COFFEYVILLE REGIONAL MEDICAL CENTER FOUNDATION: Form 990, tax year 2021
View the entire original 990 at ProPublica ↗
- Organization
- COFFEYVILLE REGIONAL MEDICAL CENTER FOUNDATION (EIN 48-0981990)
- Tax period
- 2021-01-01 to 2021-12-31
- Filed
- 2022-08-09
- IRS object ID
- 202232219349301313
- Schema version
- 2021v4.2
- 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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2022-08-09T13:50:51-05:00 | ReturnTs |
| Tax Period End | 2021-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 481026809 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Wendling Noe Nelson & Johnson LLC | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 623 SW 10th Ave Suite 300 | AddressLine1Txt |
| City | Topeka | CityNm |
| State Abbreviation | KS | StateAbbreviationCd |
| ZIP | 66612 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2021-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 480981990 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Coffeyville Regional Medical Center | BusinessNameLine1Txt |
| Business Name Line2 | Foundation Inc | BusinessNameLine2Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | COFF | BusinessNameControlTxt |
| Phone | 6202521674 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1400 W 4th Street | AddressLine1Txt |
| City | Coffeyville | CityNm |
| State Abbreviation | KS | StateAbbreviationCd |
| ZIP | 67337 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Lisa Kuehn | PersonNm |
| Person Title | Director of Development | PersonTitleTxt |
| Phone | 6202521674 | PhoneNum |
| Signature | 2022-07-28 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | Lisa | PersonFirstNm |
| Person Last | Kuehn | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Eric L Otting | PreparerPersonNm |
| PTIN | P00298454 | PTIN |
| Phone | 7852334226 | PhoneNum |
| Preparation | 2022-07-24 | PreparationDt |
Additional Filer Information AdditionalFilerInformation
Trusted Customer TrustedCustomerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | 3 | TrustedCustomerCd |
| Authentication Assurance Level | AAL1 | AuthenticationAssuranceLevelCd |
| Identity Assurance Level | IAL1 | IdentityAssuranceLevelCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2021 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | Lisa Kuehn | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1400 W 4th Street | AddressLine1Txt |
| City | Coffeyville | CityNm |
| State Abbreviation | KS | StateAbbreviationCd |
| ZIP | 67337 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $400,226 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | www.crmcinc.org | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1984 | FormationYr |
| Legal Domicile State | KS | LegalDomicileStateCd |
| Activity Or Mission | To 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 Body | 10 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 10 | VotingMembersIndependentCnt |
| Total Employee | 0 | TotalEmployeeCnt |
| Total Volunteers | 50 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $141,629 | PYContributionsGrantsAmt |
| CY Contributions Grants | $277,732 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $0 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $0 | CYProgramServiceRevenueAmt |
| PY Investment Income | $88,437 | PYInvestmentIncomeAmt |
| CY Investment Income | $101,298 | CYInvestmentIncomeAmt |
| PY Other Revenue | $7,769 | PYOtherRevenueAmt |
| CY Other Revenue | $4,515 | CYOtherRevenueAmt |
| PY Total Revenue | $237,835 | PYTotalRevenueAmt |
| CY Total Revenue | $383,545 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $474,069 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $126,149 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $0 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $0 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $18,026 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $20,114 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $36,417 | PYOtherExpensesAmt |
| CY Other Expenses | $34,978 | CYOtherExpensesAmt |
| PY Total Expenses | $510,486 | PYTotalExpensesAmt |
| CY Total Expenses | $179,153 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$272,651 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $204,392 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $2,336,098 | TotalAssetsBOYAmt |
| Total Assets EOY | $2,701,431 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $0 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $210 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $2,336,098 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $2,701,221 | NetAssetsOrFundBalancesEOYAmt |
| Mission | To 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 Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $115,740 | ExpenseAmt |
| Grant | $115,740 | GrantAmt |
| Desc | Purchase medical equipment and furnishings for Coffeyville Regional Medical Center and forgive loan due from Coffeyville Regional Medical Center. | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $16,598 | ExpenseAmt |
| Grant | $1,908 | GrantAmt |
| Desc | Assistance to Coffeyville Regional Medical Center employees. | Desc |
Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $8,500 | ExpenseAmt |
| Grant | $8,500 | GrantAmt |
| Desc | Scholarship program established to provide individuals who are studying a health-related program with financial assistance. | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expenses | $140,838 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | Yes (1) | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | 0 | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | 0 | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | 0 | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | Yes (1) | ProfessionalFundraisingInd |
| Fundraising Activities | Yes (1) | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | 0 | OperateHospitalInd |
| Grants To Organizations | Yes (1) | GrantsToOrganizationsInd |
| Grants To Individuals | Yes (1) | GrantsToIndividualsInd |
| Schedule J Required | 0 | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | 0 | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 0 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 0 | EmployeeCnt |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | Yes (1) | QuidProQuoContributionsInd |
| Quid Pro Quo Contri Discl | Yes (1) | QuidProQuoContriDisclInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | 0 | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | 0 | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 10 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 10 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | 0 | MembersOrStockholdersInd |
| Election Of Board Members | 0 | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | 0 | WhistleblowerPolicyInd |
| Document Retention Policy | 0 | DocumentRetentionPolicyInd |
| Compensation Process CEO | 0 | CompensationProcessCEOInd |
| Compensation Process Other | 0 | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Lisa Kuehn | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 6202521674 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1400 W 4th Street | AddressLine1Txt |
| City | Coffeyville | CityNm |
| State Abbreviation | KS | StateAbbreviationCd |
| ZIP | 67337 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (11 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd |
|---|---|---|---|---|---|---|
| Doug Bell | ||||||
| Trustee | 1.00 | Yes (X) | $0 | $0 | $0 | |
| Jeff Gossard | ||||||
| Secretary/Treasurer | 1.00 | Yes (X) | $0 | $0 | $0 | Yes (X) |
| Jim Lawrence | ||||||
| Trustee | 1.00 | Yes (X) | $0 | $0 | $0 | |
| Marlon Thornburg | ||||||
| Trustee | 1.00 | Yes (X) | $0 | $0 | $0 | |
| Ann Marie Vannoster | ||||||
| Trustee | 1.00 | Yes (X) | $0 | $0 | $0 | |
| LaKisha Johnson | ||||||
| Trustee | 1.00 | Yes (X) | $0 | $0 | $0 | |
| Laura Nicastro | ||||||
| Trustee | 1.00 | Yes (X) | $0 | $0 | $0 | |
| Jodi Hayse | ||||||
| Trustee/VP Beginning 01/2021 | 1.00 | Yes (X) | $0 | $0 | $0 | Yes (X) |
| Stephanie Richardson | ||||||
| President/Trustee Beginning 01/2021 | 1.00 | Yes (X) | $0 | $0 | $0 | Yes (X) |
| Richard Voss | ||||||
| VP/President Beginning 01/2021 | 1.00 | Yes (X) | $0 | $0 | $0 | Yes (X) |
| Lisa Kuehn | ||||||
| Director of Foundation | 32.00 | $0 | $73,540 | $32,376 | Yes (X) | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $0 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $73,540 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $32,376 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 0 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | 0 | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
| Cntrct Rcvd Greater Than100 K | 0 | CntrctRcvdGreaterThan100KCnt |
| Fundraising | $12,093 | FundraisingAmt |
| All Other Contributions | $265,639 | AllOtherContributionsAmt |
| Total Contributions | $277,732 | TotalContributionsAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $52,425 | TotalRevenueColumnAmt |
| Exclusion | $52,425 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $48,873 | SecuritiesAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $0 | SecuritiesAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $48,873 | SecuritiesAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $48,873 | TotalRevenueColumnAmt |
| Exclusion | $48,873 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Fundraising Gross Income | $21,196 | FundraisingGrossIncomeAmt |
| Contri Rpt Fundraising Event | $12,093 | ContriRptFundraisingEventAmt |
| Fundraising Direct Expenses | $16,681 | FundraisingDirectExpensesAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $4,515 | TotalRevenueColumnAmt |
| Exclusion | $4,515 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $383,545 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $0 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $105,813 | ExclusionAmt |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $115,740 | TotalAmt |
| Program Services | $115,740 | ProgramServicesAmt |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $10,409 | TotalAmt |
| Program Services | $10,409 | ProgramServicesAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $8,431 | TotalAmt |
| Management And General | $8,431 | ManagementAndGeneralAmt |
Fees For Services Prof Fundraising FeesForServicesProfFundraising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $18,026 | TotalAmt |
| Fundraising | $18,026 | FundraisingAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,819 | TotalAmt |
| Management And General | $5,819 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $703 | TotalAmt |
| Management And General | $703 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $558 | TotalAmt |
| Management And General | $558 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (3 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt | FundraisingFundraisingAmt |
|---|---|---|---|---|
| Other Program Activitie | $14,689 | $14,689 | ||
| Miscellaneous | $4,673 | $2,585 | $2,088 | |
| Dues and Subscriptions | $105 | $105 |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $179,153 | TotalAmt |
| Program Services | $140,838 | ProgramServicesAmt |
| Management And General | $18,201 | ManagementAndGeneralAmt |
| Fundraising | $20,114 | FundraisingAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $243,587 | BOYAmt |
| EOY | $181,530 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $388,577 | BOYAmt |
| EOY | $388,577 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $97,016 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $52,849 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,958 | BOYAmt |
| EOY | $44,167 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,677,710 | BOYAmt |
| EOY | $2,069,671 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $22,266 | BOYAmt |
| EOY | $17,486 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,336,098 | BOYAmt |
| EOY | $2,701,431 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $210 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $210 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows FASB117 | Yes (X) | OrganizationFollowsFASB117Ind |
No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,457,332 | BOYAmt |
| EOY | $2,008,146 | EOYAmt |
Donor Restriction Net Assets DonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $878,766 | BOYAmt |
| EOY | $693,075 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,336,098 | BOYAmt |
| EOY | $2,701,221 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,336,098 | BOYAmt |
| EOY | $2,701,431 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $204,392 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $160,731 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Info In Schedule O Part XII | Yes (X) | InfoInScheduleOPartXIIInd |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | Yes (1) | AccountantCompileOrReviewInd |
Acct Compile Or Review Basis AcctCompileOrReviewBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Separate Basis Fincl Stmt | Yes (X) | SeparateBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| FS Audited | 0 | FSAuditedInd |
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Organization170 | Yes (X) | PublicOrganization170Ind |
Gifts Grants Contri Rcvd170 GiftsGrantsContriRcvd170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $44,344 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $273,776 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $183,257 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $163,834 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $265,639 | CurrentTaxYearAmt |
| Total | $930,850 | TotalAmt |
Total Calendar Year170 TotalCalendarYear170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $44,344 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $273,776 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $183,257 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $163,834 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $265,639 | CurrentTaxYearAmt |
| Total | $930,850 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Substantial Contributors Tot | $339,050 | SubstantialContributorsTotAmt |
| Public Support Total170 | $591,800 | PublicSupportTotal170Amt |
Gross Investment Income170 GrossInvestmentIncome170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $49,491 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $59,845 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $61,742 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $66,631 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $52,425 | CurrentTaxYearAmt |
| Total | $290,134 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Support | $1,220,984 | TotalSupportAmt |
| Public Support CY170 | 0.48470 | PublicSupportCY170Pct |
| Public Support PY170 | 0.54530 | PublicSupportPY170Pct |
| Thirty Thr Pct Suprt Tests CY170 | Yes (X) | ThirtyThrPctSuprtTestsCY170Ind |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule D IRS990ScheduleD
CY Endwmt Fund CYEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $400,668 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $62,314 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $62,314 | OtherExpendituresAmt |
| End Year Balance | $400,668 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $370,668 | BeginningYearBalanceAmt |
| Contributions | $30,000 | ContributionsAmt |
| Investment Earnings Or Losses | $17,809 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $17,809 | OtherExpendituresAmt |
| End Year Balance | $400,668 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $370,668 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $22,011 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $22,011 | OtherExpendituresAmt |
| End Year Balance | $370,668 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $370,668 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $28,901 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $28,901 | OtherExpendituresAmt |
| End Year Balance | $370,668 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $370,668 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $33,894 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $33,894 | OtherExpendituresAmt |
| End Year Balance | $370,668 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Prmnnt Endowment Balance EOY | 1.00000 | PrmnntEndowmentBalanceEOYPct |
| Endowments Held Unrelated Org | 0 | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | 0 | EndowmentsHeldRelatedOrgInd |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $40,767 | OtherCostOrOtherBasisAmt |
| Book Value | $40,767 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $32,533 | OtherCostOrOtherBasisAmt |
| Depreciation | $29,133 | DepreciationAmt |
| Book Value | $3,400 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $23,716 | OtherCostOrOtherBasisAmt |
| Depreciation | $23,716 | DepreciationAmt |
| Book Value | $0 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $44,167 | TotalBookValueLandBuildingsAmt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part V, Line 4: | FormAndLineReferenceDesc |
| Explanation | The intended use of the Foundation's endowment funds are to provide students who need financial assistance and have a great desire to become a dietitian with an educational scholarship. Unallocated earnings can be used at the discretion of the Board. | ExplanationTxt |
