FAITH REGIONAL HEALTH SERVICES FOUNDATION: Form 990, tax year 2012
View the entire original 990 at ProPublica ↗
- Organization
- FAITH REGIONAL HEALTH SERVICES FOUNDATION (EIN 91-1772474)
- Tax period
- 2012-01-01 to 2012-12-31
- Filed
- 2013-11-14
- IRS object ID
- 201303189349301640
- 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
- Form 990
- Schedule A
- Schedule B
- Schedule D
- Schedule G
- Schedule I
- Schedule J
- Schedule L
- Schedule M
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2013-11-14T09:27:28-06:00 | Timestamp |
| Tax Period End Date | 2012-12-31 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 476097913 | EIN |
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SEIM JOHNSON LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 18081 BURT STREET SUITE 200 | AddressLine1 |
| City | OMAHA | City |
| State | NE | State |
| ZIP Code | 680224722 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2012-01-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 911772474 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | FAITH REGIONAL HEALTH SERVICES FOUNDATION | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | FAIT | NameControl |
| Phone | 4026447301 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2700 WEST NORFOLK AVENUE NO 200 | AddressLine1 |
| City | NORFOLK | City |
| State | NE | State |
| ZIP Code | 68701 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | JOHN WILKER | Name |
| Title | CFO | Title |
| Phone | 4026447301 | Phone |
| Date Signed | 2013-11-11 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | BARBARA J FAJEN | Name |
| PTIN | P00400874 | PTIN |
| Phone | 4023302660 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2012 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | JOHN WILKER | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2700 WEST NORFOLK AVENUE NO 200 | AddressLine1 |
| City | NORFOLK | City |
| State | NE | State |
| ZIP Code | 68701 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 2115894 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.FRHS.ORG | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1996 | YearFormation |
| State Legal Domicile | NE | StateLegalDomicile |
| Activity Or Mission Description | 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 DISCRIMINATES AGAINST ANYONE ON THE BASIS OF RACE, SEX, NATIONAL ORIGIN, RELIGION, OR DIAGNOSIS. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 17 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 16 | NbrIndependentVotingMembers |
| Total Nbr Employees | 0 | TotalNbrEmployees |
| Total Nbr Volunteers | 26 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 630319 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 1859393 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 0 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 0 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 159888 | InvestmentIncomePriorYear |
| Investment Income Current Year | 90432 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 78176 | OtherRevenuePriorYear |
| Other Revenue Current Year | 48548 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 868383 | TotalRevenuePriorYear |
| Total Revenue Current Year | 1998373 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 1089050 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 1001338 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 0 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 0 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 21155 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 17506 | OtherExpensePriorYear |
| Other Expenses Current Year | 34573 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 1106556 | TotalExpensesPriorYear |
| Total Expenses Current Year | 1035911 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | -238173 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 962462 | RevenuesLessExpensesCY |
| Total Assets BOY | 8690714 | TotalAssetsBOY |
| Total Assets EOY | 10042900 | TotalAssetsEOY |
| Total Liabilities BOY | 124080 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 99433 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 8566634 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 9943467 | NetAssetsOrFundBalancesEOY |
| Mission Description | 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. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 1001338 | Expense |
| Grants | 1001338 | Grants |
| Description | TO AID FAITH REGIONAL HEALTH SERVICES (FRHS) BY THE SOLICITATION OF GIFTS, GRANT 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. | Description |
| Total Program Service Expense | 1001338 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 0 | LobbyingActivities |
| Subject To Proxy Tax | 0 | SubjectToProxyTax |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 1 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 0 | ReportLandBldgEquip |
| Report Invest Oth Securities | 0 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 0 | ReportOtherAssets |
| Report Other Liabilities | 1 | ReportOtherLiabilities |
| Report Fin48 Footnote | 1 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 0 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 1 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 1 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 0 | Hospital |
| Grants To Organizations | 1 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 0 | TaxExemptBonds |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 0 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 1 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 1 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 1 | RelatedEntity |
| Related Org Controlled Entity | 0 | RelatedOrgControlledEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 3 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 0 | NumberOfEmployees |
| Unrelated Business Income | 0 | UnrelatedBusinessIncome |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 1 | QuidProQuoContributions |
| Quid Pro Quo Disclosure | 1 | QuidProQuoDisclosure |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 17 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 16 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 1 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 0 | MembersOrStockholders |
| Election Of Board Members | 1 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 1 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 0 | CompensationProcessCEO |
| Compensation Process Other | 0 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | JOHN WILKER | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 4026447249 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2700 WEST NORFOLK AVE STE 200 | AddressLine1 |
| City | NORFOLK | City |
| State | NE | State |
| ZIP Code | 68701 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (22 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Average Hours Per Week RelatedAverageHoursPerWeekRelated | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation |
|---|---|---|---|---|---|---|---|
| JOHN SEHI | |||||||
| PRESIDENT | 1.00 | 0.00 | X | X | 0 | 0 | 0 |
| TODD WRAGGE MD | |||||||
| VICE-PRESIDENT | 1.00 | 0.00 | X | X | 0 | 0 | 0 |
| GORDON ADAMS 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 |
| DONNA HERRICK | |||||||
| LCH BOARD REPRESENTATIVE | 1.00 | 1.00 | X | 0 | 0 | 0 | |
| JIM SCHEER | |||||||
| FRHS BOARD REPRESENTATIVE | 1.00 | 1.00 | 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 | |
| JACQUE 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 | |
| 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 | |
| PAUL J MCINTOSH | |||||||
| MEMBER | 1.00 | 0.00 | X | 0 | 0 | 0 | |
| HARRIET STUDEBAKER | |||||||
| MEMBER | 1.00 | 0.00 | X | 0 | 0 | 0 | |
| TIMOTHY TIGHE | |||||||
| MEMBER | 1.00 | 0.00 | X | 0 | 0 | 0 | |
| JAMES SINEK | |||||||
| CEO | 1.00 | 39.00 | X | 0 | 481208 | 32257 | |
| DOUGLAS WISMER | |||||||
| CFO (THRU 2/10/12) | 1.00 | 39.00 | X | 0 | 50821 | 2229 | |
| JOHNATHAN WILKER | |||||||
| CFO (FROM 7/16/12) | 1.00 | 39.00 | X | 0 | 68385 | 4517 | |
| BILL LUKE | |||||||
| INTERIM CFO (2/10/12-7/16/12) | 1.00 | 39.00 | X | 0 | 151913 | 0 | |
| JAKE CLAUSSEN | |||||||
| FOUNDATION DIRECTOR | 20.00 | 20.00 | X | 0 | 73182 | 5683 | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 0 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 825509 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 44686 | TotalOtherCompensation |
