COMMUNITY HOSPITAL HEALTH FOUNDATION: Form 990, tax year 2015
View the entire original 990 at ProPublica ↗
- Organization
- COMMUNITY HOSPITAL HEALTH FOUNDATION (EIN 47-0693261)
- Tax period
- 2015-07-01 to 2016-06-30
- Filed
- 2016-12-21
- IRS object ID
- 201633569349300338
- Schema version
- 2015v2.1
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule D
- Schedule G
- Schedule I
- Schedule J
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2016-12-21T14:34:03-06:00 | ReturnTs |
| Tax Period End | 2016-06-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 476097913 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SEIM JOHNSON LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 18081 BURT STREET SUITE 200 | AddressLine1Txt |
| City | OMAHA | CityNm |
| State Abbreviation | NE | StateAbbreviationCd |
| ZIP | 680224722 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2015-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 470693261 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | COMMUNITY HOSPITAL HEALTH FOUNDATION | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | COMM | BusinessNameControlTxt |
| Phone | 3083447222 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 1328 | AddressLine1Txt |
| City | MCCOOK | CityNm |
| State Abbreviation | NE | StateAbbreviationCd |
| ZIP | 69001 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | TERRI SHIPSHOCK | PersonNm |
| Person Title | EXECUTIVE DIRECTOR | PersonTitleTxt |
| Phone | 3083447222 | PhoneNum |
| Signature | 2016-12-02 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | WENDY R COOLEY | PreparerPersonNm |
| PTIN | P01523804 | PTIN |
| Phone | 4023302660 | PhoneNum |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2015 | TaxYr |
| Build TS | 2017-02-10 21:41:12Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | TERRI SHIPSHOCK | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 1328 | AddressLine1Txt |
| City | MCCOOK | CityNm |
| State Abbreviation | NE | StateAbbreviationCd |
| ZIP | 69001 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $1,048,002 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.CHMCCOOK.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1985 | FormationYr |
| Legal Domicile State | NE | LegalDomicileStateCd |
| Activity Or Mission | TO SOLICIT GIFTS, GRANTS, DEVICES AND BEQUESTS FOR THE USE AND BENEFIT OF COMMUNITY HOSPITAL ASSOCIATION OF MCCOOK. | ActivityOrMissionDesc |
| Voting Members Governing Body | 10 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 9 | VotingMembersIndependentCnt |
| Total Employee | 0 | TotalEmployeeCnt |
| Total Volunteers | 46 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $340,935 | PYContributionsGrantsAmt |
| CY Contributions Grants | $243,615 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $0 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $0 | CYProgramServiceRevenueAmt |
| PY Investment Income | $548,045 | PYInvestmentIncomeAmt |
| CY Investment Income | $108,914 | CYInvestmentIncomeAmt |
| PY Other Revenue | -$24,004 | PYOtherRevenueAmt |
| CY Other Revenue | -$18,959 | CYOtherRevenueAmt |
| PY Total Revenue | $864,976 | PYTotalRevenueAmt |
| CY Total Revenue | $333,570 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $371,248 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $327,880 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $0 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $0 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $5,406 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $39,620 | PYOtherExpensesAmt |
| CY Other Expenses | $32,406 | CYOtherExpensesAmt |
| PY Total Expenses | $410,868 | PYTotalExpensesAmt |
| CY Total Expenses | $360,286 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $454,108 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$26,716 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $3,453,379 | TotalAssetsBOYAmt |
| Total Assets EOY | $3,401,638 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $25,957 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $24,668 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $3,427,422 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $3,376,970 | NetAssetsOrFundBalancesEOYAmt |
| Mission | TO GENERATE FUNDS TO SECURE THE FUTURE OF COMMUNITY HOSPITAL BY STIMULATING PUBLIC AWARENESS AND SUPPORT. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $327,880 | ExpenseAmt |
| Grant | $327,880 | GrantAmt |
| Desc | 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, AN EVENING FOR HOSPICE GALA, A CONCERT FOR CANCER CARE AND ANNUAL APPEALS. | Desc |
| Total Program Service Expenses | $327,880 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Temp Or Permanent Endowments | Yes (1) | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | 0 | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (1) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | Yes (1) | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | 0 | OperateHospitalInd |
| Grants To Organizations | Yes (1) | GrantsToOrganizationsInd |
| Grants To Individuals | Yes (1) | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 9 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 0 | EmployeeCnt |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | Yes (1) | QuidProQuoContributionsInd |
| Quid Pro Quo Contri Discl | Yes (1) | QuidProQuoContriDisclInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 10 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 9 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | 0 | CompensationProcessCEOInd |
| Compensation Process Other | 0 | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | TERRI SHIPSHOCK EXECUTIVE DIRECTOR | PersonNm |
| Phone | 3083447222 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 1328 | AddressLine1Txt |
| City | MCCOOK | CityNm |
| State Abbreviation | NE | StateAbbreviationCd |
| ZIP | 69001 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | Yes (X) | InfoInScheduleOPartVIIInd |
Form990 Part VII Section A Form990PartVIISectionAGrp (11 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt |
|---|---|---|---|---|---|---|---|
| BILL BURTON | |||||||
| CHAIR | 0.50 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 |
| NATE SCHNEIDER | |||||||
| VICE CHAIR | 0.50 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 |
| PAT SITZMAN | |||||||
| SECRETARY | 0.50 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 |
| KIM SCHILLING | |||||||
| TREASURER | 0.50 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 |
| WARREN JONES DDS | |||||||
| MEMBER | 0.50 | 1.00 | Yes (X) | $0 | $0 | $0 | |
| DON MOORE | |||||||
| MEMBER | 0.50 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| CONNIE OLSEN | |||||||
| MEMBER | 0.50 | 1.00 | Yes (X) | $0 | $0 | $0 | |
| KELCY RUGGLES | |||||||
| MEMBER | 0.50 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| JIM ULRICH | |||||||
| MEMBER | 0.50 | 39.50 | Yes (X) | $0 | $245,519 | $39,326 | |
| WAYNE WATKINS DVM | |||||||
| MEMBER | 0.50 | 1.00 | Yes (X) | $0 | $0 | $0 | |
| TERRI SHIPSHOCK | |||||||
| EXECUTIVE DIRECTOR | 40.00 | 0.00 | Yes (X) | $0 | $96,935 | $6,664 | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $0 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $342,454 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $45,990 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 0 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
| Cntrct Rcvd Greater Than100 K | 0 | CntrctRcvdGreaterThan100KCnt |
| Fundraising | $65,018 | FundraisingAmt |
| Related Organizations | $12,050 | RelatedOrganizationsAmt |
| All Other Contributions | $166,547 | AllOtherContributionsAmt |
| Total Contributions | $243,615 | TotalContributionsAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $80,816 | TotalRevenueColumnAmt |
| Exclusion | $80,816 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $686,451 | SecuritiesAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $658,353 | SecuritiesAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $28,098 | SecuritiesAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $28,098 | TotalRevenueColumnAmt |
| Exclusion | $28,098 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Fundraising Gross Income | $37,120 | FundraisingGrossIncomeAmt |
| Contri Rpt Fundraising Event | $65,018 | ContriRptFundraisingEventAmt |
| Fundraising Direct Expenses | $56,079 | FundraisingDirectExpensesAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$18,959 | TotalRevenueColumnAmt |
| Exclusion | -$18,959 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $333,570 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $0 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $89,955 | ExclusionAmt |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $268,569 | TotalAmt |
| Program Services | $268,569 | ProgramServicesAmt |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $59,311 | TotalAmt |
| Program Services | $59,311 | ProgramServicesAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,600 | TotalAmt |
| Management And General | $6,600 | ManagementAndGeneralAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $20,276 | TotalAmt |
| Management And General | $20,276 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $644 | TotalAmt |
| Fundraising | $644 | FundraisingAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,358 | TotalAmt |
| Management And General | $124 | ManagementAndGeneralAmt |
| Fundraising | $1,234 | FundraisingAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,006 | TotalAmt |
| Fundraising | $1,006 | FundraisingAmt |
Other Expenses OtherExpensesGrp (2 entries)
| DescDesc | TotalTotalAmt | FundraisingFundraisingAmt |
|---|---|---|
| NEWSLETTER EXPENSE | $1,247 | $1,247 |
| DONOR RELATIONS | $295 | $295 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $980 | TotalAmt |
| Fundraising | $980 | FundraisingAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $360,286 | TotalAmt |
| Program Services | $327,880 | ProgramServicesAmt |
| Management And General | $27,000 | ManagementAndGeneralAmt |
| Fundraising | $5,406 | FundraisingAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $589,347 | BOYAmt |
| EOY | $521,668 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,400 | BOYAmt |
| EOY | $5,000 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,809,851 | BOYAmt |
| EOY | $2,825,786 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $42,781 | BOYAmt |
| EOY | $49,184 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,453,379 | BOYAmt |
| EOY | $3,401,638 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $524 | BOYAmt |
| EOY | $3,540 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $25,433 | BOYAmt |
| EOY | $21,128 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $25,957 | BOYAmt |
| EOY | $24,668 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,619,943 | BOYAmt |
| EOY | $1,494,924 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $230,968 | BOYAmt |
| EOY | $299,991 | EOYAmt |
Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,576,511 | BOYAmt |
| EOY | $1,582,055 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,427,422 | BOYAmt |
| EOY | $3,376,970 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,453,379 | BOYAmt |
| EOY | $3,401,638 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | -$26,716 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | -$23,736 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Info In Schedule O Part XII | Yes (X) | InfoInScheduleOPartXIIInd |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consol And Sep Basis Fincl Stmt | Yes (X) | ConsolAndSepBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Supporting Organization509a3 | Yes (X) | SupportingOrganization509a3Ind |
| Supporting Org Type1 | Yes (X) | SupportingOrgType1Ind |
| Supported Organizations | 1 | SupportedOrganizationsCnt |
Supported Org Information SupportedOrgInformationGrp
Supported Organization Name SupportedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | COMMUNITY HOSPITAL ASSOCIATION OF MCCOOK | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 470533373 | EIN |
| Organization Type | 3 | OrganizationTypeCd |
| Governing Document Listed | Yes (1) | GoverningDocumentListedInd |
| Support | $265,696 | SupportAmt |
| Other Support | $0 | OtherSupportAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Supported Organizations Total | 1 | SupportedOrganizationsTotalCnt |
| Support Sum | $265,696 | SupportSumAmt |
| Other Support Sum | $0 | OtherSupportSumAmt |
Form990 Sch A Supporting Org Form990SchASupportingOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Listed By Name Governing Doc | Yes (1) | ListedByNameGoverningDocInd |
| Suprt Org No IRS Determination | 0 | SuprtOrgNoIRSDeterminationInd |
| Supported Org Section C456 | 0 | SupportedOrgSectionC456Ind |
| Supported Org Not Organized US | 0 | SupportedOrgNotOrganizedUSInd |
| Organization Change Suprt Org | 0 | OrganizationChangeSuprtOrgInd |
| Support Non Supported Org | Yes (1) | SupportNonSupportedOrgInd |
| Payment Substantial Contribtr | 0 | PaymentSubstantialContribtrInd |
| Loan Disqualified Person | 0 | LoanDisqualifiedPersonInd |
| Controlled Disqualified Prsn | 0 | ControlledDisqualifiedPrsnInd |
| Disqualified Prsn Controll Int | 0 | DisqualifiedPrsnControllIntInd |
| Disqualified Prsn Ownr Int | 0 | DisqualifiedPrsnOwnrIntInd |
| Excess Business Holdings Rules | 0 | ExcessBusinessHoldingsRulesInd |
| Contribution Controller | 0 | ContributionControllerInd |
| Contribution Family | 0 | ContributionFamilyInd |
| Contribution35 Controlled | 0 | Contribution35ControlledInd |
Form990 Sch A Type1 Suprt Org Form990SchAType1SuprtOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Power Appoint Majority Dir Trst | Yes (1) | PowerAppointMajorityDirTrstInd |
| Operate Benefit Non Suprt Org | 0 | OperateBenefitNonSuprtOrgInd |
Form990 Schedule A Part VI Form990ScheduleAPartVIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART IV, SECTION A, LINE 6: | FormAndLineReferenceDesc |
| Explanation | THE ORGANIZATION PROVIDED GRANTS TO INDIVIDUALS IN THE FORM OF SCHOLARSHIPS FOR HIGHER EDUCATION AND MEDICAL ASSISTANCE PAYMENTS. | ExplanationTxt |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| 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) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule D IRS990ScheduleD
CY Endwmt Fund CYEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $2,566,458 | BeginningYearBalanceAmt |
| Contributions | $5,544 | ContributionsAmt |
| Investment Earnings Or Losses | $59,250 | InvestmentEarningsOrLossesAmt |
| Grants Or Scholarships | $15,224 | GrantsOrScholarshipsAmt |
| Other Expenditures | $10,534 | OtherExpendituresAmt |
| Administrative Expenses | $2,633 | AdministrativeExpensesAmt |
| End Year Balance | $2,602,861 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $2,641,004 | BeginningYearBalanceAmt |
| Contributions | $45,617 | ContributionsAmt |
| Investment Earnings Or Losses | $18,369 | InvestmentEarningsOrLossesAmt |
| Grants Or Scholarships | $11,000 | GrantsOrScholarshipsAmt |
| Other Expenditures | $102,026 | OtherExpendituresAmt |
| Administrative Expenses | $25,506 | AdministrativeExpensesAmt |
| End Year Balance | $2,566,458 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $2,419,032 | BeginningYearBalanceAmt |
| Contributions | $5,062 | ContributionsAmt |
| Investment Earnings Or Losses | $359,249 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $113,871 | OtherExpendituresAmt |
| Administrative Expenses | $28,468 | AdministrativeExpensesAmt |
| End Year Balance | $2,641,004 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $2,243,200 | BeginningYearBalanceAmt |
| Contributions | $5,955 | ContributionsAmt |
| Investment Earnings Or Losses | $257,537 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $70,128 | OtherExpendituresAmt |
| Administrative Expenses | $17,532 | AdministrativeExpensesAmt |
| End Year Balance | $2,419,032 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $2,335,881 | BeginningYearBalanceAmt |
| Contributions | $6,653 | ContributionsAmt |
| Investment Earnings Or Losses | -$30,823 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $54,809 | OtherExpendituresAmt |
| Administrative Expenses | $13,702 | AdministrativeExpensesAmt |
| End Year Balance | $2,243,200 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Designated Balance EOY | 0.39220 | BoardDesignatedBalanceEOYPct |
| Prmnnt Endowment Balance EOY | 0.60780 | PrmnntEndowmentBalanceEOYPct |
| Term Endowment Balance EOY | 0.00000 | TermEndowmentBalanceEOYPct |
| Endowments Held Unrelated Org | 0 | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | 0 | EndowmentsHeldRelatedOrgInd |
| Total Book Value Land Buildings | $0 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | PAYABLE TO AFFILIATE | Desc |
| Amt | $21,128 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $21,128 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $365,913 | TotalRevEtcAuditedFinclStmtAmt |
| Net Unrealized Gains Invst | -$23,736 | NetUnrealizedGainsInvstAmt |
| Other Revenue | $56,079 | OtherRevenueAmt |
| Revenue Not Reported | $32,343 | RevenueNotReportedAmt |
| Revenue Subtotal | $333,570 | RevenueSubtotalAmt |
| Revenue Not Reported Fincl Stmt | $0 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $333,570 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $416,365 | TotExpnsEtcAuditedFinclStmtAmt |
| Other Expenses Included | $56,079 | OtherExpensesIncludedAmt |
| Expenses Not Reported | $56,079 | ExpensesNotReportedAmt |
| Expenses Subtotal | $360,286 | ExpensesSubtotalAmt |
| Expenses Not Rpt Fincl Stmt | $0 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $360,286 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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 FOUNDATION IS A NOT-FOR-PROFIT CORPORATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND HAS RECEIVED A DETERMINATION LETTER THAT IT IS EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE INTERNAL REVENUE CODE. THE INTERNAL REVENUE SERVICE HAS ESTABLISHED STANDARDS TO BE MET TO MAINTAIN TAX-EXEMPT STATUS. THE FOUNDATION ACCOUNTS FOR UNCERTAINTIES IN ACCOUNTING FOR INCOME TAX ASSETS AND LIABILITIES USING GUIDANCE INCLUDED IN FINANCIAL ACCOUNTING STANDARDS BOARD (FASB) ACCOUNTING STANDARDS CODIFICATION (ASC) 740, INCOME TAXES. THE FOUNDATION RECOGNIZES THE EFFECT OF INCOME TAX POSITIONS ONLY IF THOSE POSITIONS ARE MORE LIKELY THAN NOT OF BEING SUSTAINED. AT JUNE 30, 2016 AND 2015, THE FOUNDATION HAD NO UNCERTAIN TAX POSITIONS ACCRUED. |
| PART XI, LINE 2D - OTHER ADJUSTMENTS: | SPECIAL EVENTS EXPENSE 56,079. |
| PART XII, LINE 2D - OTHER ADJUSTMENTS: | SPECIAL EVENTS EXPENSE 56,079. |
Schedule G IRS990ScheduleG
Fundraising Event Information FundraisingEventInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Event1 | GOLF EVENT | Event1Nm |
| Gross Receipts Event1 | $49,673 | GrossReceiptsEvent1Amt |
| Charitable Contri Event1 | $24,175 | CharitableContriEvent1Amt |
| Gross Revenue Event1 | $25,498 | GrossRevenueEvent1Amt |
| Cash Prizes Event1 | $15,655 | CashPrizesEvent1Amt |
| Rent Facility Costs Event1 | $6,560 | RentFacilityCostsEvent1Amt |
| Food And Beverage Event1 | $4,350 | FoodAndBeverageEvent1Amt |
| Other Direct Expenses Event1 | $4,315 | OtherDirectExpensesEvent1Amt |
| Event2 | DINNER EVENT | Event2Nm |
| Gross Receipts Event2 | $30,810 | GrossReceiptsEvent2Amt |
| Charitable Contri Event2 | $24,308 | CharitableContriEvent2Amt |
| Gross Revenue Event2 | $6,502 | GrossRevenueEvent2Amt |
| Cash Prizes Event2 | $150 | CashPrizesEvent2Amt |
| Rent Facility Costs Event2 | $602 | RentFacilityCostsEvent2Amt |
| Food And Beverage Event2 | $1,763 | FoodAndBeverageEvent2Amt |
| Other Direct Expenses Event2 | $6,090 | OtherDirectExpensesEvent2Amt |
| Other Events Total | 1 | OtherEventsTotalCnt |
| Gross Receipts Other Events | $21,655 | GrossReceiptsOtherEventsAmt |
| Charitable Contri Other Events | $16,535 | CharitableContriOtherEventsAmt |
| Gross Revenue Other Events | $5,120 | GrossRevenueOtherEventsAmt |
| Rent Fclty Costs Other Events | $400 | RentFcltyCostsOtherEventsAmt |
| Food And Beverage Other Events | $571 | FoodAndBeverageOtherEventsAmt |
| Entertainment Other Events | $13,300 | EntertainmentOtherEventsAmt |
| Oth Direct Expnss Other Events | $2,323 | OthDirectExpnssOtherEventsAmt |
| Gross Receipts Total | $102,138 | GrossReceiptsTotalAmt |
| Charitable Contributions Tot | $65,018 | CharitableContributionsTotAmt |
| Gross Revenue Total Events | $37,120 | GrossRevenueTotalEventsAmt |
| Cash Prizes Total Events | $15,805 | CashPrizesTotalEventsAmt |
| Rent Fclty Costs Total Events | $7,562 | RentFcltyCostsTotalEventsAmt |
| Food And Beverage Total Events | $6,684 | FoodAndBeverageTotalEventsAmt |
| Entertainment Total Events | $13,300 | EntertainmentTotalEventsAmt |
| Oth Direct Expnss Total Events | $12,728 | OthDirectExpnssTotalEventsAmt |
| Direct Expense Summary Events | $56,079 | DirectExpenseSummaryEventsAmt |
| Net Income Summary | -$18,959 | NetIncomeSummaryAmt |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (1) | GrantRecordsMaintainedInd |
