2015-01-21T13:16:33-06:00 2014-06-30 476097913 SEIM JOHNSON LLP 18081 BURT STREET SUITE 200 OMAHA NE 680224722 990 2013-07-01 237162972 COMBINED HEALTH AGENCIES DRIVE INC COMB 4026148500 212 SOUTH 74TH STREET NO 205 OMAHA NE 68114 MICHELLE GROSSMAN PRESIDENT/CEO 4026148500 2015-01-14 1 BARBARA J FAJEN P00400874 4023302660 2013 2016-04-25 22:37:26Z COMMUNITY HEALTH CHARITIES OF NEBRASKA MICHELLE GROSSMAN 212 SOUTH 74TH STREET NO 205 OMAHA NE 68114 2826343 0 3071 X WWW.CHCNE.ORG X 1971 NE IMPROVING LIVES BY RAISING FUNDS FOR NEBRASKA'S HEALTH CHARITIES THROUGH WORKPLACE GIVING. 50 49 9 53 0 0 2866092 2798842 19059 2818 15356 9594 0 0 2900507 2811254 2332879 2199775 0 0 401388 419479 0 0 53623 146763 152745 2881030 2771999 19477 39255 1776542 2444856 1422102 1997411 354440 447445 IMPROVING LIVES BY RAISING FUNDS FOR NEBRASKA'S HEALTH CHARITIES THROUGH WORKPLACE GIVING. 0 0 2605655 2199775 2818 CHC-NE CONNECTS EMPLOYEES AND EMPLOYERS VIA THE WORKPLACE TO CHC'S MEMBER CHARITIES AND THEIR PROGRAMS, SERVICES AND VOLUNTEER OPPORTUNITIES. IT IS THROUGH THIS RELATIONSHIP THAT EMPLOYEES AND EMPLOYERS HAVE THIS OPPORTUNITY TO GIVE BACK TO THE CHC-NE MEMBER CHARITIES THROUGH PAYROLL DEDUCTION. 2605655 1 1 0 0 0 0 0 0 0 1 1 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 2 0 1 9 1 0 0 0 0 0 0 0 0 0 0 X 50 49 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 0 0 X X X SHANNON CASTILLO 4026148500 212 S 74TH STREET OMAHA NE 68114 ROB REED JR DIRECTOR AT LARGE 1.00 X 0 0 0 CLARENCE NICHOLS STATE BOARD CHAIR 1.00 X X 0 0 0 LEONARD SOMMER STATE BOARD TREASURER 1.00 X X 0 0 0 PATRICK MCPHERSON STATE BOARD SECRETARY 1.00 X X 0 0 0 DAVE BUSHEY DIRECTOR AT LARGE 1.00 X 0 0 0 JOSIE ABBOUD JDRF REP 1.00 X 0 0 0 JOANN ABT DIRECTOR AT LARGE 1.00 X 0 0 0 DR ANN ANDERSON BERRY MARCH OF DIMES REP 1.00 X 0 0 0 RALPH DOVALI DIRECTOR AT LARGE 1.00 X 0 0 0 SHRRY FONTAINE UCP REP 1.00 X 0 0 0 MARTIN BEERMAN DIRECTOR AT LARGE 1.00 X 0 0 0 MARK BLAIR DIRECTOR AT LARGE 1.00 X 0 0 0 PATRICK BOOTH DIRECTOR AT LARGE 1.00 X 0 0 0 SHARON BRODKEY DIRECTOR AT LARGE 1.00 X 0 0 0 MARK BURGERS DIRECTOR AT LARGE 1.00 X 0 0 0 DOUGLAS CLARK DIRECTOR AT LARGE 1.00 X 0 0 0 MARTIE CORDARO ALS REP 1.00 X 0 0 0 LIZ CROSSON ARTHRITIS FOUNDATION REP 1.00 X 0 0 0 MICHAEL DEMMAN DIRECTOR AT LARGE 1.00 X 0 0 0 DENNIS GILBERT CROHN'S & COLITIS FND REP 1.00 X 0 0 0 LARRY GUENTHER ALZHEIMER'S REP 1.00 X 0 0 0 KERRY HEINRICH NEBRASKA KIDNEY REP 1.00 X 0 0 0 STANLEY KATHOL DIRECTOR AT LARGE 1.00 X 0 0 0 CARRIE KEENE WEST CENTRAL BOARD CHAIR 1.00 X 0 0 0 DANNY FRISBY-GRIFFIN ADA REP 1.00 X 0 0 0 RALPH A KELLOGG NEBRASKA AIDS REP 1.00 X 0 0 0 CINDY KEY