2017-11-14T06:30:35-06:00 2016-12-31 481026809 Wendling Noe Nelson & Johnson LLC 534 S Kansas Ave Suite 1500 Topeka KS 666033491 990 2016-01-01 481112955 Citizens Foundation CITI 7854627511 100 E College Drive Colby KS 67701 Greg Unruh CEO 7854627511 2017-11-01 1 Heather R Eichem P01515553 7852334226 2017-11-01 98.172.114.81 2017-11-01 09:33:22 CD P C7F69BD11539B5342AA98FD5676A33A3D336D5E8 C7F69BD11539B5342AA98FD5676A33A3D336D5E8 2016 2017-02-10 21:41:12Z Greg Unruh 100 E College Drive Colby KS 67701 258454 0 X www.nwkshealthcare.com/foundation X 1991 KS Fundraising for the benefit of Citizens Medical Center, Inc. 7 7 0 25 0 0 583341 199995 0 0 32523 27066 48035 12307 663899 239368 562429 55325 0 0 0 0 0 0 85 9132 13599 571561 68924 92338 170444 1707400 1954109 0 19653 1707400 1934456 X To support health care, treatment, health related education, as well as the promotion of health and wellness for northwest Kansas. To promote health and well being of people through the development, promotion, improvement, and support of all forms of healthcare service and means for the delivery of such service as well as the support and enhancement of existing health care treatment facilities. 0 0 6000 6000 Provide scholarships according to the restricted endowment fund guidelines. 49325 49325 Provide support for health care services in the community. 55325 1 1 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 0 0 0 0 0 0 1 1 0 0 0 0 X 7 7 0 0 0 0 1 1 0 1 1 0 0 1 1 1 1 0 0 0 0 0 X Darcy Howard 7854627511 100 E College Drive Colby KS 67701 Lana Johnson Director 1.00 0.00 X 0 0 0 Pat Mallory Vice Chair 1.00 0.00 X X 0 0 0 Sean Hankin Chair 1.00 0.00 X X 0 0 0 Phil DeYoung Secretary 1.00 0.00 X X 0 0 0 Randy Wilson Director 1.00 0.00 X 0 0 0 Michelle Ryan Director 1.00 0.00 X 0 0 0 Ken Frahm Treasurer 1.00 0.00 X X 0 0 0 Greg Unruh CEO 0.00 40.00 X 187722 0 30641 187722 0 30641 1 0 0 1 0 21110 178885 199995 27066 27066 1500 6218 -4718 -4718 -4718 29893 21110 12868 17025 17025 239368 0 0 39373 49325 49325 6000 6000 2099 2099 6800 6800 4615 4615 Uncollected pledges 85 85 68924 55325 13514 85 144338 241715 845005 3464 1135 10708 82989 3591 0 79398 1307168 1028560 7 11 1707400 1954109 19653 0 19653 X 342777 432082 994628 1132379 369995 369995 1707400 1934456 1707400 1954109 170444 56612 0 X 0 0 0 X 714025 560126 110859 583341 199910 2168261 714025 560126 110859 583341 199910 2168261 2168261 40412 -30413 23387 32523 28566 94475 2262736 929763 0.95820 0.92850 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 535309 31386 2099 564596 533807 3560 2058 535309 500243 2501 32872 1809 533807 488042 13909 1708 500243 466454 23260 1672 488042 0.20990 0.65530 0.13480 0 0 79794 3325 76469 3195 266 2929 79398 Part V, Line 4: Endowment funds are restricted for healthcare education scholarships and for capital improvements to Citizens Medical Center and its physician clinic. Harvest for Health Golf Tournament 51003 21110 29893 2700 1543 1430 1943 5252 0 0 51003 21110 29893 2700 1543 1430 1943 5252 12868 17025 1 Citizens Medical Center 100 E College Drive Colby KS 67701 480892178 501(c)(3) 46162 FMV Capital equipment, minor equipment, and health care expansion Scholarships for health care education 4 6000 FMV Part I, Line 2: Enrollment in secondary education is verified prior to disbursing scholarship funds. 0 0 0 0 0 0 0 0 0 Greg Unruh CEO 187722 0 0 0 0 0 8463 0 22178 0 218363 0 0 0 Form 990, Part VII, Section A, Line 5 Greg Unruh is the Chief Executive Officer of Citizens Medical Center (CMC) which is an unrelated organization for purposes of the Form 990. Greg also serves as the CEO of Citizens Foundation. Greg's compensation is from CMC and the portion related to the Foundation is unidentifiable. As a result, his total compesation from CMC is reported as if from the organization in accordance with the 990 instructions. Form 990, Part VI, Section A, line 6 The organization had 7 members on the Board of Directors and 23 voting members as of 12/31/2016. The voting members elect the members of the Board of Directors and vote on such other matters as are submitted to a vote. Form 990, Part VI, Section A, line 7a Citizens Foundation has 23 voting members responsible for electing and overseeing the governing body, known as the Board of Directors. The Board of Directors is responsible for managing the affairs of the Foundation. The Board of Directors may submit other matters to the voting members for a vote. Form 990, Part VI, Section B, line 11b Form 990 is provided to the Chief Executive Officer who e-mails notices to members of the Board of Trustees that the Form 990 is available for review prior to filing the return. Form 990, Part VI, Section B, line 12c A conflict of interest disclosure form is provided with a copy of the current conflict of interest policy. This disclosure form is completed by each Member upon election and annually thereafter. Form 990, Part VI, Section B, line 15 The Board of Trustees reviews the compensation of the Medical Center's CEO. The Medical Center relies on a joint wage salary report published by the Kansas Hospital and Missouri Hospital Associations, as well as any and all available local data. The Medical Center's CEO is the only individual receiving a portion of his overall compensation that is attributable to his work with the Foundation. Form 990, Part VI, Section C, line 19 The organization makes its governing documents, conflict of interest policy, and financial statements available to the public upon written request.