PHELPS COUNTY HOSPITAL FOUNDATION: Form 990, tax year 2012

View the entire original 990 at ProPublica ↗

Organization
PHELPS COUNTY HOSPITAL FOUNDATION (EIN 43-1696258)
Tax period
2012-10-01 to 2013-09-30
Filed
2014-08-14
IRS object ID
201402269349303730
Schema version
2012v2.3
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)
Timestamp2014-08-14T14:52:07-05:00Timestamp
Tax Period End Date2013-09-30TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1BKD LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1910 E ST LOUIS 200/PO BOX 1190AddressLine1
CitySPRINGFIELDCity
StateMOState
ZIP Code658062523ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2012-10-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN431696258EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1PHELPS COUNTY HOSPITAL FOUNDATIONBusinessNameLine1
FieldValueIRS element (for citing)
In Care Of Name% EDWARD CLAYTONInCareOfName
Name ControlPHELNameControl
Phone5733648899Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line11000 WEST 10TH STREETAddressLine1
Address Line2SuiteAddressLine2
CityROLLACity
StateMOState
ZIP Code65401ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameEDWARD CLAYTONName
TitleCEOTitle
Phone5733648899Phone
Date Signed2014-08-06DateSigned
Authorize Third PartytrueAuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameBrian D ToddName
Phone4178658701Phone
FieldValueIRS element (for citing)
Tax Year2012TaxYear
Build TS2015-11-30 17:44:51ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonEDWARD CLAYTONNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line11000 WEST 10TH STREETAddressLine1
CityROLLACity
StateMOState
ZIP Code65401ZIPCode
FieldValueIRS element (for citing)
Gross Receipts730942GrossReceipts
Group Return For AffiliatesfalseGroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteWWW.PCRMC.COMWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1994YearFormation
State Legal DomicileMOStateLegalDomicile
Activity Or Mission DescriptionSERVES AS THE PHILANTHROPIC ORGANIZATION THAT FACILITATES CHARITABLE DONATIONS TO SUPPORT AND ASSIST PCRMC IN PROVIDING FOR THE HEALTHCARE NEEDS OF THE COMMUNITIES IT SERVES. SEE SCHEDULE O FOR MORE DETAIL.ActivityOrMissionDescription
Nbr Voting Members Governing Body12NbrVotingMembersGoverningBody
Nbr Independent Voting Members7NbrIndependentVotingMembers
Total Nbr Employees5TotalNbrEmployees
Total Nbr Volunteers50TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year596749ContributionsGrantsPriorYear
Contributions Grants Current Year713973ContributionsGrantsCurrentYear
Program Service Revenue Prior Year0ProgramServiceRevenuePriorYear
Program Service Revenue CY0ProgramServiceRevenueCY
Investment Income Prior Year2337InvestmentIncomePriorYear
Investment Income Current Year1292InvestmentIncomeCurrentYear
Other Revenue Prior Year-20577OtherRevenuePriorYear
Other Revenue Current Year-25337OtherRevenueCurrentYear
Total Revenue Prior Year578509TotalRevenuePriorYear
Total Revenue Current Year689928TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year106883GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY196355GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year250669SalariesEtcPriorYear
Salaries Etc Current Year349595SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY86585TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year340275TotalFundrsngExpCurrentYear
Other Expense Prior Year241273OtherExpensePriorYear
Other Expenses Current Year264839OtherExpensesCurrentYear
Total Expenses Prior Year598825TotalExpensesPriorYear
Total Expenses Current Year897374TotalExpensesCurrentYear
Revenues Less Expenses Prior Year-20316RevenuesLessExpensesPriorYear
Revenues Less Expenses CY-207446RevenuesLessExpensesCY
Total Assets BOY1258749TotalAssetsBOY
Total Assets EOY1391627TotalAssetsEOY
Total Liabilities BOY1409888TotalLiabilitiesBOY
Total Liabilities EOY1750212TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY-151139NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY-358585NetAssetsOrFundBalancesEOY
Mission DescriptionOUR MISSION IS TO SERVE AS THE PHILANTHROPIC ORGANIZATION THAT FACILITATES CHARITABLE DONATIONS TO SUPPORT AND ASSIST THE MISSIONS OF PHELPS COUNTY REGIONAL MEDICAL CENTER IN PROVIDING FOR THE HEALTH CARE NEEDS OF THE COMMUNITIES IT SERVES.MissionDescription
Significant New Program ServicesfalseSignificantNewProgramServices
Significant ChangefalseSignificantChange
Expense509648Expense
Grants196355Grants
DescriptionTHE ORGANIZATION FACILITATES CHARITABLE DONATIONS TO HELP SUPPORT THE MISSIONS AND ACTIVITIES OF PHELPS COUNTY REGIONAL MEDICAL CENTER. CONTRIBUTIONS ARE RECEIVED BY THE ORGANIZATION AND DISTRIBUTED TO PCRMC FOR USE IN ITS MISSION TO PROVIDE FOR THE HEALTH CARE NEEDS OF THE COMMUNITIES IT SERVES.Description
