FAITH REGIONAL HEALTH SERVICES FOUNDATION: Form 990, tax year 2010

View the entire original 990 at ProPublica ↗

Organization
FAITH REGIONAL HEALTH SERVICES FOUNDATION (EIN 91-1772474)
Tax period
2010-01-01 to 2010-12-31
Filed
2011-11-11
IRS object ID
201143159349303639
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 ReturnHeader

FieldValueIRS element (for citing)
Timestamp2011-11-11T17:53:38-06:00Timestamp
Tax Period End Date2010-12-31TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1SEIM JOHNSON LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line118081 BURT STREET SUITE 200AddressLine1
CityOMAHACity
StateNEState
ZIP Code680224722ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2010-01-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN911772474EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1FAITH REGIONAL HEALTH SERVICES FOUNDATIONBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlFAITNameControl
Phone4026447301Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line12700 WEST NORFOLK AVENUE NO 200AddressLine1
CityNORFOLKCity
StateNEState
ZIP Code68701ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameDOUGLAS WISMERName
TitleCFOTitle
Phone4026447301Phone
Date Signed2011-11-09DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameBARBARA J FAJENName
Phone4023302660Phone
FieldValueIRS element (for citing)
Tax Year2010TaxYear
Build TS2016-03-07 17:11:31ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Address ChangeXAddressChange
Name Of Principal Officer PersonDOUGLAS WISMERNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line12700 WEST NORFOLK AVENUE NO 200AddressLine1
CityNORFOLKCity
StateNEState
ZIP Code68701ZIPCode
FieldValueIRS element (for citing)
Gross Receipts1076899GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteWWW.FRHS.ORGWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1996YearFormation
State Legal DomicileNEStateLegalDomicile
Activity Or Mission DescriptionTO AID FAITH REGIONAL HEALTH SERVICES (FRHS) BY THE SOLICITATION OF GIFTS, GRANTS, DEVICES, AND BEQUESTS EXCLUSIVELY FOR THE USE AND BENEFIT OF FRHS OR ITS PROGRAMS AND SERVICES. FRHS PROVIDES ACUTE, PREVENTIVE, AND OTHER HEALTHCARE SERVICES TO THE REGION WHILE ENCOURAGING EDUCATIONAL AND CLINICAL RESEARCH. FRHS SERVES ALL PATIENTS REGARDLESS OF THEIR ABILITY TO PAY AND DOES NOT LIMIT ITS SERVICES OR DISCRIMINATES AGAINST ANYONE ON THE BASIS OF RACE, SEX, NATIONAL ORIGIN, RELIGION, OR DIAGNOSIS.ActivityOrMissionDescription
Nbr Voting Members Governing Body17NbrVotingMembersGoverningBody
Nbr Independent Voting Members16NbrIndependentVotingMembers
Total Nbr Employees0TotalNbrEmployees
Total Nbr Volunteers20TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year1375056ContributionsGrantsPriorYear
Contributions Grants Current Year715997ContributionsGrantsCurrentYear
Program Service Revenue Prior Year0ProgramServiceRevenuePriorYear
Program Service Revenue CY0ProgramServiceRevenueCY
Investment Income Prior Year144958InvestmentIncomePriorYear
Investment Income Current Year146600InvestmentIncomeCurrentYear
Other Revenue Prior Year121328OtherRevenuePriorYear
Other Revenue Current Year-975OtherRevenueCurrentYear
Total Revenue Prior Year1641342TotalRevenuePriorYear
Total Revenue Current Year861622TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year1375817GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY878272GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year0SalariesEtcPriorYear
Salaries Etc Current Year0SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year117426TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year50676TotalFundrsngExpCurrentYear
Other Expense Prior Year32945OtherExpensePriorYear
Other Expenses Current Year50676OtherExpensesCurrentYear
Total Expenses Prior Year1526188TotalExpensesPriorYear
Total Expenses Current Year928948TotalExpensesCurrentYear
Revenues Less Expenses Prior Year115154RevenuesLessExpensesPriorYear
Revenues Less Expenses CY-67326RevenuesLessExpensesCY
Total Assets BOY8599746TotalAssetsBOY
Total Assets EOY8953529TotalAssetsEOY
Total Liabilities BOY25166TotalLiabilitiesBOY
Total Liabilities EOY10671TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY8574580NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY8942858NetAssetsOrFundBalancesEOY
Mission DescriptionTO AID FAITH REGIONAL HEALTH SERVICES (FRHS) BY THE SOLICITATION OF GIFTS, GRANTS, DEVICES AND BEQUESTS EXCLUSIVELY FOR THE USE AND BENEFITS OF FRHS OR ITS PROGRAMS AND SERVICES.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense878272Expense
Grants878272Grants
DescriptionTO AID FAITH REGIONAL HEALTH SERVICES (FRHS) BY THE SOLICITATION OF GIFTS, GRANT DEVICES AND BEQUESTS EXCLUSIVELY FOR THE USE AND BENEFIT OF FRHS OR ITS PROGRAMS AND SERVICES. FRHS PROVIDES ACUTE PREVENTATIVE AND OTHER HEALTHCARE SERVICES TO THE REGION WHILE ENCOURAGING EDUCATIONAL AND CLINICAL RESEARCH. FRHS SERVES ALL PATIENTS REGARDLESS OF THEIR ABILITY TO PAY AND DOES NOT LIMIT ITS SERVICES OR DISCRIMINATE AGAINST ANYONE ON THE BASIS OF RACE, SEX, NATIONAL ORIGIN, RELIGION OR DIAGNOSIS.Description
Total Program Service Expense878272TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities0LobbyingActivities
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments1TermOrPermanentEndowments
Report Land Bldg Equip0ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets0ReportOtherAssets
Report Other Liabilities1ReportOtherLiabilities
Report Fin48 Footnote1ReportFin48Footnote
Independent Audit Financial Stmt0IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt1ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities1FundraisingActivities
Gaming0Gaming
Hospital0Hospital
Grants To Organizations1GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds0TaxExemptBonds
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp1OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions1DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity0RelatedOrgControlledEntity
Transaction Related Entity0TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With10963NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees0NumberOfEmployees
Unrelated Business Income0UnrelatedBusinessIncome
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions1QuidProQuoContributions
Quid Pro Quo Disclosure1QuidProQuoDisclosure
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members17NbrVotingGoverningBodyMembers
Number Independent Voting Members16NumberIndependentVotingMembers
Family Or Business Relationship1FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders0MembersOrStockholders
Election Of Board Members1ElectionOfBoardMembers
Decisions Subject To Approval1DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO0CompensationProcessCEO
Compensation Process Other0CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1DOUGLAS WISMERBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number4026447249TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line12700 WEST NORFOLK AVE STE 200AddressLine1
CityNORFOLKCity
StateNEState
ZIP Code68701ZIPCode
FieldValueIRS element (for citing)
Info In Schedule O Part VIIXInfoInScheduleOPartVII

Form990 Part VII Section A Form990PartVIISectionA (22 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensation
RICK HIGGINS
PRESIDENT1.00XX000
TIMOTHY TIGHE
PRESIDENT-ELECT1.00XX000
JOHN SEHI
VICE-PRESIDENT1.00XX000
RUSS MCKILLIP
SECRETARY/TREASURER1.00XX000
VIRGIL FROEHLICH
MEMBER1.00X000
JACQUE COLLISON
MEMBER1.00X000
ALAN COLLISON
MEMBER1.00X000
ELEANOR MCINTOSH
MEMBER1.00X000
JACK BOESCH
MEMBER1.00X000
HARRIET STUDEBAKER
MEMBER1.00X000
DR DON BELL
MEMBER1.00X000
J PAUL MCINTOSH
MEMBER1.00X000
PAT HUGHES
MEMBER1.00X000
DR TODD WRAGGE
MEMBER1.00X000
DONNA HERRICK
MEMBER1.00X000
JIM SCHEER
MEMBER1.00X000
DR GORDON ADAMS
MEMBER1.00X000
JAMES SINEK
CEO1.00X046319218059
DALE POHLMAN
CFO THROUGH 6/4/20101.00X014118111808
DIANE MOUCHKA
FOUNDATION DIRECTOR40.00X08598413136
BARRY SPEAR
VP OF GROWTH & DEVELOPMENT16.00X016507610947
DOUGLAS WISMER
CFO EFFECTIVE 6/4/20101.00X017569012828
FieldValueIRS element (for citing)
Total Reportable Comp From Org0TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs1031123TotalReportableCompFrmRltdOrgs
Total Other Compensation66778TotalOtherCompensation
Number Individuals GT100 K0NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources
Number Of Contractors GT100 K0NumberOfContractorsGT100K
Fundraising Events120472FundraisingEvents
Related Organizations14115RelatedOrganizations
All Other Contributions581410AllOtherContributions
Noncash Contributions196879NoncashContributions
Total Contributions715997TotalContributions

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column146600TotalRevenueColumn
Exclusion$146,600ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities80000Securities

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Securities80000Securities

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities0Securities

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn
FieldValueIRS element (for citing)
Gross Income Fundraising Events134302GrossIncomeFundraisingEvents
Cntrbtns Rprtd Fundraising Events120472CntrbtnsRprtdFundraisingEvents
Fundraising Direct Expenses135277FundraisingDirectExpenses

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

FieldValueIRS element (for citing)
Total Revenue Column-975TotalRevenueColumn
Exclusion-$975ExclusionAmount

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column861622TotalRevenueColumn
Related Or Exempt Function Income0RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$145,625ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total878272Total
Program Services878272ProgramServices

Other Expenses OtherExpenses (3 entries)

DescriptionDescriptionTotalTotalFundraisingFundraising
DREAM TEAM EXPENSE4745747457
CHILD ADVOCACY30373037
EMPLOYEE GIVING CAMPAIG182182

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total928948Total
Program Services878272ProgramServices
Management And General0ManagementAndGeneral
Fundraising50676Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY172BOY
EOY43EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY4958790BOY
EOY4603881EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

FieldValueIRS element (for citing)
BOY663221BOY
EOY383852EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY2973515BOY
EOY3934910EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY4048BOY
EOY30843EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY8599746BOY
EOY8953529EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY14842BOY
EOY347EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY10324BOY
EOY10324EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY25166BOY
EOY10671EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY910367BOY
EOY1134240EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY2304399BOY
EOY2446077EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY5359814BOY
EOY5362541EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY8574580BOY
EOY8942858EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY8599746BOY
EOY8953529EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses-67326ReconcilationRevenueExpenses
Reconcilation Other Changes435604ReconcilationOtherChanges
Info In Schedule O Part XIIXInfoInScheduleOPartXII
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee1AuditCommittee
Financial Statement ConsolidatedXFinancialStatementConsolidated
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Supporting Organization509a3XSupportingOrganization509a3
Supporting Org509a3 Type1XSupportingOrg509a3Type1
Certification CheckboxXCertificationCheckbox
Contrib By Controlling Individual0ContribByControllingIndividual
Contribution By Related Party0ContributionByRelatedParty
Contrib By35 Controlled Entity0ContribBy35ControlledEntity

Supported Org Information SupportedOrgInformation

Name Name

FieldValueIRS element (for citing)
Business Name Line1FAITH REGIONAL HEALTH SERVICESBusinessNameLine1
FieldValueIRS element (for citing)
EIN470796875EIN
Type Of Organization3TypeOfOrganization
Listed In Governing Doc1ListedInGoverningDoc
Supported Organization Notified1SupportedOrganizationNotified
Organized In US1OrganizedInUS
Amount$878,272Amount
FieldValueIRS element (for citing)
Total Number Of Supported Orgs1TotalNumberOfSupportedOrgs
Sum Of Amounts878272SumOfAmounts

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule D IRS990ScheduleD

Current Year CurrentYear

FieldValueIRS element (for citing)
Beginning Of Year Balance5188508BeginningOfYearBalance
Contributions2727Contributions
Investment Earnings Or Losses517780InvestmentEarningsOrLosses
Grants Or Scholarships38914GrantsOrScholarships
End Of Year Balance5670101EndOfYearBalance

Current Year Minus1 Year CurrentYearMinus1Year

FieldValueIRS element (for citing)
Beginning Of Year Balance4493972BeginningOfYearBalance
Contributions6814Contributions
Investment Earnings Or Losses721427InvestmentEarningsOrLosses
Grants Or Scholarships33705GrantsOrScholarships
End Of Year Balance5188508EndOfYearBalance

Current Year Minus2 Years CurrentYearMinus2Years

FieldValueIRS element (for citing)
Beginning Of Year Balance5706317BeginningOfYearBalance
Contributions4188Contributions
Investment Earnings Or Losses-1145496InvestmentEarningsOrLosses
Grants Or Scholarships71037GrantsOrScholarships
End Of Year Balance4493972EndOfYearBalance
FieldValueIRS element (for citing)
Board Designated EOY Balance0.00000BoardDesignatedEOYBalance
Permanent Endowment EOY Balance1.00000PermanentEndowmentEOYBalance
Term Endowment EOY Balance0.00000TermEndowmentEOYBalance
Endowments Held By Unrelated Orgs0EndowmentsHeldByUnrelatedOrgs
Endowments Held By Related Orgs0EndowmentsHeldByRelatedOrgs
Total Of Book Value Land Buildings0TotalOfBookValueLandBuildings

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
DescriptionANNUITY PAYABLEDescription
Amount$10,324Amount
FieldValueIRS element (for citing)
Total Of Amounts10324TotalOfAmounts

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (2 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
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 AND THE FOUNDATION ARE NOT-FOR-PROFIT CORPORATIONS AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND ARE EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. THE INTERNAL REVENUE SERVICE HAS ESTABLISHED STANDARDS TO BE MET TO MAINTAIN TAX-EXEMPT STATUS. IN GENERAL, SUCH STANDARDS REQUIRE FAITH AND THE FOUNDATION TO MEET A COMMUNITY BENEFIT STANDARD AND COMPLY WITH VARIOUS LAWS AND REGULATIONS. FAITH ACCOUNTS FOR UNCERTAINTIES IN ACCOUNTING FOR INCOME TAX ASSETS AND LIABILITIES USING GUIDANCE INCLUDED IN FASB ASC 740, INCOME TAXES. FAITH RECOGNIZES THE EFFECT OF INCOME TAX POSITIONS ONLY IF THOSE POSITIONS ARE MORE LIKELY THAN NOT OF BEING SUSTAINED. AT DECEMBER 31, 2010 AND 2009, FAITH HAD NO UNCERTAIN TAX POSITIONS ACCRUED.

Schedule G IRS990ScheduleG

Events Information EventsInformation

FieldValueIRS element (for citing)
Name Of Event1GOLF TOURNAMENTNameOfEvent1
Gross Receipts Event153223GrossReceiptsEvent1
Charitable Contributions Event119350CharitableContributionsEvent1
Gross Revenue Event133873GrossRevenueEvent1
Cash Prizes Event14700CashPrizesEvent1
Rent Facility Costs Event13360RentFacilityCostsEvent1
Food And Beverage Event15158FoodAndBeverageEvent1
Other Direct Expenses Event111956OtherDirectExpensesEvent1
Name Of Event2WINTER GALANameOfEvent2
Gross Receipts Event2183162GrossReceiptsEvent2
Charitable Contributions Event2101122CharitableContributionsEvent2
Gross Revenue Event282040GrossRevenueEvent2
Non Cash Prizes Event2286NonCashPrizesEvent2
Rent Facility Costs Event21000RentFacilityCostsEvent2
Food And Beverage Event217127FoodAndBeverageEvent2
Other Direct Expenses Event282392OtherDirectExpensesEvent2
Total Number Of Other Events2TotalNumberOfOtherEvents
Gross Receipts Other Events18389GrossReceiptsOtherEvents
Gross Revenue Other Events18389GrossRevenueOtherEvents
Other Direct Expenses Other Events9298OtherDirectExpensesOtherEvents
Gross Receipts Total254774GrossReceiptsTotal
Charitable Contributions Total120472CharitableContributionsTotal
Gross Revenue Total Events134302GrossRevenueTotalEvents
Cash Prizes Total Events4700CashPrizesTotalEvents
Non Cash Prizes Total Events286NonCashPrizesTotalEvents
Rent Facility Costs Total Events4360RentFacilityCostsTotalEvents
Food And Beverage Total Events22285FoodAndBeverageTotalEvents
Other Direct Expenses Total Events103646OtherDirectExpensesTotalEvents
Direct Expense Summary Events135277DirectExpenseSummaryEvents
Net Income Summary-975NetIncomeSummary

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Records Maintained1RecordsMaintained

Recipient Table RecipientTable (10 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEIN Of RecipientEINOfRecipientIRC SectionIRCSectionAmount Of Cash GrantAmountOfCashGrantPurpose Of GrantPurposeOfGrant
FAITH REGIONAL HEALTH SERVICES (BED ADDITION)
1500 KOENIGSTEIN AVENUE PO BOX 869NORFOLKNE687020869470796875501(C)(3)743373FUND THE NEW BED TOWER CONSTRUCTION
FAITH REGIONAL HEALTH SERVICES (BICYCLE RODEO)
1500 KOENIGSTEIN AVENUE PO BOX 869NORFOLKNE687020869470796875501(C)(3)500FUND THE BICYCLE RODEO EVENT
FAITH REGIONAL HEALTH SERVICES (BEFRIENDER MINISTRY CONFERENCE)
1500 KOENIGSTEIN AVENUE PO BOX 869NORFOLKNE687020869470796875501(C)(3)799SUPPORT BEFRIENDER MINISTRY CONFERENCE
FAITH REGIONAL HEALTH SERVICES (CANCER CENTER TVS)
1500 KOENIGSTEIN AVENUE PO BOX 869NORFOLKNE687020869470796875501(C)(3)1224PURCHASE CANCER CENTER TVS
FAITH REGIONAL HEALTH SERVICES (COUNTRY NURSERY LANDSCAPING)
1500 KOENIGSTEIN AVENUE PO BOX 869NORFOLKNE687020869470796875501(C)(3)3567BED TOWER LANDSCAPE FUNDING
FAITH REGIONAL HEALTH SERVICES (DUSTY SHOE TOUR ADVERTISEMENT)
1500 KOENIGSTEIN AVENUE PO BOX 869NORFOLKNE687020869470796875501(C)(3)85650DUSTY SHOE TOUR ADVERTISEMENT - BED TOWER ADVERTISING
FAITH REGIONAL HEALTH SERVICES (INTERNSHIP PROGRAM)
1500 KOENIGSTEIN AVENUE PO BOX 869NORFOLKNE687020869470796875501(C)(3)4041INTERNSHIP PROGRAM
FAITH REGIONAL HEALTH SERVICES (INVESTMENT POLICY)
1500 KOENIGSTEIN AVENUE PO BOX 869NORFOLKNE687020869470796875501(C)(3)38914INVESTMENT POLICY GRANT
FAITH REGIONAL HEALTH SERVICES (GREEN SPIRAL LINDEN TREE)
1500 KOENIGSTEIN AVENUE PO BOX 869NORFOLKNE687020869470796875501(C)(3)100PURCHASE GREEN SPIRAL LINDEN TREE - BED TOWER LANDSCAPE FUNDING
FAITH REGIONAL HEALTH SERVICES (ST JOSEPH'S CHAPEL)
1500 KOENIGSTEIN AVENUE PO BOX 869NORFOLKNE687020869470796875501(C)(3)104SUPPORT ST. JOSEPH'S CHAPEL
FieldValueIRS element (for citing)
Total Nbr Of501 C3 And Govt Grants1TotalNbrOf501C3AndGovtGrants
Total Nbr Of Other Organizations0TotalNbrOfOtherOrganizations

Form990 Schedule I Part IV Form990ScheduleIPartIV

FieldValueIRS element (for citing)
IdentifierPROCEDURE FOR MONITORING GRANTS IN THE U.S.:Identifier
Return ReferencePART I, LINE 2:ReturnReference
ExplanationSCHEDULE I, PART I, LINE 2: FAITH REGIONAL HEALTH SERVICES FOUNDATION PROVIDES GRANT MONEY TO FAITH REGIONAL HEALTH SERVICES, A RELATED 501(C)(3) ORGANIZATION. FAITH REGIONAL HEALTH SERVICES PROVIDES HEALTH CARE SERVICES TO INDIVIDUALS IN THE LOCAL COMMUNITY.Explanation

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Club Dues Or FeesXClubDuesOrFees
Written Policy Re T And E Expenses1WrittenPolicyReTAndEExpenses
Substantiation Required1SubstantiationRequired
Independent ConsultantXIndependentConsultant
Form990 Of Other OrganizationsXForm990OfOtherOrganizations
Written Employment ContractXWrittenEmploymentContract
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance Payment0SeverancePayment
Supplemental Nonqual Retire Plan0SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org0CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs0CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org0CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs0CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments0AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (4 entries)

Base Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
JAMES SINEK
04451330001805907350010709048125100
DALE POHLMAN
0129373000118080661105197015298900
BARRY SPEAR
0154129000109470466306284017602300
DOUGLAS WISMER
0162862000128280654706281018851800

Form990 Schedule J Part III Form990ScheduleJPartIII

FieldValueIRS element (for citing)
Return ReferencePART I, LINE 1AReturnReference
ExplanationJAMES J. SINEK'S YMCA MEMBERSHIP AND COUNTRY CLUB DUES ARE PAID BY FAITH REGIONAL HEALTH SERVICES, A RELATED ORGANIZATION. THE AMOUNTS PAID FOR THESE ITEMS ARE ADDED TO MR SINEK'S W-2 AS WAGES.Explanation

Schedule L IRS990ScheduleL

Form990 Schedule L Part IV Form990ScheduleLPartIV

Name Of Interested Person NameOfInterestedPerson

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1DIVOTS CONFERENCE CENTERBusinessNameLine1
FieldValueIRS element (for citing)
RelationshipDONNA HERRICK IS A FOUNDATION BOARD MEMBER AND OWNER/PRESIDENT OF DIVOTSRelationship
Amount Of Transaction19733AmountOfTransaction
Description Of TransactionPROVIDES SERVICES TO THE FOUNDATION FOR THE WINTER GALA EVENT FOR FOOD AND BEVERAGESDescriptionOfTransaction
Sharing Of Revenues0SharingOfRevenues

Schedule M IRS990ScheduleM

Securities Prtnrshp Trust Intrsts SecuritiesPrtnrshpTrustIntrsts

FieldValueIRS element (for citing)
Non Cash CheckboxXNonCashCheckbox
Number Of Contributions1NumberOfContributions
Noncash Contribs Rptd F99042490NoncashContribsRptdF990
Method Of Determining RevenuesHIGH-LOW AVERAGEMethodOfDeterminingRevenues

Other Non Cash Contributions Table OtherNonCashContributionsTable (2 entries)

Non Cash CheckboxNonCashCheckboxDescriptionDescriptionNumber Of ContributionsNumberOfContributionsNoncash Contribs Rptd F990NoncashContribsRptdF990Method Of Determining RevenuesMethodOfDeterminingRevenues
XMISC ITEMS FOR EVENTS15767874FAIR MARKET VALUE
XTELEVISION ADVERTISEMENT186515FAIR MARKET VALUE
FieldValueIRS element (for citing)
Any Property That Must Be Held0AnyPropertyThatMustBeHeld
Review Process Unusual NC Gifts0ReviewProcessUnusualNCGifts
Third Parties Used0ThirdPartiesUsed

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (10 entries)

IdentifierIdentifierExplanationExplanationReturn ReferenceReturnReference
FORM 990, PART VI, SECTION A, LINE 2JACQUE COLLISON AND ALAN COLLISON, BOTH BOARD MEMBERS, HAVE A FAMILY RELATIONSHIP. FURTHERMORE, BOARD MEMBERS ELEANOR MCINTOSH AND J. PAUL MCINTOSH, HAVE A FAMILY RELATIONSHIP.
FORM 990, PART VI, SECTION A, LINE 7AFAITH REGIONAL HEALTH SERVICES FOUNDATION'S BYLAWS STATE ALL DIRECTORS SHALL BE APPOINTED BY FAITH REGIONAL HEALTH SERVICES' BOARD OF DIRECTORS.
FORM 990, PART VI, SECTION A, LINE 7BBOARD MEMBER APPOINTMENT AND RETENTION DECISIONS MADE BY THE FOUNDATION BOARD ARE APPROVED BY THE FAITH REGIONAL HEALTH SERVICES BOARD.
FORM 990, PART VI, SECTION B, LINE 11THE FORM 990 AND ALL APPLICABLE SCHEDULES WERE PREPARED AND SIGNED BY SEIM JOHNSON, LLP IN OMAHA, NEBRASKA. COPIES OF THE COMPLETED RETURN WERE DISTRIBUTED TO THE BOARD MEMBERS FOR REVIEW PRIOR TO SUBMISSION.
FAITH REGIONAL HEALTH SERVICES FOUNDATION BOARD MEMBERS COMPLETE A CONFLICT OF INTEREST STATEMENT AND DISCLOSURE ANNUALLY. THESE STATEMENTS ARE REVIEWED BY A DIRECTOR OF THE FOUNDATION.FORM 990, PART VI, SECTION B, LINE 12C
FAITH REGIONAL HEALTH SERVICES FOUNDATION DOES NOT MAKE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST STATEMENT, OR FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC.FORM 990, PART VI, SECTION C, LINE 19
AVERAGE HOURS PER WEEK DEVOTED TO A RELATED ORGANIZATIONJAMES SINEK, CEO, DEVOTES AN AVERAGE OF 39.00 HOURS PER WEEK TO FAITH REGIONAL HEALTH SERVICES, A RELATED ORGANIZATION. DOUGLAS WISMER, CFO, DEVOTES AN AVERAGE OF 39.00 HOURS PER WEEK TO FAITH REGIONAL HEALTH SERVICES, A RELATED ORGANIZATION. DALE POHLMAN, CFO , DEVOTED AN AVERAGE OF 39.00 HOURS PER WEEK TO FAITH REGIONAL HEALTH SERVICES, A RELATED ORGANIZATION. BARRY SPEAR, VP GROWTH & DEVELOPMENT, DEVOTED AN AVERAGE OF 24.00 HOUR PER WEEK TO FAITH REGIONAL HEALTH SERVICES, A RELATED ORGANIZATION.FORM 990, PART VII, SECTION A, LINE 1A:
CHANGES IN NET ASSETS OR FUND BALANCES:NET UNREALIZED GAINS ON INVESTMENTS: 435,604.FORM 990, PART XI, LINE 5:
FAITH REGIONAL HEALTH SERVICES FOUNDATION DOES HAVE AN AUDIT COMPLETED ON A CONSOLIDATED BASIS WITH FAITH REGIONAL HEALTH SERVICES AND FAITH REGIONAL PHYSICIAN SERVICES, LLC. THE BOARD OF DIRECTORS OF FAITH REGIONAL HEALTH SERVICES ASSUMES RESPONSIBILITY FOR THE OVERSIGHT OF THE AUDIT AND THE SELECTION OF AN INDEPENDENT ACCOUNTANT. THERE HAS BEEN NO CHANGE IN THE PROCESSES SINCE LAST YEAR.FORM 990, PART XII, LINE 2C:
FAITH REGIONAL HEALTH SERVICES FOUNDATION DOES NOT PAY COMPENSATION TO A CEO, EXECUTIVE DIRECTOR, TOP MANAGEMENT OFFICIAL, OFFICERS OR KEY EMPLOYESS OF THE OGANIZATION. THEREFORE, QUESTION 15A AND 15B ARE ANSWERED NO.FORM 990, PART VI, SECTION B, LINE 15:

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (2 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusDirect Controlling Entity NADirectControllingEntityNAControlled OrgControlledOrg
FAITH REGIONAL HEALTH SERVICES
1500 KOENIGSTEIN AVENORFOLKNE68701470769875PROVIDE HEALTHCARE SERVICES TO THE NORTHEAST NEBRASKA REGIONNE501(C)(3)3N/A0
LUTHERAN COMMUNITY HOSPITAL ASSOCIATION
2700 W NORFOLK AVENORFOLKNE68701470396139SUPPORT FAITH REGIONAL HEALTH SERVICESNE501(C)(3)3N/A0
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties0ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org1GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org1GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org0LoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs0RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs0RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs0PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs0PerformOfServicesByOtherOrgs
Sharing Of Facilities1SharingOfFacilities
Sharing Of Paid Employees1SharingOfPaidEmployees
Reimbursement Paid To Other Org0ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrg
Other Transfer To Other Org0OtherTransferToOtherOrg
Other Transfer From Other Org0OtherTransferFromOtherOrg

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