2011-11-11T17:53:38-06:00 2010-12-31 SEIM JOHNSON LLP 18081 BURT STREET SUITE 200 OMAHA NE 680224722 990 2010-01-01 911772474 FAITH REGIONAL HEALTH SERVICES FOUNDATION FAIT 4026447301 2700 WEST NORFOLK AVENUE NO 200 NORFOLK NE 68701 DOUGLAS WISMER 4026447301 2011-11-09 1 BARBARA J FAJEN 4023302660 2010 2016-03-07 17:11:31Z X DOUGLAS WISMER 2700 WEST NORFOLK AVENUE NO 200 NORFOLK NE 68701 1076899 0 X WWW.FRHS.ORG X 1996 NE TO AID FAITH REGIONAL HEALTH SERVICES (FRHS) BY THE SOLICITATION OF GIFTS, GRANTS, DEVICES, AND BEQUESTS EXCLUSIVELY FOR THE USE AND BENEFIT OF FRHS OR ITS PROGRAMS AND SERVICES. FRHS PROVIDES ACUTE, PREVENTIVE, AND OTHER HEALTHCARE SERVICES TO THE REGION WHILE ENCOURAGING EDUCATIONAL AND CLINICAL RESEARCH. FRHS SERVES ALL PATIENTS REGARDLESS OF THEIR ABILITY TO PAY AND DOES NOT LIMIT ITS SERVICES OR DISCRIMINATES AGAINST ANYONE ON THE BASIS OF RACE, SEX, NATIONAL ORIGIN, RELIGION, OR DIAGNOSIS. 17 16 0 20 0 0 1375056 715997 0 0 144958 146600 121328 -975 1641342 861622 1375817 878272 0 0 0 0 117426 0 50676 32945 50676 1526188 928948 115154 -67326 8599746 8953529 25166 10671 8574580 8942858 TO AID FAITH REGIONAL HEALTH SERVICES (FRHS) BY THE SOLICITATION OF GIFTS, GRANTS, DEVICES AND BEQUESTS EXCLUSIVELY FOR THE USE AND BENEFITS OF FRHS OR ITS PROGRAMS AND SERVICES. 0 0 878272 878272 TO AID FAITH REGIONAL HEALTH SERVICES (FRHS) BY THE SOLICITATION OF GIFTS, GRANT DEVICES AND BEQUESTS EXCLUSIVELY FOR THE USE AND BENEFIT OF FRHS OR ITS PROGRAMS AND SERVICES. FRHS PROVIDES ACUTE PREVENTATIVE AND OTHER HEALTHCARE SERVICES TO THE REGION WHILE ENCOURAGING EDUCATIONAL AND CLINICAL RESEARCH. FRHS SERVES ALL PATIENTS REGARDLESS OF THEIR ABILITY TO PAY AND DOES NOT LIMIT ITS SERVICES OR DISCRIMINATE AGAINST ANYONE ON THE BASIS OF RACE, SEX, NATIONAL ORIGIN, RELIGION OR DIAGNOSIS. 878272 1 1 0 0 0 0 0 0 1 0 0 0 0 1 1 0 1 0 0 0 0 0 0 1 0 0 1 0 1 0 0 0 0 0 0 0 1 1 0 0 0 0 1 0 0 0 0 1 3 0 1 0 0 0 0 0 0 1 1 0 0 0 0 X 17 16 1 0 0 0 0 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 X DOUGLAS WISMER 4026447249 2700 WEST NORFOLK AVE STE 200 NORFOLK NE 68701 X RICK HIGGINS 1.00 X X 0 0 0 TIMOTHY TIGHE 1.00 X X 0 0 0 JOHN SEHI 1.00 X X 0 0 0 RUSS MCKILLIP 1.00 X X 0 0 0 VIRGIL FROEHLICH 1.00 X 0 0 0 JACQUE COLLISON 1.00 X 0 0 0 ALAN COLLISON 1.00 X 0 0 0 ELEANOR MCINTOSH 1.00 X 0 0 0 JACK BOESCH 1.00 X 0 0 0 HARRIET STUDEBAKER 1.00 X 0 0 0 DR DON BELL 1.00 X 0 0 0 J PAUL MCINTOSH 1.00 X 0 0 0 PAT HUGHES 1.00 X 0 0 0 DR TODD WRAGGE 1.00 X 0 0 0 DONNA HERRICK 1.00 X 0 0 0 JIM SCHEER 1.00 X 0 0 0 DR GORDON ADAMS 1.00 X 0 0 0 JAMES SINEK 1.00 X 0 463192 18059 DALE POHLMAN 1.00 X 0 141181 11808 DIANE MOUCHKA 40.00 X 0 85984 13136 BARRY SPEAR 16.00 X 0 165076 10947 DOUGLAS WISMER 1.00 X 0 175690 12828 0 1031123 66778 0 0 1 0 0 120472 14115 581410 196879 715997 146600 146600 80000 80000 0 0 134302 120472 135277 -975 -975 861622 0 0 145625 878272 878272 DREAM TEAM EXPENSE 47457 47457 CHILD ADVOCACY 3037 3037 EMPLOYEE GIVING CAMPAIG 182 182 928948 878272 0 50676 172 43 4958790 4603881 663221 383852 2973515 3934910 4048 30843 8599746 8953529 14842 347 10324 10324 25166 10671 X 910367 1134240 2304399 2446077 5359814 5362541 8574580 8942858 8599746 8953529 X -67326 435604 X X 0 1 1 X 0 X X X 0 0 0 FAITH REGIONAL HEALTH SERVICES 470796875 3 1 1 1 878272 1 878272 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 5188508 2727 517780 38914 5670101 4493972 6814 721427 33705 5188508 5706317 4188 -1145496 71037 4493972 0.00000 1.00000 0.00000 0 0 0 ANNUITY PAYABLE 10324 10324 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. GOLF TOURNAMENT 53223 19350 33873 4700 3360 5158 11956 WINTER GALA 183162 101122 82040 286 1000 17127 82392 2 18389 18389 9298 254774 120472 134302 4700 286 4360 22285 103646 135277 -975 1 FAITH REGIONAL HEALTH SERVICES (BED ADDITION) 1500 KOENIGSTEIN AVENUE PO BOX 869 NORFOLK NE 687020869 470796875 501(C)(3) 743373 FUND THE NEW BED TOWER CONSTRUCTION FAITH REGIONAL HEALTH SERVICES (BICYCLE RODEO) 1500 KOENIGSTEIN AVENUE PO BOX 869 NORFOLK NE 687020869 470796875 501(C)(3) 500 FUND THE BICYCLE RODEO EVENT FAITH REGIONAL HEALTH SERVICES (BEFRIENDER MINISTRY CONFERENCE) 1500 KOENIGSTEIN AVENUE PO BOX 869 NORFOLK NE 687020869 470796875 501(C)(3) 799 SUPPORT BEFRIENDER MINISTRY CONFERENCE FAITH REGIONAL HEALTH SERVICES (CANCER CENTER TVS) 1500 KOENIGSTEIN AVENUE PO BOX 869 NORFOLK NE 687020869 470796875 501(C)(3) 1224 PURCHASE CANCER CENTER TVS FAITH REGIONAL HEALTH SERVICES (COUNTRY NURSERY LANDSCAPING) 1500 KOENIGSTEIN AVENUE PO BOX 869 NORFOLK NE 687020869 470796875 501(C)(3) 3567 BED TOWER LANDSCAPE FUNDING FAITH REGIONAL HEALTH SERVICES (DUSTY SHOE TOUR ADVERTISEMENT) 1500 KOENIGSTEIN AVENUE PO BOX 869 NORFOLK NE 687020869 470796875 501(C)(3) 85650 DUSTY SHOE TOUR ADVERTISEMENT - BED TOWER ADVERTISING FAITH REGIONAL HEALTH SERVICES (INTERNSHIP PROGRAM) 1500 KOENIGSTEIN AVENUE PO BOX 869 NORFOLK NE 687020869 470796875 501(C)(3) 4041 INTERNSHIP PROGRAM FAITH REGIONAL HEALTH SERVICES (INVESTMENT POLICY) 1500 KOENIGSTEIN AVENUE PO BOX 869 NORFOLK NE 687020869 470796875 501(C)(3) 38914 INVESTMENT POLICY GRANT FAITH REGIONAL HEALTH SERVICES (GREEN SPIRAL LINDEN TREE) 1500 KOENIGSTEIN AVENUE PO BOX 869 NORFOLK NE 687020869 470796875 501(C)(3) 100 PURCHASE GREEN SPIRAL LINDEN TREE - BED TOWER LANDSCAPE FUNDING FAITH REGIONAL HEALTH SERVICES (ST JOSEPH'S CHAPEL) 1500 KOENIGSTEIN AVENUE PO BOX 869 NORFOLK NE 687020869 470796875 501(C)(3) 104 SUPPORT ST. JOSEPH'S CHAPEL 1 0 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: FAITH REGIONAL HEALTH SERVICES FOUNDATION PROVIDES GRANT MONEY TO FAITH REGIONAL HEALTH SERVICES, A RELATED 501(C)(3) ORGANIZATION. FAITH REGIONAL HEALTH SERVICES PROVIDES HEALTH CARE SERVICES TO INDIVIDUALS IN THE LOCAL COMMUNITY. X 1 1 X X X X X 0 0 0 0 0 0 0 0 0 JAMES SINEK 0 445133 0 0 0 18059 0 7350 0 10709 0 481251 0 0 DALE POHLMAN 0 129373 0 0 0 11808 0 6611 0 5197 0 152989 0 0 BARRY SPEAR 0 154129 0 0 0 10947 0 4663 0 6284 0 176023 0 0 DOUGLAS WISMER 0 162862 0 0 0 12828 0 6547 0 6281 0 188518 0 0 PART I, LINE 1A JAMES J. SINEK'S YMCA MEMBERSHIP AND COUNTRY CLUB DUES ARE PAID BY FAITH REGIONAL HEALTH SERVICES, A RELATED ORGANIZATION. THE AMOUNTS PAID FOR THESE ITEMS ARE ADDED TO MR SINEK'S W-2 AS WAGES. DIVOTS CONFERENCE CENTER DONNA HERRICK IS A FOUNDATION BOARD MEMBER AND OWNER/PRESIDENT OF DIVOTS 19733 PROVIDES SERVICES TO THE FOUNDATION FOR THE WINTER GALA EVENT FOR FOOD AND BEVERAGES 0 X 1 42490 HIGH-LOW AVERAGE X MISC ITEMS FOR EVENTS 157 67874 FAIR MARKET VALUE X TELEVISION ADVERTISEMENT 1 86515 FAIR MARKET VALUE 0 0 0 FORM 990, PART VI, SECTION A, LINE 2 JACQUE COLLISON AND ALAN COLLISON, BOTH BOARD MEMBERS, HAVE A FAMILY RELATIONSHIP. FURTHERMORE, BOARD MEMBERS ELEANOR MCINTOSH AND J. PAUL MCINTOSH, HAVE A FAMILY RELATIONSHIP. FORM 990, PART VI, SECTION A, LINE 7A FAITH REGIONAL HEALTH SERVICES FOUNDATION'S BYLAWS STATE ALL DIRECTORS SHALL BE APPOINTED BY FAITH REGIONAL HEALTH SERVICES' BOARD OF DIRECTORS. FORM 990, PART VI, SECTION A, LINE 7B BOARD MEMBER APPOINTMENT AND RETENTION DECISIONS MADE BY THE FOUNDATION BOARD ARE APPROVED BY THE FAITH REGIONAL HEALTH SERVICES BOARD. FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 AND ALL APPLICABLE SCHEDULES WERE PREPARED AND SIGNED BY SEIM JOHNSON, LLP IN OMAHA, NEBRASKA. COPIES OF THE COMPLETED RETURN WERE DISTRIBUTED TO THE BOARD MEMBERS FOR REVIEW PRIOR TO SUBMISSION. FORM 990, PART VI, SECTION B, LINE 12C FAITH REGIONAL HEALTH SERVICES FOUNDATION BOARD MEMBERS COMPLETE A CONFLICT OF INTEREST STATEMENT AND DISCLOSURE ANNUALLY. THESE STATEMENTS ARE REVIEWED BY A DIRECTOR OF THE FOUNDATION. FORM 990, PART VI, SECTION C, LINE 19 FAITH REGIONAL HEALTH SERVICES FOUNDATION DOES NOT MAKE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST STATEMENT, OR FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC. AVERAGE HOURS PER WEEK DEVOTED TO A RELATED ORGANIZATION FORM 990, PART VII, SECTION A, LINE 1A: JAMES 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. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED GAINS ON INVESTMENTS: 435,604. FORM 990, PART XII, LINE 2C: 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 VI, SECTION B, LINE 15: FAITH REGIONAL HEALTH SERVICES FOUNDATION DOES NOT PAY COMPENSATION TO A CEO, EXECUTIVE DIRECTOR, TOP MANAGEMENT OFFICIAL, OFFICERS OR KEY EMPLOYESS OF THE OGANIZATION. THEREFORE, QUESTION 15A AND 15B ARE ANSWERED NO. FAITH REGIONAL HEALTH SERVICES 1500 KOENIGSTEIN AVE NORFOLK NE 68701 470769875 PROVIDE HEALTHCARE SERVICES TO THE NORTHEAST NEBRASKA REGION NE 501(C)(3) 3 N/A 0 LUTHERAN COMMUNITY HOSPITAL ASSOCIATION 2700 W NORFOLK AVE NORFOLK NE 68701 470396139 SUPPORT FAITH REGIONAL HEALTH SERVICES NE 501(C)(3) 3 N/A 0 0 1 1 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0