FAITH REGIONAL HEALTH SERVICES FOUNDATION: Form 990, tax year 2016
View the entire original 990 at ProPublica ↗
- Organization
- FAITH REGIONAL HEALTH SERVICES FOUNDATION (EIN 91-1772474)
- Tax period
- 2016-01-01 to 2016-12-31
- Filed
- 2017-11-14
- IRS object ID
- 201703189349305570
- Schema version
- 2016v3.0
- 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
- Form 990
- Schedule A
- Schedule B
- Schedule D
- Schedule G
- Schedule I
- Schedule J
- Schedule M
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2017-11-14T12:35:18-06:00 | ReturnTs |
| Tax Period End | 2016-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 476097913 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SEIM JOHNSON LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 18081 BURT STREET SUITE 200 | AddressLine1Txt |
| City | OMAHA | CityNm |
| State Abbreviation | NE | StateAbbreviationCd |
| ZIP | 680224722 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2016-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 911772474 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | FAITH REGIONAL HEALTH SERVICES | BusinessNameLine1Txt |
| Business Name Line2 | FOUNDATION | BusinessNameLine2Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | FAIT | BusinessNameControlTxt |
| Phone | 4026447301 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2700 WEST NORFOLK AVENUE NO 200 | AddressLine1Txt |
| City | NORFOLK | CityNm |
| State Abbreviation | NE | StateAbbreviationCd |
| ZIP | 68701 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | JOHN WILKER | PersonNm |
| Person Title | VP FINANCE | PersonTitleTxt |
| Phone | 4026447301 | PhoneNum |
| Signature | 2017-11-10 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | MEGAN L KOZIOL | PreparerPersonNm |
| PTIN | P01544037 | PTIN |
| Phone | 4023302660 | PhoneNum |
Filing Security Information FilingSecurityInformation
IP Address IPAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| I Pv4 Address | 209.34.201.180 | IPv4AddressTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IP | 2017-11-10 | IPDt |
| IP Tm | 14:02:36 | IPTm |
| IP Timezone | CS | IPTimezoneCd |
| Filing License Type | P | FilingLicenseTypeCd |
| At Submission Creation Device Id | E174F7C75A15FCA0AF1E43F729F0FF7E9FDF9AE2 | AtSubmissionCreationDeviceId |
| At Submission Filing Device Id | E174F7C75A15FCA0AF1E43F729F0FF7E9FDF9AE2 | AtSubmissionFilingDeviceId |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2016 | TaxYr |
| Build TS | 2017-02-10 21:41:12Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | JOHN WILKER | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2700 WEST NORFOLK AVENUE NO 200 | AddressLine1Txt |
| City | NORFOLK | CityNm |
| State Abbreviation | NE | StateAbbreviationCd |
| ZIP | 68701 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $1,330,242 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.FRHS.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1996 | FormationYr |
| Legal Domicile State | NE | LegalDomicileStateCd |
| Activity Or Mission | 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. | ActivityOrMissionDesc |
| Voting Members Governing Body | 19 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 18 | VotingMembersIndependentCnt |
| Total Employee | 0 | TotalEmployeeCnt |
| Total Volunteers | 45 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $1,525,744 | PYContributionsGrantsAmt |
| CY Contributions Grants | $1,149,134 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $0 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $0 | CYProgramServiceRevenueAmt |
| PY Investment Income | $42,966 | PYInvestmentIncomeAmt |
| CY Investment Income | $92,068 | CYInvestmentIncomeAmt |
| PY Other Revenue | -$37,995 | PYOtherRevenueAmt |
| CY Other Revenue | -$18,518 | CYOtherRevenueAmt |
| PY Total Revenue | $1,530,715 | PYTotalRevenueAmt |
| CY Total Revenue | $1,222,684 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $35,236 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $742,878 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $0 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $0 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $33,548 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $34,527 | PYOtherExpensesAmt |
| CY Other Expenses | $51,331 | CYOtherExpensesAmt |
| PY Total Expenses | $69,763 | PYTotalExpensesAmt |
| CY Total Expenses | $794,209 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $1,460,952 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $428,475 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $11,622,257 | TotalAssetsBOYAmt |
| Total Assets EOY | $12,540,773 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $122,720 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $192,958 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $11,499,537 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $12,347,815 | NetAssetsOrFundBalancesEOYAmt |
| Mission | 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. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $742,878 | ExpenseAmt |
| Grant | $742,878 | GrantAmt |
| Desc | 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. | Desc |
| Total Program Service Expenses | $742,878 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Temp Or Permanent Endowments | Yes (1) | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | 0 | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | Yes (1) | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | 0 | OperateHospitalInd |
| Grants To Organizations | Yes (1) | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | Yes (1) | DeductibleNonCashContriInd |
| Deductible Art Contribution | Yes (1) | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | Yes (1) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | 0 | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 1 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 0 | EmployeeCnt |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | Yes (1) | QuidProQuoContributionsInd |
| Quid Pro Quo Contri Discl | Yes (1) | QuidProQuoContriDisclInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 19 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 18 | IndependentVotingMemberCnt |
| Family Or Business Rln | Yes (1) | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | 0 | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (1) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | 0 | CompensationProcessCEOInd |
| Compensation Process Other | 0 | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | JOHN WILKER | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 4026447249 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2700 WEST NORFOLK AVE STE 200 | AddressLine1Txt |
| City | NORFOLK | CityNm |
| State Abbreviation | NE | StateAbbreviationCd |
| ZIP | 68701 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (24 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt |
|---|---|---|---|---|---|---|---|
| TODD WRAGGE MD | |||||||
| PRESIDENT | 1.00 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 |
| BRANDON DOKE | |||||||
| VICE-PRESIDENT | 1.00 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 |
| JACQUE COLLISON | |||||||
| PRESIDENT-ELECT/ LCHA BOARD REPRESENTATIVE | 1.00 | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 |
| GORDON ADAMS MD | |||||||
| PAST PRESIDENT | 1.00 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 |
| RUSS MCKILLIP | |||||||
| SECRETARY/TREASURER | 1.00 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 |
| DONALD BELL MD | |||||||
| MEMBER | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| ALAN COLLISON | |||||||
| MEMBER | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| PAT DELAY | |||||||
| MEMBER | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| JAN EINSPAHR | |||||||
| MEMBER | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| VIRGIL FROEHLICH | |||||||
| MEMBER | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| DR TRISTAN HARTZELL | |||||||
| MEMBER (FROM 2/24/2016) | 1.00 | 40.00 | Yes (X) | $0 | $2,946,020 | $34,520 | |
| DONNA HERRICK | |||||||
| LCH BOARD REPRESENTATIVE (THRU 2/24/16) | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | |
| RICK HIGGINS | |||||||
| MEMBER | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| PAT HUGHES | |||||||
| MEMBER | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| ELEANOR MCINTOSH | |||||||
| MEMBER (THRU 2/24/2016) | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| J PAUL MCINTOSH | |||||||
| MEMBER | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| JIM SCHEER | |||||||
| FRHS BOARD REPRESENTATIVE | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | |
| TOM SCHUETH | |||||||
| MEMBER | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| JOHN SEHI | |||||||
| MEMBER | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| HARRIET STUDEBAKER | |||||||
| MEMBER | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| TIMOTHY TIGHE | |||||||
| MEMBER | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| MARK KLOSTERMAN | |||||||
| CEO | 1.00 | 40.00 | Yes (X) | $0 | $517,257 | $31,301 | |
| JOHNATHAN WILKER | |||||||
| VP FINANCE | 1.00 | 40.00 | Yes (X) | $0 | $214,956 | $16,792 | |
| JAKE CLAUSSEN | |||||||
| FOUNDATION DIRECTOR | 20.00 | 20.00 | Yes (X) | $0 | $92,153 | $8,079 | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $0 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $3,770,386 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $90,692 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 0 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
| Cntrct Rcvd Greater Than100 K | 0 | CntrctRcvdGreaterThan100KCnt |
| Fundraising | $141,255 | FundraisingAmt |
| Related Organizations | $32,635 | RelatedOrganizationsAmt |
| All Other Contributions | $975,244 | AllOtherContributionsAmt |
| Noncash Contributions | $64,794 | NoncashContributionsAmt |
| Total Contributions | $1,149,134 | TotalContributionsAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $92,068 | TotalRevenueColumnAmt |
| Exclusion | $92,068 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Fundraising Gross Income | $89,040 | FundraisingGrossIncomeAmt |
| Contri Rpt Fundraising Event | $141,255 | ContriRptFundraisingEventAmt |
| Fundraising Direct Expenses | $107,558 | FundraisingDirectExpensesAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$18,518 | TotalRevenueColumnAmt |
| Exclusion | -$18,518 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,222,684 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $0 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $73,550 | ExclusionAmt |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $742,878 | TotalAmt |
| Program Services | $742,878 | ProgramServicesAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $17,783 | TotalAmt |
| Management And General | $17,783 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,394 | TotalAmt |
| Fundraising | $2,394 | FundraisingAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | FundraisingFundraisingAmt |
|---|---|---|
| CHILD ADVOCACY | $16,754 | $16,754 |
| NUCOR GOLF TOURNAMENT | $10,364 | $10,364 |
| SALES AND USE TAX | $1,964 | $1,964 |
| ANNUITY PAYMENTS | $1,369 | $1,369 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $703 | TotalAmt |
| Fundraising | $703 | FundraisingAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $794,209 | TotalAmt |
| Program Services | $742,878 | ProgramServicesAmt |
| Management And General | $17,783 | ManagementAndGeneralAmt |
| Fundraising | $33,548 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,343 | BOYAmt |
| EOY | $614 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,227,071 | BOYAmt |
| EOY | $5,704,356 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,651 | BOYAmt |
| EOY | $0 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,380,192 | BOYAmt |
| EOY | $6,835,803 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,622,257 | BOYAmt |
| EOY | $12,540,773 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $70,520 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $122,720 | BOYAmt |
| EOY | $122,438 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $122,720 | BOYAmt |
| EOY | $192,958 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,470,009 | BOYAmt |