Total Program Service Expense509648TotalProgramServiceExpense
Described In501 C3trueDescribedIn501C3
Schedule B RequiredtrueScheduleBRequired
Political ActivitiesfalsePoliticalActivities
Lobbying ActivitiesfalseLobbyingActivities
Subject To Proxy TaxfalseSubjectToProxyTax
Donor Advised FundsfalseDonorAdvisedFunds
Conservation EasementsfalseConservationEasements
Collections Of ArtfalseCollectionsOfArt
Credit CounselingfalseCreditCounseling
Term Or Permanent EndowmentsfalseTermOrPermanentEndowments
Report Land Bldg EquiptrueReportLandBldgEquip
Report Invest Oth SecuritiesfalseReportInvestOthSecurities
Report Prog Rel InvestfalseReportProgRelInvest
Report Other AssetstrueReportOtherAssets
Report Other LiabilitiestrueReportOtherLiabilities
Report Fin48 FootnotefalseReportFin48Footnote
Independent Audit Financial StmtfalseIndependentAuditFinancialStmt
Consolidated Audit Financial StmtfalseConsolidatedAuditFinancialStmt
SchoolfalseSchool
Foreign OfficefalseForeignOffice
Foreign ActivitiesfalseForeignActivities
More Than5000 K To OrganizationsfalseMoreThan5000KToOrganizations
More Than5000 K To IndividualsfalseMoreThan5000KToIndividuals
Professional FundraisingtrueProfessionalFundraising
Fundraising ActivitiestrueFundraisingActivities
GamingfalseGaming
HospitalfalseHospital
Grants To OrganizationstrueGrantsToOrganizations
Grants To IndividualsfalseGrantsToIndividuals
Schedule J RequiredtrueScheduleJRequired
Tax Exempt BondsfalseTaxExemptBonds
Excess Benefit TransactionfalseExcessBenefitTransaction
Prior Excess Benefit TransactionfalsePriorExcessBenefitTransaction
Loan To Officer Or DQPfalseLoanToOfficerOrDQP
Grant To Related PersonfalseGrantToRelatedPerson
Bsnss Rltnshp With OrganizationfalseBsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family MemberfalseBsnssRltnshpThruFamilyMember
Officer Entity With Bsnss RltnshpfalseOfficerEntityWithBsnssRltnshp
Deductible Non Cash ContributionsfalseDeductibleNonCashContributions
Deductible Contributions Of ArtfalseDeductibleContributionsOfArt
TerminatedfalseTerminated
Partial LiquidationfalsePartialLiquidation
Disregarded EntityfalseDisregardedEntity
Related EntitytrueRelatedEntity
Related Org Controlled EntityfalseRelatedOrgControlledEntity
Transfers To Exempt Non Chrtbl OrgfalseTransfersToExemptNonChrtblOrg
Activities Conducted PartnershipfalseActivitiesConductedPartnership
Schedule O RequiredtrueScheduleORequired
Number Forms Transmitted With10960NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup WitholdingtrueComplianceWithBackupWitholding
Number Of Employees5NumberOfEmployees
Employment Tax Returns FiledtrueEmploymentTaxReturnsFiled
Unrelated Business IncomefalseUnrelatedBusinessIncome
Foreign Financial AccountfalseForeignFinancialAccount
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTrans
Taxable Party NotificationfalseTaxablePartyNotification
Non Deductible ContributionsfalseNonDeductibleContributions
Quid Pro Quo ContributionstrueQuidProQuoContributions
Quid Pro Quo DisclosuretrueQuidProQuoDisclosure
Form8282 Property Disposed OffalseForm8282PropertyDisposedOf
Funds To Pay PremiumsfalseFundsToPayPremiums
Premiums PaidfalsePremiumsPaid
Indoor Tanning ServicesfalseIndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members12NbrVotingGoverningBodyMembers
Number Independent Voting Members7NumberIndependentVotingMembers
Family Or Business RelationshipfalseFamilyOrBusinessRelationship
Delegation Of Management DutiesfalseDelegationOfManagementDuties
Changes To Organizing DocsfalseChangesToOrganizingDocs
Material Diversion Or MisusefalseMaterialDiversionOrMisuse
Members Or StockholdersfalseMembersOrStockholders
Election Of Board MembersfalseElectionOfBoardMembers
Decisions Subject To ApprovalfalseDecisionsSubjectToApproval
Minutes Of Governing BodytrueMinutesOfGoverningBody
Minutes Of CommitteestrueMinutesOfCommittees
Officer Mailing AddressfalseOfficerMailingAddress
Local ChaptersfalseLocalChapters
Form990 Provided To Governing BodyfalseForm990ProvidedToGoverningBody
Conflict Of Interest PolicytrueConflictOfInterestPolicy
Annual Disclosure Covered PersonstrueAnnualDisclosureCoveredPersons
Regular Monitoring EnforcementtrueRegularMonitoringEnforcement
Whistleblower PolicytrueWhistleblowerPolicy
Document Retention PolicytrueDocumentRetentionPolicy
Compensation Process CEOfalseCompensationProcessCEO
Compensation Process OtherfalseCompensationProcessOther
Investment In Joint VenturefalseInvestmentInJointVenture
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

FieldValueIRS element (for citing)
Name PersonEDWARD CLAYTONNamePerson
Telephone Number5733648899TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line11000 WEST 10TH STREETAddressLine1
CityROLLACity
StateMOState
ZIP Code65401ZIPCode
FieldValueIRS element (for citing)
Info In Schedule O Part VIIXInfoInScheduleOPartVII

Form990 Part VII Section A Form990PartVIISectionA (13 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerAverage Hours Per Week RelatedAverageHoursPerWeekRelatedReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensation
DEBBIE SCHUETZ
TREASURER1.0XX
MARK RIEFER
MEMBER1.0X
JOHN DENBO
CEO/MEMBER1.0XX40.0028123523435
TED DAY
PRESIDENT1.0XX1.0
PAT LEADERS
SECRETARY BEGINNING 04/131.0XX
KATHY NICKASON
MEMBER1.0X
MARY GRAHAM MD
SECRETARY ENDING 4/13/MEMBER1.0XX0275000
OLLIE JACKSON
MEMBER1.0X
CINDY BEGER
MEMBER1.0X
DWIGHT LOOK
MEMBER1.0X0355300
VIRGINIA LOMAX
MEMBER BEGINNING 04/131.0X
CANDACE CONNELL
VICE PRESIDENT BEGINNING 04/131.0XX
LORRIE HARTLEY
DIRECTOR40.0X012057019754
FieldValueIRS element (for citing)
Total Reportable Comp From Org0TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs464835TotalReportableCompFrmRltdOrgs
Total Other Compensation43189TotalOtherCompensation
Number Individuals GT100 K0NumberIndividualsGT100K
Formers ListedfalseFormersListed
Total Comp GT150 KtrueTotalCompGT150K
Compensation From Other SourcesfalseCompensationFromOtherSources

Contractor Compensation ContractorCompensation

Name Of Contractor NameOfContractor

FieldValueIRS element (for citing)
Name PersonCOPLEY RAFF INCNamePerson
FieldValueIRS element (for citing)
Address Of ContractorAddressOfContractor
Description Of ServicesCONSULTING/MAILINGSDescriptionOfServices
Compensation130496Compensation
FieldValueIRS element (for citing)
Number Of Contractors GT100 K1NumberOfContractorsGT100K
Fundraising Events113547FundraisingEvents
Related Organizations19920RelatedOrganizations
All Other Contributions580506AllOtherContributions
Total Contributions713973TotalContributions
Total Program Service Revenue0TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column1292TotalRevenueColumn
Exclusion$1,292ExclusionAmount

Income From Invest Bond Proceeds IncomeFromInvestBondProceeds

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Royalties Revenue RoyaltiesRevenue

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real0Real
Personal0Personal

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn
FieldValueIRS element (for citing)
Gross Income Fundraising Events15677GrossIncomeFundraisingEvents
Cntrbtns Rprtd Fundraising Events113547CntrbtnsRprtdFundraisingEvents
Fundraising Direct Expenses41014FundraisingDirectExpenses

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

FieldValueIRS element (for citing)
Total Revenue Column-25337TotalRevenueColumn
Exclusion-$25,337ExclusionAmount

Net Income From Gaming NetIncomeFromGaming

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Income Or Loss NetIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn
FieldValueIRS element (for citing)
Total Other Revenue0TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column689928TotalRevenueColumn
Exclusion-$24,045ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total196355Total
Program Services196355ProgramServices

Grants To Domestic Individuals GrantsToDomesticIndividuals

FieldValueIRS element (for citing)
Total0Total

Foreign Grants ForeignGrants

FieldValueIRS element (for citing)
Total0Total

Benefits To Members BenefitsToMembers

FieldValueIRS element (for citing)
Total0Total

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total0Total

Comp Disqual Persons CompDisqualPersons

FieldValueIRS element (for citing)
Total0Total

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total271818Total
Program Services154375ProgramServices
Management And General14373ManagementAndGeneral
Fundraising103070Fundraising

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total11589Total
Program Services6581ProgramServices
Management And General613ManagementAndGeneral
Fundraising4395Fundraising

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total47294Total
Program Services26859ProgramServices
Management And General2501ManagementAndGeneral
Fundraising17934Fundraising

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total18894Total
Program Services10731ProgramServices
Management And General999ManagementAndGeneral
Fundraising7164Fundraising

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total0Total

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total0Total

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total0Total

Fees For Services Lobbying FeesForServicesLobbying

FieldValueIRS element (for citing)
Total0Total

Fees For Services Prof Fundraising FeesForServicesProfFundraising

FieldValueIRS element (for citing)
Total86585Total
Fundraising86585Fundraising

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total0Total

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total51731Total
Management And General5520ManagementAndGeneral
Fundraising46211Fundraising

Advertising Advertising

FieldValueIRS element (for citing)
Total0Total

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total161635Total
Program Services88934ProgramServices
Management And General20805ManagementAndGeneral
Fundraising51896Fundraising

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total13056Total
Fundraising13056Fundraising

Royalties Royalties

FieldValueIRS element (for citing)
Total0Total

Occupancy Occupancy

FieldValueIRS element (for citing)
Total8273Total
Program Services4699ProgramServices
Management And General437ManagementAndGeneral
Fundraising3137Fundraising