Schedule G IRS990ScheduleG
| Field | Value | IRS element (for citing) |
|---|---|---|
| Email Solicitations | Yes (X) | EmailSolicitationsInd |
| In Person Solicitations | Yes (X) | InPersonSolicitationsInd |
| Solicitation Of Non Govt Grants | Yes (X) | SolicitationOfNonGovtGrantsInd |
| Special Fundraising Events | Yes (X) | SpecialFundraisingEventsInd |
| Agrmt Prof Fundraising Acty | Yes (1) | AgrmtProfFundraisingActyInd |
Fundraiser Activity Info FundraiserActivityInfoGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Keller Consulting | PersonNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 5028 Wyoming Street | AddressLine1Txt |
| City | Kansas City | CityNm |
| State Abbreviation | MO | StateAbbreviationCd |
| ZIP | 64112 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activity | Fundraising Feasibility Assessment | ActivityTxt |
| Fundraiser Control Of Funds | 0 | FundraiserControlOfFundsInd |
| Gross Receipts | $0 | GrossReceiptsAmt |
| Retained By Contractor | $18,025 | RetainedByContractorAmt |
| Net To Organization | $0 | NetToOrganizationAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Retained By Contractors | $18,025 | TotalRetainedByContractorsAmt |
Fundraising Event Information FundraisingEventInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Event1 | Mum sales | Event1Nm |
| Gross Receipts Event1 | $13,196 | GrossReceiptsEvent1Amt |
| Charitable Contri Event1 | $0 | CharitableContriEvent1Amt |
| Gross Revenue Event1 | $13,196 | GrossRevenueEvent1Amt |
| Other Direct Expenses Event1 | $8,400 | OtherDirectExpensesEvent1Amt |
| Event2 | Golf Tournament | Event2Nm |
| Gross Receipts Event2 | $20,093 | GrossReceiptsEvent2Amt |
| Charitable Contri Event2 | $12,093 | CharitableContriEvent2Amt |
| Gross Revenue Event2 | $8,000 | GrossRevenueEvent2Amt |
| Non Cash Prizes Event2 | $691 | NonCashPrizesEvent2Amt |
| Rent Facility Costs Event2 | $2,000 | RentFacilityCostsEvent2Amt |
| Food And Beverage Event2 | $2,116 | FoodAndBeverageEvent2Amt |
| Other Direct Expenses Event2 | $3,474 | OtherDirectExpensesEvent2Amt |
| Gross Receipts Total | $33,289 | GrossReceiptsTotalAmt |
| Charitable Contributions Tot | $12,093 | CharitableContributionsTotAmt |
| Gross Revenue Total Events | $21,196 | GrossRevenueTotalEventsAmt |
| Non Cash Prizes Total Events | $691 | NonCashPrizesTotalEventsAmt |
| Rent Fclty Costs Total Events | $2,000 | RentFcltyCostsTotalEventsAmt |
| Food And Beverage Total Events | $2,116 | FoodAndBeverageTotalEventsAmt |
| Oth Direct Expnss Total Events | $11,874 | OthDirectExpnssTotalEventsAmt |
| Direct Expense Summary Events | $16,681 | DirectExpenseSummaryEventsAmt |
| Net Income Summary | $4,515 | NetIncomeSummaryAmt |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (1) | GrantRecordsMaintainedInd |
Recipient Table RecipientTable
Recipient Business Name RecipientBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Coffeyville Regional Medical Center Inc | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1400 W 4th Street | AddressLine1Txt |
| City | Coffeyville | CityNm |
| State Abbreviation | KS | StateAbbreviationCd |
| ZIP | 67337 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Recipient EIN | 481178846 | RecipientEIN |
| IRC Section | 501(c)(3) | IRCSectionDesc |
| Cash Grant | $115,740 | CashGrantAmt |
| Non Cash Assistance | $0 | NonCashAssistanceAmt |
| Purpose Of Grant | To purchase medical equipment and furnishings for Coffeyville Regional Medical Center. | PurposeOfGrantTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 1 | Total501c3OrgCnt |
Grants Other Asst To Indiv In US GrantsOtherAsstToIndivInUSGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Type | Tuition assistance for students enrolled in a health care field and grants to CRMC employees for emergency assistance. | GrantTypeTxt |
| Recipient | 16 | RecipientCnt |
| Cash Grant | $10,409 | CashGrantAmt |
| Valuation Method Used | Cash paid | ValuationMethodUsedDesc |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part I, Line 2: | FormAndLineReferenceDesc |
| Explanation | Amounts 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 (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part VI, Section B, line 11b | Form 990 was provided to the organization's governing body before it was filed. |
| Form 990, Part VI, Section B, line 12c | The organization reviews concerns as they are brought to the attention of management. |
| 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 written request. |
| Form 990, Part XII, line 2c | The board is provided a copy of the financial statement review report for review and approval. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp
Disregarded Entity Name DisregardedEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Coffeyville Regional Medical Center Inc | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1400 W 4th Street | AddressLine1Txt |
| City | Coffeyville | CityNm |
| State Abbreviation | KS | StateAbbreviationCd |
| ZIP | 67337 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 481178846 | EIN |
| Primary Activities | Acute care hospital providing medical care and services. | PrimaryActivitiesTxt |
| Legal Domicile State | KS | LegalDomicileStateCd |
| Exempt Code Section | 501(c)(3) | ExemptCodeSectionTxt |
| Public Charity Status | Line 3 | PublicCharityStatusTxt |
| Controlled Organization | 0 | ControlledOrganizationInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | Yes (1) | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | 0 | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | Yes (1) | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | Yes (1) | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | 0 | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (1) | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |