CROSSROADS HEALTH FOUNDATION: Form 990, tax year 2019
View the entire original 990 at ProPublica ↗
- Organization
- CROSSROADS HEALTH FOUNDATION (EIN 39-1883528)
- Tax period
- 2019-01-01 to 2019-12-31
- Filed
- 2020-06-05
- IRS object ID
- 202031579349300708
- Schema version
- 2019v5.1
- 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 | 2020-06-05T10:52:05-04:00 | ReturnTs |
| Tax Period End | 2019-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 420808359 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Ohnward Tax and Accounting | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 203 N Main St | AddressLine1Txt |
| City | Maquoketa | CityNm |
| State Abbreviation | IA | StateAbbreviationCd |
| ZIP | 52060 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2019-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 391883528 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DEWITT COMMUNITY HOSPITAL FOUNDATION | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | DEWI | BusinessNameControlTxt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1118 11TH ST | AddressLine1Txt |
| City | De Witt | CityNm |
| State Abbreviation | IA | StateAbbreviationCd |
| ZIP | 52742 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | MARK WITTE | PersonNm |
| Person Title | CHAIRMAN OF THE | PersonTitleTxt |
| Phone | 5636594233 | PhoneNum |
| Signature | 2020-05-29 | SignatureDt |
| Discuss With Paid Preparer | Yes (true) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | John Franzen | PreparerPersonNm |
| PTIN | P00050698 | PTIN |
| Phone | 5636522491 | PhoneNum |
| Preparation | 2020-06-05 | PreparationDt |
Filing Security Information FilingSecurityInformation
IP Address IPAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| I Pv4 Address | 63.142.45.126 | IPv4AddressTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IP | 2020-06-05 | IPDt |
| IP Tm | 10:54:06 | IPTm |
| Federal Original Submission Id | 4232362020157v2xatmw | FederalOriginalSubmissionId |
| Federal Original Submission Id | 2020-06-05 | FederalOriginalSubmissionIdDt |
| Filing License Type | P | FilingLicenseTypeCd |
| At Submission Creation Device Id | 22D2EFD03B2005ADEB9A86B768B52E9E988BB8E3 | AtSubmissionCreationDeviceId |
| At Submission Filing Device Id | 22D2EFD03B2005ADEB9A86B768B52E9E988BB8E3 | AtSubmissionFilingDeviceId |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2019 | TaxYr |
| Build TS | 2020-09-23 17:36:50Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $408,771 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.GENESISHEALTH.COM/GIVE | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1997 | FormationYr |
| Legal Domicile State | IA | LegalDomicileStateCd |
| Activity Or Mission | SEE SCHEDULE O. | ActivityOrMissionDesc |
| Voting Members Governing Body | 20 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 20 | VotingMembersIndependentCnt |
| Total Employee | 2 | TotalEmployeeCnt |
| Total Volunteers | 20 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $51,659 | PYContributionsGrantsAmt |
| CY Contributions Grants | $214,141 | CYContributionsGrantsAmt |
| CY Program Service Revenue | $0 | CYProgramServiceRevenueAmt |
| PY Investment Income | $190,502 | PYInvestmentIncomeAmt |
| CY Investment Income | $118,575 | CYInvestmentIncomeAmt |
| PY Other Revenue | $60,210 | PYOtherRevenueAmt |
| CY Other Revenue | $45,067 | CYOtherRevenueAmt |
| PY Total Revenue | $302,371 | PYTotalRevenueAmt |
| CY Total Revenue | $377,783 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $197,826 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $35,918 | CYGrantsAndSimilarPaidAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $63,726 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $61,960 | CYSalariesCompEmpBnftPaidAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $36,145 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $34,888 | PYOtherExpensesAmt |
| CY Other Expenses | $38,663 | CYOtherExpensesAmt |
| PY Total Expenses | $296,440 | PYTotalExpensesAmt |
| CY Total Expenses | $136,541 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $5,931 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $241,242 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $1,576,023 | TotalAssetsBOYAmt |
| Total Assets EOY | $2,021,730 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $6,525 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $6,268 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $1,569,498 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $2,015,462 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | SEE SCHEDULE O. | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $54,623 | ExpenseAmt |
| Grant | $35,919 | GrantAmt |
| Desc | THE PRIMARY EXEMPT PURPOSE OF THE DEWITT COMMUNITY HOSPITAL FOUNDATION IS TO PROVIDE FUNDING FOR SPECIFIC ITEMS AND OR PROGRAMS OF GENESIS MEDICAL CENTER, DEWITT NOT OTHERWISE PROVIDED FOR BY ITS OPERATIONAL BUDGET. | Desc |
| Total Program Service Expenses | $54,623 | 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 | false | 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 | Yes (true) | GrantsToIndividualsInd |
| Schedule J Required | false | ScheduleJRequiredInd |
| Tax Exempt Bonds | false | TaxExemptBondsInd |
