part IV

Business Transactions Involving Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 28a, 28b, or 28c.

(a) Name of interested person	(b) Relationship between interested person and the organization	(c) Amount of transaction	(d) Description of transaction	(e) Sharing of organization's revenues?
(a) Name of interested person		(c) Amount of transaction	(d) Description of transaction	Yes	No
(1) E D Associates LLC	Edward Mlinek, MD managing partner of E D Associates & TRUSTEE OF BRYAN Medical Center	465,520	Medical Director contract		No
(2) Nebraska Emergency Medicine PC	Edward Mlinek, MD, is shareholder in NE Emergency Medicine PC & TRUSTEE OF Bryan medical center	778,000	contracted fees of $773,000 plus stipend of $5,000		No

Part V

Supplemental Information
Provide additional information for responses to questions on Schedule L (see instructions).

Return Reference	Explanation

Schedule L (Form 990 or 990-EZ) 2018

Additional Data

Software ID:	18007697
Software Version:	2018v3.1

- TIN:

SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or 990-EZ or to provide any additional information.
MediumBullet

Attach to Form 990 or 990-EZ.
MediumBullet

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2018

Open to Public
Inspection

Name of the organization

BRYAN MEDICAL CENTER

Employer identification number

47-0376552

Return Reference	Explanation
Form 990, Part VI, Line 1a Delegate broad authority to a committee	The Executive Committee shall consist of the Chairperson, Vice-Chairperson, Secretary and Treasurer of the Board, the Chief of Staff, the President/Chief Executive Officer of The System and the President/Chief Operating Officer of the Corporation. The Executive Committee shall have and may exercise all of the authority and powers of the Board when the Board is not in session, except that the Executive Committee shall not have the power (a) to elect, appoint or remove any member of the Executive Committee or any trustee or officers of the Corporation; (b) to amend, alter or repeal any resolution of the Board which by its terms provides that it shall not be amended, altered or repealed by the Executive Committee. The designation and appointment of an Executive Committee and the delegation thereto of authority shall not operate to relieve the Board, or any individual trustee, of any responsibility imposed upon it or him/her by law.
Form 990, Part VI, Line 2 Family/business relationships amongst interested persons	PERSONS LISTED IN PART VII, SECTION A, MAY HAVE A BUSINESS RELATIONSHIP WITH EACH OTHER BY VIRTUE OF THEIR EMPLOYMENT BY A BRYAN HEALTH ENTITY. - , Darla Eisenhauer and Kenneth Gross - Business relationship
Form 990, Part VI, Line 6 Classes of members or stockholders	AS STATED IN THE CORPORATION'S ORGANIZING DOCUMENTS, THE SOLE CORPORATE MEMBER OF THE ORGANIZATION IS BRYAN HEALTH. BRYAN HEALTH HAS THE RIGHTS UNDER THE ORGANIZING DOCUMENTS TO: (1) APPROVE SIGNIFICANT DECISIONS OF THE ORGANIZATION'S GOVERNING BODY; (2) ELECT THE MEMBERS OF THE GOVERNING BODY; AND (3) RECEIVE ANY REMAINING ASSETS AFTER DISSOLUTION OF THE ORGANIZATION.
Form 990, Part VI, Line 7a Members or stockholders electing members of governing body	BRYAN HEALTH AS SOLE CORPORATE MEMBER OF THE ORGANIZATION, HAS THE RIGHT UNDER THE ORGANIZING DOCUMENTS TO REMOVE ANY TRUSTEE FROM OFFICE AT ANY TIME, WITH OR WITHOUT CAUSE BY A VOTE OF AT LEAST TWO-THIRDS (2/3) OF ALL THE VOTING TRUSTEES OF BRYAN HEALTH.
