FRANCISCAN CARE SERVICES INC: Form 990, tax year 2016
View the entire original 990 at ProPublica ↗
- Organization
- FRANCISCAN CARE SERVICES INC (EIN 47-0486026)
- Tax period
- 2016-01-01 to 2016-12-31
- Filed
- 2017-11-02
- IRS object ID
- 201743069349300824
- Schema version
- 2016v3.1
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule H
- Schedule J
- Schedule K
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2017-11-02T09:21:13-05:00 | ReturnTs |
| Tax Period End | 2016-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | KPMG LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1212 North 96th Street Suite 300 | AddressLine1Txt |
| City | Omaha | CityNm |
| State Abbreviation | NE | StateAbbreviationCd |
| ZIP | 68114 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2016-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 470486026 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | FRANCISCAN CARE SERVICES INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| In Care Of | % DENNIS DINSLAGE | InCareOfNm |
| Business Name Control | FRAN | BusinessNameControlTxt |
| Phone | 4023722404 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 430 NORTH MONITOR STREET | AddressLine1Txt |
| City | WEST POINT | CityNm |
| State Abbreviation | NE | StateAbbreviationCd |
| ZIP | 687881555 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | JERRY WORDEKEMPER | PersonNm |
| Person Title | President | PersonTitleTxt |
| Signature | 2017-11-01 | SignatureDt |
| Discuss With Paid Preparer | Yes (true) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | DONALD NEAL JR | PreparerPersonNm |
| PTIN | P00798244 | PTIN |
| Phone | 4023481450 | PhoneNum |
| Preparation | 2017-11-01 | PreparationDt |
Filing Security Information FilingSecurityInformation
IP Address IPAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| I Pv4 Address | 167.68.102.5 | IPv4AddressTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Federal Original Submission Id | 47006120173065000000 | FederalOriginalSubmissionId |
| Federal Original Submission Id | 2017-11-02 | FederalOriginalSubmissionIdDt |
| Filing License Type | P | FilingLicenseTypeCd |
| At Submission Creation Device Id | DB8C3D1FB4BDA2FF595D15457AF05C6EFA64716E | AtSubmissionCreationDeviceId |
| At Submission Filing Device Id | C21A27E521E242B8AC57595862A3B5635395D684 | AtSubmissionFilingDeviceId |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2016 | TaxYr |
| Build TS | 2017-02-10 21:41:12Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | JERRY WORDEKEMPER | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 430 NORTH MONITOR STREET | AddressLine1Txt |
| City | WEST POINT | CityNm |
| State Abbreviation | NE | StateAbbreviationCd |
| ZIP | 687881555 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $36,480,265 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Group Exemption | 0928 | GroupExemptionNum |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | www.fcswp.org | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1964 | FormationYr |
| Legal Domicile State | NE | LegalDomicileStateCd |
| Activity Or Mission | THE MISSION OF FRANCISCAN CARE SERVICES INC. IS TO LIVE AND TO PROMOTE THE HEALING MISSION OF JESUS CHRIST. | ActivityOrMissionDesc |
| Voting Members Governing Body | 12 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 7 | VotingMembersIndependentCnt |
| Total Employee | 290 | TotalEmployeeCnt |
| Total Volunteers | 208 | TotalVolunteersCnt |
| Total Gross UBI | $8,663 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $7,663 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $252,792 | PYContributionsGrantsAmt |
| CY Contributions Grants | $201,425 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $34,872,518 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $34,993,100 | CYProgramServiceRevenueAmt |
| PY Investment Income | $1,939,603 | PYInvestmentIncomeAmt |
| CY Investment Income | $1,176,772 | CYInvestmentIncomeAmt |
| PY Other Revenue | $17,180 | PYOtherRevenueAmt |
| CY Other Revenue | $18,517 | CYOtherRevenueAmt |
| PY Total Revenue | $37,082,093 | PYTotalRevenueAmt |
| CY Total Revenue | $36,389,814 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $5,000 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $17,484,907 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $18,515,441 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $2,043 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $13,662,192 | PYOtherExpensesAmt |
| CY Other Expenses | $13,416,798 | CYOtherExpensesAmt |
| PY Total Expenses | $31,152,099 | PYTotalExpensesAmt |
| CY Total Expenses | $31,932,239 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $5,929,994 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $4,457,575 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $68,733,058 | TotalAssetsBOYAmt |
| Total Assets EOY | $71,525,095 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $15,709,832 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $13,851,101 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $53,023,226 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $57,673,994 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | 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. | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $26,075,039 | ExpenseAmt |
| Revenue | $33,228,987 | RevenueAmt |
| Desc | 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 453 296 24 PATIENT DAYS - ACUTE 1,515 1,072 56 - SWING BED 1,147 1,034 NONE - NURSERY 112 NONE 27 OUT-PATIENT & HOME HEALTH 44,703 18,744 1,555 PHYSICIAN CLINIC VISITS 26,160 8,904 1,919 THE HOSPITAL RECEIVES GENEROUS SUPPORT FROM THE COMMUNITY NOT ONLY FINANCIALLY BUT ALSO FROM ABOUT 174 VOLUNTEERS WHO DONATED APPROXIMATELY 3,890 HOURS OF THEIR VALUABLE TIME. | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $1,902,773 | ExpenseAmt |
| Revenue | $1,782,630 | RevenueAmt |
| Desc | ASSISTED LIVING FACILITY FULFILLS THE MISSION OF THE ROMAN CATHOLIC CHURCH BY PROVIDING 67 FRAIL AND ELDERLY PEOPLE WITH ASSISTED LIVING SERVICES REGARDLESS OF THEIR ABILITY TO PAY. A TOTAL OF 16 RESIDENTS RECEIVED $249,033 IN FREE CARE DURING THE YEAR. APPROXIMATELY 34 VOLUNTEERS PROVIDED 4,836 HOURS OF SUPPORT TO THE FACILITY. | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expenses | $27,977,812 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (true) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (true) | ScheduleBRequiredInd |
| Political Campaign Acty | false | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (true) | LobbyingActivitiesInd |
| Subject To Proxy Tax | false | SubjectToProxyTaxInd |
| Donor Advised Fund | false | DonorAdvisedFundInd |
| Conservation Easements | false | ConservationEasementsInd |
| Collections Of Art | false | CollectionsOfArtInd |
| Credit Counseling | false | CreditCounselingInd |
| Temp Or Permanent Endowments | false | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (true) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | false | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | false | ReportProgramRelatedInvstInd |