Travel Travel

FieldValueIRS element (for citing)
Total1277Total
Program Services1277ProgramServices

Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials

FieldValueIRS element (for citing)
Total0Total

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total7687Total
Program Services6436ProgramServices
Management And General1251ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total0Total

Payments To Affiliates PaymentsToAffiliates

FieldValueIRS element (for citing)
Total0Total

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total14834Total
Program Services8425ProgramServices
Management And General784ManagementAndGeneral
Fundraising5625Fundraising

Insurance Insurance

FieldValueIRS element (for citing)
Total0Total

Other Expenses OtherExpenses (2 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneralFundraisingFundraising
MISCELLANEOUS494435741681202
LICENSES, DUES & SUBSCRIPTIONS14021402

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total897374Total
Program Services509648ProgramServices
Management And General47451ManagementAndGeneral
Fundraising340275Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY1101834BOY
EOY1227996EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Receivables From Officers Etc ReceivablesFromOfficersEtc

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Receivables From Disqual Persons ReceivablesFromDisqualPersons

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY12533BOY
EOY9654EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis53462LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec27643LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY41794BOY
EOY25819EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Investments Program Related InvestmentsProgramRelated

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Intangible Assets IntangibleAssets

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY102588BOY
EOY128158EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY1258749BOY
EOY1391627EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY4239BOY
EOY6213EOY

Grants Payable GrantsPayable

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Deferred Revenue DeferredRevenue

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Escrow Account Liability EscrowAccountLiability

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Loans From Officers Directors LoansFromOfficersDirectors

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Unsecured Notes Loans Payable UnsecuredNotesLoansPayable

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY1405649BOY
EOY1743999EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY1409888BOY
EOY1750212EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY-151139BOY
EOY-358585EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY-151139BOY
EOY-358585EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY1258749BOY
EOY1391627EOY
FieldValueIRS element (for citing)
Reconcilation Revenue Expenses-207446ReconcilationRevenueExpenses
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or ReviewfalseAccountantCompileOrReview
FS AuditedfalseFSAudited
Federal Grant Audit RequiredfalseFederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Supporting Organization509a3XSupportingOrganization509a3
Supporting Org509a3 Type3 Func IntXSupportingOrg509a3Type3FuncInt
Certification CheckboxXCertificationCheckbox
Contrib By Controlling IndividualfalseContribByControllingIndividual
Contribution By Related PartyfalseContributionByRelatedParty
Contrib By35 Controlled EntityfalseContribBy35ControlledEntity

Supported Org Information SupportedOrgInformation

Name Name

FieldValueIRS element (for citing)
Business Name Line1PCRMCBusinessNameLine1
FieldValueIRS element (for citing)
EIN436004435EIN
Type Of Organization03TypeOfOrganization
Listed In Governing DoctrueListedInGoverningDoc
Supported Organization NotifiedtrueSupportedOrganizationNotified
Organized In UStrueOrganizedInUS
Amount$193,500Amount
FieldValueIRS element (for citing)
Total Number Of Supported Orgs1TotalNumberOfSupportedOrgs
Sum Of Amounts193500SumOfAmounts
General ExplanationTHE FULL NAME OF THE SUPPORTED ORGANIZATION IS PHELPS COUNTY REGIONAL MEDICAL CENTER.GeneralExplanation

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

FieldValueIRS element (for citing)
Art Public Exhibition AmtsArtPublicExhibitionAmts
Held Works Of Art AmtsHeldWorksOfArtAmts
Current Year Minus3 YearsCurrentYearMinus3Years
Current Year Minus4 YearsCurrentYearMinus4Years
LandLand
BuildingsBuildings
Leasehold ImprovementsLeaseholdImprovements

