FAITH REGIONAL HEALTH SERVICES: Form 990, tax year 2023

View the entire original 990 at ProPublica ↗

Organization
FAITH REGIONAL HEALTH SERVICES (EIN 47-0796875)
Tax period
2023-01-01 to 2023-12-31
Filed
2024-11-14
IRS object ID
202433199349314248
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)
Return2024-11-14T17:33:06-06:00ReturnTs
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)
EIN470796875EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1FAITH REGIONAL HEALTH SERVICESBusinessNameLine1Txt
FieldValueIRS element (for citing)
Business Name ControlFAITBusinessNameControlTxt
Phone4023714880PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line11500 KOENIGSTEIN AVENUE PO BOX 869AddressLine1Txt
CityNORFOLKCityNm
State AbbreviationNEStateAbbreviationCd
ZIP687020869ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonBRENDA BAKERPersonNm
Person TitleVP FINANCEPersonTitleTxt
Phone4023714880PhoneNum
Signature2024-11-14SignatureDt
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
Preparation2024-11-14PreparationDt
FieldValueIRS element (for citing)
Tax2023TaxYr
Build TS2024-10-15 13:58:12ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Principal OfficerKELLY DRISCOLLPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line11500 KOENIGSTEIN AVENUE PO BOX 869AddressLine1Txt
CityNORFOLKCityNm
State AbbreviationNEStateAbbreviationCd
ZIP687020869ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$280,779,635GrossReceiptsAmt
Group Return For Affiliates0GroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website AddressWWW.FRHS.ORGWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation1996FormationYr
Legal Domicile StateNELegalDomicileStateCd
Activity Or MissionTO PROVIDE ACUTE, SKILLED AND OUTPATIENT SERVICES TO INDIVIDUALS IN OUR SERVICE AREA.ActivityOrMissionDesc
Voting Members Governing Body15VotingMembersGoverningBodyCnt
Voting Members Independent11VotingMembersIndependentCnt
Total Employee1749TotalEmployeeCnt
Total Volunteers25TotalVolunteersCnt
Total Gross UBI$248,576TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$207,821NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$3,186,882PYContributionsGrantsAmt
CY Contributions Grants$901,632CYContributionsGrantsAmt
PY Program Service Revenue$261,280,318PYProgramServiceRevenueAmt
CY Program Service Revenue$270,022,631CYProgramServiceRevenueAmt
PY Investment Income$1,361,455PYInvestmentIncomeAmt
CY Investment Income$2,917,598CYInvestmentIncomeAmt
PY Other Revenue$627,270PYOtherRevenueAmt
CY Other Revenue$1,506,958CYOtherRevenueAmt
PY Total Revenue$266,455,925PYTotalRevenueAmt
CY Total Revenue$275,348,819CYTotalRevenueAmt
PY Grants And Similar Paid$225,961PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$330,441CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$147,813,490PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$157,008,079CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$257,842CYTotalFundraisingExpenseAmt
PY Other Expenses$118,034,554PYOtherExpensesAmt
CY Other Expenses$115,076,744CYOtherExpensesAmt
PY Total Expenses$266,074,005PYTotalExpensesAmt
CY Total Expenses$272,415,264CYTotalExpensesAmt
PY Revenues Less Expenses$381,920PYRevenuesLessExpensesAmt
CY Revenues Less Expenses$2,933,555CYRevenuesLessExpensesAmt
Total Assets BOY$262,709,523TotalAssetsBOYAmt
Total Assets EOY$266,969,721TotalAssetsEOYAmt
Total Liabilities BOY$99,115,717TotalLiabilitiesBOYAmt
Total Liabilities EOY$98,020,360TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$163,593,806NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$168,949,361NetAssetsOrFundBalancesEOYAmt
MissionTO SERVE CHRIST BY PROVIDING ALL PEOPLE WITH EXEMPLARY MEDICAL SERVICES IN AN ENVIRONMENT OF LOVE AND CARE.MissionDesc
Significant New Program Srvc0SignificantNewProgramSrvcInd
Significant Change0SignificantChangeInd
Expense$230,189,280ExpenseAmt
Grant$330,441GrantAmt
Revenue$257,163,489RevenueAmt
DescFAITH REGIONAL PROVIDES HEALTHCARE TO ALL PEOPLE REGARDLESS OF THEIR ABILITY TO PAY OR THEIR INSURANCE PROVIDER. DURING THE YEAR, FAITH REGIONAL PROVIDED SIGNIFICANT SERVICES FOR MEDICARE AND MEDICAID PATIENTS.Desc

Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp

FieldValueIRS element (for citing)
Expense$16,155,527ExpenseAmt
Revenue$13,367,929RevenueAmt
DescMANY SERVICES PROVIDED BY FAITH REGIONAL ARE DONE TO MEET SPECIFIC NEEDS OF THE COMMUNITY BECAUSE NO OTHER SERVICES ARE AVAILABLE. AS A RESULT, THESE SERVICES ARE PROVIDED KNOWING THAT THEY WILL NOT BE FINANCIALLY VIABLE OR SELF-SUPPORTING. THESE SERVICES INCLUDE BEHAVIORAL HEALTH INPATIENT AND OUTPATIENT SERVICES, CHILD ADVOCACY, DIABETIC EDUCATION, DIALYSIS SERVICES, ACUTE REHABILITATIVE SERVICES, HOME HEALTH CARE AND TRANSITIONAL CARE (LONG-TERM REHABILITATION) SERVICES.Desc

Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp

FieldValueIRS element (for citing)
Expense$458,883ExpenseAmt
Revenue$0RevenueAmt
DescA SUBSTANTIAL PORTION OF COMMUNITY BENEFITS PROVIDED BY FAITH REGIONAL IS THE PROVISION OF PATIENT CARE SERVICES THAT ARE NOT PAID FOR EITHER BY THE PATIENT OR THIRD PARTY INSURANCE. DURING 2023, FAITH PROVIDED PATIENTS JUST UNDER FIVE HUNDRED THOUSAND DOLLARS IN ASSISTANCE WITH PAYING THEIR HOSPITAL BILLS.Desc
FieldValueIRS element (for citing)
Total Program Service Expenses$246,803,690TotalProgramServiceExpensesAmt
Described In Section501c3Yes (1)DescribedInSection501c3Ind
Schedule B RequiredYes (1)ScheduleBRequiredInd
Political Campaign Acty0PoliticalCampaignActyInd
Lobbying ActivitiesYes (1)LobbyingActivitiesInd
Subject To Proxy Tax0SubjectToProxyTaxInd
Donor Advised Fund0DonorAdvisedFundInd
Conservation Easements0ConservationEasementsInd
Collections Of Art0CollectionsOfArtInd
Credit Counseling0CreditCounselingInd
Donor Rstr Or Quasi EndowmentsYes (1)DonorRstrOrQuasiEndowmentsInd
Report Land Building EquipmentYes (1)ReportLandBuildingEquipmentInd
Report Investments Other Sec0ReportInvestmentsOtherSecInd
Report Program Related Invst0ReportProgramRelatedInvstInd
Report Other Assets0ReportOtherAssetsInd
Report Other LiabilitiesYes (1)ReportOtherLiabilitiesInd
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 Activities0FundraisingActivitiesInd
Gaming Activities0GamingActivitiesInd
Operate HospitalYes (1)OperateHospitalInd
Audited Financial Stmt AttYes (1)AuditedFinancialStmtAttInd
Grants To OrganizationsYes (1)GrantsToOrganizationsInd
Grants To Individuals0GrantsToIndividualsInd
Schedule J RequiredYes (1)ScheduleJRequiredInd
Tax Exempt BondsYes (1)TaxExemptBondsInd
Invest Tax Exempt Bonds0InvestTaxExemptBondsInd
Escrow Account0EscrowAccountInd
On Behalf Of Issuer0OnBehalfOfIssuerInd
Engaged In Excess Benefit Trans0EngagedInExcessBenefitTransInd
PY Excess Benefit Trans0PYExcessBenefitTransInd
Loan Outstanding0LoanOutstandingInd
Grant To Related Person0GrantToRelatedPersonInd
Business Rln With Org Mem0BusinessRlnWithOrgMemInd
Business Rln With Fam MemYes (1)BusinessRlnWithFamMemInd
Business Rln With35 Ctrl Ent0BusinessRlnWith35CtrlEntInd
Deductible Non Cash Contri0DeductibleNonCashContriInd
Deductible Art Contribution0DeductibleArtContributionInd
Terminate Operations0TerminateOperationsInd
Partial Liquidation0PartialLiquidationInd
Disregarded EntityYes (1)DisregardedEntityInd
Related EntityYes (1)RelatedEntityInd
Related Organization Ctrl EntYes (1)RelatedOrganizationCtrlEntInd
Transaction With Control EntYes (1)TransactionWithControlEntInd
Trnsfr Exmpt Non Chrtbl Rltd Org0TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted Prtshp0ActivitiesConductedPrtshpInd
Schedule O RequiredYes (1)ScheduleORequiredInd
IRP Document62IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Backup Wthld ComplianceYes (1)BackupWthldComplianceInd
Employee1749EmployeeCnt
Employment Tax Returns FiledYes (1)EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over LimitYes (1)UnrelatedBusIncmOverLimitInd
Form990 T FiledYes (1)Form990TFiledInd
Foreign Financial Account0ForeignFinancialAccountInd
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTransInd
Taxable Party Notification0TaxablePartyNotificationInd
Nondeductible Contributions0NondeductibleContributionsInd
Quid Pro Quo Contributions0QuidProQuoContributionsInd
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 Members15GoverningBodyVotingMembersCnt
Independent Voting Member11IndependentVotingMemberCnt
Family Or Business Rln0FamilyOrBusinessRlnInd
Delegation Of Mgmt Duties0DelegationOfMgmtDutiesInd
Change To Org Documents0ChangeToOrgDocumentsInd
Material Diversion Or Misuse0MaterialDiversionOrMisuseInd
Members Or StockholdersYes (1)MembersOrStockholdersInd
Election Of Board MembersYes (1)ElectionOfBoardMembersInd
Decisions Subject To ApprovaYes (1)DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (1)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (1)MinutesOfCommitteesInd
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 CEOYes (1)CompensationProcessCEOInd
Compensation Process OtherYes (1)CompensationProcessOtherInd
Investment In Joint VentureYes (1)InvestmentInJointVentureInd
Written Policy Or ProcedureYes (1)WrittenPolicyOrProcedureInd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

FieldValueIRS element (for citing)
PersonBRENDA BAKERPersonNm
Phone4026447248PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line11500 KOENIGSTEIN AVENUE PO BOX 869AddressLine1Txt
CityNORFOLKCityNm
State AbbreviationNEStateAbbreviationCd
ZIP687020869ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (22 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtHighest Compensated EmployeeHighestCompensatedEmployeeIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtOfficerOfficerIndIndividual Trustee Or DirectorIndividualTrusteeOrDirectorInd
FADI RZOUQ MD
PHYSICIAN40.000.00Yes (X)$4,831,036$0$36,247
TRISTAN L HARTZELL MD
PHYSICIAN40.001.00Yes (X)$3,399,159$0$714
JOHN LAMMLI MD
PHYSICIAN40.000.00Yes (X)$1,399,742$0$36,409
BEETHOVEN BROWN MD
PHYSICIAN40.000.00Yes (X)$1,239,450$0$13,914
NATHAN HERMAN MD
PHYSICIAN40.000.00Yes (X)$1,029,265$0$35,271
KELLY DRISCOLL
CEO40.002.00$781,144$0$39,384Yes (X)
ROBERT PRINCE MD
MEMBER - MEDICAL DIRECTOR40.000.00$708,224$0$5,575Yes (X)
LANE HANDKE MD
MEMBER - CHIEF OF STAFF40.000.00$545,247$0$30,988Yes (X)
JANNA CLINE
VP FINANCE40.002.00$272,156$0$30,551Yes (X)
BRETT JACKSON
CHAIR1.502.50$0$0$0Yes (X)Yes (X)
JOHN ROBERTSON
VICE CHAIR1.502.50$0$0$0Yes (X)Yes (X)
SUE FUCHTMAN
SECRETARY1.500.00$0$0$0Yes (X)Yes (X)
BRAD DINKEL
TREASURER1.500.00$0$0$0Yes (X)Yes (X)
STEF LACEY MD
MEMBER1.000.00$0$0$0Yes (X)
TRAVIS RUTJENS
MEMBER1.000.00$0$0$0Yes (X)
JACQUE COLLISON
MEMBER1.001.00$0$0$0Yes (X)
JOSH GOSSMAN
MEMBER1.000.00$0$0$0Yes (X)
DIANE BECKER
MEMBER1.002.50$0$0$0Yes (X)
LEON ROSENTHAL
MEMBER1.002.50$0$0$0Yes (X)
PRESTON SUNDERMAN
MEMBER1.002.50$0$0$0Yes (X)
REGINA BUSBOOM
MEMBER1.002.50$0$0$0Yes (X)
TOM SCHUETH
MEMBER1.001.00$0$0$0Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$14,205,423TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$0TotReportableCompRltdOrgAmt
Total Other Compensation$229,053TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K200IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed0FormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (1)TotalCompGreaterThan150KInd
Compensation From Other Srcs0CompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (5 entries)

Address Line1ContractorAddress/USAddress/AddressLine1TxtCityContractorAddress/USAddress/CityNmState AbbreviationContractorAddress/USAddress/StateAbbreviationCdZIPContractorAddress/USAddress/ZIPCdServicesServicesDescCompensationCompensationAmt
PATHOLOGY MEDICAL SERVICE
PO BOX 82653LINCOLNNE68501LAB SERVICES$655,577
SIOUX CITY NIGHT PATROL
PO BOX 3276SIOUX CITYIA51102SECURITY SERVICES$367,549
EIDE BAILLY LLP
18081 BURT STREETOMAHANE68022ACCOUNTING SERVICES$227,073
NORFOLK CONSTRUCTION CO
PO BOX 383NORFOLKNE68702MOWING & SNOW REMOVAL$133,038
VIRTUAL RADIOLOGIC CORPORATION
25983 NETWORK PLACECHICAGOIL60673LAB SERVICES$129,628
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K12CntrctRcvdGreaterThan100KCnt
Federated Campaigns$47,000FederatedCampaignsAmt
Related Organizations$517,634RelatedOrganizationsAmt
Government Grants$307,482GovernmentGrantsAmt
All Other Contributions$29,516AllOtherContributionsAmt
Total Contributions$901,632TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (4 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
NET PATIENT SERVICE REVENUE621110$169,652,032$169,652,032
PATIENT SVC M'CARE/MEDICAID621110$81,177,475$81,177,475
LEASED MEDICAL EMPLOYEES621110$3,365,839$3,365,839
PHYSICIAN CLINICS621110$985,779$985,779

Total Oth Program Service Rev TotalOthProgramServiceRevGrp

FieldValueIRS element (for citing)
Total Revenue Column$14,841,506TotalRevenueColumnAmt
Related Or Exempt Func Income$14,841,506RelatedOrExemptFuncIncomeAmt
FieldValueIRS element (for citing)
Total Program Service Revenue$270,022,631TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$2,701,872TotalRevenueColumnAmt
Exclusion$2,701,872ExclusionAmt

Gross Rents GrossRentsGrp

FieldValueIRS element (for citing)
Real$1,399,622RealAmt

Less Rental Expenses LessRentalExpensesGrp

FieldValueIRS element (for citing)
Real$819,623RealAmt

Rental Income Or Loss RentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Real$579,999RealAmt

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column$579,999TotalRevenueColumnAmt
Exclusion$579,999ExclusionAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

FieldValueIRS element (for citing)
Securities$4,766,066SecuritiesAmt
Other$60,000OtherAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

FieldValueIRS element (for citing)
Securities$4,610,340SecuritiesAmt
Other$0OtherAmt

Gain Or Loss GainOrLossGrp

FieldValueIRS element (for citing)
Securities$155,726SecuritiesAmt
Other$60,000OtherAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

FieldValueIRS element (for citing)
Total Revenue Column$215,726TotalRevenueColumnAmt
Exclusion$215,726ExclusionAmt
FieldValueIRS element (for citing)
Gross Sales Of Inventory$1,066GrossSalesOfInventoryAmt
Cost Of Goods Sold$853CostOfGoodsSoldAmt

Net Income Or Loss NetIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column$213TotalRevenueColumnAmt
Unrelated Business Revenue$213UnrelatedBusinessRevenueAmt

Other Revenue Misc OtherRevenueMiscGrp

FieldValueIRS element (for citing)
DescMHR HOME CARE, LLCDesc
Business456199BusinessCd
Total Revenue Column$248,363TotalRevenueColumnAmt
Unrelated Business Revenue$248,363UnrelatedBusinessRevenueAmt

Miscellaneous Revenue MiscellaneousRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$678,383TotalRevenueColumnAmt
Related Or Exempt Func Income$508,787RelatedOrExemptFuncIncomeAmt
Exclusion$169,596ExclusionAmt
FieldValueIRS element (for citing)
Other Revenue Total$926,746OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$275,348,819TotalRevenueColumnAmt
Related Or Exempt Func Income$270,531,418RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$248,576UnrelatedBusinessRevenueAmt
Exclusion$3,667,193ExclusionAmt

Grants To Domestic Orgs GrantsToDomesticOrgsGrp

FieldValueIRS element (for citing)
Total$330,441TotalAmt
Program Services$330,441ProgramServicesAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$2,418,081TotalAmt
Program Services$1,291,244ProgramServicesAmt
Management And General$1,126,837ManagementAndGeneralAmt

Comp Disqual Persons CompDisqualPersonsGrp

FieldValueIRS element (for citing)
Total$320,737TotalAmt
Program Services$320,737ProgramServicesAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$124,179,759TotalAmt
Program Services$116,204,811ProgramServicesAmt
Management And General$7,788,017ManagementAndGeneralAmt
Fundraising$186,931FundraisingAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$3,653,759TotalAmt
Program Services$3,239,145ProgramServicesAmt
Management And General$409,566ManagementAndGeneralAmt
Fundraising$5,048FundraisingAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$19,258,640TotalAmt
Program Services$17,468,696ProgramServicesAmt
Management And General$1,787,499ManagementAndGeneralAmt
Fundraising$2,445FundraisingAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$7,177,103TotalAmt
Program Services$6,385,717ProgramServicesAmt
Management And General$778,128ManagementAndGeneralAmt
Fundraising$13,258FundraisingAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$174,096TotalAmt
Program Services$13,415ProgramServicesAmt
Management And General$160,681ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$357,260TotalAmt
Program Services$27,528ProgramServicesAmt
Management And General$329,732ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$26,022,414TotalAmt
Program Services$24,185,539ProgramServicesAmt
Management And General$1,835,080ManagementAndGeneralAmt
Fundraising$1,795FundraisingAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$862,124TotalAmt
Program Services$13,095ProgramServicesAmt
Management And General$849,029ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$11,400,543TotalAmt
Program Services$10,995,387ProgramServicesAmt
Management And General$384,172ManagementAndGeneralAmt
Fundraising$20,984FundraisingAmt

Information Technology InformationTechnologyGrp

FieldValueIRS element (for citing)
Total$7,600,832TotalAmt
Program Services$6,569,605ProgramServicesAmt
Management And General$1,020,040ManagementAndGeneralAmt
Fundraising$11,187FundraisingAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$10,039,193TotalAmt
Program Services$8,283,841ProgramServicesAmt
Management And General$1,755,352ManagementAndGeneralAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$275,524TotalAmt
Program Services$239,626ProgramServicesAmt
Management And General$27,623ManagementAndGeneralAmt
Fundraising$8,275FundraisingAmt

Conferences Meetings ConferencesMeetingsGrp

FieldValueIRS element (for citing)
Total$642,416TotalAmt
Program Services$553,780ProgramServicesAmt
Management And General$83,573ManagementAndGeneralAmt
Fundraising$5,063FundraisingAmt

Interest InterestGrp

FieldValueIRS element (for citing)
Total$2,069,366TotalAmt
Program Services$86,869ProgramServicesAmt
Management And General$1,982,497ManagementAndGeneralAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$13,229,146TotalAmt
Program Services$9,330,974ProgramServicesAmt
Management And General$3,898,172ManagementAndGeneralAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$1,156,666TotalAmt
Program Services$282,827ProgramServicesAmt
Management And General$873,839ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtManagement And GeneralManagementAndGeneralAmtProgram ServicesProgramServicesAmtFundraisingFundraisingAmt
INCOME TAX$51,039$51,039
MEDICAL SUPPLIES$39,544,266$39,544,266
FOOD$911,450$2,947$908,503
DUES & SUBSCRIPTIONS$373,578$142,053$228,669$2,856

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$366,831TotalAmt
Program Services$298,975ProgramServicesAmt
Management And General$67,856ManagementAndGeneralAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$272,415,264TotalAmt
Program Services$246,803,690ProgramServicesAmt
Management And General$25,353,732ManagementAndGeneralAmt
Fundraising$257,842FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$152,063BOYAmt
EOY$129,051EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$56,344,001BOYAmt
EOY$64,430,562EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$28,936,969BOYAmt
EOY$30,789,439EOYAmt

Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp

FieldValueIRS element (for citing)
BOY$2,172,183BOYAmt
EOY$2,851,575EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

FieldValueIRS element (for citing)
BOY$4,469,606BOYAmt
EOY$4,185,985EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$4,900,162BOYAmt
EOY$4,666,219EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$305,531,742LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$187,065,878LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$117,333,789BOYAmt
EOY$118,465,864EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

FieldValueIRS element (for citing)
BOY$35,945,553BOYAmt
EOY$24,680,600EOYAmt

Investments Program Related InvestmentsProgramRelatedGrp

FieldValueIRS element (for citing)
BOY$3,248,352BOYAmt
EOY$3,152,503EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$9,206,845BOYAmt
EOY$13,617,923EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$262,709,523BOYAmt
EOY$266,969,721EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$31,612,672BOYAmt
EOY$33,773,534EOYAmt

Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$55,940,463BOYAmt
EOY$50,185,794EOYAmt

Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp

FieldValueIRS element (for citing)
EOY$1,260,526EOYAmt

Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp

FieldValueIRS element (for citing)
BOY$8,118,756BOYAmt
EOY$10,131,359EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$3,443,826BOYAmt
EOY$2,669,147EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$99,115,717BOYAmt
EOY$98,020,360EOYAmt
FieldValueIRS element (for citing)
Organization Follows FASB117Yes (X)OrganizationFollowsFASB117Ind

No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp

FieldValueIRS element (for citing)
BOY$162,593,806BOYAmt
EOY$168,949,361EOYAmt

Donor Restriction Net Assets DonorRestrictionNetAssetsGrp

FieldValueIRS element (for citing)
BOY$1,000,000BOYAmt
EOY$0EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$163,593,806BOYAmt
EOY$168,949,361EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$262,709,523BOYAmt
EOY$266,969,721EOYAmt
FieldValueIRS element (for citing)
Reconcilation Revenue Expnss$2,933,555ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst$2,422,000NetUnrlzdGainsLossesInvstAmt
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)
HospitalYes (X)HospitalInd

