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COMMUNITY HOWARD REGIONAL HEALTH FOUNDATION INC: Form 990, tax year 2011

View the entire original 990 at ProPublica ↗

Organization
COMMUNITY HOWARD REGIONAL HEALTH FOUNDATION INC (EIN 23-7309596)
Tax period
2011-01-01 to 2011-12-31
Filed
2012-05-15
IRS object ID
201231369349302498
Schema version
2011v1.2
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

FieldValueIRS element (for citing)
Timestamp2012-05-15T11:50:24-05:00Timestamp
Tax Period End Date2011-12-31TaxPeriodEndDate

Preparer Firm PreparerFirm

FieldValueIRS element (for citing)
EIN351724750EIN

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1BUCHERI MCCARTY & METZ LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1PO BOX 2147AddressLine1
CityKOKOMOCity
StateINState
ZIP Code469042147ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2011-01-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN237309596EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1HOWARD REGIONAL HEALTH SYSTEM FOUNDATION INCBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlHOWANameControl
Phone7654538458Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1PO BOX 9011AddressLine1
CityKOKOMOCity
StateINState
ZIP Code469049011ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameJOE DUNBARName
TitleSECRETARY/TREASURERTitle
Phone7654538066Phone
Date Signed2012-05-07DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameG A MCCARTY CPAName
PTINP00040892PTIN
Phone7652362300Phone
FieldValueIRS element (for citing)
Tax Year2011TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonDR SUE SCIAME-GIESECKENameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1PO BOX 9011AddressLine1
CityKOKOMOCity
StateINState
ZIP Code469049011ZIPCode
FieldValueIRS element (for citing)
Gross Receipts1482206GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteWWW.HOWARDREGIONAL.ORGWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1958YearFormation
State Legal DomicileINStateLegalDomicile
Activity Or Mission DescriptionTO IMPROVE THE QUALITY AND AVAILABILITY OF HEALTHCARE PROVIDED TO ALL PERSONS SERVED BY HOWARD REGIONAL HEALTH SYSTEMActivityOrMissionDescription
Nbr Voting Members Governing Body29NbrVotingMembersGoverningBody
Nbr Independent Voting Members0NbrIndependentVotingMembers
Total Nbr Employees0TotalNbrEmployees
Total Nbr Volunteers14TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year421905ContributionsGrantsPriorYear
Contributions Grants Current Year183257ContributionsGrantsCurrentYear
Program Service Revenue Prior Year30567ProgramServiceRevenuePriorYear
Program Service Revenue CY19220ProgramServiceRevenueCY
Investment Income Prior Year109720InvestmentIncomePriorYear
Investment Income Current Year117683InvestmentIncomeCurrentYear
Other Revenue Prior Year28107OtherRevenuePriorYear
Other Revenue Current Year18309OtherRevenueCurrentYear
Total Revenue Prior Year590299TotalRevenuePriorYear
Total Revenue Current Year338469TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year399048GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY520504GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year82604SalariesEtcPriorYear
Salaries Etc Current Year84186SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year9515TotalFundrsngExpCurrentYear
Other Expense Prior Year78121OtherExpensePriorYear
Other Expenses Current Year73971OtherExpensesCurrentYear
Total Expenses Prior Year559773TotalExpensesPriorYear
Total Expenses Current Year678661TotalExpensesCurrentYear
Revenues Less Expenses Prior Year30526RevenuesLessExpensesPriorYear
Revenues Less Expenses CY-340192RevenuesLessExpensesCY
Total Assets BOY4044389TotalAssetsBOY
Total Assets EOY3281871TotalAssetsEOY
Total Liabilities BOY569169TotalLiabilitiesBOY
Total Liabilities EOY256881TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY3475220NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY3024990NetAssetsOrFundBalancesEOY
Mission DescriptionTHE MISSION OF THE HOWARD REGIONAL HEALTH SYSTEM FOUNDATION IS TO IMPROVE THE QUALITY AND AVAILABILITY OF HEALTHCARE PROVIDED TO ALL PERSONS SERVED BY HOWARD REGIONAL HEALTH SYSTEM.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense464409Expense
Grants464409Grants
Revenue67629Revenue
DescriptionTO RECEIVE AND MAINTAIN FUNDS FOR THE CONSTRUCTION, FURNISHING, EQUIPPING AND IMPROVEMENT OF THE FACILITIES AND SERVICES OF THE HOWARD REGIONAL HEALTH SYSTEM (HOSPITAL). TO PROVIDE FINANCIAL ASSISTANCE FOR THE IMPROVEMENT OF THE HEALTH, SAFETY, AND GENERAL WELFARE, AND TO AID IN THE ALLEVIATION OF HUMAN SUFFERING OF ALL PERSONS CONNECTED WITH OR USING THE FACILITIES AND SERVICES OF THE HOSPITAL.Description

