FRANCISCAN CARE SERVICES INC: Form 990, tax year 2012
View the entire original 990 at ProPublica ↗
- Organization
- FRANCISCAN CARE SERVICES INC (EIN 47-0486026)
- Tax period
- 2012-01-01 to 2012-12-31
- Filed
- 2013-11-06
- IRS object ID
- 201333109349301458
- Schema version
- 2012v2.1
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule H
- Schedule J
- Schedule K
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2013-11-06T14:01:58-06:00 | Timestamp |
| Tax Period End Date | 2012-12-31 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | KPMG LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1212 North 96th Street Suite 300 | AddressLine1 |
| City | Omaha | City |
| State | NE | State |
| ZIP Code | 68114 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2012-01-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 470486026 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | FRANCISCAN CARE SERVICES INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| In Care Of Name | % DENNIS DINSLAGE | InCareOfName |
| Name Control | FRAN | NameControl |
| Phone | 4023722404 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 430 NORTH MONITOR STREET | AddressLine1 |
| Address Line2 | Suite | AddressLine2 |
| City | WEST POINT | City |
| State | NE | State |
| ZIP Code | 687881555 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | RONALD O BRIGGS | Name |
| Title | PRESIDENT/CEO | Title |
| Phone | 4023481450 | Phone |
| Date Signed | 2013-11-05 | DateSigned |
| Authorize Third Party | true | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Adam C Stark | Name |
| Phone | 4023481450 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2012 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | RONALD O BRIGGS | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 430 NORTH MONITOR STREET | AddressLine1 |
| City | WEST POINT | City |
| State | NE | State |
| ZIP Code | 687881555 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 29520570 | GrossReceipts |
| Group Return For Affiliates | false | GroupReturnForAffiliates |
| Group Exemption Number | 0928 | GroupExemptionNumber |
| Organization501c3 | X | Organization501c3 |
| Web Site | www.fcswp.org | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1964 | YearFormation |
| State Legal Domicile | NE | StateLegalDomicile |
| Activity Or Mission Description | THE MISSION OF FRANCISCAN CARE SERVICES INC. IS TO LIVE AND TO PROMOTE THE HEALING MISSION OF JESUS CHRIST. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 13 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 8 | NbrIndependentVotingMembers |
| Total Nbr Employees | 284 | TotalNbrEmployees |
| Total Nbr Volunteers | 232 | TotalNbrVolunteers |
| Total Gross UBI | -1308 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | -1308 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 212443 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 272049 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 25097177 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 28593940 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 605114 | InvestmentIncomePriorYear |
| Investment Income Current Year | 612854 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 0 | OtherRevenuePriorYear |
| Other Revenue Current Year | -9942 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 25914734 | TotalRevenuePriorYear |
| Total Revenue Current Year | 29468901 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 0 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 0 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 14439665 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 16115791 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 1848 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 8500555 | OtherExpensePriorYear |
| Other Expenses Current Year | 10431988 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 22940220 | TotalExpensesPriorYear |
| Total Expenses Current Year | 26547779 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 2974514 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 2921122 | RevenuesLessExpensesCY |
| Total Assets BOY | 51314692 | TotalAssetsBOY |
| Total Assets EOY | 59849731 | TotalAssetsEOY |
| Total Liabilities BOY | 13605330 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 18414964 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 37709362 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 41434767 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | 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. | MissionDescription |
| Significant New Program Services | false | SignificantNewProgramServices |
| Significant Change | false | SignificantChange |
| Expense | 21581892 | Expense |
| Grants | 0 | Grants |
| Revenue | 26462176 | Revenue |
| Description | 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 473 288 16 PATIENT DAYS - ACUTE 1,688 1,117 49 - SWING BED 1,016 829 16 - NURSERY 111 0 31 OUT-PATIENT & HOME HEALTH 44,447 20,027 924 PHYSICIAN CLINIC VISITS 24,833 9,603 2,031 THE HOSPITAL RECEIVES GENEROUS SUPPORT FROM THE COMMUNITY NOT ONLY FINANCIALLY BUT ALSO FROM ABOUT 182 VOLUNTEERS WHO DONATED APPROXIMATELY 4,420 HOURS OF THEIR VALUABLE TIME. | Description |
Activity2 Activity2
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 1905489 | Expense |
| Grants | 0 | Grants |
| Revenue | 2121822 | Revenue |
| Description | ASSISTED LIVING FACILITY FULFILLS THE MISSION OF THE ROMAN CATHOLIC CHURCH BY PROVIDING 84 FRAIL AND ELDERLY PEOPLE WITH ASSISTED LIVING SERVICES REGARDLESS OF THEIR ABILITY TO PAY. A TOTAL OF 17 RESIDENTS RECEIVED $191,171 IN FREE CARE DURING THE YEAR. APPROXIMATELY 50 VOLUNTEERS PROVIDED 3,400 HOURS OF SUPPORT TO THE FACILITY. | Description |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expense | 23487381 | TotalProgramServiceExpense |
| Described In501 C3 | true | DescribedIn501C3 |
| Schedule B Required | true | ScheduleBRequired |
| Political Activities | false | PoliticalActivities |
| Lobbying Activities | true | LobbyingActivities |
| Subject To Proxy Tax | false | SubjectToProxyTax |
| Donor Advised Funds | false | DonorAdvisedFunds |
| Conservation Easements | false | ConservationEasements |
| Collections Of Art | false | CollectionsOfArt |
| Credit Counseling | false | CreditCounseling |
| Term Or Permanent Endowments | false | TermOrPermanentEndowments |
| Report Land Bldg Equip | true | ReportLandBldgEquip |
| Report Invest Oth Securities | false | ReportInvestOthSecurities |
