CHEYENNE COUNTY HOSPITAL & HEALTH CENTER FOUNDATION: Form 990, tax year 2023

View the entire original 990 at ProPublica ↗

Organization
CHEYENNE COUNTY HOSPITAL & HEALTH CENTER FOUNDATION (EIN 47-0686476)
Tax period
2023-01-01 to 2023-12-31
Filed
2024-11-15
IRS object ID
202403209349319115
Schema version
2023v5.1
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 ReturnHeader

FieldValueIRS element (for citing)
Return2024-11-15T14:52:57-06:00ReturnTs
Tax Period End2023-12-31TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN450250958PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1EIDE BAILLY LLPBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line118081 BURT ST STE 200AddressLine1Txt
CityOMAHACityNm
State AbbreviationNEStateAbbreviationCd
ZIP680224722ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2023-01-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN470686476EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1CHEYENNE COUNTY HOSPITAL & HEALTH CENTERBusinessNameLine1Txt
Business Name Line2FOUNDATIONBusinessNameLine2Txt
FieldValueIRS element (for citing)
Business Name ControlCHEYBusinessNameControlTxt
Phone3082545825PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line11000 POLE CREEK CROSSINGAddressLine1Txt
CitySIDNEYCityNm
State AbbreviationNEStateAbbreviationCd
ZIP69162ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonJULIE SHOEMAKERPersonNm
Person TitleSECRETARYPersonTitleTxt
Phone3082545825PhoneNum
Signature2024-11-15SignatureDt
Discuss With Paid PreparerYes (1)DiscussWithPaidPreparerInd
FieldValueIRS element (for citing)
IRS Responsible Prty Info CurrYes (1)IRSResponsiblePrtyInfoCurrInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonMEGAN L KOZIOL CPAPreparerPersonNm
PTINP01544037PTIN
Phone4023302660PhoneNum
Preparation2024-11-07PreparationDt
FieldValueIRS element (for citing)
Tax2023TaxYr
Build TS2024-10-15 13:58:12ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Principal OfficerKELLY UTLEYPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line11000 POLE CREEK CROSSINGAddressLine1Txt
CitySIDNEYCityNm
State AbbreviationNEStateAbbreviationCd
ZIP69162ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$73,742GrossReceiptsAmt
Group Return For Affiliates0GroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website AddressWWW.SIDNEYRMC.COM/HEALTH-CENTER-FOUNDATIONWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation1985FormationYr
Legal Domicile StateNELegalDomicileStateCd
Activity Or MissionTO SUPPORT SIDNEY REGIONAL MEDICAL CENTER.ActivityOrMissionDesc
Voting Members Governing Body9VotingMembersGoverningBodyCnt
Voting Members Independent8VotingMembersIndependentCnt
Total Employee0TotalEmployeeCnt
Total Volunteers15TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$51,047PYContributionsGrantsAmt
CY Contributions Grants$31,191CYContributionsGrantsAmt
PY Program Service Revenue$0PYProgramServiceRevenueAmt
CY Program Service Revenue$0CYProgramServiceRevenueAmt
PY Investment Income$24,218PYInvestmentIncomeAmt
CY Investment Income$39,915CYInvestmentIncomeAmt
PY Other Revenue-$1,766PYOtherRevenueAmt
CY Other Revenue-$532CYOtherRevenueAmt
PY Total Revenue$73,499PYTotalRevenueAmt
CY Total Revenue$70,574CYTotalRevenueAmt
PY Grants And Similar Paid$49,994PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$59,236CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$0PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$0CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$17,408CYTotalFundraisingExpenseAmt
PY Other Expenses$16,630PYOtherExpensesAmt
CY Other Expenses$17,408CYOtherExpensesAmt
PY Total Expenses$66,624PYTotalExpensesAmt
CY Total Expenses$76,644CYTotalExpensesAmt
PY Revenues Less Expenses$6,875PYRevenuesLessExpensesAmt
CY Revenues Less Expenses-$6,070CYRevenuesLessExpensesAmt
Total Assets BOY$1,721,875TotalAssetsBOYAmt
Total Assets EOY$1,815,696TotalAssetsEOYAmt
Total Liabilities BOY$2,500TotalLiabilitiesBOYAmt
Total Liabilities EOY$4,041TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$1,719,375NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$1,811,655NetAssetsOrFundBalancesEOYAmt
MissionTO ASSURE THERE IS, AND ALWAYS WILL BE, A STRONG FINANCIAL FOUNDATION SUPPORTING OUR HEALTH CARE COMMUNITY.MissionDesc
Significant New Program Srvc0SignificantNewProgramSrvcInd
Significant Change0SignificantChangeInd
Expense$37,400ExpenseAmt
Grant$37,400GrantAmt
DescPROVIDE SUPPORT TO CHEYENNE COUNTY HOSPITAL ASSOCIATION, D/B/A SIDNEY REGIONAL MEDICAL CENTER, TO FURTHER THEIR QUEST TO PROVIDE THE MOST UP-TO-DATE FACILITIES, EQUIPMENT AND SERVICE.Desc

Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp

FieldValueIRS element (for citing)
Expense$16,646ExpenseAmt
Grant$16,646GrantAmt
DescPROVIDE FUNDING TO SUPPORT SCHOLARSHIPS AND INTERN PROGRAMS FOR INDIVIDUALS CURRENTLY STUDYING IN THE HEALTH CARE FIELD.Desc

Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp

FieldValueIRS element (for citing)
Expense$5,190ExpenseAmt
Grant$5,190GrantAmt
Revenue$0RevenueAmt
DescPROVIDE FUNDING TO ASSIST WITH DENTAL PROCEDURES FOR THOSE IN NEED.Desc
FieldValueIRS element (for citing)
Total Program Service Expenses$59,236TotalProgramServiceExpensesAmt
Described In Section501c3Yes (1)DescribedInSection501c3Ind
Schedule B RequiredYes (1)ScheduleBRequiredInd
Political Campaign Acty0PoliticalCampaignActyInd
Lobbying Activities0LobbyingActivitiesInd
Subject To Proxy Tax0SubjectToProxyTaxInd
Donor Advised Fund0DonorAdvisedFundInd
Conservation Easements0ConservationEasementsInd
Collections Of Art0CollectionsOfArtInd
Credit Counseling0CreditCounselingInd
Donor Rstr Or Quasi Endowments0DonorRstrOrQuasiEndowmentsInd
Report Land Building EquipmentYes (1)ReportLandBuildingEquipmentInd
Report Investments Other Sec0ReportInvestmentsOtherSecInd
Report Program Related Invst0ReportProgramRelatedInvstInd
Report Other Assets0ReportOtherAssetsInd
Report Other Liabilities0ReportOtherLiabilitiesInd
Include FIN48 FootnoteYes (1)IncludeFIN48FootnoteInd
Independent Audit Fincl Stmt0IndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtYes (1)ConsolidatedAuditFinclStmtInd
School Operating0SchoolOperatingInd
Foreign Office0ForeignOfficeInd
Foreign Activities0ForeignActivitiesInd
More Than5000 K To Org0MoreThan5000KToOrgInd
More Than5000 K To Individuals0MoreThan5000KToIndividualsInd
Professional Fundraising0ProfessionalFundraisingInd
Fundraising ActivitiesYes (1)FundraisingActivitiesInd
Gaming Activities0GamingActivitiesInd
Operate Hospital0OperateHospitalInd
Grants To OrganizationsYes (1)GrantsToOrganizationsInd
Grants To IndividualsYes (1)GrantsToIndividualsInd
Schedule J RequiredYes (1)ScheduleJRequiredInd
Tax Exempt Bonds0TaxExemptBondsInd
Engaged In Excess Benefit Trans0EngagedInExcessBenefitTransInd
PY Excess Benefit Trans0PYExcessBenefitTransInd
Loan Outstanding0LoanOutstandingInd
Grant To Related Person0GrantToRelatedPersonInd
Business Rln With Org Mem0BusinessRlnWithOrgMemInd
Business Rln With Fam Mem0BusinessRlnWithFamMemInd
Business Rln With35 Ctrl Ent0BusinessRlnWith35CtrlEntInd
Deductible Non Cash Contri0DeductibleNonCashContriInd
Deductible Art Contribution0DeductibleArtContributionInd
Terminate Operations0TerminateOperationsInd
Partial Liquidation0PartialLiquidationInd
Disregarded Entity0DisregardedEntityInd
Related EntityYes (1)RelatedEntityInd
Related Organization Ctrl Ent0RelatedOrganizationCtrlEntInd
Trnsfr Exmpt Non Chrtbl Rltd Org0TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted Prtshp0ActivitiesConductedPrtshpInd
Schedule O RequiredYes (1)ScheduleORequiredInd
IRP Document0IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Employee0EmployeeCnt
Unrelated Bus Incm Over Limit0UnrelatedBusIncmOverLimitInd
Foreign Financial Account0ForeignFinancialAccountInd
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTransInd
Taxable Party Notification0TaxablePartyNotificationInd
Nondeductible Contributions0NondeductibleContributionsInd
Quid Pro Quo ContributionsYes (1)QuidProQuoContributionsInd
Quid Pro Quo Contri DisclYes (1)QuidProQuoContriDisclInd
