COFFEYVILLE REGIONAL MEDICAL CENTER FOUNDATION: Form 990, tax year 2016
View the entire original 990 at ProPublica ↗
- Organization
- COFFEYVILLE REGIONAL MEDICAL CENTER FOUNDATION (EIN 48-0981990)
- Tax period
- 2016-01-01 to 2016-12-31
- Filed
- 2017-10-18
- IRS object ID
- 201712919349300041
- Schema version
- 2016v3.0
- 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 | 2017-10-18T13:02:18-05:00 | ReturnTs |
| Tax Period End | 2016-12-31 | 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 | 534 S Kansas Ave Suite 1500 | AddressLine1Txt |
| City | Topeka | CityNm |
| State Abbreviation | KS | StateAbbreviationCd |
| ZIP | 666033491 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2016-01-01 | 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 | 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 | PO Box 305 | AddressLine1Txt |
| City | Coffeyville | CityNm |
| State Abbreviation | KS | StateAbbreviationCd |
| ZIP | 67337 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Ann Marie Vannoster | PersonNm |
| Person Title | President | PersonTitleTxt |
| Phone | 6202521674 | PhoneNum |
| Signature | 2017-10-02 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Eric L Otting | PreparerPersonNm |
| PTIN | P00298454 | PTIN |
| Phone | 7852334226 | PhoneNum |
| Preparation | 2017-10-02 | PreparationDt |
Filing Security Information FilingSecurityInformation
IP Address IPAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| I Pv4 Address | 98.172.114.81 | IPv4AddressTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IP | 2017-10-02 | IPDt |
| IP Tm | 15:10:35 | IPTm |
| IP Timezone | CD | IPTimezoneCd |
| Filing License Type | P | FilingLicenseTypeCd |
| At Submission Creation Device Id | C25D5B149A5DEB5B624D2ED84480DFAE7FBA67D7 | AtSubmissionCreationDeviceId |
| At Submission Filing Device Id | C25D5B149A5DEB5B624D2ED84480DFAE7FBA67D7 | AtSubmissionFilingDeviceId |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2016 | TaxYr |
| Build TS | 2021-01-29 14:40:06Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | Ann Marie Vannoster | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO Box 305 | AddressLine1Txt |
| City | Coffeyville | CityNm |
| State Abbreviation | KS | StateAbbreviationCd |
| ZIP | 67337 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $173,540 | 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 | 7 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 7 | VotingMembersIndependentCnt |
| Total Employee | 0 | TotalEmployeeCnt |
| Total Volunteers | 40 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $37,372 | PYContributionsGrantsAmt |
| CY Contributions Grants | $67,082 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $0 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $0 | CYProgramServiceRevenueAmt |
| PY Investment Income | $100,510 | PYInvestmentIncomeAmt |
| CY Investment Income | $89,490 | CYInvestmentIncomeAmt |
| PY Other Revenue | $16,155 | PYOtherRevenueAmt |
| CY Other Revenue | $5,850 | CYOtherRevenueAmt |
| PY Total Revenue | $154,037 | PYTotalRevenueAmt |
| CY Total Revenue | $162,422 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $61,012 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $93,485 | 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 | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $3,629 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $37,676 | PYOtherExpensesAmt |
| CY Other Expenses | $46,067 | CYOtherExpensesAmt |
| PY Total Expenses | $98,688 | PYTotalExpensesAmt |
| CY Total Expenses | $139,552 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $55,349 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $22,870 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $2,377,473 | TotalAssetsBOYAmt |
| Total Assets EOY | $2,360,281 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $8,333 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $161 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $2,369,140 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $2,360,120 | 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 | $90,793 | ExpenseAmt |
| Grant | $90,793 | GrantAmt |
| Desc | Purchase medical equipment and furnishings for Coffeyville Regional Medical Center. | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $1,859 | ExpenseAmt |
| Grant | $1,859 | GrantAmt |
| Desc | Cash assistance to Coffeyville Regional Medical Center employees. | Desc |
Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $833 | ExpenseAmt |
| Grant | $833 | GrantAmt |
| Desc | Scholarship program established to provide individuals who are studying a health-related program with financial assistance. | Desc |
Prog Srvc Accom Acty Other ProgSrvcAccomActyOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $18,942 | ExpenseAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Prog Srvc Expense | $18,942 | TotalOtherProgSrvcExpenseAmt |
| Total Program Service Expenses | $112,427 | 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 |
| Temp Or Permanent Endowments | Yes (1) | TempOrPermanentEndowmentsInd |
| 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 | Yes (1) | 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 | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | Yes (1) | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | 0 | OperateHospitalInd |
| Grants To Organizations | Yes (1) | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | 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 With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| 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 | 3 | 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 | 0 | QuidProQuoContributionsInd |
| 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 |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 7 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 7 | 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 | Toni Thomas | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 6202521594 | 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 (9 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt |
|---|---|---|---|---|---|---|
| Doug Bell | ||||||
| Vice President | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 |
| Jeff Gossard | ||||||
| Secretary | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 |
| Jim Lawrence | ||||||
| Trustee | 1.00 | Yes (X) | $0 | $0 | $0 | |
| Steve Miller DO | ||||||
| Trustee | 1.00 | Yes (X) | $0 | $0 | $0 | |
| Marlon Thornburg | ||||||
| Trustee | 1.00 | Yes (X) | $0 | $0 | $0 | |
| Ann Marie Vannoster | ||||||
| President | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 |
| LaKisha Johnson | ||||||
| Trustee | 1.00 | Yes (X) | $0 | $0 | $0 | |
| Lauren Bertram | ||||||
| Former Director of Foundation (01/01-06/30) | 40.00 | Yes (X) | $0 | $13,825 | $1,338 | |
| Cari Redden | ||||||
| Director of Foundation (07/01-) | 40.00 | Yes (X) | $0 | $14,393 | $7,621 | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $0 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $28,218 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $8,959 | 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 | $9,096 | FundraisingAmt |
| All Other Contributions | $57,986 | AllOtherContributionsAmt |
| Noncash Contributions | $1,085 | NoncashContributionsAmt |
| Total Contributions | $67,082 | TotalContributionsAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $45,208 | TotalRevenueColumnAmt |
| Exclusion | $45,208 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $44,282 | 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 | $44,282 | SecuritiesAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $44,282 | TotalRevenueColumnAmt |
| Exclusion | $44,282 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Fundraising Gross Income | $16,968 | FundraisingGrossIncomeAmt |
| Contri Rpt Fundraising Event | $9,096 | ContriRptFundraisingEventAmt |
| Fundraising Direct Expenses | $11,118 | FundraisingDirectExpensesAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $5,850 | TotalRevenueColumnAmt |
| Exclusion | $5,850 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $162,422 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $0 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $95,340 | ExclusionAmt |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $90,793 | TotalAmt |
| Program Services | $90,793 | ProgramServicesAmt |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,692 | TotalAmt |
| Program Services | $2,692 | ProgramServicesAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $12,203 | TotalAmt |
| Management And General | $12,203 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,598 | TotalAmt |
| Program Services | $326 | ProgramServicesAmt |
| Management And General | $6,272 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $847 | TotalAmt |
| Management And General | $847 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $234 | TotalAmt |
| Management And General | $234 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,169 | TotalAmt |
| Management And General | $2,169 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt | FundraisingFundraisingAmt |
|---|---|---|---|---|
| Physician guarantee for | $16,667 | $16,667 | ||
| Miscellaneous | $3,820 | $144 | $47 | $3,629 |
| Contribution expense | $1,805 | $1,805 | ||
| Amortization | $1,500 | $1,500 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $224 | TotalAmt |
| Management And General | $224 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $139,552 | TotalAmt |
| Program Services | $112,427 | ProgramServicesAmt |
| Management And General | $23,496 | ManagementAndGeneralAmt |
| Fundraising | $3,629 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $71,746 | BOYAmt |
| EOY | $0 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $215,688 | BOYAmt |
| EOY | $246,581 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $109,816 | BOYAmt |
| EOY | $15,804 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $56,249 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $41,983 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $16,435 | BOYAmt |
| EOY | $14,266 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,895,958 | BOYAmt |
| EOY | $2,040,794 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $67,830 | BOYAmt |
| EOY | $42,836 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,377,473 | BOYAmt |
| EOY | $2,360,281 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $161 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,333 | BOYAmt |
| EOY | $0 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,333 | BOYAmt |
| EOY | $161 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,300,437 | BOYAmt |
| EOY | $1,395,145 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $698,035 | BOYAmt |
| EOY | $594,307 | EOYAmt |
Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $370,668 | BOYAmt |
| EOY | $370,668 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,369,140 | BOYAmt |
| EOY | $2,360,120 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,377,473 | BOYAmt |