Recipient Table RecipientTable
Recipient Business Name RecipientBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | COMMUNITY HOSPITAL ASSOCIATION OF MCCOOK | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1301 EAST H STREET PO BOX 1328 | AddressLine1Txt |
| City | MCCOOK | CityNm |
| State Abbreviation | NE | StateAbbreviationCd |
| ZIP | 69001 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Recipient EIN | 470533373 | RecipientEIN |
| IRC Section | 501(C)(3) | IRCSectionDesc |
| Cash Grant | $265,696 | CashGrantAmt |
| Purpose Of Grant | GENERAL SUPPORT, EQUIPMENT, SUPPLIES, PATIENT EDUCATION, TRAINING AND SCHOLARSHIPS | PurposeOfGrantTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 1 | Total501c3OrgCnt |
| Total Other Org | 0 | TotalOtherOrgCnt |
Grants Other Asst To Indiv In US GrantsOtherAsstToIndivInUSGrp (3 entries)
| Grant TypeGrantTypeTxt | RecipientRecipientCnt | Cash GrantCashGrantAmt | Non Cash AssistanceNonCashAssistanceAmt |
|---|---|---|---|
| SCHOLARSHIPS | 14 | $31,800 | $0 |
| MEDICATION ASSISTANCE | 22 | $2,399 | $0 |
| PREMIUM ASSISTANCE | 3 | $25,112 | $0 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 2: | FormAndLineReferenceDesc |
| Explanation | GRANTS ARE MADE ONLY TO SELECTED 501(C)(3) ORGANIZATIONS AND OTHER EXEMPT ORGANIZATIONS. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | JIM ULRICH | PersonNm |
| Title | MEMBER | TitleTxt |
| Base Compensation Filing Org | $0 | BaseCompensationFilingOrgAmt |
| Compensation Based On Rltd Orgs | $244,709 | CompensationBasedOnRltdOrgsAmt |
| Bonus Filing Organization | $0 | BonusFilingOrganizationAmount |
| Bonus Related Organizations | $0 | BonusRelatedOrganizationsAmt |
| Other Compensation Filing Org | $0 | OtherCompensationFilingOrgAmt |
| Other Compensation Rltd Orgs | $810 | OtherCompensationRltdOrgsAmt |
| Deferred Compensation Flng Org | $0 | DeferredCompensationFlngOrgAmt |
| Deferred Comp Rltd Orgs | $17,535 | DeferredCompRltdOrgsAmt |
| Nontaxable Benefits Filing Org | $0 | NontaxableBenefitsFilingOrgAmt |
| Nontaxable Benefits Rltd Orgs | $21,791 | NontaxableBenefitsRltdOrgsAmt |
| Total Compensation Filing Org | $0 | TotalCompensationFilingOrgAmt |
| Total Compensation Rltd Orgs | $284,845 | TotalCompensationRltdOrgsAmt |
| Comp Report Prior990 Filing Org | $0 | CompReportPrior990FilingOrgAmt |
| Comp Report Prior990 Rltd Orgs | $0 | CompReportPrior990RltdOrgsAmt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 3 | FormAndLineReferenceDesc |
| Explanation | THE EXECUTIVE DIRECTOR, TERRI SHIPSHOCK, 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. | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (8 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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 CHAIRMAN 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 11 | COMMUNITY HOSPITAL HEALTH FOUNDATION'S FORM 990 IS PREPARED BY THE FIRM SEIM JOHNSON, 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: | JIM ULRICH IS THE CEO 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. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp
Disregarded Entity Name DisregardedEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | COMMUNITY HOSPITAL ASSOCIATION OF MCCOOK | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1301 EAST H STREET PO BOX 1328 | AddressLine1Txt |
| City | MCCOOK | CityNm |
| State Abbreviation | NE | StateAbbreviationCd |
| ZIP | 69001 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 470533373 | EIN |
| Primary Activities | HEALTHCARE | PrimaryActivitiesTxt |
| Legal Domicile State | NE | LegalDomicileStateCd |
| Exempt Code Section | 501(C)(3) | ExemptCodeSectionTxt |
| Public Charity Status | LINE 3 | PublicCharityStatusTxt |
| Direct Controlling NA | N/A | DirectControllingNACd |
| Controlled Organization | 0 | ControlledOrganizationInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | Yes (1) | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (1) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | 0 | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (1) | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (1) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |