2023-11-09T11:18:56-06:00 2022-12-31 450250958 EIDE BAILLY LLP 18081 BURT ST STE 200 OMAHA NE 680224722 990 2022-01-01 470486026 FRANCISCAN CARE SERVICES INC FRAN 4023722404 430 N MONITOR ST WEST POINT NE 687881555 TYLER TOLINE PRESIDENT 4023722404 2023-11-07 1 TYLER TOLINE 999009999 1 WENDY R COOLEY CPA P01523804 4023302660 2023-11-07 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z TYLER TOLINE 430 N MONITOR ST WEST POINT NE 687881555 50944336 0 0928 X WWW.FRANHEALTH.ORG X 1964 NE TO LIVE AND TO PROMOTE THE HEALING MISSION OF JESUS CHRIST. 10 9 359 101 -539 0 755465 2077402 43944199 47243905 2919417 1604967 3654 -2534 47622735 50923740 98137 161417 0 0 23609997 27518666 0 0 3658 16332055 17223909 40040189 44903992 7582546 6019748 100320154 89392942 20267560 11254578 80052594 78138364 X THE MISSION OF FRANCISCAN CARE SERVICES, INC. IS TO LIVE AND TO PROMOTE THE HEALING MISSION OF JESUS CHRIST BY PROVIDING QUALITY HEALTH CARE AND HEALTH RELATED INPATIENT, OUTPATIENT, HOME HEALTH AND PHYSICIAN SERVICES TO ANYONE IN NORTHEAST NEBRASKA, REGARDLESS OF THEIR ABILITY TO PAY. 0 0 38471051 161417 46423841 FRANCISCAN CARE SERVICES MISSION IS TO PROVIDE QUALITY HEALTH CARE AND HEALTH RELATED INPATIENT, OUTPATIENT, HOME HEALTH AND PHYSICIAN SERVICES TO THE PEOPLE OF NORTHEASTERN NEBRASKA BY OPERATING A HOSPITAL. THE CRITICAL ACCESS HOSPITAL PROVIDES A 24-HOUR EMERGENCY ROOM AND DOES NOT DISCRIMINATE AGAINST ANY PATIENT REGARDLESS OF THEIR ABILITY TO PAY. OUR CHARITY CARE POLICY FOLLOWS RECOMMENDED STANDARDS WHICH ARE BASED UPON THE FEDERAL POVERTY GUIDELINES. THIS POLICY IS COMMUNICATED TO OUR PATIENTS ON OUR WEBSITE AND AT OUR REGISTRATION DESKS.FRANCISCAN CARE SERVICES, INC. STATS: PATIENTS SERVED DURING THE YEAR: TOTAL IN-PATIENTS DISCHARGED 389 PATIENT DAYS - ACUTE 1,381 - SWING BED 545 - NURSERY 81 OUT-PATIENT & REGISTRATIONS 49,084 HOME HEALTH & HOSPICE 5,543PHYSICIAN CLINIC VISITS 26,070 THE HOSPITAL RECEIVES GENEROUS SUPPORT FROM THE COMMUNITY NOT ONLY FINANCIALLY BUT ALSO FROM APPROXIMATELY 101 VOLUNTEERS WHO DONATED 1,666 HOURS OF THEIR VALUABLE TIME. 978999 0 817530 ST. FRANCIS SERVICES MISSION IS TO PROVIDE EFFICIENT AND PERSONALIZED PHARMACEUTICAL SERVICES TO THE SURROUNDING AREA.ST. FRANCIS SERVICES, LLC STATS: PRESCRIPTIONS COUNT: NEW 1,341 REFILL 1,491 TOTAL 2,832 BRAND 300 GENERIC 2,532 TOTAL 2,832 39450050 1 1 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 77 0 1 359 1 0 0 0 0 0 0 0 0 0 0 0 0 X 10 9 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 0 0 X ALISA BRUNSING 4023726717 430 NORTH MONITOR STREET WEST POINT NE 687881555 RHETT ECKMANN MD PHYSICIAN 44.00 X 632696 0 46699 SCOTT GREEN MD PHYSICIAN 44.00 X 626698 0 48908 THOMAS COHEE MD PHYSICIAN 42.00 X 615351 0 46860 BRIAN HASS MD PHYSICIAN 43.00 X 556146 0 46700 RENAE MEYER MD PHYSICIAN 43.00 X 390456 0 48674 TYLER TOLINE CEO & PRESIDENT 45.00 0.40 X X 384186 0 39038 TERRY NELSON ANCILLARY DIRECTOR 55.00 X 246455 0 64284 ALISA BRUNSING VICE PRESIDENT FISCAL & SUPPORT SERVICES 50.00 X 207589 0 24157 DAVID STEFFENSMEIER CHAIRMAN (THRU 4/22) 1.50 X X 0 0 0 BILL KREIKEMEIER CHAIRMAN 1.50 0.20 X X 0 0 0 GARY KAUP VICE CHAIRMAN (THRU 4/22) 1.50 X X 0 0 0 REGINA UHING VICE CHAIRMAN 1.50 X X 0 0 0 CHET MCWHORTER SECRETARY 1.50 X X 0 0 0 STEVE SWANSON TREASURER (THRU 4/22) 1.50 X X 0 0 0 JASON SMITH TREASURER 1.50 X X 0 0 0 SR PATRICIA LINSSEN TRUSTEE 2.50 10.60 X 0 0 0 BRIAN REIMERS TRUSTEE 1.00 0.20 X 0 0 0 DYANN BRADBURY TRUSTEE 0.70 X 0 0 0 RODNEY GIESE TRUSTEE 0.70 X 0 0 0 ALLEN MEISTER TRUSTEE 0.70 X 0 0 0 3659577 0 365320 33 0 1 0 BECKENHAUER CONSTRUCTION 1901 RIVERSIDE BLVD NORFOLK NE 68701 CONSTRUCTION 5577335 CERNER CORPORATION 2800 ROCKCREEK PARKWAY KANSAS CITY MO 64117 IT SOFTWARE SUPPORT 862681 LUCENT HEALTH SOLUTIONS INC PO BOX 306411 NASHVILLE TN 372306411 HEALTH PLAN ADMIN 564334 MD WEST ONE 8005 FARNAM DRIVE OMAHA NE 68114 ORTHOPEDIC SERVICES 555395 KAT ANESTHESIA LLC 1125 E WASHINGTON WEST POINT NE 68788 ANESTHESIA SERVICES 301456 10 181893 1444787 450722 2077402 HOSPITAL/CLINIC HEALTHCARE SERVIC 621110 46336855 46336855 RETAIL PHARAMACY 456110 817530 817530 DIETARY/CAFETERIA 721000 89520 89520 47243905 1603435 -539 1603974 1532 0 1532 1532 1532 18062 20596 -2534 -2534 50923740 47241371 -539 1605506 161417 161417 968797 841712 127085 