During the June 13–14 Spring General Assembly of the US Conference of Catholic Bishops in Fort Lauderdale, Florida, the USCCB voted 183-2-2 to approve major revisions to the Ethical and Religious Directives for Catholic Health Care Services, updating the fifth edition of the Directives published in 2009. Part Six of the Directives—governing collaborative arrangements between Catholic healthcare providers and other healthcare organizations and providers—was entirely rewritten, expanding guidance as to the absolute authority of the diocesan bishops in overseeing such collaborations and focusing on the distinction between a Catholic actor’s “formal” and “material” cooperation with contemporary healthcare procedures that church teaching deems immoral, such as abortion, euthanasia, assisted suicide and direct sterilization. Additionally, the number of directives in Part Six increased from six to 11. The added directives focus on ensuring Catholic control over shared facilities and prescribing behavior for employees and representatives of Catholic healthcare institutions, and ensuring that any affiliation, collaboration, acquisition, governance or management operates “in full accord with the moral teaching of the Catholic Church, including these Directives.” Both the previous and updated versions of the Directives contemplate that these systems may be the only provider of healthcare for a given area. Catholic hospitals are present in all 50 states and treat one out of six patients in the United States.