2022-10-31T14:14:55-05:00 2021-12-31 FORVIS LLP 910 E ST LOUIS 200/PO BOX 1190 SPRINGFIELD MO 658062523 990 2021-01-01 431696258 PHELPS COUNTY HOSPITAL FOUNDATION % JANA COOK PHEL 5733648899 1000 WEST 10TH STREET ROLLA MO 65401 JASON SHENEFIELD CEO 5733648899 2022-11-15 true JASON SHENEFIELD 999009999 Brian D Todd P00422601 4178658701 2022-11-15 3 2021 2022-09-23 18:48:47Z JASON SHENEFIELD 1000 WEST 10TH STREET ROLLA MO 65401 966507 false X www.phelpshealth.com X 1994 MO SERVES AS THE PHILANTHROPIC ORGANIZATION THAT FACILITATES CHARITABLE DONATIONS TO SUPPORT AND ASSIST PHELPS HEALTH IN PROVIDING HEALTHCARE. SEE SCHEDULE O FOR MORE DETAIL. 18 12 5 40 0 0 1271848 950123 0 0 6610 -16156 -33254 -16790 1245204 917177 2223762 52126 0 0 469554 500858 37289 18012 207052 124414 98683 2855019 669679 -1609815 247498 812497 1097667 379240 395660 433257 702007 OUR MISSION IS TO SERVE AS THE PHILANTHROPIC ORGANIZATION THAT FACILITATES CHARITABLE DONATIONS TO SUPPORT AND ASSIST THE MISSION OF PHELPS HEALTH TO IMPROVE THE HEALTH AND WELLNESS OF PEOPLE IN OUR REGION. false false 349933 52126 THE ORGANIZATION FACILITATES CHARITABLE DONATIONS TO HELP SUPPORT THE MISSION AND ACTIVITIES OF PHELPS. CONTRIBUTIONS ARE RECEIVED BY THE ORGANIZATION AND DISTRIBUTED TO PHELPS HEALTH FOR USE IN ITS MISSION TO IMPROVE THE HEALTH AND WELLNESS OF PEOPLE IN OUR REGION. 349933 true true false false false false false false false false true false false true true false false false false false false false false true true false false true false true false false false false false false false false false false false false false true false false false true 7 0 true 5 true false false false false false true true false false false false false false false X 18 12 false false false false false false false true true false false false true true true true true false false false X JANA COOK 5734587916 1000 WEST 10TH STREET ROLLA MO 65401 X CHRISTOPHER R SPENCER PRESIDENT 1.0 40.0 X X 0 926101 56618 EDWARD J CLAYTON EX-OFFICIO MBR/CEO END 07/21 1.0 40.0 X X 0 404726 34765 JASON L SHENEFIELD EX-OFFICIO MBR/CEO BEG 07/21 1.0 40.0 X X 0 310104 57227 BEENA J GREEN BOARD MEMBER END 09/21 1.0 40.0 X 0 309345 17400 KERI S BROOKSHIRE-HEAVIN EX-OFFICIO MEMBER/CNO/COO 1.0 40.0 X 0 265110 38755 JANA COOK EX-OFFICIO MEMBER/CFO 1.0 40.0 X X 0 225829 52746 DAVID SELZER EXECUTIVE DIRECTOR 40.0 1.0 X X 0 139433 34801 BOBBIE STIRITZ BOARD MEMBER 40.0 1.0 X 57981 0 15239 FRANCINE D MERENGHI EX-OFFICIO MEMBER END 04/21 1.0 1.0 X 0 0 0 ANDREW MILLER SECRETARY BEG 10/21 1.0 1.0 X X 0 0 0 DR RON WILKERSON TREASURER BEG 10/21 1.0 1.0 X X 0 0 0 JESSICA BEUCLER BOARD MEMBER 1.0 1.0 X 0 0 0 SAMMY AUXIER JR BOARD MEMBER 1.0 1.0 X 0 0 0 JOY TUCKER BOARD MEMBER 1.0 1.0 X 0 0 0 ERNIE KOST BOARD MEMBER 1.0 1.0 X 0 0 0 BRENNA WEINBAUM BOARD MEMBER BEG 11/21 1.0 1.0 X 0 0 0 CINDY A BEGER VICE PRESIDENT 1.0 1.0 X X 0 0 0 STEVE DAVIS BOARD MEMBER BEG 04/21 1.0 1.0 X 0 0 0 JEFF TURNBOUGH BOARD MEMBER BEG 04/21 1.0 1.0 X 0 0 0 BUZZ HARVEY BOARD MEMBER 1.0 1.0 X 0 0 0 MATT KEYES BOARD MEMBER BEG 04/21 1.0 1.0 X 0 0 0 57981 2580648 307551 0 false true false 0 97547 852576 950123 0 1344 1344 0 0 0 0 0 17500 -17500 -17500 -17500 15040 97547 31830 -16790 -16790 0 0 0 0 0 0 0 917177 -32946 52126 52126 0 0 0 73220 73220 0 325028 187326 12907 124795 17371 