2025-11-13T15:37:50-06:00 2024-12-31 450250958 EIDE BAILLY LLP 18081 BURT ST STE 200 OMAHA NE 680224722 990 2024-01-01 470486026 FRANCISCAN CARE SERVICES INC FRAN 4023722404 430 N MONITOR ST WEST POINT NE 687881555 TYLER TOLINE PRESIDENT 4023722404 2025-11-11 1 1 WENDY R COOLEY CPA P01523804 4023302660 2025-11-11 2024 2025-03-06 01:10:19Z TYLER TOLINE 430 N MONITOR ST WEST POINT NE 687881555 62299830 0 0928 X WWW.FRANHEALTH.ORG X 1964 NE TO LIVE AND TO PROMOTE THE HEALING MISSION OF JESUS CHRIST BY OPERATING A HOSPITAL. 10 9 387 202 0 0 261317 1196625 54065832 59473302 1213165 1616976 5317 -2865 55545631 62284038 73266 34221 0 0 30059386 33005758 0 0 4044 19006567 23355827 49139219 56395806 6406412 5888232 103783500 115080397 14015571 12497524 89767929 102582873 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 AND PHYSICIAN SERVICES TO ANYONE IN NORTHEAST NEBRASKA, REGARDLESS OF THEIR ABILITY TO PAY. 1 0 46313705 34221 56647651 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 BY OPERATING A HOSPITAL. 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.FRANCISCAN CARE SERVICES, INC. STATS: PATIENTS SERVED DURING THE YEAR: TOTAL IN-PATIENTS DISCHARGED 428 PATIENT DAYS - ACUTE 1,532 - SWING BED 417 - NURSERY 79 OUT-PATIENT & REGISTRATIONS 47,936 HOME HEALTH & HOSPICE 3,665PHYSICIAN CLINIC VISITS 32,735 THE HOSPITAL RECEIVES GENEROUS SUPPORT FROM THE COMMUNITY NOT ONLY FINANCIALLY BUT ALSO FROM APPROXIMATELY 202 VOLUNTEERS WHO DONATED 1,727 HOURS OF THEIR VALUABLE TIME. 2162467 2790323 ST. FRANCIS SERVICES MISSION IS TO PROVIDE EFFICIENT AND PERSONALIZED PHARMACEUTICAL SERVICES TO THE SURROUNDING AREA.ST. FRANCIS SERVICES, LLC STATS: PRESCRIPTIONS COUNT: NEW 26,273 REFILL 28,860 TOTAL 55,133 562800 32463 JOYRIDE PUBLIC TRANSIT'S MISSION IS TO PROVIDE SAFE, EFFICIENT, AND AFFORDABLE PUBLIC TRANSPORTATION TO AREA RESIDENTS IN ACCORDANCE WITH LOCAL, STATE, AND FEDERAL GUIDELINES. 49038972 1 1 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 1 0 0 0 1 72 0 1 387 1 0 0 0 0 0 0 0 0 0 0 0 0 X 10 9 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X ALISA BRUNSING 4023726717 430 NORTH MONITOR STREET WEST POINT NE 687881555 TYLER TOLINE CEO & PRESIDENT 45.00 0.30 X X 421214 0 52224 BILL KREIKEMEIER CHAIRMAN 1.50 0.10 X X 0 0 0 REGINA UHING VICE CHAIRMAN 1.50 X X 0 0 0 CHET MCWHORTER SECRETARY 1.50 X X 0 0 0 JASON SMITH TREASURER 1.50 X X 0 0 0 SR PATRICIA LINSSEN TRUSTEE 1.80 7.90 X 0 0 0 BRIAN REIMERS TRUSTEE 1.00 0.10 X 0 0 0 DYANN BRADBURY TRUSTEE 1.00 X 0 0 0 RODNEY GIESE TRUSTEE 1.00 X 0 0 0 ALLEN MEISTER TRUSTEE 1.00 X 0 0 0 ALISA BRUNSING CFO 50.00 X 254718 0 11880 TERRY NELSON ANCILLARY DIRECTOR 50.00 X 204164 0 32971 JEFF GEAGHAN CIO 50.00 X 176549 0 50893 DARA SCHLECHT CNO 50.00 X 192165 0 50998 RHETT ECKMANN MD PHYSICIAN 43.70 X 662375 0 83684 RENAE MEYER MD PHYSICIAN 41.90 X 383061 0 59540 THOMAS COHEE MD PHYSICIAN 43.90 X 673802 0 56573 BRIAN HASS MD PHYSICIAN 44.10 X 557013 0 88733 ZACHARY WORDEKEMPER MD PHYSICIAN 44.80 X 810097 0 29500 4335158 0 516996 44 0 1 0 BECKENHAUER CONSTRUCTION 1901 RIVERSIDE BLVD NORFOLK NE 68701 BUILDING CONSTRUCTION 3230905 MEYER BUILDING CO INC 650 E DEERE ST WEST POINT NE 68788 BUILDING CONSTRUCTION 1972556 CERNER CORP CO ORACLE AMERICA INC PO BOX 203448 DALLAS TX 753203448 IT SOFTWARE SUPPORT 1078117 LUCENT HEALTH SOLUTIONS LLC PO BOX 306411 NASHVILLE TN 372306411 HEALTH PLAN ADMIN 1048702 MD WEST ONE 8005 FARNAM DRIVE STE 305 OMAHA NE 68114 ORTHOPEDIC SERVICES 779613 19 52101 1065336 79188 1196625 HOSPITAL/CLINIC HEALTHCARE SERVIC 621110 56498651 56498651 RETAIL PHARMACY 456110 2790323 2790323 DIETARY/CAFETERIA 721000 151865 151865 PUBLIC TRANSIT 485000 32463 32463 59473302 1596039 1596039 20937 0 20937 20937 20937 12927 15792 -2865 -2865 62284038 59470437 0 1616976 X 34221 34221 1447776 1235163 212613 92121 92121 24269781 21721874 2547907 699500 542572 156928 4876821 3806734 1070087 1619759 1434826 184933 107862 107862 95206 95206 5325 5325 5853070 4889848 963222 309349 