PHELPS COUNTY HOSPITAL FOUNDATION: Form 990, tax year 2011

View the entire original 990 at ProPublica ↗

Organization
PHELPS COUNTY HOSPITAL FOUNDATION (EIN 43-1696258)
Tax period
2011-10-01 to 2012-09-30
Filed
2013-08-14
IRS object ID
201302269349303365
Schema version
2011v1.5
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)
Timestamp2013-08-14T14:57:48-05:00Timestamp
Tax Period End Date2012-09-30TaxPeriodEndDate

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 Date2011-10-01TaxPeriodBeginDate

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
CityROLLACity
StateMOState
ZIP Code65401ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameEDWARD CLAYTONName
TitleCFOTitle
Date Signed2013-08-14DateSigned
Authorize Third PartytrueAuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
Phone4178658701Phone
FieldValueIRS element (for citing)
Tax Year2011TaxYear
Build TS2016-02-25 16:41:14ZBuildTS

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 Receipts611505GrossReceipts
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 Body10NbrVotingMembersGoverningBody
Nbr Independent Voting Members5NbrIndependentVotingMembers
Total Nbr Employees3TotalNbrEmployees
Total Nbr Volunteers40TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year588201ContributionsGrantsPriorYear
Contributions Grants Current Year596749ContributionsGrantsCurrentYear
Program Service Revenue Prior Year0ProgramServiceRevenuePriorYear
Program Service Revenue CY0ProgramServiceRevenueCY
Investment Income Prior Year3613InvestmentIncomePriorYear
Investment Income Current Year2337InvestmentIncomeCurrentYear
Other Revenue Prior Year-24163OtherRevenuePriorYear
Other Revenue Current Year-20577OtherRevenueCurrentYear
Total Revenue Prior Year567651TotalRevenuePriorYear
Total Revenue Current Year578509TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year84454GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY106883GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year197376SalariesEtcPriorYear
Salaries Etc Current Year250669SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year491942TotalFundrsngExpCurrentYear
Other Expense Prior Year121249OtherExpensePriorYear
Other Expenses Current Year241273OtherExpensesCurrentYear
Total Expenses Prior Year403079TotalExpensesPriorYear
Total Expenses Current Year598825TotalExpensesCurrentYear
Revenues Less Expenses Prior Year164572RevenuesLessExpensesPriorYear
Revenues Less Expenses CY-20316RevenuesLessExpensesCY
Total Assets BOY1092636TotalAssetsBOY
Total Assets EOY1258749TotalAssetsEOY
Total Liabilities BOY1223459TotalLiabilitiesBOY
Total Liabilities EOY1409888TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY-130823NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY-151139NetAssetsOrFundBalancesEOY
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
Expense106883Expense
Grants106883Grants
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 Expense106883TotalProgramServiceExpense
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 FundraisingfalseProfessionalFundraising
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
Transaction Related EntityfalseTransactionRelatedEntity
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 Employees3NumberOfEmployees
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 Members10NbrVotingGoverningBodyMembers
Number Independent Voting Members5NumberIndependentVotingMembers
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 DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensation
DEBBIE SCHUETZ
TREASURER1.0XX000
MARK RIEFER
MEMBER1.0X000
JOHN DENBO
CEO/MEMBER1.0XX027797824232
TED DAY
PRESIDENT1.0XX000
DR JOHN PARK
MEMBER THROUGH 12/111.0X000
PAT LEADERS
MEMBER1.0X000
YVONNE DAWDY
VICE PRESIDENT THROUGH 04/121.0XX017000
KATHY NICKASON
MEMBER1.0X000
MARY GRAHAM MD
SECRETARY1.0XX0300000
OLLIE JACKSON
MEMBER, BEGINNING 01/121.0X000
CINDY BEGER
MEMBER, BEGINNING 12/111.0X000
DWIGHT LOOK
MEMBER, BEGINNING 01/121.0X041670
LORRIE HARTLEY
DIRECTOR40.0X08461616956
FieldValueIRS element (for citing)
Total Reportable Comp From Org0TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs398461TotalReportableCompFrmRltdOrgs
Total Other Compensation41188TotalOtherCompensation
Number Individuals GT100 K0NumberIndividualsGT100K
Formers ListedfalseFormersListed
Total Comp GT150 KtrueTotalCompGT150K
Compensation From Other SourcesfalseCompensationFromOtherSources
Number Of Contractors GT100 K0NumberOfContractorsGT100K
Fundraising Events94324FundraisingEvents
Related Organizations13700RelatedOrganizations
All Other Contributions488725AllOtherContributions
Total Contributions596749TotalContributions
Total Program Service Revenue0TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column2337TotalRevenueColumn
Exclusion$2,337ExclusionAmount

Income From Invest Bond Proceeds IncomeFromInvestBondProceeds

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Royalties Revenue RoyaltiesRevenue

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 Events12419GrossIncomeFundraisingEvents
Cntrbtns Rprtd Fundraising Events94324CntrbtnsRprtdFundraisingEvents
Fundraising Direct Expenses32996FundraisingDirectExpenses

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

FieldValueIRS element (for citing)
Total Revenue Column-20577TotalRevenueColumn
Exclusion-$20,577ExclusionAmount

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 Column578509TotalRevenueColumn
Exclusion-$18,240ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total106883Total
Program Services106883ProgramServices

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)
Total196402Total
Fundraising196402Fundraising

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total6639Total
Fundraising6639Fundraising

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total34090Total
Fundraising34090Fundraising

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total13538Total
Fundraising13538Fundraising

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)
Total0Total

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total0Total

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total94918Total
Fundraising94918Fundraising