| 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 |
| 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 |
| Backup Wthld Compliance | Yes (true) | BackupWthldComplianceInd |
| Employee | 2 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (true) | EmploymentTaxReturnsFiledInd |
| 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 | false | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | false | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | false | PayPremiumsPrsnlBnftCntrctInd |
| Form8899 Filedind | false | Form8899Filedind |
| Form1098 C Filed | false | Form1098CFiledInd |
| 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 | 20 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 20 | 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 |
| 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 | Yes (true) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (true) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (true) | CompensationProcessCEOInd |
| Compensation Process Other | false | CompensationProcessOtherInd |
| Investment In Joint Venture | false | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | IA | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | ROBIN KROGMAN | PersonNm |
| Phone | 5636594233 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1118 11TH ST | AddressLine1Txt |
| City | De Witt | CityNm |
| State Abbreviation | IA | StateAbbreviationCd |
| ZIP | 52742 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| No Listed Persons Compensated | Yes (X) | NoListedPersonsCompensatedInd |
Form990 Part VII Section A Form990PartVIISectionAGrp (22 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 |
|---|---|---|---|---|---|---|---|
| MARK WITTE | |||||||
| CHAIRMAN OF THE BOARD | 0.50 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 |
| MIKE BARNES | |||||||
| VICE CHAIR | 0.50 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 |
| BARRY VOSLER | |||||||
| TREASURER | 0.50 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 |
| PAT HENRICKSEN | |||||||
| SECRETARY | 0.50 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 |
| CORINA ANDERSEN | |||||||
| DIRECTOR | 0.10 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| CRAIG BORMANN | |||||||
| DIRECTOR | 0.10 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| JEAN BORMANN | |||||||
| DIRECTOR | 0.10 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| DIANE CLAEYS | |||||||
| DIRECTOR | 0.10 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| ILENE DECKERT | |||||||
| DIRECTOR | 0.10 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| ROGER HILL | |||||||
| DIRECTOR | 0.10 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| MIKE JACOBS | |||||||
| DIRECTOR | 0.10 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| TAMMY LAURSEN | |||||||
| DIRECTOR | 0.10 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| TONY MANATT | |||||||
| DIRECTOR | 0.10 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| JIM NELSON | |||||||
| DIRECTOR | 0.10 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| KATHY ROLLINGS | |||||||
| DIRECTOR | 0.10 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| MARY RUETER | |||||||
| DIRECTOR | 0.10 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| STEVE THAYER | |||||||
| DIRECTOR | 0.10 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| TRACI PAULSEN | |||||||
| DIRECTOR | 0.10 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| ADAM GRAVERT | |||||||
| DIRECTOR | 0.10 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| MYRNA TUBBS | |||||||
| DIRECTOR | 0.10 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| CURT COLEMAN | |||||||
| EX OFFICIO-NON VOTE | 0.10 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| ROBIN KROGMAN | |||||||
| FOUNDATION DIRECTOR | 40.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $0 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $0 | 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 | false | CompensationFromOtherSrcsInd |
| All Other Contributions | $214,141 | AllOtherContributionsAmt |
| Total Contributions | $214,141 | TotalContributionsAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $33,207 | TotalRevenueColumnAmt |
| Exclusion | $33,207 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $85,368 | SecuritiesAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $85,368 | SecuritiesAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $85,368 | TotalRevenueColumnAmt |
| Exclusion | $85,368 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Fundraising Gross Income | $76,055 | FundraisingGrossIncomeAmt |
| Fundraising Direct Expenses | $30,988 | FundraisingDirectExpensesAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $45,067 | TotalRevenueColumnAmt |
| Exclusion | $45,067 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $377,783 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $0 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $163,642 | ExclusionAmt |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $23,676 | TotalAmt |
| Program Services | $23,676 | ProgramServicesAmt |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $12,242 | TotalAmt |
| Program Services | $12,242 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $56,100 | TotalAmt |
| Management And General | $28,050 | ManagementAndGeneralAmt |
| Fundraising | $28,050 | FundraisingAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $49 | TotalAmt |
| Management And General | $49 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,683 | TotalAmt |
| Management And General | $842 | ManagementAndGeneralAmt |
| Fundraising | $841 | FundraisingAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,128 | TotalAmt |
| Management And General | $2,064 | ManagementAndGeneralAmt |
| Fundraising | $2,064 | FundraisingAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,773 | TotalAmt |
| Management And General | $1,773 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,190 | TotalAmt |
| Fundraising | $5,190 | FundraisingAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $531 | TotalAmt |
| Program Services | $531 | ProgramServicesAmt |
Payments To Affiliates PaymentsToAffiliatesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $15,000 | TotalAmt |
| Program Services | $15,000 | ProgramServicesAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Management And GeneralManagementAndGeneralAmt | Program ServicesProgramServicesAmt |
|---|---|---|---|
| OUTSIDE SERVICES | $12,995 | $12,995 | |
| DUES & SUBSCRIPTIONS | $441 | $441 | |
| OTHER EXPENSES | $1,108 | $1,108 | |
| SUPPLIES | $1,625 | $1,625 |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $136,541 | TotalAmt |
| Program Services | $54,623 | ProgramServicesAmt |
| Management And General | $45,773 | ManagementAndGeneralAmt |
| Fundraising | $36,145 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $87,959 | BOYAmt |
| EOY | $835,914 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,488,064 | BOYAmt |
| EOY | $1,185,816 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,576,023 | BOYAmt |
| EOY | $2,021,730 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,483 | BOYAmt |
| EOY | $1,226 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,042 | BOYAmt |
| EOY | $5,042 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,525 | BOYAmt |
| EOY | $6,268 | 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 | $813,573 | BOYAmt |
| EOY | $995,879 | EOYAmt |
Donor Restriction Net Assets DonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $755,925 | BOYAmt |
| EOY | $1,019,583 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,569,498 | BOYAmt |
| EOY | $2,015,462 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,576,023 | BOYAmt |
| EOY | $2,021,730 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $241,242 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $204,723 | NetUnrlzdGainsLossesInvstAmt |
| Prior Period Adjustments | -$1 | PriorPeriodAdjustmentsAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | false | AccountantCompileOrReviewInd |
| FS Audited | false | FSAuditedInd |
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 | $46,611 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $262,620 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $100,754 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $51,659 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $214,141 | CurrentTaxYearAmt |
| Total | $675,785 | TotalAmt |
Total Calendar Year170 TotalCalendarYear170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $46,611 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $262,620 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $100,754 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $51,659 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $214,141 | CurrentTaxYearAmt |
| Total | $675,785 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Substantial Contributors Tot | $123,881 | SubstantialContributorsTotAmt |
| Public Support Total170 | $551,904 | PublicSupportTotal170Amt |
Gross Investment Income170 GrossInvestmentIncome170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $15,866 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $16,220 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $27,286 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $34,473 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $33,207 | CurrentTaxYearAmt |
| Total | $127,052 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Support | $802,837 | TotalSupportAmt |
| Gross Receipts Rltd Activities | $585,592 | GrossReceiptsRltdActivitiesAmt |
| Public Support CY170 | 0.68740 | PublicSupportCY170Pct |
| Public Support PY170 | 0.77930 | 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 | $344,907 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $75,760 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $420,667 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $373,402 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | -$28,495 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $344,907 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $317,760 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $55,642 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $373,402 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $302,760 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $15,000 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $317,760 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $319,315 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | -$3,868 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $12,687 | OtherExpendituresAmt |
