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FRANCISCAN CARE SERVICES INC: Form 990, tax year 2014

View the entire original 990 at ProPublica ↗

Organization
FRANCISCAN CARE SERVICES INC (EIN 47-0486026)
Tax period
2014-01-01 to 2014-12-31
Filed
2015-11-10
IRS object ID
201523149349302382
Schema version
2014v5.0
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 ReturnHeader

FieldValueIRS element (for citing)
Return2015-11-10T14:17:55-06:00ReturnTs
Tax Period End2014-12-31TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1KPMG LLPBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line11212 North 96th Street Suite 300AddressLine1Txt
CityOmahaCityNm
State AbbreviationNEStateAbbreviationCd
ZIP68114ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2014-01-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN470486026EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1FRANCISCAN CARE SERVICES INCBusinessNameLine1Txt
FieldValueIRS element (for citing)
In Care Of% DENNIS DINSLAGEInCareOfNm
Business Name ControlFRANBusinessNameControlTxt
Phone4023722404PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1430 NORTH MONITOR STREETAddressLine1Txt
CityWEST POINTCityNm
State AbbreviationNEStateAbbreviationCd
ZIP687881555ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonJERRY WORDEKEMPERPersonNm
Person TitlePRESIDENT/CEOPersonTitleTxt
Phone4023722404PhoneNum
Signature2015-11-04SignatureDt
Discuss With Paid PreparerYes (true)DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonLORRAINE A EGGERPreparerPersonNm
PTINP00223617PTIN
Phone4023481450PhoneNum
FieldValueIRS element (for citing)
Tax2014TaxYr
Build TS2016-03-07 17:11:31ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Principal OfficerJERRY WORDEKEMPERPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line1430 NORTH MONITOR STREETAddressLine1Txt
CityWEST POINTCityNm
State AbbreviationNEStateAbbreviationCd
ZIP687881555ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$36,039,718GrossReceiptsAmt
Group Return For AffiliatesfalseGroupReturnForAffiliatesInd
Group Exemption0928GroupExemptionNum
Organization501c3Yes (X)Organization501c3Ind
Website Addresswww.fcswp.orgWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation1964FormationYr
Legal Domicile StateNELegalDomicileStateCd
Activity Or MissionTHE MISSION OF FRANCISCAN CARE SERVICES INC. IS TO LIVE AND TO PROMOTE THE HEALING MISSION OF JESUS CHRIST.ActivityOrMissionDesc
Voting Members Governing Body12VotingMembersGoverningBodyCnt
Voting Members Independent7VotingMembersIndependentCnt
Total Employee288TotalEmployeeCnt
Total Volunteers225TotalVolunteersCnt
Total Gross UBI$20,543TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$789NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$228,857PYContributionsGrantsAmt
CY Contributions Grants$394,122CYContributionsGrantsAmt
PY Program Service Revenue$30,750,139PYProgramServiceRevenueAmt
CY Program Service Revenue$34,034,850CYProgramServiceRevenueAmt
PY Investment Income$1,241,050PYInvestmentIncomeAmt
CY Investment Income$1,494,877CYInvestmentIncomeAmt
PY Other Revenue$33,163PYOtherRevenueAmt
CY Other Revenue$33,032CYOtherRevenueAmt
PY Total Revenue$32,253,209PYTotalRevenueAmt
CY Total Revenue$35,956,881CYTotalRevenueAmt
PY Grants And Similar Paid$0PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$0CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$16,741,438PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$17,476,444CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$1,959CYTotalFundraisingExpenseAmt
PY Other Expenses$12,329,565PYOtherExpensesAmt
CY Other Expenses$14,120,042CYOtherExpensesAmt
PY Total Expenses$29,071,003PYTotalExpensesAmt
CY Total Expenses$31,596,486CYTotalExpensesAmt
PY Revenues Less Expenses$3,182,206PYRevenuesLessExpensesAmt
CY Revenues Less Expenses$4,360,395CYRevenuesLessExpensesAmt
Total Assets BOY$63,580,869TotalAssetsBOYAmt
Total Assets EOY$66,324,457TotalAssetsEOYAmt
Total Liabilities BOY$18,117,513TotalLiabilitiesBOYAmt
Total Liabilities EOY$17,073,655TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$45,463,356NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$49,250,802NetAssetsOrFundBalancesEOYAmt
Info In Schedule O Part IIIYes (X)InfoInScheduleOPartIIIInd
MissionTHE 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 SrvcfalseSignificantNewProgramSrvcInd
Significant ChangefalseSignificantChangeInd
Expense$25,810,793ExpenseAmt
Grant$0GrantAmt
Revenue$32,026,083RevenueAmt
DescFRANCISCAN 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 475 277 38 PATIENT DAYS - ACUTE 1,588 1,054 92 - SWING BED 1,324 1,139 46 - NURSERY 162 NONE 57 OUT-PATIENT & HOME HEALTH 42,988 18,026 1,339 PHYSICIAN CLINIC VISITS 26,099 9,191 1,908 THE HOSPITAL RECEIVES GENEROUS SUPPORT FROM THE COMMUNITY NOT ONLY FINANCIALLY BUT ALSO FROM ABOUT 179 VOLUNTEERS WHO DONATED APPROXIMATELY 3,260 HOURS OF THEIR VALUABLE TIME.Desc

Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp

FieldValueIRS element (for citing)
Expense$1,912,802ExpenseAmt
Grant$0GrantAmt
Revenue$2,041,799RevenueAmt
DescASSISTED LIVING FACILITY FULFILLS THE MISSION OF THE ROMAN CATHOLIC CHURCH BY PROVIDING 87 FRAIL AND ELDERLY PEOPLE WITH ASSISTED LIVING SERVICES REGARDLESS OF THEIR ABILITY TO PAY. A TOTAL OF 18 RESIDENTS RECEIVED $234,050 IN FREE CARE DURING THE YEAR. APPROXIMATELY 46 VOLUNTEERS PROVIDED 4,500 HOURS OF SUPPORT TO THE FACILITY.Desc
FieldValueIRS element (for citing)
Total Program Service Expenses$27,723,595TotalProgramServiceExpensesAmt
Described In Section501c3Yes (true)DescribedInSection501c3Ind
Schedule B RequiredYes (true)ScheduleBRequiredInd
Political Campaign ActyfalsePoliticalCampaignActyInd
Lobbying ActivitiesYes (true)LobbyingActivitiesInd
Subject To Proxy TaxfalseSubjectToProxyTaxInd
Donor Advised FundfalseDonorAdvisedFundInd
Conservation EasementsfalseConservationEasementsInd
Collections Of ArtfalseCollectionsOfArtInd
Credit CounselingfalseCreditCounselingInd
Temp Or Permanent EndowmentsfalseTempOrPermanentEndowmentsInd
Report Land Building EquipmentYes (true)ReportLandBuildingEquipmentInd
Report Investments Other SecfalseReportInvestmentsOtherSecInd
Report Program Related InvstfalseReportProgramRelatedInvstInd
Report Other AssetsfalseReportOtherAssetsInd
Report Other LiabilitiesfalseReportOtherLiabilitiesInd
Include FIN48 FootnoteYes (true)IncludeFIN48FootnoteInd
Independent Audit Fincl StmtYes (true)IndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtYes (true)ConsolidatedAuditFinclStmtInd
School OperatingfalseSchoolOperatingInd
Foreign OfficefalseForeignOfficeInd
Foreign ActivitiesfalseForeignActivitiesInd
More Than5000 K To OrgfalseMoreThan5000KToOrgInd
More Than5000 K To IndividualsfalseMoreThan5000KToIndividualsInd
Professional FundraisingfalseProfessionalFundraisingInd
Fundraising ActivitiesfalseFundraisingActivitiesInd
Gaming ActivitiesfalseGamingActivitiesInd
Operate HospitalYes (true)OperateHospitalInd
Audited Financial Stmt AttYes (true)AuditedFinancialStmtAttInd
Grants To OrganizationsfalseGrantsToOrganizationsInd
Grants To IndividualsfalseGrantsToIndividualsInd
Schedule J RequiredYes (true)ScheduleJRequiredInd
Tax Exempt BondsYes (true)TaxExemptBondsInd
Invest Tax Exempt BondsfalseInvestTaxExemptBondsInd
Escrow AccountfalseEscrowAccountInd
On Behalf Of IssuerfalseOnBehalfOfIssuerInd
Engaged In Excess Benefit TransfalseEngagedInExcessBenefitTransInd
PY Excess Benefit TransfalsePYExcessBenefitTransInd
Loan OutstandingfalseLoanOutstandingInd
Grant To Related PersonfalseGrantToRelatedPersonInd
Business Rln With Org MemfalseBusinessRlnWithOrgMemInd
Business Rln With Fam MemYes (true)BusinessRlnWithFamMemInd
Business Rln With Officer EntfalseBusinessRlnWithOfficerEntInd
Deductible Non Cash ContrifalseDeductibleNonCashContriInd
Deductible Art ContributionfalseDeductibleArtContributionInd
Terminate OperationsfalseTerminateOperationsInd
Partial LiquidationfalsePartialLiquidationInd
Disregarded EntityfalseDisregardedEntityInd
Related EntityYes (true)RelatedEntityInd
Related Organization Ctrl EntfalseRelatedOrganizationCtrlEntInd
Trnsfr Exmpt Non Chrtbl Rltd OrgfalseTrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted PrtshpfalseActivitiesConductedPrtshpInd
Schedule O RequiredYes (true)ScheduleORequiredInd
IRP Document61IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Backup Wthld ComplianceYes (true)BackupWthldComplianceInd
Employee288EmployeeCnt
Employment Tax Returns FiledYes (true)EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over LimitYes (true)UnrelatedBusIncmOverLimitInd
Form990 T FiledYes (true)Form990TFiledInd
Foreign Financial AccountfalseForeignFinancialAccountInd
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTransInd
Taxable Party NotificationfalseTaxablePartyNotificationInd
Nondeductible ContributionsfalseNondeductibleContributionsInd
Quid Pro Quo ContributionsfalseQuidProQuoContributionsInd
Form8282 Property Disposed OffalseForm8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft CntrctfalseRcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft CntrctfalsePayPremiumsPrsnlBnftCntrctInd
Indoor Tanning ServicesfalseIndoorTanningServicesInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members12GoverningBodyVotingMembersCnt
Independent Voting Member7IndependentVotingMemberCnt
Family Or Business RlnYes (true)FamilyOrBusinessRlnInd
Delegation Of Mgmt DutiesfalseDelegationOfMgmtDutiesInd
Change To Org DocumentsfalseChangeToOrgDocumentsInd
Material Diversion Or MisusefalseMaterialDiversionOrMisuseInd
Members Or StockholdersYes (true)MembersOrStockholdersInd
Election Of Board MembersYes (true)ElectionOfBoardMembersInd
Decisions Subject To ApprovaYes (true)DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (true)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (true)MinutesOfCommitteesInd
Officer Mailing AddressfalseOfficerMailingAddressInd
Local ChaptersfalseLocalChaptersInd
Form990 Provided To Gvrn BodyYes (true)Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (true)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (true)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (true)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (true)WhistleblowerPolicyInd
Document Retention PolicyYes (true)DocumentRetentionPolicyInd
Compensation Process CEOYes (true)CompensationProcessCEOInd
Compensation Process OtherfalseCompensationProcessOtherInd
Investment In Joint VenturefalseInvestmentInJointVentureInd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

FieldValueIRS element (for citing)
PersonDENNIS DINSLAGEPersonNm
Phone4023726703PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1430 NORTH MONITOR STREETAddressLine1Txt
CityWEST POINTCityNm
State AbbreviationNEStateAbbreviationCd
ZIP687881555ZIPCd
FieldValueIRS element (for citing)
Info In Schedule O Part VIIYes (X)InfoInScheduleOPartVIIInd

Form990 Part VII Section A Form990PartVIISectionAGrp (21 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndOfficerOfficerIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtKey EmployeeKeyEmployeeIndHighest Compensated EmployeeHighestCompensatedEmployeeInd
RONALD O BRIGGS
CEO & TRUSTEE45.00.35Yes (X)Yes (X)$247,860$0$38,817
BILL KREIKEMEIER
CHAIRMAN1.50.0Yes (X)Yes (X)$0$0$0
JEROME STEFFEN
VICE CHAIRMAN1.50.25Yes (X)Yes (X)$0$0$0
JACKIE RIDDER
SECRETARY1.50.0Yes (X)Yes (X)$0$0$0
STEVE AUSDEMORE
TREASURER1.50.0Yes (X)Yes (X)$0$0$0
SR JO ELLEN KOHLMANN
TRUSTEE1.00.0Yes (X)$0$0$0
SR ROCHELLE KERKHOF
TRUSTEE1.00.0Yes (X)$0$0$0
CHAD ORTMEIER DDS
TRUSTEE1.00.25Yes (X)$0$0$0
MARY JANATA
TRUSTEE1.00.0Yes (X)$0$0$0
GARRY CLARK
TRUSTEE1.00.0Yes (X)$0$0$0
GARY KAUP
TRUSTEE1.00.0Yes (X)$0$0$0
DAVE STEFFENSMEIER
TRUSTEE1.00.0Yes (X)$0$0$0
STEVE SWANSON
TRUSTEE1.00.0Yes (X)$0$0$0
SR DORIS JURGENSON
TRUSTEE1.00.0Yes (X)$0$0$0
DENNIS DINSLAGE
VP FISCAL & SUPPORT SERVICES42.00.0Yes (X)$161,115$0$32,948
TERRY NELSON
REHAB MANAGER55.00.0$196,069$0$41,225Yes (X)
KENNETH PITZ MD
PHYSICIAN40.00.0$465,402$0$39,338Yes (X)
MICHAEL BITTLES MD
PHYSICIAN40.00.0$379,599$0$39,922Yes (X)
SCOTT GREEN MD
PHYSICIAN44.710.0$379,154$0$41,338Yes (X)
RHETT ECKMANN MD
PHYSICIAN43.130.0$363,346$0$39,133Yes (X)
BRIAN HASS MD
PHYSICIAN42.420.0$341,383$0$37,633Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$2,533,928TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$0TotReportableCompRltdOrgAmt
Total Other Compensation$310,354TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K16IndivRcvdGreaterThan100KCnt
Former Ofcr Employees ListedfalseFormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (true)TotalCompGreaterThan150KInd
Compensation From Other SrcsfalseCompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (5 entries)

Address Line1ContractorAddress/USAddress/AddressLine1TxtCityContractorAddress/USAddress/CityNmState AbbreviationContractorAddress/USAddress/StateAbbreviationCdZIPContractorAddress/USAddress/ZIPCdServicesServicesDescCompensationCompensationAmt
CYPRESS BENEFIT ADMINISTRATOR
PO BOX 7020APPLETONWI549127020HEALTH PLAN ADMIN$443,683
MCKESSON TECHNOLOGIES INC
5995 WINDWARD PARKWAYALPHARETTAGA30005IT SOFTWARE SUPPORT$381,342
KAT ANESTHESIA LLC
606 VISTA AVENUEWEST POINTNE68788ANESTHESIA SERVICES$363,640
IP PATHWAYS LLC
2550 73RD STREETURBANDALEIA50322IT SOFTWARE SUPPORT$278,004
ELKHORN VALLEY ANESTHESIA PC INC
814 VIA LINDAWEST POINTNE68788ANESTHESIA SERVICES$239,712
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K10CntrctRcvdGreaterThan100KCnt
Related Organizations$369,575RelatedOrganizationsAmt
All Other Contributions$24,547AllOtherContributionsAmt
Total Contributions$394,122TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (3 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
HOSPITAL/CLINIC HEALTHCARE SERVICES621110$31,940,668$31,940,668
ASSISTED LIVING-ELDER CARE623000$1,992,111$1,992,111
DIETARY/CAFETERIA721000$102,071$102,071
FieldValueIRS element (for citing)
Total Program Service Revenue$34,034,850TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$1,310,820TotalRevenueColumnAmt
Unrelated Business Revenue$20,543UnrelatedBusinessRevenueAmt
Exclusion$1,290,277ExclusionAmt