| Number Individuals GT100 K | 0 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
| Number Of Contractors GT100 K | 0 | NumberOfContractorsGT100K |
| Fundraising Events | 107480 | FundraisingEvents |
| All Other Contributions | 1751913 | AllOtherContributions |
| Noncash Contributions | 49516 | NoncashContributions |
| Total Contributions | 1859393 | TotalContributions |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 90432 | TotalRevenueColumn |
| Exclusion | $90,432 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Income Fundraising Events | 166069 | GrossIncomeFundraisingEvents |
| Cntrbtns Rprtd Fundraising Events | 107480 | CntrbtnsRprtdFundraisingEvents |
| Fundraising Direct Expenses | 117521 | FundraisingDirectExpenses |
Net Income From Fundraising Events NetIncomeFromFundraisingEvents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 48548 | TotalRevenueColumn |
| Exclusion | $48,548 | ExclusionAmount |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 1998373 | TotalRevenueColumn |
| Related Or Exempt Function Income | 0 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $138,980 | ExclusionAmount |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1001338 | Total |
| Program Services | 1001338 | ProgramServices |
Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 13418 | Total |
| Management And General | 13418 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1712 | Total |
| Fundraising | 1712 | Fundraising |
Other Expenses OtherExpenses (2 entries)
| DescriptionDescription | TotalTotal | FundraisingFundraising |
|---|---|---|
| DREAM TEAM EXPENSE | 15612 | 15612 |
| CHILD ADVOCACY | 3831 | 3831 |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1035911 | Total |
| Program Services | 1001338 | ProgramServices |
| Management And General | 13418 | ManagementAndGeneral |
| Fundraising | 21155 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1011 | BOY |
| EOY | 5334 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4828231 | BOY |
| EOY | 5117029 | EOY |
Pledges And Grants Receivable PledgesAndGrantsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 169570 | BOY |
| EOY | 93614 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3636704 | BOY |
| EOY | 4826923 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 55198 | BOY |
| EOY | 0 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 8690714 | BOY |
| EOY | 10042900 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 26359 | BOY |
| EOY | 1712 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 97721 | BOY |
| EOY | 97721 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 124080 | BOY |
| EOY | 99433 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1352860 | BOY |
| EOY | 1667972 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1837912 | BOY |
| EOY | 2887619 | EOY |
Permanently Restricted Net Assets PermanentlyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5375862 | BOY |
| EOY | 5387876 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 8566634 | BOY |
| EOY | 9943467 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 8690714 | BOY |
| EOY | 10042900 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expenses | 962462 | ReconcilationRevenueExpenses |
| Reconciliation Unrealized Invest | 414371 | ReconciliationUnrealizedInvest |
| Reconcilation Other Changes | 0 | ReconcilationOtherChanges |
| Info In Schedule O Part XII | X | InfoInScheduleOPartXII |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
FS Audited Basis FSAuditedBasis
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Statement Consolidated | X | FinancialStatementConsolidated |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | 1 | AuditCommittee |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Supporting Organization509a3 | X | SupportingOrganization509a3 |
| Supporting Org509a3 Type1 | X | SupportingOrg509a3Type1 |
| Certification Checkbox | X | CertificationCheckbox |
| Contrib By Controlling Individual | 0 | ContribByControllingIndividual |
| Contribution By Related Party | 0 | ContributionByRelatedParty |
| Contrib By35 Controlled Entity | 0 | ContribBy35ControlledEntity |
