STRATEGY STUDIO / PUBLIC DATA EXPLORER

COFFEYVILLE REGIONAL MEDICAL CENTER FOUNDATION: Form 990, tax year 2023

View the entire original 990 at ProPublica ↗

Organization
COFFEYVILLE REGIONAL MEDICAL CENTER FOUNDATION (EIN 48-0981990)
Tax period
2023-01-01 to 2023-12-31
Filed
2024-11-15
IRS object ID
202443209349326789
Schema version
2023v5.1
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Return2024-11-15T18:48:05+00:00ReturnTs
Tax Period End2023-12-31TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN440160260PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1Forvis Mazars LLPBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line1910 E St Louis 200 PO Box 1190AddressLine1Txt
CitySpringfieldCityNm
State AbbreviationMOStateAbbreviationCd
ZIP658062523ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2023-01-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN480981990EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1COFFEYVILLE REGIONAL MEDICAL CENTER FOUNDATION INCBusinessNameLine1Txt
FieldValueIRS element (for citing)
Business Name ControlCOFFBusinessNameControlTxt
Phone6202521659PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line11400 W 4th StreetAddressLine1Txt
CityCoffeyvilleCityNm
State AbbreviationKSStateAbbreviationCd
ZIP67337ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonAmy TaylorPersonNm
Person TitleDirector of FoundationPersonTitleTxt
Phone6202521659PhoneNum
Signature2024-11-16SignatureDt
Discuss With Paid PreparerYes (true)DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonBrian ToddPreparerPersonNm
PTINP00422601PTIN
Phone4178658701PhoneNum
Preparation2024-11-16PreparationDt
FieldValueIRS element (for citing)
Tax2023TaxYr
Build TS2024-10-15 13:58:12ZBuildTS

Form 990 IRS990

Principal Ofcr Business Name PrincipalOfcrBusinessName

FieldValueIRS element (for citing)
Business Name Line1Lisa KuehnBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line11400 W 4th StreetAddressLine1Txt
CityCoffeyvilleCityNm
State AbbreviationKSStateAbbreviationCd
ZIP67337ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$494,596GrossReceiptsAmt
Group Return For AffiliatesfalseGroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website AddressWWW.CRMCINC.ORG/FOUNDATIONWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation1984FormationYr
Legal Domicile StateKSLegalDomicileStateCd
Activity Or MissionTO PROVIDE SUPPORT AND FINANCIAL ASSISTANCE TO COFFEYVILLE REGIONAL MEDICAL CENTER TO ACHIEVE AND MAINTAIN EXCELLENCE AS A HEALTHCARE PROVIDER AND LEADER FOR THE COMMUNITY SERVED.ActivityOrMissionDesc
Voting Members Governing Body10VotingMembersGoverningBodyCnt
Voting Members Independent9VotingMembersIndependentCnt
Total Employee0TotalEmployeeCnt
Total Volunteers33TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$313,403PYContributionsGrantsAmt
CY Contributions Grants$381,915CYContributionsGrantsAmt
PY Program Service Revenue$0PYProgramServiceRevenueAmt
CY Program Service Revenue$0CYProgramServiceRevenueAmt
PY Investment Income$70,542PYInvestmentIncomeAmt
CY Investment Income$78,005CYInvestmentIncomeAmt
PY Other Revenue$10,362PYOtherRevenueAmt
CY Other Revenue$15,863CYOtherRevenueAmt
PY Total Revenue$394,307PYTotalRevenueAmt
CY Total Revenue$475,783CYTotalRevenueAmt
PY Grants And Similar Paid$403,881PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$123,929CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$0PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$0CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$10,689CYTotalFundraisingExpenseAmt
PY Other Expenses$53,617PYOtherExpensesAmt
CY Other Expenses$44,924CYOtherExpensesAmt
PY Total Expenses$457,498PYTotalExpensesAmt
CY Total Expenses$168,853CYTotalExpensesAmt
PY Revenues Less Expenses-$63,191PYRevenuesLessExpensesAmt
CY Revenues Less Expenses$306,930CYRevenuesLessExpensesAmt
Total Assets BOY$2,272,789TotalAssetsBOYAmt
Total Assets EOY$2,783,251TotalAssetsEOYAmt
Total Liabilities BOY$221TotalLiabilitiesBOYAmt
Total Liabilities EOY$105TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$2,272,568NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$2,783,146NetAssetsOrFundBalancesEOYAmt
MissionTO PROVIDE SUPPORT AND FINANCIAL ASSISTANCE TO COFFEYVILLE REGIONAL MEDICAL CENTER TO ACHIEVE AND MAINTAIN EXCELLENCE AS A HEALTHCARE PROVIDER AND LEADER FOR THE COMMUNITY SERVED.MissionDesc
Significant New Program SrvcfalseSignificantNewProgramSrvcInd
Significant ChangefalseSignificantChangeInd
Expense$101,179ExpenseAmt
Grant$101,179GrantAmt
DescPURCHASE MEDICAL EQUIPMENT AND FURNISHINGS FOR COFFEYVILLE REGIONAL MEDICAL CENTER AND FORGIVE LOAN DUE FROM COFFEYVILLE REGIONAL MEDICAL CENTER.Desc

Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp

FieldValueIRS element (for citing)
Expense$14,050ExpenseAmt
Grant$14,050GrantAmt
DescASSISTANCE TO COFFEYVILLE REGIONAL MEDICAL CENTER EMPLOYEES.Desc

Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp

FieldValueIRS element (for citing)
Expense$8,700ExpenseAmt
Grant$8,700GrantAmt
DescSCHOLARSHIP PROGRAM ESTABLISHED TO PROVIDE INDIVIDUALS WHO ARE STUDYING A HEALTH-RELATED PROGRAM WITH FINANCIAL ASSISTANCE.Desc
FieldValueIRS element (for citing)
Total Program Service Expenses$123,929TotalProgramServiceExpensesAmt
Described In Section501c3Yes (true)DescribedInSection501c3Ind
Schedule B RequiredYes (true)ScheduleBRequiredInd
Political Campaign ActyfalsePoliticalCampaignActyInd
Lobbying ActivitiesfalseLobbyingActivitiesInd
Donor Advised FundfalseDonorAdvisedFundInd
Conservation EasementsfalseConservationEasementsInd
Collections Of ArtfalseCollectionsOfArtInd
Credit CounselingfalseCreditCounselingInd
Donor Rstr Or Quasi EndowmentsYes (true)DonorRstrOrQuasiEndowmentsInd
Report Land Building EquipmentYes (true)ReportLandBuildingEquipmentInd
Report Investments Other SecfalseReportInvestmentsOtherSecInd
Report Program Related InvstfalseReportProgramRelatedInvstInd
Report Other AssetsfalseReportOtherAssetsInd
Report Other LiabilitiesfalseReportOtherLiabilitiesInd
Include FIN48 FootnotefalseIncludeFIN48FootnoteInd
Independent Audit Fincl StmtfalseIndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtfalseConsolidatedAuditFinclStmtInd
School OperatingfalseSchoolOperatingInd
Foreign OfficefalseForeignOfficeInd
Foreign ActivitiesfalseForeignActivitiesInd
More Than5000 K To OrgfalseMoreThan5000KToOrgInd
More Than5000 K To IndividualsfalseMoreThan5000KToIndividualsInd
Professional FundraisingfalseProfessionalFundraisingInd
Fundraising ActivitiesYes (true)FundraisingActivitiesInd
Gaming ActivitiesfalseGamingActivitiesInd
Operate HospitalfalseOperateHospitalInd
Grants To OrganizationsYes (true)GrantsToOrganizationsInd
Grants To IndividualsYes (true)GrantsToIndividualsInd
Schedule J RequiredfalseScheduleJRequiredInd
Tax Exempt BondsfalseTaxExemptBondsInd
Engaged In Excess Benefit TransfalseEngagedInExcessBenefitTransInd
PY Excess Benefit TransfalsePYExcessBenefitTransInd
Loan OutstandingfalseLoanOutstandingInd
Grant To Related PersonfalseGrantToRelatedPersonInd
Business Rln With Org MemfalseBusinessRlnWithOrgMemInd
Business Rln With Fam MemfalseBusinessRlnWithFamMemInd
Business Rln With35 Ctrl EntfalseBusinessRlnWith35CtrlEntInd
Deductible Non Cash ContrifalseDeductibleNonCashContriInd
Deductible Art ContributionfalseDeductibleArtContributionInd
Terminate OperationsfalseTerminateOperationsInd
Partial LiquidationfalsePartialLiquidationInd
Disregarded EntityfalseDisregardedEntityInd
Related EntityYes (true)RelatedEntityInd
Related Organization Ctrl EntfalseRelatedOrganizationCtrlEntInd
Trnsfr Exmpt Non Chrtbl Rltd OrgfalseTrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted PrtshpfalseActivitiesConductedPrtshpInd
Schedule O RequiredYes (true)ScheduleORequiredInd
IRP Document0IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Employee0EmployeeCnt
Unrelated Bus Incm Over LimitfalseUnrelatedBusIncmOverLimitInd
Foreign Financial AccountfalseForeignFinancialAccountInd
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTransInd
Taxable Party NotificationfalseTaxablePartyNotificationInd
Nondeductible ContributionsfalseNondeductibleContributionsInd
Quid Pro Quo ContributionsYes (true)QuidProQuoContributionsInd
Quid Pro Quo Contri DisclYes (true)QuidProQuoContriDisclInd
Form8282 Property Disposed OffalseForm8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft CntrctfalseRcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft CntrctfalsePayPremiumsPrsnlBnftCntrctInd
Indoor Tanning ServicesfalseIndoorTanningServicesInd
Subj To Tax Rmnrtn Ex Prcht PymtfalseSubjToTaxRmnrtnExPrchtPymtInd
Subject To Excs Tax Net Invst IncfalseSubjectToExcsTaxNetInvstIncInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members10GoverningBodyVotingMembersCnt
Independent Voting Member9IndependentVotingMemberCnt
Family Or Business RlnfalseFamilyOrBusinessRlnInd
Delegation Of Mgmt DutiesfalseDelegationOfMgmtDutiesInd
Change To Org DocumentsfalseChangeToOrgDocumentsInd
Material Diversion Or MisusefalseMaterialDiversionOrMisuseInd
Members Or StockholdersfalseMembersOrStockholdersInd
Election Of Board MembersfalseElectionOfBoardMembersInd
Decisions Subject To ApprovafalseDecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (true)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (true)MinutesOfCommitteesInd
Officer Mailing AddressfalseOfficerMailingAddressInd
Local ChaptersfalseLocalChaptersInd
Form990 Provided To Gvrn BodyYes (true)Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (true)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (true)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (true)RegularMonitoringEnfrcInd
Whistleblower PolicyfalseWhistleblowerPolicyInd
Document Retention PolicyfalseDocumentRetentionPolicyInd
Compensation Process CEOfalseCompensationProcessCEOInd
Compensation Process OtherfalseCompensationProcessOtherInd
Investment In Joint VenturefalseInvestmentInJointVentureInd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1Lisa KuehnBusinessNameLine1Txt
FieldValueIRS element (for citing)
Phone6202521674PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line11400 W 4th StreetAddressLine1Txt
CityCoffeyvilleCityNm
State AbbreviationKSStateAbbreviationCd
ZIP67337ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (11 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndOfficerOfficerIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmt
Doug Bell
President1.00.0Yes (X)Yes (X)$0$0$0
Jeff Gossard
Secretary/Treasurer1.00.0Yes (X)Yes (X)$0$0$0
Jodi Hayse
Trustee1.00.0Yes (X)Yes (X)$0$0$0
Ann Marie Vannoster
Trustee1.00.0Yes (X)$0$0$0
Jim Lawrence
Trustee1.00.0Yes (X)$0$0$0
LaKisha Johnson
Trustee1.00.0Yes (X)$0$0$0
Laura Nicastro
Trustee1.00.0Yes (X)$0$0$0
Marlon Thornburg
Trustee1.00.0Yes (X)$0$0$0
Richard Voss
Trustee1.00.0Yes (X)$0$0$0
Stephanie Richardson
Trustee1.032.0Yes (X)$0$39,548$3,566
Lisa Kuehn
Director of Foundation32.00.0Yes (X)$0$90,554$7,916
FieldValueIRS element (for citing)
Total Reportable Comp From Org$0TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$130,102TotReportableCompRltdOrgAmt
Total Other Compensation$11,482TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K0IndivRcvdGreaterThan100KCnt
Former Ofcr Employees ListedfalseFormerOfcrEmployeesListedInd
Total Comp Greater Than150 KfalseTotalCompGreaterThan150KInd
Compensation From Other SrcsfalseCompensationFromOtherSrcsInd
Cntrct Rcvd Greater Than100 K0CntrctRcvdGreaterThan100KCnt
Fundraising$11,530FundraisingAmt
All Other Contributions$370,385AllOtherContributionsAmt
Total Contributions$381,915TotalContributionsAmt

Total Oth Program Service Rev TotalOthProgramServiceRevGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt
Related Or Exempt Func Income$0RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$0ExclusionAmt
FieldValueIRS element (for citing)
Total Program Service Revenue$0TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$66,722TotalRevenueColumnAmt
Exclusion$66,722ExclusionAmt

Rental Income Or Loss RentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Real$0RealAmt
Personal$0PersonalAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

FieldValueIRS element (for citing)
Securities$11,283SecuritiesAmt

Gain Or Loss GainOrLossGrp

FieldValueIRS element (for citing)
Securities$11,283SecuritiesAmt
Other$0OtherAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

FieldValueIRS element (for citing)
Total Revenue Column$11,283TotalRevenueColumnAmt
Exclusion$11,283ExclusionAmt
FieldValueIRS element (for citing)
Fundraising Gross Income$34,676FundraisingGrossIncomeAmt
Contri Rpt Fundraising Event$11,530ContriRptFundraisingEventAmt
Fundraising Direct Expenses$18,813FundraisingDirectExpensesAmt

Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp

FieldValueIRS element (for citing)
Total Revenue Column$15,863TotalRevenueColumnAmt
Exclusion$15,863ExclusionAmt

Miscellaneous Revenue MiscellaneousRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt
Related Or Exempt Func Income$0RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$0ExclusionAmt
FieldValueIRS element (for citing)
Other Revenue Total$0OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$475,783TotalRevenueColumnAmt
Related Or Exempt Func Income$0RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$93,868ExclusionAmt

Grants To Domestic Orgs GrantsToDomesticOrgsGrp

FieldValueIRS element (for citing)
Total$101,179TotalAmt
Program Services$101,179ProgramServicesAmt

Grants To Domestic Individuals GrantsToDomesticIndividualsGrp

FieldValueIRS element (for citing)
Total$22,750TotalAmt
Program Services$22,750ProgramServicesAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$8,263TotalAmt
Management And General$8,263ManagementAndGeneralAmt

Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp

FieldValueIRS element (for citing)
Total$19,680TotalAmt
Management And General$19,680ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$5,075TotalAmt
Program Services$0ProgramServicesAmt
Management And General$0ManagementAndGeneralAmt
Fundraising$5,075FundraisingAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$2,611TotalAmt
Management And General$2,611ManagementAndGeneralAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$1,118TotalAmt
Management And General$1,118ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp

FieldValueIRS element (for citing)
DescMiscellaneousDesc
Total$8,177TotalAmt
Management And General$2,563ManagementAndGeneralAmt
Fundraising$5,614FundraisingAmt

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$0TotalAmt
Program Services$0ProgramServicesAmt
Management And General$0ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$168,853TotalAmt
Program Services$123,929ProgramServicesAmt
Management And General$34,235ManagementAndGeneralAmt
Fundraising$10,689FundraisingAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$139,160BOYAmt
EOY$425,297EOYAmt

Receivables From Officers Etc ReceivablesFromOfficersEtcGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp

FieldValueIRS element (for citing)
BOY$388,577BOYAmt
EOY$388,577EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$56,468LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$54,526LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$2,841BOYAmt
EOY$1,942EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

FieldValueIRS element (for citing)
BOY$1,724,565BOYAmt
EOY$1,932,303EOYAmt

Investments Other Securities InvestmentsOtherSecuritiesGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt

Investments Program Related InvestmentsProgramRelatedGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$17,646BOYAmt
EOY$35,132EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$2,272,789BOYAmt
EOY$2,783,251EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$221BOYAmt
EOY$105EOYAmt

Loans From Officers Directors LoansFromOfficersDirectorsGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$221BOYAmt
EOY$105EOYAmt
FieldValueIRS element (for citing)
Organization Follows FASB117Yes (X)OrganizationFollowsFASB117Ind