| Report Other Assets | false | ReportOtherAssetsInd |
| Report Other Liabilities | false | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (true) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (true) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (true) | ConsolidatedAuditFinclStmtInd |
| School Operating | false | SchoolOperatingInd |
| Foreign Office | false | ForeignOfficeInd |
| Foreign Activities | false | ForeignActivitiesInd |
| More Than5000 K To Org | false | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividualsInd |
| Professional Fundraising | false | ProfessionalFundraisingInd |
| Fundraising Activities | false | FundraisingActivitiesInd |
| Gaming Activities | false | GamingActivitiesInd |
| Operate Hospital | Yes (true) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (true) | AuditedFinancialStmtAttInd |
| Grants To Organizations | false | GrantsToOrganizationsInd |
| Grants To Individuals | false | GrantsToIndividualsInd |
| Schedule J Required | Yes (true) | ScheduleJRequiredInd |
| Tax Exempt Bonds | Yes (true) | TaxExemptBondsInd |
| Invest Tax Exempt Bonds | false | InvestTaxExemptBondsInd |
| Escrow Account | false | EscrowAccountInd |
| On Behalf Of Issuer | false | OnBehalfOfIssuerInd |
| Engaged In Excess Benefit Trans | false | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | false | PYExcessBenefitTransInd |
| Loan Outstanding | false | LoanOutstandingInd |
| Grant To Related Person | false | GrantToRelatedPersonInd |
| Business Rln With Org Mem | false | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | Yes (true) | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | false | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | false | DeductibleNonCashContriInd |
| Deductible Art Contribution | false | DeductibleArtContributionInd |
| Terminate Operations | false | TerminateOperationsInd |
| Partial Liquidation | false | PartialLiquidationInd |
| Disregarded Entity | false | DisregardedEntityInd |
| Related Entity | Yes (true) | RelatedEntityInd |
| Related Organization Ctrl Ent | false | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | false | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | false | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (true) | ScheduleORequiredInd |
| IRP Document | 63 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (true) | BackupWthldComplianceInd |
| Employee | 290 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (true) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | Yes (true) | UnrelatedBusIncmOverLimitInd |
| Form990 T Filed | Yes (true) | Form990TFiledInd |
| Foreign Financial Account | false | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | false | TaxablePartyNotificationInd |
| Nondeductible Contributions | false | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | false | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | false | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | false | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | false | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 12 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 7 | IndependentVotingMemberCnt |
| Family Or Business Rln | Yes (true) | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | false | DelegationOfMgmtDutiesInd |
| Change To Org Documents | false | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (true) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (true) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (true) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (true) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (true) | MinutesOfCommitteesInd |
| Officer Mailing Address | false | OfficerMailingAddressInd |
| Local Chapters | false | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (true) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (true) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (true) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (true) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (true) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (true) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (true) | CompensationProcessCEOInd |
| Compensation Process Other | false | CompensationProcessOtherInd |
| Investment In Joint Venture | false | InvestmentInJointVentureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | DENNIS DINSLAGE | PersonNm |
| Phone | 4023726703 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 430 NORTH MONITOR STREET | AddressLine1Txt |
| City | WEST POINT | CityNm |
| State Abbreviation | NE | StateAbbreviationCd |
| ZIP | 687881555 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | Yes (X) | InfoInScheduleOPartVIIInd |
Form990 Part VII Section A Form990PartVIISectionAGrp (21 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Key EmployeeKeyEmployeeInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|---|
| Jerry Wordekemper | |||||||||
| CEO & Trustee | 45.0 | 0.35 | Yes (X) | Yes (X) | $200,751 | $0 | $40,935 | ||
| Bill Kreikemeier | |||||||||
| Chairman | 1.5 | 0.0 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| Jerome Steffen | |||||||||
| Vice Chairman | 1.5 | 0.25 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| Jackie Ridder | |||||||||
| Secretary | 1.5 | 0.0 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| Steve Ausdemore | |||||||||
| Treasurer | 1.5 | 0.0 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| Chad Ortmeier DDS | |||||||||
| Trustee | 1.0 | 0.25 | Yes (X) | $0 | $0 | $0 | |||
| Mary Janata | |||||||||
| Trustee | 1.0 | 0.0 | Yes (X) | $0 | $0 | $0 | |||
| Garry Clark | |||||||||
| Trustee | 1.0 | 0.0 | Yes (X) | $0 | $0 | $0 | |||
| Gary Kaup | |||||||||
| Trustee | 1.0 | 0.0 | Yes (X) | $0 | $0 | $0 | |||
| Dave Steffensmeier | |||||||||
| Trustee | 1.0 | 0.0 | Yes (X) | $0 | $0 | $0 | |||
| Steve Swanson | |||||||||
| Trustee | 1.0 | 0.0 | Yes (X) | $0 | $0 | $0 | |||
| Kari Penrose | |||||||||
| trustee | 1.0 | 0.0 | Yes (X) | $0 | $0 | $0 | |||
| Sr Barbara Mathe | |||||||||
| Trustee | 1.0 | 0.0 | Yes (X) | $0 | $0 | $0 | |||
| Sr Sarah Bertler | |||||||||
| Trustee | 1.0 | 0.0 | Yes (X) | $0 | $0 | $0 | |||
| Dennis Dinslage | |||||||||
| V.P. Fiscal & Support Services | 42.0 | 0.0 | Yes (X) | $164,928 | $0 | $38,554 | |||
| Terry Nelson | |||||||||
| Rehab Manager | 55.0 | 0.0 | $189,203 | $0 | $43,575 | Yes (X) | |||
| Kenneth Pitz MD | |||||||||
| Physician | 40.0 | 0.0 | $483,778 | $0 | $42,148 | Yes (X) | |||
| Michael Bittles MD | |||||||||
| Physician | 40.0 | 0.0 | $399,177 | $0 | $42,684 | Yes (X) | |||
| Scott Green MD | |||||||||
| Physician | 42.79 | 0.0 | $393,475 | $0 | $44,148 | Yes (X) | |||
| Brian Hass MD | |||||||||
| Physician | 42.73 | 0.0 | $334,452 | $0 | $41,945 | Yes (X) | |||
| Rhett Eckmann MD | |||||||||
| Physician | 42.71 | 0.0 | $346,602 | $0 | $41,945 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $2,512,366 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $335,934 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 17 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | false | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (true) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | false | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| KAT ANESTHESIA LLC | |||||
| 606 VISTA AVENUE | WEST POINT | NE | 68788 | ANESTHESIA SERVICES | $604,860 |
| CYPRESS BENEFIT ADMINISTRATOR | |||||
| PO BOX 7020 | APPLETON | WI | 549127020 | HEALTH PLAN ADMIN | $520,346 |
| MCKESSON TECHNOLOGIES INC | |||||
| 5995 WINDWARD PARKWAY | ALPHARETTA | GA | 30005 | IT SOFTWARE SUPPORT | $284,960 |
| HOLLAND BASHMAN ARCHITECTS | |||||
| 119 SOUTH 49 AVENUE | OMAHA | NE | 68132 | ARCHITECT SERVICES | $254,655 |
| PRAIRIE HEALTH VENTURES | |||||
| 290 THE APOTHECARY 140 N 8TH ST | LINCOLN | NE | 68508 | IT DATA SUPPORT | $237,842 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 8 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $160,000 | RelatedOrganizationsAmt |
| Government Grants | $10,854 | GovernmentGrantsAmt |
| All Other Contributions | $30,571 | AllOtherContributionsAmt |
| Total Contributions | $201,425 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| HOSPITAL/CLINIC HEALTHCARE SERVICES | 621110 | $33,156,283 | $33,156,283 |
| ASSISTED LIVING-ELDER CARE | 623000 | $1,735,334 | $1,735,334 |
| DIETARY/CAFETERIA | 721000 | $101,483 | $101,483 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $34,993,100 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,227,503 | TotalRevenueColumnAmt |
| Unrelated Business Revenue | $8,663 | UnrelatedBusinessRevenueAmt |
| Exclusion | $1,218,840 | ExclusionAmt |
Incm From Invest Bond Proceeds IncmFromInvestBondProceedsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Royalties Revenue RoyaltiesRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $0 | RealAmt |
| Personal | $0 | PersonalAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $19,565 | OtherAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $70,296 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | -$50,731 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$50,731 | TotalRevenueColumnAmt |
| Exclusion | -$50,731 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Fundraising Gross Income | $0 | FundraisingGrossIncomeAmt |
| Fundraising Direct Expenses | $0 | FundraisingDirectExpensesAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gaming Gross Income | $0 | GamingGrossIncomeAmt |
| Gaming Direct Expenses | $0 | GamingDirectExpensesAmt |
Net Income From Gaming NetIncomeFromGamingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Sales Of Inventory | $38,672 | GrossSalesOfInventoryAmt |
| Cost Of Goods Sold | $20,155 | CostOfGoodsSoldAmt |
Net Income Or Loss NetIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $18,517 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $18,517 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $0 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $36,389,814 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $35,011,617 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $8,663 | UnrelatedBusinessRevenueAmt |
| Exclusion | $1,168,109 | ExclusionAmt |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Foreign Grants ForeignGrantsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Benefits To Members BenefitsToMembersGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $682,287 | TotalAmt |
| Program Services | $593,963 | ProgramServicesAmt |
| Management And General | $88,324 | ManagementAndGeneralAmt |
Comp Disqual Persons CompDisqualPersonsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $14,205,615 | TotalAmt |
| Program Services | $12,744,887 | ProgramServicesAmt |
| Management And General | $1,460,728 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $385,630 | TotalAmt |
| Program Services | $306,341 | ProgramServicesAmt |
| Management And General | $79,289 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,340,104 | TotalAmt |
| Program Services | $1,884,776 | ProgramServicesAmt |
| Management And General | $455,328 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $901,805 | TotalAmt |
| Program Services | $799,242 | ProgramServicesAmt |
| Management And General | $102,563 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $21,518 | TotalAmt |
| Management And General | $21,518 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $75,235 | TotalAmt |
| Management And General | $75,235 | ManagementAndGeneralAmt |
Fees For Services Lobbying FeesForServicesLobbyingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,587 | TotalAmt |
| Management And General | $3,587 | ManagementAndGeneralAmt |
Fees For Services Prof Fundraising FeesForServicesProfFundraising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,804,565 | TotalAmt |
| Program Services | $2,453,181 | ProgramServicesAmt |
| Management And General | $351,384 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $140,913 | TotalAmt |
| Program Services | $139,291 | ProgramServicesAmt |
| Management And General | $1,622 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,483,058 | TotalAmt |
| Program Services | $1,325,862 | ProgramServicesAmt |
| Management And General | $157,196 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $764,466 | TotalAmt |
| Program Services | $613,733 | ProgramServicesAmt |
| Management And General | $150,733 | ManagementAndGeneralAmt |
Royalties RoyaltiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,212,644 | TotalAmt |
| Program Services | $1,036,776 | ProgramServicesAmt |
| Management And General | $175,868 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $119,583 | TotalAmt |
| Program Services | $100,729 | ProgramServicesAmt |
| Management And General | $18,854 | ManagementAndGeneralAmt |
Pymt Travel Entrtnmnt Pub Ofcl PymtTravelEntrtnmntPubOfclGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $66,893 | TotalAmt |
| Program Services | $61,677 | ProgramServicesAmt |
| Management And General | $5,216 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Payments To Affiliates PaymentsToAffiliatesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,476,915 | TotalAmt |
| Program Services | $2,793,177 | ProgramServicesAmt |
| Management And General | $683,738 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $97,575 | TotalAmt |
| Management And General | $97,575 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt | FundraisingFundraisingAmt |
|---|---|---|---|---|
| MEDICAL SUPPLIES | $3,001,100 | $3,001,100 | ||
| DUES & SUBSCRIPTIONS | $145,325 | $123,077 | $22,248 | |
| WOMEN'S AUXILIARY SUPPLIES | $2,043 | $2,043 | ||
| UNRELATED BUSINESS INCOME TAXE | $1,378 | $1,378 |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $31,932,239 | TotalAmt |
| Program Services | $27,977,812 | ProgramServicesAmt |
| Management And General | $3,952,384 | ManagementAndGeneralAmt |
| Fundraising | $2,043 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $872,518 | BOYAmt |
| EOY | $1,138,159 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $12,249,756 | BOYAmt |
| EOY | $14,771,903 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,719,283 | BOYAmt |
| EOY | $4,863,872 | EOYAmt |
Receivables From Officers Etc ReceivablesFromOfficersEtcGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $655,855 | BOYAmt |
| EOY | $679,371 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $220,214 | BOYAmt |
| EOY | $182,017 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $60,422,447 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $33,902,508 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $28,175,209 | BOYAmt |
| EOY | $26,519,939 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $19,439,232 | BOYAmt |
| EOY | $21,184,977 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,379,934 | BOYAmt |
| EOY | $1,030,832 | EOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,021,057 | BOYAmt |
| EOY | $1,154,025 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $68,733,058 | BOYAmt |
| EOY | $71,525,095 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,609,107 | BOYAmt |
| EOY | $3,921,270 | EOYAmt |
Grants Payable GrantsPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $540,464 | BOYAmt |
| EOY | $168,130 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,560,261 | BOYAmt |
| EOY | $9,761,701 | EOYAmt |
Escrow Account Liability EscrowAccountLiabilityGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Loans From Officers Directors LoansFromOfficersDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $15,709,832 | BOYAmt |
| EOY | $13,851,101 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $53,023,226 | BOYAmt |
| EOY | $57,673,994 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $53,023,226 | BOYAmt |
| EOY | $57,673,994 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $68,733,058 | BOYAmt |
| EOY | $71,525,095 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $4,457,575 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $193,193 | NetUnrlzdGainsLossesInvstAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | false | AccountantCompileOrReviewInd |
| FS Audited | Yes (true) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consol And Sep Basis Fincl Stmt | Yes (X) | ConsolAndSepBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (true) | AuditCommitteeInd |
| Federal Grant Audit Required | false | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Grassroots Lobbying | TotalGrassrootsLobbyingGrp | |
| Total Direct Lobbying | TotalDirectLobbyingGrp | |
| Total Lobbying Expend | TotalLobbyingExpendGrp | |
| Other Exempt Purpose Expend | OtherExemptPurposeExpendGrp | |
| Total Exempt Purpose Expend | TotalExemptPurposeExpendGrp | |
| Lobbying Nontaxable Amount | LobbyingNontaxableAmountGrp | |
| Grassroots Nontaxable | GrassrootsNontaxableGrp | |
| Tot Lbbyng Grassroot Mns Non Tx | TotLbbyngGrassrootMnsNonTxGrp | |
| Tot Lbby Expend Mns Lbbyng Non Tx | TotLbbyExpendMnsLbbyngNonTxGrp | |
| Volunteers | false | VolunteersInd |
| Paid Staff Or Management | false | PaidStaffOrManagementInd |
| Media Advertisements | false | MediaAdvertisementsInd |
| Mailings Members | false | MailingsMembersInd |
| Publications Or Broadcast | false | PublicationsOrBroadcastInd |
| Grants Other Organizations | Yes (true) | GrantsOtherOrganizationsInd |
| Grants Other Organizations | $3,587 | GrantsOtherOrganizationsAmt |
| Direct Contact Legislators | Yes (true) | DirectContactLegislatorsInd |
| Rallies Demonstrations | false | RalliesDemonstrationsInd |
| Other Activities | false | OtherActivitiesInd |
| Total Lobbying Expenditures | $3,587 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | false | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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. |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Art Public Exhibition Amounts | ArtPublicExhibitionAmountsGrp | |
| Held Works Art | HeldWorksArtGrp | |
| CY Minus3 Yr Endwmt Fund | CYMinus3YrEndwmtFundGrp | |
| CY Minus4 Yr Endwmt Fund | CYMinus4YrEndwmtFundGrp |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $508,681 | OtherCostOrOtherBasisAmt |
| Book Value | $508,681 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | $0 | InvestmentCostOrOtherBasisAmt |
| Other Cost Or Other Basis | $21,630,705 | OtherCostOrOtherBasisAmt |
| Depreciation | $9,969,217 | DepreciationAmt |
| Book Value | $11,661,488 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Leasehold Improvements | LeaseholdImprovementsGrp |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | $0 | InvestmentCostOrOtherBasisAmt |
| Other Cost Or Other Basis | $37,392,578 | OtherCostOrOtherBasisAmt |
| Depreciation | $23,933,291 | DepreciationAmt |
| Book Value | $13,459,287 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $890,483 | OtherCostOrOtherBasisAmt |
| Depreciation | $0 | DepreciationAmt |
| Book Value | $890,483 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $26,519,939 | TotalBookValueLandBuildingsAmt |
| Federal Income Tax Liability | $0 | FederalIncomeTaxLiabilityAmt |
| Total Liability | $0 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $36,578,002 | TotalRevEtcAuditedFinclStmtAmt |
| Net Unrealized Gains Invst | $193,193 | NetUnrealizedGainsInvstAmt |
| Revenue Not Reported | $193,193 | RevenueNotReportedAmt |
| Revenue Subtotal | $36,384,809 | RevenueSubtotalAmt |
| Other Revenues Not Included | $5,005 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | $5,005 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $36,389,814 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $31,930,196 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Subtotal | $31,930,196 | ExpensesSubtotalAmt |
| Other Expenses Not Included | $2,043 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $2,043 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $31,932,239 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| SCHEDULE D, PART XI, LINE 4B | AUXILIARY GIFT SHOP SALES 29,213 AUXILIARY GIFT SHOP COGS (20,155) --------- NET GAIN FROM SALES 9,058 AUXILIARY FUNDS RAISED 5,947 AUXILIARY DONATION TO HOSPITAL (10,000) --------- TOTAL 5,005 |
| SCHEDULE D, PART XII, LINE 4B | AUXILIARY OPERATING EXPENSES 2,043 |
| 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 H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (true) | FinancialAssistancePolicyInd |
| Written Policy | Yes (true) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (true) | FPGReferenceFreeCareInd |
| Percent100 | Yes (X) | Percent100Ind |
| FPG Reference Discounted Care | Yes (true) | FPGReferenceDiscountedCareInd |
| Percent200 D | Yes (X) | Percent200DInd |
| Free Care Medically Indigent | Yes (true) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (true) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | false | ExpensesExceedBudgetInd |
| Annual Community Bnft Report | Yes (true) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (true) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 125 | PersonsServedCnt |