Activity2 Activity2

FieldValueIRS element (for citing)
Expense56095Expense
Grants56095Grants
DescriptionTO AID AND PROMOTE EDUCATION AND SCIENTIFIC RESEARCH IN THE ADVANCEMENT OF KNOWLEDGE RELATING TO THE DISCOVERY, PREVENTION, AND THE TREATMENT OF DISEASE. TO PROVIDE SCHOLARSHIPS TO STUDENTS PURSUING DEGREES AND CERTIFICATES IN HEALTH CARE PROFESSIONS.Description
FieldValueIRS element (for citing)
Total Program Service Expense520504TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities0LobbyingActivities
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments1TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets0ReportOtherAssets
Report Other Liabilities1ReportOtherLiabilities
Report Fin48 Footnote0ReportFin48Footnote
Independent Audit Financial Stmt1IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt1ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities1FundraisingActivities
Gaming0Gaming
Hospital0Hospital
Grants To Organizations1GrantsToOrganizations
Grants To Individuals1GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds0TaxExemptBonds
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp1OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity0RelatedOrgControlledEntity
Transaction Related Entity0TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With10962NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees0NumberOfEmployees
Unrelated Business Income0UnrelatedBusinessIncome
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members29NbrVotingGoverningBodyMembers
Number Independent Voting Members0NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders0MembersOrStockholders
Election Of Board Members0ElectionOfBoardMembers
Decisions Subject To Approval0DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy0WhistleblowerPolicy
Document Retention Policy0DocumentRetentionPolicy
Compensation Process CEO0CompensationProcessCEO
Compensation Process Other0CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
States Where Copy Of Return Is FiledINStatesWhereCopyOfReturnIsFiled
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

FieldValueIRS element (for citing)
Name PersonBETHANY QUINNNamePerson
Telephone Number7654538066TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line13500 S LAFOUNTAINAddressLine1
CityKOKOMOCity
StateINState
ZIP Code46902ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (31 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensation
DR SUE SCIAME-GEISECKE
PRESIDENT1.00XX000
REBECCA VENT
1ST VICE-PRESIDENT1.00XX000
GREG GRISWOLD
2ND VICE-PRESIDENT1.00XX000
JOE DUNBAR
SECRETARY/TREASURER1.00XX000
JAMES ALENDER
DIRECTOR1.00X038706113810
TED BROWN
DIRECTOR1.00X022233712417
RALPH BAER
DIRECTORX000
MARSHA BOWLING
DIRECTOR1.00X000
DR WALTER BROWN
DIRECTORX000
JEFF CARDWELL
DIRECTORX000
TAMMIE MEADOWS
DIRECTORX000
DR BERNARD FOGELSON
DIRECTORX000
BOB FUNK
DIRECTOR1.00X000
RANDY MORRIS
DIRECTORX000
SHERRY HORNER
DIRECTOR1.00X000
AARON HUNLEY
DIRECTOR1.00X000
CELESTINE JOHNSON
DIRECTORX000
KIM LAFOLLETTE
DIRECTORX000
GREG SULLIVAN
DIRECTORX000
CHANDA MALOTT
DIRECTORX000
ALAN WARNER
DIRECTORX000
DR ROBERT MILLER
DIRECTORX000
DR LAURIE PETERS
DIRECTORX000
JUNE SCOGGINS
DIRECTORX000
BRIAN SHEARER
DIRECTORX000
DWIGHT SINGER
DIRECTORX000
DAWN SMITH
DIRECTORX000
RICK SMITH
DIRECTORX000
MATT TATE
DIRECTORX000
BOB MASSEY
DIRECTORX000
KELLY GOAD
FOUNDATION DIRECTOR40.00X0525498571
FieldValueIRS element (for citing)
Total Reportable Comp From Org0TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs661947TotalReportableCompFrmRltdOrgs
Total Other Compensation34798TotalOtherCompensation
Number Individuals GT100 K0NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources
Number Of Contractors GT100 K0NumberOfContractorsGT100K
Related Organizations64023RelatedOrganizations
All Other Contributions119234AllOtherContributions
Total Contributions183257TotalContributions

Program Service Revenue ProgramServiceRevenue

FieldValueIRS element (for citing)
DescriptionCAPITAL LEASEDescription
Business Code532000BusinessCode
Total Revenue Column19220TotalRevenueColumn
Related Or Exempt Function Income19220RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Program Service Revenue19220TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column69274TotalRevenueColumn
Exclusion$69,274ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities1181369Securities

