2019-11-08T15:01:53-06:00 2018-12-31 KPMG LLP 1212 North 96th Street Suite 300 Omaha NE 68114 990 2018-01-01 470486026 FRANCISCAN CARE SERVICES INC % ALISA BRUNSING FRAN 4023722404 430 NORTH MONITOR STREET WEST POINT NE 687881555 DAVID AMEEN President 2019-11-05 true DONALD NEAL JR P00798244 4023481450 167.68.102.5 47006120193125000001 2019-11-08 P 65CF9D49F64C2267637B54237ED8CC7527705457 55718AD0153E791F3315D72D27656E543FED7AC8 2018 2020-03-31 21:24:44Z DAVID AMEEN 430 NORTH MONITOR STREET WEST POINT NE 687881555 37336378 false 0928 X www.fcswp.org X 1964 NE THE MISSION OF FRANCISCAN CARE SERVICES INC. IS TO LIVE AND TO PROMOTE THE HEALING MISSION OF JESUS CHRIST. 12 8 310 226 2478 1478 261678 1841243 35129469 34419893 1335333 1039828 16741 16484 36743221 37317448 0 13730621 0 0 19560867 20885689 0 0 1927 12929987 13193471 32490854 47809781 4252367 -10492333 80878525 65168569 14365430 13238931 66513095 51929638 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, PHYSICIAN AND ASSISTED LIVING SERVICES TO ANYONE IN NORTHEAST NEBRASKA, REGARDLESS OF THEIR ABILITY TO PAY. false true 41723612 13730621 33102903 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. PATIENTS SERVED DURING THE YEAR: TOTAL MEDICARE MEDICAID IN-PATIENTS DISCHARGED 350 239 16 PATIENT DAYS - ACUTE 1,238 936 44 - SWING BED 643 562 NONE - NURSERY 82 NONE 22 OUT-PATIENT & HOME HEALTH 48,795 19,743 1,401 PHYSICIAN CLINIC VISITS 23,537 7,536 1,922 THE HOSPITAL RECEIVES GENEROUS SUPPORT FROM THE COMMUNITY NOT ONLY FINANCIALLY BUT ALSO FROM ABOUT 179 VOLUNTEERS WHO DONATED 3,449 HOURS OF THEIR VALUABLE TIME. 1665971 0 1333474 ASSISTED LIVING FACILITY FULFILLS THE MISSION OF THE ROMAN CATHOLIC CHURCH BY PROVIDING 54 FRAIL AND ELDERLY PEOPLE WITH ASSISTED LIVING SERVICES REGARDLESS OF THEIR ABILITY TO PAY. A TOTAL OF 16 RESIDENTS RECEIVED $261,437 IN FREE CARE DURING THE YEAR. APPROXIMATELY 47 VOLUNTEERS PROVIDED 3,734 HOURS OF SUPPORT TO THE FACILITY. 43389583 true true false true false false false false false false true false false true false true true true false false false false false false false false true true true false true true false false false false false false false false true false false false false false false true false false false true 54 0 true 310 true true true false false false false false false false false false false false X 12 8 false false false false true true true true true false false true true true true true true true false false X ALISA BRUNSING 4023722360 430 NORTH MONITOR STREET WEST POINT NE 687881555 X Jerry Wordekemper CEO & Trustee 45.0 0.38 X X 217285 0 44690 DAVE STEFFENSMEIER Chairman 1.5 0.19 X X 0 0 0 BILL KREIKEMEIR Chairman (thru 4/2018) 0.5 0.0 X X 0 0 0 GARY KAUP VICE CHAIRMAN 1.5 0.0 X X 0 0 0 JACKIE RIDDER Trustee 1.5 0.0 X X 0 0 0 MARY JANATA SECRETARY 1.5 0.0 X X 0 0 0 STEVE SWANSON TRUSTEE 1.5 0.0 X X 0 0 0 JEROME STEFFEN Trustee (thru 4/2018) 0.33 0.0 X 0 0 0 CHAD ORTMEIER DDS Trustee 1.0 0.0 X 0 0 0 KARI PENROSE TRUSTEE 1.0 0.0 X 0 0 0 SR BARBARA MATHE TRUSTEE (thru 6/2018) 0.5 0.0 X 0 0 0 REGINA UHING TRUSTEE 1.0 0.0 X 0 0 0 Sr PATRICIA LINSSEN Trustee 3.69 3.84 X 0 0 0 JASON SMITH Trustee 0.67 0.0 X 0 0 0 CHET MCWHORTER TRUSTEE 0.67 0.0 X 0 0 0 Dennis Dinslage V.P. Fiscal & Support Services 42.0 0.0 X 168287 0 41256 Terry Nelson Rehab Manager 55.0 0.0 X 209495 0 46011 JEAN MEIERGERD CHIEF INFORMATION OFFICER 50.0 0.0 X 151385 0 30215 Kenneth Pitz MD Physician 40.0 0.0 X 493739 0 45118 Scott Green MD Physician 44.04 0.0 X 572333 0 47118 Brian Hass MD Physician 43.69 0.0 X 498213 0 44865 Rhett Eckmann MD Physician 43.88 0.0 X 493033 0 44915 THOMAS COHEE MD PHYSICIAN 43.42 0.0 X 464264 0 42258 3268034 0 386446 21 false true false MCS CONSTRUCTION 1020 CENTENNIAL RD WEST POINT NE 68788 CONSTRUCTION SERVICE 5595810 CERNER 2800 ROCKCREEK PARKWAY KANSAS CITY MO 64117 IT SOFTWARE SUPPPORT 1277715 KAT ANESTHESIA LLC 606 VISTA AVENUE WEST POINT NE 68788 ANESTHESIA SERVICES 581629 CYPRESS BENEFIT ADMINISTRATOR PO BOX 7020 APPLETON WI 549127020 HEALTH PLAN ADMIN 514509 ALLSCRIPTS HEALTHCARE LLC 24630 NETWORK PLACE CHICAGO IL 606731246 IT SOFTWARE SUPPORT 184789 9 0 0 0 1766817 9000 65426 1841243 HOSPITAL/CLINIC HEALTHCARE SERVICES 621110 33022887 33022887 ASSISTED LIVING-ELDER CARE 623000 1297989 1297989 DIETARY/CAFETERIA 721000 99017 99017 34419893 1037223 2478 1034745 0 0 0 0 0 2605 2605 2605 2605 0 0 0 0 0 0 35414 18930 16484 16484 0 37317448 34436377 2478 1037350 13730621 13730621 0 0 0 923788 786700 137088 0 0 0 16002666 14272466 1730200 440904 346855 94049 2516620 2002101 514519 1001711 881519 120192 0 6705 6705 78275 78275 3466 3466 0 0 2593142 2208315 384827 161227 159888 1339 1672563 1520203 152360 974013 773742 200271 0 1026169 877517 148652 126972 106975 19997 0 57090 53922 3168 0 0 3291361 2616348 675013 124603 124603 MEDICAL SUPPLIES 2912407 2912407 DUES & SUBSCRIPTIONS 163322 140004 23318 WOMEN'S AUXILIARY SUPPLIES 1927 1927 UNRELATED BUSINESS INCOME TAXE 229 229 47809781 43389583 4418271 1927 1077600 1347168 12199619 5391953 0 0 4507822 5271921 0 0 0 0 0 0 659769 643216 224236 343757 62991200 38574920 31894560 24416280 24657049 23170336 768187 564490 0 0 0 0 4889683 4019448 80878525 65168569 5195777 4806316 0 0 71896 14679 9097757 8417936 0 0 0 0 0 0 0 0 0 0 14365430 13238931 X 63863095 50819190 2650000 1110448 0 0 66513095 51929638 80878525 65168569 X -10492333 -2551572 -1539552 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false true 3466 true false false 3466 false SCHEDULE C, PART II-B, LINE F MEMBERSHIP DUES PAID TO HEALTH CARE ASSOCIATIONS OF WHICH A PERCENTAGE OF THE DUES ARE ALLOCATED TO LOBBYING ACTIVITIES. SCHEDULE C, PART II-B, LINE G OCCASIONAL PHONE CALL OR EMAIL TO AND FROM OUR REPRESENTATIVES. 290006 290006 21912628 11491181 10421447 40696566 27083739 13612827 92000 0 92000 24416280 SETTLEMENTS RECEIVABLE 1570175 CHARITABLE FOUNDATION 1110448 LIFE INSURANCE VALUE 551880 RETIREMENT 457(F) PLAN 786945 4019448 0 0 X 34756590 -2551572 -2551572 37308162 9286 9286 37317448 47807854 47807854 1927 1927 47809781 SCHEDULE D, PART X, LINE 2 FIN 48 FOOTNOTE ON AUDITED FINANCIAL STATEMENTS: The Internal Revenue Service has ruled that the Organization is exempt from federal income taxes under Section 501(c)(3) of the Internal Revenue Code (the "Code") and exempt from federal income taxes on related income pursuant to Section 501(a) of the Code. Income tax provisions for the Organization are not material to the financial statements. SCHEDULE D, PART XI, LINE 4B AUXILIARY GIFT SHOP SALES 27,640 AUXILIARY GIFT SHOP COGS (18,930) --------- NET GAIN FROM SALES 8,710 AUXILIARY FUNDS RAISED 5,802 AUXILIARY DONATION TO HOSPITAL (5,226) --------- TOTAL 9,286 ========= SCHEDULE D, PART XII, LINE 4B AUXILIARY OPERATING EXPENSES 1,927 true true X true X true X true true false true true 130 322265 0 322265 0.00670 1567 1587622 1110474 477148 0.01000 1697 1909887 1110474 799413 0.01670 2225 251597 29166 222431 0.00460 130 117356 0 117356 0.00250 11804 7171040 5525274 1645766 0.03440 14159 7539993 5554440 1985553 0.04150 15856 9449880 6664914 2784966 0.05820 3035 0 3035 0.00010 5232 42829 3102 39727 0.00080 117 16299 0 16299 0.00030 5349 62163 3102 59061 0.00120 true 974824 194965 12337625 12643826 -306201 X true true 1 1 ST FRANCIS MEMORIAL HOSPITAL 430 N MONITOR ST WEST POINT NE 68788 www.fcswp.org 180001 X X X X ST FRANCIS MEMORIAL HOSPITAL 1 false false true X X X X X X X X X 16 true true true true X SEE PART V, SECTION C X true 16 true SEE PART V, SECTION C false true X 100 200. X X X true true X X X true X See Part V, Section C X See Part V, Section C X SEE PART V, SECTION C X X X X X X true X false X X X X true X false false SCHEDULE H, PART V, SECTION B, LINE 5 Input from diverse sectors involved in public health was obtained through key informant interviews from the followings groups: elected officials, hospital administrators, behavioral health practitioners, community-based organizations, community college administrators, Public Health students, health education directors, minority community leaders, business leaders, Community Action Agency leaders, youth-serving organizations, long-term care facilities, organizations for persons with disabilities, university representatives, hospice centers, Educational Service Units, Ponca Tribe representatives, Federally-Qualified Health Center leaders, organizations representing the elderly, housing officials, domestic violence organizations, Chamber of Commerce leaders, Veterans organizations, and city health officials. Data was also collected through community-level health surveys administered on-line and through regular mail. The survey was available to the public on January 20, 2016. Patrons were invited to take the survey by means of several routes including public press releases and radio public service announcements; Chamber of Commerce newsletters; through employers, senior citizen centers; social media posts; and flyers that were posted or flyers that were distributed to school students via mass distribution efforts. Those interested in taking the survey were encouraged to do so online, or were invited to request a hard-copy survey. Surveys were also available in Spanish. The number of surveys completed was 1,472. In an effort to ensure broad participation throughout the health district, Elkhorn Logan Valley Public Health Department (ELVPHD) focused special attention on gathering assessments from minorities, the elderly and veterans. Some of the methods to ensure that these special populations input was gained included: * The community health needs assessment was translated into Spanish; * Two bilingual ELVPHD staff engaged the Hispanic community directly and through various partners to ensure broad participation; * ELVPHD worked with Midtown Health Center, the local Federally-Qualified Health Center, to engage their patients to complete the assessment. * ELVPHD engaged the Ponca Tribe of Nebraska to encourage tribal members to complete the assessment; * ELVPHD placed a staff member at various WIC and immunization clinics in the area to reach lower-income consumers; * ELVPHD has staff visit local senior centers to complete assessments on site; and * The ELVPHD Veterans Services Programming Coordinator worked with veterans to complete assessments. In April 2016, a Community Health Improvement Plan Stakeholder/Focus Group was held in West Point, Nebraska and Norfolk, Nebraska. Approximately 325 invitations were sent out to key stakeholders in the public health system. The public was invited to attend the focus groups as well. There were 40 individuals that attended the Focus Group meeting in West Point, and 52 individuals attended the Focus Group meeting in Norfolk. Meeting participants include elected officials, hospital administration, behavioral health practitioners, community-based organizations, community college administrators, Public Health students, health education directors, minority community leaders, business leaders, Community Action Agency leaders, youth-serving organizations, long-term care facilities, organizations for persons with disabilities, university representatives, hospice centers, Educational Service Units, Ponca Tribe representatives, Federally-Qualified Health Center leaders, organizations representing the elderly, housing officials, domestic violence organizations, Chamber of Commerce leaders, Veterans organizations, and city health officials. SCHEDULE H, 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. SCHEDULE H, PART V, SECTION B, LINE 6b St. Francis Memorial Hospital conducted its CHNA in conjunction with Elkhorn Logan Valley Public Health Department. SCHEDULE H, PART V, SECTION B, LINE 7a The CHNA for St. Francis Memorial Hospital is available at http://fcswp.org/file_download/inline/23ee6053-24fe-4cbd-8eb4-ed78a5856511 SCHEDULE H, PART V, SECTION B, LINE 10A St. Francis Memorial Hospitals CHNA implementation strategy is available at file://sfmh-na-fs1/Roaming%20Profiles/abrunsing/Desktop/Community%20Health %20Needs%20Assessment%20Implementation%20Plan%202017-2019.pdf SCHEDULE H, PART V, SECTION B, LINE 11 The 2016 CHNA revealed four main health priorities in our area: 1) Obesity, 2) Access to Care, 3) Cancer Prevention and Screening, and 4) Standard Motor Vehicular Safety. Several overall goals were established based on the preceding health priorities. Actions taken in 2018 to address the health priorities are as follows: To address the health priority of obesity, we have used many different programs to encourage employees and the community to stay healthy. They are as follows: 1. Weight Watchers classes are held in our conference room free of charge to anyone that wants to participate. 2. Hosted a free 4th of July Fun Run for the community. 3. Provide low cost memberships to our Wellness Facility. 4. Have employees that are members of the West Point Trails Committee that are working to provide a safe walking/biking trail in the West Point community. Phase I of the project was paved in 2018. 5. Our health coaches and registered dietician provide nutritional counseling to our patients and employees. 6. We provide accommodations for breastfeeding mother on our campus and a lactation consultant is available to all new mothers to provide education and support. 7. Provided the local schools with a sugary drink display to educate students on the amount of sugar in different drinks and promote healthy drink options. 8. Held a healthy cooking demonstration for our staff. 9. Our registered dietician presented a teen nutrition class to the 7th grade classes at both West Point-Beemer High School and Guardian Angels Central Catholic High School. 10. Hosted a bike rodeo to re-enforce bike safety and to promote exercise. Two bikes were given away to participants. 11. Sponsored "Food in the Field" program to demonstrate how to pack a healthy lunch while in the field. 12. Sponsored a color run to promote community wellness. 13. The Cardiac Rehab department conducted education on metabolic syndrome. 14. Sponsored a local volleyball league to promote wellness. To address the health priority of access to care, the following actions were taken: 1. We employ an Advanced Practice Registered Nurse (APRN) with a specialty in mental health. She sees patients at three of our clinics as well as area nursing homes. Her schedule is always full. We also have the capability to access a psychiatrist through telehealth if the APRN feels she has a patient who needs additional assistance. 2. We also offer reduced rate mental health services for our employees through our Employee Assistance Program. 3. Our APRN also has mental health APRN students who complete their clinical rotation with her in the clinic. We hope to be able to recruit one of these students in the future to increase the amount of mental health services we can provide. 4. Business Health and Wellness went to approximately 40 businesses during the year doing laboratory and blood pressure screenings. 5. Hosted the 5th Annual March Health Fair for people of the area providing healthy cooking demonstrations, low cost blood tests, screenings and health education. 6. Offer well-child checks at all six of our clinic locations. 7. Business Health and Wellness and Home Health offer flu shots at area senior centers and onsite at several businesses at a competitive rate. 8. Provide job shadow opportunities for area high school students. To address the health priority of cancer prevention and screening, we provided the following activities, some of which are also included under access to care: 1.We provide on-site preventive screenings at area businesses through our Business Health and Wellness Program. We have staff that go on-site and perform blood draws and take vitals so individuals in the area do not have to miss work. This helps identify individuals who have health needs and need to be seen by a healthcare provider. 2. We have a respiratory therapist that provides smoking cessation counseling to patients. We are a tobacco/smoke free campus to encourage healthy habits among our patients, employees and community. 3. We send out reminders for colonoscopies and mammographies to patients at the recommended times. 4. In collaboration with the Elkhorn Logan Valley Public Health Department we had Fecal Occult Blood Test Kits for colon cancer screening available for the community during our annual health fair. 5. Held a "Womens Night Out" in October with Dr. Galva as the guest speaker who spoke on the importance of breast self-exams. Also provided evening mammograms for patient convenience. 6. Provided community education through the "Caring for You" newsletter about the importance of colon cancer screening. 7. Provided free skin checks for employees. 8. Provided free colorectal cancer screening for employees. To address the health priority of standard motor vehicular safety, we provided multiple child safety seat checks in our service area to ensure that children are buckled into their car seat appropriately and to make sure they are using the appropriate child safety seat. We also provided safe driving education in our "Caring for You" newsletter. SCHEDULE H, PART V, SECTION B, LINE 13H Other factors used in determining eligibility for financial assistance include eligibility for Medicaid, Social Security or a bank loan. SCHEDULE H, PART V, SECTION B, LINE 14 According to our financial assistance policy, patients who are deemed to be eligible for financial assistance will not be charged for care more than Amounts Generally Billed (AGB) by the hospital to individuals who have health insurance covering such care. Discounts granted to eligible patients under this policy will be taken from gross charges. The hospital utilizes the look-back method to establish its AGB and AGB Percentage. The AGB is the hospital's gross charges multiplied by the AGB Percentage. The hospital's AGB Percentage during 2018 was 75%. The AGB Percentage is calculated by dividing the total of all claims allowed by health insurers during the prior 12-month period by the total gross charges for those claims. Claims are considered to be "allowedbased upon when the care was provided, but when the insurer determines the allowable amount of the claim. The amount "allowed" includes the amount the insurer will pay plus the amount for which the individual is personally responsible (including co-pays and deductibles). Allowed claims are included in the AGB Percentage calculation regardless of whether they have been paid or collected. "Health insurers" for purposes of this definition are Medicare fee-for-service and all private health insurers. SCHEDULE H, PART V, SECTION B, LINE 16A The FAP is available at http://fcswp.org/file_download/inline/a0e97036-1d8b-46e5-acce-be381c441aa4 SCHEDULE H, PART V, SECTION B, LINE 16B The FAP application form is available at http://fcswp.org/file_download/inline/8472e986-5d29-4ca2-855a-ff6a3b2d45fc SCHEDULE H, PART V, SECTION B, LINE 16C A plain language summary of the FAP is available at http://fcswp.org/file_download/inline/587ab2c1-9339-4c38-aa97-8579030c40be 1 ST JOSEPH'S RETIREMENT COMMUNITY 320 E DECATUR ST WEST POINT NE 68788 ASSISTED LIVING FACILITY Schedule H, 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. Schedule H, Part I, Line 7, Column F The amount used to compute column (f) is from the amount reported on Form 990, Part IX, line 25, column (a). Schedule H, Part I, Line 7G Subsidized health services of $1,645,766 are reported on line 7g. Of this amount, $1,640,672 represents the community benefit attributable to physician services. Schedule H, Part II 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 help sponsor the local blood drive through the American Red Cross. We donate funds to different organizations to improve the communitys health and safety. Schedule H, 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 patients 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 contracted discounts have been applied, then only the 20% coinsurance that is owed by the patient is written off to bad debt. Schedule H, 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 individuals 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 $194,965 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 $194,965 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. Schedule H, Part III, Line 4 The accounts receivable footnote which discusses bad debt expense is on page 6 of the Notes to Financial Statements. Schedule H, 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 2018 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 $288,746 while the associated costs were $805,395 for a shortfall of ($516,649). 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 ($306,201) and the Medicare Part B shortfall of ($516,649) for a total shortfall of ($822,850) 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. Schedule H, 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 must accompany the financial assistance application. A determination of approval or denial is made from this application and is based upon hospital established guidelines." Needs Assessment 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. Patient Education of Eligibility for Assistance 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://fcswp.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://fcswp.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. Community Information Franciscan Care Services, Inc. is located in a rural area, predominantly agricultural based. The population of the five county service area is approximately 18,000 people. The median household income is approximately $50,000. The population is predominantly Caucasian, high-school educated, and geriatric in nature. There is a small population of Hispanic descent. Promotion of Community Health 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, a nurse, dentist, a school guidance counselor, 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 one general surgeon, one orthopaedic surgeon, five family practice physicians, three physician assistants, and two 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, Orthopaedics, 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 host an annual health fair to reach out to those who do not regularly schedule a clinic visit or annual lab tests. Affiliated Health Care System 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 and a liberal arts college located in Wisconsin, Nebraska and Ohio. Each organization within the Ministry is responsible for carrying out the healing and education mission of the Catholic Church according to the needs of their community. State Filing of Community Benefit Report 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. true ST JOSEPH'S ELDER SERVICES Inc 540 EAST WASHINGTON ST WEST POINT NE 68788 814879204 501(C)(3) 700250 13030371 VARIOUS ASSETS PROGRAM SUPPORT 1 0 SCHEDULE I, PART I, LINE 2 During 2018, Franciscan Care Services transfered cash, net property and equipment, and other current assets and liabilities for a total of $13,730,621 to St. Joseph's Elder Services,Inc., a related entity under Franciscan Sisters of Christian Charity Sponsored Ministries, Inc. Records have been maintained to substantiate the amounts transferred. X X X X false true false true false false false false false Jerry Wordekemper CEO & Trustee 160175 0 31228 0 25882 0 12048 0 34767 0 264100 0 0 0 Dennis Dinslage V.P. Fiscal & Support Services 143083 0 23813 0 1391 0 9179 0 33461 0 210927 0 0 0 Terry Nelson Rehab Manager 187492 0 200 0 21803 0 16500 0 31067 0 257062 0 0 0 Kenneth Pitz MD Physician 465551 0 200 0 27988 0 12500 0 34415 0 540654 0 0 0 Scott Green MD Physician 421980 0 137579 0 12774 0 14500 0 34415 0 621248 0 0 0 Brian Hass MD Physician 379130 0 99803 0 19280 0 12211 0 34451 0 544875 0 0 0 Rhett Eckmann MD Physician 355809 0 124810 0 12414 0 12211 0 34501 0 539745 0 0 0 JEAN MEIERGERD CHIEF INFORMATION OFFICER 95947 0 46948 0 8490 0 0 0 31233 0 182618 0 0 0 THOMAS COHEE MD PHYSICIAN 410130 0 43939 0 10195 0 12500 0 31555 0 508319 0 0 0 SCHEDULE J, PART I, LINE 4b QUESTIONS REGARDING COMPENSATION DURING 2018, 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. PITZ $12,500 MR. NELSON $16,500 SCHEDULE J, PART I, LINE 5a QUESTIONS REGARDING COMPENSATION AT THE BEGINNING OF THE CALENDAR YEAR, THERE WAS A WRITTEN AGREEMENT ESTABLISHED REGARDING THE POTENTIAL AMOUNT OF SUPPLEMENTAL INCOME THAT CERTAIN 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 WRITTEN AGREEMENT. THE FORMULA IN SUMMARY 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, DRS. GREEN, ECKMANN, COHEE AND HASS RECEIVED A PAYMENT. A HOSPITAL AUTHORITY NO 1 OF CUMING COUNTY NE 470762878 2016-10-01 10000000 SEE SCHEDULE K, PART VI false false false A 1520251 0 10000000 0 0 0 0 0 0 0 10000000 0 2012 true false true true A false false false false 0.00000 0.00000 0.00000 false false false true A false true false false 0 false 0 false true A true SCHEDULE K, PART 1, LINE A, COLUMN F: THE BOND IS BEING REISSSUED FOR FEDERAL TAX PURPOSE 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. BARBARA STEFFEN SEE PART V 25722 EMPLOYMENT false DAN HAKEL SEE PART V 176686 EMPLOYMENT true BRENDA WISNIESKI SEE PART V 45683 EMPLOYMENT false MARGUERITE KAUP SEE PART V 20967 EMPLOYMENT false AGNES DINSLAGE SEE PART V 26152 EMPLOYMENT false Meagan Janata SEE PARY V 11825 EMPLOYMENT false JILL HAKEL SEE PART V 38960 EMPLOYMENT false Pamela Danielski SEE PART V 33726 EMPLOYMENT false SCHEDULE L, PART IV BARBARA STEFFEN IS A FAMILY MEMBER OF JEROME STEFFEN, TRUSTEE DAN HAKEL IS A FAMILY MEMBER OF CHAD ORTMEIER, TRUSTEE BRENDA WISNIESKI IS A FAMILY MEMBER OF MARY JANATA, TRUSTEE MARGUERITE KAUP IS A FAMILY MEMBER OF GARY KAUP, TRUSTEE AGNES DINSLAGE IS A FAMILY MEMBER OF DENNIS DINSLAGE, OFFICER MEAGAN JANATA IS A FAMILY MEMBER TO MARY JANATA, TRUSTEE JILL HAKEL IS A FAMILY MEMBER OF CHAD ORTMEIER, TRUSTEE PAMELA DANIELSKI IS A FAMILY MEMBER TO JEAN MEIERGERD, KEY EMPLOYEE FORM 990, PART III, Line 3 FRANCISCAN CARE SERVICES, INC., DOING BUSINESS AS ST. FRANCIS MEMORIAL HOSPITAL AND ST. JOSEPH'S RETIREMENT COMMUNITY, IS A NOT-FOR-PROFIT CORPORATION IN NEBRASKA. ST. JOSEPH'S RETIREMENT COMMUNITY PROVIDES ASSISTED LIVING SERVICES TO THE RESIDENTS OF WEST POINT, NEBRASKA AND THE SURROUNDING COMMUNITY. DURING 2018, ST. JOSEPH'S RETIREMENT COMMUNITY WAS TRANSFERRED TO ST. JOSEPH'S ELDERS SERVICES INC., A RELATED ENTITY UNDER FRANCISCAN SISTERS OF CHRISTIAN CHARITY SPONSORED MINISTRIES, INC. FORM 990, PART IV, LINE 12a Checklist of Required Schedules The organization's financial statements were audited on a separate basis but also consolidated at the organization's parent level. The organization uses the separate audited financial statements for tax return purposes. FORM 990, PART VI, SECTION A, LINE 6 THE ORGANIZATION IS A NOT-FOR-PROFIT CORPORATION WHOSE MEMBER IS FRANCISCAN SISTERS OF CHRISTIAN CHARITY SPONSORED MINISTRIES, INC. FORM 990, PART VI, SECTION A, LINE 7A & 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 TO 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 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 FORM 990 WILL BE AVAILABLE FOR ALL BOARD MEMBERS TO REVIEW AT THEIR MONTHLY BOARD MEETING BEFORE THE 990 IS FILED. FORM 990 IS MADE AVAILABLE IN THE ADMINISTRATIVE OFFICE FOR ANY INDIVIDUAL REQUESTING TO INSPECT IT AS REQUIRED BY INTERNAL REVENUE CODE SECTION 6104. FORM 990, PART VI, SECTION B, LINE 12C THE CORPORATE COMPLIANCE OFFICER (CCO) AND SEVERAL MEMBERS OF THE CORPORATE COMPLIANCE COMMITTEE ATTEND BOARD, ADMINISTRATIVE, 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 FCS, INC. OR EMPLOYED BY A BUSINESS WITH WHICH FCS CONDUCTS BUSINESS. ANY NEW CONFLICTS THAT ARISE DURING THE YEAR NEED TO BE REPORTED TO THE 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 ADMINISTRATIVE LEVEL, THE STAFF MEMBER IDENTIFIES THE CONFLICT AND THE ADMINISTRATIVE 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 & 15B FRANCISCAN CARE SERVICES, INC. STRIVES TO PROVIDE A FAIR AND COMPETITIVE COMPENSATION PACKAGE FOR ITS EXECUTIVE. 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 COMPENSATIONS 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 LIKED 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 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 AVAILABLE TO THE PUBLIC. FORM 990, PRT XI, LINE 9: IN 2017, ST. JOSEPHS RETIREMENT COMMUNITY FOUNDATION RECEIVED $2,650,000 OF RESTRICTED DONATIONS FOR THE CONSTRUCTION OF A NURSING HOME FACILITY. FRANCISCAN CARE SERVICES IS RECOGNIZING ITS INTEREST IN THE RESTRICTED NET ASSETS OF THE FOUNDATION. IN 2018, FRANCISCAN CARE SERVICES RECOGNIZED AN ADDITIONAL $177,265 INTEREST IN THE RESTRICTED NET ASSETS OF THE FOUNDATION. FRANCISCAN CARE SERVICES RECEIVED PAYMENT OF $1,716,817 OF THESE RESTRICTED DONATIONS RESULTING IN A NET DECREASE IN THE INTEREST IN THE RESTRICTED NET ASSETS OF THE FOUNDATION OF ($1,539,552). HOLY FAMILY CONVENT FRANCISCAN SISTERS 2409 SOUTH ALVERNO ROAD MANITOWOC WI 54220 390808523 RELIGION WI 501(C)(3) LINE 1 NA false FRANCISCAN SISTERS OF CHRISTIAN CHARITY 1415 SOUTH RAPIDS ROAD MANITOWOC WI 54220 391530622 EDU/HLTHCARE WI 501(C)(3) LINE 1 SEE LINE 1 false ST FRANCIS MEMORIAL HOSPITAL FOUNDATION 430 N MONITOR ST WEST POINT NE 68788 470629079 FUNDRAISING NE 501(C)(3) 12A TYPE I NA false ST JOSEPHS RETIREMENT COMMUNITY FDN PO BOX 65 WEST POINT NE 68788 470790644 FUNDRAISING NE 501(C)(3) 12A TYPE I NA false HOLY FAMILY MEMORIAL INC 2300 WESTERN AVE PO BOX 1450 MANITOWOC WI 54221 390806395 HEALTHCARE WI 501(C)(3) Line 3 SEE LINE 2 false ST PAUL ELDER SERVICES INC 316 EAST 14TH STREET KAUKAUNA WI 54130 391029149 ELDER CARE WI 501(C)(3) LINE 10 SEE LINE 2 false GOOD SAMARITAN MEDICAL CENTER 800 FOREST AVENUE ZANESVILLE OH 43701 314379479 HOLDING CO. OH 501(C)(3) 12A TYPE I SEE LINE 2 false SILVER LAKE COLLEGE OF HOLY FAMILY INC 2406 SOUTH ALVERNO ROAD MANITOWOC WI 54220 390980974 HIGHER EDUCAT WI 501(C)(3) LINE 2 SEE LINE 2 false 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 false HOLY FAMILY HEALTH SERVICES 3310 CALUMET AVENUE MANITOWOC WI 54220 391572253 PHARMACY WI See Pt II Ln 5 C CORP 0 0 false false true true true true false false false false true false false true false true true true false true ALL TRANSACTIONS WERE BETWEEN 501(c)(3) ORGS