Incm From Invest Bond Proceeds IncmFromInvestBondProceedsGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Royalties Revenue RoyaltiesRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Rental Income Or Loss RentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Real$0RealAmt
Personal$0PersonalAmt

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

FieldValueIRS element (for citing)
Other$248,147OtherAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

FieldValueIRS element (for citing)
Other$64,090OtherAmt

Gain Or Loss GainOrLossGrp

FieldValueIRS element (for citing)
Other$184,057OtherAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

FieldValueIRS element (for citing)
Total Revenue Column$184,057TotalRevenueColumnAmt
Exclusion$184,057ExclusionAmt

Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Net Income From Gaming NetIncomeFromGamingGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt
FieldValueIRS element (for citing)
Gross Sales Of Inventory$51,779GrossSalesOfInventoryAmt
Cost Of Goods Sold$18,747CostOfGoodsSoldAmt

Net Income Or Loss NetIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column$33,032TotalRevenueColumnAmt
Related Or Exempt Func Income$33,032RelatedOrExemptFuncIncomeAmt
FieldValueIRS element (for citing)
Other Revenue Total$0OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$35,956,881TotalRevenueColumnAmt
Related Or Exempt Func Income$34,067,882RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$20,543UnrelatedBusinessRevenueAmt
Exclusion$1,474,334ExclusionAmt

Grants To Domestic Orgs GrantsToDomesticOrgsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Grants To Domestic Individuals GrantsToDomesticIndividualsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Foreign Grants ForeignGrantsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Benefits To Members BenefitsToMembersGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$722,873TotalAmt
Program Services$626,963ProgramServicesAmt
Management And General$95,910ManagementAndGeneralAmt

Comp Disqual Persons CompDisqualPersonsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$13,214,088TotalAmt
Program Services$11,896,708ProgramServicesAmt
Management And General$1,317,380ManagementAndGeneralAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$347,930TotalAmt
Program Services$275,725ProgramServicesAmt
Management And General$72,205ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$2,339,048TotalAmt
Program Services$1,877,754ProgramServicesAmt
Management And General$461,294ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$852,505TotalAmt
Program Services$757,977ProgramServicesAmt
Management And General$94,528ManagementAndGeneralAmt

Fees For Services Management FeesForServicesManagementGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$10,681TotalAmt
Management And General$10,681ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$80,155TotalAmt
Management And General$80,155ManagementAndGeneralAmt

Fees For Services Lobbying FeesForServicesLobbyingGrp

FieldValueIRS element (for citing)
Total$4,038TotalAmt
Management And General$4,038ManagementAndGeneralAmt

Fees For Services Prof Fundraising FeesForServicesProfFundraising

FieldValueIRS element (for citing)
Total$0TotalAmt

Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$2,786,819TotalAmt
Program Services$2,432,534ProgramServicesAmt
Management And General$354,285ManagementAndGeneralAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$139,925TotalAmt
Program Services$137,376ProgramServicesAmt
Management And General$2,549ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$1,632,509TotalAmt
Program Services$1,499,509ProgramServicesAmt
Management And General$132,987ManagementAndGeneralAmt
Fundraising$13FundraisingAmt

Information Technology InformationTechnologyGrp

FieldValueIRS element (for citing)
Total$621,350TotalAmt
Program Services$498,241ProgramServicesAmt
Management And General$123,109ManagementAndGeneralAmt

Royalties RoyaltiesGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$1,315,301TotalAmt
Program Services$1,113,207ProgramServicesAmt
Management And General$202,094ManagementAndGeneralAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$124,352TotalAmt
Program Services$105,012ProgramServicesAmt
Management And General$19,340ManagementAndGeneralAmt

Pymt Travel Entrtnmnt Pub Ofcl PymtTravelEntrtnmntPubOfclGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Conferences Meetings ConferencesMeetingsGrp

FieldValueIRS element (for citing)
Total$86,425TotalAmt
Program Services$75,438ProgramServicesAmt
Management And General$10,987ManagementAndGeneralAmt

Interest InterestGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Payments To Affiliates PaymentsToAffiliatesGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$3,826,602TotalAmt
Program Services$3,068,431ProgramServicesAmt
Management And General$758,171ManagementAndGeneralAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$111,374TotalAmt
Management And General$111,374ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (3 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmtFundraisingFundraisingAmt
MEDICAL SUPPLIES$3,252,246$3,252,246
DUES & SUBSCRIPTIONS$126,319$106,474$19,845
WOMEN'S AUXILIARY SUPPLIES$1,946$1,946

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$31,596,486TotalAmt
Program Services$27,723,595ProgramServicesAmt
Management And General$3,870,932ManagementAndGeneralAmt
Fundraising$1,959FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$609,224BOYAmt
EOY$847,529EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$4,721,588BOYAmt
EOY$7,779,255EOYAmt

Pledges And Grants Receivable PledgesAndGrantsReceivableGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$4,631,173BOYAmt
EOY$4,267,858EOYAmt

Receivables From Officers Etc ReceivablesFromOfficersEtcGrp

FieldValueIRS element (for citing)
BOY$29,333BOYAmt
EOY$0EOYAmt

Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp

FieldValueIRS element (for citing)
BOY$20,000BOYAmt
EOY$20,000EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

FieldValueIRS element (for citing)
BOY$524,057BOYAmt
EOY$561,443EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$180,475BOYAmt
EOY$156,350EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$58,975,118LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$28,637,293LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$32,365,890BOYAmt
EOY$30,337,825EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

FieldValueIRS element (for citing)
BOY$15,519,238BOYAmt
EOY$19,337,390EOYAmt

Investments Other Securities InvestmentsOtherSecuritiesGrp

FieldValueIRS element (for citing)
BOY$1,899,432BOYAmt
EOY$1,795,562EOYAmt

Investments Program Related InvestmentsProgramRelatedGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Intangible Assets IntangibleAssetsGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$3,080,459BOYAmt
EOY$1,221,245EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$63,580,869BOYAmt
EOY$66,324,457EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$3,947,984BOYAmt
EOY$4,892,701EOYAmt

Grants Payable GrantsPayableGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Deferred Revenue DeferredRevenueGrp

FieldValueIRS element (for citing)
BOY$1,477,150BOYAmt
EOY$1,187,379EOYAmt

Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$12,692,379BOYAmt
EOY$10,993,575EOYAmt

Escrow Account Liability EscrowAccountLiabilityGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Loans From Officers Directors LoansFromOfficersDirectorsGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$18,117,513BOYAmt
EOY$17,073,655EOYAmt
FieldValueIRS element (for citing)
Organization Follows SFAS117Yes (X)OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

FieldValueIRS element (for citing)
BOY$45,463,356BOYAmt
EOY$49,250,802EOYAmt

Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$45,463,356BOYAmt
EOY$49,250,802EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$63,580,869BOYAmt
EOY$66,324,457EOYAmt
FieldValueIRS element (for citing)
Reconcilation Revenue Expnss$4,360,395ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst-$572,949NetUnrlzdGainsLossesInvstAmt
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or ReviewfalseAccountantCompileOrReviewInd
FS AuditedYes (true)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Consol And Sep Basis Fincl StmtYes (X)ConsolAndSepBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit CommitteeYes (true)AuditCommitteeInd
Federal Grant Audit RequiredfalseFederalGrantAuditRequiredInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
HospitalYes (X)HospitalInd

