2024-05-14T14:03:43-05:00 2023-06-30 450250958 EIDE BAILLY LLP 18081 BURT ST STE 200 OMAHA NE 680224722 990 2022-07-01 261778815 FILLMORE COUNTY HOSPITAL FOUNDATION FILL 4027593167 1900 F STREET GENEVA NE 68361 JIM DONOVAN PRESIDENT 4027593167 2024-05-14 1 JIM DONOVAN 999009999 1 WENDY R COOLEY CPA P01523804 4023302660 2024-05-14 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z JIM DONOVAN 1900 F STREET GENEVA NE 68361 1239243 0 X WWW.MYFCH.ORG/FOUNDATION X 2008 NE SEE SCHEDULE O.THE PURPOSE OF THE FOUNDATION SHALL BE TO SUPPORT FILLMORE COUNTY HOSPITAL OF GENEVA, NEBRASKA IN ITS ENDEAVORS OF NEW TECHNOLOGIES, RECRUITMENT, EXPANSION, CONTINUING EDUCATION, MARKETING, PURCHASING OF SUPPLIES AND EQUIPMENT, AND PROVIDING SUPPORT AND HELP FOR THE CITIZENS OF FILLMORE COUNTY AND SURROUNDING AREAS IN THEIR PHYSICAL AND MENTAL HEALTH NEEDS. 11 11 0 15 0 0 1034073 1169197 0 0 42017 60988 -57842 -5699 1018248 1224486 64015 153091 0 0 0 0 0 0 0 21018 21406 85033 174497 933215 1049989 2323216 3460564 15000 0 2308216 3460564 X THE PURPOSE OF THE FOUNDATION SHALL BE TO SUPPORT FILLMORE COUNTY HOSPITAL OF GENEVA, NEBRASKA IN ITS ENDEAVORS OF NEW TECHNOLOGIES, RECRUITMENT, EXPANSION, CONTINUING EDUCATION, MARKETING, PURCHASING OF SUPPLIES AND EQUIPMENT, AND PROVIDING SUPPORT AND HELP FOR THE CITIZENS OF FILLMORE COUNTY AND SURROUNDING AREAS IN THEIR PHYSICAL AND MENTAL HEALTH NEEDS. 0 0 161545 153091 THE FOUNDATION'S PRIMARY EXEMPT PURPOSE FOR EXPENSES IS FOR FUNDRAISING. FUNDRAISING AIDS THE HOSPITAL IN PURCHASE OF SUPPLIES AND EQUIPMENT, EXPANSION AND UPKEEP OF THE BUILDING. IN ADDITION, ADVERTISING AND POSTAGE EXPENSES ASSOCIATED WITH THOSE FUNDRAISING EFFORTS. 161545 1 1 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 X 11 11 0 0 0 0 0 1 0 1 0 0 0 1 0 0 1 0 0 0 X DAYLE HARLOW 4027598200 1900 F STREET PO BOX 193 GENEVA NE 68361 DAYLE HARLOW EXECUTIVE DIRECTOR 10.00 30.00 X 0 101699 49477 JIM DONOVAN PRESIDENT 0.50 0.00 X X 0 0 0 MITCHELL SCHLEGELMILCH VICE PRESIDENT 0.50 0.00 X X 0 0 0 PENNI BRUNING VICE PRESIDENT THRU 11/22 0.50 0.00 X X 0 0 0 SHAUN FARMER SECRETARY/TREASURER 0.50 0.00 X X 0 0 0 JUDY LICHTI DIRECTOR 0.50 0.00 X 0 0 0 RICHARD WALTER DIRECTOR 0.50 0.00 X 0 0 0 KRISTI BRISKE DIRECTOR 0.50 0.00 X 0 0 0 JAY LYNCH DIRECTOR 0.50 0.00 X 0 0 0 MEGAN NUNNS DIRECTOR 0.50 0.00 X 0 0 0 JACK GALUSHA DIRECTOR 0.50 0.00 X 0 0 0 JENNY HOARTY DIRECTOR 0.50 0.00 X 0 0 0 MARY HOUCHIN DIRECTOR 0.50 0.00 X 0 0 0 RYAN KNESS DIRECTOR THRU 5/23 0.50 0.00 X 0 0 0 0 101699 49477 0 0 1 0 0 40970 3700 1124527 1169197 60988 60988 9058 40970 14757 -5699 -5699 1224486 0 0 55289 149591 149591 3500 3500 3700 3700 9252 9252 1968 1968 3463 3463 1961 1961 854 854 208 208 174497 161545 12952 0 379351 399235 366275 301564 509800 255813 44673 20000 1022783 2200284 267173 334 16495 2323216 3460564 15000 0 15000 0 X 728206 1530361 1580010 1930203 2308216 3460564 2323216 3460564 1049989 102359 0 X X 0 1 X 1 0 X X X 1 FILLMORE COUNTY HOSPITAL 470529089 3 1 149591 0 1 149591 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 842573 65262 102359 67299 12267 930628 938409 77143 -159781 13198 842573 696689 69795 221704 39365 10414 938409 642719 37887 24572 8489 696689 611199 35548 44644 40918 7754 642719 1.00000 0.00000 0.00000 1 0 0 INVESTMENT IN NPG 267173 C 267173 PART V, LINE 4: ENDOWMENT FUNDS WILL BE USED TO FURTHER THE MISSION OF HEALTHCARE SERVICES PROVIDED BY THE FILLMORE COUNTY HOSPITAL THROUGH OPERATIONAL AND CAPITAL NEEDS. GOLF TOURNAMENT 30837 23933 6904 2887 1303 500 1674 1040 2962 TRIVIA NIGHT 19191 17037 2154 200 1800 354 2037 50028 40970 9058 2887 1303 700 3474 1394 4999 14757 -5699 1 FILLMORE COUNTY HOSPITAL 1900 F STREET GENEVA NE 68361 470529089 GOVERNMENT 0 149591 OTHER CAPITAL CONTRIBUTIONS 1 0 PART I, LINE 2: THE PURPOSE OF THE FOUNDATION IS TO SUPPORT FILLMORE COUNTY HOSPITAL AND PROVIDING SUPPORT AND HELP FOR THE CITIZENS OF FILLMORE COUNTY AND SURROUNDING AREAS IN THEIR PHYSICAL AND MENTAL HEALTH NEEDS. AS SUCH, THE ONLY GRANTS THAT ARE ISSUED ARE FOR THE BENEFIT OF THE HOSPITAL AND THE COMMUNITY IT SERVES. 0 0 0 0 0 0 0 0 0 DAYLE HARLOW EXECUTIVE DIRECTOR 0 94251 0 7326 0 122 0 15133 0 35448 0 152280 0 0 PART I, LINE 3 THE COMPENSATION FOR DAYLE HARLOW, EXECUTIVE DIRECTOR, IS PAID BY FILLMORE COUNTY HOSPITAL, A RELATED ENTITY. FILLMORE COUNTY HOSPITAL HAS A COMPENSATION COMMITTEE COMPRISED OF THE CEO, CFO, COO, AND CHRO. ANNUALLY, THE COMMITTEE MEETS TO REVIEW WAGES OF DEPARTMENTS AND INDIVIDUAL STAFF WITH DATA FROM THE NEBRASKA HOSPITAL ASSOCIATION SALARY SURVEY PERFORMED BY GALLAGHER. FORM 990, PART VI, SECTION A, LINE 7A THE BOARD OF DIRECTORS OF THE FILLMORE COUNTY HOSPITAL FOUNDATION SHALL BE BE CONFIRMED BY A MAJORITY OF THE BOARD OF DIRECTORS OF ITS SUPPORTING ORGANIZATION, THE FILLMORE COUNTY HOSPITAL. FORM 990, PART VI, SECTION A, LINE 8B THERE ARE NO COMMITTEES WITH AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY. FORM 990, PART VI, SECTION B, LINE 11B COPIES OF THE FORM 990 ARE DISTRIBUTED AT A MONTHLY BOARD MEETING AND REVIEWED PRIOR TO FILING WITH THE IRS. 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 THE FOUNDATION DOES NOT MAKE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, OR FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC. FORM 990, PART XII, LINE 2C: THE BOARD OF DIRECTORS OF THE FILLMORE COUNTY HOSPITAL, FILLMORE COUNTY, NEBRASKA ASSUME RESPONSIBILITY FOR THE OVERSIGHT OF THE ANNUAL ENGAGEMENT WITH THE INDEPENDENT ACCOUNTANT. THERE HAVE BEEN NO CHANGES FROM PROCEDURES FOLLOWED IN PRIOR YEARS. FILLMORE COUNTY HOSPITAL 1900 F STREET GENEVA NE 68361 470529089 HOSPITAL NE GOVT N/A N/A 0 0 1 1 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0