COFFEYVILLE REGIONAL MEDICAL CENTER FOUNDATION: Form 990, tax year 2024
View the entire original 990 at ProPublica ↗
- Organization
- COFFEYVILLE REGIONAL MEDICAL CENTER FOUNDATION (EIN 48-0981990)
- Tax period
- 2024-01-01 to 2024-12-31
- Filed
- 2025-11-17
- IRS object ID
- 202523219349326487
- Schema version
- 2024v5.1
- 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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2025-11-17T19:53:55+00:00 | ReturnTs |
| Tax Period End | 2024-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 440160260 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Forvis Mazars LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1551 N Waterfront Pkwy Ste 300 | AddressLine1Txt |
| City | Wichita | CityNm |
| State Abbreviation | KS | StateAbbreviationCd |
| ZIP | 672066601 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2024-01-01 | 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 FOUNDATION INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | COFF | BusinessNameControlTxt |
| Phone | 6202521659 | 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 | Amy Taylor | PersonNm |
| Person Title | Director of Foundation | PersonTitleTxt |
| Phone | 6202521659 | PhoneNum |
| Signature | 2025-11-18 | SignatureDt |
| Discuss With Paid Preparer | Yes (true) | DiscussWithPaidPreparerInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IRS Responsible Prty Info Curr | Yes (true) | IRSResponsiblePrtyInfoCurrInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Kevin Ensminger | PreparerPersonNm |
| PTIN | P01310558 | PTIN |
| Phone | 3162652811 | PhoneNum |
| Preparation | 2025-11-18 | PreparationDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2024 | TaxYr |
| Build TS | 2025-03-06 01:10:19Z | BuildTS |
Form 990 IRS990
Principal Ofcr Business Name PrincipalOfcrBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Amy Taylor | 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) |
|---|---|---|
| Gross Receipts | $768,194 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.CRMCINC.ORG/FOUNDATION | 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 | 12 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 12 | VotingMembersIndependentCnt |
| Total Employee | 0 | TotalEmployeeCnt |
| Total Volunteers | 35 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| PY Contributions Grants | $381,915 | PYContributionsGrantsAmt |
| CY Contributions Grants | $695,649 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $0 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $0 | CYProgramServiceRevenueAmt |
| PY Investment Income | $78,005 | PYInvestmentIncomeAmt |
| CY Investment Income | $57,966 | CYInvestmentIncomeAmt |
| PY Other Revenue | $15,863 | PYOtherRevenueAmt |
| CY Other Revenue | $3,307 | CYOtherRevenueAmt |
| PY Total Revenue | $475,783 | PYTotalRevenueAmt |
| CY Total Revenue | $756,922 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $123,929 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $146,408 | 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 | $6,570 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $44,924 | PYOtherExpensesAmt |
| CY Other Expenses | $59,724 | CYOtherExpensesAmt |
| PY Total Expenses | $168,853 | PYTotalExpensesAmt |
| CY Total Expenses | $206,132 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $306,930 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $550,790 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $2,783,251 | TotalAssetsBOYAmt |
| Total Assets EOY | $3,505,896 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $105 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $370 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $2,783,146 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $3,505,526 | 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 | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $143,008 | ExpenseAmt |
| Grant | $143,008 | 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 | $3,000 | ExpenseAmt |
| Grant | $3,000 | GrantAmt |
| Desc | SCHOLARSHIP PROGRAM ESTABLISHED TO PROVIDE INDIVIDUALS WHO ARE STUDYING A HEALTH-RELATED PROGRAM WITH FINANCIAL ASSISTANCE. | Desc |
Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $400 | ExpenseAmt |
| Grant | $400 | GrantAmt |
| Desc | ASSISTANCE TO COFFEYVILLE REGIONAL MEDICAL CENTER EMPLOYEES. | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expenses | $146,408 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (true) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (true) | ScheduleBRequiredInd |
| Political Campaign Acty | false | PoliticalCampaignActyInd |
| Lobbying Activities | false | LobbyingActivitiesInd |
| Subject To Proxy Tax | false | SubjectToProxyTaxInd |
| Donor Advised Fund | false | DonorAdvisedFundInd |
| Conservation Easements | false | ConservationEasementsInd |
| Collections Of Art | false | CollectionsOfArtInd |
| Credit Counseling | false | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | Yes (true) | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (true) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | false | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | false | ReportProgramRelatedInvstInd |
| Report Other Assets | false | ReportOtherAssetsInd |
| Report Other Liabilities | false | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | false | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | false | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | false | ConsolidatedAuditFinclStmtInd |
| School Operating | false | SchoolOperatingInd |
| Foreign Office | false | ForeignOfficeInd |
| Foreign Activities | false | ForeignActivitiesInd |
| More Than5000 K To Org | false | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividualsInd |
| Professional Fundraising | false | ProfessionalFundraisingInd |
| Fundraising Activities | Yes (true) | FundraisingActivitiesInd |
| Gaming Activities | false | GamingActivitiesInd |
| Operate Hospital | false | OperateHospitalInd |
| Grants To Organizations | Yes (true) | GrantsToOrganizationsInd |
| Grants To Individuals | false | GrantsToIndividualsInd |
| Schedule J Required | Yes (true) | ScheduleJRequiredInd |
| Tax Exempt Bonds | false | TaxExemptBondsInd |
| Escrow Account | false | EscrowAccountInd |
| On Behalf Of Issuer | false | OnBehalfOfIssuerInd |
| Engaged In Excess Benefit Trans | false | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | false | PYExcessBenefitTransInd |
| Loan Outstanding | false | LoanOutstandingInd |
| Grant To Related Person | false | GrantToRelatedPersonInd |
| Business Rln With Org Mem | false | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | false | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | false | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | false | DeductibleNonCashContriInd |
| Deductible Art Contribution | false | DeductibleArtContributionInd |
| Terminate Operations | false | TerminateOperationsInd |
| Partial Liquidation | false | PartialLiquidationInd |
| Disregarded Entity | false | DisregardedEntityInd |
| Related Entity | false | RelatedEntityInd |
| Related Organization Ctrl Ent | false | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | false | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | false | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | false | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (true) | ScheduleORequiredInd |
| IRP Document | 0 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 0 | EmployeeCnt |
| Unrelated Bus Incm Over Limit | false | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | false | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | false | TaxablePartyNotificationInd |
| Nondeductible Contributions | false | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | Yes (true) | QuidProQuoContributionsInd |
| Quid Pro Quo Contri Discl | Yes (true) | QuidProQuoContriDisclInd |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | false | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | false | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | false | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | false | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | false | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 12 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 12 | IndependentVotingMemberCnt |
| Family Or Business Rln | false | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | false | DelegationOfMgmtDutiesInd |
| Change To Org Documents | false | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | false | MembersOrStockholdersInd |
| Election Of Board Members | false | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | false | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (true) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (true) | MinutesOfCommitteesInd |
| Officer Mailing Address | false | OfficerMailingAddressInd |
| Local Chapters | false | LocalChaptersInd |
| Policies Reference Chapters | false | PoliciesReferenceChaptersInd |
| Form990 Provided To Gvrn Body | Yes (true) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (true) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (true) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (true) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | false | WhistleblowerPolicyInd |
| Document Retention Policy | false | DocumentRetentionPolicyInd |
| Compensation Process CEO | false | CompensationProcessCEOInd |
| Compensation Process Other | false | CompensationProcessOtherInd |
| Investment In Joint Venture | false | InvestmentInJointVentureInd |
| Written Policy Or Procedure | false | WrittenPolicyOrProcedureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Amy Taylor | 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 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| No Listed Persons Compensated | Yes (X) | NoListedPersonsCompensatedInd |
Form990 Part VII Section A Form990PartVIISectionAGrp (13 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt |
|---|---|---|---|---|---|---|---|
| Doug Bell | |||||||
| Chairman | 1.0 | 0.0 | Yes (X) | Yes (X) | $0 | $0 | $0 |
| Laura Nicastro | |||||||
| Secretary / Treasurer | 1.0 | 0.0 | Yes (X) | Yes (X) | $0 | $0 | $0 |
| Richard Voss | |||||||
| Vice Chairman | 1.0 | 0.0 | Yes (X) | Yes (X) | $0 | $0 | $0 |
| Ann Marie Vannoster | |||||||
| Trustee | 1.0 | 0.0 | Yes (X) | $0 | $0 | $0 | |
| Beth Kelly | |||||||
| Trustee | 1.0 | 0.0 | Yes (X) | $0 | $0 | $0 | |
| Jeff Gossard | |||||||
| Trustee | 1.0 | 0.0 | Yes (X) | $0 | $0 | $0 | |
| Jim Lawrence | |||||||
| Trustee | 1.0 | 0.0 | Yes (X) | $0 | $0 | $0 | |
| Jodi Hayse | |||||||
| Trustee | 1.0 | 0.0 | Yes (X) | $0 | $0 | $0 | |
| Judy Hiner | |||||||
| Trustee | 1.0 | 0.0 | Yes (X) | $0 | $0 | $0 | |
| Kris Crane | |||||||
| Trustee | 1.0 | 0.0 | Yes (X) | $0 | $0 | $0 | |
| LaKisha Johnson | |||||||
| Trustee | 1.0 | 0.0 | Yes (X) | $0 | $0 | $0 | |
| Marlon Thornburg | |||||||
| Trustee | 1.0 | 0.0 | Yes (X) | $0 | $0 | $0 | |
| Amy Taylor | |||||||
| Director of Foundation | 40.0 | 0.0 | Yes (X) | $67,154 | $0 | $39,175 | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $67,154 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $39,175 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 0 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | false | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | false | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | Yes (true) | CompensationFromOtherSrcsInd |
| Cntrct Rcvd Greater Than100 K | 0 | CntrctRcvdGreaterThan100KCnt |
| Fundraising | $21,110 | FundraisingAmt |
| All Other Contributions | $674,539 | AllOtherContributionsAmt |
| Total Contributions | $695,649 | TotalContributionsAmt |
Total Oth Program Service Rev TotalOthProgramServiceRevGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $0 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $0 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $0 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $57,966 | TotalRevenueColumnAmt |
| Exclusion | $57,966 | ExclusionAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $0 | RealAmt |
| Personal | $0 | PersonalAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $0 | SecuritiesAmt |
| Other | $0 | OtherAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Fundraising Gross Income | $14,579 | FundraisingGrossIncomeAmt |
| Contri Rpt Fundraising Event | $21,110 | ContriRptFundraisingEventAmt |
| Fundraising Direct Expenses | $11,272 | FundraisingDirectExpensesAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $3,307 | TotalRevenueColumnAmt |
| Exclusion | $3,307 | ExclusionAmt |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $0 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $0 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $0 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $756,922 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $0 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $61,273 | ExclusionAmt |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $143,008 | TotalAmt |
| Program Services | $143,008 | ProgramServicesAmt |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,400 | TotalAmt |
| Program Services | $3,400 | ProgramServicesAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $14,280 | TotalAmt |
| Management And General | $14,280 | ManagementAndGeneralAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $20,160 | TotalAmt |
| Management And General | $20,160 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,342 | TotalAmt |
| Program Services | $0 | ProgramServicesAmt |
| Management And General | $0 | ManagementAndGeneralAmt |
| Fundraising | $4,342 | FundraisingAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,348 | TotalAmt |
| Management And General | $2,348 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $559 | TotalAmt |
| Management And General | $559 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | Miscellaneous | Desc |
| Total | $18,035 | TotalAmt |
| Management And General | $15,807 | ManagementAndGeneralAmt |
| Fundraising | $2,228 | FundraisingAmt |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
| Program Services | $0 | ProgramServicesAmt |
| Management And General | $0 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $206,132 | TotalAmt |
| Program Services | $146,408 | ProgramServicesAmt |
| Management And General | $53,154 | ManagementAndGeneralAmt |
| Fundraising | $6,570 | FundraisingAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $425,297 | BOYAmt |
| EOY | $944,714 | EOYAmt |
Receivables From Officers Etc ReceivablesFromOfficersEtcGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $388,577 | BOYAmt |
| EOY | $888,577 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $56,493 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $55,085 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,942 | BOYAmt |
| EOY | $1,408 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,932,303 | BOYAmt |
| EOY | $1,639,698 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $35,132 | BOYAmt |
| EOY | $31,499 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,783,251 | BOYAmt |
| EOY | $3,505,896 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $105 | BOYAmt |
| EOY | $370 | EOYAmt |
Loans From Officers Directors LoansFromOfficersDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $105 | BOYAmt |
| EOY | $370 | 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 | $1,925,948 | BOYAmt |
| EOY | $2,390,625 | EOYAmt |
Donor Restriction Net Assets DonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $857,198 | BOYAmt |
| EOY | $1,114,901 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,783,146 | BOYAmt |
| EOY | $3,505,526 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,783,251 | BOYAmt |
| EOY | $3,505,896 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $550,790 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $171,590 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | Yes (true) | 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 | false | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Separate Basis Fincl Stmt | Yes (X) | SeparateBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (true) | AuditCommitteeInd |
| Federal Grant Audit Required | false | 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 | $163,834 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $265,639 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $298,779 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $381,915 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $695,649 | CurrentTaxYearAmt |
| Total | $1,805,816 | TotalAmt |
Tax Rev Levied Orgnztnl Bnft170 TaxRevLeviedOrgnztnlBnft170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Govt Furn Srvc Fclts Vl170 GovtFurnSrvcFcltsVl170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Total Calendar Year170 TotalCalendarYear170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $163,834 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $265,639 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $298,779 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $381,915 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $695,649 | CurrentTaxYearAmt |
| Total | $1,805,816 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Substantial Contributors Tot | $760,552 | SubstantialContributorsTotAmt |
| Public Support Total170 | $1,045,264 | PublicSupportTotal170Amt |
Gross Investment Income170 GrossInvestmentIncome170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $66,631 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $52,425 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $57,833 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $66,722 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $57,966 | CurrentTaxYearAmt |
| Total | $301,577 | TotalAmt |
Unrelated Business Net Incm170 UnrelatedBusinessNetIncm170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Other Income170 OtherIncome170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $0 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $0 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $0 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $15,863 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $3,307 | CurrentTaxYearAmt |
| Total | $19,170 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Support | $2,126,563 | TotalSupportAmt |
| Gross Receipts Rltd Activities | $0 | GrossReceiptsRltdActivitiesAmt |
| Public Support CY170 | 0.49153 | PublicSupportCY170Pct |
| Public Support PY170 | 0.48990 | PublicSupportPY170Pct |
| Thirty Thr Pct Suprt Tests CY170 | Yes (X) | ThirtyThrPctSuprtTestsCY170Ind |
Form990 Schedule A Part VI Form990ScheduleAPartVIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Schedule A, Part II, Line 10 Other Income | FormAndLineReferenceDesc |
| Explanation | DESCRIPTION - EVENT INCOME, COLUMN A - , COLUMN B - , COLUMN C - , COLUMN D - 15863.0, COLUMN E - 3307.0, COLUMN F - 19170.0; | ExplanationTxt |
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 | $50,272 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $50,272 | OtherExpendituresAmt |
| End Year Balance | $400,668 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $400,668 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $67,813 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $67,813 | OtherExpendituresAmt |
| End Year Balance | $400,668 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $400,668 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $10,883 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $10,883 | OtherExpendituresAmt |
| End Year Balance | $400,668 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| 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 Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| 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 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Designated Balance EOY | 0.0 | BoardDesignatedBalanceEOYPct |