| Report Prog Rel Invest | false | ReportProgRelInvest |
| Report Other Assets | false | ReportOtherAssets |
| Report Other Liabilities | false | ReportOtherLiabilities |
| Report Fin48 Footnote | true | ReportFin48Footnote |
| Independent Audit Financial Stmt | true | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | true | ConsolidatedAuditFinancialStmt |
| School | false | School |
| Foreign Office | false | ForeignOffice |
| Foreign Activities | false | ForeignActivities |
| More Than5000 K To Organizations | false | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividuals |
| Professional Fundraising | false | ProfessionalFundraising |
| Fundraising Activities | false | FundraisingActivities |
| Gaming | false | Gaming |
| Hospital | true | Hospital |
| Financial Stmt Attached | true | FinancialStmtAttached |
| Grants To Organizations | false | GrantsToOrganizations |
| Grants To Individuals | false | GrantsToIndividuals |
| Schedule J Required | true | ScheduleJRequired |
| Tax Exempt Bonds | true | TaxExemptBonds |
| Invest Tax Exempt Bonds | false | InvestTaxExemptBonds |
| Escrow Account | false | EscrowAccount |
| On Behalf Of Issuer | false | OnBehalfOfIssuer |
| Excess Benefit Transaction | false | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | false | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | true | LoanToOfficerOrDQP |
| Grant To Related Person | false | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | false | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | true | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | false | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | false | DeductibleNonCashContributions |
| Deductible Contributions Of Art | false | DeductibleContributionsOfArt |
| Terminated | false | Terminated |
| Partial Liquidation | false | PartialLiquidation |
| Disregarded Entity | false | DisregardedEntity |
| Related Entity | true | RelatedEntity |
| Related Org Controlled Entity | false | RelatedOrgControlledEntity |
| Transfers To Exempt Non Chrtbl Org | false | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | false | ActivitiesConductedPartnership |
| Schedule O Required | true | ScheduleORequired |
| Number Forms Transmitted With1096 | 43 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | true | ComplianceWithBackupWitholding |
| Number Of Employees | 284 | NumberOfEmployees |
| Employment Tax Returns Filed | true | EmploymentTaxReturnsFiled |
| Unrelated Business Income | false | UnrelatedBusinessIncome |
| Foreign Financial Account | false | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTrans |
| Taxable Party Notification | false | TaxablePartyNotification |
| Non Deductible Contributions | false | NonDeductibleContributions |
| Quid Pro Quo Contributions | false | QuidProQuoContributions |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | false | FundsToPayPremiums |
| Premiums Paid | false | PremiumsPaid |
| Indoor Tanning Services | false | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 13 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 8 | NumberIndependentVotingMembers |
| Family Or Business Relationship | false | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | false | DelegationOfManagementDuties |
| Changes To Organizing Docs | true | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuse |
| Members Or Stockholders | true | MembersOrStockholders |
| Election Of Board Members | true | ElectionOfBoardMembers |
| Decisions Subject To Approval | true | DecisionsSubjectToApproval |
| Minutes Of Governing Body | true | MinutesOfGoverningBody |
| Minutes Of Committees | true | MinutesOfCommittees |
| Officer Mailing Address | false | OfficerMailingAddress |
| Local Chapters | false | LocalChapters |
| Form990 Provided To Governing Body | true | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | true | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | true | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | true | RegularMonitoringEnforcement |
| Whistleblower Policy | true | WhistleblowerPolicy |
| Document Retention Policy | true | DocumentRetentionPolicy |
| Compensation Process CEO | true | CompensationProcessCEO |
| Compensation Process Other | false | CompensationProcessOther |
| Investment In Joint Venture | false | InvestmentInJointVenture |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | DENNIS DINSLAGE | NamePerson |
| Telephone Number | 4023726703 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 430 NORTH MONITOR STREET | AddressLine1 |
| City | WEST POINT | City |
| State | NE | State |
| ZIP Code | 687881555 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | X | InfoInScheduleOPartVII |
Form990 Part VII Section A Form990PartVIISectionA (21 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Average Hours Per Week RelatedAverageHoursPerWeekRelated | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | Key EmployeeKeyEmployee | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|---|---|
| RONALD O BRIGGS | |||||||||
| CEO & TRUSTEE | 45.0 | 0.35 | X | X | 239382 | 0 | 33604 | ||
| SR ROCHELLE KERKHOF | |||||||||
| TRUSTEE | 1.0 | 0.0 | X | 0 | 0 | 0 | |||
| JAY HANSEN DDS | |||||||||
| CHAIRMAN | 1.5 | 0.0 | X | X | 0 | 0 | 0 | ||
| BRIAN REIMERS | |||||||||
| VICE CHAIR & SECRETARY | 1.5 | 0.0 | X | X | 0 | 0 | 0 | ||
| CONRAD REESON | |||||||||
| TRUSTEE | 1.0 | 0.0 | X | 0 | 0 | 0 | |||
| SUE STEFFENSMEIER | |||||||||
| TRUSTEE | 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 | |||||||||
| CHAIR & VICE CHAIR | 1.5 | 0.0 | X | X | 0 | 0 | 0 | ||
| JEROME STEFFEN | |||||||||
| TRUSTEE | 1.0 | 0.25 | 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 | |||
| DENNIS DINSLAGE | |||||||||
| VP FISCAL & SUPPORT SERVICES | 42.0 | 0.0 | X | 149509 | 0 | 26980 | |||
| TERRY NELSON | |||||||||
| REHAB MANAGER | 55.0 | 0.0 | 291057 | 0 | 50547 | X | |||
| MICHAEL BITTLES MD | |||||||||
| PHYSICIAN | 40.0 | 0.0 | 356160 | 0 | 35065 | X | |||
| SCOTT GREEN MD | |||||||||
| PHYSICIAN | 44.5 | 0.0 | 362505 | 0 | 36565 | X | |||
| RHETT ECKMANN MD | |||||||||
| PHYSICIAN | 43.3 | 0.0 | 304440 | 0 | 34276 | X | |||
| BRIAN HASS MD | |||||||||
| PHYSICIAN | 43.3 | 0.0 | 315369 | 0 | 32276 | X | |||
| KENNETH PITZ MD | |||||||||
| PHYSICIAN | 40.0 | 0.0 | 465374 | 0 | 32815 | X | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 2483796 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 282128 | TotalOtherCompensation |
| Number Individuals GT100 K | 14 | NumberIndividualsGT100K |
| Formers Listed | false | FormersListed |
| Total Comp GT150 K | true | TotalCompGT150K |
| Compensation From Other Sources | false | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| ELKHORN VALLEY ANESTHESIA PC INC | |||||
| 814 VIA LINDA | WEST POINT | NE | 68788 | ANESTHESIA SERVICES | 595388 |
| MCKESSON TECHNOLOGIES INC | |||||
| 5995 WINDWARD PARKWAY | ALPHARETTA | GA | 30005 | IT SOFTWARE SUPPORT | 1126299 |
| CYPRESS BENEFIT ADMINISTRATOR | |||||
| PO BOX 7020 | APPLETON | WI | 549127020 | HEALTH PLAN ADMIN | 388163 |
| IP PATHWAYS LLC | |||||
| 2550 73RD STREET | URBANDALE | IA | 50322 | IT SOFTWARE/SUPPORT | 436217 |
| MCSBCI CONSTRUCTION | |||||
| 1020 CENTENNIAL RD | WEST POINT | NE | 68788 | GENERAL CONSTRUCTION | 3259293 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 13 | NumberOfContractorsGT100K |
| Related Organizations | 207717 | RelatedOrganizations |
| All Other Contributions | 64332 | AllOtherContributions |
| Total Contributions | 272049 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|
| HOSPITAL/CLINIC HEALTHCARE SERVICES | 621110 | 26379836 | 26379836 |
| ASSISTED LIVING-ELDER CARE | 623000 | 2114894 | 2114894 |
| DIETARY/CAFETERIA | 721000 | 99210 | 99210 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 28593940 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 624058 | TotalRevenueColumn |
| Unrelated Business Revenue | -1308 | UnrelatedBusinessRevenue |
| Exclusion | $625,366 | ExclusionAmount |
Income From Invest Bond Proceeds IncomeFromInvestBondProceeds
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Royalties Revenue RoyaltiesRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 0 | Real |
| Personal | 0 | Personal |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 9264 | Other |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 20468 | Other |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | -11204 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -11204 | TotalRevenueColumn |
| Exclusion | -$11,204 | ExclusionAmount |
Net Income From Fundraising Events NetIncomeFromFundraisingEvents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Net Income From Gaming NetIncomeFromGaming
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Sales Of Inventory | 21259 | GrossSalesOfInventory |
| Cost Of Goods Sold | 31201 | CostOfGoodsSold |
Net Income Or Loss NetIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -9942 | TotalRevenueColumn |
| Related Or Exempt Function Income | -9942 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 0 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 29468901 | TotalRevenueColumn |
| Related Or Exempt Function Income | 28583998 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | -1308 | UnrelatedBusinessRevenue |
| Exclusion | $614,162 | ExclusionAmount |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Grants To Domestic Individuals GrantsToDomesticIndividuals
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Foreign Grants ForeignGrants
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Benefits To Members BenefitsToMembers
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 795580 | Total |
| Program Services | 709643 | ProgramServices |
| Management And General | 85937 | ManagementAndGeneral |
Comp Disqual Persons CompDisqualPersons
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 12017568 | Total |
| Program Services | 10873206 | ProgramServices |
| Management And General | 1144362 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 344789 | Total |
| Program Services | 273564 | ProgramServices |
| Management And General | 71225 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2181621 | Total |
| Program Services | 1776176 | ProgramServices |
| Management And General | 405445 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 776233 | Total |
| Program Services | 694063 | ProgramServices |
| Management And General | 82170 | ManagementAndGeneral |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 16716 | Total |
| Management And General | 16716 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 76045 | Total |
| Management And General | 76045 | ManagementAndGeneral |
Fees For Services Lobbying FeesForServicesLobbying
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2502 | Total |
| Management And General | 2502 | ManagementAndGeneral |
Fees For Services Prof Fundraising FeesForServicesProfFundraising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1463951 | Total |
| Program Services | 1243547 | ProgramServices |
| Management And General | 220404 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 116753 | Total |
| Program Services | 115778 | ProgramServices |
| Management And General | 975 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2018231 | Total |
| Program Services | 1890554 | ProgramServices |
| Management And General | 127565 | ManagementAndGeneral |
| Fundraising | 112 | Fundraising |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 416621 | Total |
| Program Services | 337499 | ProgramServices |
| Management And General | 79122 | ManagementAndGeneral |
Royalties Royalties
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 937516 | Total |
| Program Services | 805987 | ProgramServices |
| Management And General | 131529 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 107783 | Total |
| Program Services | 92430 | ProgramServices |
| Management And General | 15353 | ManagementAndGeneral |
Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 37213 | Total |
| Program Services | 34090 | ProgramServices |
| Management And General | 3123 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Payments To Affiliates PaymentsToAffiliates
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2471647 | Total |
| Program Services | 2002251 | ProgramServices |
| Management And General | 469396 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 122301 | Total |
| Management And General | 122301 | ManagementAndGeneral |
Other Expenses OtherExpenses (3 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral | FundraisingFundraising |
|---|---|---|---|---|
| MEDICAL SUPPLIES | 2558693 | 2558693 | ||
| DUES & SUBSCRIPTIONS | 84280 | 79900 | 4380 | |
| WOMEN'S AUXILIARY SUPPLIES | 1736 | 1736 |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 26547779 | Total |
| Program Services | 23487381 | ProgramServices |
| Management And General | 3058550 | ManagementAndGeneral |
| Fundraising | 1848 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 250 | BOY |
| EOY | 438314 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3692484 | BOY |
| EOY | 4547776 | EOY |
Pledges And Grants Receivable PledgesAndGrantsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3739182 | BOY |
| EOY | 3405108 | EOY |
Receivables From Officers Etc ReceivablesFromOfficersEtc
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 36667 | EOY |
Receivables From Disqual Persons ReceivablesFromDisqualPersons
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Other Notes Loans Receivable Net OtherNotesLoansReceivableNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 57333 | BOY |
| EOY | 6667 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 476860 | BOY |
| EOY | 507728 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 165599 | BOY |
| EOY | 173947 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 56073432 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 22827472 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 28436191 | BOY |
| EOY | 33245960 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 8852017 | BOY |
| EOY | 13512035 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5234304 | BOY |
| EOY | 1822887 | EOY |
Investments Program Related InvestmentsProgramRelated
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Intangible Assets IntangibleAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 660472 | BOY |
| EOY | 2152642 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 51314692 | BOY |
| EOY | 59849731 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4568798 | BOY |
| EOY | 5103998 | EOY |
Grants Payable GrantsPayable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 22000 | BOY |
| EOY | 10000 | EOY |
Deferred Revenue DeferredRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Tax Exempt Bond Liabilities TaxExemptBondLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 9014532 | BOY |
| EOY | 13300966 | EOY |
Escrow Account Liability EscrowAccountLiability
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Loans From Officers Directors LoansFromOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 13605330 | BOY |
| EOY | 18414964 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 37709362 | BOY |
| EOY | 41434767 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Permanently Restricted Net Assets PermanentlyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 37709362 | BOY |
| EOY | 41434767 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 51314692 | BOY |
| EOY | 59849731 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expenses | 2921122 | ReconcilationRevenueExpenses |
| Reconciliation Unrealized Invest | 804283 | ReconciliationUnrealizedInvest |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | false | AccountantCompileOrReview |
| FS Audited | true | FSAudited |
FS Audited Basis FSAuditedBasis
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Statement Both | X | FinancialStatementBoth |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | true | AuditCommittee |
| Federal Grant Audit Required | false | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Grassroots Lobbying | TotalGrassrootsLobbying | |
| Total Direct Lobbying | TotalDirectLobbying | |
| Total Lobbying Expenditures | TotalLobbyingExpenditures | |
| Other Exempt Purpose Expenditures | OtherExemptPurposeExpenditures | |
| Total Exempt Purpose Expenditures | TotalExemptPurposeExpenditures | |
| Lobbying Nontaxable | LobbyingNontaxableAmount | |
| Grassroots Nontaxable | GrassrootsNontaxableAmount | |
| Tot Lobbying Grassroot Minus Non Tx | TotLobbyingGrassrootMinusNonTx | |
| Tot Lobby Expend Mns Lobbying Nontx | TotLobbyExpendMnsLobbyingNontx | |
| Volunteers | false | Volunteers |
| Paid Staff Or Management | false | PaidStaffOrManagement |
| Media Advertisements | false | MediaAdvertisements |
| Mailings Members | false | MailingsMembers |
| Publications Or Broadcast | false | PublicationsOrBroadcast |
| Grants Other Organizations | true | GrantsOtherOrganizations |
| Grants Other Organizations | $2,502 | GrantsOtherOrganizationsAmount |
| Direct Contact Legislators | true | DirectContactLegislators |
| Direct Contact Legislators | $0 | DirectContactLegislatorsAmount |
| Rallies Demonstrations | false | RalliesDemonstrations |
| Other Activities | false | OtherActivities |
| Total Lobbying Expenditures IIB | 2502 | TotalLobbyingExpendituresIIB |
| Not Described In501c3 | false | NotDescribedIn501c3 |
Form990 Schedule C Part IV Form990ScheduleCPartIV (2 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| 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. |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Art Public Exhibition Amts | ArtPublicExhibitionAmts | |
| Held Works Of Art Amts | HeldWorksOfArtAmts | |
| Current Year Minus3 Years | CurrentYearMinus3Years | |
| Current Year Minus4 Years | CurrentYearMinus4Years |
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 367466 | OtherCostOrOtherBasis |
| Book Value | 367466 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 20020988 | OtherCostOrOtherBasis |
| Depreciation | 6871874 | Depreciation |
| Book Value | 13149114 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Leasehold Improvements | LeaseholdImprovements |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 30880187 | OtherCostOrOtherBasis |
| Depreciation | 15955598 | Depreciation |
| Book Value | 14924589 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 4804791 | OtherCostOrOtherBasis |
| Book Value | 4804791 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 33245960 | TotalOfBookValueLandBuildings |
| Federal Income Tax Liability | 0 | FederalIncomeTaxLiability |
| Total Of Amounts | 0 | TotalOfAmounts |
| Footnote In Part XIII | X | FootnoteInPartXIII |
| Tot Revenue Etc Audited Fincl Stmt | 30280518 | TotRevenueEtcAuditedFinclStmt |
| Net Unrealized Gains Investments | 804283 | NetUnrealizedGainsInvestments |
| Revenue Not Rptd F990 | 804283 | RevenueNotRptdF990 |
| Revenue Subtotal | 29476235 | RevenueSubtotal |
| Other Revenues Not Included | -7334 | OtherRevenuesNotIncluded |
| Revenue Not Rptd On Fin Stmt | -7334 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 29468901 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 26546043 | TotExpensesEtcAuditedFinclStmt |
| Expenses Subtotal | 26546043 | ExpensesSubtotal |
| Other Expenses Not Included | 1736 | OtherExpensesNotIncluded |
| Expenses Not Rptd On Fin Stmt | 1736 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 26547779 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIII Form990ScheduleDPartXIII (3 entries)
| IdentifierIdentifier | ExplanationExplanation | Return ReferenceReturnReference |
|---|---|---|
| PART XI, LINE 4B | AUXILIARY GIFT SHOP SALES 21,259 AUXILIARY GIFT SHOP COGS (31,201) ------------- NET LOSS FROM SALES ( 9,942) AUXILIARY FUNDS RAISED 7,778 AUXILIARY DONATION TO HOSPITAL -5,170 ------------- TOTAL ( 7,334) | |
| PART XII, LINE 4B | AUXILIARY OPERATING EXPENSES 1,736 | |
| PART X, LINE 2 | The organization has evaluated and reviewed uncertain tax positions and found the potential exposure to be insignificant. | FIN 48 FOOTNOTE ON AUDITED FINANCIAL STATEMENTS: |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | true | CharityCarePolicy |
| Written Policy | true | WrittenPolicy |
| Policy Applied To All Hospitals | X | PolicyAppliedToAllHospitals |
| FPG Reference Free Care | true | FPGReferenceFreeCare |
| Pcent100 | X | Pcent100 |
| FPG Reference Discounted Care | true | FPGReferenceDiscountedCare |
| Pcent200 D | X | Pcent200D |
| Free Disc Care Medically Indigent | true | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | true | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | true | ExpensesExceededBudget |
| Unable To Provide Care | false | UnableToProvideCare |
| Annual Community Benefit Report | true | AnnualCommunityBenefitReport |
| Report Publically Available | true | ReportPublicallyAvailable |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 143 | PersonsServed |
| Total Community Benefit Expense | 331907 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 0 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 331907 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01250 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 3515 | PersonsServed |
| Total Community Benefit Expense | 1438873 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 1316730 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 122143 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00460 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 3658 | PersonsServed |
| Total Community Benefit Expense | 1770780 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 1316730 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 454050 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01710 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 6815 | PersonsServed |
| Total Community Benefit Expense | 149579 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 14399 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 135180 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00510 | PercentOfTotalExpense |
Health Professions Education HealthProfessionsEducation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 145 | PersonsServed |
| Total Community Benefit Expense | 103036 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 0 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 103036 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00390 | PercentOfTotalExpense |
Subsidized Health Services SubsidizedHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 25111 | PersonsServed |
| Total Community Benefit Expense | 5013926 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 4258721 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 755205 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.02840 | PercentOfTotalExpense |
Cash And In Kind Contributions CashAndInKindContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 7111 | PersonsServed |
| Total Community Benefit Expense | 47491 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 3235 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 44256 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00170 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 39182 | PersonsServed |
| Total Community Benefit Expense | 5314032 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 4276355 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1037677 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.03910 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 42840 | PersonsServed |
| Total Community Benefit Expense | 7084812 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 5593085 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1491727 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.05620 | PercentOfTotalExpense |
Economic Development EconomicDevelopment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 1650 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 1650 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00010 | PercentOfTotalExpense |
Environmental Improvements EnvironmentalImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 2031 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 2031 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00010 | PercentOfTotalExpense |
Health Improvement Advocacy HealthImprovementAdvocacy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 1820 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 1820 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00010 | PercentOfTotalExpense |
Workforce Development WorkforceDevelopment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 1550 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 1550 | NetCommunityBuildingExpense |
Total Total
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 7051 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 7051 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00030 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | true | BadDebtExpenseReported |
| Bad Debt Expense | $938,814 | BadDebtExpenseAmount |
| Amount Attributable To | 164923 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 10664281 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 10721443 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | -57162 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | X | CostToChargeRatio |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | true | WrittenDebtCollectionPolicy |
| Provision For Charity Care | true | ProvisionForCharityCare |
| Number Of Hospital Facilities | 1 | NumberOfHospitalFacilities |
Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility Number | 1 | FacilityNumber |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ST FRANCIS MEMORIAL HOSPITAL | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 430 N MONITOR ST | AddressLine1 |
| City | WEST POINT | City |
| State | NE | State |
| ZIP Code | 68788 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | X | LicensedHospital |
| General Medical And Surgical | X | GeneralMedicalAndSurgical |
| Critical Access Hospital | X | CriticalAccessHospital |
| Er24 Hours | X | Er24Hours |
Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ST FRANCIS MEMORIAL HOSPITAL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
| Eligibility Criteria Explained | true | EligibilityCriteriaExplained |
| Uses FPG Free | true | UsesFPGFree |
| FPG Free Percent | 100 | FPGFreePercent |
| Uses FPG Discounted | true | UsesFPGDiscounted |
| FPG Discount Percent | 200. | FPGDiscountPercent |
| Explains Basis | true | ExplainsBasis |
| Income Level | X | IncomeLevel |
| Asset Level | X | AssetLevel |
| Medical Indigency | X | MedicalIndigency |
| Other Factors | X | OtherFactors |
| Explains Application Method | true | ExplainsApplicationMethod |
| Includes Publicity Measures | true | IncludesPublicityMeasures |
| Posted On Website | X | PostedOnWebsite |
| Posted In Emergency Room | X | PostedInEmergencyRoom |
| Posted In Admission Office | X | PostedInAdmissionOffice |
| Available On Request | X | AvailableOnRequest |
| Other Publicity | X | OtherPublicity |
| Actions On Nonpayment | true | ActionsOnNonpayment |
| Collection Activities | false | CollectionActivities |
| Notified All Patients | X | NotifiedAllPatients |
| Documented Determination | X | DocumentedDetermination |
| Nondiscrim Emergency Care Policy | true | NondiscrimEmergencyCarePolicy |
| Average Negotiated Rates | X | AverageNegotiatedRates |
| Amounts Generally Billed | false | AmountsGenerallyBilled |
| Gross Charges | false | GrossCharges |
Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Other Facilities | 1 | NumberOfOtherFacilities |
Other Facilities OtherFacilities
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ST JOSEPH'S RETIREMENT COMMUNITY | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 320 E DECATUR | AddressLine1 |
| City | WEST POINT | City |
| State | NE | State |
| ZIP Code | 68788 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility Type | ASSISTED LIVING FACILITY | FacilityType |
Form990 Schedule H Part VI Form990ScheduleHPartVI (13 entries)
| IdentifierIdentifier | ExplanationExplanation |
|---|---|
| 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 7G FRANCISCAN CARE SERVICES, INC. INCLUDED PHYSICIAN CLINIC COSTS OF $755,205 AS SUBSIDIZED HEALTH SERVICES. 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 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 patients account balance when it is determined that the patient will not pay. Therefore, if the patient is self pay and has not paid any of the balance, then 100% of charges are written off. If the patient has commercial insurance and cannot pay the 20% coinsurance that is due after insurance has paid and the contracted discounts have been applied, then only the 20% coinsurance that is owed by the patient is written off to bad debt. PART III, LINE 3 The amount reported on line three is estimated based on an analysis performed by the Patient Accounting Manager and the Patient Financial Counselor. A review of the accounts written off to bad debt is done, taking into consideration the individuals financial situation. During the review, they identify accounts that could have been written off as charity care if sufficient information was received. As a result of the analysis, it was determined that $164,923 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 $164,923 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 from our audited financial statements is as follows: "Accounts receivable for patients, insurance companies, and governmental agencies are based on gross charges. An allowance for uncollectible accounts is established on an aggregate basis by using historical write-off rate factors applied to unpaid accounts based on aging. Loss rate factors are based on historical loss experience and adjusted for economic conditions and other trends affecting the Organization's ability to collect outstanding amounts. Uncollectible amounts are written off against the allowance for doubtful accounts in the period they are determined to be uncollectible." |
| PART III, LINE 8 | Total revenue received from Medicare and Medicare allowable costs reported on Part III, lines 5 & 6 were taken directly from the 2012 Medicare cost report. In addition to the revenue received from Medicare and the Medicare allowable costs reported on the Medicare cost report, we also receive part b payments (fee schedule) from Medicare for certain lab, radiology, rehabilitation and physician services. These amounts are not included on the Medicare cost report. The revenue received from Medicare for our part b services was $511,032 while the associated costs were $644,165 for a shortfall of ($133,133). The costs for the services reimbursed on a fee schedule methodology were calculated based on the cost to charge ratio from the cost report for that department. The shortfall reported on Part III, line 7 of ($57,162) and the medicare part b shortfall of ($133,133) for a total shortfall of ($190,295) should be treated as a community benefit because these are costs over and above the amount that Medicare pays us. These services are integral services 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." PART V, SECTION B - ST. FRANCIS MEMORIAL HOSPITAL (1) 1. Lines 1 - 7 Not applicable for 2012. 2. Lines 10 11 - Not applicable. 3. Line 12 Other factors that we use in determining eligibility for any discounts include eligibility for Medicaid or other assistance and a bank loan. 4. Line 14g - The policy is attached to the billing statement after contact has been made by the Financial Counselor. 5. Lines 16e 22 Not applicable. |
| NEEDS ASSESSMENT | The health care needs of the communities we serve are assessed in many different ways. We work closely with the local area 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, 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 Hospital and Clinic entrance 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 $35,500. 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, 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. During 2012, we initiated an e-ICU program with Alegent Health in Omaha, NE. This program allows an intensivist at Omaha's Lakeside Hospital to follow our most critical patients without transferring the patient to Omaha. We also began offering a free in-home monitoring service to our patients for 60-days after discharge through our Home Health Department. We provide free sport screens to area athletes who think they may have been injured at a practice or game. We offer reduced-cost screens and health education for 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. |
| AFFILIATED HEALTH CARE SYSTEM | Franciscan Care Services, Inc. is a part of the Franciscan Sisters of Christian Charity Sponsored Ministries, a not-for-profit system of acute and long-term health care facilities and a liberal arts college located in Wisconsin, Nebraska and Ohio. Each organization within the Ministry is responsible for carrying out the healing and education mission of the Catholic Church according to the needs of their community. |
| STATE FILING OF COMMUNITY BENEFIT REPORT | The community benefit report is filed with the Nebraska Hospital Association. The report is also sent to our local mayor and our state and congressional representatives. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | X | CompensationCommittee |
| Independent Consultant | X | IndependentConsultant |
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | false | SeverancePayment |
| Supplemental Nonqual Retire Plan | true | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | false | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | true | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | false | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | false | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | false | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | false | AnyNonFixedPayments |
| Initial Contract Exception | false | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (8 entries)
| TitleTitle | Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| RONALD O BRIGGS | ||||||||||||||
| CEO & TRUSTEE | 176275 | 0 | 35442 | 0 | 27665 | 0 | 11712 | 0 | 23812 | 0 | 274906 | 0 | 0 | 0 |
| DENNIS DINSLAGE | ||||||||||||||
| VP FISCAL & SUPPORT SERVICES | 120339 | 0 | 21724 | 0 | 7446 | 0 | 8184 | 0 | 19912 | 0 | 177605 | 0 | 0 | 0 |
| TERRY NELSON | ||||||||||||||
| REHAB MANAGER | 167451 | 0 | 123192 | 0 | 414 | 0 | 30250 | 0 | 21762 | 0 | 343069 | 0 | 0 | 0 |
| MICHAEL BITTLES MD | ||||||||||||||
| PHYSICIAN | 346730 | 0 | 200 | 0 | 9230 | 0 | 13000 | 0 | 23761 | 0 | 392921 | 0 | 0 | 0 |
| SCOTT GREEN MD | ||||||||||||||
| PHYSICIAN | 252248 | 0 | 97121 | 0 | 13136 | 0 | 14500 | 0 | 23761 | 0 | 400766 | 0 | 0 | 0 |
| RHETT ECKMANN MD | ||||||||||||||
| PHYSICIAN | 237096 | 0 | 58844 | 0 | 8500 | 0 | 12211 | 0 | 23761 | 0 | 340412 | 0 | 0 | 0 |
| BRIAN HASS MD | ||||||||||||||
| PHYSICIAN | 240231 | 0 | 62873 | 0 | 12265 | 0 | 12211 | 0 | 21761 | 0 | 349341 | 0 | 0 | 0 |
| KENNETH PITZ MD | ||||||||||||||
| PHYSICIAN | 431480 | 0 | 7620 | 0 | 26274 | 0 | 12500 | 0 | 22011 | 0 | 499885 | 0 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII (2 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| PART I, LINE 4B | QUESTIONS REGARDING COMPENSATION | DURING 2012, 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. TERRY NELSON, REHAB MANAGER, ALSO HAD A WRITTEN AGREEMENT AT THE BEGINNING OF THE CALENDAR YEAR WHICH ALLOWED FOR INCENTIVE COMPENSATION TO BE EARNED BASED UPON A PRE-DETERMINED FORMULA. IN SUMMARY, THE FORMULA TO CALCULATE HIS INCENTIVE COMPENSATION IS BASED ON THE NET COLLECTED REVENUE OF HIS DEPARTMENT LESS WAGE EXPENSE MULTIPLIED BY FIVE PERCENT. DURING THE YEAR, TERRY NELSON RECEIVED A PAYMENT. |
Schedule K IRS990ScheduleK
Form990 Schedule K Part I Form990ScheduleKPartI (2 entries)
| Bond ReferenceBondReferenceCd | Issuer EINIssuerEIN | Date IssuedDateIssued | Issue PriceIssuePrice | Description Of PurposeDescriptionOfPurpose | DefeasedDefeased | On Behalf Of IssuerOnBehalfOfIssuer | Pool FinancingPoolFinancing |
|---|---|---|---|---|---|---|---|
| HOSPITAL AUTHORITY NO 1 OF CUMING COUNTY NE | |||||||
| A | 470762878 | 2010-07-27 | 12000000 | SEE SCHEDULE K, PART VI | false | false | false |
| HOSPITAL AUTHORITY NO 1 OF CUMING COUNTY NE | |||||||
| B | 470762878 | 2009-03-31 | 2200000 | SEE SCHEDULE K, PART VI | false | false | false |
Form990 Schedule K Part II Form990ScheduleKPartII (2 entries)
| Bond ReferenceBondReferenceCd | Amount RetiredAmountRetired | Amount Bond DefeasedAmountBondDefeased | Total ProceedsTotalProceeds | Amount In Reserve FundAmountInReserveFund | Capitalized InterestCapitalizedInterest | Refunding EscrowRefundingEscrow | Issuance Costs From ProceedsIssuanceCostsFromProceeds | Credit EnhancementCreditEnhancement | Working Capital ExpendituresWorkingCapitalExpenditures | Capital ExpendituresCapitalExpenditures | Other Spent ProceedsOtherSpentProceeds | Amount UnspentAmountUnspent | Year Of Subst CompletionYearOfSubstCompletion | Current RefundingCurrentRefunding | Advance RefundingAdvanceRefunding | Final Allocation MadeFinalAllocationMade | Adequate Books And Recds MaintaindAdequateBooksAndRecdsMaintaind |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| A | 192867 | 0 | 12000000 | 0 | 0 | 0 | 0 | 0 | 0 | 12000000 | 0 | 0 | 2012 | false | false | true | true |
| B | 706167 | 0 | 2200000 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 1999 | true | false | true | true |
Form990 Schedule K Part III Form990ScheduleKPartIII (2 entries)
| Bond ReferenceBondReferenceCd | Owning Bond Financed PropertyOwningBondFinancedProperty | Any Lease ArrangementsAnyLeaseArrangements | Mngment Cntrct Bond Financd PrprtyMngmentCntrctBondFinancdPrprty | Any Research AgreementsAnyResearchAgreements | Prcntge Prvt Business Use By OthersPrcntgePrvtBusinessUseByOthers | Percentage Of Prvt Business Re UBIPercentageOfPrvtBusinessReUBI | Total Private Business UseTotalPrivateBusinessUse | Bond Iss Meet Prvt Security Pay TestBondIssMeetPrvtSecurityPayTest | Change In Use Bond Financed PropChangeInUseBondFinancedProp | Remedial Action TakenRemedialActionTaken | Non Qualified Bond Remed ProcdrsNonQualifiedBondRemedProcdrs |
|---|---|---|---|---|---|---|---|---|---|---|---|
| A | false | false | false | false | 0.00000 | 0.00000 | 0.00000 | false | false | false | true |
| B | 0 |
Form990 Schedule K Part IV Form990ScheduleKPartIV (2 entries)
| Bond ReferenceBondReferenceCd | Form8038 T FiledForm8038TFiled | Exception To RebateExceptionToRebate | Variable Rate IssueVariableRateIssue | Hedge Identified In Books And RecdsHedgeIdentifiedInBooksAndRecds | Gross Proceeds Invested In GICGrossProceedsInvestedInGIC | Business Name Line1NameOfGICProvider/BusinessNameLine1 | Gross Proceeds InvestedGrossProceedsInvested | Written Proc To Monitor ReqsWrittenProcToMonitorReqs |
|---|---|---|---|---|---|---|---|---|
| 0 | ||||||||
| A | false | true | true | false | false | 0 | false | true |
| 0 | ||||||||
| B | false | true | false | false | false | 0 | false | true |
Form990 Schedule K Part V Form990ScheduleKPartV (2 entries)
| Bond ReferenceBondReferenceCd | Proc To Undertk Corrective ActionProcToUndertkCorrectiveAction |
|---|---|
| A | true |
| B | true |
Form990 Schedule K Part VI Form990ScheduleKPartVI (2 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| SCHEDULE K, PART 1, LINE A, COLUMN F: | 0 | 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: | 0 | 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
DQP Table DQPTable
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | NA | NamePerson |
Loan Table LoanTable (2 entries)
| Relationship With OrganizationRelationshipWithOrganization | Purpose Of LoanPurposeOfLoan | Loan From OrganizationLoanFromOrganization | Original PrincipalOriginalPrincipalAmount | Balance DueBalanceDue | DefaultDefault | Approved By BoardApprovedByBoard | Written AgreementWrittenAgreement |
|---|---|---|---|---|---|---|---|
| KENNETH PITZMD | |||||||
| HIGHEST COMPENSATION | RELOCATION | X | $22,000 | 14667 | false | true | true |
| KENNETH PITZMD | |||||||
| HIGHEST COMPENSATION | RELOCATION | X | $22,000 | 22000 | false | true | true |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Balance Due | 36667 | TotalBalanceDue |
Form990 Schedule L Part IV Form990ScheduleLPartIV (11 entries)
| RelationshipRelationship | Amount Of TransactionAmountOfTransaction | Description Of TransactionDescriptionOfTransaction | Sharing Of RevenuesSharingOfRevenues |
|---|---|---|---|
| AGNES DINSLAGE | |||
| SEE PART V | 23858 | EMPLOYMENT | false |
| NANCY NELSON | |||
| SEE PART V | 37610 | EMPLOYMENT | false |
| CHERI DOESCHER | |||
| SEE PART V | 27687 | EMPLOYMENT | false |
| BARBARA STEFFEN | |||
| SEE PART V | 20492 | EMPLOYMENT | false |
| DAVID RIDDER | |||
| SEE PART V | 78200 | EMPLOYMENT | false |
| TERRI RIDDER | |||
| SEE PART V | 80023 | EMPLOYMENT | false |
| DOROTHY BURGER | |||
| SEE PART V | 37409 | EMPLOYMENT | false |
| ANGELA WEGNER | |||
| SEE PART V | 30004 | EMPLOYMENT | false |
| ERIN RIDDER | |||
| SEE PART V | 13530 | EMPLOYMENT | false |
| DAN HAKEL | |||
| SEE PART V | 98761 | EMPLOYMENT | false |
| BRENDA WISNIESKI | |||
| SEE PART V | 37258 | EMPLOYMENT | false |
Form990 Schedule L Part V Form990ScheduleLPartV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | SCHEDULE L, PART IV | Identifier |
| Explanation | DAVID RIDDER IS A FAMILY MEMBER OF JACKIE RIDDER, TRUSTEE TERRI RIDDER IS A FAMILY MEMBER OF JACKIE RIDDER, TRUSTEE DOROTHY BURGER IS A FAMILY MEMBER OF JACKIE RIDDER, TRUSTEE ANGELA WEGNER IS A FAMILY MEMBER OF JACKIE RIDDER, TRUSTEE ERIN RIDDER IS A FAMILY MEMBER OF JACKIE RIDDER, TRUSTEE 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 AGNES DINSLAGE IS A FAMILY MEMBER OF DENNIS DINSLAGE, OFFICER NANCY NELSON IS A FAMILY MEMBER OF TERRY NELSON, KEY EMPLOYEE CHERI DOESCHER IS A FAMILY MEMBER OF TERRY NELSON, KEY EMPLOYEE | Explanation |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (8 entries)
| IdentifierIdentifier | ExplanationExplanation | Return ReferenceReturnReference |
|---|---|---|
| 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 | 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. | Checklist of Required Schedules |
| FORM 990, PART VI, LINE 4 | THE NAME OF THE SOLE MEMBER OF FRANCISCAN CARE SERVICES INC. WAS CHANGED FROM FRANCISCAN SISTERS OF CHRISTIAN CHARITY HEALTHCARE MINISTRY, INC. TO THE FRANCISCAN SISTERS OF CHRISTIAN CHARITY SPONSORED MINISTRIES, INC. |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII (8 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Public Charity StatusPublicCharityStatus | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Controlled OrgControlledOrg |
|---|---|---|---|---|---|---|---|---|---|---|
| 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 1 | 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 |
Form990 Schedule R Part III Form990ScheduleRPartIII
Name Of Related Org NameOfRelatedOrg
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | NONE | BusinessNameLine1 |
Form990 Schedule R Part IV Form990ScheduleRPartIV
Name Of Related Org NameOfRelatedOrg
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | HOLY FAMILY HEALTH SERVICES | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3310 CALUMET AVENUE | AddressLine1 |
| City | MANITOWOC | City |
| State | WI | State |
| ZIP Code | 54220 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 391572253 | EIN |
| Primary Activity | PHARMACY | PrimaryActivity |
| Legal Domicile State | WI | LegalDomicileState |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | See Pt II Ln 5 | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Type Of Entity | C CORP | TypeOfEntity |
| Controlled Org | false | ControlledOrg |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | false | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | false | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | true | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | true | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | true | LoansOrGuaranteesFromOtherOrg |
| Dividends Related Organization | false | DividendsRelatedOrganization |
| Sale Of Assets To Other Org | false | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | false | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | false | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | false | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | false | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | false | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | true | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | false | SharingOfFacilities |
| Sharing Of Paid Employees | false | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | true | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | true | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | false | OtherTransferToOtherOrg |
| Other Transfer From Other Org | true | OtherTransferFromOtherOrg |
Transactions Related Orgs Table TransactionsRelatedOrgsTable
Name Of Other Organization NameOfOtherOrganization
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ALL TRANSACTIONS WERE BETWEEN 501(c)(3) ORGS | BusinessNameLine1 |