20195614 18213470 1982144 472957 375639 97318 4545207 3685374 859833 1336091 1194676 141415 29888 29888 76642 76642 4054 4054 4324717 3715256 609461 196422 190662 5760 2092761 1914997 177764 1359262 1096333 262929 860911 732706 128205 192020 169068 22952 181699 166570 15129 149385 120489 28896 2839361 2291913 547448 315760 315760 MEDICAL SUPPLIES 4323175 4323175 DUES & SUBSCRIPTIONS 274194 256593 17601 HOSPITAL AUXILIARY SUPP 3658 3658 44903992 39450050 5450284 3658 1170074 398001 10882426 6007043 6239833 6054575 1053454 1017381 642674 743200 71299956 47502140 22694069 23797816 55738036 49762979 290731 0 1608857 1611947 100320154 89392942 7981182 5722362 6279401 5532216 6006977 0 20267560 11254578 X 79842514 77855269 210080 283095 80052594 78138364 100320154 89392942 X 6019748 -7813530 -120448 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 1 4054 1 0 0 4054 0 PART II-B, LINE 1: MEMBERSHIP DUES PAID TO HEALTH CARE ASSOCIATIONS OF WHICH A PERCENTAGE OF THE DUES ARE ALLOCATED TO LOBBYING ACTIVITIES. OCCASIONAL PHONE CALL OR EMAIL TO AND FROM OUR REPRESENTATIVES. 560688 560688 25099577 14049627 11049950 45272731 33452513 11820218 366960 366960 23797816 43107682 -7813530 -7813530 50921212 2528 2528 50923740 44900334 0 44900334 3658 3658 44903992 PART XI, LINE 4B - OTHER ADJUSTMENTS: AUXILIARY INCOME 2,528. PART XII, LINE 4B - OTHER ADJUSTMENTS: AUXILIARY OPERATING EXPENSES 3,658. 1 1 X 1 X 1 X 1 1 0 1 1 102 75407 0 75407 0.00170 1727 3127133 2312620 814513 0.01810 1829 3202540 2312620 889920 0.01980 3975 280218 31815 248403 0.00550 73 161404 0 161404 0.00360 8080 8625177 7964172 661005 0.01470 12128 9066799 7995987 1070812 0.02380 13957 12269339 10308607 1960732 0.04360 6110 0 6110 0.00010 758 72181 1135 71046 0.00160 115 41858 0 41858 0.00090 873 120149 1135 119014 0.00260 1 917830 183566 15220156 15461864 -241708 X 1 1 1 1 ST FRANCIS MEMORIAL HOSPITAL 430 NORTH MONITOR STREET WEST POINT NE 68788 WWW.FRANHEALTH.ORG 180001 X X X X ST FRANCIS MEMORIAL HOSPITAL 1 0 0 1 X X X X X X X X X 22 1 1 1 1 X HTTPS://FRANHEALTH.ORG/ABOUT/NEEDS-ASSESSMENT.HTML X 1 22 1 HTTPS://FRANHEALTH.ORG/ABOUT/NEEDS-ASSESSMENT.HTML 0 1 X 100.000000000000 200.000000000000 X X 1 1 X X X 1 X HTTPS://FRANHEALTH.ORG/PATIENTS-VISITORS/PATIENT-FINANCIAL-INFORMATION.HTML X HTTPS://FRANHEALTH.ORG/PATIENTS-VISITORS/PATIENT-FINANCIAL-INFORMATION.HTML X HTTPS://FRANHEALTH.ORG/PATIENTS-VISITORS/PATIENT-FINANCIAL-INFORMATION.HTML X X X X X X 1 X 0 X X X X 1 X 0 0 ST. FRANCIS MEMORIAL HOSPITAL PART V, SECTION B, LINE 5: IN 2022, THE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) PROCESS WAS A SHIFT TO A MAINLY ONLINE AND VIRTUAL VERSION DUE TO THE LEVEL OF RESPONSE NEEDED BY ELKHORN LOGAN VALLEY PUBLIC HEALTH DEPARTMENT (ELVHD) AND THE HOSPITAL SYSTEMS THAT PARTICIPATED TO RESPOND TO THE VARIOUS STAGES OF THE COVID-19 PANDEMIC. THERE WERE FOUR KEY ASSESSMENTS THAT WERE DONE.1. THE 2021 NEBRASKA RISK AND PROTECTIVE FACTOR STUDENT SURVEY WAS USED. THIS SURVEY IS DESIGNED TO ASSESS ADOLESCENT SUBSTANCE USE, DELINQUENT BEHAVIOR, AND MANY OF THE RISK AND PROTECTIVE MEASURES THAT PREDICT ADOLESCENT PROBLEM BEHAVIORS. IN THE ELVPHD DISTRICT THERE WERE 466 TOTAL STUDENTS THAT RESPONDED TO THE SURVEY, REPRESENTING 19.7% OF ELIGIBLE STUDENTS.2. AN ELECTRONIC SURVEY, IN MULTIPLE LANGUAGES, SENT TO ETHNIC MINORITIES IN OUR SERVICE AREA VIA SOCIAL MEDIA AND IN-PERSON AT VARIOUS EVENTS AND WALK-IN CLINICS. THE SURVEY PERIOD SPANNED FROM NOVEMBER 2021 TO APRIL 2022. THE PURPOSE OF THE SURVEY WAS TO DETERMINE THE KEY HEALTH ISSUES FACING OUR MINORITY POPULATIONS, AS WELL AS WHAT ISSUES THE PARTICIPANTS WANTED ADDRESSED BY THE HEALTH CARE SYSTEM. 90 SURVEYS WERE COLLECTED AND ANALYZED.A. IN ADDITION TO THE ELECTRONIC SURVEY, ELVPHD ALSO SCHEDULED TWO COMMUNITY LISTENING SESSIONS IN MAY 2022 - ONE IN NORFOLK, NEBRASKA AND ONE IN WEST POINT, NEBRASKA. APPROXIMATELY 20 PEOPLE ATTENDED THE LISTENING SESSIONS.3. ON JUNE 16, 2022, AN ELECTRONIC SURVEY WAS SENT TO HEALTHCARE SYSTEM COLLABORATORS AND PARTNERS INCLUDING LONG-TERM CARE FACILITIES, CHILDCARE PROVIDERS, SCHOOL OFFICIALS, HEALTH DEPARTMENT AND HOSPITAL BOARD MEMBERS, CLINICIANS, EMS, UNL EXTENSION OFFICES, ELECTED OFFICIALS, BEHAVIORAL HEALTH PROVIDERS, LAW ENFORCEMENT, NORTHEAST COMMUNITY COLLEGE, COMMUNITY-BASED ORGANIZATIONS, CITY EMPLOYEES, TRIBAL ORGANIZATIONS, JAILS, ORGANIZATIONS REPRESENTING THOSE WITH DISABILITIES, CHURCHES, AND SENIOR CITIZEN CENTERS. THE SURVEY OFFERED RESPONDENTS AN OPPORTUNITY TO INDICATE THEIR ISSUES OR CONCERNS, PROPOSE AREAS OF IMPROVEMENT, AND SUBMIT THEIR FEEDBACK IN TERMS OF OPPORTUNITIES ON THE HORIZON TO BE PURSUED. APPROXIMATELY 40 SURVEYS WERE RECEIVED. 