2025-11-13T15:37:23-06:00 2024-12-31 450250958 EIDE BAILLY LLP 18081 BURT ST STE 200 OMAHA NE 680224722 990 2024-01-01 470796875 FAITH REGIONAL HEALTH SERVICES FAIT 4023714880 1500 KOENIGSTEIN AVENUE PO BOX 869 NORFOLK NE 687020869 BRENDA BAKER VP FINANCE 4023714880 2025-11-13 1 1 MEGAN L KOZIOL CPA P01544037 4023302660 2025-11-10 2024 2025-03-06 01:10:19Z BRENDA BAKER 1500 KOENIGSTEIN AVENUE PO BOX 869 NORFOLK NE 687020869 289415235 0 X WWW.FRHS.ORG X 1996 NE TO PROVIDE ACUTE, SKILLED AND OUTPATIENT SERVICES TO INDIVIDUALS IN OUR SERVICE AREA. 15 11 1778 60 252048 213913 901632 1143461 270022631 278930543 2917598 5816504 1506958 2717089 275348819 288607597 330441 252731 0 0 157008079 161487491 0 0 244114 115076744 118642178 272415264 280382400 2933555 8225197 266969721 276486027 98020360 95855092 168949361 180630935 TO SERVE CHRIST BY PROVIDING ALL PEOPLE WITH EXEMPLARY MEDICAL SERVICES IN AN ENVIRONMENT OF LOVE AND CARE. 0 0 235175217 252731 265697626 FAITH REGIONAL PROVIDES HEALTHCARE TO ALL PEOPLE REGARDLESS OF THEIR ABILITY TO PAY OR THEIR INSURANCE PROVIDER. DURING THE YEAR, FAITH REGIONAL PROVIDED SIGNIFICANT SERVICES FOR MEDICARE AND MEDICAID PATIENTS. 16505458 0 13811552 MANY SERVICES PROVIDED BY FAITH REGIONAL ARE DONE TO MEET SPECIFIC NEEDS OF THE COMMUNITY BECAUSE NO OTHER SERVICES ARE AVAILABLE. AS A RESULT, THESE SERVICES ARE PROVIDED KNOWING THAT THEY WILL NOT BE FINANCIALLY VIABLE OR SELF-SUPPORTING. THESE SERVICES INCLUDE BEHAVIORAL HEALTH INPATIENT AND OUTPATIENT SERVICES, CHILD ADVOCACY, DIABETIC EDUCATION, DIALYSIS SERVICES, ACUTE REHABILITATIVE SERVICES, HOME HEALTH CARE AND TRANSITIONAL CARE (LONG-TERM REHABILITATION) SERVICES. 1092182 0 0 A SUBSTANTIAL PORTION OF COMMUNITY BENEFITS PROVIDED BY FAITH REGIONAL IS THE PROVISION OF PATIENT CARE SERVICES THAT ARE NOT PAID FOR EITHER BY THE PATIENT OR THIRD PARTY INSURANCE. DURING THE YEAR, FAITH PROVIDED OVER ONE MILLION DOLLARS IN ASSISTANCE WITH PAYING THEIR HOSPITAL BILLS. 252772857 1 1 0 1 0 0 0 0 0 1 1 0 0 1 1 1 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 1 1 0 0 1 97 0 1 1778 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 15 11 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 X BRENDA BAKER 4026447249 1500 KOENIGSTEIN AVENUE PO BOX 869 NORFOLK NE 687020869 MARYANN HARTZELL MD MEMBER - CHIEF OF STAFF 40.00 0.00 X 584556 0 20077 LANE HANDKE MD MEMBER - MEDICAL DIRECTOR 40.00 0.00 X 510212 0 31424 BRETT JACKSON CHAIR 1.50 2.50 X X 0 0 0 JOHN ROBERTSON VICE CHAIR 1.50 2.50 X X 0 0 0 SUE FUCHTMAN SECRETARY 1.50 0.00 X X 0 0 0 BRAD DINKEL TREASURER 1.50 0.00 X X 0 0 0 STEF LACEY MD MEMBER 1.00 0.00 X 0 0 0 TRAVIS RUTJENS MEMBER 1.00 0.00 X 0 0 0 JACQUE COLLISON MEMBER 1.00 1.00 X 0 0 0 JOSH GOSSMAN MEMBER 1.00 0.00 X 0 0 0 DIANE BECKER MEMBER 1.00 0.00 X 0 0 0 LEON ROSENTHAL MEMBER 1.00 2.50 X 0 0 0 PRESTON SUNDERMAN MEMBER 1.00 2.50 X 0 0 0 REGINA BUSBOOM MEMBER 1.00 2.50 X 0 0 0 TOM SCHUETH MEMBER 1.00 0.00 X 0 0 0 KELLY DRISCOLL CEO 40.00 2.00 X 791760 0 40222 JANNA CLINE VP FINANCE THRU 4/24 40.00 2.00 X 159578 0 13089 BRENDA BAKER VP FINANCE 40.00 2.00 X 117628 0 3431 FADI RZOUQ MD PHYSICIAN 40.00 0.00 X 4926180 0 36945 TRISTAN L HARTZELL MD PHYSICIAN 40.00 1.00 X 3803189 0 20493 JOHN LAMMLI MD PHYSICIAN 40.00 0.00 X 1680523 0 40569 BEETHOVEN BROWN MD PHYSICIAN 40.00 0.00 X 1138684 0 14533 NATHAN HERMAN MD PHYSICIAN 40.00 0.00 X 975354 0 36076 14687664 0 256859 242 0 1 0 PATHOLOGY MEDICAL SERVICE PO BOX 82653 LINCOLN NE 68501 LAB SERVICES 669835 SANDERLING RENAL SERVICES PO BOX 19883 NASHVILLE TN 37219 RENAL DIALYSIS SERVICES 415075 SIOUX CITY NIGHT PATROL PO BOX 3276 SIOUX CITY IA 51102 SECURITY SERVICES 358134 EIDE BAILLY LLP 18081 BURT STREET OMAHA NE 68022 ACCOUNTING SERVICES 255361 VIRTUAL RADIOLOGY CORPORATION 25983 NETWORK PLACE CHICAGO IL 60673 RADIOLOGY SERVICES 166590 7 45000 831226 241719 25516 1143461 NET PATIENT SERVICE REVENUE 621110 265084228 265084228 LEASED MEDICAL EMPLOYEES 621110 3064110 3064110 PHYSICIAN CLINICS 621110 210347 210347 10571858 10571858 278930543 2882823 2882823 1761887 0 1761887 1761887 1761887 920000 2821319 278661 528977 641339 2292342 2933681 2933681 MHR HOME CARE, LLC 456199 252048 252048 703154 578635 124519 955202 288607597 279509178 252048 7702910 X 252731 252731 2277616 