2021-11-11T07:59:13-06:00 2020-12-31 476097913 SEIM JOHNSON LLP 18081 BURT STREET SUITE 200 OMAHA NE 680224722 990 2020-01-01 911772474 FAITH REGIONAL HEALTH SERVICES FOUNDATION FAIT 4026447301 2700 WEST NORFOLK AVENUE NO 200 NORFOLK NE 68701 JANNA CLINE CFO 4026447301 2021-11-10 1 JANNA CLINE 999009999 WENDY R COOLEY P01523804 4023302660 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z KELLY DRISCOLL 2700 WEST NORFOLK AVENUE NO 200 NORFOLK NE 68701 1414249 0 X WWW.FRHS.ORG/ABOUT-US/FOUNDATION/ X 1996 NE TO AID FAITH REGIONAL HEALTH SERVICES (FRHS) BY THE SOLICITATION OF GIFTS, GRANTS, DEVICES AND BEQUESTS EXCLUSIVELY FOR THE USE AND BENEFIT OF FRHS OR ITS PROGRAMS AND SERVICES. 18 17 0 28 0 0 997651 1055078 0 0 774611 269220 16814 50849 1789076 1375147 5688057 88567 0 0 0 0 0 0 25180 0 46505 5688057 135072 -3898981 1240075 12055232 14062496 107470 121379 11947762 13941117 TO AID FAITH REGIONAL HEALTH SERVICES (FRHS) BY THE SOLICITATION OF GIFTS, GRANTS, DEVICES AND BEQUESTS EXCLUSIVELY FOR THE USE AND BENEFITS OF FRHS OR ITS PROGRAMS AND SERVICES. 0 0 88567 88567 TO AID FAITH REGIONAL HEALTH SERVICES (FRHS) BY THE SOLICITATION OF GIFTS, GRANTS, DEVICES AND BEQUESTS EXCLUSIVELY FOR THE USE AND BENEFIT OF FRHS OR ITS PROGRAMS AND SERVICES. FRHS PROVIDES ACUTE, PREVENTATIVE AND OTHER HEALTHCARE SERVICES TO THE REGION WHILE ENCOURAGING EDUCATIONAL AND CLINICAL RESEARCH. FRHS SERVES ALL PATIENTS REGARDLESS OF THEIR ABILITY TO PAY AND DOES NOT LIMIT ITS SERVICES OR DISCRIMINATE AGAINST ANYONE ON THE BASIS OF RACE, SEX, NATIONAL ORIGIN, RELIGION OR DIAGNOSIS. 88567 1 1 0 0 0 0 0 0 0 1 0 0 0 0 1 1 0 1 0 0 0 0 0 0 1 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 1 1 0 0 0 0 0 0 X 18 17 1 0 0 0 0 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 X JANNA CLINE 4026447249 2700 WEST NORFOLK AVE STE 200 NORFOLK NE 68701 DR TRISTAN HARTZELL MEMBER 1.00 40.00 X 0 3743115 12690 JACQUE COLLISON PRESIDENT/LCHA BOARD REP 1.00 3.50 X X 0 0 0 JAN EINSPAHR VICE-PRESIDENT 1.00 0.00 X X 0 0 0 BRANDON DOKE PRESIDENT-ELECT 1.00 0.00 X X 0 0 0 TODD WRAGGE PAST PRESIDENT 1.00 0.00 X X 0 0 0 RUSS MCKILLIP SECRETARY/TREASURER 1.00 0.00 X X 0 0 0 DONALD BELL MD MEMBER 1.00 0.00 X 0 0 0 ALAN COLLISON MEMBER 1.00 0.00 X 0 0 0 PAT DELAY MEMBER 1.00 0.00 X 0 0 0 JARED JANSEN MEMBER 1.00 0.00 X 0 0 0 VIRGIL FROEHLICH MEMBER 1.00 0.00 X 0 0 0 RICK HIGGINS MEMBER 1.00 0.00 X 0 0 0 PATRICK HUGHES MEMBER 1.00 0.00 X 0 0 0 GORDON ADAMS MD MEMBER 1.00 0.00 X 0 0 0 JIM SCHEER FRHS BOARD REPRESENTATIVE 1.00 0.50 X 0 0 0 TOM SCHUETH MEMBER 1.00 0.00 X 0 0 0 HARRIET STUDEBAKER MEMBER 1.00 0.00 X 0 0 0 TIMOTHY TIGHE MEMBER 1.00 0.00 X 0 0 0 KELLY DRISCOLL CEO 1.00 40.00 X 0 571572 47310 JOHN WILKER VP FINANCE 1.00 40.00 X 0 302590 31809 RACHEL REISER FOUNDATION DIRECTOR 20.00 20.00 X 0 68885 28561 0 4686162 120370 0 0 1 0 0 172131 35000 847947 6921 1055078 269220 269220 89951 172131 39102 50849 50849 1375147 0 0 320069 88567 88567 21325 21325 10512 10512 MISCELLANEOUS FUNDRAISI 14668 14668 