AMERICAN LUNG ASSN REP 1.00 X 0 0 0 JOHN GESSERT DIRECTOR AT LARGE 1.00 X 0 0 0 TERESA LAYTON DIRECTOR AT LARGE 1.00 X 0 0 0 THOMAS MACY DIRECTOR AT LARGE 1.00 X 0 0 0 LORI MCCLURG DIRECTOR AT LARGE 1.00 X 0 0 0 DEENIE MEYERSON DIRECTOR AT LARGE 1.00 X 0 0 0 ANGELA MILLER SUSAN G. KOMEN NE REP 1.00 X 0 0 0 MICHAEL NORTON DIRECTOR AT LARGE 1.00 X 0 0 0 DAVID GALINSKY DIRECTOR AT LARGE 1.00 X 0 0 0 ERICA HINRICHS DIRECTOR AT LARGE 1.00 X 0 0 0 STEVE PATTERSON DIRECTOR AT LARGE 1.00 X 0 0 0 STEPHEN PETERS LEUKEMIA & LYMPHOMA REP 1.00 X 0 0 0 BRIAN PICKERING DIRECTOR AT LARGE 1.00 X 0 0 0 AMBER PRESTON DIRECTOR AT LARGE 1.00 X 0 0 0 GARY JOHNSON DIRECTOR AT LARGE 1.00 X 0 0 0 BETSY KURTZER ALZHEIMER'S REP 1.00 X 0 0 0 DIANE RANDOLPH NE HOSPICE & PALLIATIVE RE 1.00 X 0 0 0 ANDREW ROUILLARD DIRECTOR AT LARGE 1.00 X 0 0 0 LOREN STEENSON DIRECTOR AT LARGE 1.00 X 0 0 0 TARA STINGLEY CFF REP 1.00 X 0 0 0 FRANKLIN THOMPSON DIRECTOR AT LARGE 1.00 X 0 0 0 DR JODY WOODWORTH DIRECTOR AT LARGE 1.00 X 0 0 0 MICHELLE GROSSMAN PRESIDENT/CEO 40.00 X X 86583 0 9528 CRISTA LATHAM DIRECTOR AT LARGE 1.00 X 0 0 0 DOUGLAS OLDAKER DIRECTOR AT LARGE 1.00 X 0 0 0 JEFF PARKER DIRECTOR AT LARGE 1.00 X 0 0 0 CRAIG SALL DIRECTOR AT LARGE 1.00 X 0 0 0 MARK WESTERGARD NAT'L MS SOCIETY REP 1.00 X 0 0 0 SHANNON CASTILLO DIRECTOR OF FINANACE 40.00 X 39104 0 3801 125687 0 13329 0 0 0 0 0 1701437 1097405 2798842 MEMBER AFFILIATE FEES 900099 2000 2000 LEADERSHIP 25 INCOME 900099 818 818 2818 10805 10805 13878 15089 -1211 -1211 -1211 2811254 2818 0 9594 2199775 2199775 160703 111075 35619 14009 207204 143216 45925 18063 11589 8010 2569 1010 14753 10197 3270 1286 25230 17229 5835 2166 16118 12894 1612 1612 4145 4145 4974 3482 995 497 34468 27182 3840 3446 26780 21424 2678 2678 9391 7043 470 1878 3519 3167 352 3737 2989 374 374 3562 2850 356 356 AFFILIATION FEES 38137 30509 3814 3814 MISCELLANEOUS 5203 2394 621 2188 PUBLIC SECTOR FEES 1727 1727 MEMBERSHIP DUES 984 492 246 246 2771999 2605655 112721 53623 412 965051 291275 13017 1058691 974595 5727 2697 28672 20708 7375 7964 381120 448772 31942 32760 1776542 2444856 16242 20112 1405860 1974799 2500 1422102 1997411 X -386162 -385480 387303 470583 353299 362342 354440 447445 1776542 2444856 39255 53750 0 X X 0 1 X 1 0 X 2483443 2533334 2732783 2866092 2781061 13396713 2483443 2533334 2732783 2866092 2781061 13396713 1753212 11643501 4509 6106 3 13470 10805 34893 16297 18354 14855 19059 28522 97087 13528693 0.86070 0.87060 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 425096 8225 61228 494549 378355 7043 39698 425096 365870 8260 4225 378355 309525 6600 49745 365870 281946 8646 18933 309525 0.73000 0.27000 0 0 28672 20708 7964 7964 X 2868782 53750 7923 61673 2807109 4145 4145 2811254 2775777 7923 7923 2767854 4145 4145 2771999 PART V, LINE 4: CHC HOLDS ENDOWMENT FUNDS FOR SUPPORT OF ITS PROGRAMS AND OPERATIONS. PART X, LINE 2: CHC'S OPERATION IS TAX-EXEMPT UNDER 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. AT JUNE 30, 2014 AND 2013, CHC EVALUATED ITS TAX POSITIONS AND CONCLUDED THAT IT HAD MAINTAINED ITS TAX EXEMPT STATUS AND HAD TAKEN NO UNCERTAIN TAX POSITIONS THAT REQUIRE ADJUSTMENT TO THE FINANCIAL STATEMENTS. THEREFORE, NO PROVISION OR LIABILITY FOR INCOME TAXES HAS BEEN INCLUDED IN THE FINANCIAL STATEMENTS. WITH FEW EXCEPTIONS, CHC IS NO LONGER SUBJECT TO U.S. FEDERAL INCOME TAX EXAMINATIONS BY TAX AUTHORITIES FOR THE YEARS BEFORE 2011. 1 ALZHEIMER'S ASSOCIATION GREAT PLAINS 5601 S 27TH ST STE 201 LINCOLN NE 68512 480931989 501(C)(3) 90012 TO PROVIDE EDUCATION AND SUPPORT TO ALZHEIMERS RELATED DISEASES ALZHEIMER'S ASSOCIATION MIDLANDS CHAPTER 1941 S 42ND ST STE 20 OMAHA NE 68105 470648438 501(C)(3) 126722 TO PROVIDE EDUCATION AND SUPPORT TO ALZHEIMERS RELATED DISEASES AMERICAN DIABETES ASSN OF NE 14216 DAYTON CIR STE 6 OMAHA NE 68137 131623888 501(C)(3) 94854 TO ASSIST IN FINDING A CURE FOR DIABETES, IMPROVING CARE, AND PROVIDING INFORMATION AND SUPPORT TO PEOPLE WITH DIABETES THROUGH RESEARCH, COMMUNITY PROGRAMS AND ADVOCACY. AMERICAN LUNG ASSN OF THE CENTRAL STATES 8900 W DODGE RD STE 226 OMAHA NE 68114 430662525 501(C)(3) 48194 TO FIGHT LUNG DISEASE AND PROMOTE LUNG HEALTH THROUGH EDUCATION, ADVOCACY, RESEARCH, AND COMMUNITY PROGRAMS FOR ALL RESIDENTS. ARTHRITIS FOUNDATION NEBRASKA CHAPTER 600 N 93RD ST STE 206 OMAHA NE 68114 470483544 501(C)(3) 38496 TO IMPROVE LIVES THROUGH LEADERSHIP IN THE PREVENTION, CONTROL AND CURE OF ARTHRITIS AND RELATED DISEASES. BLAIR AREA COMMUNITY FOUNDATION 1646 WASHINGTON ST BLAIR NE 68008 470825771 501(C)(3) 16096 TO ENRICH THE QUALITY OF LIFE IN WASHINGTON COUNTY, NEBRASKA. CROHN'S & COLITIS FOUNDATION OF NEBRASKA 1941 S 42ND ST STE 543 OMAHA NE 68105 136193105 501(C)(3) 61550 TO CURE CROHN'S DISEASE AND ULCERATIVE COLITIS, AND TO IMPROVE THE QUALITY OF LIFE OF CHILDREN AND ADULTS AFFECTED BY THESE DISEASES. CYSTIC FIBROSIS FOUNDATION NE CHAPTER 11917 PIERCE PLAZA OMAHA NE 68144 131930701 501(C)(3) 60614 TO SUPPORT INNOVATIVE RESEARCH TO CONTROL AND CURE CYSTIC FIBROSIS, PROVIDE SPECIALIZED MEDICAL CARE THROUGH A NATIONWIDE NETWORK OF CENTERS, AND OFFER PHARMACY AND OTHER PATIENT SERVICES. JUVENILE DIABETES RESEARCH FOUNDATION 9202 WEST DODGE RD STE 304 OMAHA NE 68114 231907729 501(C)(3) 170175 TO IMPROVE THE LIVES OF CHILDREN AND ADULTS LIVING WITH TYPE 1 DIABETES THROUGH FUNDING RESEARCH TO CURE, TREAT, AND PREVENT THIS DISEASE. MAKE A WISH FOUNDATION 11926 ARBOR ST STE 102 OMAHA NE 68144 470671096 501(C)(3) 11004 TO GRANT THE WISHES OF CHILDREN AGES 2 1/2 TO NOT YET 18 IN NEBRASKA BATTLING A LIFE-THREATENING ILLNESS. MARCH OF DIMES NEBRASKA CHAPTER 11840 NICHOLAS ST STE 220 OMAHA NE 68154 131846366 501(C)(3) 77177 TO IMPROVE THE LIVES OF INFANTS BY PREVENTING PREMATURE BIRTH, BIRTH DEFECTS AND INFANT MORTALITY. MUSCULAR DYSTROPHY ASSOCIATION 4654 S 132ND ST OMAHA NE 68137 131665552 501(C)(3) 29078 TO ASSIST IN FIGHTING NEUROMUSCULAR DISEASES THROUGH WORLDWIDE RESEARCH, A NATIONWIDE NETWORK OF CLINICS OFFERING COMPREHENSIVE MEDICAL SERVICES, AND FAR-REACHING PROFESSIONAL AND PUBLIC HEALTH EDUCATION. NATIONAL MULTIPLE SCLEROSIS SOCIETY NE CHAPTER 328 S 72ND ST OMAHA NE 68114 470439079 501(C)(3) 94524 TO AID IN ENDING THE DEVASTING EFFECTS OF MS, OFFERING INFORMATION AND REFERRAL, EDUCATION AND DIRECT ASSISTANCE TO OVER 25,000 PEOPLE AFFECTED BY MS. NEBRASKA AIDS PROJECT 139 S 40TH ST OMAHA NE 68131 470786622 501(C)(3) 54178 TO LEAD THE COMMUNITY IN THE FIGHT TO OVERCOME HIV/AIDS AND ITS STIGMA THROUGH EDUCATION, SUPPORTIVE SERVICES AND ADVOCACY. NEBRASKA HOSPICE & PALLIATIVE CARE PARTNERSHIP 3900 NW 12TH ST STE 100 LINCOLN NE 68521 470673727 501(C)(3) 52635 TO IMPROVE CARE AND CONDITIONS FOR CHRONICALLY AND TERMINALLY ILL NEBRASKANS THROUGH PUBLIC AND PROFESSIONAL EDUCATION, RESEARCH AND ADVOCACY. NEBRASKA KIDNEY ASSOCIATION INC 11725 ARBOR ST STE 210 OMAHA NE 68114 237225449 501(C)(3) 46517 TO PROVIDE INFORMATION AND REFERRALS TO THOSE WITH KIDNEY AND UROLOGIC DISEASES AND TRANSPLANT PATIENTS, EMERGENCY FUNDING, EARLY DETECTION SCREENINGS, PROFESSIONAL EDUCATION, PUBLIC EDUCATION. PROJECT HARMONY 11949 Q STREET OMAHA NE 68137 470789054 501(C)(3) 6509 TO PROVIDE FORENSIC INTERVIEWS, MEDICAL EXAMINATIONS AND REFERRALS FOR COUNSELING TO CHILD ABUSE VICTIMS. SUSAN G KOMEN FOR THE CURE NEBRASKA 8610 BRENTWOOD DRIVE 3 LAVISTA NE 68128 260056671 501(C)(3) 113141 TO PROVIDE GRANTS TO LOCAL ORGANIZATIONS TO SUPPORT BREAST HEALTH EDUCATION, SCREENING AND TREATMENT PROGRAMS ACROSS THE STATE. THE ALS ASSN KEITH WORTHINGTON CHAPTER 10730 PACIFIC ST STE 228 OMAHA NE 68114 481021611 501(C)(3) 55469 TO EMPOWER PEOPLE WITH ALS AND THEIR FAMILIES TO LIVE FULLER LIVES, PROVIDING THEM WITH SERVICES AND SUPPORT WHILE FUNDING GLOBAL RESEARCH TO FIND A CURE. THE LEUKEMIA & LYMPHOMA SOCIETY 10832 OLD MILL ROAD STE 2 OMAHA NE 68154 135644916 501(C)(3) 125143 TO CURE LEUKEMIA, NON-HODGKIN'S LYMPHOMA, HODGKINS LYMPHOMA AND MYELOMA AND IMPROVE THE QUALITY OF LIFE OF PATIENTS AND FAMILIES. UNITED CEREBRAL PALSY OF NEBRASKA 920 S 107TH ST STE 302 OMAHA NE 68114 470534212 501(C)(3) 23106 TO PROVIDE PROGRAMS, SERVICES, INFORMATION, REFERRAL, AND FINANCIAL SUPPORT FOR INDIVIDUALS AND FAMILIES WITH CEREBRAL PALSY AS WELL AS OTHER DISABILITIES. PART I, LINE 2: FUNDS CONTRIBUTED BY DONORS IN WORKPLACE CAMPAIGNS CONDUCTED BY OR IN PARTNERSHIP WITH CHC-NE ARE EITHER DESIGNATED OR UNDESIGNATED FOR SPECIFIC AGENCIES. DESIGNATED FUNDS: FULL MEMBER AGENCIES ARE CREDITED WITH ALL SPECIFICALLY DESIGNATED FUNDS. DESIGNATED FUNDS ARE DISTRIBUTED QUARTERLY (SEPTEMBER, DECEMBER, MARCH AND JUNE) THE FISCAL YEAR FOLLOWING THE FISCAL YEAR IN WHICH THEY WERE PLEDGED. UNDESIGNATED FUNDS: THE UNDESIGNATED FUNDS, LESS EXPENSES ARE CREDITED TO EACH MEMBER AGENCY BASED ON THE PERCENTAGE OF EACH AGENCY'S DESIGNATED FUNDS RELATIVE TO THE TOTAL OF ALL DESIGNATED FUNDS. THIS PERCENTAGE IS CALCULATED ANNUALLY AT THE END OF EVERY FISCAL YEAR FOR EACH AGENCY BY DIVIDING ITS DESIGNATED FUNDS BY THE TOTAL OF ALL DESIGNATED FUNDS FROM NON-NATIONAL CAMPAIGNS. UNDESIGNATED FUNDS ARE DISTRIBUTED FROM AVAILABLE COLLECTED RECEIVABLES ON THE LAST DAY OF EACH CALENDAR QUARTER (SEPTEMBER, DECEMBER, MARCH AND JUNE). FORM 990, PART VI, SECTION B, LINE 11 A COPY OF THE FORM 990 IS PROVIDED TO ALL THE MEMBERS OF THE FINANCE COMMITTEE TO BE REVIEWED AND APPROVED BEFORE IT IS FILED. A COPY IS ALSO EMAILED TO EACH BOARD MEMBER AND IS PROVIDED AT CLOSEST SCHEDULED BOARD MEETING. FORM 990, PART VI, SECTION B, LINE 12C THE CONFLICT OF INTEREST POLICY IS RENEWED EACH YEAR AND BOARD MEMBERS AND CHC-NE EMPLOYEES ARE ASKED TO DISCLOSE POTENTIAL CONFLICTS. THE CEO MONITORS THESE WITH THE ASSISTANCE OF THE ADMINISTRATIVE ASSISTANT. IF A CONFLICT EXISTS FOR A BOARD MEMBER IT IS ADDRESSED. FORM 990, PART VI, SECTION B, LINE 15A THE PRESIDENT & CEO POSITION IS REVIEWED ANNUALLY BY THE HUMAN RESOURCE COMMITTEE. THIS COMMITTEE CONSISTS OF THE BOARD CHAIR, IMMEDIATE PAST BOARD CHAIR AND AT LEAST THREE BUT NO MORE THAN FIVE OTHER BOARD MEMBERS. THIS COMMITTEE IS ALSO RESPONSIBLE FOR ANY OTHER HUMAN RESOURCE ISSUES THAT MAY ARISE WITH THE CEO. GOALS AND ACHIEVEMENTS ARE REVIEWED AS WELL AS ANNUAL SALARY INCREASE. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART XII, LINE 2C: THE TREASURER OF THE BOARD IS THE CHAIRMAN OF THE FINANCE COMMITTEE. THE TREASURER ALONG WITH THE FINANCE COMMITTEE ASSUMES RESPONSIBILITY FOR THE OVERSIGHT OF THE AUDIT OF THE ORGANIZATION'S FINANCIAL STATEMENTS AND THE SELECTION OF AN INDEPENDENT ACCOUNTANT. THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR.