NEBRASKA FOUNDATION FOR MEDICAL CARE: Form 990, tax year 2012

View the entire original 990 at ProPublica ↗

Organization
NEBRASKA FOUNDATION FOR MEDICAL CARE (EIN 23-7438953)
Tax period
2012-01-01 to 2012-12-31
Filed
2013-06-06
IRS object ID
201301579349300605
Schema version
2012v2.1
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)
Timestamp2013-06-06T09:10:05-05:00Timestamp
Tax Period End Date2012-12-31TaxPeriodEndDate

Preparer Firm PreparerFirm

FieldValueIRS element (for citing)
EIN470526649EIN

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1DANA F COLE & COMPANY LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line11248 O STREET SUITE 500AddressLine1
CityLINCOLNCity
StateNEState
ZIP Code68508ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2012-01-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN237438953EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1NEBRASKA FOUNDATION FOR MEDICAL CAREBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlNEBRNameControl
Phone4024741222Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1233 S 13TH STREET No 1200AddressLine1
CityLINCOLNCity
StateNEState
ZIP Code68508ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameDale MahlmanName
TitleExecutive Vice PresidentTitle
Phone4024741222Phone
Date Signed2013-06-03DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameTHOMAS M OBRISTName
PTINP00249566PTIN
Phone4024799300Phone
FieldValueIRS element (for citing)
Tax Year2012TaxYear
Build TS2016-02-25 16:41:14ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonDale MahlmanNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1233 S 13TH STREET No 1200AddressLine1
CityLINCOLNCity
StateNEState
ZIP Code68508ZIPCode
FieldValueIRS element (for citing)
Gross Receipts167GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501cXOrganization501c
Web SiteN/AWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1974YearFormation
State Legal DomicileNEStateLegalDomicile
Activity Or Mission DescriptionSERVE AS A PEER REVIEW ORGANIZATION IN THE MEDICAL FIELD.ActivityOrMissionDescription
Nbr Voting Members Governing Body21NbrVotingMembersGoverningBody
Nbr Independent Voting Members21NbrIndependentVotingMembers
Total Nbr Employees0TotalNbrEmployees
Total Nbr Volunteers0TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year0ContributionsGrantsPriorYear
Contributions Grants Current Year0ContributionsGrantsCurrentYear
Program Service Revenue Prior Year0ProgramServiceRevenuePriorYear
Program Service Revenue CY0ProgramServiceRevenueCY
Investment Income Prior Year203InvestmentIncomePriorYear
Investment Income Current Year167InvestmentIncomeCurrentYear
Other Revenue Prior Year0OtherRevenuePriorYear
Other Revenue Current Year0OtherRevenueCurrentYear
Total Revenue Prior Year203TotalRevenuePriorYear
Total Revenue Current Year167TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year55073GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY15526GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year0SalariesEtcPriorYear
Salaries Etc Current Year0SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year28056OtherExpensePriorYear
Other Expenses Current Year27746OtherExpensesCurrentYear
Total Expenses Prior Year83129TotalExpensesPriorYear
Total Expenses Current Year43272TotalExpensesCurrentYear
Revenues Less Expenses Prior Year-82926RevenuesLessExpensesPriorYear
Revenues Less Expenses CY-43105RevenuesLessExpensesCY
Total Assets BOY411124TotalAssetsBOY
Total Assets EOY377309TotalAssetsEOY
Total Liabilities BOY6261TotalLiabilitiesBOY
Total Liabilities EOY15551TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY404863NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY361758NetAssetsOrFundBalancesEOY
Mission DescriptionTO SERVE AS A PEER REVIEW ORGANIZATION TO REVIEW PROFESSIONAL MEDICAL SERVICES AND ACTIVITIES PROVIDED IN THE HEALTH CARE FIELD.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
DescriptionTO SERVE AS A PEER REVIEW ORGANIZATION TO REVIEW PROFESSIONAL MEDICAL SERVICES AND ACTIVITIES PROVIDED IN THE HEALTH CARE FIELD.Description
Described In501 C30DescribedIn501C3
Schedule B Required0ScheduleBRequired
Political Activities0PoliticalActivities
Subject To Proxy Tax0SubjectToProxyTax
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments0TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets0ReportOtherAssets
Report Other Liabilities0ReportOtherLiabilities
Report Fin48 Footnote0ReportFin48Footnote
Independent Audit Financial Stmt0IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt0ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital0Hospital
Grants To Organizations1GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required0ScheduleJRequired
Tax Exempt Bonds0TaxExemptBonds
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity0RelatedOrgControlledEntity
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With10961NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees0NumberOfEmployees
Unrelated Business Income0UnrelatedBusinessIncome
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members21NbrVotingGoverningBodyMembers
Number Independent Voting Members21NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders0MembersOrStockholders
Election Of Board Members0ElectionOfBoardMembers
Decisions Subject To Approval0DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body0Form990ProvidedToGoverningBody
Conflict Of Interest Policy0ConflictOfInterestPolicy
Whistleblower Policy0WhistleblowerPolicy
Document Retention Policy0DocumentRetentionPolicy
Compensation Process CEO0CompensationProcessCEO
Compensation Process Other0CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
Other WebsiteXOtherWebsite
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1NE FOUNDATION FOR MEDICAL CAREBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number4024741222TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1233 S 13TH ST SUITE 1200AddressLine1
CityLINCOLNCity
StateNEState
ZIP Code68508ZIPCode
FieldValueIRS element (for citing)
No Listed Persons CompensatedXNoListedPersonsCompensated