290089 19260 2564261 2293578 270683 1988994 1551892 437102 1068904 885893 183011 283099 246006 37093 181016 167578 13438 112636 24753 87883 3072178 2399483 672695 264714 264714 MEDICAL SUPPLIES 7105518 7105518 DUES & SUBSCRIPTIONS 339651 316823 22828 HOSPITAL AUXILIARY SUPP 4044 4044 56395806 49038972 7352790 4044 250167 1992480 11065821 2555087 8720822 8068250 1203784 1527230 908559 1016036 77464662 47372291 23922995 30092371 55850324 64503142 120605 37090 1740423 5288711 103783500 115080397 9248389 8513650 4767182 3983874 14015571 12497524 X 89660867 99793834 107062 2789039 89767929 102582873 103783500 115080397 X 5888232 4349284 2577428 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 1 5325 1 0 0 5325 0 PART II-B, LINE 1: MEMBERSHIP DUES PAID TO HEALTH CARE ASSOCIATIONS OF WHICH A PERCENTAGE OF THE DUES ARE ALLOCATED TO LOBBYING ACTIVITIES. OCCASIONAL PHONE CALL OR EMAIL TO AND FROM OUR REPRESENTATIVES. 677661 677661 25600136 15355421 10244715 44001483 32016870 11984613 7185382 7185382 30092371 66631642 4349284 4349284 62282358 1680 1680 62284038 56391762 0 56391762 4044 4044 56395806 PART XI, LINE 4B - OTHER ADJUSTMENTS: AUXILIARY INCOME 1,680. PART XII, LINE 4B - OTHER ADJUSTMENTS: AUXILIARY OPERATING EXPENSES 4,044. 1 1 X 1 X 1 X 1 1 0 1 1 84 66152 0 66152 0.00120 1792 3706297 2917195 789102 0.01400 1876 3772449 2917195 855254 0.01520 5527 283899 27668 256231 0.00450 63 198990 0 198990 0.00350 10189 10915933 10497127 418806 0.00740 15779 11398822 10524795 874027 0.01540 17655 15171271 13441990 1729281 0.03060 17950 0 17950 0.00030 981 77742 1290 76452 0.00140 315 24154 0 24154 0.00040 1296 119846 1290 118556 0.00210 1 1478884 295000 16272453 16707334 -434881 X 1 1 1 1 FRANCISCAN HEALTHCARE 430 NORTH MONITOR STREET WEST POINT NE 68788 WWW.FRANHEALTH.ORG 180001 X X X X FRANCISCAN HEALTHCARE 1 0 0 1 X X X X X X X X X 22 1 1 1 1 X PART V, PAGE 8 X 1 22 1 WWW.FRANHEALTH.ORG/ABOUT/NEEDS-ASSESSMENT.HTML 0 1 X 100.000000000000 200.000000000000 X 1 1 X X X 1 X HTTPS://FRANHEALTH.ORG/PATIENTS-VISITORS/PATIENT-FINANCIAL-INFORMATION.HTML X HTTPS://FRANHEALTH.ORG/PATIENTS-VISITORS/PATIENT-FINANCIAL-INFORMATION.HTML X HTTPS://FRANHEALTH.ORG/PATIENTS-VISITORS/PATIENT-FINANCIAL-INFORMATION.HTML X X X X X X 1 X 0 X X X X 1 X 0 0 FRANCISCAN HEALTHCARE PART V, SECTION B, LINE 5: IN 2022, THE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) PROCESS WAS A SHIFT TO A MAINLY ONLINE AND VIRTUAL VERSION DUE TO THE LEVEL OF RESPONSE NEEDED BY ELKHORN LOGAN VALLEY PUBLIC HEALTH DEPARTMENT (ELVHD) AND THE HOSPITAL SYSTEMS THAT PARTICIPATED TO RESPOND TO THE VARIOUS STAGES OF THE COVID-19 PANDEMIC. THERE WERE FOUR KEY ASSESSMENTS THAT WERE DONE.1. THE 2021 NEBRASKA RISK AND PROTECTIVE FACTOR STUDENT SURVEY WAS USED. THIS SURVEY IS DESIGNED TO ASSESS ADOLESCENT SUBSTANCE USE, DELINQUENT BEHAVIOR, AND MANY OF THE RISK AND PROTECTIVE MEASURES THAT PREDICT ADOLESCENT PROBLEM BEHAVIORS. IN THE ELVPHD DISTRICT THERE WERE 466 TOTAL STUDENTS THAT RESPONDED TO THE SURVEY, REPRESENTING 19.7% OF ELIGIBLE STUDENTS.2. AN ELECTRONIC SURVEY, IN MULTIPLE LANGUAGES, SENT TO ETHNIC MINORITIES IN OUR SERVICE AREA VIA SOCIAL MEDIA AND IN-PERSON AT VARIOUS EVENTS AND WALK-IN CLINICS. THE SURVEY PERIOD SPANNED FROM NOVEMBER 2021 TO APRIL 2022. THE PURPOSE OF THE SURVEY WAS TO DETERMINE THE KEY HEALTH ISSUES FACING OUR MINORITY POPULATIONS, AS WELL AS WHAT ISSUES THE PARTICIPANTS WANTED ADDRESSED BY THE HEALTH CARE SYSTEM. 90 SURVEYS WERE COLLECTED AND ANALYZED.A. IN ADDITION TO THE ELECTRONIC SURVEY, ELVPHD ALSO SCHEDULED TWO COMMUNITY LISTENING SESSIONS IN MAY 2022 - ONE IN NORFOLK, NEBRASKA AND ONE IN WEST POINT, NEBRASKA. APPROXIMATELY 20 PEOPLE ATTENDED THE LISTENING SESSIONS.3. ON JUNE 16, 2022, AN ELECTRONIC SURVEY WAS SENT TO HEALTHCARE SYSTEM COLLABORATORS AND PARTNERS INCLUDING LONG-TERM CARE FACILITIES, CHILDCARE PROVIDERS, SCHOOL OFFICIALS, HEALTH DEPARTMENT AND HOSPITAL BOARD MEMBERS, CLINICIANS, EMS, UNL EXTENSION OFFICES, ELECTED OFFICIALS, BEHAVIORAL HEALTH PROVIDERS, LAW ENFORCEMENT, NORTHEAST COMMUNITY COLLEGE, COMMUNITY-BASED ORGANIZATIONS, CITY EMPLOYEES, TRIBAL ORGANIZATIONS, JAILS, ORGANIZATIONS REPRESENTING THOSE WITH DISABILITIES, CHURCHES, AND SENIOR CITIZEN CENTERS. THE SURVEY OFFERED RESPONDENTS AN OPPORTUNITY TO INDICATE THEIR ISSUES OR CONCERNS, PROPOSE AREAS OF IMPROVEMENT, AND SUBMIT THEIR FEEDBACK IN TERMS OF OPPORTUNITIES ON THE HORIZON TO BE PURSUED. APPROXIMATELY 40 SURVEYS WERE RECEIVED. 4. RESIDENTS IN BURT, CUMING, STANTON, AND MADISON COUNTIES WERE INVITED TO TAKE A COMMUNITY-LEVEL HEALTH ASSESSMENT SURVEY THROUGH PUBLIC PRESS RELEASES, RADIO PUBLIC SERVICE ANNOUNCEMENTS, CHAMBER OF COMMERCE NEWSLETTERS, POSTS AT EMPLOYERS AND AREA BUSINESSES, SENIOR CITIZENS CENTERS, SOCIAL MEDIA POSTS, AND DISTRIBUTION OF PAPER FLYERS. APPROXIMATELY 1,100 SURVEYS WERE COMPLETED. IN ALL, THERE WERE 1,657 UNDUPLICATED PARTICIPANTS. THE TOTAL PARTICIPATION RATE WAS UP 16.5% FROM 2019 (1,422 PARTICIPANTS IN 2019 COMPARED TO 1,657 PARTICIPANTS IN 2022). FRANCISCAN HEALTHCARE PART V, SECTION B, LINE 6A: FRANCISCAN HEALTHCARE CONDUCTED ITS CHNA IN CONJUNCTION WITH FAITH REGIONAL HEALTH SERVICES IN NORFOLK, NEBRASKA. FRANCISCAN HEALTHCARE PART V, SECTION B, LINE 6B: FRANCISCAN HEALTHCARE CONDUCTED ITS CHNA IN CONJUNCTION WITH ELKHORN LOGAN VALLEY PUBLIC HEALTH DEPARTMENT. FRANCISCAN HEALTHCARE PART V, SECTION B, LINE 11: THE 2022 CHNA REVEALED TWO MAIN HEALTH PRIORITIES IN OUR AREA: 1) BEHAVIORAL/MENTAL HEALTH AND 2) CANCER PREVENTION AND SCREENING. THE CHNA IMPLEMENTATION PLAN HAS THE FOLLOWING GOALS TO IMPROVE THE HEALTH PRIORITIES IDENTIFIED. FOR THE HEALTH PRIORITY OF BEHAVIORAL/MENTAL HEALTH WE WILL:1. CONTINUE PROVIDING JOB SHADOWING EXPERIENCES AND PRECEPTORSHIP PROGRAMS FOR POTENTIAL BEHAVIORAL/MENTAL HEALTH STUDENTS ENTERING THE PIPELINE, AND FOR CURRENT MEDICAL STUDENTS COMPLETING FIELD TRAINING. RECRUIT BEHAVIORAL/MENTAL HEALTH PROVIDERS. IN 2024, WE HAD ONE LMHP STUDENT COMPLETE THEIR PSYCHOLOGY ROTATION WITH OUR CHILD PSYCHOLOGIST, AND WE STARTED RECRUITING FOR A COUNSELOR IN THE WEST POINT CLINIC.2. CONTINUE TELEMEDICINE ACCESS IN THE DISTRICT FOCUSING ON BEHAVIORAL AND MENTAL HEALTH SERVICES. IN 2024, VARIOUS MEDICAL STAFF CONTINUED TO USE TELEHEALTH TO REACH PATIENTS AND PROVIDE ACCESS TO CARE FOR MENTAL HEALTH VISITS.3. CONTINUED USE OF CLINICAL ASSESSMENTS FOR ALL PATIENT ENCOUNTERS IN THE MEDICAL SETTING FOR SUBSTANCE MISUSE AND/OR SUBSTANCE ABUSE DISORDERS AND SUICIDE RISK AND TRIAGE. IN 2024, WE SCREENED ALL PATIENTS, 12 YEARS OF AGE AND OLDER FOR DEPRESSION AND SUICIDE. IF THE SCREENING WAS POSITIVE, WE PROVIDED APPROPRIATE REFERRAL FOR TREATMENT.FOR THE HEALTH PRIORITY OF CANCER PREVENTION AND SCREENING WE WILL:1. INCREASE PHYSICAL ACTIVITY THROUGH INSTRUCTION OF EVIDENCE-BASED CURRICULUMS GEARED TOWARDS DIETARY IMPROVEMENTS AND HEALTHY LIFESTYLES. EVIDENCE-BASED CURRICULUMS MAY INCLUDE: A. NATIONAL DIABETES PREVENTION PROJECT (NDDP) - BOTH TRADITIONAL AND HYBRID B. HEALTH COACHES C. EATING SMART AND BEING ACTIVE IN 2024, HEALTH COACHES MET WITH PRE-DIABETIC AND DIABETIC PATIENTS TO DISCUSS HOW THEY CAN CHANGE THEIR LIFESTYLE TO BE COMPLIANT WITH THEIR DISEASE. THIS INCLUDES HOW PHYSICAL ACTIVITY CAN PLAY A PART IN THEIR LIFESTYLE.2. INCREASE CREATION OF (OR ENHANCED ACCESS TO) PUBLIC PLACES FOR PUBLIC USE TO INCREASE PHYSICAL ACTIVITY AND IMPROVE PHYSICAL FITNESS. ITEMS TO CONSIDER INCLUDE CREATING WALKING TRAILS, PARKS IMPROVEMENT, INCLUSIVE PLAYGROUNDS, AND PARTNERSHIPS WITH CORE HEALTH. IN 2024, FRANCISCAN HEALTHCARE WAS INSTRUMENTAL IN THE WEST POINT TRAILS AND PATHWAYS PROJECT AS WELL AS THE NELIGH PARK INCLUSIVE PLAYGROUND AREA. WE ENCOURAGED OUR PATIENTS TO UTILIZE THESE SPACES FOR PHYSICAL ACTIVITY. WE ALSO HELD PHYSICAL FITNESS CLASSES AT CORE HEALTH AT NO FEE OR REDUCED FEES FOR THE COMMUNITY AND STARTED AN INCLUSIVE PLAYGROUND PROJECT IN THE OAKLAND COMMUNITY.3. INCREASE ACCESS AND UTILIZATION OF FREE AND LOW-COST CANCER SCREENINGS. SUCH EXAMPLES INCLUDE: PARTICIPATION AS HEALTHCARE PROVIDER IN THE NEBRASKA DHHS EVERY WOMAN MATTERS PROGRAM AS A PROVIDER OF FREE PAP TESTS, PELVIC EXAMS, CLINICAL BREAST EXAMS AND LAB FEES, AND MAMMOGRAPHY FOR ELIGIBLE WOMEN. IN 2024, FRANCISCAN HEALTHCARE CONTINUED TO PARTICIPATE IN THE NEBRASKA DHHS EVERY WOMAN MATTERS PROGRAM. WE ALSO HAVE A CASH LAB DAY ONCE A MONTH WHERE PATIENTS CAN RECEIVE PSA SCREENINGS AT A REDUCED RATE.4. INCREASE REFERRALS FOR AGE-APPROPRIATE ROUTINE CANCER SCREENINGS THROUGH REMINDER/RECALL INITIATIVES FOR BREAST CANCER SCREENING, CERVICAL CANCER SCREENING, PROSTATE CANCER SCREENING, COLON CANCER SCREENING, AND LUNG CANCER SCREENING FOR CURRENT OR FORMER SMOKERS. IN 2024, WHEN A PATIENT SCHEDULED THEIR ANNUAL PHYSICAL, A HEALTH COACH REACHED OUT TO THEM TO HELP THEM SCHEDULE THEIR LAB WORK AND MAMMOGRAPHY, IF APPROPRIATE. DURING THE ANNUAL PHYSICAL, THE PROVIDER WENT THROUGH THE SCREENINGS THAT ARE APPLICABLE TO PATIENTS BASED ON THEIR AGE AND RISK FACTORS AND ENCOURAGED THEM TO DO THEM AS APPROPRIATE. FOR LUNG CANCER SCREENING FRANCISCAN HEALTHCARE TEAMED UP WITH A RADIOLOGIST WHO HAD A GRANT TO INCREASE LOW DOSE CT LUNG SCANS FOR LUNG CANCER SCREENING. FRANCISCAN HEALTHCARE IMPROVED DOCUMENTATION OF SMOKING HISTORY AND SMOKING PACK YEARS, INCLUDING RADIOLOGY TECHS DOCUMENTING SMOKING HISTORY AND CREATED A PROTOCOL FOR ORDERING AND OBTAINING LOW DOSE CT LUNG SCANS WHEN CRITERIA WAS MET. WE ALSO HAD PATIENT EDUCATION CARDS AVAILABLE IN AREAS OF THE HOSPITAL AND CLINIC THAT PATIENTS COULD COMPLETE AND SELF-REFER FOR A SCAN, IF INDICATED. THROUGH INCREASED AWARENESS OF ALL STAFF, WE HAVE INCREASED THE NUMBER OF LOW DOSE CT LUNG SCANS PERFORMED BY 115% FROM 2022 TO 2024. WE ALSO PARTNERED WITH THE ELKHORN LOGAN VALLEY PUBLIC HEALTH DEPARTMENT TO MAKE OUTREACH CALLS TO WOMEN WHO ARE NOT UP TO DATE WITH BREAST OR CERVICAL CANCER SCREENING.5. INCREASE THE ADMINISTRATION OF HPV VACCINES THROUGH UTILIZATION OF THIRD-PARTY REIMBURSEMENT FOR INSURED CLIENTS AND VACCINES FOR CHILDREN (VFC) PROGRAM FOR MEDICAID, UNINSURED AND UNDERINSURED CLIENTS. IN 2024, FRANCISCAN HEALTHCARE CONTINUED TO PARTICIPATE IN THE VACCINES FOR CHILDREN PROGRAM, AND DURING PATIENTS' WELLNESS VISITS, THE NURSE AND PHYSICIAN OFFER THE HPV VACCINE IF THE PATIENT QUALIFIES.6. CONTINUE OFFERING SMOKING CESSATION CLASSES FOR INDIVIDUALS WHO DESIRE TO STOP USING TOBACCO PRODUCTS. IN 2024, WE OFFERED SMOKING CESSATION CLASSES FOR PATIENTS. THE CLASS IS OFFERED TO PATIENTS BY THE PROVIDER DURING CLINIC VISITS OR HOSPITAL STAYS.THE CHNA ONLY FOCUSES ON TWO MAIN HEALTH PRIORITIES. HOWEVER, IT SHOULD BE NOTED THAT SOME OF THE OTHER OPPORTUNITIES FOR PRIORITIZATION THAT WERE IDENTIFIED DURING THE CHNA SUCH AS RECRUITMENT AND RETENTION OF HEALTHCARE WORKFORCE, HOME STABILITY, FOOD INSECURITY, OPIOID OVERDOSE AND MISUSE, MEDICAID REIMBURSEMENT FOR LONG-TERM CARE FACILITIES, SHORTAGE OF EMS PROVIDERS, ETC. ARE STILL ISSUES THAT WE FACE AND WORK THROUGH OFTEN. JUST BECAUSE THEY ARE NOT PART OF THE CHNA, DOES NOT MEAN THAT WE ARE NOT FOCUSING ON THEM AND WORKING TO IMPROVE THE OUTCOMES. PART V, SECTION B, LINE 7A: COMMUNITY HEALTH NEEDS ASSESSMENT WEBSITE:WWW.FRANHEALTH.ORG/ABOUT/NEEDS-ASSESSMENT.HTML 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: SUBSIDIZED HEALTH SERVICES OF $418,806 ARE REPORTED ON LINE 7G. THIS AMOUNT REPRESENTS THE COMMUNITY BENEFIT ATTRIBUTABLE TO HOME HEALTH AND PHYSICIAN SERVICES. PART II, COMMUNITY BUILDING ACTIVITIES: FRANCISCAN CARE SERVICES, INC., HAS BEEN INVOLVED IN MANY COMMUNITY BUILDING ACTIVITIES OVER THE LAST YEAR. THE PRESIDENT/CEO AND A BOARD MEMBER ARE ON THE PLANNING COMMITTEE FOR A NEW RECREATION CENTER IN WEST POINT, NE. WE ALSO ASSISTED WITH A DONATION FOR THE GRANT WRITING FOR THE NEW RECREATION CENTER. WE MAKE DONATIONS TO VARIOUS FIRE AND RESCUE DEPARTMENTS, SCHOOLS, PARISHES, CITIES, ETC. TO IMPROVE THE COMMUNITY'S HEALTH AND SAFETY. WE PROVIDE COMMUNITY SUPPORT THROUGH USAGE OF OUR CONFERENCE ROOMS FOR VARIOUS EVENTS SUCH AS: MEDICARE PART D ENROLLMENT BY COMMUNITY VOLUNTEERS, WEIGHT LOSS CLASS FOR THE PUBLIC, ENGLISH AS A SECOND LANGUAGE CLASSES FOR THE COMMUNITY. WE RUN A FOOD PANTRY, SUPPLY DME TO PATIENTS WHO CAN'T AFFORD THEM, AND ORGANIZE A SANTA'S HELPERS PROGRAM FOR THE COMMUNITY. WORKFORCE DEVELOPMENT INCLUDES TIME SPENT BY AN EMPLOYEE ON THE NE WORKFORCE INVESTMENT BOARD AND A NE STATE REHABILITATION COUNCIL. 