Supported Org Information SupportedOrgInformation
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | FAITH REGIONAL HEALTH SERVICES | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 470796875 | EIN |
| Type Of Organization | 3 | TypeOfOrganization |
| Listed In Governing Doc | 1 | ListedInGoverningDoc |
| Supported Organization Notified | 1 | SupportedOrganizationNotified |
| Organized In US | 1 | OrganizedInUS |
| Amount | $1,001,338 | Amount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Number Of Supported Orgs | 1 | TotalNumberOfSupportedOrgs |
| Sum Of Amounts | 1001338 | SumOfAmounts |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| 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) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule D IRS990ScheduleD
Current Year CurrentYear
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 5578113 | BeginningOfYearBalance |
| Contributions | 12162 | Contributions |
| Investment Earnings Or Losses | 444388 | InvestmentEarningsOrLosses |
| Grants Or Scholarships | 10092 | GrantsOrScholarships |
| End Of Year Balance | 6024571 | EndOfYearBalance |
Current Year Minus1 Year CurrentYearMinus1Year
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 5670101 | BeginningOfYearBalance |
| Contributions | 13321 | Contributions |
| Investment Earnings Or Losses | -38571 | InvestmentEarningsOrLosses |
| Grants Or Scholarships | 66738 | GrantsOrScholarships |
| End Of Year Balance | 5578113 | EndOfYearBalance |
Current Year Minus2 Years CurrentYearMinus2Years
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 5188508 | BeginningOfYearBalance |
| Contributions | 2727 | Contributions |
| Investment Earnings Or Losses | 517780 | InvestmentEarningsOrLosses |
| Grants Or Scholarships | 38914 | GrantsOrScholarships |
| End Of Year Balance | 5670101 | EndOfYearBalance |
Current Year Minus3 Years CurrentYearMinus3Years
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 4493972 | BeginningOfYearBalance |
| Contributions | 6814 | Contributions |
| Investment Earnings Or Losses | 721427 | InvestmentEarningsOrLosses |
| Grants Or Scholarships | 33705 | GrantsOrScholarships |
| End Of Year Balance | 5188508 | EndOfYearBalance |
Current Year Minus4 Years CurrentYearMinus4Years
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 5706317 | BeginningOfYearBalance |
| Contributions | 4188 | Contributions |
| Investment Earnings Or Losses | -1145496 | InvestmentEarningsOrLosses |
| Grants Or Scholarships | 71037 | GrantsOrScholarships |
| End Of Year Balance | 4493972 | EndOfYearBalance |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Designated EOY Balance | 0.00000 | BoardDesignatedEOYBalance |
| Permanent Endowment EOY Balance | 1.00000 | PermanentEndowmentEOYBalance |
| Term Endowment EOY Balance | 0.00000 | TermEndowmentEOYBalance |
| Endowments Held By Unrelated Orgs | 0 | EndowmentsHeldByUnrelatedOrgs |
| Endowments Held By Related Orgs | 0 | EndowmentsHeldByRelatedOrgs |
| Total Of Book Value Land Buildings | 0 | TotalOfBookValueLandBuildings |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | ANNUITY PAYABLE | Description |
| Amount | $97,721 | Amount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 97721 | TotalOfAmounts |
| Footnote In Part XIII | X | FootnoteInPartXIII |
| Tot Revenue Etc Audited Fincl Stmt | 2519353 | TotRevenueEtcAuditedFinclStmt |
| Net Unrealized Gains Investments | 414371 | NetUnrealizedGainsInvestments |
| Donated Srvc And Use Of Facilities | 2506 | DonatedSrvcAndUseOfFacilities |
| Other Revenues | 117521 | OtherRevenues |
| Revenue Not Rptd F990 | 534398 | RevenueNotRptdF990 |
| Revenue Subtotal | 1984955 | RevenueSubtotal |
| Investment Expenses Not Included | 13418 | InvestmentExpensesNotIncluded |
| Revenue Not Rptd On Fin Stmt | 13418 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 1998373 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 1142520 | TotExpensesEtcAuditedFinclStmt |
| Donated Services Use Of Facilities | 2506 | DonatedServicesUseOfFacilities |
| Other Expenses Included | 117521 | OtherExpensesIncluded |
| Expenses Not Rptd F990 | 120027 | ExpensesNotRptdF990 |
| Expenses Subtotal | 1022493 | ExpensesSubtotal |
| Investment Expenses Not Included2 | 13418 | InvestmentExpensesNotIncluded2 |
| Expenses Not Rptd On Fin Stmt | 13418 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 1035911 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIII Form990ScheduleDPartXIII (4 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: | 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 CAN SPECIFY CONTRIBUTIONS TO ANY OF THE ENDOWMENT FUNDS. |
| DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: | 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. IN GENERAL, SUCH STANDARDS REQUIRE FRHS AND THE FOUNDATION TO MEET A COMMUNITY BENEFIT STANDARD AND COMPLY WITH VARIOUS LAWS AND REGULATIONS. 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, 2012 AND 2011, 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, 2009. |
| PART XI, LINE 2D - OTHER ADJUSTMENTS: | FUNDRAISING EXPENSES 117,521. | |
| PART XII, LINE 2D - OTHER ADJUSTMENTS: | FUNDRAISING EXPENSES 117,521. |
Schedule G IRS990ScheduleG
Events Information EventsInformation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Event1 | GOLF TOURNAMENT | NameOfEvent1 |
| Gross Receipts Event1 | 42797 | GrossReceiptsEvent1 |
| Charitable Contributions Event1 | 21395 | CharitableContributionsEvent1 |
| Gross Revenue Event1 | 21402 | GrossRevenueEvent1 |
| Cash Prizes Event1 | 4175 | CashPrizesEvent1 |
| Non Cash Prizes Event1 | 810 | NonCashPrizesEvent1 |
| Rent Facility Costs Event1 | 4777 | RentFacilityCostsEvent1 |
| Food And Beverage Event1 | 4578 | FoodAndBeverageEvent1 |
| Other Direct Expenses Event1 | 12389 | OtherDirectExpensesEvent1 |
| Name Of Event2 | WINTER GALA | NameOfEvent2 |
| Gross Receipts Event2 | 230752 | GrossReceiptsEvent2 |
| Charitable Contributions Event2 | 86085 | CharitableContributionsEvent2 |
| Gross Revenue Event2 | 144667 | GrossRevenueEvent2 |
| Cash Prizes Event2 | 855 | CashPrizesEvent2 |
| Non Cash Prizes Event2 | 780 | NonCashPrizesEvent2 |
| Rent Facility Costs Event2 | 1150 | RentFacilityCostsEvent2 |
| Food And Beverage Event2 | 16171 | FoodAndBeverageEvent2 |
| Other Direct Expenses Event2 | 71836 | OtherDirectExpensesEvent2 |
| Gross Receipts Total | 273549 | GrossReceiptsTotal |
| Charitable Contributions Total | 107480 | CharitableContributionsTotal |
| Gross Revenue Total Events | 166069 | GrossRevenueTotalEvents |
| Cash Prizes Total Events | 5030 | CashPrizesTotalEvents |
| Non Cash Prizes Total Events | 1590 | NonCashPrizesTotalEvents |
| Rent Facility Costs Total Events | 5927 | RentFacilityCostsTotalEvents |
| Food And Beverage Total Events | 20749 | FoodAndBeverageTotalEvents |
| Other Direct Expenses Total Events | 84225 | OtherDirectExpensesTotalEvents |
| Direct Expense Summary Events | 117521 | DirectExpenseSummaryEvents |
| Net Income Summary | 48548 | NetIncomeSummary |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Records Maintained | 1 | RecordsMaintained |
Recipient Table RecipientTable (17 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EIN Of RecipientEINOfRecipient | IRC SectionIRCSection | Amount Of Cash GrantAmountOfCashGrant | Purpose Of GrantPurposeOfGrant |
|---|---|---|---|---|---|---|---|
| FAITH REGIONAL HEALTH SERVICES | |||||||
| 2700 WEST NORFOLK AVENUE | NORFOLK | NE | 68701 | 470796875 | 501(C)(3) | 847707 | FUNDING FOR PURCHASE OF LINAC-CT UPGRADES |
| FAITH REGIONAL HEALTH SERVICES | |||||||
| 2700 WEST NORFOLK AVENUE | NORFOLK | NE | 68701 | 470796875 | 501(C)(3) | 71986 | FUNDING FOR PURCHASE OF CANCER CENTER VANS |
| FAITH REGIONAL HEALTH SERVICES | |||||||
| 2700 WEST NORFOLK AVENUE | NORFOLK | NE | 68701 | 470796875 | 501(C)(3) | 20077 | FUNDING FOR PURCHASE OF PEDIATRIC EQUIPMENT '11 WINTER GALA |
| FAITH REGIONAL HEALTH SERVICES | |||||||
| 2700 WEST NORFOLK AVENUE | NORFOLK | NE | 68701 | 470796875 | 501(C)(3) | 17158 | FUNDING FOR PURCHASE OF PATIENT ROOM WHITEBOARDS |
| FAITH REGIONAL HEALTH SERVICES | |||||||
| 2700 WEST NORFOLK AVENUE | NORFOLK | NE | 68701 | 470796875 | 501(C)(3) | 12268 | FUNDING FOR PURCHASE OF ZOOM CART |
| FAITH REGIONAL HEALTH SERVICES | |||||||
| 2700 WEST NORFOLK AVENUE | NORFOLK | NE | 68701 | 470796875 | 501(C)(3) | 12223 | FUNDING FOR PURCHASE OF WIRELESS EKG |
| FAITH REGIONAL HEALTH SERVICES | |||||||