Form990 Part VII Section A Form990PartVIISectionA (22 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationOfficerOfficer
CJOSE FRIESEN MD
DIRECTOR1.00X000
TODD PANKRATZ MD
SECRETARY - TREASURER1.00X000X
JAMES GIGANTELLI MD
DIRECTOR1.00X000
VALERIE HUCKABY
DIRECTOR1.00X000
DANIEL NOBLE MD
PRESIDENT1.00X000X
BRITT A THEDINGER MD
DIRECTOR1.00X000
JASON KRUGER MD
DIRECTOR1.00X000
ZACH ROSOL
DIRECTOR1.00X000
ART MOLNAR MD
DIRECTOR1.00X000
JORDAN WARCHOL
DIRECTOR1.00X000
KEVIN NOHNER MD
PRESIDENT-ELECT1.00X000X
PETER WHITTED MD
DIRECTOR1.00X000
CHUCK GREGORIUS MD
IMMEDIATE PAST PRESIDENT1.00X000
MARVIN BITTNER MD
DIRECTOR1.00X000
GERALD LUCKEY MD
DIRECTOR1.00X000
JON HEDGECOCK
DIRECTOR1.00X000
MICHELLE SELL
DIRECTOR1.00X000
MICHAEL ZARUBA
DIRECTOR1.00X000
LES SPY
DIRECTOR1.00X000
AMIT CHAKRABORTY
DIRECTOR1.00X000
JAN BAUSCH
DIRECTOR1.00X000
MAUREEN BAUSCH
CONSUMER MEMBER1.00X000
FieldValueIRS element (for citing)
Total Reportable Comp From Org0TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation0TotalOtherCompensation
Number Individuals GT100 K0NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K0TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources
Number Of Contractors GT100 K0NumberOfContractorsGT100K

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column167TotalRevenueColumn
Exclusion$167ExclusionAmount

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column167TotalRevenueColumn
Related Or Exempt Function Income0RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$167ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total15526Total

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total10500Total

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total1000Total

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total4Total

Occupancy Occupancy

FieldValueIRS element (for citing)
Total14596Total

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total1456Total

Other Expenses OtherExpenses (3 entries)