| EOY | $1,567,227 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,592,228 | BOYAmt |
| EOY | $5,333,278 | EOYAmt |
Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,437,300 | BOYAmt |
| EOY | $5,447,310 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,499,537 | BOYAmt |
| EOY | $12,347,815 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,622,257 | BOYAmt |
| EOY | $12,540,773 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $428,475 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $419,803 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Info In Schedule O Part XII | Yes (X) | InfoInScheduleOPartXIIInd |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Supporting Organization509a3 | Yes (X) | SupportingOrganization509a3Ind |
| Supporting Org Type1 | Yes (X) | SupportingOrgType1Ind |
| Supported Organizations | 1 | SupportedOrganizationsCnt |
Supported Org Information SupportedOrgInformationGrp
Supported Organization Name SupportedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | FAITH REGIONAL HEALTH SERVICES | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 470796875 | EIN |
| Organization Type | 3 | OrganizationTypeCd |
| Governing Document Listed | Yes (1) | GoverningDocumentListedInd |
| Support | $742,878 | SupportAmt |
| Other Support | $0 | OtherSupportAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Supported Organizations Total | 1 | SupportedOrganizationsTotalCnt |
| Support Sum | $742,878 | SupportSumAmt |
| Other Support Sum | $0 | OtherSupportSumAmt |
Form990 Sch A Supporting Org Form990SchASupportingOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Listed By Name Governing Doc | Yes (1) | ListedByNameGoverningDocInd |
| Suprt Org No IRS Determination | 0 | SuprtOrgNoIRSDeterminationInd |
| Supported Org Section C456 | 0 | SupportedOrgSectionC456Ind |
| Supported Org Not Organized US | 0 | SupportedOrgNotOrganizedUSInd |
| Organization Change Suprt Org | 0 | OrganizationChangeSuprtOrgInd |
| Support Non Supported Org | 0 | SupportNonSupportedOrgInd |
| Payment Substantial Contribtr | 0 | PaymentSubstantialContribtrInd |
| Loan Disqualified Person | 0 | LoanDisqualifiedPersonInd |
| Controlled Disqualified Prsn | 0 | ControlledDisqualifiedPrsnInd |
| Disqualified Prsn Controll Int | 0 | DisqualifiedPrsnControllIntInd |
| Disqualified Prsn Ownr Int | 0 | DisqualifiedPrsnOwnrIntInd |
| Excess Business Holdings Rules | 0 | ExcessBusinessHoldingsRulesInd |
| Contribution Controller | 0 | ContributionControllerInd |
| Contribution Family | 0 | ContributionFamilyInd |
| Contribution35 Controlled | 0 | Contribution35ControlledInd |
Form990 Sch A Type1 Suprt Org Form990SchAType1SuprtOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Power Appoint Majority Dir Trst | Yes (1) | PowerAppointMajorityDirTrstInd |
| Operate Benefit Non Suprt Org | 0 | OperateBenefitNonSuprtOrgInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule D IRS990ScheduleD
CY Endwmt Fund CYEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $7,172,111 | BeginningYearBalanceAmt |
| Contributions | $10,010 | ContributionsAmt |
| Investment Earnings Or Losses | $419,803 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $7,601,924 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $7,388,088 | BeginningYearBalanceAmt |
| Contributions | $11,370 | ContributionsAmt |
| Investment Earnings Or Losses | -$209,870 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $17,477 | OtherExpendituresAmt |
| End Year Balance | $7,172,111 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $7,065,293 | BeginningYearBalanceAmt |
| Contributions | $12,155 | ContributionsAmt |
| Investment Earnings Or Losses | $310,640 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $166,091 | OtherExpendituresAmt |
| End Year Balance | $7,221,997 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $6,024,571 | BeginningYearBalanceAmt |
| Contributions | $25,899 | ContributionsAmt |
| Investment Earnings Or Losses | $1,029,674 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $14,851 | OtherExpendituresAmt |
| End Year Balance | $7,065,293 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $5,578,113 | BeginningYearBalanceAmt |
| Contributions | $12,162 | ContributionsAmt |
| Investment Earnings Or Losses | $444,388 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $10,092 | OtherExpendituresAmt |
| End Year Balance | $6,024,571 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Designated Balance EOY | 0.00680 | BoardDesignatedBalanceEOYPct |
| Prmnnt Endowment Balance EOY | 0.71660 | PrmnntEndowmentBalanceEOYPct |
| Term Endowment Balance EOY | 0.27660 | TermEndowmentBalanceEOYPct |
| Endowments Held Unrelated Org | 0 | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | 0 | EndowmentsHeldRelatedOrgInd |
| Total Book Value Land Buildings | $0 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | ANNUITY PAYABLE | Desc |
| Amt | $122,438 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $122,438 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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, 2016 AND 2015, FAITH HAD NO UNCERTAIN TAX POSITIONS ACCRUED. |
Schedule G IRS990ScheduleG
Fundraising Event Information FundraisingEventInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Event1 | GOLF TOURNAMENT | Event1Nm |
| Gross Receipts Event1 | $49,792 | GrossReceiptsEvent1Amt |
| Charitable Contri Event1 | $27,388 | CharitableContriEvent1Amt |
| Gross Revenue Event1 | $22,404 | GrossRevenueEvent1Amt |
| Cash Prizes Event1 | $4,550 | CashPrizesEvent1Amt |
| Non Cash Prizes Event1 | $4,088 | NonCashPrizesEvent1Amt |
| Rent Facility Costs Event1 | $14,805 | RentFacilityCostsEvent1Amt |
| Other Direct Expenses Event1 | $4,193 | OtherDirectExpensesEvent1Amt |
| Event2 | WINTER GALA | Event2Nm |
| Gross Receipts Event2 | $180,503 | GrossReceiptsEvent2Amt |
| Charitable Contri Event2 | $113,867 | CharitableContriEvent2Amt |
| Gross Revenue Event2 | $66,636 | GrossRevenueEvent2Amt |
| Cash Prizes Event2 | $1,000 | CashPrizesEvent2Amt |
| Non Cash Prizes Event2 | $32,397 | NonCashPrizesEvent2Amt |
| Rent Facility Costs Event2 | $19,325 | RentFacilityCostsEvent2Amt |
| Entertainment Event2 | $2,875 | EntertainmentEvent2Amt |
| Other Direct Expenses Event2 | $24,325 | OtherDirectExpensesEvent2Amt |
| Gross Receipts Total | $230,295 | GrossReceiptsTotalAmt |
| Charitable Contributions Tot | $141,255 | CharitableContributionsTotAmt |
| Gross Revenue Total Events | $89,040 | GrossRevenueTotalEventsAmt |
| Cash Prizes Total Events | $5,550 | CashPrizesTotalEventsAmt |
| Non Cash Prizes Total Events | $36,485 | NonCashPrizesTotalEventsAmt |
| Rent Fclty Costs Total Events | $34,130 | RentFcltyCostsTotalEventsAmt |
| Entertainment Total Events | $2,875 | EntertainmentTotalEventsAmt |
| Oth Direct Expnss Total Events | $28,518 | OthDirectExpnssTotalEventsAmt |
| Direct Expense Summary Events | $107,558 | DirectExpenseSummaryEventsAmt |
| Net Income Summary | -$18,518 | NetIncomeSummaryAmt |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (1) | GrantRecordsMaintainedInd |
Recipient Table RecipientTable
Recipient Business Name RecipientBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | FAITH REGIONAL HEALTH SERVICES | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2700 WEST NORFOLK AVENUE | AddressLine1Txt |
| City | NORFOLK | CityNm |
| State Abbreviation | NE | StateAbbreviationCd |
| ZIP | 68701 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Recipient EIN | 470796875 | RecipientEIN |
| IRC Section | 501(C)(3) | IRCSectionDesc |
| Cash Grant | $742,878 | CashGrantAmt |
| Purpose Of Grant | FUNDING FOR HOSPITAL OPERATIONS AND PROJECTS | PurposeOfGrantTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 1 | Total501c3OrgCnt |
| Total Other Org | 0 | TotalOtherOrgCnt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 2: | FormAndLineReferenceDesc |
| Explanation | 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. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (3 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| DR TRISTAN HARTZELL | ||||||||||||||