Form8282 Property Disposed Of0Form8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft Cntrct0RcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft Cntrct0PayPremiumsPrsnlBnftCntrctInd
Indoor Tanning Services0IndoorTanningServicesInd
Subj To Tax Rmnrtn Ex Prcht Pymt0SubjToTaxRmnrtnExPrchtPymtInd
Subject To Excs Tax Net Invst Inc0SubjectToExcsTaxNetInvstIncInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members9GoverningBodyVotingMembersCnt
Independent Voting Member8IndependentVotingMemberCnt
Family Or Business Rln0FamilyOrBusinessRlnInd
Delegation Of Mgmt Duties0DelegationOfMgmtDutiesInd
Change To Org Documents0ChangeToOrgDocumentsInd
Material Diversion Or Misuse0MaterialDiversionOrMisuseInd
Members Or Stockholders0MembersOrStockholdersInd
Election Of Board Members0ElectionOfBoardMembersInd
Decisions Subject To Approva0DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (1)MinutesOfGoverningBodyInd
Minutes Of Committees0MinutesOfCommitteesInd
Officer Mailing Address0OfficerMailingAddressInd
Local Chapters0LocalChaptersInd
Form990 Provided To Gvrn BodyYes (1)Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (1)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (1)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (1)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (1)WhistleblowerPolicyInd
Document Retention PolicyYes (1)DocumentRetentionPolicyInd
Compensation Process CEO0CompensationProcessCEOInd
Compensation Process Other0CompensationProcessOtherInd
Investment In Joint Venture0InvestmentInJointVentureInd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1KELLY UTLEYBusinessNameLine1Txt
FieldValueIRS element (for citing)
Phone3082545825PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line11000 POLE CREEK CROSSINGAddressLine1Txt
CitySIDNEYCityNm
State AbbreviationNEStateAbbreviationCd
ZIP69162ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (10 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtOfficerOfficerInd
DR JAMES POPOVICH
MEMBER1.0039.00Yes (X)$0$624,896$50,829
BILL BUTKUS
PRESIDENT1.000.00Yes (X)$0$0$0Yes (X)
KURT KAISER
VICE PRESIDENT1.000.00Yes (X)$0$0$0Yes (X)
SEAN DOYLE
TREASURER1.000.00Yes (X)$0$0$0Yes (X)
JULIE SHOEMAKER
SECRETARY1.000.00Yes (X)$0$0$0Yes (X)
STAN BELIEU
MEMBER1.004.00Yes (X)$0$0$0
NANCI MCCASLIN
MEMBER1.004.00Yes (X)$0$0$0
SHANE COCHRAN
MEMBER1.000.00Yes (X)$0$0$0
NICKY RADCLIFFE
MEMBER1.000.00Yes (X)$0$0$0
KELLY UTLEY
CFO1.0039.00$0$263,484$37,363Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$0TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$888,380TotReportableCompRltdOrgAmt
Total Other Compensation$88,192TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K0IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed0FormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (1)TotalCompGreaterThan150KInd
Compensation From Other Srcs0CompensationFromOtherSrcsInd
Cntrct Rcvd Greater Than100 K0CntrctRcvdGreaterThan100KCnt
Fundraising$23,364FundraisingAmt
Related Organizations$5,000RelatedOrganizationsAmt
All Other Contributions$2,827AllOtherContributionsAmt
Total Contributions$31,191TotalContributionsAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$16,762TotalRevenueColumnAmt
Exclusion$16,762ExclusionAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

FieldValueIRS element (for citing)
Securities$23,153SecuritiesAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