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 C IRS990ScheduleC

FieldValueIRS element (for citing)
Volunteers0VolunteersInd
Paid Staff Or Management0PaidStaffOrManagementInd
Media Advertisements0MediaAdvertisementsInd
Mailings Members0MailingsMembersInd
Publications Or Broadcast0PublicationsOrBroadcastInd
Grants Other Organizations0GrantsOtherOrganizationsInd
Direct Contact Legislators0DirectContactLegislatorsInd
Rallies Demonstrations0RalliesDemonstrationsInd
Other ActivitiesYes (1)OtherActivitiesInd
Other Activities$14,066OtherActivitiesAmt
Total Lobbying Expenditures$14,066TotalLobbyingExpendituresAmt
Not Described Section501c30NotDescribedSection501c3Ind

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferencePART II-B, LINE 1:FormAndLineReferenceDesc
ExplanationFAITH REGIONAL PAID DUES TO THE NEBRASKA HOSPITAL ASSOCIATION AND THE AMERICAN HOSPITAL ASSOCIATION. A PORTION OF THE DUES WERE USED FOR LOBBYING ACTIVITIES.ExplanationTxt

Schedule D IRS990ScheduleD

CY Endwmt Fund CYEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$6,442,730BeginningYearBalanceAmt
Contributions$40ContributionsAmt
Investment Earnings Or Losses$91,856InvestmentEarningsOrLossesAmt
End Year Balance$6,534,626EndYearBalanceAmt

CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$6,611,965BeginningYearBalanceAmt
Contributions$76ContributionsAmt
Investment Earnings Or Losses-$169,311InvestmentEarningsOrLossesAmt
End Year Balance$6,442,730EndYearBalanceAmt

CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$5,533,918BeginningYearBalanceAmt
Contributions$50ContributionsAmt
Investment Earnings Or Losses$1,077,997InvestmentEarningsOrLossesAmt
End Year Balance$6,611,965EndYearBalanceAmt

CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$5,523,918BeginningYearBalanceAmt
Contributions$10,000ContributionsAmt
Investment Earnings Or Losses$1,022,500InvestmentEarningsOrLossesAmt
Other Expenditures$1,022,500OtherExpendituresAmt
End Year Balance$5,533,918EndYearBalanceAmt

CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$8,052,916BeginningYearBalanceAmt
Contributions$15,000ContributionsAmt
Investment Earnings Or Losses$1,454,367InvestmentEarningsOrLossesAmt
Other Expenditures$3,998,365OtherExpendituresAmt
End Year Balance$5,523,918EndYearBalanceAmt
FieldValueIRS element (for citing)
Board Designated Balance EOY0.00790BoardDesignatedBalanceEOYPct
Prmnnt Endowment Balance EOY0.99210PrmnntEndowmentBalanceEOYPct
Term Endowment Balance EOY0.00000TermEndowmentBalanceEOYPct
Endowments Held Unrelated Org0EndowmentsHeldUnrelatedOrgInd
Endowments Held Related OrgYes (1)EndowmentsHeldRelatedOrgInd
Related Org List Sch RYes (1)RelatedOrgListSchRInd

Land LandGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$4,220,548OtherCostOrOtherBasisAmt
Book Value$4,220,548BookValueAmt

Buildings BuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$139,612,564OtherCostOrOtherBasisAmt
Depreciation$75,666,928DepreciationAmt
Book Value$63,945,636BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$145,170,283OtherCostOrOtherBasisAmt
Depreciation$105,951,737DepreciationAmt
Book Value$39,218,546BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$16,528,347OtherCostOrOtherBasisAmt
Depreciation$5,447,213DepreciationAmt
Book Value$11,081,134BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$118,465,864TotalBookValueLandBuildingsAmt

Other Assets Org OtherAssetsOrgGrp (4 entries)

DescDescBook ValueBookValueAmt
ACCRUED INTEREST RECEIVABLE$133,724
OTHER INVESTMENTS$10,131,359
ESTIMATED THIRD PARTY PAYOR SETTLEMENTS - MEDICARE & MEDICAID$683,693
RIGHT OF USE ASSETS$2,669,147
FieldValueIRS element (for citing)
Total Book Value Other Assets$13,617,923TotalBookValueOtherAssetsAmt

Other Liabilities Org OtherLiabilitiesOrgGrp

FieldValueIRS element (for citing)
DescLEASE LIABILITYDesc
Amt$2,669,147Amt
FieldValueIRS element (for citing)
Total Liability$2,669,147TotalLiabilityAmt
Footnote TextYes (X)FootnoteTextInd

Supplemental Information Detail SupplementalInformationDetail (2 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
PART V, LINE 4:CARSON CANCER CENTER ENDOWMENT FUNDS ARE PERMANENTLY SET ASIDE TO GENERATE INVESTMENT EARNINGS TO BE USED TO FUND CAPITAL EQUIPMENT PURCHASES AND/OR OPERATIONS OF THE CARSON REGIONAL CANCER CENTER. INVESTMENT EARNINGS ON THESE FUNDS ARE RESTRICTED AS TO USE. GENERAL ENDOWMENT FUNDS ARE PERMANENTLY SET ASIDE TO GENERATE INVESTMENT EARNINGS. INVESTMENT EARNINGS ON THESE FUNDS ARE NOT RESTRICTED AS TO USE. THE HOSPICE ENDOWMENT FUNDS ARE PERMANENTLY SET ASIDE TO GENERATE INVESTMENT EARNINGS TO BENEFIT THE HOSPICE PROGRAM AND ITS PATIENTS. INVESTMENT INCOME ON THESE FUNDS IS RESTRICTED AS TO USE. THE CARDIAC SERVICES ENDOWMENT FUNDS ARE PERMANENTLY SET ASIDE TO GENERATE INVESTMENT EARNINGS TO FUND FAITH REGIONAL HEALTH SERVICE'S CARDIAC PROGRAM CAPITAL AND/OR OPERATIONAL EXPENSES. THE EDUCATION ENDOWMENT FUNDS ARE PERMANENTLY SET ASIDE TO GENERATE INVESTMENT EARNINGS TO BENEFIT FAITH REGIONAL HEALTH SERVICE'S EDUCATION PROGRAMS AND ITS EFFORTS TO RECRUIT AND RETAIN EMPLOYEES. INVESTMENT INCOME ON THESE FUNDS IS RESTRICTED AS TO USE. ST. JOSEPH'S NURSING HOME/SKYVIEW VILLA ENDOWMENT FUNDS ARE PERMANENTLY SET ASIDE TO GENERATE INVESTMENT EARNINGS TO BE USED TO FUND CAPITAL EQUIPMENT PURCHASES AND/OR OPERATION OF ST. JOSEPH'S NURSING HOME AND SKYVIEW VILLA. INVESTMENT EARNINGS ON THESE FUNDS ARE RESTRICTED AS TO USE. THE PEDIATRIC ENDOWMENT FUNDS ARE PERMANENTLY SET ASIDE TO GENERATE INVESTMENT EARNINGS TO BENEFIT FAITH REGIONAL HEALTH SERVICE'S CHILDREN'S CARE FUND. DONORS MAY SPECIFY CONTRIBUTIONS TO ANY OF THE ENDOWMENT FUNDS.
PART X, LINE 2:FAITH REGIONAL HEALTH SERVICES ACCOUNTS FOR UNCERTAINTIES IN ACCOUNTING FOR INCOME TAX ASSETS AND LIABILITIES USING GUIDANCE INCLUDED IN FASB ASC 740, INCOME TAXES. FAITH RECOGNIZES THE EFFECT OF INCOME TAX POSITIONS ONLY IF THOSE POSITIONS ARE MORE LIKELY THAN NOT OF BEING SUSTAINED. AT DECEMBER 31, 2023 AND 2022, FAITH HAD NO UNCERTAIN TAX POSITIONS ACCRUED.

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Financial Assistance PolicyYes (1)FinancialAssistancePolicyInd
Written PolicyYes (1)WrittenPolicyInd
All Hospitals PolicyYes (X)AllHospitalsPolicyInd
FPG Reference Free CareYes (1)FPGReferenceFreeCareInd

Free Care Oth Percentage FreeCareOthPercentageGrp

FieldValueIRS element (for citing)
OtherYes (X)OtherInd
Free Care Other400.000000000000FreeCareOtherPct
FieldValueIRS element (for citing)
FPG Reference Discounted CareYes (1)FPGReferenceDiscountedCareInd
Percent400Yes (X)Percent400Ind
Free Care Medically IndigentYes (1)FreeCareMedicallyIndigentInd
Financial Assistance BudgetYes (1)FinancialAssistanceBudgetInd
Expenses Exceed BudgetYes (1)ExpensesExceedBudgetInd
Unable To Provide Care0UnableToProvideCareInd
Annual Community Bnft ReportYes (1)AnnualCommunityBnftReportInd
Report Publically Available0ReportPublicallyAvailableInd

Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp

FieldValueIRS element (for citing)
Total Community Benefit Expns$825,487TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$589,929DirectOffsettingRevenueAmt
Net Community Benefit Expns$235,558NetCommunityBenefitExpnsAmt
Total Expense0.00090TotalExpensePct

Unreimbursed Medicaid UnreimbursedMedicaidGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$16,995,778TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$11,867,793DirectOffsettingRevenueAmt
Net Community Benefit Expns$5,127,985NetCommunityBenefitExpnsAmt
Total Expense0.01880TotalExpensePct

Total Financial Assistance Typ TotalFinancialAssistanceTyp

FieldValueIRS element (for citing)
Total Community Benefit Expns$17,821,265TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$12,457,722DirectOffsettingRevenueAmt
Net Community Benefit Expns$5,363,543NetCommunityBenefitExpnsAmt
Total Expense0.01970TotalExpensePct

Community Health Services CommunityHealthServicesGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$1,535,175TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$0DirectOffsettingRevenueAmt
Net Community Benefit Expns$1,535,175NetCommunityBenefitExpnsAmt
Total Expense0.00560TotalExpensePct

Health Professions Education HealthProfessionsEducationGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$1,404,710TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$0DirectOffsettingRevenueAmt
Net Community Benefit Expns$1,404,710NetCommunityBenefitExpnsAmt
Total Expense0.00520TotalExpensePct

Subsidized Health Services SubsidizedHealthServicesGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$16,155,527TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$13,367,929DirectOffsettingRevenueAmt
Net Community Benefit Expns$2,787,598NetCommunityBenefitExpnsAmt
Total Expense0.01020TotalExpensePct

Cash And In Kind Contributions CashAndInKindContributionsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$330,441TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$0DirectOffsettingRevenueAmt
Net Community Benefit Expns$330,441NetCommunityBenefitExpnsAmt
Total Expense0.00120TotalExpensePct

Total Other Benefits TotalOtherBenefitsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$19,425,853TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$13,367,929DirectOffsettingRevenueAmt
Net Community Benefit Expns$6,057,924NetCommunityBenefitExpnsAmt
Total Expense0.02220TotalExpensePct

Total Community Benefits TotalCommunityBenefitsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$37,247,118TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$25,825,651DirectOffsettingRevenueAmt
Net Community Benefit Expns$11,421,467NetCommunityBenefitExpnsAmt
Total Expense0.04190TotalExpensePct

Community Support CommunitySupportGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$1,770TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$0DirectOffsettingRevenueAmt
Net Community Benefit Expns$1,770NetCommunityBenefitExpnsAmt
Total Expense0.00000TotalExpensePct

Environmental Improvements EnvironmentalImprovementsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$121,019TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$0DirectOffsettingRevenueAmt
Net Community Benefit Expns$121,019NetCommunityBenefitExpnsAmt
Total Expense0.00040TotalExpensePct

Total Communtity Building Acty TotalCommuntityBuildingActyGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$122,789TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$122,789NetCommunityBenefitExpnsAmt
Total Expense0.00040TotalExpensePct
FieldValueIRS element (for citing)
Bad Debt Expense ReportedYes (1)BadDebtExpenseReportedInd
Bad Debt Expense$13,692,219BadDebtExpenseAmt
Bad Debt Expense Attributable$1,478,760BadDebtExpenseAttributableAmt
Reimbursed By Medicare$46,902,445ReimbursedByMedicareAmt
Cost Of Care Reimbursed By Medcr$60,881,518CostOfCareReimbursedByMedcrAmt
Medicare Surplus Or Shortfall-$13,979,073MedicareSurplusOrShortfallAmt

Costing Methodology Used CostingMethodologyUsedGrp

FieldValueIRS element (for citing)
OtherYes (X)OtherInd
FieldValueIRS element (for citing)
Written Debt Collection PolicyYes (1)WrittenDebtCollectionPolicyInd
Financial Assistance PrvsnYes (1)FinancialAssistancePrvsnInd

Management Co And Jnt Ventures ManagementCoAndJntVenturesGrp

Entity Name EntityName

FieldValueIRS element (for citing)
Business Name Line11 NORTHEAST NE SURGICAL CENTER LLCBusinessNameLine1Txt
FieldValueIRS element (for citing)
Primary ActivitiesSURGICAL SERVICESPrimaryActivitiesTxt
Org Profit Or Ownership0.59900OrgProfitOrOwnershipPct
Ofcr Etc Profit Or Ownership0.00000OfcrEtcProfitOrOwnershipPct
Physicians Profit Or Ownership0.40100PhysiciansProfitOrOwnershipPct
FieldValueIRS element (for citing)
Hospital Facilities2HospitalFacilitiesCnt

Hospital Facilities HospitalFacilitiesGrp (2 entries)

FacilityFacilityNumAddress Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdWebsite AddressWebsiteAddressTxtState LicenseStateLicenseNumLicensed HospitalLicensedHospitalIndGeneral Medical And SurgicalGeneralMedicalAndSurgicalIndEmergency Room24 HrsEmergencyRoom24HrsIndFacility Reporting GroupFacilityReportingGroupCd
FAITH REGIONAL HEALTH SERVICES - WEST
12700 WEST NORFOLK AVENUENORFOLKNE68701WWW.FRHS.ORG520001Yes (X)Yes (X)Yes (X)A
FAITH REGIONAL HEALTH SERVICES - EAST
21500 KOENIGSTEIN AVENUENORFOLKNE68701WWW.FRHS.ORG520002Yes (X)Yes (X)A

Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1FACILITY REPORTING GROUP - ABusinessNameLine1Txt
FieldValueIRS element (for citing)
First Licensed CY Or PY0FirstLicensedCYOrPYInd
Tax Exempt Hospital CY Or PY0TaxExemptHospitalCYOrPYInd
CHNA ConductedYes (1)CHNAConductedInd
Community DefinitionYes (X)CommunityDefinitionInd
Community DemographicsYes (X)CommunityDemographicsInd
Existing ResourcesYes (X)ExistingResourcesInd
How Data ObtainedYes (X)HowDataObtainedInd
Community Health NeedsYes (X)CommunityHealthNeedsInd
Community Hlth Needs Id ProcessYes (X)CommunityHlthNeedsIdProcessInd
Consulting ProcessYes (X)ConsultingProcessInd
CHNA Conducted22CHNAConductedYr
Take Into Account Others InputYes (1)TakeIntoAccountOthersInputInd
CHNA Conducted With Other FcltsYes (1)CHNAConductedWithOtherFcltsInd
CHNA Conducted With Non FcltsYes (1)CHNAConductedWithNonFcltsInd
CHNA Report Widely AvailableYes (1)CHNAReportWidelyAvailableInd
Rpt Available On Own WebsiteYes (X)RptAvailableOnOwnWebsiteInd
Own Website URLHTTPS://WWW.FRHS.ORG/ABOUT-US/REPORTS/OwnWebsiteURLTxt
Paper Copy Public InspectionYes (X)PaperCopyPublicInspectionInd
Implementation Strategy AdoptYes (1)ImplementationStrategyAdoptInd
Implementation Strategy Adpt22ImplementationStrategyAdptYr
Strategy Posted WebsiteYes (1)StrategyPostedWebsiteInd
Strategy Website URLHTTPS://WWW.FRHS.ORG/ABOUT-US/REPORTS/StrategyWebsiteURLTxt
Organization Incur Excise Tax0OrganizationIncurExciseTaxInd
Elig Criteria ExplainedYes (1)EligCriteriaExplainedInd
FPG Family Incm Lmt Free DscntYes (X)FPGFamilyIncmLmtFreeDscntInd
FPG Family Incm Lmt Free Care400.000000000000FPGFamilyIncmLmtFreeCarePct
FPG Family Incm Lmt Dscnt Care400.000000000000FPGFamilyIncmLmtDscntCarePct
Income Level CriteriaYes (X)IncomeLevelCriteriaInd
Asset Level CriteriaYes (X)AssetLevelCriteriaInd
Medical Indigency CriteriaYes (X)MedicalIndigencyCriteriaInd
Insurance Status CriteriaYes (X)InsuranceStatusCriteriaInd
Underinsurance Stat CriteriaYes (X)UnderinsuranceStatCriteriaInd
Other CriteriaYes (X)OtherCriteriaInd
Explained BasisYes (1)ExplainedBasisInd
App Financial Asst ExplnYes (1)AppFinancialAsstExplnInd
Described InfoYes (X)DescribedInfoInd
Described Suprt DocYes (X)DescribedSuprtDocInd
Provided Hospital ContactYes (X)ProvidedHospitalContactInd
Includes Publicity MeasuresYes (1)IncludesPublicityMeasuresInd
FAP Available On WebsiteYes (X)FAPAvailableOnWebsiteInd
FAP Available On Website URLFRHS.ORG/PATIENTS-VISITORS/BILLING-INSURANCE-FINANCIAL-ASSISTANCE/FINANCIALFAPAvailableOnWebsiteURLTxt
FAP App Available On WebsiteYes (X)FAPAppAvailableOnWebsiteInd
FAP App Available On Website URLFRHS.ORG/PATIENTS-VISITORS/BILLING-INSURANCE-FINANCIAL-ASSISTANCE/FINANCIALFAPAppAvailableOnWebsiteURLTxt
FAP Summary On WebsiteYes (X)FAPSummaryOnWebsiteInd
FAP Summary On Website URLFRHS.ORG/PATIENTS-VISITORS/BILLING-INSURANCE-FINANCIAL-ASSISTANCE/FINANCIALFAPSummaryOnWebsiteURLTxt
FAP Avlbl On Request No ChargeYes (X)FAPAvlblOnRequestNoChargeInd
FAP App Avlbl On Request No ChrgYes (X)FAPAppAvlblOnRequestNoChrgInd
FAP Sum Avlbl On Request No ChrgYes (X)FAPSumAvlblOnRequestNoChrgInd
Notified FAP Copy Bill DisplayYes (X)NotifiedFAPCopyBillDisplayInd
Communtity Notified FAPYes (X)CommuntityNotifiedFAPInd
FAP TranslatedYes (X)FAPTranslatedInd
FAP Actions On NonpaymentYes (1)FAPActionsOnNonpaymentInd
Permit No ActionsYes (X)PermitNoActionsInd
Collection Activities0CollectionActivitiesInd
Provided Written NoticeYes (X)ProvidedWrittenNoticeInd
Made Effort Orally NotifyYes (X)MadeEffortOrallyNotifyInd
Processed FAP ApplicationYes (X)ProcessedFAPApplicationInd
Made Presumptive Elig DetermYes (X)MadePresumptiveEligDetermInd
Nondis Emergency Care PolicyYes (1)NondisEmergencyCarePolicyInd
Look Back Medicaid Medcr PrvtYes (X)LookBackMedicaidMedcrPrvtInd
Amounts Generally Billed0AmountsGenerallyBilledInd
Gross Charges0GrossChargesInd