| EOY | $2,360,281 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $22,870 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $44,675 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | -$76,565 | 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 | $179,344 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $107,481 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $50,825 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $37,372 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $67,082 | CurrentTaxYearAmt |
| Total | $442,104 | TotalAmt |
Total Calendar Year170 TotalCalendarYear170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $179,344 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $107,481 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $50,825 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $37,372 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $67,082 | CurrentTaxYearAmt |
| Total | $442,104 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total170 | $442,104 | PublicSupportTotal170Amt |
Gross Investment Income170 GrossInvestmentIncome170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $41,784 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $66,841 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $104,969 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $69,859 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $45,208 | CurrentTaxYearAmt |
| Total | $328,661 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Support | $770,765 | TotalSupportAmt |
| Public Support CY170 | 0.57360 | PublicSupportCY170Pct |
| Public Support PY170 | 0.61590 | 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 | $370,668 | BeginningYearBalanceAmt |
| End Year Balance | $370,668 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $370,668 | BeginningYearBalanceAmt |
| End Year Balance | $370,668 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $370,668 | BeginningYearBalanceAmt |
| End Year Balance | $370,668 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $370,668 | BeginningYearBalanceAmt |
| End Year Balance | $370,668 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $370,668 | BeginningYearBalanceAmt |
| 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 |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $32,533 | OtherCostOrOtherBasisAmt |
| Depreciation | $20,570 | DepreciationAmt |
| Book Value | $11,963 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $23,716 | OtherCostOrOtherBasisAmt |
| Depreciation | $21,413 | DepreciationAmt |
| Book Value | $2,303 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $14,266 | TotalBookValueLandBuildingsAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part V, Line 4: | The intended use of the Foundation's endowment funds are to provide students who needs financial assistance and have a great desire to become a dietitian with a educational scholarship. |
| Part X, Line 2: | Management is not aware of any uncertainties in income tax positions. |
Schedule G IRS990ScheduleG
Fundraising Event Information FundraisingEventInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Event1 | Golf Tournament | Event1Nm |
| Gross Receipts Event1 | $19,314 | GrossReceiptsEvent1Amt |
| Charitable Contri Event1 | $6,591 | CharitableContriEvent1Amt |
| Gross Revenue Event1 | $12,723 | GrossRevenueEvent1Amt |
| Cash Prizes Event1 | $303 | CashPrizesEvent1Amt |
| Non Cash Prizes Event1 | $2,570 | NonCashPrizesEvent1Amt |
| Rent Facility Costs Event1 | $1,055 | RentFacilityCostsEvent1Amt |
| Food And Beverage Event1 | $1,122 | FoodAndBeverageEvent1Amt |
| Other Direct Expenses Event1 | $2,509 | OtherDirectExpensesEvent1Amt |
| Event2 | 5K Spring Chicken Walk/Run | Event2Nm |
| Gross Receipts Event2 | $6,750 | GrossReceiptsEvent2Amt |
| Charitable Contri Event2 | $2,505 | CharitableContriEvent2Amt |
| Gross Revenue Event2 | $4,245 | GrossRevenueEvent2Amt |
| Other Direct Expenses Event2 | $3,559 | OtherDirectExpensesEvent2Amt |
| Gross Receipts Total | $26,064 | GrossReceiptsTotalAmt |
| Charitable Contributions Tot | $9,096 | CharitableContributionsTotAmt |
| Gross Revenue Total Events | $16,968 | GrossRevenueTotalEventsAmt |
| Cash Prizes Total Events | $303 | CashPrizesTotalEventsAmt |
| Non Cash Prizes Total Events | $2,570 | NonCashPrizesTotalEventsAmt |
| Rent Fclty Costs Total Events | $1,055 | RentFcltyCostsTotalEventsAmt |
| Food And Beverage Total Events | $1,122 | FoodAndBeverageTotalEventsAmt |
| Oth Direct Expnss Total Events | $6,068 | OthDirectExpnssTotalEventsAmt |
| Direct Expense Summary Events | $11,118 | DirectExpenseSummaryEventsAmt |
| Net Income Summary | $5,850 | 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 | $90,793 | CashGrantAmt |
| 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 |
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 are sent in response to specific requests. These requests are considered and voted by the Foundation's board before being dispersed. | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (6 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 XI, line 9: | Write off of uncollectible pledges -76,565. |
| Form 990, Part XII, Line 2c: | The board is provided a copy of the financial statement Review Report for review and approval. |
| Form 990, Page 12, Part XI, line 9 | Amount relates to the write-off of pledges deemed uncollectible during FY 2016. |
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 | 0 | 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 |