FieldValueIRS element (for citing)
Securities$0SecuritiesAmt

Gain Or Loss GainOrLossGrp

FieldValueIRS element (for citing)
Securities$23,153SecuritiesAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

FieldValueIRS element (for citing)
Total Revenue Column$23,153TotalRevenueColumnAmt
Exclusion$23,153ExclusionAmt
FieldValueIRS element (for citing)
Fundraising Gross Income$2,636FundraisingGrossIncomeAmt
Contri Rpt Fundraising Event$23,364ContriRptFundraisingEventAmt
Fundraising Direct Expenses$3,168FundraisingDirectExpensesAmt

Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp

FieldValueIRS element (for citing)
Total Revenue Column-$532TotalRevenueColumnAmt
Exclusion-$532ExclusionAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$70,574TotalRevenueColumnAmt
Related Or Exempt Func Income$0RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$39,383ExclusionAmt

Grants To Domestic Orgs GrantsToDomesticOrgsGrp

FieldValueIRS element (for citing)
Total$37,400TotalAmt
Program Services$37,400ProgramServicesAmt

Grants To Domestic Individuals GrantsToDomesticIndividualsGrp

FieldValueIRS element (for citing)
Total$21,836TotalAmt
Program Services$21,836ProgramServicesAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$3,099TotalAmt
Fundraising$3,099FundraisingAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$4,041TotalAmt
Fundraising$4,041FundraisingAmt

Conferences Meetings ConferencesMeetingsGrp

FieldValueIRS element (for citing)
Total$1,144TotalAmt
Fundraising$1,144FundraisingAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$3,008TotalAmt
Fundraising$3,008FundraisingAmt

Other Expenses OtherExpensesGrp (3 entries)

DescDescTotalTotalAmtFundraisingFundraisingAmt
MISCELLANEOUS FUNDRAISI$5,932$5,932
OTHER EXPENSES$114$114
DUES$70$70

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$76,644TotalAmt
Program Services$59,236ProgramServicesAmt
Management And General$0ManagementAndGeneralAmt
Fundraising$17,408FundraisingAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$1,104,971BOYAmt
EOY$1,072,978EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$202,590LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$67,585LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$138,012BOYAmt
EOY$135,005EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

FieldValueIRS element (for citing)
BOY$478,892BOYAmt
EOY$607,713EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$1,721,875BOYAmt
EOY$1,815,696EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$2,500BOYAmt

Deferred Revenue DeferredRevenueGrp

FieldValueIRS element (for citing)
EOY$4,041EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$2,500BOYAmt
EOY$4,041EOYAmt
FieldValueIRS element (for citing)
Organization Follows FASB117Yes (X)OrganizationFollowsFASB117Ind

No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp

FieldValueIRS element (for citing)
BOY$1,473,611BOYAmt
EOY$1,570,201EOYAmt

Donor Restriction Net Assets DonorRestrictionNetAssetsGrp

FieldValueIRS element (for citing)
BOY$245,764BOYAmt
EOY$241,454EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$1,719,375BOYAmt
EOY$1,811,655EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$1,721,875BOYAmt
EOY$1,815,696EOYAmt
FieldValueIRS element (for citing)
Reconcilation Revenue Expnss-$6,070ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst$98,350NetUnrlzdGainsLossesInvstAmt
Other Changes In Net Assets$0OtherChangesInNetAssetsAmt
Info In Schedule O Part XIIYes (X)InfoInScheduleOPartXIIInd
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or Review0AccountantCompileOrReviewInd
FS AuditedYes (1)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Consolidated Basis Fincl StmtYes (X)ConsolidatedBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit CommitteeYes (1)AuditCommitteeInd
Federal Grant Audit Required0FederalGrantAuditRequiredInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Supporting Organization509a3Yes (X)SupportingOrganization509a3Ind
Supporting Org Type3 Func IntYes (X)SupportingOrgType3FuncIntInd
Supported Organizations1SupportedOrganizationsCnt

Supported Org Information SupportedOrgInformationGrp

Supported Organization Name SupportedOrganizationName

FieldValueIRS element (for citing)
Business Name Line1CHEYENNE COUNTY HOSPITAL ASSOCIATION INCBusinessNameLine1Txt
FieldValueIRS element (for citing)
EIN470408242EIN
Organization Type3OrganizationTypeCd
Governing Document ListedYes (1)GoverningDocumentListedInd
Support$37,000SupportAmt
Other Support$0OtherSupportAmt
FieldValueIRS element (for citing)
Supported Organizations Total1SupportedOrganizationsTotalCnt
Support Sum$37,000SupportSumAmt
Other Support Sum$0OtherSupportSumAmt

Form990 Sch A Supporting Org Form990SchASupportingOrgGrp

FieldValueIRS element (for citing)
Listed By Name Governing DocYes (1)ListedByNameGoverningDocInd
Suprt Org No IRS Determination0SuprtOrgNoIRSDeterminationInd
Supported Org Section C4560SupportedOrgSectionC456Ind
Supported Org Not Organized US0SupportedOrgNotOrganizedUSInd
Organization Change Suprt Org0OrganizationChangeSuprtOrgInd
Support Non Supported Org0SupportNonSupportedOrgInd
Payment Substantial Contribtr0PaymentSubstantialContribtrInd
Loan Disqualified Person0LoanDisqualifiedPersonInd
Controlled Disqualified Prsn0ControlledDisqualifiedPrsnInd
Disqualified Prsn Controll Int0DisqualifiedPrsnControllIntInd
Disqualified Prsn Ownr Int0DisqualifiedPrsnOwnrIntInd
Excess Business Holdings Rules0ExcessBusinessHoldingsRulesInd
Contribution Controller0ContributionControllerInd
Contribution Family0ContributionFamilyInd
Contribution35 Controlled0Contribution35ControlledInd

Form990 Sch A Type3 Sprt Org All Form990SchAType3SprtOrgAllGrp

FieldValueIRS element (for citing)
Timely Provided DocumentsYes (1)TimelyProvidedDocumentsInd
Officers Close RelationshipYes (1)OfficersCloseRelationshipInd
Supported Org Voice InvestmentYes (1)SupportedOrgVoiceInvestmentInd

Form990 Sch A Type3 Func Int Form990SchAType3FuncIntGrp

FieldValueIRS element (for citing)
Activities TestYes (X)ActivitiesTestInd
Activities Further Exempt PrpsYes (1)ActivitiesFurtherExemptPrpsInd
Activities Engaged Org InvlmntYes (1)ActivitiesEngagedOrgInvlmntInd

Form990 Schedule A Part VI Form990ScheduleAPartVIGrp (3 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
SECTION D, LINE 3:THE SUPPORTED ORGANIZATION, CHEYENNE COUNTY HOSPITAL ASSOCIATION, INC., APPOINTS 2 MEMBERS OF ITS BOARD OF DIRECTORS TO SIT ON THE BOARD OF DIRECTORS OF THE CHEYENNE COUNTY HOSPITAL AND HEALTH CENTER FOUNDATION. THESE DIRECTORS SERVE TO ASSIST IN THE DIRECTION OF THE FOUNDATION AND LEND A SIGNIFICANT VOICE TO ALL POLICIES AND PROCEDURES AND SERVE DURING THE ENTIRE YEAR. ADDITIONALLY, THE CFO OF THE CHEYENNE COUNTY HOSPITAL ASSOCIATION SERVES ON THE BOARD AS A FINANCIAL REPRESENTATIVE GIVING GUIDANCE TO THE BOARD AS NEEDED.
SECTION E, LINE 2A:THE PURPOSE OF THE ORGANIZATION IS TO SUPPORT THE CHEYENNE COUNTY HOSPITAL ASSOCIATION TO ASSURE THAT THERE IS AND ALWAYS WILL BE A STRONG FOUNDATION SUPPORTING HEALTH CARE IN CHEYENNE COUNTY. DURING 2023, THE FOUNDATION'S ACTIVITIES WERE FOCUSED ON THE SUPPORT OF THE HEALTHCARE MISSION AND INCREASING COMMUNITY AWARENESS OF THE FOUNDATION ITSELF. SIDNEY REGIONAL MEDICAL CENTER REQUESTED SUPPORT FROM THE FOUNDATION IN THE FORM OF FUNDING FOR EDUCATION AND SCHOLARSHIPS. THE FOUNDATION ALSO FUNDED AND HOSTED INTERNS WHO FURTHERED THEIR HEALTHCARE EDUCATION BY SHADOWING AND WORKING WITHIN THE HOSPITAL ORGANIZATION. MANY OF THESE INTERNS, AS WELL AS SCHOLARSHIP RECIPIENTS OF THE FOUNDATION, GO ON AND SUCCEED IN THEIR HEALTHCARE PROFESSIONS AND RETURN TO THE SIDNEY, NEBRASKA AREA AFTER THEIR TRAINING AND EDUCATION IS COMPLETE.
SECTION E, LINE 2B:IF THE FOUNDATION DIDN'T EXIST THERE WOULD STILL NEED TO BE A MECHANISM FOR ACCEPTING BEQUESTS AND OTHER GIFTS FROM PATIENTS, AS WELL AS FUNDRAISING FOR NEEDED EQUIPMENT AND FACILITIES IMPROVEMENTS. THE INTERN PROGRAM WOULD CONTINUE IN ORDER TO FURTHER THE RECRUITING EFFORTS BY THE HOSPITAL. THESE DEEPLY ROOTED EVENTS WOULD NEED TO CONTINUE TO BE HELD WITHIN THE COMMUNITY IN ORDER TO PROMOTE HEALTHY LIVING ACTIVITIES AND HOSPITAL COMMUNITY BENEFITS.

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

FieldValueIRS element (for citing)
ContributorRESTRICTEDContributorNum

Contributor Business Name ContributorBusinessName

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor US Address ContributorUSAddress

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Total ContributionsRESTRICTEDTotalContributionsAmt

Schedule D IRS990ScheduleD

Land LandGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$126,483OtherCostOrOtherBasisAmt
Book Value$126,483BookValueAmt

Buildings BuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$75,188OtherCostOrOtherBasisAmt
Depreciation$66,666DepreciationAmt
Book Value$8,522BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$919OtherCostOrOtherBasisAmt
Depreciation$919DepreciationAmt
Book Value$0BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$135,005TotalBookValueLandBuildingsAmt
Footnote TextYes (X)FootnoteTextInd

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferencePART X, LINE 2:FormAndLineReferenceDesc
ExplanationTHE ORGANIZATION ACCOUNTS FOR UNCERTAINTIES IN ACCOUNTING FOR INCOME TAX ASSETS AND LIABILITIES USING GUIDANCE INCLUDED IN FASB ASC 740, INCOME TAXES. THE ORGANIZATION RECOGNIZES THE EFFECT OF INCOME TAX POSITIONS ONLY IF THOSE POSITIONS ARE MORE LIKELY THAN NOT OF BEING SUSTAINED. AT DECEMBER 31, 2023 AND 2022, THE ORGANIZATION HAD NO UNCERTAIN TAX POSITIONS ACCRUED.ExplanationTxt

Schedule G IRS990ScheduleG

Fundraising Event Information FundraisingEventInformationGrp

FieldValueIRS element (for citing)
Event1GOLF TOURNAMENTEvent1Nm
Gross Receipts Event1$26,000GrossReceiptsEvent1Amt
Charitable Contri Event1$23,364CharitableContriEvent1Amt
Gross Revenue Event1$2,636GrossRevenueEvent1Amt
Cash Prizes Event1$356CashPrizesEvent1Amt
Rent Facility Costs Event1$1,140RentFacilityCostsEvent1Amt
Food And Beverage Event1$1,140FoodAndBeverageEvent1Amt
Other Direct Expenses Event1$532OtherDirectExpensesEvent1Amt
Gross Receipts Total$26,000GrossReceiptsTotalAmt
Charitable Contributions Tot$23,364CharitableContributionsTotAmt
Gross Revenue Total Events$2,636GrossRevenueTotalEventsAmt
Cash Prizes Total Events$356CashPrizesTotalEventsAmt
Rent Fclty Costs Total Events$1,140RentFcltyCostsTotalEventsAmt
Food And Beverage Total Events$1,140FoodAndBeverageTotalEventsAmt
Oth Direct Expnss Total Events$532OthDirectExpnssTotalEventsAmt
Direct Expense Summary Events$3,168DirectExpenseSummaryEventsAmt
Net Income Summary-$532NetIncomeSummaryAmt

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Grant Records MaintainedYes (1)GrantRecordsMaintainedInd