4. RESIDENTS IN BURT, CUMING, STANTON, AND MADISON COUNTIES WERE INVITED TO TAKE A COMMUNITY-LEVEL HEALTH ASSESSMENT SURVEY THROUGH PUBLIC PRESS RELEASES, RADIO PUBLIC SERVICE ANNOUNCEMENTS, CHAMBER OF COMMERCE NEWSLETTERS, POSTS AT EMPLOYERS AND AREA BUSINESSES, SENIOR CITIZENS CENTERS, SOCIAL MEDIA POSTS, AND DISTRIBUTION OF PAPER FLYERS. APPROXIMATELY 1,100 SURVEYS WERE COMPLETED. IN ALL, THERE WERE 1,657 UNDUPLICATED PARTICIPANTS. THE TOTAL PARTICIPATION RATE WAS UP 16.5% FROM 2019 (1,422 PARTICIPANTS IN 2019 COMPARED TO 1,657 PARTICIPANTS IN 2022). ST. FRANCIS MEMORIAL HOSPITAL PART V, SECTION B, LINE 6A: ST. FRANCIS MEMORIAL HOSPITAL CONDUCTED ITS CHNA IN CONJUNCTION WITH FAITH REGIONAL HEALTH SERVICES IN NORFOLK, NEBRASKA. ST. FRANCIS MEMORIAL HOSPITAL PART V, SECTION B, LINE 6B: ST. FRANCIS MEMORIAL HOSPITAL CONDUCTED ITS CHNA IN CONJUNCTION WITH ELKHORN LOGAN VALLEY PUBLIC HEALTH DEPARTMENT. ST. FRANCIS MEMORIAL HOSPITAL PART V, SECTION B, LINE 11: THE 2022 CHNA REVEALED TWO MAIN HEALTH PRIORITIES IN OUR AREA: 1) BEHAVIORAL/MENTAL HEALTH AND 2) CANCER PREVENTION AND SCREENING. THE CHNA IMPLEMENTATION PLAN HAS THE FOLLOWING GOALS TO IMPROVE THE HEALTH PRIORITIES IDENTIFIED. FOR THE HEALTH PRIORITY OF BEHAVIORAL/MENTAL HEALTH WE WILL:1. CONTINUE PROVIDING JOB SHADOWING EXPERIENCES AND PRECEPTORSHIP PROGRAMS FOR POTENTIAL BEHAVIORAL/MENTAL HEALTH STUDENTS ENTERING THE PIPELINE, AND FOR CURRENT MEDICAL STUDENTS COMPLETING FIELD TRAINING. RECRUIT BEHAVIORAL/MENTAL HEALTH PROVIDERS.2. CONTINUE TELEMEDICINE ACCESS IN THE DISTRICT FOCUSING ON BEHAVIORAL AND MENTAL HEALTH SERVICES.3. CONTINUED USE OF CLINICAL ASSESSMENTS FOR ALL PATIENT ENCOUNTERS IN THE MEDICAL SETTING: A. SUBSTANCE MISUSE AND/OR SUBSTANCE ABUSE DISORDERS.B. SUICIDE RISK AND TRIAGE.FOR THE HEALTH PRIORITY OF CANCER PREVENTION AND SCREENING WE WILL:1. INCREASE PHYSICAL ACTIVITY THROUGH INSTRUCTION OF EVIDENCE-BASED CURRICULUMS GEARED TOWARDS DIETARY IMPROVEMENTS AND HEALTHY LIFESTYLES. EVIDENCE-BASED CURRICULUMS MAY INCLUDE: A. NATIONAL DIABETES PREVENTION PROJECT (NDDP) - BOTH TRADITIONAL AND HYBRID B. HEALTH COACHES C. EATING SMART AND BEING ACTIVE 2. INCREASE CREATION OF (OR ENHANCED ACCESS TO) PUBLIC PLACES FOR PUBLIC USE TO INCREASE PHYSICAL ACTIVITY AND IMPROVE PHYSICAL FITNESS. ITEMS TO CONSIDER INCLUDE CREATING WALKING TRAILS, PARKS IMPROVEMENT, INCLUSIVE PLAYGROUNDS, AND PARTNERSHIPS WITH CORE HEALTH.3. INCREASE ACCESS AND UTILIZATION OF FREE AND LOW-COST CANCER SCREENINGS. SUCH EXAMPLES INCLUDE: PARTICIPATION AS HEALTHCARE PROVIDER IN THE NEBRASKA DHHS EVERY WOMAN MATTERS PROGRAM AS PROVIDER OF FREE PAP TESTS, PELVIC EXAMS, CLINICAL BREAST EXAMS AND LAB FEES, AND MAMMOGRAPHY FOR ELIGIBLE WOMEN. 4. INCREASE REFERRALS FOR AGE-APPROPRIATE ROUTINE CANCER SCREENINGS THROUGH REMINDER/RECALL INITIATIVES FOR: BREAST CANCER SCREENING, CERVICAL CANCER SCREENING, PROSTATE CANCER SCREENING, COLON CANCER SCREENING, AND LUNG CANCER SCREENING FOR CURRENT OR FORMER SMOKERS.5. INCREASE THE ADMINISTRATION OF HPV VACCINES THROUGH UTILIZATION OF THIRD-PARTY REIMBURSEMENT FOR INSURED CLIENTS AND VACCINES FOR CHILDREN (VFC) PROGRAM FOR MEDICAID, UNINSURED AND UNDERINSURED CLIENTS. 6. CONTINUE OFFERING SMOKING CESSATION CLASSES FOR INDIVIDUALS WHO DESIRE TO STOP USING TOBACCO PRODUCTS.THE CHNA ONLY FOCUSES ON TWO MAIN HEALTH PRIORITIES. HOWEVER, IT SHOULD BE NOTED THAT SOME OF THE OTHER OPPORTUNITIES FOR PRIORITIZATION THAT WERE IDENTIFIED DURING THE CHNA SUCH AS RECRUITMENT AND RETENTION OF HEALTHCARE WORKFORCE, HOME STABILITY, FOOD INSECURITY, OPIOID OVERDOSE AND MISUSE, MEDICAID REIMBURSEMENT FOR LONG-TERM CARE FACILITIES, SHORTAGE OF EMS PROVIDERS, ETC. ARE STILL ISSUES THAT WE FACE AND WORK THROUGH OFTEN. JUST BECAUSE THEY ARE NOT PART OF THE CHNA, DOES NOT MEAN THAT WE ARE NOT FOCUSING ON THEM AND WORKING TO IMPROVE THE OUTCOMES. ST. FRANCIS MEMORIAL HOSPITAL PART V, SECTION