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

FieldValueIRS element (for citing)
ContributorRESTRICTEDContributorNum

Contributor Business Name ContributorBusinessName

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor US Address ContributorUSAddress

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Total ContributionsRESTRICTEDTotalContributionsAmt

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
Total Grassroots LobbyingTotalGrassrootsLobbyingGrp
Total Direct LobbyingTotalDirectLobbyingGrp
Total Lobbying ExpendTotalLobbyingExpendGrp
Other Exempt Purpose ExpendOtherExemptPurposeExpendGrp
Total Exempt Purpose ExpendTotalExemptPurposeExpendGrp
Lobbying Nontaxable AmountLobbyingNontaxableAmountGrp
Grassroots NontaxableGrassrootsNontaxableGrp
Tot Lbbyng Grassroot Mns Non TxTotLbbyngGrassrootMnsNonTxGrp
Tot Lbby Expend Mns Lbbyng Non TxTotLbbyExpendMnsLbbyngNonTxGrp
VolunteersfalseVolunteersInd
Paid Staff Or ManagementfalsePaidStaffOrManagementInd
Media AdvertisementsfalseMediaAdvertisementsInd
Mailings MembersfalseMailingsMembersInd
Publications Or BroadcastfalsePublicationsOrBroadcastInd
Grants Other OrganizationsYes (true)GrantsOtherOrganizationsInd
Grants Other Organizations$4,038GrantsOtherOrganizationsAmt
Direct Contact LegislatorsYes (true)DirectContactLegislatorsInd
Rallies DemonstrationsfalseRalliesDemonstrationsInd
Other ActivitiesfalseOtherActivitiesInd
Total Lobbying Expenditures$4,038TotalLobbyingExpendituresAmt
Not Described Section501c3falseNotDescribedSection501c3Ind

Supplemental Information Detail SupplementalInformationDetail (2 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
SCHEDULE C, PART II-B, LINE FMEMBERSHIP DUES PAID TO HEALTH CARE ASSOCIATIONS OF WHICH A PERCENTAGE OF THE DUES ARE ALLOCATED TO LOBBYING ACTIVITIES.
SCHEDULE C, PART II-B, LINE GOCCASIONAL PHONE CALL OR EMAIL TO AND FROM OUR REPRESENTATIVES.

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Art Public Exhibition AmountsArtPublicExhibitionAmountsGrp
Held Works ArtHeldWorksArtGrp
CY Minus3 Yr Endwmt FundCYMinus3YrEndwmtFundGrp
CY Minus4 Yr Endwmt FundCYMinus4YrEndwmtFundGrp

Land LandGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$394,766OtherCostOrOtherBasisAmt
Book Value$394,766BookValueAmt

Buildings BuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$21,260,672OtherCostOrOtherBasisAmt
Depreciation$8,494,773DepreciationAmt
Book Value$12,765,899BookValueAmt
FieldValueIRS element (for citing)
Leasehold ImprovementsLeaseholdImprovementsGrp

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$37,295,849OtherCostOrOtherBasisAmt
Depreciation$20,142,520DepreciationAmt
Book Value$17,153,329BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$23,831OtherCostOrOtherBasisAmt
Book Value$23,831BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$30,337,825TotalBookValueLandBuildingsAmt
Federal Income Tax Liability$0FederalIncomeTaxLiabilityAmt
Total Liability$0TotalLiabilityAmt
Footnote TextYes (X)FootnoteTextInd
Total Rev Etc Audited Fincl Stmt$35,362,288TotalRevEtcAuditedFinclStmtAmt
Net Unrealized Gains Invst-$572,949NetUnrealizedGainsInvstAmt
Revenue Not Reported-$572,949RevenueNotReportedAmt
Revenue Subtotal$35,935,237RevenueSubtotalAmt
Other Revenues Not Included$21,644OtherRevenuesNotIncludedAmt
Revenue Not Reported Fincl Stmt$21,644RevenueNotReportedFinclStmtAmt
Total Revenue Per Form990$35,956,881TotalRevenuePerForm990Amt
Tot Expns Etc Audited Fincl Stmt$31,593,635TotExpnsEtcAuditedFinclStmtAmt
Expenses Subtotal$31,593,635ExpensesSubtotalAmt
Other Expenses Not Included$2,851OtherExpensesNotIncludedAmt
Expenses Not Rpt Fincl Stmt$2,851ExpensesNotRptFinclStmtAmt
Total Expenses Per Form990$31,596,486TotalExpensesPerForm990Amt

Supplemental Information Detail SupplementalInformationDetail (3 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
SCHEDULE D, PART XI, LINE 4BAUXILIARY GIFT SHOP SALES 39,571 AUXILIARY GIFT SHOP COGS (18,747) ------------- NET gain FROM SALES 20,824 AUXILIARY FUNDS RAISED 6,490 AUXILIARY DONATION TO HOSPITAL (5,670) ------------- TOTAL 21,644
SCHEDULE D, PART XII, LINE 4BAUXILIARY OPERATING EXPENSES 2,851
SCHEDULE D, PART X, LINE 2FIN 48 FOOTNOTE ON AUDITED FINANCIAL STATEMENTS: The organization has evaluated and reviewed uncertain tax positions and found the potential exposure to be insignificant.

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Financial Assistance PolicyYes (true)FinancialAssistancePolicyInd
Written PolicyYes (true)WrittenPolicyInd
All Hospitals PolicyYes (X)AllHospitalsPolicyInd
FPG Reference Free CareYes (true)FPGReferenceFreeCareInd
Percent100Yes (X)Percent100Ind
FPG Reference Discounted CareYes (true)FPGReferenceDiscountedCareInd
Percent200 DYes (X)Percent200DInd
Free Care Medically IndigentYes (true)FreeCareMedicallyIndigentInd
Financial Assistance BudgetYes (true)FinancialAssistanceBudgetInd
Expenses Exceed BudgetYes (true)ExpensesExceedBudgetInd
Unable To Provide CarefalseUnableToProvideCareInd
Annual Community Bnft ReportYes (true)AnnualCommunityBnftReportInd
Report Publically AvailableYes (true)ReportPublicallyAvailableInd

Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp

FieldValueIRS element (for citing)
Persons Served169PersonsServedCnt
Total Community Benefit Expns$536,119TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$536,119NetCommunityBenefitExpnsAmt
Total Expense0.01700TotalExpensePct

Unreimbursed Medicaid UnreimbursedMedicaidGrp

FieldValueIRS element (for citing)
Persons Served3289PersonsServedCnt
Total Community Benefit Expns$1,772,982TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$1,441,088DirectOffsettingRevenueAmt
Net Community Benefit Expns$331,894NetCommunityBenefitExpnsAmt
Total Expense0.01050TotalExpensePct

Total Financial Assistance Typ TotalFinancialAssistanceTyp

FieldValueIRS element (for citing)
Persons Served3458PersonsServedCnt
Total Community Benefit Expns$2,309,101TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$1,441,088DirectOffsettingRevenueAmt
Net Community Benefit Expns$868,013NetCommunityBenefitExpnsAmt
Total Expense0.02750TotalExpensePct

Community Health Services CommunityHealthServicesGrp

FieldValueIRS element (for citing)
Persons Served4658PersonsServedCnt
Total Community Benefit Expns$220,248TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$25,904DirectOffsettingRevenueAmt
Net Community Benefit Expns$194,344NetCommunityBenefitExpnsAmt
Total Expense0.00620TotalExpensePct

