2015-11-10T14:17:55-06:00 2014-12-31 KPMG LLP 1212 North 96th Street Suite 300 Omaha NE 68114 990 2014-01-01 470486026 FRANCISCAN CARE SERVICES INC % DENNIS DINSLAGE FRAN 4023722404 430 NORTH MONITOR STREET WEST POINT NE 687881555 JERRY WORDEKEMPER PRESIDENT/CEO 4023722404 2015-11-04 true LORRAINE A EGGER P00223617 4023481450 2014 2016-03-07 17:11:31Z JERRY WORDEKEMPER 430 NORTH MONITOR STREET WEST POINT NE 687881555 36039718 false 0928 X www.fcswp.org X 1964 NE THE MISSION OF FRANCISCAN CARE SERVICES INC. IS TO LIVE AND TO PROMOTE THE HEALING MISSION OF JESUS CHRIST. 12 7 288 225 20543 789 228857 394122 30750139 34034850 1241050 1494877 33163 33032 32253209 35956881 0 0 0 0 16741438 17476444 0 0 1959 12329565 14120042 29071003 31596486 3182206 4360395 63580869 66324457 18117513 17073655 45463356 49250802 X THE MISSION OF FRANCISCAN CARE SERVICES INC. IS TO LIVE AND TO PROMOTE THE HEALING MISSION OF JESUS CHRIST BY PROVIDING QUALITY HEALTH CARE AND HEALTH RELATED INPATIENT, OUTPATIENT, HOME HEALTH, PHYSICIAN AND ASSISTED LIVING SERVICES TO ANYONE IN NORTHEAST NEBRASKA, REGARDLESS OF THEIR ABILITY TO PAY. false false 25810793 0 32026083 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 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. 1912802 0 2041799 ASSISTED 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. 27723595 true true false true false false false false false false true false false false false true true true false false false false false false false false true true false false true true false false false false false false false false true false false false false false false true false false false true 61 0 true 288 true true true false false false false false false false false false X 12 7 true false false false true true true true true false false true true true true true true true false false X DENNIS DINSLAGE 4023726703 430 NORTH MONITOR STREET WEST POINT NE 687881555 X RONALD O BRIGGS CEO & TRUSTEE 45.0 0.35 X X 247860 0 38817 BILL KREIKEMEIER CHAIRMAN 1.5 0.0 X X 0 0 0 JEROME STEFFEN VICE CHAIRMAN 1.5 0.25 X X 0 0 0 JACKIE RIDDER SECRETARY 1.5 0.0 X X 0 0 0 STEVE AUSDEMORE TREASURER 1.5 0.0 X X 0 0 0 SR JO ELLEN KOHLMANN TRUSTEE 1.0 0.0 X 0 0 0 SR ROCHELLE KERKHOF TRUSTEE 1.0 0.0 X 0 0 0 CHAD ORTMEIER DDS TRUSTEE 1.0 0.25 X 0 0 0 MARY JANATA TRUSTEE 1.0 0.0 X 0 0 0 GARRY CLARK TRUSTEE 1.0 0.0 X 0 0 0 GARY KAUP TRUSTEE 1.0 0.0 X 0 0 0 DAVE STEFFENSMEIER TRUSTEE 1.0 0.0 X 0 0 0 STEVE SWANSON TRUSTEE 1.0 0.0 X 0 0 0 SR DORIS JURGENSON TRUSTEE 1.0 0.0 X 0 0 0 DENNIS DINSLAGE VP FISCAL & SUPPORT SERVICES 42.0 0.0 X 161115 0 32948 TERRY NELSON REHAB MANAGER 55.0 0.0 X 196069 0 41225 KENNETH PITZ MD PHYSICIAN 40.0 0.0 X 465402 0 39338 MICHAEL BITTLES MD PHYSICIAN 40.0 0.0 X 379599 0 39922 SCOTT GREEN MD PHYSICIAN 44.71 0.0 X 379154 0 41338 RHETT ECKMANN MD PHYSICIAN 43.13 0.0 X 363346 0 39133 BRIAN HASS MD PHYSICIAN 42.42 0.0 X 341383 0 37633 2533928 0 310354 16 false true false CYPRESS BENEFIT ADMINISTRATOR PO BOX 7020 APPLETON WI 549127020 HEALTH PLAN ADMIN 443683 MCKESSON TECHNOLOGIES INC 5995 WINDWARD PARKWAY ALPHARETTA GA 30005 IT SOFTWARE SUPPORT 381342 KAT ANESTHESIA LLC 606 VISTA AVENUE WEST POINT NE 68788 ANESTHESIA SERVICES 363640 IP PATHWAYS LLC 2550 73RD STREET URBANDALE IA 50322 IT SOFTWARE SUPPORT 278004 ELKHORN VALLEY ANESTHESIA PC INC 814 VIA LINDA WEST POINT NE 68788 ANESTHESIA SERVICES 239712 10 369575 24547 394122 HOSPITAL/CLINIC HEALTHCARE SERVICES 621110 31940668 31940668 ASSISTED LIVING-ELDER CARE 623000 1992111 1992111 DIETARY/CAFETERIA 721000 102071 102071 34034850 1310820 20543 1290277 0 0 0 0 0 248147 64090 184057 184057 184057 0 0 51779 18747 33032 33032 0 35956881 34067882 20543 1474334 0 0 0 0 722873 626963 95910 0 13214088 11896708 1317380 347930 275725 72205 2339048 1877754 461294 852505 757977 94528 0 10681 10681 80155 80155 4038 4038 0 0 2786819 2432534 354285 139925 137376 2549 1632509 1499509 132987 13 621350 498241 123109 0 1315301 1113207 202094 124352 105012 19340 0 86425 75438 10987 0 0 3826602 3068431 758171 111374 111374 MEDICAL SUPPLIES 3252246 3252246 DUES & SUBSCRIPTIONS 126319 106474 19845 WOMEN'S AUXILIARY SUPPLIES 1946 1946 31596486 27723595 3870932 1959 609224 847529 4721588 7779255 0 0 4631173 4267858 29333 0 0 0 20000 20000 524057 561443 180475 156350 58975118 28637293 32365890 30337825 15519238 19337390 1899432 1795562 0 0 0 0 3080459 1221245 63580869 66324457 3947984 4892701 0 0 1477150 1187379 12692379 10993575 0 0 0 0 0 0 0 0 0 0 18117513 17073655 X 45463356 49250802 0 0 0 0 45463356 49250802 63580869 66324457 4360395 -572949 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false true 4038 true false false 4038 false SCHEDULE C, PART II-B, LINE F MEMBERSHIP DUES PAID TO HEALTH CARE ASSOCIATIONS OF WHICH A PERCENTAGE OF THE DUES ARE ALLOCATED TO LOBBYING ACTIVITIES. SCHEDULE C, PART II-B, LINE G OCCASIONAL PHONE CALL OR EMAIL TO AND FROM OUR REPRESENTATIVES. 394766 394766 21260672 8494773 12765899 37295849 20142520 17153329 23831 23831 30337825 0 0 X 35362288 -572949 -572949 35935237 21644 21644 35956881 31593635 31593635 2851 2851 31596486 SCHEDULE D, PART XI, LINE 4B AUXILIARY 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 4B AUXILIARY OPERATING EXPENSES 2,851 SCHEDULE D, PART X, LINE 2 FIN 48 FOOTNOTE ON AUDITED FINANCIAL STATEMENTS: The organization has evaluated and reviewed uncertain tax positions and found the potential exposure to be insignificant. true true X true X true X true true true false true true 169 536119 536119 0.01700 3289 1772982 1441088 331894 0.01050 3458 2309101 1441088 868013 0.02750 4658 220248 25904 194344 0.00620 233 125687 125687 0.00400 23860 5465598 4671511 794087 0.02510 28751 5811533 4697415 1114118 0.03530 32209 8120634 6138503 1982131 0.06280 300 300 3077 3077 0.00010 7423 49995 1774 48221 0.00150 1993 1993 2427 2427 0.00010 2138 2138 0.00010 7423 59930 1774 58156 0.00180 true 534680 106936 11444954 11768238 -323284 X true true 1 1 ST FRANCIS MEMORIAL HOSPITAL 430 N MONITOR ST WEST POINT NE 68788 www.fcswp.org NE LIC#180001 X X X X ST FRANCIS MEMORIAL HOSPITAL 1 false false true X X X X X X X X 13 true true true true X SEE PART V, SECTION C X true 13 true SEE PART V, SECTION C false false true X 100 200. X X X true true X X true X X X X X X true X false X X true X false false SCHEDULE H, PART V, SECTION B, LINE 5 INPUT FROM DIVERSE SECTORS INVOLVED IN PUBLIC HEALTH WAS OBTAINED THROUGH KEY INFORMANT INTERVIEWS FROM THE 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 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 & 10a THE CHNA FOR ST. FRANCIS MEMORIAL HOSPITAL IS AVAILABLE AT HTTP://WORDPRESS.fcswp.org/community-health-needs-assessment/. SCHEDULE H, PART V, SECTION B, LINE 11 THE 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 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 16c A PLAIN LANGUAGE SUMMARY OF THE FAP IS AVAILABLE AT HTTP://WWW.FCSWP.ORG/CHARITY-CARE/. SCHEDULE H, PART V, SECTION B, LINE 16i A 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. 1 ST JOSEPH'S RETIREMENT COMMUNITY 320 E DECATUR WEST POINT NE 68788 ASSISTED LIVING FACILITY SCHEDULE H, PART I, LINE 7 A cost-to-charge ratio was used to calculate the cost of community benefit expenses detailed in the table for Part I, line 7(a) - 7(k). The cost-to-charge ratio was derived from Worksheet 2, Ratio of Patient Care Cost-to-Charges. SCHEDULE H, PART I, LINE 7, COLUMN F THE AMOUNT USED TO COMPUTE COLUMN (F) IS FROM THE AMOUNT REPORTED ON FORM 990, PART IX, LINE 25, COLUMN (A). SCHEDULE H, PART I, LINE 7g Subsidized health services of $794,087 are reported on line 7g. Of this amount, $788,499 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 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 4 The accounts receivable footnote which discusses bad debt expense is on page 7 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 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 9B In 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 ASSESSMENT The 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 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 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 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 $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 HEALTH The 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 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. X X X X false true false true false false false false false RONALD O BRIGGS CEO & TRUSTEE 161988 0 55461 0 30411 0 12082 0 28765 0 288707 0 0 0 DENNIS DINSLAGE VP FISCAL & SUPPORT SERVICES 126506 0 27831 0 6778 0 8815 0 25436 0 195366 0 0 0 TERRY NELSON REHAB MANAGER 180620 0 3845 0 11604 0 16500 0 26231 0 238800 0 0 0 KENNETH PITZ MD PHYSICIAN 429793 0 8585 0 27024 0 12500 0 28612 0 506514 0 0 0 MICHAEL BITTLES MD PHYSICIAN 369825 0 250 0 9524 0 13000 0 28695 0 421294 0 0 0 SCOTT GREEN MD PHYSICIAN 268704 0 98275 0 12175 0 14500 0 28612 0 422266 0 0 0 RHETT ECKMANN MD PHYSICIAN 241178 0 113148 0 9020 0 12211 0 28695 0 404252 0 0 0 BRIAN HASS MD PHYSICIAN 234965 0 95549 0 10869 0 12211 0 27195 0 380789 0 0 0 SCHEDULE J, PART I, LINE 4b QUESTIONS 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 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. A HOSPITAL AUTHORITY NO 1 OF CUMING COUNTY NE 470762878 2010-07-27 12000000 SEE SCHEDULE K, PART VI false false false A 1006425 0 12000000 0 0 0 0 0 0 12000000 0 0 2012 false false true true A false false false false 0.00000 0.00000 0.00000 false false false true A false true true false 0 false 0 false true A true SCHEDULE K, PART 1, LINE A, COLUMN F: THE 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. 0 BARBARA STEFFEN SEE PART V 20817 EMPLOYMENT false DAN HAKEL SEE PART V 118049 EMPLOYMENT true BRENDA WISNIESKI SEE PART V 39067 EMPLOYMENT false MARGUERITE KAUP SEE PART V 47361 EMPLOYMENT false AGNES DINSLAGE SEE PART V 25704 EMPLOYMENT false NANCY NELSON SEE PART V 33530 EMPLOYMENT false CHERI DROESCHER SEE PART V 29624 EMPLOYMENT false SCHEDULE L, PART IV BARBARA STEFFEN IS A FAMILY MEMBER OF JEROME STEFFEN, TRUSTEE DAN HAKEL IS A FAMILY MEMBER OF CHAD ORTMEIER, TRUSTEE BRENDA WISNIESKI IS A FAMILY MEMBER OF MARY JANATA, TRUSTEE MARGUERITE KAUP IS A FAMILY MEMBER OF GARY KAUP, TRUSTEE AGNES DINSLAGE IS A FAMILY MEMBER OF DENNIS DINSLAGE, OFFICER NANCY NELSON IS A FAMILY MEMBER OF TERRY NELSON, KEY EMPLOYEE CHERI DROESCHER IS A FAMILY MEMBER OF terry nelson, key employee FORM 990, PART VI, 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 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. 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) 11A TYPE I NA false ST JOSEPHS RETIREMENT COMMUNITY FDN PO BOX 65 WEST POINT NE 68788 470790644 FUNDRAISING NE 501(C)(3) 11A 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 9 SEE LINE 2 false GOOD SAMARITAN MEDICAL CENTER 800 FOREST AVENUE ZANESVILLE OH 43701 314379479 HOLDING CO. OH 501(C)(3) 11A 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 HOLY FAMILY HEALTH SERVICES 3310 CALUMET AVENUE MANITOWOC WI 54220 391572253 PHARMACY WI See Pt II Ln 5 C CORP false false false true true true false false false false false false false true false true true true false true ALL TRANSACTIONS WERE BETWEEN 501(c)(3) ORGS