Form 990, Part VI, Line 7b Decisions requiring approval by members or stockholders	BRYAN HEALTH IS THE SOLE MEMBER OF BRYAN MEDICAL CENTER ("MEDICAL CENTER"). PURSUANT TO THE GOVERNING DOCUMENTS, THE BOARD OF THE MEDICAL CENTER MAY MANAGE THE AFFAIRS OF THE CORPORATION; HOWEVER, THE BOARD MAY NOT, WITHOUT THE PRIOR APPROVAL OF THE HEALTH SYSTEM: (1) ADOPT ANY LONG-TERM CAPITAL OR OPERATIONAL BUDGET; (2) ADOPT ANY CHANGES IN ANY ANNUAL OR LONG-TERM CAPITAL BUDGET OR OPERATIONAL EXPENSE BUDGET EXCEEDING $5,000,000 IN ANY SINGLE TRANSACTION OR $10,000,000 IN ANY CORPORATION FISCAL YEAR; (3) APPROVE OR IMPLEMENT AMENDMENTS TO ITS MISSION STATEMENT OR STRATEGIC PLAN; (4) APPROVE ANY INDEBTEDNESS OR INCUR A MORTGAGE OR LIEN OF ANY KIND OR NATURE ON ASSETS OF THE CORPORATION WHERE THE BORROWING OR INDEBTEDNESS EXCEEDS $5,000,000 IN ANY SINGLE TRANSACTION OR A TOTAL OF $10,000,000 IN ANY CORPORATION FISCAL YEAR; (5) ENGAGE IN OR ENTER INTO ANY TRANSACTION OR TRANSACTIONS PROVIDING FOR THE TRANSFER, SALE OR OTHER DISPOSITION OF CAPITAL ASSETS IN ANY SINGLE TRANSACTION OF $5,000,000 OR A TOTAL OF $10,000,000 IN ANY CORPORATION FISCAL YEAR; (6) APPROVE THE ELECTION OF MEMBERS OF THE BOARD; (7) APPROVE THE APPOINTMENT OF THE SYSTEM PRESIDENT/CHIEF EXECUTIVE OFFICER; (8) APPROVE PARTICIPATION IN OTHER HEALTH CARE SYSTEMS BY AFFILIATION OR MERGER; (9) APPROVE ITS LIQUIDATION OR DISSOLUTION; (10) ORGANIZE OR ACQUIRE, OR AUTHORIZE THE ORGANIZATION OR ACQUISITION OF ANY INTEREST IN, AS ALLOWED BY THE CODE, OF ANY CORPORATION, ASSOCIATION, LIMITED LIABILITY COMPANY, PARTNERSHIP; TRUST, SHARED SERVICE ARRANGEMENT; JOINT VENTURE OR OTHER ENTITY, DIRECTLY OR INDIRECTLY, WHERE THE CAPITAL EXPENDITURES OR OPERATING EXPENSES BY THE CORPORATION IN CONNECTION WITH SUCH ORGANIZATION OR ACQUISITION IN ANY SINGLE TRANSACTION EXCEEDS $5,000,000 OR A TOTAL OF $10,000,000 IN ANY CORPORATION FISCAL YEAR; (11) AMEND THE ARTICLES OF INCORPORATION OR BYLAWS OF THE CORPORATION; OR (12) TAKE ANY OTHER ACTIONS WHICH MAY BE INCONSISTENT WITH THE SYSTEM'S GOALS AND OBJECTIVES.
Form 990, Part VI, Line 11b Review of form 990 by governing body	THIS 990 WAS PREPARED BY BRYAN HEALTH'S TAX DIVISION. DURING THE RETURN PREPARATION PROCESS, THE TAX DIVISION WORKS DILIGENTLY WITH OTHER DEPARTMENTS INCLUDING HUMAN RESOURCES, FINANCE, LEGAL, AND ADVANCEMENT TO GATHER INFORMATION TO COMPLETE FORM 990 AND ATTACHED SCHEDULES IN AN ACCURATE AND THOROUGH MANNER. THIS 990 WAS REVIEWED BY THE CHIEF EXECUTIVE OFFICER, CHIEF FINANCIAL OFFICER, AND OTHER KEY OFFICERS OF BRYAN HEALTH. THIS 990 WAS ALSO REVIEWED BY AN INDEPENDENT ACCOUNTING FIRM. BRYAN HEALTH'S BOARD OF TRUSTEES HAS DELEGATED THE REVIEW OF THE FORM 990 TO THE BOARD'S AUDIT COMMITTEE. EACH MEMBER OF THE AUDIT COMMITTEE RECEIVED A COMPLETE COPY OF THIS 990, PRIOR TO FILING THE FORM WITH THE INTERNAL REVENUE SERVICE.
Form 990, Part VI, Line 12c Conflict of interest policy	BRYAN MEDICAL CENTER HAS ADOPTED A WRITTEN CONFLICT OF INTEREST POLICY THAT IS MONITORED AND ENFORCED BY THE GOVERNANCE COMMITTEE OF THE BOARD OF TRUSTEES OF BRYAN HEALTH. BOARD MEMBERS, OFFICERS AND KEY EMPLOYEES ARE REQUIRED TO ANNUALLY COMPLETE A CONFLICT OF INTEREST AND DISCLOSURE QUESTIONNAIRE TO IDENTIFY ANY FAMILY AND BUSINESS RELATIONSHIPS AND TRANSACTIONS, OR OTHER TRANSACTIONS THAT MAY POSE A POTENTIAL CONFLICT. THE QUESTIONNAIRE REQUIRES EACH COVERED PERSON TO SIGN A STATEMENT CERTIFYING THAT HE/SHE: (1) HAS REPORTED INFORMATION THAT IS CORRECT AND COMPLETE TO THE BEST OF THEIR KNOWLEDGE; (2) HAS READ THE CONFLICT OF INTEREST POLICY AND UNDERSTANDS THE POLICY, AND (3) AGREES TO COMPLY WITH ALL REQUIREMENTS OF THE POLICY. COVERED PERSONS ARE ALSO REQUIRED TO DISCLOSE REAL OR POTENTIAL CONFLICTS AT THE TIME SUCH CONFLICTS ARISE. PERSONS WHO HAVE NOT RETURNED QUESTIONNAIRES ARE CONTACTED ADDITIONAL TIMES IN AN EFFORT TO RECEIVE COMPLETE AND ACCURATE RESPONSES FROM ALL PERSONS. FAILURE TO COMPLETE THE QUESTIONNAIRE CAN RESULT IN DISCIPLINARY ACTIONS. THE QUESTIONNAIRES ARE REVIEWED IN DETAIL BY THE GOVERNANCE COMMITTEE OF BRYAN HEALTH. CONFLICTS ARE CLOSELY MONITORED BY MEMBERS OF THE GOVERNANCE COMMITTEE. THE CONFLICT OF INTEREST POLICY HAS RESTRICTIONS FOR ANY BOARD MEMBER WITH A CONFLICT OF INTEREST; SUCH AS, PROHIBITING THEM FROM VOTING WITH REGARD TO CERTAIN TRANSACTIONS IN WHICH THEY HAVE AN INTEREST.
