CHURCHILL COMMUNITY HOSPITAL AUXILIARY: Form 990, tax year 2012

View the entire original 990 at ProPublica ↗

Organization: CHURCHILL COMMUNITY HOSPITAL AUXILIARY (EIN 88-0379320)
Tax period: 2012-01-01 to 2012-12-31
Filed: 2013-05-07
IRS object ID: 201331279349301608
Schema version: 2012v2.0
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 D
Schedule I
Schedule O

Return header ReturnHeader

Field	Value	IRS element (for citing)
Timestamp	2013-05-07T13:56:02-07:00	Timestamp
Tax Period End Date	2012-12-31	TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

Field	Value	IRS element (for citing)
Business Name Line1	BARNETT HADEN BUSINESS AND TAX CONSULTING	BusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

Field	Value	IRS element (for citing)
Address Line1	356 S TAYLOR ST	AddressLine1
City	FALLON	City
State	NV	State
ZIP Code	894063227	ZIPCode

Field	Value	IRS element (for citing)
Return Type	990	ReturnType
Tax Period Begin Date	2012-01-01	TaxPeriodBeginDate

Filer Filer

Field	Value	IRS element (for citing)
EIN	880379320	EIN

Name Name

Field	Value	IRS element (for citing)
Business Name Line1	CHURCHILL COMMUNITY HOSPITAL AUXILIARY	BusinessNameLine1

Field	Value	IRS element (for citing)
Name Control	CHUR	NameControl
Phone	7758672170	Phone

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	PO BOX 1707	AddressLine1
City	FALLON	City
State	NV	State
ZIP Code	89407	ZIPCode

Officer Officer

Field	Value	IRS element (for citing)
Name	LARRY WHITELEY	Name
Title	Treasurer	Title
Date Signed	2013-05-07	DateSigned
Authorize Third Party	true	AuthorizeThirdParty

Preparer Preparer

Field	Value	IRS element (for citing)
Name	BARNETT HADEN	Name
PTIN	P00043942	PTIN
Phone	7754231040	Phone
Self Employed	X	SelfEmployed

Field	Value	IRS element (for citing)
Tax Year	2012	TaxYear
Build TS	2016-02-25 16:41:14Z	BuildTS

Form 990 IRS990

Field	Value	IRS element (for citing)
Name Of Principal Officer Person	LARRY WHITELEY	NameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

Field	Value	IRS element (for citing)
Address Line1	1491 LATTIN ROAD	AddressLine1
City	FALLON	City
State	NV	State
ZIP Code	89406	ZIPCode

Field	Value	IRS element (for citing)
Gross Receipts	246019	GrossReceipts
Group Return For Affiliates	false	GroupReturnForAffiliates
All Affiliates Included	false	AllAffiliatesIncluded
Organization501c3	X	Organization501c3
Web Site	N/A	WebSite
Type Of Organization Other	X	TypeOfOrganizationOther
Year Formation	1997	YearFormation
State Legal Domicile	NV	StateLegalDomicile
Activity Or Mission Description	PROVIDE FUNDS TO PURCHASE MEDICAL EQUIPMENT AND TRAINING FOR LOCAL HOSPITAL.	ActivityOrMissionDescription
Nbr Voting Members Governing Body	14	NbrVotingMembersGoverningBody
Nbr Independent Voting Members	0	NbrIndependentVotingMembers
Total Nbr Employees	0	TotalNbrEmployees
Total Gross UBI	0	TotalGrossUBI
Contributions Grants Prior Year	950	ContributionsGrantsPriorYear
Contributions Grants Current Year	870	ContributionsGrantsCurrentYear
Program Service Revenue Prior Year	41352	ProgramServiceRevenuePriorYear
Program Service Revenue CY	32824	ProgramServiceRevenueCY
Investment Income Prior Year	412	InvestmentIncomePriorYear
Investment Income Current Year	109	InvestmentIncomeCurrentYear
Other Revenue Prior Year	147640	OtherRevenuePriorYear
Other Revenue Current Year	189151	OtherRevenueCurrentYear
Total Revenue Prior Year	190354	TotalRevenuePriorYear
Total Revenue Current Year	222954	TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year	62908	GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY	69679	GrantsAndSimilarAmntsCY
Benefits Paid To Members CY	0	BenefitsPaidToMembersCY
Salaries Etc Current Year	0	SalariesEtcCurrentYear
Total Prof Fundrsng Exp CY	0	TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year	0	TotalFundrsngExpCurrentYear
Other Expense Prior Year	111025	OtherExpensePriorYear
Other Expenses Current Year	123895	OtherExpensesCurrentYear
Total Expenses Prior Year	173933	TotalExpensesPriorYear
Total Expenses Current Year	193574	TotalExpensesCurrentYear
Revenues Less Expenses Prior Year	16421	RevenuesLessExpensesPriorYear
Revenues Less Expenses CY	29380	RevenuesLessExpensesCY
Total Assets BOY	258550	TotalAssetsBOY
Total Assets EOY	287930	TotalAssetsEOY
Total Liabilities EOY	0	TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY	258550	NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY	287930	NetAssetsOrFundBalancesEOY
Info In Schedule O Part III	X	InfoInScheduleOPartIII
Mission Description	NONE	MissionDescription
Significant New Program Services	false	SignificantNewProgramServices
Significant Change	false	SignificantChange
Expense	52132	Expense
Description	FUNDS PROVIDED TO PURCHASE MEDICAL EQUIPMENT AND BUILDING IMPROVEMENT AT THE HOSPITAL	Description

Activity2 Activity2

Field	Value	IRS element (for citing)
Expense	26550	Expense
Description	EMERGENCY MONITORING EQUIPMENT MAINTENANCE & PURCHASE	Description

Activity3 Activity3

Field	Value	IRS element (for citing)
Expense	15547	Expense
Description	ASSISTANCE TO PATIENTS $2,690GRANTS/DONATIONS TO OTHER CHARITABLE ORGANIZATIONS $ 12,857	Description

Field	Value	IRS element (for citing)
Total Of Other Program Service Exp	2000	TotalOfOtherProgramServiceExp
Total Program Service Expense	96229	TotalProgramServiceExpense
Described In501 C3	true	DescribedIn501C3
Schedule B Required	false	ScheduleBRequired
Political Activities	false	PoliticalActivities
Lobbying Activities	false	LobbyingActivities
Subject To Proxy Tax	false	SubjectToProxyTax
Donor Advised Funds	false	DonorAdvisedFunds
Conservation Easements	false	ConservationEasements
Collections Of Art	false	CollectionsOfArt
Credit Counseling	false	CreditCounseling
Term Or Permanent Endowments	false	TermOrPermanentEndowments
Report Land Bldg Equip	true	ReportLandBldgEquip
Report Invest Oth Securities	false	ReportInvestOthSecurities
Report Prog Rel Invest	false	ReportProgRelInvest
Report Other Assets	false	ReportOtherAssets
Report Other Liabilities	false	ReportOtherLiabilities
Report Fin48 Footnote	false	ReportFin48Footnote
Independent Audit Financial Stmt	false	IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt	false	ConsolidatedAuditFinancialStmt
School	false	School
Foreign Office	false	ForeignOffice
Foreign Activities	false	ForeignActivities
More Than5000 K To Organizations	false	MoreThan5000KToOrganizations
More Than5000 K To Individuals	false	MoreThan5000KToIndividuals
Professional Fundraising	false	ProfessionalFundraising
Fundraising Activities	false	FundraisingActivities
Gaming	false	Gaming
Hospital	false	Hospital
Grants To Organizations	true	GrantsToOrganizations
Grants To Individuals	true	GrantsToIndividuals
Schedule J Required	false	ScheduleJRequired
Tax Exempt Bonds	false	TaxExemptBonds
Invest Tax Exempt Bonds	false	InvestTaxExemptBonds
Escrow Account	false	EscrowAccount
On Behalf Of Issuer	false	OnBehalfOfIssuer
Excess Benefit Transaction	false	ExcessBenefitTransaction
Prior Excess Benefit Transaction	false	PriorExcessBenefitTransaction
Loan To Officer Or DQP	false	LoanToOfficerOrDQP
Grant To Related Person	false	GrantToRelatedPerson
Bsnss Rltnshp With Organization	false	BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member	false	BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp	false	OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions	false	DeductibleNonCashContributions
Deductible Contributions Of Art	false	DeductibleContributionsOfArt
Terminated	false	Terminated
Partial Liquidation	false	PartialLiquidation
Disregarded Entity	false	DisregardedEntity
Related Entity	false	RelatedEntity
Related Org Controlled Entity	false	RelatedOrgControlledEntity
Transaction Related Entity	false	TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org	false	TransfersToExemptNonChrtblOrg
Activities Conducted Partnership	false	ActivitiesConductedPartnership
Schedule O Required	true	ScheduleORequired
Number Forms Transmitted With1096	0	NumberFormsTransmittedWith1096
Number W2 G Included	0	NumberW2GIncluded
Compliance With Backup Witholding	false	ComplianceWithBackupWitholding
Number Of Employees	0	NumberOfEmployees
Employment Tax Returns Filed	false	EmploymentTaxReturnsFiled
Unrelated Business Income	false	UnrelatedBusinessIncome
Form990-T Filed	false	Form990-TFiled
Foreign Financial Account	false	ForeignFinancialAccount
Prohibited Tax Shelter Trans	false	ProhibitedTaxShelterTrans
Taxable Party Notification	false	TaxablePartyNotification
Non Deductible Contributions	false	NonDeductibleContributions
Quid Pro Quo Contributions	false	QuidProQuoContributions
Form8282 Property Disposed Of	false	Form8282PropertyDisposedOf
Number Of8282 Filed	0	NumberOf8282Filed
Funds To Pay Premiums	false	FundsToPayPremiums
Premiums Paid	false	PremiumsPaid
Form8899 Filed	false	Form8899Filed
Form1098 C Filed	false	Form1098CFiled
Excess Business Holdings	false	ExcessBusinessHoldings
Taxable Distributions	false	TaxableDistributions
Distribution To Donor	false	DistributionToDonor
Filed Lieu1041	false	FiledLieu1041
Licensed More Than One State	false	LicensedMoreThanOneState
Indoor Tanning Services	false	IndoorTanningServices
Info In Schedule O Part VI	X	InfoInScheduleOPartVI
Nbr Voting Governing Body Members	14	NbrVotingGoverningBodyMembers
Number Independent Voting Members	0	NumberIndependentVotingMembers
Family Or Business Relationship	false	FamilyOrBusinessRelationship
Delegation Of Management Duties	false	DelegationOfManagementDuties
Changes To Organizing Docs	false	ChangesToOrganizingDocs
Material Diversion Or Misuse	false	MaterialDiversionOrMisuse
Members Or Stockholders	false	MembersOrStockholders
Election Of Board Members	false	ElectionOfBoardMembers
Decisions Subject To Approval	false	DecisionsSubjectToApproval
Minutes Of Governing Body	true	MinutesOfGoverningBody
Minutes Of Committees	true	MinutesOfCommittees
Officer Mailing Address	false	OfficerMailingAddress
Local Chapters	false	LocalChapters
Form990 Provided To Governing Body	true	Form990ProvidedToGoverningBody
Conflict Of Interest Policy	false	ConflictOfInterestPolicy
Annual Disclosure Covered Persons	false	AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement	false	RegularMonitoringEnforcement
Whistleblower Policy	false	WhistleblowerPolicy
Document Retention Policy	false	DocumentRetentionPolicy
Compensation Process CEO	false	CompensationProcessCEO
Compensation Process Other	false	CompensationProcessOther
Investment In Joint Venture	false	InvestmentInJointVenture
Upon Request	X	UponRequest

The Books Are In Care Of TheBooksAreInCareOf

Field	Value	IRS element (for citing)
Name Person	LARRY WHITELEY	NamePerson
Telephone Number	7754239202	TelephoneNumber

Address US AddressUS

Field	Value	IRS element (for citing)
Address Line1	1491 LATTIN ROAD	AddressLine1
City	FALLON	City
State	NV	State
ZIP Code	89406	ZIPCode

Field	Value	IRS element (for citing)
No Listed Persons Compensated	X	NoListedPersonsCompensated

Form990 Part VII Section A Form990PartVIISectionA (14 entries)

TitleTitle	Average Hours Per WeekAverageHoursPerWeek	Average Hours Per Week RelatedAverageHoursPerWeekRelated	Individual Trustee Or DirectorIndividualTrusteeOrDirector	Reportable Comp From OrganizationReportableCompFromOrganization	Reportable Comp From Related OrgsReportableCompFromRelatedOrgs	Other CompensationOtherCompensation	OfficerOfficer
DAHN GRAHAM
THRIFT SHOP MGR	15.00	0.00	X	0	0	0
SALLY QUIGLEY
SPECIAL PROJECT	10.00	0.00	X	0	0	0
MAE HADEN
MEMBERSHIP	15.00	0.00	X	0	0	0
WERNER VINSON
HOSP VOLUNTEER	15.00	0.00	X	0	0	0
DIANA EDGMON
PAST PRESIDENT	10.00	0.00	X	0	0	0
TONI WEST-GUILLEN
HOSP LIAISON	10.00	0.00	X	0	0	0
SALLY BELL
LIFELINE CHAIRM	15.00	0.00	X	0	0	0
MONICA LAWRENCE
HOSP LIAISN	10.00	0.00	X	0	0	0
DIANE HOGAN
GIFT SHOP MGR	15.00	0.00	X	0	0	0
MARIE BODIN
FUND RAISING	15.00	0.00	X	0	0	0
DONA EVEATT
President	15.00	0.00		0	0	0	X
LINDA MILLER
Vice President	15.00	0.00		0	0	0	X
MARY EPPLEY
Secretary	15.00	0.00		0	0	0	X
LARRY WHITELEY
Treasurer	15.00	0.00		0	0	0	X

Field	Value	IRS element (for citing)
Number Individuals GT100 K	0	NumberIndividualsGT100K
Formers Listed	false	FormersListed
Total Comp GT150 K	false	TotalCompGT150K
Compensation From Other Sources	false	CompensationFromOtherSources
Number Of Contractors GT100 K	0	NumberOfContractorsGT100K
Membership Dues	870	MembershipDues
Total Contributions	870	TotalContributions

Program Service Revenue ProgramServiceRevenue

Field	Value	IRS element (for citing)
Description	LIFELINE MACHINE	Description
Business Code	621610	BusinessCode
Total Revenue Column	32824	TotalRevenueColumn
Related Or Exempt Function Income	32824	RelatedOrExemptFunctionIncome

Field	Value	IRS element (for citing)
Total Program Service Revenue	32824	TotalProgramServiceRevenue

Investment Income InvestmentIncome

Field	Value	IRS element (for citing)
Total Revenue Column	109	TotalRevenueColumn
Exclusion	$109	ExclusionAmount

Income From Invest Bond Proceeds IncomeFromInvestBondProceeds

Field	Value	IRS element (for citing)
Total Revenue Column	0	TotalRevenueColumn

Royalties Revenue RoyaltiesRevenue

Field	Value	IRS element (for citing)
Total Revenue Column	0	TotalRevenueColumn

Gross Rents GrossRents

Field	Value	IRS element (for citing)
Real	1500	Real

Less Rental Expenses LessRentalExpenses

Field	Value	IRS element (for citing)
Real	150	Real

Rental Income Or Loss RentalIncomeOrLoss

Field	Value	IRS element (for citing)
Real	1350	Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

Field	Value	IRS element (for citing)
Total Revenue Column	1350	TotalRevenueColumn
Related Or Exempt Function Income	1350	RelatedOrExemptFunctionIncome

Net Gain Or Loss Investments NetGainOrLossInvestments

Field	Value	IRS element (for citing)
Total Revenue Column	0	TotalRevenueColumn

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

Field	Value	IRS element (for citing)
Total Revenue Column	0	TotalRevenueColumn

Net Income From Gaming NetIncomeFromGaming

Field	Value	IRS element (for citing)
Total Revenue Column	0	TotalRevenueColumn

Field	Value	IRS element (for citing)
Gross Sales Of Inventory	210716	GrossSalesOfInventory
Cost Of Goods Sold	22915	CostOfGoodsSold

Net Income Or Loss NetIncomeOrLoss

Field	Value	IRS element (for citing)
Total Revenue Column	187801	TotalRevenueColumn
Related Or Exempt Function Income	187801	RelatedOrExemptFunctionIncome

Field	Value	IRS element (for citing)
Total Other Revenue	0	TotalOtherRevenue

Total Revenue TotalRevenue

Field	Value	IRS element (for citing)
Total Revenue Column	222954	TotalRevenueColumn
Related Or Exempt Function Income	221975	RelatedOrExemptFunctionIncome
Exclusion	$109	ExclusionAmount

Field	Value	IRS element (for citing)
Info In Schedule O Part IX	X	InfoInScheduleOPartIX

Grants To Domestic Orgs GrantsToDomesticOrgs

Field	Value	IRS element (for citing)
Total	57432	Total
Program Services	57432	ProgramServices

Grants To Domestic Individuals GrantsToDomesticIndividuals

Field	Value	IRS element (for citing)
Total	12247	Total
Program Services	12247	ProgramServices

Foreign Grants ForeignGrants

Field	Value	IRS element (for citing)
Total	0	Total

Benefits To Members BenefitsToMembers

Field	Value	IRS element (for citing)
Total	0	Total

Comp Current Officers Directors CompCurrentOfficersDirectors

Field	Value	IRS element (for citing)
Total	0	Total

Comp Disqual Persons CompDisqualPersons

Field	Value	IRS element (for citing)
Total	0	Total

Other Salaries And Wages OtherSalariesAndWages

Field	Value	IRS element (for citing)
Total	0	Total

Pension Plan Contributions PensionPlanContributions

Field	Value	IRS element (for citing)
Total	0	Total

Other Employee Benefits OtherEmployeeBenefits

Field	Value	IRS element (for citing)
Total	0	Total

Payroll Taxes PayrollTaxes

Field	Value	IRS element (for citing)
Total	0	Total

Fees For Services Management FeesForServicesManagement

Field	Value	IRS element (for citing)
Total	0	Total

Fees For Services Legal FeesForServicesLegal

Field	Value	IRS element (for citing)
Total	0	Total

Fees For Services Accounting FeesForServicesAccounting

Field	Value	IRS element (for citing)
Total	585	Total
Management And General	585	ManagementAndGeneral

Fees For Services Lobbying FeesForServicesLobbying

Field	Value	IRS element (for citing)
Total	0	Total

Fees For Services Prof Fundraising FeesForServicesProfFundraising

Field	Value	IRS element (for citing)
Total	0	Total

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

Field	Value	IRS element (for citing)
Total	0	Total

Fees For Services Other FeesForServicesOther

Field	Value	IRS element (for citing)
Total	34052	Total
Management And General	34052	ManagementAndGeneral

Advertising Advertising

Field	Value	IRS element (for citing)
Total	1319	Total
Management And General	1319	ManagementAndGeneral

Office Expenses OfficeExpenses

Field	Value	IRS element (for citing)
Total	3723	Total
Management And General	3723	ManagementAndGeneral

Information Technology InformationTechnology

Field	Value	IRS element (for citing)
Total	0	Total

Royalties Royalties

Field	Value	IRS element (for citing)
Total	0	Total

Occupancy Occupancy

Field	Value	IRS element (for citing)
Total	14644	Total
Management And General	14644	ManagementAndGeneral

Travel Travel

Field	Value	IRS element (for citing)
Total	1980	Total
Management And General	1980	ManagementAndGeneral

Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials

Field	Value	IRS element (for citing)
Total	0	Total

Conferences Meetings ConferencesMeetings

Field	Value	IRS element (for citing)
Total	14224	Total
Management And General	14224	ManagementAndGeneral

Interest Interest

Field	Value	IRS element (for citing)
Total	0	Total

Payments To Affiliates PaymentsToAffiliates

Field	Value	IRS element (for citing)
Total	0	Total

Depreciation Depletion DepreciationDepletion

Field	Value	IRS element (for citing)
Total	6305	Total
Management And General	6305	ManagementAndGeneral

Insurance Insurance

Field	Value	IRS element (for citing)
Total	1985	Total
Management And General	1985	ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescription	TotalTotal	Management And GeneralManagementAndGeneral	Program ServicesProgramServices
REPAIRS & MAINTENANCE	1765	1765
LIFELINE LEASING	2478	2478
SUPPLIES	7133	7133
LIFELINE MONITORING	26550		26550

All Other Expenses AllOtherExpenses

Field	Value	IRS element (for citing)
Total	7152	Total
Management And General	7152	ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

Field	Value	IRS element (for citing)
Total	193574	Total
Program Services	96229	ProgramServices
Management And General	97345	ManagementAndGeneral
Fundraising	0	Fundraising

Cash Non Interest Bearing CashNonInterestBearing

Field	Value	IRS element (for citing)
BOY	500	BOY
EOY	192518	EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

Field	Value	IRS element (for citing)
BOY	190215	BOY
EOY	30046	EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

Field	Value	IRS element (for citing)
EOY	0	EOY

Accounts Receivable AccountsReceivable

Field	Value	IRS element (for citing)
EOY	0	EOY

Receivables From Officers Etc ReceivablesFromOfficersEtc

Field	Value	IRS element (for citing)
EOY	0	EOY

Receivables From Disqual Persons ReceivablesFromDisqualPersons

Field	Value	IRS element (for citing)
EOY	0	EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

Field	Value	IRS element (for citing)
EOY	0	EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

Field	Value	IRS element (for citing)
BOY	10383	BOY
EOY	7951	EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

Field	Value	IRS element (for citing)
EOY	57	EOY

Field	Value	IRS element (for citing)
Land Buildings Equipment Basis	76513	LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec	19155	LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

Field	Value	IRS element (for citing)
BOY	57452	BOY
EOY	57358	EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

Field	Value	IRS element (for citing)
EOY	0	EOY

Investments Other Securities InvestmentsOtherSecurities

Field	Value	IRS element (for citing)
EOY	0	EOY

Investments Program Related InvestmentsProgramRelated

Field	Value	IRS element (for citing)
EOY	0	EOY

Intangible Assets IntangibleAssets

Field	Value	IRS element (for citing)
EOY	0	EOY

Other Assets Total OtherAssetsTotal

Field	Value	IRS element (for citing)
EOY	0	EOY

Total Assets TotalAssets

Field	Value	IRS element (for citing)
BOY	258550	BOY
EOY	287930	EOY

Total Liabilities TotalLiabilities

Field	Value	IRS element (for citing)
BOY	0	BOY
EOY	0	EOY

Field	Value	IRS element (for citing)
Do Not Follow SFAS117	X	DoNotFollowSFAS117

Retained Earnings Endowment Etc RetainedEarningsEndowmentEtc

Field	Value	IRS element (for citing)
BOY	258550	BOY
EOY	287930	EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

Field	Value	IRS element (for citing)
BOY	258550	BOY
EOY	287930	EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

Field	Value	IRS element (for citing)
BOY	258550	BOY
EOY	287930	EOY

Field	Value	IRS element (for citing)
Reconcilation Revenue Expenses	29380	ReconcilationRevenueExpenses
Method Of Accounting Cash	X	MethodOfAccountingCash
Accountant Compile Or Review	false	AccountantCompileOrReview
FS Audited	false	FSAudited
Federal Grant Audit Required	false	FederalGrantAuditRequired

Schedule A IRS990ScheduleA

Field	Value	IRS element (for citing)
Supporting Organization509a3	X	SupportingOrganization509a3
Supporting Org509a3 Type3 Non Func	X	SupportingOrg509a3Type3NonFunc
Contrib By Controlling Individual	false	ContribByControllingIndividual
Contribution By Related Party	false	ContributionByRelatedParty
Contrib By35 Controlled Entity	false	ContribBy35ControlledEntity

Supported Org Information SupportedOrgInformation

Name Name

Field	Value	IRS element (for citing)
Business Name Line1	BANNER CHURCHILL COMUNITY HOSPITAL	BusinessNameLine1

Field	Value	IRS element (for citing)
EIN	450233470	EIN
Type Of Organization	7	TypeOfOrganization
Listed In Governing Doc	false	ListedInGoverningDoc
Supported Organization Notified	true	SupportedOrganizationNotified
Organized In US	true	OrganizedInUS
Amount	$52,132	Amount

Field	Value	IRS element (for citing)
Total Number Of Supported Orgs	1	TotalNumberOfSupportedOrgs
Sum Of Amounts	52132	SumOfAmounts

Schedule D IRS990ScheduleD

Leasehold Improvements LeaseholdImprovements

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	53729	OtherCostOrOtherBasis
Depreciation	11334	Depreciation
Book Value	42395	BookValue

Equipment Equipment

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	9433	OtherCostOrOtherBasis
Depreciation	1556	Depreciation
Book Value	7877	BookValue

Other Land Buildings OtherLandBuildings

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	13351	OtherCostOrOtherBasis
Depreciation	6265	Depreciation
Book Value	7086	BookValue

Field	Value	IRS element (for citing)
Total Of Book Value Land Buildings	57358	TotalOfBookValueLandBuildings

Schedule I IRS990ScheduleI

Field	Value	IRS element (for citing)
Records Maintained	false	RecordsMaintained

Recipient Table RecipientTable

Recipient Name Business RecipientNameBusiness

Field	Value	IRS element (for citing)
Business Name Line1	BANNER CHURCHILL HOSPITIAL	BusinessNameLine1

Address US AddressUS

Field	Value	IRS element (for citing)
Address Line1	801 E WILLIAMS AVE	AddressLine1
City	FALLON	City
State	NV	State
ZIP Code	89406	ZIPCode

Field	Value	IRS element (for citing)
EIN Of Recipient	450233470	EINOfRecipient
Amount Of Cash Grant	52132	AmountOfCashGrant
Amount Of Non Cash Assistance	0	AmountOfNonCashAssistance
Purpose Of Grant	PURCHASE EQUIPMENT FOR THE HOSPITAL	PurposeOfGrant

Field	Value	IRS element (for citing)
Total Nbr Of501 C3 And Govt Grants	1	TotalNbrOf501C3AndGovtGrants
Total Nbr Of Other Organizations	0	TotalNbrOfOtherOrganizations

Form990 Schedule I Part III Form990ScheduleIPartIII

Field	Value	IRS element (for citing)
Type Of Grant	AWARD SCHOLARSHIPS TO INDIVIDUALS AND ASSIST PATIENTS	TypeOfGrant
Number Of Recipients	2	NumberOfRecipients
Amount Of Cash Grant	2000	AmountOfCashGrant

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (3 entries)

IdentifierIdentifier	Return ReferenceReturnReference	ExplanationExplanation
Form 990, Part VI, Line 19	Form 990, Part VI, Line 19: Other Organization Documents Publicly Available	FORM 990, PART VI, SECTION C, LINE 19: THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST.
Form 990, Part VI, Line 11b	Form 990, Part VI, Line 11b: Form 990 Review Process	FORM 990, PART VI, SECTION B, LINE 11: THE ORGANIZATION'S FORM 990 IS REVIEWED AND APPROVED AT AN EXECUTIVE BOARD MEETING.
Form 990, Part III, Line 4d	Form 990, Part III, Line 4d: Other Program Services Description	OTHER PROGRAM SERVICES 4: ASSISTANCE TO PATIENTS $2,690GRANTS/DONATIONS TO OTHER CHARITABLE ORGANIZATIONS $ 12,857