FAITH REGIONAL HEALTH SERVICES: Form 990, tax year 2010
View the entire original 990 at ProPublica ↗
- Organization
- FAITH REGIONAL HEALTH SERVICES (EIN 47-0796875)
- Tax period
- 2010-01-01 to 2010-12-31
- Filed
- 2011-11-11
- IRS object ID
- 201103159349303975
- Schema version
- 2010v3.2
- 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 H
- Schedule I
- Schedule J
- Schedule K
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2011-11-11T17:53:38-06:00 | Timestamp |
| Tax Period End Date | 2010-12-31 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
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 | 2010-01-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 470796875 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | FAITH REGIONAL HEALTH SERVICES | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | FAIT | NameControl |
| Phone | 4023714880 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1500 KOENIGSTEIN AVENUE PO BOX 869 | AddressLine1 |
| City | NORFOLK | City |
| State | NE | State |
| ZIP Code | 687020869 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | DOUGLAS WISMER | Name |
| Title | CFO | Title |
| Phone | 4023713402 | Phone |
| Date Signed | 2011-11-09 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | BARBARA J FAJEN | Name |
| Phone | 4023302660 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2010 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | JAMES J SINEK | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1500 KOENIGSTEIN AVENUE PO BOX 869 | AddressLine1 |
| City | NORFOLK | City |
| State | NE | State |
| ZIP Code | 687020869 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 143526588 | 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 | FAITH REGIONAL HEALTH SERVICES IS A HEALTHCARE ORGANIZATION PROVIDING ACUTE, SKILLED AND OUTPATIENT SERVICES TO INDIVIDUALS IN OUR SERVICE AREA. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 15 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 9 | NbrIndependentVotingMembers |
| Total Nbr Employees | 1438 | TotalNbrEmployees |
| Total Nbr Volunteers | 186 | TotalNbrVolunteers |
| Total Gross UBI | 321331 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 159872 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 1580016 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 1228007 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 142225769 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 140448769 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 639670 | InvestmentIncomePriorYear |
| Investment Income Current Year | 387599 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 176528 | OtherRevenuePriorYear |
| Other Revenue Current Year | 221862 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 144621983 | TotalRevenuePriorYear |
| Total Revenue Current Year | 142286237 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 315802 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 491544 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 72641870 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 75834466 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 483312 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 62898742 | OtherExpensePriorYear |
| Other Expenses Current Year | 61532461 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 135856414 | TotalExpensesPriorYear |
| Total Expenses Current Year | 137858471 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 8765569 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 4427766 | RevenuesLessExpensesCY |
| Total Assets BOY | 189016005 | TotalAssetsBOY |
| Total Assets EOY | 185782930 | TotalAssetsEOY |
| Total Liabilities BOY | 112670191 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 105166197 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 76345814 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 80616733 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | FAITH REGIONAL HEALTH SERVICES (FAITH REGIONAL), A NOT-FOR-PROFIT HEALTH CARE FACILITY LOCATED IN NORTHEAST NEBRASKA OPERATES FOR THE BENEFIT OF THE INDIVIDUALS IN ITS SERVICE AREA. FAITH REGIONAL SERVES ALL PATIENTS REGARDLESS OF THEIR ABILITY TO PAY AND DOES NOT LIMIT ITS SERVICES OR DISCRIMINATE AGAINST ANYONE ON THE BASIS OF RACE, COLOR, SEX, NATIONAL ORIGIN, SEXUAL ORIENTATION, RELIGION, AGE, DISABILITY, DISEASE, OR DIAGNOSIS. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 64910178 | Expense |
| Revenue | 42618868 | Revenue |
| Description | FAITH REGIONAL PROVIDES HEALTHCARE TO ALL PEOPLE REGARDLESS OF THEIR ABILITY TO PAY OR THEIR INSURANCE PROVIDER. DURING 2010 FAITH PROVIDED 12,456 PATIENT DAYS TO MEDICARE PATIENTS AND 2,273 PATIENT DAYS TO MEDICAID PATIENTS. | Description |
Activity2 Activity2
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 18863784 | Expense |
| Revenue | 13154795 | Revenue |
| Description | MANY SERVICES PROVIDED BY FAITH REGIONAL ARE DONE SO TO MEET SPECIFIC NEEDS OF THE COMMUNITY BECAUSE NO OTHER SERVICES ARE AVAILABLE. AS A RESULT, THESE SERVICES ARE PROVIDED KNOWING THAT THEY WILL NOT BE FINANCIALLY VIABLE OR SELF-SUPPORTING. THESE SERVICES INCLUDE ACUTE REHABILITATION, BEHAVIORAL HEALTH INPATIENT SERVICES, CARDIOPULMONARY REHABILTIATION SERVICES, DIALYSIS, HOME HEALTH CARE AND TRANSITIONAL CARE (LONG-TERM REHABILITIATION) SERVICES. | Description |
Activity3 Activity3
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 5777593 | Expense |
| Description | A SUBSTANTIAL PORTION OF COMMUNITY BENEFITS PROVIDED BY FAITH REGIONAL IS THE PROVISION OF PATIENT CARE SERVICES THAT ARE NOT PAID FOR EITHER BY THE PATIENT OR A THIRD PARTY INSURANCE. DURING 2010 FAITH REGIONAL PROVIDED PATIENTS OVER $5 MILLION IN ASSISTANCE WITH PAYING THEIR HOSPITAL BILLS. | Description |
Activity Other ActivityOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 31433764 | Expense |
| Grants | 491544 | Grants |
| Revenue | 84048724 | Revenue |
| Description | FAITH REGIONAL IS COMMITTED TO MAINTAINING AND ENHANCING THE QUALITY OF CARE THROUGH THE PROVISION OF EDUCATION TO EMPLOYEES AND MEDICAL STAFF AND THROUGH THE OFFERING OF BENEFITS THAT SUPPORT EDUCATION.BENEFITS TO OUR EMPLOYEES INCLUDE EDUCATIONAL LOANS, TUITION REIMBURSEMENT AND WORKSHOP EXPENSE REIMBURSEMENT. A TOTAL OF 16,000 HOURS OF EDUCATION HOURS WERE PROVIDED TO OUR 1100 EMPLOYEES AND MEDICAL STAFF MEMBERS. THIS INCLUDED 550 PROGRAMS AND 3,700 HOURS OF CONTINUING EDUCATION FOR HEALTHCARE PROFESSIONALS AND PHYSICIANS. FAITH REGIONAL ALSO PROMOTES HEALTHCARE CAREER BY PARTICIPATING AT HIGH SCHOOL CAREER FAIRS, OFFERING STUDENT SHADOWING AND HOSTING MEDICAL EXPLORERS. | Description |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Other Program Service Exp | 31433764 | TotalOfOtherProgramServiceExp |
| Total Of Other Program Service Grnt | 491544 | TotalOfOtherProgramServiceGrnt |
| Total Of Other Program Service Rev | 84048724 | TotalOfOtherProgramServiceRev |
| Total Program Service Expense | 120985319 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 0 | LobbyingActivities |
| 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 | 1 | 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 | 0 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 1 | Hospital |
| Financial Stmt Attached | 0 | FinancialStmtAttached |
| Grants To Organizations | 1 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 1 | TaxExemptBonds |
| Invest Tax Exempt Bonds | 0 | InvestTaxExemptBonds |
| Escrow Account | 0 | EscrowAccount |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuer |
| 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 | 1 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 1 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 1 | DisregardedEntity |
| Related Entity | 1 | RelatedEntity |
| Related Org Controlled Entity | 1 | RelatedOrgControlledEntity |
| Transaction Related Entity | 1 | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 106 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 1438 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 1 | UnrelatedBusinessIncome |
| Form990-T Filed | 1 | Form990-TFiled |
| 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 | 0 | QuidProQuoContributions |
| 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 | 15 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 9 | 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 | 1 | 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 | 1 | CompensationProcessCEO |
| Compensation Process Other | 1 | CompensationProcessOther |
| Investment In Joint Venture | 1 | InvestmentInJointVenture |
| Written Policy Or Procedure | 1 | WrittenPolicyOrProcedure |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DOUGLAS WISMER | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 4026447249 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1500 KOENIGSTEIN AVENUE PO BOX 869 | AddressLine1 |
| City | NORFOLK | City |
| State | NE | State |
| ZIP Code | 687020869 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | X | InfoInScheduleOPartVII |
Form990 Part VII Section A Form990PartVIISectionA (29 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|
| JIM MILLER | |||||||
| PRESIDENT | 1.00 | X | X | 0 | 0 | 0 | |
| BERT LAMMLI | |||||||
| VICE PRESIDENT | 1.00 | X | X | 0 | 0 | 0 | |
| BERNIE AUTEN | |||||||
| TREASURER | 1.00 | X | X | 0 | 0 | 0 | |
| PAUL SANDALL | |||||||
| SECRETARY | 1.00 | X | X | 0 | 0 | 0 | |
| ANITA BRENNEMAN | |||||||
| MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| JOHN DINKEL | |||||||
| MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| JEFF EISENMENGER | |||||||
| MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| DR LEON GEBHARDT | |||||||
| MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| DONNA HERRICK | |||||||
| MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| DR STEF LACEY | |||||||
| MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| DAVID MAUCH | |||||||
| MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| SCOTT MILLER | |||||||
| MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| JEFF PAPE | |||||||
| MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| MARY KAY UHING | |||||||
| MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| DR PHIL ECKSTROM | |||||||
| MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| JAMES J SINEK | |||||||
| CEO | 39.00 | X | 463192 | 0 | 18059 | ||
| DALE POHLMAN | |||||||
| CFO (01/10 - 06/10) | 39.00 | X | 141181 | 0 | 11808 | ||
| DOUGLAS WISMER | |||||||
| CFO (06/10 - PRESENT) | 39.00 | X | 175690 | 0 | 12828 | ||
| LINDA MILLER | |||||||
| CNO | 40.00 | X | 154494 | 0 | 16386 | ||
| DR DEAN FRENCH | |||||||
| VP MEDICAL AFFAIRS | 40.00 | X | 369366 | 0 | 17379 | ||
| H MICHAEL HAMMOND | |||||||
| VP ALLIED HEALTH | 40.00 | X | 179052 | 0 | 18460 | ||
| JANET PINKELMAN | |||||||
| VP HUMAN RESOURCES | 40.00 | X | 139419 | 0 | 7873 | ||
| PATRICK ROCHE | |||||||
| COO - FRPS | 40.00 | X | 179302 | 0 | 18633 | ||
| BARRY SPEAR | |||||||
| VP GROWTH AND DEVELOPMENT | 24.00 | X | 165076 | 0 | 10947 | ||
| JOSEPH MCCLAIN MD | |||||||
| CARDIOVASCULAR SURGEON | 40.00 | 838773 | 0 | 40935 | X | ||
| DOUGLAS WELSH MD | |||||||
| CARDIOLOGIST | 40.00 | 700920 | 0 | 41380 | X | ||
| RIAD MEADA MD | |||||||
| CARDIOVASCULAR SURGEON | 40.00 | 612360 | 0 | 30519 | X | ||
| MOHAMMAD IMRAN MD | |||||||
| CARDIOLOGIST | 40.00 | 570698 | 0 | 29859 | X | ||
| JEFFREY YOSTEN MD | |||||||
| DIRECTOR OF ER MEDICINE | 40.00 | 555242 | 0 | 17544 | X | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 5244765 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 292610 | TotalOtherCompensation |
| Number Individuals GT100 K | 58 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| JE DUNN CONSTRUCTION CO | |||||
| 929 HOLMES | KANSAS CITY | MO | 641062682 | CONSTRUCTION | 6965407 |
| HDR ARCHITECTURE | |||||
| 8404 INDIAN HILLS DR | OMAHA | NE | 68114 | ARCHITECTURE FEES | 1062443 |
| QUAMMEN HEALTH CARE CONSULTANT | |||||
| PO BOX 560070 | MONTVERDE | FL | 34756 | IT CONSULTING | 913300 |
| NEBRASKA LAB LINC | |||||
| PO BOX 30244 | MIDDLEBURG HEIGHTS | OH | 44130 | LAB SERVICES | 445622 |
| MIDWEST HEME MANAGEMENT INC | |||||
| 8625 OAKMONT | LINCOLN | NE | 685269616 | MEDICAL SERVICES | 386783 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 10 | NumberOfContractorsGT100K |
| Federated Campaigns | 17000 | FederatedCampaigns |
| Related Organizations | 878272 | RelatedOrganizations |
| All Other Contributions | 332735 | AllOtherContributions |
| Total Contributions | 1228007 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (5 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome | Unrelated Business RevenueUnrelatedBusinessRevenue | ExclusionExclusionAmount |
|---|---|---|---|---|---|
| NET PATIENT SERVICE RE | 623000 | 93300592 | 93300592 | ||
| MEDICARE/MEDICAID | 623000 | 42618868 | 42618868 | ||
| OTHER OPERATING REVENU | 900099 | 2475808 | 1849426 | 147149 | $479,233 |
| PHYSICIAN CLINICS | 621110 | 1064447 | 1064447 | ||
| LEASED MEDICAL EMPLOYE | 900099 | 989054 | 989054 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 140448769 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 504241 | TotalRevenueColumn |
| Exclusion | $504,241 | ExclusionAmount |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 1171389 | Real |
Less Rental Expenses LessRentalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 1123709 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 47680 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 47680 | TotalRevenueColumn |
| Exclusion | $47,680 | ExclusionAmount |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 116642 | Other |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | -116642 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -116642 | TotalRevenueColumn |
| Exclusion | -$116,642 | ExclusionAmount |
Other Revenue Misc OtherRevenueMisc
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | MHR HOME CARE LLC | Description |
| Business Code | 446199 | BusinessCode |
| Total Revenue Column | 174182 | TotalRevenueColumn |
| Unrelated Business Revenue | 174182 | UnrelatedBusinessRevenue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 174182 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 142286237 | TotalRevenueColumn |
| Related Or Exempt Function Income | 139822387 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 321331 | UnrelatedBusinessRevenue |
| Exclusion | $914,512 | ExclusionAmount |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 491544 | Total |
| Program Services | 491544 | ProgramServices |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2099144 | Total |
| Program Services | 1441870 | ProgramServices |
| Management And General | 481251 | ManagementAndGeneral |
| Fundraising | 176023 | Fundraising |
Comp Disqual Persons CompDisqualPersons
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 267881 | Total |
| Program Services | 267881 | ProgramServices |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 58114185 | Total |
| Program Services | 51400743 | ProgramServices |
| Management And General | 6647927 | ManagementAndGeneral |
| Fundraising | 65515 | Fundraising |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2622467 | Total |
| Program Services | 2319516 | ProgramServices |
| Management And General | 299995 | ManagementAndGeneral |
| Fundraising | 2956 | Fundraising |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 8840997 | Total |
| Program Services | 7819671 | ProgramServices |
| Management And General | 1011359 | ManagementAndGeneral |
| Fundraising | 9967 | Fundraising |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3889792 | Total |
| Program Services | 3440437 | ProgramServices |
| Management And General | 444970 | ManagementAndGeneral |
| Fundraising | 4385 | Fundraising |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 281694 | Total |
| Management And General | 281694 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 237594 | Total |
| Management And General | 237594 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 148788 | Total |
| Management And General | 148788 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 9132982 | Total |
| Program Services | 6063986 | ProgramServices |
| Management And General | 2908694 | ManagementAndGeneral |
| Fundraising | 160302 | Fundraising |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 412245 | Total |
| Program Services | 396273 | ProgramServices |
| Management And General | 7749 | ManagementAndGeneral |
| Fundraising | 8223 | Fundraising |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 30274621 | Total |
| Program Services | 26687756 | ProgramServices |
| Management And General | 3545511 | ManagementAndGeneral |
| Fundraising | 41354 | Fundraising |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3010799 | Total |
| Program Services | 2764233 | ProgramServices |
| Management And General | 246566 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 23022 | Total |
| Program Services | 22631 | ProgramServices |
| Management And General | 391 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3893343 | Total |
| Program Services | 3893343 | ProgramServices |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 9223629 | Total |
| Program Services | 9223629 | ProgramServices |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 796918 | Total |
| Program Services | 796918 | ProgramServices |
Other Expenses OtherExpenses (3 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral | FundraisingFundraising |
|---|---|---|---|---|
| BAD DEBT | 3824326 | 3824326 | ||
| DUES & SUBSCRIPTIONS | 252396 | 110458 | 127351 | 14587 |
| LICENSES | 20104 | 20104 |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 137858471 | Total |
| Program Services | 120985319 | ProgramServices |
| Management And General | 16389840 | ManagementAndGeneral |
| Fundraising | 483312 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 619 | BOY |
| EOY | 73 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 33213189 | BOY |
| EOY | 20380825 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 17792284 | BOY |
| EOY | 18245967 | EOY |
Other Notes Loans Receivable Net OtherNotesLoansReceivableNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1007053 | BOY |
| EOY | 782142 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3551580 | BOY |
| EOY | 4083846 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 609230 | BOY |
| EOY | 1139734 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 190995534 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 68849448 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 118927406 | BOY |
| EOY | 122146086 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 8836148 | BOY |
| EOY | 13126141 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 22385 | BOY |
| EOY | 25302 | EOY |
Investments Program Related InvestmentsProgramRelated
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1741235 | BOY |
| EOY | 2028769 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3314876 | BOY |
| EOY | 3824045 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 189016005 | BOY |
| EOY | 185782930 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 19442300 | BOY |
| EOY | 13599377 | EOY |
Tax Exempt Bond Liabilities TaxExemptBondLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 78062054 | BOY |
| EOY | 75508998 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 14646394 | BOY |
| EOY | 15134135 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 519443 | BOY |
| EOY | 923687 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 112670191 | BOY |
| EOY | 105166197 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 76317737 | BOY |
| EOY | 80588488 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 28077 | BOY |
| EOY | 28245 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 76345814 | BOY |
| EOY | 80616733 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 189016005 | BOY |
| EOY | 185782930 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | 4427766 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | -156847 | 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 |
| Audit Committee | 1 | AuditCommittee |
| Financial Statement Consolidated | X | FinancialStatementConsolidated |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
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 | 5188508 | BeginningOfYearBalance |
| Contributions | 2727 | Contributions |
| Investment Earnings Or Losses | 517780 | InvestmentEarningsOrLosses |
| Grants Or Scholarships | 38914 | GrantsOrScholarships |
| End Of Year Balance | 5670101 | EndOfYearBalance |
Current Year Minus1 Year CurrentYearMinus1Year
| 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 Minus2 Years CurrentYearMinus2Years
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 5706317 | BeginningOfYearBalance |
| Contributions | 4188 | Contributions |
| Investment Earnings Or Losses | -1146496 | InvestmentEarningsOrLosses |
| Grants Or Scholarships | 71037 | GrantsOrScholarships |
| End Of Year Balance | 4492972 | 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 | 1 | EndowmentsHeldByRelatedOrgs |
| Are Related Orgs Listed Schedule R | 1 | AreRelatedOrgsListedScheduleR |
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 1006212 | OtherCostOrOtherBasis |
| Book Value | 1006212 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | 7149316 | InvestmentCostOrOtherBasis |
| Other Cost Or Other Basis | 85558275 | OtherCostOrOtherBasis |
| Depreciation | 32204007 | Depreciation |
| Book Value | 60503584 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | 176685 | InvestmentCostOrOtherBasis |
| Other Cost Or Other Basis | 88977606 | OtherCostOrOtherBasis |
| Depreciation | 35520127 | Depreciation |
| Book Value | 53634164 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 8127440 | OtherCostOrOtherBasis |
| Depreciation | 1125314 | Depreciation |
| Book Value | 7002126 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 122146086 | TotalOfBookValueLandBuildings |
Other Liabilities OtherLiabilities (2 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| ESTIMATED THIRD PARTY PAYOR SETTLEMENTS - MEDICARE & MEDICAID | $500,564 |
| DEFERRED COMP INVESTMENT | $423,123 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 923687 | TotalOfAmounts |
| Total Revenue | 142286237 | TotalRevenue |
| Total Expenses | 137858471 | TotalExpenses |
| Excess Or Deficit For Year | 4427766 | ExcessOrDeficitForYear |
| Net Unrealized GL On Investments | -156847 | NetUnrealizedGLOnInvestments |
| Total Adjustments | -156847 | TotalAdjustments |
| Excess Or Deficit Per FS | 4270919 | ExcessOrDeficitPerFS |
| Tot Revenue Etc Audited Fincl Stmt | 143253099 | TotRevenueEtcAuditedFinclStmt |
| Net Unrealized Gains Investments | -156847 | NetUnrealizedGainsInvestments |
| Other Revenues | 1123709 | OtherRevenues |
| Revenue Not Rptd F990 | 966862 | RevenueNotRptdF990 |
| Revenue Subtotal | 142286237 | RevenueSubtotal |
| Revenue Not Rptd On Fin Stmt | 0 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 142286237 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 138982180 | TotExpensesEtcAuditedFinclStmt |
| Other Expenses Included | 1123709 | OtherExpensesIncluded |
| Expenses Not Rptd F990 | 1123709 | ExpensesNotRptdF990 |
| Expenses Subtotal | 137858471 | ExpensesSubtotal |
| Expenses Not Rptd On Fin Stmt | 0 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 137858471 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV (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 ARE 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 CARDIAC PROGRAM CAPITAL AND/OR OPERATIONAL EXPENSES. THE EDUCATION ENDOWMENT FUNDS ARE PERMANENTLY SET ASIDE TO GENERATE INVESTMENT EARNINGS TO BENEFIT FAITH REGIONAL HEALTH SERVICE'S EDUCATION PROGRAMS AND ITS EFFORTS TO RECRUIT AND RETAIN EMPLOYEES. INVESTMENT INCOME ON THESE FUNDS ARE 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. DONORS CAN SPECIFY CONTRIBUTIONS TO ANY OF THE ENDOWMENT FUNDS. |
| DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: | PART X: | FAITH REGIONAL DID NOT REPORT ANY INCOME TAX EXPENSE OR BENEFIT, NOR HAVE ANY DEFERRED TAX ASSETS OR LIABILITIES IN 2010. THE FOLLOWING IS THE RELEVANT PORTION OF THE FINANCIAL STATEMENT FOOTNOTE ON INCOME TAXES INCLUDED IN THE CONSOLIDATED FINANCIAL STATEMENTS OF FAITH REGIONAL HEALTH SERVICES AND AFFILIATES. "FAITH ADOPTED FASB ASC TOPIC 740 SUBTOPIC 10 SECTION 25, ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES - AN INTERPRETATION OF FASB ASC 740 DURING 2007. SECTION 25 PROVIDES SPECIFIC GUIDANCE ON HOW TO ADDRESS UNCERTAINTY IN ACCOUNTING FOR INCOME TAX ASSETS AND LIABILITIES, PRESCRIBING RECOGNITION THRESHOLDS AND MEASUREMENT ATTRIBUTES. THE ADOPTION OF SECTION 25 BY FAITH DID NOT HAVE A MATERIAL IMPACT ON FAITH' FINANCIAL POSITION, RESULTS OF OPERATIONS OR CASH FLOWS." |
| PART XII, LINE 2D - OTHER ADJUSTMENTS: | RENTAL EXPENSES 1,123,709. | |
| PART XIII, LINE 2D - OTHER ADJUSTMENTS: | RENTAL EXPENSES 1,123,709. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | 1 | CharityCarePolicy |
| Written Policy | 1 | WrittenPolicy |
| FPG Reference Free Care | 1 | FPGReferenceFreeCare |
Other Percentage OtherPercentage
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | X | Other |
| Free Other Percentage | 400.000000000000 | FreeOtherPercentage |
| Field | Value | IRS element (for citing) |
|---|---|---|
| FPG Reference Discounted Care | 1 | FPGReferenceDiscountedCare |
| Pcent350 | X | Pcent350 |
| Free Disc Care Medically Indigent | 1 | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | 1 | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | 1 | ExpensesExceededBudget |
| Unable To Provide Care | 0 | UnableToProvideCare |