Form 990, Part VI, Line 15a Process to establish compensation of top management official	BRYAN HEALTH'S BOARD OF TRUSTEES BELIEVES COMPENSATION FOR THE SENIOR MANAGEMENT TEAM MUST REFLECT THE COMPLEXITIES OF LEADING AND MANAGING A MULTI-HOSPITAL HEALTH SYSTEM THAT PROVIDES SERVICES THROUGHOUT MUCH OF THE STATE. RECOGNIZING THAT ITS LEADERS ARE RESPONSIBLE FOR THE QUALITY OF CARE, PATIENT SERVICES AND OVERALL FINANCIAL HEALTH OF one of THE LARGEST PRIVATE EMPLOYERs IN LINCOLN/LANCASTER COUNTY, BRYAN HEALTH'S BOARD HAS ESTABLISHED A COMPENSATION PLAN THAT MATCHES THIS LEVEL OF RESPONSIBILITY. THIS PLAN, KNOWN AS THE SENIOR MANAGEMENT COMPENSATION PHILOSOPHY IS REVIEWED AT LEAST ANNUALLY BY BRYAN HEALTH'S COMPENSATION COMMITTEE. THIS COMPENSATION PHILOSOPHY TARGETS BASE SALARY FOR SENIOR MANAGERS AT THE 50TH PERCENTILE OF THE MARKET. THE COMPENSATION COMMITTEE IS APPOINTED BY BRYAN HEALTH'S BOARD OF TRUSTEES AND IS MADE UP OF INDEPENDENT COMMUNITY LEADERS WHO ALL SERVE VOLUNTARILY, AND WHO MUST ADHERE TO A STRINGENT CONFLICT OF INTEREST POLICY. EXECUTIVE COMPENSATION IS DETERMINED AND REVIEWED PURSUANT TO GUIDELINES OUTLINED IN THE INTERMEDIATE SANCTION RULES UNDER IRC SECTION 4958 INCLUDING TAKING STEPS TO MEET THE REBUTTABLE PRESUMPTION STANDARD OF REASONABLENESS UNDER TREASURY REGULATION SECTION 53.4958-6. THE COMPENSATION COMMITTEE CONDUCTS A COMPREHENSIVE ANNUAL REVIEW OF ALL COMPENSATION PROVIDED BY THE ORGANIZATION TO THE SENIOR MANAGEMENT TEAM. THIS REVIEW IS CONDUCTED BY THE COMMITTEE BY UTILIZING NATIONAL SALARY SURVEYS, CONDUCTED BY INDEPENDENT EXTERNAL FIRMS. COMPENSATION FOR SENIOR MANAGERS IS COMPARED TO COMPENSATION OF SENIOR MANAGERS AT LIKE INSTITUTIONS ACROSS THE U.S. TO DETERMINE THAT THE VALUE OF COMPENSATION PROVIDED IS REASONABLE AND AT FAIR MARKET VALUE. THE COMPENSATION COMMITTEE ALSO WORKS DIRECTLY WITH AN EXTERNAL INDEPENDENT COMPENSATION CONSULTANT TO REVIEW THE REASONABLENESS OF TOTAL COMPENSATION PROVIDED TO THE SENIOR MANAGEMENT TEAM, AND TO ASSURE THAT THE TOTAL COMPENSATION PAID CONFORMS TO THE OVERALL COMPENSATION PHILOSOPHY. THE COMPENSATION CONSULTANT PROVIDES WRITTEN OPINIONS TO THE COMPENSATION COMMITTEE THAT ASSESSES THE REASONABLENESS OF THE TOTAL EXECUTIVE COMPENSATION PAID TO SENIOR MANAGERS. THE ANNUAL COMPENSATION REVIEW PROCEDURE WAS COMPLETED BY THE COMPENSATION COMMITTEE ON April 26, 2018. ALL DECISIONS OF THE COMPENSATION COMMITTEE ARE CONTEMPORANEOUSLY DOCUMENTED IN THE COMPENSATION COMMITTEE MINUTES WHICH ARE TIMELY REVIEWED AND APPROVED BY THE COMMITTEE.
Form 990, Part VI, Line 15b Process to establish compensation of other employees	SEE FORM 990, PART VI, SECTION B, LINE 15A.
Form 990, Part VI, Line 19 Required documents available to the public	THE ORGANIZATION'S ARTICLES OF INCORPORATION AND AMENDMENTS ARE AVAILABLE TO THE PUBLIC ON THE NEBRASKA SECRETARY OF STATE'S WEBSITE AT WWW.SOS.NE.GOV. ALSO, THIS ORGANIZATION IS INCLUDED WITHIN THE CONSOLIDATED FINANCIAL STATEMENTS OF BRYAN HEALTH THAT ARE MADE AVAILABLE TO THE PUBLIC BY THE POSTING OF THESE DOCUMENTS THROUGH THE MUNICIPAL SECURITIES RULEMAKING BOARD WEBSITE AT EMMA.MSRB.ORG. THE ORGANIZATION'S OTHER GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE GENERALLY NOT MADE AVAILABLE TO THE PUBLIC. FEDERAL TAX LAWS DO NOT REQUIRE THAT GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICIES AND FINANCIAL STATEMENTS BE MADE AVAILABLE FOR PUBLIC INSPECTION.