135072 88567 21325 25180 9122 2197 2704919 2946572 93735 220950 9233970 10892137 13486 640 12055232 14062496 19225 107470 102154 107470 121379 X 1264316 1409568 10683446 12531549 11947762 13941117 12055232 14062496 1240075 753280 0 X X 0 1 X 1 0 X X 1 FAITH REGIONAL HEALTH SERVICES 470796875 3 1 88567 0 1 88567 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 5523918 10000 1022500 1022500 5533918 8052916 15000 1454367 3998365 5523918 8361450 50 -308584 8052916 7601924 10000 749526 8361450 7172111 10010 419803 7601924 0.00932 0.99068 0.00000 0 0 0 ANNUITY PAYABLE 102154 102154 X PART V, LINE 4: CARSON CANCER CENTER ENDOWMENT FUNDS ARE PERMANENTLY SET ASIDE TO GENERATE INVESTMENT EARNINGS TO BE USED TO FUND CAPITAL EQUIPMENT PURCHASES AND/OR OPERATIONS OF THE CARSON REGIONAL CANCER CENTER. INVESTMENT EARNINGS ON THESE FUNDS ARE TEMPORARILY 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 TEMPORARILY RESTRICTED AS TO USE. THE CARDIAC SERVICES ENDOWMENT FUNDS ARE PERMANENTLY SET ASIDE TO GENERATE INVESTMENT EARNINGS TO FUND FAITH REGIONAL HEALTH SERVICE'S (FRHS) CARDIAC PROGRAM CAPITAL AND/OR OPERATIONAL EXPENSES. THE EDUCATION ENDOWMENT FUNDS ARE PERMANENTLY SET ASIDE TO GENERATE INVESTMENT EARNINGS TO BENEFIT FRHS'S EDUCATION PROGRAMS AND ITS EFFORTS TO RECRUIT AND RETAIN EMPLOYEES. INVESTMENT INCOME ON THESE FUNDS IS TEMPORARILY 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 TEMPORARILY RESTRICTED AS TO USE. THE PEDIATRIC ENDOWMENT FUNDS ARE PERMANENTLY SET ASIDE TO GENERATE INVESTMENT EARNINGS TO BENEFIT FRHS'S CHILDREN'S CARE FUND. DONORS MAY SPECIFY CONTRIBUTIONS TO ANY OF THE ENDOWMENT FUNDS. PART X, LINE 2: FAITH REGIONAL HEALTH SERVICES (FRHS) AND FAITH REGIONAL HEALTH SERVICES FOUNDATION (THE FOUNDATION) ARE NOT-FOR-PROFIT CORPORATIONS AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND ARE EXEMPT FROM FEDERAL AND NEBRASKA STATE INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. FAITH REGIONAL PHYSICIAN SERVICES (FRPS) IS A LIMITED LIABILITY COMPANY WHOLLY OWNED BY FRHS. THE INTERNAL REVENUE SERVICE HAS ESTABLISHED STANDARDS TO BE MET TO MAINTAIN TAX-EXEMPT STATUS. FAITH 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, 2020 AND 2019, FAITH HAD NO UNCERTAIN TAX POSITIONS ACCRUED. GOLF TOURNAMENT 78055 44824 33231 3874 6930 4234 12152 WINTER GALA 131647 91247 40400 2547 2500 3345 1 52380 36060 16320 500 2851 169 262082 172131 89951 6921 9781 4234 2500 15666 39102 50849 1 FAITH REGIONAL HEALTH SERVICES 2700 WEST NORFOLK AVENUE NORFOLK NE 68701 470796875 501(C)(3) 88567 FUNDING FOR HOSPITAL OPERATIONS AND PROJECTS 1 0 PART I, LINE 2: FAITH REGIONAL HEALTH SERVICES FOUNDATION PROVIDES GRANT MONEY TO FAITH REGIONAL HEALTH SERVICES, A RELATED 501(C)(3) ORGANIZATION. FAITH REGIONAL HEALTH SERVICES PROVIDES HEALTH CARE SERVICES TO INDIVIDUALS IN NORTHEAST NEBRASKA. 0 0 0 0 0 0 0 0 0 DR TRISTAN HARTZELL MEMBER 0 1035059 0 2707531 0 525 0 11400 0 1290 0 3755805 0 0 KELLY DRISCOLL CEO 0 559840 0 0 0 11732 0 11400 0 35910 0 618882 0 0 JOHN WILKER VP FINANCE 0 295920 0 0 0 6670 0 10588 0 21221 0 334399 0 0 PART I, LINE 3 FAITH REGIONAL HEALTH SERVICES FOUNDATION DOES NOT COMPENSATE ANY OFFICERS, DIRECTORS, OR KEY EMPLOYEES. THE COMPENSATION LISTED IN SCHEDULE J IS PAID BY FAITH REGIONAL HEALTH SERVICES (FRHS), A RELATED ENTITY. THEIR COMPENSATION IS DETERMINED BY GATHERING DATA FROM EXTERNAL SURVEYS AND FORM 990 DATA PROVIDED BY COMPARABLE FACILITIES. FACILITIES USED ARE SIMILAR IN SIZE OF HOSPITAL, REVENUE, AND NUMBER OF FTES. WAGES ARE GATHERED AND COMPARED BY TITLE, RESPONSIBILITIES AND YEARS OF EXPERIENCE. THE SALARY RECOMMENDATIONS ARE MADE BY THE FRHS HUMAN RESOURCES DEPARTMENT. THE FRHS 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 A, LINE 2 JACQUE COLLISON AND ALAN COLLISON, BOTH BOARD MEMBERS, HAVE A FAMILY RELATIONSHIP. FORM 990, PART VI, SECTION A, LINE 7A FAITH REGIONAL HEALTH SERVICES FOUNDATION'S BYLAWS STATE ALL DIRECTORS SHALL BE APPOINTED BY THE FAITH REGIONAL HEALTH SERVICES BOARD OF DIRECTORS. FORM 990, PART VI, SECTION A, LINE 7B BOARD MEMBER APPOINTMENT AND RETENTION DECISIONS MADE BY THE FOUNDATION BOARD ARE APPROVED BY THE FAITH REGIONAL HEALTH SERVICES BOARD OF DIRECTORS. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 AND ALL APPLICABLE SCHEDULES WERE PREPARED AND SIGNED BY SEIM JOHNSON, LLP IN OMAHA, NEBRASKA. COPIES OF THE COMPLETED RETURN WERE DISTRIBUTED TO THE BOARD MEMBERS FOR REVIEW PRIOR TO SUBMISSION TO THE IRS. FORM 990, PART VI, SECTION B, LINE 12C FAITH REGIONAL HEALTH SERVICES FOUNDATION BOARD MEMBERS COMPLETE A CONFLICT OF INTEREST STATEMENT AND DISCLOSURE ANNUALLY. THESE STATEMENTS ARE REVIEWED BY A DIRECTOR OF THE FOUNDATION. FORM 990, PART VI, SECTION B, LINE 15 FAITH REGIONAL HEALTH SERVICES FOUNDATION DOES NOT PAY COMPENSATION TO A CEO, EXECUTIVE DIRECTOR, TOP MANAGEMENT OFFICIAL,OR ANY KEY EMPLOYESS OF THE ORGANIZATION. THEREFORE, IT IS NOT NECESSARY FOR THE FOUNDATION TO HAVE A PROCESS TO DETERMINE COMPENSATION FOR THESE POSITIONS. FORM 990, PART VI, SECTION C, LINE 19 FAITH REGIONAL HEALTH SERVICES FOUNDATION DOES NOT MAKE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST STATEMENT, OR FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC. FORM 990, PART XII, LINE 2C: FAITH REGIONAL HEALTH SERVICES FOUNDATION HAS AN AUDIT COMPLETED ON A CONSOLIDATED BASIS WITH FAITH REGIONAL HEALTH SERVICES AND FAITH REGIONAL PHYSICIAN SERVICES, LLC. THE BOARD OF DIRECTORS OF FAITH REGIONAL HEALTH SERVICES ASSUMES RESPONSIBILITY FOR THE OVERSIGHT OF THE AUDIT AND THE SELECTION OF AN INDEPENDENT ACCOUNTANT. THERE HAVE BEEN NO CHANGES IN THIS PROCESS FROM PRIOR YEARS. FAITH REGIONAL HEALTH SERVICES 2700 W NORFOLK AVE NORFOLK NE 68701 470769875 PROVIDE HEALTHCARE SERVICES TO THE NORTHEAST NEBRASKA REGION NE 501(C)(3) 3 LUTHERAN COMMUNITY HOSPITAL ASSOCIATION 0 LUTHERAN COMMUNITY HOSPITAL ASSOCIATION 2700 W NORFOLK AVE NORFOLK NE 68701 470396139 SUPPORT FAITH REGIONAL HEALTH SERVICES NE 501(C)(3) 3 N/A 0 0 1 1 0 0 0 0 0 0 0 0 1 0 1 1 0 0 0 0