HENDERSON HEALTH CARE FOUNDATION: Form 990EZ, tax year 2012
View the entire original 990 at ProPublica ↗
- Organization
- HENDERSON HEALTH CARE FOUNDATION (EIN 47-0794089)
- Tax period
- 2012-01-01 to 2012-12-31
- Filed
- 2013-08-08
- IRS object ID
- 201332209349200588
- 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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2013-08-08T14:30:07-05:00 | Timestamp |
| Tax Period End Date | 2012-12-31 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | LARRY R COX CPA | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 88 | AddressLine1 |
| City | HENDERSON | City |
| State | NE | State |
| ZIP Code | 68371 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990EZ | ReturnType |
| Tax Period Begin Date | 2012-01-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 470794089 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | HENDERSON HEALTH CARE FOUNDATION | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | HEND | NameControl |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 488 | AddressLine1 |
| City | HENDERSON | City |
| State | NE | State |
| ZIP Code | 68371 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | ARLYCE FRIESEN | Name |
| Title | SECRETARY | Title |
| Date Signed | 2013-07-31 | DateSigned |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | LARRY R COX | Name |
| Phone | 4027235311 | Phone |
| Date Prepared | 2013-07-31 | DatePrepared |
| Self Employed | X | SelfEmployed |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2012 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990-EZ IRS990EZ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Change | X | AddressChange |
| Method Of Accounting Cash | X | MethodOfAccountingCash |
| Web Site | N/A | WebSite |
| Organization501c3 | X | Organization501c3 |
| Gross Receipts | 68988 | GrossReceipts |
| Info In Schedule O Part I | X | InfoInScheduleOPartI |
| Contributions Gifts Grants Etc | 65918 | ContributionsGiftsGrantsEtc |
| Investment Income | 1798 | InvestmentIncome |
| Gross Amount From Sale Of Assets | 1272 | GrossAmountFromSaleOfAssets |
| Gain Or Loss From Sale Of Assets | 1272 | GainOrLossFromSaleOfAssets |
| Total Revenue | 68988 | TotalRevenue |
| Grants And Similar Amounts Paid | 116278 | GrantsAndSimilarAmountsPaid |
| Printing Publications Postage | 376 | PrintingPublicationsPostage |
| Other Expenses Total | 5658 | OtherExpensesTotal |
| Total Expenses | 122312 | TotalExpenses |
| Excess Or Deficit For Year | -53324 | ExcessOrDeficitForYear |
| Net Assets Or Fund Balances BOY | 189629 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 136305 | NetAssetsOrFundBalancesEOY |
Cash Savings And Investments CashSavingsAndInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 189629 | BOY |
| EOY | 136305 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 189629 | BOY |
| EOY | 136305 | EOY |
Net Assets Or Fund Balances NetAssetsOrFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 189629 | BOY |
| EOY | 136305 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Primary Exempt Purpose | SUPPORT LOCAL HEALTH CARE ORGANIZATIONS | PrimaryExemptPurpose |
Program Service Accomplishment ProgramServiceAccomplishment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description Program Service Accom | CHARITABLE PUBLIC HEALTH CARE THROUGH SUPPORT OF 501(C)(3) HOSPITAL AND RELATED FACILITIES | DescriptionProgramServiceAccom |
| Program Service Expenses | 122312 | ProgramServiceExpenses |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expenses | 122312 | TotalProgramServiceExpenses |
Officer Director Trustee Key Empl OfficerDirectorTrusteeKeyEmpl (14 entries)
| TitleTitle | Avg Hours Per Wk Devoted To PositionAvgHoursPerWkDevotedToPosition | CompensationCompensation |
|---|---|---|
| BERGEN KEN | ||
| PRESIDENT | 000.00 | 0 |
| THIESZEN LELAN | ||
| VICE PRESIDE | 000.00 | 0 |
| JANZEN ARVID | ||
| TREASURER | 000.00 | 0 |
| FRIESEN ARLYCE | ||
| SECRETARY | 000.00 | 0 |
| JANZEN KIM | ||
| EXECUTIVE DI | 000.00 | 0 |
| THIESZEN MARLENE | ||
| DIRECTOR | 000.00 | 0 |
| VANDERNECK LINDA | ||
| DIRECTOR | 000.00 | 0 |
| HUBER LOREN | ||
| DIRECTOR | 000.00 | 0 |
| FRIESEN BLAINE | ||
| DIRECTOR | 000.00 | 0 |
| OTT TAMMY | ||
| DIRECTOR | 000.00 | 0 |
| FRIESEN ORIE | ||
| DIRECTOR | 000.00 | 0 |
| BROWN CHERYL | ||
| CEO/ADMINIST | 000.00 | 0 |
| MYERS JILL | ||
| CFO/COO | 000.00 | 0 |
| SCHOTSCH KAREN | ||
| CITY CHAMBER | 000.00 | 0 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Not Previously Rpt | false | ActivitiesNotPreviouslyRpt |
| Made Changes To Orgnzng Etc Doc | false | MadeChangesToOrgnzngEtcDoc |