Form 990, Part VII, Section A COMPENSATION OF OFFICERS, DIRECTORS, TRUSTEES & KEY EMPLOYEES	IN KEEPING WITH BRYAN HEALTH'S BELIEFS AND STANDARDS OF BEHAVIOR REGARDING STEWARDSHIP, NO BOARD MEMBER SERVING ON BRYAN MEDICAL CENTER'S BOARD IS COMPENSATED FOR THEIR SERVICES AS BOARD MEMBERS. COMPENSATION AMOUNTS REPORTED ARE FOR SERVICES PROVIDED AS MEDICAL PROFESSIONALS OR EXECUTIVES OF THE ORGANIZATION, OR A RELATED ORGANIZATION.
Form 990, Part VIII, Line 2f Other Program Service Revenue	Purchase Rebates - Total Revenue: 2353475, Related or Exempt Function Revenue: 2353475, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: ;
Form 990, Part VIII, Line 11d Other Miscellaneous Revenue	Other Income - Total Revenue: 5896755, Related or Exempt Function Revenue: , Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: 5896755;
Form 990, Part IX, Line 11g Other Fees	Consulting - Total Expense: 2670767, Program Service Expense: 2670767, Management and General Expenses: , Fundraising Expenses: ; Lease Commissions - Total Expense: 213148, Program Service Expense: 213148, Management and General Expenses: , Fundraising Expenses: ; Medical Director Fees - Total Expense: 1980402, Program Service Expense: 1980402, Management and General Expenses: , Fundraising Expenses: ; Test Services - Total Expense: 1929514, Program Service Expense: 1929514, Management and General Expenses: , Fundraising Expenses: ; Laboratory Services - Total Expense: 3038283, Program Service Expense: 3038283, Management and General Expenses: , Fundraising Expenses: ; Physician Fees - Total Expense: 22103229, Program Service Expense: 22103229, Management and General Expenses: , Fundraising Expenses: ; Collections Services - Total Expense: 1523162, Program Service Expense: 1523162, Management and General Expenses: , Fundraising Expenses: ; Professional Fees - Total Expense: 5955690, Program Service Expense: 5955690, Management and General Expenses: , Fundraising Expenses: ; Anesthesiology Fees - Total Expense: 2197092, Program Service Expense: 2197092, Management and General Expenses: , Fundraising Expenses: ; Miscellaneous Fees - Total Expense: 3040318, Program Service Expense: 2538909, Management and General Expenses: 501409, Fundraising Expenses: ; Laundry Service - Total Expense: 2242657, Program Service Expense: 2242657, Management and General Expenses: , Fundraising Expenses: ; Security - Total Expense: 1614425, Program Service Expense: 1614425, Management and General Expenses: , Fundraising Expenses: ; Service Agreements - Total Expense: 13089240, Program Service Expense: 13089240, Management and General Expenses: , Fundraising Expenses: ; Ambulance Service - Total Expense: 286649, Program Service Expense: 286649, Management and General Expenses: , Fundraising Expenses: ; Miscellaneous Outside Service - Total Expense: 12722036, Program Service Expense: 12431120, Management and General Expenses: 290916, Fundraising Expenses: ; Janitorial Services - Total Expense: 315286, Program Service Expense: 315286, Management and General Expenses: , Fundraising Expenses: ;
Form 990, Part XI, Line 9 Other changes in net assets or fund balances	Deferred Tax - 475945; Pension Liability - -3440060; Transfer to related entity - -44565325; Change in Temporarily Restricted Interest in Bryan Foundation - 308811; Change in Permanently Restricted Interest in Bryan Foundation - 180675; Other - 5616; Investments in Master Limited Partnerships - 269281;