| Total Community Benefit Expns | $434,104 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $434,104 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01360 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 857 | PersonsServedCnt |
| Total Community Benefit Expns | $1,219,256 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,003,582 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $215,674 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00680 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 982 | PersonsServedCnt |
| Total Community Benefit Expns | $1,653,360 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,003,582 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $649,778 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02040 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 3661 | PersonsServedCnt |
| Total Community Benefit Expns | $245,269 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $40,444 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $204,825 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00640 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 58 | PersonsServedCnt |
| Total Community Benefit Expns | $103,849 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $103,849 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00330 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 8543 | PersonsServedCnt |
| Total Community Benefit Expns | $6,116,201 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $5,291,017 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $825,184 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02580 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 12262 | PersonsServedCnt |
| Total Community Benefit Expns | $6,465,319 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $5,331,461 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,133,858 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.03550 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 13244 | PersonsServedCnt |
| Total Community Benefit Expns | $8,118,679 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $6,335,043 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,783,636 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.05590 | TotalExpensePct |
Economic Development EconomicDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,666 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $2,666 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00010 | TotalExpensePct |
Community Support CommunitySupportGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 8163 | PersonsServedCnt |
| Total Community Benefit Expns | $47,075 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,600 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $45,475 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00140 | TotalExpensePct |
Workforce Development WorkforceDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 70 | PersonsServedCnt |
| Total Community Benefit Expns | $13,769 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $13,769 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00040 | TotalExpensePct |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 8233 | PersonsServedCnt |
| Total Community Benefit Expns | $63,510 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,600 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $61,910 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00190 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (true) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $859,189 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $171,838 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $11,610,082 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $11,825,553 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$215,471 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | Yes (X) | CostToChargeRatioInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (true) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (true) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ST FRANCIS MEMORIAL HOSPITAL | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 430 N MONITOR ST | AddressLine1Txt |
| City | WEST POINT | CityNm |
| State Abbreviation | NE | StateAbbreviationCd |
| ZIP | 68788 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | www.fcswp.org | WebsiteAddressTxt |
| State License | NE License #180001 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Critical Access Hospital | Yes (X) | CriticalAccessHospitalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ST FRANCIS MEMORIAL HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | false | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | false | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (true) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Prior CHNA Impact | Yes (X) | PriorCHNAImpactInd |
| CHNA Conducted | 16 | CHNAConductedYr |
| Take Into Account Others Input | Yes (true) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | Yes (true) | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | Yes (true) | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (true) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | SEE PART V, SECTION C | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (true) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 16 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (true) | StrategyPostedWebsiteInd |
| Strategy Website URL | SEE PART V, SECTION C | StrategyWebsiteURLTxt |
| Organization Incur Excise Tax | false | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (true) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 100 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 200. | FPGFamilyIncmLmtDscntCarePct |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Other Criteria | Yes (X) | OtherCriteriaInd |
| Explained Basis | Yes (true) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (true) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Includes Publicity Measures | Yes (true) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | See Part V, Section C | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | See Part V, Section C | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | SEE PART V, SECTION C | FAPSummaryOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| Notified FAP Copy Bill Display | Yes (X) | NotifiedFAPCopyBillDisplayInd |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| FAP Translated | Yes (X) | FAPTranslatedInd |
| FAP Actions On Nonpayment | Yes (true) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | false | CollectionActivitiesInd |
| Provided Written Notice | Yes (X) | ProvidedWrittenNoticeInd |
| Made Effort Orally Notify | Yes (X) | MadeEffortOrallyNotifyInd |
| Processed FAP Application | Yes (X) | ProcessedFAPApplicationInd |
| Made Presumptive Elig Determ | Yes (X) | MadePresumptiveEligDetermInd |
| Nondis Emergency Care Policy | Yes (true) | NondisEmergencyCarePolicyInd |
| Look Back Medicare Private | Yes (X) | LookBackMedicarePrivateInd |
| Amounts Generally Billed | false | AmountsGenerallyBilledInd |
| Gross Charges | false | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (11 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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 from 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 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, city health officials. |
| SCHEDULE H, PART V, SECTION B, LINE 6a | ST. FRANCIS MEMORIAL HOSPITAL CONDUCTED ITS CHNA IN CONJUNCTION WITH OAKLAND MERCY HOSPITAL 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/about/needs-assessment.html |
| SCHEDULE H, PART V, SECTION B, LINE 10A | ST. FRANCIS MEMORIAL HOSPITAL'S CHNA IMPLEMENTATION STRATEGY IS AVAILABLE AT: HTTP://FCSWP.ORG/ABOUT/NEEDS-ASSESSMENT.HTML |
| SCHEDULE H, PART V, SECTION B, LINE 11 | The 2013 CHNA revealed four main health priorities in our area: 1) Obesity, 2) Behavioral/Mental Health, 3) Prevention, and 4) Risky Behaviors. Several overall goals were established based on the preceding health priorities. Actions taken in 2016 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. Sponsored a Heart-to-Heart Dinner with the Elkhorn Logan Valley Public Health Department during which a physician spoke about healthy eating. (2014) 2. The "Biggest Loser" weight loss program was offered to employees to participate in. (2014) 3. A Weight Watchers class is held in one of our meeting rooms free of charge to anyone who wants to participate. (All 3 years) 4. A body mass index program was offered to employees. (2014) 5. Hosted a free 4th of July fun run. (All 3 years) 6. Provide low cost memberships to our Wellness Facility. (All 3 years) 7. As a facility, we took part in the "Take 10" weight loss program sponsored by the Elkhorn Logan Valley Public Health Department. (2014) 8. Offered a class on how to read food labels. (2015) 9. For the past three years we have been involved in providing a safe walking/biking trail in the West Point community. In 2016, approval was given for the trails project by the West Point City Council. Fundraising has begun and to date there has been approximately $600,000 raised. The paving of the trail is expected to begin in September 2017. (All 3 years) 10. Our health coaches and registered dietician have provided nutritional counseling to our patients and employees as they are being seen in our clinic. (All 3 years) 11. Provide accommodations for breastfeeding mother on our campus and a lactation consultant that is available to all new mothers to provide education and support. (All 3 years) 12. Our registered dietician worked with the local schools to have a sugary drink display on-site at each of the schools. This was done to educate students on the amount of sugar in different drinks and promote healthy drink options. (2016) 13. Offered a healthy cooking demonstration during the Health Fair. (2016) Even though obesity remains a problem in the service area, the survey indicates that the trend is moving downward. The percent of adults who were obese went from 29.4% of the service area in 2013 to 23.4% in 2014. Also, the percent of adults who reported exercising for 20-30 minutes, 3 times per week or less was 66% in 2013 compared to 72% in 2016. The number of activities that are offered to the community and to our employees have helped to shift the mindset of the community to live a healthier lifestyle. We will continue these efforts going forward. To address the health priority of behavioral/mental health, the following actions were taken: 1. Employ an Advanced Practice Registered Nurse (APRN) with a specialty in mental health. She sees patients at three of our clinics as well as nursing homes. Her schedule is usually full. (All 3 years) 2. Patients are able to access a psychiatrist through telehealth if the APRN feels she has a patient who needs additional assistance. (All 3 years) 3. Offer reduced rate mental health services for our employees through our Employee Assistance Program. (All 3 years) 4. We were working with our social worker to become licensed so we would have two providers available to provide mental health counseling. However, the social worker left our organization in 2016 and we have not found a replacement for that position to date. (All 3 years) 5. Our APRN also has mental health APRN students who complete their clinical rotations 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. (All 3 years) St. Francis Memorial Hospital is constantly looking for ways to continue to provide access to behavioral/mental health services in our service area. Our Mental Health APRN continues to have a very busy schedule. We are still searching for a social worker with the credentials to be able to offer an additional provider for mental health counseling. To address the health priority of prevention, there were many activities that were taken in 2016 to prevent illnesses and keep people healthy. 1. Provided a calcium intake program. (2014) 2. Provided 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. (All 3 years) 3. Hosted our 1st Annual Health Fair for the community in 2014 and continued them in 2015 and 2016. The health fair provides low cost laboratory screenings. (All 3 years) 4. Offer well-child checks and immunizations at all of our satellite clinic locations. (All 3 years) 5. Smoking cessation counseling is offered to our patients. (All 3 years) 6. We are a tobacco/smoke free campus to encourage healthy habits among our patients, employees and community. (All 3 years) 7. Our health coaches provide chronic disease management for patients in the area of diabetes, congestive heart failure, COPD, high blood pressure, hyperlipidemia, and osteoporosis. Our goal is to help monitor these individuals so they stay healthy. (All 3 years) 8. Offer flu shots to all patients, staff and their family, senior centers, nursing homes, and area businesses. (All 3 years) 9. Coordinate with the area schools to complete baseline concussion testing for student athletes. (All 3 years) 10. Send out reminders for colonoscopies and mammographies to patients at the recommended times. (All 3 years) 11. A Certified Ergonomics Assessment Specialist is available to go out to businesses and perform an ergonomics assessment to prevent workplace injury. (All 3 years) 12. Expanded our CAPTURE Fall Prevention Program to St. Josephs Retirement Community to prevent resident falls at our Assisted Living Facility. (2015, 2016) 13. Offer CPR and First Aide training for area businesses. (All 3 years) The health coaches at Dinklage Medical Clinic continue to be very integral to getting patients in for preventative care services. If you look at the impact of the survey, we moved the needle to the right on women who are up-to-date on their breast cancer screenings from 75.5% in 2012 to 77.2% in 2014, but we actually fell short on up-to-date colon cancer screenings and cervical cancer screenings from 2012 to 2014. Colon cancer screenings went from 60.6% of the service area in 2012 to 59.8% in 2014. Cervical cancer screenings went from 84.2% in 2012 to 80.3% in 2014. That is why our goal is more focused for 2017-2019 to utilize our health coaches and send out reminders or call patients when they are due for a colonoscopy and/or mammography. To address the health priority of risky behaviors, we provided the following activities: 1. Held three child safety seat checks every year 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. (All 3 years) 2. Worked with the local high schools to bring the Grim Reaper program to the schools. The Grim Reaper program is an event designed to instill teenagers with the potentially dangerous consequences of drinking alcohol and texting while driving. During the week the program was scheduled, there was a student death in the area and the event was cancelled. We are hopeful that the event will take place during the 2017-18 school year. (2016) Risky behaviors was a rather broad priority for the 2014-2016 CHNA Implementation Plan. While we promoted safety in 2014-2016, we felt that we needed to narrow down the priority to standard motor vehicular safety for 2017-2019. We will focus again on the child safety seat checks as well as seat belt use and high school teen safe driving. The 2016 CHNA that was just completed identified four main health priorities in our area: 1) Obesity, 2) Access to Care, 3) Cancer Prevention and Screening, and 4) Standard Motor Vehicular Safety. In the 2016 CHNA we basically identified the same needs that we had during the 2013 CHNA, but made them more specific. Goals to address the significant needs identified in the CHNA are as follows: 1) Promote healthy vending machines in communities, schools (including concession stands), and workplaces. 2) Work with the Chamber of Commerce to establish West Point as a site for the Bountiful Basket program. 3) Have a healthy cooking demonstration at least four times per year for employees and explore offering it to the community. 4) Health coaches and registered dietician will provide nutritional counseling and healthy eating habits for our patients, staff and local students. 5) Collaborate with Northern Nebraska |
| 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 2016 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://WWW.FCSWP.ORG/PATIENTS-VISITORS/PATIENT-FINANCIAL-INFORMATION.HTML |
| SCHEDULE H, PART V, SECTION B, LINE 16B | THE FAP APPLICATION FORM IS AVAILABLE AT HTTP://WWW.FCSWP.ORG/PATIENTS-VISITORS/PATIENT-FINANCIAL-INFORMATION.HTML |
| SCHEDULE H, PART V, SECTION B, LINE 16C | A PLAIN LANGUAGE SUMMARY OF THE FAP IS AVAILABLE AT HTTP://WWW.FCSWP.ORG/PATIENTS-VISITORS/PATIENT-FINANCIAL-INFORMATION.HTML |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ST JOSEPH'S RETIREMENT COMMUNITY | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 320 E DECATUR ST | AddressLine1Txt |
| City | WEST POINT | CityNm |
| State Abbreviation | NE | StateAbbreviationCd |
| ZIP | 68788 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | ASSISTED LIVING FACILITY | FacilityTxt |
Supplemental Information Detail SupplementalInformationDetail (15 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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 $825,184 are reported on line 7g. Of this amount, $818,960 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 $171,838 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 $171,838 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 pages 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 2016 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 $347,787 while the associated costs were $682,684 for a shortfall of ($334,897). 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 ($215,471) and the Medicare Part B shortfall of ($334,897) for a total shortfall of ($550,368) 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 biiling 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://WWW.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://WWW.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, to farmers 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, six 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, Sioux Falls, and Omaha to meet the health needs of the community. Specialists that see patients in our Outpatient Clinic include Audiology, Cardiology, ENT, 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 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. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Independent Consultant | Yes (X) | IndependentConsultantInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | false | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (true) | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | false | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | Yes (true) | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | false | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | false | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | false | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | false | AnyNonFixedPaymentsInd |
| Initial Contract Exception | false | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (8 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Jerry Wordekemper | ||||||||||||||
| CEO & Trustee | $149,417 | $0 | $29,192 | $0 | $22,142 | $0 | $10,475 | $0 | $31,842 | $0 | $243,068 | $0 | $0 | $0 |
| Dennis Dinslage | ||||||||||||||
| V.P. Fiscal & Support Services | $134,348 | $0 | $26,258 | $0 | $4,322 | $0 | $9,049 | $0 | $30,908 | $0 | $204,885 | $0 | $0 | $0 |
| Terry Nelson | ||||||||||||||
| Rehab Manager | $188,229 | $0 | $200 | $0 | $774 | $0 | $16,500 | $0 | $28,631 | $0 | $234,334 | $0 | $0 | $0 |
| Kenneth Pitz MD | ||||||||||||||
| Physician | $455,840 | $0 | $200 | $0 | $27,738 | $0 | $12,500 | $0 | $31,445 | $0 | $527,723 | $0 | $0 | $0 |
| Michael Bittles MD | ||||||||||||||
| Physician | $389,203 | $0 | $200 | $0 | $9,774 | $0 | $13,000 | $0 | $31,481 | $0 | $443,658 | $0 | $0 | $0 |
| Scott Green MD | ||||||||||||||
| Physician | $256,667 | $0 | $127,034 | $0 | $9,774 | $0 | $14,500 | $0 | $31,445 | $0 | $439,420 | $0 | $0 | $0 |
| Brian Hass MD | ||||||||||||||
| Physician | $247,822 | $0 | $70,461 | $0 | $16,169 | $0 | $12,211 | $0 | $31,531 | $0 | $378,194 | $0 | $0 | $0 |
| Rhett Eckmann MD | ||||||||||||||
| Physician | $251,758 | $0 | $85,019 | $0 | $9,825 | $0 | $12,211 | $0 | $31,531 | $0 | $390,344 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| SCHEDULE J, PART I, LINE 4b | QUESTIONS REGARDING COMPENSATION DURING 2016, FRANCISCAN CARE SERVICES INC. CONTRIBUTED FUNDS TO AN IRC SECTION 457(F) PLAN FOR THE FOLLOWING INDIVIDUALS: DR. BITTLES $13,000 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 AND HASS RECEIVED A PAYMENT. |
Schedule K IRS990ScheduleK
Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
Issuer Name IssuerName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | HOSPITAL AUTHORITY NO 1 OF CUMING COUNTY NE | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Issuer EIN | 470762878 | BondIssuerEIN |
