Skip to content
Nonprofiteer
← CHEYENNE COUNTY HOSPITAL ASSOCIATION INC

Form 990 for tax year 2023

Filed by CHEYENNE COUNTY HOSPITAL ASSOCIATION INC.

Totals

Total revenue
$85,611,869
Total expenses
$78,259,704
Contributions and grants received
$8,475,463
Grants paid
$17,200
Program services expenses (Part IX)
$69,466,873
Management and general expenses
$8,792,831
Fundraising expenses
$0
Program service expenses (Part III)
$69,466,873

Program services were 88.8% of total expenses calculated — Part IX's program-services column over total expenses, both as filed.

Listed in Part VII

  • SARA SHOLAR MD

    PHYSICIAN AT LARGE

    Total calculated
    $717,961
    From this org
    $669,484
    From related orgs
    $0
    Other
    $48,477
    Hours/week
    40

    Schedule J breakdown matched by us

    Base
    $669,484
    Bonus
    $0
    Other
    $0
    Deferred
    $15,250
    Nontaxable benefits
    $33,371
    Filer's total
    $718,105

  • JAMES POPOVICH MD

    CHIEF OF MEDICAL STAFF

    Total calculated
    $675,725
    From this org
    $624,896
    From related orgs
    $0
    Other
    $50,829
    Hours/week
    39 + 1 related

    Schedule J breakdown matched by us

    Base
    $624,896
    Bonus
    $0
    Other
    $0
    Deferred
    $15,250
    Nontaxable benefits
    $35,723
    Filer's total
    $675,869

  • WILLIAM PILE

    CHAIRMAN

    Total calculated
    $0
    Hours/week
    4

  • TIM MILLER

    VICE CHAIRMAN

    Total calculated
    $0
    Hours/week
    4

  • KATHY NARJES

    SECRETARY

    Total calculated
    $0
    Hours/week
    4

  • JEFF ELLWANGER

    TREASURER

    Total calculated
    $0
    Hours/week
    4

  • STAN BELIEU

    MEMBER

    Total calculated
    $0
    Hours/week
    4 + 1 related

  • NANCI MCCASLIN

    MEMBER

    Total calculated
    $0
    Hours/week
    4 + 1 related

  • CLEM SCHUMACHER

    MEMBER

    Total calculated
    $0
    Hours/week
    4

  • JEFF HELLER

    MEMBER

    Total calculated
    $0
    Hours/week
    4

  • WILLIAM ROBINSON

    MEMBER

    Total calculated
    $0
    Hours/week
    4

  • DWIGHT SMITH

    MEMBER THRU 8/2024

    Total calculated
    $0
    Hours/week
    4

  • KELLY UTLEY

    CFO

    Total calculated
    $300,847
    From this org
    $263,484
    From related orgs
    $0
    Other
    $37,363
    Hours/week
    39 + 1 related

    Schedule J breakdown matched by us

    Base
    $239,987
    Bonus
    $22,705
    Other
    $792
    Deferred
    $13,629
    Nontaxable benefits
    $23,878
    Filer's total
    $300,991

  • JASON PETIK

    CEO

    Total calculated
    $0
    Hours/week
    40

  • KELLY CASEY MD

    SURGEON

    Total calculated
    $814,837
    From this org
    $749,258
    From related orgs
    $0
    Other
    $65,579
    Hours/week
    40

    Schedule J breakdown matched by us

    Base
    $585,043
    Bonus
    $164,215
    Other
    $0
    Deferred
    $30,000
    Nontaxable benefits
    $35,723
    Filer's total
    $814,981

  • REBECCA L ALLARD MD

    PHYSICIAN

    Total calculated
    $768,897
    From this org
    $710,817
    From related orgs
    $0
    Other
    $58,080
    Hours/week
    40

    Schedule J breakdown matched by us

    Base
    $685,817
    Bonus
    $25,000
    Other
    $0
    Deferred
    $22,500
    Nontaxable benefits
    $35,724
    Filer's total
    $769,041

  • ARIEL SORIANO

    PHYSICIAN

    Total calculated
    $635,723
    From this org
    $614,660
    From related orgs
    $0
    Other
    $21,063
    Hours/week
    40

    Schedule J breakdown matched by us

    Base
    $614,660
    Bonus
    $0
    Other
    $0
    Deferred
    $3,565
    Nontaxable benefits
    $17,642
    Filer's total
    $635,867

  • THERESA SIMMONS

    CRNA

    Total calculated
    $551,175
    From this org
    $514,624
    From related orgs
    $0
    Other
    $36,551
    Hours/week
    40

    Schedule J breakdown matched by us

    Base
    $513,237
    Bonus
    $1,387
    Other
    $0
    Deferred
    $972
    Nontaxable benefits
    $35,723
    Filer's total
    $551,319

  • APRIL SMITH MD

    HOSPITALIST

    Total calculated
    $545,367
    From this org
    $492,926
    From related orgs
    $0
    Other
    $52,441
    Hours/week
    40

    Schedule J breakdown matched by us

    Base
    $492,926
    Bonus
    $0
    Other
    $0
    Deferred
    $15,250
    Nontaxable benefits
    $37,335
    Filer's total
    $545,511

Compensation is as filed in Part VII: reportable pay from this organization and from related organizations, other compensation, and hours per week. The total, marked calculated, is our sum of the three dollar columns, with a blank column counted as $0; the form itself has no total. On a Form 990-EZ the columns are Part IV's instead — compensation, contributions to benefit plans, and expense account — and the total sums those. A Schedule J breakdown is as filed: base pay, bonus, other, deferred compensation and nontaxable benefits from this organization, with any from related organizations beside each, and the filer's own total. It is shown with the Part VII listing of the same name on the same return. The form gives no key between the two, so that pairing is ours, and is marked matched by us.

Schedule J

Answered yes

  • 3 · Compensation committee
  • 3 · Written employment contract
  • 3 · Compensation survey or study
  • 3 · Approval by the board or compensation committee

Answered no

  • 4a · Severance or change-of-control payment
  • 4b · Supplemental nonqualified retirement plan
  • 4c · Equity-based compensation arrangement
  • 5a · Pay contingent on this organization's revenues
  • 5b · Pay contingent on a related organization's revenues
  • 6a · Pay contingent on this organization's net earnings
  • 6b · Pay contingent on a related organization's net earnings
  • 7 · Other non-fixed payments
  • 8 · Paid under the initial-contract exception

The filer's explanations (Part III)

SCHEDULE J, PART III:
JASON PETIK, CEO, RECEIVES COMPENSATION FROM POUDRE VALLEY MEDICAL GROUP, AN UNRELATED ENTITY. POUDRE VALLEY MEDICAL GROUP PROVIDES MANAGEMENT SERVICES TO ITS CLIENTS, INCLUDING THE SIDNEY REGIONAL MEDICAL CENTER. THE SIDNEY REGIONAL MEDICAL CENTER'S BOARD OF DIRECTORS SETS THE COMPENSATION FOR MR. PETIK. MR. PETIK RECEIVED TOTAL COMPENSATION OF $390,340. MR. PETIK'S COMPENSATION IS REFLECTED IN PART IX, LINE 11A.

Part I's answers as filed. A line not listed was left unanswered; on lines 1a and 3 that means the box was not checked.

Grants on this return

Related organizations on this return

Schedule R Part II: tax-exempt organizations related to the filer by control. It does not record shared board members or money.

Provenance

Return type
form_990
Tax year
2023
Filed
15 November 2024
IRS schema version
2023v5.1
Source object
202433209349327058

Check it against the return as filed: the GivingTuesday Data Lake hosts a public copy of the original XML.

The source document this was parsed from is served over the API, which is where bulk and document access live.