| Annual Community Benefit Report | 1 | AnnualCommunityBenefitReport |
| Report Publically Available | 1 | ReportPublicallyAvailable |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 2455477 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 2455477 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01830 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 9770447 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 8208222 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1562225 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01170 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 12225924 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 8208222 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 4017702 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.03000 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 777429 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 61523 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 715906 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00530 | PercentOfTotalExpense |
Subsidized Health Services SubsidizedHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 13154795 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 7847989 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 5306806 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.03960 | PercentOfTotalExpense |
Cash And In Kind Contributions CashAndInKindContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 411713 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 411713 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00310 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 14343937 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 7909512 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 6434425 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.04800 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 26569861 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 16117734 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 10452127 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.07800 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 1 | BadDebtExpenseReported |
| Bad Debt Expense | $1,644,629 | BadDebtExpenseAmount |
| Amount Attributable To | 69909 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 33970833 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 42956418 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | -8985585 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost Accounting System | X | CostAccountingSystem |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | 1 | WrittenDebtCollectionPolicy |
| Provision For Charity Care | 1 | ProvisionForCharityCare |
Form990 Schedule H Part IV Form990ScheduleHPartIV
Name Of Entity NameOfEntity
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | 3 NORTHEAST NE IMAGING CENTER LLC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description Ent Primary Activity | IMAGING SERVICES | DescriptionEntPrimaryActivity |
| Organization Profit Or Ownership | 0.25000 | OrganizationProfitOrOwnership |
| Officers Etc Profit Or Ownership | 0.00000 | OfficersEtcProfitOrOwnership |
| Physicans Profit Or Ownership | 0.75000 | PhysicansProfitOrOwnership |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Hospital Facilities | 2 | NumberOfHospitalFacilities |
Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA (2 entries)
| Facility NumberFacilityNumber | Address Line1Address/AddressLine1 | CityAddress/City | StateAddress/State | ZIP CodeAddress/ZIPCode | Licensed HospitalLicensedHospital | General Medical And SurgicalGeneralMedicalAndSurgical | Er24 HoursEr24Hours |
|---|---|---|---|---|---|---|---|
| FAITH REGIONAL HEALTH SERVICES - EAST | |||||||
| 1 | 1500 KOENIGSTEIN AVE | NORFOLK | NE | 68701 | X | X | |
| FAITH REGIONAL HEALTH SERVICES - WEST | |||||||
| 2 | 2700 NORFOLK AVENUE | NORFOLK | NE | 68701 | X | X | X |
Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB (2 entries)
| Hospital Facility NumberHospitalFacilityNumber |
|---|
| FAITH REGIONAL HEALTH SERVICES |
| 1 |
| FAITH REGIONAL HEALTH SERVICES |
| 2 |
Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Other Facilities | 3 | NumberOfOtherFacilities |
Other Facilities OtherFacilities (3 entries)
| Address Line1Address/AddressLine1 | CityAddress/City | StateAddress/State | ZIP CodeAddress/ZIPCode | Facility TypeFacilityType |
|---|---|---|---|---|
| ST JOSEPH REHABILITIATION & CARE CTR | ||||
| 401 N 18TH STREET | NORFOLK | NE | 68701 | SKILLED NURSING FACILITY |
| NORTHEAST NE IMAGING CENTER LLC | ||||
| 301 NORTH 27TH ST STE 15 | NORFOLK | NE | 68701 | IMAGING CENTER |
| NORTHEAST NE SURGERY CENTER LLC | ||||
| 301 NORTH 27TH ST STE 3 | NORFOLK | NE | 68701 | SURGERY CENTER |
Form990 Schedule H Part VI Form990ScheduleHPartVI (14 entries)
| ExplanationExplanation |
|---|
| PART I, LINE 3C: FAITH REGIONAL USES THE FEDERAL POVERTY GUIDELINES TO DETERMINE ELIGIBILITY FOR DISCOUNTED CARE. FINANCIALLY RESPONSIBLE PARTIES WHO SUBMIT A COMPLETE, VERIFIABLE APPLICATION FOR FINANCIAL ASSISTANCE WILL BE CONSIDERED FOR FREE OR REDUCED "CHARITY CARE" FINANCIAL ASSISTANCE ON THE BASIS OF THE FEDERAL POVERTY GUIDELINES (400% FPG LIMIT).ELIGIBILITY FOR THIS PROGRAM WILL BE DETERMINED BY FAMILY SIZE, GROSS INCOME BASED ON THE FEDERAL POVERY GUIDELINES AND AN ASSET TEST. THE GROSS INCOME LEVELS ARE UPDATED EACH YEAR AS THE FEDERAL POVERTY GUIDELINES ARE UPDATED.CHARITY CARE MAY BE GRANTED WITH RESPECT TO ANY DOLLARS OWED BY A FINANCIALLY RESPONSIBLE PARTY, INCLUDING, BUT NOT LIMITED TO, DEDUCTIBLE, COINSURANCE AND COPAYMENT AMOUNTS; CHARGES FOR NON-COVERED SERVICES AND MEDICAID COST OF SHARE AMOUNTS.CHARITY CARE MAY BE AUTHORIZED FOR FINANCIALLY RESPONSIBLE PARTIES WITH INCOME LEVELS EXCEEDING 400% FPG IN THE CASE OF UNUSUAL, SPECIAL AND/OR EXTENUATING CIRCUMSTANCES. THESE INSTANCES ARE GENERALLY DUE TO MEDICAL CATASTROPHE SITUATIONS. |
| PART I, LINE 7: FAITH REGIONAL USES A COST ACCOUNTING SYSTEM TO DETERMINE COSTS REPORTABLE ON PART I, LINE 7 (AND ELSEWHERE ON SCHEDULE H). THE FIRST STEP IN THE COST ACCOUNTING PROCESS IS TO ALLOCATE THE OVERHEAD EXPENSES (ADMINISTRATION AND GENERAL, PLANT, ETC) TO THE REVENUE PRODUCING DEPARTMENTS (OPERATING ROOM, IMAGING, ONCOLOGY, ETC). THIS IS DONE SIMILAR TO THE MEDICARE COST REPORT USING A SINGLE STEP DOWN METHOD TO ALLOCATE THE COSTS USING APPLICABLE STATISTICS. FOR EXAMPLE: PLANT EXPENSES ARE ALLOCATED DOWN TO THE OTHER DEPARTMENTS USING CURRENT SQUARE FOOTAGE SO DEPARTMENTS WITH MORE SQUARE FOOTAGE WILL BE ALLOCATED MORE PLANT EXPENSES; DIETARY EXPENSES ARE ALLOCATED BASED ON MEALS SERVED; EMPLOYEE BENEFITS ARE ALLOCATED BASED ON SALARIES; ADMINISTRATIVE AND GENERAL EXPENSES ARE ALLOCATED BASED ON ACCUMULATED COSTS; AND SO ON. ONCE ALL THE OVERHEAD EXPENSES ARE ALLOCATED TO THE REVENUE PRODUCING DEPARTMENTS THE COSTS ARE FURTHER ALLOCATED DOWN TO THE CHARGE CODE LEVEL. IN ORDER TO DO THIS WE USE TWO DIFFERENT METHODS DEPENDING ON THE DEPARTMENT. FOR SPECIFIC DEPARTMENTS WE USE A RVU (RELATIVE VALUE UNIT) ALLOCATION WHERE EACH PROCEDURE IS WEIGHTED BY THE INTENSITY OF THE SERVICE AND IS THEN ALLOCATED COST BASED ON THAT LEVEL OF INTENSITY. FOR EXAMPLE AN XRAY WITH SEDATION IS MORE COMPLICATED AND TIME INTENSIVE THAN A SIMPLE CHEST XRAY SO IT WOULD HAVE A HIGHER RVU VALUE AND, IN TURN, A HIGHER COST ALLOCATED TO IT. THE DEPARTMENTS USING THIS ALLOCATION METHOD ARE IMAGING, CARDIAC CATH, CT, MRI, ULTRASOUND, NUCLEAR MEDICINE, RADIATION ONCOLOGY, AND REHAB (PHYSICAL, OCCUPATIONAL AND SPEECH THERAPY).FOR THE OTHER DEPARTMENTS WE USE A RATIO OF COST TO CHARGE METHOD TO ALLOCATE THE COSTS DOWN TO THE CHARGE CODE LEVEL.AFTER ALL THE COSTS HAVE BEEN ALLOCATED TO THE CHARGE CODES THE COSTING IS APPLIED TO ALL PATIENT ACCOUNTS BASED ON THEIR CHARGES TO DETERMINE THE COST OF THEIR ENCOUNTER AND THEN REPORTS CAN BE RUN TO DETERMINE THE PROFITABILITY OF CERTAIN PAYORS, SERVICE LINES OR DEPARTMENTS. FOR SCHEDULE H PART III, LINE 2, A REPORT WAS RUN ON ALL PATIENTS THAT HAD ACCOUNTS WRITTEN OFF AS BAD DEBT DURING 2010 SHOWING THEIR CHARGES, PAYMENTS AND COSTS. THE AMOUNT REPORTED ON LINE 2 REPRESENTS ALL COSTS LESS ANY PAYMENTS RECEIVED ON THOSE ACCOUNTS. |
| PART I, LINE 7G: MANY SERVICES PROVIDED BY FAITH REGIONAL ARE DONE SO TO MEET SPECIFIC NEEDS OF THE COMMUNITY BECAUSE NO OTHER SERVICES ARE AVAILABLE. AS A RESULT, THESE SERVICES ARE PROVIDED KNOWING THAT THEY WILL NOT BE FINANCIALLY VIABLE OR SELF-SUPPORTING. FAITH REGIONAL DID NOT INCLUDE COSTS ATTRIBUTABLE TO PHYSICIAN CLINICS AS SUBSIDIZED SERVICES.A SUBSIDIZED HEALTH SERVICE BENEFIT WAS CALCULATED FOR THE ACUTE REHABILITIATION, BEHAVIORAL HEALTH INPATIENT SERVICES, CARDIOPULMONARY REHABILITATION, DIALYSIS, HOME HEALTH CARE, TRANSITIONAL CARE (LONG-TERM REHABILITATION) AND SKILLED NURSING CARE DEPARTMENTS TO RECOGNIZE THAT THESE AREAS OPERATE AT A NEGATIVE MARGIN WHEN THE INDIRECT COSTS ARE CONSIDERED.THE REPORTED SUBSIDIZED LOSS REPRESENTS THE DIFFERENCE IN NET REVENUE RECEIVED FROM ALL PAYORS IN ADDITION TO ANY MISCELLANEOUS OPERATING REVENUE REPORTED BY THE DEPARTMENT LESS TOTAL OPERATING EXPENSES (DIRECT + INDIRECT COSTS INCLUDED) APPLICABLE TO EACH DEPARTMENT. |
| PART I, L7 COL(F): FAITH REGIONAL ACCOUNTS FOR DISCOUNTS OR PAYMENTS ON PATIENT ACCOUNTS PREVIOUSLY DETERMINED AS BAD DEBT BY CREDITING THE BAD DEBT EXPENSE ACCOUNT. |
| PART II: NONE |
| PART III, LINE 4: THE AUDITED FINANCIAL STATEMENT FOOTNOTES FOR FAITH REGIONAL DO NOT CONTAIN A FOOTNOTE RELATED TO BAD DEBT EXPENSE. BAD DEBT EXPENSE IS IDENTIFIED ON THE CONSOLIDATED STATEMENT OF OPERATIONS WHICH IS CONSISTENT WITH THE REPORTING PRACTICE OF OTHER HEALTH CARE ORGANIZATIONS.DESCRIBE THE COSTING METHOD USED TO DETERMINE AMOUNTS REPORTED IN LINES 2 & 3:FAITH REGIONAL USES A COST ACCOUNTING SYSTEM TO DETERMINE COSTS REPORTABLE ON LINES 2 & 3 (AND ELSEWHERE ON SCHEDULE H). THE FIRST STEP IN THE COST ACCOUNTING PROCESS IS TO ALLOCATE THE OVERHEAD EXPENSES (ADMINISTRATION AND GENERAL, PLANT, ETC) TO THE REVENUE PRODUCING DEPARTMENTS (OPERATING ROOM, IMAGING, ONCOLOGY, ETC). THIS IS DONE SIMILAR TO THE MEDICARE COST REPORT USING A SINGLE STEP DOWN METHOD TO ALLOCATE THE COSTS USING APPLICABLE STATISTICS. FOR EXAMPLE: PLANT EXPENSES ARE ALLOCATED DOWN TO THE OTHER DEPARTMENTS USING CURRENT SQUARE FOOTAGE SO DEPARTMENTS WITH MORE SQUARE FOOTAGE WILL BE ALLOCATED MORE PLANT EXPENSES; DIETARY EXPENSES ARE ALLOCATED BASED ON MEALS SERVED; EMPLOYEE BENEFITS ARE ALLOCATED BASED ON SALARIES; ADMINISTRATIVE AND GENERAL EXPENSES ARE ALLOCATED BASED ON ACCUMULATED COSTS; AND SO ON. ONCE ALL THE OVERHEAD EXPENSES ARE ALLOCATED TO THE REVENUE PRODUCING DEPARTMENTS THE COSTS ARE FURTHER ALLOCATED DOWN TO THE CHARGE CODE LEVEL. IN ORDER TO DO THIS WE USE 2 DIFFERENT METHODS DEPENDING ON THE DEPARTMENT. FOR SPECIFIC DEPARTMENTS WE USE A RVU (RELATIVE VALUE UNIT) ALLOCATION WHERE EACH PROCEDURE IS WEIGHTED BY THE INTENSITY OF THE SERVICE AND IS THEN ALLOCATED COST BASED ON THAT LEVEL OF INTENSITY. FOR EXAMPLE, AN XRAY WITH SEDATION IS MORE COMPLICATED AND TIME INTENSIVE THAN A SIMPLE CHEST XRAY SO IT WOULD HAVE A HIGHER RVU VALUE AND IN-TURN A HIGHER COST ALLOCATED TO IT. THE DEPARTMENTS USING THIS ALLOCATION METHOD ARE IMAGING, CARDIAC CATH, CT, MRI, ULTRASOUND, NUCLEAR MEDICINE, RADIATION ONCOLOGY, AND REHAB (PHYSICAL, OCCUPATIONAL AND SPEECH THERAPY). FOR THE OTHER DEPARTMENTS WE USE A RATIO OF COST TO CHARGE METHOD TO ALLOCATE THE COSTS DOWN TO THE CHARGE CODE LEVEL.AFTER ALL THE COSTS HAVE BEEN ALLOCATED TO THE CHARGE CODES, THE COSTING IS APPLIED TO ALL PATIENT ACCOUNTS BASED ON THEIR CHARGES TO DETERMINE THE COST OF THEIR ENCOUNTER AND THEN REPORTS CAN BE RUN TO DETERMINE THE PROFITABILITY OF CERTAIN PAYORS, SERVICE LINES OR DEPARTMENTS. FOR SCHEDULE H PART III, LINE 2, BAD DEBT DURING 2010 WAS MULTIPLIED BY THE RATIO COST TO CHARGES. TO DETERMINE THE AMOUNT TO REPORT ON LINE 3 (ESTIMATED BAD DEBTS THAT COULD BE ATTRIBUTED TO THE PATIENTS ELIGIBLE UNDER THE CHARITY CARE POLICY); WE DIVIDED TOTAL CHARITY CARE FOR 2010 BY TOTAL NET PATIENT REVENUE AND MULITPLIED THIS RESULTING PERCENTAGE (4.25%) BY BAD DEBT EXPENSE (AT COST). FAITH REGIONAL ACCOUNTS FOR DISCOUNTS OR PAYMENTS ON PATIENT ACCOUNTS PREVIOUSLY DETERMINED AS BAD DEBT BY CREDITING THE BAD DEBT EXPENSE ACCOUNT. |
| PART III, LINE 8: FAITH REGIONAL USES A COST ACCOUNTING SYSTEM TO DETERMINE COSTS TO BE REPORTED IN SCHEDULE H. THE MEDICARE COSTS WERE DETERMINED BY RUNNING A REPORT SHOWING ALL MEDICARE ACCOUNTS DURING 2010 AND REPORTING ALL PAYMENTS RECEVIED ON LINE 5 AND THE TOTAL COSTS (DIRECT AND INDIRECT) ASSOCIATED WITH THOSE ACCOUNTS ON LINE 6. |
| PART III, LINE 9B: THROUGHOUT THE COLLECTION PROCESS EACH ACCOUNT IS ALSO CONSIDERED FOR FINANCIAL ASSISTANCE FOR THOSE GUARANTORS THAT ARE FINANCIALLY UNABLE TO PAY OR EXPRESS INABILITY TO PAY. ALL CORRESPONDENCE, INCLUDING STATEMENTS AND COLLECTION LETTERS INCLUDE A STATEMENT THAT "FINANCIAL ASSISTANCE MAY BE AVAILABLE." ACCOUNTS THAT ARE NOT SUCCESSFULLY RESOLVED ARE CONSIDERED FOR REFERRAL TO OUTSIDE COLLECTION AGENCIES. THE PATIENT ACCOUNTS' STAFF MEMBER WILL REVIEW THE ACCOUNT TO INSURE ALL PROCESSES ARE COMPLETE, AND THEN FLAG THE ACCOUNT TO BE SENT TO OUTSIDE COLLECTION AGENCIES. THE COLLECTION AGENCIES WE UTILIZE ALSO HAVE COPIES OF OUR FINANCIAL ASSISTANCE POLICY AND APPLICATION IF THE NEED ARISES. |
| PART I, LINE 6A:FAITH REGIONAL'S COMMUNITY BENEFIT REPORT IS FILED WITH THE NEBRASKA HOSPITAL ASSOCIATION AND IS AVAILABLE TO THE PUBLIC ON OUR WEBSITE: WWW.FRHS.ORG |
| PART VI, LINE 2: FAITH REGIONAL DOES NOT COMPLETE A FORMAL NEEDS ASSESSMENT AT THIS TIME AS THE PUBLIC HEALTH DEPARTMENT HAS DONE SEVERAL IN THE PAST COUPLE OF YEARS AND FAITH HAS CHOSEN NOT TO DUPLICATE THE WORK AS THE HEALTH DEPARTMENT DOES A COMPLETE REPORT. IN ADDITION TO THE PUBLIC HEALTH DEPARTMENT'S ASSESSMENT, FAITH REGIONAL IS INTIMATELY INVOLVED IN THE ELKHORN ECONOMIC DEVELOPMENT ASSOCIATION, BOTH ON THE BOARD AND THROUGH FINANCIAL SUPPORT. THAT INVOLVMENT IS INTENDED TO FACILITATE COMMUNITY GROWTH, JOB DEVELOPMENT, INFRASTRUCTURE DEVELOPMENT AND BUSINESS EDUCATION/TRAINING. FAITH REGIONAL IS ALSO A MEMBER OF THE NORFOLK CHAMBER OF COMMERCE WHICH IS INVOLVED IN BUSINESS RETAIL DEVELOPMENT AND SUPPORT AS WELL AS THE COMMUNITY IMPROVEMENT PROJECTS. FAITH ALSO WORKS WITH ORGANIZATIONS LIKE THE ORPHAN GRAIN TRAIN IN PROVIDING MEDICINE AND MEDICAL EQUIPMENT/SUPPLIES TO OTHER NATIONS IN NEED. |
| PART VI, LINE 3: PATIENTS RECEIVING CARE ARE GIVEN INFORMATION REGARDING FAITH REGIONAL'S FINANCIAL ASSISTANCE PROGRAM THROUGH THE USE OF BROCHURES HANDED OUT BY REGISTRATION, HOSPITAL SOCIAL SERVICES, M.A.S.H. (MEDICAL ADVOCACY SERVICES FOR HEALTHCARE) PERSONNEL, AND BY PATIENT ACCOUNTS STAFF. ANY PATIENT OR FAMILY MEMBER THAT EXPRESSES CONCERN REGARDING ABILITY TO PAY FOR SERVICES WILL BE DIRECTED TO A SOCIAL WORKER, REGISTRATION CLERK, CASHIER, OR FINANCIAL SERVICES REPRESENTATIVE WHO WILL THEN GIVE THEM AN APPLICATION FOR PATIENT FINANCIAL ASSISTANCE ALONG WITH A BROCHURE EXPLAINING HOW TO COMPLETE THE APPLICATION. THE APPLICATION WILL NEED TO BE SUBMITTED ALONG WITH PROOF OF THEIR GROSS INCOME FOR THE PRECEDING THREE MONTHS. THIS CAN BE ACCOMPLISHED BY PROVIDING CHECK STUBS FOR THE PRECEDING THREE MONTHS, PROVIDING THE MOST RECENTLY FILED TAX RETURN OR BY PRESENTING A STATEMENT FROM THEIR EMPLOYER (ON COMPANY LETTERHEAD) INDICATING GROSS INCOME FOR EACH OF THE PREVIOUS THREE MONTHS. MEDICARE PATIENTS MAY SHOW THEIR ORIGINAL DETERMINATION AMOUNT, A PHOTOCOPY OF A MONTHLY CHECK, OR A COPY OF THEIR BANK STATEMENT.THE FINANCIAL SERVICES REPRESENTATIVE WILL THEN MULTIPLY THE GROSS INCOME FOR THE THREE MONTHS BY FOUR TO GET AN ANNUAL GROSS INCOME. THE FINANCIAL SERVICE REPRESENTATIVE WILL ALSO REVIEW THE PATIENT'S ASSETS TO SEE IF THERE IS SUFFICIENT EQUITY TO HELP PAY FOR HEALTH SERVICES. THE EQUITY OF ASSETS WILL BE DETERMINED AS FOLLOWS: REAL ESTATE - WE WILL EXCLUDE THE PRIMARY RESIDENCE ALONG WITH UP TO 1 ACRE OF LAND THAT THE RESIDENCE IS ON; WE WILL INCLUDE RENTAL PROPERTIES, ALL HOMES OR REAL PROPERTY ABOVE AND BEYOND THE PRIMARY RESIDENCE, CABINS, RECREATIONAL PROPERTY, ETC., AS WELL AS REAL ESTATE OWNED FOR BUSINESS PURPOSES.PERSONAL PROPERTY - WE WILL EXCLUDE ONE VEHICLE PER WAGE EARNER (OR SOCIAL SECURITY OR DISABILITY RECIPIENT); WE WILL CONSIDER THE EQUITY IN MOTOR VEHICLES (MOTORCYCLES, MOTOR HOMES, BOATS, BOAT TRAILERS, AND ATVS).OTHER PERSONAL PROPERTY WILL INCLUDE STOCKS, BONDS, CDS, FUTURES, ANTIQUE COLLECTIBLES, AND ANY OTHER COLLECTIONS OF VALUE.THE HOUSEHOLD SIZE WILL BE DETERMINED USING THE FEDERAL HOUSEHOLD DEFINITIONS.IF THERE IS AN OMISSION OF INFORMATION ON THE APPLICATIONS OR INFORMATION PROVIDED APPEARS TO BE INCORRECT, A LETTER WILL BE SENT TO THE PATIENT REQUESTING THE MISSING INFORMATION OR REQUESTING CLARIFICATION OF THE INFORMATION. THE DATE THAT THE LETTER IS SENT WILL BE DOCUMENTED ON A LOG OF PENDING APPLICATIONS. IF THE REQUESTED DOCUMENTATION IS NOT RETURNED IN NINE WORKING DAYS, THE APPLICATION WILL BE DENIED.THE TEAM LEADER FOR THE PATIENT FINANCIAL SERVICES REPRESENTATIVES WILL REVIEW THE APPLICATION AND ASSETS AND MAKE A DETERMINIATION WITHIN 3 DAYS OF THE RECEIPT OF A COMPLETE APPLICATION. THE TEAM LEADER WILL THENNOTIFY (BY LETTER) THE PATIENT INDICATING THAT THE APPLCIATION HAS BEEN APPROVED OR DENIED. IF THE APPLICATION IS DENIED THE PATIENT MAY APPLY AGAIN IF THEIR FINANCIAL CIRCUMSTANCES CHANGE. |
| PART VI, LINE 4: FAITH REGIONAL'S PRIMARY SERVICE AREA CONSISTS OF ANTELOPE, HOLT, KNOX, MADISON, PIERCE, PLATTE, STANTON AND WAYNE COUNTIES IN NEBRASKA REPRESENTING A POPULATION OF APPROXIMATELY 116,000 PEOPLE. THE HOSPITAL'S SECONDARY SERVICE AREA CONSISTS OF BOONE, CEDAR, COLFAX, CUMING AND DIXON COUNTIES IN NEBRASKA REPRESENTING APPROXIMATELY 40,000 PEOPLE. FAITH REGIONAL ALSO HAS A TERTIARY SERVICE AREA OF CHERRY, BROWN, KEYA PAHA, ROCK, BOYD, GARFIELD, WHEELER, GREELEY, NANCE, DAKOTA, THURSTON AND BURT COUNTIES IN NEBRASKA WITH APPROXIMATELY A POPULATION OF 57,400.FOR THE YEAR ENDED DECEMBER 31, 2010, 91% OF FAITH REGIONAL'S DISCHARGES WERE FROM PATIENTS RESIDING IN THE PRIMARY SERVICE AREA; 5% FROM THE SECONDARY; AND 1% FROM THE TERTIARY SERVICE AREAS. THE REMAINING 3% OF DISCHARGES WERE FROM PATIENTS RESIDING OUTSIDE OF THE DEFINED SERVICE AREA.DEMOGRAPHIC SURVEY (SOURCE: US CENSUS BUREAU 2010 CENSUS)MADISON COUNTY:TOTAL POPULATION: 34,876AVERAGE INCOME: $42,911"PERCENT OF INDIVIDUALS BELOW POVERTY LEVEL": 12%BREAKOUT OF POPULATION BY AGE:AGE POPULATION % OF TOTALLESS THAN 19 9,911 28.4%20 - 24 2,458 7.1%25 - 44 8,037 23.0%45 - 64 9,346 26.8%65+ 5,124 14.7%TOTAL 34,876 100.0%BREAKOUT OF POPULATION BY RACE:RACE POPULATION % OF TOTALWHITE 30,752 88.2%BLACK/AFRICAN AMERICAN 444 1.3%AMERICAN INDIAN 401 1.1%ASIAN/PACIFIC ISLANDER 183 0.5%OTHER 3,096 8.9%TOTAL 34,876 100.0% |
| PART VI, LINE 6: FAITH REGIONAL, A NOT-FOR-PROFIT HEALTH CARE FACILITY, LOCATED IN NORTHEAST NEBRASKA, OPERATES FOR THE BENEFIT OF THE INDIVIDUALS IN THE SERVICE AREA. FAITH REGIONAL SERVES ALL PATIENTS REGARDLESS OF THEIR ABILITY TO PAY AND DOES NOT LIMIT ITS SERVICES OR DISCRIMINATE AGAINST ANYONE ON THE BASIS OF RACE, COLOR, SEX, NATIONAL ORIGIN, SEXUAL ORIENTATION, RELIGION, AGE, DISABILITY, DISEASE, OR DIAGNOSIS. FAITH REGIONAL ALSO PROVIDES COMMUNICATIONS SERVICES (E.G. BILINGUAL STAFF AND INTERPRETERS, SIGN LANGUAGE INTERPRETERS, TDD SERVICES, ETC) FOR SENSORY IMPAIRED INDIVIDUALS. FAITH REGIONAL EVALUATES ITSELF ON ITS EFFECTIVENESS ANNUALLY BY EXAMINING ITS ABILITY TO FULFILL ITS MISSION, ACCOMPLISH ITS VISION, PROVIDE SERVICE, AND MAINTAIN ITS VALUES. FAITH REGIONAL'S MISSION, VISION, SERVICE, AND VALUESARE: THE MISSION: THE MISSION IS TO SERVE CHRIST BY PROVIDING ALL PEOPLE WITH EXEMPLARY MEDICAL SERVICES IN AN ENVIRONMENT OF LOVE AND CARE.THE VISION: THE VISION OF FAITH REGIONAL HEALTH SERVICES IS TO BECOME A REGIONAL REFERRAL CENTER BY PROVIDING THE MOST COMPREHENSIVE, HIGH QUALITY HEALTH SERVICES TO THE RESIDENTS OF NORTHEAST NEBRASKA. THE VALUES:SPIRITUALITYEXCELLENCEINTEGRITYCOMPASSIONRESPECTSTEWARDSHIPFAITH REGIONAL'S PROGRAM SERVICE ACCOMPLISHMENTS ARE BASED ON THE COMMUNITY ACCOUNTABILITY STANDARDS DEVELOPED BY THE VOLUNTARY HOSPITALS OF AMERICA (VHA). THESE FOUR STANDARDS ARE:1) DEMONSTRATE LEADERSHIP AS A CHARITABLE INSTITUTION . "ORGANIZATIONS SHOULD ACTIVELY PURSUE AN UNDERSTANDING OF THEIR COMMUNITIES' NEEDS AND FULFILL THEM TO THE BEST OF THEIR ABILITY. THIS INCLUDES REACHING OUT WITH PREVENTATIVE AND OTHER HEALTHCARE, PARTICIPATING IN MEDICARE, MEDICAID AND OTHER REIMBURSEMENT PROGRAMS FOR THE NEEDY, AND SOLICITING AND DONATING FUNDS TO HELP THOSE IN NEED."2) PROVIDING ESSENTIAL HEALTH CARE SERVICES - "ORGANIZATIONS SHOULD ASSESS THEIR COMMUNITIES' HEALTH NEEDS AND WORK TO MEET THEM AS NECESSARY, INCLUDING COOPERATING WITH OTHER COMMUNITY HEALTH CARE PROVIDERS TO PROVIDE THE BEST CARE POSSIBLE AND OFFERING 24-HOUR EMERGENCY SERVICES."3) BEING ACCOUNTABLE TO THE COMMUNITY. "ORGANIZATIONS SHOULD WORK WITH A VOLUNTEER GOVERNING BOARD THAT IS REPRESENTATIVE OF THE COMMUNITY. ORGANIZATIONS ARE ALSO ENCOURAGED TO VOLUNTARILY DISCLOSE INFORMATION ABOUT FINANCIAL STATUS, COMMUNITIY BENEFIT ACTIVITIES, SERVICES AND CHARITY CARE, AND TO ADVOCATE HEALTH CARE COST CONTAINMENT AND OTHER ISSUES AS APPROPRIATE."4) MAINTAING EVIDENCE OF COMMITMENT TO COMMUNITY BENEFIT. "ORGANIZATIONS SHOULD EMBRACE A MISSION STATEMENT AND BYLAWS REFLECTING A COMMITMENT TO THE GOOD OF THE COMMUNITY AND SHOULD ACT AS LEADERS IN ORGANIZING COMMUNITY BENEFIT ACTIVITIES, BASED ON COMMUNITY NEEDS, SHOULD BE PART OF A STRATEGIC PLAN, AND EMPLOYEES AND MEDICAL STAFF SHOULD BE EDUCATED AND INVOLVED IN THESE ACTIVITIES."FAITH REGIONAL REGOGNIZES ITS OBLIGATION TO DEMONSTRATE LEADERSHIP AS A CHARITABLE ORGANIZATION BY PROVIDING A FULL RANGE OF HEALTH CARE, HEALTH EDUCATION AND WELLNESS RELATED SERVICES TO THE COMMUNITY, AND PARTICIPATING IN FEDERAL, STATE AND LOCAL PROGRAMS TO PROVIDE HEALTH BENEFITS TO THOSE IN NEED.DURING 2010, FAITH REGIONAL PARTICIPATED IN A VARIETY OF PROGRAMS INTENDED TO BENEFIT THE ELDERLY AND NEEDY POPULATIONS WITHIN, AND THOSE INDIVIDUALS ENTERING, ITS SERVICE AREA. THESE INCLUDE MEDICARE, MEDICAID, CHAMPUS, WORKERS COMPENSATION, AND OTHER DISCOUNTED HEALTH INSURANCE PROGRAMS. FAITH IS ALSO A PARTICIPATING PROVIDER WITH SEVERAL COMMERCIAL INSURANCE COMPANIES PROVIDING MANAGED CARE TO EMPLOYERS IN OUR COMMUNITIES. THIS PARTICIPATION PROVIDES INDIVIDUALS WITH ACCESS TO A LOCAL HEALTH CARE PROVIDER. IN ADDITION, FAITH PROVIDES CHARITY CARE FOR THOSE INDIVIDUALS, WHEN IDENTIFIED, WHO ARE FOUND TO BE UNABLE TO PAY FOR SERVICES RENDERED. BECAUSE OF ITS PARTICIPATATION IN VARIOUS HEALTH INSURANCE AND CHARITY PROGRAMS, FAITH REGIONAL ACCEPTS CONTRACTUALLY DISCOUNTED PAYMENTS AS PAYMENT IN FULL. THIS DISCOUNTED PAYMENT VARIES WITH THE TYPE OF THIRD PARTY PAYOR. THESE AMOUNTS, CONTRACTUAL ADJUSTMENTS, ARE DISCOUNTED FROM NORMAL CHARGES. IN ADDITION TO PROVIDING UNCOMPENSATED MEDICAL CARE, DURING 2010 FAITH REGIONAL ALSO PROVIDED CASH AND IN-KIND CONTRIBUTIONS TO VARIOUS COMMUNITY ORGANIZATIONS TO FURTHER THE MISSION OF THOSE ORGANIZATIONS AND IMPROVE OVERALL AWARENESS OF HEALTHCARE RELATED ISSUES IN OUR COMMUNITIES. ORGANIZATIONS RECEIVING CASH OR IN-KIND CONTRIBUTIONS FROM FAITH INCLUDE:THE AMERICAN RED CROSS, AMERICAN HEART ASSOCIATION, CITY OF NORFOLK, BIRTHRIGHT OF NORFOLK, PLANNED APPROACH TO COMMUNITY HEALTH (PATCH), AND NORFOLK AREA CHAMBER OF COMMERCE. ALSO DURING 2010 FAITH CONTRIBUTED FINANCIAL SUPPORT FOR A NEW 4-YEAR NURSING SCHOOL IN NORFOLK, NE THROUGH COLLABORATION BETWEEN NORTHEAST COMMUNITY COLLEGE AND THE UNIVERSITY OF NEBRASKA.FAITH REGIONAL ALSO FINANCIALLY SUPPORTS THE NORFOLK COMMUNITY "FREE CLINIC" THROUGH PHYSICIAN RECRUITMENT AND CLINIC SPACE DONATION. FAITH REGIONAL PROVIDES TRANSPORTATION SERVICES PRIMARILY TO RADIATION ONCOLOGY AND RENAL DIALYSIS PATIENTS AT NO CHARGE.FAITH REGIONAL REMAINS ACCOUNTABLE TO THE COMMUNITY BY WORKING WITH A VOLUNTEER GOVERNING BOARD THAT IS REPRESENTATIVE OF THE COMMUNITY IT SERVES. COOPERATION WITH COMMUNITY BASED HEALTH ORGANIZATIONS IDENTIFY PERTINENT ISSUES RELATED TO ESSENTIAL SERVICES, CHARITY CARE, HEALTH CARE COST CONTAINMENT, COMMUNITY BENEFIT ACTIVITIES AND OTHERS AS APPROPRIATE. FAITH REGIONAL CONTINUES TO OPERATE UNDER A VOLUNTEER GOVERNING BOARD AND REMAINS ACTIVELY INVOLVED IN ADVOCATING PUBLIC AWARENESS OF HEALTH CARE AND HEALTH CARE POLICY ISSUES. DISCLOSURES OF FINANCIAL INFORMATION, COMMUNITY BENEFIT INFORMATION AND ADVOCACY ISSUES IS PROVIDED THROUGH A VARIETY OF MEDIA INCLUDING AN ANNUAL REPORT TO THE COMMUNITY, MEDIA RELEASES, AND ITS INTERNET WEBSITE: WWW.FRHS.ORGFAITH REGIONAL'S CONTRIBUTION TO THE COMMUNITY NOT ONLY INCLUDES COMPENSATED AND DONATED TIME BUT ALSO EQUIPMENT, MATERIALS AND SPACE. MEETING ROOMS ARE PROVIDED AS NEEDED AND EQUIPMENT AND MATERIALS (E.G. COMPUTERS, COPIER,FAXES, TELEPHONES, CHILDBIRTH PROPS, PROJECTORS, MANNEQUINS, HEARING BOOTH, AUDIOMETERS, BEDS, MONITORS, WARMING UNITS, MINOR INSTRUMENTS, ETC) ARE PROVIDED AT NO CHARGE. A MAJOR CONCERN IN HEALTH CARE THAT CAN SOMETIMES BE "HIDDEN" IS THAT OF SEXUAL ABUSE AND NEGLECT IN CHILDREN. THE NORTHEAST NEBRASKA CHILD ADVOCACY PROGRAM AT FAITH REGIONAL PROVIDES A SAFE, NON THREATENING ENVIRONMENT WHERE CHILDREN (AGES INFANT TO 18) WHO ARE VICTIMS OF ABUSE RECEIVE IMMEDIATE MEDICAL CARE AND FORENSIC INTERVIEWS FROM VARIOUS AGENCIES WORKING TOGETHER. ALL OF THESE SERVICES ARE AVAILABLE FREE TO FAMILIES WITHIN A 24-COUNTY AREA. |
| PART VI, LINE 7: N/A |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Records Maintained | 1 | RecordsMaintained |
Recipient Table RecipientTable (9 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EIN Of RecipientEINOfRecipient | IRC SectionIRCSection | Amount Of Non Cash AssistanceAmountOfNonCashAssistance | Method Of ValuationMethodOfValuation | Description Of Non Cash AssistanceDescriptionOfNonCashAssistance | Purpose Of GrantPurposeOfGrant | Amount Of Cash GrantAmountOfCashGrant |
|---|---|---|---|---|---|---|---|---|---|---|
| THE AMERICAN RED CROSS | ||||||||||
| 3838 DEWEY AVENUE | OMAHA | NE | 68105 | 530196605 | 501(C)(3) | 27185 | FMV | IN-KIND RENT | DEFRAY OPERATING COSTS | |
| NORTHEAST NEBRASKA AREA HEALTH EDUCATION CENTER (AHEC) | ||||||||||
| 110 NORTH 16TH STREET SUITE 2 | NORFOLK | NE | 68701 | 223867376 | 501(C)(3) | 25912 | FMV | IN-KIND RENT | DEFRAY OPERATING COSTS | |
| NORFOLK COMMUNITY HEALTHCARE CLINIC INC | ||||||||||
| 110 NORTH 16TH STREET SUITE 16 | NORFOLK | NE | 68701 | 470833378 | 501(C)(3) | 45771 | FMV | IN-KIND RENT | DEFRAY OPERATING COSTS | |
| ORPHAN GRAIN TRAIN | ||||||||||
| PO BOX 1466 | NORFOLK | NE | 68702 | 311614650 | 501(C)(3) | 6300 | FMV | DONATION OF DISHES | SUPPORT MISSION OF ORPHAN GRAIN TRAIN | |
| UNIVERSITY OF NE - UNMC COLLEGE OF NURSING | ||||||||||
| 3838 HOLDREGE STREET | LINCOLN | NE | 68503 | 470049123 | 501(C)(3) | HELP FUND NEW NURSING COLLEGE LOCATION IN NORFOLK, NE | 250000 | |||
| BLOOMFIELD COMMUNITY CLINIC | ||||||||||
| 105 SOUTH BROADWAY | BLOOMFIELD | NE | 68718 | 261507298 | ASSIST IN DEVELOPMENT OF COMMUNITY MEDICAL CLINIC | 15000 | ||||
| MAKE-A-WISH FOUNDATION | ||||||||||
| 11926 ARBOR STREET SUITE 102 | OMAHA | NE | 68144 | 470671096 | 501(C)(3) | 5585 | FMV | DONATION OF JACKETS | GOLF TOURNAMENT FOR BENEFIT OF MAKE-A-WISH FOUNDATION | |
| AMERICAN HEART ASSOCIATION | ||||||||||
| 460 N LINDBERGH BLVD | ST LOUIS | MO | 63141 | 135613797 | 501(C)(3) | GO RED FOR WOMEN EVENT | 10500 | |||
| FAITH REGIONAL HEALTH SERVICES FOUNDATION | ||||||||||
| 2700 WEST NORFOLK AVENUE SUITE 200 | NORFOLK | NE | 68701 | 911772474 | 501(C)(3) | GENERAL OPERATIONS | 14115 | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Nbr Of501 C3 And Govt Grants | 8 | TotalNbrOf501C3AndGovtGrants |
| Total Nbr Of Other Organizations | 1 | TotalNbrOfOtherOrganizations |
Form990 Schedule I Part IV Form990ScheduleIPartIV (2 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| PROCEDURE FOR MONITORING GRANTS IN THE U.S.: | PART I, LINE 2: | SCHEDULE I, PART I, LINE 2: IN-KIND DONATIONS OF RENT ARE MADE TO 501(C)(3) ORGANIZATIONS. THESE DONATIONS HELP THE DONEE ORGANIZATIONS MINIMIZE CASH NEEDED FOR OPERATING COSTS AND ALLOW THE ORGANIZATIONS TO USE THEIR AVAILABLE FUNDS IN FURTHERANCE OF THEIR MISSIONS. CASH DONATIONS ARE ALSO MADE TO 501(C)(3) ORGANIZATIONS, MANY OF WHICH HAVE HEALTH CARE OR SOCIAL SERVICES MISSIONS. THESE DONATIONS ARE SOMETIME RESTRICTED FOR A SPECIFIC USE OR ACTIVITY. 501(C)(3) ORGANIZATIONS ARE BOUND BY THEIR ARTICLES OF ORGANIZATION AND STATED MISSIONS TO CONDUCTING ACTIVITIES STRICTLY FOR CHARITABLE PURPOSES. FAITH REGIONAL DOES NOT REQUEST GRANT REPORTS FROM DONEE CHARITABLE ORGANIZATIONS. |
| OTHER INFORMATION: | PART IV: | SCHEDULE I, PART II, LINE 1(A): IN 2010 FAITH REGIONAL MADE A $15,000 CONTRIBUTION TO THE BLOOMFIELD COMMUNITY CLINIC, NOW CALLED THE BLOOMFIELD MEDICAL CLINIC, FOR DEVELOPMENT OF THEIR NEW CLINIC. FAITH REGIONAL RECEIVED NOTICE FROM THE BLOOMFIELD COMMUNITY CLINIC, AFTER REQUESTING THEIR EIN, THAT THEY ARE NOT A 501(C)(3) ORGANIZATION AND ARE A FOR-PROFIT ORGANIZATION. FAITH REGIONAL CONSIDERS THIS PAYMENT WITHIN THEIR CHARITABLE MISSION OF PROMOTING HEALTH CARE IN THE COMMUNITY OF NORFOLK, NE. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Travel For Companions | X | TravelForCompanions |
| Idemnification Gross Up Payments | X | IdemnificationGrossUpPayments |
| 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 (13 entries)
| 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 J SINEK | |||||||||||||
| 445133 | 0 | 0 | 0 | 18059 | 0 | 7350 | 0 | 10709 | 0 | 481251 | 0 | 0 | 0 |
| DALE POHLMAN | |||||||||||||
| 129373 | 0 | 0 | 0 | 11808 | 0 | 6611 | 0 | 5197 | 0 | 152989 | 0 | 0 | 0 |
| DOUGLAS WISMER | |||||||||||||
| 162862 | 0 | 0 | 0 | 12828 | 0 | 6547 | 0 | 6281 | 0 | 188518 | 0 | 0 | 0 |
| LINDA MILLER | |||||||||||||
| 138109 | 0 | 0 | 0 | 16385 | 0 | 7245 | 0 | 9141 | 0 | 170880 | 0 | 0 | 0 |
| DR DEAN FRENCH | |||||||||||||
| 351987 | 0 | 0 | 0 | 17379 | 0 | 7350 | 0 | 10029 | 0 | 386745 | 0 | 0 | 0 |
| H MICHAEL HAMMOND | |||||||||||||
| 160592 | 0 | 0 | 0 | 18460 | 0 | 8302 | 0 | 10158 | 0 | 197512 | 0 | 0 | 0 |
| PATRICK ROCHE | |||||||||||||
| 160669 | 0 | 0 | 0 | 18633 | 0 | 8250 | 0 | 10383 | 0 | 197935 | 0 | 0 | 0 |
| BARRY SPEAR | |||||||||||||
| 154129 | 0 | 0 | 0 | 10947 | 0 | 4663 | 0 | 6284 | 0 | 176023 | 0 | 0 | 0 |
| JOSEPH MCCLAIN MD | |||||||||||||
| 797838 | 0 | 0 | 0 | 40935 | 0 | 7350 | 0 | 33585 | 0 | 879708 | 0 | 0 | 0 |
| DOUGLAS WELSH MD | |||||||||||||
| 659540 | 0 | 0 | 0 | 41380 | 0 | 9800 | 0 | 31580 | 0 | 742300 | 0 | 0 | 0 |
| RIAD MEADA MD | |||||||||||||
| 581841 | 0 | 0 | 0 | 30519 | 0 | 7350 | 0 | 23169 | 0 | 642879 | 0 | 0 | 0 |
| MOHAMMAD IMRAN MD | |||||||||||||
| 540839 | 0 | 0 | 0 | 29859 | 0 | 0 | 0 | 29859 | 0 | 600557 | 0 | 0 | 0 |
| JEFFREY YOSTEN MD | |||||||||||||
| 537698 | 0 | 0 | 0 | 17544 | 0 | 7350 | 0 | 10194 | 0 | 572786 | 0 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Reference | PART I, LINE 1A | ReturnReference |
| Explanation | JAMES J. SINEK'S YMCA MEMBERSHIP AND COUNTRY CLUB DUES ARE PAID BY FAITH REGIONAL HEALTH SERVICES. THE AMOUNTS PAID FOR THESE ITEMS ARE ADDED TO MR. SINEK'S W-2 AS WAGES. BARRY SPEAR'S COUNTRY CLUB DUES ARE PAID BY FAITH REGIONAL HEALTH SERVICES. THE AMOUNT PAID FOR THIS ITEM IS ADDED TO MR. SPEAR'S W-2 AS WAGES. | Explanation |
Schedule K IRS990ScheduleK
Form990 Schedule K Part I Form990ScheduleKPartI (2 entries)
| Issuer EINIssuerEIN | CUSIP NumberCUSIPNumber | Date IssuedDateIssued | Issue PriceIssuePrice | Description Of PurposeDescriptionOfPurpose | DefeasedDefeased | On Behalf Of IssuerOnBehalfOfIssuer | Pool FinancingPoolFinancing |
|---|---|---|---|---|---|---|---|
| HOSPITAL AUTHORITY #1 OF MADISON COUNTY NEBRASKA | |||||||
| 521357975 | 557463DR9 | 2008-07-10 | 65501382 | FUND NEW BED TOWER AND REIMBURSE PRIOR CAPITAL, REFUND PRIOR ISSUES | 0 | 0 | 0 |
| HOSPITAL AUTHORITY #1 OF MADISON COUNTY NEBRASKA | |||||||
| 521357975 | 557352EF4 | 2008-11-20 | 15000000 | CONSTRUCTION OF TOWER | 0 | 0 | 0 |
Form990 Schedule K Part II Form990ScheduleKPartII (2 entries)
| Amount RetiredAmountRetired | Total ProceedsTotalProceeds | Amount In Reserve FundAmountInReserveFund | Capitalized InterestCapitalizedInterest | Refunding EscrowRefundingEscrow | Capital ExpendituresCapitalExpenditures | Other Spent ProceedsOtherSpentProceeds | Year Of Subst CompletionYearOfSubstCompletion | Current RefundingCurrentRefunding | Advance RefundingAdvanceRefunding | Final Allocation MadeFinalAllocationMade | Adequate Books And Recds MaintaindAdequateBooksAndRecdsMaintaind | Credit EnhancementCreditEnhancement |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 5130000 | 65984915 | 5822866 | 113793 | 12532261 | 38580806 | 8935189 | 2010 | 1 | 1 | 1 | 1 | |
| 15039468 | 15016635 | 2010 | 0 | 0 | 1 | 1 | 22833 |
Form990 Schedule K Part III Form990ScheduleKPartIII (2 entries)
| Owning Bond Financed PropertyOwningBondFinancedProperty | Any Lease ArrangementsAnyLeaseArrangements | Mngment Cntrct Bond Financd PrprtyMngmentCntrctBondFinancdPrprty | Any Research AgreementsAnyResearchAgreements | Bond Counsel Routinely EngagedBondCounselRoutinelyEngaged | Prcntge Prvt Business Use By OthersPrcntgePrvtBusinessUseByOthers | Percentage Of Prvt Business Re UBIPercentageOfPrvtBusinessReUBI | Total Private Business UseTotalPrivateBusinessUse | Post Issuance Compliance ProcdrsPostIssuanceComplianceProcdrs |
|---|---|---|---|---|---|---|---|---|
| 0 | 0 | 1 | 0 | 1 | 0.00000 | 0.00000 | 0.00000 | 1 |
| 0 | 0 | 1 | 0 | 1 | 0.00000 | 0.00000 | 0.00000 | 1 |
Form990 Schedule K Part IV Form990ScheduleKPartIV (2 entries)
| Form8038 T FiledForm8038TFiled | Variable Rate IssueVariableRateIssue | Hedge Identified In Books And RecdsHedgeIdentifiedInBooksAndRecds | Gross Proceeds Invested In GICGrossProceedsInvestedInGIC | Gross Proceeds InvestedGrossProceedsInvested | Exception To RebateExceptionToRebate |
|---|---|---|---|---|---|
| 0 | 0 | 0 | 0 | 0 | 1 |
| 0 | 1 | 0 | 0 | 0 | 1 |
Form990 Schedule K Part V Form990ScheduleKPartV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | SCHEDULE K SUPPLENTAL INFORMATION | Identifier |
| Explanation | SCHEDULE K, PART II, LINE 3: THE TOTAL PROCEEDS DO NOT AGREE TO THE ISSUE PRICE IN PART I, COLUMN (E) DUE TO INVESTMENT EARNINGS. | Explanation |
Schedule L IRS990ScheduleL
Form990 Schedule L Part IV Form990ScheduleLPartIV (5 entries)
| RelationshipRelationship | Amount Of TransactionAmountOfTransaction | Description Of TransactionDescriptionOfTransaction | Sharing Of RevenuesSharingOfRevenues |
|---|---|---|---|
| JUDITH MILLER | |||
| JUDITH'S SPOUSE IS JAMES MILLER, BOARD MEMBER. | 23953 | JUDITH IS AN EMPLOYEE OF FAITH REGIONAL HEALTH SERVICES. | 0 |
| PAMELA PILE | |||
| PAMELA'S BROTHER-IN-LAW IS JOHN DINKEL, BOARD MEMBER. | 44942 | PAMELA IS AN EMPLOYEE OF FAITH REGIONAL HEALTH SERVICES. | 0 |
| LORI KNAPP | |||
| LORI'S BROTHER-IN-LAW IS SCOTT MILLER, A BOARD MEMBER. | 39673 | LORI IS AN EMPLOYEE OF FAITH REGIONAL HEALTH SERVICES. | 0 |
| DANIELLE FREUDENBURG | |||
| DANIELLE'S BROTHER-IN-LAW IS SCOTT MILLER, A BOARD MEMBER. | 38846 | DANIELLE IS AN EMPLOYEE OF FAITH REGIONAL HEALTH SERVICES. | 0 |
| PATHOLOGY MEDICAL SERVICES PC | |||
| DR. LACY SERVES AS A DIRECTOR, AND HE IS A SHAREHOLDER OF THE COMPANY | 120467 | PATHOLOGY MEDICAL SERVICES PC PROVIDES SERVICES TO FAITH REGIONAL HEALTH SERVICES. | 0 |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (11 entries)
| IdentifierIdentifier | ExplanationExplanation | Return ReferenceReturnReference |
|---|---|---|
| FORM 990, PART VI, SECTION A, LINE 2 | JOHN DINKEL AND MARY KAY UHING HAVE A FAMILY RELATIONSHIP. | |
| FORM 990, PART VI, SECTION A, LINE 6 | FAITH REGIONAL HAS ONE NONPROFIT 501(C)(3) CORPORATE MEMBER, LUTHERAN COMMUNITY HOSPITAL ASSOCIATION. | |
| FORM 990, PART VI, SECTION A, LINE 7A | PURSUANT TO FAITH REGIONAL'S 2008 RESTATED BYLAWS, THE SOLE CORPORATE MEMBER, LUTHERAN COMMUNITY HOSPITAL ASSOCIATION, APPOINTS 14 OF THE 15 VOTING MEMBERS OF THE BOARD OF DIRECTORS OF FAITH REGIONAL HEALTH SERVICES. | |
| FORM 990, PART VI, SECTION A, LINE 7B | FAITH REGIONAL'S RESTATED BYLAWS RESERVE CERTAIN POWERS TO ITS SOLE MEMBER, LUTHERAN COMMUNITY HOSPITAL ASSOCIATION. THERE ARE 13 RESERVED POWERS, INCLUDING APPOINTMENT AND REMOVAL OF DIRECTORS, OTHER THAN CHIEF OF STAFF, AMENDMENT OF THE ARTICLES OF INCORPORATION AND BYLAWS, AMENDMENT OF THE MISSION, VISION AND VALUE STATEMENTS, AMONG OTHERS. | |
| FORM 990, PART VI, SECTION B, LINE 11 | THE FORM 990 AND ALL APPLICABLE SCHEDULES WERE PREPARED BY SEIM JOHNSON, LLP IN OMAHA, NE. POST-AUDIT REVIEW, FORM 990 AND SCHEDULES ARE MAILED TO EACH BOARD MEMBER. FORM 990 IS REVIEWED AND DISCUSSED AT THE SCHEDULED BOARD MEETING PRIOR TO SUBMISSION TO IRS. | |
| FAITH REGIONAL'S BOARD MEMBERS ARE REQUIRED TO SIGN A NEW CONFLICT OF INTEREST STATEMENT AND DISCLOSURE ANNUALLY. ANY CONFLICTS ARE REVIEWED BY THE BOARD. A MEMBER WITH A CONFLICT IS EXCUSED FROM THE BOARD DELIBERATIONS AND ACTION. | FORM 990, PART VI, SECTION B, LINE 12C | |
| DETERMINATION OF COMPENSATION FOR THE CEO AND OTHER OFFICERS AND KEY EMPLOYEES IS MADE BY GATHERING DATA FROM EXTERNAL SURVEYS AND THE FORM 990 DATA PROVIDED BY COMPARABLE FACILITIES. FACILITIES USED ARE DETERMINED BY SIMILAR BED SIZE, NET REVENUES AND NUMBER OF FTES. WAGES ARE GATHERED AND COMPARED BY TITLE, RESPONSIBILITIES, AND YEARS OF EXPERIENCE. THE SALARY RECOMMENDATIONS ARE MADE BY THE HUMAN RESOURCE DEPARTMENT. THE GOVERNING BOARD APPROVES THE SALARY RECOMMENDATIONS FOR THE CEO; THE CEO APPROVES THE RECOMMENDATIONS FOR THE OTHER OFFICERS AND VICE-PRESIDENTS; AND THE VICE-PRESIDENTS APPROVE THE RECOMMENDATIONS FOR THE "DIRECTORS" OF VARIOUS HOSPITAL DEPARTMENTS. | FORM 990, PART VI, SECTION B, LINE 15 | |
| FAITH REGIONAL DOES NOT MAKE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY OR FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC. | FORM 990, PART VI, SECTION C, LINE 19 | |
| JAMES SINEK, CEO, DEVOTES AN AVERAGE OF 1.00 HOURS PER WEEK TO FAITH REGIONAL HEALTH SERVICES FOUNDATION, A RELATED ORGANIZATION. DOUGLAS WISMER, CFO, DEVOTES AN AVERAGE OF 1.00 HOURS PER WEEK TO FAITH REGIONAL HEALTH SERVICES FOUNDATION, A RELATED ORGANIZATION. DALE POHLMAN, CFO , DEVOTED AN AVERAGE OF 1.00 HOURS PER WEEK TO FAITH REGIONAL HEALTH SERVICES FOUNDATION, A RELATED ORGANIZATION. BARRY SPEAR, VP GROWTH & DEVELOPMENT, DEVOTED AN AVERAGE OF 16.00 HOUR PER WEEK TO FAITH REGIONAL HEALTH SERVICES FOUNDATION, A RELATED ORGANIZATION. | FORM 990, PART VII, SECTION A, LINE 1A: | |
| CHANGES IN NET ASSETS OR FUND BALANCES: | NET UNREALIZED LOSSES ON INVESTMENTS: -156,847. | FORM 990, PART XI, LINE 5: |
| THE FINANCE/AUDIT COMMITTEE MEETS MONTHLY TO REVIEW OUR UNAUDITED FINANCIAL STATEMENTS. IN NOVEMBER OF EACH YEAR THEY MEET TO APPROVE OUR ANNUAL BUDGET AND FIVE-YEAR STRATEGIC FINANCIAL PLAN. IN DECEMBER THEY WILL REVIEW AND APPROVE THE ENGAGEMENT LETTER PREPARED BY OUR EXTERNAL AUDITORS, SEIM JOHNSON, LLP, WHICH OUTLINES THE SCOPE OF THEIR AUDIT AND THEIR FEES AND EXPENSES. IN JANUARY OF THE SUCCEEDING YEAR THEY WILL MEET IN EXECUTIVE SESSION WITH SEIM JOHNSON, LLP REPRESENTATIVES TO DISCUSS ANY CONCERNS OR ISSUES THEY MAY HAVE. AT THE CLOSE OF THE AUDIT THEY MEET WITH THE FAITH REGIONAL EXECUTIVE TEAM AND SEIM JOHNSON, LLP REPRESENTATIVES TO DISCUSS ANY AUDIT ISSUES. IN MID TO LATE MARCH THEY THEN MEET AGAIN WITH SEIM JOHNSON, LLP REPRESENTATIVES TO DISCUSS THE DRAFT AND FINAL AUDITED FINANCIAL STATEMENTS INCLUDING THEIR OPINION. REGARDING THE SELECTION OF AN EXTERNAL AUDITOR, THE COMMITTEE HAS IN THE PAST SELECTED UP TO THREE REGIONAL CPA FIRMS SPECIALIZING IN HEALTHCARE AUDITS TO SEND RFPS TO AND THEN REVIEW THE RFPS AT A LATER DATE. THE LAST TIME THIS WAS DONE THEY REAFFIRMED THE RETENTION OF SEIM JOHNSON, LLP AS THE EXTERNAL AUDITOR. EACH FIVE YEARS, ALTHOUGH NOT REQUIRED BY THE SARBANES-OXLEY LEGISLATION, SEIM JOHNSON, LLP ROTATES ONE OF THEIR PARTNERS TO THE FAITH REGIONAL ENGAGEMENT. | FORM 990, PART XII, LINE 2C: |
Schedule R IRS990ScheduleR
Form990 Schedule R Part I Form990ScheduleRPartI
Name Of Disregarded Entity NameOfDisregardedEntity
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | FAITH REGIONAL PHYSICIAN SERVICES LLC | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2700 WEST NORFOLK AVENUE | AddressLine1 |
| City | NORFOLK | City |
| State | NE | State |
| ZIP Code | 68701 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 421629846 | EIN |
| Primary Activities | PHYSICIAN SERVICES | PrimaryActivities |
| Legal Domicile State | NE | LegalDomicileState |
| Total Income | 11350683 | TotalIncome |
| EOY Assets | 3631411 | EOYAssets |
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 | Controlled OrgControlledOrg |
|---|---|---|---|---|---|---|---|---|---|
| LUTHERAN COMMUNITY HOSPITAL ASSOCIATION | |||||||||
| 2700 W NORFOLK AVE | NORFOLK | NE | 68701 | 470396139 | SUPPORT FAITH REGIONAL HEALTH SERVICES | NE | 501(C)(3) | 3 | 0 |
| FAITH REGIONAL HEALTH SERVICES FOUNDATION | |||||||||
| 1500 KOENIGSTEIN AVE | NORFOLK | NE | 68701 | 911772474 | SUPPORT FAITH REGIONAL HEALTH SERVICES | NE | 501(C)(3) | 11A | 1 |
Form990 Schedule R Part III Form990ScheduleRPartIII
Name Of Related Org NameOfRelatedOrg
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | NORTHEAST NEBRASKA SURGERY CENTER | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 301 N 27TH STREET | AddressLine1 |
| City | NORFOLK | City |
| State | NE | State |
| ZIP Code | 68701 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 470819088 | EIN |
| Primary Activity | OUTPATIENT SURGERY | PrimaryActivity |
| Legal Domicile State | NE | LegalDomicileState |
| Predominant Income Type | RELATED | PredominantIncomeType |
| Share Of Total Income | 541779 | ShareOfTotalIncome |
| Share Of EOY Assets | 2029644 | ShareOfEOYAssets |
| Disproportionate Allocations | 0 | DisproportionateAllocations |
| General Or Managing Partner | 0 | GeneralOrManagingPartner |
| Percentage Ownership | 0.94195 | PercentageOwnership |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 1 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 0 | 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 |
| 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 | 1 | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | 0 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 0 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 1 | 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 | 1 | OtherTransferFromOtherOrg |
Transactions Related Orgs Table TransactionsRelatedOrgsTable (4 entries)
| Transaction TypeTransactionType | Amount InvolvedAmountInvolved | Method Of Amt DeterminationMethodOfAmtDetermination |
|---|---|---|
| FAITH REGIONAL HEALTH SERVICES FOUNDATION | ||
| C | 878272 | FAIR MARKET VALUE |
| NORTHEAST NEBRASKA SURGERY CENTER | ||
| N | 989054 | FAIR MARKET VALUE |
| NORTHEAST NEBRASKA SURGERY CENTER | ||
| A | 265416 | FAIR MARKET VALUE |
| NORTHEAST NEBRASKA SURGERY CENTER | ||
| R | 87460 | FAIR MARKET VALUE |
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