Health Professions Education HealthProfessionsEducationGrp

FieldValueIRS element (for citing)
Persons Served233PersonsServedCnt
Total Community Benefit Expns$125,687TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$125,687NetCommunityBenefitExpnsAmt
Total Expense0.00400TotalExpensePct

Subsidized Health Services SubsidizedHealthServicesGrp

FieldValueIRS element (for citing)
Persons Served23860PersonsServedCnt
Total Community Benefit Expns$5,465,598TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$4,671,511DirectOffsettingRevenueAmt
Net Community Benefit Expns$794,087NetCommunityBenefitExpnsAmt
Total Expense0.02510TotalExpensePct

Total Other Benefits TotalOtherBenefitsGrp

FieldValueIRS element (for citing)
Persons Served28751PersonsServedCnt
Total Community Benefit Expns$5,811,533TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$4,697,415DirectOffsettingRevenueAmt
Net Community Benefit Expns$1,114,118NetCommunityBenefitExpnsAmt
Total Expense0.03530TotalExpensePct

Total Community Benefits TotalCommunityBenefitsGrp

FieldValueIRS element (for citing)
Persons Served32209PersonsServedCnt
Total Community Benefit Expns$8,120,634TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$6,138,503DirectOffsettingRevenueAmt
Net Community Benefit Expns$1,982,131NetCommunityBenefitExpnsAmt
Total Expense0.06280TotalExpensePct

Physical Imprv And Housing PhysicalImprvAndHousingGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$300TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$300NetCommunityBenefitExpnsAmt

Economic Development EconomicDevelopmentGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$3,077TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$3,077NetCommunityBenefitExpnsAmt
Total Expense0.00010TotalExpensePct

Community Support CommunitySupportGrp

FieldValueIRS element (for citing)
Persons Served7423PersonsServedCnt
Total Community Benefit Expns$49,995TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$1,774DirectOffsettingRevenueAmt
Net Community Benefit Expns$48,221NetCommunityBenefitExpnsAmt
Total Expense0.00150TotalExpensePct

Environmental Improvements EnvironmentalImprovementsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$1,993TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$1,993NetCommunityBenefitExpnsAmt

Coalition Building CoalitionBuildingGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$2,427TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$2,427NetCommunityBenefitExpnsAmt
Total Expense0.00010TotalExpensePct

Workforce Development WorkforceDevelopmentGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$2,138TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$2,138NetCommunityBenefitExpnsAmt
Total Expense0.00010TotalExpensePct

Total Communtity Building Acty TotalCommuntityBuildingActyGrp

FieldValueIRS element (for citing)
Persons Served7423PersonsServedCnt
Total Community Benefit Expns$59,930TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$1,774DirectOffsettingRevenueAmt
Net Community Benefit Expns$58,156NetCommunityBenefitExpnsAmt
Total Expense0.00180TotalExpensePct
FieldValueIRS element (for citing)
Bad Debt Expense ReportedYes (true)BadDebtExpenseReportedInd
Bad Debt Expense$534,680BadDebtExpenseAmt
Bad Debt Expense Attributable$106,936BadDebtExpenseAttributableAmt
Reimbursed By Medicare$11,444,954ReimbursedByMedicareAmt
Cost Of Care Reimbursed By Medcr$11,768,238CostOfCareReimbursedByMedcrAmt
Medicare Surplus Or Shortfall-$323,284MedicareSurplusOrShortfallAmt

Costing Methodology Used CostingMethodologyUsedGrp

FieldValueIRS element (for citing)
Cost To Charge RatioYes (X)CostToChargeRatioInd
FieldValueIRS element (for citing)
Written Debt Collection PolicyYes (true)WrittenDebtCollectionPolicyInd
Financial Assistance PrvsnYes (true)FinancialAssistancePrvsnInd
Hospital Facilities1HospitalFacilitiesCnt

Hospital Facilities HospitalFacilitiesGrp

FieldValueIRS element (for citing)
Facility1FacilityNum

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1ST FRANCIS MEMORIAL HOSPITALBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line1430 N MONITOR STAddressLine1Txt
CityWEST POINTCityNm
State AbbreviationNEStateAbbreviationCd
ZIP68788ZIPCd
FieldValueIRS element (for citing)
Website Addresswww.fcswp.orgWebsiteAddressTxt
State LicenseNE LIC#180001StateLicenseNum
Licensed HospitalYes (X)LicensedHospitalInd
General Medical And SurgicalYes (X)GeneralMedicalAndSurgicalInd
Critical Access HospitalYes (X)CriticalAccessHospitalInd
Emergency Room24 HrsYes (X)EmergencyRoom24HrsInd

Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1ST FRANCIS MEMORIAL HOSPITALBusinessNameLine1Txt
FieldValueIRS element (for citing)
Facility1FacilityNum
First Licensed CY Or PYfalseFirstLicensedCYOrPYInd
Tax Exempt Hospital CY Or PYfalseTaxExemptHospitalCYOrPYInd
CHNA ConductedYes (true)CHNAConductedInd
Community DefinitionYes (X)CommunityDefinitionInd
Community DemographicsYes (X)CommunityDemographicsInd
Existing ResourcesYes (X)ExistingResourcesInd
How Data ObtainedYes (X)HowDataObtainedInd
Community Health NeedsYes (X)CommunityHealthNeedsInd
Other Health IssuesYes (X)OtherHealthIssuesInd
Community Hlth Needs Id ProcessYes (X)CommunityHlthNeedsIdProcessInd
Consulting ProcessYes (X)ConsultingProcessInd
CHNA Conducted13CHNAConductedYr
Take Into Account Others InputYes (true)TakeIntoAccountOthersInputInd
CHNA Conducted With Other FcltsYes (true)CHNAConductedWithOtherFcltsInd
CHNA Conducted With Non FcltsYes (true)CHNAConductedWithNonFcltsInd
CHNA Report Widely AvailableYes (true)CHNAReportWidelyAvailableInd
Rpt Available On Own WebsiteYes (X)RptAvailableOnOwnWebsiteInd
Own Website URLSEE PART V, SECTION COwnWebsiteURLTxt
Paper Copy Public InspectionYes (X)PaperCopyPublicInspectionInd
Implementation Strategy AdoptYes (true)ImplementationStrategyAdoptInd
Implementation Strategy Adpt13ImplementationStrategyAdptYr
Strategy Posted WebsiteYes (true)StrategyPostedWebsiteInd
Strategy Website URLSEE PART V, SECTION CStrategyWebsiteURLTxt
Strategy AttachedfalseStrategyAttachedInd
Organization Incur Excise TaxfalseOrganizationIncurExciseTaxInd
Elig Criteria ExplainedYes (true)EligCriteriaExplainedInd
FPG Family Incm Lmt Free DscntYes (X)FPGFamilyIncmLmtFreeDscntInd
FPG Family Incm Lmt Free Care100FPGFamilyIncmLmtFreeCarePct
FPG Family Incm Lmt Dscnt Care200.FPGFamilyIncmLmtDscntCarePct
Asset Level CriteriaYes (X)AssetLevelCriteriaInd
Medical Indigency CriteriaYes (X)MedicalIndigencyCriteriaInd
Other CriteriaYes (X)OtherCriteriaInd
Explained BasisYes (true)ExplainedBasisInd
App Financial Asst ExplnYes (true)AppFinancialAsstExplnInd
Described InfoYes (X)DescribedInfoInd
Described Suprt DocYes (X)DescribedSuprtDocInd
Includes Publicity MeasuresYes (true)IncludesPublicityMeasuresInd
FAP Summary On WebsiteYes (X)FAPSummaryOnWebsiteInd
FAP Summary On Website URLXFAPSummaryOnWebsiteURLTxt
FAP Avlbl On Request No ChargeYes (X)FAPAvlblOnRequestNoChargeInd
FAP App Avlbl On Request No ChrgYes (X)FAPAppAvlblOnRequestNoChrgInd
FAP Notice DisplayedYes (X)FAPNoticeDisplayedInd
Other PublicityYes (X)OtherPublicityInd
FAP Actions On NonpaymentYes (true)FAPActionsOnNonpaymentInd
Permit No ActionsYes (X)PermitNoActionsInd
Collection ActivitiesfalseCollectionActivitiesInd
FAP Notified All PatientsYes (X)FAPNotifiedAllPatientsInd
Documented Elig DeterminationYes (X)DocumentedEligDeterminationInd
Nondis Emergency Care PolicyYes (true)NondisEmergencyCarePolicyInd
Average Negotiated RatesYes (X)AverageNegotiatedRatesInd
Amounts Generally BilledfalseAmountsGenerallyBilledInd
Gross ChargesfalseGrossChargesInd

Supplemental Information SupplementalInformationGrp (8 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
SCHEDULE H, PART V, SECTION B, LINE 5INPUT FROM DIVERSE SECTORS INVOLVED IN PUBLIC HEALTH WAS OBTAINED THROUGH KEY INFORMANT INTERVIEWS FROM THE FOLLOWING GROUPS: STATE SENATORS/CITY/COUNTY ELECTED OFFICIALS, HOSPITALS ADMINISTRATORS, ALLIED HEALTH PROGRAMS, LICENSED MEDICAL PRACTITIONERS, BEHAVIORAL HEALTH EXECUTIVES, EMERGENCY RESPONSE PLANNERS, COMMUNITY-BASED ORGANIZATIONS, FAMILY PLANNING DIRECTOR, COMMUNITY COLLEGE ADMINISTRATORS, HEALTHCARE STUDENTS, HEALTH EDUCATION DIRECTORS, COMMUNITY HEALTH CENTER EXECUTIVES, MINORITY community LEADERS, business leaders and SCHOOL ADMINISTRATORS. OPINIONS AND INSIGHT FROM MINORITY GROUPS WERE SOUGHT AS PART OF THE PROCESS BY CONDUCTING DOOR-TO-DOOR SURVEYS OF HISPANIC HOUSEHOLDS IN WEST POINT, stanton, NORFOLK, AND MADISON, NEBRASKA. DATA WAS ALSO COLLECTED THROUGH COMMUNITY-LEVEL HEALTH SURVEYS ADMINISTERED ON-LINE AND THROUGH REGULAR MAIL. THIS WAS ACCOMPLISHED BY DISTRIBUTING POSTCARDS INVITING PARTICIPATION IN THE COMMUNITY-LEVEL SURVEY TO EVERY POSTAL PATRON (APPROXIMATELY 23,000 HOUSEHOLDS) IN THE ELKHORN LOGAN VALLEY PUBLIC HEALTH DEPARTMENT JURISDICTION ON TWO SEPARATE OCCASIONS. LASTLY, A COMMUNITY HEALTH IMPROVEMENT PLAN STAKEHOLDER/FOCUS GROUP WAS HELD IN WEST POINT, NEBRASKA AND NORFOLK, NEBRASKA. APPROXIMATELY 275 INVITATIONS WERE SENT OUT TO KEY STAKEHOLDERS IN THE PUBLIC HEALTH SYSTEM. THERE WERE 39 INDIVIDUALS THAT ATTENDED THE FOCUS GROUP MEETING IN westpoint, and 36 individuals attended the focus group meeting in NORFOLK. MEETING PARTICIPANTS INCLUDE MEMBERS OF THE HISPANIC COMMUNITY, ELECTED OFFICIALS, HOSPITALS AND HEALTH CARE PROFESSIONALS, DENTAL ADVOCATES, AGENCIES SERVING ELDERLY, CITIZENS AT LARGE, BEHAVIORAL HEALTH, MENTAL HEALTH, BUSINESS/INDUSTRIES, SCHOOLS, CHURCHES AND OTHER RELIGIOUS AFFILIATES, NOT-FOR-PROFIT AGENCIES, YOUTH AND FAMILY SERVING ORGANIZATIONS, LAW ENFORCEMENT, TRIBAL REPRESENTATIVES, AND PREVENTION COMMUNITY ORGANIZERS.
SCHEDULE H, PART V, SECTION B, LINE 6aST. 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 6bST. FRANCIS MEMORIAL HOSPITAL CONDUCTED ITS CHNA IN CONJUNCTION WITH ELKHORN LOGAN VALLEY PUBLIC HEALTH DEPARTMENT.
SCHEDULE H, PART V, SECTION B, LINE 7a & 10aTHE CHNA FOR ST. FRANCIS MEMORIAL HOSPITAL IS AVAILABLE AT HTTP://WORDPRESS.fcswp.org/community-health-needs-assessment/.
SCHEDULE H, PART V, SECTION B, LINE 11THE 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. THESE GOALS ARE: 1) ENHANCE ACCESS TO CARE, 2) CREATE OPPORTUNITIES FOR COMMUNITY ORGANIZATIONS TO PROVIDE AND PARTICIPATE IN ACTIVITIES THAT PROMOTE HEALTHY LIFESTYLES, 3) RAISE COMMUNITY LEVEL OF AWARENESS REGARDING PUBLIC HEALTH ISSUES, 4) EXPAND SAFETY PROGRAMMING AND INFORMATION OFFEREd TO THE PUBLIC, AND 5) HELP THE PUBLIC BECOME MORE INFORMED ABOUT WHAT PUBLIC HEALTH IS AND WHAT SERVICES ARE AVAILABLE IN THIS AREA. WE HAVE DETAILED THE ACTIONS THAT WERE TAKEN IN 2014 TO RESPOND TO THE ISSUES IDENTIFIED IN THE CHNA on our website at http://wordpress.fcswp.org/community-health-needs-assessment/.
SCHEDULE H, PART V, SECTION B, LINE 13hOTHER 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 16cA PLAIN LANGUAGE SUMMARY OF THE FAP IS AVAILABLE AT HTTP://WWW.FCSWP.ORG/CHARITY-CARE/.
SCHEDULE H, PART V, SECTION B, LINE 16iA PLAIN LANGUAGE SUMMARY OF THE FINANCIAL ASSISTANCE POLICY IS INCLUDED WITH THE BILLING STATEMENT AFTER CONTACT HAS BEEN MADE BY THE FINANCIAL COUNSELOR. ALSO, EMPLOYEES MAY REFER PATIENTS WHO ARE UNINSURED OR UNDERINSURED TO THE FINANCIAL COUNSELOR.
FieldValueIRS element (for citing)
Facility1FacilityNum

Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp

Oth Hlth Care Fclts OthHlthCareFcltsGrp

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1ST JOSEPH'S RETIREMENT COMMUNITYBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line1320 E DECATURAddressLine1Txt
CityWEST POINTCityNm
State AbbreviationNEStateAbbreviationCd
ZIP68788ZIPCd
FieldValueIRS element (for citing)
FacilityASSISTED LIVING FACILITYFacilityTxt