Advertising Advertising

FieldValueIRS element (for citing)
Total0Total

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total98124Total
Fundraising98124Fundraising

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total0Total

Royalties Royalties

FieldValueIRS element (for citing)
Total0Total

Occupancy Occupancy

FieldValueIRS element (for citing)
Total15837Total
Fundraising15837Fundraising

Travel Travel

FieldValueIRS element (for citing)
Total2160Total
Fundraising2160Fundraising

Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials

FieldValueIRS element (for citing)
Total0Total

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total14902Total
Fundraising14902Fundraising

Interest Interest

FieldValueIRS element (for citing)
Total0Total

Payments To Affiliates PaymentsToAffiliates

FieldValueIRS element (for citing)
Total0Total

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total12809Total
Fundraising12809Fundraising

Insurance Insurance

FieldValueIRS element (for citing)
Total0Total

Other Expenses OtherExpenses (2 entries)

DescriptionDescriptionTotalTotalFundraisingFundraising
LICENSES, DUES & SUBSCRIPTIONS18311831
MISCELLANEOUS692692

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total598825Total
Program Services106883ProgramServices
Management And General0ManagementAndGeneral
Fundraising491942Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY993898BOY
EOY1101834EOY

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)
BOY661BOY
EOY12533EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis53462LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec11668LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY16674BOY
EOY41794EOY

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)
BOY81403BOY
EOY102588EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY1092636BOY
EOY1258749EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY3591BOY
EOY4239EOY

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)
BOY1219868BOY
EOY1405649EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY1223459BOY
EOY1409888EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY-130823BOY
EOY-151139EOY

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-130823BOY
EOY-151139EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY1092636BOY
EOY1258749EOY
FieldValueIRS element (for citing)
Reconcilation Revenue Expenses-20316ReconcilationRevenueExpenses
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$106,883Amount
FieldValueIRS element (for citing)
Total Number Of Supported Orgs1TotalNumberOfSupportedOrgs
Sum Of Amounts106883SumOfAmounts
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
LandLand
BuildingsBuildings
Leasehold ImprovementsLeaseholdImprovements

Equipment Equipment

FieldValueIRS element (for citing)
Investment Cost Or Other Basis0InvestmentCostOrOtherBasis
Other Cost Or Other Basis53462OtherCostOrOtherBasis
Depreciation11668Depreciation
Book Value41794BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis0OtherCostOrOtherBasis
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings41794TotalOfBookValueLandBuildings

Other Assets OtherAssets (3 entries)

DescriptionDescriptionBook ValueBookValue
DUE FROM HOME HEALTH102456
DUE FROM PMGI88
DUE FROM BOND CLINIC44
FieldValueIRS element (for citing)
Total Book Value Other Assets102588TotalBookValueOtherAssets
Federal Income Tax Liability0FederalIncomeTaxLiability

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
DescriptionDUE TO PCRMCDescription
Amount$1,405,649Amount
FieldValueIRS element (for citing)
Total Of Amounts1405649TotalOfAmounts

Schedule G IRS990ScheduleG

Events Information EventsInformation

FieldValueIRS element (for citing)
Name Of Event1GOLF TOURNAMENTNameOfEvent1
Gross Receipts Event176640GrossReceiptsEvent1
Charitable Contributions Event168797CharitableContributionsEvent1
Gross Revenue Event17843GrossRevenueEvent1
Non Cash Prizes Event19126NonCashPrizesEvent1
Rent Facility Costs Event17843RentFacilityCostsEvent1
Food And Beverage Event16656FoodAndBeverageEvent1
Other Direct Expenses Event13190OtherDirectExpensesEvent1
Name Of Event2HEART TO HEARTNameOfEvent2
Gross Receipts Event230103GrossReceiptsEvent2
Charitable Contributions Event225527CharitableContributionsEvent2
Gross Revenue Event24576GrossRevenueEvent2
Food And Beverage Event24576FoodAndBeverageEvent2
Other Direct Expenses Event21605OtherDirectExpensesEvent2
Total Number Of Other Events0TotalNumberOfOtherEvents
Gross Receipts Total106743GrossReceiptsTotal
Charitable Contributions Total94324CharitableContributionsTotal
Gross Revenue Total Events12419GrossRevenueTotalEvents
Non Cash Prizes Total Events9126NonCashPrizesTotalEvents
Rent Facility Costs Total Events7843RentFacilityCostsTotalEvents
Food And Beverage Total Events11232FoodAndBeverageTotalEvents
Other Direct Expenses Total Events4795OtherDirectExpensesTotalEvents
Direct Expense Summary Events32996DirectExpenseSummaryEvents
Net Income Summary-20577NetIncomeSummary

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 Grant106883AmountOfCashGrant
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
Base Compensation Filing Org0BaseCompensationFilingOrg
Comp Based On Related Orgs256111CompBasedOnRelatedOrgs
Bonus Filing Org0BonusFilingOrg
Bonus Related Orgs0BonusRelatedOrgs
Other Compensation Filing Org0OtherCompensationFilingOrg
Other Compensation Related Orgs21867OtherCompensationRelatedOrgs
Deferred Comp Filing Org0DeferredCompFilingOrg
Deferred Comp Related Orgs15018DeferredCompRelatedOrgs
Nontaxable Benefits Filing Org0NontaxableBenefitsFilingOrg
Nontaxable Benefits Related Orgs9214NontaxableBenefitsRelatedOrgs
Total Compensation Filing Org0TotalCompensationFilingOrg
Total Compensation Related Orgs302210TotalCompensationRelatedOrgs
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, YVONNE DAWDY, 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

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
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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