2025-05-15T12:22:08-05:00 2024-06-30 450250958 EIDE BAILLY LLP 18081 BURT ST STE 200 OMAHA NE 680224722 990 2023-07-01 470693261 COMMUNITY HOSPITAL HEALTH FOUNDATION COMM 3083447222 PO BOX 1328 MCCOOK NE 69001 JESSICA BORTNER EXECUTIVE DIRECTOR 3083447222 2025-05-15 1 1 WENDY R COOLEY CPA P01523804 4023302660 2025-05-13 2023 2025-03-06 01:10:19Z JESSICA BORTNER PO BOX 1328 MCCOOK NE 69001 1295357 0 X WWW.CHMCCOOK.ORG X 1985 NE TO SOLICIT GIFTS, GRANTS, DEVICES AND BEQUESTS FOR THE USE AND BENEFIT OF COMMUNITY HOSPITAL ASSOCIATION OF MCCOOK. 10 9 0 20 0 0 1631751 502857 0 0 140223 110072 -44597 -29995 1727377 582934 451820 459942 0 0 0 0 0 0 1409 37829 37279 489649 497221 1237728 85713 5851906 6434060 14416 6902 5837490 6427158 TO GENERATE FUNDS TO SECURE THE FUTURE OF COMMUNITY HOSPITAL BY STIMULATING PUBLIC AWARENESS AND SUPPORT. 0 0 459942 459942 TO AID COMMUNITY HOSPITAL ASSOCIATION OF MCCOOK BY THE SOLICITATION OF GIFTS, GRANTS, DEVICES AND BEQUESTS EXCLUSIVELY FOR THE USE AND BENEFIT OF THE HOSPITAL OR ITS PROGRAMS AND SERVICES. COMMUNITY HOSPITAL ASSOCIATION OF MCCOOK PROVIDES ACUTE, PREVENTATIVE, AND OTHER HEALTHCARE SERVICES ON A NONDISCRIMINITORY BASIS AND IN AN ENVIRONMENT WHICH IS RESPONSIVE TO THE UNIQUE NEEDS OF ITS PATIENTS. FUNDRAISING ACTIVITIES INCLUDE A GOLF TOURNAMENT AND CONCERT. 459942 1 1 0 0 0 0 0 0 0 1 0 0 0 0 0 1 1 1 0 0 0 0 0 0 1 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 9 0 1 0 0 0 0 0 0 1 1 0 0 0 0 0 0 X 10 9 0 0 0 0 1 1 0 1 1 0 0 1 1 1 1 1 1 0 0 0 X JESSICA BORTNER EXECUTIVE DIRECTOR 3083447222 PO BOX 1328 MCCOOK NE 69001 X TROY BRUNTZ PRESIDENT & CEO 1.00 39.00 X X 0 320646 45198 JESSICA BORTNER EXECUTIVE DIRECTOR 40.00 0.00 X 0 103511 44447 NEIL GOHL CHAIR 1.00 0.00 X X 0 0 0 BRUCE MCDOWELL VICE CHAIR 1.00 0.00 X X 0 0 0 JIM HALL SECRETARY 1.00 0.00 X X 0 0 0 MATT TILLER TREASURER 1.00 0.00 X X 0 0 0 CATHY KENNY MEMBER 1.00 0.00 X 0 0 0 SHARI LEWIS MEMBER 1.00 0.00 X 0 0 0 DAWNA BATES MEMBER THRU 12/23 1.00 0.00 X 0 0 0 KRISTIN STAGEMEYER CPA MEMBER THRU 12/23 1.00 1.00 X 0 0 0 KURT VOSBURG MEMBER THRU 12/23 1.00 1.00 X 0 0 0 ASHLEY VONTZ MEMBER 1.00 1.00 X 0 0 0 KAREN CRAW MEMBER 1.00 1.00 X 0 0 0 MATT NIELSEN MEMBER 1.00 1.00 X 0 0 0 0 424157 89645 0 0 1 0 0 93789 82586 326482 502857 163036 163036 596438 649402 -52964 -52964 -52964 33026 93789 63021 -29995 -29995 582934 0 0 80077 444124 444124 15818 15818 343 343 34317 34317 1210 1210 1409 1409 497221 459942 35870 1409 741225 900764 5089579 5509534 21102 23762 5851906 6434060 14416 6902 14416 6902 X 3834928 4478051 2002562 1949107 5837490 6427158 5851906 6434060 85713 503955 0 X X 0 1 X 1 0 X X 1 COMMUNITY HOSPITAL ASSOCIATION OF MCCOOK 470533373 3 1 435425 0 1 435425 0 1 0 0 0 0 1 0 0 0 0 0 0 0 0 0 1 0 PART IV, SECTION A, LINE 6: THE ORGANIZATION PROVIDED GRANTS TO INDIVIDUALS IN THE FORM OF SCHOLARSHIPS FOR HIGHER EDUCATION FOR STUDENTS PURSUING A HEALTHCARE CAREER AND OTHER TYPES OF ASSISTANCE PAYMENTS TO HOSPITAL PATIENTS. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 3660864 3766 446030 165441 3945219 3482371 5110 214711 41328 3660864 3811948 5826 -260507 74896 3482371 3290398 12744 508806 3811948 3130914 4680 180448 10800 11875 2969 3290398 0.59310 0.40690 0.00000 0 0 0 X 1149910 503955 63021 566976 582934 0 582934 560242 63021 63021 497221 0 497221 PART V, LINE 4: THE ORGANIZATION'S ENDOWMENT FUNDS ARE USED IN SUPPORT OF THE COMMUNITY HOSPITAL'S PROGRAMS AND PROJECTS, INCLUDING PROPERTY AND EQUIPMENT PURCHASES, SCHOLARSHIPS, HOSPICE PROGRAMS, REHABILITATION SERVICES AND OTHERS. PART X, LINE 2: THE HOSPITAL AND FOUNDATION ACCOUNT FOR UNCERTAINTIES IN ACCOUNTING FOR INCOME TAX ASSETS AND LIABILITIES USING GUIDANCE INCLUDED IN FASB ASC 740, INCOME TAXES. THE HOSPITAL AND FOUNDATION RECOGNIZE THE EFFECT OF INCOME TAX POSITIONS ONLY IF THOSE POSITIONS ARE MORE LIKELY THAN NOT OF BEING SUSTAINED. AT JUNE 30, 2024 AND 2023, THE HOSPITAL AND FOUNDATION HAD NO UNCERTAIN TAX POSITIONS ACCRUED. GOLF EVENT 49718 37333 12385 10000 1200 5310 CONCERT 77097 56456 20641 8544 4417 33550 126815 93789 33026 10000 1200 13854 4417 33550 63021 -29995 1 COMMUNITY HOSPITAL ASSOCIATION OF MCCOOK 1301 EAST H STREET PO BOX 1328 MCCOOK NE 69001 470533373 501(C)(3) 0 437927 GENERAL SUPPORT, EQUIPMENT, SUPPLIES, PATIENT EDUCATION, TRAINING AND SCHOLARSHIPS 1 0 SCHOLARSHIPS 8 8300 MEDICATION ASSISTANCE 18 1321 INSURANCE ASSISTANCE 5 204 TRANSPORTATION ASSISTANCE 29 3500 LODGING ASSISTANCE 5 2493 PART I, LINE 2: GRANTS ARE MADE ONLY TO SELECTED 501(C)(3) ORGANIZATIONS AND OTHER EXEMPT ORGANIZATIONS. 0 0 0 0 0 0 0 0 0 TROY BRUNTZ PRESIDENT & CEO 0 315180 0 4500 0 966 0 22829 0 28582 0 372057 0 0 JESSICA BORTNER EXECUTIVE DIRECTOR 0 98623 0 4375 0 513 0 7853 0 39166 0 150530 0 0 PART I, LINE 3 THE EXECUTIVE DIRECTOR, JESSICA BORTNER, IS PAID BY COMMUNITY HOSPITAL ASSOCIATION OF MCCOOK, A RELATED ENTITY. THE PROCESS FOR DETERMINING THE COMPENSATION OF THE EXECUTIVE DIRECTOR (ED) IS AS FOLLOWS: THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS IS RESPONSIBLE FOR SETTING THE SALARY OF THE ED. ANNUALLY, THE COMMITTEE CONDUCTS A REVIEW OF THE ED'S PERFORMANCE, ABILITIES, AND OVERALL EFFECTIVENESS. THE COMMITTEE IS PRESENTED WITH SALARY AND COMPENSATION SURVEY DATA THAT IS COMPILED BY THE HUMAN RESOURCE DEPARTMENT. ALL SOURCE DOCUMENTATION IS GIVEN TO THE COMMITTEE AS WELL AS SUMMARIES PROVIDED FOR EASE OF REFERENCE. THE EXECUTIVE COMMITTEE CONDUCTS THE PERFORMANCE REVIEW WITH THE ED AND FOLLOWS WITH A MEETING IN PRIVATE CHAMBERS TO DISCUSS THE REVIEW AND TO DELIBERATE ANY AND ALL CHANGES TO THE EMPLOYMENT AGREEMENT, INCLUDING COMPENSATION AND GOALS FOR THE FOLLOWING YEAR. CONTEMPORANEOUS RECORDS ARE KEPT OF ALL SURVEY AND COMPARABILITY DATA USED ALONG WITH THE RESULTS AND DECISIONS OF THE EXECUTIVE COMMITTEE'S MEETING ON COMPENSATION. FORM 990, PART VI, SECTION A, LINE 1A COMMUNITY HOSPITAL HEALTH FOUNDATION HAS A SEPARATE COMMITTEE FROM THE HOSPITAL FOR BUDGET AND FINANCE RECOMMENDATIONS/DECISIONS. FORM 990, PART VI, SECTION A, LINE 6 THE COMMUNITY HOSPITAL FOUNDATION HAS ONE MEMBER, THE COMMUNITY HOSPITAL ASSOCIATION. THE COMMUNITY HOSPITAL ASSOCIATION APPOINTS SIX OF THE TEN MEMBERS OF THE FOUNDATION'S BOARD OF DIRECTORS. THE REMAINING FOUR DIRECTORS INCLUDE THREE DIRECTORS FROM THE HOSPITAL ASSOCIATION'S BOARD (ONE OF WHOM IS THE THE CHAIR OF THE BOARD) AND THE PRESIDENT OF THE HOSPITAL ASSOCIATION. FORM 990, PART VI, SECTION A, LINE 7A VACANCIES FROM DIRECTORS WHOSE TERMS EXPIRE DURING THE ORGANIZATION'S TAX YEAR ARE FILLED BY NEW DIRECTORS APPOINTED BY THE FOUNDATION'S SOLE MEMBER, THE COMMUNITY HOSPITAL ASSOCIATION (SEE FORM 990, PART VI, SECTION A, LINE 6). VACANCIES OTHER THAN BY TERM EXPIRATION, ARE FILLED BY A MAJORITY VOTE OF THE REMAINING DIRECTORS OF THE FOUNDATION. FORM 990, PART VI, SECTION B, LINE 11B COMMUNITY HOSPITAL HEALTH FOUNDATION'S FORM 990 IS PREPARED BY THE FIRM EIDE BAILLY, LLP. MANAGEMENT RECEIVES DRAFT COPIES OF THE COMPLETED FORM 990 FOR REVIEW. AFTER MANAGEMENT HAS REVIEWED THE RETURNS, COMPLETE COPIES ARE DISTRIBUTED TO ALL MEMBERS OF THE BOARD OF DIRECTORS OF THE COMMUNITY HOSPITAL HEALTH FOUNDATION AND THE RETURNS ARE APPROVED FOR FILING BY THE FINANCE COMMITTEE OF THE BOARD. BOARD COMMITTEE APPROVAL IS REQUIRED PRIOR TO SIGNATURE AND SUBMISSION OF THE FORM 990 TO THE IRS. FORM 990, PART VI, SECTION B, LINE 12C THE COMMUNITY HOSPITAL HEALTH FOUNDATION POLICY REQUIRES ALL EMPLOYEES, CONTRACTORS, AND AGENTS TO REPORT ANY CONFLICTS OF INTEREST THAT ARISE. IN ADDITION, THE FOUNDATION HAS A CONFLICT OF INTEREST POLICY THAT IS APPLICABLE TO DIRECTORS, OFFICERS, MEMBERS OF COMMITTEES AND SUBCOMMITTEES WITH BOARD-DELEGATED POWERS AND KEY EMPLOYEES. THE POLICY REQUIRES, AMONG OTHER THINGS, ALL APPLICABLE PERSONS TO DISCLOSE ANY RELATIONSHIPS THAT MAY CREATE A CONFLICT OF INTEREST. ALL APPLICABLE PERSONS ARE REQUIRED TO COMPLETE AN ANNUAL DISCLOSURE OF ALL SUCH RELATIONSHIPS. ALL SUCH RELATIONSHIPS ARE DISCLOSED TO THE ENTIRE BOARD AND SENIOR MANAGEMENT, AND ANY AND ALL CONFLICTS OR POTENTIAL CONFLICTS ARE MONITORED BY SENIOR MANAGEMENT. FORM 990, PART VI, SECTION B, LINE 15 THE FOUNDATION DOES NOT PAY A CEO, EXECUTIVE DIRECTOR, OFFICERS, TOP MANAGEMENT OFFICIAL, OR ANY KEY EMPLOYEES. THEREFORE, THERE IS NOT A PROCESS IN PLACE FOR DETERMINING COMPENSATION. FORM 990, PART VI, SECTION C, LINE 19 COMMUNITY HOSPITAL FOUNDATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, FORM 1023, FORM 990 AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. ANY INDIVIDUAL THAT WOULD LIKE A COPY OF ANY OF THE ABOVE MENTIONED DOCUMENTS CAN INSPECT THOSE DOCUMENTS IN PERSON AT THE FOUNDATION'S OFFICE DURING NORMAL BUSINESS HOURS OR REQUEST A COPY IN PERSON, BY PHONE, OR BY MAIL, AND WE WILL PROVIDE A COPY FREE OF CHARGE. FORM 990, PART VII, SECTION A: TROY BRUNTZ IS AN EMPLOYEE OF COMMUNITY HOSPITAL ASSOCIATION OF MCCOOK, A RELATED ENTITY, AND SERVES ON THE BOARD OF DIRECTORS FOR THE COMMUNITY HOSPITAL HEALTH FOUNDATION. HE IS NOT BEING PAID BY THE HOSPITAL FOR HIS SERVICE ON THE BOARD OF DIRECTORS. FORM 990, PART XI, LINE 2C: COMMUNITY HOSPITAL HEALTH FOUNDATION HAS A SEPARATE COMMITTEE FROM THE HOSPITAL FOR BUDGET AND FINANCE RECOMMENDATIONS/DECISIONS. THE FOUNDATION'S MANAGEMENT STAFF DOES TAKE MOST OF ITS MAJOR FISCAL OVERSIGHT DECISIONS, INCLUDING AUDITOR SELECTION, REVIEW AND ACCEPTANCE OF AUDITED FINANCIAL STATEMENTS, AND TAX REVIEW TO THE COMMITTEE FOR A RECOMMENDATION AND THEN TO THE FULL BOARD FOR ACTION. THE FULL BOARD HAS ULTIMATE OVERSIGHT OF ALL FISCAL MATTERS. THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. COMMUNITY HOSPITAL ASSOCIATION OF MCCOOK 1301 EAST H STREET PO BOX 1328 MCCOOK NE 69001 470533373 HEALTHCARE NE 501(C)(3) LINE 3 N/A 0 0 1 1 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0