B, LINE 13H: OTHER FACTORS USED IN DETERMING ELIGIBILITY FOR FINACIAL ASSISTANCE INCLUDE ELIGIBILITY FOR MEDICAID, SOCIAL SECURITY OR A BANK LOAN. PART I, LINE 6A: THE COMMUNITY BENEFIT REPORT IS NOT PREPARED BY A RELATED ORGANIZATION. PART I, LINE 7: A COST-TO-CHARGE RATIO WAS USED TO CALCULATE THE COST OF COMMUNITY BENEFIT EXPENSES DETAILED IN THE TABLE FOR PART I, LINE 7(A) - 7(K). THE COST-TO-CHARGE RATIO WAS DERIVED FROM WORKSHEET 2, RATIO OF PATIENT CARE COST-TO-CHARGES. PART I, LINE 7G: SUBSIDIZED HEALTH SERVICES OF $661,005 ARE REPORTED ON LINE 7G. THIS AMOUNT REPRESENTS THE COMMUNITY BENEFIT ATTRIBUTABLE TO HOME HEALTH AND PHYSICIAN SERVICES. PART I, LN 7 COL(F): THE AMOUNT USED TO COMPUTE COLUMN (F) IS FROM THE AMOUNT REPORTED ON FORM 990, PART IX, LINE 25, COLUMN (A). PART II, COMMUNITY BUILDING ACTIVITIES: FRANCISCAN CARE SERVICES, INC. CURRENTLY HAS INVOLVEMENT IN THE ELKHORN LOGAN VALLEY PUBLIC HEALTH DEPARTMENT BOARD WHICH LOOKS AT HOW THE COMMUNITY ADDRESSES HEALTH AND SAFETY ISSUES, THE ACCESS INDIVIDUALS HAVE TO HEALTH CARE SERVICES, AND THE STAFF NECESSARY TO PROVIDE HEALTHCARE SERVICES. WE SPEND A CONSIDERABLE AMOUNT OF TIME AND EFFORT IN EDUCATING HEALTHCARE PROFESSIONALS. WE HAVE MANY RESIDENTS AND CLINICAL COLLEGE STUDENTS ON-SITE THROUGHOUT THE YEAR. WE ALSO HAVE A JOB SHADOWING PROGRAM FOR HIGH SCHOOL STUDENTS IN THE AREA. WE HELP EDUCATE THESE INDIVIDUALS IN THE HOPE THAT THEY WILL COME BACK TO THE COMMUNITY TO PROVIDE HEALTHCARE SERVICES. WE PROVIDE FUNDS FOR ACTIVITIES AT AREA SCHOOLS THAT PROVIDE A SAFE ENVIRONMENT AND EDUCATION FOR OUR YOUTH. WE DONATE FUNDS TO DIFFERENT ORGANIZATIONS TO IMPROVE THE COMMUNITY'S HEALTH AND SAFETY. PART III, LINE 2: THE AMOUNT REPORTED ON LINE TWO IS TAKEN DIRECTLY FROM THE GENERAL LEDGER. THE AMOUNT THAT IS WRITTEN OFF TO BAD DEBT IS THE PATIENT'S ACCOUNT BALANCE WHEN IT IS DETERMINED THAT THE PATIENT WILL NOT PAY. THEREFORE, IF THE PATIENT IS SELF PAY AND HAS NOT PAID ANY OF THE BALANCE, THEN 100% OF CHARGES ARE WRITTEN OFF. IF THE PATIENT HAS COMMERCIAL INSURANCE AND CANNOT PAY THE 20% COINSURANCE THAT IS DUE AFTER INSURANCE HAS PAID AND THE CONTRACTUAL DISCOUNTS HAVE BEEN APPLIED, THEN ONLY THE 20% COINSURANCE THAT IS OWED BY THE PATIENT IS WRITTEN OFF TO BAD DEBT. PART III, LINE 3: THE AMOUNT REPORTED ON LINE THREE IS ESTIMATED BASED ON PAST FINANCIAL ANALYSIS PERFORMED BY THE PATIENT ACCOUNTING MANAGER AND THE PATIENT FINANCIAL COUNSELOR. HISTORICALLY, A REVIEW OF THE ACCOUNTS WRITTEN OFF TO BAD DEBT WAS DONE, TAKING INTO CONSIDERATION THE INDIVIDUAL'S FINANCIAL SITUATION. DURING THE REVIEW, ACCOUNTS THAT COULD HAVE BEEN WRITTEN OFF AS CHARITY CARE IF SUFFICIENT INFORMATION WAS RECEIVED WERE IDENTIFIED. AS A RESULT OF THE ANALYSIS, IT WAS DETERMINED THAT $183,566 WOULD POSSIBLY HAVE QUALIFIED AS CHARITY CARE.THERE IS A FINE LINE BETWEEN BAD DEBT AND CHARITY CARE. THERE ARE THOSE INDIVIDUALS WHO JUST WILL NOT PAY, BUT THERE ARE A LARGER NUMBER OF INDIVIDUALS WHO CANNOT PAY, BUT DO NOT WANT TO FILL OUT THE PAPERWORK FOR CHARITY CARE OR DO NOT WANT TO EVEN ASK FOR CHARITY CARE. WE HAVE ESTIMATED THAT $183,566 OF OUR BAD DEBT EXPENSE SHOULD HAVE BEEN CLASSIFIED AS CHARITY CARE IF THE APPROPRIATE PAPERWORK WAS RECEIVED. THESE ARE THE DOLLARS THAT SHOULD BE CLASSIFIED AS COMMUNITY BENEFIT. PART III, LINE 4: THE HOSPITAL'S FINANCIAL STATEMENTS DO NOT CONTAIN A SPECIFIC FOOTNOTE DESCRIBING BAD DEBT EXPENSE AND ALLOWANCE FOR DOUBTFUL ACCOUNTS. HOWEVER, PAGES 8 AND 9 OF THE ATTACHED FINANCIAL STATEMENTS INCLUDE FOOTNOTES TITLED "ACCOUNTS RECEIVABLE", "REVENUE RECOGNITION - PATIENT SERVICE REVENUE" THAT DISCUSS BAD DEBT EXPENSE. PART III, LINE 8: TOTAL REVENUE RECEIVED FROM MEDICARE AND THE MEDICARE ALLOWABLE COSTS REPORTED ON PART III, LINES 5 & 6 WAS TAKEN DIRECTLY FROM THE 2022 MEDICARE COST REPORT. IN ADDITION TO THE REVENUE RECEIVED FROM MEDICARE AND THE MEDICARE ALLOWABLE COSTS REPORTED ON THE MEDICARE COST REPORT, WE ALSO RECEIVE MEDICARE PART B PAYMENTS (FEE SCHEDULE) FOR CERTAIN LAB, RADIOLOGY, AND PHYSICIAN SERVICES. THESE AMOUNTS ARE NOT INCLUDED ON THE MEDICARE COST REPORT. THE REVENUE RECEIVED FOR MEDICARE PART B SERVICES WAS $401,934 WHILE THE ASSOCIATED COSTS WERE $1,244,998 FOR A SHORTFALL OF ($843,064). THE COSTS FOR THE SERVICES REIMBURSED ON A FEE SCHEDULE METHODOLOGY WERE CALCULATED USING THE COST TO CHARGE RATIO FROM THE MEDICARE COST REPORT FOR THAT DEPARTMENT.THE SHORTFALL REPORTED ON PART III, LINE 7 OF ($241,708) AND THE MEDICARE PART B SHORTFALL OF ($843,064) FOR A TOTAL SHORTFALL OF ($1,084,772) SHOULD BE TREATED AS A COMMUNITY BENEFIT BECAUSE THESE ARE COSTS OVER AND ABOVE THE AMOUNT THAT MEDICARE PAYS US. THESE SERVICES ARE INTEGRAL TO THE COMMUNITY AND WOULD NOT BE AVAILABLE TO THE COMMUNITY IF THEY WERE NOT PROVIDED BY OUR FACILITY. PART III, LINE 9B: IN OUR BILLING AND COLLECTION POLICY THERE IS A SECTION ON FINANCIAL ASSISTANCE. IT STATES: "FRANCISCAN CARE SERVICES HAS A FINANCIAL ASSISTANCE PROGRAM TO ASSIST PATIENTS THAT ARE FINANCIALLY BURDENED AND UNABLE TO PAY FOR THEIR MEDICAL EXPENSES. A FINANCIAL ASSISTANCE APPLICATION MUST BE COMPLETED AND TURNED IN TO THE PATIENT FINANCIAL COUNSELOR. A COPY OF THE MOST CURRENT TAX RETURN (IRS FORM 1040 OR 1040A) MUST ACCOMPANY THE FINANCIAL ASSISTANCE APPLICATION. A DETERMINATION OF APPROVAL OR DENIAL IS MADE FROM THIS APPLICATION AND IS BASED UPON ESTABLISHED GUIDELINES." PART VI, LINE 2: THE HEALTH CARE NEEDS OF THE COMMUNITIES WE SERVE ARE ASSESSED IN MANY WAYS. WE WORK CLOSELY WITH THE ELKHORN LOGAN VALLEY PUBLIC HEALTH DEPARTMENT WHO SURVEYS THE AREA POPULATION TO ASCERTAIN HEALTH DISPARITIES, COLLABORATE ON HEALTH SCREENINGS, AND DETERMINE AREAS OF NEED. AS OUR PHYSICIANS AND OTHER HEALTH CARE WORKERS SEE PATIENTS, THEY DISCUSS THEIR CURRENT STATUS AND WHAT ELSE WE CAN DO FOR THEM. ALSO, OUR BOARD MEMBERS AND EMPLOYEES WHO ARE IN THE PUBLIC ADVISE US AS TO WHAT HEALTH CARE NEEDS ARE IN THE COMMUNITY THAT WE DO NOT CURRENTLY ADDRESS. MANY OF OUR EMPLOYEES ARE INVOLVED IN STATE AND NATIONAL ORGANIZATIONS THAT KEEP US UP TO DATE ON THE CURRENT TRENDS IN HEALTH CARE THAT ARE BROUGHT BACK TO OUR COMMUNITY. THROUGH STRATEGIC PLANNING WITH THE PHYSICIANS, THE BOARD OF DIRECTORS, AND HOSPITAL LEADERS, WE LOOK AT WHAT THE NEEDS OF THE COMMUNITY ARE AND HOW WE CAN ADDRESS THEM. ALL THESE GROUPS WORK TOGETHER WITH ADMINISTRATION TO CONTINUE TO ADDRESS THE HEALTH CARE NEEDS OF THE COMMUNITY. PART VI, LINE 3: ON THE CONDITIONS OF ADMISSION AND CONSENT FOR TREATMENT FORM THAT IS SIGNED BY EACH PATIENT OF THE HOSPITAL, THERE IS A FINANCIAL AGREEMENT SECTION THAT STATES "IF YOU HAVE LIMITED INSURANCE OR DO NOT HAVE INSURANCE, YOU MAY REQUEST TO MEET WITH OUR PATIENT FINANCIAL COUNSELOR TO SET UP A PAYMENT PLAN OR TO DETERMINE IF YOU ARE ELIGIBLE FOR FINANCIAL ASSISTANCE." CONTACT INFORMATION FOR FINANCIAL ASSISTANCE IS POSTED AT THE MAIN ENTRANCE TO THE HOSPITAL AND CLINIC AND ALSO AT THE EMERGENCY ROOM ENTRANCE. THE FINANCIAL ASSISTANCE POLICY (FAP), THE PLAIN LANGUAGE SUMMARY OF THE FAP, AND THE APPLICATION FOR FINANCIAL ASSISTANCE IS ALSO POSTED ON OUR WEBSITE AT HTTP://FRANHEALTH.ORG/PATIENTS-VISITORS/PATIENT-FINANCIAL-INFORMATION.HTML. A PLAIN LANGUAGE SUMMARY OF THE FAP IS OFFERED TO PATIENTS UPON REGISTRATION. ON OUR PATIENT BILLS THERE IS A SECTION THAT STATES "WE ALSO OFFER FINANCIAL ASSISTANCE TO PATIENTS WHO QUALIFY. PLEASE CONTACT THE PATIENT FINANCIAL COUNSELOR AT 402-372-4029 FOR MORE INFORMATION OR VISIT OUR WEBSITE AT HTTP://FRANHEALTH.ORG/PATIENTS-VISITORS/PATIENT-FINANCIAL-INFORMATION.HTML."ALSO, IF THE PATIENT FINANCIAL COUNSELOR CONTACTS A PATIENT REGARDING PAYMENT OF A BILL, A LETTER AND A SUMMARY OF THE FINANCIAL ASSISTANCE POLICY IS SENT TO THEM WHICH STATES THAT IF THEY ARE UNABLE TO PAY THEIR BILL THEY MAY BE ELIGIBLE FOR OUR FINANCIAL ASSISTANCE PROGRAM. PART VI, LINE 4: FRANCISCAN CARE SERVICES, INC. IS LOCATED IN A RURAL AREA, PREDOMINANTLY AGRICULTURALLY BASED. THE POPULATION OF OUR SERVICE AREA IS APPROXIMATELY 16,000 PEOPLE. THE MEDIAN HOUSEHOLD INCOME IS APPROXIMATELY $69,000. THE POPULATION IS PREDOMINANTLY CAUCASIAN, HIGH SCHOOL EDUCATED, AND GERIATRIC IN NATURE. THERE IS A GROWING POPULATION OF HISPANIC DESCENT. PART VI, LINE 5: THE BOARD OF DIRECTORS IS COMPRISED OF INDIVIDUALS FROM THE SURROUNDING COMMUNITIES. THE BOARD MEMBERS ARE DIVERSE IN BACKGROUND RANGING FROM SISTERS FROM OUR SPONSOR, PUBLIC HEALTH DIRECTOR, BANKERS, AND BUSINESS OWNERS WHO ARE NEITHER EMPLOYEES (EXCEPT CEO), CONTRACTORS, OR FAMILY MEMBERS. WE HOPE THE DIVERSE BACKGROUNDS OF OUR BOARD MEMBERS GIVE US THE INSIGHT WE NEED TO FULFILL THE NEEDS OF THE COMMUNITY. FRANCISCAN CARE SERVICES, INC. HAS AN OPEN MEDICAL STAFF THAT INCLUDES SEVEN FAMILY PRACTICE PHYSICIANS, FIVE PHYSICIAN ASSISTANTS, AND FIVE NURSE PRACTITIONERS. WE CONTRACT WITH AN ORTHOPEDIC GROUP TO PROVIDE SERVICES FOR US IN THE WEST POINT CLINIC. THERE ARE ALSO A NUMBER OF SPECIALISTS THAT COME IN FROM THE NEARBY COMMUNITIES OF NORFOLK, FREMONT, AND OMAHA TO MEET THE HEALTH NEEDS OF THE COMMUNITY. SPECIALISTS THAT SEE PATIENTS IN OUR OUTPATIENT CLINIC INCLUDE AUDIOLOGY, CARDIOLOGY, DERMATOLOGY, ENT, GENERAL SURGERY, NEPHROLOGY, NEUROLOGY, OBSTETRICS/GYNECOLOGY, ONCOLOGY, OPHTHALMOLOGY, PAIN, PODIATRY, PULMONOLOGY, RHEUMATOLOGY, UROLOGY, AND VASCULAR. THERE ARE MANY DIFFERENT PROGRAMS THAT WE ARE ABLE TO OFFER DUE TO SURPLUS FUNDS FROM OPERATIONS. OUR CLINICS PROVIDE DISEASE MANAGEMENT THROUGH THE USE OF HEALTH COACHES TO HELP PATIENTS MANAGE CHRONIC HEALTH CONDITIONS SUCH AS DIABETES, HYPERTENSION, COPD, CLOTTING, AND OSTEOPOROSIS. THIS IS A PROGRAM THAT IS GOOD FOR OUR PATIENTS EVEN THOUGH WE RECEIVE LITTLE TO NO REIMBURSEMENT FOR PROVIDING THIS SERVICE. WE PROVIDE FREE SPORT SCREENS TO AREA ATHLETES WHO HAVE BEEN INJURED AT A PRACTICE OR GAME. WE OFFER REDUCED-COST SCREENS AND HEALTH EDUCATION TO BUSINESSES IN OUR SERVICE AREA TO REACH OUT TO THOSE INDIVIDUALS WHO DO NOT TAKE THE TIME TO COME TO OUR FACILITY TO SEE US. WE PROVIDE A NUMBER OF EXERCISE PROGRAMS FOR THE ELDERLY IN THE COMMUNITY. WE OFFER DISCOUNTED LABS TO THE COMMUNITY. WE ARE ALSO ABLE TO CONTINUALLY INVEST BACK INTO THE ORGANIZATION WITH NEW EQUIPMENT AND IMPROVEMENTS TO FACILITIES. IN 2022, CAPITAL PURCHASES/IMPROVEMENTS INCLUDE AN OR TABLE, INFUSION PUMPS, COMBI OVEN, VEHICLES FOR REHAB AND HOME HEALTH, ER REMODEL, AND VARIOUS IT UPDATES. PART VI, LINE 6: FRANCISCAN CARE SERVICES, INC. IS A PART OF THE FRANCISCAN SISTERS OF CHRISTIAN CHARITY SPONSORED MINISTRIES, A NOT-FOR-PROFIT SYSTEM OF ACUTE AND LONG-TERM HEALTH CARE FACILITIES LOCATED IN WISCONSIN, NEBRASKA AND OHIO. EACH ORGANIZATION WITHIN THE MINISTRY IS RESPONSIBLE FOR CARRYING OUT THE HEALING MISSION OF THE CATHOLIC CHURCH ACCORDING TO THE NEEDS OF THEIR COMMUNITY. PART VI, LINE 7: THE COMMUNITY BENEFIT REPORT IS FILED WITH THE NEBRASKA HOSPITAL ASSOCIATION. THE REPORT IS ALSO SENT TO OUR LOCAL MAYOR AND OUR STATE AND CONGRESSIONAL REPRESENTATIVES. 1 ORPHAN GRAIN TRAIN 601 W PHILLIP AVE NORFOLK NE 68701 311614650 501(C)(3) 0 11536 FMV MEDICAL SUPPLIES PROGRAM SUPPORT ST JOSEPH'S ELDER SERVICES INC 540 E WASHINGTON ST WEST POINT NE 68788 814879204 501(C)(3) 107381 0 PROGRAM SUPPORT WEST POINT LITTLE LEAGUE BASEBALL ASSOCIATION 424 S BRUNER WEST POINT NE 68788 824270831 501(C)(3) 7500 0 PROGRAM SUPPORT THE CATTLEMAN'S BALL OF NEBRASKA INC 4834 ROAD T DAVENPORT NE 68335 911812186 501(C)(3) 30000 0 PROGRAM SUPPORT 4 0 PART I, LINE 2: APPLICANTS FOR GRANT FUNDING ARE REQUIRED TO PROVIDE FINANCIAL AND PERFORMANCE RESULTS TO ENSURE PROPER USE OF THE APPLIED FUNDS. GRANT FUND DOLLARS MUST BE SPENT AS INTENDED. AS A GRANTEE, WE COMPLY WITH THE PROGRAM EXPECTATIONS, USE FUNDS IN AN EFFICIENT MANNER AND REMAIN FISCALLY RESPONSIBLE. X X X 0 1 0 1 0 0 0 0 0 RHETT ECKMANN MD PHYSICIAN 341976 0 276446 0 14274 0 12211 0 34488 0 679395 0 0 0 SCOTT GREEN MD PHYSICIAN 376184 0 231445 0 19069 0 14500 0 34408 0 675606 0 0 0 THOMAS COHEE MD PHYSICIAN 377652 0 215469 0 22230 0 12500 0 34360 0 662211 0 0 0 BRIAN HASS MD PHYSICIAN 329440 0 203902 0 22804 0 12211 0 34489 0 602846 0 0 0 RENAE MEYER MD PHYSICIAN 285310 0 90134 0 15012 0 12500 0 36174 0 439130 0 0 0 TYLER TOLINE CEO & PRESIDENT 241540 0 85644 0 57002 0 7400 0 31638 0 423224 0 0 0 TERRY NELSON ANCILLARY DIRECTOR 197094 0 48173 0 1188 0 30150 0 34134 0 310739 0 0 0 ALISA BRUNSING VICE PRESIDENT FISCAL & SUPPORT SERV 170853 0 31885 0 4851 0 24157 0 0 0 231746 0 0 0 PART I, LINE 4B DURING 2022, FRANCISCAN CARE SERVICES, INC. CONTRIBUTED FUNDS TO AN IRC SECTION 457(F) PLAN FOR THE FOLLOWING INDIVIDUALS: DR. COHEE $12,500 DR. GREEN $4,000 DR. ECKMANN $4,321 DR. HASS $4,321 DR. MEYER $12,500 MR. NELSON $16,500 MS. BRUNSING $14,620 PART I, LINE 5 IN EACH OF THE FAMILY PRACTICE PHYSICIAN'S CONTRACTS, THERE IS A SECTION THAT ESTABLISHES THE POTENTIAL AMOUNT OF SUPPLEMENTAL INCOME THAT THE PHYSICIANS