2012-11-09T11:58:56-06:00 2012-06-30 476097913 SEIM JOHNSON LLP 18081 BURT STREET SUITE 200 OMAHA NE 680224722 990 2011-07-01 237162972 COMBINED HEALTH AGENCIES DRIVE COMMUNITY HEALTH CHARITIES NEBRASKA COMB 4026148500 212 SOUTH 74TH STREET NO 205 OMAHA NE 68114 MICHELLE GROSSMAN 4026148500 2012-11-07 1 JULIE M GERKEN P00400882 4023302660 2011 2016-02-24 21:20:13Z MICHELLE GROSSMAN 212 SOUTH 74TH STREET NO 205 OMAHA NE 68114 2747641 0 3071 X WWW.CHCNE.ORG X 1971 NE IMPROVING LIVES BY RAISING FUNDS FOR NEBRASKA'S HEALTH CHARITIES 48 48 9 0 0 0 2533334 2732783 18354 14855 6106 3 0 0 2557794 2747641 2034095 2228555 0 0 369817 365381 0 0 46966 140711 142877 2544623 2736813 13171 10828 1866384 1888894 1573025 1581195 293359 307699 IMPROVING LIVES BY RAISING FUNDS FOR NEBRASKA'S HEALTH CHARITIES 0 0 2590616 2228555 14855 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 AGENCIES THROUGH PAYROLL DEDUCTION. 2590616 1 1 0 0 0 0 0 0 0 1 1 0 0 0 1 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 0 1 2 0 1 9 1 0 0 0 0 0 1 1 0 0 0 0 X 48 48 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 0 0 X X X WENDY OHL 4026148500 212 S 74TH STREET OMAHA NE 68114 ROB REED JR 1.00 X X 0 0 0 LEONARD SOMMER 1.00 X X 0 0 0 PATRICK MCPHERSON 1.00 X X 0 0 0 JOSIE ABBOUD 1.00 X 0 0 0 JOANN ABT 1.00 X 0 0 0 ANN ANDERSON BERRY 1.00 X 0 0 0 VICKI ANZALONE 1.00 X 0 0 0 GAVIN ATKINSON 1.00 X 0 0 0 MARTIN BEERMAN 1.00 X 0 0 0 PATRICK BOOTH 1.00 X 0 0 0 SHARON BRODKEY 1.00 X 0 0 0 TRACY CARTWRIGHT 1.00 X 0 0 0 MARTIE CORDARO 1.00 X 0 0 0 LIZ CROSSON 1.00 X 0 0 0 MICHAEL DEMMAN 1.00 X 0 0 0 EDWARD EASTERLIN 1.00 X 0 0 0 DAVID GILINSKY 1.00 X 0 0 0 ROBERT GIRTHOFFER 1.00 X 0 0 0 LARRY GUENTHER 1.00 X 0 0 0 KERRY HEINRICH 1.00 X 0 0 0 LANCE JONES 1.00 X 0 0 0 STANLEY KATHOL 1.00 X 0 0 0 CARRIE KEENE 1.00 X 0 0 0 KIRK KELLNER 1.00 X 0 0 0 CINDY KEY 1.00 X 0 0 0 JIM LANDEN 1.00 X 0 0 0 TERESA LAYTON 1.00 X 0 0 0 THOMAS MACY 1.00 X 0 0 0 LORI MCCLURG 1.00 X 0 0 0 DEENIE MEYERSON 1.00 X 0 0 0 ANGELA MILLER 1.00 X 0 0 0 SCOTT MINER 1.00 X 0 0 0 CLARENCE NICHOLS 1.00 X 0 0 0 SHANE OSBORN 1.00 X 0 0 0 MARK OSTRONIC 1.00 X 0 0 0 STEVE PATTERSON 1.00 X 0 0 0 STEPHEN PETERS 1.00 X 0 0 0 BRIAN PICKERING 1.00 X 0 0 0 AMBER PRESTON 1.00 X 0 0 0 DAVID PROUGH 1.00 X 0 0 0 TADD PULLIN 1.00 X 0 0 0 DIANE RANDOLPH 1.00 X 0 0 0 ANDREW ROUILLARD 1.00 X 0 0 0 CRAIG SALL 1.00 X 0 0 0 LOREN STEENSON 1.00 X 0 0 0 TARA STINGLEY 1.00 X 0 0 0 FRANKLIN THOMPSON 1.00 X 0 0 0 DR JODY WOODWORTH 1.00 X 0 0 0 MICHELLE GROSSMAN 40.00 X 78895 0 9699 WENDY OHL 40.00 X 44634 0 2749 123529 0 12448 0 0 0 0 0 1499434 1233349 2732783 ADMINISTRATIVE FEES 900099 14144 14144 LEADERSHIP 25 INCOME 900099 711 711 14855 3 3 2747641 14855 0 3 2228555 2228555 135978 67989 61190 6799 191031 153543 16367 21121 8763 7137 638 988 6420 5551 81 788 23189 15773 5409 2007 12973 10379 1297 1297 7211 5048 1442 721 34500 27001 4050 3449 26044 20836 2604 2604 9036 6777 452 1807 4441 4270 38 133 4089 3271 409 409 3573 2859 357 357 AFFILIATION FEES 35889 28711 3589 3589 MISCELLANEOUS 2183 942 826 415 PUBLIC SECTOR FEES 1683 1347 168 168 MEMBERSHIP DUES 1255 627 314 314 2736813 2590616 99231 46966 145 145 276675 245138 1216000 1255147 2370 4824 38943 27741 12603 11202 328085 341221 30506 31217 1866384 1888894 11772 5270 1561253 1575925 1573025 1581195 X -422809 -402284 379607 364451 336561 345532 293359 307699 1866384 1888894 X 10828 3512 X X 0 1 1 X 0 X 2280698 2460234 2483443 2533334 2732783 12490492 2280698 2460234 2483443 2533334 2732783 12490492 1460776 11029716 22182 9908 4509 6106 3 42708 998 745 16297 18354 14855 51249 12584449 0.87650 0.90610 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 365870 8260 4225 378355 309525 6600 49745 365870 281946 8646 18933 309525 339458 8915 -66427 281946 0.91320 0.08680 0 0 36812 26007 10805 2131 1734 397 11202 PAYABLE TO AGENCIES - DESIGNATED 1091284 PAYABLE TO AGENCIES - UNDESIGNATED 484641 1575925 2747641 2736813 10828 3512 3512 14340 889854 3512 3512 886342 1861299 1861299 2747641 875514 0 875514 1861299 1861299 2736813 DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: CHC HOLDS ENDOWMENT FUNDS FOR SUPPORT OF ITS PROGRAMS AND OPERATIONS. DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: COMBINED HEALTH AGENCIES DRIVE, INC. DBA COMMUNITY HEALTH CHARITIES OF NEBRASKA'S (CHC) 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. CHC ACCOUNTS FOR UNCERTAINTIES IN ACCOUNTING FOR INCOME TAX ASSETS AND LIABILITIES USING GUIDANCE INCLUDED IN FASB ASC 740, INCOME TAXES. CHC RECOGNIZES THE EFFECT OF INCOME TAX POSITIONS ONLY IF THOSE POSITIONS ARE MORE LIKELY THAN NOT OF BEING SUSTAINED. AT JUNE 30, 2012 AND 2011, 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 2009. PART XII, LINE 4B - OTHER ADJUSTMENTS: FAS 136 ADJUSTMENT 1,861,299. PART XIII, LINE 4B - OTHER ADJUSTMENTS: FAS 136 ADJUSTMENT 1,861,299. 1 ALZHEIMER'S ASSOCIATION GREAT PLAINS 5601 S 27TH ST STE 201 LINCOLN NE 68512 480931989 501(C)(3) 93556 GENERAL ALZHEIMER'S ASSOCIATION MIDLANDS CHAPTER CENTER MALL 1941 S 42ND ST STE 205 OMAHA NE 68105 470648438 501(C)(3) 94964 GENERAL AMERICAN CANCER SOCIETY 1100 PENNSYLVANIA AVENUE KANSAS CITY MO 64105 131788491 501(C)(3) 16687 GENERAL AMERICAN DIABETES ASSN OF NE 14216 DAYTON CIR STE 6 OMAHA NE 68137 131623888 501(C)(3) 82193 GENERAL AMERICAN LUNG ASSN OF THE CENTRAL STATES 8900 W DODGE RD STE 226 OMAHA NE 68114 430662525 501(C)(3) 40899 GENERAL ARTHRITIS FOUNDATION NEBRASKA CHAPTER 600 N 93RD ST STE 206 OMAHA NE 68114 470483544 501(C)(3) 42150 GENERAL BLAIR AREA COMMUNITY FOUNDATION 1646 WASHINGTON ST BLAIR NE 68008 470825771 501(C)(3) 240317 GENERAL CROHN'S & COLITIS FOUNDATION OF NEBRASKA 1941 S 42ND ST STE 543 OMAHA NE 68105 136193105 501(C)(3) 27409 GENERAL CYSTIC FIBROSIS FOUNDATION NE CHAPTER 11917 PIERCE PLAZA OMAHA NE 68144 131930701 501(C)(3) 49597 GENERAL JUVENILE DIABETES RESEARCH FOUNDATION 9202 WEST DODGE RD STE 304 OMAHA NE 68114 231907729 501(C)(3) 229350 GENERAL MARCH OF DIMES NEBRASKA CHAPTER 11840 NICHOLAS ST STE 220 OMAHA NE 68154 131846366 501(C)(3) 87631 GENERAL MUSCULAR DYSTROPHY ASSOCIATION 4654 S 132ND ST OMAHA NE 68137 131665552 501(C)(3) 28575 GENERAL NATIONAL MULTIPLE SCLEROSIS SOCIETY NE CHAPTER 328 S 72ND ST OMAHA NE 68114 470439079 501(C)(3) 99232 GENERAL NEBRASKA AIDS PROJECT 139 S 40TH ST OMAHA NE 68131 470786622 501(C)(3) 70149 GENERAL NEBRASKA HOSPICE & PALLIATIVE CARE PARTNERSHIP 3900 NW 12TH ST STE 100 LINCOLN NE 68521 470673727 501(C)(3) 36888 GENERAL NEBRASKA KIDNEY ASSOCIATION INC 11725 ARBOR ST STE 210 OMAHA NE 68114 237225449 501(C)(3) 43021 GENERAL OMAHA CHRISTIAN ACADEMY 5612 L ST OMAHA NE 68117 470708320 501(C)(3) 18424 GENERAL OPEN DOOR MISSION 2828 NORTH 23RD STREET EAST OMAHA NE 68110 470411375 501(C)(3) 24608 GENERAL PREVENT BLINDNESS NEBRASKA 6818 GROVER ST STE 102 OMAHA NE 68106 470539539 501(C)(3) 21333 GENERAL ST JUDE'S CHILDREN'S HOSPITAL 1830 CRAIG PARK DR STE 105 ST LOUIS MO 63146 351044585 501(C)(3) 25779 GENERAL SUSAN G KOMEN FOR THE CURE NEBRASKA 8610 BRENTWOOD DRIVE 3 LAVISTA NE 68128 260056671 501(C)(3) 131060 GENERAL THE ALS ASSN KEITH WORTHINGTON CHAPTER 10730 PACIFIC ST STE 228 OMAHA NE 68114 481021611 501(C)(3) 51663 GENERAL THE LEUKEMIA & LYMPHOMA SOCIETY 10832 OLD MILL ROAD STE 2 OMAHA NE 68154 135644916 501(C)(3) 122630 GENERAL UNITED CEREBRAL PALSY OF NEBRASKA 920 S 107TH ST STE 302 OMAHA NE 68114 470534212 501(C)(3) 29849 GENERAL MAKE A WISH FOUNDATION 11926 ARBOR ST STE 102 OMAHA NE 68144 470671096 501(C)(3) 14208 GENERAL UNITED WAY OF THE MIDLANDS 1805 HARNEY ST OMAHA NE 68102 470376605 501(C)(3) 5045 GENERAL NEBRASKA HUMANE SOCIETY 8929 FORT STREET OMAHA NE 68134 473078997 501(C)(3) 6881 GENERAL ZION LUTHERAN CHURCH SCHOLARSHIP FUND 14205 IDA STREET OMAHA NE 68142 470529151 501(C)(3) 9000 GENERAL EDUCATIONAL CONCERNS FOR HUNGER ORGANIZATIONS 17391 DURRANCE ROAD NORTH FORT MYERS FL 33917 237275283 501(C)(3) 5040 GENERAL GOD OF WONDER 1386 S 1ST ST PO BOX 786 HAMILTON MT 59840 260586277 501(C)(3) 5040 GENERAL HAITIAN AMERICAN FRIENDSHIP FOUNDATION PO BOX 3421 FORT MYERS FL 33918 953248186 501(C)(3) 5040 GENERAL IMPACTLIVES INC 6985 OXFORD STREET ST LOUIS PARK MN 55426 830487437 501(C)(3) 6120 GENERAL LITTLE VIKES ATHLETIC ASSOCIATION AUXILLARY 2582 REDICK AVENUE OMAHA NE 68112 470594972 501(C)(3) 6768 GENERAL PROJECT HARMONY 11949 Q STREET OMAHA NE 68137 470789054 501(C)(3) 6093 GENERAL SUSAN G KOMEN FOR THE CURE 5005 LBJ FREEWAY STE 250 DALLAS TX 75244 751835298 501(C)(3) 7945 GENERAL 35 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, 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: 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 AGENCY IS 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-FEDERAL CAMPAIGNS. UNDESIGNATED FUNDS ARE DISTRIBUTED FROM AVAILABLE COLLECTED RECEIVABLES ON THE LAST DAY OF EACH CALENDAR QUARTER (SEPTEMBER, DECEMBER, MARCH AND JUNE) THE AGENCIES ARE ALL 501(C)(3) ORGANIZATIONS ORGANIZED IN THE UNITED STATES. FORM 990, PART VI, SECTION B, LINE 11 A COPY OF THE 990 TAX RETURN WILL BE E-MAILED TO EACH BOARD MEMBER AND THERE WILL BE AN OPPORTUNITY TO ASK QUESTIONS AT THE NEXT BOARD MEETING FOLLOWING THE DISBURSEMENT OF THE DOCUMENT. FORM 990, PART VI, SECTION B, LINE 12C THE CONFLICT OF INTEREST POLICY IS RENEWED EACH YEAR AND BOARD MEMBERS 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. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED GAINS ON INVESTMENTS: 3,512. 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 ASSUME 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.