FRANCISCAN HEALTH RENSSELAER: Form 990, tax year 2016

View the entire original 990 at ProPublica ↗

Organization: FRANCISCAN HEALTH RENSSELAER (EIN 47-3825106)
Tax period: 2016-01-01 to 2016-12-31
Filed: 2017-11-15
IRS object ID: 201723199349308592
Schema version: 2016v3.1
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 D
Schedule H
Schedule J
Schedule O
Schedule R

Return header ReturnHeader

Field	Value	IRS element (for citing)
Return	2017-11-15T12:49:24-06:00	ReturnTs
Tax Period End	2016-12-31	TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

Preparer Firm Name PreparerFirmName

Field	Value	IRS element (for citing)
Business Name Line1	PricewaterhouseCoopers LLP	BusinessNameLine1Txt

Preparer US Address PreparerUSAddress

Field	Value	IRS element (for citing)
Address Line1	2001 MARKET ST SUITE 1800	AddressLine1Txt
City	PHILADELPHIA	CityNm
State Abbreviation	PA	StateAbbreviationCd
ZIP	19103	ZIPCd

Field	Value	IRS element (for citing)
Return Type	990	ReturnTypeCd
Tax Period Begin	2016-01-01	TaxPeriodBeginDt

Filer Filer

Field	Value	IRS element (for citing)
EIN	473825106	EIN

Business Name BusinessName

Field	Value	IRS element (for citing)
Business Name Line1	FRANCISCAN HEALTH RENSSELAER INC	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
In Care Of	% JASON GEDDES	InCareOfNm
Business Name Control	FRAN	BusinessNameControlTxt
Phone	2198665141	PhoneNum

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	1104 E GRACE ST	AddressLine1Txt
City	RENSSELAER	CityNm
State Abbreviation	IN	StateAbbreviationCd
ZIP	47978	ZIPCd

Business Officer BusinessOfficerGrp

Field	Value	IRS element (for citing)
Person	KEVIN D LEAHY	PersonNm
Person Title	PRESIDENT	PersonTitleTxt
Phone	5742563935	PhoneNum
Signature	2017-11-11	SignatureDt
Discuss With Paid Preparer	Yes (true)	DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

Field	Value	IRS element (for citing)
Preparer Person	ERIC M MCNEIL	PreparerPersonNm
PTIN	P00460263	PTIN
Phone	2673303000	PhoneNum

Filing Security Information FilingSecurityInformation

IP Address IPAddress

Field	Value	IRS element (for citing)
I Pv4 Address	155.201.188.33	IPv4AddressTxt

Field	Value	IRS element (for citing)
Federal Original Submission Id	23522320173195000011	FederalOriginalSubmissionId
Federal Original Submission Id	2017-11-15	FederalOriginalSubmissionIdDt
Filing License Type	P	FilingLicenseTypeCd
At Submission Creation Device Id	CE88C8CFFE51E99E9DF9B7C5B75C02950C36D7D6	AtSubmissionCreationDeviceId
At Submission Filing Device Id	7C276736B1F8534619D83B6F2AADECD8007A5E58	AtSubmissionFilingDeviceId

Field	Value	IRS element (for citing)
Tax	2016	TaxYr
Build TS	2017-02-10 21:41:12Z	BuildTS

Form 990 IRS990

Field	Value	IRS element (for citing)
Principal Officer	KEVIN D LEAHY	PrincipalOfficerNm

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	1515 DRAGOON TRAIL	AddressLine1Txt
City	MISHAWAKA	CityNm
State Abbreviation	IN	StateAbbreviationCd
ZIP	46544	ZIPCd

Field	Value	IRS element (for citing)
Gross Receipts	$32,175,573	GrossReceiptsAmt
Group Return For Affiliates	false	GroupReturnForAffiliatesInd
Group Exemption	0928	GroupExemptionNum
Organization501c3	Yes (X)	Organization501c3Ind
Website Address	WWWW.FRANCISCANALLIANCE.ORG	WebsiteAddressTxt
Type Of Organization Corp	Yes (X)	TypeOfOrganizationCorpInd
Formation	2015	FormationYr
Legal Domicile State	IN	LegalDomicileStateCd
Activity Or Mission	SEE SCHEDULE O	ActivityOrMissionDesc
Voting Members Governing Body	5	VotingMembersGoverningBodyCnt
Voting Members Independent	4	VotingMembersIndependentCnt
Total Employee	245	TotalEmployeeCnt
Total Volunteers	15	TotalVolunteersCnt
Total Gross UBI	$37,724	TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm	$22,434	NetUnrelatedBusTxblIncmAmt
PY Contributions Grants	$28,263	PYContributionsGrantsAmt
CY Contributions Grants	$11,320	CYContributionsGrantsAmt
PY Program Service Revenue	$10,769,787	PYProgramServiceRevenueAmt
CY Program Service Revenue	$31,791,620	CYProgramServiceRevenueAmt
PY Investment Income	$332	PYInvestmentIncomeAmt
CY Investment Income	$1,233	CYInvestmentIncomeAmt
PY Other Revenue	$0	PYOtherRevenueAmt
CY Other Revenue	$371,400	CYOtherRevenueAmt
PY Total Revenue	$10,798,382	PYTotalRevenueAmt
CY Total Revenue	$32,175,573	CYTotalRevenueAmt
PY Grants And Similar Paid	$0	PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid	$0	CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members	$0	PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members	$0	CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid	$6,789,412	PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid	$18,273,443	CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns	$0	PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns	$0	CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense	$0	CYTotalFundraisingExpenseAmt
PY Other Expenses	$5,827,258	PYOtherExpensesAmt
CY Other Expenses	$20,632,880	CYOtherExpensesAmt
PY Total Expenses	$12,616,670	PYTotalExpensesAmt
CY Total Expenses	$38,906,323	CYTotalExpensesAmt
PY Revenues Less Expenses	-$1,818,288	PYRevenuesLessExpensesAmt
CY Revenues Less Expenses	-$6,730,750	CYRevenuesLessExpensesAmt
Total Assets BOY	$27,927,367	TotalAssetsBOYAmt
Total Assets EOY	$33,358,310	TotalAssetsEOYAmt
Total Liabilities BOY	$22,695,252	TotalLiabilitiesBOYAmt
Total Liabilities EOY	$34,998,130	TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY	$5,232,115	NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY	-$1,639,820	NetAssetsOrFundBalancesEOYAmt
Info In Schedule O Part III	Yes (X)	InfoInScheduleOPartIIIInd
Mission	THE PURPOSES FOR WHICH FRANCISCAN HEALTH RENSSELAER IS FORMED ARE: TO CONTINUE THE HEALING MINISTRY OF CHRIST IN ACCORDANCE WITH THE TEACHINGS OF THE ROMAN CATHOLIC CHURCH AND, IN PARTNERSHIP WITH OTHERS, TO PROVIDE A FULL CONTINUUM OF HEALTH CARE SERVICES; TO CARRY ON EDUCATIONAL ACTIVITIES RELATED TO THE PROMOTION OF HEALTH; TO PROMOTE AND CARRY ON SCIENTIFIC RESEARCH RELATED TO HEALTH CARE; AND TO PARTICIPATE IN ANY ACTIVITY DESIGNED AND CONDUCTED TO PROMOTE THE GENERAL HEALTH OF THOSE SERVED BY FRANCISCAN HEALTH RENSSELAER. THE REVENUES OF FRANCISCAN HEALTH RENSSELAER ALLOW FOR THE OPERATION OF HEALTH CARE FACILITIES WHERE THE PURPOSE IS TO RESPECT LIFE AND TO PRESERVE HEALTH AS WELL AS TREAT ILLNESS AND INJURY. THIS ALLOWS FOR THE ACCOMPLISHMENT OF THE CORPORATE MINISTRY WHICH HAS THE FOLLOWING CENTRAL CONCERNS: COMPASSION FOR THOSE IN NEED, RESPECT FOR LIFE AND THE DIGNITY OF PERSONS, WELLNESS AND THE PREVENTION OF ILLNESS, RESTORATION TO HEALTH, AND THE ACCEPTANCE OF DEATH AS TH	MissionDesc
Significant New Program Srvc	false	SignificantNewProgramSrvcInd
Significant Change	false	SignificantChangeInd
Expense	$34,327,705	ExpenseAmt
Grant	$0	GrantAmt
Revenue	$32,066,117	RevenueAmt
Desc	FRANCISCAN HEALTH RENSSELAER, INC. IS A TWENTY FIVE BED CRITICAL CARE HOSPITAL LOCATED IN RENSSELAER, INDIANA PROVIDING HEALTH CARE SERVICES TO THE RESIDENTS OF JASPER AND SURROUNDING COUNTIES. SERVICES PROVIDED INCLUDE INPATIENT AND OUTPATIENT MEDICAL, SURGICAL, EXTENDED CARE, DIAGNOSTIC, EMERGENCY CARE, HOME HEALTH AND HOSPICE SERVICES AS WELL AS THE OPERATION OF TWO RURAL HEALTH CLINICS. SPECIALTY SERVICES INCLUDE CARDIOLOGY, ORTHOPEDICS, UROLOGY, AND ONCOLOGY.	Desc
Total Program Service Expenses	$34,327,705	TotalProgramServiceExpensesAmt
Described In Section501c3	Yes (true)	DescribedInSection501c3Ind
Schedule B Required	Yes (true)	ScheduleBRequiredInd
Political Campaign Acty	false	PoliticalCampaignActyInd
Lobbying Activities	false	LobbyingActivitiesInd
Subject To Proxy Tax	false	SubjectToProxyTaxInd
Donor Advised Fund	false	DonorAdvisedFundInd
Conservation Easements	false	ConservationEasementsInd
Collections Of Art	false	CollectionsOfArtInd
Credit Counseling	false	CreditCounselingInd
Temp Or Permanent Endowments	false	TempOrPermanentEndowmentsInd
Report Land Building Equipment	Yes (true)	ReportLandBuildingEquipmentInd
Report Investments Other Sec	false	ReportInvestmentsOtherSecInd
Report Program Related Invst	false	ReportProgramRelatedInvstInd
Report Other Assets	false	ReportOtherAssetsInd
Report Other Liabilities	Yes (true)	ReportOtherLiabilitiesInd
Include FIN48 Footnote	false	IncludeFIN48FootnoteInd
Independent Audit Fincl Stmt	false	IndependentAuditFinclStmtInd
Consolidated Audit Fincl Stmt	Yes (true)	ConsolidatedAuditFinclStmtInd
School Operating	false	SchoolOperatingInd
Foreign Office	false	ForeignOfficeInd
Foreign Activities	false	ForeignActivitiesInd
More Than5000 K To Org	false	MoreThan5000KToOrgInd
More Than5000 K To Individuals	false	MoreThan5000KToIndividualsInd
Professional Fundraising	false	ProfessionalFundraisingInd
Fundraising Activities	false	FundraisingActivitiesInd
Gaming Activities	false	GamingActivitiesInd
Operate Hospital	Yes (true)	OperateHospitalInd
Audited Financial Stmt Att	Yes (true)	AuditedFinancialStmtAttInd
Grants To Organizations	false	GrantsToOrganizationsInd
Grants To Individuals	false	GrantsToIndividualsInd
Schedule J Required	Yes (true)	ScheduleJRequiredInd
Tax Exempt Bonds	false	TaxExemptBondsInd
Engaged In Excess Benefit Trans	false	EngagedInExcessBenefitTransInd
PY Excess Benefit Trans	false	PYExcessBenefitTransInd
Loan Outstanding	false	LoanOutstandingInd
Grant To Related Person	false	GrantToRelatedPersonInd
Business Rln With Org Mem	false	BusinessRlnWithOrgMemInd
Business Rln With Fam Mem	false	BusinessRlnWithFamMemInd
Business Rln With Officer Ent	false	BusinessRlnWithOfficerEntInd
Deductible Non Cash Contri	false	DeductibleNonCashContriInd
Deductible Art Contribution	false	DeductibleArtContributionInd
Terminate Operations	false	TerminateOperationsInd
Partial Liquidation	false	PartialLiquidationInd
Disregarded Entity	false	DisregardedEntityInd
Related Entity	Yes (true)	RelatedEntityInd
Related Organization Ctrl Ent	false	RelatedOrganizationCtrlEntInd
Trnsfr Exmpt Non Chrtbl Rltd Org	false	TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted Prtshp	false	ActivitiesConductedPrtshpInd
Schedule O Required	Yes (true)	ScheduleORequiredInd
IRP Document	67	IRPDocumentCnt
IRP Document W2 G	0	IRPDocumentW2GCnt
Backup Wthld Compliance	Yes (true)	BackupWthldComplianceInd
Employee	245	EmployeeCnt
Employment Tax Returns Filed	Yes (true)	EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over Limit	false	UnrelatedBusIncmOverLimitInd
Foreign Financial Account	false	ForeignFinancialAccountInd
Prohibited Tax Shelter Trans	false	ProhibitedTaxShelterTransInd
Taxable Party Notification	false	TaxablePartyNotificationInd
Nondeductible Contributions	false	NondeductibleContributionsInd
Quid Pro Quo Contributions	false	QuidProQuoContributionsInd
Form8282 Property Disposed Of	false	Form8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft Cntrct	false	RcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft Cntrct	false	PayPremiumsPrsnlBnftCntrctInd
Form8899 Filedind	false	Form8899Filedind
Form1098 C Filed	false	Form1098CFiledInd
Indoor Tanning Services	false	IndoorTanningServicesInd
Info In Schedule O Part VI	Yes (X)	InfoInScheduleOPartVIInd
Governing Body Voting Members	5	GoverningBodyVotingMembersCnt
Independent Voting Member	4	IndependentVotingMemberCnt
Family Or Business Rln	false	FamilyOrBusinessRlnInd
Delegation Of Mgmt Duties	false	DelegationOfMgmtDutiesInd
Change To Org Documents	false	ChangeToOrgDocumentsInd
Material Diversion Or Misuse	false	MaterialDiversionOrMisuseInd
Members Or Stockholders	Yes (true)	MembersOrStockholdersInd
Election Of Board Members	false	ElectionOfBoardMembersInd
Decisions Subject To Approva	Yes (true)	DecisionsSubjectToApprovaInd
Minutes Of Governing Body	Yes (true)	MinutesOfGoverningBodyInd
Minutes Of Committees	Yes (true)	MinutesOfCommitteesInd
Officer Mailing Address	false	OfficerMailingAddressInd
Local Chapters	false	LocalChaptersInd
Form990 Provided To Gvrn Body	Yes (true)	Form990ProvidedToGvrnBodyInd
Conflict Of Interest Policy	Yes (true)	ConflictOfInterestPolicyInd
Annual Disclosure Covered Prsn	Yes (true)	AnnualDisclosureCoveredPrsnInd
Regular Monitoring Enfrc	Yes (true)	RegularMonitoringEnfrcInd
Whistleblower Policy	false	WhistleblowerPolicyInd
Document Retention Policy	false	DocumentRetentionPolicyInd
Compensation Process CEO	false	CompensationProcessCEOInd
Compensation Process Other	false	CompensationProcessOtherInd
Investment In Joint Venture	false	InvestmentInJointVentureInd
States Where Copy Of Return Is Fld	IN	StatesWhereCopyOfReturnIsFldCd
Other Website	Yes (X)	OtherWebsiteInd
Upon Request	Yes (X)	UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Field	Value	IRS element (for citing)
Person	JASON GEDDES	PersonNm
Phone	5742546268	PhoneNum

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	1515 DRAGOON TRAIL	AddressLine1Txt
City	MISHAWAKA	CityNm
State Abbreviation	IN	StateAbbreviationCd
ZIP	46544	ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (11 entries)

TitleTitleTxt	Average Hours Per WeekAverageHoursPerWeekRt	Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt	Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd	Reportable Comp From OrgReportableCompFromOrgAmt	Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt	Other CompensationOtherCompensationAmt	OfficerOfficerInd	Highest Compensated EmployeeHighestCompensatedEmployeeInd
SISTER JANE MARIE KLEIN
CHAIR & DIRECTOR	5.0	51.0	Yes (X)	$0	$0	$0
KEVIN D LEAHY
PRESIDENT & DIRECTOR	5.0	51.0	Yes (X)	$0	$1,847,162	$808,104	Yes (X)
SISTER M ANN KATHLEEN MAGIERA
TREASURER & DIRECTOR	5.0	46.0	Yes (X)	$0	$0	$0	Yes (X)
SISTER M MADONNA ROUGEAU
DIRECTOR	5.0	45.0	Yes (X)	$0	$0	$0
SISTER ROSE AGNES PFAUTSCH
DIRECTOR	5.0	10.0	Yes (X)	$0	$0	$0
SISTER LETHIA MARIE LEVEILLE
SECRETARY	5.0	46.0		$0	$0	$0	Yes (X)
TERRANCE WILSON
FACILITY CEO/PRES OF HOSP DIV	5.0	40.0		$0	$832,500	$524,108	Yes (X)
THOMAS GRYZBEK
SR VP OF POST ACUTE SVCS DIV	0.0	40.0		$0	$616,904	$174,558	Yes (X)
SUSAN HOOKER
MANAGER - PHARMACY OPERATIONS	40.0	0.0		$114,947	$0	$21,411		Yes (X)
LINDA BRADBURY
CLINICAL STAFF PHARMACIST	40.0	0.0		$102,573	$0	$9,796		Yes (X)
CATHERINE LARSON
NURSE PRACTITIONER	40.0	0.0		$103,560	$0	$352		Yes (X)

Field	Value	IRS element (for citing)
Total Reportable Comp From Org	$321,080	TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org	$3,296,566	TotReportableCompRltdOrgAmt
Total Other Compensation	$1,538,329	TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K	3	IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed	false	FormerOfcrEmployeesListedInd
Total Comp Greater Than150 K	Yes (true)	TotalCompGreaterThan150KInd
Compensation From Other Srcs	false	CompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (3 entries)

Address Line1ContractorAddress/USAddress/AddressLine1Txt	CityContractorAddress/USAddress/CityNm	State AbbreviationContractorAddress/USAddress/StateAbbreviationCd	ZIPContractorAddress/USAddress/ZIPCd	ServicesServicesDesc	CompensationCompensationAmt
ILLINOIS ANESTHESIA
2001 N MATTIS AVE BOX 7048	CHAMPAIGN	IL	61826	ANESTHESIA SERVICES	$414,917
XTEND HEALTHCARE LLC
500 W MAIN STREET SUITE 14	HENDERSONVILLE	TN	37075	FINANCIAL SERVICES	$354,191
BLUE CO LLC
2712 SOLUTIONS CENTER	CHICAGO	IL	60677	ACCOUNTING SERVICES	$125,343

Field	Value	IRS element (for citing)
Cntrct Rcvd Greater Than100 K	3	CntrctRcvdGreaterThan100KCnt
Government Grants	$11,320	GovernmentGrantsAmt
All Other Contributions	$0	AllOtherContributionsAmt
Total Contributions	$11,320	TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (2 entries)

DescDesc	BusinessBusinessCd	Total Revenue ColumnTotalRevenueColumnAmt	Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt	ExclusionExclusionAmt
PATIENT SERVICE AND OTHER REVENUES	622110	$31,732,441	$31,732,441
CAFETERIA	722320	$59,179		$59,179

Field	Value	IRS element (for citing)
Total Program Service Revenue	$31,791,620	TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$1,233	TotalRevenueColumnAmt
Exclusion	$1,233	ExclusionAmt

Incm From Invest Bond Proceeds IncmFromInvestBondProceedsGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$0	TotalRevenueColumnAmt

Royalties Revenue RoyaltiesRevenueGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$0	TotalRevenueColumnAmt

Rental Income Or Loss RentalIncomeOrLossGrp

Field	Value	IRS element (for citing)
Real	$0	RealAmt
Personal	$0	PersonalAmt

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$0	TotalRevenueColumnAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$0	TotalRevenueColumnAmt

Field	Value	IRS element (for citing)
Fundraising Gross Income	$0	FundraisingGrossIncomeAmt
Fundraising Direct Expenses	$0	FundraisingDirectExpensesAmt

Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$0	TotalRevenueColumnAmt

Field	Value	IRS element (for citing)
Gaming Gross Income	$0	GamingGrossIncomeAmt
Gaming Direct Expenses	$0	GamingDirectExpensesAmt

Net Income From Gaming NetIncomeFromGamingGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$0	TotalRevenueColumnAmt

Field	Value	IRS element (for citing)
Gross Sales Of Inventory	$0	GrossSalesOfInventoryAmt
Cost Of Goods Sold	$0	CostOfGoodsSoldAmt

Net Income Or Loss NetIncomeOrLossGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$0	TotalRevenueColumnAmt

Other Revenue Misc OtherRevenueMiscGrp (2 entries)

DescDesc	BusinessBusinessCd	Total Revenue ColumnTotalRevenueColumnAmt	Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt	Unrelated Business RevenueUnrelatedBusinessRevenueAmt
OTHER REVENUE	900099	$333,676	$333,676
LABORATORY		$37,724		$37,724

Field	Value	IRS element (for citing)
Other Revenue Total	$371,400	OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$32,175,573	TotalRevenueColumnAmt
Related Or Exempt Func Income	$32,066,117	RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue	$37,724	UnrelatedBusinessRevenueAmt
Exclusion	$60,412	ExclusionAmt

Grants To Domestic Orgs GrantsToDomesticOrgsGrp

Field	Value	IRS element (for citing)
Total	$0	TotalAmt

Grants To Domestic Individuals GrantsToDomesticIndividualsGrp

Field	Value	IRS element (for citing)
Total	$0	TotalAmt

Foreign Grants ForeignGrantsGrp

Field	Value	IRS element (for citing)
Total	$0	TotalAmt

Benefits To Members BenefitsToMembersGrp

Field	Value	IRS element (for citing)
Total	$0	TotalAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

Field	Value	IRS element (for citing)
Total	$0	TotalAmt

Comp Disqual Persons CompDisqualPersonsGrp

Field	Value	IRS element (for citing)
Total	$0	TotalAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

Field	Value	IRS element (for citing)
Total	$13,748,671	TotalAmt
Program Services	$11,249,629	ProgramServicesAmt
Management And General	$2,499,042	ManagementAndGeneralAmt

Pension Plan Contributions PensionPlanContributionsGrp

Field	Value	IRS element (for citing)
Total	$800,628	TotalAmt
Program Services	$655,101	ProgramServicesAmt
Management And General	$145,527	ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

Field	Value	IRS element (for citing)
Total	$2,748,643	TotalAmt
Program Services	$2,249,033	ProgramServicesAmt
Management And General	$499,610	ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

Field	Value	IRS element (for citing)
Total	$975,501	TotalAmt
Program Services	$798,188	ProgramServicesAmt
Management And General	$177,313	ManagementAndGeneralAmt

Fees For Services Management FeesForServicesManagementGrp

Field	Value	IRS element (for citing)
Total	$0	TotalAmt

Fees For Services Legal FeesForServicesLegalGrp

Field	Value	IRS element (for citing)
Total	$0	TotalAmt

Fees For Services Accounting FeesForServicesAccountingGrp

Field	Value	IRS element (for citing)
Total	$0	TotalAmt

Fees For Services Lobbying FeesForServicesLobbyingGrp

Field	Value	IRS element (for citing)
Total	$0	TotalAmt

Fees For Services Prof Fundraising FeesForServicesProfFundraising

Field	Value	IRS element (for citing)
Total	$0	TotalAmt

Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp

Field	Value	IRS element (for citing)
Total	$0	TotalAmt

Fees For Services Other FeesForServicesOtherGrp

Field	Value	IRS element (for citing)
Total	$969,775	TotalAmt
Program Services	$901,067	ProgramServicesAmt
Management And General	$68,708	ManagementAndGeneralAmt

Advertising AdvertisingGrp

Field	Value	IRS element (for citing)
Total	$300,694	TotalAmt
Program Services	$300,694	ProgramServicesAmt

Office Expenses OfficeExpensesGrp

Field	Value	IRS element (for citing)
Total	$41,984	TotalAmt
Program Services	$23,155	ProgramServicesAmt
Management And General	$18,829	ManagementAndGeneralAmt

Information Technology InformationTechnologyGrp

Field	Value	IRS element (for citing)
Total	$2,428,830	TotalAmt
Program Services	$2,428,830	ProgramServicesAmt

Royalties RoyaltiesGrp

Field	Value	IRS element (for citing)
Total	$0	TotalAmt

Occupancy OccupancyGrp

Field	Value	IRS element (for citing)
Total	$721,426	TotalAmt
Program Services	$721,426	ProgramServicesAmt

Travel TravelGrp

Field	Value	IRS element (for citing)
Total	$187,624	TotalAmt
Program Services	$162,639	ProgramServicesAmt
Management And General	$24,985	ManagementAndGeneralAmt

Pymt Travel Entrtnmnt Pub Ofcl PymtTravelEntrtnmntPubOfclGrp

Field	Value	IRS element (for citing)
Total	$0	TotalAmt

Conferences Meetings ConferencesMeetingsGrp

Field	Value	IRS element (for citing)
Total	$9,319	TotalAmt
Program Services	$6,240	ProgramServicesAmt
Management And General	$3,079	ManagementAndGeneralAmt

Interest InterestGrp

Field	Value	IRS element (for citing)
Total	$835,567	TotalAmt
Program Services	$835,567	ProgramServicesAmt

Payments To Affiliates PaymentsToAffiliatesGrp

Field	Value	IRS element (for citing)
Total	$0	TotalAmt

Depreciation Depletion DepreciationDepletionGrp

Field	Value	IRS element (for citing)
Total	$2,336,844	TotalAmt
Program Services	$2,336,844	ProgramServicesAmt

Insurance InsuranceGrp

Field	Value	IRS element (for citing)
Total	$314,847	TotalAmt
Program Services	$314,847	ProgramServicesAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDesc	TotalTotalAmt	Program ServicesProgramServicesAmt	Management And GeneralManagementAndGeneralAmt
PURCHASED SERVICES	$4,161,816	$3,876,568	$285,248
MEDICAL SUPPLIES/DRUGS	$3,521,866	$3,521,866
REPAIRS & MAINTENANCE	$1,249,745	$561,355	$688,390
ASSESSMENTS	$1,190,052	$1,057,192	$132,860

All Other Expenses AllOtherExpensesGrp

Field	Value	IRS element (for citing)
Total	$2,362,491	TotalAmt
Program Services	$2,327,464	ProgramServicesAmt
Management And General	$35,027	ManagementAndGeneralAmt

Total Functional Expenses TotalFunctionalExpensesGrp

Field	Value	IRS element (for citing)
Total	$38,906,323	TotalAmt
Program Services	$34,327,705	ProgramServicesAmt
Management And General	$4,578,618	ManagementAndGeneralAmt
Fundraising	$0	FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

Field	Value	IRS element (for citing)
BOY	$1,309,117	BOYAmt
EOY	$2,024,641	EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

Field	Value	IRS element (for citing)
BOY	$0	BOYAmt
EOY	$0	EOYAmt

Pledges And Grants Receivable PledgesAndGrantsReceivableGrp

Field	Value	IRS element (for citing)
BOY	$0	BOYAmt
EOY	$0	EOYAmt

Accounts Receivable AccountsReceivableGrp

Field	Value	IRS element (for citing)
BOY	$3,701,307	BOYAmt
EOY	$5,103,136	EOYAmt

Receivables From Officers Etc ReceivablesFromOfficersEtcGrp

Field	Value	IRS element (for citing)
BOY	$0	BOYAmt
EOY	$0	EOYAmt

Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp

Field	Value	IRS element (for citing)
BOY	$0	BOYAmt
EOY	$0	EOYAmt

Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp

Field	Value	IRS element (for citing)
BOY	$0	BOYAmt
EOY	$0	EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

Field	Value	IRS element (for citing)
BOY	$1,180,930	BOYAmt
EOY	$976,241	EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

Field	Value	IRS element (for citing)
BOY	$0	BOYAmt
EOY	$0	EOYAmt

Field	Value	IRS element (for citing)
Land Bldg Equip Cost Or Other Bss	$28,493,822	LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec	$3,471,059	LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

Field	Value	IRS element (for citing)
BOY	$21,250,689	BOYAmt
EOY	$25,022,763	EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

Field	Value	IRS element (for citing)
BOY	$0	BOYAmt
EOY	$0	EOYAmt

Investments Other Securities InvestmentsOtherSecuritiesGrp

Field	Value	IRS element (for citing)
BOY	$82,451	BOYAmt
EOY	$84,000	EOYAmt

Investments Program Related InvestmentsProgramRelatedGrp

Field	Value	IRS element (for citing)
BOY	$0	BOYAmt
EOY	$0	EOYAmt

Intangible Assets IntangibleAssetsGrp

Field	Value	IRS element (for citing)
BOY	$0	BOYAmt
EOY	$0	EOYAmt

Other Assets Total OtherAssetsTotalGrp

Field	Value	IRS element (for citing)
BOY	$402,873	BOYAmt
EOY	$147,529	EOYAmt

Total Assets TotalAssetsGrp

Field	Value	IRS element (for citing)
BOY	$27,927,367	BOYAmt
EOY	$33,358,310	EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

Field	Value	IRS element (for citing)
BOY	$1,139,146	BOYAmt
EOY	$1,804,991	EOYAmt

Grants Payable GrantsPayableGrp

Field	Value	IRS element (for citing)
BOY	$0	BOYAmt
EOY	$0	EOYAmt

Deferred Revenue DeferredRevenueGrp

Field	Value	IRS element (for citing)
BOY	$0	BOYAmt
EOY	$0	EOYAmt

Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$0	BOYAmt
EOY	$0	EOYAmt

Escrow Account Liability EscrowAccountLiabilityGrp

Field	Value	IRS element (for citing)
BOY	$0	BOYAmt
EOY	$0	EOYAmt

Loans From Officers Directors LoansFromOfficersDirectorsGrp

Field	Value	IRS element (for citing)
BOY	$0	BOYAmt
EOY	$0	EOYAmt

Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp

Field	Value	IRS element (for citing)
BOY	$0	BOYAmt
EOY	$0	EOYAmt

Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp

Field	Value	IRS element (for citing)
BOY	$19,062,232	BOYAmt
EOY	$20,100,912	EOYAmt

Other Liabilities OtherLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$2,493,874	BOYAmt
EOY	$13,092,227	EOYAmt

Total Liabilities TotalLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$22,695,252	BOYAmt
EOY	$34,998,130	EOYAmt

Field	Value	IRS element (for citing)
Organization Follows SFAS117	Yes (X)	OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

Field	Value	IRS element (for citing)
BOY	$5,149,664	BOYAmt
EOY	-$1,723,820	EOYAmt

Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp

Field	Value	IRS element (for citing)
BOY	$82,451	BOYAmt
EOY	$84,000	EOYAmt

Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp

Field	Value	IRS element (for citing)
BOY	$0	BOYAmt
EOY	$0	EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

Field	Value	IRS element (for citing)
BOY	$5,232,115	BOYAmt
EOY	-$1,639,820	EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

Field	Value	IRS element (for citing)
BOY	$27,927,367	BOYAmt
EOY	$33,358,310	EOYAmt

Field	Value	IRS element (for citing)
Info In Schedule O Part XI	Yes (X)	InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss	-$6,730,750	ReconcilationRevenueExpnssAmt
Other Changes In Net Assets	-$141,185	OtherChangesInNetAssetsAmt
Method Of Accounting Accrual	Yes (X)	MethodOfAccountingAccrualInd
Accountant Compile Or Review	false	AccountantCompileOrReviewInd
FS Audited	Yes (true)	FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

Field	Value	IRS element (for citing)
Consolidated Basis Fincl Stmt	Yes (X)	ConsolidatedBasisFinclStmtInd

Field	Value	IRS element (for citing)
Audit Committee	Yes (true)	AuditCommitteeInd
Federal Grant Audit Required	false	FederalGrantAuditRequiredInd

Schedule A IRS990ScheduleA

Field	Value	IRS element (for citing)
Hospital	Yes (X)	HospitalInd

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

Field	Value	IRS element (for citing)
Contributor	RESTRICTED	ContributorNum

Contributor Business Name ContributorBusinessName

Field	Value	IRS element (for citing)
Business Name Line1	RESTRICTED	BusinessNameLine1

Contributor US Address ContributorUSAddress

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)
Total Contributions	RESTRICTED	TotalContributionsAmt

Schedule D IRS990ScheduleD

Field	Value	IRS element (for citing)
Art Public Exhibition Amounts		ArtPublicExhibitionAmountsGrp
Held Works Art		HeldWorksArtGrp
CY Minus3 Yr Endwmt Fund		CYMinus3YrEndwmtFundGrp
CY Minus4 Yr Endwmt Fund		CYMinus4YrEndwmtFundGrp

Land LandGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$675,791	OtherCostOrOtherBasisAmt
Book Value	$675,791	BookValueAmt

Buildings BuildingsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$16,471,346	OtherCostOrOtherBasisAmt
Depreciation	$1,450,913	DepreciationAmt
Book Value	$15,020,433	BookValueAmt

Leasehold Improvements LeaseholdImprovementsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$484,426	OtherCostOrOtherBasisAmt
Depreciation	$44,404	DepreciationAmt
Book Value	$440,022	BookValueAmt

Equipment EquipmentGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$7,048,087	OtherCostOrOtherBasisAmt
Depreciation	$1,969,265	DepreciationAmt
Book Value	$5,078,822	BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$3,814,172	OtherCostOrOtherBasisAmt
Depreciation	$6,477	DepreciationAmt
Book Value	$3,807,695	BookValueAmt

Field	Value	IRS element (for citing)
Total Book Value Land Buildings	$25,022,763	TotalBookValueLandBuildingsAmt
Federal Income Tax Liability	$0	FederalIncomeTaxLiabilityAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (5 entries)

DescDesc	AmtAmt
CAPITAL LEASES	$589,307
DUE TO THIRD PARTY PAYORS	$1,585,381
ACCRUED PAYROLL	$953,109
OTHER SHORT TERM LIABILITY	$9,942,076
ESTIMATED INSURANCE LIABILITY	$22,354

Field	Value	IRS element (for citing)
Total Liability	$13,092,227	TotalLiabilityAmt

Schedule H IRS990ScheduleH

Field	Value	IRS element (for citing)
Financial Assistance Policy	Yes (true)	FinancialAssistancePolicyInd
Written Policy	Yes (true)	WrittenPolicyInd
All Hospitals Policy	Yes (X)	AllHospitalsPolicyInd
FPG Reference Free Care	Yes (true)	FPGReferenceFreeCareInd
Percent200	Yes (X)	Percent200Ind
FPG Reference Discounted Care	Yes (true)	FPGReferenceDiscountedCareInd
Percent400	Yes (X)	Percent400Ind
Free Care Medically Indigent	Yes (true)	FreeCareMedicallyIndigentInd
Financial Assistance Budget	Yes (true)	FinancialAssistanceBudgetInd
Expenses Exceed Budget	Yes (true)	ExpensesExceedBudgetInd
Unable To Provide Care	false	UnableToProvideCareInd
Annual Community Bnft Report	Yes (true)	AnnualCommunityBnftReportInd
Report Publically Available	Yes (true)	ReportPublicallyAvailableInd

Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$366,676	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$366,676	NetCommunityBenefitExpnsAmt
Total Expense	0.00940	TotalExpensePct

Unreimbursed Medicaid UnreimbursedMedicaidGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$5,623,407	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$2,182,709	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$3,440,698	NetCommunityBenefitExpnsAmt
Total Expense	0.08840	TotalExpensePct

Total Financial Assistance Typ TotalFinancialAssistanceTyp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$5,990,083	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$2,182,709	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$3,807,374	NetCommunityBenefitExpnsAmt
Total Expense	0.09780	TotalExpensePct

Community Health Services CommunityHealthServicesGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$23,490	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$45	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$23,445	NetCommunityBenefitExpnsAmt
Total Expense	0.00060	TotalExpensePct

Health Professions Education HealthProfessionsEducationGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$15,535	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$15,535	NetCommunityBenefitExpnsAmt
Total Expense	0.00040	TotalExpensePct

Subsidized Health Services SubsidizedHealthServicesGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$520,032	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$144,187	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$375,845	NetCommunityBenefitExpnsAmt
Total Expense	0.00970	TotalExpensePct

Cash And In Kind Contributions CashAndInKindContributionsGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$48,891	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$48,891	NetCommunityBenefitExpnsAmt
Total Expense	0.00130	TotalExpensePct

Total Other Benefits TotalOtherBenefitsGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$607,948	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$144,232	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$463,716	NetCommunityBenefitExpnsAmt
Total Expense	0.01200	TotalExpensePct

Total Community Benefits TotalCommunityBenefitsGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$6,598,031	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$2,326,941	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$4,271,090	NetCommunityBenefitExpnsAmt
Total Expense	0.10980	TotalExpensePct

Workforce Development WorkforceDevelopmentGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$69,351	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$69,351	NetCommunityBenefitExpnsAmt
Total Expense	0.00180	TotalExpensePct

Total Communtity Building Acty TotalCommuntityBuildingActyGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$69,351	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$69,351	NetCommunityBenefitExpnsAmt
Total Expense	0.00180	TotalExpensePct

Field	Value	IRS element (for citing)
Bad Debt Expense Reported	Yes (true)	BadDebtExpenseReportedInd
Bad Debt Expense	$2,613,601	BadDebtExpenseAmt
Reimbursed By Medicare	$13,679,648	ReimbursedByMedicareAmt
Cost Of Care Reimbursed By Medcr	$15,609,920	CostOfCareReimbursedByMedcrAmt
Medicare Surplus Or Shortfall	-$1,930,272	MedicareSurplusOrShortfallAmt

Costing Methodology Used CostingMethodologyUsedGrp

Field	Value	IRS element (for citing)
Cost To Charge Ratio	Yes (X)	CostToChargeRatioInd

Field	Value	IRS element (for citing)
Written Debt Collection Policy	Yes (true)	WrittenDebtCollectionPolicyInd
Financial Assistance Prvsn	Yes (true)	FinancialAssistancePrvsnInd
Hospital Facilities	1	HospitalFacilitiesCnt

Hospital Facilities HospitalFacilitiesGrp

Field	Value	IRS element (for citing)
Facility	1	FacilityNum

Business Name BusinessName

Field	Value	IRS element (for citing)
Business Name Line1	FRANCISCAN HEALTH RENSSELAER INC	BusinessNameLine1Txt

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	1104 E GRACE ST	AddressLine1Txt
City	RENSSELAER	CityNm
State Abbreviation	IN	StateAbbreviationCd
ZIP	47978	ZIPCd

Field	Value	IRS element (for citing)
Website Address	WWW.FRANCISCANALLIANCE.ORG/HOSPITALS	WebsiteAddressTxt
State License	15-005072-1	StateLicenseNum
Licensed Hospital	Yes (X)	LicensedHospitalInd
Critical Access Hospital	Yes (X)	CriticalAccessHospitalInd
Emergency Room24 Hrs	Yes (X)	EmergencyRoom24HrsInd

Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp

Hospital Facility Name HospitalFacilityName

Field	Value	IRS element (for citing)
Business Name Line1	FRANCISCAN HEALTH RENSSELAER INC	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
First Licensed CY Or PY	false	FirstLicensedCYOrPYInd
Tax Exempt Hospital CY Or PY	Yes (true)	TaxExemptHospitalCYOrPYInd
CHNA Conducted	Yes (true)	CHNAConductedInd
Community Definition	Yes (X)	CommunityDefinitionInd
Community Demographics	Yes (X)	CommunityDemographicsInd
Existing Resources	Yes (X)	ExistingResourcesInd
How Data Obtained	Yes (X)	HowDataObtainedInd
Community Health Needs	Yes (X)	CommunityHealthNeedsInd
Other Health Issues	Yes (X)	OtherHealthIssuesInd
Community Hlth Needs Id Process	Yes (X)	CommunityHlthNeedsIdProcessInd
Consulting Process	Yes (X)	ConsultingProcessInd
Prior CHNA Impact	Yes (X)	PriorCHNAImpactInd
CHNA Conducted	16	CHNAConductedYr
Take Into Account Others Input	Yes (true)	TakeIntoAccountOthersInputInd
CHNA Conducted With Other Fclts	Yes (true)	CHNAConductedWithOtherFcltsInd
CHNA Conducted With Non Fclts	Yes (true)	CHNAConductedWithNonFcltsInd
CHNA Report Widely Available	Yes (true)	CHNAReportWidelyAvailableInd
Rpt Available On Own Website	Yes (X)	RptAvailableOnOwnWebsiteInd
Own Website URL	SEE PART V-C	OwnWebsiteURLTxt
Implementation Strategy Adopt	Yes (true)	ImplementationStrategyAdoptInd
Implementation Strategy Adpt	16	ImplementationStrategyAdptYr
Strategy Posted Website	Yes (true)	StrategyPostedWebsiteInd
Strategy Website URL	SEE PART V-C	StrategyWebsiteURLTxt
Organization Incur Excise Tax	false	OrganizationIncurExciseTaxInd
Elig Criteria Explained	Yes (true)	EligCriteriaExplainedInd
FPG Family Incm Lmt Free Dscnt	Yes (X)	FPGFamilyIncmLmtFreeDscntInd
FPG Family Incm Lmt Free Care	200.	FPGFamilyIncmLmtFreeCarePct
FPG Family Incm Lmt Dscnt Care	400.	FPGFamilyIncmLmtDscntCarePct
Asset Level Criteria	Yes (X)	AssetLevelCriteriaInd
Medical Indigency Criteria	Yes (X)	MedicalIndigencyCriteriaInd
Underinsurance Stat Criteria	Yes (X)	UnderinsuranceStatCriteriaInd
Explained Basis	Yes (true)	ExplainedBasisInd
App Financial Asst Expln	Yes (true)	AppFinancialAsstExplnInd
Described Info	Yes (X)	DescribedInfoInd
Described Suprt Doc	Yes (X)	DescribedSuprtDocInd
Provided Hospital Contact	Yes (X)	ProvidedHospitalContactInd
Includes Publicity Measures	Yes (true)	IncludesPublicityMeasuresInd
FAP Available On Website	Yes (X)	FAPAvailableOnWebsiteInd
FAP Available On Website URL	SEE SECTION C	FAPAvailableOnWebsiteURLTxt
FAP App Available On Website	Yes (X)	FAPAppAvailableOnWebsiteInd
FAP App Available On Website URL	SEE SECTION C	FAPAppAvailableOnWebsiteURLTxt
FAP Summary On Website	Yes (X)	FAPSummaryOnWebsiteInd
FAP Summary On Website URL	SEE SECTION C	FAPSummaryOnWebsiteURLTxt
FAP Avlbl On Request No Charge	Yes (X)	FAPAvlblOnRequestNoChargeInd
FAP App Avlbl On Request No Chrg	Yes (X)	FAPAppAvlblOnRequestNoChrgInd
FAP Sum Avlbl On Request No Chrg	Yes (X)	FAPSumAvlblOnRequestNoChrgInd
Notified FAP Copy Bill Display	Yes (X)	NotifiedFAPCopyBillDisplayInd
FAP Translated	Yes (X)	FAPTranslatedInd
FAP Actions On Nonpayment	Yes (true)	FAPActionsOnNonpaymentInd
Permit No Actions	Yes (X)	PermitNoActionsInd
Collection Activities	false	CollectionActivitiesInd
Provided Written Notice	Yes (X)	ProvidedWrittenNoticeInd
Made Effort Orally Notify	Yes (X)	MadeEffortOrallyNotifyInd
Processed FAP Application	Yes (X)	ProcessedFAPApplicationInd
Made Presumptive Elig Determ	Yes (X)	MadePresumptiveEligDetermInd
Nondis Emergency Care Policy	Yes (true)	NondisEmergencyCarePolicyInd
Look Back Medicare Private	Yes (X)	LookBackMedicarePrivateInd
Amounts Generally Billed	false	AmountsGenerallyBilledInd
Gross Charges	false	GrossChargesInd

Supplemental Information SupplementalInformationGrp (7 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
LINE 2	THE JASPER COUNTY HOSPITAL WAS ACQUIRED BY FRANCISCAN ALLIANCE, INC. EFFECTIVE SEPTEMBER 1, 2015, AND BECAME FRANCISCAN HEALTH RENSSELAER, INC. ("RENSSELAER"). LINE 5 - INPUT FROM THE COMMUNITY A STATEWIDE FOCUS GROUP WAS HELD TO DISCUSS REGIONAL ISSUES WITH STATE PUBLIC HEALTH LEADERS. THE FOCUS GROUP WAS CO-SPONSORED BY INDIANA UNIVERSITY HEALTH, ST. VINCENT HEALTH, AND COMMUNITY HEALTH NETWORK. ATTENDEES INCLUDED: - HEALTH BY DESIGN/ALLIANCE FOR HEALTH PROMOTION KIM IRWIN, EXECUTIVE DIRECTOR - HEALTH OCCUPATION STUDENT ASSOCIATION (INDIANA) EDDIE ERICKSON, STATE COORDINATOR; HOLLI FRODGE, STATE PRESIDENT - HOOSIER ENVIRONMENTAL COUNCIL INDRA FRANK, ENVIRONMENTAL HEALTH PROJECT DIRECTOR - INDIANA AREA HEALTH EDUCATION CENTERS DR. JENNIFER TAYLOR, DIRECTOR OF EVALUATION - INDIANA ASSOCIATION OF AREA AGENCIES ON AGING KRISTEN LAEACE, CEO; DAWNE LYON; AND ELVA JAMES, EXECUTIVE DIRECTOR, AREA 4 AGENCY OF AGING - LEADING AGE INDIANA JIM LEICH, EXECUTIVE DIRECTOR; KATHY JOHNSON, DIRECTOR OF TRAINING - INDIANA CARDIOVASCULAR AND DIABETES COALITION SHARA WESLEY, COALITION MANAGER; JENNIFER PFERRER, CHAIRPERSON - INDIANA COALITION AGAINST DOMESTIC VIOLENCE COLLEEN YEAKLE, COORDINATOR OF PREVENTION INITIATIVES - INDIANA CANCER CONSORTIUM KEYLEE WRIGHT, CANCER CONTROL SECTION DIRECTOR - INDIANA JOINT ASTHMA COALITION - KELLI MCCRARY, COALITION COORDINATOR - IU HEALTH - JOYCE HERTKO - INDIANA HEALTHY WEIGHT INITIATIVE - ERIC BEERS, COALITION COORDINATOR - INDIANA HOSPITAL ASSOCIATION - BERNIE ULRICH, VICE PRESIDENT - INDIANA IMMUNIZATION COALITION - LISA ROBERSON, DIRECTOR - INDIANA MINORITY HEALTH COALITION - ANITA OHMIT, DIRECTOR OF RESEARCH; CALVIN ROBERSON, VP OF PLANNING AND PROGRAM DEVELOPMENT - INDIANA NURSES ASSOCIATION - BLAYNE MILEY, DIRECTOR OF POLICY AND ADVOCACY - INDIANA PSYCHOLOGICAL ASSOCIATION - DR. KATHLEEN VOGLER, PAST PRESIDENT; TABITHA ARNETTE, EXECUTIVE DIRECTOR - INDIANA PRIMARY HEALTH CARE ASSOCIATION - PHIL MORPHEW, CEO; ELAINE WILLIAMS, RESOURCE DEVELOPMENT PROGRAM DIRECTOR - INDIANA SCHOOL NURSES ASSOCIATION - CAROLYN SNYDER, EXECUTIVE DIRECTOR - INDIANA STATE DEPARTMENT OF HEALTH - DR. JOAN DUWVE, CHIEF MEDICAL OFFICER; KATELIN RYAN, DIRECTOR OF PROGRAM EVALUATION; J. DAVID HOPPER, DIRECTOR, LOCAL HEALTH DEPARTMENT OUTREACH DIVISION - INDIANA SOCIETY FOR PUBLIC HEALTH EDUCATION - HEIDI HANCHER-RAUCH, ADVOCACY CHAIR; JENNIFER CONNER, PRESIDENT - IUPUI FAIRBANKS SCHOOL OF PUBLIC HEALTH - SULA HOOD; CYNTHIA STONE - IUPUI POLIS CENTER - KAREN COMER - YMCA OF GREATER INDIANA - CHELSY WINTERS, ASSOCIATE DIRECTOR OF HEALTH PARTNERSHIPS PROGRAMS; ANN GRAVES, DIRECTOR OF HEALTH INITIATIVES AND PARTNERSHIPS IN ADDITION, LOCAL PUBLIC HEALTH AND SOCIAL SERVICE LEADERS WERE CONSULTED ON THE COMMUNITY HEALTH ISSUES, PRIORITIZATION OF NEEDS, AND COMMUNITY STRENGTHS. COMMUNITY HEALTH NEEDS ASSESSMENT ATTENDEE LIST STEVE WOOD MAYOR, CITY OF RENSSELAER KENDELL CULP PRESIDENT, JASPER COUNTY COMMISSIONERS REIN BONTRAGER MEMBER, JASPER COUNTY COUNCIL JOHN POTTER JUDGE, JASPER COUNTY CIRCUIT COURT JAMES WAKEFIELD PHYSICIAN, CHRISTIAN CLINIC NANCY BAILEY NURSE, JASPER COUNTY HEALTH DEPARTMENT DOUG GUTWELN REPRESENTATIVE, INDIANA GENERAL ASSEMBLY HARLEY HOUGTON DENTIST KEVIN DEFRIES CHIROPRACTOR CATHY TICEN WABASH VALLEY HOSPITAL OUTPATIENT SERVICES WANDA GIFFORD NURSE PRACTITIONER, WHEATFIELD HEALTH CENTRE CATHY LARSON NURSE PRACTITIONER, BROCK HEALTH CENTRE SCOTT JAMES ADMINISTRATOR, GEORGE ADE MEMORIAL HEALTH CENTER KEVIN KELLY JASPER COUNTY ECONOMIC DEVELOPMENT OFFICE SHEILA SCHROEDER JASPER COUNTY ECONOMIC DEVELOPMENT OFFICE KEN DOBIN PLANT MANAGER, CON AGRA FOODS PAUL LADD SEALY COMPONENT GROUP CRAIG WAGNER STARK TRUSS COMPANY CHAR SHAW FBI BUILDINGS INC. NED SPEICHER SUPERINTENDENT, RENSSELAER CENTRAL SCHOOL CORPORATION AARON CASE SUPERINTENDENT, KANKAKEE VALLEY SCHOOL CORPORATION ED HABROWSKI ASST. SUPERINTENDENT, RENSSELAER CENTRAL SCHOOL CORPORATION KIM LOBSIGER PRINCIPAL, KANKAKEE VALLEY HIGH SCHOOL ROBERT PASTOOR PRESIDENT, SAINT JOSEPHS COLLEGE WALT STANLEY HOSPITAL BOARD OF TRUSTEES PATTY KERN COOPERATIVE SCHOOL SERVICES DAVID VANDERLUGT PHYSICIAN, DEMOTTE PHYSICIANS CHRISTINE HASEKELL PROSECUTOR, JASPER COUNTY PROSECUTORS OFFICE GERRY WHITE OFFICE OF COMMUNITY AND RURAL AFFAIRS SANDRA BEHRENS NORTHWEST INDIANA AHEC JOHN MAGEE AREA SPECIALIST, USDA RURAL DEVELOPMENT PAM HABROWSKI PHARMACIST JODY MELTON COMMUNITY MEMBER BILL HOLLERMAN MEMBER, RENSSELAER CITY COUNCIL TIM SCHREEG PRESIDENT/CEO, FRANCISCAN HEALTH RENSSELAER, INC. DEB ELLIS ALTERNACARE DIRECTOR, FRANCISCAN HEALTH RENSSELAER, INC. STACIE KLINGER, VP PATIENT SERVICES, FRANCISCAN HEALTH RENSSELAER, INC. JEFF WEBB, VP FINANCIAL SERVICES, FRANCISCAN HEALTH RENSSELAER, INC. KAREN RIENTS, DIRECTOR HOME HEALTH CARE AND HOSPICE LISA DECKER VICE PRESIDENT, FRANCISCAN HEALTH LAFAYETTE JASON MIDDLETON DIRECTOR, FRANCISCAN HEALTH - LAFAYETTE, CRAWFORDSVILLE, AND RENSSELAER JENNIFER HELTON BELSTRA MILLING COMPANY PAT WILLIAMSON CHIEF DEPUTY, JASPER COUNTY SHERIFF'S OFFICE JASON EASTLAND DIRECTOR, RENSSELAER CARE CENTER CHERYL SPROWL RENSSELAER CARE CENTER
LINES 6A AND 6B	ALL FRANCISCAN HEALTH FACILITIES COLLABORATED IN A STATEWIDE PARTNERSHIP WITH ST. VINCENT HEALTH, INDIANA UNIVERSITY HEALTH, COMMUNITY HEALTH NETWORK, INDIANA UNIVERSITY RICHARD M. FAIRBANKS SCHOOL OF PUBLIC HEALTH AT INDIANAPOLIS, AND WITH EACH FACILITY WITHIN THE FRANCISCAN HEALTH SYSTEM.
LINE 7A	THE CHNA REPORT IS AVAILABLE ON FRANCISCAN ALLIANCES WEBSITE AT HTTPS://WWW.FRANCISCANHEALTH.ORG/COMMUNITYHEALTH.
LINE 10	THE IMPLEMENTATION PLAN IS AVAILABLE ON FRANCISCAN ALLIANCES WEBSITE AT HTTPS://WWW.FRANCISCANHEALTH.ORG/COMMUNITYHEALTH.
LINE 11	BASED ON THE 2016 CHNA, SEVERAL PRIORITY HEALTH NEEDS, INCLUDING SOCIAL DETERMINANTS OF HEALTH, WERE IDENTIFIED. PER IRS GUIDELINES, THE LIST BELOW PROVIDES THE PRIORITY NEEDS, WHICH NEEDS RENSSELAER WILL COMMIT TO WORKING ON, AND JUSTIFICATION OF WHY THE OTHER NEEDS WERE NOT SELECTED. SELECTION OF PRIORITY HEALTH NEEDS WERE BASED ON THE MAGNITUDE, IMPACT, FEASIBILITY, COST, AND PARTNERSHIPS. HEALTH NEED: HEALTH PROFESSIONS SHORTAGES/CRITICAL ACCESS INFRASTRUCTURE DESCRIPTION: AS IS THE CASE IN MANY FEDERALLY DESIGNATED RURAL AREAS, PRIMARY CARE AND OTHER HEALTH SERVICES ARE IN SHORT SUPPLY. JASPER COUNTY, AND FOUR OF SEVEN BOUNDARY COUNTIES, ARE FIVE OF 31 HOSPITALS IN INDIANA WITHOUT INPATIENT OBSTETRICAL SERVICES. IT IS ALSO A MENTAL HEALTH AND PRIMARY CARE HEALTH PROFESSIONS SHORTAGE AREA. RENSSELAER PRIORITY: YES JUSTIFICATION/EXPLANATION: RENSSELAER WILL WORK TO RECRUIT PRIMARY CARE AND SPECIALTY CARE PROVIDERS TO THE AREA. HEALTH NEED: BEHAVIORAL HEALTH DESCRIPTION: LACK OF MENTAL HEALTH PROVIDERS, HIGH RATES OF SUBSTANCE ABUSE (INCLUDING ALCOHOL), ABOVE STATE AVERAGE RATES OF SUICIDE, AND HIGH RATES OF PRESCRIBED CONTROLLED SUBSTANCES ARE OF CONCERN. RENSSELAER PRIORITY: NO JUSTIFICATION/EXPLANATION: RENSSELAER DOES NOT HAVE THE CAPACITY TO PROVIDE SERVICES IN THIS AREA. HEALTH NEED: LACK OF PREVENTATIVE BEHAVIORS DESCRIPTION: LOW RATES OF HEALTH SCREENINGS, ESPECIALLY CANCER-RELATED, LOW VACCINE RATES, AND HIGH RATES OF INJURY SUGGEST HEALTH BEHAVIORS NEED IMPROVEMENT. RENSSELAER PRIORITY: YES JUSTIFICATION/EXPLANATION: RENSSELAER DOES WILL WORK TO PROVIDE ADDITIONAL SERVICES IN THE COMMUNITY. HEALTH NEED: PHYSICAL ACTIVITY AND NUTRITION DESCRIPTION: OBESITY, DIABETES MANAGEMENT, ARTHRITIS, AND CARDIOVASCULAR CONDITIONS ALL SCORE HIGHLY IN INCIDENT RATES AND PERCEPTION OF NEED. A COMMON THEME AMONGST ALL OF THESE CLINICAL ISSUES IS THE LACK OF PHYSICAL ACTIVITY AND PROPER NUTRITION. CONCERNS ABOUT PUBLIC SAFETY AND LACK OF BUILT CONTRIBUTE TO THIS ISSUE. RENSSELAER PRIORITY: YES JUSTIFICATION/EXPLANATION: RENSSELAER WILL WORK TO SUPPORT COMMUNITY DEVELOPMENT THAT PROVIDES OPPORTUNITIES FOR PHYSICAL ACTIVITY AND APPROPRIATE NUTRITION. HEALTH NEED: TOBACCO DESCRIPTION: AS IS TRUE IN MOST INDIANA COUNTIES, TOBACCO CONTINUES TO BE AN ISSUE AND MAY CONTRIBUTE TO OTHER CONDITIONS, INCLUDING LUNG CANCER AND ASTHMA. RENSSELAER PRIORITY: INDIRECTLY JUSTIFICATION/EXPLANATION: THE STAFF WILL CONTINUE TO REFER PATIENTS READY TO QUIT TO THE STATE RUN HELPLINE. 2013-2016 COMMUNITY HEALTH IMPROVEMENT PLAN RESULTS IN THE 2013-2016 CYCLE, THE PREDECESSOR TO RENSSELAER HAD THREE PRIORITY AREAS. THE FOLLOWING TABLE REVIEWS THE PREVIOUS PRIORITY AREAS, RESULTS, AND FUTURE EFFORTS: PRIORITY: IMPROVEMENT IN EMERGENCY DEPARTMENT CARE RESULTS: EMERGENCY SERVICES WERE GREATLY IMPROVED TO PROVIDE BETTER SERVICE TO THE CRITICAL ACCESS SERVICE AREA. CONTINUATION: NOT AS A PRIORITY FUTURE EFFORTS: THE CHANGES HAVE BEEN INSTITUTIONALIZED AND WILL CONTINUE AS PART OF STANDARD HOSPITAL ADMINISTRATION. PRIORITY: INCREASED SPECIALTY CARE IN SURGERY RESULTS: HOSPITAL PARTNERSHIPS WERE DEVELOPED TO BRING SURGICAL SERVICES TO THE CRITICAL ACCESS SERVICE AREA TWO DAYS A WEEK. CONTINUATION: NOT AS A PRIORITY FUTURE EFFORTS: THE CHANGES HAVE BEEN INSTITUTIONALIZED AND WILL CONTINUE AS PART OF STANDARD HOSPITAL ADMINISTRATION. PRIORITY: IMPROVEMENT OF HOSPITAL QUALITY ISSUES RESULTS: QUALITY OF CARE INCREASED TO BETTER SERVE THE CRITICAL ACCESS SERVICE AREA. CONTINUATION: NOT AS A PRIORITY FUTURE EFFORTS: THE CHANGES HAVE BEEN INSTITUTIONALIZED AND WILL CONTINUE AS PART OF STANDARD HOSPITAL ADMINISTRATION. 2016-2018 COMMUNITY HEALTH IMPROVEMENT PLAN (CHIP) THREE PRIORITY AREAS HAVE BEEN IDENTIFIED FOR THE 2016-2018 TIMEFRAME - RECRUITMENT OF A PRIMARY CARE PHYSICIAN AND RECRUITMENT OF A SPECIALTY CARE PHYSICIAN. THESE WERE SELECTED BECAUSE RENSSELAER IS A CRITICAL ACCESS HOSPITAL IN A HRSA IDENTIFIED HPSA AND MPSA. IN ADDITION, IN THE LAST TWO YEARS THE COUNTY HAS LOST FIVE PHYSICIANS DUE TO RETIREMENT AND DEATH. BECAUSE OF THE RURAL LOCATION AND BARRIERS THAT COME WITH CRITICAL ACCESS/RURAL HOSPITALS, RECRUITMENT HAS BEEN EXTREMELY DIFFICULT. THE PRIORITIES HAVE BEEN MODIFIED TO FIND AT LEAST ADVANCED PRACTICE PROFESSIONALS AND POTENTIAL TRANSPORTATION OPTIONS TO THE CLOSEST FRANCISCAN HEALTH FACILITIES.
LINES 15 AND 16	THROUGH FRANCISCAN ALLIANCE, INC. ("FRANCISCAN"), WE CONTINUE THE HEALING MINISTRY OF CHRIST IN A CATHOLIC HEALTH CARE SYSTEM THAT UPHOLDS THE MORAL VALUES AND TEACHINGS OF THE CATHOLIC CHURCH. CENTRAL CONCERNS OF THIS CORPORATE MINISTRY INCLUDE COMPASSION FOR THOSE IN NEED, RESPECT FOR LIFE AND THE DIGNITY OF PERSONS. FRANCISCAN BELIEVES IN THE DIGNITY, UNIQUENESS, AND WORTH OF EACH INDIVIDUAL AND, WITHIN THE LIMITS OF OUR RESOURCES, FRANCISCAN OFFERS A COMPREHENSIVE RANGE OF HEALTH CARE SERVICES TO ALL REGARDLESS OF RACE, CREED, COLOR, SEX, NATIONAL ORIGIN, HANDICAP OR AN INDIVIDUAL'S FINANCIAL CAPABILITY. IN LIGHT OF THIS BELIEF, WE CONSIDER OUR HEALTH CARE SERVICES TO BE REACHING OUT AND RESPONDING, IN A CHRIST-LIKE MANNER, TO THOSE WHO ARE PHYSICALLY, MATERIALLY, OR SPIRITUALLY IN NEED. FRANCISCAN IS COMMITTED TO PROVIDING FINANCIAL ASSISTANCE, IN THE FORM OF CHARITY CARE OR UNINSURED DISCOUNTS, TO PERSONS WHO ARE UNINSURED OR UNDERINSURED, WHO ARE INELIGIBLE FOR GOVERNMENTAL OR SOCIAL SERVICE PROGRAMS, AND WHO OTHERWISE ARE UNABLE TO PAY FOR EMERGENCY SERVICES OR MEDICALLY NECESSARY CARE BASED ON THEIR INDIVIDUAL FINANCIAL SITUATION. CONSISTENT WITH OUR MISSION TO DELIVER COMPASSIONATE, HIGH QUALITY, AFFORDABLE HEALTH CARE AND TO ADVOCATE FOR THOSE WHO ARE POOR AND DISENFRANCHISED, FRANCISCAN STRIVES TO ENSURE THE FINANCIAL CAPACITY OF PEOPLE WHO NEED MEDICALLY NECESSARY HEALTH CARE SERVICES DOES NOT PREVENT THEM FROM SEEKING OR RECEIVING THAT CARE. FRANCISCAN'S FINANCIAL ASSISTANCE POLICY IS DESIGNED TO ALLOW RELIEF FROM ALL OR PART OF THE CHARGES RELATED TO EMERGENCY OR MEDICALLY NECESSARY HEALTH CARE SERVICES THAT EXCEED A PATIENT'S REASONABLE ABILITY TO PAY. IN ORDER TO ENSURE TRANSPARENCY, CONSISTENCY AND FAIRNESS, WE ASK PATIENTS TO COOPERATE BY PROVIDING NECESSARY INFORMATION TO DETERMINE THEIR ELIGIBILITY FOR FINANCIAL ASSISTANCE. FOR PATIENTS NOT INITIALLY IDENTIFIED AS QUALIFYING FOR FINANCIAL ASSISTANCE, RENSSELAER COMMUNICATES THE AVAILABILITY OF CHARITY CARE AND FINANCIAL ASSISTANCE IN THE APPLICABLE LANGUAGES OF THE HOSPITAL COMMUNITY THROUGH THE FOLLOWING MEANS: 1. RENSSELAER COMMUNICATES THE AVAILABILITY OF FINANCIAL ASSISTANCE IN APPROPRIATE CARE SETTINGS SUCH AS EMERGENCY DEPARTMENTS, ADMITTING/REGISTRATION AREAS, PHYSICIAN OFFICES, BILLING OFFICES, OUTPATIENT SERVICE SETTINGS, AND ON OUR HOSPITALS' WEBSITES. SIGNS/POSTINGS INFORM PATIENTS THAT FREE OR REDUCED COST CARE MAY BE AVAILABLE TO QUALIFYING PATIENTS WHO COMPLETE A FINANCIAL ASSISTANCE APPLICATION. 2. BROCHURES SUMMARIZING OUR FINANCIAL ASSISTANCE PROGRAMS ARE AVAILABLE THROUGHOUT RENSSELAER. 3. FINANCIAL COUNSELORS AND BUSINESS OFFICE PERSONNEL ARE AVAILABLE TO HELP PATIENTS UNDERSTAND AND APPLY FOR LOCAL, STATE, FEDERAL HEALTH CARE, AND HEALTH INSURANCE EXCHANGE PROGRAMS AND RENSSELAER'S FINANCIAL ASSISTANCE PROGRAMS. 4. ALL BILLS AND STATEMENTS FOR SERVICES INFORM UNINSURED PATIENTS THAT FINANCIAL ASSISTANCE IS AVAILABLE. 5. PATIENTS/GUARANTORS MAY REQUEST A COPY OF THE FINANCIAL ASSISTANCE APPLICATION BY CALLING THE RENSSELAER BILLING OFFICE OR DOWNLOADING A COPY AT NO COST FROM THE RENSSELAER WEBSITE. 6. PATIENTS/GUARANTORS CAN REQUEST FINANCIAL ASSISTANCE INFORMATION BY CALLING RENSSELAER'S BILLING OFFICE PHONE LINE ON A 24-HOUR BASIS. 7. INDIVIDUALS OTHER THAN THE PATIENT, SUCH AS THE PATIENT'S PHYSICIAN, FAMILY MEMBERS, COMMUNITY OR RELIGIOUS GROUPS, SOCIAL SERVICES, OR HOSPITAL PERSONNEL MAY MAKE REQUESTS FOR FINANCIAL ASSISTANCE ON THE PATIENT'S BEHALF, SUBJECT TO APPLICABLE PRIVACY LAWS. 8. PRIOR TO TRANSFER TO A COLLECTION AGENCY, RENSSELAER SENDS A MINIMUM OF 4 STATEMENTS AND MAKES 7 PHONE CALL ATTEMPTS TO CONTACT THE PATIENT/GUARANTOR AT THE ADDRESS AND PHONE NUMBER PROVIDED BY THE PATIENT/GUARANTOR. STATEMENTS AND COMMUNICATIONS INFORM THE PATIENT OF THE AMOUNT DUE AND IF THEY CANNOT PAY THEIR BALANCE, THE AVAILABILITY OF FINANCIAL ASSISTANCE. A PATIENT'S QUALIFICATION FOR CHARITY CARE IS DETERMINED THROUGH A FINANCIAL ASSISTANCE APPLICATION AND SCREENING PROCESS. PATIENTS WHO MAY QUALIFY FOR MEDICAID OR ANY OTHER GOVERNMENTAL ASSISTANCE MUST BE DENIED COVERAGE OR ASSISTANCE FROM THOSE GOVERNMENTAL PROGRAMS PRIOR TO RECEIVING APPROVAL FOR CHARITY CARE. AS SUCH, RENSSELAER OFFERS PATIENTS ASSISTANCE IN APPLYING OR ENROLLING IN SUCH PROGRAMS. A PATIENT WILL NEED TO FILL OUT, SIGN, AND SUBMIT THE FINANCIAL ASSISTANCE APPLICATION ALONG WITH ALL REQUESTED DOCUMENTATION OF INCOME, EXPENSES, ASSETS, AND LIABILITIES. RENSSELAER'S BILLING OFFICE WILL PLACE THE PATIENT'S ACCOUNT ON HOLD ONCE A FINANCIAL ASSISTANCE APPLICATION HAS BEEN REQUESTED AND UNTIL A FINANCIAL ASSISTANCE DETERMINATION IS MADE. APPLICANTS ARE TREATED WITH DIGNITY AND RESPECT THROUGHOUT THE FINANCIAL ASSISTANCE PROCESS AND ALL INFORMATION/MATERIALS RECEIVED ARE CONFIDENTIALLY MAINTAINED. RENSSELAER ALSO UTILIZES AN EXTERNAL VENDOR, SERVICE, OR DATA SOURCE THAT PROVIDES INFORMATION ON A PATIENT'S OR GUARANTOR'S ABILITY TO PAY (I.E. CREDIT SCORING). ELIGIBILITY FOR CHARITY CARE MAY BE DETERMINED AT ANY POINT IN THE COLLECTIONS CYCLE (I.E. PRIOR TO THE PROVISION OF SERVICES, DURING THE NORMAL COLLECTIONS CYCLE, OR MAY BE USED TO RE-CLASSIFY ACCOUNTS AFTER THEY HAVE BEEN DEEMED UNCOLLECTIBLE AND SUBSEQUENTLY RETURNED FROM A THIRD PARTY COLLECTION AGENCY). ONCE APPROVED, THE PATIENT WILL REMAIN ELIGIBLE FOR CHARITY CARE FOR A MAXIMUM OF FOUR MONTHS. THE ELIGIBILITY PERIOD WILL BEGIN FROM THE DATE OF THE PATIENT'S APPROVAL OF CHARITY CARE. CHARITY CARE DISCOUNTS WILL BE GIVEN FOR CURRENT OPEN ACCOUNTS AND THE FOLLOWING FOUR MONTHS OF EMERGENCY SERVICES OR MEDICALLY NECESSARY CARE. AFTER THE ELIGIBILITY PERIOD HAS ELAPSED, THE PATIENT MUST REAPPLY FOR FINANCIAL ASSISTANCE.
LINES 16A, 16B, AND 16C	THE FAP, FAP APPLICATION FORM, AND PLAIN LANGUAGE SUMMARY OF THE FAP ARE AVAILBALE AT THE FOLLOWING ADDRESS: https://www.franciscanhealth.org/patients-and-visitors/billing-insurance/f inancial-assistance

Field	Value	IRS element (for citing)
Facility	2	FacilityNum

Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp

Oth Hlth Care Fclts OthHlthCareFcltsGrp (2 entries)

Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	FacilityFacilityTxt
FRANCISCAN BROOK HEALTH CENTER
420 E MAIN STREET	BROOK	IN	47922	RURAL HEALTH CENTER
FRANCISCAN WHEATFIELD HEALTH CENTER
429 SOUTH BIERMA ST	WHEATFIELD	IN	463926004	RURAL HEALTH CENTER

Supplemental Information Detail SupplementalInformationDetail (5 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
SCHEDULE H, PART VI, LINE 2	NEEDS ASSESSMENT Rensselaer is a Hospital Affiliate of Franciscan Alliance, Inc. Rensselaer assesses the health care needs of the communities we serve by collaborating with public and private agencies to determine community health needs and how best to address them. Franciscan Alliance, Inc.'s Corporate Community Benefit Committee, as well as committees in the local facilities, committed to an ongoing assessment of community health needs and priorities based upon health initiatives of the municipal, county, and state health departments, community-based assessments by other public sector partners, professional research consultant reports, and faith-based partners within the communities served. In addition, our hospitals address public agency and community group requests to provide community benefit activities and programs that meet certain specialty or hybrid needs or populations. -------------------------------------------------------------------
SCHEDULE H, PART VI, ITEM 3	FINANCIAL ASSISTANCE POLICY RENSSELAER INFORMS AND EDUCATES PATIENTS AND PERSONS WHO MAY BE BILLED FOR PATIENT CARE ABOUT THEIR ELIGIBILITY FOR ASSISTANCE UNDER FEDERAL, STATE, OR LOCAL GOVERNMENT PROGRAMS OR UNDER RENSSELAER'S FINANCIAL ASSISTANCE AND CHARITY CARE POLICY. FOR PATIENTS NOT INITIALLY IDENTIFIED AS QUALIFYING FOR FINANCIAL ASSISTANCE, RENSSELAER COMMUNICATES THE AVAILABILITY OF CHARITY CARE AND FINANCIAL ASSISTANCE IN THE APPLICABLE LANGUAGES OF THE HOSPITAL COMMUNITY THROUGH THE FOLLOWING MEANS: 1. RENSSELAER COMMUNICATES THE AVAILABILITY OF FINANCIAL ASSISTANCE IN APPROPRIATE CARE SETTINGS SUCH AS EMERGENCY DEPARTMENTS, ADMITTING/REGISTRATION AREAS, BILLING OFFICES, OUTPATIENT SERVICE SETTINGS, AND ON OUR HOSPITALS' WEBSITES. SIGNS/POSTINGS INFORM PATIENTS THAT FREE OR REDUCED COST CARE MAY BE AVAILABLE TO QUALIFYING PATIENTS WHO COMPLETE A FINANCIAL ASSISTANCE APPLICATION. 2. BROCHURES SUMMARIZING OUR FINANCIAL ASSISTANCE PROGRAMS ARE AVAILABLE THROUGHOUT THE HOSPITAL. 3. FINANCIAL COUNSELORS AND BUSINESS OFFICE PERSONNEL ARE AVAILABLE TO HELP PATIENTS UNDERSTAND AND APPLY FOR LOCAL, STATE, FEDERAL HEALTH CARE PROGRAMS; HEALTH INSURANCE EXCHANGES; AND RENSSELAER'S FINANCIAL ASSISTANCE PROGRAMS. 4. ALL BILLS AND STATEMENTS FOR SERVICES INFORM UNINSURED PATIENTS THAT FINANCIAL ASSISTANCE IS AVAILABLE. 5. PATIENTS/GUARANTORS MAY REQUEST A COPY OF THE FINANCIAL ASSISTANCE APPLICATION BY CALLING THE RENSSELAER'S BILLING OFFICE OR DOWNLOADING A COPY AT NO COST FROM RENSSELAER'S WEBSITE. 6. INDIVIDUALS OTHER THAN THE PATIENT, SUCH AS THE PATIENT'S PHYSICIAN, FAMILY MEMBERS, COMMUNITY OR RELIGIOUS GROUPS, SOCIAL SERVICES, OR HOSPITAL PERSONNEL MAY MAKE REQUESTS FOR FINANCIAL ASSISTANCE ON THE PATIENT'S BEHALF, SUBJECT TO APPLICABLE PRIVACY LAWS. 7. RENSSELAER SENDS 4 STATEMENTS AND MAKES 7 PHONE CALL ATTEMPTS TO CONTACT THE PATIENT/GUARANTOR AT THE ADDRESS AND PHONE NUMBER PROVIDED BY THE PATIENT/GUARANTOR. STATEMENTS AND COMMUNICATIONS INFORM THE PATIENT OF THE AMOUNT DUE AND IF THEY CANNOT PAY THEIR BALANCE THE AVAILABILITY OF FINANCIAL ASSISTANCE. ------------------------------------------------
SCHEDULE H, PART VI, ITEM 4	COMMUNITY INFORMATION RENSSELAER SERVES A LARGE GEOGRAPHIC AREA WHICH INCLUDES 4 COUNTIES IN INDIANA (JASPER, NEWTON, PULASKI, AND WHITE). THE POPULATION OF THE COMMUNITIES THAT WE SERVE WAS ESTIMATED AT CLOSE TO 87,000 PEOPLE WITH AN AVERAGE HOUSEHOLD INCOME ABOVE $53,000 IN 2016. FOR THESE COMMUNITIES, THE PERCENTAGE OF RESIDENTS BELOW THE FEDERAL POVERTY LEVEL WAS ESTIMATED AT 11.0%. THE PERCENTAGE OF INPATIENTS FROM THESE COMMUNITIES WHO WERE SERVED BY MEDICAID WAS 16.5%. AND THE PERCENTAGE OF INPATIENTS FROM THESE COMMUNITIES WHO WERE UNINSURED WAS APPROXIMATELY 3.5%. IN COMPARISON, THE PERCENTAGES OF MEDICAID AND UNINSURED INPATIENTS TREATED BY FRANCISCAN HEALTH RENSSELAER WERE 9.0% AND 1.6% RESPECTIVELY IN 2016. THERE ARE 2 OTHER HOSPITALS THAT SERVE WITHIN THESE COMMUNITIES AS WELL. ------------------------------------------------
SCHEDULE H, PART VI, ITEM 5 & PART 1, LINE 6A	OTHER INFORMATION "OUR GIVING JOURNAL" AT WWW.FRANCISCANALLIANCE.ORG/COMMUNITYBENEFIT REFLECTS RENSSELAER'S MISSION OF "CONTINUING CHRIST'S MINISTRY IN OUR FRANCISCAN TRADITION" ALONG WITH A REPORT OF OUR COMMUNITY BENEFIT ACTIVITIES. ALTHOUGH IT IS NOT ALL INCLUSIVE OF THE MANY BENEFITS PROVIDED BY RENSSELAER IT DOES PORTRAY THE SIGNIFICANT BENEFITS THAT REFLECT OUR COMMITMENT TO HEALTHCARE AND THE COMMUNITIES WE ARE PRIVILEGED TO SERVE. THE FOLLOWING IS A SUBSET OF THE MANY CLINICAL SERVICES AS WELL AS POPULATION HEALTH IMPROVEMENT AND COMMUNITY OUTREACH ACTIVITIES OFFERED BY ONE OR MORE OF RENSSELAER'S HEALTHCARE FACILITIES: - INPATIENT HOSPITAL SERVICES INCLUDING: MEDICAL SERVICES, SURGICAL SERVICES, INTENSIVE CARE SERVICES, TELEMETRY SERVICES, ONCOLOGY SERVICES, GENERAL SURGERY SERVICES, CARDIOLOGY SERVICES, VASCULAR SERVICES, ORTHOPEDICS, ENDOSCOPY SERVICES, ANESTHESIA SERVICES, HOSPICE SERVICES, AND EXTENDED CARE. - EMERGENCY SERVICES INCLUDING: 24 HOUR EMERGENCY ROOM SERVICES. - OUTPATIENT SERVICES INCLUDING: LABORATORY SERVICES, PHYSICAL THERAPY SERVICES, OCCUPATIONAL THERAPY SERVICES, SPEECH THERAPY SERVICES, GENERAL RADIOLOGY SERVICES, COMPUTED TOMOGRAPHY SERVICES, MAGNETIC RESONANCE IMAGING (MRI), NUCLEAR MEDICINE SERVICES, MAMMOGRAPHY SERVICES, GASTRO/INTESTINAL SERVICES, SLEEP LABORATORY, OUTPATIENT SURGERY, ELECTROCARDIOGRAM (EKG) SERVICES, MEDICAL ONCOLOGY SERVICES, PHARMACY, OCCUPATIONAL MEDICINE SERVICES, CARDIAC REHABILITATION SERVICES, WOUND HEALING AND PREVENTION, NUTRITIONAL COUNSELING, DIABETES MANAGEMENT, SOCIAL SERVICES, PALLIATIVE CARE, BEHAVIORAL HEALTH, STROKE SERVICES, HOME HEALTH SERVICES, SKILLED NURSING SERVICES, AND SOCIAL SERVICES. - SUBSIDIZED HEALTHCARE SERVICES OFFERED BY RENSSELAER: - RENSSELAER HAS NEIGHBORHOOD HEALTH CLINICS THAT OFFER FAMILY PRACTICE SERVICES DESIGNED FOR FAMILIES WITHOUT ACCESS TO AFFORDABLE HEALTH CARE. THE FOCUS IS ON PROVIDING PRIMARY AND PREVENTIVE CARE AS WELL AS HEALTH EDUCATION. THESE CLINICS OFFER FREE IMMUNIZATIONS. - RENSSELAER'S SEXUAL ASSAULT CLINICS THAT PROVIDE MEDICAL AND FORENSIC ASSISTANCE THAT IS SENSITIVE TO THE SPECIAL NEEDS OF THE VICTIM AS WELL AS A VICTIM ADVOCATE PROGRAM AND CRISIS INTERVENTION COUNSELORS. - RENSSELAER'S DIABETES EDUCATION CENTERS OFFER A NUMBER OF DIABETES CLASSES AND INDIVIDUALIZED SESSIONS TO HELP PATIENTS TAKE CONTROL OF THEIR HEALTH WITH A FOCUS ON NUTRITIONAL, EXERCISE, MEDICATIONS, CHRONIC CONDITIONS, PRECONCEPTION AND PREGNANCY, BLOOD GLUCOSE MONITORING, GOAL SETTING, PROBLEM SOLVING, PSYCHOSOCIAL ADJUSTMENT, DETECTION/TREATMENT OF HIGH AND LOW BLOOD SUGAR, AND INSULIN ADMINISTRATION. - RENSSELAER'S HOSPICE CARE SERVICES PROVIDE A SENSE OF DIGNITY AND COMPASSION TO BOTH THE PATIENT AND THEIR FAMILY IN CARING FOR PATIENTS WITH A LIFE EXPECTANCY OF SIX MONTHS OR LESS. OUR PROGRAMS AFFIRM AND CELEBRATE LIFE AND REGARD DYING AS A NATURAL PROCESS, RECOGNIZING THAT EVERY PERSON HAS THE RIGHT TO DIE WITH DIGNITY, PEACE, AND COMFORT REGARDLESS OF THEIR ETHNIC, FAITH BACKGROUND, OR ABILITY TO PAY. - PALLIATIVE CARE SERVICES ASSIST PATIENTS AND FAMILIES IN MAKING COMPLEX MEDICAL DECISIONS BY PROVIDING A GOOD UNDERSTANDING OF THE PATIENT'S PRESENT CONDITION, COORDINATING AND COMMUNICATING CARE WITH PHYSICIANS, ADVOCATING FOR PATIENTS' WISHES, AND HELPING THEM TO ACHIEVE A SENSE OF CONTROL OVER THEIR MEDICAL CARE. PALLIATIVE CARE IS OFFERED REGARDLESS OF THE STAGE OF DISEASE OR THE NEED FOR OTHER THERAPIES AND CAN BE PROVIDED CONCURRENTLY WITH LIFE-PROLONGING CARE OR AS THE MAIN FOCUS OF CARE. - EMERGENCY SERVICES PROVIDE OUR COMMUNITIES WITH STATE-OF-THE-ART EMERGENCY FACILITIES, OPEN 24-HOURS A DAY, SEVEN DAYS A WEEK. EQUIPPED WITH ADVANCED MEDICAL TECHNOLOGY, OUR EMERGENCY TEAM OF SPECIALLY TRAINED PHYSICIANS AND NURSES TREAT THEIR PATIENTS FOR TRAUMA, STROKE, CARDIAC, AND OTHER LIFE-THREATENING CONDITIONS IN ADULTS AND CHILDREN. - INDIGENT HEALTH CARE CLINICS. - HEALTH AND WELLNESS CENTERS AND HEALTHY LIVING EDUCATION CENTERS. - COMMUNITY OUTREACH AND EDUCATION PROGRAMS INCLUDING: HEALTH FAIRS, FREE HEALTH SCREENINGS, FREE IMMUNIZATIONS, FREE BREAST HEALTH SCREENING SERVICES, FREE PROSTRATE SCREENINGS, FREE SKIN CANCER SCREENINGS, FREE CERVICAL CANCER SCREENINGS, FREE GLUCOSE SCREENINGS, FREE CHOLESTEROL SCREENINGS, FREE BONE DENSITY SCREENINGS, FREE LUNG SCREENINGS, FREE SPA SERVICES FOR CANCER PATIENTS, ONLINE HEALTH CONDITION ASSESSMENT TOOLS, CANCER PREVENTION ACTIVITIES, SENIOR HEALTH EDUCATION, DIABETES MANAGEMENT EDUCATION AND ACTIVITIES, CARDIAC RISK FACTORS EDUCATIONAL SESSIONS AND ONLINE TOOLS, HOSPICE AND PALLIATIVE CARE COUNSELING AND EDUCATION SERVICES, SMOKING CESSATION PROGRAMS, BASIC LIFE-SAVING SKILLS PROGRAMS, CHILDREN'S HEALTH NEEDS ACTIVITIES, CHILDHOOD OBESITY ACTIVITIES, WEIGHT LOSS EDUCATION, ORGAN AND TISSUE DONATION FAIRS, VOLUNTEER ADVOCATES FOR SENIORS, PARENTING PROGRAMS, ATHLETIC TRAINING (SCHOOLS AND VARIOUS MARATHONS), FLU VACCINATIONS, CHILD SEAT SAFETY PROGRAMS, BEREAVEMENT SUPPORT GROUPS, COMMUNITY EDUCATION LECTURES, CAREGIVERS EDUCATION SYMPOSIUMS, HEALTH CAREER DAYS, BABYSITTING COURSE, FOOD SHARE PROGRAMS, NUTRITIONAL COUNSELING FOR GRADE SCHOOLS AND SENIORS, ETC. - SOCIAL SERVICES INCLUDING: PASTORAL CARE, EUCHARISTIC MINISTRY PROGRAM, NO ONE DIES ALONE PROGRAMS, GRIEVANCE SUPPORT PROGRAMS FOR CHILDREN, LANGUAGE INTERPRETER SERVICES, DEAF INTERPRETER SERVICES, TRANSPORTATION FOR THE INDIGENT, ENROLLMENT ASSISTANCE IN MEDICAID AND HEALTH INSURANCE EXCHANGES, CHRISTIAN LEGAL CLINIC, TRANSPORTATION SERVICE FOR INDIGENT PATIENTS, ETC. THE WEB SITE HAS HEALTHY LIVING SECTIONS THAT OFFER TIPS AND SUGGESTIONS ON BEGINNING AND MAINTAINING DIET AND EXERCISE REGIMENTS TO OPTIMIZE HEALTHY LIFESTYLES. RENSSELAER'S GOVERNING BODY IS COMPOSED OF INDEPENDENT MEMBERS REPRESENTING THE BROAD COMMUNITY SERVED BY FRANCISCAN HEALTH RENSSELAER. MEDICAL STAFF PRIVILEGES ARE AVAILABLE TO QUALIFIED PHYSICIANS. FRANCISCAN HEALTH RENSSELAER ALSO USES ITS SURPLUS FOR IMPROVEMENT IN PATIENT CARE, TO EXPAND AND REPLACE FACILITIES AND EQUIPMENT, AMORTIZATION OF INDEBTEDNESS, AND MEDICAL TRAINING, EDUCATION, AND RESEARCH. FRANCISCAN ALLIANCE, INC. AND ITS ACCOUNTABLE CARE ORGANIZATION ("ACO") WAS THE FIRST AND ONLY PIONEER ACO IN INDIANA AND AMONG THE FIRST IN THE COUNTRY TO PARTNER WITH MEDICARE AS AN ACO. RENSSELAER ALSO PARTICIPATES IN VARIOUS MEDICARE SHARED SAVINGS ACO PROGRAMS AND NONGOVERNMENTAL ACO PROGRAMS. FORMED IN 2011, FRANCISCAN ACOS PROVIDE COORDINATED, COMPREHENSIVE CARE ACROSS HOSPITALS, PHYSICIAN PRACTICES, AND OTHER HEALTHCARE PROVIDERS, WITH THE AIM OF BRINGING DOWN THE OVERALL COSTS OF MEDICAL CARE AND IMPROVING THE HEALTH OF PATIENTS ATTRIBUTED TO THE ACOS. UNDER THE ACO MODEL, ATTRIBUTED BENEFICIARIES MAINTAIN THE ABILITY TO SEE ANY DOCTOR OR HEALTHCARE PROVIDER, AS WELL AS THE FULL BENEFITS ASSOCIATED WITH TRADITIONAL MEDICARE, BUT WITH THE ADDED BENEFIT OF A MORE COORDINATED CARE EXPERIENCE. THIS INCLUDES COORDINATION OF PREVENTIVE HEALTH SERVICES, THE ASSIGNMENT OF CARE MANAGERS, THE PROVISION OF SOCIAL SUPPORT SERVICES, AND SUPPORT FOR PERSONS WITH CHRONIC HEALTH CONDITIONS, SUCH AS DIABETES AND CONGESTIVE HEART FAILURE. FRANCISCAN ACOS SERVE APPROXIMATELY 107,000 MEDICARE BENEFICIARIES AND APPROXIMATELY 82,000 NONGOVERNMENTAL ACO BENEFICIARIES. RENSSELAER'S ACO EFFORTS INCLUDE IMPROVED COMMUNICATION AND INFORMATION SHARING AMONG AFFILIATED AND NONAFFILIATED HEALTHCARE PROVIDERS REGARDING ACO PATIENTS, ALONG WITH THE EXPANSION OF ACO CASE MANAGEMENT RESOURCES, THE ASSIGNMENT OF DEDICATED CHRONIC DISEASE CASE ADVOCATES TO PATIENTS, EVALUATING THE QUALITY AND CAPABILITIES OF LONG-TERM CARE FACILITIES THAT ACO PATIENTS MAY TRANSITION TO, AND WORKING WITH POST-ACUTE CARE PROVIDERS TO IMPROVE THEIR CONTINUING CARE CAPABILITIES. THE SUPPORTING RESOURCES AND TECHNOLOGY OF FRANCISCAN ACOS ARE FUNDAMENTAL FOR IMPROVING POPULATION HEALTH AND MAKING HEALTHCARE COSTS MORE AFFORDABLE TO THE PATIENTS IN OUR COMMUNITIES WE ARE PRIVILEGED TO SERVE. RENSSELAER AND ITS EMPLOYEES SPONSOR AND PARTICIPATE IN MANY COMMUNITY HEALTH IMPROVEMENT INITIATIVES AND ACTIVITIES. COMMUNITY HEALTH FAIRS, EDUCATION SESSIONS AND SUPPORT GROUPS ARE MADE AVAILABLE THROUGH PROGRAMS SUCH AS THE ORTHOPEDIC ROAD SHOW, ASK-THE-DOC SEMINARS, DAY OF DANCE, HEART HEALTH CLASSES, SENIOR CITIZENS DAY AT THE FAIR, SPIRIT OF WOMEN, PERINATAL EDUCATION, BEREAVEMENT SUPPORT GROUPS, CANCER SCREENING CLINICS, ARTHRITIS EXERCISE GROUP, SMOKING CESSATION CLASSES, PROSTATE SCREENINGS, CANCER SURVIVORS DAY, NUTRITIONAL COUNSELING SERVICES TO NAME A FEW. ----------------------------------------- SCHEDULE H, PART VI, ITEM 6 ROLE OF AFFILIATES EVERY HOSPITAL WITHIN OUR SYSTEM HAS THE DEGREE OF AUTONOMY AND FLEXIBILITY TO MEET THE NEEDS OF THE COMMUNITIES IT SERVES. EACH FACILITY PERFORMS A MISSION ASSESSMENT THAT IS SPECIFICALLY DESIGNATED FOR THE IDENTIFIED HEALTH CARE NEEDS WITHIN THE INDIVIDUAL SERVICE AREAS. THE INDIVIDUAL AND REGIONAL COMMUNITY BENEFI
SCHEDULE H, PART III, LINE 2	Throughout the year, the Corporation estimates this allowance based on the aging of its patient accounts receivable, historical collection experience, and other relevant factors. These factors include changes in the economy and unemployment rates, which has an impact on the number of uninsured and underinsured patients, as well as trends in health care coverage, such as the increased burden of deductibles, copayments, and coinsurance payments to be made by patients with insurance. After satisfaction of amounts due from insurance and reasonable efforts to collect from the patient have been exhausted, the Corporation follows established procedures for placing certain past due patient balances with collection agencies, subject to the terms and certain restrictions on collection efforts as determined by the Corporation. Uncollectible patient accounts receivable are written off against the allowance for doubtful accounts with any subsequent recoveries being recorded against the provision for doubtful accounts. ----------------------------------------- SCHEDULE H, PART III, LINE 3 The corporation has a system-wide charity care and uninsured discount policy; has detailed administrative procedures established for qualifying and enrolling patients for charity care or uninsured/underinsured discounts; uses various analytical programs including soft credit inquiries that do not affect credit scores to help assess a patient's ability to pay; and utilizes numerous mechanisms to inform and educate patients about their eligibility for assistance which are detailed under Schedule H, Part VI, item 3. Despite these rigorous efforts, patients who need subsidized care may not seek this assistance or choose to enroll in the state's Medicaid program. Also, as further described in HFMA statement No. 15, the appropriate classification of charity care and bad debt is often difficult. The urgency of some treatments, as well as certain federal regulations, often requires the provision of service without consideration of the patient's ability to pay. Some patients have complex medical conditions with unpredictable treatment needs. For these and other reasons, Rensselaer believes, a portion of its bad debt expense as reported on Line 3 of Part III represents charity care delivered to individuals in the communities it serves consistent with its charitable healthcare mission. -------------------------------------- SCHEDULE H, PART III, LINE 4 Rensselaer is included in the consolidated audited financial statements of Franciscan Alliance, Inc. The Corporation's allowance for doubtful accounts footnote from its audited financial statements is as follows: "The collection of outstanding patient accounts receivable from governmental payors, managed care and other third party payors, and patients is the Corporation's primary source of cash. The Corporation's main collection risk relates to uninsured patient accounts and patient accounts for which the third party payor has paid amounts in accordance with the applicable agreement, however the patient's responsibility, usually in the form of deductibles, copayments, and coinsurance payments, remain outstanding ("self pay accounts"). The Corporation's patient accounts receivable is reduced by an allowance for amounts, primarily self pay accounts, which could become uncollectible in the future. Throughout the year, the Corporation estimated this allowance based on the aging of its patient accounts receivable, historical collection experience, and other relevant factors. These factors include changes in the economy and unemployment rates, which has an impact on the number of uninsured and underinsured patients, as well as trends in health care coverage, such as the increased burden of deductibles, copayments, and coinsurance payments to be made by patients with insurance. After satisfaction of amounts due from insurance and reasonable efforts to collect from the patient have been exhausted, the Corporation follows established procedures for placing certain past due patient balances with collection agencies, subject to the terms and certain restrictions on collection efforts determined by the Corporation. Uncollectible patient accounts receivable are written off against the allowance for doubtful accounts with any subsequent recoveries being recorded against the provision for doubtful accounts. ------------------------------------------------ SCHEDULE H, PART III, LINE 8 Consistent with the charitable healthcare mission of Rensselaer and the community benefit standard set forth in IRS Revenue Ruling 69-545 and the requirements of IRC Section 501(r), Rensselaer provides care for all patients covered by Medicare seeking medical care at Rensselaer. Such care is provided regardless of whether the reimbursement provided for such services meets or exceeds the costs incurred by Rensselaer to provide such services. Like Medicaid, payment rates for Medicare are set by law rather than through a negotiation process as with private insurers. These payment rates are currently set below the costs of providing care resulting in underpayments. Medicare rates are determined within the context of all the budgetary needs of the federal government and Medicare payments have historically been set below the costs of providing care to Medicare patients though how far below varies over time and by service. Each year Medicare is supposed to provide hospitals an increase in both inpatient and outpatient payments to account for inflation in the prices for goods and services hospitals must purchase in order to provide patient care. However inpatient updates have been set below the rate of inflation and actually negative in recent years resulting in a shortfall that has grown over time. The compounding issue that occurs is that this shortfall jeopardizes hospital's ability to serve their communities because they are not reimbursed their incurred costs. Providers make the decision to eliminate or significantly reduce necessary clinical services within the marketplace placing the Medicare shortfall burden on others that do, such as Rensselaer. Given that Rensselaer provides such services to Medicare patients knowing that they will result in a loss, and given that Rensselaer believes that it provides these services in an efficient and cost effective manner, the shortfall reported on Line 7 of Part III should be viewed as community benefit provided by Rensselaer. ------------------------------------------------ SCHEDULE H, PART III, LINE 9B Rensselaer's written Charity Care and Uninsured Patient Discount Policy and Patient Collection Procedure include various provisions on the collection practices to be followed for patients who are known to qualify for charity or financial assistance. If a patient qualifies for charity or financial assistance certain collection practices do not apply. ------------------------------------------------ State filing of Community Benefit Report IN