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis53462OtherCostOrOtherBasis
Depreciation27643Depreciation
Book Value25819BookValue
FieldValueIRS element (for citing)
Other Land BuildingsOtherLandBuildings
Total Of Book Value Land Buildings25819TotalOfBookValueLandBuildings

Other Assets OtherAssets (3 entries)

DescriptionDescriptionBook ValueBookValue
DUE FROM HOME HEALTH124693
DUE FROM PMGI3303
DUE FROM BOND CLINIC162
FieldValueIRS element (for citing)
Total Book Value Other Assets128158TotalBookValueOtherAssets
Federal Income Tax Liability0FederalIncomeTaxLiability

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
DescriptionDUE TO PCRMCDescription
Amount$1,743,999Amount
FieldValueIRS element (for citing)
Total Of Amounts1743999TotalOfAmounts

Schedule G IRS990ScheduleG

FieldValueIRS element (for citing)
Agreement Ref FundraisingtrueAgreementRefFundraising

Fundraiser Activity Information FundraiserActivityInformation

FieldValueIRS element (for citing)
Name Of IndividualCOPLEY RAFF INCNameOfIndividual

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1233 NEEDHAM STREET SUITE 300AddressLine1
CityNEWTONCity
StateMAState
ZIP Code02464ZIPCode
FieldValueIRS element (for citing)
ActivityCAMPAIGN PLANNINGActivity
Fundraiser Control Of FundsfalseFundraiserControlOfFunds
Gross Receipts408107GrossReceipts
Amount Retained By Contractor86585AmountRetainedByContractor
Net To Organization321522NetToOrganization
FieldValueIRS element (for citing)
Total Gross Receipts408107TotalGrossReceipts
Total Retained By Contractors86585TotalRetainedByContractors
Total Net To Organization321522TotalNetToOrganization

Events Information EventsInformation

FieldValueIRS element (for citing)
Name Of Event1GOLF TOURNAMENTNameOfEvent1
Gross Receipts Event188552GrossReceiptsEvent1
Charitable Contributions Event178145CharitableContributionsEvent1
Gross Revenue Event110407GrossRevenueEvent1
Non Cash Prizes Event112926NonCashPrizesEvent1
Rent Facility Costs Event110407RentFacilityCostsEvent1
Food And Beverage Event17228FoodAndBeverageEvent1
Other Direct Expenses Event11326OtherDirectExpensesEvent1
Name Of Event2HEART TO HEARTNameOfEvent2
Gross Receipts Event240672GrossReceiptsEvent2
Charitable Contributions Event235402CharitableContributionsEvent2
Gross Revenue Event25270GrossRevenueEvent2
Food And Beverage Event25270FoodAndBeverageEvent2
Other Direct Expenses Event23857OtherDirectExpensesEvent2
Total Number Of Other Events0TotalNumberOfOtherEvents
Gross Receipts Total129224GrossReceiptsTotal
Charitable Contributions Total113547CharitableContributionsTotal
Gross Revenue Total Events15677GrossRevenueTotalEvents
Non Cash Prizes Total Events12926NonCashPrizesTotalEvents
Rent Facility Costs Total Events10407RentFacilityCostsTotalEvents
Food And Beverage Total Events12498FoodAndBeverageTotalEvents
Other Direct Expenses Total Events5183OtherDirectExpensesTotalEvents
Direct Expense Summary Events41014DirectExpenseSummaryEvents
Net Income Summary-25337NetIncomeSummary

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Records MaintainedtrueRecordsMaintained

Recipient Table RecipientTable

Recipient Name Business RecipientNameBusiness

FieldValueIRS element (for citing)
Business Name Line1PHELPS COUNTY REGIONAL MEDICAL CENTERBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line11000 W 10TH STREETAddressLine1
CityROLLACity
StateMOState
ZIP Code65401ZIPCode
FieldValueIRS element (for citing)
EIN Of Recipient436004435EINOfRecipient
IRC SectionPHELPS CO RMCIRCSection
Amount Of Cash Grant193500AmountOfCashGrant
Purpose Of GrantSUPPORT PROGRAMSPurposeOfGrant
FieldValueIRS element (for citing)
Total Nbr Of501 C3 And Govt Grants1TotalNbrOf501C3AndGovtGrants

Form990 Schedule I Part IV Form990ScheduleIPartIV

FieldValueIRS element (for citing)
IdentifierMONITORING OF GRANT FUNDSIdentifier
Return ReferenceSCHEDULE I, PART I, LINE 2ReturnReference
ExplanationGRANTS ARE PROVIDED TO A RELATED ORGANIZATION AS PART OF THE FOUNDATION'S MISSION. GRANT SPENDING IS MONITORED MONTHLY BY PCRMC ACCOUNTING DEPARTMENT AND FINANCIAL INFORMATION IS FORWARDED TO DIRECTOR OF FOUNDATION TO DETERMINE IF ADDITIONAL GRANT FUNDS ARE NEEDED.Explanation

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Severance PaymentfalseSeverancePayment
Supplemental Nonqual Retire PlanfalseSupplementalNonqualRetirePlan
Equity Based Comp ArrangementfalseEquityBasedCompArrangement
Comp Based On Revenue Of Filing OrgfalseCompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related OrgsfalseCompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing OrgfalseCompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate OrgsfalseCompBasedNetEarningsRelateOrgs
Any Non Fixed PaymentsfalseAnyNonFixedPayments
Initial Contract ExceptionfalseInitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII

FieldValueIRS element (for citing)
Name PersonJOHN DENBONamePerson
TitleCEO/MEMBERTitle
Base Compensation Filing Org0BaseCompensationFilingOrg
Comp Based On Related Orgs259930CompBasedOnRelatedOrgs
Bonus Filing Org0BonusFilingOrg
Bonus Related Orgs0BonusRelatedOrgs
Other Compensation Filing Org0OtherCompensationFilingOrg
Other Compensation Related Orgs21305OtherCompensationRelatedOrgs
Deferred Comp Filing Org0DeferredCompFilingOrg
Deferred Comp Related Orgs16868DeferredCompRelatedOrgs
Nontaxable Benefits Filing Org0NontaxableBenefitsFilingOrg
Nontaxable Benefits Related Orgs6567NontaxableBenefitsRelatedOrgs
Total Compensation Filing Org0TotalCompensationFilingOrg
Total Compensation Related Orgs304670TotalCompensationRelatedOrgs
Comp Report Prior990 Filing Org0CompReportPrior990FilingOrg
Comp Report Prior990 Related Orgs0CompReportPrior990RelatedOrgs

Form990 Schedule J Part III Form990ScheduleJPartIII

FieldValueIRS element (for citing)
IdentifierCOMPENSATION DETERMINATIONIdentifier
Return ReferenceSCHEDULE J, PART I, LINE 3ReturnReference
ExplanationPHELPS COUNTY REGIONAL MEDICAL CENTER, 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.Explanation