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2018

Additional Data

Software ID:	18007697
Software Version:	2018v3.1

1	Briefly describe the organization’s mission or most significant activities: TO PROVIDE EXCELLENT CARE AND PROMOTE HEALTH WITH A FOCUS ON QUALITY, COLLABORATION AND COMPASSION. During 2018, Bryan Medical Center provided charity care to 9,365 patients at a cost of $12.5 million.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	19
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	15
5	Total number of individuals employed in calendar year 2018 (Part V, line 2a) ......	5	4,703
6	Total number of volunteers (estimate if necessary) .............	6	766
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	864,108
b	Net unrelated business taxable income from Form 990-T, line 34 .........	7b	0

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	1,184,477	1,125,823
9	Program service revenue (Part VIII, line 2g) .........	621,462,724	648,259,209
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	6,443,818	9,661,901
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	8,778,143	12,374,259
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	637,869,162	671,421,192
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	292,517	320,730
14	Benefits paid to or for members (Part IX, column (A), line 4).....		0
15	Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10)	264,341,850	276,154,923
16a	Professional fundraising fees (Part IX, column (A), line 11e) .....		0
b	Total fundraising expenses (Part IX, column (D), line 25) 0
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	308,780,537	317,390,673
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	573,414,904	593,866,326
19	Revenue less expenses. Subtract line 18 from line 12.......	64,454,258	77,554,866
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	1,018,963,782	1,010,195,092
21	Total liabilities (Part X, line 26).............	244,555,228	225,056,462
22	Net assets or fund balances. Subtract line 21 from line 20.....	774,408,554	785,138,630

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 583,314,066 including grants of $ 320,730 ) (Revenue $ 648,259,209 )
	BRYAN MEDICAL CENTER IS A NATIONALLY RECOGNIZED NON-PROFIT, ACUTE CARE HOSPITAL, PROVIDING EXEMPLARY COMPREHENSIVE PATIENT CARE SERVICES, MEDICAL EDUCATION, AND COMMUNITY SERVICES TO RESIDENTS OF THE LINCOLN COMMUNITY, STATE OF NEBRASKA, AND OTHER STATES IN THE REGION. BRYAN MEDICAL CENTER IS PART OF BRYAN HEALTH, ONE OF THE LARGEST NON-PROFIT HEALTH CARE ORGANIZATIONS IN THE REGION. BRYAN MEDICAL CENTER IS THE LARGEST HOSPITAL IN LINCOLN, LICENSED FOR 640 BEDS AT TWO SEPARATE LOCATIONS. PREMIER SERVICES INCLUDE CARDIOLOGY, ORTHOPEDICS, TRAUMA, NEUROSCIENCE, MENTAL HEALTH, WOMEN AND CHILDREN'S HEALTH AND ONCOLOGY. BRYAN MEDICAL CENTER IS THE COMMUNITY'S ONLY PROVIDER OF INPATIENT MENTAL HEALTH SERVICES AND HAS HELPED THOUSANDS OF INDIVIDUALS OVER THE YEARS THROUGH THE BRYAN INDEPENDENCE CENTER RESIDENTIAL SUBSTANCE ABUSE TREATMENT PROGRAM. DURING 2018, BRYAN MEDICAL CENTER ADMITTED 29,199 INPATIENTS, DELIVERED 3,439 BABIES, AND HAD 84,396 EMERGENCY ROOM VISITS. BRYAN MEDICAL CENTER IS COMMITTED TO PROVIDING HEALTH CARE SERVICES FOR THOSE IN NEED REGARDLESS OF THEIR ABILITY TO PAY. DURING 2018, BRYAN MEDICAL CENTER PROVIDED LIFE-SAVING PROCEDURES AND MEDICATIONS FOR OVER 9,365 INDIVIDUALS WHO WERE NOT ELIGIBLE FOR ANY GOVERNMENT OR STATE SUPPORT, AND DID NOT HAVE THE FINANCIAL RESOURCES TO PAY THEIR HEALTH CARE SERVICES. UNREIMBURSED COST FOR CHARITY CARE TOTALED $12.5 MILLION. BRYAN MEDICAL CENTER ALSO INCURRED $38.9 MILLION IN UNREIMBURSED MEDICARE COSTS, AND $21.4 MILLION IN MEDICAID COSTS AND SUPPORT OF OTHER PUBLIC PROGRAMS. BRYAN MEDICAL CENTER SERVED 31,779 MEDICAID PATIENTS IN 2018. BRYAN MEDICAL CENTER PROVIDED $2.5 MILLION IN THE SUPPORT OF HEALTH PROFESSIONALS' EDUCATION, THROUGH RESIDENCY PROGRAMS AND IN SUPPORT OF THE BRYAN COLLEGE OF HEALTH SCIENCES. DURING FALL 2018, THERE WERE 716 STUDENTS ENROLLED IN GRADUATE AND UNDERGRADUATE DEGREE PROGRAMS THROUGH BRYAN'S SCHOOL OF NURSING, HEALTH PROFESSIONS AND NURSE ANESTHESIA PROGRAMS. COMMUNITY EDUCATION, SUPPORT PROGRAMS, AND SERVICES SUBSIDIZED BY THE MEDICAL CENTER TOTALED $1.4 MILLION. DONATIONS TO OTHER NON-PROFIT ORGANIZATIONS TOTALED MORE THAN $676,000. BRYAN MEDICAL CENTER'S QUANTIFIABLE COMMUNITY BENEFIT FOR 2018 TOTALED MORE THAN $77.3 MILLION.

4b	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )












4c	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )












4d	Other program services (Describe in Schedule O.)
	(Expenses $ including grants of $ ) (Revenue $ )
4e	Total program service expenses583,314,066

(A) Name and Title	(B) Average hours per week (list any hours for related organizations below dotted line)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)				(D) Reportable compensation from the organization (W- 2/1099-MISC)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)	(F) Estimated amount of other compensation from the organization and related organizations
(A) Name and Title
(18) GENE STOHS MD TRUSTEE	2.0 .......................0	X				0	0	0
(19) LISA VAIL VP-PATIENT CARE SERVICES/CNO, TRUSTEE	60.0 .......................0	X				428,153	0	31,770
(20) RUSSELL GRONEWOLD VP FINANCE & CHIEF FINANCIAL OFFICER	25.0 .......................35.0		X			0	773,597	39,708
(21) RICHARD LLOYD President - College of Health Sciences	60.0 .......................1.0			X		316,469	0	31,621
(22) DAVID REESE VP - CLINICAL & SUPPORT SERVICES	59.0 .......................1.0			X		364,670	0	48,720
(23) WARREN ENGLER MENTAL HEALTH SERVICES DIRECTOR	50.0 .......................0				X	180,329	0	33,255
(24) SHARON HADENFELDT DEAN OF NURSE ANESTHESIA, BRYAN COLLEGE OF HEALTH SCIENCES	50.0 .......................0				X	236,629	0	25,659
(25) TROY HOTTOVY INFORMATION TECHNOLOGY DIRECTOR	50.0 .......................0				X	203,936	0	37,350
(26) SHANNON PECKA ASSOCIATE PROFESSOR-Nurse Anesthesia	50.0 .......................0				X	193,802	0	32,757
(27) JEROME WOHLEB PHARMACY DIRECTOR	50.0 .......................0				X	233,187	0	34,131

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	2,920,796	2,193,634	397,674

1a	Federated campaigns..		1a
b	Membership dues..		1b
c	Fundraising events..		1c
d	Related organizations		1d	487,447
e	Government grants (contributions)		1e

f	All other contributions, gifts, grants, and similar amounts not included above		1f	638,376

g	Noncash contributions included in lines 1a - 1f:$
h Total. Add lines 1a-1f.......		1,125,823

		Business Code
2a	NET PATIENT REVENUE	621990	626,012,840	626,012,840
b	BRYAN COLLEGE OF HEALTH SCIENCES REV	611600	10,785,270	10,785,270
c	PROGRAM RENTAL REVENUE	531190	4,222,266	4,222,266
d	PHARMACY	446110	4,365,297	4,365,297
e	Specialty Care Revenue	621990	520,061	520,061
f	All other program service revenue.		2,353,475	2,353,475	0	0
g	Total. Add lines 2a–2f ....		648,259,209

3 Investment income (including dividends, interest, and othersimilar amounts) ......			7,075,650		-269,281	7,344,931
4 Income from investment of tax-exempt bond proceeds
5 Royalties...........
		(ii) Personal	(i) Real
6a	Gross rents		17,224
b	Less: rental expenses		30,953
c	Rental income or (loss)	0	-13,729
d	Net rental income or (loss)......			-13,729		-13,729
		(ii) Other	(i) Securities
7a	Gross amount from sales of assets other than inventory	1,723,571	30,000,868
b	Less: cost or other basis and sales expenses	338,962	28,799,226
c	Gain or (loss)	1,384,609	1,201,642
d	Net gain or (loss).....			2,586,251			2,586,251
8a	Gross income from fundraising events (not including $ of contributions reported on line 1c). See Part IV, line 18 ....
	a
b	Less: direct expenses ...b
c	Net income or (loss) from fundraising events..
9a	Gross income from gaming activities. See Part IV, line 19 ...
	a
b	Less: direct expenses ...b
c	Net income or (loss) from gaming activities..
10a	Gross sales of inventory, less returns and allowances ..
	a
b	Less: cost of goods sold ..b
c	Net income or (loss) from sales of inventory..
Business Code			Miscellaneous Revenue
11a	CAFETERIA		722210	3,474,027			3,474,027
b	CHILD CARE		624410	1,870,088			1,870,088
c	LAB REFERRED TESTING		900099	1,147,118		1,147,118
d	All other revenue ....			5,896,755	0	0	5,896,755
e	Total. Add lines 11a–11d ......			12,387,988
12	Total revenue. See Instructions......			671,421,192	648,259,209	864,108	21,172,052

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21	320,730	320,730
2	Grants and other assistance to domestic individuals. See Part IV, line 22
3	Grants and other assistance to foreign organizations, foreign governments, and foreign individuals. See Part IV, line 15 and 16.
4	Benefits paid to or for members
5	Compensation of current officers, directors, trustees, and key employees ....	2,027,969	1,176,222	851,747
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) ....
7	Other salaries and wages	209,247,580	207,391,281	1,856,299
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	16,760,520	16,611,832	148,688
9	Other employee benefits .......	32,973,980	32,681,458	292,522
10	Payroll taxes ...........	15,144,874	15,010,519	134,355
11	Fees for services (non-employees):
a	Management ......
b	Legal .........	188,306		188,306
c	Accounting ...........	195,031		195,031
d	Lobbying ...........
e	Professional fundraising services. See Part IV, line 17
f	Investment management fees ......	5,900		5,900
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O)	74,921,898	74,129,573	792,325	0
12	Advertising and promotion ....	823,109		823,109
13	Office expenses .......	16,965,914	16,815,404	150,510
14	Information technology ......	12,404,167	12,294,126	110,041
15	Royalties ..
16	Occupancy ...........	7,640,405	7,572,625	67,780
17	Travel ............	499,733	463,818	35,915
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .
19	Conferences, conventions, and meetings ....	302,552	298,968	3,584
20	Interest ...........	3,951,596	3,916,541	35,055
21	Payments to affiliates .......
22	Depreciation, depletion, and amortization ..	41,359,083	40,992,174	366,909
23	Insurance ...	510,763	506,232	4,531
24	Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a	MEDICAL SUPPLIES	117,594,900	117,594,900
b	BAD DEBT	32,095,375	32,095,375
c	CORPORATE COST ALLOCATION	4,061,264		4,061,264
d	Recruitment Expense	384,078	380,670	3,408
e	All other expenses	3,486,599	3,061,618	424,981	0
25	Total functional expenses. Add lines 1 through 24e	593,866,326	583,314,066	10,552,260	0
26	Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here if following SOP 98-2 (ASC 958-720).

1	Cash–non-interest-bearing ........				1
2	Savings and temporary cash investments .........			190,472,678	2	167,295,564
3	Pledges and grants receivable, net ......				3
4	Accounts receivable, net .............			82,955,198	4	75,614,759
5	Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of Schedule L .............
				0	5	0
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), persons described in section 4958(c)(3)(B), and contributing employers and sponsoring organizations of section 501(c)(9) voluntary employees' beneficiary organizations (see instructions) Complete Part II of Schedule L ..............
					6	0
7	Notes and loans receivable, net ....				7
8	Inventories for sale or use ........			11,265,058	8	13,119,275
9	Prepaid expenses and deferred charges ......			8,064,501	9	7,435,288
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	956,009,588
b	Less: accumulated depreciation	10b	538,893,564	396,554,476	10c	417,116,024
11	Investments—publicly traded securities .			239,840,601	11	241,517,630
12	Investments—other securities. See Part IV, line 11 .....			40,875,000	12	40,278,000
13	Investments—program-related. See Part IV, line 11 ..			0	13
14	Intangible assets ...............				14
15	Other assets. See Part IV, line 11 ...........			48,936,270	15	47,818,552
16	Total assets. Add lines 1 through 15 (must equal line 34)...			1,018,963,782	16	1,010,195,092

17	Accounts payable and accrued expenses .....	59,612,765	17	52,079,357
18	Grants payable ...		18
19	Deferred revenue .........		19
20	Tax-exempt bond liabilities .........	103,352,500	20	90,522,500
21	Escrow or custodial account liability. Complete Part IV of Schedule D		21
22	Loans and other payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
	persons. Complete Part II of Schedule L..		22	0
23	Secured mortgages and notes payable to unrelated third parties ..	30,500,000	23	30,500,000
24	Unsecured notes and loans payable to unrelated third parties ..		24
25	Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17 - 24). Complete Part X of Schedule D	51,089,963	25	51,954,605
26	Total liabilities. Add lines 17 through 25..	244,555,228	26	225,056,462

	Organizations that follow SFAS 117 (ASC 958), check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets	752,162,516	27	762,396,037
28	Temporarily restricted net assets ...........	14,584,568	28	14,900,448
29	Permanently restricted net assets	7,661,470	29	7,842,145
	Organizations that do not follow SFAS 117 (ASC 958), check here and complete lines 30 through 34.
30	Capital stock or trust principal, or current funds .....		30
31	Paid-in or capital surplus, or land, building or equipment fund ...		31
32	Retained earnings, endowment, accumulated income, or other funds		32
33	Total net assets or fund balances ...........	774,408,554	33	785,138,630
34	Total liabilities and net assets/fund balances ........	1,018,963,782	34	1,010,195,092

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	(g) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	Yes	No
(1)BRYAN HEALTH 1600 SOUTH 48TH STREET LINCOLN,NE68506 36-3414823	HEALTHCARE	NE	501(c)(3)	Type III-FI	BRYAN HEALTH		No
(2)CRETE AREA MEDICAL CENTER 2910 BETTEN DRIVE CRETE,NE68333 47-0841285	HEALTHCARE	NE	501(c)(3)	3	BRYAN HEALTH		No
(3)BRYAN FOUNDATION 1600 SOUTH 48TH STREET LINCOLN,NE68506 23-7005720	FUNDRAISING	NE	501(c)(3)	7	BRYAN HEALTH		No
(4)BRYAN PHYSICIAN NETWORK 1600 SOUTH 48TH STREET LINCOLN,NE68506 20-1357375	HEALTHCARE	NE	501(c)(3)	10	BRYAN HEALTH		No
(5)Merrick Medical Center 1715 26th St Central City,NE688269501 82-0906268	Healthcare	NE	501(c)(3)	3	Bryan Health		No
(6)Merrick Medical Center Foundation 1715 26th St Central City,NE688269501 47-0710738	Fundraising	NE	501(c)(3)	7	Merrick Medical Center		No

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Predominant income(related, unrelated, excluded from tax under sections 512-514)	(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?		(k) Percentage ownership
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity		(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No
(1) Lincoln Digestive Health Center LLC 1600 S 48th Street Lincoln,NE68506 37-1833798	Health Care	NE	Bryan Medical Center	Related	-44,816	365,470		No	0		No	51 %
(2) Doctor's Outpatient Surgery Center LLC 1600 S 48th Street Lincoln,NE68506 36-4835603	Healthcare	NE	Bryan Medical Center	Related	-771,749	839,910		No			No	51 %
(3) Head and Neck Surgical Partners LLC 1600 South 48th Street Lincoln,NE68506 91-1824787	Healthcare	NE	Bryan Medical Center	Related	647,111	68,842		No			No	51 %

(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(e) Are all partners section 501(c)(3) organizations?		(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?
(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	Yes	No	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No