2015-08-03T10:58:28-05:00 2014-12-31 481026809 Wendling Noe Nelson & Johnson LLC 534 S Kansas Ave Suite 1500 Topeka KS 666033491 990 2014-01-01 481112955 Citizens Foundation CITI 7854627511 100 E College Drive Colby KS 67701 Greg Unruh CEO 7854627511 2015-07-24 1 Heather R Eichem P01515553 7852334226 2015-07-24 2014 2016-04-25 22:37:26Z Greg Unruh 100 E College Drive Colby KS 67701 180272 0 X www.nwkshealthcare.com/foundation X 1991 KS Fundraising for the benefit of Citizens Medical Center, Inc. 7 7 0 63 0 0 542601 110859 0 0 -30413 23387 17525 26295 529713 160541 1266146 182894 0 0 0 0 13342 0 1751 9901 11202 1289389 194096 -759676 -33555 1598010 1641539 0 0 1598010 1641539 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 5000 5000 Provide scholarships according to the restricted endowment fund guidelines. 177894 177894 Provide support for health care services in the community. 182894 1 1 0 0 0 0 0 0 0 1 0 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 1 0 0 0 1 0 0 1 0 0 0 0 0 0 1 1 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 Patsy Evans 7854627511 100 E College Drive Colby KS 67701 Kathy Kersenbrock-Ostmeyer Chairperson 1.00 X X 0 0 0 Sean Hankin Vice Chairperson 1.00 X X 0 0 0 Vern Schwanke Secretary 1.00 X X 0 0 0 Ken Frahm Treasurer 1.00 X X 0 0 0 Phil DeYoung Director 1.00 X 0 0 0 Kasiah Rothchild Director 1.00 X 0 0 0 Pat Mallory Director 1.00 X 0 0 0 Clyde Kevan Trenkle CEO 1.00 40.00 X 0 209490 16647 0 209490 16647 0 0 1 0 0 110859 110859 23387 23387 46026 19731 26295 26295 160541 0 0 49682 177894 177894 5000 5000 2654 2654 20 20 6797 6797 Uncollected pledges 1731 1731 194096 182894 9451 1751 72925 80509 833950 236815 13972 11091 4403 3751 672756 1309367 4 6 1598010 1641539 0 0 X 727209 1220067 500806 51477 369995 369995 1598010 1641539 1598010 1641539 -33555 77084 0 X 0 0 0 X 102514 27744 714025 560126 110859 1515268 102514 27744 714025 560126 110859 1515268 1515268 44541 87702 40412 -30413 23387 165629 1680897 811445 0.90150 0.90880 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 500243 2501 32872 1809 533807 488042 13909 1708 500243 466454 23260 1672 488042 442875 600 24576 1597 466454 423288 21126 1539 442875 0.69310 0.30690 0.00000 1 0 0 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 31191 31191 4674 6600 Jewelry Fair 11854 11854 6757 1 2980 2980 1699 46025 46025 4674 15056 19730 26295 1 Citizens Medical Center 100 E College Drive Colby KS 67701 480892178 501(c)(3) 177894 FMV Clinic Health Care expansion project Scholarships for health care education 4 5000 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 Clyde Kevan Trenkle CEO 0 166248 0 28035 0 15207 0 0 0 16647 0 226137 0 0 Form 990, Part VI, Section A, line 6 The organization had 7 members on the Board of Directors and 24 voting members as of 12/31/2014. 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 24 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 11 Form 990 is provided to the governing body and reviewed prior to filing. 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 C, line 19 The organization makes its governing documents, conflict of interest policy, and financial statements available to the public upon written request. Citizens Medical Center Inc 100 E College Drive Colby KS 67701 480892178 Hospital KS 501(c)(3) Line 3 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0