MAY RECEIVE DURING THE YEAR BASED ON THEIR INDIVIDUAL PRODUCTIVITY. EACH OF THESE PHYSICIANS IS PAID A BASE SALARY AS AN EMPLOYED PHYSICIAN OF THE ORGANIZATION. IN ADDITION, THE PHYSICIAN MAY EARN ADDITIONAL COMPENSATION BASED ON A PRE-DETERMINED CALCULATED FORMULA AS STIPULATED IN THE CONTRACT. THE FORMULA IS CALCULATED BY TAKING THE INDIVIDUAL'S PRODUCTIVITY REVENUE FOR THE CALENDAR YEAR LESS ANY CONTRACTUAL ADJUSTMENTS OR WRITE-OFFS AND THEN MULTIPLYING THAT NET AMOUNT BY A PRE-DETERMINED PERCENTAGE. IF THIS CALCULATED AMOUNT EXCEEDS THEIR BASE SALARY, THE PHYSICIAN IS PAID THE VARIANCE. DURING THE YEAR, DR. GREEN, DR. ECKMANN, DR. COHEE, DR. HASS, AND DR. MEYER RECEIVED A PAYMENT. A HOSPITAL AUTHORITY NO 1 OF CUMING COUNTY NE 470762878 000000000 2016-10-01 10000000 FOR AN ADDITION TO AND IMPROVEMENTS FOR EXISTING HOSPITAL FACILITIES. 0 0 0 A 4428971 10000000 10000000 2012 1 0 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 A 0 0 1 0 0 0 0 0 1 A 1 SCHEDULE K, PART I, LINE A, COLUMN F: THE BOND IS BEING REISSUED FOR FEDERAL TAX PURPOSES AS OF OCTOBER 1, 2016 DUE TO CHANGES TO THE TERMS OF THE OBLIGATION. THE NOTES WERE ORIGINALLY ISSUED FOR THE PURPOSE OF PROVIDING A LOAN TO FRANCISCAN CARE SERVICES, INC. (THE "HOSPITAL") FOR AN ADDITION TO AND IMPROVEMENTS FOR EXISTING HOSPITAL FACILITIES LOCATED IN THE CITY OF WEST POINT, NEBRASKA, OWNED BY THE HOSPITAL. FORM 990, PART VI, SECTION A, LINE 1A THE EXECUTIVE COMMITTEE SHALL HAVE THE AUTHORITY TO ACCOMPLISH THOSE TASKS ASSIGNED IT BY THE BOARD OF DIRECTORS AND TO TRANSACT THE ESSENTIAL BUSINESS OF THE BOARD THAT CANNOT AWAIT A REGULAR OR SPECIAL MEETING OF THE BOARD, PROVIDED THAT NO ACTION TAKEN AT SUCH MEETINGS SHALL BE IN CONFLICT WITH THE EXPRESSED POLICIES OF THE BOARD OR THE AUTHORITY GRANTED THIS COMMITTEE BY THE BOARD OR BY-LAWS. FORM 990, PART VI, SECTION A, LINE 6 THE ORGANIZATION IS A NOT-FOR-PROFIT CORPORATION WHOSE SOLE CORPORATE MEMBER IS FRANCISCAN SISTERS OF CHRISTIAN CHARITY SPONSORED MINISTRIES, INC. FORM 990, PART VI, SECTION A, LINE 7A THE FRANCISCAN SISTERS OF CHRISTIAN CHARITY SPONSORED MINISTRIES, INC., A WISCONSIN NON-STOCK, NOT FOR PROFIT CORPORATION IS THE SOLE CORPORATE MEMBER OF FRANCISCAN CARE SERVICES, INC. AND HAS THE AUTHORITY TO APPOINT AND REMOVE MEMBERS OF THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION A, LINE 7B THE FRANCISCAN SISTERS OF CHRISTIAN CHARITY SPONSORED MINISTRIES, INC., A WISCONSIN NON-STOCK, NOT FOR PROFIT CORPORATION HAS THE FOLLOWING RESERVED POWERS OVER FRANCISCAN CARE SERVICES, INC.: A) APPROVAL OF THE PHILOSOPHY, MISSION AND VALUES STATEMENTS OF THE CORPORATION. B) AMENDMENT OF ARTICLES OF INCORPORATION AND BY-LAWS OF THE CORPORATION. C) APPOINTMENT AND REMOVAL OF MEMBERS OF THE BOARD OF DIRECTORS. D) APPROVAL OF THE CREATION AND DISSOLUTION OF THIS CORPORATION OR ANY SUBSIDIARY CORPORATIONS, AS WELL AS APPROVAL OF ANY MERGER, CONSOLIDATION, AFFILIATION, JOINT VENTURE OR OTHER FORM OF CORPORATE REORGANIZATION OF THIS CORPORATION OR ANY SUBSIDIARY OF WHICH THIS CORPORATION IS THE MEMBER OR CONTROLLING SHAREHOLDER. E) APPOINTMENT, EVALUATION AND DISCHARGE OF THE PRESIDENT OF THE CORPORATION. F) APPROVAL OF BORROWING IN EXCESS OF THE LIMIT ESTABLISHED BY THE MEMBER. G) APPROVAL OF PURCHASE, MORTGAGE OR SALE OF REAL ESTATE, OR LEASE OF REAL ESTATE, BY OR TO THE CORPORATION FOR LONGER THAN ONE YEAR. H) IMPLEMENTATION OF SPONSOR APPOINTMENT, SALARY NEGOTIATION, AND REASSIGNMENT PROCESSES FOR FRANCISCAN SISTER PERSONNEL WITHIN THIS CORPORATION. I) APPROVAL OF CAPITAL AND OPERATING BUDGETS. J) REQUIREMENT OF A CERTIFIED AUDIT OF CORPORATE FUNDS AT ANY TIME AND APPROVAL OF THE FISCAL AUDITOR OF THE CORPORATION ANNUALLY. K) APPROVAL OF ALL INSURANCE CARRIERS AND INSURANCE COVERAGE FOR THE CORPORATION. L) APPROVAL OF LONG-RANGE OR STRATEGIC PLANS OF THE CORPORATION. FORM 990, PART VI, SECTION B, LINE 11B FORM 990 IS REVIEWED PRIOR TO SUBMISSION TO THE IRS BY THE MEMBER (FRANCISCAN SISTERS OF CHRISTIAN CHARITY SPONSORED MINISTRIES, INC.) AND THE FINANCE COMMITTEE OF THE FRANCISCAN CARE SERVICES, INC. BOARD OF DIRECTORS. A COPY OF THE FORM 990 WILL BE AVAILABLE FOR ALL BOARD MEMBERS TO REVIEW AT THEIR MONTHLY BOARD MEETING BEFORE THE FORM 990 IS FILED. FORM 990 IS MADE AVAILABLE IN THE ADMINSTRATIVE OFFICE FOR ANY INDIVIDUAL REQUESTING TO INSPECT IT AS REQUIRED BY INTERNAL REVENUE CODE 6104. FORM 990, PART VI, SECTION B, LINE 12C THE CORPORATE COMPLIANCE OFFICER (CCO) AND SEVERAL MEMBERS OF THE CORPORATE COMPLIANCE COMMITTEE ATTEND BOARD, ADMINSTRATIVE, AND DEPARTMENT MANAGER MEETINGS. THE CCO ENSURES THAT ALL BOARD, MEDICAL STAFF, ADMINISTRATION STAFF, DEPARTMENT MANAGERS, AND INDIVIDUALS WHO HAVE PURCHASING AUTHORITY REVIEW THE CONFLICT OF INTEREST POLICY ANNUALLY AND DISCLOSE ANY CONFLICTS THAT MIGHT EXIST. EACH INDIVIDUAL IS ALSO ASKED TO IDENTIFY ANY FAMILY MEMBERS THAT ARE AN EMPLOYEE OF FRANCISCAN CARE SERVICES, INC. (FCS) OR EMPLOYED BY A BUSINESS WITH WHICH FCS CONDUCTS BUSINESS. ANY NEW CONFLICTS THAT ARISE DURING THE YEAR NEED TO BE REPORTED TO THE CORPORATE COMPLIANCE OFFICER IMMEDIATELY. IF A CONFLICT EXISTS AT THE BOARD LEVEL, THE PERSON OR THE CCO OR COMMITTEE MEMBER IDENTIFIES THAT THE CONFLICT EXISTS AND THEN THE BOARD DETERMINES IF THE PERSON CAN TAKE PART IN THE DELIBERATIONS OR NEEDS TO LEAVE THE ROOM. THE PERSON WOULD NOT BE ABLE TO VOTE AND IT IS IDENTIFIED IN THE MINUTES OF THE MEETING. AT THE ADMINSTRATIVE LEVEL, THE STAFF MEMBER IDENTIFIES THE CONFLICT AND THE ADMINSTRATIVE TEAM DETERMINES IF THE PERSON CAN TAKE PART IN THE DISCUSSION OR NEEDS TO LEAVE THE ROOM. THIS IS ALSO THE POLICY AT THE MEDICAL STAFF AND MANAGER MEETINGS. FORM 990, PART VI, SECTION B, LINE 15A FRANCISCAN CARE SERVICES, INC. STRIVES TO PROVIDE A FAIR AND COMPETITIVE COMPENSATION PACKAGE FOR ITS EXECUTIVES. THIS PACKAGE SHALL INCLUDE, BUT IS NOT LIMITED TO SALARY, INCENTIVE BONUS, LIFE INSURANCE, HEALTH BENEFITS, AND A MATCHING DEFINED CONTRIBUTION TO A 403(B) RETIREMENT PLAN. THE SALARY RANGE AND TOTAL COMPENSATION SHALL BE BASED UPON SURVEYS OF THE GEOGRAPHIC WEST NORTH CENTRAL STATES AVERAGE FOR THE POSITION AS REPORTED BY AN INDEPENDENT EXECUTIVE COMPENSATION MARKET ANALYSIS FOR LIKE-SIZED ORGANIZATIONS AND THE EXECUTIVE COMPENSATION SURVEY FOR NEBRASKA HOSPITALS PROVIDED BY THE NEBRASKA HOSPITAL ASSOCIATION. BONUSES ARE GIVEN BASED UPON ACHIEVEMENT OF STRATEGIC GOALS AGREED UPON BY THE FRANCISCAN CARE SERVICES BOARD OF DIRECTORS AND THE PRESIDENT OF THE FRANCISCAN SISTERS OF CHRISTIAN CHARITY SPONSORED MINISTRIES, INC. THESE BONUSES ARE BASED UPON A PERCENTAGE OF SALARY AND ARE NOT TO EXCEED 25%. THE PRESIDENT/CEO'S COMPENSATION IS SET BY THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS AND THE SPONSORED MINISTRIES PRESIDENT AFTER A PERFORMANCE APPRAISAL CONDUCTED BY THE EXECUTIVE COMMITTEE OF THE FCS BOARD (SERVING AS THE COMPENSATION COMMITTEE) AND THE PRESIDENT OF THE FRANCISCAN SISTERS OF CHRISTIAN CHARITY SPONSORED MINISTRIES, INC. ALL MEMBERS OF THE BOARD PROVIDE THEIR INPUT THROUGH A WRITTEN APPRAISAL PRESENTED TO THE COMPENSATION COMMITTEE. MINUTES OF THE MEETING ARE KEPT BY THE SPONSORED MINISTRIES PRESIDENT. ALL OTHER EXECUTIVES ARE REVIEWED BY THE FRANCISCAN CARE SERVICES, INC. PRESIDENT/CEO, WHO SETS THEIR COMPENSATION BASED UPON THE ABOVE SURVEYS AND PRINCIPLES. FORM 990, PART VI, SECTION C, LINE 19 NO DOCUMENTS ARE AVAILABLE TO THE PUBLIC. FORM 990, PART XI, LINE 9: CHANGE IN BENEFICIAL INTEREST OF A CHARITABLE FOUNDATION -120,448. ST FRANCIS SERVICES LLC 430 N MONITOR ST WEST POINT NE 68788 852622665 PHARMACY NE 817530 692055 FRANCISCAN CARE SERVICES INC HOLY FAMILY CONVENT FRANCISCAN SISTERS 2409 SOUTH ALVERNO ROAD MANITOWOC WI 54220 390808523 RELIGION WI 501(C)(3) LINE 1 N/A 0 FRANCISCAN SISTERS OF CHRISTIAN CHARITY SPONSORED MINISTRIES INC 1415 SOUTH RAPIDS ROAD MANITOWOC WI 54220 391530622 HEALTHCARE WI 501(C)(3) LINE 1 SEE LINE 1 0 ST FRANCIS MEMORIAL HOSPITAL FOUNDATION 430 N MONITOR ST WEST POINT NE 68788 470629079 FUNDRAISING NE 501(C)(3) LINE 12A, I N/A 0 ST JOSEPHS RETIREMENT COMMUNITY FOUNDATION PO BOX 65 WEST POINT NE 68788 470790644 FUNDRAISING NE 501(C)(3) LINE 12A, I N/A 0 ST PAUL ELDER SERVICES INC 316 EAST 14TH STREET KAUKAUNA WI 54130 391029149 ELDER CARE WI 501(C)(3) LINE 10 SEE LINE 2 0 GOOD SAMARITAN MEDICAL CENTER 800 FOREST AVENUE ZANESVILLE OH 43701 314379479 HOLDING COMPANY OH 501(C)(3) LINE 12A, I SEE LINE 2 0 ST JOSEPH'S ELDER SERVICES INC 540 EAST WASHINGTON STREET WEST POINT NE 68788 814879204 ELDER CARE NE 501(C)(3) LINE 10 SEE LINE 2 0 0 1 1 1 1 0 0 0 0 1 0 0 1 0 1 1 1 0 1