| Organization Had UBI | false | OrganizationHadUBI |
| Subject To Proxy Tax | false | SubjectToProxyTax |
| Organization Dissolved Etc | false | OrganizationDissolvedEtc |
| Did Org File Form1120 POL This Year | false | DidOrgFileForm1120POLThisYear |
| Made Loans To From Officers | false | MadeLoansToFromOfficers |
| Engaged In Excess Benefit Trans | false | EngagedInExcessBenefitTrans |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTrans |
The Books Are In Care Of TheBooksAreInCareOf
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | ARLYCE FRIESEN | NamePerson |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 488 | AddressLine1 |
| City | HENDERSON | City |
| State | NE | State |
| ZIP Code | 68371 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 4027234414 | TelephoneNumber |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Foreign Financial Account | false | ForeignFinancialAccount |
| Foreign Office | false | ForeignOffice |
| Maintain Any Donor Advised Funds | false | MaintainAnyDonorAdvisedFunds |
| Does Org Have Hospital | false | DoesOrgHaveHospital |
| Tanning Services Provided | false | TanningServicesProvided |
| Related Org Controlled Entity | false | RelatedOrgControlledEntity |
| Transaction With Control Entity | false | TransactionWithControlEntity |
| Engage Political Cmpgn Activities | false | EngagePoliticalCmpgnActivities |
| Engage In Lobbying Activities | false | EngageInLobbyingActivities |
| Operating School | false | OperatingSchool |
| Trnsfrs Exempt Non Char Related Org | false | TrnsfrsExemptNonCharRelatedOrg |
| Part VI Of Comp Of Highest Paid Empl | NONE | PartVIOfCompOfHighestPaidEmpl |
| Part VIA Hghst Paid Cntrct Prof Ser | NONE | PartVIAHghstPaidCntrctProfSer |
| Filed Schedule A | true | FiledScheduleA |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Publicly Supported Org170b1 Avi | X | PubliclySupportedOrg170b1Avi |
Gifts Grants Contrib Received170 GiftsGrantsContribReceived170
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 223395 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 140404 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 122968 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 153087 | CurrentTaxYearMinus1Year |
| Current Tax Year | 65918 | CurrentTaxYear |
| Total | 705772 | Total |
Total170 Total170
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 223395 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 140404 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 122968 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 153087 | CurrentTaxYearMinus1Year |
| Current Tax Year | 65918 | CurrentTaxYear |
| Total | 705772 | Total |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Amounts Subst Contributors Total | 209285 | AmountsSubstContributorsTotal |
| Public Support Total170 | 496487 | PublicSupportTotal170 |
Gross Investment Income170 GrossInvestmentIncome170
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 2675 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 4108 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 1516 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 2101 | CurrentTaxYearMinus1Year |
| Current Tax Year | 1798 | CurrentTaxYear |
| Total | 12198 | Total |
Other Income170 OtherIncome170
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus1 Year | 2 | CurrentTaxYearMinus1Year |
| Current Tax Year | 1272 | CurrentTaxYear |
| Total | 1274 | Total |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Support | 719244 | TotalSupport |
| Gross Receipts From Admissions Etc | 1798 | GrossReceiptsFromAdmissionsEtc |
| Public Support Pertcentage170 | 0.69030 | PublicSupportPertcentage170 |
| Public Support Pertcent Prior Year | 0.66040 | PublicSupportPertcentPriorYear |
| Thirty Three Percnt Tests CY170 | X | ThirtyThreePercntTestsCY170 |
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 O IRS990ScheduleO
General Explanation GeneralExplanation (2 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| PAYMENTS TO AFFILIATES | FORM 990-EZ, PART I, LINE 10 | HENDERSON HEALTH CARE SERVICES AFFILIATED HOSPITAL 116,278 1621 FRONT STREET HENDERSON NE 68371 |
| OTHER EXPENSES | FORM 990-EZ, PART I, LINE 16 | EXPENSES GOLF TOURNAMENT EXPENSES 2,741 SPRING FLING EXPENSES 2,917 TOTAL 5,658 |
Compensation Explanation CompensationExplanation
Compensation Compensation (14 entries)
| BERGEN KEN |
| THIESZEN LELAN |
| JANZEN ARVID |
| FRIESEN ARLYCE |
| JANZEN KIM |
| THIESZEN MARLENE |
| VANDERNECK LINDA |
| HUBER LOREN |
| FRIESEN BLAINE |
| OTT TAMMY |
| FRIESEN ORIE |
| BROWN CHERYL |
| MYERS JILL |
| SCHOTSCH KAREN |
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