Recipient Table RecipientTable

Recipient Business Name RecipientBusinessName

FieldValueIRS element (for citing)
Business Name Line1CHEYENNE COUNTY HOSPITAL ASSOCIATION INCBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line11000 POLE CREEK CROSSINGAddressLine1Txt
CitySIDNEYCityNm
State AbbreviationNEStateAbbreviationCd
ZIP69162ZIPCd
FieldValueIRS element (for citing)
Recipient EIN470408242RecipientEIN
IRC Section501(C)(3)IRCSectionDesc
Cash Grant$37,400CashGrantAmt
Non Cash Assistance$0NonCashAssistanceAmt
Purpose Of GrantFURTHER QUEST TO PROVIDE THE MOST UP-TO-DATE FACILITIES, EQUIPMENT AND SERVICEPurposeOfGrantTxt
FieldValueIRS element (for citing)
Total501c3 Org1Total501c3OrgCnt
Total Other Org0TotalOtherOrgCnt

Grants Other Asst To Indiv In US GrantsOtherAsstToIndivInUSGrp (3 entries)

Grant TypeGrantTypeTxtRecipientRecipientCntCash GrantCashGrantAmt
INTERN PROGRAM3$14,146
ORTHO SERVICES1$5,190
SCHOLARSHIPS3$2,500

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferencePART I, LINE 2:FormAndLineReferenceDesc
ExplanationCHEYENNE COUNTY HOSPITAL & HEALTH CENTER FOUNDATION PROVIDES FUNDS TO CHEYENNE COUNTY HOSPITAL ASSOCIATION, D/B/A SIDNEY REGIONAL MEDICAL CENTER, A RELATED ENTITY. GRANTS CAN BE EASILY MONITORED THROUGH THE USE OF SHARED ACCOUNTING SERVICES. GRANTS TO INDIVIDUALS ARE PAID DIRECTLY FOR THOSE IN NEED.ExplanationTxt

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Severance Payment0SeverancePaymentInd
Supplemental Nonqual Rtr Plan0SupplementalNonqualRtrPlanInd
Equity Based Comp Arrngm0EquityBasedCompArrngmInd
Comp Based On Revenue Of Flng Org0CompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related Orgs0CompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng Org0CompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd Orgs0CompBsdNetEarnsRltdOrgsInd
Any Non Fixed Payments0AnyNonFixedPaymentsInd
Initial Contract Exception0InitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (2 entries)

TitleTitleTxtBase Compensation Filing OrgBaseCompensationFilingOrgAmtCompensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmtBonus Filing OrganizationBonusFilingOrganizationAmountBonus Related OrganizationsBonusRelatedOrganizationsAmtOther Compensation Filing OrgOtherCompensationFilingOrgAmtOther Compensation Rltd OrgsOtherCompensationRltdOrgsAmtDeferred Compensation Flng OrgDeferredCompensationFlngOrgAmtDeferred Comp Rltd OrgsDeferredCompRltdOrgsAmtNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmtNontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmtTotal Compensation Filing OrgTotalCompensationFilingOrgAmtTotal Compensation Rltd OrgsTotalCompensationRltdOrgsAmtComp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmtComp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt
DR JAMES POPOVICH
MEMBER$0$624,896$0$0$0$0$0$15,250$0$35,723$0$675,869$0$0
KELLY UTLEY
CFO$0$239,987$0$22,705$0$792$0$13,629$0$23,878$0$300,991$0$0

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferencePART I, LINE 3FormAndLineReferenceDesc
ExplanationKELLY UTLEY, THE TOP MANAGEMENT OFFICIAL OF THE FOUNDATION, IS AN EMPLOYEE OF CHEYENNE COUNTY HOSPITAL ASSOCIATION, D/B/A SIDNEY REGIONAL MEDICAL CENTER, A RELATED ENTITY. THE BOARD OF DIRECTORS OF THE MEDICAL CENTER REVIEWS MARKET COMPENSATION DATA FOR ALL HOSPITAL STAFF AND THE CEO OF THE MEDICAL CENTER APPROVES THE COMPENSATION.ExplanationTxt