| 2700 WEST NORFOLK AVENUE | NORFOLK | NE | 68701 | 470796875 | 501(C)(3) | 6000 | FUNDING FOR NURSE LEARNING EXPERIENCE |
| FAITH REGIONAL HEALTH SERVICES | |||||||
| 2700 WEST NORFOLK AVENUE | NORFOLK | NE | 68701 | 470796875 | 501(C)(3) | 5322 | FUNDING FOR PURCHASE OF CARDIAC REHAB STAIRMASTER |
| FAITH REGIONAL HEALTH SERVICES | |||||||
| 2700 WEST NORFOLK AVENUE | NORFOLK | NE | 68701 | 470796875 | 501(C)(3) | 3753 | FUNDING FOR SUPPORT OF INTERNSHIP PROGRAM |
| FAITH REGIONAL HEALTH SERVICES | |||||||
| 2700 WEST NORFOLK AVENUE | NORFOLK | NE | 68701 | 470796875 | 501(C)(3) | 2075 | FUNDING FOR PURCHASE OF TWO BARIATRIC WHEEL CHAIRS. |
| FAITH REGIONAL HEALTH SERVICES | |||||||
| 2700 WEST NORFOLK AVENUE | NORFOLK | NE | 68701 | 470796875 | 501(C)(3) | 1201 | FUNDING FOR PURCHASE OF APPEARANCE PRODUCTS |
| FAITH REGIONAL HEALTH SERVICES | |||||||
| 2700 WEST NORFOLK AVENUE | NORFOLK | NE | 68701 | 470796875 | 501(C)(3) | 507 | FUNDING FOR PURCHASE OF DOPPLER EQUIPMENT |
| FAITH REGIONAL HEALTH SERVICES | |||||||
| 2700 WEST NORFOLK AVENUE | NORFOLK | NE | 68701 | 470796875 | 501(C)(3) | 500 | FUNDING FOR DR. JOSEPH DAVID SCHOLARSHIPS |
| FAITH REGIONAL HEALTH SERVICES | |||||||
| 2700 WEST NORFOLK AVENUE | NORFOLK | NE | 68701 | 470796875 | 501(C)(3) | 255 | FUNDING FOR CARSON CANCER CENTER FBLA SNACKS |
| FAITH REGIONAL HEALTH SERVICES | |||||||
| 2700 WEST NORFOLK AVENUE | NORFOLK | NE | 68701 | 470796875 | 501(C)(3) | 155 | FUNDING FOR DEVELOPMENT OF CARSON CANCER CENTER STAR PROGRAM |
| FAITH REGIONAL HEALTH SERVICES | |||||||
| 2700 WEST NORFOLK AVENUE | NORFOLK | NE | 68701 | 470796875 | 501(C)(3) | 101 | FUNDING FOR FUNDING OF ST. JOSEPH'S CASINO DAY |
| FAITH REGIONAL HEALTH SERVICES | |||||||
| 2700 WEST NORFOLK AVENUE | NORFOLK | NE | 68701 | 470796875 | 501(C)(3) | 50 | FUNDING FOR CARSON CANCER CENTER SNACKS |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Nbr Of501 C3 And Govt Grants | 1 | TotalNbrOf501C3AndGovtGrants |
| Total Nbr Of Other Organizations | 0 | TotalNbrOfOtherOrganizations |
Form990 Schedule I Part IV Form990ScheduleIPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | PROCEDURE FOR MONITORING GRANTS IN THE U.S.: | Identifier |
| Return Reference | PART I, LINE 2: | ReturnReference |
| Explanation | SCHEDULE I, 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. | Explanation |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Club Dues Or Fees | X | ClubDuesOrFees |
| Written Policy Re T And E Expenses | 1 | WrittenPolicyReTAndEExpenses |
| Substantiation Required | 1 | SubstantiationRequired |
| Independent Consultant | X | IndependentConsultant |
| Form990 Of Other Organizations | X | Form990OfOtherOrganizations |
| Written Employment Contract | X | WrittenEmploymentContract |
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | 0 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 0 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 0 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 0 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 0 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 0 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (2 entries)
| TitleTitle | Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| JAMES SINEK | ||||||||||||||
| CEO | 0 | 481208 | 0 | 0 | 0 | 0 | 0 | 7500 | 0 | 24757 | 0 | 513465 | 0 | 0 |
| BILL LUKE | ||||||||||||||
| INTERIM CFO (2/10/12-7/16/12) | 0 | 151913 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 151913 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII (2 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| 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. | |
| PART III | PART II: COMPENSATION REPORTED FOR BILL LUKE IS COMPENSATION RECEIVED SOLELY FROM FRHS, A RELATED ORGANIZATION. BILL LUKE ALSO RECEIVED COMPENSATION FROM LUKE AND ASSOCIATES, INC., AN UNRELATED BUSINESS. MR. LUKE'S SERVICES FOR LUKE AND ASSOCAITES, INC. ARE NOT RELATED TO FRHS, AND ARE IS NOT REPORTED IN THIS FORM 990. | SUPPLEMENTAL INFORMATION |
Schedule L IRS990ScheduleL
Form990 Schedule L Part IV Form990ScheduleLPartIV
Name Of Interested Person NameOfInterestedPerson
