2022-10-31T10:55:05-05:00 2021-12-31 450250958 EIDE BAILLY LLP 18081 BURT STREET SUITE 200 OMAHA NE 680224722 990 2021-01-01 470486026 FRANCISCAN CARE SERVICES INC FRAN 4023722404 430 NORTH MONITOR STREET WEST POINT NE 687881555 TYLER TOLINE PRESIDENT 4023722404 2022-10-27 1 TYLER TOLINE 999009999 WENDY R COOLEY P01523804 4023302660 2022-10-27 3 AAL1 IAL1 2021 2022-09-23 18:48:47Z TYLER TOLINE 430 NORTH MONITOR STREET WEST POINT NE 687881555 47642222 0 0928 X WWW.FRANHEALTH.ORG X 1964 NE THE MISSION OF FRANCISCAN CARE SERVICES, INC. IS TO LIVE AND TO PROMOTE THE HEALING MISSION OF JESUS CHRIST. 9 8 329 165 -3734 0 4960572 755465 38019654 43944199 2805908 2919417 5115 3654 45791249 47622735 10924 98137 0 0 21562070 23609997 0 0 3301 14482641 16332055 36055635 40040189 9735614 7582546 90915746 100320154 19615554 20267560 71300192 80052594 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 35062526 98137 43912969 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. 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 330 PATIENT DAYS - ACUTE 1,121 - SWING BED 732 - NURSERY 76 OUT-PATIENT & REGISTRATIONS 46,550 HOME HEALTH & HOSPICE 5,313PHYSICIAN CLINIC VISITS 24,378 THE HOSPITAL RECEIVES GENEROUS SUPPORT FROM THE COMMUNITY NOT ONLY FINANCIALLY BUT ALSO FROM APPROXIMATELY 165 VOLUNTEERS WHO DONATED 1,418 HOURS OF THEIR VALUABLE TIME. 148449 0 34884 ST. FRANCIS SERVICES MISSION IS TO PROVIDE EFFICIENT AND PERSONALIZED PHARMACEUTICAL SERVICES TO THE SURROUNDING AREA.ST. FRANCIS SERVICES, LLC STATS: PRESCRIPTIONS COUNT: NEW 620 REFILL 248 TOTAL 868 BRAND 93 GENERIC 775 TOTAL 868 35210975 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 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 0 1 0 0 0 1 77 0 1 329 1 0 0 0 0 0 0 0 0 0 0 0 0 X 9 8 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 TYLER TOLINE CEO & PRESIDENT 45.00 0.40 X X 365515 0 32280 DAVID STEFFENSMEIER CHAIRMAN 1.50 0.20 X X 0 0 0 GARY KAUP VICE CHAIRMAN 1.50 0.00 X X 0 0 0 CHET MCWHORTER SECRETARY 1.50 0.00 X X 0 0 0 STEVE SWANSON TREASURER 1.50 0.00 X X 0 0 0 REGINA UHING TRUSTEE 1.00 0.00 X 0 0 0 SR PATRICIA LINSSEN TRUSTEE 2.40 7.40 X 0 0 0 JASON SMITH TRUSTEE 1.00 0.00 X 0 0 0 BRIAN REIMERS TRUSTEE 1.00 0.00 X 0 0 0 ALISA BRUNSING CFO 50.00 0.00 X 190922 0 20364 TERRY NELSON ANCILLARY DIRECTOR 55.00 0.00 X 215808 0 60573 SCOTT GREEN MD PHYSICIAN 45.00 0.00 X 622581 0 49344 THOMAS COHEE MD PHYSICIAN 44.00 0.00 X 604046 0 44484 RHETT ECKMANN MD PHYSICIAN 44.00 0.00 X 570210 0 47241 BRIAN HASS MD PHYSICIAN 45.00 0.00 X 597005 0 47241 RENAE MEYER MD PHYSICIAN 43.00 0.00 X 389557 0 43448 3555644 0 344975 23 0 1 0 BECKENHAUER CONSTRUCTION 1901 RIVERSIDE BLVD NORFOLK NE 68701 CONSTRUCTION 1939361 CERNER CORPORATION 2800 ROCKCREEK PARKWAY KANSAS CITY MO 64117 IT SOFTWARE SUPPORT 787540 KAT ANESTHESIA LLC 1125 E WASHINGTON ST WEST POINT NE 68788 ANESTHESIA SERVICES 672504 LUCENT HEALTH SOLUTIONS INC PO BOX 306411 NASHVILLE TN 372306411 HEALTH PLAN ADMIN 513369 MEYER BUILDING CO INC 650 E DEERE STREET WEST POINT NE 68788 CONSTRUCTION 498291 15 344432 254485 156548 755465 HOSPITAL/CLINIC HEALTHCARE SERVIC 621110 43832830 43832830 DIETARY/CAFETERIA 721000 76485 76485 RETAIL PHARAMACY 446110 34884 34884 43944199 2918617 -3734 2922351 800 0 800 800 800 23141 19487 3654 3654 47622735 43947853 -3734 2923151 X 98137 98137 885462 767013 118449 17710606 15900008 1810598 443315 351648 91667 3462112 2811694 650418 1108502 987129 121373 112328 112328 83030 83030 4051 4051 4365923 3847968 517955 235836 234315 1521 1950184 1793783 156401 1231448 991966 239482 689874 587022 102852 103385 91042 12343 122039 117335 4704 169366 136428 32938 3177601 2561440 616161 134619 134619 MEDICAL SUPPLIES 3685686 3685686 DUES & SUBSCRIPTIONS 263384 248361 15023 HOSPITAL AUXILIARY SUPP 3301 3301 40040189 35210975 4825913 3301 5341813 1170074 8854508 10882426 5492129 6239833 920977 1053454 652783 642674 68416369 45722300 20197689 22694069 47372891 55738036 342734 290731 1740222 1608857 90915746 100320154 5020955 7981182 7009147 6279401 7585452 6006977 19615554 20267560 X 70919744 79842514 380448 210080 71300192 80052594 90915746 100320154 X 7582546 1429856 -260000 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 1 4051 1 0 0 4051 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. 350006 350006 23334432 13536429 9798003 41838897 32185871 9653026 2893034 2893034 22694069 MEDICARE ACCELERATED PAYMENTS PAYABLE 4794490 HHS STIMULUS FUNDS PAYABLE 1212487 6006977 48920837 1429856 1429856 47490981 131754 131754 47622735 39914388 0 39914388 125801 125801 40040189 PART XI, LINE 4B - OTHER ADJUSTMENTS: AUXILIARY INCOME 9,254. GRANT REFUND AND CREDIT 122,500. PART XII, LINE 4B - OTHER ADJUSTMENTS: AUXILIARY OPERATING EXPENSES 3,301. GRANT REFUND AND CREDIT 122,500. 1 1 X 1 X 1 X 1 1 1 0 1 1 104 182178 182178 0.00450 1550 2395700 1603530 792170 0.01980 1654 2577878 1603530 974348 0.02430 3021 258269 44722 213547 0.00530 50 196437 196437 0.00490 8189 8165842 7275464 890378 0.02220 11260 8620548 7320186 1300362 0.03240 12914 11198426 8923716 2274710 0.05670 5610 5610 0.00010 871 84117 2221 81896 0.00200 64 24950 24950 0.00060 935 114677 2221 112456 0.00270 1 612600 122520 14422909 14574986 -152077 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 19 1 1 1 1 X HTTPS://FRANHEALTH.ORG/ABOUT/NEEDS-ASSESSMENT.HTML X 1 19 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: ST. FRANCIS MEMORIAL HOSPITAL TOOK INTO ACCOUNT INPUT FROM PERSONS WHO REPRESENT THE BROAD INTERESTS OF THE COMMUNITY SERVED VIA SURVEYS AND A TOWN HALL MEETING WITH COMMUNITY STAKEHOLDERS.DATA WAS COLLECTED THROUGH COMMUNITY-LEVEL HEALTH SURVEYS ADMINISTERED ON-LINE AND THROUGH REGULAR MAIL AVAILABLE IN BOTH ENGLISH AND SPANISH. PATRONS WERE INVITED TO TAKE THE SURVEY BY MEANS OF SEVERAL ROUTES - INCLUDING PUBLIC PRESS RELEASES, RADIO PUBLIC SERVICE ANNOUNCEMENTS; CHAMBER OF COMMERCE NEWSLETTERS; THROUGH EMPLOYERS AND AREA BUSINESSES, SENIOR CITIZEN CENTERS; SOCIAL MEDIA POSTS; AND DISTRIBUTION OF PAPER FLYERS. THOSE INTERESTED IN TAKING THE SURVEY WERE ENCOURAGED TO DO SO ONLINE, OR WERE INVITED TO REQUEST A HARD-COPY SURVEY. THE NUMBER OF SURVEYS COMLETED WAS 1,422.ON APRIL 30, 2019, A COMMUNITY HEALTH IMPROVEMENT PLAN STAKEHOLDER TOWN HALL MEETING WAS HELD IN NORFOLK, NEBRASKA. ON MAY 1, 2019, AN IDENTICAL MEETING WAS HELD IN WEST POINT, NEBRASKA. APPROXIMATELY 260 INVITATIONS WERE SENT OUT TO KEY STAKEHOLDERS IN THE PUBLIC HEALTH SYSTEM. THE PUBLIC WAS INVITED TO ATTEND THE TOWN HALL MEETINGS AS WELL. THERE WERE 50 INDIVIDUALS THAT ATTENDED THE TOWN HALL MEETING IN WEST POINT, AND 34 INDIVIDUALS ATTENDED THE TOWN HALL MEETING IN NORFOLK. MEETING PARTICIPANTS INCLUDED INDIVIDUALS FROM THE FOLLOWING SECTORS: ELECTED OFFICIALS, HOSPITALS AND CLINICS, LONG-TERM CARE, BEHAVIORAL HEALTH, COMMUNITY-BASED ORGANIZATIONS, TRAILS COMMITTEE MEMBERS, CENTER FOR RURAL AFFAIRS, INSTITUTES OF HIGHER EDUCATION, HOSPITAL BOARD MEMBERS, PONCA TRIBE OF NEBRASKA, FEDERALLY-QUALIFIED HEALTH CENTER, CHAMBER OF COMMERCE, ECONOMIC DEVELOPMENT, UNL COUNTY EXTENSION, JUVENILE DIVERSION, PUBLIC HEALTH LIAISON/ADVOCATE, CUMING COUNTY PUBLIC POWER DISTRICT, LAW ENFORCEMENT, CITY EMPLOYEES, MEDICAL RESPONSE SYSTEMS, VETERAN SERVICE OFFICERS, AND SCHOOLS. ST. FRANCIS MEMORIAL HOSPITAL PART V, SECTION B, LINE 6A: ST. FRANCIS MEMORIAL HOSPITAL CONDUCTED ITS CHNA IN CONJUNCTION WITH MERCYONE OAKLAND MEDICAL CENTER IN OAKLAND, NEBRASKA AND 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 2019 CHNA REVEALED TWO MAIN HEALTH PRIORITIES IN OUR AREA: 1) CHRONIC DISEASE CONTROL AND SEPSIS AND 2) BEHAVIORAL/MENTAL HEALTH. THE CHNA IMPLEMENTATION PLAN HAS THE FOLLOWING GOALS TO IMPROVE THE HEALTH PRIORITIES IDENTIFIED.FOR THE HEALTH PRIORITY OF CHRONIC DISEASE CONTROL AND SEPSIS WE WILL:1. INCREASE PRIMARY CARE VISITS2. INCREASE SCREENING VISITS SUCH A MAMMOGRAMS, PROSTATE, COLONOSCOPY, AND VACCINATIONS.3. INCREASE PARTICIPATION IN THE CLINIC CHRONIC CARE MANAGEMENT PROGRAM.4. INCREASE PARTICIPATION IN THE CLINIC TRANSITIONAL CARE MANAGEMENT PROGRAM.5. IDENTIFY TOBACCO USERS AND PROVIDE CESSATION PROGRAM INFORMATION.6. SPONSOR INCREASED EAT WELL AND BE ACTIVE CLASSES.FOR THE HEALTH PRIORITY OF BEHAVIOR/MENTAL HEALTH WE WILL:1. RECRUIT BEHAVIORAL/MENTAL HEALTH PROVIDERS.2. DEVELOPMENT OF RECRUITMENT INCENTIVES.3. IDENTIFY TELEMEDICINE ALTERNATIVES.4. SUICIDE PREVENTION PROGRAM DEVELOPMENT.DURING THE DEVLOPMENT OF THE CHNA IT WAS DETERMINED THAT THE HEALTH PRIORITIES WERE REDUCED TO JUST TWO TO ACHIEVE A MORE-MEANINGFUL IMPACT ON THE SELECTED PRIORITIES. HOWEVER, IT SHOULD BE NOTED THAT SOME OF THE OTHER OPPORTUNITIES FOR PRIORITIZATION THAT WERE IDENTIFIED SUCH AS VAPING-RELATED LUNG DISEASE, OPIOID OVERDOSE/MISUSE, THE DISPROPORTIONATE RETIREMENT RATES OF HEALTHCARE PROFESSIONALS, POST-FLOOD WATER QUALITY ISSUES, NATURAL DISASTER PREPAREDNESS, 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 $890,378 ARE REPORTED ON LINE 7G. THIS AMOUNT REPRESENTS THE COMMUNITY BENEFIT ATTRIBUTABLE TO 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 HAVE MULTIPLE STAFF MEMBERS THAT ARE PART OF THE WEST POINT TRAILS PROJECT. THIS WAS A PROJECT TO HELP IMPROVE THE HEALTH AND WELLNESS OF THE PERSONS IN THE COMMUNITY AND SURROUNDING AREA. 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 $122,520 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 $122,520 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, 9, 10 AND 11 OF THE ATTACHED FINANCIAL STATEMENTS INCLUDE FOOTNOTES TITLED "ACCOUNTS RECEIVABLE", "REVENUE RECOGNITION - PATIENT SERVICE REVENUE AND "FEDERAL FINANCIAL ASSISTANCE PROGRAMS" 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 2021 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 $393,917 WHILE THE ASSOCIATED COSTS WERE $1,087,597 FOR A SHORTFALL OF ($693,680). 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 ($152,077) AND THE MEDICARE PART B SHORTFALL OF ($693,680) FOR A TOTAL SHORTFALL OF ($845,757) 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 INTO 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 DIFFERENT 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 OF 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." THE FINANCIAL ASSISTANCE POLICY (FAP), THE PLAIN LANGUAGE SUMMARY OF THE FAP, THE APPLICATION FOR FINANCIAL ASSISTANCE, AND FINANCIAL ASSISTANCE CONTACT INFORMATION IS POSTED AT THE MAIN ENTRANCE TO THE HOSPITAL AND CLINIC AND ALSO AT THE EMERGENCY ROOM ENTRANCE AND 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 THE FIVE-COUNTY SERVICE AREA IS APPROXIMATELY 18,000 PEOPLE. THE MEDIAN HOUSEHOLD INCOME IS APPROXIMATELY $59,000. 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 DIRECTORS, 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 SIX FAMILY PRACTICE PHYSICIANS, FIVE PHYSICIAN ASSISTANTS, AND THREE NURSE PRACTITIONERS. 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, ORTHOPEDICS, 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 2021, SOME OF THE EQUIPMENT THAT WAS PURCHASED INCLUDES AN MRI, MICRODRILLS AND SAWS FOR ORTHOPEDIC CASES, DECONTAMINATION 3-BAY ADJUSTABLE SINK, ARTERIAL DOPPLER MACHINE, PHARMACY REFRIGERATOR, AND A SECURITY CAMERA UPGRADE. 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 8637 FMV MEDICAL SUPPLIES PROGRAM SUPPORT WEST POINT COMMUNITY FOUNDATION PO BOX 65 WEST POINT NE 68788 363819725 501(C)(3) 50000 0 PROGRAM SUPPORT ST JOSEPH'S ELDER SERVICES INC 540 E WASHINGTON ST WEST POINT NE 68788 814879204 501(C)(3) 34500 0 PROGRAM SUPPORT 3 0 PART I, LINE 2: DURING 2021, FRANCISCAN CARE SERVICES TRANSFERRED CASH OF $50,000 TO WEST POINT COMMUNITY FOUNDATION FOR PROGRAM SUPPORT FOR THE NELIGH PARK INCLUSIVE PLAYGROUND, CASH OF $34,500 TO ST. JOSEPH'S ELDER SERVICES INC., A RELATED ENTITY UNDER FRANCISCAN SISTERS OF CHRISTIAN CHARITY SPONSORED MISTRIES, INC, AND MEDICAL SUPPLIES VALUED AT $8,637 TO ORPHAN GRAIN TRAIN FOR PROGRAM SUPPORT X X X 0 1 0 1 0 0 0 0 0 SCOTT GREEN MD PHYSICIAN 436361 0 172032 0 14188 0 14500 0 34844 0 671925 0 0 0 THOMAS COHEE MD PHYSICIAN 403424 0 178892 0 21730 0 12500 0 31984 0 648530 0 0 0 BRIAN HASS MD PHYSICIAN 367628 0 205509 0 23868 0 12211 0 35030 0 644246 0 0 0 RHETT ECKMANN MD PHYSICIAN 354982 0 201454 0 13774 0 12211 0 35030 0 617451 0 0 0 RENAE MEYER MD PHYSICIAN 286245 0 87738 0 15574 0 12500 0 30948 0 433005 0 0 0 TYLER TOLINE CEO & PRESIDENT 250700 0 60500 0 54315 0 0 0 32280 0 397795 0 0 0 TERRY NELSON ANCILLARY DIRECTOR 188409 0 10500 0 16899 0 28051 0 32522 0 276381 0 0 0 ALISA BRUNSING CFO 157601 0 28889 0 4432 0 8966 0 11398 0 211286 0 0 0 PART I, LINE 4B DURING 2021, 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 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 2016-10-01 10000000 FOR AN ADDITION TO AND IMPROVEMENTS FOR EXISTING HOSPITAL FACILITIES. 0 0 0 A 3676036 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 IV, LINE 12A: CHECKLIST OF REQUIRED SCHEDULES THE ORGANIZATIONS'S FINANCIAL STATEMENTS WERE AUDITED ON A CONSOLIDATED BASIS AT THE ORGANIZATION'S PARENT LEVEL. THE ORGANIZATION USES SCHEDULES FROM THE CONSOLIDATED AUDITED FINACIALS STATEMENTS FOR TAX RETURN PURPOSES. 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 IX, LINE 11G OTHER CONTRACTORS: PROGRAM SERVICE EXPENSES 3,847,968. MANAGEMENT AND GENERAL EXPENSES 517,955. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,365,923. FORM 990, PART XI, LINE 9: CHANGE IN BENEFICIAL INTEREST OF A CHARITABLE FOUNDATION -260,000. ST FRANCIS SERVICES LLC 430 N MONITOR ST WEST POINT NE 68788 852622665 PHARMACY NE 34884 201782 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 RETIRMENT 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 HOLY FAMILY MEMORIAL INC 2300 WESTERN AVE MANITOWOC WI 54220 390806395 HEALTHCARE WI 501(C)(3) LINE 3 SEE LINE 2 0 HOLY FAMILY HEALTH SERVICES 3310 CALUMET AVENUE MANITOWOC WI 54220 391572253 PHARMACY WI HOLY FAMILY MEMORIAL INC C 0 0 1 1 1 1 0 0 0 0 1 0 0 1 0 1 1 1 0 1