| MEMBER (FROM 2/24/2016) | $0 | $951,117 | $0 | $1,994,251 | $0 | $652 | $0 | $7,950 | $0 | $26,570 | $0 | $2,980,540 | $0 | $0 |
| MARK KLOSTERMAN | ||||||||||||||
| CEO | $0 | $507,114 | $0 | $422 | $0 | $9,721 | $0 | $7,950 | $0 | $23,351 | $0 | $548,558 | $0 | $0 |
| JOHNATHAN WILKER | ||||||||||||||
| VP FINANCE | $0 | $213,105 | $0 | $422 | $0 | $1,429 | $0 | $0 | $0 | $16,792 | $0 | $231,748 | $0 | $0 |
Schedule M IRS990ScheduleM
Works Of Art WorksOfArtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Non Cash Checkbox | Yes (X) | NonCashCheckboxInd |
| Contribution | 2 | ContributionCnt |
| Noncash Contributions Rpt F990 | $575 | NoncashContributionsRptF990Amt |
| Method Of Determining Revenues | FMV | MethodOfDeterminingRevenuesTxt |
Clothing And Household Goods ClothingAndHouseholdGoodsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Non Cash Checkbox | Yes (X) | NonCashCheckboxInd |
| Noncash Contributions Rpt F990 | $8,111 | NoncashContributionsRptF990Amt |
| Method Of Determining Revenues | FMV | MethodOfDeterminingRevenuesTxt |
Collectibles CollectiblesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Non Cash Checkbox | Yes (X) | NonCashCheckboxInd |
| Contribution | 5 | ContributionCnt |
| Noncash Contributions Rpt F990 | $1,315 | NoncashContributionsRptF990Amt |
| Method Of Determining Revenues | FMV | MethodOfDeterminingRevenuesTxt |
Food Inventory FoodInventoryGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Non Cash Checkbox | Yes (X) | NonCashCheckboxInd |
| Contribution | 4 | ContributionCnt |
| Noncash Contributions Rpt F990 | $1,605 | NoncashContributionsRptF990Amt |
| Method Of Determining Revenues | FMV | MethodOfDeterminingRevenuesTxt |
Other Non Cash Contri Table OtherNonCashContriTableGrp (7 entries)
| Non Cash CheckboxNonCashCheckboxInd | DescDesc | ContributionContributionCnt | Noncash Contributions Rpt F990NoncashContributionsRptF990Amt | Method Of Determining RevenuesMethodOfDeterminingRevenuesTxt |
|---|---|---|---|---|
| Yes (X) | SPORTING EQUIPMENT | 16 | $5,713 | FMV |
| Yes (X) | TICKETS | 21 | $5,375 | FMV |
| Yes (X) | OTHER MISCELLANEOUS ITEMS | 12 | $3,476 | FMV |
| Yes (X) | GIFT BASKETS | 17 | $3,470 | FMV |
| Yes (X) | GIFT CERTIFICATES | 15 | $3,348 | GIFT CERTIFICATE VAL |
| Yes (X) | ELECTRONICS | 7 | $2,418 | FMV |
| Yes (X) | RECREATION TRIPS | 2 | $1,080 | FMV |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Any Property That Must Be Held | 0 | AnyPropertyThatMustBeHeldInd |
| Review Process Unusual NC Gifts | Yes (1) | ReviewProcessUnusualNCGiftsInd |
| Third Parties Used | 0 | ThirdPartiesUsedInd |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (8 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 2 | JACQUE COLLISON AND ALAN COLLISON, BOTH BOARD MEMBERS, HAVE A FAMILY RELATIONSHIP. FURTHERMORE, BOARD MEMBERS ELEANOR MCINTOSH AND J. PAUL MCINTOSH, 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 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 VI, SECTION B, LINE 15: | FAITH REGIONAL HEALTH SERVICES FOUNDATION DOES NOT PAY COMPENSATION TO A CEO, EXECUTIVE DIRECTOR, TOP MANAGEMENT OFFICIAL, OFFICERS OR KEY EMPLOYESS OF THE ORGANIZATION. THEREFORE, QUESTION 15A AND 15B ARE ANSWERED NO. |
| 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. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (3 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Controlled OrganizationControlledOrganizationInd | Direct Controlling NADirectControllingNACd |
|---|---|---|---|---|---|---|---|---|---|---|---|
| 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 | 0 | N/A | |
| FAITH REGIONAL HEALTH SERVICES PHO INC | |||||||||||
| 2700 W NORFOLK AVE | NORFOLK | NE | 68701 | IMPROVE HEALTHCARE SERVICES | NE | PENDING | FAITH REGIONAL HEALTH SERVICES | Yes (1) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | Yes (1) | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (1) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | Yes (1) | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | 0 | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (1) | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
Comments