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Securities1132960Securities

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities48409Securities

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column48409TotalRevenueColumn
Related Or Exempt Function Income48409RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Gross Income Fundraising Events29086GrossIncomeFundraisingEvents
Fundraising Direct Expenses10777FundraisingDirectExpenses

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

FieldValueIRS element (for citing)
Total Revenue Column18309TotalRevenueColumn
Exclusion$18,309ExclusionAmount

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column338469TotalRevenueColumn
Related Or Exempt Function Income67629RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$87,583ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total464409Total
Program Services464409ProgramServices

Grants To Domestic Individuals GrantsToDomesticIndividuals

FieldValueIRS element (for citing)
Total56095Total
Program Services56095ProgramServices

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total61120Total
Management And General61120ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total21900Total
Management And General21900ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total1166Total
Management And General1166ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total12750Total
Management And General12750ManagementAndGeneral

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total14219Total
Management And General14219ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total11717Total
Management And General11717ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total2903Total
Management And General2903ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total17945Total
Management And General17945ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total85Total
Management And General85ManagementAndGeneral

Other Expenses OtherExpenses (3 entries)

DescriptionDescriptionTotalTotalFundraisingFundraisingManagement And GeneralManagementAndGeneral
OTHER FUNDRAISING EXPEN95159515
PROVISION FOR UNCOLLECT38973897
DUES AND SUBSCRIPTIONS940940

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total678661Total
Program Services520504ProgramServices
Management And General148642ManagementAndGeneral
Fundraising9515Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY430151BOY
EOY310865EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY461220BOY
EOY395182EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

FieldValueIRS element (for citing)
BOY51620BOY
EOY36295EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY548298BOY
EOY214281EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis510LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec510LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY85BOY
EOY0EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY2381969BOY
EOY2162356EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY171046BOY
EOY162892EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY4044389BOY
EOY3281871EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY2236BOY
EOY1738EOY

Deferred Revenue DeferredRevenue

FieldValueIRS element (for citing)
BOY23482BOY
EOY4244EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY499124BOY
EOY210037EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY44327BOY
EOY40862EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY569169BOY
EOY256881EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY2808909BOY
EOY2401411EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY510127BOY
EOY467395EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY156184BOY
EOY156184EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY3475220BOY
EOY3024990EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY4044389BOY
EOY3281871EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses-340192ReconcilationRevenueExpenses
Reconcilation Other Changes-110038ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee0AuditCommittee
Financial Statement BothXFinancialStatementBoth
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Publicly Supported Org170b1 AviXPubliclySupportedOrg170b1Avi

Gifts Grants Contrib Received170 GiftsGrantsContribReceived170

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years250435CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years219996CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years205117CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year421905CurrentTaxYearMinus1Year
Current Tax Year183257CurrentTaxYear
Total1280710Total

Total170 Total170

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years250435CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years219996CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years205117CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year421905CurrentTaxYearMinus1Year
Current Tax Year183257CurrentTaxYear
Total1280710Total
FieldValueIRS element (for citing)
Amounts Subst Contributors Total245802AmountsSubstContributorsTotal
Public Support Total1701034908PublicSupportTotal170

Gross Investment Income170 GrossInvestmentIncome170

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years234042CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years100145CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years72574CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year116496CurrentTaxYearMinus1Year
Current Tax Year69274CurrentTaxYear
Total592531Total
FieldValueIRS element (for citing)
Total Support1873241TotalSupport
Gross Receipts From Admissions Etc580143GrossReceiptsFromAdmissionsEtc
Public Support Pertcentage1700.55250PublicSupportPertcentage170
Public Support Pertcent Prior Year0.66020PublicSupportPertcentPriorYear
Thirty Three Percnt Tests CY170XThirtyThreePercntTestsCY170

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule D IRS990ScheduleD

Current Year CurrentYear

FieldValueIRS element (for citing)
Beginning Of Year Balance156184BeginningOfYearBalance
End Of Year Balance156184EndOfYearBalance

Current Year Minus1 Year CurrentYearMinus1Year

FieldValueIRS element (for citing)
Beginning Of Year Balance156184BeginningOfYearBalance
End Of Year Balance156184EndOfYearBalance

Current Year Minus2 Years CurrentYearMinus2Years

FieldValueIRS element (for citing)
Beginning Of Year Balance156184BeginningOfYearBalance
End Of Year Balance156184EndOfYearBalance

Current Year Minus3 Years CurrentYearMinus3Years

FieldValueIRS element (for citing)
Beginning Of Year Balance156184BeginningOfYearBalance
End Of Year Balance156184EndOfYearBalance
FieldValueIRS element (for citing)
Endowments Held By Unrelated Orgs0EndowmentsHeldByUnrelatedOrgs
Endowments Held By Related Orgs0EndowmentsHeldByRelatedOrgs

Equipment Equipment

FieldValueIRS element (for citing)
Investment Cost Or Other Basis510InvestmentCostOrOtherBasis
Depreciation510Depreciation
Book Value0BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings0TotalOfBookValueLandBuildings

Other Liabilities OtherLiabilities (2 entries)

DescriptionDescriptionAmountAmount
ACCRUED INTEREST$939
LIABILITY UNDER TRUST AGREEMENT$39,923
FieldValueIRS element (for citing)
Total Of Amounts40862TotalOfAmounts
Total Revenue338469TotalRevenue
Total Expenses678661TotalExpenses
Excess Or Deficit For Year-340192ExcessOrDeficitForYear
Net Unrealized GL On Investments-108047NetUnrealizedGLOnInvestments
Other-$1,991OtherAmount
Total Adjustments-110038TotalAdjustments
Excess Or Deficit Per FS-450230ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt239208TotRevenueEtcAuditedFinclStmt
Net Unrealized Gains Investments-108047NetUnrealizedGainsInvestments
Other Revenues8786OtherRevenues
Revenue Not Rptd F990-99261RevenueNotRptdF990
Revenue Subtotal338469RevenueSubtotal
Revenue Not Rptd On Fin Stmt0RevenueNotRptdOnFinStmt
Total Revenue Per Form990338469TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt689438TotExpensesEtcAuditedFinclStmt
Other Expenses Included10777OtherExpensesIncluded
Expenses Not Rptd F99010777ExpensesNotRptdF990
Expenses Subtotal678661ExpensesSubtotal
Expenses Not Rptd On Fin Stmt0ExpensesNotRptdOnFinStmt
Total Expenses Per Form990678661TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (3 entries)

IdentifierIdentifierExplanationExplanation
PART XI, LINE 8 - OTHER ADJUSTMENTS:CHANGE IN VALUE OF CHARITABLE REMAINDER TRUST -1,991.
PART XII, LINE 2D - OTHER ADJUSTMENTS:CHANGE IN VALUE FOR CHARITABLE REMAINDER TRUST -1,991. FUNDRAISING COSTS (NETTED ON 990) 10,777.
PART XIII, LINE 2D - OTHER ADJUSTMENTS:FUNDRAISING COSTS (NETTED ON 990) 10,777.

Schedule G IRS990ScheduleG

Events Information EventsInformation

FieldValueIRS element (for citing)
Name Of Event1ANNUAL GOLF OUTINGNameOfEvent1
Gross Receipts Event129086GrossReceiptsEvent1
Gross Revenue Event129086GrossRevenueEvent1
Cash Prizes Event11950CashPrizesEvent1
Other Direct Expenses Event18827OtherDirectExpensesEvent1
Gross Receipts Total29086GrossReceiptsTotal
Gross Revenue Total Events29086GrossRevenueTotalEvents
Cash Prizes Total Events1950CashPrizesTotalEvents
Other Direct Expenses Total Events8827OtherDirectExpensesTotalEvents
Direct Expense Summary Events10777DirectExpenseSummaryEvents
Net Income Summary18309NetIncomeSummary

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Records Maintained0RecordsMaintained

Recipient Table RecipientTable

Recipient Name Business RecipientNameBusiness

FieldValueIRS element (for citing)
Business Name Line1HOWARD REGIONAL HEALTH SYSTEMBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line13500 S LAFOUNTAIN STAddressLine1
CityKOKOMOCity
StateINState
ZIP Code46902ZIPCode
FieldValueIRS element (for citing)
EIN Of Recipient351128451EINOfRecipient
IRC Section501(C)(3)IRCSection
Amount Of Cash Grant464409AmountOfCashGrant
Method Of ValuationBOOK VALUEMethodOfValuation
Purpose Of GrantTO RECEIVE AND MAINTAIN FUNDS FOR THE CONSTRUCTION, FURNISHING, EQUIPPING AND IMPROVEMENT OF THE FACILITIES AND SERVICES OF THE HOWARD GIONAL HEALTH SYSTEM (HOSPITAL). TO PROVIDE FINANCIAL ASSISTANCE FOR THE IMPROVEMENT OF THE HEALTH, SAFETY, AND GENERAL WELFARE, AND TO AID IN THE ALLEVIATION OF HUMAN SUFFERING OF ALL PERSONS CONNECTED WITH OR USING THE FACILITIES AND SERVICES OF THE HOSPITAL.PurposeOfGrant
FieldValueIRS element (for citing)
Total Nbr Of501 C3 And Govt Grants1TotalNbrOf501C3AndGovtGrants

Form990 Schedule I Part III Form990ScheduleIPartIII

FieldValueIRS element (for citing)
Type Of GrantTO PROMOTE EDUCATION BY PROVIDING FINANCIAL ASSISTANCE WITH CONTINUING EDUCATION. TO PROVIDE SCHOLARSHIPS TO STUDENTS PURSUING DEGRESS AND CERTIFICATES IN HEALTH CARE PROFESSIONS.TypeOfGrant
Number Of Recipients58NumberOfRecipients
Amount Of Cash Grant56095AmountOfCashGrant

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Severance Payment0SeverancePayment
Supplemental Nonqual Retire Plan0SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org0CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs0CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org0CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs0CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments0AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (2 entries)

Base Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
JAMES ALENDER
0387061000000013810040087100
TED BROWN
0222337000000012417023475400

Schedule L IRS990ScheduleL

Form990 Schedule L Part IV Form990ScheduleLPartIV (2 entries)

RelationshipRelationshipDescription Of TransactionDescriptionOfTransactionSharing Of RevenuesSharingOfRevenues
JAMES ALENDER
BOARD OF DIRECTOREMPLOYEE AND OFFICER OF HOWARD REGIONAL HEALTH SYSTEM (RELATED ORGANIZATION - SEE SCHEDULE R)0
TED BROWN
BOARD OF DIRECTOREMPLOYEE AND OFFICER OF HOWARD REGIONAL HEALTH SYSTEM (RELATED ORGANIZATION - SEE SCHEDULE R)0

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (5 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
FORM 990, PART VI, SECTION B, LINE 11THE FINANCE COMMITTEE OF THE GOVERNING BODY REVIEWS THE FORM 990 PRIOR TO ITS SIGNING AND SUBMISSION TO THE INTERNAL REVENUE SERVICE.
FORM 990, PART VI, SECTION B, LINE 12CALL INTERESTED PERSONS ARE REQUIRED TO DISLOSE ANY CONFLICTS OF INTEREST, OR POSSIBLE CONFLICTS OF INTEREST THAT MIGHT POTENTIALLY AFFECT THEIR JUDGMENT IN MAKING DECISIONS ON BEHALF OF THE FOUNDATION BY COMPLETING A CONFLICT OF INTEREST/DISCLOSURE STATEMENT ANNUALLY.
FORM 990, PART VI, SECTION C, LINE 19THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST.
FORM 990, PART XI, LINE 5:NET UNREALIZED LOSSES ON INVESTMENTS: -108,047. CHANGE IN VALUE OF CHARITABLE REMAINDER TRUST -1,991. TOTAL TO FORM 990, PART XI, LINE 5: -110,038.CHANGES IN NET ASSETS OR FUND BALANCES:
FORM 990, PART V, LINE 2A:THE ORGANIZATION LEASES THE FOUNDATION SPECIALIST FROM A RELATED ENTITY, HOWARD REGIONAL HEALTH SYSTEM.LEASED EMPLOYEES:

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII

Name Of Disregarded Entity NameOfDisregardedEntity

FieldValueIRS element (for citing)
Business Name Line1HOWARD REGIONAL HEALTH SYSTEMBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line13500 S LAFOUNTAIN STAddressLine1
CityKOKOMOCity
StateINState
ZIP Code46902ZIPCode
FieldValueIRS element (for citing)
EIN351128451EIN
Primary ActivitiesHOSPITALPrimaryActivities
Legal Domicile StateINLegalDomicileState
Exempt Code Section501(C)(3)ExemptCodeSection
Public Charity Status170(B)(1)(A)IIIPublicCharityStatus
Direct Controlling Entity NAN/ADirectControllingEntityNA
Controlled Org0ControlledOrg
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties0ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org0GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org0GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org0LoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs0RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs0RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs0PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs0PerformOfServicesByOtherOrgs
Sharing Of Facilities1SharingOfFacilities
Sharing Of Paid Employees1SharingOfPaidEmployees
Reimbursement Paid To Other Org0ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrg
Other Transfer To Other Org0OtherTransferToOtherOrg
Other Transfer From Other Org0OtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable (2 entries)

Transaction TypeTransactionTypeAmount InvolvedAmountInvolvedMethod Of Amt DeterminationMethodOfAmtDetermination
HOWARD REGIONAL HEALTH SYSTEM
N84186COST BASIS
HOWARD REGIONAL HEALTH SYSTEM
M2903COST ALLOCATION