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (5 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990, PART VI, SECTION A, LINE 8BTHERE IS NO COMMITTEE WITH THE AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY.
FORM 990, PART VI, SECTION B, LINE 11BTHE FORM 990 INFORMATION IS ACCUMULATED BY THE ACCOUNTING DEPARTMENT AND SUBMITTED TO THE INDEPENDENT PUBLIC ACCOUNTANTS FOR FURTHER REVIEW AND PREPARATION. COMMUNICATIONS BETWEEN THE INDEPENDENT PUBLIC ACCOUNTANTS AND THE ACCOUNTING DEPARTMENT FINALIZE THE PREPARATION OF THE FORM 990. AFTER THE PREPARATION IS COMPLETE, THE CFO OF CHEYENNE COUNTY HOSPITAL ASSOCIATION, D/B/A SIDNEY REGIONAL MEDICAL CENTER, REVIEWS THE FORM 990. UPON APPROVAL, THE FORM 990 IS E-MAILED TO ALL MEMBERS OF THE BOARD OF DIRECTORS FOR THEIR REVIEW. ONCE THE FORM 990 HAS BEEN REVIEWED BY ALL PARTIES, IT WILL BE SUBMITTED TO THE IRS ON OR BEFORE THE EXTENDED DUE DATE.
FORM 990, PART VI, SECTION B, LINE 12CEACH YEAR, ALL BOARD MEMBERS ARE REQUIRED TO DISCLOSE ANY CONFLICTS OF INTEREST. ANY DUALITY OF INTEREST OR POTENTIAL CONFLICT OF INTEREST ON THE PART OF ANY OFFICER, DIRECTOR, COMMITTEE MEMBER, OR KEY EMPLOYEE IS REQUIRED TO BE DISCLOSED TO THE BOARD OF DIRECTORS AND MADE A MATTER OF BOARD RECORD WHENEVER IT ARISES, OR WHENEVER IT INVOLVES A MATTER OF BOARD ACTION. ANY OFFICER, DIRECTOR, COMMITTEE MEMBER, OR KEY EMPLOYEE HAVING A DUALITY OF INTEREST OR A POSSIBLE CONFLICT OF INTEREST IN ANY MATTER ABSTAINS FROM DISCUSSION AND THE VOTE.
FORM 990, PART VI, SECTION C, LINE 19THE FOUNDATION MAKES ITS GOVERNING DOCUMENTS AND FINANCIAL STATEMENTS, BUT NOT ITS CONFLICY OF INTEREST POLICY, AVAILABLE TO THE PUBLIC UPON REQUEST.
FORM 990, PART VI, SECTION B, LINE 15:AS THE ORGANIZATION DOES NOT HAVE ANY EMPLOYEES, THERE IS NO INDEPENDENT REVIEW AND APPROVAL OF COMPENSATION.

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp

Disregarded Entity Name DisregardedEntityName

FieldValueIRS element (for citing)
Business Name Line1CHEYENNE COUNTY HOSPITAL ASSOCIATION INCBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line11000 POLE CREEK CROSSINGAddressLine1Txt
CitySIDNEYCityNm
State AbbreviationNEStateAbbreviationCd
ZIP69162ZIPCd
FieldValueIRS element (for citing)
EIN470408242EIN
Primary ActivitiesPROVIDING HEALTH CARE TO THOSE IN THE COMMUNITYPrimaryActivitiesTxt
Legal Domicile StateNELegalDomicileStateCd
Exempt Code Section501(C)(3)ExemptCodeSectionTxt
Public Charity StatusLINE 3PublicCharityStatusTxt
Direct Controlling NAN/ADirectControllingNACd
Controlled Organization0ControlledOrganizationInd
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts Rylts0ReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth OrgYes (1)GiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth OrgYes (1)GiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth Org0LoansOrGuaranteesFromOthOrgInd
Div Related Organization0DivRelatedOrganizationInd
Asset Sale To Other Org0AssetSaleToOtherOrgInd
Asset Purchase From Other Org0AssetPurchaseFromOtherOrgInd
Asset Exchange0AssetExchangeInd
Rental Of Facilities To Oth Org0RentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth Org0RentalOfFcltsFromOthOrgInd
Perform Of Services For Oth OrgYes (1)PerformOfServicesForOthOrgInd
Perform Of Services By Other Org0PerformOfServicesByOtherOrgInd
Sharing Of FacilitiesYes (1)SharingOfFacilitiesInd
Paid Employees SharingYes (1)PaidEmployeesSharingInd
Reimbursement Paid To Other OrgYes (1)ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other OrgYes (1)ReimbursementPaidByOtherOrgInd
Transfer To Other Org0TransferToOtherOrgInd
Transfer From Other Org0TransferFromOtherOrgInd

Comments

Anonymous: no account or email. Up to 2,000 characters, at most one link. Comments are checked automatically; some wait for review.