| Bond Issued | 2016-10-01 | BondIssuedDt |
| Issue Price | $10,000,000 | IssuePriceAmt |
| Purpose | SEE SCHEDULE K, PART VI | PurposeDesc |
| Defeased | false | DefeasedInd |
| On Behalf Of Issuer | false | OnBehalfOfIssuerInd |
| Pool Financing | false | PoolFinancingInd |
Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Retired | $164,986 | RetiredAmt |
| Bond Defeased | $0 | BondDefeasedAmt |
| Total Proceeds | $10,000,000 | TotalProceedsAmt |
| In Reserve Fund | $0 | InReserveFundAmt |
| Capitalized Interest | $0 | CapitalizedInterestAmt |
| Refunding Escrow | $0 | RefundingEscrowAmt |
| Issuance Costs From Proceeds | $0 | IssuanceCostsFromProceedsAmt |
| Credit Enhancement | $0 | CreditEnhancementAmt |
| Working Capital Expenditures | $0 | WorkingCapitalExpendituresAmt |
| Capital Expenditures | $0 | CapitalExpendituresAmt |
| Other Spent Proceeds | $10,000,000 | OtherSpentProceedsAmt |
| Unspent | $0 | UnspentAmt |
| Substantial Completion | 2012 | SubstantialCompletionYr |
| Current Refunding | Yes (true) | CurrentRefundingInd |
| Advance Refunding | false | AdvanceRefundingInd |
| Final Allocation Made | Yes (true) | FinalAllocationMadeInd |
| Adequate Books And Rec Maint | Yes (true) | AdequateBooksAndRecMaintInd |
Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Owning Bond Financed Property | false | OwningBondFinancedPropertyInd |
| Any Lease Arrangements | false | AnyLeaseArrangementsInd |
| Mgmt Contract Bond Fincd Prop | false | MgmtContractBondFincdPropInd |
| Any Research Agreements | false | AnyResearchAgreementsInd |
| Private Bus Use By Others | 0 | PrivateBusUseByOthersPct |
| Bond Iss Meet Prvt Sec Pymt Test | false | BondIssMeetPrvtSecPymtTestInd |
| Change In Use Bond Financed Prop | false | ChangeInUseBondFinancedPropInd |
| Remedial Action Taken | false | RemedialActionTakenInd |
| Procs Nonqualified Bond Remdtd | Yes (true) | ProcsNonqualifiedBondRemdtdInd |
Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Form8038 T Filed | false | Form8038TFiledInd |
| Exception To Rebate | Yes (true) | ExceptionToRebateInd |
| Variable Rate Issue | false | VariableRateIssueInd |
| Hedge Identified In Bks And Rec | false | HedgeIdentifiedInBksAndRecInd |
Hedge Provider Name HedgeProviderName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | 0 | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Proceeds Invested In GIC | false | GrossProceedsInvestedInGICInd |
GIC Provider Name GICProviderName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | 0 | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Proceeds Invested | false | GrossProceedsInvestedInd |
| Written Proc To Monitor Reqs | Yes (true) | WrittenProcToMonitorReqsInd |
Procedures Corrective Action ProceduresCorrectiveActionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Procedures Corrective Action | Yes (true) | ProceduresCorrectiveActionInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE K, PART 1, LINE A, COLUMN F: | FormAndLineReferenceDesc |
| Explanation | 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. | ExplanationTxt |
Schedule L IRS990ScheduleL
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp (7 entries)
| Relationship DescriptionRelationshipDescriptionTxt | TransactionTransactionAmt | TransactionTransactionDesc | Sharing Of RevenuesSharingOfRevenuesInd |
|---|---|---|---|
| BARBARA STEFFEN | |||
| SEE PART V | $25,928 | EMPLOYMENT | false |
| DAN HAKEL | |||
| SEE PART V | $134,853 | EMPLOYMENT | Yes (true) |
| BRENDA WISNIESKI | |||
| SEE PART V | $41,779 | EMPLOYMENT | false |
| MARGUERITE KAUP | |||
| SEE PART V | $40,393 | EMPLOYMENT | false |
| AGNES DINSLAGE | |||
| SEE PART V | $27,070 | EMPLOYMENT | false |
| NANCY NELSON | |||
| SEE PART V | $46,264 | EMPLOYMENT | false |
| JILL HAKEL | |||
| SEE PART V | $35,390 | EMPLOYMENT | false |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE L, PART IV | FormAndLineReferenceDesc |
| Explanation | 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 NANCY NELSON IS A FAMILY MEMBER OF TERRY NELSON, KEY EMPLOYEE JILL HAKEL IS A FAMILY MEMBER OF CHAD ORTMEIER, TRUSTEE | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (8 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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 2 | DAVE STEFFENSMEIER, TRUSTEE HAS A BUSINESS RELATIONSHIP WITH GARRY CLARK, TRUSTEE. DAVE IS THE CHAIRMAN OF THE CUMING COUNTY ECONOMICS DEVELOPMENT BOARD AND GARRY IS AN EMPLOYEE. |
| 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. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (9 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|---|
| 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 |
| NORTH END HOME MEDICAL SERVICES LLC | ||||||||||
| 3310 CALUMET AVENUE | MANITOWOC | WI | 54220 | 391868808 | MEDICAL EQUIP | WI | 501(C)(3) | LINE 3 | SEE LINE 5 | false |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp
Related Organization Name RelatedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | HOLY FAMILY HEALTH SERVICES | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3310 CALUMET AVENUE | AddressLine1Txt |
| City | MANITOWOC | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 54220 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 391572253 | EIN |
| Primary Activities | PHARMACY | PrimaryActivitiesTxt |
| Legal Domicile State | WI | LegalDomicileStateCd |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | See Pt II Ln 5 | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Entity Type | C CORP | EntityTypeTxt |
| Controlled Organization | false | ControlledOrganizationInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | false | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | Yes (true) | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (true) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | Yes (true) | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | Yes (true) | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | false | DivRelatedOrganizationInd |
| Asset Sale To Other Org | false | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | false | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | false | AssetExchangeInd |
| Rental Of Facilities To Oth Org | Yes (true) | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | false | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | false | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (true) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | false | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (true) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (true) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (true) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | false | TransferToOtherOrgInd |
| Transfer From Other Org | Yes (true) | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp
Other Organization Name OtherOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ALL TRANSACTIONS WERE BETWEEN 501(c)(3) ORGS | BusinessNameLine1Txt |