Schedule J IRS990ScheduleJ

Field	Value	IRS element (for citing)
Severance Payment	false	SeverancePaymentInd
Supplemental Nonqual Rtr Plan	Yes (true)	SupplementalNonqualRtrPlanInd
Equity Based Comp Arrngm	false	EquityBasedCompArrngmInd
Comp Based On Revenue Of Flng Org	false	CompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related Orgs	false	CompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng Org	false	CompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd Orgs	false	CompBsdNetEarnsRltdOrgsInd
Any Non Fixed Payments	false	AnyNonFixedPaymentsInd
Initial Contract Exception	false	InitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (3 entries)

TitleTitleTxt	Base Compensation Filing OrgBaseCompensationFilingOrgAmt	Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt	Bonus Filing OrganizationBonusFilingOrganizationAmount	Bonus Related OrganizationsBonusRelatedOrganizationsAmt	Other Compensation Filing OrgOtherCompensationFilingOrgAmt	Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt	Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt	Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt	Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt	Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt	Total Compensation Filing OrgTotalCompensationFilingOrgAmt	Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt	Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt	Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt
KEVIN D LEAHY
PRESIDENT & DIRECTOR	$0	$1,773,741	$0	$0	$0	$73,421	$0	$785,812	$0	$22,292	$0	$2,655,266	$0	$0
TERRANCE WILSON
FACILITY CEO/PRES OF HOSP DIV	$0	$799,442	$0	$0	$0	$33,058	$0	$498,404	$0	$25,704	$0	$1,356,608	$0	$0
THOMAS GRYZBEK
SR VP OF POST ACUTE SVCS DIV	$0	$574,150	$0	$0	$0	$42,754	$0	$156,067	$0	$18,491	$0	$791,462	$0	$0

Supplemental Information Detail SupplementalInformationDetail (3 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
SCHEDULE J, PART I, LINE 3	FRANCISCAN HEALTH RENSSELAER, INC. DOES NOT COMPENSATE ITS PRESIDENT.
SCHEDULE J, PART I, LINE 4B	CERTAIN OFFICERS AND DIRECTORS OF FRANCISCAN HEALTH RENSSELAER, INC. ARE COMPENSATED BY A RELATED ORGANIZATION, FRANCISCAN ALLIANCE, INC. FRANCISCAN ALLIANCE, INC. MAINTAINS A SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN. THESE BENEFITS ARE SUBJECT TO A SIGNIFICANT RISK OF FORFEITURE AND AS SUCH POSSIBLY MAY NEVER BE PAID OUT TO THE EXECUTIVES PARTICIPATING IN THE PLAN.
SCHEDULE J, PART II, COLUMN (C)	DEFERRED COMPENSATION FROM A RELATED ORGANIZATION INCLUDES SPLIT-DOLLAR LIFE INSURANCE, AND CHANGE IN PRESENT VALUE OF THE QUALIFIED AND, IF APPLICABLE, NONQUALIFIED DEFINED BENEFIT PLAN. THE CHANGE IN VALUE OF THE NONQUALIFIED BENEFIT PLAN IS SUBJECT TO A SIGNIFICANT RISK OF FORFEITURE AND AS SUCH POSSIBLY MAY NEVER BE PAID TO THE EXECUTIVE PARTICIPATING IN THE NONQUALIFIED DEFINED BENEFIT PLAN. CHANGES IN THE AMOUNT REFLECTED BETWEEN YEARS IS PRIMARILY A FUNCTION OF THE FLUCTUATION IN THE ACTUARIAL DISCOUNT RATE USED TO MEASURE THIS FUTURE LIABILITY WHICH MAY NEVER BE PAID TO THE EXECUTIVES.

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (5 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
FORM 990, PART I, LINE 1	THE MISSION OF FRANCISCAN HEALTH RENSSELAER IS TO PROVIDE THE HIGHEST QUALITY OF HEALTHCARE IN A COMPASSIONATE MANNER TO OUR PATIENTS AND TO THOSE IN THE LOCAL COMMUNITY WE SERVE. FORM 990, PART VI, LINE 6 FRANCISCAN ALLIANCE, INC. IS THE SOLE MEMBER OF FRANCISCAN HEALTH RENSSELAER, INC. FORM 990, PART VI, LINE 7B CERTAIN POWERS HAVE BEEN RESERVED TO THE MEMBER. THOSE POWERS INCLUDE: - THE ADOPTION, AMENDMENT, RESTATEMENT OR REPEAL OF THE MISSION STATEMENT OF THE CORPORATION; - THE EXPANSION OF SERVICES OF THE CORPORATION TO PROMOTE THE HEALTH OF A BROAD CROSS-SECTION OF THE COMMUNITY SERVED BASED ON MEDICAL NECESSITY REGARDLESS OF THE PATIENTS RACE, CREED, NATIONAL ORIGIN, GENDER, PAYOR SOURCE OR ABILITY TO PAY CONSISTENT WITH THE REQUIREMENTS OF SECTIONS 501(C)(3) AND 501(R) OF THE CODE AND APPLICABLE IRS REVENUE RULINGS AND SIMILAR GUIDANCE ISSUED BY THE INTERNAL REVENUE SERVICE FROM TIME TO TIME; - ASSURING THAT THE CORPORATION IS IN COMPLIANCE WITH THE OPERATING COVENANTS REGARDING PROTECTION OF THE CHARITABLE MISSION OF THE SOLE MEMBER AND ITS CHARITY CARE AND COMMUNITY BENEFIT POLICIES, AS AMENDED FROM TIME TO TIME AND IS ACTING EXCLUSIVELY IN FURTHERANCE OF ITS TAX EXEMPT PURPOSES AND IN A MANNER THAT WILL NOT ADVERSELY AFFECT THE TAX EXEMPT STATUS OF THE CORPORATION OR THE SOLE MEMBER; AND - ASSURING THAT THE CORPORATION IS IN COMPLIANCE WITH THE ETHICAL AND RELIGIOUS DIRECTIVES FOR CATHOLIC HEALTH CARE SERVICES, AS PROMULGATED FROM TIME TO TIME BY THE UNITED STATES CONFERENCE OF CATHOLIC BISHOPS, OR ITS SUCCESSOR, AND AS INTERPRETED BY THE LOCAL BISHOP FROM TIME TO TIME, INCLUDING, WITHOUT LIMITATION, THE EXCLUSIVE RIGHT TO DETERMINE AND MAINTAIN THE RELIGIOUS IDENTITY, PHILOSOPHY, MISSION, AND PURPOSE OF THE CORPORATION, AND TO APPROVE ANY CHANGE IN THE FUNDAMENTAL PURPOSES, MISSION OR OPERATION OF THE CORPORATION AS WELL AS THE RIGHT TO APPROVE ANY SALE, PURCHASE, MORTGAGE OR ENCUMBRANCE OF ANY REAL PROPERTY OF THE CORPORATION, WHERE SUCH APPROVAL IS REQUIRED BY CANON LAW. - AMEND, RESTATE OR REPEAL THE ARTICLES OF INCORPORATION OR BYLAWS OF THE CORPORATION AFTER CONSULTATION WITH THE BOARD; - APPROVE A PLAN OF DISSOLUTION OF THE CORPORATION, DISSOLVE THE CORPORATION, AND WIND UP AND LIQUIDATE THE CORPORATIONS BUSINESS AND AFFAIRS; - APPROVE A PLAN OF MERGER OR CONSOLIDATION OF THE CORPORATION INTO OR WITH ANOTHER ENTITY, OR THE ORGANIZATION OF OR AFFILIATION WITH ANOTHER ENTITY, OR THE ACQUISITION OF THE ASSETS, MEMBERSHIP INTERESTS, STOCK OR OTHER OWNERSHIP INTERESTS OF ANOTHER ENTITY; - APPROVE THE SALE, LEASE OR OTHER TRANSFER OF ANY ASSETS OF THE CORPORATION OTHER THAN IN THE ORDINARY AND USUAL COURSE OF THE CORPORATIONS BUSINESS AND IN EXCESS OF AN AMOUNT ESTABLISHED FROM TIME TO TIME BY THE SOLE MEMBER; - VOLUNTARILY DECLARE THE BANKRUPTCY OF THE CORPORATION; - APPROVE THE ADMISSION OR REMOVAL OF A MEMBER; - APPROVE A STRATEGIC PLAN OF THE CORPORATION AND ANY MODIFICATIONS THERETO OR REPLACEMENTS THEREOF DEVELOPED AND RECOMMENDED BY THE BOARD IN CONJUNCTION WITH THE HOSPITAL, WITH SUCH MODIFICATIONS THERETO AS THE MEMBER MAY DEEM NECESSARY OR APPROPRIATE; - APPROVE ANNUAL AND LONG-TERM CAPITAL AND OPERATING BUDGETS DEVELOPED AND RECOMMENDED BY THE BOARD IN CONJUNCTION WITH THE HOSPITAL, WITH SUCH MODIFICATIONS AS SOLE MEMBER MAY DEEM NECESSARY OR APPROPRIATE, OR APPROVE ANY CHANGES THEREIN OR DEVIATIONS THEREFROM; - APPROVE THE INCURRENCE OF DEBT BY THE CORPORATION OR ANY ORGANIZATION CONTROLLED BY THE CORPORATION (OTHER THAN ACCOUNTS PAYABLE INCURRED FOR THE ACQUISITION OF GOODS AND SERVICES IN THE ORDINARY AND USUAL COURSE OF THE CORPORATIONS BUSINESS) AND TO GRANT ANY SECURITY INTERESTS, PLACE ANY ENCUMBRANCES OR ENTER INTO ANY COVENANTS IN CONNECTION WITH THE INCURRENCE OF SUCH DEBT; - CHANGE THE STATUS OF THE CORPORATION FOR FEDERAL TAX PURPOSES, MAKE ANY STATE OR FEDERAL TAX ELECTION ON BEHALF OF THE CORPORATION AND SELECT OR DISMISS THE INDEPENDENT PUBLIC ACCOUNTANTS FOR THE CORPORATION; - APPROVE AND ENTER INTO, IN THE NAME OF OR ON BEHALF OF THE CORPORATION, MANAGED CARE AND OTHER THIRD PARTY PAYOR CONTRACTS, AMENDMENTS THERETO OR THE TERMINATION THEREOF BY THE COMPANY HEALTH INSURANCE PLANS; - APPROVE PROGRAMS AND THE CORPORATIONS PARTICIPATION THEREIN TO SUPPORT CLINICAL INTEGRATION INITIATIVES (INCLUDING, WITHOUT LIMITATION, ACCOUNTABLE CARE ORGANIZATIONS AND MEDICAL HOMES); - PROMULGATE POLICIES BINDING ON THE CORPORATION. - ADOPT, AMEND AND TERMINATE EMPLOYEE BENEFITS AND EMPLOYEE BENEFIT PLANS, INCLUDING, BUT NOT LIMITED TO RETIREMENT PLANS, DEFERRED COMPENSATION PLANS, AND EMPLOYEE WELFARE PLANS PROVIDING FOR HEALTH, DENTAL AND VISION BENEFITS, DISABILITY BENEFITS, DEATH BENEFITS, PAID TIME OFF BENEFITS, PREPAID LEGAL SERVICES, DAY CARE CENTERS, SCHOLARSHIP FUNDS, APPRENTICESHIP AND TRAINING BENEFITS, OR OTHER BENEFITS; - APPOINT AND REMOVE THE CORPORATIONS OFFICERS, WITH OR WITHOUT CAUSE, AFTER CONSULTATION WITH THE BOARD; - CHOOSE OR DISMISS THE INDEPENDENT PUBLIC ACCOUNTS FOR THE CORPORATION; AND - REVIEW AND APPROVE THE CORPORATIONS COMPLIANCE PLAN. - MONITORING MISSION INTEGRATION ENDEAVORS OF THE CORPORATION AND THE HOSPITAL; - THE QUALITY AND SAFETY PLANS FOR THE CORPORATION AND THE HOSPITAL; - ALL MEDICAL STAFF AFFAIRS FOR THE CORPORATION AND THE HOSPITAL INCLUDING BUT NOT LIMITED TO ACTING AS THE BOARD FOR THE APPROVAL OF THE APPOINTMENTS AND RE-APPOINTMENTS AND THE GRANTING OF CLINICAL PRIVILEGES TO PHYSICIANS TO THE MEDICAL STAFF AS RECOMMENDED BY THE MEDICAL STAFF AFFAIRS/QUALITY IMPROVEMENT COMMITTEE OF THE HOSPITAL; - ACTING AS THE BOARD FOR THE CREDENTIALING AND RE-CREDENTIALING OF ALLIED HEALTH PERSONNEL AS RECOMMENDED BY THE MEDICAL STAFF AFFAIRS/QUALITY IMPROVEMENT COMMITTEE OF THE HOSPITAL; - THE DEVELOPMENT AND RECOMMENDATION OF THE ANNUAL BUDGET OF THE CORPORATION INCLUDING STAFFING, APPROPRIATE FOR THE SCOPE AND COMPLEXITY FOR SERVICES OFFERED AT THE HOSPITAL AND OTHER FACILITIES OF THE CORPORATION; - THE DEVELOPMENT AND RECOMMENDATION OF THE CORPORATIONS STRATEGIC PLAN IN ACCORD WITH THE MISSION, VISION, VALUES, AND STRATEGIC PLAN OF THE SOLE MEMBER; - ACTIVE PARTICIPATION IN RELEVANT PROGRAMS OF RESEARCH, EDUCATION, AND HEALTH - PROJECTS, ALL IN THE FURTHERANCE OF THE PROMOTION OF HEALTH; - PROVISION FOR THE ADEQUACY OF THE PHYSICAL PLANT OF THE HOSPITAL AND OTHER FACILITIES OF THE CORPORATION; AND - ASSISTING THE SOLE MEMBER AND OTHER ENTITIES IN WHICH THE SOLE MEMBER HAS AN OWNERSHIP INTEREST, WITH RESPECT TO THE MANAGEMENT AND OPERATION OF THEIR HEALTH CARE FACILITIES AND OPERATIONS WITHIN THE WESTERN INDIAN REGION. THE NATURE OF THEIR VOTING RIGHTS: ON MATTERS RESERVED TO EITHER THE MEMBER OR THE MEMBER'S FRANCISCAN ALLIANCE, INC. BOARD, MAJORITY VOTE AT WHICH A QUORUM IS PRESENT.
FORM 990, PART VI, SECTION B, LINE 11B	THE INFORMATION TO PREPARE THE FORM 990 IS GATHERED BY FINANCE STAFF AND MISSION REPRESENTATIVES AND PROVIDED TO ITS ACCOUNTING FIRM WHO PREPARES THE RETURN. SENIOR MANAGEMENT THEN REVIEWS THE RETURN PRIOR TO FILING. THE FORM 990 IS ALSO MADE AVAILABLE TO FRANCISCAN HEALTH RENSSELAER'S BOARD OF TRUSTEES PRIOR TO FILING.
FORM 990, PART VI, SECTION B, LINE 12C	THE CORPORATION REQUIRES ANNUAL CONFLICT OF INTEREST STATEMENTS FROM EACH DIRECTOR, PRINCIPAL OFFICER, MEMBERS OF COMMITTEES WITH BOARD DESIGNATED POWERS, KEY EMPLOYEES, AND EXECUTIVE LEADERSHIP COMMITTEE MEMBERS WHICH AFFIRMS THAT THEY HAVE RECEIVED, READ, AND UNDERSTAND THE CONFLICT OF INTEREST POLICY AND HAVE AGREED TO COMPLY WITH THE POLICY. IN CONNECTION WITH ANY ACTUAL OR POSSIBLE CONFLICT OF INTEREST, A DIRECTOR, PRINCIPAL OFFICER OR MEMBER OF A COMMITTEE WITH BOARD DESIGNATED POWERS MUST DISCLOSE THE EXISTENCE AND NATURE OF THE FINANCIAL INTEREST TO THE DIRECTORS AND MEMBERS OF COMMITTEES WITH BOARD DELEGATED POWERS CONSIDERING THE PROPOSED TRANSACTION OR ARRANGEMENTS. AFTER DISCLOSURES OF THE FINANCIAL INTEREST, THE DIRECTOR, PRINCIPAL OR COMMITTEE MEMBER SHALL LEAVE THE BOARD OR COMMITTEE MEETING WHILE THE FINANCIAL INTEREST IS DISCUSSED AND VOTE TAKEN. IN ADDITION, ONGOING REVIEWS AND ASSESSMENTS ARE MADE TO MAKE CERTAIN THAT THE CORPORATION OPERATES IN A MANNER CONSISTENT WITH ITS CHARITABLE PURPOSES. IN CONDUCTING THE ONGOING REVIEWS AND ASSESSMENTS, THE CORPORATION USES INTERNAL AND EXTERNAL ADVISORS. REVIEWS INCLUDE COMPENSATION ARRANGEMENTS, ACQUISITIONS, PARTNERSHIPS, JOINT VENTURE ARRANGEMENTS, AND AGREEMENTS TO PROVIDE HEALTH CARE PRODUCTS/SERVICES, ETC.
FORM 990, PART VI, SECTION B, LINES 15A AND 15B	FRANCISCAN HEALTH RENSSELAER, INC. DOES NOT COMPENSATE ITS OFFICERS OR KEY EMPLOYEES.
FORM 990, PART XI, LINE 9	EQUITY TRANSFERS TO AFFILIATES (142,734) CHANGE IN TEMP. RESTRICTED NET ASSETS 1,549 ---------- TOTAL (141,185)

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (7 entries)

Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	EINEIN	Primary ActivitiesPrimaryActivitiesTxt	Legal Domicile StateLegalDomicileStateCd	Exempt Code SectionExemptCodeSectionTxt	Public Charity StatusPublicCharityStatusTxt	Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt	Controlled OrganizationControlledOrganizationInd
FRANCISCAN ALLIANCE INC
1515 DRAGOON TRAIL	MISHAWAKA	IN	46544	351330472	HEALTH SRVCS	IN	501(C)(3)	3	NA	false
HILLS INSURANCE COMPANY INC
1515 DRAGOON TRAIL	MISHAWAKA	IN	46544	030372512	CAPTIVE INS	VT	501(C)(3)	12 - TYPE 1	FRANCISCAN	false
SISTERS OF ST FRANCIS OF PERPETUAL ADOR
PO BOX 766	MISHAWAKA	IN	46546	351328145	RELIGIOUS	IN	501(C)(3)	1	NA	false
ST ALEXIS HOSPITAL ASSOCIATION
PO BOX 1290	MISHAWAKA	IN	46546	340714485	SUPPORT ALEXA	OH	501(C)(3)	3	FRANCISCAN	false
AT YOUR SERVICE HOME CARE INC
4701 N KEYSTONE AVE S418	INDIANAPOLIS	IN	46205	352107306	HEALTHCARE	IN	501(C)(3)	10	FRANCISCAN	false
FRANCISCAN VNS HOME CARE INC
4701 N KEYSTONE AVE S418	INDIANAPOLIS	IN	46205	350868199	HOME HEALTH	IN	501(C)(3)	10	FRANCISCAN	false
FRANCISCAN HEALTH FOUNDATION INC
1515 DRAGOON TRAIL	MISHAWAKA	IN	46544	351955283	FUNDRAISING	IN	501(C)(3)	7	FRANCISCAN	false

Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (8 entries)

Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	EINEIN	Primary ActivitiesPrimaryActivitiesTxt	Legal Domicile StateLegalDomicileStateCd	Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt	Predominant Income TypePredominantIncomeTypeTxt
FRANCISCAN SURGERY CENTER LLC
421 N EMERSON AVE	BEECH GROVE	IN	46107	352128334	MEDICAL SERVICES	IN	NA	N/A
LAFAYETTE HEART PROGRAM HOLDINGS
1501 HARTFORD STREET	LAFAYETTE	IN	47904	383750811	MEDICAL SERVICES	IN	NA	N/A
ST ANTHONY HEALTH NETWORK LLC
PO BOX 310	MISHAWAKA	IN	465460310	351985170	CLAIMS PROCESSING	IN	NA	N/A
ST FRANCIS MOORESVILLE SURGERY CENTER
1215 HADLEY ROAD SUITE 100	MOORESVILLE	IN	46158	202256900	MEDICAL SERVICES	IN	NA	N/A
ST FRANCIS RADIATION THERAPY CENTERS
421 N EMERSON AVE	BEECH GROVE	IN	46107	770663631	MEDICAL SERVICES	IN	NA	N/A
ST FRANCIS IMAGING CTR (GREENWOOD)
421 N EMERSON AVE	GREENWOOD	IN	46107	204607426	IMAGING SERVICES	IN	NA	N/A
TONN AND BLANK CONST LLC
1623 GREENWOOD AVE	MICHIGAN CITY	IN	46360	263919039	CONSTRUCTION	IN	NA	N/A
MAJOR HOSP CARDIAC DIAGNOSTICS LLC
2451 INTELLIPLEX DR	SHELBYVILLE	IL	46176	208715441	MEDICAL SERVICES	IN	NA	N/A

Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (3 entries)

Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	EINEIN	Primary ActivitiesPrimaryActivitiesTxt	Legal Domicile StateLegalDomicileStateCd	Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt	Entity TypeEntityTypeTxt
FRANCISCAN HOLDING CORPORATION
1515 DRAGOON TRAIL	MISHAWAKA	IN	46544	363593505	HOLDING CO.	IN	NA	C CORP
FRANCISCAN ACO INC
700 E SOUTHPORT RD	INDIANAPOLIS	IN	46107	351904455	INSURANCE	IN	NA	C CORP
ST JAMES PHO INC
30 E 11TH ST SUITE 402	CHICAGO HEIGHTS	IL	60411	363945083	MANAGED CARE	IL	NA	C CORP

Field	Value	IRS element (for citing)
Receipt Of Int Annts Rnts Rylts	false	ReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth Org	false	GiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth Org	false	GiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other Org	false	LoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth Org	Yes (true)	LoansOrGuaranteesFromOthOrgInd
Div Related Organization	false	DivRelatedOrganizationInd
Asset Sale To Other Org	false	AssetSaleToOtherOrgInd
Asset Purchase From Other Org	false	AssetPurchaseFromOtherOrgInd
Asset Exchange	false	AssetExchangeInd
Rental Of Facilities To Oth Org	false	RentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth Org	false	RentalOfFcltsFromOthOrgInd
Perform Of Services For Oth Org	false	PerformOfServicesForOthOrgInd
Perform Of Services By Other Org	false	PerformOfServicesByOtherOrgInd
Sharing Of Facilities	false	SharingOfFacilitiesInd
Paid Employees Sharing	false	PaidEmployeesSharingInd
Reimbursement Paid To Other Org	false	ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other Org	false	ReimbursementPaidByOtherOrgInd
Transfer To Other Org	false	TransferToOtherOrgInd
Transfer From Other Org	Yes (true)	TransferFromOtherOrgInd