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (6 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
ORGANIZATION'S SIGNIFICANT ACTIVITIESFORM 990, PART I, LINE 1THE JOY OF CARING CANCER FUND OFFERS FINANCIAL ASSISTANCE FOR CANCER PATIENTS WHO MAY HAVE DIFFICULTY MANAGING THEIR DAILY ACTIVITIES AND CAPITAL NEEDS RELATED TO CANCER SERVICES. APPROXIMATELY 240 PEOPLE RECEIVED BENEFITS FROM THIS FUND THIS YEAR. COMPREHENSIVE BREAST CENTER PROVIDES WOMEN WITH A CHANCE AGAINST BREAST CANCER, THROUGH MANY COMMUNITY LEADERS' COMMITMENT. A KEY ELEMENT OF THE CENTER IS MAMMOGRAMS. SEVENTEEN PEOPLE WERE SERVED THIS YEAR. THE GUARDIAN ANGEL FUND PROVIDES A PHILANTHROPIC OPPORTUNITY FOR GRATEFUL PATIENTS TO RECOGNIZE A SPECIAL CAREGIVER WHO THEY BELIEVE MADE A DIFFERENCE IN THEIR STAY OR VISIT. THROUGH THIS PROGRAM, OVER 80 EMPLOYEES HAVE BEEN RECOGNIZED BY APPROXIMATELY 200 PATIENTS.
REVIEW OF THE FORM 990FORM 990, PART VI, SECTION B, LINE 11BTHE 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.
CONFLICT OF INTEREST POLICYFORM 990, PART VI, SECTION B, LINE 12CALL 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.
COMPENSATION REVIEWFORM 990, PART VI, SECTION B, LINE 15ATHE TOP MANAGEMENT OFFICIAL OF THE ORGANIZATION IS COMPENSATED BY PHELPS COUNTY REGIONAL MEDICAL CENTER, 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 POSITION OF THE ORGANIZATION. PAY RAISES ARE APPROVED BY THE BOARD OF DIRECTORS, AND DOCUMENTED IN THE BOARD MINUTES.
DOCUMENT DISCLOSUREFORM 990, PART VI, SECTION C, LINE 19THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST.
BOARD MEMBER COMPENSATIONFORM 990, PART VII, SECTION ADWIGHT LOOK AND MARY GRAHAM, BOARD MEMBERS, RECEIVE 1099 COMPENSATION FROM PHELPS COUNTY REGIONAL MEDICAL CENTER FOR SERVICES PERFORMED. JOHN DENBO, CEO, AND LORRIE HARTLEY, DIRECTOR, RECEIVE W-2 COMPENSATION FROM PHELPS COUNTY REGIONAL MEDICAL CENTER FOR THEIR SERVICES AS EMPLOYEES. NO BOARD MEMBERS ARE COMPENSATED FOR THEIR SERVICES AS A BOARD MEMBER.

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII

Name Of Disregarded Entity NameOfDisregardedEntity

FieldValueIRS element (for citing)
Business Name Line1PHELPS COUNTY REGIONAL MEDICAL CENTERBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line11000 W 10TH STREETAddressLine1
CityROLLACity
StateMOState
ZIP Code65401ZIPCode
FieldValueIRS element (for citing)
EIN436004435EIN
Primary ActivitiesHEALTH CAREPrimaryActivities
Legal Domicile StateMOLegalDomicileState
Exempt Code Section501(C)(3)ExemptCodeSection
Public Charity Status3PublicCharityStatus

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1NABusinessNameLine1
FieldValueIRS element (for citing)
Controlled OrgfalseControlledOrg
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents RoyaltiesfalseReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other OrgtrueGiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other OrgtrueGiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other OrgfalseLoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other OrgtrueLoansOrGuaranteesFromOtherOrg
Dividends Related OrganizationfalseDividendsRelatedOrganization
Sale Of Assets To Other OrgfalseSaleOfAssetsToOtherOrg
Purchase Of Assets From Other OrgfalsePurchaseOfAssetsFromOtherOrg
Exchange Of AssetsfalseExchangeOfAssets
Rental Of Facilities To Other OrgsfalseRentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other OrgsfalseRentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other OrgstruePerformOfServicesForOtherOrgs
Perform Of Services By Other OrgsfalsePerformOfServicesByOtherOrgs
Sharing Of FacilitiestrueSharingOfFacilities
Sharing Of Paid EmployeestrueSharingOfPaidEmployees
Reimbursement Paid To Other OrgtrueReimbursementPaidToOtherOrg
Reimbursement Paid By Other OrgtrueReimbursementPaidByOtherOrg
Other Transfer To Other OrgfalseOtherTransferToOtherOrg
Other Transfer From Other OrgfalseOtherTransferFromOtherOrg

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