Supplemental Information SupplementalInformationGrp (8 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
PART V, SECTION BFACILITY REPORTING GROUP A
FACILITY REPORTING GROUP A CONSISTS OF:- FACILITY 1: FAITH REGIONAL HEALTH SERVICES - WEST, - FACILITY 2: FAITH REGIONAL HEALTH SERVICES - EAST
FACILITY REPORTING GROUP - A PART V, SECTION B, LINE 5:THE MULTI-STEP PROCESS BEGAN WITH THE MOBILIZING FOR ACTION THROUGH PLANNING AND PARTNERSHIP (MAPP) PROCESS. A NUMBER OF INDIVIDUALS AND ORGANIZATIONS WITH A COMMON INTEREST IN PUBLIC HEALTH CONTRIBUTED TO IDENTIFYING THE TRENDS, FACTORS, AND EVENTS THAT INFLUENCE THE HEALTH AND QUALITY OF LIFE IN OUR COMMUNITIES AND/OR THE WORK OF THE PUBLIC HEALTH SYSTEM. CONTRIBUTORS REPRESENTED A VARIETY OF ARENAS, SECTORS AND BACKGROUNDS, AND EVERY EFFORT WAS PLACED ON HAVING EQUAL AND FAIR REPRESENTATION ACROSS ALL COUNTIES AND SECTOR FOCUS AREAS. INPUT FROM DIVERSE SECTORS INVOLVED IN PUBLIC HEALTH WAS OBTAINED THROUGH KEY INFORMANT INTERVIEWS FROM THE FOLLOWING GROUPS:-ECONOMIC DEVELOPMENT-CHAMBER OF COMMERCE-FINANCIAL INSTITUTION-HOSPITAL/CLINIC WORKERS-ELVPHD BOARD OF HEALTH-TRAILS COMMITTEE MEMBERS-LONG-TERM CARE-MEDICAL RESPONSE SYSTEMS-NEBRASKA DHHS-VETERAN SERVICE OFFICER-UNL COUNTY EXTENSION-ELECTED OFFICIALS-JUVENILE DIVERSION-LEAGUE OF HUMAN DIGNITY-NORFOLK SAFE COMMUNITIES-BEHAVIORAL HEALTH-HOSPITAL BOARD MEMBERS-NEBRASKA SEE TO LEARN PROGRAM-PUBLIC HEALTH LIAISON/ADVOCATE-SCHOOL NURSES AND SCHOOL ADMINISTRATORS-CENTER FOR RURAL AFFAIRS-CUMING COUNTY PUBLIC POWER DISTRICT-LAW ENFORCEMENT-INSTITUTES OF HIGHER EDUCATION-COMMUNITY-BASED ORGANIZATIONS-CITY EMPLOYEES-NEBRASKA BICYCLING ALLIANCE-AREA AGENCY ON AGING-PONCA TRIBE OF NEBRASKA-FEDERALLY-QUALIFIED HEALTH CENTER-NORFOLK FAMILY COALITION-NEIGHBORING LOCAL PUBLIC HEALTH DEPARTMENTSCOMMUNITY ENGAGEMENT WAS AN OVERARCHING CONCEPT ENCOMPASSING THE COMMUNITY HEALTH NEEDS ASSESSMENT AND FORMATION OF THE COMMUNITY HEALTH IMPROVEMENT PLAN.
FACILITY REPORTING GROUP - A PART V, SECTION B, LINE 6A:FAITH REGIONAL HEALTH SERVICES - WEST AND FAITH REGIONAL HEALTH SERVICES - EAST PARTNERED WITH THE ELKHORN LOGAN VALLEY PUBLIC HEALTH DEPARTMENT (ELVPHD) AND ITS RESPECTIVE DISTRICT HOSPITALS TO COMPLETE THE CHNA, THOSE HOSPITALS ARE AS FOLLOWS:-FRANCISCAN HEALTHCARE, WEST POINT, NE (CUMING COUNTY)
FACILITY REPORTING GROUP - A PART V, SECTION B, LINE 6B:FAITH REGIONAL HEALTH SERVICES PARTNERED WITH ITS LOCAL HEALTH DEPARTMENT, ELKHORN LOGAN VALLEY PUBLIC HEALTH DEPARTMENT TO COMPLETE THE CHNA.
FACILITY REPORTING GROUP - A PART V, SECTION B, LINE 11:FAITH REGIONAL HEALTH SERVICES HAS IDENTIFIED TWO PRIORITY AREAS IN THE CHNA: CANCER PREVENTION AND SCREENING AND BEHAVIORAL/MENTAL HEALTH. FOR EACH OF THESE AREAS, GOALS AND IMPLEMENTATION STRATEGIES ARE IDENTIFIED IN THE HOSPITAL COMMUNITY HEALTH IMPLEMENTATION PLAN.THE GOALS FOCUSED ON CANCER PREVENTION AND SCREENING INCLUDE THE FOLLOWING: 1) INCREASE CANCER SCREENING AND PREVENTION IN OUR SERVICE AREA. 2) INCREASING PATIENT AND PROVIDER COMMUNICATION ABOUT SCREENINGS UTILIZING ELECTRONIC HEALTH RECORD (EHR) EPIC. 3) DECREASED THE BURDEN OF OBESITY IN THE ELVPHD DISTRICT AS A SIGNIFICANT RISK FACTOR FOR CANCER.THE GOALS FOCUSED ON BEHAVIORAL/MENTAL HEALTH INCLUDE THE FOLLOWING: 1) INCREASE INTERNSHIP AND PRECEPTORSHIP OPPORTUNITIES IN THE INPATIENT OR OUTPATIENT SETTINGS FOR MENTAL HEALTH NURSING, MENTAL HEALTH THERAPISTS AND SOCIAL WORK DEGREES. 2) INCREASE TELEHEALTH ENCOUNTERS IN THE OUTPATIENT CLINIC IN BOTH MED MANAGEMENT AND THERAPY ENCOUNTERS. 3) DECREASE FINANCIAL BARRIERS TO INDIVIDUALS RECEIVING MENTAL HEALTH SERVICES, INPATIENT AND OUTPATIENT THROUGH USE OF REGION IV FUNDING. 4) MAINTAIN RELATIONSHIPS WITH REGION IV COORDINATOR AND REGION IV LAW ENFORCEMENT TO IMPROVE EASE OF ACCESS FOR REGIONAL CARE.THERE WERE NOT ANY NEEDS IDENTIFIED IN THE CHNA THAT ARE NOT BEING ADDRESSED BY THE HOSPITAL.
FACILITY REPORTING GROUP - A PART V, SECTION B, LINE 13B:FOR MEDICARE PATIENTS, THE HOSPITAL MAY USE THE ORIGINAL DETERMINATION AMOUNT.
FACILITY REPORTING GROUP - A PART V, SECTION B, LINE 13H:CHARITY CARE MAY BE AUTHORIZED FOR FINANCIALLY RESPONSIBLE PARTIES WITH INCOME LEVELS EXCEEDING 400% FPG IN THE CASE OF UNUSUAL, SPECIAL AND/OR EXTENUATING CIRCUMSTANCES. THESE INSTANCES ARE GENERALLY DUE TO MEDICAL CATASTROPHE SITUATIONS.
FieldValueIRS element (for citing)
Facility2FacilityNum

Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp

Oth Hlth Care Fclts OthHlthCareFcltsGrp (2 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdFacilityFacilityTxt
1 - NORTHEAST NE SURGERY CENTER LLC
301 NORTH 27TH ST STE 3NORFOLKNE68701SURGERY CENTER
3 - ST JOSEPH REHABILITATION & CARE CTR
401 N 18TH STREETNORFOLKNE68701SKILLED NURSING FACILITY

Supplemental Information Detail SupplementalInformationDetail (15 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
PART I, LINE 3C:IN ADDITION TO FEDERAL POVERTY GUIDELINES, FAITH REGIONAL USES ASSET LEVEL, MEDICAL INDIGENCY, INSURANCE STATUS, UNDERINSURANCE STATUS AND FOR MEDICARE PATIENTS, THE HOSPITAL MAY USE THE ORIGINAL DETERMINATION AMOUNT, TO DETERMINE ELIGIBILITY FOR FREE OR DISCOUNTED CARE. FAMILY SIZE AND INCOME LEVEL ARE USED TO DETERMINE WHERE THE PATIENT FALLS IN RELATION TO RECEIVING FREE CARE OR DISCOUNTED CARE.CHARITY CARE MAY BE AUTHORIZED FOR FINANCIALLY RESPONSIBLE PARTIES WITH INCOME LEVELS EXCEEDING 400% FPG IN THE CASE OF UNUSUAL, SPECIAL AND/OR EXTENUATING CIRCUMSTANCES. THESE INSTANCES ARE GENERALLY DUE TO MEDICAL CATASTROPHE SITUATIONS.
PART I, LINE 6A:FAITH REGIONAL'S ANNUAL COMMUNITY BENEFIT REPORT IS NOT PREPARED BY A RELATED ORGANIZATION.
PART I, LINE 7:FAITH REGIONAL USES A COST ACCOUNTING SYSTEM TO DETERMINE COSTS REPORTABLE ON PART I, LINE 7 (AND ELSEWHERE ON SCHEDULE H). THE FIRST STEP IN THE COST ACCOUNTING PROCESS IS TO ALLOCATE THE OVERHEAD EXPENSES (ADMINISTRATION AND GENERAL, PLANT, ETC) TO THE REVENUE PRODUCING DEPARTMENTS (OPERATING ROOM, IMAGING, ONCOLOGY, ETC). THIS IS DONE SIMILAR TO THE MEDICARE COST REPORT USING A SINGLE STEP DOWN METHOD TO ALLOCATE THE COSTS USING APPLICABLE STATISTICS. FOR EXAMPLE: PLANT EXPENSES ARE ALLOCATED DOWN TO THE OTHER DEPARTMENTS USING CURRENT SQUARE FOOTAGE SO DEPARTMENTS WITH MORE SQUARE FOOTAGE WILL BE ALLOCATED MORE PLANT EXPENSES; DIETARY EXPENSES ARE ALLOCATED BASED ON MEALS SERVED; EMPLOYEE BENEFITS ARE ALLOCATED BASED ON SALARIES; ADMINISTRATIVE AND GENERAL EXPENSES ARE ALLOCATED BASED ON ACCUMULATED COSTS; AND SO ON. ONCE ALL THE OVERHEAD EXPENSES ARE ALLOCATED TO THE REVENUE PRODUCING DEPARTMENTS THE COSTS ARE FURTHER ALLOCATED DOWN TO THE CHARGE CODE LEVEL. IN ORDER TO DO THIS, TWO DIFFERENT METHODS ARE USED DEPENDING ON THE DEPARTMENT. SPECIFIC DEPARTMENTS USE A RVU (RELATIVE VALUE UNIT) ALLOCATION WHERE EACH PROCEDURE IS WEIGHTED BY THE INTENSITY OF THE SERVICE AND IS THEN ALLOCATED COST BASED ON THAT LEVEL OF INTENSITY. FOR EXAMPLE AN XRAY WITH SEDATION IS MORE COMPLICATED AND TIME INTENSIVE THAN A SIMPLE CHEST XRAY SO IT WOULD HAVE A HIGHER RVU VALUE AND, IN TURN, A HIGHER COST ALLOCATED TO IT. THE DEPARTMENTS USING THIS ALLOCATION METHOD ARE IMAGING, CARDIAC CATH, CT, MRI, ULTRASOUND, NUCLEAR MEDICINE, RADIATION ONCOLOGY, AND REHAB (PHYSICAL, OCCUPATIONAL AND SPEECH THERAPY).THE OTHER DEPARTMENTS USE A RATIO OF COST TO CHARGE METHOD TO ALLOCATE THE COSTS DOWN TO THE CHARGE CODE LEVEL.AFTER ALL THE COSTS HAVE BEEN ALLOCATED TO THE CHARGE CODES THE COSTING IS APPLIED TO ALL PATIENT ACCOUNTS BASED ON THEIR CHARGES TO DETERMINE THE COST OF THEIR ENCOUNTER AND THEN REPORTS CAN BE RUN TO DETERMINE THE PROFITABILITY OF CERTAIN PAYORS, SERVICE LINES OR DEPARTMENTS.
PART I, LINE 7G:MANY SERVICES PROVIDED BY FAITH REGIONAL ARE DONE SO TO MEET SPECIFIC NEEDS OF THE COMMUNITY BECAUSE NO OTHER SERVICES ARE AVAILABLE. AS A RESULT, THESE SERVICES ARE PROVIDED KNOWING THAT THEY WILL NOT BE FINANCIALLY VIABLE OR SELF-SUPPORTING. FAITH REGIONAL DID NOT INCLUDE ANY PHYSICIAN CLINIC EXPENSES AS SUBSIDIZED HEALTH SERVICES.
PART II, COMMUNITY BUILDING ACTIVITIES:COMMUNITY BUILDING ACTIVITIES DURING THE YEAR INCLUDED EXPENSES FOR THE NORFOLK AREA BIG GIVE, AS WELL AS CARDBOARD RECYCLING.
PART III, LINE 2:THE AMOUNT ON LINE 2 REPRESENTS IMPLICIT PRICE CONCESSIONS. FAITH DETERMINES ITS ESTIMATE OF IMPLICIT PRICE CONCESSIONS BASED ON HISTORICAL COLLECTION EXPERIENCE WITH VARIOUS CLASSES OF PATIENTS.
PART III, LINE 3:THE ESTIMATED AMOUNT OF THE ORGANIZATION'S IMPLICIT PRICE CONCESSIONS ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S CHARITY CARE POLICY IS CALCULATED BASED ON AN APPROXIMATE 10.8% OF INDIVIDUALS LIVING BELOW THE POVERTY LEVEL IN THE SERVICE AREA.
PART III, LINE 4:THE FOOTNOTE TO THE ORGANIZATION'S FINANCIAL STATEMENTS THAT DESCRIBES IMPLICIT PRICE CONCESSIONS IS LOCATED IN FOOTNOTE 1 ON PAGE 14 OF THE ATTACHED FINANCIAL STATEMENTS.
PART III, LINE 8:THE ENTIRE MEDICARE SHORTFALL IS CONSIDERED A COMMUNITY BENEFIT. SERVICES ARE PROVIDED TO PATIENTS UNDER THE MEDICARE PROGRAM EVEN THOUGH THE HOSPITAL KNOWS THEY WILL NOT RECOVER ALL OF THE COSTS FROM PROVIDING THE SERVICES. THIS PROGRAM IS CONSIDERED SUBSIDIZED BY THE HOSPITAL AND OTHER PAYORS. PATIENTS RELY ON THESE SERVICES FOR THEIR HEALTH AND WELL-BEING AND ARE ESSENTIAL FOR THEIR ACCESS TO HEALTHCARE. TOTAL REVENUE RECEIVED FROM MEDICARE IS THE GROSS REIMBURSEMENT PLUS SETTLEMENT. BOTH TOTAL REVENUE RECEIVED FROM MEDICARE AND THE MEDICARE ALLOWABLE COSTS ARE REPORTED FROM THE MEDICARE COST REPORT. THE MEDICARE COST REPORT IS COMPLETED BASED ON THE RULES AND REGULATIONS SET FORTH BY CENTERS FOR MEDICARE AND MEDICAID SERVICES.
PART III, LINE 9B:FRHS WILL NOT ENGAGE IN ECAS, EITHER DIRECTLY OR BY ANY DEBT COLLECTION AGENCY OR OTHER PARTY TO WHICH THE HOSPITAL HAS REFERRED THE PATIENT'S DEBT, BEFORE REASONABLE EFFORTS ARE MADE TO DETERMINE WHETHER A RESPONSIBLE INDIVIDUAL(S) IS ELIGIBLE FOR ASSISTANCE UNDER THE FAP.AT LEAST THREE SEPARATE STATEMENTS FOR COLLECTIONS OF SELF-PAY ACCOUNTS SHALL BE MAILED TO THE LAST KNOWN ADDRESS OF EACH RESPONSIBLE INDIVIDUAL(S); PROVIDED, HOWEVER, THAT NO ADDITIONAL STATEMENTS NEED BE SENT AFTER A RESPONSIBLE INDIVIDUAL(S) SUBMITS A COMPLETE APPLICATION FOR FINANCIAL ASSISTANCE UNDER THE FAP OR HAS PAID IN-FULL. AT LEAST 120 DAYS MUST LAPSED BETWEEN THE FIRST AND LAST OF THESE REQUIRED THREE MAILINGS.AT LEAST ONE OF THE STATEMENTS MAILED OR EMAILED WILL INCLUDE WRITTEN NOTICE THAT INFORMS THE RESPONSIBLE INDIVIDUAL(S) ABOUT THE ECAS THAT ARE INTENDED TO BE TAKEN IF THE RESPONSIBLE INDIVIDUAL(S) DOES NOT APPLY FOR FINANCIAL ASSISTANCE UNDER THE FAP GUIDELINES OR PAY THE AMOUNT DUE BY THE BILLING DEADLINE. SUCH STATEMENT MUST BE PROVIDED TO THE RESPONSIBLE INDIVIDUAL(S) AT LEAST 30 DAYS BEFORE THE DEADLINE SPECIFIED IN THE STATEMENT.PRIOR TO INITIATION OF ANY ECAS, AN ORAL ATTEMPT WILL BE MADE TO CONTACT RESPONSIBLE INDIVIDUAL(S) BY TELEPHONE AT THE LAST KNOWN TELEPHONE NUMBER, IF ANY, AT LEAST ONCE DURING THE SERIES OF MAILED STATEMENTS IF THE ACCOUNT REMAINS UNPAID. DURING ALL CONVERSATION, THE PATIENT OR RESPONSIBLE INDIVIDUAL(S) WILL BE INFORMED ABOUT THE FINANCIAL ASSISTANCE THAT MAY BE AVAILABLE UNDER THE FAP. IF AN APPLICATION, COMPLETE OR INCOMPLETE, FOR FINANCIAL ASSISTANCE UNDER THE FAP IS SUBMITTED BY A RESPONSIBLE INDIVIDUAL(S), AT ANY TIME PRIOR TO THE APPLICATION DEADLINE, FRHS WILL SUSPEND ECAS WHILE SUCH FINANCIAL ASSISTANCE APPLICATION IS PENDING. THIS WILL INCLUDE ANY CURRENT ACCOUNTS AND BAD DEBT ACCOUNTS GOING BACK 240 DAYS FROM THE DATE OF THE FIRST STATEMENT ON THE ACCOUNT.
PART VI, LINE 2:FAITH REGIONAL CHOSE TO PARTNER WITH THE ELKHORN LOGAN VALLEY PUBLIC HEALTH DEPARTMENT (ELVPHD) AND ITS RESPECTIVE DISTRICT HOSPITALS TO COMPLETE THE JOINT COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) IN 2022. IN ADDITION TO THE PUBLIC HEALTH DEPARTMENT'S ASSESSMENT, FAITH REGIONAL IS INTIMATELY INVOLVED IN THE ELKHORN ECONOMIC DEVELOPMENT ASSOCIATION, BOTH ON THE BOARD AND THROUGH FINANCIAL SUPPORT. THAT INVOLVEMENT IS INTENDED TO FACILITATE COMMUNITY GROWTH, JOB DEVELOPMENT, INFRASTRUCTURE DEVELOPMENT AND BUSINESS EDUCATION/TRAINING. FAITH REGIONAL IS ALSO A MEMBER OF THE NORFOLK CHAMBER OF COMMERCE WHICH IS INVOLVED IN BUSINESS RETAIL DEVELOPMENT AND SUPPORT AS WELL AS THE COMMUNITY IMPROVEMENT PROJECTS. FAITH ALSO WORKS WITH ORGANIZATIONS LIKE THE ORPHAN GRAIN TRAIN IN PROVIDING MEDICINE AND MEDICAL EQUIPMENT/SUPPLIES TO OTHER NATIONS IN NEED.
PART VI, LINE 3:PATIENTS RECEIVING CARE ARE GIVEN INFORMATION REGARDING FAITH REGIONAL'S FINANCIAL ASSISTANCE PROGRAM THROUGH THE USE OF BROCHURES HANDED OUT BY REGISTRATION, HOSPITAL SOCIAL SERVICES, M.A.S.H. (MEDICAL ADVOCACY SERVICES FOR HEALTHCARE) PERSONNEL AND BY PATIENT ACCOUNTS STAFF. ANY PATIENT OR FAMILY MEMBER THAT EXPRESSES CONCERN REGARDING ABILITY TO PAY FOR SERVICES WILL BE DIRECTED TO A SOCIAL WORKER, REGISTRATION CLERK, CASHIER OR FINANCIAL SERVICES REPRESENTATIVE WHO WILL THEN GIVE THEM AN APPLICATION FOR PATIENT FINANCIAL ASSISTANCE ALONG WITH A BROCHURE EXPLAINING HOW TO COMPLETE THE APPLICATION.
PART VI, LINE 4:FAITH REGIONAL'S PRIMARY SERVICE AREA CONSISTS OF ANTELOPE, BOONE, HOLT, KNOX, MADISON, PIERCE, PLATTE, STANTON AND WAYNE COUNTIES IN NEBRASKA. THE HOSPITAL'S SECONDARY SERVICE AREA CONSISTS OF CEDAR, COLFAX, CUMING AND DIXON COUNTIES IN NEBRASKA. FAITH REGIONAL ALSO HAS A TERTIARY SERVICE AREA OF BOYD, BROWN, BURT, CHERRY, DAKOTA, GARFIELD, KEYA PAHA, NANCE, ROCK, THURSTON AND WHEELER COUNTIES IN NEBRASKA.BASED ON U.S. CENSUS INFORMATION, THE ABOVE COUNTIES IN THE FRHS PRIMARY AND SECONDARY SERVICE AREAS REPRESENT A TOTAL POPULATION OF 209,753. THE RACIAL MAKEUP OF THE SERVICE AREA POPULATION IS MAJORITY WHITE WITH 92.6% IDENTIFYING AS WHITE ALONE AND 7.4% IDENTIFYING AS NON-WHITE. THE SERVICE AREA'S MOST SIGNIFICANT RACIAL MINORITY IS HISPANIC WITH AN AVERAGE 8.5% PERCENT HISPANIC/LATINO POPULATION.THE MEDIAN HOUSEHOLD INCOME OF OUR SERVICE AREA IS $55,451 AND THE PER CAPITA INCOME IS $29,078, COMPARED TO THE MEDIAN HOUSEHOLD INCOME FOR NEBRASKA AT $50,695 AND THE PER CAPITA INCOME AT $26,113. AN AVERAGE OF 10.8% OF THE FRHS SERVICE AREA LIVES IN POVERTY, AND AN AVERAGE 9% DO NOT HAVE HEALTH INSURANCE.
PART VI, LINE 5:FAITH REGIONAL, A NOT-FOR-PROFIT HEALTH CARE FACILITY, LOCATED IN NORTHEAST NEBRASKA, OPERATES FOR THE BENEFIT OF THE INDIVIDUALS IN THE SERVICE AREA. FAITH REGIONAL SERVES ALL PATIENTS REGARDLESS OF THEIR ABILITY TO PAY AND DOES NOT LIMIT ITS SERVICES OR DISCRIMINATE AGAINST ANYONE ON THE BASIS OF RACE, COLOR, SEX, NATIONAL ORIGIN, SEXUAL ORIENTATION, RELIGION, AGE, DISABILITY, DISEASE OR DIAGNOSIS. FAITH REGIONAL ALSO PROVIDES COMMUNICATIONS SERVICES (E.G. BILINGUAL STAFF AND INTERPRETERS, SIGN LANGUAGE INTERPRETERS, TDD SERVICES, ETC) FOR SENSORY IMPAIRED INDIVIDUALS. FAITH REGIONAL EVALUATES ITSELF ON ITS EFFECTIVENESS ANNUALLY BY EXAMINING ITS ABILITY TO FULFILL ITS MISSION, ACCOMPLISH ITS VISION, PROVIDE SERVICE AND MAINTAIN ITS VALUES. FAITH REGIONAL'S MISSION, VISION, SERVICE AND VALUES ARE: THE MISSION: THE MISSION IS TO SERVE CHRIST BY PROVIDING ALL PEOPLE WITH EXEMPLARY MEDICAL SERVICES IN AN ENVIRONMENT OF LOVE AND CARE.THE VISION: THE VISION OF FAITH REGIONAL HEALTH SERVICES IS TO BECOME A REGIONAL REFERRAL CENTER BY PROVIDING THE MOST COMPREHENSIVE, HIGH QUALITY HEALTH SERVICES TO THE RESIDENTS OF NORTHEAST NEBRASKA. THE VALUES:-SPIRITUALITY-EXCELLENCE-INTEGRITY-COMPASSION-RESPECT-STEWARDSHIPFAITH REGIONAL'S PROGRAM SERVICE ACCOMPLISHMENTS ARE BASED ON THE COMMUNITY ACCOUNTABILITY STANDARDS DEVELOPED BY THE VOLUNTARY HOSPITALS OF AMERICA (VHA). THESE FOUR STANDARDS ARE:1) DEMONSTRATE LEADERSHIP AS A CHARITABLE INSTITUTION.2) PROVIDING ESSENTIAL HEALTH CARE SERVICES.3) BEING ACCOUNTABLE TO THE COMMUNITY.4) MAINTAINING EVIDENCE OF COMMITMENT TO COMMUNITY BENEFIT.FAITH REGIONAL RECOGNIZES ITS OBLIGATION TO DEMONSTRATE LEADERSHIP AS A CHARITABLE ORGANIZATION BY PROVIDING A FULL RANGE OF HEALTH CARE, HEALTH EDUCATION AND WELLNESS RELATED SERVICES TO THE COMMUNITY, AND PARTICIPATING IN FEDERAL, STATE AND LOCAL PROGRAMS TO PROVIDE HEALTH BENEFITS TO THOSE IN NEED. FAITH REGIONAL FINANCIALLY SUPPORTS VARIOUS OUTREACH ACTIVITIES IN WHICH HOSPITAL PROVIDERS TRAVEL OUT TO SURROUNDING COMMUNITIES TO PROVIDE SERVICES WHICH MAY OTHERWISE NOT BE AVAILABLE. FAITH REGIONAL PROVIDES TRANSPORTATION SERVICES PRIMARILY TO RADIATION ONCOLOGY PATIENTS AT NO CHARGE.FAITH REGIONAL REMAINS ACCOUNTABLE TO THE COMMUNITY BY WORKING WITH A VOLUNTEER GOVERNING BOARD THAT IS REPRESENTATIVE OF THE COMMUNITY IT SERVES. COOPERATION WITH COMMUNITY BASED HEALTH ORGANIZATIONS IDENTIFY PERTINENT ISSUES RELATED TO ESSENTIAL SERVICES, CHARITY CARE, HEALTH CARE COST CONTAINMENT, COMMUNITY BENEFIT ACTIVITIES AND OTHERS AS APPROPRIATE. FAITH REGIONAL CONTINUES TO OPERATE UNDER A VOLUNTEER GOVERNING BOARD AND REMAINS ACTIVELY INVOLVED IN ADVOCATING PUBLIC AWARENESS OF HEALTH CARE AND HEALTH CARE POLICY ISSUES. DISCLOSURES OF COMMUNITY BENEFIT INFORMATION AND ADVOCACY ISSUES ARE PROVIDED THROUGH A VARIETY OF MEDIA INCLUDING MEDIA RELEASES AND ITS INTERNET WEBSITE: WWW.FRHS.ORG.FAITH REGIONAL'S CONTRIBUTION TO THE COMMUNITY NOT ONLY INCLUDES COMPENSATED AND DONATED TIME BUT ALSO EQUIPMENT, MATERIALS AND SPACE. MEETING ROOMS ARE PROVIDED AS NEEDED AND EQUIPMENT AND MATERIALS (E.G. COMPUTERS, COPIER, FAXES, TELEPHONES, CHILDBIRTH PROPS, PROJECTORS, MANNEQUINS, HEARING BOOTH, AUDIOMETERS, BEDS, MONITORS, WARMING UNITS, MINOR INSTRUMENTS, ETC.) ARE PROVIDED AT NO CHARGE. A MAJOR CONCERN IN HEALTH CARE THAT CAN SOMETIMES BE "HIDDEN" IS THAT OF SEXUAL ABUSE AND NEGLECT IN CHILDREN. THE NORTHEAST NEBRASKA CHILD ADVOCACY PROGRAM AT FAITH REGIONAL PROVIDES A SAFE, NON THREATENING ENVIRONMENT WHERE CHILDREN (AGES INFANT TO 18) WHO ARE VICTIMS OF ABUSE RECEIVE IMMEDIATE MEDICAL CARE AND FORENSIC INTERVIEWS FROM VARIOUS AGENCIES WORKING TOGETHER. ALL OF THESE SERVICES ARE AVAILABLE FREE TO FAMILIES WITHIN A 24-COUNTY AREA.
PART VI, LINE 6:FAITH REGIONAL IS NOT PART OF AN AFFILIATED HEALTH CARE SYSTEM.

Schedule I IRS990ScheduleI

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

Recipient Table RecipientTable (5 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdRecipient EINRecipientEINIRC SectionIRCSectionDescCash GrantCashGrantAmtNon Cash AssistanceNonCashAssistanceAmtPurpose Of GrantPurposeOfGrantTxt
FOR THE GIRLS NORFOLK
PO BOX 1124NORFOLKNE68702460972709501(C)(3)$7,500$0SPONSORSHIPS
NORFOLK AREA UNITED WAY
PO BOX 1041NORFOLKNE68702470492054501(C)(3)$6,000$0ANNUAL GIVING/CAPITAL CAMPAIGN
NORFOLK FAMILY YMCA
301 W BENJAMIN AVENORFOLKNE68701465709553501(C)(3)$105,000$0FACILITY EXPANSION AND ROUNDTABLE EVENT
GREATER NORFOLK ECONOMIC DEVELOPMENT FOUNDATION
609 W NORFOLK AVENORFOLKNE68701363441719501(C)(3)$50,000$0TO PROVIDE TRANSPORTATION FOR EMPLOYEES TO AND FROM WORK.
NORTH FORK AREA TRANSIT
222 N 4TH STNORFOLKNE68701237207097501(C)(3)$50,000$0TO PROVIDE TRANSPORTATION FOR EMPLOYEES TO AND FROM WORK.
FieldValueIRS element (for citing)
Total501c3 Org5Total501c3OrgCnt
Total Other Org0TotalOtherOrgCnt

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferencePART I, LINE 2:FormAndLineReferenceDesc
ExplanationCASH DONATIONS ARE MADE TO ORGANIZATIONS, MANY OF WHICH HAVE HEALTH CARE OR SOCIAL SERVICES MISSIONS. THESE DONATIONS ARE SOMETIMES RESTRICTED FOR A SPECIFIC USE OR ACTIVITY. 501(C)(3) ORGANIZATIONS ARE BOUND BY THEIR ARTICLES OF ORGANIZATION AND STATED MISSIONS TO CONDUCT ACTIVITIES STRICTLY FOR CHARITABLE PURPOSES. FAITH REGIONAL DOES NOT REQUEST GRANT REPORTS FROM DONEE CHARITABLE ORGANIZATIONS.ExplanationTxt

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Form990 Of Other OrganizationsYes (X)Form990OfOtherOrganizationsInd
Written Employment ContractYes (X)WrittenEmploymentContractInd
Compensation SurveyYes (X)CompensationSurveyInd
Board Or Committee ApprovalYes (X)BoardOrCommitteeApprovalInd
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 PaymentsYes (1)AnyNonFixedPaymentsInd
Initial Contract Exception0InitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (9 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
FADI RZOUQ MD
PHYSICIAN$1,010,067$0$3,820,969$0$0$0$13,200$0$24,445$0$4,868,681$0$0$0
TRISTAN L HARTZELL MD
PHYSICIAN$1,115,995$0$2,283,164$0$0$0$0$0$2,112$0$3,401,271$0$0$0
JOHN LAMMLI MD
PHYSICIAN$777,721$0$622,021$0$0$0$13,200$0$24,607$0$1,437,549$0$0$0
BEETHOVEN BROWN MD
PHYSICIAN$1,239,400$0$50$0$0$0$13,200$0$1,913$0$1,254,563$0$0$0
NATHAN HERMAN MD
PHYSICIAN$480,969$0$548,296$0$0$0$13,200$0$23,307$0$1,065,772$0$0$0
KELLY DRISCOLL
CEO$696,897$0$72,772$0$11,475$0$16,500$0$25,083$0$822,727$0$0$0
ROBERT PRINCE MD
MEMBER - MEDICAL DIRECTOR$708,174$0$50$0$0$0$279$0$5,304$0$713,807$0$0$0
LANE HANDKE MD
MEMBER - CHIEF OF STAFF$330,405$0$214,842$0$0$0$9,167$0$23,025$0$577,439$0$0$0
JANNA CLINE
VP FINANCE$272,106$0$50$0$0$0$8,317$0$23,637$0$304,110$0$0$0

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferencePART I, LINE 7FormAndLineReferenceDesc
ExplanationPHYSICIANS HAVE AN OPPORTUNITY TO EARN PRODUCTION BONUSES IF THE PROVIDER REACHES ABOVE RELATIVE VALUE UNIT AMOUNTS. PAYOUTS ARE DEPENDENT ON THEIR BASE SALARY PERCENTILE. PHYSICIANS ALSO HAVE AN OPPORTUNITY TO EARN A QUALITY BONUS IF THEY MEET CERTAIN CRITERIA THROUGHOUT THE YEAR WHICH INCLUDES MIPS-QPP TARGETS, MEETING ATTENDANCE, COMMUNITY SERVICE, AND EVENT SPONSORSHIPS. PHYSICIANS RECEIVING THESE BONUSES DURING THE YEAR INCLUDE THE FOLLOWING: TRISTAN HARTZELL, M.D. FADI RZOUQ, M.D. NATHAN HERMAN, M.D. JOHN LAMMLI, M.D. LANE HANDKE, M.D.ExplanationTxt

Schedule K IRS990ScheduleK

Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp (2 entries)

Bond ReferenceBondReferenceCdBond Issuer EINBondIssuerEINCUSIPCUSIPNumBond IssuedBondIssuedDtIssue PriceIssuePriceAmtPurposePurposeDescDefeasedDefeasedIndOn Behalf Of IssuerOnBehalfOfIssuerIndPool FinancingPoolFinancingInd
HOSPITAL AUTHORITY #1 OF MADISON COUNTY NEBRASKA
A521357975557352EX52017-08-17$44,772,246REFUND PRIOR ISSUES (07/10/08 & 11/20/08)000
HOSPITAL AUTHORITY #1 OF MADISON COUNTY NEBRASKA
B521357975557352FQ92018-05-10$32,483,418CONSTRUCT FACILITY000

Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp (2 entries)

Bond ReferenceBondReferenceCdRetiredRetiredAmtTotal ProceedsTotalProceedsAmtIssuance Costs From ProceedsIssuanceCostsFromProceedsAmtOther Spent ProceedsOtherSpentProceedsAmtRefunding Tax Exempt BondsRefundingTaxExemptBondsIndRefunding Taxable BondsRefundingTaxableBondsIndFinal Allocation MadeFinalAllocationMadeIndAdequate Books And Rec MaintAdequateBooksAndRecMaintIndCapitalized InterestCapitalizedInterestAmtCapital ExpendituresCapitalExpendituresAmtSubstantial CompletionSubstantialCompletionYr
A$23,429,132$44,772,246$712,032$44,060,214Yes (1)Yes (1)Yes (1)Yes (1)
B$6,786,500$32,483,418$580,86200Yes (1)Yes (1)$2,577,140$29,325,4162019

Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp (2 entries)

Bond ReferenceBondReferenceCdOwning Bond Financed PropertyOwningBondFinancedPropertyIndAny Lease ArrangementsAnyLeaseArrangementsIndMgmt Contract Bond Fincd PropMgmtContractBondFincdPropIndAny Research AgreementsAnyResearchAgreementsIndPrivate Bus Use By OthersPrivateBusUseByOthersPctPrivate Bus Concerning UBIPrivateBusConcerningUBIPctTotal Private Business UseTotalPrivateBusinessUsePctBond Iss Meet Prvt Sec Pymt TestBondIssMeetPrvtSecPymtTestIndChange In Use Bond Financed PropChangeInUseBondFinancedPropIndProcs Nonqualified Bond RemdtdProcsNonqualifiedBondRemdtdInd
A00000.005400.000000.0054000Yes (1)
B00000.000000.000000.00000000

Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp (2 entries)

Bond ReferenceBondReferenceCdForm8038 T FiledForm8038TFiledIndRebate Not Due YetRebateNotDueYetIndException To RebateExceptionToRebateIndNo Rebate DueNoRebateDueIndVariable Rate IssueVariableRateIssueIndHedge Identified In Bks And RecHedgeIdentifiedInBksAndRecIndGross Proceeds Invested In GICGrossProceedsInvestedInGICIndGross Proceeds InvestedGrossProceedsInvestedIndWritten Proc To Monitor ReqsWrittenProcToMonitorReqsInd
A000Yes (1)0000Yes (1)
B000Yes (1)0000Yes (1)

Procedures Corrective Action ProceduresCorrectiveActionGrp (2 entries)

Bond ReferenceBondReferenceCdProcedures Corrective ActionProceduresCorrectiveActionInd
AYes (1)
BYes (1)

Supplemental Information Detail SupplementalInformationDetail (2 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
DATE REBATE COMPUTATION PERFORMEDISSUER NAME: HOSPITAL AUTHORITY #1 OF MADISON COUNTY NEBRASKA DATE THE REBATE COMPUTATION WAS PERFORMED: 07/01/2018 ISSUER NAME: HOSPITAL AUTHORITY #1 OF MADISON COUNTY NEBRASKA DATE THE REBATE COMPUTATION WAS PERFORMED: 12/31/2019
SCHEDULE K, PART IV, ARBITRAGE, LINC 2C:NOTE REGARDING THE FIRST REBATE COMPUTATION ON 7/1/18: AS NO REBATABLE ARBITRAGE WAS EARNED ON THE ADVANCE REFUNDING ESCROW AND THE DEBT SERVICE FUND WAS OPERATED ON A BONA RIDE BASIS, NO FURTHER REBATE ANALYSIS IS NECESSARY. NOTE REGARDING THE COMPUTATION ON 12/31/19: SINCE THE BOND PROCEEDS HAVE BEEN SPENT AND THE DEBT SERVICE FUND WAS OPERATED ON A BONA FIDE BASIS, NO FURTHER REBATE CALCULATIONS ARE NECESSARY.

Schedule L IRS990ScheduleL

Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp (3 entries)

Relationship DescriptionRelationshipDescriptionTxtTransactionTransactionAmtTransactionTransactionDescSharing Of RevenuesSharingOfRevenuesInd
TRACY COLLISON
DAUGHTER-IN-LAW OF JACQUE COLLISON, A BOARD MEMBER$85,689TRACY IS AN EMPLOYEE OF FAITH REGIONAL HEALTH SERVICES.0
CHRISTINE PRINCE
WIFE OF ROBERT PRINCE, A BOARD MEMBER$96,371CHRISTINE IS AN EMPLOYEE OF FAITH REGIONAL HEALTH SERVICES.0
SHARON GOSSMAN
MOTHER OF JOSH GOSSMAN, A BOARD MEMBER$138,677SHARON IS AN EMPLOYEE OF FAITH REGIONAL HEALTH SERVICES.0

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (9 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990, PART VI, SECTION A, LINE 1ATHE EXECUTIVE COMMITTEE, CONSISTING OF THE IMMEDIATE PAST CHAIR, THE CHAIR, THE VICE CHAIR, THE SECRETARY, THE TREASURER, AND ONE PHYSICIAN BOARD MEMBER, HAS AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY. IF THE IMMEDIATE PAST CHAIR IS NO LONGER A VOTING DIRECTOR, HE OR SHE SHALL NEVERTHELESS SERVE IN A VOTING CAPACITY ON THE EXECUTIVE COMMITTEE.
FORM 990, PART VI, SECTION A, LINE 6FAITH REGIONAL HAS ONE NONPROFIT 501(C)(3) CORPORATE MEMBER, LUTHERAN COMMUNITY HOSPITAL ASSOCIATION, A RELATED ORGANIZATION.
FORM 990, PART VI, SECTION A, LINE 7ATHE SOLE CORPORATE MEMBER, LUTHERAN COMMUNITY HOSPITAL ASSOCIATION, APPOINTS 13 VOTING MEMBERS OF THE BOARD OF DIRECTORS OF FAITH REGIONAL HEALTH SERVICES.
FORM 990, PART VI, SECTION A, LINE 7BCERTAIN POWERS ARE RESERVED TO ITS SOLE MEMBER, LUTHERAN COMMUNITY HOSPITAL ASSOCIATION. THERE ARE 13 RESERVED POWERS, INCLUDING APPOINTMENT AND REMOVAL OF DIRECTORS, OTHER THAN CHIEF OF STAFF AND THE PHYSICIAN SERVICES MEDICAL DIRECTOR, AMENDMENT OF THE ARTICLES OF INCORPORATION AND BYLAWS, AMENDMENT OF THE MISSION, VISION AND VALUE STATEMENTS, AMONG OTHERS.
FORM 990, PART VI, SECTION B, LINE 11BFORM 990 INFORMATION SCHEDULES ARE COMPLETED IN-HOUSE BY THE REIMBURSEMENT ACCOUNTANT AND REVIEWED BY THE CONTROLLER AND CFO. THE INFORMATION IS PROVIDED FOR RETURN PREPARATION AND SIGNATURE. FORM 990 IS REVIEWED AND DISCUSSED WITH THE CFO AND COPIES OF THE COMPLETED RETURN ARE DISTRIBUTED TO THE BOARD MEMBERS FOR REVIEW PRIOR TO SUBMISSION TO THE IRS.
FORM 990, PART VI, SECTION B, LINE 12CFAITH REGIONAL'S BOARD MEMBERS ARE REQUIRED TO SIGN A CONFLICT OF INTEREST STATEMENT AND DISCLOSURE ANNUALLY. ANY CONFLICTS ARE REVIEWED BY BOTH THE GOVERNANCE COMMITTEE AND INDEPENDENT LEGAL COUNSEL. THE GOVERNANCE COMMITTEE PRESENTS RECOMMENDATIONS TO THE FULL BOARD. A MEMBER WITH A CONFLICT IS EXCUSED FROM THE BOARD DELIBERATIONS AND ACTION.
FORM 990, PART VI, SECTION B, LINE 15DETERMINATION OF COMPENSATION FOR THE CEO AND OTHER OFFICERS IS MADE BY GATHERING DATA FROM EXTERNAL SURVEYS AND THE FORM 990 DATA PROVIDED BY COMPARABLE FACILITIES. FACILITIES USED ARE DETERMINED BY SIMILAR BED SIZE, NET REVENUES AND NUMBER OF FTES. WAGES ARE GATHERED AND COMPARED BY TITLE, RESPONSIBILITIES AND YEARS OF EXPERIENCE. THE SALARY RECOMMENDATIONS ARE MADE BY THE HUMAN RESOURCE DEPARTMENT. THE GOVERNING BOARD APPROVES THE SALARY RECOMMENDATIONS FOR THE CEO; THE CEO APPROVES THE RECOMMENDATIONS FOR THE OTHER OFFICERS AND VICE-PRESIDENTS; AND THE VICE-PRESIDENTS APPROVE THE RECOMMENDATIONS FOR THE DIRECTORS OF VARIOUS HOSPITAL DEPARTMENTS.
FORM 990, PART VI, SECTION C, LINE 19FAITH REGIONAL DOES NOT MAKE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY OR FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC.
FORM 990, PART XII, LINE 2C:THE FINANCE/AUDIT COMMITTEE OF THE BOARD OF DIRECTORS ASSUMES RESPONSBILITY FOR OVERSIGHT OF THE AUDIT AND SELECTION OF AN INDEPENDENT ACCOUNTANT. THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR.

Schedule R IRS990ScheduleR

Id Disregarded Entities IdDisregardedEntitiesGrp (3 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdTotal IncomeTotalIncomeAmtEnd Of Year AssetsEndOfYearAssetsAmtBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Txt
FAITH REGIONAL PHYSICIAN SERVICES LLC
2700 WEST NORFOLK AVENUENORFOLKNE68701421629846PHYSICIAN SERVICESNE$51,514,303$23,534,826FAITH REGIONAL HEALTH SERVICES
FAITH REGIONAL HEALTH SERVICES PHO INC
2700 WEST NORFOLK AVENUENORFOLKNE68701IMPROVE HEALTHCARE SERVICESNE$0$0FAITH REGIONAL HEALTH SERVICES
ST JOSEPH'S REHABILITATION AND CARE CENTER
401 N 18TH STNORFOLKNE68701470796875NURSING HOMENE$6,160,249$3,536,616FAITH REGIONAL HEALTH SERVICES

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (2 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdExempt Code SectionExemptCodeSectionTxtPublic Charity StatusPublicCharityStatusTxtDirect Controlling NADirectControllingNACdControlled OrganizationControlledOrganizationIndBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Txt
LUTHERAN COMMUNITY HOSPITAL ASSOCIATION
2700 W NORFOLK AVENORFOLKNE68701470396139SUPPORT FAITH REGIONAL HEALTH SERVICESNE501(C)(3)LINE 3N/A0
FAITH REGIONAL HEALTH SERVICES FOUNDATION
2700 W NORFOLK AVENORFOLKNE68701911772474SUPPORT FAITH REGIONAL HEALTH SERVICESNE501(C)(3)LINE 12A, IYes (1)FAITH REGIONAL HEALTH SERVICES

Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp

Related Organization Name RelatedOrganizationName

FieldValueIRS element (for citing)
Business Name Line1NORTHEAST NEBRASKA SURGERY CENTERBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line1301 N 27TH STREETAddressLine1Txt
CityNORFOLKCityNm
State AbbreviationNEStateAbbreviationCd
ZIP68701ZIPCd
FieldValueIRS element (for citing)
EIN470819088EIN
Primary ActivitiesOUTPATIENT SURGERYPrimaryActivitiesTxt
Legal Domicile StateNELegalDomicileStateCd

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1FAITH REGIONAL HEALTH SERVICESBusinessNameLine1Txt
FieldValueIRS element (for citing)
Predominant Income TypeRELATEDPredominantIncomeTypeTxt
Share Of Total Income$782,391ShareOfTotalIncomeAmt
Share Of EOY Assets$2,821,432ShareOfEOYAssetsAmt
Disproportionate Allocations0DisproportionateAllocationsInd
General Or Managing Partner0GeneralOrManagingPartnerInd
Ownership0.59900OwnershipPct
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts Rylts0ReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth Org0GiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth OrgYes (1)GiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other OrgYes (1)LoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth OrgYes (1)LoansOrGuaranteesFromOthOrgInd
Div Related Organization0DivRelatedOrganizationInd
Asset Sale To Other Org0AssetSaleToOtherOrgInd
Asset Purchase From Other Org0AssetPurchaseFromOtherOrgInd
Asset Exchange0AssetExchangeInd
Rental Of Facilities To Oth OrgYes (1)RentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth Org0RentalOfFcltsFromOthOrgInd
Perform Of Services For Oth Org0PerformOfServicesForOthOrgInd
Perform Of Services By Other OrgYes (1)PerformOfServicesByOtherOrgInd
Sharing Of FacilitiesYes (1)SharingOfFacilitiesInd
Paid Employees SharingYes (1)PaidEmployeesSharingInd
Reimbursement Paid To Other Org0ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrgInd
Transfer To Other Org0TransferToOtherOrgInd
Transfer From Other Org0TransferFromOtherOrgInd

Transactions Related Org TransactionsRelatedOrgGrp (4 entries)

Transaction TypeTransactionTypeTxtInvolvedInvolvedAmtMethod Of Amount DeterminationMethodOfAmountDeterminationTxt
NORTHEAST NEBRASKA SURGERY CENTER
O$2,937,632FAIR MARKET VALUE
NORTHEAST NEBRASKA SURGERY CENTER
J$647,521FAIR MARKET VALUE
FAITH REGIONAL HEALTH SERVICES FOUNDATION
C$517,634FAIR MARKET VALUE
NORTHEAST NEBRASKA SURGERY CENTER
D$180,065FAIR MARKET VALUE

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