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FRANCISCAN CARE SERVICES INC: Form 990, tax year 2013

View the entire original 990 at ProPublica ↗

Organization
FRANCISCAN CARE SERVICES INC (EIN 47-0486026)
Tax period
2013-01-01 to 2013-12-31
Filed
2014-11-10
IRS object ID
201423149349301067
Schema version
2013v3.1
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Return2014-11-10T09:45:55-06:00ReturnTs
Tax Period End2013-12-31TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1KPMG LLPBusinessNameLine1

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line11212 North 96th Street Suite 300AddressLine1
CityOmahaCity
StateNEState
ZIP Code68114ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2013-01-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN470486026EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1FRANCISCAN CARE SERVICES INCBusinessNameLine1
FieldValueIRS element (for citing)
In Care Of% DENNIS DINSLAGEInCareOfNm
Business Name ControlFRANBusinessNameControlTxt
Phone4023722404PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1430 NORTH MONITOR STREETAddressLine1
Address Line2SuiteAddressLine2
CityWEST POINTCity
StateNEState
ZIP Code687881555ZIPCode

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonRONALD O BRIGGSPersonNm
Person TitlePRESIDENT/CEOPersonTitleTxt
Phone4023481450PhoneNum
Signature2013-11-05SignatureDt
Discuss With Paid PreparerYes (true)DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonDonald Neal JRPreparerPersonNm
PTINP00798244PTIN
Phone4023481450PhoneNum
FieldValueIRS element (for citing)
Tax2013TaxYr
Build TS2015-11-30 17:44:51ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Principal OfficerRONALD O BRIGGSPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line1430 NORTH MONITOR STREETAddressLine1
CityWEST POINTCity
StateNEState
ZIP Code687881555ZIPCode
FieldValueIRS element (for citing)
Gross Receipts$32,306,915GrossReceiptsAmt
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 Body13VotingMembersGoverningBodyCnt
Voting Members Independent8VotingMembersIndependentCnt
Total Employee302TotalEmployeeCnt
Total Volunteers251TotalVolunteersCnt
Total Gross UBI$1,696TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$272,049PYContributionsGrantsAmt
CY Contributions Grants$228,857CYContributionsGrantsAmt
PY Program Service Revenue$28,593,940PYProgramServiceRevenueAmt
CY Program Service Revenue$30,750,139CYProgramServiceRevenueAmt
PY Investment Income$612,854PYInvestmentIncomeAmt
CY Investment Income$1,241,050CYInvestmentIncomeAmt
PY Other Revenue-$9,942PYOtherRevenueAmt
CY Other Revenue$33,163CYOtherRevenueAmt
PY Total Revenue$29,468,901PYTotalRevenueAmt
CY Total Revenue$32,253,209CYTotalRevenueAmt
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$16,115,791PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$16,741,438CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$1,921CYTotalFundraisingExpenseAmt
PY Other Expenses$10,431,988PYOtherExpensesAmt
CY Other Expenses$12,329,565CYOtherExpensesAmt
PY Total Expenses$26,547,779PYTotalExpensesAmt
CY Total Expenses$29,071,003CYTotalExpensesAmt
PY Revenues Less Expenses$2,921,122PYRevenuesLessExpensesAmt
CY Revenues Less Expenses$3,182,206CYRevenuesLessExpensesAmt
Total Assets BOY$59,849,731TotalAssetsBOYAmt
Total Assets EOY$63,580,869TotalAssetsEOYAmt
Total Liabilities BOY$18,414,964TotalLiabilitiesBOYAmt
Total Liabilities EOY$18,117,513TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$41,434,767NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$45,463,356NetAssetsOrFundBalancesEOYAmt
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$23,663,591ExpenseAmt
Grant$0GrantAmt
Revenue$28,715,377RevenueAmt
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 434 266 27 PATIENT DAYS - ACUTE 1,645 1,166 71 - SWING BED 1,061 856 NONE - NURSERY 115 NONE 42 OUT-PATIENT & HOME HEALTH 41,989 18,589 1,397 PHYSICIAN CLINIC VISITS 24,648 9,480 1,817 THE HOSPITAL RECEIVES GENEROUS SUPPORT FROM THE COMMUNITY NOT ONLY FINANCIALLY BUT ALSO FROM ABOUT 194 VOLUNTEERS WHO DONATED APPROXIMATELY 3,530 HOURS OF THEIR VALUABLE TIME.Desc

Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp

FieldValueIRS element (for citing)
Expense$1,907,274ExpenseAmt
Grant$0GrantAmt
Revenue$2,067,925RevenueAmt
DescASSISTED LIVING FACILITY FULFILLS THE MISSION OF THE ROMAN CATHOLIC CHURCH BY PROVIDING 88 FRAIL AND ELDERLY PEOPLE WITH ASSISTED LIVING SERVICES REGARDLESS OF THEIR ABILITY TO PAY. A TOTAL OF 18 RESIDENTS RECEIVED $218,407 IN FREE CARE DURING THE YEAR. APPROXIMATELY 57 VOLUNTEERS PROVIDED 3,840 HOURS OF SUPPORT TO THE FACILITY.Desc
FieldValueIRS element (for citing)
Total Program Service Expenses$25,570,865TotalProgramServiceExpensesAmt
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 OutstandingYes (true)LoanOutstandingInd
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 Document56IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Backup Wthld ComplianceYes (true)BackupWthldComplianceInd
Employee302EmployeeCnt
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 Members13GoverningBodyVotingMembersCnt
Independent Voting Member8IndependentVotingMemberCnt
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 STREETAddressLine1
CityWEST POINTCity
StateNEState
ZIP Code687881555ZIPCode
FieldValueIRS element (for citing)
Info In Schedule O Part VIIYes (X)InfoInScheduleOPartVIIInd

Form990 Part VII Section A Form990PartVIISectionAGrp (23 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)$240,382$0$36,162
SR ROCHELLE KERKHOF
TRUSTEE1.00.0Yes (X)$0$0$0
BRIAN REIMERS
VICE CHAIRMAN/TERM 3/31/20131.50.0Yes (X)Yes (X)$0$0$0
CONRAD REESON
TRUSTEE/TERM 3/31/20131.00.0Yes (X)$0$0$0
SUE STEFFENSMEIER
TRUSTEE/TERM 3/31/20131.00.0Yes (X)$0$0$0
SR JO ELLEN KOHLMANN
TRUSTEE1.00.0Yes (X)$0$0$0
STEVE AUSDEMORE
TREASURER1.50.0Yes (X)Yes (X)$0$0$0
BILL KREIKEMEIER
CHAIRMAN1.50.0Yes (X)Yes (X)$0$0$0
JEROME STEFFEN
VICE CHAIRMAN1.50.25Yes (X)Yes (X)$0$0$0
CHAD ORTMEIER DDS
TRUSTEE1.00.25Yes (X)$0$0$0
JACKIE RIDDER
SECRETARY1.50.0Yes (X)Yes (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
DENNIS DINSLAGE
VP FISCAL & SUPPORT SERVICES42.00.0Yes (X)$156,415$0$30,249
TERRY NELSON
REHAB MANAGER55.00.0$192,382$0$39,314Yes (X)
MICHAEL BITTLES MD
PHYSICIAN40.00.0$356,738$0$37,466Yes (X)
SCOTT GREEN MD
PHYSICIAN44.440.0$369,092$0$38,966Yes (X)
RHETT ECKMANN MD
PHYSICIAN44.960.0$338,084$0$36,677Yes (X)
BRIAN HASS MD
PHYSICIAN45.190.0$343,498$0$36,677Yes (X)
KENNETH PITZ MD
PHYSICIAN40.00.0$464,746$0$36,966Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$2,461,337TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$0TotReportableCompRltdOrgAmt
Total Other Compensation$292,477TotalOtherCompensationAmt
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/AddressLine1CityContractorAddress/USAddress/CityStateContractorAddress/USAddress/StateZIP CodeContractorAddress/USAddress/ZIPCodeServicesServicesDescCompensationCompensationAmt
MCSBCI CONSTRUCTION
1020 CENTENNIAL RDWEST POINTNE68788GENERAL CONSTRUCTION$1,616,322
MCKESSON TECHNOLOGIES INC
5995 WINDWARD PARKWAYALPHARETTAGA30005IT SOFTWARE SUPPORT$1,564,400
ELKHORN VALLEY ANESTHESIA PC INC
814 VIA LINDAWEST POINTNE68788ANESTHESIA SERVICES$529,776
CYPRESS BENEFIT ADMINISTRATOR
PO BOX 7020APPLETONWI549127020HEALTH PLAN ADMIN$388,373
MCS CONSTRUCTION INC
1020 CENTENNIAL RDWEST POINTNE68788GENERAL CONSTRUCTION$145,166
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K12CntrctRcvdGreaterThan100KCnt
Related Organizations$161,896RelatedOrganizationsAmt
All Other Contributions$66,961AllOtherContributionsAmt
Total Contributions$228,857TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (3 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
HOSPITAL/CLINIC HEALTHCARE SERVICES621110$28,625,311$28,625,311
ASSISTED LIVING-ELDER CARE623000$2,013,806$2,013,806
DIETARY/CAFETERIA721000$111,022$111,022
FieldValueIRS element (for citing)
Total Program Service Revenue$30,750,139TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$1,244,004TotalRevenueColumnAmt
Unrelated Business Revenue$1,696UnrelatedBusinessRevenueAmt
Exclusion$1,242,308ExclusionAmt

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$21,561OtherAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

FieldValueIRS element (for citing)
Other$24,515OtherAmt

Gain Or Loss GainOrLossGrp

FieldValueIRS element (for citing)
Other-$2,954OtherAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

FieldValueIRS element (for citing)
Total Revenue Column-$2,954TotalRevenueColumnAmt
Exclusion-$2,954ExclusionAmt

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$62,354GrossSalesOfInventoryAmt
Cost Of Goods Sold$29,191CostOfGoodsSoldAmt

Net Income Or Loss NetIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column$33,163TotalRevenueColumnAmt
Related Or Exempt Func Income$33,163RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
FieldValueIRS element (for citing)
Other Revenue Total$0OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$32,253,209TotalRevenueColumnAmt
Related Or Exempt Func Income$30,783,302RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$1,696UnrelatedBusinessRevenueAmt
Exclusion$1,239,354ExclusionAmt

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$699,165TotalAmt
Program Services$607,940ProgramServicesAmt
Management And General$91,225ManagementAndGeneralAmt

Comp Disqual Persons CompDisqualPersonsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$13,019,926TotalAmt
Program Services$11,737,430ProgramServicesAmt
Management And General$1,282,496ManagementAndGeneralAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$360,058TotalAmt
Program Services$286,337ProgramServicesAmt
Management And General$73,721ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$1,819,550TotalAmt
Program Services$1,470,118ProgramServicesAmt
Management And General$349,432ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$842,739TotalAmt
Program Services$750,722ProgramServicesAmt
Management And General$92,017ManagementAndGeneralAmt

Fees For Services Management FeesForServicesManagementGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$13,065TotalAmt
Management And General$13,065ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$77,109TotalAmt
Management And General$77,109ManagementAndGeneralAmt

Fees For Services Lobbying FeesForServicesLobbyingGrp

FieldValueIRS element (for citing)
Total$2,733TotalAmt
Management And General$2,733ManagementAndGeneralAmt

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$2,201,240TotalAmt
Program Services$1,925,049ProgramServicesAmt
Management And General$276,191ManagementAndGeneralAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$121,451TotalAmt
Program Services$120,163ProgramServicesAmt
Management And General$1,288ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$1,649,289TotalAmt
Program Services$1,532,033ProgramServicesAmt
Management And General$116,993ManagementAndGeneralAmt
Fundraising$263FundraisingAmt

Information Technology InformationTechnologyGrp

FieldValueIRS element (for citing)
Total$594,464TotalAmt
Program Services$478,083ProgramServicesAmt
Management And General$116,381ManagementAndGeneralAmt

Royalties RoyaltiesGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$1,270,349TotalAmt
Program Services$1,076,242ProgramServicesAmt
Management And General$194,107ManagementAndGeneralAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$114,893TotalAmt
Program Services$103,106ProgramServicesAmt
Management And General$11,787ManagementAndGeneralAmt

Pymt Travel Entrtnmnt Pub Ofcl PymtTravelEntrtnmntPubOfclGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Conferences Meetings ConferencesMeetingsGrp

FieldValueIRS element (for citing)
Total$38,301TotalAmt
Program Services$33,902ProgramServicesAmt
Management And General$4,399ManagementAndGeneralAmt

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$3,415,961TotalAmt
Program Services$2,747,203ProgramServicesAmt
Management And General$668,758ManagementAndGeneralAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$104,695TotalAmt
Management And General$104,695ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (3 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmtFundraisingFundraisingAmt
MEDICAL SUPPLIES$2,570,432$2,570,432
DUES & SUBSCRIPTIONS$153,925$132,105$21,820
WOMEN'S AUXILIARY SUPPLIES$1,658$1,658

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$29,071,003TotalAmt
Program Services$25,570,865ProgramServicesAmt
Management And General$3,498,217ManagementAndGeneralAmt
Fundraising$1,921FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$438,314BOYAmt
EOY$609,224EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$4,547,776BOYAmt
EOY$4,721,588EOYAmt

Pledges And Grants Receivable PledgesAndGrantsReceivableGrp

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

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$3,405,108BOYAmt
EOY$4,631,173EOYAmt

Receivables From Officers Etc ReceivablesFromOfficersEtcGrp

FieldValueIRS element (for citing)
BOY$36,667BOYAmt
EOY$29,333EOYAmt

Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp

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

Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp

FieldValueIRS element (for citing)
BOY$6,667BOYAmt
EOY$20,000EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

FieldValueIRS element (for citing)
BOY$507,728BOYAmt
EOY$524,057EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$173,947BOYAmt
EOY$180,475EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$58,231,471LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$25,865,581LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$33,245,960BOYAmt
EOY$32,365,890EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

FieldValueIRS element (for citing)
BOY$13,512,035BOYAmt
EOY$15,519,238EOYAmt

Investments Other Securities InvestmentsOtherSecuritiesGrp

FieldValueIRS element (for citing)
BOY$1,822,887BOYAmt
EOY$1,899,432EOYAmt

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$2,152,642BOYAmt
EOY$3,080,459EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$59,849,731BOYAmt
EOY$63,580,869EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$5,103,998BOYAmt
EOY$3,947,984EOYAmt

Grants Payable GrantsPayableGrp

FieldValueIRS element (for citing)
BOY$10,000BOYAmt
EOY$0EOYAmt

Deferred Revenue DeferredRevenueGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$1,477,150EOYAmt

Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$13,300,966BOYAmt
EOY$12,692,379EOYAmt

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$18,414,964BOYAmt
EOY$18,117,513EOYAmt
FieldValueIRS element (for citing)
Organization Follows SFAS117Yes (X)OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

FieldValueIRS element (for citing)
BOY$41,434,767BOYAmt
EOY$45,463,356EOYAmt

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$41,434,767BOYAmt
EOY$45,463,356EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$59,849,731BOYAmt
EOY$63,580,869EOYAmt
FieldValueIRS element (for citing)
Reconcilation Revenue Expnss$3,182,206ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst$846,383NetUnrlzdGainsLossesInvstAmt
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$2,733GrantsOtherOrganizationsAmt
Direct Contact LegislatorsYes (true)DirectContactLegislatorsInd
Rallies DemonstrationsfalseRalliesDemonstrationsInd
Other ActivitiesfalseOtherActivitiesInd
Total Lobbying Expenditures$2,733TotalLobbyingExpendituresAmt
Not Described Section501c3falseNotDescribedSection501c3Ind

Supplemental Information Detail SupplementalInformationDetail (2 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
PART IV SUPPLEMENTAL INFORMATIONPART II-B, LINE F: MEMBERSHIP DUES PAID TO HEALTH CARE ASSOCIATIONS OF WHICH A PERCENTAGE OF THE DUES ARE ALLOCATED TO LOBBYING ACTIVITIES.
PART II-B, LINE G:OCCASIONAL 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$367,466OtherCostOrOtherBasisAmt
Book Value$367,466BookValueAmt

Buildings BuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$21,225,308OtherCostOrOtherBasisAmt
Depreciation$7,701,019DepreciationAmt
Book Value$13,524,289BookValueAmt
FieldValueIRS element (for citing)
Leasehold ImprovementsLeaseholdImprovementsGrp

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$36,621,207OtherCostOrOtherBasisAmt
Depreciation$18,164,562DepreciationAmt
Book Value$18,456,645BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$17,490OtherCostOrOtherBasisAmt
Book Value$17,490BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$32,365,890TotalBookValueLandBuildingsAmt
Federal Income Tax Liability$0FederalIncomeTaxLiabilityAmt
Total Liability$0TotalLiabilityAmt
Footnote TextYes (X)FootnoteTextInd
Total Rev Etc Audited Fincl Stmt$33,096,414TotalRevEtcAuditedFinclStmtAmt
Net Unrealized Gains Invst$846,383NetUnrealizedGainsInvstAmt
Revenue Not Reported$846,383RevenueNotReportedAmt
Revenue Subtotal$32,250,031RevenueSubtotalAmt
Other Revenues Not Included$3,178OtherRevenuesNotIncludedAmt
Revenue Not Reported Fincl Stmt$3,178RevenueNotReportedFinclStmtAmt
Total Revenue Per Form990$32,253,209TotalRevenuePerForm990Amt
Tot Expns Etc Audited Fincl Stmt$29,069,345TotExpnsEtcAuditedFinclStmtAmt
Expenses Subtotal$29,069,345ExpensesSubtotalAmt
Other Expenses Not Included$1,658OtherExpensesNotIncludedAmt
Expenses Not Rpt Fincl Stmt$1,658ExpensesNotRptFinclStmtAmt
Total Expenses Per Form990$29,071,003TotalExpensesPerForm990Amt

Supplemental Information Detail SupplementalInformationDetail (3 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
PART XI, LINE 4BAUXILIARY GIFT SHOP SALES 48,945 AUXILIARY GIFT SHOP COGS (29,191) ------------- NET gain FROM SALES 19,754 AUXILIARY FUNDS RAISED 6,437 AUXILIARY DONATION TO HOSPITAL (23,013) ------------- TOTAL 3,178
PART XII, LINE 4BAUXILIARY OPERATING EXPENSES 1,658
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 BudgetfalseExpensesExceedBudgetInd
Annual Community Bnft ReportYes (true)AnnualCommunityBnftReportInd
Report Publically AvailableYes (true)ReportPublicallyAvailableInd

Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp

FieldValueIRS element (for citing)
Persons Served132PersonsServedCnt
Total Community Benefit Expns$296,798TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$0DirectOffsettingRevenueAmt
Net Community Benefit Expns$296,798NetCommunityBenefitExpnsAmt
Total Expense0.01020TotalExpensePct

Unreimbursed Medicaid UnreimbursedMedicaidGrp

FieldValueIRS element (for citing)
Persons Served3177PersonsServedCnt
Total Community Benefit Expns$1,561,541TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$1,384,568DirectOffsettingRevenueAmt
Net Community Benefit Expns$176,973NetCommunityBenefitExpnsAmt
Total Expense0.00610TotalExpensePct

Total Financial Assistance Typ TotalFinancialAssistanceTyp

FieldValueIRS element (for citing)
Persons Served3309PersonsServedCnt
Total Community Benefit Expns$1,858,339TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$1,384,568DirectOffsettingRevenueAmt
Net Community Benefit Expns$473,771NetCommunityBenefitExpnsAmt
Total Expense0.01630TotalExpensePct

Community Health Services CommunityHealthServicesGrp

FieldValueIRS element (for citing)
Persons Served5617PersonsServedCnt
Total Community Benefit Expns$140,259TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$16,149DirectOffsettingRevenueAmt
Net Community Benefit Expns$124,110NetCommunityBenefitExpnsAmt
Total Expense0.00430TotalExpensePct

Health Professions Education HealthProfessionsEducationGrp

FieldValueIRS element (for citing)
Persons Served157PersonsServedCnt
Total Community Benefit Expns$80,292TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$80,292NetCommunityBenefitExpnsAmt
Total Expense0.00280TotalExpensePct

Subsidized Health Services SubsidizedHealthServicesGrp

FieldValueIRS element (for citing)
Persons Served23102PersonsServedCnt
Total Community Benefit Expns$5,418,893TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$4,583,586DirectOffsettingRevenueAmt
Net Community Benefit Expns$835,307NetCommunityBenefitExpnsAmt
Total Expense0.02870TotalExpensePct

Cash And In Kind Contributions CashAndInKindContributionsGrp

FieldValueIRS element (for citing)
Persons Served7885PersonsServedCnt
Total Community Benefit Expns$56,047TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$2,340DirectOffsettingRevenueAmt
Net Community Benefit Expns$53,707NetCommunityBenefitExpnsAmt
Total Expense0.00180TotalExpensePct

Total Other Benefits TotalOtherBenefitsGrp

FieldValueIRS element (for citing)
Persons Served36761PersonsServedCnt
Total Community Benefit Expns$5,695,491TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$4,602,075DirectOffsettingRevenueAmt
Net Community Benefit Expns$1,093,416NetCommunityBenefitExpnsAmt
Total Expense0.03760TotalExpensePct

Total Community Benefits TotalCommunityBenefitsGrp

FieldValueIRS element (for citing)
Persons Served40070PersonsServedCnt
Total Community Benefit Expns$7,553,830TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$5,986,643DirectOffsettingRevenueAmt
Net Community Benefit Expns$1,567,187NetCommunityBenefitExpnsAmt
Total Expense0.05390TotalExpensePct

Economic Development EconomicDevelopmentGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$1,925TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$1,925NetCommunityBenefitExpnsAmt
Total Expense0.00010TotalExpensePct

Environmental Improvements EnvironmentalImprovementsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$1,906TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$1,906NetCommunityBenefitExpnsAmt
Total Expense0.00010TotalExpensePct

Health Improvement Advocacy HealthImprovementAdvocacyGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$352TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$352NetCommunityBenefitExpnsAmt
Total Expense0.00000TotalExpensePct

Workforce Development WorkforceDevelopmentGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$804TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$804NetCommunityBenefitExpnsAmt
Total Expense0.00000TotalExpensePct

Total Communtity Building Acty TotalCommuntityBuildingActyGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$4,987TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$4,987NetCommunityBenefitExpnsAmt
Total Expense0.00020TotalExpensePct
FieldValueIRS element (for citing)
Bad Debt Expense ReportedYes (true)BadDebtExpenseReportedInd
Bad Debt Expense$601,817BadDebtExpenseAmt
Bad Debt Expense Attributable$120,363BadDebtExpenseAttributableAmt
Reimbursed By Medicare$10,908,849ReimbursedByMedicareAmt
Cost Of Care Reimbursed By Medcr$11,139,342CostOfCareReimbursedByMedcrAmt
Medicare Surplus Or Shortfall-$230,493MedicareSurplusOrShortfallAmt

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 HOSPITALBusinessNameLine1

US Address USAddress

FieldValueIRS element (for citing)
Address Line1430 N MONITOR STAddressLine1
CityWEST POINTCity
StateNEState
ZIP Code68788ZIPCode
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 HOSPITALBusinessNameLine1
FieldValueIRS element (for citing)
Facility1FacilityNum
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 Report Widely AvailableYes (true)CHNAReportWidelyAvailableInd
Rpt Available On Own WebsiteYes (X)RptAvailableOnOwnWebsiteInd
Own Website URLSEE PART V, SECTION COwnWebsiteURLTxt
Rpt Available Upon RequestYes (X)RptAvailableUponRequestInd
Adopt Implementation StrategyYes (X)AdoptImplementationStrategyInd
Develop Community Wide PlanYes (X)DevelopCommunityWidePlanInd
Include Operational PlanYes (X)IncludeOperationalPlanInd
Adopt BudgetYes (X)AdoptBudgetInd
Prioritize Health NeedsYes (X)PrioritizeHealthNeedsInd
Prioritize ServicesYes (X)PrioritizeServicesInd
All Needs AddressedfalseAllNeedsAddressedInd
Organization Incur Excise TaxfalseOrganizationIncurExciseTaxInd
Elig Criteria ExplainedYes (true)EligCriteriaExplainedInd
FPG Used Deter Elig Free CareYes (true)FPGUsedDeterEligFreeCareInd
FPG Family Incm Lmt Free Care100FPGFamilyIncmLmtFreeCarePct
FPG Used Determ Elig Dscnt CareYes (true)FPGUsedDetermEligDscntCareInd
FPG Family Incm Lmt Dscnt Care200.FPGFamilyIncmLmtDscntCarePct
Explained BasisYes (true)ExplainedBasisInd
Income LevelYes (X)IncomeLevelInd
Asset LevelYes (X)AssetLevelInd
Medical IndigencyYes (X)MedicalIndigencyInd
Other FactorsYes (X)OtherFactorsInd
App Financial Asst ExplnYes (true)AppFinancialAsstExplnInd
Includes Publicity MeasuresYes (true)IncludesPublicityMeasuresInd
Posted On WebsiteYes (X)PostedOnWebsiteInd
Posted In Emergency RoomYes (X)PostedInEmergencyRoomInd
Posted In Admission OfficeYes (X)PostedInAdmissionOfficeInd
Available On RequestYes (X)AvailableOnRequestInd
Other PublicityYes (X)OtherPublicityInd
FAP Actions On NonpaymentYes (true)FAPActionsOnNonpaymentInd
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

FieldValueIRS element (for citing)
Form And Line ReferencePART V, SECTION B - ST. FRANCIS MEMORIAL HOSPITAL (1)FormAndLineReferenceDesc
Explanation1. Line 3 - Input from diverse sectors involved in public health was obtained through key informant interviews from the followings groups: state senators/city/county elected officials, hospital 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 West Point, 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 the 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. 2. Line 4 - St. Francis Memorial Hospital conducted its CHNA in conjunction with Oakland Mercy Hospital in Oakland, Nebraska and Faith Regional Health Services in Norfolk, Nebraska. 3. LINE 5 - WWW.FCSWP.ORG/COMMUNITY-HEALTH-NEEDS-ASSESSMENT/ 4. Line 7 -We developed strategic goals as a part of our CHNA Implementation Plan on the top four health needs identified. After the top four health needs were identified, the percentage of respondents for any particular healthcare need was very small. 5. Lines 10 - 11 - Not applicable. 6. Line 12I - Other factors that we use in determining eligibility for any discounts include eligibility for Medicaid or other assistance and a bank loan. 7. Line 14g - The policy is attached to the billing statement after contact has been made by the Financial Counselor. 8. Lines 16e - 22 - Not applicable.ExplanationTxt
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 COMMUNITYBusinessNameLine1

US Address USAddress

FieldValueIRS element (for citing)
Address Line1320 E DECATURAddressLine1
CityWEST POINTCity
StateNEState
ZIP Code68788ZIPCode
FieldValueIRS element (for citing)
FacilityASSISTED LIVING FACILITYFacilityTxt

Supplemental Information Detail SupplementalInformationDetail (12 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
PART I, LINE 3CNOT APPLICABLE
PART I, LINE 6ANOT APPLICABLE PART I, LINE 7 A cost-to-charge ratio was used to calculate the cost of community benefit expenses detailed in the table for Part I, line 7(a) - 7(k). The cost-to-charge ratio was derived from Worksheet 2, Ratio of Patient Care Cost-to-Charges. PART I, LINE 7, COLUMN (F) THE AMOUNT USED TO COMPUTE COLUMN (F) IS FROM THE AMOUNT REPORTED ON FORM 990, PART IX, LINE 25, COLUMN (A). PART I, LINE 7G Subsidized health services of $835,307 are reported on line 7g. Of this amount, $830,509 represents the community benefit attributable to physician services.
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. PART III, LINE 2 The amount reported on line two is taken directly from the general ledger. The amount that is written off to bad debt is the patient's account balance when it is determined that the patient will not pay. Therefore, if the patient is self pay and has not paid any of the balance, then 100% of charges are written off. If the patient has commercial insurance and cannot pay the 20% coinsurance that is due after insurance has paid and the contracted discounts have been applied, then only the 20% coinsurance that is owed by the patient is written off to bad debt. PART III, LINE 3 The amount reported on line three is estimated based on past financial analysis performed by the Patient Accounting Manager and the Patient Financial Counselor. Historically, a review of the accounts written off to bad debt was done, taking into consideration the individual's financial situation. During the review, accounts that could have been written off as charity care if sufficient information was received were identified. As a result of the analysis, it was determined that $120,363 would possibly have qualified as charity care. There is a fine line between bad debt and charity care. There are those individuals who just will not pay, but there are a larger number of individuals who cannot pay, but do not want to fill out the paperwork for charity care or do not want to even ask for charity care. We have estimated that $120,363 of our bad debt expense should have been classified as charity care if the appropriate paperwork was received. These are the dollars that should be classified as community benefit.
PART III, LINE 4The accounts receivable footnote which discusses bad debt expense is on page 7 of the Notes to Financial Statements.
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 2013 Medicare Cost Report. The Medicare shortfall reported on Part III, line 7 is significantly larger this year due to the 2% sequestration payment cuts imposed by CMS. 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 $357,387 while the associated costs were $598,900 for a shortfall of ($241,513). 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 ($230,493) and the Medicare Part B shortfall of ($241,513) for a total shortfall of ($472,006) should be treated as a community benefit because these are costs over and above the amount that Medicare pays us. These services are integral to the community and would not be available to the community if they were not provided by our facility.
PART III, LINE 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, five 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, 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. During 2013 we implemented a new electronic medical record system, recruited our sixth family practice physician that will start in 2014, and signed an agreement to lease physician office space in Hooper, Nebraska. We are able to stay up-to-date with our information technology and continue to grow our practices due to surplus funds from operations.
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$168,961$0$43,177$0$28,244$0$11,874$0$26,312$0$278,568$0$0$0
DENNIS DINSLAGE
VP FISCAL & SUPPORT SERVICES$126,274$0$24,095$0$6,046$0$8,559$0$22,428$0$187,402$0$0$0
TERRY NELSON
REHAB MANAGER$180,778$0$0$0$11,604$0$16,500$0$24,313$0$233,195$0$0$0
MICHAEL BITTLES MD
PHYSICIAN$347,214$0$0$0$9,524$0$13,000$0$26,169$0$395,907$0$0$0
SCOTT GREEN MD
PHYSICIAN$264,217$0$94,921$0$9,954$0$14,500$0$26,169$0$409,761$0$0$0
RHETT ECKMANN MD
PHYSICIAN$241,034$0$86,188$0$10,862$0$12,211$0$26,169$0$376,464$0$0$0
BRIAN HASS MD
PHYSICIAN$259,021$0$70,320$0$14,157$0$12,211$0$26,169$0$381,878$0$0$0
KENNETH PITZ MD
PHYSICIAN$430,214$0$7,508$0$27,024$0$12,500$0$26,169$0$503,415$0$0$0

Supplemental Information Detail SupplementalInformationDetail (2 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
PART I, LINE 4BQUESTIONS REGARDING COMPENSATION DURING 2013, 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
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 (2 entries)

Bond ReferenceBondReferenceCdBond Issuer EINBondIssuerEINBond IssuedBondIssuedDtIssue PriceIssuePriceAmtPurposePurposeDescDefeasedDefeasedIndOn Behalf Of IssuerOnBehalfOfIssuerIndPool FinancingPoolFinancingInd
HOSPITAL AUTHORITY NO 1 OF CUMING COUNTY NE
A4707628782010-07-27$12,000,000SEE SCHEDULE K, PART VIfalsefalsefalse
HOSPITAL AUTHORITY NO 1 OF CUMING COUNTY NE
B4707628782009-03-31$2,200,000SEE SCHEDULE K, PART VIfalsefalsefalse

Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp (2 entries)

Bond ReferenceBondReferenceCdRetiredRetiredAmtBond DefeasedBondDefeasedAmtTotal ProceedsTotalProceedsAmtIn Reserve FundInReserveFundAmtCapitalized InterestCapitalizedInterestAmtRefunding EscrowRefundingEscrowAmtIssuance Costs From ProceedsIssuanceCostsFromProceedsAmtCredit EnhancementCreditEnhancementAmtWorking Capital ExpendituresWorkingCapitalExpendituresAmtCapital ExpendituresCapitalExpendituresAmtOther Spent ProceedsOtherSpentProceedsAmtUnspentUnspentAmtSubstantial CompletionSubstantialCompletionYrCurrent RefundingCurrentRefundingIndAdvance RefundingAdvanceRefundingIndFinal Allocation MadeFinalAllocationMadeIndAdequate Books And Rec MaintAdequateBooksAndRecMaintInd
A$591,049$0$12,000,000$0$0$0$0$0$0$12,000,000$0$02012falsefalseYes (true)Yes (true)
B$916,572$0$2,200,000$0$0$0$0$0$0$0$0$01999Yes (true)falseYes (true)Yes (true)

Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp (2 entries)

Bond ReferenceBondReferenceCdOwning Bond Financed PropertyOwningBondFinancedPropertyIndAny Lease ArrangementsAnyLeaseArrangementsIndMgmt Contract Bond Fincd PropMgmtContractBondFincdPropIndAny Research AgreementsAnyResearchAgreementsIndPrivate Bus Use By OthersPrivateBusUseByOthersPctPrivate Bus Concerning UBIPrivateBusConcerningUBIPctTotal Private Business UseTotalPrivateBusinessUsePctBond Iss Meet Prvt Sec Pymt TestBondIssMeetPrvtSecPymtTestIndChange In Use Bond Financed PropChangeInUseBondFinancedPropIndRemedial Action TakenRemedialActionTakenIndProcs Nonqualified Bond RemdtdProcsNonqualifiedBondRemdtdInd
Afalsefalsefalsefalse0.000000.000000.00000falsefalsefalseYes (true)
B0

Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp (2 entries)

Bond ReferenceBondReferenceCdForm8038 T FiledForm8038TFiledIndException To RebateExceptionToRebateIndVariable Rate IssueVariableRateIssueIndHedge Identified In Bks And RecHedgeIdentifiedInBksAndRecIndGross Proceeds Invested In GICGrossProceedsInvestedInGICIndBusiness Name Line1GICProviderName/BusinessNameLine1Gross Proceeds InvestedGrossProceedsInvestedIndWritten Proc To Monitor ReqsWrittenProcToMonitorReqsInd
0
AfalseYes (true)Yes (true)falsefalse0falseYes (true)
0
BfalseYes (true)falsefalsefalse0falseYes (true)

Procedures Corrective Action ProceduresCorrectiveActionGrp (2 entries)

Bond ReferenceBondReferenceCdProcedures Corrective ActionProceduresCorrectiveActionInd
AYes (true)
BYes (true)

Supplemental Information Detail SupplementalInformationDetail (2 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
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.
SCHEDULE K, PART I, LINE B, COLUMN F:REVENUE REFUNDING BONDS ISSUED TO REFUND THE SERIES 1999 BONDS ISSUED IN THE ORIGINAL AMOUNT OF $4,250,000. THE SERIES 1999 BONDS WERE ISSUED TO REFINANCE THE COST OF CONSTRUCTION AND ACQUIRING A RESIDENTIAL CARE FACILITY AND REFINANCE THE COSTS OF CONSTRUCTION AND ACQUIRING ADDITIONS AND IMPROVEMENTS TO THE EXISTING HOSPITAL FACILITIES.

Schedule L IRS990ScheduleL

Loans Btwn Org Interested Prsn LoansBtwnOrgInterestedPrsnGrp (2 entries)

Relationship With OrgRelationshipWithOrgTxtLoan PurposeLoanPurposeTxtLoan From OrganizationLoanFromOrganizationIndOriginal PrincipalOriginalPrincipalAmtBalance DueBalanceDueAmtDefaultDefaultIndBoard Or Committee ApprovalBoardOrCommitteeApprovalIndWritten AgreementWrittenAgreementInd
KENNETH PITZMD
HIGHEST COMPRELOCATIONYes (X)$22,000$7,333falseYes (true)Yes (true)
KENNETH PITZMD
HIGHEST COMPRELOCATIONYes (X)$22,000$22,000falseYes (true)Yes (true)
FieldValueIRS element (for citing)
Total Balance Due$29,333TotalBalanceDueAmt

Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp (7 entries)

Relationship DescriptionRelationshipDescriptionTxtTransactionTransactionAmtTransactionTransactionDescSharing Of RevenuesSharingOfRevenuesInd
AGNES DINSLAGE
SEE PART V$26,589EMPLOYMENTfalse
NANCY NELSON
SEE PART V$37,985EMPLOYMENTfalse
CHERI DROESCHER
SEE PART V$29,927EMPLOYMENTfalse
BARBARA STEFFEN
SEE PART V$21,978EMPLOYMENTfalse
DAN HAKEL
SEE PART V$112,913EMPLOYMENTYes (true)
BRENDA WISNIESKI
SEE PART V$38,799EMPLOYMENTfalse
MARGUERITE KAUP
SEE PART V$44,543EMPLOYMENTfalse

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 (7 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990, PART VI, LINE 2DAVE STEFFENSMEIER, TRUSTEE HAS A FAMILY RELATIONSHIP AND BUSINESS RELATIONSHIP WITH SUE STEFFENSMEIER. DAVE IS THE SPOUSE OF SUE AND HE WAS APPOINTED TO THE BOARD OF TRUSTEES WHEN SUE'S TERM EXPIRED. 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.
PART VI, SECTION A, LINE 6THE ORGANIZATION IS A NOT-FOR-PROFIT CORPORATION WHOSE MEMBER IS FRANCISCAN SISTERS OF CHRISTIAN CHARITY SPONSORED MINISTRIES,INC.
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.
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.
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.
PART VI, SECTION C, LINE 19NO DOCUMENTS AVAILABLE TO THE PUBLIC
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/AddressLine1CityUSAddress/CityStateUSAddress/StateZIP CodeUSAddress/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdExempt Code SectionExemptCodeSectionTxtPublic Charity StatusPublicCharityStatusTxtBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Controlled 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 Partnership IdRelatedOrgTxblPartnershipGrp

Related Organization Name RelatedOrganizationName

FieldValueIRS element (for citing)
Business Name Line1NONEBusinessNameLine1

Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp

Related Organization Name RelatedOrganizationName

FieldValueIRS element (for citing)
Business Name Line1HOLY FAMILY HEALTH SERVICESBusinessNameLine1

US Address USAddress

FieldValueIRS element (for citing)
Address Line13310 CALUMET AVENUEAddressLine1
CityMANITOWOCCity
StateWIState
ZIP Code54220ZIPCode
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 5BusinessNameLine1
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 SharingfalsePaidEmployeesSharingInd
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) ORGSBusinessNameLine1