No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp

FieldValueIRS element (for citing)
BOY$1,576,068BOYAmt
EOY$1,925,948EOYAmt

Donor Restriction Net Assets DonorRestrictionNetAssetsGrp

FieldValueIRS element (for citing)
BOY$696,500BOYAmt
EOY$857,198EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$2,272,568BOYAmt
EOY$2,783,146EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$2,272,789BOYAmt
EOY$2,783,251EOYAmt
FieldValueIRS element (for citing)
Reconcilation Revenue Expnss$306,930ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst$203,648NetUnrlzdGainsLossesInvstAmt
Other Changes In Net Assets$0OtherChangesInNetAssetsAmt
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or ReviewYes (true)AccountantCompileOrReviewInd

Acct Compile Or Review Basis AcctCompileOrReviewBasisGrp

FieldValueIRS element (for citing)
Separate Basis Fincl StmtYes (X)SeparateBasisFinclStmtInd
FieldValueIRS element (for citing)
FS AuditedfalseFSAuditedInd
Audit CommitteeYes (true)AuditCommitteeInd
Federal Grant Audit RequiredfalseFederalGrantAuditRequiredInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Public Organization170Yes (X)PublicOrganization170Ind

Gifts Grants Contri Rcvd170 GiftsGrantsContriRcvd170Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$183,257CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$163,834CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$265,639CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$298,779CurrentTaxYearMinus1YearAmt
Current Tax Year$381,915CurrentTaxYearAmt
Total$1,293,424TotalAmt

Tax Rev Levied Orgnztnl Bnft170 TaxRevLeviedOrgnztnlBnft170Grp

FieldValueIRS element (for citing)
Total$0TotalAmt

Govt Furn Srvc Fclts Vl170 GovtFurnSrvcFcltsVl170Grp

FieldValueIRS element (for citing)
Total$0TotalAmt

Total Calendar Year170 TotalCalendarYear170Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$183,257CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$163,834CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$265,639CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$298,779CurrentTaxYearMinus1YearAmt
Current Tax Year$381,915CurrentTaxYearAmt
Total$1,293,424TotalAmt
FieldValueIRS element (for citing)
Substantial Contributors Tot$502,406SubstantialContributorsTotAmt
Public Support Total170$791,018PublicSupportTotal170Amt

Gross Investment Income170 GrossInvestmentIncome170Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$61,742CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$66,631CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$52,425CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$57,833CurrentTaxYearMinus1YearAmt
Current Tax Year$66,722CurrentTaxYearAmt
Total$305,353TotalAmt

Unrelated Business Net Incm170 UnrelatedBusinessNetIncm170Grp

FieldValueIRS element (for citing)
Total$0TotalAmt

Other Income170 OtherIncome170Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$0CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$0CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$0CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$0CurrentTaxYearMinus1YearAmt
Current Tax Year$15,863CurrentTaxYearAmt
Total$15,863TotalAmt
FieldValueIRS element (for citing)
Total Support$1,614,640TotalSupportAmt
Gross Receipts Rltd Activities$0GrossReceiptsRltdActivitiesAmt
Public Support CY1700.4899PublicSupportCY170Pct
Public Support PY1700.4991PublicSupportPY170Pct
Thirty Thr Pct Suprt Tests CY170Yes (X)ThirtyThrPctSuprtTestsCY170Ind

Form990 Schedule A Part VI Form990ScheduleAPartVIGrp

FieldValueIRS element (for citing)
Form And Line ReferenceSchedule A, Part II, Line 10 Other IncomeFormAndLineReferenceDesc
ExplanationDESCRIPTION - EVENT INCOME, COLUMN A - , COLUMN B - , COLUMN C - , COLUMN D - , COLUMN E - 15863.0, COLUMN F - 15863.0;ExplanationTxt

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

FieldValueIRS element (for citing)
ContributorRESTRICTEDContributorNum

Contributor Business Name ContributorBusinessName

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor US Address ContributorUSAddress

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Total ContributionsRESTRICTEDTotalContributionsAmt

Schedule D IRS990ScheduleD

CY Endwmt Fund CYEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$400,668BeginningYearBalanceAmt
Investment Earnings Or Losses$67,813InvestmentEarningsOrLossesAmt
Other Expenditures$67,813OtherExpendituresAmt
End Year Balance$400,668EndYearBalanceAmt

CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$400,668BeginningYearBalanceAmt
Investment Earnings Or Losses$10,883InvestmentEarningsOrLossesAmt
Other Expenditures$10,883OtherExpendituresAmt
End Year Balance$400,668EndYearBalanceAmt

CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$400,668BeginningYearBalanceAmt
Investment Earnings Or Losses$62,314InvestmentEarningsOrLossesAmt
Other Expenditures$62,314OtherExpendituresAmt
End Year Balance$400,668EndYearBalanceAmt

CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$370,668BeginningYearBalanceAmt
Contributions$30,000ContributionsAmt
Investment Earnings Or Losses$17,809InvestmentEarningsOrLossesAmt
Other Expenditures$17,809OtherExpendituresAmt
End Year Balance$400,668EndYearBalanceAmt

CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$370,668BeginningYearBalanceAmt
Investment Earnings Or Losses$22,011InvestmentEarningsOrLossesAmt
Other Expenditures$22,011OtherExpendituresAmt
End Year Balance$370,668EndYearBalanceAmt
FieldValueIRS element (for citing)
Board Designated Balance EOY0.0BoardDesignatedBalanceEOYPct
Prmnnt Endowment Balance EOY1.0PrmnntEndowmentBalanceEOYPct
Term Endowment Balance EOY0.0TermEndowmentBalanceEOYPct
Endowments Held Unrelated OrgfalseEndowmentsHeldUnrelatedOrgInd
Endowments Held Related OrgfalseEndowmentsHeldRelatedOrgInd

Buildings BuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$32,533OtherCostOrOtherBasisAmt
Depreciation$30,810DepreciationAmt
Book Value$1,723BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$23,935OtherCostOrOtherBasisAmt
Depreciation$23,716DepreciationAmt
Book Value$219BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$1,942TotalBookValueLandBuildingsAmt

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferenceSchedule D, Part V, Line 4 Intended uses of endowment fundsFormAndLineReferenceDesc
ExplanationThe intended use of the Foundation's Cape endowment funds are to provide students who need financial assistance and have a great desire to become a dietitian with an educational scholarship. This fund was endowed by the board of directors. Unallocated earnings can be used at the discretion of the Board. The Endowment of the Best Scholarship is for students who have desire to become a healthcare worker, this fund was endowed as requested by the donor.ExplanationTxt

Schedule G IRS990ScheduleG

Fundraising Event Information FundraisingEventInformationGrp

FieldValueIRS element (for citing)
Event1Mum salesEvent1Nm
Gross Receipts Event1$18,050GrossReceiptsEvent1Amt
Gross Revenue Event1$18,050GrossRevenueEvent1Amt
Other Direct Expenses Event1$10,151OtherDirectExpensesEvent1Amt
Event2Golf TournamentEvent2Nm
Gross Receipts Event2$22,977GrossReceiptsEvent2Amt
Charitable Contri Event2$11,530CharitableContriEvent2Amt
Gross Revenue Event2$11,447GrossRevenueEvent2Amt
Non Cash Prizes Event2$967NonCashPrizesEvent2Amt
Rent Facility Costs Event2$3,401RentFacilityCostsEvent2Amt
Food And Beverage Event2$1,876FoodAndBeverageEvent2Amt
Other Direct Expenses Event2$921OtherDirectExpensesEvent2Amt
Other Events Total1OtherEventsTotalCnt
Gross Receipts Other Events$5,179GrossReceiptsOtherEventsAmt
Gross Revenue Other Events$5,179GrossRevenueOtherEventsAmt
Oth Direct Expnss Other Events$1,497OthDirectExpnssOtherEventsAmt
Gross Receipts Total$46,206GrossReceiptsTotalAmt
Charitable Contributions Tot$11,530CharitableContributionsTotAmt
Gross Revenue Total Events$34,676GrossRevenueTotalEventsAmt
Non Cash Prizes Total Events$967NonCashPrizesTotalEventsAmt
Rent Fclty Costs Total Events$3,401RentFcltyCostsTotalEventsAmt
Food And Beverage Total Events$1,876FoodAndBeverageTotalEventsAmt
Oth Direct Expnss Total Events$12,569OthDirectExpnssTotalEventsAmt
Direct Expense Summary Events$18,813DirectExpenseSummaryEventsAmt
Net Income Summary$15,863NetIncomeSummaryAmt

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Grant Records MaintainedYes (true)GrantRecordsMaintainedInd

Recipient Table RecipientTable

Recipient Business Name RecipientBusinessName

FieldValueIRS element (for citing)
Business Name Line1Coffeyville Regional Medical Center IncBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line11400 W 4th StreetAddressLine1Txt
CityCoffeyvilleCityNm
State AbbreviationKSStateAbbreviationCd
ZIP67337ZIPCd
FieldValueIRS element (for citing)
Recipient EIN481178846RecipientEIN
IRC Section501(C)(3)IRCSectionDesc
Cash Grant$19,975CashGrantAmt
Non Cash Assistance$81,204NonCashAssistanceAmt
Valuation Method UsedProperty appraisalValuationMethodUsedDesc
Non Cash AssistanceReal estateNonCashAssistanceDesc
Purpose Of GrantTo give property and purchase medical equipment and furnishings for Coffeyville Regional Medical Center.PurposeOfGrantTxt
FieldValueIRS element (for citing)
Total501c3 Org1Total501c3OrgCnt
Total Other Org0TotalOtherOrgCnt

Grants Other Asst To Indiv In US GrantsOtherAsstToIndivInUSGrp

FieldValueIRS element (for citing)
Grant TypeTuition assistance for students enrolled in a health care field and grants to CRMC employees for emergency assistance.GrantTypeTxt
Recipient28RecipientCnt
Cash Grant$22,750CashGrantAmt

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferenceSchedule I, Part I, Line 2 Procedures for monitoring use of grant funds.FormAndLineReferenceDesc
ExplanationAmounts dispersed to the Medical Center and Medical Center employees for emergency assistance are made in response to specific requests. These requests are considered and approved by the Foundation's board. Tuition assistance is approved for disbursement from the Foundation board based on a review of scholarship applications. Disbursements for scholarships are written to the student's university.ExplanationTxt

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (3 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Form 990, Part VI, Line 11b Review of form 990 by governing bodyAn independent accounting firm prepares and reviews the Form 990. The return is then reviewed by the Organization's CFO, COO and Controller. Any questions or concerns are addressed, and any corrections or clarifications are made. The final Form 990, with all required schedules, is provided to the entire board prior to filing the 990.
Form 990, Part VI, Line 12c Conflict of interest policyA conflict of interest disclosure form is provided with a copy of the conflict of interest policy. This disclosure is completed by each member of the board upon election and annually thereafter. If a conflict of interest is discovered, the member concerned is not allowed to vote on the related matter.
Form 990, Part VI, Line 19 Required documents available to the publicThe organization makes its governing documents, conflict of interest policy, and financial statements available to the public upon written request.

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp

Disregarded Entity Name DisregardedEntityName

FieldValueIRS element (for citing)
Business Name Line1Coffeyville Regional Medical Center IncBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line11400 W 4th StreetAddressLine1Txt
CityCoffeyvilleCityNm
State AbbreviationKSStateAbbreviationCd
ZIP67337ZIPCd
FieldValueIRS element (for citing)
EIN481178846EIN
Primary ActivitiesAcute care hospital providing medical care and services.PrimaryActivitiesTxt
Legal Domicile StateKSLegalDomicileStateCd
Exempt Code Section501(c)(3)ExemptCodeSectionTxt
Public Charity Status3PublicCharityStatusTxt

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1NABusinessNameLine1Txt
FieldValueIRS element (for citing)
Controlled OrganizationfalseControlledOrganizationInd
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts RyltsfalseReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth OrgYes (true)GiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth OrgfalseGiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other OrgYes (true)LoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth OrgfalseLoansOrGuaranteesFromOthOrgInd
Div Related OrganizationfalseDivRelatedOrganizationInd
Asset Sale To Other OrgfalseAssetSaleToOtherOrgInd
Asset Purchase From Other OrgfalseAssetPurchaseFromOtherOrgInd
Asset ExchangefalseAssetExchangeInd
Rental Of Facilities To Oth OrgfalseRentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth OrgfalseRentalOfFcltsFromOthOrgInd
Perform Of Services For Oth OrgYes (true)PerformOfServicesForOthOrgInd
Perform Of Services By Other OrgfalsePerformOfServicesByOtherOrgInd
Sharing Of FacilitiesYes (true)SharingOfFacilitiesInd
Paid Employees SharingYes (true)PaidEmployeesSharingInd
Reimbursement Paid To Other OrgfalseReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other OrgfalseReimbursementPaidByOtherOrgInd
Transfer To Other OrgfalseTransferToOtherOrgInd
Transfer From Other OrgfalseTransferFromOtherOrgInd