2012-03-30T12:07:11-05:00 2011-06-30 DANA F COLE & COMPANY LLP 1248 O STREET SUITE 500 LINCOLN NE 68508 990 2010-07-01 470548478 Family Health Services Inc FAMI 4023352988 PO Box 279 Tecumseh NE 684500279 SHARON RICKMAN 4023352988 2012-03-26 1 KENT M KLUTE 4024799300 2010 2016-02-24 21:20:13Z Sharon Rickman PO Box 279 Tecumseh NE 684500279 702341 0 X www.fhsi.org X 1973 NE The Organization's purpose is to provide family planning information and services and to administer services uder the supplemental food program for women, infants and children in a nine county area in southeast Nebraska; to receive, hold and disburse funds and administer such funds exclusively for educational and charitable purposes without penuniary gain or profit, incindental or otherwise to its directors. 9 9 25 25 0 0 901906 625607 41742 49875 3975 1782 5469 25077 953092 702341 0 0 0 0 489640 565851 0 0 0 275039 273352 764679 839203 188413 -136862 512753 362850 70998 57957 441755 304893 X The Organization's purpose is to provide family planning information and services and to administer services uder the supplemental food program for women, infants and children in a nine county area in southeast Nebraska; to receive, hold and disburse funds and administer such funds exclusively for educational and charitable purposes without penuniary gain or profit, incindental or otherwise to its directors. 0 0 362779 Supplemental food program for women, infants and children. Grant administration and services ina nine county area in Southeast Nebraska. 431318 49875 Family planning services in a nine county area in Southeast Nebraska. 794097 1 0 0 0 0 0 0 0 0 1 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 0 0 0 0 0 0 0 0 0 0 0 0 1 7 0 1 25 1 0 0 0 0 0 0 0 0 X 9 9 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 0 0 X Jean Brinkman 4023352988 PO Box 279 Tecumseh NE 684500279 Mike Wendt 1.00 X X 0 0 0 Laurence Falk 1.00 X X 0 0 0 Janelle Moran 1.00 X X 0 0 0 Stephanie Clark 1.00 X 0 0 0 Ted Harshbarger 1.00 X 0 0 0 Rochelle Collins 1.00 X 0 0 0 Paula Darling 1.00 X 0 0 0 Vinny Bittinger 1.00 X 0 0 0 Shirley Terry 1.00 X 0 0 0 Sharon Rickman 40.00 X 61639 0 0 Jean Brinkman 40.00 X 53174 0 0 114813 0 0 0 0 0 0 0 616405 9202 625607 Patient Fees 621300 28572 28572 Private isurance reimb 621300 18783 18783 Medicaid reimbursement 621300 2520 2520 49875 1782 1782 Miscellaneous 900099 25077 25077 25077 702341 49875 0 26859 114813 103332 11481 378303 351951 26352 31459 28314 3145 41276 37148 4128 5500 5500 910 910 26539 26539 40388 40388 58631 58631 27582 27582 30413 30413 13839 13839 Contraceptives and phar 20224 20224 Patient care and lab fe 19631 19631 Telephone 12927 12927 Miscellaneous 6506 6506 Staff development 5202 5202 5060 5060 839203 794097 45106 0 288137 130794 56486 56911 62545 73040 7015 3292 17750 18637 17463 8890 248855 177634 63304 71221 53 65 512753 362850 70998 57957 70998 57957 X 441755 304893 441755 304893 512753 362850 -136862 0 X 0 1 1 X 1 1 X 400283 441228 671567 901906 625607 3040591 400283 441228 671567 901906 625607 3040591 3040591 2984 3976 3977 3975 1782 16694 11 2617 4043 5469 25077 37217 3094502 252822 0.98260 0.95930 X 248855 177634 71221 71221 702341 839203 -136862 0 -136862 708418 6077 6077 702341 0 702341 845280 6077 6077 839203 0 839203 Form 990, Part VI, Section B, line 11 The 990 is reviewed by the board before filing Form 990, Part VI, Section B, line 12c The conflict of interest policy is monitored by the board. Form 990, Part VI, Section B, line 15a The compensation of the Executive Director is set by the board annually after review of the director's performance. Form 990, Part VI, Section C, line 19 The governing documents and financial statements are available upon request. This return is being filed between March 1, 2012, and March 30, 2012, as directed by the IRS in Notice 2012-4, because electronic filing was not available January 1, 2012 through February 29, 2012. We request that penalties be waived because it would be inequitable to impose a penalty on us due to the unusual circumstances requiring us to delay the filing of this return.