1148872 1128744 231011 231011 127211816 119341552 7667699 202565 3847661 3395680 451981 20457609 18499702 1957907 7461778 6605701 856077 207033 1697 205336 353604 2899 350705 29699124 27367162 2331862 100 745503 9801 735702 6707435 5035519 1653320 18596 8292963 7224856 1046792 21315 10588409 8794388 1794021 255718 233701 22017 604329 522497 81437 395 1927603 86869 1840734 13732707 10183071 3549636 1761659 385055 1376604 INCOME TAX 43642 43642 MEDICAL SUPPLIES 42231575 42231575 FOOD 911833 909566 2267 DUES & SUBSCRIPTIONS 234977 77540 156552 885 344064 187770 156036 258 280382400 252772857 27365429 244114 129051 214505 64430562 69818883 30789439 30004992 2851575 2692992 4185985 4406602 4666219 4975021 317864659 199122398 118465864 118742261 24680600 28604721 3152503 2635072 13617923 14390978 266969721 276486027 33773534 35284061 50185794 44390745 1260526 1000616 10131359 12033190 2669147 3146480 98020360 95855092 X 168949361 180630935 168949361 180630935 266969721 276486027 8225197 3456377 0 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 14759 14759 0 PART II-B, LINE 1: FAITH REGIONAL PAID DUES TO THE NEBRASKA HOSPITAL ASSOCIATION AND THE AMERICAN HOSPITAL ASSOCIATION. A PORTION OF THE DUES WERE USED FOR LOBBYING ACTIVITIES. 6534626 111709 60 6646275 6442730 40 91856 6534626 6611965 76 -169311 6442730 5533918 50 1077997 6611965 5523918 10000 1022500 1022500 5533918 0.00780 0.99220 0.00000 0 1 1 4881992 4881992 151501462 80209876 71291586 150475663 113164432 37311231 11005542 5748090 5257452 118742261 ACCRUED INTEREST RECEIVABLE 152308 OTHER INVESTMENTS 12033190 RIGHT OF USE ASSETS 2205480 14390978 LEASE LIABILITY 3146480 3146480 X PART V, LINE 4: CARSON CANCER CENTER ENDOWMENT FUNDS ARE PERMANENTLY SET ASIDE TO GENERATE INVESTMENT EARNINGS TO BE USED TO FUND CAPITAL EQUIPMENT PURCHASES AND/OR OPERATIONS OF THE CARSON REGIONAL CANCER CENTER. INVESTMENT EARNINGS ON THESE FUNDS ARE RESTRICTED AS TO USE. GENERAL ENDOWMENT FUNDS ARE PERMANENTLY SET ASIDE TO GENERATE INVESTMENT EARNINGS. INVESTMENT EARNINGS ON THESE FUNDS ARE NOT RESTRICTED AS TO USE. THE HOSPICE ENDOWMENT FUNDS ARE PERMANENTLY SET ASIDE TO GENERATE INVESTMENT EARNINGS TO BENEFIT THE HOSPICE PROGRAM AND ITS PATIENTS. INVESTMENT INCOME ON THESE FUNDS IS RESTRICTED AS TO USE. THE CARDIAC SERVICES ENDOWMENT FUNDS ARE PERMANENTLY SET ASIDE TO GENERATE INVESTMENT EARNINGS TO FUND FAITH REGIONAL HEALTH SERVICE'S CARDIAC PROGRAM CAPITAL AND/OR OPERATIONAL EXPENSES. THE EDUCATION ENDOWMENT FUNDS ARE PERMANENTLY SET ASIDE TO GENERATE INVESTMENT EARNINGS TO BENEFIT FAITH REGIONAL HEALTH SERVICE'S EDUCATION PROGRAMS AND ITS EFFORTS TO RECRUIT AND RETAIN EMPLOYEES. INVESTMENT INCOME ON THESE FUNDS IS RESTRICTED AS TO USE. ST. JOSEPH'S NURSING HOME/SKYVIEW VILLA ENDOWMENT FUNDS ARE PERMANENTLY SET ASIDE TO GENERATE INVESTMENT EARNINGS TO BE USED TO FUND CAPITAL EQUIPMENT PURCHASES AND/OR OPERATION OF ST. JOSEPH'S NURSING HOME AND SKYVIEW VILLA. INVESTMENT EARNINGS ON THESE FUNDS ARE RESTRICTED AS TO USE. THE PEDIATRIC ENDOWMENT FUNDS ARE PERMANENTLY SET ASIDE TO GENERATE INVESTMENT EARNINGS TO BENEFIT FAITH REGIONAL HEALTH SERVICE'S CHILDREN'S CARE FUND. DONORS MAY SPECIFY CONTRIBUTIONS TO ANY OF THE ENDOWMENT FUNDS. PART X, LINE 2: FAITH REGIONAL HEALTH SERVICES ACCOUNTS FOR UNCERTAINTIES IN ACCOUNTING FOR INCOME TAX ASSETS AND LIABILITIES USING GUIDANCE INCLUDED IN FASB ASC 740, INCOME TAXES. FAITH RECOGNIZES THE EFFECT OF INCOME TAX POSITIONS ONLY IF THOSE POSITIONS ARE MORE LIKELY THAN NOT OF BEING SUSTAINED. AT DECEMBER 31, 2024 AND 2023, FAITH HAD NO UNCERTAIN TAX POSITIONS ACCRUED. 1 1 X 1 X 400.000000000000 1 X 1 1 1 0 1 0 1092000 0 1092000 0.00390 19932667 19429709 502958 0.00180 21024667 19429709 1594958 0.00570 282261 1598904 22410 1576494 0.00560 171 2477957 0 2477957 0.00880 7158828 3444945 3713883 0.01320 395000 383552 383552 0.00140 677432 11619241 3467355 8151886 0.02900 677432 32643908 22897064 9746844 0.03470 1350 125377 0 125377 0.00040 25000 2808 0 2808 0.00000 26350 128185 128185 0.00040 1 11659626 1259240 40337605 48545270 -8207665 X 1 1 1 NORTHEAST NE SURGICAL CENTER LLC SURGICAL SERVICES 0.59320 0.00000 0.40680 2 1 FAITH REGIONAL HEALTH SERVICES - WEST 2700 WEST NORFOLK AVENUE NORFOLK NE 68701 WWW.FRHS.ORG 520001 X X X A 2 FAITH REGIONAL HEALTH SERVICES - EAST 1500 KOENIGSTEIN AVENUE NORFOLK NE 68701 WWW.FRHS.ORG 520002 X X A FACILITY REPORTING GROUP - A 0 0 1 X X X X X X X 22 1 1 1 1 X HTTPS://WWW.FRHS.ORG/ABOUT-US/REPORTS/ X 1 22 1 HTTPS://WWW.FRHS.ORG/ABOUT-US/REPORTS/ 0 1 X 400.000000000000 400.000000000000 X X X X X X 1 1 X X X 1 X FRHS.ORG/PATIENTS-VISITORS/BILLING-INSURANCE-FINANCIAL-ASSISTANCE/FINANCIAL X FRHS.ORG/PATIENTS-VISITORS/BILLING-INSURANCE-FINANCIAL-ASSISTANCE/FINANCIAL X FRHS.ORG/PATIENTS-VISITORS/BILLING-INSURANCE-FINANCIAL-ASSISTANCE/FINANCIAL X X X X X X 1 X 0 X X X X 1 X 0 0 PART V, SECTION B FACILITY REPORTING GROUP A FACILITY REPORTING GROUP A CONSISTS OF: - FACILITY 1: FAITH REGIONAL HEALTH SERVICES - WEST, - FACILITY 2: FAITH REGIONAL HEALTH SERVICES - EAST FACILITY REPORTING GROUP - A PART V, SECTION B, LINE 5: THE MULTI-STEP PROCESS BEGAN WITH THE MOBILIZING FOR ACTION THROUGH PLANNING AND PARTNERSHIP (MAPP) PROCESS. A NUMBER OF INDIVIDUALS AND ORGANIZATIONS WITH A COMMON INTEREST IN PUBLIC HEALTH CONTRIBUTED TO IDENTIFYING THE TRENDS, FACTORS, AND EVENTS THAT INFLUENCE THE HEALTH AND QUALITY OF LIFE IN OUR COMMUNITIES AND/OR THE WORK OF THE PUBLIC HEALTH SYSTEM. CONTRIBUTORS REPRESENTED A VARIETY OF ARENAS, SECTORS AND BACKGROUNDS, AND EVERY EFFORT WAS PLACED ON HAVING EQUAL AND FAIR REPRESENTATION ACROSS ALL COUNTIES AND SECTOR FOCUS AREAS. INPUT FROM DIVERSE SECTORS INVOLVED IN PUBLIC HEALTH WAS OBTAINED THROUGH KEY INFORMANT INTERVIEWS FROM THE FOLLOWING GROUPS:-ECONOMIC DEVELOPMENT-CHAMBER OF COMMERCE-FINANCIAL INSTITUTION-HOSPITAL/CLINIC WORKERS-ELVPHD BOARD OF HEALTH-TRAILS COMMITTEE MEMBERS-LONG-TERM CARE-MEDICAL RESPONSE SYSTEMS-NEBRASKA DHHS-VETERAN SERVICE OFFICER-UNL COUNTY EXTENSION-ELECTED OFFICIALS-JUVENILE DIVERSION-LEAGUE OF HUMAN DIGNITY-NORFOLK SAFE COMMUNITIES-BEHAVIORAL HEALTH-HOSPITAL BOARD MEMBERS-NEBRASKA SEE TO LEARN PROGRAM-PUBLIC HEALTH LIAISON/ADVOCATE-SCHOOL NURSES AND SCHOOL ADMINISTRATORS-CENTER FOR RURAL AFFAIRS-CUMING COUNTY PUBLIC POWER DISTRICT-LAW ENFORCEMENT-INSTITUTES OF HIGHER EDUCATION-COMMUNITY-BASED ORGANIZATIONS-CITY EMPLOYEES-NEBRASKA BICYCLING ALLIANCE-AREA AGENCY ON AGING-PONCA TRIBE OF NEBRASKA-FEDERALLY-QUALIFIED HEALTH CENTER-NORFOLK FAMILY COALITION-NEIGHBORING LOCAL PUBLIC HEALTH DEPARTMENTSCOMMUNITY ENGAGEMENT WAS AN OVERARCHING CONCEPT ENCOMPASSING THE COMMUNITY HEALTH NEEDS ASSESSMENT AND FORMATION OF THE COMMUNITY HEALTH IMPROVEMENT PLAN. FACILITY REPORTING GROUP - A PART V, SECTION B, LINE 6A: FAITH REGIONAL HEALTH SERVICES - WEST AND FAITH REGIONAL HEALTH SERVICES - EAST PARTNERED WITH THE ELKHORN LOGAN VALLEY PUBLIC HEALTH DEPARTMENT (ELVPHD) AND ITS RESPECTIVE DISTRICT HOSPITALS TO COMPLETE THE CHNA, THOSE HOSPITALS ARE AS FOLLOWS:-FRANCISCAN HEALTHCARE, WEST POINT, NE (CUMING COUNTY) FACILITY REPORTING GROUP - A PART V, SECTION B, LINE 6B: FAITH REGIONAL HEALTH SERVICES PARTNERED WITH ITS LOCAL HEALTH DEPARTMENT, ELKHORN LOGAN VALLEY PUBLIC HEALTH DEPARTMENT TO COMPLETE THE CHNA. FACILITY REPORTING GROUP - A PART V, SECTION B, LINE 11: FAITH REGIONAL HEALTH SERVICES HAS IDENTIFIED TWO PRIORITY AREAS IN THE CHNA: CANCER PREVENTION AND SCREENING AND BEHAVIORAL/MENTAL HEALTH. FOR EACH OF THESE AREAS, GOALS AND IMPLEMENTATION STRATEGIES ARE IDENTIFIED IN THE HOSPITAL COMMUNITY HEALTH IMPLEMENTATION PLAN.THE GOALS AND ACTIVITIES FOCUSED ON CANCER PREVENTION AND SCREENING INCLUDE THE FOLLOWING: 1) DECREASE THE BURDEN OF OBESITY IN OUR SERVICE ASEA AS A SIGNIFICANT RISK FACTOR FOR CANCER. ACTIVITY: REGISTERED DIETICIANS COMPLETED FREE PRESENTATIONS FOR BUSINESSES ABOUT HEART HEALTH. CONTINUED TO PROVIDE DIETARY CONSULT SERVICES TO INPATIENT, OUTPATIENT, CANCER CENTER, AMH, MOSAIC, HEADSTART, CARDIAC REHAB, AND PULMONARY REHAB. 2) INCREASE CANCER-SCREENING RATES WITHIN THE SERVICE AREA. ACTIVITY: ATTENDED MULTIPLE COMMUNITY EVENTS IN THE AREA AND RAISED AWARENESS OF CANCER SCREENING ACTIVITIES AND HANDED OUT FREE COLON CANCER KITS. CONTINUED TO OFFER FREE SKIN CANCER SCREENINGS. 3) INCREASE CANCER-PREVENTION ACTIVITIES WITHIN THE SERVICE AREA. ACTIVITY: ATTENDED MULTIPLE COMMUNITY EVENTS AND HANDED OUT 250 FREE IN-HOME RADON KITS.THE GOALS AND ACTIVITIES FOCUSED ON BEHAVIORAL/MENTAL HEALTH INCLUDE THE FOLLOWING: 1) INCREASE ACCESS TO BEHAVIORAL/MENTAL HEALTH SERVICES IN THE ELVPHD HEALTH DISTRICT. ACTIVITY: OFFERING OUTPATIENT TELEHEALTH OPTIONS, OUTREACH IN PERSON FOR CHILD MEDICATION MANAGEMENT, ADULT IN PERSON FOR ADULT MEDICATION MANAGEMENT. ALSO EXPANDED SERVICES HIRING ADDITIONAL STAFF. INCREASE ACCESS TO TRAINING GEARED TOWARDS EARLY DETECTION OF SUICIDAL IDEATION AND TIMELY REFERRAL AND/OR INTERVENTION IN THE ELVPHD DISTRICT. ACTIVITY: HAVE HAD DISCUSSIONS/EDUCATION WITH SERVICE AREA LAW ENFORCEMENT REGARDING EPC PROCESS AND THE COLLABORATIVE NEEDS BETWEEN THEM AND FRHS TO ENSURE PATIENTS ARE RECEIVING MENTAL HEALTH SERVICES APPROPRIATELY AND TIMELY. 2) DECREASE THE IMPACT AND EFFECT OF PRESCRIPTION DRUG (FENTANYL) OVERDOSE IN THE ELVPHD DISTRICT. ACTIVITY: FRHS CONTINUES TO PROVIDE MEDICAL CARE TO PATIENTS WHO HAVE OVERDOSED. THERE ARE FOLLOW UP SERVICES THAT ARE ARRANGED UPON DISCHARGE WHEN THEY ARE WILLING TO SEEK TREATMENT. THIS MAY INCLUDE A SUBSTANCE USE EVAL AND COORDINATION FOR A BED AT A TREATMENT FACILITY IF THEY ARE ON THE BEHAVIORAL HEALTH UNIT. OR IF THEY ARE ON MEDICAL FLOOR, WE PROVIDE PATIENTS WITH RESOURCES AND COORDINATION OF A BED AT A SUBSTANCE USE FACILITY AS WELL. 3) MENTAL HEALTH CRISIS, INCREASE STRATEGIES RELATED TO ELIMINATING BARRIERS IN EQUITABLE ACCESS TO BEHAVIORAL HEALTH SERVICES. ACTIVITY: WE HAVE AN INTAKE COORDINATION LINE FOR REFERRALS TO INPATIENT PSYCHIATRIC CARE WHICH IS ANSWERED BY A BEHAVIORAL HEALTH SOCIAL WORKER. PROVIDED EDUCATIONAL PRESENTATIONS TO THE SERVICE AREA REGARDING MENTAL HEALTH DIAGNOSIS AND TREATMENT OPTIONS INCLUDING INPATIENT AND OUTPATIENT SERVICES AND THE STEPS TO ADMISSION TO DECREASE THE BARRIERS TO ACCESS. CONTINUE TO WORK WITH LAW ENFORCEMENT IN OUR REGION TO ACCEPT REFERRALS.THERE WERE NOT ANY NEEDS IDENTIFIED IN THE CHNA THAT ARE NOT BEING ADDRESSED BY THE HOSPITAL. FACILITY REPORTING GROUP - A PART V, SECTION B, LINE 13B: FOR MEDICARE PATIENTS, THE HOSPITAL MAY USE THE ORIGINAL DETERMINATION AMOUNT. FACILITY REPORTING GROUP - A PART V, SECTION B, LINE 13H: CHARITY CARE MAY BE AUTHORIZED FOR FINANCIALLY RESPONSIBLE PARTIES WITH INCOME LEVELS EXCEEDING 400% FPG IN THE CASE OF UNUSUAL, SPECIAL AND/OR EXTENUATING CIRCUMSTANCES. THESE INSTANCES ARE GENERALLY DUE TO MEDICAL CATASTROPHE SITUATIONS. 2 1 - NORTHEAST NE SURGERY CENTER LLC 301 NORTH 27TH ST STE 3 NORFOLK NE 68701 SURGERY CENTER 3 - ST JOSEPH REHABILITATION & CARE CTR 401 N 18TH STREET NORFOLK NE 68701 SKILLED NURSING FACILITY PART I, LINE 3C: IN ADDITION TO FEDERAL POVERTY GUIDELINES, FAITH REGIONAL USES ASSET LEVEL, MEDICAL INDIGENCY, INSURANCE STATUS, UNDERINSURANCE STATUS AND FOR MEDICARE PATIENTS, THE HOSPITAL MAY USE THE ORIGINAL DETERMINATION AMOUNT, TO DETERMINE ELIGIBILITY FOR FREE OR DISCOUNTED CARE. FAMILY SIZE AND INCOME LEVEL ARE USED TO DETERMINE WHERE THE PATIENT FALLS IN RELATION TO RECEIVING FREE CARE OR DISCOUNTED CARE.CHARITY CARE MAY BE AUTHORIZED FOR FINANCIALLY RESPONSIBLE PARTIES WITH INCOME LEVELS EXCEEDING 400% FPG IN THE CASE OF UNUSUAL, SPECIAL AND/OR EXTENUATING CIRCUMSTANCES. THESE INSTANCES ARE GENERALLY DUE TO MEDICAL CATASTROPHE SITUATIONS. PART I, LINE 7: FAITH REGIONAL USES A COST ACCOUNTING SYSTEM TO DETERMINE COSTS REPORTABLE ON PART I, LINE 7 (AND ELSEWHERE ON SCHEDULE H). THE FIRST STEP IN THE COST ACCOUNTING PROCESS IS TO ALLOCATE THE OVERHEAD EXPENSES (ADMINISTRATION AND GENERAL, PLANT, ETC) TO THE REVENUE PRODUCING DEPARTMENTS (OPERATING ROOM, IMAGING, ONCOLOGY, ETC). THIS IS DONE SIMILAR TO THE MEDICARE COST REPORT USING A SINGLE STEP DOWN METHOD TO ALLOCATE THE COSTS USING APPLICABLE STATISTICS. FOR EXAMPLE: PLANT EXPENSES ARE ALLOCATED DOWN TO THE OTHER DEPARTMENTS USING CURRENT SQUARE FOOTAGE SO DEPARTMENTS WITH MORE SQUARE FOOTAGE WILL BE ALLOCATED MORE PLANT EXPENSES; DIETARY EXPENSES ARE ALLOCATED BASED ON MEALS SERVED; EMPLOYEE BENEFITS ARE ALLOCATED BASED ON SALARIES; ADMINISTRATIVE AND GENERAL EXPENSES ARE ALLOCATED BASED ON ACCUMULATED COSTS; AND SO ON. ONCE ALL THE OVERHEAD EXPENSES ARE ALLOCATED TO THE REVENUE PRODUCING DEPARTMENTS THE COSTS ARE FURTHER ALLOCATED DOWN TO THE CHARGE CODE LEVEL. IN ORDER TO DO THIS, TWO DIFFERENT METHODS ARE USED DEPENDING ON THE DEPARTMENT. SPECIFIC DEPARTMENTS USE A RVU (RELATIVE VALUE UNIT) ALLOCATION WHERE EACH PROCEDURE IS WEIGHTED BY THE INTENSITY OF THE SERVICE AND IS THEN ALLOCATED COST BASED ON THAT LEVEL OF INTENSITY. FOR EXAMPLE AN XRAY WITH SEDATION IS MORE COMPLICATED AND TIME INTENSIVE THAN A SIMPLE CHEST XRAY SO IT WOULD HAVE A HIGHER RVU VALUE AND, IN TURN, A HIGHER COST ALLOCATED TO IT. THE DEPARTMENTS USING THIS ALLOCATION METHOD ARE IMAGING, CARDIAC CATH, CT, MRI, ULTRASOUND, NUCLEAR MEDICINE, RADIATION ONCOLOGY, AND REHAB (PHYSICAL, OCCUPATIONAL AND SPEECH THERAPY).THE OTHER DEPARTMENTS USE A RATIO OF COST TO CHARGE METHOD TO ALLOCATE THE COSTS DOWN TO THE CHARGE CODE LEVEL.AFTER ALL THE COSTS HAVE BEEN ALLOCATED TO THE CHARGE CODES THE COSTING IS APPLIED TO ALL PATIENT ACCOUNTS BASED ON THEIR CHARGES TO DETERMINE THE COST OF THEIR ENCOUNTER AND THEN REPORTS CAN BE RUN TO DETERMINE THE PROFITABILITY OF CERTAIN PAYORS, SERVICE LINES OR DEPARTMENTS. PART I, LINE 7G: MANY SERVICES PROVIDED BY FAITH REGIONAL ARE DONE SO TO MEET SPECIFIC NEEDS OF THE COMMUNITY BECAUSE NO OTHER SERVICES ARE AVAILABLE. AS A RESULT, THESE SERVICES ARE PROVIDED KNOWING THAT THEY WILL NOT BE FINANCIALLY VIABLE OR SELF-SUPPORTING. FAITH REGIONAL DID NOT INCLUDE ANY PHYSICIAN CLINIC EXPENSES AS SUBSIDIZED HEALTH SERVICES. PART II, COMMUNITY BUILDING ACTIVITIES: COMMUNITY BUILDING ACTIVITIES DURING THE YEAR INCLUDED EXPENSES FOR THE NORFOLK AREA BIG GIVE. PART III, LINE 2: THE AMOUNT ON LINE 2 REPRESENTS IMPLICIT PRICE CONCESSIONS. FAITH DETERMINES ITS ESTIMATE OF IMPLICIT PRICE CONCESSIONS BASED ON HISTORICAL COLLECTION EXPERIENCE WITH VARIOUS CLASSES OF PATIENTS. PART III, LINE 3: THE ESTIMATED AMOUNT OF THE ORGANIZATION'S IMPLICIT PRICE CONCESSIONS ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S CHARITY CARE POLICY IS CALCULATED BASED ON AN APPROXIMATE 10.8% OF INDIVIDUALS LIVING BELOW THE POVERTY LEVEL IN THE SERVICE AREA. PART III, LINE 4: THE FOOTNOTE TO THE ORGANIZATION'S FINANCIAL STATEMENTS THAT DESCRIBES IMPLICIT PRICE CONCESSIONS IS LOCATED IN FOOTNOTE 1 ON PAGE 14 OF THE ATTACHED FINANCIAL STATEMENTS. PART III, LINE 8: THE ENTIRE MEDICARE SHORTFALL IS CONSIDERED A COMMUNITY BENEFIT. SERVICES ARE PROVIDED TO PATIENTS UNDER THE MEDICARE PROGRAM EVEN THOUGH THE HOSPITAL KNOWS THEY WILL NOT RECOVER ALL OF THE COSTS FROM PROVIDING THE SERVICES. THIS PROGRAM IS CONSIDERED SUBSIDIZED BY THE HOSPITAL AND OTHER PAYORS. PATIENTS RELY ON THESE SERVICES FOR THEIR HEALTH AND WELL-BEING AND ARE ESSENTIAL FOR THEIR ACCESS TO HEALTHCARE. TOTAL REVENUE RECEIVED FROM MEDICARE IS THE GROSS REIMBURSEMENT PLUS SETTLEMENT. BOTH TOTAL REVENUE RECEIVED FROM MEDICARE AND THE MEDICARE ALLOWABLE COSTS ARE REPORTED FROM THE MEDICARE COST REPORT. THE MEDICARE COST REPORT IS COMPLETED BASED ON THE RULES AND REGULATIONS SET FORTH BY CENTERS FOR MEDICARE AND MEDICAID SERVICES.HOSPITAL SERVICES RENDERED ON A FEE SCHEDULE ARE NOT INCLUDED IN THE MEDICARE CALCULATIONS PER THE 990 INSTRUCTIONS. HAD THIS BEEN REPORTED THE HOSPITAL WOULD HAVE HAD A GREATER LOSS FROM MEDICARE SERVICES OF $623,705.MEDICARE FEE SCHEDULE REVENUE $1,093,563MEDICARE ESTIMATED COSTS OF CARE RELATING TO PAYMENTS $1,717,268NET (SHORTAGE) $(623,705) PART III, LINE 9B: FRHS WILL NOT ENGAGE IN ECAS, EITHER DIRECTLY OR BY ANY DEBT COLLECTION AGENCY OR OTHER PARTY TO WHICH THE HOSPITAL HAS REFERRED THE PATIENT'S DEBT, BEFORE REASONABLE EFFORTS ARE MADE TO DETERMINE WHETHER A RESPONSIBLE INDIVIDUAL(S) IS ELIGIBLE FOR ASSISTANCE UNDER THE FAP.IF AN APPLICATION, COMPLETE OR INCOMPLETE, FOR FINANCIAL ASSISTANCE UNDER THE FAP IS SUBMITTED BY A RESPONSIBLE INDIVIDUAL(S), AT ANY TIME PRIOR TO THE APPLICATION DEADLINE, FRHS WILL SUSPEND ECAS WHILE SUCH FINANCIAL ASSISTANCE APPLICATION IS PENDING. THIS WILL INCLUDE ANY CURRENT ACCOUNTS AND BAD DEBT ACCOUNTS GOING BACK 240 DAYS FROM THE DATE OF THE FIRST STATEMENT ON THE ACCOUNT. PART VI, LINE 2: FAITH REGIONAL CHOSE TO PARTNER WITH THE ELKHORN LOGAN VALLEY PUBLIC HEALTH DEPARTMENT (ELVPHD) AND ITS RESPECTIVE DISTRICT HOSPITALS TO COMPLETE THE JOINT COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) IN 2022. IN ADDITION TO THE PUBLIC HEALTH DEPARTMENT'S ASSESSMENT, FAITH REGIONAL IS INTIMATELY INVOLVED IN THE ELKHORN ECONOMIC DEVELOPMENT ASSOCIATION, BOTH ON THE BOARD AND THROUGH FINANCIAL SUPPORT. THAT INVOLVEMENT IS INTENDED TO FACILITATE COMMUNITY GROWTH, JOB DEVELOPMENT, INFRASTRUCTURE DEVELOPMENT AND BUSINESS EDUCATION/TRAINING. FAITH REGIONAL IS ALSO A MEMBER OF THE NORFOLK CHAMBER OF COMMERCE WHICH IS INVOLVED IN BUSINESS RETAIL DEVELOPMENT AND SUPPORT AS WELL AS THE COMMUNITY IMPROVEMENT PROJECTS. FAITH ALSO WORKS WITH ORGANIZATIONS LIKE THE ORPHAN GRAIN TRAIN IN PROVIDING MEDICINE AND MEDICAL EQUIPMENT/SUPPLIES TO OTHER NATIONS IN NEED. PART VI, LINE 3: PATIENTS RECEIVING CARE ARE GIVEN INFORMATION REGARDING FAITH REGIONAL'S FINANCIAL ASSISTANCE PROGRAM THROUGH THE USE OF BROCHURES HANDED OUT BY REGISTRATION, HOSPITAL SOCIAL SERVICES, M.A.S.H. (MEDICAL ADVOCACY SERVICES FOR HEALTHCARE) PERSONNEL AND BY PATIENT ACCOUNTS STAFF. ANY PATIENT OR FAMILY MEMBER THAT EXPRESSES CONCERN REGARDING ABILITY TO PAY FOR SERVICES WILL BE DIRECTED TO A SOCIAL WORKER, REGISTRATION CLERK, CASHIER OR FINANCIAL SERVICES REPRESENTATIVE WHO WILL THEN GIVE THEM AN APPLICATION FOR PATIENT FINANCIAL ASSISTANCE ALONG WITH A BROCHURE EXPLAINING HOW TO COMPLETE THE APPLICATION. PART VI, LINE 4: FAITH REGIONAL'S PRIMARY SERVICE AREA CONSISTS OF ANTELOPE, BOONE, HOLT, KNOX, MADISON, PIERCE, PLATTE, STANTON AND WAYNE COUNTIES IN NEBRASKA. THE HOSPITAL'S SECONDARY SERVICE AREA CONSISTS OF CEDAR, COLFAX, CUMING AND DIXON COUNTIES IN NEBRASKA. FAITH REGIONAL ALSO HAS A TERTIARY SERVICE AREA OF BOYD, BROWN, BURT, CHERRY, DAKOTA, GARFIELD, KEYA PAHA, NANCE, ROCK, THURSTON AND WHEELER COUNTIES IN NEBRASKA.BASED ON U.S. CENSUS INFORMATION, THE ABOVE COUNTIES IN THE FRHS PRIMARY AND SECONDARY SERVICE AREAS REPRESENT A TOTAL POPULATION OF 209,753. THE RACIAL MAKEUP OF THE SERVICE AREA POPULATION IS MAJORITY WHITE WITH 92.6% IDENTIFYING AS WHITE ALONE AND 7.4% IDENTIFYING AS NON-WHITE. THE SERVICE AREA'S MOST SIGNIFICANT RACIAL MINORITY IS HISPANIC WITH AN AVERAGE 8.5% PERCENT HISPANIC/LATINO POPULATION.THE MEDIAN HOUSEHOLD INCOME OF OUR SERVICE AREA IS $55,451 AND THE PER CAPITA INCOME IS $29,078, COMPARED TO THE MEDIAN HOUSEHOLD INCOME FOR NEBRASKA AT $50,695 AND THE PER CAPITA INCOME AT $26,113. AN AVERAGE OF 10.8% OF THE FRHS SERVICE AREA LIVES IN POVERTY, AND AN AVERAGE 9% DO NOT HAVE HEALTH INSURANCE. PART VI, LINE 5: FAITH REGIONAL, A NOT-FOR-PROFIT HEALTH CARE FACILITY, LOCATED IN NORTHEAST NEBRASKA, OPERATES FOR THE BENEFIT OF THE INDIVIDUALS IN THE SERVICE AREA. FAITH REGIONAL SERVES ALL PATIENTS REGARDLESS OF THEIR ABILITY TO PAY AND DOES NOT LIMIT ITS SERVICES OR DISCRIMINATE AGAINST ANYONE ON THE BASIS OF RACE, COLOR, SEX, NATIONAL ORIGIN, SEXUAL ORIENTATION, RELIGION, AGE, DISABILITY, DISEASE OR DIAGNOSIS. FAITH REGIONAL ALSO PROVIDES COMMUNICATIONS SERVICES (E.G. BILINGUAL STAFF AND INTERPRETERS, SIGN LANGUAGE INTERPRETERS, TDD SERVICES, ETC) FOR SENSORY IMPAIRED INDIVIDUALS. FAITH REGIONAL EVALUATES ITSELF ON ITS EFFECTIVENESS ANNUALLY BY EXAMINING ITS ABILITY TO FULFILL ITS MISSION, ACCOMPLISH ITS VISION, PROVIDE SERVICE AND MAINTAIN ITS VALUES. FAITH REGIONAL'S MISSION, VISION, SERVICE AND VALUES ARE: THE MISSION: THE MISSION IS TO SERVE CHRIST BY PROVIDING ALL PEOPLE WITH EXEMPLARY MEDICAL SERVICES IN AN ENVIRONMENT OF LOVE AND CARE.THE VISION: THE VISION OF FAITH REGIONAL HEALTH SERVICES IS TO BECOME A REGIONAL REFERRAL CENTER BY PROVIDING THE MOST COMPREHENSIVE, HIGH QUALITY HEALTH SERVICES TO THE RESIDENTS OF NORTHEAST NEBRASKA. THE VALUES:-SPIRITUALITY-EXCELLENCE-INTEGRITY-COMPASSION-RESPECT-STEWARDSHIPFAITH REGIONAL'S PROGRAM SERVICE ACCOMPLISHMENTS ARE BASED ON THE COMMUNITY ACCOUNTABILITY STANDARDS DEVELOPED BY THE VOLUNTARY HOSPITALS OF AMERICA (VHA). THESE FOUR STANDARDS ARE:1) DEMONSTRATE LEADERSHIP AS A CHARITABLE INSTITUTION.2) PROVIDING ESSENTIAL HEALTH CARE SERVICES.3) BEING ACCOUNTABLE TO THE COMMUNITY.4) MAINTAINING EVIDENCE OF COMMITMENT TO COMMUNITY BENEFIT.FAITH REGIONAL RECOGNIZES ITS OBLIGATION TO DEMONSTRATE LEADERSHIP AS A CHARITABLE ORGANIZATION BY PROVIDING A FULL RANGE OF HEALTH CARE, HEALTH EDUCATION AND WELLNESS RELATED SERVICES TO THE COMMUNITY, AND PARTICIPATING IN FEDERAL, STATE AND LOCAL PROGRAMS TO PROVIDE HEALTH BENEFITS TO THOSE IN NEED. FAITH REGIONAL FINANCIALLY SUPPORTS VARIOUS OUTREACH ACTIVITIES IN WHICH HOSPITAL PROVIDERS TRAVEL OUT TO SURROUNDING COMMUNITIES TO PROVIDE SERVICES WHICH MAY OTHERWISE NOT BE AVAILABLE. FAITH REGIONAL PROVIDES TRANSPORTATION SERVICES PRIMARILY TO RADIATION ONCOLOGY PATIENTS AT NO CHARGE.FAITH REGIONAL REMAINS ACCOUNTABLE TO THE COMMUNITY BY WORKING WITH A VOLUNTEER GOVERNING BOARD THAT IS REPRESENTATIVE OF THE COMMUNITY IT SERVES. COOPERATION WITH COMMUNITY BASED HEALTH ORGANIZATIONS IDENTIFY PERTINENT ISSUES RELATED TO ESSENTIAL SERVICES, CHARITY CARE, HEALTH CARE COST CONTAINMENT, COMMUNITY BENEFIT ACTIVITIES AND OTHERS AS APPROPRIATE. FAITH REGIONAL CONTINUES TO OPERATE UNDER A VOLUNTEER GOVERNING BOARD AND REMAINS ACTIVELY INVOLVED IN ADVOCATING PUBLIC AWARENESS OF HEALTH CARE AND HEALTH CARE POLICY ISSUES. DISCLOSURES OF COMMUNITY BENEFIT INFORMATION AND ADVOCACY ISSUES ARE PROVIDED THROUGH A VARIETY OF MEDIA INCLUDING MEDIA RELEASES AND ITS INTERNET WEBSITE: WWW.FRHS.ORG.FAITH REGIONAL'S CONTRIBUTION TO THE COMMUNITY NOT ONLY INCLUDES COMPENSATED AND DONATED TIME BUT ALSO EQUIPMENT, MATERIALS AND SPACE. MEETING ROOMS ARE PROVIDED AS NEEDED AND EQUIPMENT AND MATERIALS (E.G. COMPUTERS, COPIER, FAXES, TELEPHONES, CHILDBIRTH PROPS, PROJECTORS, MANNEQUINS, HEARING BOOTH, AUDIOMETERS, BEDS, MONITORS, WARMING UNITS, MINOR INSTRUMENTS, ETC.) ARE PROVIDED AT NO CHARGE. A MAJOR CONCERN IN HEALTH CARE THAT CAN SOMETIMES BE "HIDDEN" IS THAT OF SEXUAL ABUSE AND NEGLECT IN CHILDREN. THE NORTHEAST NEBRASKA CHILD ADVOCACY PROGRAM AT FAITH REGIONAL PROVIDES A SAFE, NON THREATENING ENVIRONMENT WHERE CHILDREN (AGES INFANT TO 18) WHO ARE VICTIMS OF ABUSE RECEIVE IMMEDIATE MEDICAL CARE AND FORENSIC INTERVIEWS FROM VARIOUS AGENCIES WORKING TOGETHER. ALL OF THESE SERVICES ARE AVAILABLE FREE TO FAMILIES WITHIN A 24-COUNTY AREA. 1 FOR THE GIRLS NORFOLK PO BOX 1124 NORFOLK NE 68702 460972709 501(C)(3) 7500 0 SPONSORSHIPS NORFOLK AREA UNITED WAY PO BOX 1041 NORFOLK NE 68702 470492054 501(C)(3) 6000 0 ANNUAL GIVING/CAPITAL CAMPAIGN NORFOLK FAMILY YMCA 301 W BENJAMIN AVE NORFOLK NE 68701 465709553 501(C)(3) 105000 0 FACILITY EXPANSION AND ROUNDTABLE EVENT 3 0 PART I, LINE 2: CASH DONATIONS ARE MADE TO ORGANIZATIONS, MANY OF WHICH HAVE HEALTH CARE OR SOCIAL SERVICES MISSIONS. THESE DONATIONS ARE SOMETIMES RESTRICTED FOR A SPECIFIC USE OR ACTIVITY. 501(C)(3) ORGANIZATIONS ARE BOUND BY THEIR ARTICLES OF ORGANIZATION AND STATED MISSIONS TO CONDUCT ACTIVITIES STRICTLY FOR CHARITABLE PURPOSES. FAITH REGIONAL DOES NOT REQUEST GRANT REPORTS FROM DONEE CHARITABLE ORGANIZATIONS. X X X X 0 0 0 0 0 0 0 1 0 FADI RZOUQ MD PHYSICIAN 1025312 0 3900868 0 0 0 13800 0 24543 0 4964523 0 0 0 TRISTAN L HARTZELL MD PHYSICIAN 1048430 0 2754759 0 0 0 0 0 21891 0 3825080 0 0 0 JOHN LAMMLI MD PHYSICIAN 1495284 0 185239 0 0 0 17250 0 24717 0 1722490 0 0 0 BEETHOVEN BROWN MD PHYSICIAN 1138634 0 50 0 0 0 13800 0 1976 0 1154460 0 0 0 NATHAN HERMAN MD PHYSICIAN 490628 0 484726 0 0 0 13800 0 23514 0 1012668 0 0 0 KELLY DRISCOLL CEO 707070 0 73640 0 11050 0 17250 0 25172 0 834182 0 0 0 MARYANN HARTZELL MD MEMBER - CHIEF OF STAFF 584506 0 50 0 0 0 0 0 21475 0 606031 0 0 0 LANE HANDKE MD MEMBER - MEDICAL DIRECTOR 370524 0 139688 0 0 0 9874 0 22756 0 542842 0 0 0 JANNA CLINE VP FINANCE THRU 4/24 145736 0 13842 0 0 0 5675 0 7892 0 173145 0 0 0 PART I, LINE 7 PHYSICIANS HAVE AN OPPORTUNITY TO EARN PRODUCTION BONUSES IF THE PROVIDER REACHES ABOVE RELATIVE VALUE UNIT AMOUNTS. PAYOUTS ARE DEPENDENT ON THEIR BASE SALARY PERCENTILE. PHYSICIANS RECEIVING THESE BONUSES DURING THE YEAR INCLUDE THE FOLLOWING: TRISTAN HARTZELL, M.D. FADI RZOUQ, M.D. NATHAN HERMAN, M.D. JOHN LAMMLI, M.D. LANE HANDKE, M.D. A HOSPITAL AUTHORITY #1 OF MADISON COUNTY NEBRASKA 521357975 557352EX5 2017-08-17 44772246 REFUND PRIOR ISSUES (07/10/08 & 11/20/08) 0 0 0 B HOSPITAL AUTHORITY #1 OF MADISON COUNTY NEBRASKA 521357975 557352FQ9 2018-05-10 32483418 CONSTRUCT FACILITY 0 0 0 A 25284667 44772246 712032 44060214 1 1 1 1 B 8192638 32483418 2577140 580862 29325416 2019 0 0 1 1 A 0 0 0 0 0.00540 0.00000 0.00540 0 0 1 B 0 0 0 0 0.00000 0.00000 0.00000 0 0 0 A 0 0 0 1 0 0 0 0 1 B 0 0 0 1 0 0 0 0 1 A 1 B 1 DATE REBATE COMPUTATION PERFORMED ISSUER NAME: HOSPITAL AUTHORITY #1 OF MADISON COUNTY NEBRASKA DATE THE REBATE COMPUTATION WAS PERFORMED: 07/01/2018 ISSUER NAME: HOSPITAL AUTHORITY #1 OF MADISON COUNTY NEBRASKA DATE THE REBATE COMPUTATION WAS PERFORMED: 12/31/2019 SCHEDULE K, PART IV, ARBITRAGE, LINC 2C: NOTE REGARDING THE FIRST REBATE COMPUTATION ON 7/1/18: AS NO REBATABLE ARBITRAGE WAS EARNED ON THE ADVANCE REFUNDING ESCROW AND THE DEBT SERVICE FUND WAS OPERATED ON A BONA RIDE BASIS, NO FURTHER REBATE ANALYSIS IS NECESSARY. NOTE REGARDING THE COMPUTATION ON 12/31/19: SINCE THE BOND PROCEEDS HAVE BEEN SPENT AND THE DEBT SERVICE FUND WAS OPERATED ON A BONA FIDE BASIS, NO FURTHER REBATE CALCULATIONS ARE NECESSARY. TRACI COLLISON DAUGHTER-IN-LAW OF JACQUE COLLISON, A BOARD MEMBER 87779 TRACI IS AN EMPLOYEE OF FAITH REGIONAL HEALTH SERVICES. 0 SHARON GOSSMAN MOTHER OF JOSH GOSSMAN, A BOARD MEMBER 143233 SHARON IS AN EMPLOYEE OF FAITH REGIONAL HEALTH SERVICES. 0 FORM 990, PART VI, SECTION A, LINE 1A THE EXECUTIVE COMMITTEE, CONSISTING OF THE IMMEDIATE PAST CHAIR, THE CHAIR, THE VICE CHAIR, THE SECRETARY, THE TREASURER, AND ONE PHYSICIAN BOARD MEMBER, HAS AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY. IF THE IMMEDIATE PAST CHAIR IS NO LONGER A VOTING DIRECTOR, HE OR SHE SHALL NEVERTHELESS SERVE IN A VOTING CAPACITY ON THE EXECUTIVE COMMITTEE. FORM 990, PART VI, SECTION A, LINE 6 FAITH REGIONAL HAS ONE NONPROFIT 501(C)(3) CORPORATE MEMBER, LUTHERAN COMMUNITY HOSPITAL ASSOCIATION, A RELATED ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 7A THE SOLE CORPORATE MEMBER, LUTHERAN COMMUNITY HOSPITAL ASSOCIATION, APPOINTS 13 VOTING MEMBERS OF THE BOARD OF DIRECTORS OF FAITH REGIONAL HEALTH SERVICES. FORM 990, PART VI, SECTION A, LINE 7B CERTAIN POWERS ARE RESERVED TO ITS SOLE MEMBER, LUTHERAN COMMUNITY HOSPITAL ASSOCIATION. THERE ARE 13 RESERVED POWERS, INCLUDING APPOINTMENT AND REMOVAL OF DIRECTORS, OTHER THAN CHIEF OF STAFF AND THE PHYSICIAN SERVICES MEDICAL DIRECTOR, AMENDMENT OF THE ARTICLES OF INCORPORATION AND BYLAWS, AMENDMENT OF THE MISSION, VISION AND VALUE STATEMENTS, AMONG OTHERS. FORM 990, PART VI, SECTION B, LINE 11B FORM 990 INFORMATION SCHEDULES ARE COMPLETED IN-HOUSE BY THE REIMBURSEMENT ACCOUNTANT AND REVIEWED BY THE CONTROLLER AND CFO. THE INFORMATION IS PROVIDED FOR RETURN PREPARATION AND SIGNATURE. FORM 990 IS REVIEWED AND DISCUSSED WITH THE CFO AND COPIES OF THE COMPLETED RETURN ARE DISTRIBUTED TO THE BOARD MEMBERS FOR REVIEW PRIOR TO SUBMISSION TO THE IRS. FORM 990, PART VI, SECTION B, LINE 12C FAITH REGIONAL'S BOARD MEMBERS ARE REQUIRED TO SIGN A CONFLICT OF INTEREST STATEMENT AND DISCLOSURE ANNUALLY. ANY CONFLICTS ARE REVIEWED BY BOTH THE GOVERNANCE COMMITTEE AND INDEPENDENT LEGAL COUNSEL. THE GOVERNANCE COMMITTEE PRESENTS RECOMMENDATIONS TO THE FULL BOARD. A MEMBER WITH A CONFLICT IS EXCUSED FROM THE BOARD DELIBERATIONS AND ACTION. FORM 990, PART VI, SECTION B, LINE 15 DETERMINATION OF COMPENSATION FOR THE CEO AND OTHER OFFICERS IS MADE BY GATHERING DATA FROM EXTERNAL SURVEYS AND THE FORM 990 DATA PROVIDED BY COMPARABLE FACILITIES. FACILITIES USED ARE DETERMINED BY SIMILAR BED SIZE, NET REVENUES AND NUMBER OF FTES. WAGES ARE GATHERED AND COMPARED BY TITLE, RESPONSIBILITIES AND YEARS OF EXPERIENCE. THE SALARY RECOMMENDATIONS ARE MADE BY THE HUMAN RESOURCE DEPARTMENT. THE GOVERNING BOARD APPROVES THE SALARY RECOMMENDATIONS FOR THE CEO; THE CEO APPROVES THE RECOMMENDATIONS FOR THE OTHER OFFICERS AND VICE-PRESIDENTS; AND THE VICE-PRESIDENTS APPROVE THE RECOMMENDATIONS FOR THE DIRECTORS OF VARIOUS HOSPITAL DEPARTMENTS. FORM 990, PART VI, SECTION C, LINE 19 FAITH REGIONAL DOES NOT MAKE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY OR FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC. FORM 990, PART IX, LINE 11G PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 19,159,118. MANAGEMENT AND GENERAL EXPENSES 1,985,057. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 21,144,175. OTHER FEES FOR SERVICES: PROGRAM SERVICE EXPENSES 2,144,976. MANAGEMENT AND GENERAL EXPENSES 295,683. FUNDRAISING EXPENSES 100. TOTAL EXPENSES 2,440,759. CONTRACT LABOR: PROGRAM SERVICE EXPENSES 6,063,068. MANAGEMENT AND GENERAL EXPENSES 51,122. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 6,114,190. FORM 990, PART XII, LINE 2C: THE FINANCE/AUDIT COMMITTEE OF THE BOARD OF DIRECTORS ASSUMES RESPONSBILITY FOR OVERSIGHT OF THE AUDIT AND SELECTION OF AN INDEPENDENT ACCOUNTANT. THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. 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