DescriptionDescriptionTotalTotal
MISCELLANEOUS166
PROPERTY TAX22
POSTAGE2

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total43272Total

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY409543BOY
EOY377184EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis33743LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec33618LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY1581BOY
EOY125EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY411124BOY
EOY377309EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY6261BOY
EOY15551EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY6261BOY
EOY15551EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY404863BOY
EOY361758EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY404863BOY
EOY361758EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY411124BOY
EOY377309EOY
FieldValueIRS element (for citing)
Reconcilation Revenue Expenses-43105ReconcilationRevenueExpenses
Reconcilation Other Changes0ReconcilationOtherChanges
Info In Schedule O Part XIIXInfoInScheduleOPartXII
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review1AccountantCompileOrReview

Accountant Compile Or Review Basis AccountantCompileOrReviewBasis

FieldValueIRS element (for citing)
Financial Statement SeparateXFinancialStatementSeparate
FieldValueIRS element (for citing)
FS Audited0FSAudited
Audit Committee1AuditCommittee
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule D IRS990ScheduleD

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis33743OtherCostOrOtherBasis
Depreciation33618Depreciation
Book Value125BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings125TotalOfBookValueLandBuildings

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Records Maintained1RecordsMaintained

Recipient Table RecipientTable (2 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEIN Of RecipientEINOfRecipientIRC SectionIRCSectionAmount Of Cash GrantAmountOfCashGrantPurpose Of GrantPurposeOfGrant
Nebraska Medical Association
233 S 13th Street Suite 1200LincolnNE68508470372108501(c)(6)9276Sponsorships
ED Bellis Healcare Consulting LLC
5406 PoppletonOmahaNE681064548178716000Sponsorships
FieldValueIRS element (for citing)
Total Nbr Of501 C3 And Govt Grants0TotalNbrOf501C3AndGovtGrants
Total Nbr Of Other Organizations2TotalNbrOfOtherOrganizations

Form990 Schedule I Part IV Form990ScheduleIPartIV

FieldValueIRS element (for citing)
IdentifierProcedure for Monitoring Grants in the U.S.:Identifier
Return ReferencePart I, Line 2:ReturnReference
ExplanationSchedule I, Part I, Line 2: The Board of Director's for the organizatioin reviews the assistance awarded and requires a majority vote.Explanation

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (3 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
Form 990, Part VI, Section B, line 11Form 990, Part VI, Section A, line 10: THE EXECUTIVE VICE PRESIDENT REVIEWS THE FORM 990 BEFORE IT'S FILED AND SIGNS THE RETURN.
Form 990, Part VI, Section C, line 19THE ORGANIZATION'S GOVERNING DOCUMENTS AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST TO THE ORGANIZATION'S EXECUTIVE VICE PRESIDENT.
Form 990, Part XII, Line 2cThe Board of Directors and Executive Vice President oversee the compilation process. This process has not changed from prior years.Oversight of Compilation Procedures

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII

Name Of Disregarded Entity NameOfDisregardedEntity

FieldValueIRS element (for citing)
Business Name Line1Nebraska Medical AssociationBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1233 S 13th Street Suite 1200AddressLine1
CityLincolnCity
StateNEState
ZIP Code68508ZIPCode
FieldValueIRS element (for citing)
EIN470372108EIN
Primary ActivitiesMember ServicesPrimaryActivities
Legal Domicile StateNELegalDomicileState
Exempt Code Section501(c)(6)ExemptCodeSection
Direct Controlling Entity NAN/ADirectControllingEntityNA
Controlled Org0ControlledOrg
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties0ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org1GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org0GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org0LoansOrGuaranteesFromOtherOrg
Dividends Related Organization0DividendsRelatedOrganization
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs0RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs1RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs0PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs0PerformOfServicesByOtherOrgs
Sharing Of Facilities0SharingOfFacilities
Sharing Of Paid Employees0SharingOfPaidEmployees
Reimbursement Paid To Other Org1ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrg
Other Transfer To Other Org0OtherTransferToOtherOrg
Other Transfer From Other Org0OtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable (3 entries)

Transaction TypeTransactionTypeAmount InvolvedAmountInvolvedMethod Of Amt DeterminationMethodOfAmtDetermination
Nebraska Medical Association
K14596Cash
Nebraska Medical Association - Management fees
P10500Cash
Nebraska Medical Association - Sponsorships
B9276Cash

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