Supplemental Information Detail SupplementalInformationDetail (11 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
SCHEDULE H, PART I, LINE 7A 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 $794,087 are reported on line 7g. Of this amount, $788,499 represents the community benefit attributable to physician services.
SCHEDULE H, PART IIFranciscan 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 community's health and safety. SCHEDULE H, PART III, LINE 2 The amount reported on line 2 is taken directly from the general ledger. The amount that is written off to bad debt is the patient's account balance when it is determined that the patient will not pay. Therefore, if the patient is self pay and has not paid any of the balance, then 100% of charges are written off. If the patient has commercial insurance and cannot pay the 20% coinsurance that is due after insurance has paid and the 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 3 is estimated based on past financial analysis performed by the Patient Accounting Manager and the Patient Financial Counselor. Historically, a review of the accounts written off to bad debt was done, taking into consideration the individual's financial situation. During the review, accounts that could have been written off as charity care if sufficient information was received were identified. 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 $106,936 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 4The accounts receivable footnote which discusses bad debt expense is on page 7 of the Notes to Financial Statements.
SCHEDULE H, PART III, LINE 8Total revenue received from Medicare and the Medicare allowable costs reported on Part III, lines 5 & 6 was taken directly from the 2014 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 $362,366 while the associated costs were $669,477 for a shortfall of ($307,111). The costs for the services reimbursed on a fee schedule methodology were calculated based on the cost to charge ratio from the Medicare cost report for that department. The shortfall reported on Part III, line 7 of ($323,284) and the Medicare Part B shortfall of ($307,111) for a total shortfall of ($630,395) 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 9BIn our 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. An assistance application must be completed and turned into the Financial Counselor. A copy of the most current tax information must accompany the application. A determination of approval or denial is made from this application and is based upon hospital established guidelines."
NEEDS ASSESSMENTThe health care needs of the communities we serve are assessed in many different ways. We work closely with 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 ASSISTANCEOn 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 Financial Counselor to set up a payment plan or to determine if you are eligible for charity care." The collection policy is posted at the main entrance to the hospital and clinic and also at the emergency room entrance. Also, if the Financial Counselor contacts a patient regarding payment of a bill, a letter and a copy of the collection policy is sent to them which states that if they are unable to pay they may be eligible for the charitable care program that we offer. Lastly, on our website www.fcswp.org there is a section on Patient Financial Information. In this section there is information on our charity care policy and who to contact if the patient would like more information.
COMMUNITY INFORMATIONFranciscan 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 $48,000. The population is predominantly Caucasian, high-school educated, and geriatric in nature. There is a small population of Hispanic descent.
PROMOTION OF COMMUNITY HEALTHThe board of directors is comprised of persons 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 one nurse practitioner. There are also a number of specialists that come in from the nearby communities of Norfolk, Fremont, and Omaha to meet the health needs of the community. Specialists that see patients in our Outpatient Clinic include Audiology, Cardiology, 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 HOSTED A HEALTH FAIR TO REACH OUT TO THOSE WHO DO NOT REGULARLY SCHEDULE A CLINIC VISIT OR ANNUAL LAB TESTS. During 2014 WE OPENED A NEW PHYSICIAN CLINIC IN HOOPER, NEBRASKA AND ADDED A SIXTH FAMILY PRACTICE PHYSICIAN TO OUR PHYSICIAN CLINICS IN SEPTEMBER.
AFFILIATED HEALTH CARE SYSTEMFranciscan 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 REPORTThe 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

FieldValueIRS element (for citing)
Compensation CommitteeYes (X)CompensationCommitteeInd
Independent ConsultantYes (X)IndependentConsultantInd
Compensation SurveyYes (X)CompensationSurveyInd
Board Or Committee ApprovalYes (X)BoardOrCommitteeApprovalInd
Severance PaymentfalseSeverancePaymentInd
Supplemental Nonqual Rtr PlanYes (true)SupplementalNonqualRtrPlanInd
Equity Based Comp ArrngmfalseEquityBasedCompArrngmInd
Comp Based On Revenue Of Flng OrgYes (true)CompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related OrgsfalseCompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng OrgfalseCompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd OrgsfalseCompBsdNetEarnsRltdOrgsInd
Any Non Fixed PaymentsfalseAnyNonFixedPaymentsInd
Initial Contract ExceptionfalseInitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (8 entries)

TitleTitleTxtBase Compensation Filing OrgBaseCompensationFilingOrgAmtCompensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmtBonus Filing OrganizationBonusFilingOrganizationAmountBonus Related OrganizationsBonusRelatedOrganizationsAmtOther Compensation Filing OrgOtherCompensationFilingOrgAmtOther Compensation Rltd OrgsOtherCompensationRltdOrgsAmtDeferred Compensation Flng OrgDeferredCompensationFlngOrgAmtDeferred Comp Rltd OrgsDeferredCompRltdOrgsAmtNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmtNontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmtTotal Compensation Filing OrgTotalCompensationFilingOrgAmtTotal Compensation Rltd OrgsTotalCompensationRltdOrgsAmtComp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmtComp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt
RONALD O BRIGGS
CEO & TRUSTEE$161,988$0$55,461$0$30,411$0$12,082$0$28,765$0$288,707$0$0$0
DENNIS DINSLAGE
VP FISCAL & SUPPORT SERVICES$126,506$0$27,831$0$6,778$0$8,815$0$25,436$0$195,366$0$0$0
TERRY NELSON
REHAB MANAGER$180,620$0$3,845$0$11,604$0$16,500$0$26,231$0$238,800$0$0$0
KENNETH PITZ MD
PHYSICIAN$429,793$0$8,585$0$27,024$0$12,500$0$28,612$0$506,514$0$0$0
MICHAEL BITTLES MD
PHYSICIAN$369,825$0$250$0$9,524$0$13,000$0$28,695$0$421,294$0$0$0
SCOTT GREEN MD
PHYSICIAN$268,704$0$98,275$0$12,175$0$14,500$0$28,612$0$422,266$0$0$0
RHETT ECKMANN MD
PHYSICIAN$241,178$0$113,148$0$9,020$0$12,211$0$28,695$0$404,252$0$0$0
BRIAN HASS MD
PHYSICIAN$234,965$0$95,549$0$10,869$0$12,211$0$27,195$0$380,789$0$0$0

Supplemental Information Detail SupplementalInformationDetail (2 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
SCHEDULE J, PART I, LINE 4bQUESTIONS REGARDING COMPENSATION DURING 2014, 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 5aQUESTIONS 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

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd

Issuer Name IssuerName

FieldValueIRS element (for citing)
Business Name Line1HOSPITAL AUTHORITY NO 1 OF CUMING COUNTY NEBusinessNameLine1Txt
FieldValueIRS element (for citing)
Bond Issuer EIN470762878BondIssuerEIN
Bond Issued2010-07-27BondIssuedDt
Issue Price$12,000,000IssuePriceAmt
PurposeSEE SCHEDULE K, PART VIPurposeDesc
DefeasedfalseDefeasedInd
On Behalf Of IssuerfalseOnBehalfOfIssuerInd
Pool FinancingfalsePoolFinancingInd

Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Retired$1,006,425RetiredAmt
Bond Defeased$0BondDefeasedAmt
Total Proceeds$12,000,000TotalProceedsAmt
In Reserve Fund$0InReserveFundAmt
Capitalized Interest$0CapitalizedInterestAmt
Refunding Escrow$0RefundingEscrowAmt
Issuance Costs From Proceeds$0IssuanceCostsFromProceedsAmt
Credit Enhancement$0CreditEnhancementAmt
Working Capital Expenditures$0WorkingCapitalExpendituresAmt
Capital Expenditures$12,000,000CapitalExpendituresAmt
Other Spent Proceeds$0OtherSpentProceedsAmt
Unspent$0UnspentAmt
Substantial Completion2012SubstantialCompletionYr
Current RefundingfalseCurrentRefundingInd
Advance RefundingfalseAdvanceRefundingInd
Final Allocation MadeYes (true)FinalAllocationMadeInd
Adequate Books And Rec MaintYes (true)AdequateBooksAndRecMaintInd

Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Owning Bond Financed PropertyfalseOwningBondFinancedPropertyInd
Any Lease ArrangementsfalseAnyLeaseArrangementsInd
Mgmt Contract Bond Fincd PropfalseMgmtContractBondFincdPropInd
Any Research AgreementsfalseAnyResearchAgreementsInd
Private Bus Use By Others0.00000PrivateBusUseByOthersPct
Private Bus Concerning UBI0.00000PrivateBusConcerningUBIPct
Total Private Business Use0.00000TotalPrivateBusinessUsePct
Bond Iss Meet Prvt Sec Pymt TestfalseBondIssMeetPrvtSecPymtTestInd
Change In Use Bond Financed PropfalseChangeInUseBondFinancedPropInd
Remedial Action TakenfalseRemedialActionTakenInd
Procs Nonqualified Bond RemdtdYes (true)ProcsNonqualifiedBondRemdtdInd

Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Form8038 T FiledfalseForm8038TFiledInd
Exception To RebateYes (true)ExceptionToRebateInd
Variable Rate IssueYes (true)VariableRateIssueInd
Hedge Identified In Bks And RecfalseHedgeIdentifiedInBksAndRecInd

Hedge Provider Name HedgeProviderName

FieldValueIRS element (for citing)
Business Name Line10BusinessNameLine1Txt
FieldValueIRS element (for citing)
Gross Proceeds Invested In GICfalseGrossProceedsInvestedInGICInd

GIC Provider Name GICProviderName

FieldValueIRS element (for citing)
Business Name Line10BusinessNameLine1Txt
FieldValueIRS element (for citing)
Gross Proceeds InvestedfalseGrossProceedsInvestedInd
Written Proc To Monitor ReqsYes (true)WrittenProcToMonitorReqsInd

Procedures Corrective Action ProceduresCorrectiveActionGrp

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Procedures Corrective ActionYes (true)ProceduresCorrectiveActionInd

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferenceSCHEDULE K, PART 1, LINE A, COLUMN F:FormAndLineReferenceDesc
ExplanationTHE 2010 PROJECT CONSISTS OF A THREE STORY PATIENT BED ADDITION TO AND RELATED FIXED EQUIPMENT FOR THE EXISTING HOSPITAL FACILITY. THE 2010 PROJECT DOES NOT INCLUDE CERTAIN SPACE ON THE FIRST FLOOR NOT EXCEEDING 650 SQUARE FEET OF SPACE WITH ALLOCATED COSTS NOT IN EXCESS OF $250,000, WHICH IS TO BE UNFINISHED AND IS EXPECTED TO BE USED FOR STORAGE BUT WHICH MAY BE ALLOCATED TO AND SUBSEQUENTLY UTILIZED FOR PRIVATE OR UNRELATED BUSINESS ACTIVITY SUCH AS FOR A RETAIL PHARMACY.ExplanationTxt

Schedule L IRS990ScheduleL

FieldValueIRS element (for citing)
Total Balance Due$0TotalBalanceDueAmt

Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp (7 entries)

Relationship DescriptionRelationshipDescriptionTxtTransactionTransactionAmtTransactionTransactionDescSharing Of RevenuesSharingOfRevenuesInd
BARBARA STEFFEN
SEE PART V$20,817EMPLOYMENTfalse
DAN HAKEL
SEE PART V$118,049EMPLOYMENTYes (true)
BRENDA WISNIESKI
SEE PART V$39,067EMPLOYMENTfalse
MARGUERITE KAUP
SEE PART V$47,361EMPLOYMENTfalse
AGNES DINSLAGE
SEE PART V$25,704EMPLOYMENTfalse
NANCY NELSON
SEE PART V$33,530EMPLOYMENTfalse
CHERI DROESCHER
SEE PART V$29,624EMPLOYMENTfalse

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferenceSCHEDULE L, PART IVFormAndLineReferenceDesc
ExplanationBARBARA 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 CHERI DROESCHER IS A FAMILY MEMBER OF terry nelson, key employeeExplanationTxt

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (6 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990, PART VI, LINE 2DAVE 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 11BForm 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 12CThe 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 & 15BFranciscan 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 19NO DOCUMENTS AVAILABLE TO THE PUBLIC
FORM 990, Part IV, Line 12aChecklist 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.

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (8 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdExempt Code SectionExemptCodeSectionTxtPublic Charity StatusPublicCharityStatusTxtBusiness Name Line1DirectControllingEntityName/BusinessNameLine1TxtControlled OrganizationControlledOrganizationInd
HOLY FAMILY CONVENT FRANCISCAN SISTERS
2409 SOUTH ALVERNO ROADMANITOWOCWI54220390808523RELIGIONWI501(C)(3)LINE 1NAfalse
FRANCISCAN SISTERS OF CHRISTIAN CHARITY
1415 SOUTH RAPIDS ROADMANITOWOCWI54220391530622EDU/HLTHCAREWI501(C)(3)LINE 1SEE LINE 1false
ST FRANCIS MEMORIAL HOSPITAL FOUNDATION
430 N MONITOR STWEST POINTNE68788470629079FUNDRAISINGNE501(C)(3)11A TYPE INAfalse
ST JOSEPHS RETIREMENT COMMUNITY FDN
PO BOX 65WEST POINTNE68788470790644FUNDRAISINGNE501(C)(3)11A TYPE INAfalse
HOLY FAMILY MEMORIAL INC
2300 WESTERN AVE PO BOX 1450MANITOWOCWI54221390806395HEALTHCAREWI501(C)(3)Line 3SEE LINE 2false
ST PAUL ELDER SERVICES INC
316 EAST 14TH STREETKAUKAUNAWI54130391029149ELDER CAREWI501(C)(3)LINE 9SEE LINE 2false
GOOD SAMARITAN MEDICAL CENTER
800 FOREST AVENUEZANESVILLEOH43701314379479HOLDING CO.OH501(C)(3)11A TYPE ISEE LINE 2false
SILVER LAKE COLLEGE OF HOLY FAMILY INC
2406 SOUTH ALVERNO ROADMANITOWOCWI54220390980974HIGHER EDUCATWI501(C)(3)LINE 2SEE LINE 2false

Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp

Related Organization Name RelatedOrganizationName

FieldValueIRS element (for citing)
Business Name Line1HOLY FAMILY HEALTH SERVICESBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line13310 CALUMET AVENUEAddressLine1Txt
CityMANITOWOCCityNm
State AbbreviationWIStateAbbreviationCd
ZIP54220ZIPCd
FieldValueIRS element (for citing)
EIN391572253EIN
Primary ActivitiesPHARMACYPrimaryActivitiesTxt
Legal Domicile StateWILegalDomicileStateCd

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1See Pt II Ln 5BusinessNameLine1Txt
FieldValueIRS element (for citing)
Entity TypeC CORPEntityTypeTxt
Controlled OrganizationfalseControlledOrganizationInd
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts RyltsfalseReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth OrgfalseGiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth OrgYes (true)GiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other OrgYes (true)LoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth OrgYes (true)LoansOrGuaranteesFromOthOrgInd
Div Related OrganizationfalseDivRelatedOrganizationInd
Asset Sale To Other OrgfalseAssetSaleToOtherOrgInd
Asset Purchase From Other OrgfalseAssetPurchaseFromOtherOrgInd
Asset ExchangefalseAssetExchangeInd
Rental Of Facilities To Oth OrgfalseRentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth OrgfalseRentalOfFcltsFromOthOrgInd
Perform Of Services For Oth OrgfalsePerformOfServicesForOthOrgInd
Perform Of Services By Other OrgYes (true)PerformOfServicesByOtherOrgInd
Sharing Of FacilitiesfalseSharingOfFacilitiesInd
Paid Employees SharingYes (true)PaidEmployeesSharingInd
Reimbursement Paid To Other OrgYes (true)ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other OrgYes (true)ReimbursementPaidByOtherOrgInd
Transfer To Other OrgfalseTransferToOtherOrgInd
Transfer From Other OrgYes (true)TransferFromOtherOrgInd

Transactions Related Org TransactionsRelatedOrgGrp

Other Organization Name OtherOrganizationName

FieldValueIRS element (for citing)
Business Name Line1ALL TRANSACTIONS WERE BETWEEN 501(c)(3) ORGSBusinessNameLine1Txt