| Prmnnt Endowment Balance EOY | 1.0 | PrmnntEndowmentBalanceEOYPct |
| Term Endowment Balance EOY | 0.0 | TermEndowmentBalanceEOYPct |
| Endowments Held Unrelated Org | false | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | false | EndowmentsHeldRelatedOrgInd |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $32,558 | OtherCostOrOtherBasisAmt |
| Depreciation | $31,369 | DepreciationAmt |
| Book Value | $1,189 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $23,935 | OtherCostOrOtherBasisAmt |
| Depreciation | $23,716 | DepreciationAmt |
| Book Value | $219 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $1,408 | TotalBookValueLandBuildingsAmt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Schedule D, Part V, Line 4 Intended uses of endowment funds | FormAndLineReferenceDesc |
| Explanation | The 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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Event1 | GOLF TOURNAMENT | Event1Nm |
| Gross Receipts Event1 | $35,689 | GrossReceiptsEvent1Amt |
| Charitable Contri Event1 | $21,110 | CharitableContriEvent1Amt |
| Gross Revenue Event1 | $14,579 | GrossRevenueEvent1Amt |
| Non Cash Prizes Event1 | $2,059 | NonCashPrizesEvent1Amt |
| Rent Facility Costs Event1 | $4,056 | RentFacilityCostsEvent1Amt |
| Food And Beverage Event1 | $3,638 | FoodAndBeverageEvent1Amt |
| Other Direct Expenses Event1 | $1,519 | OtherDirectExpensesEvent1Amt |
| Gross Revenue Event2 | $0 | GrossRevenueEvent2Amt |
| Gross Revenue Other Events | $0 | GrossRevenueOtherEventsAmt |
| Gross Receipts Total | $35,689 | GrossReceiptsTotalAmt |
| Charitable Contributions Tot | $21,110 | CharitableContributionsTotAmt |
| Gross Revenue Total Events | $14,579 | GrossRevenueTotalEventsAmt |
| Non Cash Prizes Total Events | $2,059 | NonCashPrizesTotalEventsAmt |
| Rent Fclty Costs Total Events | $4,056 | RentFcltyCostsTotalEventsAmt |
| Food And Beverage Total Events | $3,638 | FoodAndBeverageTotalEventsAmt |
| Oth Direct Expnss Total Events | $1,519 | OthDirectExpnssTotalEventsAmt |
| Direct Expense Summary Events | $11,272 | DirectExpenseSummaryEventsAmt |
| Net Income Summary | $3,307 | NetIncomeSummaryAmt |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (true) | 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 | $113,600 | CashGrantAmt |
| Non Cash Assistance | $29,408 | NonCashAssistanceAmt |
| Valuation Method Used | PROPERTY APPRAISAL | ValuationMethodUsedDesc |
| Non Cash Assistance | REAL ESTATE | NonCashAssistanceDesc |
| Purpose Of Grant | TO GIVE PROPERTY AND PURCHASE MEDICAL EQUIPMENT AND FURNISHINGS FOR COFFEYVILLE REGIONAL MEDICAL CENTER. | PurposeOfGrantTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 1 | Total501c3OrgCnt |
| Total Other Org | 0 | TotalOtherOrgCnt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Schedule I, Part I, Line 2 Procedures for monitoring use of grant funds | 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 J IRS990ScheduleJ
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Amy Taylor | PersonNm |
| Title | Director of Foundation | TitleTxt |
| Base Compensation Filing Org | $67,154 | BaseCompensationFilingOrgAmt |
| Compensation Based On Rltd Orgs | $0 | CompensationBasedOnRltdOrgsAmt |
| Bonus Filing Organization | $0 | BonusFilingOrganizationAmount |
| Bonus Related Organizations | $0 | BonusRelatedOrganizationsAmt |
| Other Compensation Filing Org | $0 | OtherCompensationFilingOrgAmt |
| Other Compensation Rltd Orgs | $0 | OtherCompensationRltdOrgsAmt |
| Deferred Compensation Flng Org | $6,972 | DeferredCompensationFlngOrgAmt |
| Deferred Comp Rltd Orgs | $0 | DeferredCompRltdOrgsAmt |
| Nontaxable Benefits Filing Org | $32,203 | NontaxableBenefitsFilingOrgAmt |
| Nontaxable Benefits Rltd Orgs | $0 | NontaxableBenefitsRltdOrgsAmt |
| Total Compensation Filing Org | $106,329 | TotalCompensationFilingOrgAmt |
| Total Compensation Rltd Orgs | $0 | TotalCompensationRltdOrgsAmt |
| Comp Report Prior990 Filing Org | $0 | CompReportPrior990FilingOrgAmt |
| Comp Report Prior990 Rltd Orgs | $0 | CompReportPrior990RltdOrgsAmt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Schedule J, Part II COMPENSATION FROM AN UNRELATED ORGANIZATION OR INDIVIDUAL | FormAndLineReferenceDesc |
| Explanation | NAME - AMY TAYLOR, COMPENSATION FROM UNRELATED ORGANIZATION - 106329.260000, NAME OF UNRELATED ORGANIZATION - COFFEYVILLE REGIONAL MEDICAL CENTER, TYPE OF COMPENSATION - WAGES | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part VI, Line 11b Review of form 990 by governing body | An 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 policy | A 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 public | The organization makes its governing documents, conflict of interest policy, and financial statements available to the public upon written request. |