2025-05-06T12:31:31-05:00 2024-06-30 450250958 EIDE BAILLY LLP 18081 BURT ST STE 200 OMAHA NE 680224722 990 2023-07-01 261778815 FILLMORE COUNTY HOSPITAL FOUNDATION FILL 4027593167 1900 F STREET GENEVA NE 68361 JAMES DONOVAN PRESIDENT 4027593167 2025-05-01 1 1 WENDY R COOLEY CPA P01523804 4023302660 2025-05-01 2023 2025-03-06 01:10:19Z JAMES DONOVAN 1900 F STREET GENEVA NE 68361 477683 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. 12 12 0 15 0 0 1169197 391291 0 0 60988 71924 -5699 -1131 1224486 462084 153091 61837 0 0 0 0 0 0 2165 21406 23966 174497 85803 1049989 376281 3460564 3958924 0 0 3460564 3958924 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. 1 0 72903 61837 THE FOUNDATION'S PRIMARY EXEMPT PURPOSE FOR EXPENSES IS FOR FUNDRAISING. FUNDRAISING AIDS THE HOSPITAL IN THE PURCHASE OF SUPPLIES AND EQUIPMENT, PROVIDING SUPPORT TO EMPLOYEES AND EXPANSION AND UPKEEP OF THE BUILDING. IN ADDITION, ADVERTISING AND POSTAGE EXPENSES ASSOCIATED WITH THOSE FUNDRAISING EFFORTS. 72903 1 1 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 36 0 1 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 X 12 12 0 0 0 0 0 1 0 1 0 0 0 1 0 0 1 0 0 0 X IAN HRAKSY 4027598200 1900 F STREET PO BOX 193 GENEVA NE 68361 JAMES DONOVAN PRESIDENT 1.00 0.00 X X 0 0 0 MITCHELL SCHLEGELMILCH VICE PRESIDENT 1.00 0.00 X X 0 0 0 SHAUN FARMER SECRETARY/TREASURER 1.00 0.00 X X 0 0 0 SHELLY CASSIDY DIRECTOR 1.00 0.00 X 0 0 0 RICHARD WALTER DIRECTOR 1.00 0.00 X 0 0 0 NANCY MEYER DIRECTOR 1.00 0.00 X 0 0 0 KRISTI BRISKE DIRECTOR THRU 03/24 1.00 0.00 X 0 0 0 JAY LYNCH DIRECTOR THRU 12/23 1.00 0.00 X 0 0 0 JACK GALUSHA DIRECTOR 1.00 0.00 X 0 0 0 MEGAN NUNNS DIRECTOR 1.00 0.00 X 0 0 0 JUDY LICHTI DIRECTOR 1.00 0.00 X 0 0 0 MARY HOUCHIN DIRECTOR 1.00 0.00 X 0 0 0 TAYLOR SLUKA DIRECTOR 1.00 0.00 X 0 0 0 JENNY HOARTY DIRECTOR 1.00 0.00 X 0 0 0 DAYLE HARLOW EXECUTIVE DIRECTOR 5.00 35.00 X 0 154622 39697 0 154622 39697 0 0 1 0 0 36586 354705 391291 71924 71924 14468 36586 15599 -1131 -1131 462084 0 0 70793 1967 1967 59870 59870 3700 3700 7035 7035 2145 2145 8254 8254 667 667 2165 2165 85803 72903 10735 2165 700799 548024 255813 84913 20000 261667 2200284 2783182 267173 267174 16495 13964 3460564 3958924 0 0 X 1530361 1765636 1930203 2193288 3460564 3958924 3460564 3958924 376281 122079 0 X X 0 1 X 1 0 X X X 1 FILLMORE COUNTY HOSPITAL 470529089 3 1 60837 0 1 60837 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 930628 60205 114424 14085 1091172 842573 65262 102359 67299 12267 930628 938409 77143 -159781 13198 842573 696689 69795 221704 39365 10414 938409 642719 37887 24572 8489 696689 1.00000 0.00000 0.00000 1 0 0 INVESTMENT IN NPG 267174 C 267174 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 31629 21961 9668 3070 2818 3370 2037 TRIVIA NIGHT 19425 14625 4800 2220 361 1723 51054 36586 14468 3070 2818 3370 2220 361 3760 15599 -1131 1 HOSPITAL EMPLOYEE SUPPORT 180 49600 HOSPITAL EMPLOYEE CRISIS ASSISTANCE 16 9270 SCHOLARSHIPS 1 1000 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, THE HOSPITAL EMPLOYEES AND THE COMMUNITY IT SERVES. 0 0 0 0 0 0 0 0 0 DAYLE HARLOW EXECUTIVE DIRECTOR 0 144512 0 10110 0 0 0 8364 0 31333 0 194319 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. THE COMPENSATION AMOUNTS REPORTED ON SCHEDULE J, PART II IS FOR SERVICES PROVIDED TO BOTH THE FILLMORE COUNTY HOSPITAL AND THE FILLMORE COUNTY HOSPITAL FOUNDATION. ONLY 10% OF HER TIME IS FOR SERVICES PROVIDED TO THE FOUNDATION. FORM 990, PART III, LINE 2 THE FILLMORE COUNTY HOSPITAL FOUNDATION ESTABLISHED AN EMPLOYEE ASSISTANCE PROGRAM FOR HOSPITAL EMPLOYEES WHO HAVE SUFFERED SOME SORT OF CRISIS IN THEIR LIVES. THERE IS AN APPLICATION PROCESS THAT IS APPROVED THROUGH THE ADMINISTRATIVE TEAM AT FILLMORE COUNTY HOSPITAL, AND EMPLOYEES ARE ABLE TO RECEIVE $500 PER CALENDAR YEAR FOR QUALIFYING CRISES. THE RESTRICTED ACCOUNT IS FUNDED THROUGH A HOSPITAL EMPLOYEE DONATION PROGRAM THROUGH PAYROLL, WHERE 10% OF THE ANNUAL PROCEEDS FUND THE EMPLOYEE ASSSITANCE PROGRAM. 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 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0