2014-11-10T09:45:55-06:00 2013-12-31 KPMG LLP 1212 North 96th Street Suite 300 Omaha NE 68114 990 2013-01-01 470486026 FRANCISCAN CARE SERVICES INC % DENNIS DINSLAGE FRAN 4023722404 430 NORTH MONITOR STREET Suite WEST POINT NE 687881555 RONALD O BRIGGS PRESIDENT/CEO 4023481450 2013-11-05 true Donald Neal JR P00798244 4023481450 2013 2015-11-30 17:44:51Z RONALD O BRIGGS 430 NORTH MONITOR STREET WEST POINT NE 687881555 32306915 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. 13 8 302 251 1696 0 272049 228857 28593940 30750139 612854 1241050 -9942 33163 29468901 32253209 0 0 0 0 16115791 16741438 0 0 1921 10431988 12329565 26547779 29071003 2921122 3182206 59849731 63580869 18414964 18117513 41434767 45463356 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 23663591 0 28715377 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 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. 1907274 0 2067925 ASSISTED 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. 25570865 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 true false false true false false false false false false true false false false true 56 0 true 302 true true true false false false false false false false false false X 13 8 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 240382 0 36162 SR ROCHELLE KERKHOF TRUSTEE 1.0 0.0 X 0 0 0 BRIAN REIMERS VICE CHAIRMAN/TERM 3/31/2013 1.5 0.0 X X 0 0 0 CONRAD REESON TRUSTEE/TERM 3/31/2013 1.0 0.0 X 0 0 0 SUE STEFFENSMEIER TRUSTEE/TERM 3/31/2013 1.0 0.0 X 0 0 0 SR JO ELLEN KOHLMANN TRUSTEE 1.0 0.0 X 0 0 0 STEVE AUSDEMORE TREASURER 1.5 0.0 X X 0 0 0 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 CHAD ORTMEIER DDS TRUSTEE 1.0 0.25 X 0 0 0 JACKIE RIDDER SECRETARY 1.5 0.0 X 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 DENNIS DINSLAGE VP FISCAL & SUPPORT SERVICES 42.0 0.0 X 156415 0 30249 TERRY NELSON REHAB MANAGER 55.0 0.0 X 192382 0 39314 MICHAEL BITTLES MD PHYSICIAN 40.0 0.0 X 356738 0 37466 SCOTT GREEN MD PHYSICIAN 44.44 0.0 X 369092 0 38966 RHETT ECKMANN MD PHYSICIAN 44.96 0.0 X 338084 0 36677 BRIAN HASS MD PHYSICIAN 45.19 0.0 X 343498 0 36677 KENNETH PITZ MD PHYSICIAN 40.0 0.0 X 464746 0 36966 2461337 0 292477 16 false true false MCSBCI CONSTRUCTION 1020 CENTENNIAL RD WEST POINT NE 68788 GENERAL CONSTRUCTION 1616322 MCKESSON TECHNOLOGIES INC 5995 WINDWARD PARKWAY ALPHARETTA GA 30005 IT SOFTWARE SUPPORT 1564400 ELKHORN VALLEY ANESTHESIA PC INC 814 VIA LINDA WEST POINT NE 68788 ANESTHESIA SERVICES 529776 CYPRESS BENEFIT ADMINISTRATOR PO BOX 7020 APPLETON WI 549127020 HEALTH PLAN ADMIN 388373 MCS CONSTRUCTION INC 1020 CENTENNIAL RD WEST POINT NE 68788 GENERAL CONSTRUCTION 145166 12 161896 66961 228857 HOSPITAL/CLINIC HEALTHCARE SERVICES 621110 28625311 28625311 ASSISTED LIVING-ELDER CARE 623000 2013806 2013806 DIETARY/CAFETERIA 721000 111022 111022 30750139 1244004 1696 1242308 0 0 0 0 0 21561 24515 -2954 -2954 -2954 0 0 62354 29191 33163 33163 0 0 32253209 30783302 1696 1239354 0 0 0 0 699165 607940 91225 0 13019926 11737430 1282496 360058 286337 73721 1819550 1470118 349432 842739 750722 92017 0 13065 13065 77109 77109 2733 2733 0 0 2201240 1925049 276191 121451 120163 1288 1649289 1532033 116993 263 594464 478083 116381 0 1270349 1076242 194107 114893 103106 11787 0 38301 33902 4399 0 0 3415961 2747203 668758 104695 104695 MEDICAL SUPPLIES 2570432 2570432 DUES & SUBSCRIPTIONS 153925 132105 21820 WOMEN'S AUXILIARY SUPPLIES 1658 1658 29071003 25570865 3498217 1921 438314 609224 4547776 4721588 0 0 3405108 4631173 36667 29333 0 0 6667 20000 507728 524057 173947 180475 58231471 25865581 33245960 32365890 13512035 15519238 1822887 1899432 0 0 0 0 2152642 3080459 59849731 63580869 5103998 3947984 10000 0 0 1477150 13300966 12692379 0 0 0 0 0 0 0 0 0 0 18414964 18117513 X 41434767 45463356 0 0 0 0 41434767 45463356 59849731 63580869 3182206 846383 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false true 2733 true false false 2733 false PART IV SUPPLEMENTAL INFORMATION PART 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. 367466 367466 21225308 7701019 13524289 36621207 18164562 18456645 17490 17490 32365890 0 0 X 33096414 846383 846383 32250031 3178 3178 32253209 29069345 29069345 1658 1658 29071003 PART XI, LINE 4B AUXILIARY 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 4B AUXILIARY OPERATING EXPENSES 1,658 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 false true true 132 296798 0 296798 0.01020 3177 1561541 1384568 176973 0.00610 3309 1858339 1384568 473771 0.01630 5617 140259 16149 124110 0.00430 157 80292 80292 0.00280 23102 5418893 4583586 835307 0.02870 7885 56047 2340 53707 0.00180 36761 5695491 4602075 1093416 0.03760 40070 7553830 5986643 1567187 0.05390 1925 1925 0.00010 1906 1906 0.00010 352 352 0.00000 804 804 0.00000 4987 4987 0.00020 true 601817 120363 10908849 11139342 -230493 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 true X X X X X X X X 13 true true true X SEE PART V, SECTION C X X X X X X X false false true true 100 true 200. true X X X X true true X X X X X true false X X true X false false PART V, SECTION B - ST. FRANCIS MEMORIAL HOSPITAL (1) 1. 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. 1 ST JOSEPH'S RETIREMENT COMMUNITY 320 E DECATUR WEST POINT NE 68788 ASSISTED LIVING FACILITY PART I, LINE 3C NOT APPLICABLE PART I, LINE 6A NOT 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 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. 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 4 The accounts receivable footnote which discusses bad debt expense is on page 7 of the Notes to Financial Statements. 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 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 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, 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 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 168961 0 43177 0 28244 0 11874 0 26312 0 278568 0 0 0 DENNIS DINSLAGE VP FISCAL & SUPPORT SERVICES 126274 0 24095 0 6046 0 8559 0 22428 0 187402 0 0 0 TERRY NELSON REHAB MANAGER 180778 0 0 0 11604 0 16500 0 24313 0 233195 0 0 0 MICHAEL BITTLES MD PHYSICIAN 347214 0 0 0 9524 0 13000 0 26169 0 395907 0 0 0 SCOTT GREEN MD PHYSICIAN 264217 0 94921 0 9954 0 14500 0 26169 0 409761 0 0 0 RHETT ECKMANN MD PHYSICIAN 241034 0 86188 0 10862 0 12211 0 26169 0 376464 0 0 0 BRIAN HASS MD PHYSICIAN 259021 0 70320 0 14157 0 12211 0 26169 0 381878 0 0 0 KENNETH PITZ MD PHYSICIAN 430214 0 7508 0 27024 0 12500 0 26169 0 503415 0 0 0 PART I, LINE 4B QUESTIONS 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 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 B HOSPITAL AUTHORITY NO 1 OF CUMING COUNTY NE 470762878 2009-03-31 2200000 SEE SCHEDULE K, PART VI false false false A 591049 0 12000000 0 0 0 0 0 0 12000000 0 0 2012 false false true true B 916572 0 2200000 0 0 0 0 0 0 0 0 0 1999 true false true true A false false false false 0.00000 0.00000 0.00000 false false false true B 0 A false true true false 0 false 0 false true B false true false false 0 false 0 false true A true B 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. 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. KENNETH PITZMD HIGHEST COMP RELOCATION X 22000 7333 false true true KENNETH PITZMD HIGHEST COMP RELOCATION X 22000 22000 false true true 29333 AGNES DINSLAGE SEE PART V 26589 EMPLOYMENT false NANCY NELSON SEE PART V 37985 EMPLOYMENT false CHERI DROESCHER SEE PART V 29927 EMPLOYMENT false BARBARA STEFFEN SEE PART V 21978 EMPLOYMENT false DAN HAKEL SEE PART V 112913 EMPLOYMENT true BRENDA WISNIESKI SEE PART V 38799 EMPLOYMENT false MARGUERITE KAUP SEE PART V 44543 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 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 6 THE ORGANIZATION IS A NOT-FOR-PROFIT CORPORATION WHOSE MEMBER IS FRANCISCAN SISTERS OF CHRISTIAN CHARITY SPONSORED MINISTRIES,INC. 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. 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. 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. PART VI, SECTION C, LINE 19 NO DOCUMENTS AVAILABLE TO THE PUBLIC 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 NONE 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 false true true false true ALL TRANSACTIONS WERE BETWEEN 501(c)(3) ORGS