CHEYENNE COUNTY HOSPITAL & HEALTH CENTER FOUNDATION: Form 990, tax year 2019

View the entire original 990 at ProPublica ↗

Organization
CHEYENNE COUNTY HOSPITAL & HEALTH CENTER FOUNDATION (EIN 47-0686476)
Tax period
2019-01-01 to 2019-12-31
Filed
2020-11-16
IRS object ID
202003219349317935
Schema version
2019v5.1
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)
Return2020-11-16T15:55:38-06:00ReturnTs
Tax Period End2019-12-31TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN476097913PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1SEIM JOHNSON LLPBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line118081 BURT STREET SUITE 200AddressLine1Txt
CityOMAHACityNm
State AbbreviationNEStateAbbreviationCd
ZIP680224722ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2019-01-01TaxPeriodBeginDt

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)
PersonKELLY UTLEYPersonNm
Person TitleCFOPersonTitleTxt
Phone3082545825PhoneNum
Signature2020-11-13SignatureDt
Discuss With Paid PreparerYes (1)DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonMEGAN L KOZIOLPreparerPersonNm
PTINP01544037PTIN
Phone4023302660PhoneNum

Filing Security Information FilingSecurityInformation

IP Address IPAddress

FieldValueIRS element (for citing)
I Pv4 Address163.116.133.113IPv4AddressTxt
FieldValueIRS element (for citing)
IP2020-11-13IPDt
IP Tm13:16:59IPTm
IP TimezoneCSIPTimezoneCd
Filing License TypePFilingLicenseTypeCd
At Submission Creation Device IdB319C935D5CD5DD24452FA9CD51ABCBD1A9C8C2CAtSubmissionCreationDeviceId
At Submission Filing Device IdB319C935D5CD5DD24452FA9CD51ABCBD1A9C8C2CAtSubmissionFilingDeviceId
FieldValueIRS element (for citing)
Tax2019TaxYr
Build TS2021-01-29 14:40:06ZBuildTS

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$60,157GrossReceiptsAmt
Group Return For Affiliates0GroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website AddressWWW.SIDNEYRMC.COMWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation1985FormationYr
Legal Domicile StateNELegalDomicileStateCd
Activity Or MissionHEALTH CENTER FOUNDATION SUPPORTS SIDNEY REGIONAL MEDICAL CENTER IN THEIR QUEST TO PROVIDE THE MOST UP-TO-DATE FACILITIES, EQUIPMENT AND SERVICES. THROUGH OUR RESPONSIBLE DONATION MANAGEMENT, WE ARE HELPING TO ASSURE THAT OUR COMMUNITY WILL CONTINUE TO HAVE LOCAL, QUALITY HEALTH CARE AND CURRENT STATE-OF-THE-ART TECHNOLOGIES, IN A FACILITY MAINTAINED AND UPDATED TO MEET THE EMERGING AND GROWING NEEDS OF CHEYENNE COUNTY AND THE SURROUNDING REGIONS.ActivityOrMissionDesc
Voting Members Governing Body8VotingMembersGoverningBodyCnt
Voting Members Independent8VotingMembersIndependentCnt
Total Employee0TotalEmployeeCnt
Total Volunteers70TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$31,523PYContributionsGrantsAmt
CY Contributions Grants$28,875CYContributionsGrantsAmt
PY Program Service Revenue$0PYProgramServiceRevenueAmt
CY Program Service Revenue$0CYProgramServiceRevenueAmt
PY Investment Income$33,416PYInvestmentIncomeAmt
CY Investment Income$28,189CYInvestmentIncomeAmt
PY Other Revenue-$3,710PYOtherRevenueAmt
CY Other Revenue-$6,096CYOtherRevenueAmt
PY Total Revenue$61,229PYTotalRevenueAmt
CY Total Revenue$50,968CYTotalRevenueAmt
PY Grants And Similar Paid$14,844PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$13,014CYGrantsAndSimilarPaidAmt
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$11,468CYTotalFundraisingExpenseAmt
PY Other Expenses$15,029PYOtherExpensesAmt
CY Other Expenses$11,468CYOtherExpensesAmt
PY Total Expenses$29,873PYTotalExpensesAmt
CY Total Expenses$24,482CYTotalExpensesAmt
PY Revenues Less Expenses$31,356PYRevenuesLessExpensesAmt
CY Revenues Less Expenses$26,486CYRevenuesLessExpensesAmt
Total Assets BOY$1,562,301TotalAssetsBOYAmt
Total Assets EOY$1,656,652TotalAssetsEOYAmt
Total Liabilities BOY$0TotalLiabilitiesBOYAmt
Total Liabilities EOY$0TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$1,562,301NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$1,656,652NetAssetsOrFundBalancesEOYAmt
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$3,074ExpenseAmt
Grant$3,074GrantAmt
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$9,940ExpenseAmt
Grant$9,940GrantAmt
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$0ExpenseAmt
Grant$0GrantAmt
DescPROVIDE FUNDING TO ASSIST WITH DENTAL PROCEDURES FOR THOSE IN NEED.Desc
FieldValueIRS element (for citing)
Total Program Service Expenses$13,014TotalProgramServiceExpensesAmt
Described In Section501c3Yes (1)DescribedInSection501c3Ind
Schedule B Required0ScheduleBRequiredInd
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 Organizations0GrantsToOrganizationsInd
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 Members8GoverningBodyVotingMembersCnt
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 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 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 (9 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtOfficerOfficerIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorInd
KELLY UTLEY
EXECUTIVE DIRECTOR1.0039.00Yes (X)$0$181,083$8,360
BILL BUTKUS
PRESIDENT1.000.00Yes (X)$0$0$0Yes (X)
GERALD BERLAGE
VICE PRESIDENT1.000.00Yes (X)$0$0$0Yes (X)
LEASA DORNBIER
SECRETARY1.000.00Yes (X)$0$0$0Yes (X)
SEAN DOYLE
TREASURER1.000.00Yes (X)$0$0$0Yes (X)
STAN BELIEU
MEMBER1.004.00$0$0$0Yes (X)
SHERI EHLER
MEMBER1.000.00$0$0$0Yes (X)
VICKIE SMITH
MEMBER1.000.00$0$0$0Yes (X)
NANCI MCCASLIN
MEMBER1.004.00$0$0$0Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$0TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$181,083TotReportableCompRltdOrgAmt
Total Other Compensation$8,360TotalOtherCompensationAmt
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$17,070FundraisingAmt
All Other Contributions$11,805AllOtherContributionsAmt
Total Contributions$28,875TotalContributionsAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$13,336TotalRevenueColumnAmt
Exclusion$13,336ExclusionAmt

Less Rental Expenses LessRentalExpensesGrp

FieldValueIRS element (for citing)
Real$3,780RealAmt

Rental Income Or Loss RentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Real-$3,780RealAmt

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column-$3,780TotalRevenueColumnAmt
Exclusion-$3,780ExclusionAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

FieldValueIRS element (for citing)
Securities$14,853SecuritiesAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

FieldValueIRS element (for citing)
Securities$0SecuritiesAmt

Gain Or Loss GainOrLossGrp

FieldValueIRS element (for citing)
Securities$14,853SecuritiesAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

FieldValueIRS element (for citing)
Total Revenue Column$14,853TotalRevenueColumnAmt
Exclusion$14,853ExclusionAmt
FieldValueIRS element (for citing)
Fundraising Gross Income$3,093FundraisingGrossIncomeAmt
Contri Rpt Fundraising Event$17,070ContriRptFundraisingEventAmt
Fundraising Direct Expenses$5,409FundraisingDirectExpensesAmt

Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp

FieldValueIRS element (for citing)
Total Revenue Column-$2,316TotalRevenueColumnAmt
Exclusion-$2,316ExclusionAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$50,968TotalRevenueColumnAmt
Related Or Exempt Func Income$0RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$22,093ExclusionAmt

Grants To Domestic Orgs GrantsToDomesticOrgsGrp

FieldValueIRS element (for citing)
Total$3,074TotalAmt
Program Services$3,074ProgramServicesAmt

Grants To Domestic Individuals GrantsToDomesticIndividualsGrp

FieldValueIRS element (for citing)
Total$9,940TotalAmt
Program Services$9,940ProgramServicesAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$2,200TotalAmt
Fundraising$2,200FundraisingAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$85TotalAmt
Fundraising$85FundraisingAmt

Conferences Meetings ConferencesMeetingsGrp

FieldValueIRS element (for citing)
Total$519TotalAmt
Fundraising$519FundraisingAmt

Payments To Affiliates PaymentsToAffiliatesGrp

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

Other Expenses OtherExpensesGrp (2 entries)

DescDescTotalTotalAmtFundraisingFundraisingAmt
MISCELLANEOUS FUNDRAISI$5,586$5,586
DUES & SUBSCRIPTIONS$70$70

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$24,482TotalAmt
Program Services$13,014ProgramServicesAmt
Management And General$0ManagementAndGeneralAmt
Fundraising$11,468FundraisingAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$1,071,845BOYAmt
EOY$1,080,095EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$202,590LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$55,555LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$150,043BOYAmt
EOY$147,035EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

FieldValueIRS element (for citing)
BOY$340,413BOYAmt
EOY$429,522EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$1,562,301BOYAmt
EOY$1,656,652EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt
FieldValueIRS element (for citing)
Organization Follows FASB117Yes (X)OrganizationFollowsFASB117Ind

No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp

FieldValueIRS element (for citing)
BOY$1,319,859BOYAmt
EOY$1,411,471EOYAmt

Donor Restriction Net Assets DonorRestrictionNetAssetsGrp

FieldValueIRS element (for citing)
BOY$242,442BOYAmt
EOY$245,181EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$1,562,301BOYAmt
EOY$1,656,652EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$1,562,301BOYAmt
EOY$1,656,652EOYAmt
FieldValueIRS element (for citing)
Reconcilation Revenue Expnss$26,486ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst$67,865NetUnrlzdGainsLossesInvstAmt
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$3,074SupportAmt
Other Support$0OtherSupportAmt
FieldValueIRS element (for citing)
Supported Organizations Total1SupportedOrganizationsTotalCnt
Support Sum$3,074SupportSumAmt
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 2019, 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 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$54,636DepreciationAmt
Book Value$20,552BookValueAmt

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$147,035TotalBookValueLandBuildingsAmt
Footnote TextYes (X)FootnoteTextInd

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferencePART X, LINE 2:FormAndLineReferenceDesc
ExplanationSIDNEY REGIONAL MEDICAL CENTER AND CHEYENNE COUNTY HOSPITAL AND HEALTH CENTER FOUNDATION ARE EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE INTERNAL REVENUE CODE AND A SIMILAR PROVISION OF STATE LAW. THE INTERNAL REVENUE SERVICE HAS ESTABLISHED STANDARDS TO BE MET TO MAINTAIN TAX-EXEMPT STATUS. THE SYSTEM ACCOUNTS FOR UNCERTAINTIES IN ACCOUNTING FOR INCOME TAX ASSETS AND LIABILITIES USING GUIDANCE INCLUDED IN FASB ASC 740, INCOME TAXES. THE SYSTEM RECOGNIZES THE EFFECT OF INCOME TAX POSITIONS ONLY IF THOSE POSITIONS ARE MORE LIKELY THAN NOT OF BEING SUSTAINED. AT DECEMBER 31, 2019, THE SYSTEM HAD NO UNCERTAIN TAX POSITIONS ACCRUED.ExplanationTxt

Schedule G IRS990ScheduleG

Fundraising Event Information FundraisingEventInformationGrp

FieldValueIRS element (for citing)
Event1GOLF TOURNAMENTEvent1Nm
Gross Receipts Event1$20,163GrossReceiptsEvent1Amt
Charitable Contri Event1$17,070CharitableContriEvent1Amt
Gross Revenue Event1$3,093GrossRevenueEvent1Amt
Non Cash Prizes Event1$1,905NonCashPrizesEvent1Amt
Rent Facility Costs Event1$1,449RentFacilityCostsEvent1Amt
Other Direct Expenses Event1$2,055OtherDirectExpensesEvent1Amt
Gross Receipts Total$20,163GrossReceiptsTotalAmt
Charitable Contributions Tot$17,070CharitableContributionsTotAmt
Gross Revenue Total Events$3,093GrossRevenueTotalEventsAmt
Non Cash Prizes Total Events$1,905NonCashPrizesTotalEventsAmt
Rent Fclty Costs Total Events$1,449RentFcltyCostsTotalEventsAmt
Oth Direct Expnss Total Events$2,055OthDirectExpnssTotalEventsAmt
Direct Expense Summary Events$5,409DirectExpenseSummaryEventsAmt
Net Income Summary-$2,316NetIncomeSummaryAmt

Schedule I IRS990ScheduleI

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

Grants Other Asst To Indiv In US GrantsOtherAsstToIndivInUSGrp (2 entries)

Grant TypeGrantTypeTxtRecipientRecipientCntCash GrantCashGrantAmt
INTERN PROGRAM2$7,940
SCHOLARSHIP PROGRAM2$2,000

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. THE FUNDS ARE UTILIZED FOR ASSET PURCHASES AND OPERATIONS OF THE HOSPITAL. THE INTERNSHIP AND SCHOLARSHIP PROGRAM GRANTS LEARNING OPPORTUNITIES TO INDIVIDUALS IN THE AREA CURRENTLY STUDYING IN THE HEALTH CARE FIELD.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

FieldValueIRS element (for citing)
PersonKELLY UTLEYPersonNm
TitleEXECUTIVE DIRECTORTitleTxt
Base Compensation Filing Org$0BaseCompensationFilingOrgAmt
Compensation Based On Rltd Orgs$180,412CompensationBasedOnRltdOrgsAmt
Bonus Filing Organization$0BonusFilingOrganizationAmount
Bonus Related Organizations$0BonusRelatedOrganizationsAmt
Other Compensation Filing Org$0OtherCompensationFilingOrgAmt
Other Compensation Rltd Orgs$671OtherCompensationRltdOrgsAmt
Deferred Compensation Flng Org$0DeferredCompensationFlngOrgAmt
Deferred Comp Rltd Orgs$8,360DeferredCompRltdOrgsAmt
Nontaxable Benefits Filing Org$0NontaxableBenefitsFilingOrgAmt
Nontaxable Benefits Rltd Orgs$0NontaxableBenefitsRltdOrgsAmt
Total Compensation Filing Org$0TotalCompensationFilingOrgAmt
Total Compensation Rltd Orgs$189,443TotalCompensationRltdOrgsAmt
Comp Report Prior990 Filing Org$0CompReportPrior990FilingOrgAmt
Comp Report Prior990 Rltd Orgs$0CompReportPrior990RltdOrgsAmt

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferencePART I, LINE 3FormAndLineReferenceDesc
ExplanationKELLY UTLEY, THE EXECUTIVE DIRECTOR 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 FOR THE EXECUTIVE DIRECTOR.ExplanationTxt

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (4 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
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 EXECUTIVE DIRECTOR 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 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 Org0GiftGrntCapContriFromOthOrgInd
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.