2014-11-17T12:42:37-06:00 2013-12-31 476097913 SEIM JOHNSON LLP 18081 BURT STREET SUITE 200 OMAHA NE 680224722 990 2013-01-01 911772474 FAITH REGIONAL HEALTH SERVICES FOUNDATION FAIT 4026447301 2700 WEST NORFOLK AVENUE NO 200 NORFOLK NE 68701 JOHN WILKER CFO 4026447301 2014-11-08 1 BARBARA J FAJEN P00400874 4023302660 2013 2015-11-30 17:44:51Z JOHN WILKER 2700 WEST NORFOLK AVENUE NO 200 NORFOLK NE 68701 657227 0 X WWW.FRHS.ORG 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. FRHS PROVIDES ACUTE, PREVENTIVE 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. 17 16 0 20 0 0 1859393 333979 0 0 90432 161597 48548 31170 1998373 526746 1001338 955478 0 0 0 0 0 0 60049 34573 74900 1035911 1030378 962462 -503632 10042900 10483330 99433 117771 9943467 10365559 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 955478 955478 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. 955478 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 1 0 1 1 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 1 1 0 0 0 0 X 17 16 1 0 0 0 0 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 X JOHN WILKER 4026447249 2700 WEST NORFOLK AVE STE 200 NORFOLK NE 68701 GORDON ADAMS MD PRESIDENT 1.00 0.00 X X 0 0 0 JACQUE COLLISON VICE-PRESIDENT 1.00 1.00 X X 0 0 0 TODD WRAGGE MD PRESIDENT-ELECT 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 BRANDON DOKE MEMBER 1.00 0.00 X 0 0 0 VIRGIL FROEHLICH MEMBER 1.00 0.00 X 0 0 0 DONNA HERRICK LCH BOARD REPRESENTATIVE 1.00 1.00 X 0 0 0 RICK HIGGINS MEMBER 1.00 0.00 X 0 0 0 PAT HUGHES MEMBER 1.00 0.00 X 0 0 0 ELEANOR MCINTOSH MEMBER 1.00 0.00 X 0 0 0 J PAUL MCINTOSH MEMBER 1.00 0.00 X 0 0 0 JIM SCHEER FRHS BOARD REPRESENTATIVE 1.00 2.00 X 0 0 0 JOHN SEHI PAST PRESIDENT 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 JAMES SINEK CEO 01/01/2013 - 02/14/2013 1.00 39.00 X 0 414444 15892 TIMOTHY AUWARTER INTERIM CEO 02/15/2013 - 12/31/2013 1.00 39.00 X 0 302986 19061 JOHNATHAN WILKER CFO 1.00 39.00 X 0 186676 10917 JAKE CLAUSSEN FOUNDATION DIRECTOR 20.00 20.00 X 0 78069 13340 0 982175 59210 0 0 1 0 0 174870 159109 72563 333979 161597 161597 161651 174870 130481 31170 31170 526746 0 0 192767 955478 955478 14851 14851 26 26 DREAM TEAM EXPENSE 56541 56541 CHILD ADVOCACY 3482 3482 1030378 955478 14851 60049 5334 9571 5117029 4381623 93614 16228 4826923 6075908 10042900 10483330 1712 20050 97721 97721 99433 117771 X 1667972 1874504 2887619 3077280 5387876 5413775 9943467 10365559 10042900 10483330 -503632 925724 0 X X 0 1 X 1 0 X X X 0 0 0 FAITH REGIONAL HEALTH SERVICES 470796875 3 1 1 1 955478 1 955478 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 6024571 25899 1029674 14851 7065293 5578113 12162 444388 10092 6024571 5670101 13321 -38571 66738 5578113 5188508 2727 517780 38914 5670101 4493972 6814 721427 33705 5188508 0.00720 0.76630 0.22650 0 0 0 ANNUITY PAYABLE 97721 97721 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, 2013 AND 2012, FAITH HAD NO UNCERTAIN TAX POSITIONS ACCRUED. WITH FEW EXCEPTIONS, FAITH IS NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS FOR YEARS ENDED PRIOR TO DECEMBER 31, 2010. GOLF TOURNAMENT 51935 7299 44636 4450 1789 7645 3897 5153 WINTER GALA 190116 73101 117015 375 69378 17987 19807 2 94470 94470 336521 174870 161651 4825 71167 25632 3897 24960 130481 31170 1 FAITH REGIONAL HEALTH SERVICES 2700 WEST NORFOLK AVENUE NORFOLK NE 68701 470796875 501(C)(3) 955478 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. X 1 1 X X X X X 0 0 0 0 0 0 0 0 0 JAMES SINEK CEO 01/01/2013 - 02/14/2013 0 414444 0 0 0 0 0 7650 0 8242 0 430336 0 0 TIMOTHY AUWARTER INTERIM CEO 02/15/2013 - 12/31/2013 0 302986 0 0 0 0 0 7650 0 11411 0 322047 0 0 JOHNATHAN WILKER CFO 0 186676 0 0 0 0 0 0 0 10917 0 197593 0 0 PART I, LINE 1A JAMES J. SINEK'S YMCA MEMBERSHIP AND COUNTRY CLUB DUES ARE PAID BY FAITH REGIONAL HEALTH SERVICES, A RELATED ORGANIZATION. THE AMOUNTS PAID FOR THESE ITEMS ARE ADDED TO MR. SINEK'S W-2 AS WAGES. 0 BETTY FROEHLICH BOARD MEMBER VIRGIL FROEHLICH'S WIFE, BETTY, IS EMPLOYED BY THE FOUNDATION 39184 WAGES 0 X 1 298 FMV X 18277 FMV X 9 3270 FMV X 2 266 FMV X OTHER MISCELL 31 14657 FMV X GIFT CERTIFIC 57 14132 GIFT CERTIFICATE VAL X ELECTRONICS 7 7732 FMV X RECREATION TR 6 6125 FMV X GIFT BASKETS 27 3804 FMV X TICKETS 19 2913 FMV X SPORTING EQUI 10 1089 FMV 0 1 0 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 11 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 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 THE PROCESSES SINCE LAST YEAR. 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 OGANIZATION. THEREFORE, QUESTION 15A AND 15B ARE ANSWERED NO. FAITH REGIONAL HEALTH SERVICES 1500 KOENIGSTEIN 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 0 0 0 0 0 0 0 0 0 1 0 1 1 0 0 0 0