| End Year Balance | $302,760 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Designated Balance EOY | 1.00000 | BoardDesignatedBalanceEOYPct |
| Endowments Held Unrelated Org | false | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | false | EndowmentsHeldRelatedOrgInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Endowment funds intended uses (Part V, line 4) | FormAndLineReferenceDesc |
| Explanation | The Endowment funds intended use is in conjunction with the Mission of the DeWitt Community Hospital Foundation, outlined in Part III, Line 1. | ExplanationTxt |
Schedule G IRS990ScheduleG
Fundraising Event Information FundraisingEventInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Event1 | GOLF OUTING | Event1Nm |
| Gross Receipts Event1 | $44,080 | GrossReceiptsEvent1Amt |
| Gross Revenue Event1 | $44,080 | GrossRevenueEvent1Amt |
| Other Direct Expenses Event1 | $15,574 | OtherDirectExpensesEvent1Amt |
| Event2 | WPFTC | Event2Nm |
| Gross Receipts Event2 | $31,875 | GrossReceiptsEvent2Amt |
| Gross Revenue Event2 | $31,875 | GrossRevenueEvent2Amt |
| Other Direct Expenses Event2 | $15,414 | OtherDirectExpensesEvent2Amt |
| Other Events Total | 1 | OtherEventsTotalCnt |
| Gross Receipts Other Events | $100 | GrossReceiptsOtherEventsAmt |
| Gross Revenue Other Events | $100 | GrossRevenueOtherEventsAmt |
| Gross Receipts Total | $76,055 | GrossReceiptsTotalAmt |
| Gross Revenue Total Events | $76,055 | GrossRevenueTotalEventsAmt |
| Oth Direct Expnss Total Events | $30,988 | OthDirectExpnssTotalEventsAmt |
| Direct Expense Summary Events | $30,988 | DirectExpenseSummaryEventsAmt |
| Net Income Summary | $45,067 | NetIncomeSummaryAmt |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | false | GrantRecordsMaintainedInd |
Recipient Table RecipientTable
Recipient Business Name RecipientBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | GENESIS HEALTH SYSTEM- IOWA | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1118 11TH ST | AddressLine1Txt |
| City | De Witt | CityNm |
| State Abbreviation | IA | StateAbbreviationCd |
| ZIP | 52742 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Recipient EIN | 421418847 | RecipientEIN |
| IRC Section | 501 | IRCSectionDesc |
| Cash Grant | $23,676 | CashGrantAmt |
| Purpose Of Grant | SUPPORT HEALTHCARE | PurposeOfGrantTxt |
Grants Other Asst To Indiv In US GrantsOtherAsstToIndivInUSGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Type | EDUCATION ASSISTANCE | GrantTypeTxt |
| Recipient | 11 | RecipientCnt |
| Cash Grant | $12,242 | CashGrantAmt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990 governing body review Part VI line 11 | FORM 990, PART VI, LINE 11B - ORGANIZATIONS PROCESS TO REVIEW FORM 990 PRIOR TO FILING FORM 990 RETURN OF ORGANIZAION EXEMPT FROM INCOME TAX. THE RETURN IS REVIEWED BY THE DEWITT COMMUNITY HOSPITAL FOUNDATION EXECUTIVE BOARD. ANY REVISIONS NOTED ARE CORRECTED AND THEN THE FINAL RETURN IS SIGNED BY AN EXECUTIVE OF THE BOARD. |
| Conflict of interest policy compliance Part VI line 12c | FORM 990, PART VI, LINE 12C - ENFORCEMENT OF CONFLICTS POLICY.ANY COVERED PERSON, DEFINED AS ANY DIRECTOR, OFFICER, MEMBER OF THE BOARD OR BOARD COMMITTEE OF DEWITT COMMUNITY HOSPITAL FOUNDATION (DCHF), SHOULD DISCLOSE AN INTEREST OR POTENTIAL INTEREST AS SOON AS THEY BECOME AWARE OF A POTENTIAL TRANSACTION THAT COULD BE CONSIDERED A POTENTIAL CONFLICT BY THE DIRECTOR, THE BOARD, OR COMMITTEE OF THE BOARD. COVERED PERSONS ARE REQUIRED ANNUALLY TO DISCLOSE ANY POSSIBLE PERSONAL, FAMILY, OR BUSINESS RELATIONS THAT REASONABLY COULD GIVE RISE TO AN INTEREST OR CONFLICT INVOLVING DCHF, AND ACKNOWLEDGE BY HIS OR HER SIGNATURE THAT HE OR SHE IS FAMILIAR WITH AND IS IN COMPLIANCE WITH THE LETTER AND SPIRIT OF THIS POLICY. ANY COVERED PERSON FOUND TO HAVE A CONFLICT OF INTERST MAY MAKE A FORM 990, PART VI, LINE 12C - ENFORCEMENT OF CONFLICTS POLICY- CONTUINUED..PRESENTATION AT THE BOARD OR COMMITTEE MEETING TO PRESENT INFORMATION AND ADDRESS ANY QUESTIONS RAISED BY OTHER DIRECTORS OR COMMITTEE MEMBERS. SAID PERSON SHALL NOT BE ALLOWED TO ACTIVELY AND AGGRESSIVELY ADVOCATE IN HIS OR HER OWN BEHALF NOR SHALL SUCH COMMUNICATION AND DISCUSSION BE WITH/THRU ANOTHER DIRECTOR. AFTER SUCH PRESENTATION, THE PERSON SHALL LEAVE THE MEETING DURING THE DISCUSSION OF, AND VOTE ON, THE APPLICABLE TRANSACTON OR ARRANGEMENT. |
| CEO executive director top management comp Part VI line 15a | COMPENSATION PROCESS FOR THE TOP OFFICIAL IS REVIEWED BY THE EXECUTIVE BOARD OF DIRECTORS. |
| Governing documents etc available to public Part VI line 19 | FORM 990, PART VI, LINE 19 - GOVERNING DOCUMENTS DISCLOSURE EXPLANATION.THE FOUNDATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC, UPON REQUEST. |
| Part III response or note to any other line in Part III | FORM 990 - ORGANIZATIONS MISSIONTHE MISSION OF THE DEWITT COMMUNITY HOSPITAL FOUNDATION IS TO SUPPORT THE MISSION OF GENESIS MEDICAL CENTER, DEWITT AND OTHER HEALTH CARE RELATED NEEDS, BY PROMOTING HEALTH CARE AWARENESS AND CREATING OPPORTUNITIES FOR FINANCIAL GIVING. |
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