CITIZENS FOUNDATION: Form 990, tax year 2012
View the entire original 990 at ProPublica ↗
- Organization
- CITIZENS FOUNDATION (EIN 48-1112955)
- Tax period
- 2012-01-01 to 2012-12-31
- Filed
- 2013-11-11
- IRS object ID
- 201323169349301517
- Schema version
- 2012v2.1
- 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
- Form 990
- Schedule A
- Schedule B
- Schedule D
- Schedule G
- Schedule I
- Schedule M
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2013-11-11T08:55:40-06:00 | Timestamp |
| Tax Period End Date | 2012-12-31 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 481026809 | EIN |
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Wendling Noe Nelson & Johnson LLC | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 534 S Kansas Ave Suite 1500 | AddressLine1 |
| City | Topeka | City |
| State | KS | State |
| ZIP Code | 666033491 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2012-01-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 481112955 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Citizens Foundation | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | CITI | NameControl |
| Phone | 7854627511 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 100 E College Drive | AddressLine1 |
| City | Colby | City |
| State | KS | State |
| ZIP Code | 67701 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Kevan Trenkle | Name |
| Title | CEO | Title |
| Phone | 7854627511 | Phone |
| Date Signed | 2013-11-07 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Derek H Hart | Name |
| PTIN | P01054116 | PTIN |
| Phone | 7852334226 | Phone |
| Date Prepared | 2013-11-07 | DatePrepared |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2012 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | Kevan Trenkle | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 100 E College Drive | AddressLine1 |
| City | Colby | City |
| State | KS | State |
| ZIP Code | 67701 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 794608 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | www.nwkshealthcare.com/foundation | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1991 | YearFormation |
| State Legal Domicile | KS | StateLegalDomicile |
| Activity Or Mission Description | Fundraising for the benefit of Citizens Medical Center, Inc. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 7 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 7 | NbrIndependentVotingMembers |
| Total Nbr Employees | 0 | TotalNbrEmployees |
| Total Nbr Volunteers | 15 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 102939 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 714025 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 0 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 0 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 87702 | InvestmentIncomePriorYear |
| Investment Income Current Year | 40412 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 0 | OtherRevenuePriorYear |
| Other Revenue Current Year | 0 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 190641 | TotalRevenuePriorYear |
| Total Revenue Current Year | 754437 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 5500 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 26807 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 0 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 0 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 20614 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 29750 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 233512 | OtherExpensePriorYear |
| Other Expenses Current Year | 17218 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 239012 | TotalExpensesPriorYear |
| Total Expenses Current Year | 64639 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | -48371 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 689798 | RevenuesLessExpensesCY |
| Total Assets BOY | 1668290 | TotalAssetsBOY |
| Total Assets EOY | 2358293 | TotalAssetsEOY |
| Total Liabilities BOY | 118 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 323 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 1668172 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 2357970 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | 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. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 5500 | Expense |
| Grants | 5500 | Grants |
| Description | Provide scholarships according to the restricted endowment fund guidelines. | Description |
Activity2 Activity2
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 20000 | Expense |
| Grants | 20000 | Grants |
| Description | Provide support for health care services in the community. | Description |
Activity3 Activity3
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 1307 | Expense |
| Grants | 1307 | Grants |
| Description | Provide coats for needy children in the community. | Description |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expense | 26807 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 0 | LobbyingActivities |
| Subject To Proxy Tax | 0 | SubjectToProxyTax |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 1 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 0 | ReportLandBldgEquip |
| Report Invest Oth Securities | 0 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 0 | ReportOtherAssets |
| Report Other Liabilities | 0 | ReportOtherLiabilities |
| Report Fin48 Footnote | 0 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 0 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 0 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 1 | ProfessionalFundraising |
| Fundraising Activities | 1 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 0 | Hospital |
| Grants To Organizations | 1 | GrantsToOrganizations |
| Grants To Individuals | 1 | GrantsToIndividuals |
| Schedule J Required | 0 | ScheduleJRequired |
| Tax Exempt Bonds | 0 | TaxExemptBonds |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 0 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 0 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 1 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 1 | RelatedEntity |
| Related Org Controlled Entity | 0 | RelatedOrgControlledEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 1 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 0 | NumberOfEmployees |
| Unrelated Business Income | 0 | UnrelatedBusinessIncome |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 1 | QuidProQuoContributions |
| Quid Pro Quo Disclosure | 1 | QuidProQuoDisclosure |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 7 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 7 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 1 | MembersOrStockholders |
| Election Of Board Members | 1 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 0 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 0 | WhistleblowerPolicy |
| Document Retention Policy | 0 | DocumentRetentionPolicy |
| Compensation Process CEO | 0 | CompensationProcessCEO |
| Compensation Process Other | 0 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Kevan Trenkle | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 7854627511 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 100 E College Drive | AddressLine1 |
| City | Colby | City |
| State | KS | State |
| ZIP Code | 67701 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| No Listed Persons Compensated | X | NoListedPersonsCompensated |
Form990 Part VII Section A Form990PartVIISectionA (7 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation |
|---|---|---|---|---|---|---|
| Sue Evans | ||||||
| Chairperson | 1.00 | X | X | 0 | 0 | 0 |
| Kathy Kersenbrock-Ostmeyer | ||||||
| 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 |
| Sean Hankin | ||||||
| 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 | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 0 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 0 | TotalOtherCompensation |
| Number Individuals GT100 K | 0 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 0 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
| Number Of Contractors GT100 K | 0 | NumberOfContractorsGT100K |
| Fundraising Events | 25780 | FundraisingEvents |
| All Other Contributions | 688245 | AllOtherContributions |
| Noncash Contributions | 250833 | NoncashContributions |
| Total Contributions | 714025 | TotalContributions |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 40412 | TotalRevenueColumn |
| Exclusion | $40,412 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Income Fundraising Events | 40171 | GrossIncomeFundraisingEvents |
| Cntrbtns Rprtd Fundraising Events | 25780 | CntrbtnsRprtdFundraisingEvents |
| Fundraising Direct Expenses | 40171 | FundraisingDirectExpenses |
Net Income From Fundraising Events NetIncomeFromFundraisingEvents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 754437 | TotalRevenueColumn |
| Related Or Exempt Function Income | 0 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $40,412 | ExclusionAmount |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 20000 | Total |
| Program Services | 20000 | ProgramServices |
Grants To Domestic Individuals GrantsToDomesticIndividuals
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 6807 | Total |
| Program Services | 6807 | ProgramServices |
Fees For Services Prof Fundraising FeesForServicesProfFundraising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 20614 | Total |
| Fundraising | 20614 | Fundraising |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 4893 | Total |
| Management And General | 4893 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 4409 | Total |
| Fundraising | 4409 | Fundraising |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2945 | Total |
| Management And General | 2945 | ManagementAndGeneral |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 244 | Total |
| Management And General | 244 | ManagementAndGeneral |
Other Expenses OtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | Uncollected pledges | Description |
| Total | 4727 | Total |
| Fundraising | 4727 | Fundraising |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 64639 | Total |
| Program Services | 26807 | ProgramServices |
| Management And General | 8082 | ManagementAndGeneral |
| Fundraising | 29750 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6994 | BOY |
| EOY | 16080 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 904052 | BOY |
| EOY | 1521446 | EOY |
Pledges And Grants Receivable PledgesAndGrantsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 79709 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 28878 | BOY |
| EOY | 4204 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 728313 | BOY |
| EOY | 736847 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 53 | BOY |
| EOY | 7 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1668290 | BOY |
| EOY | 2358293 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 118 | BOY |
| EOY | 323 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 118 | BOY |
| EOY | 323 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1298177 | BOY |
| EOY | 1322928 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 665047 | EOY |
Permanently Restricted Net Assets PermanentlyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 369995 | BOY |
| EOY | 369995 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1668172 | BOY |
| EOY | 2357970 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1668290 | BOY |
| EOY | 2358293 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expenses | 689798 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | 0 | ReconcilationOtherChanges |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 0 | FSAudited |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Publicly Supported Org170b1 Avi | X | PubliclySupportedOrg170b1Avi |
Gifts Grants Contrib Received170 GiftsGrantsContribReceived170
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 1103143 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 49148 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 102514 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 27744 | CurrentTaxYearMinus1Year |
| Current Tax Year | 714025 | CurrentTaxYear |
| Total | 1996574 | Total |
Total170 Total170
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 1103143 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 49148 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 102514 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 27744 | CurrentTaxYearMinus1Year |
| Current Tax Year | 714025 | CurrentTaxYear |
| Total | 1996574 | Total |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total170 | 1996574 | PublicSupportTotal170 |
Gross Investment Income170 GrossInvestmentIncome170
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 19327 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 3693 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 44541 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 87702 | CurrentTaxYearMinus1Year |
| Current Tax Year | 40412 | CurrentTaxYear |
| Total | 195675 | Total |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Support | 2192249 | TotalSupport |
| Gross Receipts From Admissions Etc | 848984 | GrossReceiptsFromAdmissionsEtc |
| Public Support Pertcentage170 | 0.91070 | PublicSupportPertcentage170 |
| Public Support Pertcent Prior Year | 0.88370 | PublicSupportPertcentPriorYear |
| Thirty Three Percnt Tests CY170 | X | ThirtyThreePercntTestsCY170 |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| 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) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule D IRS990ScheduleD
Current Year CurrentYear
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 1268240 | BeginningOfYearBalance |
| Investment Earnings Or Losses | 35481 | InvestmentEarningsOrLosses |
| Other Expenditures | 4784 | OtherExpenditures |
| Administrative Expenses | 1672 | AdministrativeExpenses |
| End Of Year Balance | 1297265 | EndOfYearBalance |
Current Year Minus1 Year CurrentYearMinus1Year
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 726432 | BeginningOfYearBalance |
| Contributions | 516260 | Contributions |
| Investment Earnings Or Losses | 27145 | InvestmentEarningsOrLosses |
| Administrative Expenses | 1597 | AdministrativeExpenses |
| End Of Year Balance | 1268240 | EndOfYearBalance |
Current Year Minus2 Years CurrentYearMinus2Years
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 621836 | BeginningOfYearBalance |
| Contributions | 99940 | Contributions |
| Investment Earnings Or Losses | 6195 | InvestmentEarningsOrLosses |
| Administrative Expenses | 1539 | AdministrativeExpenses |
| End Of Year Balance | 726432 | EndOfYearBalance |
Current Year Minus3 Years CurrentYearMinus3Years
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 263408 | BeginningOfYearBalance |
| Contributions | 332872 | Contributions |
| Investment Earnings Or Losses | 27773 | InvestmentEarningsOrLosses |
| Grants Or Scholarships | 1000 | GrantsOrScholarships |
| Administrative Expenses | 1217 | AdministrativeExpenses |
| End Of Year Balance | 621836 | EndOfYearBalance |
Current Year Minus4 Years CurrentYearMinus4Years
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 200012 | BeginningOfYearBalance |
| Contributions | 55000 | Contributions |
| Investment Earnings Or Losses | 13476 | InvestmentEarningsOrLosses |
| Grants Or Scholarships | 4000 | GrantsOrScholarships |
| Administrative Expenses | 1080 | AdministrativeExpenses |
| End Of Year Balance | 263408 | EndOfYearBalance |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Designated EOY Balance | 0.20000 | BoardDesignatedEOYBalance |
| Permanent Endowment EOY Balance | 0.29000 | PermanentEndowmentEOYBalance |
| Term Endowment EOY Balance | 0.51000 | TermEndowmentEOYBalance |
| Endowments Held By Unrelated Orgs | 1 | EndowmentsHeldByUnrelatedOrgs |
| Endowments Held By Related Orgs | 0 | EndowmentsHeldByRelatedOrgs |
| Total Of Book Value Land Buildings | 0 | TotalOfBookValueLandBuildings |
Form990 Schedule D Part XIII Form990ScheduleDPartXIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | Description of Intended Use of Endowment Funds: | Identifier |
| Return Reference | Part V, Line 4: | ReturnReference |
| Explanation | Endowment funds are restricted for healthcare education scholarships and for capital improvements to Citizens Medical Center and its physician clinic. | Explanation |
Schedule G IRS990ScheduleG
| Field | Value | IRS element (for citing) |
|---|---|---|
| Mail Solicitations | X | MailSolicitations |
| Email Solicitations | X | EmailSolicitations |
| Phone Solicitations | X | PhoneSolicitations |
| In Person Solicitations | X | InPersonSolicitations |
| Solicitation Of Non Govt Grants | X | SolicitationOfNonGovtGrants |
| Special Fundraising Events | X | SpecialFundraisingEvents |
| Agreement Ref Fundraising | 1 | AgreementRefFundraising |
Fundraiser Activity Information FundraiserActivityInformation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Individual | Virgil Scott | NameOfIndividual |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 4657 Rabbit Mountain Road | AddressLine1 |
| City | Broomfield | City |
| State | CO | State |
| ZIP Code | 80020 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activity | Consultation on fundraising related to expansion of the FCHC | Activity |
| Fundraiser Control Of Funds | 0 | FundraiserControlOfFunds |
| Gross Receipts | 665046 | GrossReceipts |
| Amount Retained By Contractor | 20614 | AmountRetainedByContractor |
| Net To Organization | 644432 | NetToOrganization |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Gross Receipts | 665046 | TotalGrossReceipts |
| Total Retained By Contractors | 20614 | TotalRetainedByContractors |
| Total Net To Organization | 644432 | TotalNetToOrganization |
Events Information EventsInformation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Event1 | Harvest for Health Golf Tournament | NameOfEvent1 |
| Gross Receipts Event1 | 20982 | GrossReceiptsEvent1 |
| Charitable Contributions Event1 | 13140 | CharitableContributionsEvent1 |
| Gross Revenue Event1 | 7842 | GrossRevenueEvent1 |
| Rent Facility Costs Event1 | 3932 | RentFacilityCostsEvent1 |
| Other Direct Expenses Event1 | 3910 | OtherDirectExpensesEvent1 |
| Name Of Event2 | Scrub sales | NameOfEvent2 |
| Gross Receipts Event2 | 24243 | GrossReceiptsEvent2 |
| Charitable Contributions Event2 | 3561 | CharitableContributionsEvent2 |
| Gross Revenue Event2 | 20682 | GrossRevenueEvent2 |
| Other Direct Expenses Event2 | 20682 | OtherDirectExpensesEvent2 |
| Total Number Of Other Events | 3 | TotalNumberOfOtherEvents |
| Gross Receipts Other Events | 20726 | GrossReceiptsOtherEvents |
| Charitable Contrib Other Events | 9079 | CharitableContribOtherEvents |
| Gross Revenue Other Events | 11647 | GrossRevenueOtherEvents |
| Other Direct Expenses Other Events | 11647 | OtherDirectExpensesOtherEvents |
| Gross Receipts Total | 65951 | GrossReceiptsTotal |
| Charitable Contributions Total | 25780 | CharitableContributionsTotal |
| Gross Revenue Total Events | 40171 | GrossRevenueTotalEvents |
| Rent Facility Costs Total Events | 3932 | RentFacilityCostsTotalEvents |
| Other Direct Expenses Total Events | 36239 | OtherDirectExpensesTotalEvents |
| Direct Expense Summary Events | 40171 | DirectExpenseSummaryEvents |
| Net Income Summary | 0 | NetIncomeSummary |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Records Maintained | 1 | RecordsMaintained |
Recipient Table RecipientTable
Recipient Name Business RecipientNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Citizens Medical Center | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 100 E College Drive | AddressLine1 |
| City | Colby | City |
| State | KS | State |
| ZIP Code | 67701 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN Of Recipient | 480892178 | EINOfRecipient |
| IRC Section | 501(c)(3) | IRCSection |
| Amount Of Cash Grant | 20000 | AmountOfCashGrant |
| Method Of Valuation | FMV | MethodOfValuation |
| Purpose Of Grant | Medical equipment | PurposeOfGrant |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Nbr Of501 C3 And Govt Grants | 1 | TotalNbrOf501C3AndGovtGrants |
Form990 Schedule I Part III Form990ScheduleIPartIII (2 entries)
| Type Of GrantTypeOfGrant | Number Of RecipientsNumberOfRecipients | Amount Of Cash GrantAmountOfCashGrant | Method Of ValuationMethodOfValuation | Amount Of Non Cash AssistanceAmountOfNonCashAssistance | Description Of Non Cash AssistanceDescriptionOfNonCashAssistance |
|---|---|---|---|---|---|
| Scholarships for health care education | 4 | 5500 | FMV | ||
| Coats for needy children | 42 | FMV | 1307 | Winter coats |
Form990 Schedule I Part IV Form990ScheduleIPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | Procedure for Monitoring Grants in the U.S.: | Identifier |
| Return Reference | Part I, Line 2: | ReturnReference |
| Explanation | Schedule I, Part I, Line 2: Enrollment in secondary education is verified prior to disbursing scholarship funds. Coats are given directly to needy children in the community. | Explanation |
Schedule M IRS990ScheduleM
Other Non Cash Contributions Table OtherNonCashContributionsTable
| Field | Value | IRS element (for citing) |
|---|---|---|
| Non Cash Checkbox | X | NonCashCheckbox |
| Description | Grain | Description |
| Number Of Contributions | 2 | NumberOfContributions |
| Noncash Contribs Rptd F990 | 250833 | NoncashContribsRptdF990 |
| Method Of Determining Revenues | Market price on date of donation | MethodOfDeterminingRevenues |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Any Property That Must Be Held | 0 | AnyPropertyThatMustBeHeld |
| Review Process Unusual NC Gifts | 0 | ReviewProcessUnusualNCGifts |
| Third Parties Used | 0 | ThirdPartiesUsed |
Form990 Schedule M Part II Form990ScheduleMPartII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | Method for Determining Number of Contributors: | Identifier |
| Return Reference | Part I, Column (b): | ReturnReference |
| Explanation | The number of contributions is reported. | Explanation |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (5 entries)
| Return ReferenceReturnReference | ExplanationExplanation |
|---|---|
| Form 990, Part VI, Section A, line 6 | The organization had 7 members on the Board of Directors and 24 voting members as of 12/31/2012. 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. |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII
Name Of Disregarded Entity NameOfDisregardedEntity
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Citizens Medical Center Inc | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 100 E College Drive | AddressLine1 |
| City | Colby | City |
| State | KS | State |
| ZIP Code | 67701 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 480892178 | EIN |
| Primary Activities | Hospital | PrimaryActivities |
| Legal Domicile State | KS | LegalDomicileState |
| Exempt Code Section | 501(c)(3) | ExemptCodeSection |
| Public Charity Status | Line 3 | PublicCharityStatus |
| Controlled Org | 0 | ControlledOrg |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 0 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 1 | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | 0 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 0 | LoansOrGuaranteesFromOtherOrg |
| Dividends Related Organization | 0 | DividendsRelatedOrganization |
| Sale Of Assets To Other Org | 0 | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | 0 | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | 0 | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | 0 | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | 0 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 0 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 0 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 1 | SharingOfFacilities |
| Sharing Of Paid Employees | 1 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 1 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 0 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 0 | OtherTransferFromOtherOrg |
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