10249 295 6827 58261 34196 1284 22781 26978 13195 4993 8790 0 0 5990 5990 0 18012 18012 0 20084 20084 0 49981 27040 12015 10926 14670 14670 0 0 0 0 1847 1847 0 0 771 377 143 251 0 LICENSES, DUES, SUBSCRIPTION 5340 5340 669679 349933 112694 207052 0 0 572379 876303 0 0 0 0 0 0 0 0 0 0 0 0 8860 2802 19972 11664 21004 8308 0 0 0 0 0 0 0 0 210254 210254 812497 1097667 20033 40307 0 0 3854 0 0 0 0 0 0 0 0 0 0 0 355353 355353 379240 395660 X 433257 702007 0 0 433257 702007 812497 1097667 247498 21252 X false false false X X 1 PHELPS HEALTH 436004435 3 true 52126 0 1 52126 0 true false false false false false false false false false false false false false false false SCHEDULE A, PART IV, SECTION C, LINE 1 CONTROL AND MANAGEMENT OF SUPPORTING ORGANIZATION: THE BUSINESS AND AFFAIRS OF THE FOUNDATION SHALL BE MANAGED BY OR UNDER THE DIRECTION OF THE BOARD OF DIRECTORS OF THE FOUNDATION EXCEPT THAT THE BOARD OF DIRECTORS OF THE FOUNDATION SHALL NOT BE AUTHORIZED TO AMEND THE FOUNDATION ARTICLES OF INCORPORATION OR BYLAWS WITHOUT WRITTEN APPROVAL OF THE BOARD OF TRUSTEES OF THE HOSPITAL. IN ADDTION, THE HOSPITAL BOARD OF TRUSTEES SHALL BE ENTITLED TO PROPOSE THAT THE BOARD OF DIRECTORS OF THE FOUNDATION FROM TIME TO TIME ADOPT RESOLUTIONS REGARDING SPECIFIC FUND RAISING ACTIVITIES IN SUPPORT OF THE HOSPITAL, OR TO USE ITS ASSETS IN A MANNER DESIRED BY THE HOSPITAL FOR THE BENEFIT OF THE HOSPITAL OR ITS AFFILIATES. ONE HALF OF THE BOARD OF DIRECTORS OF THE FOUNDATION ARE EITHER APPOINTED BY THE HOSPITAL BOARD OF TRUSTEES OR CEO OF THE HOSPITAL, AND/OR ARE EMPLOYEES OF THE HOSPITAL. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 19972 11664 8308 8308 DUE FROM HOME HEALTH 201641 DUE FROM PMGI 8613 210254 0 DUE TO PHELPS HEALTH 355353 355353 true HEALTH PHILANTHROPY SVCS GRP CAMPAIGN false 17693 17693 GOLF TOURNAMENT 98315 83275 15040 0 6950 9624 8459 0 3180 BUTTERFLY RELEA 14272 14272 0 161 125 355 0 2976 0 0 0 0 0 0 0 0 0 0 112587 97547 15040 0 7111 9749 8814 0 6156 31830 -16790 true PHELPS HEALTH 1000 W 10TH STREET ROLLA MO 65401 436004435 501(C)(3) 52126 SUPPORT PROGRAMS 1 SCHEDULE I, PART I, LINE 2 MONITORING OF GRANT FUNDS: GRANTS ARE PROVIDED TO A RELATED ORGANIZATION AS PART OF THE FOUNDATION'S MISSION. GRANT SPENDING IS MONITORED MONTHLY BY PHELPS HEALTH ACCOUNTING DEPARTMENT AND FINANCIAL INFORMATION IS FORWARDED TO DIRECTOR OF FOUNDATION TO DETERMINE IF ADDITIONAL GRANT FUNDS ARE NEEDED. false false false false false false false false false DAVID SELZER EXECUTIVE DIRECTOR 0 133143 0 108 0 6182 0 8810 0 25991 0 174234 0 0 CHRISTOPHER R SPENCER PRESIDENT 0 906499 0 102 0 19500 0 17400 0 39218 0 982719 0 0 KERI S BROOKSHIRE-HEAVIN EX-OFFICIO MEMBER/CNO/COO 0 250937 0 265 0 13908 0 16223 0 22532 0 303865 0 0 JASON L SHENEFIELD EX-OFFICIO MBR/CEO BEG 07/21 0 307560 0 102 0 2442 0 17400 0 39827 0 367331 0 0 JANA COOK EX-OFFICIO MEMBER/CFO 0 212837 0 319 0 12673 0 14085 0 38661 0 278575 0 0 EDWARD J CLAYTON EX-OFFICIO MBR/CEO END 07/21 0 384402 0 0 0 20324 0 17400 0 17365 0 439491 0 0 BEENA J GREEN BOARD MEMBER END 09/21 0 279766 0 29039 0 540 0 17400 0 0 0 326745 0 0 SCHEDULE J, PART I, LINE 3 COMPENSATION DETERMINATION: PHELPS HEALTH, A RELATED ORGANIZATION, USES A WRITTEN EMPLOYMENT CONTRACT, COMPENSATION SURVEY OR STUDY, AND APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE IN DETERMINING THE COMPENSATION OF THE CEO. SCHEDULE J, PART I, LINE 7 NONFIXED PAYMENTS: PHELPS HEALTH, A RELATED ORGANIZATION, PROVIDES CHRISTOPHER SPENCER, JASON SHENEFIELD, KERI BROOKSHIRE-HEAVIN, BEENA GREEN AND JANA COOK THE POTENTIAL TO RECEIVE ANNUAL BONUS COMPENSATION. INCENTIVE COMPENSATION IS CALCULATED BASED ON THEIR WRVU GOAL. FORM 990, PART I, LINE 1 ORGANIZATION'S SIGNIFICANT ACTIVITIES: THE PHELPS HEALTH FOUNDATION IS A 501(C)(3) TAX EXEMPT, NOT-FOR-PROFIT SUPPORTING ORGANIZATION TO PHELPS HEALTH, ESTABLISHED IN 1996. OUR MISSION IS TO SERVE AS THE PHILANTHROPIC ORGANIZATION THAT FACILITATES CHARITABLE DONATIONS TO SUPPORT AND ASSIST THE MISSION OF PHELPS HEALTH TO IMPROVE THE HEALTH AND WELLNESS OF PEOPLE IN OUR REGION. THE FOUNDATION EXISTS TO ENSURE THAT HEALTH CARE DELIVERY IN PHELPS COUNTY AND THE SURROUNDING COMMUNITIES CONTINUES TO BE TRANSFORMATIONAL. THROUGH PATIENT-CENTERED AND COMMUNITY-FOCUSED INITIATIVES, THE FOUNDATION WORKS IN COOPERATION WITH CLINICIANS, STAFF, PATIENTS, FRIENDS AND DONORS TO ENSURE THE GREATEST NEEDS AND OPPORTUNITIES ARE FUNDED ACROSS PHELPS HEALTH. FORM 990, PART VI, SECTION B, LINE 11B REVIEW OF THE FORM 990: THE FORM 990 IS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM BASED ON INTERNAL FINANCIAL STATEMENTS AND INFORMATION PROVIDED BY THE ACCOUNTING DEPARTMENT OF THE ORGANIZATION. THE FORM IS REVIEWED BY THE CFO AND CONTROLLER OF THE ORGANIZATION BEFORE BEING FILED WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C CONFLICT OF INTEREST POLICY: ALL EMPLOYEES, DIRECTORS, OFFICERS AND TRUSTEES ARE COVERED UNDER THE CONFLICT OF INTEREST POLICY. EACH INDIVIDUAL IS REQUIRED TO SUBMIT ANY POTENTIAL CONFLICTS FOR REVIEW BY THE BOARD AND, IF NECESSARY, GENERAL COUNSEL SO THAT A DETERMINATION OF CONFLICT CAN BE ISSUED. IF A CONFLICT DOES EXIST, THE AFFECTED INDIVIDUAL IS NOT ALLOWED TO VOTE WITH REGARDS TO TRANSACTIONS THAT INVOLVE THE ORGANIZATION AND POTENTIALLY THE CONFLICTED PARTY AND WILL BE EXCUSED FROM THE BOARD SESSION DURING THE VOTING PERIOD. IN ADDITION, THE BOARD MAINTAINS THE RIGHT TO APPOINT AN INDEPENDENT THIRD PARTY TO RESEARCH THE POTENTIAL TRANSACTION AND ANY POSSIBLE ALTERNATIVES. FORM 990, PART VI, SECTION B, LINE 15A COMPENSATION REVIEW: THE TOP MANAGEMENT OFFICIAL OF THE ORGANIZATION IS COMPENSATION BY PHELPS HEALTH, A RELATED ORGANIZATION. HUMAN RESOURCES CONDUCTS AN ORGANIZATION-WIDE COMPENSATION REVIEW BASED ON MARKET DATA COLLECTED FROM COMPETITIVE MARKETS. RECOMMENDED ADJUSTMENTS ARE BASED ON THE DATA COLLECTED AND THE FINANCIAL POSITIONS OF THE ORGANIZATION. PAY RAISES ARE APPROVED BY THE BOARD OF DIRECTORS AND DOCUMENTED IN THE BOARD MINUTES. FORM 990, PART VI, SECTION C, LINE 19 DOCUMENT DISCLOSURE: THE ORGANIZATION MAKES ITS GOVERNMENT DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART VII, SECTION A BOARD MEMBER COMPENSATION: KERI BROOKSHIRE-HEAVIN, DR. CHRISTOPHER SPENCER, JASON SHENEFIELD, JANA COOK, AND DAVID SELZER RECEIVE W-2 COMPENSATION FROM PHELPS HEALTH FOR THEIR SERVICES AS EMPLOYEES. NO BOARD MEMBERS ARE COMPENSATED FOR THEIR SERVICES AS A BOARD MEMBER. PHELPS HEALTH 1000 W 10TH STREET ROLLA MO 65401 436004435 HEALTH CARE MO 501(C)(3) 3 NA false false true false false true false false false false false true false true true true true false false