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 SHADOW 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. PART III, LINE 2: THE AMOUNT ON LINE 2 IS IMPLICIT PRICE CONCESSIONS. THE ORGANIZATION DETERMINES ITS ESTIMATE OF IMPLICIT PRICE CONCESSIONS BASED ON HISTORICAL COLLECTION EXPERIENCE WITH VARIOUS CLASSES OF PATIENTS. 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 AS IMPLICIT PRICE CONCESSIONS 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 $295,000 WOULD POSSIBLY HAVE QUALIFIED AS CHARITY CARE.THERE IS A FINE LINE BETWEEN IMPLICIT PRICE CONCESSIONS 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 $295,000 OF OUR IMPLICIT PRICE CONCESSIONS 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: PAGE 10 OF THE ATTACHED AUDITED FINANCIAL STATEMENTS DISCUSSES IMPLICIT PRICE CONCESSIONS. 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 2024 MEDICARE COST REPORT. IN ADDITION TO THE REVENUE RECEIVED FROM MEDICARE AND THE MEDICARE ALLOWABLE COSTS REPORTED ON THE MEDICARE COST REPORT, WE ALSO RECEIVE MEDICARE PART B PAYMENTS (FEE SCHEDULE) FOR CERTAIN LAB, RADIOLOGY, AND PHYSICIAN SERVICES. THESE AMOUNTS ARE NOT INCLUDED ON THE MEDICARE COST REPORT. THE REVENUE RECEIVED FOR MEDICARE PART B SERVICES WAS $427,018 WHILE THE ASSOCIATED COSTS WERE $1,572,557 FOR A SHORTFALL OF ($1,145,539). THE COSTS FOR THE SERVICES REIMBURSED ON A FEE SCHEDULE METHODOLOGY WERE CALCULATED USING THE COST TO CHARGE RATIO FROM THE MEDICARE COST REPORT FOR THAT DEPARTMENT.THE SHORTFALL REPORTED ON PART III, LINE 7 OF ($434,881) AND THE MEDICARE PART B SHORTFALL OF ($1,145,539) FOR A TOTAL SHORTFALL OF ($1,580,420) 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: THE HOSPITAL MUST DETERMINE WHETHER AN INDIVIDUAL IS FAP-ELIGIBLE OR PROVIDE REQUIRED NOTICES DURING A NOTIFICATION PERIOD ENDING 120 DAYS AFTER THE DATE OF THE FIRST BILLING STATEMENT. ALTHOUGH THE HOSPITAL MAY USE EXTRAORDINARY COLLECTION EFFORTS AFTER THE 120-DAY NOTIFICATION PERIOD, WE MUST STILL ACCEPT AND PROCESS A FAP APPLICATION FOR AN ADDITIONAL 120 DAYS. THE TOTAL PERIOD DURING WHICH WE MUST ACCEPT AND PROCESS FAP APPLICATIONS IS 240 DAYS FROM THE DATE OF THE FIRST BILLING STATEMENT. IF THE HOSPITAL RECEIVES A FAP APPLICATION DURING THE APPLICATION PERIOD, WE MUST SUSPEND ANY EXTRAORDINARY COLLECTION EFFORTS STARTED UNTIL THE APPLICATION IS PROCESSED, AND IF THE INDIVIDUAL IS FAP-ELIGIBLE, MUST SEEK TO REVERSE THE EXTRAORDINARY COLLECTION EFFORTS AND PROMPTLY REFUND ANY OVERPAID AMOUNTS. DEBTS MAY BE REFERRED TO THIRD PARTIES TO ASSIST WITH COLLECTION EFFORTS, THEY MAY NOT BE SOLD TO THIRD PARTIES DURING THE NOTIFICATION PERIOD UNTIL AN ELIGIBILITY DETERMINATION HAS BEEN MADE. PART VI, LINE 2: THE HEALTH CARE NEEDS OF THE COMMUNITIES WE SERVE ARE ASSESSED IN MANY WAYS. WE WORK CLOSELY WITH THE 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 THESE GROUPS WORK TOGETHER WITH ADMINISTRATION TO CONTINUE TO ADDRESS THE HEALTH CARE NEEDS OF THE COMMUNITY. PART VI, LINE 3: 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 PATIENT FINANCIAL COUNSELOR TO SET UP A PAYMENT PLAN OR TO DETERMINE IF YOU ARE ELIGIBLE FOR FINANCIAL ASSISTANCE." THE FINANCIAL ASSISTANCE POLICY (FAP), THE PLAIN LANGUAGE SUMMARY OF THE FAP, THE APPLICATION FOR FINANCIAL ASSISTANCE, AND FINANCIAL ASSISTANCE CONTACT INFORMATION IS POSTED AT THE MAIN ENTRANCE TO THE HOSPITAL AND CLINIC AND ALSO AT THE EMERGENCY ROOM ENTRANCE AND IS ALSO POSTED ON OUR WEBSITE AT HTTP://FRANHEALTH.ORG/PATIENTS-VISITORS/PATIENT-FINANCIAL-INFORMATION.HTML. A PLAIN LANGUAGE SUMMARY OF THE FAP IS OFFERED TO PATIENTS UPON REGISTRATION. ON OUR PATIENT BILLS THERE IS A SECTION THAT STATES "WE ALSO OFFER FINANCIAL ASSISTANCE TO PATIENTS WHO QUALIFY. PLEASE CONTACT THE PATIENT FINANCIAL COUNSELOR AT 402-372-4029 FOR MORE INFORMATION OR VISIT OUR WEBSITE AT HTTP://FRANHEALTH.ORG/PATIENTS-VISITORS/PATIENT-FINANCIAL-INFORMATION.HTML."ALSO, IF THE PATIENT FINANCIAL COUNSELOR CONTACTS A PATIENT REGARDING PAYMENT OF A BILL, A LETTER AND A SUMMARY OF THE FINANCIAL ASSISTANCE POLICY IS SENT TO THEM WHICH STATES THAT IF THEY ARE UNABLE TO PAY THEIR BILL, THEY MAY BE ELIGIBLE FOR OUR FINANCIAL ASSISTANCE PROGRAM. PART VI, LINE 4: FRANCISCAN CARE SERVICES, INC. IS LOCATED IN A RURAL AREA, PREDOMINANTLY AGRICULTURALLY BASED. THE POPULATION OF OUR SERVICE AREA IS APPROXIMATELY 18,000 PEOPLE. THE MEDIAN HOUSEHOLD INCOME IS APPROXIMATELY $69,000. THE POPULATION IS PREDOMINANTLY CAUCASIAN, HIGH SCHOOL EDUCATED, AND GERIATRIC IN NATURE. THERE IS A GROWING POPULATION OF HISPANIC DESCENT. PART VI, LINE 5: THE BOARD OF DIRECTORS IS COMPRISED OF INDIVIDUALS FROM THE SURROUNDING COMMUNITIES. THE BOARD MEMBERS ARE DIVERSE IN BACKGROUND RANGING FROM SISTERS FROM OUR SPONSOR, PUBLIC HEALTH DIRECTOR, BANKERS, AND BUSINESS OWNERS 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 SEVEN FAMILY PRACTICE PHYSICIANS, A CHILD PSYCHOLOGIST, FIVE PHYSICIAN ASSISTANTS, AND FIVE NURSE PRACTITIONERS. WE CONTRACT WITH AN ORTHOPEDIC GROUP TO PROVIDE SERVICES FOR US IN THE WEST POINT CLINIC. 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. THE SPECIALISTS SEE PATIENTS IN EITHER OUR RURAL HEALTH CLINIC OR OUTPATIENT CLINIC. SPECIALISTS INCLUDE AUDIOLOGY, CARDIOLOGY, DERMATOLOGY, ENT, GENERAL SURGERY, NEPHROLOGY, NEUROLOGY, OBSTETRICS/GYNECOLOGY, ONCOLOGY, OPHTHALMOLOGY, PAIN, PODIATRY, PULMONOLOGY, RHEUMATOLOGY, UROLOGY, AND VASCULAR. THERE ARE MANY DIFFERENT PROGRAMS THAT WE ARE ABLE TO OFFER DUE TO SURPLUS FUNDS FROM OPERATIONS. OUR CLINICS PROVIDE DISEASE MANAGEMENT THROUGH THE USE OF HEALTH COACHES TO HELP PATIENTS MANAGE CHRONIC HEALTH CONDITIONS SUCH AS DIABETES, HYPERTENSION, COPD, CLOTTING, AND OSTEOPOROSIS. THIS IS A PROGRAM THAT IS GOOD FOR OUR PATIENTS EVEN THOUGH WE RECEIVE LITTLE TO NO REIMBURSEMENT FOR PROVIDING THIS SERVICE. WE PROVIDE FREE SPORT SCREENS TO AREA ATHLETES WHO HAVE BEEN INJURED AT A PRACTICE OR GAME. WE OFFER REDUCED-COST SCREENS AND HEALTH EDUCATION TO BUSINESSES IN OUR SERVICE AREA TO REACH OUT TO THOSE INDIVIDUALS WHO DO NOT TAKE THE TIME TO COME TO OUR FACILITY TO SEE US. WE PROVIDE A NUMBER OF EXERCISE PROGRAMS FOR THE ELDERLY IN THE COMMUNITY. WE OFFER DISCOUNTED LABS TO THE COMMUNITY. WE ARE ALSO ABLE TO INVEST BACK INTO THE ORGANIZATION WITH NEW EQUIPMENT AND IMPROVEMENTS TO FACILITIES. IN 2024, CAPITAL PURCHASES/IMPROVEMENTS INCLUDE PATIENT BEDS, A FETAL MONITOR, A CT MACHINE, AN OVERHEAD GAIT TRAINING SYSTEM, AN ADDITION AND RENOVATIONS TO THE OAKLAND CLINIC, AND VARIOUS IT UPDATES. PART VI, LINE 6: 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 LOCATED IN WISCONSIN, NEBRASKA AND OHIO. EACH ORGANIZATION WITHIN THE MINISTRY IS RESPONSIBLE FOR CARRYING OUT THE HEALING MISSION OF THE CATHOLIC CHURCH ACCORDING TO THE NEEDS OF THEIR COMMUNITY. PART VI, LINE 7: 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. 1 ORPHAN GRAIN TRAIN 601 W PHILLIP AVE NORFOLK NE 68701 311614650 501(C)(3) 0 27963 FMV MEDICAL SUPPLIES PROGRAM SUPPORT CENTRAL CATHOLIC HS OF WEST POINT ACTIVITIES BOOSTER CLUB 419 E DECATUR ST WEST POINT NE 68788 470481878 501(C)(3) 6258 0 PROGRAM SUPPORT 2 0 PART I, LINE 2: APPLICANTS FOR GRANT FUNDING ARE REQUIRED TO PROVIDE FINANCIAL AND PERFORMANCE RESULTS TO ENSURE PROPER USE OF THE APPLIED FUNDS. GRANT FUND DOLLARS MUST BE SPENT AS INTENDED. AS A GRANTEE, WE COMPLY WITH THE PROGRAM EXPECTATIONS, USE FUNDS IN AN EFFICIENT MANNER AND REMAIN FISCALLY RESPONSIBLE. X 1 1 X X X 0 1 0 1 0 0 0 0 0 ZACHARY WORDEKEMPER MD PHYSICIAN 332721 0 410270 0 67106 0 12500 0 17000 0 839597 0 0 0 RHETT ECKMANN MD PHYSICIAN 310496 0 333115 0 18764 0 35571 0 48113 0 746059 0 0 0 THOMAS COHEE MD PHYSICIAN 350432 0 298462 0 24908 0 12500 0 44073 0 730375 0 0 0 BRIAN HASS MD PHYSICIAN 287264 0 214807 0 54942 0 41821 0 46912 0 645746 0 0 0 TYLER TOLINE CEO & PRESIDENT 273218 0 78909 0 69087 0 10242 0 41982 0 473438 0 0 0 RENAE MEYER MD PHYSICIAN 246217 0 101534 0 35310 0 12500 0 47040 0 442601 0 0 0 ALISA BRUNSING CFO 174084 0 37328 0 43306 0 11880 0 0 0 266598 0 0 0 DARA SCHLECHT CNO 155439 0 36083 0 643 0 6150 0 44848 0 243163 0 0 0 TERRY NELSON ANCILLARY DIRECTOR 160156 0 41999 0 2009 0 9433 0 23538 0 237135 0 0 0 JEFF GEAGHAN CIO 145284 0 30704 0 561 0 4468 0 46425 0 227442 0 0 0 PART I, LINE 4B DURING 2024, FRANCISCAN CARE SERVICES, INC. CONTRIBUTED FUNDS TO AN IRC SECTION 457(F) PLAN FOR THE FOLLOWING INDIVIDUALS: DR. COHEE $12,500 DR. WORDEKEMPER $12,500 DR. ECKMANN $4,321 DR. HASS $4,321 DR. MEYER $12,500 PART I, LINE 5 IN EACH OF THE FAMILY PRACTICE PHYSICIAN'S CONTRACTS, THERE IS A SECTION THAT ESTABLISHES THE POTENTIAL AMOUNT OF SUPPLEMENTAL INCOME THAT THE 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 CONTRACT. THE FORMULA 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, DR. ECKMANN, DR. COHEE, DR. HASS, DR. MEYER, AND DR. WORDEKEMPER RECEIVED A PAYMENT. A HOSPITAL AUTHORITY NO 1 OF CUMING COUNTY NE 470762878 000000000 2016-10-01 10000000 FOR AN ADDITION TO AND IMPROVEMENTS FOR EXISTING HOSPITAL FACILITIES. 0 0 0 A 5988813 10000000 10000000 2012 1 0 1 1 A 0 0 0 0 0 0 1 A 0 0 1 0 0 0 0 0 1 A 1 SCHEDULE K, PART I, LINE A, COLUMN F: THE BOND IS BEING REISSUED FOR FEDERAL TAX PURPOSES AS OF OCTOBER 1, 2016 DUE TO CHANGES TO THE TERMS OF THE OBLIGATION. THE NOTES WERE ORIGINALLY ISSUED FOR THE PURPOSE OF PROVIDING A LOAN TO FRANCISCAN CARE SERVICES, INC. (THE "HOSPITAL") FOR AN ADDITION TO AND IMPROVEMENTS FOR EXISTING HOSPITAL FACILITIES LOCATED IN THE CITY OF WEST POINT, NEBRASKA, OWNED BY THE HOSPITAL. RODNEY SCHLECHT FAMILY MEMBER OF KEY EMPLOYEE, DARA SCHLECHT 92121 W-2 WAGES 0 FORM 990, PART III, LINE 2 IN 2024, FRANCISCAN CARE SERVICES STARTED JOYRIDE PUBLIC TRANSIT, A SERVICE THAT PROVIDE SAFE, EFFICIENT, AND AFFORDABLE PUBLIC TRANSPORTATION TO AREA RESIDENTS IN ACCORDANCE WITH LOCAL, STATE, AND FEDERAL GUIDELINES. FORM 990, PART VI, SECTION A, LINE 1A THE EXECUTIVE COMMITTEE SHALL HAVE THE AUTHORITY TO ACCOMPLISH THOSE TASKS ASSIGNED IT BY THE BOARD OF DIRECTORS AND TO TRANSACT THE ESSENTIAL BUSINESS OF THE BOARD THAT CANNOT AWAIT A REGULAR OR SPECIAL MEETING OF THE BOARD, PROVIDED THAT NO ACTION TAKEN AT SUCH MEETINGS SHALL BE IN CONFLICT WITH THE EXPRESSED POLICIES OF THE BOARD OR THE AUTHORITY GRANTED THIS COMMITTEE BY THE BOARD OR BY-LAWS. FORM 990, PART VI, SECTION A, LINE 6 THE ORGANIZATION IS A NOT-FOR-PROFIT CORPORATION WHOSE SOLE CORPORATE MEMBER IS FRANCISCAN SISTERS OF CHRISTIAN CHARITY SPONSORED MINISTRIES, INC. FORM 990, PART VI, SECTION A, LINE 7A THE FRANCISCAN SISTERS OF CHRISTIAN CHARITY SPONSORED MINISTRIES, INC., A WISCONSIN NON-STOCK, NOT FOR PROFIT CORPORATION IS THE SOLE CORPORATE MEMBER OF FRANCISCAN CARE SERVICES, INC. AND HAS THE AUTHORITY TO APPOINT AND REMOVE MEMBERS OF THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION A, LINE 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 OF THE BOARD OF DIRECTORS. D) APPROVAL OF THE CREATION AND DISSOLUTION OF THIS CORPORATION OR ANY SUBSIDIARY CORPORATIONS, AS WELL AS APPROVAL OF ANY MERGER, CONSOLIDATION, AFFILIATION, JOINT VENTURE OR OTHER FORM OF CORPORATE REORGANIZATION OF THIS CORPORATION OR ANY SUBSIDIARY OF WHICH THIS CORPORATION IS THE MEMBER OR CONTROLLING SHAREHOLDER. E) APPOINTMENT, EVALUATION AND DISCHARGE OF THE PRESIDENT OF THE CORPORATION. F) APPROVAL OF BORROWING IN EXCESS OF THE LIMIT ESTABLISHED BY THE MEMBER. G) APPROVAL OF PURCHASE, MORTGAGE OR SALE OF REAL ESTATE, OR LEASE OF REAL ESTATE, BY OR TO THE CORPORATION FOR LONGER THAN ONE YEAR. H) IMPLEMENTATION OF SPONSOR APPOINTMENT, SALARY NEGOTIATION, AND REASSIGNMENT PROCESSES FOR FRANCISCAN SISTER PERSONNEL WITHIN THIS CORPORATION. I) APPROVAL OF CAPITAL AND OPERATING BUDGETS. J) REQUIREMENT OF A CERTIFIED AUDIT OF CORPORATE FUNDS AT ANY TIME AND APPROVAL OF THE FISCAL AUDITOR OF THE CORPORATION ANNUALLY. K) APPROVAL OF ALL INSURANCE CARRIERS AND INSURANCE COVERAGE FOR THE CORPORATION. L) APPROVAL OF LONG-RANGE OR STRATEGIC PLANS OF THE CORPORATION. FORM 990, PART VI, SECTION B, LINE 11B FORM 990 IS REVIEWED PRIOR TO SUBMISSION TO THE IRS 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 THE FORM 990 WILL BE AVAILABLE FOR ALL BOARD MEMBERS TO REVIEW AT THEIR MONTHLY BOARD MEETING BEFORE THE FORM 990 IS FILED. FORM 990 IS MADE AVAILABLE IN THE ADMINSTRATIVE OFFICE FOR ANY INDIVIDUAL REQUESTING TO INSPECT IT AS REQUIRED BY INTERNAL REVENUE CODE 6104. FORM 990, PART VI, SECTION B, LINE 12C THE CORPORATE COMPLIANCE OFFICER (CCO) AND SEVERAL MEMBERS OF THE CORPORATE COMPLIANCE COMMITTEE ATTEND BOARD, ADMINSTRATIVE, 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 FRANCISCAN CARE SERVICES, INC. (FCS) OR EMPLOYED BY A BUSINESS WITH WHICH FCS CONDUCTS BUSINESS. ANY NEW CONFLICTS THAT ARISE DURING THE YEAR NEED TO BE REPORTED TO THE CORPORATE 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 ADMINSTRATIVE LEVEL, THE STAFF MEMBER IDENTIFIES THE CONFLICT AND THE ADMINSTRATIVE TEAM DETERMINES IF THE PERSON CAN TAKE PART IN THE DISCUSSION OR NEEDS TO LEAVE THE ROOM. THIS IS ALSO THE POLICY AT THE MEDICAL STAFF AND MANAGER MEETINGS. FORM 990, PART VI, SECTION B, LINE 15 FRANCISCAN CARE SERVICES, INC. STRIVES TO PROVIDE A FAIR AND COMPETITIVE COMPENSATION PACKAGE FOR ITS EXECUTIVES. 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 COMPENSATION 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 LIKE-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 THE FRANCISCAN SISTERS OF CHRISTIAN CHARITY SPONSORED MINISTRIES, INC. ALL MEMBERS OF THE BOARD PROVIDE THEIR INPUT THROUGH A WRITTEN APPRAISAL PRESENTED TO THE COMPENSATION COMMITTEE. MINUTES OF THE MEETING ARE KEPT BY THE SPONSORED MINISTRIES PRESIDENT. ALL OTHER EXECUTIVES ARE REVIEWED BY THE FRANCISCAN CARE SERVICES, INC. PRESIDENT/CEO, WHO SETS THEIR COMPENSATION BASED UPON THE ABOVE SURVEYS AND PRINCIPLES. FORM 990, PART VI, SECTION C, LINE 19 NO DOCUMENTS ARE AVAILABLE TO THE PUBLIC. FORM 990, PART IX, LINE 11G OTHER CONTRACTORS: PROGRAM SERVICE EXPENSES 4,889,848. MANAGEMENT AND GENERAL EXPENSES 963,222. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 5,853,070. FORM 990, PART XI, LINE 9: CHANGE IN BENEFICIAL INTEREST OF A CHARITABLE FOUNDATION 2,577,428. ST FRANCIS SERVICES LLC 430 N MONITOR ST WEST POINT NE 68788 852622665 PHARMACY NE 3543972 1623347 FRANCISCAN CARE SERVICES INC HOLY FAMILY CONVENT FRANCISCAN SISTERS 2409 SOUTH ALVERNO ROAD MANITOWOC WI 54220 390808523 RELIGION WI 501(C)(3) LINE 1 N/A 0 FRANCISCAN SISTERS OF CHRISTIAN CHARITY SPONSORED MINISTRIES INC 1415 SOUTH RAPIDS ROAD MANITOWOC WI 54220 391530622 HEALTHCARE WI 501(C)(3) LINE 1 SEE LINE 1 0 ST FRANCIS MEMORIAL HOSPITAL FOUNDATION 430 N MONITOR ST WEST POINT NE 68788 470629079 FUNDRAISING NE 501(C)(3) LINE 12A, I N/A 0 ST JOSEPHS RETIREMENT COMMUNITY FOUNDATION PO BOX 65 WEST POINT NE 68788 470790644 FUNDRAISING NE 501(C)(3) LINE 12A, I N/A 0 ST PAUL ELDER SERVICES INC 316 EAST 14TH STREET KAUKAUNA WI 54130 391029149 ELDER CARE WI 501(C)(3) LINE 10 SEE LINE 2 0 GOOD SAMARITAN MEDICAL CENTER 800 FOREST AVENUE ZANESVILLE OH 43701 314379479 HOLDING COMPANY OH 501(C)(3) LINE 12A, I SEE LINE 2 0 ST JOSEPH'S ELDER SERVICES INC 540 EAST WASHINGTON STREET WEST POINT NE 68788 814879204 ELDER CARE NE 501(C)(3) LINE 10 SEE LINE 2 0 THE FRANCISCAN CENTER 6751 CALUMET AVENUE MANITOWOC WI 54220 932455812 MUSIC AND PERFORMING ARTS WI 501(C)(3) LINE 1 SEE LINE 2 0 CLEMENT MANOR INC 3939 S 92ND ST GREENFIELD WI 53228 391020547 ELDER CARE WI 501(C)(3) LINE 10 SEE LINE 2 0 0 0 1 0 0 0 0 0 0 1 0 0 1 0 1 1 1 0 1