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DIVOTS CONFERENCE CENTER | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Relationship | DONNA HERRICK IS A FRHS BOARD REPRESENTATIVE AND OWNER/PRESIDENT OF DIVOTS | Relationship |
| Amount Of Transaction | 18446 | AmountOfTransaction |
| Description Of Transaction | PROVIDES SERVICES TO THE FOUNDATION FOR THE WINTER GALA EVENT FOR FOOD AND BEVERAGES | DescriptionOfTransaction |
| Sharing Of Revenues | 0 | SharingOfRevenues |
Schedule M IRS990ScheduleM
Works Of Art WorksOfArt
| Field | Value | IRS element (for citing) |
|---|---|---|
| Non Cash Checkbox | X | NonCashCheckbox |
| Number Of Contributions | 5 | NumberOfContributions |
| Noncash Contribs Rptd F990 | 700 | NoncashContribsRptdF990 |
| Method Of Determining Revenues | FMV | MethodOfDeterminingRevenues |
Clothing And Household Goods ClothingAndHouseholdGoods
| Field | Value | IRS element (for citing) |
|---|---|---|
| Non Cash Checkbox | X | NonCashCheckbox |
| Noncash Contribs Rptd F990 | 7990 | NoncashContribsRptdF990 |
| Method Of Determining Revenues | FMV | MethodOfDeterminingRevenues |
Collectibles Collectibles
| Field | Value | IRS element (for citing) |
|---|---|---|
| Non Cash Checkbox | X | NonCashCheckbox |
| Number Of Contributions | 20 | NumberOfContributions |
| Noncash Contribs Rptd F990 | 3592 | NoncashContribsRptdF990 |
| Method Of Determining Revenues | FMV | MethodOfDeterminingRevenues |
Food Inventory FoodInventory
| Field | Value | IRS element (for citing) |
|---|---|---|
| Non Cash Checkbox | X | NonCashCheckbox |
| Number Of Contributions | 13 | NumberOfContributions |
| Noncash Contribs Rptd F990 | 2476 | NoncashContribsRptdF990 |
| Method Of Determining Revenues | FMV | MethodOfDeterminingRevenues |
Other Non Cash Contributions Table OtherNonCashContributionsTable (8 entries)
| Non Cash CheckboxNonCashCheckbox | DescriptionDescription | Number Of ContributionsNumberOfContributions | Noncash Contribs Rptd F990NoncashContribsRptdF990 | Method Of Determining RevenuesMethodOfDeterminingRevenues |
|---|---|---|---|---|
| X | GIFT CERTIFICATES | 54 | 9433 | GIFT CERTIFICATE VALUE |
| X | TICKETS | 8 | 870 | FMV |
| X | RECREATION TRIPS | 7 | 10400 | FMV |
| X | ELECTRONICS | 9 | 2775 | FMV |
| X | SPORTING EQUIPMENT | 5 | 1005 | FMV |
| X | GIFT BASKETS | 14 | 1638 | FMV |
| X | EYEWARE | 3 | 1846 | FMV |
| X | OTHER MISCELLANEOUS ITEMS | 30 | 6791 | FMV |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Any Property That Must Be Held | 0 | AnyPropertyThatMustBeHeld |
| Review Process Unusual NC Gifts | 1 | ReviewProcessUnusualNCGifts |
| Third Parties Used | 0 | ThirdPartiesUsed |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (8 entries)
| Return ReferenceReturnReference | ExplanationExplanation |
|---|---|
| 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. |
| 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. |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII (2 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Public Charity StatusPublicCharityStatus | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Controlled OrgControlledOrg | Direct Controlling Entity NADirectControllingEntityNA |
|---|---|---|---|---|---|---|---|---|---|---|---|
| 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 | 0 | N/A | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 0 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 1 | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | 1 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 0 | LoansOrGuaranteesFromOtherOrg |
| Dividends Related Organization | 0 | DividendsRelatedOrganization |
| Sale Of Assets To Other Org | 0 | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | 0 | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | 0 | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | 0 | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | 0 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 0 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 0 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 1 | SharingOfFacilities |
| Sharing Of Paid Employees | 1 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 0 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 0 | OtherTransferFromOtherOrg |
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